ANTIFUNGALS-WPS Office-1.pdf Drugs ppt it can work in any device

The slide explains more about drugs for fungi

1. ANTIFUNGALS
Prepared by Esther Dolly Mwenda Student
Recturer

2. Introduction
Antifungals
Antifungals
Antifungaldrugsareusedtotreatinfectionscausedby
fungusandtopreventthedevelopmentoffungalinfectionsin
patientswithweakenedimmunesystems.
Afungusisalivingorganismthatcancauseinfectionwhenit
growsinthehumanbody.Inhealthypeople,fungalinfections
tendtobemildandtreatable.Forcancerpatients,however,
fungalinfectionscanbecomesevereandmustbetreated
quickly.

3. Antifungals cont
Common Sideeffectsof
antifungals
Antifungal drugs that are applied
topically rarely cause side effects
unless the patient is allergic to the
drug. Side effects are more common
when drugs are taken orally or
intravenously.

4. Antifungals cont
Themostcommonreactionsfromantifungal
drugsarenausea,diarrhoeaandother
gastrointestinalsymptoms. These
symptomsusuallyaffectlessthan10%of
patients.Caspofungin,oneofthe
antifungals,alsoproducesfewsideeffects.
Themostcommonsideeffectisrash.

5. Antifungals cont
Treatment
Thenatureoftreatmentdependsontwoimportant
factors,theseare:
1.Typeoffungus
Amouldisafungusthatgrowsintheformof
multicellularfilamentscalledhyphae.Mouldsare
large.

6. Antifungals cont
Yeastsaresmall,single-celledfungiofthe
phylumAscomycotathatreproducebyfission
orbudding,thedaughtercellsoftenremain
attached
Dimorphicareatypeoffungiwhichcanexist
asmouldfilamentousformorasyeast.

7. Antifungals cont
Thelocationoftheinfection:nails,hair,
skinorsystemicfungalinfectionwhichis
anindicationofseriousimmunologic
compromise.

8. Antifungals cont
Inthetreatmentofsuperficialfungal
infections,itisgenerallyrecommendedthat
oralmedicationshouldbesupplemented
withtopicalantifungalcreamorointmentin
ordertoachievebetterresultsand
treatmenttominimumoffourtosixweeks.

9. Antifungals cont
Antifungalsareclassifiedasfollows:
Polyene
Imidazole
Triazole/azoles
Penicillinderived
Fluorinatedpyrimidinederivatives
Otherse.g.Echinocandin

10. Antifungals cont
POLYENES
Polyenesaredrugsthatworkbyattachingtothe
sterolcomponentfoundinthefungalmembrane,
causingthecellstobecomeporousanddie.
Thetwopolyenesmostcommonlyusedare:
Nystatin(Mycostatin)and
AmphotericinB(Fungizone).

11. Antifungals cont
Nystatin
Itisoftenusedasatopicalagenttotreatsuperficial
infectionsoristakenorallytotreatcandida
infectionssuchasoraloroesophagealcandidiasis.
Thesedrugs,calledlipidformulations,causefewer
sideeffectsthantraditionalamphotericinB.

12. Antifungals cont
Presentation:oralsuspension100,000units/ml
Indication:OralCandidiasis,vaginal
candidiasis
Doses:
Adultsbymouth,intestinalcandidiasis
500,000unitsevery6hoursdoubledin
severeinfections
Children100,000unit’sqid
Vaginal pessaries 100,000 units: two tablets
inserted vaginally daily for two weeks

13. Antifungals cont
Sideeffects:Nausea,vomiting,diarrhoeawithhigh
doses
Contra-Indications:Sensitisation
NursingImplication/considerations
Monitorvitalsignsevery15-30minutesduringfirst
infusionandnotechangesinpulseandblood
pressure.
MonitorbloodstudiesHb,Haematocrit(HCT),K,Na
Ca,andMgeverytwoweeks.

14. Antifungals cont
Monitorweightofthepatientweekly,as
oedemaislikelytoensue
Monitorforrenaltoxicity;increaseinBUNand
creatinineandifBUNis>40mg/dlorif
creatinineis>3mg/dldrugmaybestoppedor
reducedosage.
MonitorforHepatoxicity;increasingAST/ASL
alkalinephosphataseandbilirubin.

15. Antifungals cont
Monitorforallergicreactions;dermatitis,rash,drug
shouldbediscontinued.
ImidazoleAntifungals
Thisgroupincludesclotrimazole,econazole.Isoconazole,
ketaconazoleandtioconazole.Theyareactiveagainstawide
rangeoffungiandyeasts.Theirmajorindicationisinthe
treatmentofvaginalcandidiasisanddermatophyte
infections.

