NSG3100 unit 7
Amphotericin B Deoxycholate med class
antifungal
Primary Indications for Amphotericin B Deoxycholate (2):
Drug of choice for severe systemic mycoses. Prophylactic for immunosuppressed patients
(given in a low-dose amphotericin ("LDA"))
MOA of Amphotericin B Deoxycholate:
Damages fungal cell membranes
how should we infuse Amphotericin B Deoxycholate? to prevent? compatible with?
Infuse slow (2-6 hours) to prevent hypotension, hypokalemia, & shock. D5W compatible
medication only
Drugs to avoid with Amphotericin B Deoxycholate (2)
drugs that could worsen nephrotoxicity or hypokalemia
Adverse Effects of Amphotericin B Deoxycholate :
Up to 50% experience fever, chills, vomiting, anorexia, & headache at onset of therapy.,
Phlebitis common during IV therapy → use CVC/PICC if possible, Ototoxicity, Nephrotoxicity,
Electrolyte imbalance (hypokalemia & hypomagnesemia), Hepatotoxicity, Anaphylaxis- cardiac
arrest reported,Blood dyscrasias (thrombocytopenia, leukopenia, anemia)
Fluconazole med class
antifungal
Fluconazole Primary Indications (2): routes?
Highly effective in treating candidiasis: oropharyngeal, esophageal, vulvovaginal, & various
other C. albicans infections. Prophylaxis in immunosuppressed patients. Route: PO, IV
MOA of Fluconazole:
, Interferes with the synthesis of ergosterol, breaking down fungal cell membrane
Adverse Effects of Fluconazole (3)
Nausea, vomiting, diarrhea with high doses. Stevens-Johnson syndrome in immunosuppressed
patients widespread of skin rash (blistering)
Contraindications with Fluconazole (4)
Hypersensitivity to the drug or another -azole, Caution in patients with hepatic or renal
impairment metabolize in liver, excrete by kidney, May worsen pre-existing hypokalemia , Not
recommended in pregnancy
Fluconazole IV incompatibilities
Warfarin (increases bleeding) Phenytoin (increases serum level adjust doses) Oral
hypoglycemics → hypoglycemia. Prolongs the effects of fentanyl, benzodiazepines, TCAs,
methadone
what med taken with Fluconazole cause cardiotoxicity and death
Erythromycin
Nystatin med class
antifungal
indications for Nystatin? routes?
Superficial fungal infections, typically C. albicans. Routes:Oral suspension, powders, creams,
intravaginal suppositories no IV
Adverse Effects with Nystatin (3)
Minor skin irritation or contact dermatitis with skin applications. N/V/D with oral preparations
Nursing Considerations with Nystatin (3)
Safe in pregnancy (Category B), Not as effective/convenient in treating yeast intravaginal
infection. Monitor for new rash → call MD
Mycoses means:
fungal infection
Amphotericin B Deoxycholate med class
antifungal
Primary Indications for Amphotericin B Deoxycholate (2):
Drug of choice for severe systemic mycoses. Prophylactic for immunosuppressed patients
(given in a low-dose amphotericin ("LDA"))
MOA of Amphotericin B Deoxycholate:
Damages fungal cell membranes
how should we infuse Amphotericin B Deoxycholate? to prevent? compatible with?
Infuse slow (2-6 hours) to prevent hypotension, hypokalemia, & shock. D5W compatible
medication only
Drugs to avoid with Amphotericin B Deoxycholate (2)
drugs that could worsen nephrotoxicity or hypokalemia
Adverse Effects of Amphotericin B Deoxycholate :
Up to 50% experience fever, chills, vomiting, anorexia, & headache at onset of therapy.,
Phlebitis common during IV therapy → use CVC/PICC if possible, Ototoxicity, Nephrotoxicity,
Electrolyte imbalance (hypokalemia & hypomagnesemia), Hepatotoxicity, Anaphylaxis- cardiac
arrest reported,Blood dyscrasias (thrombocytopenia, leukopenia, anemia)
Fluconazole med class
antifungal
Fluconazole Primary Indications (2): routes?
Highly effective in treating candidiasis: oropharyngeal, esophageal, vulvovaginal, & various
other C. albicans infections. Prophylaxis in immunosuppressed patients. Route: PO, IV
MOA of Fluconazole:
, Interferes with the synthesis of ergosterol, breaking down fungal cell membrane
Adverse Effects of Fluconazole (3)
Nausea, vomiting, diarrhea with high doses. Stevens-Johnson syndrome in immunosuppressed
patients widespread of skin rash (blistering)
Contraindications with Fluconazole (4)
Hypersensitivity to the drug or another -azole, Caution in patients with hepatic or renal
impairment metabolize in liver, excrete by kidney, May worsen pre-existing hypokalemia , Not
recommended in pregnancy
Fluconazole IV incompatibilities
Warfarin (increases bleeding) Phenytoin (increases serum level adjust doses) Oral
hypoglycemics → hypoglycemia. Prolongs the effects of fentanyl, benzodiazepines, TCAs,
methadone
what med taken with Fluconazole cause cardiotoxicity and death
Erythromycin
Nystatin med class
antifungal
indications for Nystatin? routes?
Superficial fungal infections, typically C. albicans. Routes:Oral suspension, powders, creams,
intravaginal suppositories no IV
Adverse Effects with Nystatin (3)
Minor skin irritation or contact dermatitis with skin applications. N/V/D with oral preparations
Nursing Considerations with Nystatin (3)
Safe in pregnancy (Category B), Not as effective/convenient in treating yeast intravaginal
infection. Monitor for new rash → call MD
Mycoses means:
fungal infection
