ANTIFUNGAL

DECRIPTION They are used to treat infections caused by fungi, whether systemic or local.
ACTION Most antifungal bind to components of the fungal cell membrane, leading to death of the
fungal cell.
INDICATIONS 1. They are categorized as either systemic or topical (local).
2. Are used to relieve both kinds of fungal infections.
NURSING 1. Note that before beginning antifungal therapy, the diagnosis that the infection is in fact
MANAGEMENT caused by a fungus must be made because antifungal drugs are not effective against
bacterial or viral infections.
2. Know that any factor predisposing the client to the infection, such as other drugs
(corticosteroids or other immunosuppressive) or Foley catheters should be removed.
3. Monitor liver function closely.
4. Evaluate the effectiveness of interventions using the following criterion: the client will
be free of fungal infections.

SYSTEMIC ANTIFUNGAL AGENTS TOPICAL ANTIFUNGAL AGENTS

GENERAL Vary in effectiveness and toxicities.
INFORMATION Systemic fungal (mycotic) infections are
difficult to treat because systemic
antifungals sometimes are needed in high
doses to reach the site to be effective.
PHARMACO 1. Bind with sterol in the cell membrane
DYNAMICS and the fungus is selectively destroyed.
2. These agents also inhibit cell membrane
synthesis, leading to bacteriostasis of the
organism.
PHARMACO- 1. Treatment of serious and potentially
THERAPEUTICS fatal fungal infections.
2. Treatment of oral and pharyngeal
candidiasis.
3. Treatment of cryptococcal meningitis.
4. Opportunistic candida or cryptococcal
infections in clients infected with HIV.
PHARMACO- 1. Absorption through the GI system unless
KINETICS IV preps are used.
2. Distribution varies with the drug used.
3. Excretion is through the urine.
CONTRA- 1. Allergy or known hypersensitivity to the
INDICATIONS drug.
2. Do not use with other nephrotoxic
agents.
3. Use with caution in clients with renal or
liver disease.
DRUG (see specific agents)
INTERACTIONS
SIDE EFFECTS 1. CNS: drowsiness, dizziness, headache
2. GI: nausea, vomiting, epigastic distress,
anorexia, hepatic insufficiency.
3. DERM: dermatitis, IV prep can cause
burning at infusion site, or phlebitis.
NURSING 1. Assessment:
MANAGEMENT a. Assess and record baseline vital signs,
breath sounds, weight, and general physical
state of health.
b. Determine that a fungal infection is
present.
c. Review medical Hx for presence of liver
or renal insufficiency and for presence of
drugs that may interact with the antifungal.
2. Planning/implementation:
a. Monitor urinary output, serial renal and
liver profiles.
1. Are used for fungal infections that are
not life-threatening.
2. Infections may be involved the
integumentary system and mucous
membranes.
1. The action varies with the drug.
2. Some cause cell death, some cause
fungostasis, and others inhibit further cell
growth of the fungus.
1. Treatment of candida (candidiasis may
occur in mouth, vagina, skin, hair, nails)
2. May be used in diaper rash in children.
1. Bind to skin and mucous membranes,
where the drug is gradually released from
these tissues.
2. Are absorbed in very small amounts and
are excreted in the urine and stool.
Allergies to these drugs, liver failure, , and
first trimester of pregnancy.
Vary depending the drug.
1. CNS: headache, lethargy, neuritis
2. DERM: photosensitivity, allergic
hypersensitivity
3. GI: nausea, vomiting, dry mouth, thirst,
black furred tongue
1. Assessment:
a. evaluate the client for the presence of
infection
b. Assess the client’s ability to understand
administration instructions.
c. Assess signs of superinfection such as
fever, redness, pain, and swelling.
2. Planning/implementation
a. Instruct the client on how to administer
the drug.
b. Teach the client to complete entire
course of therapy or a relapse will occur.
 b. instruct client on how to take and c. Instruct client to report the presence of
monitor medication at home. any other medications in the regimen.
c. Assess effectiveness of the therapy by 3. Evaluation: The outcome of drug
monitoring CBC, fever and client’s overall therapy may be evaluated as successful if it
state of health. the client’s infection subsides.
3. EVALUATION;
The outcome of drug therapy with systemic
antifungal agents may be evaluated as
successful as follows:
a. the infection will subside, as evidence by
the client being afebrile, and WBC being in
normal range.
b. The client experiences minimal or no
side effects.
EXAMPLES 1. Amphoterecin B 1. Griseofulvin
2. Ketoconazole 2. Nyastatin
3. Micronazole 3.Clotrimazole
4. Miconazole
5. Fluconazole
6. Intraconazole