16. Antifungals cont
Clotrimazole
Presentation:Pessariescontaining100mg,500mg.
Lozenges1%,Cream1%,topical505,vaginalcream
1%,lotions1%andsolutions1%.
Indications:vaginalandvulvalcandidiasis
Dose:insert2pessariesatnightfor3nights,oral
pessariesfor6nights.Fororaldropsaftermeals3
timesandforfungaldermatosisapplytwicedaily.
Sideeffects:occasionallocalirritation.

17. Antifungals cont
Caution:antibiotictherapy,oralcontraceptives,
pregnancy,diabetesmellitusmayaffecttheclinical
effectivenessofclotrimazole.
Contraindications:hypersensitivity.

18. Antifungals cont
Ketoconazole
Presentation:tabletcontaining200mg,
suspensioncontaining100mg/5ml.
Indications:Systemic mycosis, serious
chronic resistant mucocutaneous
candidiasis, serious GIT mycosis,
resident dermatophyte of the skin and
finger nails (not for toes).

19. Antifungals cont
Dose:adult200mgo.ddailywithfoodusuallyfor
14days.Ifresponseispoorafter14days
continueuntilatleast1weekaftersymptoms
haveclearedandculturebecomesnegative.
Maximumdose400mgdaily.Children3mg/Kg
bodyweight.Inchronicvaginalcandidiasis
400mgdailywithfoodfor5days.

20. Antifungals cont
Sideeffects:nausea,vomiting,abdominalpain,
rashes,urticarial,thrombocytopeniararely,
gynaecomastia,fatalliverdamageifgiven
morethan14days.
Caution:monitorLFT’s,avoidinporphyriaand
pregnancy
Contraindications:Liverimpairment.

21. Antifungals cont
NursingImplications
Assessforsignsandsymptomsofinfection;drainage,
sorethroat,urinarypain,haematuriaandfever.
Obtainculturesforsensitivitytestsbeforebeginning
treatment.
MonitorforHepatoxicity;increasedAST,ALT,alkaline
phosphatase,bilirubin,drugisdiscontinuedif
hepatotoxicityoccurs.

22. Antifungals cont
Triazole/AzolesAntifungals
Thisgroupincludesfluconazoleand
itraconazolewhichareabsorbedby
mouth.Theyareindicatedforthe
treatmentoflocalandsystemic
candidiasisandcryptococcalinfections,
alsoindicatedinthetreatmentof
aspergillosisandhistoplasmosis.

23. Antifungals cont
Fluconazole
Presentation:capsulescontaining50mg,150mg
and200mg.Suspensioncontaining50mg/5mls,
200mg/5mls.IVinfusioncontaining2mg/ml.
Indications:acuteandrecurrentvaginal
candidiasis,tineapedis,mucosalcandidiasis,
tineacorporis,tineacrurisanddermal
candidiasis,systemiccandidiasis,cryptococcal
infectionsincludingmeningitis.

24. Antifungals cont
Alsousedinthepreventionofcryptococcal
meningitisinAIDS,inimmune-compromised
patientsaftercytotoxictreatmentorradiotherapy.
Dose:
Vaginalcandidiasissingledose150mg
Mucosalcandidiasis50-100mgfor7-14days.
Tinea pedis, corporis, cruris and dermal
candidiasis oral 50mg for 2-4 weeks.

25. Antifungals cont
Systemiccandidiasis:infusion400mginitially
then200mgdailyandcontinuedaccordingto
patientresponse.
Incryptococcalmeningitis800mgdaily.
Childrenover1yearoralorIV2mg/Kgbody
weight.Systemicandlife-threatening
infections3-6mg/Kgbodyweightandcanbe
increasedupto12mg/Kgbodyweightinchild
aged5-13years.

26. Antifungals cont
Caution:renalimpairment,pregnancy,
breastfeeding,children(onlyifno
alternative),raisedliverenzymes.
Sideeffects:vestibularandauditory
damage, nephrotoxicity,antibiotic
associatedcolitis,nausea,vomiting,
rash.
Contraindications:Children under 1 year.

27. Antifungals cont
NursingImplications
Assessforsignsandsymptomsofinfection:
clearingofCSFcultureduringtreatment,obtain
cultureandsensitivitybaselineandduring
treatment.
Monitorforhepatotoxicity;increasedASTand
ALT,alkalinephosphatase,bilirubin,drugmay
bediscontinuediftoxicityoccurs.

