Antifungals

and
Antivirals
Group 4
ANTIFUNGALS
- medicines that kill or stop the
growth of fungi (the plural of
fungus) that cause infections
AMPHOTHERECIN B

Classifications
● Therapeutic: polyene
● Pharmacologic: antifungals
Actions
● Amphotericin products bind to sterols in the fungal cell membrane, altering
permeability and allowing intracellular components to leak out.
● Inhibit fungal growth and multiplication, If the level is high enough, the
drugs can destroy fungi.
Indications
● Used to treat potentially life threatening fungal infections.
Side Effects
● Stomach pain or cramping, heartburn, diarrhoea, weight loss, lack of
energy, pale skin, headache, dizziness, shortness of breathing, and redness
or swelling at the injection site.
Adverse reaction
● fever
● loss of potassium
● loss of magnesium and anaphylaxis.
Contraindication and Cautions
● Contraindicated in patients hypersensitive to these drugs or to any of their
components.
● Use caution with concomitant use of caspofungin and cyclosporine
because of the possibility of elevated liver enzymes.
● Administer IV amphotericin under close clinical observation. Acute infusion
reactions can occur, including fever, shaking chills, hypotension, anorexia,
nausea, vomiting, and tachypnea.
● Amphotericin formulations aren’t interchangeable and are each prescribed
differently.
Nursing Responsibilities
● Ensure patients is adequately hydrated before and during therapy.
● Obtain baseline FBC, serum electrolytes, renal and liver function tests.
Repeat the measurements during therapy.
● Observe for adverse effect during the first 30 minutes of administration
especially for cardiotoxicity.
● Monitor and document vital signs including blood pressure and fluid
balance. See instructions to “Monitor” under Special Conditions.
● Assess IV site carefully before and during infusion of amphotericin.
NYSTAMIN
Classifications
● Therapeutic: polyenes
● Pharmacologic: Antifungals
Actions
● Binding to sterols in the plasma membranes of fungi causing the cells to
leak, eventually leading to fungal cell death.
● Indicated for the treatment of candidal infections of the skin, mucous
membranes and gastrointestinal tract.
Indications
● Nystatin is available in oral formulations for the treatment and/or
prevention of oral candidiasis (a.k.a. thrush), intestinal candidiasis, and
anal candidiasis

Side Effects
● Frequent: mouth irritation, abdominal pain nausea, vomiting, diarrhoea and
skin rash.
● Occasional: Fever, Soar throat, skin pain, red or purple skin rash,
● Rare: Bloody diarrhoea, Muscle pain(myalgia), skin reactions including:
rashes and hives(urticaria)
Adverse Reactions
● CNS: Hallucinations (seeing or hearing things that are not there),Thoughts of hurting
yourself or suicide., dizziness or passing out, headache, not able to sleep, and
seizures.
● GI: diarrhea, nausea, stomach pain (large doses), vomiting.

● SKIN: rash and hives

Contraindication
● Hypersensitivity to nystatin is a contraindication for its use. Some nystatin oral
suspension preparations contain sugar and are unsuitable for children with
disaccharide intolerance.

Cautions
● Stop using nystatin if you have mouth irritation.
Nursing Responsibilities
EVALUATION
● Monitor symptoms and healing of skin lesions to help document drug
effectiveness
● Notify physician immediately of severe rashes or dermatitis because certain
conditions may indicate serious hypersensitivity reaction

INTERVENTIONS
● Avoid contact with cutaneous lesions when treating patient.
● Always wash hands thoroughly and disinfect equipment (whirlpools,
electrotherapeutic devices, treatment tables, and so forth) to help prevent
the spread of infection.
PATIENT/FAMILY TEACHING
● Advise patient to report any increased local sensitivity to this drug (pain,
burning, itching, swelling).
● Instruct patient about proper hygiene
● Advise patient to seek medical help if infections persist or recur after the full
treatment. Recurrent fungal infections may be a sign of systemic illness.
FLUCONAZOLE

Classifications
● Therapeutic: triazoles
● Pharmacologic: antifungals

Actions
● Inhibits fungal cytochrome P-450 (responsible for fungal sterol synthesis).
● Weakens fungal cell walls.
Indications
● Used to treat serious fungal or yeast infections, including vaginal
candidiasis, oropharyngeal candidiasis (thrush, oral thrush), esophageal
candidiasis (candida esophagitis), other candida infections (including
urinary tract infections, peritonitis [inflammation of the lining of the
stomach], and infections that may occur in different parts of the body), or
fungal (cryptococcal) meningitis.
● To prevent candidiasis in patients receiving bone marrow transplant and
patients with cancer.
Side Effects
● Frequent: headache, abdominal pain, diarrhea, feeling or being sick
(nausea or vomiting), skin rash, acid indigestion, dizziness, changes in the
way food taste.
● Occasional: belching, unpleasant (after) taste, heartburn, indigestion,
stomach discomfort or upset.
● Rare: liver problems, seizures, decreased WBC or platelet counts, heart
rhythm changes, decreased adrenal gland function, severe allergic or skin
reactions.
Adverse Reactions
● CNS: headache, dizziness.

