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Drugs used to treat infections caused by fungi  Systemic  Topical.

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Presentation on theme: "Drugs used to treat infections caused by fungi  Systemic  Topical."— Presentation transcript:


2 Drugs used to treat infections caused by fungi  Systemic  Topical

3  Very large and diverse group of microorganisms  Broken down into yeasts and molds  Fungal infections also known as mycoses  Some fungi are part of the normal flora of the skin, mouth, intestines, vagina  Reproduce by budding  Can be used for  Baking  Alcoholic beverages

4  Multicellular  Characterized by long, branching filaments called hyphae

5 Four general types  Cutaneous  Subcutaneous  Superficial  Systemic* *Can be life threatening *Usually occur in immunocompromised host

6 Candida albicans  Due to antibiotic therapy, antineoplastics, or immunosuppressants (corticosteroids)  May result in overgrowth and systemic infections  Growth in the mouth is called thrush or oral candidiasis  Common in newborn infants and immunocompromised patients Vaginal candidiasis  “Yeast infection”  Pregnancy, women with diabetes mellitus, women taking oral contraceptives

7 Systemic  amphotericin B, caspofungin, fluconazole, ketoconazole, others Topical  Examples: clotrimazole, miconazole, nystatin Major groups based on their mechanisms of action  Polyenes: amphotericin B and nystatin  Imidazoles: ketoconazole (Nizoral)  Triazoles: fluconazole (Diflucan), itraconazole (Sporanox)  Echinocandins: caspofungin (Cancidas), micafungin  Listed individually, not by mechanism of action:  griseofulvin, flucytosine

8 Polyenes: amphotericin B and nystatin  Bind to sterols in cell membrane lining  Result: fungal cell death  Do not bind to human cell membranes or kill human cells  Use: Serious systemic fungal infections  Administered: IV, PO, topical

9 Flucytosine (Ancobon)  Also known as 5-fluorocytosine (antimetabolite)  Taken up by fungal cells and interferes with DNA synthesis  Result: fungal cell death  Use: Systemic mycoses due to Candida species or Cryptococcus neoformans – administered orally

10 Imidazoles and triazoles: Ketoconazole (Nizoral), fluconazole (Diflucan)  Inhibit fungal cell cytochrome P-450 enzymes, resulting in cell membrane leaking  Lead to altered cell membrane  Result: fungal cell death  Use: Ketoconazol (Nizoral): (po/topical): candidiasis, histoplasmosis, coccidoidomycosis; cutaneous candidiasis; tinea infections  Use: fluconazole (Diflucan): (po/IV): systemic, oral, esophageal or vaginal candidiasis; prevention of candidiasis after bone marrow transplant; cryptococcal meningitis.

11 griseofulvin  Disrupts cell division  Result: inhibited fungal mitosis (reproduction)  Use: (po) Dermatophytosis (skin, hair, nails)

12 Echinocandins: capsofungin (Cancidas)  Prevent the synthesis of glucans, which are essential components of fungal cell walls  Causes fungal cell death  Use: (IV) Invasive aspergillosis, Candidiasis

13  Systemic and topical fungal infections  Drug of choice for the treatment of many severe systemic fungal infections is amphotericin B  Choice of drug depends on type and location of infection

14  Fever / Headache  Malaise  Hypotension  Muscle and joint pain  Lowered potassium and magnesium levels  Main concerns:  *Renal toxicity  *Neurotoxicity: seizures and paresthesias  Many other adverse effects  Chills  Dysrhythmias  Nausea  Anorexia

15 Fluconazole (Diflucan)  Nausea, vomiting, diarrhea, stomach pain,  increased liver function studies Flucytosine (Ancobon)  Nausea, vomiting, anorexia, headache, dizziness, others griseofulvin  Rash, urticaria, headache, nausea, vomiting, anorexia, others

16  Liver failure  Renal failure  Porphyria: genetic disorder-erythrocyte formation/liver dysfunction (griseofulvin)

17  Many antifungal drugs are metabolized by the cytochrome P-450 enzyme system  Co administration of two drugs that are metabolized by this system may result in competition for these enzymes, and thus higher levels of one of the drugs

18  Before beginning therapy, assess for hypersensitivity, contraindications, and conditions that require cautious use  Obtain baseline VS, CBC, liver and renal function studies, and EKG  Assess for other medications used (prescribed and OTC) in order to avoid drug interactions  Follow manufacturer’s directions reconstitution and administration  Monitor VS of patients receiving IV infusions every 15 to 30 minutes  During IV infusions, monitor I&O to identify adverse effects

19 amphotericin B  To reduce the severity of the infusion-related reactions, pretreatment with an antipyretic (acetaminophen), antihistamines, antiemetics, and corticosteroid may be given  Use IV infusion pumps and the most distal veins possible  Some oral forms should be given with meals to decrease GI upset; others require an empty stomach—be sure to check

20  Nystatin given as an oral lozenge should be slowly and completely dissolved in the mouth  (not chewed or swallowed whole)  Nystatin suspension should be swished thoroughly in the mouth as long as possible before swallowing  Monitor for therapeutic effects  Easing of the symptoms of infection  Improved energy levels  Normal vital signs, including temperature Monitor carefully for adverse effects

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