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Drug/Bug pair: Amphotericin B
treats: candida infections
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Administration considerations for Amphotercine B (antifungal)
- - premedicate with acetaminophen (for fever) plus diphenhydramine and meperidine (Demerol) for rigors
- - infuse over 4-6 hours
- - safest antifungal for pregnancy
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Toxicites of Amphotericin B (antifungal)
- Nephrotoxicity (increased BUN/SrCr) - monitor, treat/prevent wiht normal saline infusions
- Electrolyte abnormalities (K/Mg) - increased waste of electrolytes, decreasing serum levels
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Liposomal amphotericin
- Antifungal
- Reserved for pts who have failed standard amphotericin
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Toxicities of Liposomal amphotericin compared to amphotericin B
- - less infusion reactions
- - less nephrotoxicity
- - less electrolyte abnormalitites
- (equally as effective, more expensive)
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Azole Antifungals
- ex. fluconazole, voriconazole
- inhibits p450 enzyme activity in fungus
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Drug/bug pair: voriconazole
treats: aspergillus
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Toxicities of azole antifungals
voriconazole: visual changes, vasodilation, vomitting
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Drug interactions of azole antifungals
- related to p450 enzyme:
- warfarin (inhibits metabolism resulting in increased levels)
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Flucytosine (5-FC)
- antifungal
- causes bone marrow suppression, N/V/D
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Echinocandins
- antifungal
- ex. caspofungin
- disrupts cell wall resulting in death
- new, well tolerated, very effective
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