(Week 9)

ANTI BACTERIAL DRUGS

ANTI FUNGAL MEDICATIONS
_______________________________________

Prepared by: Maria Seniz C. Calma, RN MAN

 INTRODUCTION
_________________________________

This lesson module will serve as the basis for the students
understanding on the anti infective medication. The focus is on the
mechanism of actions, indications for the drugs, adverse reactions
and nursing responsibilities when antibacterial and anti fungal
medications are administered to the clients.
LESSON MODULE

This lesson module will give you an idea about :

1. Antibacterial medications such as Penicillin
cephalosporins ,macrolides and other anti-
bacterials
2. Antifungal medications( the “azoles”)
 LEARNING OBJECTIVES:
• Explain the mechanisms of action of anti-bacterial drugs
• Describe the three general adverse effects associated with anti-bacterial drug
therapy
• Categorize commonly prescribed anti-bacterial drugs according to their
corresponding class with the use of suffix mnemonics
• Differentiate various categories of anti-bacterial drugs
• Explain the implications of non-compliance to anti-bacterial drug therapy
• Discuss the classification of anti Fungal medications, the mechanism of
actions, adverse effects and the nursing considerations for these group of
drugs
• Discuss the importance of the nursing role in caring for clients under anti-
bacterial and antifungal medications.
.
 Anti-
infective
Agents
Antibacterial drugs
Antibacterial/ Antimicrobial
Substances that inhibit growth of or kill bacteria and other
microorganism
Antibiotic
Chemical produced by one kind of microorganism that inhibits the
growth of or kill another

Bacteriostatic: inhibit bacterial growth

Bactericidal: kill bacteria
Narrow therapeutic index:
*monitor serum drug levels
MECHANISMS OF ACTIONS

1. Bacterial cell-wall synthesis

2. Membrane permeability
3. Protein synthesis
4. DNA & RNA synthesis
5. Cell metabolism
 Peak and Trough
Peak and trough are methods used to establish the effectiveness
of a drug

Peak is drawing the serum blood

levels after the drug is administered
as it distributes rapidly and reaches
its peak in therapeutic range

Trough is drawing the serum blood

levels right before the next dose.
Trough is the lowest drug level that
is needed to reach therapeutic range.
Antibacterial drugs
• Long half-life
• Most: not highly protein-bound
• Severe infections: continuous

• Once-daily dosing:
o Less adverse effects
o Client adherence

• Bacteria: sensitivity vs resistance

• Cross-resistance
• Multi-antibiotic therapy
Antibacterial drugs
General Adverse Reactions
• Hypersensitivity
• Superinfection
• Organ Toxicity
NOTES
Assess renal & liver function, allergies
Close monitoring: 1st & 2nd dose
VS, UO, Labs: liver enzymes
Culture & Sensitivity prior
S/E & A/R (side effects/Adverse Reactions)
Have epinephrine available
NOTES
Assessment
Culture & Sensitivity
Skin Testing
Client Education
o Drug action
o How to take drug
o Watch out for (Report S/E or A/E)
o Drug interactions
o Take FULL COURSE of drug
Client Teaching
Take ALL PRESCRIBED antibiotics to prevent
drug resistance
Keep drug out of children’s reach
Report: S/E or A/E
Increase Oral Fluid Intake (unless
contraindicated)
Take with meals
Antibacterial drugs
Narrow-spectrum:
One type of Microorganism (selective)

Broad-spectrum:
Gram (+) and (-) bacteria
Microorganism is unidentified by C&S
Antibacterial drugs
•Penicillins cillin
•Cephalosporins ceph/cef
•Macrolides mycin
•Tetracyclines cycline
•Aminoglycosides micin
•Fluoroquinolones floxacin
•Sulfonamides sulfa
 Penicillin
Beta-lactam antibiotics
• Penicillin G
• Procaine penicillin

Over usage: staph mutant strains

Penicillinase
*Note drug interactions
***********************************************
3types
Broad Spectrum Penicillin gram (+)(-)
Penicillinase Resistant Penicillin Affected by beta-lactamases /
penicillinase
For: S. Aureus
• Cloxacillin: highly protein-bound
• Dicloxacillin
Penicillin
Extended-Spectrum Penicillins
o Anti-pseudomonal penicillins
o Gram (-)
o Not penicillinase resistant
o Less toxic than aminoglycosides
Beta-lactamase inhibitors
• Makes antibiotic more effective
• Clavulanic acid
• Sulbactam
• Tazobactam
PO: Amoxicillin + Clavulanic acid (Augmentin)

