ANTIFUNGAL DRUGS POLYENES (AMPHOTERICIN B)

 An infection caused by a fungus is called MYCOSIS
 a fungal or mycotic infection maybe SUPERFICIAL or SYSTEMIC
 A superficial fungal infections are acquired VIA COTACT with an infected
person
 FUNGI known as DERMATOPHYTES cause superficial fungal infections
involving the integumentary system, including m.m., hair, nails and most
skin areas
FUNGAL INFECTIONS
 Antifungal drug is choice for treating severe systemic infection is
Amphotericin B. Introduced in1956 and used currently with close
supervision because of its toxicity
 Amphotericin B is effective against numerous fungal disease including
histoplasmosis, cryptococcosis, coccidioimyosis, asperegillosis,
blastomycosis, and candidiasis.
PHARMACODYNAMICS

1. OPPORTUNISTIC INFECTIONS AND NON-OPPORTUNISTIC INFECTIONS  Not absorbed from the GI tract
 occur in the immunocompromised or debilitated  IV administration in low doses for treating systemic fungal infection
Ex. Cancer, aids  Peak effect occurs 1-2 hours after IV infusion, duration is 20 hours

 Vagina, intestine is an example of opportunistic infection such as

CANDIDIASIS SIDE EFFECTS AND ADVERSE REACTION

ANTIFUNGAL DRUGS  Side effects and adversions for amphotericin B include flush, fever, chills
n/v HpT. Paresthesian ,& thrombophlebitis amphotericin B. is considered
 Called antimycotic drugs, are used to treat fungal infection
highly toxic and can cause nephrotoxicity and electrolysis imbalance
especially hypokalemia and magnesemia ( decrease serum K and
-POLYENES= EX. AMPHOTERICIN AND NYSTATIN magnesium level). Urinary output, -- & serum createnine need to be
closely monitor.
-AZOLES= EX. KETOCONAZOLE

- ANTIMETABOLITES= EX. FLUCYTOCINE NYSTATIN (MYCOSTATIN)

-ECHICOCANDINS= EX. CASPOFUNGIN

 Another polyene antifungal drug is administered orally or topically to
-ANTIPROTOZOAL= EX. ATOVAQUONE treat candida infection.
 It is available in suspensions, clean ointment, and vaginal tablets
 Nystatin is poorly absorbed in GI tract, however the oral tablet form is
used for intestinal candidiasis
 The most common use of nystatin is in oral suspension for candida
suspension in the mouth
 PHARMACOKINETICS ECHINOCANDINS

 The action of echinocandins is inhibits biosynthesis of essential

 Is poorly absorbed. It is a protein binding power and half-life ace
components of the fungal cell wall which interferes with growth and
unknown
reproduction. Caspofungin is used to treat candida & aspergillus
 Drug is excreted unchanged in feces
infections. This drug only administered IV because it is not absorbed in
the GI tract
 Phlebitis at the IV site and increase of AST & Act all common adverse
PHARMACODYNAMICS
effects.
 Increase the permeability of the fungal cell membrane, thus causing the
ANTIPROTOZOAL
fungal cell to become unstable & to discharge its content
 This drug has fungistatic & fungicidal action. The onset of action for fungal
 Atovaquone (mepron) is antiprotozoal agent used to treat mild to
tablet or cream is approximately 24 0r more hours
moderate pneumocystis carinii pneumonia. This drug acts by disrupting
mitochondrial electron transport inhibiting DNA synthesis.
AZOLE GROUP

PEPTIDES
 Is effective against candidiasis (superficial & systematic)
 Inhibits cytochrome. In fungal cell interfering with the formation of
 The two group of peptides used as antibiotics are the polymyxins &
ergosterol. Is a major sterol in the fungal cell membrane, cell permeability
bacteriacin. Peptides are derived from cultures of bacillus subtilis & this
and leakage are increased
groups appears to interfere with bacterial cell membrane function.
 Available in vaginal tablet

ANTIMETABOLITE POLYMYXINS

 Where 1 of the early groups of antibacterial, but many of the early

 FLUCYTOSINE acts by selectively penetrating the fungal cells w/c drugs were discontinued because they cause nephroxicity
converts it into fluorouracil, an antimetabolite that disrupts fungal DNA
and RNA synthesis. It is well absorbed from the GI tract. Flucytosine is
used in combination with other antifungal drug such as Amphotericin B. Severe adverse effects

 High serum levels polymyxins can cause nephoxicity & neuroxicity. The
BUW & severe creatinine levels are elevated, however when the serum
drug levels decrease renal toxicity is usually reverse. 8/sx. Of neuro
toxicity (toxicity of nerves) includes paresthesia (abnormal sensation
 such as numbness, tingling, burning and prickling) and dizziness.
Neurotoxicity is usually reversible when the drug is discontinued.
BACITRACIN
 Has polypeptide structure and acts inhibiting bacterial cell wall
synthesis and damaging the cell-wall membrane. the drug action can be
bacteriostatic or bactericidal. bacitracin is not absorbed by the GI tract
and if given orally is excreted in the feces
 Bacitracin is effective against most gram-positive and some negative
bacteria. OTC bacitracin Ng is available for application skin
SIDE EFFECT AND ADVERSE REACTION
 The side effect of bacitracin includes redness, rush, nausea and
vomiting. Severe adverse reactions are renal damage and ototoxiciy.
Mild to severe allergy reaction, ranging from hives to anaphylaxis may
occur
METRONIDAZOLE
 Acts by imparing DNA function of susceptible bacteria. this drug is used
primarily to treat various disorder associated with the organism in the
GI tract
 For amebiasis
SIDE EFFECTS 7 ADVERSE REACTION
 Dizziness, headache, confusion, depression, irritability, weakness and
insomnia. The client taking high doses of metronidazole may develop
dark or reddish brown urine. Dry mouth, metallic or bitter taste and GI
distress may occur. Paresthesia, nasal congestion, decrease libido,
dysuria, incontinence, & ECG changes develop.
VACCINES
 Have been developed to prevent diseases such as smallpox,
chickenpox, mumps, rabies, and influenza
DIAGNOSTIC TEST FOR INFLUENZA
 Several office laboratory test can be used to diagnose influenza. The
diagnostic test directigen flu A. has been available for many year--- to
detect influenza A. however it does not detect influenza B. flu O/A.
Thermo biostar, boulder, lolo, quickvue influenza test- (quidel, san
diego & z stat flu) (zymettxl, Oklahoma city) a new diagnostic test that
identify both influenza A & B. these test used throat swabs, nasal swabs
or nasal aspiration. Results are available within 10 to 20 minutes.
Quickvue tend to be easy and fast for rapid diagnosis pr influenza A & B.
ANTIVIRAL NON-HIV DRUGS
 Antiviral drugs are used to prevent or delay the spread of viral
infections. They inhibit viral replication by interfering with viral nucleic
acid synthesis in the cell. There are group of antiviral drugs effective
against ---- viruses such as influenza, A AND B helps species cytomegalo
virus (CCMV) and humsn immunodeficiency virus (HIV) drugs HIV
NON CLASSIFIED ANTIVIRAL
 The first two antivirals, amantadine, hydrochloride (symmetrel) &
Rimantadine hydrochloride (Flumadine) were used to treat type A
influenza. Both these anti virals are non-classified antiviral. Originally
amantadine was used to treat Parkinsonism. And laler found to be
effective against type B influenza.