● GI: nausea, vomiting, abdominal pain, diarrhea, dyspepsia, taste perversion.

● SKIN: rash

Contraindication
● Rarely, anaphylaxis has been reported.
● Contraindicated in patients who have shown hypersensitivity to fluconazole or to any
of its excipients.
● Contraindicated with CYP34A substrates that may lead to QT-interval prolongation
(astemizole, erythromycin, primozide, quinidine).
Cautions
● Use dosage forms containing benzyl alcohol derivatives cautiously in
neonates or avoid use.
● Use cautiously in patients hypersensitive to other antifungal azole
compounds.
● Recommended when administering fluconazole to patients with
proarrhythmic conditions.
● Oral suspension contains sucrose and shouldn’t be used in patients with
heredity fructose, glucose, or galactose malabsorption or sucrase-
isomaltase deficiency
Nurse Responsibilities
Alert: Serious hepatoxicity has occurred in patients with underlying medical conditions. Monitor
LFTs and discontinue drug if hepatic dysfunction develops.
INTERVENTION/EVALUATION:
● Rare cases of exfoliative skin disorders have been reported. Closely monitor patients who
develop mild rash. Stop drug if lesions progress.
● Use cautiously in patients with renal impairment. Monitor renal function during treatment;
dosage adjustment may be necessary.
● Monitor potassium level.
● Likelihood of adverse reactions may be greater in patients infected with HIV.

PATIENT/FAMILY TEACHING
● Tell patient to take drug as directed, even after feeling better.
● Instruct patient to report all adverse reactions promptly.
KETOCONAZOLE (TOPICAL)
Classifications
● Therapeutic: antifungals
● Pharmacologic: imidazoles

Actions
● Probably inhibits yeast growth by altering the permeability of the cell
membrane
Indications
● Seborrheic Dermatitis

Adults and children age 12 and older

○ Apply foam to affected area b.i.d. for 4 weeks. Apply gel to affected area once daily for
2 weeks.
○ Apply cream to affected area b.i.d. for 4 weeks or until clearing
● Tinea corporis, tinea cruris, tinea pedis, tinea versicolor from susceptible organisms;
seborrheic dermatitis; cutaneous candidiasis
Adults
○ Cover affected and immediate surrounding areas once daily for at least 2 weeks with
2% cream.
○ Patients with tinea pedis need 6 weeks of treatment.
○ For tinea (pityriasis) versicolor, if using 2% shampoo, apply to affected area of damp
skin, lather, leave on for 5 minutes, and rinse (one application is usually sufficient)
● Scaling caused by dandruff
Adults and children age 12 and older
○ Using 1% OTC shampoo, wet hair, lather, and rinse thoroughly; repeat. Use
every 3 to 4 days for up to 8 weeks; then apply only as needed to control
dandruff
■ Children younger than age 12: Consult health care provider before use
Side Effects
● Systemic ketoconazole administration most commonly causes
gastrointestinal side effects. These include nausea, vomiting, constipation,
abdominal pain, dry mouth, flatulence, and tongue discoloration

Adverse reaction
● Skin: pruritus, application-site reaction, oiliness or dryness of hair and
scalp with shampoo use; application-site reaction, burning with foam or
gel; severe irritation, and stinging or burning with cream
Contraindication and Cautions
● Product contains sodium and sulfite anhydrous, which may cause severe or life-
threatening allergic reactions, including anaphylaxis, in patients with asthma. It is not
a dialyzable drug.