IV: Ampicillin + Sulbactam (Unasyn)

Piperacillin + Tazobactam (Zosyn)

Amoxicillin: most prescribed Ampicillin

Cephalosporins
Gram (+)(-) bacteria
Resistant to beta-lactamase

Four “generations”
1st gen: Cefazolin, Cephalexin
2nd gen: Cefaclor, Cefuroxime
3rd gen: Ceftazidime, Ceftriaxone
4th gen: Cefexime
Macrolides
Action:
Bacteriostatic.
Broad-spectrum: large size
Inhibits synthesis of protein in bacteria.
Efective against gram positive and moderatetly effective to some gram
negative bacteria
Used to treat infections of respiratory tract, G.I.
Drugs: azithromycin(zithromax), Clarithromycin(Biaxin), Erythromycin(E-
mycin)
Erythromycin: 1st macrolide
Extended Macrolide Group
Clarithromycin
Azithromycin
Subgroups of Macrolides
Lincosamides: Clindamycin
*more effective / lesser S/E
Inhibit bacterial protein synthesis and have both
bacteriostatic and bacteriocidal actions defending on the
dosage.
Active against: Gram positive, including Staphylococcus
aureus and anaerobic organism.
Vancomycin: S. Aureus
*VRE: Endocarditis
*Quinopristin / Dalfopristin
Vancomycin: S. Aureus
*VRE: Endocarditis
*Quinopristin / Dalfopristin
Glycopeptide bactericidal antibiotic used to treat Staphylococcal
infection
Causes Ototoxicity – permanent hearing loss & loss of balance
Caution with renal failure
Still used for Staph. Aureus resistant strain
Prophylaxis with penicillin allergies
Tetracyclines
The first broad spectrum antibiotics effective against gram positive and
gram negative bacteria
- Photosensitivity + Discolors permanent teeth
inhibit protein synthesis
X 1st tri: teratogenic
Low doses: minimize toxic effects

PO/IM: painful/IV: severe cases

X with antacids, Ca/Iron
Doxy/minocycline
Has Bacteriostatic effect
 Doxycycline
 Minocycline
 Methacycline
 Aminoglycosides
Gram (-) bacteria
Inhibit bacterial protein synthesis
Used against gram negative ( E. coli, Proteus, Pseudomonas)
Streptomycin sulfate: 1st available
• Neomycin
• Paromomycin
• Gentamicin - Pseudomonas
• Tobramycin
• Amikacin
• Netilmicin

Can cross blood-brain barrier in children, X

in adults
Fluoroquinolones
Interfere with DNA gyrase, w/c is needed to synthesize bacterial DNA
Gram Positive & Gram Negative
Bactericidal
Useful in treatment of UTI, Lower RTI, skin, soft tissue, bone & joint
infections and GIT infections

Examples:
Nalidixic acid Cinoxacin
Ciprofloxacin Moxifloxacin
Norfloxacin Levofloxacin
 UNCLASSIFIED Antibacterial Drugs
Chloramphenicol:
•Toxic: bone marrow depression
•Typhoid fever
Spectinomycin HCl
•Gonorrhea
•IM: single dose
Quinupristin/dalfopristin
•Vancomycin-resistant E.cocci
•IV: WOF pain, edema, phlebitis
 Sulfonamides
•Inhibit synthesis of FOLIC ACID
•Alternative for penG allergies
Sulfisoxazole
Sulfadiazine
Sulfamethoxazole
Trisulfapyrimidines
•Longer duration of action
90% effective against
Escherichia coli
Used for urinary tract infection, otitis media, Respiratory infection ,
gastrointestinal infection
 Sulfonamides
Topical/Opthalmic prep.

Mafenide Acetate (Sulfamylon)

•2nd – 3rd degree burns
•Prevent sepsis

Silver sulfadiazine (Silvadene)

