AMPHOTERICIN B Infusion reaction contd Mild reactions pretreatment options

Amphotericin b infusion reaction contd mild reactions

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AMPHOTERICIN B Infusion reaction (cont’d) Mild reactions: pretreatment options Diphenhydramine plus acetaminophen Aspirin can help but may increase renal damage IV meperidine or dantrolene can be given if rigors occur Hydrocortisone can be given with caution
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AMPHOTERICIN B Nephrotoxicity Extent of kidney damage related to total dose administered over the full course of treatment If total dose >4 g, residual impairment likely Damage minimized by infusing 1 L of saline on days of treatment
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AMPHOTERICIN B Nephrotoxicity (cont’d) Avoid concurrent use of other nephrotoxic drugs Aminoglycosides, cyclosporines Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided Monitor serum creatinine every 3–4 days Reduce dosage if >3.5 mg/dL
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AMPHOTERICIN B Hypokalemia Results from damage to the kidneys Potassium supplements may be needed Monitor serum levels Hematologic effects Can cause bone marrow suppression Anemia: monitor hematocrit
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AZOLES Broad-spectrum antifungal drugs Alternative to ampho B for most systemic mycoses Lower toxicity Can be given orally Disadvantage Inhibit P450 drug-metabolizing enzymes and can increase the levels of many other drugs
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ITRACONAZOLE (SPORANOX) Azole group of antifungal agents Lower toxicity level Uses Systemic mycoses (alternative to ampho B) Mechanisms of action Inhibits the synthesis of ergosterol Inhibits fungal cytochrome P450–dependent enzymes
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ITRACONAZOLE (SPORANOX) Side effects (well tolerated in usual doses) Cardiosuppression Transient decrease in ventricular ejection fraction Liver damage Watch for signs of liver dysfunction Can inhibit drug-metabolizing enzymes GI effects Nausea, vomiting, diarrhea
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FLUCONAZOLE (DIFLUCAN) Azole group of antifungal agents Fungistatic Same mechanism of action as itraconazole Oral absorption good IV and oral dosage the same
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FLUCONAZOLE (DIFLUCAN) Adverse effects Nausea Headache Vomiting Abdominal pain Diarrhea
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VORICONAZOLE (VFEND) Azole group of antifungal agents Broad spectrum of fungal pathogens Uses Candidemia Invasive aspergillosis Esophageal candidiasis Scedosporium apiospermum –resistant infections Mechanism of action Suppresses synthesis of ergosterol
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VORICONAZOLE (VFEND) Adverse effects Hepatotoxicity Visual disturbances, hallucinations Fetal injury Hypersensitivity reactions Nausea, vomiting, and abdominal pain Headache Drug interactions
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ECHINOCANDINS Newest class of antifungal drugs Disrupt the fungal cell wall Oral dose effective treatment mainly for Aspergillus and Candida Caspofungin Micafungin Anidulafungin
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DRUGS FOR SUPERFICIAL MYCOSES Mycoses caused by two groups of organisms Candida species Usually in mucous membranes and moist skin Chronic infections may involve scalp, skin, and nails Dermatophytic infections (eg, ringworm) Usually confined to skin, hair, and nails More common than Candida infections in nails
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