S/S of amphotericin B infusion reaction.
Amphotericin B is given IV and cytokines cause reactions
- Rigors (severe shivers)
- Phlebitis (tough on veins)
- Bone Marrow Suppression
How should amphotericin B be infused?
slowly (2-4 hours) b/c it is hard on veins
also rotate sites
How can risk for kidney damage be decreased when taking amphotericin B?
infuse 1L of saline on days amphotericin B is infused
What is the risk due to amphotericin B suppressing Bone Marrow?
Which medications can be used to treat amphotericin B infusion reactions?
- dantrolene (if rigors are occurring)
What electrolyte changes can occur as an adverse effect of amphotericin B?
- give K+ supplements)
- watch for anemia
Azole antifungal can lead to:
Watch for JAUNDICE
Adverse effects of Amphotericin B (IV only Antifungal)
Adverse effects of Azole (-conazole) (IV & PO Antifungal)
- CYP interactions
Which is more convenient and better tolerated, Ampthotericin B or Azole?
Azole b/c it is also PO
—– antifungals can effect kidneys
—– antifungals can effect liver
MOA: Amphotericin B
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
What is the problem w/ Amphotericin B?
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)
Which is more serious, the Red Man Syndrome from
Vancomycin or the Red Man Syndrome-like issues w/ Amphotericin B?
Red Man is caused by histamine but this issue is caused by cytokines
Which adverse effects of Amphotericin B affects all clients but usually corrects after the med is discontinued?
- avoid NSAIDS
Watch which levels w/ Amphotericin B to avoid dysrhythmias?
b/c it leads to hypokalemia
If Amphotericin B is so nasty, why use it at all?
Even though the S/E are severe, systemic fungal infections are much more severe.
MOA: Azoles (-conazole)
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)
How well do -conazole work?
one dose is usually enough to treat a typical yeast infection
Adverse effects of -conazole
- decreased ejection fraction (itraconazole)
- CYP interactions
Why is -conazole a problem for clients w/ HF?
It lowers the ejection fraction for about 12hrs each time the drug is taken
Specifically w/ itraconazole
S/S to watch for on -conazole
- decreased HR, BP
- drug interactions (mess w/ CYP
Which drugs can be a deadly combo w/ -conazole?
- drugs w/ narrow therapeutic range (ex: phenytoin, dioxin) due to CYP interactions
- antidysrhythmia drugs