- Body system
- Anti-infectives
- Name stem
- -azole, -fungin
- Drug cards
- 1 in this guide
Drugs in this class
Other examples: Nystatin, Amphotericin B, Voriconazole, Micafungin, Terbinafine, Clotrimazole.
How antifungals work
Azoles block ergosterol synthesis; polyenes (nystatin, amphotericin B) bind ergosterol and make the fungal membrane leak; echinocandins (-fungin) block fungal cell wall synthesis.
Uses
- Oral thrush (nystatin, clotrimazole troches, fluconazole)
- Vaginal candidiasis
- Systemic candidiasis
- Aspergillosis and other invasive molds
- Cryptococcal meningitis
Adverse effects
- Liver injury and QT prolongation (azoles)
- Nephrotoxicity, infusion reactions, hypokalemia and hypomagnesemia (amphotericin B)
- GI upset
Nursing considerations
- Review interactions before starting an azole.
- Amphotericin B: premedicate as ordered, monitor vital signs during the infusion, and check kidney function and electrolytes.
- Nystatin suspension: swish and hold in the mouth, then swallow or spit as directed.
Patient teaching
- Finish the full course.
- Report yellowing of the skin, dark urine or palpitations.
Antifungals NCLEX practice questions
Answer each question to see the rationale.
3 questions. Choose an answer to see the rationale.
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How should nystatin oral suspension be used for thrush?
Show answer
Answer A: Swish in the mouth for as long as possible, then swallow or spit as directed Nystatin acts topically; contact with the oral lesions is what makes it work.
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Which lab values are most important during amphotericin B therapy?
Show answer
Answer B: Creatinine, potassium and magnesium Amphotericin B is nephrotoxic and causes potassium and magnesium wasting.
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A patient on warfarin is started on fluconazole. What should the nurse expect?
Show answer
Answer A: The INR may rise, increasing bleeding risk Fluconazole inhibits warfarin metabolism, raising the INR.
Frequently asked questions
What are antifungals?
Antifungals treat yeast and mold infections. Azoles have many drug interactions and liver effects; amphotericin B is highly toxic to the kidneys.
How do antifungals work?
Azoles block ergosterol synthesis; polyenes (nystatin, amphotericin B) bind ergosterol and make the fungal membrane leak; echinocandins (-fungin) block fungal cell wall synthesis.
What are examples of antifungals?
Fluconazole, Nystatin, Amphotericin B, Voriconazole, Micafungin, Terbinafine and Clotrimazole.
What are the nursing considerations for antifungals?
Review interactions before starting an azole. Amphotericin B: premedicate as ordered, monitor vital signs during the infusion, and check kidney function and electrolytes.