28. Antifungals cont
PenicillinDerivedAntifungals
InthisgroupisGriseofulvinandotherdrugs
thatareselectivelyconcentratedonkeratinized
tissue.ThismakesGriseofulvintobethedrug
ofchoiceforwidespreadorintractable
dermatophyteinfection.Itiswellabsorbedby
mouthbutinactivewhenappliedtopically.

29. Antifungals cont
Griseofulvin
Presentation:tabletcontaining125mg,500mg.Suspension
containing125mg/5mls.
Indications:treatmentofringworminfectionsoftheskin,hair,
nailsnamelytineacorporis,tineapedis,tineacruris,tinea
barbae,andtineacapitis.
Dose:adult500mgdailyindivideddosesorasasingledose.
Child19mg/KGbodyweightindivideddosesorasasingle
dose.

30. Griseofulvin cont
•Usually taken for 2 to 4 weeks for skin infections.
•4 to 6 weeks for hair and scalp infections,
•4 to 8 weeks for foot infections,
•3 to 4 months for fingernail infection
•at least 6 months for toenail infections.

31. Antifungals cont
Sideeffects:headache,nausea,vomiting,
rashes,photosensitivity,dizziness,fatigue,
agranulocytosis,leucopenia, lupus
erythematous,toxicepidermalnecrolysis,
peripheralneuropathy,confusionand
impairedcoordination.

32. Antifungals cont
Caution:inbreastfeeding,enhancesthe
effectsofalcoholandmayimpair
performanceofskilledtasks,e.g.,driving.
Contraindications: hypersensitivity,
hepatocellularfailure,lupuserythematosis,
andinpregnancy.

33. Antifungals cont
NursingImplications
Administerthedrugwithhighfat
meal.
MonitorINRWarfarineffectiveness
maybecompromised.

34. Antifungals cont
FluorinatedPyrimidineDerivative
Antifungals
Theseincludeflucytosine.Thisisa
syntheticdrugwhichisonlyactiveagainst
yeastandhasbeenusedforthetreatment
ofsystemiccandidiasis,cryptococcosisand
toruplopsosis.
Flucyto

35. Antifungals cont
Flucytosine
Indications:systemicyeastandfungalinfections
andasanadjuncttoamphotericin,cryptococcal
meningitis.
Dose:byIVover20-40minutesadultand
children200mg/Kgdailyin4divideddoses
usuallyfornotmore7days.Inextremely
sensitiveorganism100-150mg/Kgdailyandtreat
foratleast4monthsincryptococcalmeningitis.

36. Antifungals cont
Sideeffects:rarebutmayhavenausea,
vomiting,diarrhoea,rashes,lessfrequently
confusion,hallucinations,convulsions,
headache,sedation,vertigo,alteredliver
functiontests,blooddisordersincluding
thrombocytopeniaandaplasticanaemia.
Caution:renalimpairment,elderly,blood
disorders,pregnancyandbreastfeeding.

37. Antifungals cont
Nursingimplications:
Evaluatehaematologicprofilesbefore
eachdose.
Donotcrushtablet.
Informpatienttofallpregnantwhile
takingthedrug.

38. Antifungals cont
OtherAntifungals
Echinocandins
Echinocandinsareanewclassofantifungal
drugsthatworkbydisruptingthewallthat
surroundsfungalcells.Caspofungin
(Cancidas)isthefirstofthisnewclassof
drugstobeapproved.Itisaneffective
treatmentforsevere,systemicfungal
infections,andisgiventopatientswhodo
notrespondtoothertherapies.

39. IEC TO THE CLIENT
•Educate females to thoughly clean the toilet before
use to prevent infection.
•.iron the underwear were possible or let it dry
under the sun to destroy micro organisms.
•. Stress the importance of the mother taking care of
the child who has or had ringworms to have a
child's own bathing towel, face towels and avoid
sharing these with others.

40. IEC cont
•Educate the mother the importance of cutting hair
short and cutting nails short.
•ASSIGNMENT
•1) WHAT ARE ANTIFUNGALS
•2) STATE THE 5 CATEGORIES OF ANTIFUNGALS
•3) HOW LONG IS GRISEOFULVIN TAKEN IN HAIR
AND SCALP INFECTION?

41. References
Bertram G,.(2010). Basic and Clinical
pharmacology.10th Ed California, San
Francisco,CA 94143-0450
Ministry of Health,.(2020). Zambia National
Formulary. Ndeke House Lusaka

42. Thank you ??????