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49 Cards in this Set
- Front
- Back
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What are fungi? |
- single celled or multi-celled organisms - include mushrooms, yeasts, and molds - decompose dead organisms - humans exposed by handling contaminated soil or inhaling spores - difficult to treat |
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Types of Fungal infections (Mycoses) |
- superficial - systemic |
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Superficial fungal infections |
- affects hair, skin, nails, and mucous membranes - is treated with topical agents |
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Systemic fungal infections |
- affect internal organs - are less common - can be fatal in immunosuppressed pts - treated with oral or parenteral agents |
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What has no affect on fungi? |
antibiotics |
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Pt's at risk for mycoses |
- human body is quite resistant to fungi - most serious fungal infections occur in pt's with suppressed immune defenses (ex. pt with HIV) - Infection can be either community-acquired or opportunistic |
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Goals of Antifungal therapy |
- to rid the body of the fungal infection while causing as few adverse effects as possible - for superficial infections, topical solutions are most commonly recommended - for systemic infections, oral medications are given |
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Superficial Mycoses Drugs [prototype] |
nystatin (Mycostatin) |
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Superficial Mycoses Drugs [MOA] |
- Binds to sterols in fungal cell membranes - allows leakage of intercellular contents |
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Superficial Mycoses Drugs [primary use] |
- Candida infections of intestines, vagina, skin, and mouth |
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Superficial Mycoses Drugs [adverse effects] |
- minor skin irritation, nausea, vomiting, diarrhea |
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Nursing Roles for Superficial Mycoses Drugs |
- Assess for signs of contact dermatitis (if present, withhold drug and notify primary health-care provider) - Don't use superficial Mycoses drugs intravaginally during pregnancy to treat infection caused by Gardnerella vaginalis or Trichomonas species (use cautiously for lactating pts) - Meds may be "swished and spit" to treat candidiasis - monitor for nausea, vomiting, diarrhea with high doses |
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Systemic Mycoses Drugs [prototype] |
amphotericin B (Fungizone) |
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Systemic Mycoses Drugs [MOA] |
- Binds to ergosterol in fungal cell membranes, causing them to become permeable or leaky |
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Systemic Mycoses Drugs [primary use] |
- has wide spectrum of activity - includes most fungi pathogenic to humans |
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Systemic Mycoses Drugs [adverse effects] |
- fever, chills, vomit, headache at start of therapy - Phlebitis is common during IV therapy - Nephrotoxicity (observed in 80% of pt's taking this drug), electrolyte imbalances are common - Cardiac arrest, hypotension, dysrhythmias are possible |
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Azole antifungal [prototype] |
fluconazole (Diflucan) - given to diabetics |
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Azole antifungal [MOA] |
act by interfering with synthesis of egrosterol |
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Azole antifungal [primary use] |
- to treat fungal infections in CNS, bone, eye, urinary tract, respiratory tract - not effective against non-albicans Candida species |
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Azole antifungal [adverse effects] |
nausea, vomiting, diarrhea reported a high doses |
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Nursing Roles for Systemic Mycoses Drugs |
- Use cautiously with renal impairment, severe bone marrow suppression, and pregnancy - Amphotericin B (Fungizone) can cause kidney damage (closely monitor fluid and electrolyte status) - Amphotericin B can cause ototoxicity - It is used in life threatening fungal infections - renal toxicity can occur - Has cardiac side effects - know the infusion rate and dosage limitations - Assess for hearing loss, vertigo, unsteady gait, tinnitus |
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Nursing Roles for Azole Therapy |
- Contraindicated with chronic alcoholism (toxic to liver) - Assess for nausea, vomit, abdominal pain, diarrhea - monitor for S&S of hepatotoxicity - may affect glycemic control in diabetic pt's; monitor blood sugar - Monitor for alcohol use; raises risk of nausea, vomit, increased BP |
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Protozoan Infections |
- single celled animals - currently cause significant dz in Africa, South America, and Asia; developing countries (Haiti) - Thrive in areas of poor sanitation - drugs used to treat bacterial and fungal infections are ineffective - most common is malaria |
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Prevention Goals of Antimalarial Therapy |
- CDC recommends prophylactic antimalarials - Use prior to, during, and for 2 weeks after visits to infested areas |
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Treatment Goals for Antimalarial Therapy |
- interrupts erythrocytic stage - eliminates merozoites from red blood cells |
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Pharmacotherapy of Malaria |
