Antifungal Agents

Overview

• Used for patients susceptible to fungal organisms:
  • Candida
  • Coccidioids (Valley fever)
  • Aspergillus (respiratory illness from inhaling spores)
• Multiple sites of infection:
  • Oral
  • Esophageal
  • Skin
  • Pulmonary
  • Vaginal
  • Systemic

Side Effects

• Common side effects:
  • Headache
  • Nausea
  • Vomiting
  • Liver dysfunction
  • Renal dysfunction
  • Toxicity
• Amphotericin B specific side effects:
  • Fever
  • Shivering
  • Renal or neurotoxicity
  • Cardiac dysrhythmias

Precautions

• Considerations for:
  • Renal impairment
  • Liver impairment
• Many drug interactions
• Contraindicated in liver failure due to metabolism concerns

Nursing Actions

• Monitor LFTs (liver function tests)
• Monitor BUN and creatinine levels (kidney function)
• Pre-medication to reduce side effects:
  • Antipyretics (reduce fever)
  • Antihistamines
  • Anti-emetics (reduce nausea/vomiting)
  • Corticosteroids

Administration

• Symptoms are more common with IV administration

Examples of Antifungal Drugs

• Fluconazole
• Amphotericin B
• Nystatin
• Ketoconazole

Amphotericin B

• Administered IV
• Used for cryptococcal meningitis
  • Not crucial for testing

Nystatin

• Used for oral, topical, or vaginal fungal infections
• Example use: Oral thrush in infants (painful, causes feeding issues)