Antifungals Practice Questions with Answers and NCLEX® Review

Introduction to Antifungal Medications

Antifungal medications are mainly used to treat Candida fungal infections. These medications may be fungicidal ( to destroy fungi) or fungistatic (to slow the multiplication of fungi).

Amphotericin B is an antifungal medication used to treat systemic fungal infections such as blastomycosis, histoplasmosis, and coccidioidomycosis. This medication is administered intravenously (IV). Fluconazole is a common antifungal medication that treats many fungal infections like candidiasis, aspergillosis, cryptococcosis, and blastomycosis.

Nystatin is another antifungal medication that treats vaginal yeast infections, Candida esophagitis (thrush), oral thrush, and diaper rash caused by Candida albicans. Caspofungin is used to treat invasive forms of candidiasis (yeast infections) caused by Aspergillus fumigatus in people who cannot take Amphotericin B or other antifungal drugs like Fluconazole.

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Remember that antifungals are very liver toxic.

Amphotericin B 

Amphotericin B is an antifungal medication that works by binding to ergosterol in the cell membrane of fungi, which inhibits its ability to synthesize sterols and disrupts membrane permeability.

It can be used for several types of infections, and is administered intravenously (IV) or intramuscularly (IM). 

Amphotericin B is for serious fungal infections, and can result in many side effects. The most adverse effect is renal injury. 

Important labs and assessment data to recognize: 

• Creatinine over 1.3 = bad kidneys
• Urine 30 ml/hr or less = kidney distress
• Oliguria = low output of urine

Amphotericin B Mechanism of Action

Amphotericin B binds to ergosterol in the fungal cell membrane, which leads to the formation of pores and ion leakage. The resulting loss of membrane integrity causes fungal cell death.

Fluconazole

Fluconazole is a common antifungal drug used to treat various fungal infections. This medication is available in both oral and intravenous forms, and works by inhibiting the growth of fungi.

It’s most commonly prescribed for vaginal yeast infections, but can also be used for other conditions such as thrush (oral) or candidiasis (skin).

Fluconazole Mechanism of Action

Fluconazole inhibits the enzyme 14-demethylase, which converts lanosterol to ergosterol.

Nystatin 

Nystatin, a broad-spectrum antifungal agent, is used to treat fungal infections of the skin, mouth, and vagina. It can also be used to prevent infection in people with weakened immune systems, such as cancer clients or clients undergoing organ transplants.

Nystatin Mechanism of Action

Nystatin binds to sterols in the plasma membranes of fungi, causing the cells to leak. This eventually causes fungal cell death.

Caspofungin

Caspofungin is an antifungal drug used to treat serious and invasive fungal infections like Candida species and Aspergillus species. It works by disrupting the cell membranes of fungi, causing them to leak and die.

Caspofungin Mechanism of Action

Caspofungin blocks the synthesis of β-(1→3)-d-glucan by noncompetitive inhibition of EGS, which results in disruption of the fungal cell wall.

Antifungal Medications Nursing Interventions

Renal damage is the most severe adverse reaction with the use of amphotericin B. This renal impairment usually improves with a modification of the dosage regimen (reduced dosage or increased time between doses).

• Assess serum creatinine levels and blood urea nitrogen (BUN) levels
  • If the BUN exceeds 40 mg/dL or the serum creatinine level exceeds 3 mg/dL, the health care provider (HCP) may discontinue the drug or reduce the dosage until renal function improves.
• Monitor lab results and report to the HCP.
• Assess the skin before application of the medication.
• Clean the involved area and apply the ointment or cream to the skin as prescribed.
• Avoid increasing or decreasing the amount of prescribed ointment or cream.

Antifungal Medications Conclusion

Antifungal medications are used to treat Candida fungal infections. Some of these drugs can be fungicidal, while others are fungistatic.

Fluconazole is an antifungal medication that treats many fungal infections like candidiasis, aspergillosis, cryptococcosis, and blastomycosis. Amphotericin B is an antifungal medication used to treat fungal infections such as blastomycosis, histoplasmosis, and coccidioidomycosis. This medication is taken through an IV.

Nystatin treats vaginal yeast infections, Candida esophagitis (thrush), oral thrush, and diaper rash. Caspofungin is used to treat invasive forms of candidiasis (yeast infections) caused by Aspergillus fumigatus in people who cannot take Amphotericin B or other antifungal drugs like Fluconazole.

Sources

https://clinicalinfo.hiv.gov/en/drugs/amphotericin-b/patient 

https://medlineplus.gov/druginfo/meds/a682643.html 

https://www.aocd.org/page/Fluconazole 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202846/ 

https://www.ncbi.nlm.nih.gov/books/NBK545140/