- most common protozoal dz - 2nd most fatal infectious dz in the world - caused by protozoan Plasmodium - Transmitted by bite of female Anopheles mosquito - Requires multi drug therapy due to complicated life cycle of parasite - drugs administered for prophylaxis, as therapy for acute attacks, and to prevent relapse |
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Malarial Antiprotozoal Drugs [prototype] |
chloroquine (Arlan) |
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Malarial Antiprotozoal Drugs [MOA] |
- concentrates in food vacuoles of Plasmodium that resides in red blood cells - believed to prevent metabolism of heme - builds to toxic levels within parasite |
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Malarial Anriprotozoal Drugs [Primary] |
- as prototype for treating malaria for over 60 yrs |
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Malaria Antiprotozoal Drugs [adverse effects] |
- nausea, diarrhea, headache - CNS and cardiovascular toxicity at higher doses |
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Nonmalarial Protozoan Infections |
- thrive in unsanitary conditions - Other protozoal dzs include: Amebiasis, giardiasis (in the gut), Trichomoniasis - Treatment of non-Plasmodium protozoan dz requires different set of medications from those used for malaria |
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Amebiasis / Entamoeba histolytica |
- primarily infects large intestine, causing diarrhea - commonly travels to the liver to form liver abscess - rarely travels to other organs such as the brain, lungs, and kidney - source of infection is fecal contaminated water |
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Giardiasis / Giardia lamblia |
- infects the intestines, causing malabsorption, fatigue, and abdominal pain - source is fecal contaminated water |
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Malaria / Plasmodium (various species) |
- infects the red blood cells - causes fever, chills, and fatigue - some Plasmodia invade the liver and other tissues - Bite of female Anopheles mosquito |
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Trichomoniasis / Trichomonas vaginallis |
- common sexually transmitted dz (STD) - causes vaginitis in females and urethritis in males - Transmitted through sexual contact with infected fluids |
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Nonmalarial Antiprotozoal Drugs [prototype] |
metronidazole (Flagyl) |
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Nonmalarial Antiprotozoal Drugs [MOA] |
acts as antiprotozoal drug as well as an antibiotic against anaerobic bacteria |
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Nonmalarial Antiprotozaol Drugs [primary use] |
treats most forms of amebiasis |
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Nonmalarial Antiprotozoal Drugs [adverse effects] |
anorexia, nausea, diarrhea, dizziness, headache, dry mouth, unpleasant metallic taste (which pt must be told to expect) |
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Black Box warning for metronidazole (Flagyl) |
it is carcinogenic in lab animals and should be used only in approved indications |
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Nursing Roles for Malarial Antiprotozoals |
- contraindicated with hematological disorders, severe skin disorders, pregnancy - use cautiously with pre-existing cadiovascular dz, lactating pts - Test for G6PD deficiency - Chloroquine may potentiate anemia, bone marrow depression - Obtain baseline ECG because of potential cardiac complications - monitor for GI side effects such as vomit, diarrhea, abdomnial pain - oral antimalarials can be given with food to reduce GI distress - Monitor for signs of toxicity |
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Nursing Roles for Nonmalarial Antiprotozoals |
- Contraindicated in pts with blood dyscrasias, active organic dz of CNS, during first month of pregnancy - Contraindicated in alcoholics - closely monitored VS and thyroid function during therapy - Monitor for GI distress; oral meds can be given with food - Metronidazole may cause dry mouth and metallic taste - Monitor for CNS toxicity |
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Helminth Infections |
- Parasitic worms that cause significant dz in certain regions of the world - Three types: Roundworms, Flukes, Tapeworms - Enteriobiasis (pinworm) is most common helminth infection - most helminths enter body through the skin or GI tract |
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Goals for Helminth Pharmacotherapy |
- kill parasites locally - disrupt their life cycles - resistance not yet a problem |
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Antihelminthic Drugs [prototype] |
mebendazole (Vermox) |
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Antihelminthic Drugs [MOA] |
broad spectrum antihelminthic drug |
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Antihelminthic Drugs [primary use] |
treat wide range of helminth infection |
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Antihelminthic Drugs [adverse effects] |
As worms die, abdominal pain, distention, and diarrhea may be experienced |
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Nursing Roles for Antihelminthic Drugs |
- use cautiously in pts who are pregnant or lactating, have liver dz, or are younger than 2 - identify specific worm before initiating treatment - monitor lab results: Leukopenia, thrombocytopenia, agranulocytosis associated with albendazole (Albenza) - educate pt on nature of worm infestation: Some types of worms will be expelled in stool, take showers rather than baths, change undergarments, linens, and towels daily |
