Drugs for Fungal, Protozoal, and Helminthic Infections

1
Drugs for Fungal, Protozoal, and Helminthic
Infections

• Chapter 35

2
Pathophysiology

• Compare and Contrast the pathophysiology of
  fungal, protozoal, and helminthic infections.
• Identify clients at risk for these infections.

3
Mycoses

• Identify the classifications of mycoses.
• Differentiate between the two classifications.
• Compare and contrast pharmacotherapy for the two
  classifications

4
Cellular Structure of Fungi

• Similar to human cells
• Different steroid present in plasma membranes
• Human cholesterol
• Fungi ergosterol
• What is the pharmacologic implication of this
  difference?
• Discuss the limitations of antifungal therapy.

5
Systemic Antifungal Therapy NCs

• Contraindicated known hypersensitivity
• Cautiously renal impairment, severe BM
  suppression, pregnancy, heart disease
• Baseline CS
• Baseline and periodic BUN, creatinine, CBC,
  e-lytes, LFTs VS (esp. pulse BP)
• Monitor for s/s of ototoxicity, hypokalemia
• Evaluate all other meds taken
• Elderly daily RFTs, LFTs monitor for change in
  urine output, appetite, or weight

6
Antifungal Amphoteracin B

• 80 some degree of kidney damage
• Closely monitor
• IO
• weight
• Immediately report
• Oliguria, change in IO ratio, hematuria,
  abnormal RFTs

7
Systemic Antifungal Client Teaching

• Complete full course of treatment
• Keep all scheduled appts and lab visits
• No alcohol
• Report change in appetite, wt loss, jaundice
• Reliable contraception
• Monitor urine output drink plenty of fluids
• Immediately report any change in urine output

8
Azole Antifungal Therapy

• Describe the mechanism of action and therapeutic
  benefits of Azole antifungal therapy.

9
Azoles NCs

• Contraindication hypersensitivity
• Cautiously renal impairment
• Baseline and periodic BUN, creatinine, LFTs
• No ketoconazole if chronic alcoholism
• Assess for nausea, vomiting, abd. pain, diarrhea
• Monitor for s/s of hepatotoxicity
• Evaluate all medications taken
• No concurrent therapy with meds that decrease
  renal or liver function
• If diabetic, monitor glucose level

10
Azoles Client Teaching

• Complete full course of treatment
• Report use of other prescription, OTC, herbal
  meds or dietary supplements
• No alcohol
• Reliable contraception
• Monitor urine output drink plenty of fluids
• Immediately report s/s of hepatotoxicity
• If diabetic, ? frequency of glucose monitoring
• Report hypoglycemia

11
Superficial Antifungal Therapy

• Describe the safest way to treat superficial
  fungal infections.
• Discuss the different preparations available to
  treat superficial antifungal therapy.
• Discuss nursing interventions related to
  application of antifungal medications.

12
Superficial Antifungal Therapy NCs

• Assess for s/s of contact dermatitis
• Cautiously lactating
• Oral swish and swallow
• Assess for n/v/d at higher doses
• swish and spit if GI side effects
• Monitor for signs of improvement to evaluate
  effectiveness of med

13
Superficial Antifungal Therapy Client Teaching

• Complete full course of treatment
• If self-treating with OTCs follow directions
  carefully, notify HCP if symptoms gt 7-10 days
• No sex until vaginal treatment complete
• Vaginal candidiasis
• Use correct method of administering suppository,
  cream or ointment
• Oral hygiene before oral lozenge or
  swish-and-swallow formulations

14
Protozoal Infection

• Discuss the challenges to pharmacotherapy of
  protozoal infections.
• Identify a common protozoal infection.
• Describe the infectious cycle of this infection.

15
Antimalarial Therapy

• What is the overarching goal of malarial
  pharmacotherapy?
• Goals of therapy
• Prevention of disease
• Treatment of acute disease
• Prevention of relapse

16
Antimalarial Therapy NCs

• Contraindicated hematological disorders, severe
  skin disorders, pregnancy
• Cautiously CVD, lactation
• Baseline CBC, LFTs, RFTs, G6PD deficiency, ECG,
  VS (esp. T BP), hearing vision tests
• Evaluate all other meds
• During RX closely monitor VS and periodic ECG
  and CBC
• Assess for GI side effects
• Assess for s/s of allergic reaction
• Monitor for signs of toxicity

17
Antimalarial Therapy Client Teaching

• Complete full course of treatment
• Take with food
• Measures to avoid postural hypotension
• Reliable contraception
• Use caution when performing hazardous activities
• Immediately report flushing, rashes, edema,
  itching, tinnitus, blurred vision, seizures

18
G6PD Deficiency

• Describe the role of G6DP deficiency in the
  development of malarial infections.
• Discuss the implication for pharmacotherapy in
  individuals with this deficiency.

19
Nonmalarial Protozoal Infections

• Describe the factors that contribute to
  nonmalarial protozoal infections.
• Discuss the role of metronidazole (Flagyl) p. 527
  in nonmalarial protozoal infections.
• Describe the mechanism of action
• Identify indications for treatment

20
Nonmalarial Protozoal Therapy NCs

• Contraindicated blood dyscrasias, active organ
  disease of CNS, first mo of pregnancy, alcoholism
• Cautiously peripheral neuropathy, pre-existing
  liver disease, hx BM suppression
• Baseline CBC, thyroid, LFTs, VS
• Evaluate all other meds taken
• Closely monitor VS and thyroid function

21
Nonmalarial Protozoal Therapy NCs

• Give oral meds with food
• Metronidazole
• Dry mouth and metallic taste
• Monitor for CNS toxicity
• Seizures, parasthesia
• Monitor for s/s of allergic response
• Urticaria, pruritis

22
Nonmalarial Protozoal Infections Client Teaching

• Complete full course of treatment
• Take with food
• Reliable contraception
• Avoid concurrent hepatotoxic drugs alcohol
• Urine may turn reddish brown
• Treat sexual partner concurrently
• Immediately report seizures, numbness in limbs,
  n/v, hives, itching

23
Helminths

• Parasitic worms
• Classifications
• Nematatodes (roundworms)
• Trematodes (flukes)
• Cestodes (tapeworms)
• Common infections
• Globally Ascaris lumbicoides
• U.S. Enterobius vermicularis

24
Helminth Lifecycle

• Several stages
• Immature and mature forms
• Portal of entry
• Skin
• GI tract
• May form cysts in skeletal muscle or organs
• Many adults die without reinfecting host

25
Antihelmintic Therapy NCs

• Cautiously pregnancy, lactation, pre-existing
  liver disease, lt 2 yrs of age
• Baseline VS, CBC, LFTs
• Specimen analysis Feces, blood, urine, sputum,
  tissue)
• Evaluate all meds
• Monitor labs closely
• Some worms will be expelled in stool

26
Antihelmintic Therapy NCs

• Shower instead of bath
• Change undergarments, linens, towels daily
• Assess for GI symptoms
• Monitor for CNS side effects of thiabendazole
• Monitor for allergic response
• Urticaria, pruritis

27
Antihelminthic Therapy Client Teaching

• Complete full course of treatment
• Reliable contraception
• Treat close personal contacts concurrently
• Report itching and hives, fatigue, fever,
  anorexia, dark urine, abdominal pain