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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  • Spring '14
  • AnnMaradiegue

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