Chapter 11:

Antifungal Agents

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How Fungus Differs from Bacteria
 Fungus
o Composed of a rigid cell wall made up of chitin and
various polysaccharides, and a cell membrane
containing ergosterol.
o Protective layers of the fungal cell make the
organism resistant to antibiotics.

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Patients Susceptible to Fungal Infections
 Patients with AIDS and AIDS-related complex (ARC)
 Patients taking immunosuppressant drugs
 Patients who have undergone transplantation surgery or
cancer treatment
 Members of growing elderly population no longer
protected from environmental fungi

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Culture
 A culture should be obtained prior to prescribing anti-
fungal agents.
 Patients on antifungal agents are typically
immunosuppressed and should not be placed at
additional risks for incorrect agent and toxic effects.

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Most Common Systemic Antifungal Agents
 Caspofungin (Cancidas) (IV)
o Approved for the treatment of invasive aspergillosis
in patients who are refractory to other treatments
 Flucytosine (Ancobon) (Oral)
o Less toxic drug used for the treatment of systemic
infections caused by Candida or Cryptococcus
 Nystatin (Mycostatin, Nilstat) (Oral)
o Used for the treatment of intestinal candidiasis; also
available in a number of topical preparations

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Use of Antifungals Across the Life Span

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Site of Action of Antifungals

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Azoles

 Indications - Newer class of drugs used to treat

systemic fungal infections, less toxic than amphotericin
B but also less effective, bind to sterols and can cause
cell death, inhibit glucan synthesis
 Pharmacokinetics – Absorbed rapidly from the GI
tract, metabolized in the liver and excreted in urine and
feces
 Contraindications – Hepatic and renal dysfunction,
pregnancy and lactation and drugs that prolong the QTc
interval
 Adverse effect- Liver toxicity and tetrogenic effects
 Drug-to–Drug Interaction- Many

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Echinocandin Antifungals

 Indications – Another group of antifungals, inhibit

glucan synthesis leading to death of the cell wall
 Pharmacokinetics – Given IV, rapid onset, metabolized
degradation and excreted in feces
 Contraindications – Hepatic /renal dysfunction,
pregnancy and lactation
 Adverse effect- Liver toxicity, tetrogenic effects and
bone marrow supression
 Drug-to–Drug Interaction- Cyclosporine

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Question #1
Please answer the following statement as true or false.

Nystatin, taken orally, is used for the treatment of

intestinal candidiasis.

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Answer to Question #1

True

Rationale: Nystatin (Mycostatin, Nilstat) (Oral)

o Used for the treatment of intestinal candidiasis; also
available as a topical preparation.

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Other Antifungal Agents : Amphotericin B

 Indications – Very potent – reserved for progressive

potential fatal fungal infections
 Pharmacokinetics - IV form only, metabolism not well
understood, excreted in the urine
 Contraindications – Pregnancy, lactation and renal
impairment
 Adverse Effect - related to their toxic effects on the
liver and kidneys, severe renal impairment and bone
marrow suppression
 Drug-to-drug Interaction- Nephrotoxic antibiotics or
antineoplastics, cyclosporine, or corticosteroids

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Other Antifungal Agents : Flucytosine

 Indications – Prevent the fungal cells from reproducing

by altering the cell membrane
 Pharmacokinetics – IV form only, metabolism not well
understood, excreted in the urine
 Contraindications – Pregnancy, lactation and renal
impairment
 Adverse Effect – Toxic effects on the liver and kidneys
and bone marrow suppression
 Drug-to-drug Interaction- Nephrotoxic antibiotics or
antineoplastics, cyclosporine, or corticosteroids

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Topical Antifungal Agents

 Indication- Work to alter the cell permeability of the

fungus, causing prevention of replication and fungal
death, indicated only for local treatment of mycoses,
including tinea infections
 Pharmacokinetics- Not systemic
 Contraindications- Limited to known allergy to any of
these drugs
 Adverse Reactions- Irritation, burning, rash, and
swelling at the site
 Drug-to-drug Interactions: Unknown

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Question #2
Which of the following is considered a contraindication
of Ketoconazole ?
A. Patients with renal problems
B. Patients with fertility problems
C. Patients with hepatic problems
D. Patients with GI problems

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Answer to Question #2

B. Patients with fertility problems

Rationale: Contraindications – not drug of choice for

patients with endocrine or fertility problems.

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Nursing Considerations for Systemic
Antifungal Agents
Assess:
– History of allergy to antifungal
– Physical status
– Culture of the infected area
– Renal and hepatic function tests and CBC

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Nursing Considerations for Topical
Antifungal Agents
Assess:
– Known allergy to any topical antifungal agent
– Physical status
– Culture and sensitivity testing
– Area of application for color, temperature, and
evidence of lesions

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Prototype Antifungal Agent #1

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Prototype Antifungal Agent #2

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Prototype Antifungal Agent #3

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Question #3
The nurse is caring for a patient with a fungal infection.
Which of the following would be considered an adverse
effect of an antifungal medication?
A. Burning or irritation in the sexual partner
B. Abnormal kidney function tests
C. Upper abdominal pain
D. Urinary retention

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Answer to Question #3

A. Burning or irritation in the sexual partner

Rationale: Adverse effects: Troche: nausea, vomiting,

abnormal liver function tests; topical: stinging, redness,
urticaria, edema; vaginal: lower abdominal pain, urinary
frequency, burning or irritation in the sexual partner

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