Antifungals (Systemic)

Antifungals (Systemic)

Action: Antifungals act by increasing cell membrane permeability in susceptible organisms by binding sterols and decreasing potassium, sodium, and nutrients in the cell.

Uses: Antifungals are used for infection of histoplasmosis, blastomycosis, coccidiomycosis, cryptococcosis, aspergillosis, phycomycosis, candidiasis, sporotrichosis causing severe meningitis, septicemia, and skin infection.

Side effects / Adverse reactions: The most serious adverse reactions include renal tubular acidosis, permanent renal impairment, anuria, oliguria, hemorrhagic gastroenteritis, acute liver failure, nausea, vomiting, anorexia, headache, fever, and chills.

Contraindication: Persons with severe bone depression or hypersensitivity should not use these products.

Precautions: Antifungals should be use with caution in renal disease, pregnancy, and hepatic disease.

Interaction: Please check individual monographs since interaction vary widely among products.

Possible nursing diagnoses:
» Risk for infection [uses]
» Risk for injury [adverse reactions]
» Knowledge deficit [teaching]

Nursing Considerations

» VS q15-30min during first infusion; note changes in pulse, B/P
» I&O ratio; watch for decreasing urinary output, change in specific gravity; discontinue drug to prevent permanent damage to renal tubules
» Blood studies: CBC, K, Na, Ca, Mg q2wk
» Weight weekly; if weight increases over 2 1b/wk, edema is present; renal damage should be considered
» For renal toxicity: increasing BUN, if >40 mg/dl or if serum creatinine >3 mg/dl; drug may be discontinued or dosage reduce
» For hepatotoxicity: increasing AST, ALT, ALK phosphatase, bilirubin
» For allergic reaction: dermatitis, rash; drug should be discontinued, antihistamine (mild reaction) or epINEPHrine (severe reaction) administered
» For hypokalemia: anorexia, weakness, decreased reflexes, dizziness, increased urinary output, increased thirst, paresthesias
» For ototxicity tinnitus (ringing, roaring in eas), vertigo, loss of hearing (rare)

» IV using in -line filter (mean pore diameter >1 um) using distal veins; check for extravasation, necrosis q8h
» Drug only after C&S confirms organism, drug needed to treat condition; make sure drug is used in life-threatening infections

Perform / Provide:
» Protection from light during infusion, cover with foil
» Symptomatic treatment as ordered for adverse reaction: aspirin, antihistamines, antiemetics, antispasmodics
» Storage protected from moisture and light; diluted sol is stable for 24 hr

» Therapeutic response; decreased fever, malaise, rash, negative C&S for infecting organism

Teach patient/family:
» That long-term therapy may be needed to clear infection (2 wk-3 mo depending on type of infection)

Selected Generic Names

amphotericin B

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