1. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 9 Antifungal and Antiviral Agents

2. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antifungal Agents  Nystatin  This antifungal drug binds to sterols in the fungal cell membrane. The fungal cell eventually dies off.  It is poorly absorbed from the gastrointestinal tract when taken orally.  It has both fungicidal and fungistatic activity.  It is used for both the treatment and prevention of oral candidiasis. 2

3. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antifungal Agents  Nystatin  Dose forms include an aqueous suspension, pastilles, and vaginal tablets.  The aqueous suspension and pastilles contain sugar.  Oral dose forms should be dissolved slowly in the mouth.  Good oral hygiene is essential because of the high sugar content.  Adverse effects include gastrointestinal effects. 3

4. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antifungal Agents  Clotrimazole  This is a synthetic antifungal drug that alters cell membrane permeability.  It is indicated for the treatment of oropharyngeal candidiasis  It is available as an oral lozenge and as a vaginal cream.  The lozenge contains sugar so good oral hygiene is essential.  Adverse effects include abdominal pain, diarrhea, and nausea. 4

5. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antifungal Agents  Ketoconazole  This is an imidazole that also alters cell membrane permeability.  It requires an acidic environment for absorption.  Any medicine that increases stomach pH should not be used with this drug.  It is effective against a wide number of fungal infections.  The most common adverse reactions are nausea and vomiting.  Ketoconazole is associated with hepatotoxicity. Liver function is monitored while the patient receives this drug. 5

6. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antifungal Agents  Acyclovir  This drug exerts its antiviral action on herpes viruses by interfering with DNA polymerase and inhibiting DNA replication.  Only 15%-30% is absorbed when taken orally. It is widely distributed throughout the body.  It is effective against herpes simplex types I and II and varicella-zoster.  Topical adverse effects include burning, stinging, and mild pain. 6

7. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antifungal Agents  Acyclovir  Adverse effects with oral administration include headache, vertigo, dizziness, insomnia, and fatigue.  Gastrointestinal adverse effects include nausea, vomiting, and diarrhea.  Adverse effects associated with parenteral administration include irritation, pain, stinging, and erythema at the injection site. 7

8. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antifungal Agents  Penciclovir  It is indicated for oral herpes simplex.  Penciclovir is available as a topical cream.  It should be applied every 2 hours while awake.  Penciclovir decreases healing time by 1 day. 8

9. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antifungal Agents  Famciclovir  It is used to treat herpes simplex.  Famciclovir is converted to penciclovir after oral administration.  Adverse effects include headache, nausea, and vomiting. 9

10. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antifungal Agents  Docosanol 10%  Docosanol 10% is indicated for the treatment of oral herpes simplex virus.  This is the only antiviral drug that is available without a prescription.  It is a topical cream.  Apply within 12 hours of prodromal symptoms.  Decreases healing time by about 1 day. 10

11. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Acquired Immunodeficiency Syndrome (AIDS)  Those persons with AIDS receive a number of medications from different chemical classes. This combination is often referred to as a “cocktail.”  The adverse effects of these medications are many.  Oral adverse effects are common with these medications.  These persons are at high risk for opportunistic infections. As a result, they are often treated for tuberculosis, Pneumocystis carinii pneumonia, herpes infections, and candidiasis. 11

12. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Other Antiviral Agents  Some of these drugs are used to treat or prevent the flu.  Other drugs are used to treat hepatitis or multiple sclerosis.  Some drugs are used to treat certain types of leukemia.  Several of these drugs have oral adverse effects. 12