 PRINCIPLES OF
ANTIMICROBIAL AND
ANTIFUNGAL THERAPY
ANTI- FUNGAL MEDICATIONS
Fungi
 “mycoses “
 major two types: yeasts and molds.
 Mycotic Infections:
 Cutaneous
 Subcutaneous
 Superficial
 Systemic:
 FUNGAL INFECTIONS
TRICOPHYTOSIS (RINGWORM)
• TINEA BARBAE (Barbers itch)
TINEA FLAVAHYPO or HYPER
pigmentation of the skin
• Treatment : Antifungal agents
Ketoconazole, fluconazole ,griseofulvin
Micoconazole
Taken 2-3 weeks
Antibiotic maybe added
 Antifungal Drugs
CAUSES OF FUNGAL INFECTIONS:
1- Abuse of broad spectrum antibiotics
2- Decrease in the patient immunity
Targets of antifungal drugs
Classification of Antifungal Drugs
1- Antifungal Antibiotics :
Griseofulvin
Polyene macrolide : Amphotericin- B & Nystatin
• 2- Synthetic :
Azoles :
A) Imidazoles : Ketoconazole , Miconazole
B) Triazoles : Fluconazole , Itraconazole
OTHER SYNTHETIC FUNGAL MEDICATIONS
• Flucytosine
• Squalene epoxidase inhibitors
Ex: Terbinafine & Naftifine.
Classification According to Route of Administration
• Systemic :
- Griseofulvin , Amphotericin- B , Ketoconazole ,
Fluconazole , Terbinafine.
• Topical
In candidiasis :
- Imidazoles : Ketoconazole , Miconazole.
- Triazoles : Terconazole.
- Polyene macrolides : Nystatin , Amphotericin-B
- Gentian violet : Has antifungal & antibacterial.
Amphotericin B
• Amphotericin A & B are antifungal antibiotics.
• Amphotericin A is not used clinically.
• It is a natural polyene macrolide
• (polyene = many double bonds )
• (macrolide = containing a large lactone ring )
Mechanism of action:
AMPHOTERICIN B
• It is a selective fungicidal drug.
• Disrupt fungal cell membrane by binding to
ergosterol , so alters the permeability of the cell
membrane leading to leakage of intracellular ions
& macromolecules ( cell death ).
Pharmacokinetics OF AMPHOTERICIN B
• Poorly absorbed orally , is effective for fungal
infection of gastrointestinal tract.
• For systemic infections given as slow I.V.
• Highly bound to plasma protein .
• Poorly crossing BBB.
• Metabolized in liver
• Excreted slowly in urine over a period of several
days.
• Half-life 15 days.
AMPHOTERICIN B : Adverse Effects
Immediate reactions ( Infusion –related toxicity ).
• Fever, muscle spasm, vomiting ,headache,
hypotension.
• Can be avoided by :
A. Slowing the infusion
B. Decreasing the daily dose
C. Premedication with antipyretics,
antihistamincs or corticosteroids.
D. A test dose.
2- LATE REACTIONS/TOXICITY
• Most serious is renal toxicity (nearly in all
patients ).
• Hypokalemia
• Hypomagnesaemia
• Impaired liver functions
• Thrombocytopenia
• Anemia
AMPHOTERICIN B : Clinical uses
• broad spectrum fungicidal action.
• The drug of choice : life-threatening mycotic
infections. / serious fungal
infection.
• In cancer patients with neutropenia who remain
febrile on broad –spectrum antibiotics.
Amphotericin is the drug of choice for:
-Disseminated histoplasmosis
-Disseminated and meningeal coccidioidomycosis
-Disseminated and meningeal cryptococcosis
-Invasive aspergillosis
-Deep candidiasis
-Mucormycosis
Amphotericin is an alternative drug
for:
-Blastomycosis
-Paracoccidioidomycosis
-Extracutaneous sporotrichosis

Amphotericin is preferred when these mycoses are rapidly

progressive, occur in immunocompromised host or involve
the CNS
Routes of Administration:
AMPHOTERICIN B
Slow I.V. For systemic fungal disease.
Intrathecal for fungal C.N.S. infections.
Topical drops & direct subconjunctival injection for
Mycotic corneal ulcers & keratitis.
Local injection into the joint in fungal arthritis.
Bladder irrigation in Candiduria.
This is the mode of administration of Amphotericin B
IV
Most common adverse reaction of Amphotericin B
Most serious is RENAL TOXICITY.
Polyene Antifungals Means :
There are large number of unsaturated
bonds in the chemical structure.
What is the main action of Polyene Antifungals?
These drugs permeate into ergosterol-rich
membranes( characteristics of Fungi) where they
produce a detergent like effect.
• Nystatin
• It is a polyene macrolide ,similar in structure
& mechanism to amphotericin B.
• Used only topically.
• It is available as creams, ointment ,
suppositories & other preparations.
• Too toxic for systemic use.
• Not significantly absorbed from skin, mucous
membrane, GIT .
• Clinical uses - NYSTATIN
• Superficial candidiasis of mouth, esophagus,
intestinal tract.
• Vaginal candidiasis
• Can be used in combination with antibacterial
agents & corticosteroids.
This polyene Antifungal is toxic when given
parenterally . The preparation is usually given by
TOPICAL adminstration and is not absorbed by
oral administration.
NYSTATIN