NURSING RESPONSIBILITIES
● History taking: Assess for allergy for ketoconazole, fungal meningitis, hepatic failure,
pregnancy, lactation
● Physical Assessment: Assess for skin color, lesions; orientation, reflexes, affect;
bowel sounds; LFTs; CBC and differential; culture of area involved
● Most patients show improvement soon after treatment begins
● Treatment of tinea corporis or tinea cruris should continue for at least 2 weeks to
reduce possibility of recurrence
PATIENT TEACHING
● Tell patient to stop drug and notify prescriber if hypersensitivity reaction occurs
● Advise patient to check with prescriber if condition worsens; drug may have to be stopped
and diagnosis reevaluated
● Tell patient to avoid using shampoo on scalp if skin is broken or inflamed
● Advise patient that foam and gel are flammable and to avoid fire, flame, and smoking during
and immediately after application
● Instruct patient to dispense foam into cap of can or other cool surface and not to spray
directly onto affected skin of the hands. If fingers are warm, tell patient to rinse them in cold
water and dry well; then, using fingertips, to gently massage foam into affected areas until it
disappears
● Instruct patient to not wash areas where gel was applied for at least 3 hours and to wait at
least 20 minutes after application before applying makeup or sunscreen to the affected areas
● Instruct patient to wash hands before and after use, unless affected areas are on hands
● Warn patient that shampoo applied to permanent-waved hair removes curl
● Warn patient to avoid drug contact with eyes
MICAFUNGIN
Classifications
● Therapeutic: antifungals
● Pharmacologic: echinocandins

Actions
● Micafungin inhibits the synthesis of beta-1,3-D-glucan, an essential
component of fungal cell walls which is not present in mammalian cells. It
does this by inhibiting beta-1,3-D-glucan synthase.
Indications
● Candidemia, acute disseminated candidiasis, and Candida peritonitis
and abscesses
○ Adults: 100 mg IV daily for 10 to 47 days (mean duration, 15 days)
○ Children age 4 months and older: 2mg/kg IV once daily. Maximum
dosage is 100 mg daily

● To treat candidemia, acute disseminated candidiasis, Candida

peritonitis, and abscesses without meningoencephalitis, ocular
dissemination, or both
○ Children younger than age 4 months: 4 mg/kg IV once daily
● Esophageal candidiasis
○ Adults: 150 mg IV daily for 10-30 days (mean duration, 15 days)
○ Children age hormone and older weighing more than 30 kg: 2.5 mg/kg IV once
daily
○ Maximum dosage is 150 mg daily
○ Children age 4 months and older weighing 30 kg or less: 3 mg/kg IV once daily
● To prevent candidal infection in hematopoietic stem cell transplant recipients
○ Adults: 50 mg IV daily for 6-51 days (mean duration, 19 days)
○ Children age 4 months and older: 1 mg/kg IV once daily. Maximum dosage is 50
mg daily
SIDE EFFECTS
● Swelling/redness/irritation at the injection site, nausea/vomiting, diarrhea, headache,
or trouble sleeping may occur
ADVERSE EFFECTS
CNS: headache, insomnia, anxiety, dizziness, pyrexia, rigors, delirium, seizures, intracranial
hemorrhage
CV: atrial fibrillation, bradycardia, cardiac disorders, HTN, hypotension, tachycardia, vascular
disorders, phlebitis, edema, cardiac arrest, MI, pericardial effusion
EENT: epistaxis

GI: Abdominal pain, abdominal distention, diarrhea, nausea, vomiting, anorexia, dyspepsia,
mucositis, constipation
GU: decreased urine output, hematuria
HEMATOLOGIC: leukopenia, neutropenia, thrombocytopenia, anemia

HEPATIC: elevated LFT values, hepatic injury, hepatomegaly, hyperbilirubinemia

METABOLIC: hypocalcemia, hypokalemia, hypomagnesemia, hypophosphatemia,

hyperglycemia, hypoglycemia, hyperkalemia, hypernatremia
RESPIRATORY: cough, dyspnea

SKIN: infusion-site inflammation, pruritus, rash, urticaria

OTHER: hypersensitivity reactions

CONTRAINDICATIONS AND CAUTIONS
● Contraindicated in patients hypersensitive to drugs
● Effects of micafungin are unknown in patients with severe hepatic disease. It is not a
dialyzable drug

NURSING CONSIDERATIONS
● Injection-site reactions occur more often in patients receiving drug by peripheral IV
● To reduce the risk of histamine-mediated reactions, infuse drug over at least 1 hour
Alert: If patient develops signs of serious hypersensitivity reaction, including shock, stop
infusion and notify prescriber immediately
● Monitor hepatic and renal function during therapy
● Monitor patient for hemolysis and hemolytic anemia
PATIENT TEACHING
● Advise patient to report pain or redness at infusion site
● Teach patient about adverse reactions and to report them immediately
● Tell patient lab tests will most likely be needed to monitor hematologic,
renal, and hepatic function
ANTIVIRALS
- medications that help your body
fight off certain viruses that can
cause disease
- protect you from getting viral
infections or spreading a virus to
others
AMANTADINE
Classifications
● Therapeutic: antivirals
● Pharmacologic: systhetic cyclic primary amines

Actions
● interferes with the release of infectious viral nucleic acid into the host cell
through interaction with the transmembrane domain of the M2 protein of
the virus
Indications
● Lower dosage are recommended for patients with renal impairment.
● Refer to the manufacturer’s product information for specific dosage
adjustments.

