Test 3 - Antifungals (Josh) Flashcards Preview

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Flashcards in Test 3 - Antifungals (Josh) Deck (23)
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1
Q

S/S of amphotericin B infusion reaction.

A

Amphotericin B is given IV and cytokines cause reactions

  • Fever
  • Chills
  • Rigors (severe shivers)
  • Nausea
  • Headache
  • Phlebitis (tough on veins)
  • Nephrotoxicity
  • Hypokalemia
  • Bone Marrow Suppression
2
Q

How should amphotericin B be infused?

A

slowly (2-4 hours) b/c it is hard on veins

also rotate sites

3
Q

How can risk for kidney damage be decreased when taking amphotericin B?

A

infuse 1L of saline on days amphotericin B is infused

4
Q

What is the risk due to amphotericin B suppressing Bone Marrow?

A

anemia

5
Q

Which medications can be used to treat amphotericin B infusion reactions?

A
  • diphenhydramine
  • acetaminophen
  • dantrolene (if rigors are occurring)
6
Q

What electrolyte changes can occur as an adverse effect of amphotericin B?

A

hypokalemia
Low iron

  • give K+ supplements)
  • watch for anemia
7
Q

Azole antifungal can lead to:

A

Hepatoxicity

Watch for JAUNDICE

8
Q

Adverse effects of Amphotericin B (IV only Antifungal)

A
  • nephrotoxicity
9
Q

Adverse effects of Azole (-conazole) (IV & PO Antifungal)

A
  • Hepatotoxicity

- CYP interactions

10
Q

Which is more convenient and better tolerated, Ampthotericin B or Azole?

A

Azole b/c it is also PO

11
Q

—– antifungals can effect kidneys

—– antifungals can effect liver

A

Amphotericin B

Azole

12
Q

MOA: Amphotericin B

A

Binds to the fungal membrane (ergosterol) which causes it to become more permeable

Cations start to leak out which slows down production or kills the fungus

13
Q

What is the problem w/ Amphotericin B?

A

The ergosterol in the fungal membrane that it binds to is similar to CHOLESTEROL… which means it’s toxic to us (just not as much as it is to fungi)

14
Q

Which is more serious, the Red Man Syndrome from

Vancomycin or the Red Man Syndrome-like issues w/ Amphotericin B?

A

Amphotericin B

Red Man is caused by histamine but this issue is caused by cytokines

15
Q

Which adverse effects of Amphotericin B affects all clients but usually corrects after the med is discontinued?

A

Renal Impairment

  • avoid NSAIDS
16
Q

Watch which levels w/ Amphotericin B to avoid dysrhythmias?

A

Potassium levels

b/c it leads to hypokalemia

17
Q

If Amphotericin B is so nasty, why use it at all?

A

Even though the S/E are severe, systemic fungal infections are much more severe.

18
Q

MOA: Azoles (-conazole)

A

Mess w/ CYP of fungi

The fungal enzyme 14-alpha-demethylase helps make ergosterol which is used to make strong fungal cell walls

-conazole work by inhibiting the 14-alpha-demethylase, preventing the formation of ergosterol and the strong fungal cell wall (weak cell wall —> death)

19
Q

How well do -conazole work?

A

really well

one dose is usually enough to treat a typical yeast infection

20
Q

Adverse effects of -conazole

A
  • decreased ejection fraction (itraconazole)
  • hepatoxicity
  • CYP interactions
21
Q

Why is -conazole a problem for clients w/ HF?

A

It lowers the ejection fraction for about 12hrs each time the drug is taken

Specifically w/ itraconazole

22
Q

S/S to watch for on -conazole

A
  • decreased HR, BP
  • JAUNDICE
  • drug interactions (mess w/ CYP
23
Q

Which drugs can be a deadly combo w/ -conazole?

A
  • drugs w/ narrow therapeutic range (ex: phenytoin, dioxin) due to CYP interactions
  • antidysrhythmia drugs