This Imidazole drug is only absorbed under acidic

condition and is cleared almost exclusively by
Hepatic metabolism

KETOCONAZOLE
Azoles
• A group of synthetic fungistatic
agents with a broad spectrum of
activity .
• They have antibacterial , antiprotozoal
anthelminthic & antifungal activity .
• Mechanism of Action OF AZOLES
1-Inhibit the fungal cytochrome P450 enzyme, (α-
demethylase) which is responsible for converting
lanosterol to ergosterol ( the main sterol in
fungal cell membrane ).

2- Inhibition of mitochondrial cytochrome oxidase

leading to accumulation of peroxides that cause
autodigestion of the fungus.

3- Imidazoles may alter RNA& DNA metabolism.

Mechanism of action
-Inhibition of sterol 14-alpha-demethylase, a
cytochrome P450-dependent


blockade of the synthesis of ergosterol in fungal cell
membranes

-The ultimate effect may be fungicidal or

fungistatic depending on the organism and on
drug concentration.
Azoles
• Actions: - antibacterial , antiprotozoal,
anthelminthic & antifungal.
- fungistatic agents.

CLASSIFICATIONS :
• Imidazole group
• Triazole group
The Imidazoles( DERIVATIVES)
• Ketoconazole
• Miconazole
• Clotrimazole, ECONAZOLE
• - lack selectivity
• - they inhibit human gonadal and steroid synthesis leading
to decrease testosterone & cortisol production.
• - Also, inhibit human P-450 hepatic enzyme.
Ketoconazole:
- A Ergosterol Biosynthesis inhibitors

- Imidazole derivative,
orally active for systemic infections.
Well absorbed orally .
- Depends mainly on low stomach pH for absorption.
Bioavailability is decreased with antacids, H2 blockers , proton pump
inhibitors & food
- All its metabolites are inactive and mainly used
topically.
•Ketoconazole
• Cola drinks improve absorption in patients with
achlorhydria.
• Half-life increases with the dose , it is (7-8 hrs).
• Inactivated in liver & excreted in bile (feces ) & urine.
• Does not cross BBB.

Clinical uses – ketokonazole

Used topically or systematic (oral route only ) to treat
1- Oral & vaginal candidiasis.
2- Dermatophytosis.
3- Systemic mycoses & mucocutaneous candidiasis.
KETOKONAZOLE : Adverse Effects
• Nausea, vomiting ,anorexia
• Hepatotoxic
• Inhibits human P 450 enzymes causing drug-drug
interactions.
• Inhibits adrenal & gonadal steroids leading to :
a. Menstrual irregularities
b. Loss of libido
c. Impotence
d. Gynaecomastia in males
Contraindications & Drug interactions

• Contraindicated in :
• Pregnancy, lactation ,hepatic dysfunction
• Interact with enzyme inhibitors , enzyme
inducers.
• H2 blockers & antacids decrease its
absorption ( depends on low ph)
Triazoles ( DERIVATIVES)
• F luconazole fiv-e
• I traconazole
• V oriconazole

• They are :
- Selective
- Resistant to degradation
- Causing less endocrine disturbance
 Fluconazole
• Water soluble
• Completely absorbed from GIT
• Excellent bioavailability after oral
administration
• Bioavailability is not affected by food or
gastric PH ( unlike ketoconazole)
• Conc. in plasma is same by oral or IV route
• Has the least effect on hepatic microsomal
enzymes
Continuation : Fluconazole
• Drug interactions are less common
• Penetrates well BBB so, it is the drug of choice of
cryptococcal meningitis
• Safely given in patients receiving bone marrow
transplants (reducing fungal infections)
• Excreted mainly through kidney
• Half-life 25-30 hours
• Resistance is not a problem
Clinical uses of FLUCONAZOLE
• Candidiasis
- is effective in all forms of mucocutaneous
candidiasis)
- Cryptococcus meningitis
- Histoplasmosis, blastomycosis, , ring worm.
- Not effective in aspergillosis
• Side effects OF fluconazole
• Nausea, vomiting, headache, skin rash ,
diarrhea, abdominal pain , reversible
alopecia.
• Hepatic failure may lead to death
• Highly teratogenic ( as other azoles)
• No endocrine side effects
Itraconazole
• Lacks endocrine side effects
• Has a broad spectrum activity
• Given orally & IV
• Food increases its absorption
• Metabolized in liver to active metabolite
• Highly lipid soluble ,well distributed to bone,
sputum ,adipose tissues.
• Can not cross BBB (blood brain barrier)
Continuation : Itraconazole (cont.)
• Half-life 30-40 hours
• Used orally in dermatophytosis & vulvo-vaginal
candidiasis.
• IV only in serious infections.
• Effective in AIDS-associated histoplasmosis