Side Effects
● This can increase your risk of side effects such as nausea, dizziness, or
insomnia.
● Serious eye symptoms such as sudden vision loss.
● Depression, unusual changes in behaviour or mood, mental illness, or
thoughts about or attempted suicide.
Adverse reaction
● CNS: dizziness, insomnia, irritability, light- headedness, depression, fatigue,
confusion, hallucinations, anxiety, ataxia, headache, nervousness, dream
abnormalities, agitation, somnolence, dystonia.
● CV: HF, peripheral edema, orthostatic hypotension.

● EENT: blurred vision, cataract, dry eye.

● GI: nausea, anorexia, constipation, vomiting, dry mouth, diarrhea.

● GU: UTI, BPH.

Contraindication and Cautions
● Contraindicated in patients with hypersensitivity to the drug or
components of the formulation
● Patients with a history of epilepsy or other seizures should be observed
closely for possible increased seizure activity.
● Severe kidney disease.
Nursing Responsibilities
Base line assessment
● Question of history in hypertensive or epilepsy
● Obtain baseline height, weight, BP

Patient/family teaching
● Tell patient to take drug exactly as prescribed because not doing so may result in
serious adverse reactions or death
● Instruct patient to notify prescriber of adverse reactions, especially dizziness,
depression, anxiety, nausea, and urine retention.
● Encourage patient with Parkinson disease to gradually increase physical activity as
symptoms improve.
● Advise patient to avoid alcohol while taking F drug.
● Tell patient that if dizziness occurs when standing up, not to stand or
change positions too quickly
● Stress importance of taking extended- release capsules at bedtime.
ACYCLOVIR

Classifications
● Therapeutic: antivirals
● Pharmacologic: nucleosides and nucleotides

Actions
● Interferes with DNA synthesis and inhibits viral multiplication.
Indications
● Treatment of herpes simplex virus infections (HSV-1 and HSV-2)
● Prophylaxis of herpes simplex virus infections in immunocompromised
patients
● Treatment of varicella-zoster virus (VZV) infections (chickenpox and
shingles)

Side Effects
● Common side effects include nausea, vomiting, diarrhea, and headache.
● Rare side effects may include rash, dizziness, and fatigue.
Adverse Reaction
● CNS: headache, malaise, encephalopathic changes (including lethargy,
obtundation, tremor, confusion, hallucinations, agitation, seizures, coma).
● EENT: gum pain, canker sores (buccal tablets)
● GI: nausea, vomiting, diarrhea
● GU: acute renal failure, hematuria
● Hematologic: leukopenia, thrombocytopenia, thrombocytosis
● Skin: Inflammation or phlebitis, at injection site, rash, urticaria, eczema,
dryness, pruritis, contact dermatitis, application - site reaction; mild pain,
burning, or stinging (topical or buccal form);
● SJS toxic epidermal necrolysis. Others angioedema, anaphylaxis.
Contraindication and Cautions
● Contraindicated in patients hypersensitive to drug.
● Use cautiously in patient with neurologic problems, renal disease, or dehydration, and in
those receiving other nephrotoxic drugs.
● Drug increases risk of thrombotic thrombocytopenic purpura and hemolytic-uremic
syndrome in patients who are immunocompromised which can be fatal.

Nursing Responsibilities
● Assess the patient's medical history, especially any kidney or neurologic disorders, and
allergies.
● Monitor renal function through serum creatinine and ensure adequate hydration.
● Administer the medication as prescribed, adhering to the correct dosage and route of
administration.
● Watch for adverse reactions, particularly signs of neurological side effects.
● Ensure patient compliance with medication and provide support for managing side effects.
Patient Teaching
● Educate the patient about the importance of completing the full course of
treatment.
● Advise patients to report any unusual side effects or allergic reactions promptly.
● Tell patient drug is effective in managing herpes infection but doesn't eliminate or
cure it. Warn patient that drug won't prevent spread of infection to others.
● Tell patient to avoid sexual contact while visible lesions are present. Virus
transmission can occur during treatment.
● Teach patient about early signs and symptoms of herpes infection ( such as
itching, tingling or pain)
ENTACAVIR

Classifications
● Therapeutic: antivirals
● Pharmacologic: nucleosides-nucleotides

