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Lecture

ID management IV .rtf

12 Pages
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Department
Nursing
Course Code
NURS 2050
Professor
Cynthia Barkhouse Mckeen

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Description
Infection Disease Management IV KT o 22 year old female o CC: vaginal burning and pruritis, some discharge, patient states she is “feeling very uncomfortable and cranky” o HPI: symptoms started 1.5 days ago; patient notes she has just finished an antibiotic Rx for UTI X 1 week (yesterday) from walk in clinic & that this has happened to her before after antibiotic Rx. o PMHx: otherwise healthy o Meds: 1.Purchased OTC Canestin™ combi pack “1 day therapy” yesterday – product caused burning and more irritation 2. Septra for UTI X 1 week –finshed yesterday  What else would you like to know?  Many things to ask/get – a few key:  Exam -Visual inspection, swabs  Sexual history  UTI symptoms KT  KT read in Woman’s Health that you can now buy oral medications without a prescription at the pharmacy for yeast infections  She asks the pharmacists as the topical preparation is very irritating.  The PhC takes a history and recommends Fluconazole 150 mg po X 1 dose for vulvovaginal candidiasis and recommends she return to clinic in 1 week if symptoms do not improve. Fungal infections i. Systemic mycotic infections - Candidiasis, aspergillosis, cryptococcu(opportunistic, immunocompromised) - sporotrichosis, blastomycosis, histoplasmosis,(nonopportunistic) ii. Superficial mycotic infections - Candidiasis - Dermatophytes (tinea = diseases caused by dermatophytes, ringworm, dandruff) Drugs for Systemic fungal infections a. Polyene antifungals: conjugated doub**All polyenes are toxic! 1. Amphotericin B: Amphoterrible!  Because it is highly toxic, and only used in fungal infections that are toxic  MOA: binds competitively to ergosterol in the fungal cell membrane; This increases permeability and leakage of K+, which leads to cell death. It is also toxic to us, b/c we have sterols in our CM; however, it binds stronger to ergosterol. (∆we have similar effects)  Broad spectrum (not much is resistant)  Poorly absorbed – only IV route used  Lipid based formulations – less toxicity but $$$  Benefit verses harm assessment – reserved for infections that are aggressive and potentially fatal and not able to be treated by anAzole Adverse Reactions:  Infusion reactions: phlebitis, fever, chills, rigors, nausea, headache, edema  Nephrotoxicity: InALL patients, damage is related to dose.  Bone marrow suppression: must monitor blood counts to make sure platelete are good. 2. Nystatin**Toxic  Orally not absorbed (not absorbed in stomache)  used for superficial mycosis; dropper liquid for oral thrush  candidal infections- specifically intestinal candidiasis. b. Azole antifungals: have 2 or 3 nitrogens in their five-membered azole ring  Similar spectrum & mechanisms of actions  Don’t see much resistanceanisms causing systemic or deep fungal infections covered a. Imidazoles: 2 azole rings, tinea type infections/ topical • Ketoconazole • Miconazole (topical) • Clotrimazole (topical) Canestin • Econazol
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