Test 3 - Antifungals (Josh)

Question 1

S/S of amphotericin B infusion reaction.

Answer 1

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

Question 2

How should amphotericin B be infused?

Answer 2

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

also rotate sites

Question 3

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

Answer 3

infuse 1L of saline on days amphotericin B is infused

Question 4

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

Answer 4

anemia

Question 5

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

Answer 5

• diphenhydramine
• acetaminophen
• dantrolene (if rigors are occurring)

Question 6

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

Answer 6

hypokalemia
Low iron

• give K+ supplements)
• watch for anemia

Question 7

Azole antifungal can lead to:

Answer 7

Hepatoxicity

Watch for JAUNDICE

Question 8

Adverse effects of Amphotericin B (IV only Antifungal)

Answer 8

• nephrotoxicity

Question 9

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

Answer 9

• Hepatotoxicity

- CYP interactions

Question 10

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

Answer 10

Azole b/c it is also PO

Question 11

—– antifungals can effect kidneys

—– antifungals can effect liver

Answer 11

Amphotericin B

Azole

Question 12

MOA: Amphotericin B

Answer 12

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

Question 13

What is the problem w/ Amphotericin B?

Answer 13

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)

Question 14

Which is more serious, the Red Man Syndrome from

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

Answer 14

Amphotericin B

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

Question 15

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

Answer 15

Renal Impairment

• avoid NSAIDS

Question 16

Watch which levels w/ Amphotericin B to avoid dysrhythmias?

Answer 16

Potassium levels

b/c it leads to hypokalemia

Question 17

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

Answer 17

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

Question 18

MOA: Azoles (-conazole)

Answer 18

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)

Question 19

How well do -conazole work?

Answer 19

really well

one dose is usually enough to treat a typical yeast infection

Question 20

Adverse effects of -conazole

Answer 20

• decreased ejection fraction (itraconazole)
• hepatoxicity
• CYP interactions

Question 21

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

Answer 21

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

Specifically w/ itraconazole

Question 22

S/S to watch for on -conazole

Answer 22

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

Question 23

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

Answer 23

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