LO 12

Question 1

Describe fungal infections

Answer 1

They are more likely to occur in patients who are immunocompromised, and they can become chronic

Question 2

What are the two common groups of fungal infections and the interventions used?

Answer 2

1. Mucocutaneous candidal infections - managed with nystatin, clotrimazole, ketoconazole, or fluconazole
2. Tinea - affects the skin and produces athlete’s foot, “jock itch,” and ringworm; managed both with prescription and over-the-counter medications

Question 3

How long is the treatment course for anti-fungals?

Answer 3

Usually 2 weeks

Question 4

What common drug do anti-fungals tend to disrupt?

Answer 4

Oral contraceptives

Question 5

C. Albicans infections typically result in __________ patients as a result of ____________

Answer 5

1. immunocompromised
2. superinfection/suprainfection

Question 6

What are the predisposing factors for fungal infections?

Answer 6

1. Chronic antibiotic use
2. Immune compromised (chemo/radiation, HIV, Chronic corticosteroids)
3. Appliances (e.g. dentures)

Question 7

Antifungal medications can be divided into _________ and __________

Answer 7

1. Natural
2. Synthetic

Question 8

Natural antifungals are in the drug group __________

Answer 8

Polyene

Question 9

Synthetic anti-fungal medications are in the drug group ________ or __________

Answer 9

1. Imidazole
2. Triazole

Question 10

What are the trade names for nystatin? (natural antifungal=Polyene)

Answer 10

1. Candistatin
2. Mycostatin
3. Nilstat

• Don’t confuse w/ cholesterol “statin” meds

Question 11

What is the first choice ant-fungal medication?

Answer 11

nystatin

Question 12

How does nystatin impact fungi?

Answer 12

Fungicidal and fungistatic

Question 13

What are the adverse reactions of nystatin?

Answer 13

GI adverse reactions - nausea, vomiting, and diarrhea

Question 14

What dose form does nystatin come in?

Answer 14

1. aqueous suspension containing 50% sucrose
2. Swish, swirl, and spit or swallow 5 ml four times daily - The suspension should remain in the mouth for 2 minutes for the best effect

Question 15

What is the common suffix for synthetic anti-fungals?

Answer 15

azole

Question 16

What do synthetic antifungals tend to interact with?

Answer 16

inhibitors liver enzymes cytochrome P450

Question 17

The trade name for ketoconazole is ___________

Answer 17

Nizoral

Question 18

ketoconazole/ Nizoral requires __________ for optimal absorption

Answer 18

High acidity - take with OJ or cola

Question 19

What drugs do ketoconazole/ Nizoral interact with?

Answer 19

Antacids will lower absorption - requires highly acidic environment for optimal absorption

Question 20

What are the adverse affects of ketoconazole/ Nizoral

Answer 20

1. GI effects - nausea and vomiting
2. Hepatotoxicity

Question 21

Describe the RX for ketoconazole/ Nizoral

Answer 21

1. For treatment of Candida is 200 to 400 mg orally daily
2. Used for at least 2 weeks; 6 to 12 months may be required for chronic mucocutaneous candidiasis

Question 22

What is the trade name for clotrimazole?

Answer 22

Canesten

Question 23

What are the adverse reactions of clotrimazole/Canesten?

Answer 23

1. GI - abdominal pain, diarrhea, and nausea
2. Xerostomia

Question 24

Who should NOT take clotrimazole/Canesten?

Answer 24

1. Diabetics
2. Children

Question 25

What is the trade name of fluoconazole?

Answer 25

Diflucan

Question 26

What is the benefit of fluoconazol/Diflucan?

Answer 26

Improved safety and predictable absorption

Question 27

What is Dr. I's #2 choice for an antifungal?

Answer 27

Diflucan

Question 28

List the drugs in the Polyene group

Answer 28

nystatin =Candistatin =Mycostatin =Nilstat

Question 29

List the drugs in the Imidazole group

Answer 29

ketoconazole/Nizoral & clotrimazole/ Canesten

Question 30

List the drugs in the Triazole group

Answer 30

fluoconazol/Diflucan

Question 31

What are antivirals used for?

Answer 31

1. Shown to reduce both the duration of the lesion and the pain of the lesions on the lips and face associated with both primary and recurrent herpes simplex 2. MOST EFFECTIVE DURING PRODROMAL STAGE

Question 31

List 3 common antiviral medications

Answer 31

1. acyclovir 2. Abreva 3. penciclovir

Question 32

What is the effective spectrum of acyclovir (Zovirax)?

Answer 32

1. HSV #1 2. HSV #2 3. HHV #3 4. HHV #5 5. EBV (Epstein Barr virus)

Question 33

What are the routes of administration for acyclovir (Zovirax)?

Answer 33

1. Topical: burning, itching 2. Oral: nausea, vomiting, diarrhea 3. Injection: irritation at injection site, Seizures

Question 34

What is suggested for patients with Frequent HSV#1 lesions?

Answer 34

1. Zovirax (acyclovir ointment) to have on hand and apply during prodromal stage. 2. Avoid systemic AV Rx for the severe adverse RXNs

Question 35

Describe treatment for HIV

Answer 35

1. HIV+ is associated with increase opportunistic infections: Tb, HSV, C. albicans, Pneumonia, Flu virus 2. ALWAYS check for C. albicans 3. AB or AF prophylaxis? NOT REQUIRED 4. Higly Affective AntiRetroviral Treatment =“HAART” or AntiRetroviral Treatment=“ART” ( Highly active anti retroviral treatment or anti retroviral treatment)🡺“Cocktail” e.g. Azidothymidine (AZT)

Question 36

What are the general and oral adverse reactions of AZT?

Answer 36

General 1. bone marrow depression 2. CNS effects include headache, agitation and insomnia Oral 1. taste perversion 2. edema of the tongue 3. bleeding gums 4. mouth ulcers 5. Pigmentation of oral mucosa

Question 37

What 4 things should you know about HIV+ patients before treatment?

Answer 37

1. **CD4 count** - should be > 200 cells/mm. 2. Platelet count- should be >60,000/mcl (normal is 150,000-450,000) 3. Absolute neutrophil count- if <500 cells/mcl., requires prophy AB 4. **Viral load** - should be <3,000/mcl. * 1 & 4 are the most important

Question 38

What should you know if HIV patient has comorbidities such as diabetes or if client is on Coumadin?

Answer 38

1. Diabetes - A1C- >8% is poorly controlled. 2. Coumadin - Able to treat as long as it is in the therapeutic range of 2-3 (if >3, do not treat)