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What are infectious diseases caused by fungi called?
Who do we see most mycoses in? Provide examples.
Immunocompromised: HIV, transplant, chemo)
List 2 systemic mycoses drugs.
What is the MOA of systemic mycosis drugs?
Binds to sterols (ergosterol in fungi) and creates pores in membrane → potassium/electrolytes leak out → cell dies
What accounts for the toxic effects of anti-fungals?
They bind to sterols, which include cholesterol, but their affinity is for ergosterol.
Are dosage adjustments of anti-fungals required for people with renal failure?
To decrease fever/chills, side effects of anti-fungals, what should we do for our pts?
Premedicate with antipyretic, antihistamine and steroids.
What can happen to the kidneys when taking an antifungal? What is the effect?
Reversible decrease in GFR and renal tubular function; the effect is a loss of potassium and magnesium
List some nursing implications of renal impairment due to anti-fungal drugs.
- Replace electrolytes
- IV hydration
- monitor potassium, magnesium, BUN, and creatinine levels
What is the advantage of AmBisone over Amphotericin B?
↓ renal and infusion-related toxicity
What class of drugs are among the most widely used for anti-fungal treatment? What is the main drug and how do you remember it?
- Triazoles; Posaconazole (Noxafil)
- Don't be a posuh, Tri Posaconazole for Fungus
Why are Triazoles emerging as first-line therapies for severe fungal disease?
Wide spectrum w/o nephrotoxicity of Amphotericin B.
What is the MOA of Triazoles? What is the main Triazole?
Disruption of ergosterol which increases permeability of fungal membrane
What are some adverse side effects of Posaconazole?
Well tolerated, but may see GI issues or hepatotoxicity
Critical Thinking: Walk through how to figure out what the side effects of AMV antifungals are based on the MOA. Then work through the nursing implications. Keep in mind that Posaconazle is used b/c it has much fewer renal toxicities.
MOA = create holes/increase perm in membrane. This allows K+/Mg+ to escape and cell dies. The major side effects are renal, the electrolytes are lost due to a reversable decrease in GFR. Nursing indications say we need to flush the kideys with lots of H2O, monitor the BUN/Creatinine levles and then replace the electrolytes. The hard part is remembering that fever/chills can be side effects of this as well.
What would you like to do?
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