Question

Pete Zaria has a history of HIV and has developed esophageal candidiasis.  The hospitalist prescribes fluconazole 400mg IV once daily.

1. BRIEFLY describe the MOA of the “azole” antifungals.

2. What laboratory values must be frequently monitored in patients receiving fluconazole?

After being hospitalized and receiving treatment for 5 days, Pete’s condition deteriorates, and blood cultures reveal systemic fungal infection.  Amphotericin B is ordered.

1. How is this medication administered? (include information re:  route, setting, rate, dose, etc…)

2. What are the major adverse effects of amphotericin B?  How should the nurse monitor for these adverse effects?

Answer 1

antifungals medication prevent cytochrome P450 dependent 14 alpha sterol demethylase, there by inhibit protein synthesis ithin the fungal cell itself or affect permeabilitility of fungal cell membrane and leads intracellular swelling and inhibits cell division and inhibit intracellular adhesion and epithelial penetration by enhancing protrusion of cytoplasm through membrane.

patient receives fluconazole, the following blood test to be done and monitored before and throughout the course in order to assess the side effects:  blood urea nitrogen and creatinine to be checked in patient with renal insufficency and they require dose adjustment. liver functon test should be monitored because this medication may cause increased SGOT, SGPT, Alkaline phosphate, bilirubin levels

AMPHOTERICIN B   is a fungal medication which binds to fungal cell membrane and permitting leakage of cellular contents.

is administered via Intravenous for active and dangerous fungal infections, topical antifungal for superficial fungal infections.

route , dosage, setting, rate: amphotericin is given test dose of 1mg and starting dose of 0.25 mg/kg and slowly and increase dose of amphotericin B 0.5mg/kg and upto 1mg/kg /day can be given an dit shoul be administered for hospitalized patients. amphotercin B is available in 50 ml vial and it mixed ith 10 ml of water and again 1mg mixed with D5Wat at aconcentration of 100mcg/ml. patient is tested for allergy with test dose of 1mg in 20 ml of D5W for 30 minutes. and rate of infusion via infusion pump over 6 hours slowly.

Major side effects of medication: Headcahe, Nephrotoxicity, heamturia, fever, chills, hypokalemia, hypotension, arrythemias,nausea, vomiting , diarrhoea, phlebitis, hypersensitivity reactions, shortness of breath, double vision, wheezing, elloish of skin an deyes, hearing changes, bleeding, black stools.

monitoring the patient who receives Amphotericn B:

Assess the patient closely for any sideefffects such as chills, fever, headache, nausea, vomiting after giving test dose and also after giving each dose for any sideeffects. patient should be premedicated with antipyrectics, corticosteriods, antihistamines, antiemetics. ensuring sodium balance of patient helps to subsides these side effects.

he should be Monitored by checking  vital signs before and and after giving test dose and after giving each dose and throughout the therapy.and ensure his intake and output are balanced and hydrate him in order to prevent nephrotoxicity. and observe inject site frequently for any phlebitis. his lung sounds are assessed for any crepts, wheeze or any lung sounds