Actions
● Inhibits HBV polymerase and reduces viral DNA levels
Indications
Chronic HBV infection in patients with active viral replication and either
persistently increased aminotransferase levels or histologically active
disease
● adults and adolescents (16+) with no previous nucleoside treatment and with
compensated liver disease: 0.5mg PO once daily at least 2hrs after a meal and
2hrs before next meal
● Adults and adolescents(16+) with a hx of hepatitis B viremia and who are taking
lamivudine or telbivudine or have resistance mutations, or patients with
decompensated liver disease: 1mg PO once daily at least 2hrs after a meal and
2hrs before next meal
● children (2-15) and weighing at least 10 kg who have had no previous nucleoside
treatment
○ weighs more than 30kg: 10 mL (0.5mg) oral solution or one 0.5-mg tablet PO
once daily
○ weighs 26-30 kg: 9mL (0.45mg) oral solution PO once daily
○ weighs 23-26 kg: 8mL (0.4mg) oral solution PO once daily
○ weighs 20-23 kg: 7mL (0.35mg) oral solution PO once daily
○ weighs 17-20 kg: 6mL (0.3mg) oral solution PO once daily
○ weighs 14-17 kg: 5mL (0.25mg) oral solution PO once daily
○ weighs 11-14 kg: 4mL (0.2mg) oral solution PO once daily
○ weighs 10-11 kg: 3mL (0.15mg) oral solution PO once daily
● children (2-15) and weighing at least 10 kg who are lamivudine-experienced
○ weighs more than 30kg: 20 mL (1mg) oral solution or one 1-mg tablet PO
once daily
○ weighs 26-30 kg: 18mL (0.9mg) oral solution PO once daily
○ weighs 23-26 kg: 16mL (0.8mg) oral solution PO once daily
○ weighs 20-23 kg: 14mL (0.7mg) oral solution PO once daily
○ weighs 17-20 kg: 12mL (0.6mg) oral solution PO once daily
○ weighs 14-17 kg: 10mL (0.5mg) oral solution PO once daily
○ weighs 11-14 kg: 8mL (0.4mg) oral solution PO once daily
○ weighs 10-11 kg: 6mL (0.3mg) oral solution PO once daily
Side Effect
Signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips,
tongue, or throat. Mild symptoms such as:
○ unusual muscle pain;
○ feeling cold;
○ trouble breathing;
○ feeling dizzy, light-headed, tired, or very weak;
○ stomach pain, vomiting;
○ fast or irregular heartbeats
Side Effect
May also cause severe liver symptoms
○ swelling around your midsection
○ nausea
○ stomach pain
○ loss of appetite
○ dark urine
○ clay-colored stools
○ jaundice (yellowing of the skin or eyes)
Side Effect
Common side effects of entecavir may include:
○ nausea;
○ dizziness, tired feeling; or
○ headache
Adverse Reactions
● CNS: dizziness, fatigue, headache

● GI: diarrhea, dyspepsia, nausea

● GU: glycosuria, hematuria

● Hepatic: hepatomegaly

● Metabolic: lactic acidosis

Contraindication and Cautions
● patients who are hypersensitive to drug or its components
○ black box warning: don't use in patients infected with both HIV and HBV who
aren't also receiving highly active antiretroviral therapy (HAART)
● use cautiously in patients with renal impairment and in patients who have had a
liver transplant
○ black box warning: may cause life threatening lactic acidosis and severe
hepatomegaly with steatosis when used alone or in combination with
antiretrovirals
● HBV infection may worsen severely after therapy stops. Monitor hepatic function for
several months in patients who stop therapy. If appropriate, start therapy for HBV
infection.
○ monitor patients with renal impairment and patients who have had a liver transplant
○ oral solution should be used for patients weighing up to 30kg and for doses less
than 0.5mg
○ in elderly, adjust dosage for age related decrease in renal function

● Pregnancy-Lactation-Reproduction
○ use cautiously in pregnant women and only if benefit outweighs risk to the fetus
○ register pregnant women in the Antiretrovirals Pregnancy Registry at 1-800-258-4263
○ It isn't known if the drug appears in human milk. Patients should discontinue
breastfeeding or discontinue drugs.
Patient Teaching
● take drug on an empty stomach
● proper use of dosing spoon
● tell patient to report all the adverse effect and any new drugs that has been
taken
● explain that this drug doesn't reduce the risk of HBV transmission
● teach the signs and symptoms of lactic acidosis ○ include such as muscle pain,
weakness, dyspnea, GI distress, cold hands and feet, dizziness, or fast or
irregular heartbeat
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