Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction to Clinical...

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Introduction to Clinical Pharmacology

Chapter 12Antifungal and Antiparasitic

Drugs

Introduction to Clinical Pharmacology

Chapter 12Antifungal and Antiparasitic

Drugs


Antifungal Drugs: Actions and UsesAntifungal Drugs: Actions and Uses

• Fungicidal OR fungistatic: Action is related to their concentration in body tissues

• Used prophylactically to prevent fungal infection in immunocompromised patients

• Used to treat superficial and deep fungal infections; systemic infections; superficial infections of nail beds and oral, anal, and vaginal areas


Helminthic and Protozoal Infections and AmebiasisHelminthic and Protozoal Infections and Amebiasis• Helminthic infections: Invasion of body by

parasitic worms

– Anthelmintic drugs kill the parasites

• Protozoal infections: Single-cell parasites

– Antiprotozoal drugs work to inhibit DNA synthesis, effectively killing the organism

• Amebiasis is a parasitic gastrointestinal disorder


Antifungal Drugs: Adverse ReactionsAntifungal Drugs: Adverse Reactions

• Topical administration: Integumentary reactions

– Irritation and burning sensation; redness, stinging; abdominal pain (vaginal preparations)

• Systemic administration

– Headache; rash; nausea; vomiting; diarrhea; anorexia and malaise; abdominal, joint, or muscle pain


Antifungal Drugs: Contraindications, Precautions, and InteractionsAntifungal Drugs: Contraindications, Precautions, and Interactions

• Contraindicated in patients with a history of allergies to the drug; during pregnancy and lactation

• Contraindications for antifungal drugs: Griseofulvin; voriconazole; itraconazole

• Used cautiously in patients with renal dysfunction and/or hepatic impairment

• Interactions possible depending on the individual drugs, and many interactions can occur


Nursing Process: AssessmentNursing Process: Assessment• Preadministration assessment:

– Assess for signs of the infection before giving the first dose; take and record vital signs

– Inspect superficial fungal infections of the skin or skin structures and record

– Ask about pain and presence of white plaques or sore areas of the oral or perineal areas and any vaginal discharge


Nursing Process: Assessment (cont.)Nursing Process: Assessment (cont.)

• Ongoing assessment:

– Carefully observe the patient every 2 to 4 hours for adverse drug reactions

– If administered topically, instruct the patient to look for signs of improvement and adverse reactions both minor and severe


Nursing Process: Nursing DiagnosisNursing Process: Nursing Diagnosis

• Impaired Comfort related to IV administration of amphotericin B

• Risk for Ineffective Tissue Perfusion: Renal related to adverse reactions of antifungal drugs


Nursing Process: PlanningNursing Process: Planning

• The expected outcome depends on the reason for administering the antifungal drug but includes an optimal response to therapy:

– Patient relates to the management of adverse reactions and has an understanding of and compliance with the prescribed treatment regimen


Nursing Process: ImplementationNursing Process: Implementation

• Promoting an optimal response therapy:

– Amphotericin B: Protect IV solution from exposure to light; administer immediately after the drug is reconstituted; renal damage is the most serious adverse reaction to the use of amphotericin B—hence, serum creatinine levels and BUN levels are checked frequently


Nursing Process: Implementation (cont.)Nursing Process: Implementation (cont.)

• Promoting an optimal response therapy (cont.):

– Topical antifungal infection preparations: Inspect the area at the time of each topical application; if administered vaginally, question the patient regarding any discomfort or other sensations experienced; evaluate and chart the patient’s response to therapy daily



• Monitoring and managing patient needs:

– Impaired comfort: Medication administration

•Use precautions when administering amphotericin B intravenously; inform before the drug is given that the side effects can be uncomfortable; provide warm blankets; reassure that the medications administered before the antifungal are to help ease the reaction



• Monitoring and managing patient needs (cont.):

– Risk for ineffective tissue perfusion: Renal

•Carefully monitor fluid intake and output, serum creatinine levels, and BUN levels

•Gerontologic alert: Fluconazole



• Educating the patient and family:

– For topical antifungal drugs include the importance of cleanliness and using the correct ointment amount in the prescribed frequency in the teaching plan

– For ringworm infections advise keeping towels and facecloths used for bathing separate from those of other family members



• Educating the patient and family (cont.):

– Teach drug-specific points for the following drugs

•Flucytosine; griseofulvin; ketoconazole; itraconazole; miconazole


Nursing Process: EvaluationNursing Process: Evaluation

• The therapeutic effect is achieved; signs and symptoms of infection improve; optimal skin integrity is maintained

• Adverse reactions are identified, reported, and managed

• Patient and family demonstrate understanding of the drug regimen

• Patient verbalizes the importance of complying with the prescribed therapeutic regimen


Antiparasitic DrugsAntiparasitic Drugs

• Anthelmintic drugs: Used against invasion of parasitic worms (helminthiasis)

• Antiprotozoal drugs: Used against invasion of single-celled parasites


Anthelmintic Drugs: Actions and UsesAnthelmintic Drugs: Actions and Uses• Albendazole: Interferes with synthesis, resulting in

death of larva; used to treat larval forms of pork tapeworm and liver, lung, and peritoneum disease caused by dog tapeworm

• Mebendazole: Blocks glucose uptake by helminth; used to treat whipworm, pinworm, roundworm, American hookworm, and common hookworm

• Pyrantel: Ability to paralyze helminth; used to treat roundworm and pinworm

• Thiabendazole: Interrupts the life cycle of the helminth; used to treat threadworm


Anthelmintic Drugs: Adverse ReactionsAnthelmintic Drugs: Adverse Reactions

• Generalized adverse reactions:

– Drowsiness, dizziness, nausea, vomiting, abdominal pain and cramps, diarrhea

• Serious adverse effects:

– Rash


Anthelmintic Drugs: Contraindications and PrecautionsAnthelmintic Drugs: Contraindications and Precautions

• Contraindicated in patients:

– With a history of hypersensitivity; during pregnancy

• Used cautiously in patients:

– With hepatic or renal impairment; during lactation; with malnutrition or anemia


Anthelmintic Drugs: InteractionsAnthelmintic Drugs: Interactions

Interactant drug Effect of interaction

Dexamethasone Increased effectiveness of albendazole

Cimetidine Interferes with elimination of albendazole

Hydantoins and carbamazepine

Lower levels of mebendazole

Xanthine derivatives Increased serum level, possible toxic effects of the xanthines


Antiprotozoal Drugs: Actions and UsesAntiprotozoal Drugs: Actions and Uses

• Actions:

– Interfere with life cycle of the plasmodium

– Prevent development of plasmodium

– Prevent the mosquito from ingesting the plasmodium

• Used for the treatment of:

– Malaria


Antiprotozoal Drugs: Adverse ReactionsAntiprotozoal Drugs: Adverse Reactions

• Gastrointestinal reactions:

– Vomiting; anorexia; abdominal cramping; diarrhea; nausea

• Other body system reactions:

– Headache; dizziness; visual disturbances; hypotension; photosensitivity; cinchonism


Antiprotozoal Drugs: Contraindications and PrecautionsAntiprotozoal Drugs: Contraindications and Precautions• Contraindicated in patients:

– With known hypersensitivity; during pregnancy

• Used cautiously:

– With children; lactating patients; patients with hepatic or renal disease or bone marrow depression

• Quinine not prescribed for:

– Patients with myasthenia gravis


Antiprotozoal Drugs: InteractionsAntiprotozoal Drugs: Interactions

Interactant drug Effect of interaction

Antacids, iron Decreased absorption of the antimalarial

Digoxin Increased risk of digoxin toxicity

Barbiturates, phenytoin, and carbamazepine

Decreased effectiveness of doxycycline

Warfarin Increased risk of bleeding


Antiparasitic Drugs: Nursing Process: AssessmentAntiparasitic Drugs: Nursing Process: Assessment• Preadministration assessment:

– Diagnosis of helminth infection: Examination of stool; weigh patient to determine drug dosage

• Ongoing assessment:

– Save and transport all stools passed after intake of drug to laboratory

– Acutely ill: Monitor vital signs; record fluid intake/output every 4 hours

– Observe patient for adverse reactions


Antiparasitic Drugs: Nursing Process: Nursing DiagnosisAntiparasitic Drugs: Nursing Process: Nursing Diagnosis

• Diarrhea related to parasitic invasion of body

• Risk for Deficient Fluid Volume related to parasitic invasion of body

• Imbalanced Nutrition: Less Than Body Requirements—adverse reaction to drug therapy

• Risk for Impaired Respiratory Function—adverse reaction to drug therapy


Antiparasitic Drugs: Nursing Process: PlanningAntiparasitic Drugs: Nursing Process: Planning

• Depends on the patient and the type of helminth infection

• Outcome: Reduction of anxiety, optimal response to therapy, management of adverse reactions, understanding of and compliance with prescribed therapeutic regimen


Antiparasitic Drugs: Nursing Process: ImplementationAntiparasitic Drugs: Nursing Process: Implementation

• Promoting optimal response to therapy:

– Patient and family: Explain treatment and future preventive measure; discuss concerns and questions

– Based on the hospital policy, linen precaution necessary


Antiparasitic Drugs: Nursing Process: Implementation (cont.)Antiparasitic Drugs: Nursing Process: Implementation (cont.)• Monitoring and managing patient needs:

– Diarrhea and risk of fluid body volume deficit: Monitor fluid intake and output; IV fluid and electrolyte replacement may be necessary

– Risk for imbalanced nutrition: Gastrointestinal upset causing nausea, vomiting, abdominal pain, and diarrhea; consider patient’s food preference and encourage intake of nutritious balanced meal

– Risk for impaired respiratory function: With inhaled treatments of pentamidine, bronchodilator may be prescribed; instruct patient and family on use


Antiparasitic Drugs: Nursing Process: Implementation (cont.)Antiparasitic Drugs: Nursing Process: Implementation (cont.)• Educating patients and family members:

– Instruction about taking the drugs as well as the household precautions to be followed until helminth is eliminated

– Prepare the education plan to be followed


Antiparasitic Drugs: Nursing Process: EvaluationAntiparasitic Drugs: Nursing Process: Evaluation• Therapeutic effect achieved; adverse

reactions identified, reported, and successfully managed; stool specimen negative for parasites; patient verbalizes an understanding of the therapeutic regimen modalities and the importance of continued follow-up testing, and complying with the prescribed regimen and preventive measures


QuestionQuestion

• Is the following question true or false?

• Itraconazole is taken on an empty stomach. Therapy continues for at least 6 months until the infection is controlled.


AnswerAnswer

• False

• Itraconazole is taken with food. Therapy continues for at least 3 months until the infection is controlled.


QuestionQuestion

• Is the following question true or false?

• A fungus is a single-celled plant that can cause yeast-like infections.


AnswerAnswer

• True

• A fungus is a single-celled plant that can cause yeast-like infections. These are called fungal or mycotic infections. Antifungal drugs slow or destroy fungi.


QuestionQuestion

• Is the following statement true or false?

• Superficial fungal infections to the skin, nails, and genital area are bothersome and are treated with parenteral medications.


AnswerAnswer

• False

• Superficial fungal infections to the skin, nails, and genital area are bothersome and are treated topically or by oral preparations. Systemic infections happen when the fungi gain entry into the body; these are serious infections, especially for those immunocompromised.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction to Clinical...

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