Side effects :
• Nausea, vomiting, hypokalemia, hypertension,
edema, inhibits the metabolism of many drugs as
oral anticoagulants.
ITRACONAZOLE : continuation
• Effective for treatment of onychomycoses.
• Should not be given in patients with
ventricular dysfunction.
• Evaluation of hepatic function is
recommended.
 Voriconazole
• A broad spectrum antifungal agent
• Given orally or IV
• High oral bioavailability
• Penetrates tissues well including CSF
• Inhibit P450
• Used for the treatment of invasive aspergillosis &
serious infections.
• Reversible visual disturbances
• REMINDERS :
Better absorbed as ORAL meds :
Fluconazole : 90 %
Itraconazole : 55 %
Penetration to CNS ( passes thru BBB)
Fluconazole
RENAL Excretion highest at 75 %
Fluconazole
Longest half-life
Itraconazole >>> than 35 hours ( 30-40 )

The drug that causes Gynecomastia, decreased libido,

impotence, menstrual irregularities
KETOCONAZOLE

The anti Fungal drug that causes Hypokalemia and

Hypertension

Itraconazole
Drug of choice for BLASTOMYCOSIS
KETOCONAZOLE
DRUG OF CHOICE FOR MENINGEAL
COCCIDIODOMYCOSIS
FLUCONAZOLE
DRUG OF CHOICE FOR PARACOCCIDIODOMYCOSIS
KETOCONAZOLE
DRUG OF CHOICE FOR MENINGEAL CRYPTOCOCOCCIS
FLUCONAZOLE
-Systemic azoles are contraindicated in pregnancy
(potential teratogenic effects and endocrine toxicity for
the fetus)
Between Itraconazole and Fluconazole, which one
is eliminated via the renal system?
Fluconazole
Between Itraconazole and Fluconazole, which one
needs Hepatic function tests while the client is
undergoing the treatment?
ITRACONAZOLE
Flucytosine
• Flucytosine is a fluorinated SYNTHETIC
pyrimidine antimetabolite (cytotoxic drug ) often
given in combination with amphotericin B &
itraconazole.
• Systemic fungistatic
- Powerful agent for systemic infections.
- Taken up by fungal cells and interferes with DNA
synthesis
- Prodrug to produce 5-flurouracil.
Mechanism of action of
FLUCYTOCINE
• Converted within the fungal cell to 5- fluorouracil(
Not in human cell ), that inhibits thymidylate
synthetase enzyme that inhibits DNA synthesis.

• ( Amphotericin B increases cell permeability ,

allowing more 5-FC to penetrate the cell, they
are synergistic).
Mechanism of action
-The drug is accumulated in fungal cells by the action of a membrane
permease and is converted by a cytosine deaminase to 5-fluorouracil

5-fluorouracil is metabolized to 5-fluorouridylic acid which can be :

a) incorporated into the RNA (this leads to a misreading of the fungal

genetic code)

b) further metabolized to 5-deoxyfluorouridylic acid, a potent inhibitor

of thymidylate synthase (this leads to a blockade of fungal DNA
synthesis)

-The ultimate effect may be fungicidal or fungistatic depending on the

organism and on drug concentration.
Pharmacokinetics Of FLUCYTOCINE

• Rapidly & well absorbed orally

• Widely distributed including CSF AND
EYES.
• Mainly excreted unchanged through
kidney 99%
• Half-life 3-6 hours >>>>Renal failure-
up to 200 hrs.
• Given: Oral and IV.
Clinical uses of FLUCYTOCINE
• Severe deep fungal infections as in meningitis
• Generally given with amphotericin B
• For cryptococcal meningitis in AIDS patients
Deep candida infections, cryptococcal meningitidis
(always in combination with amphotericin B)
-Chromomycosis (effectiveness is limited)

Contraindications
-Pregnancy ( 5-fluorouracil is teratogenic)
FLUCYTOCINE : Adverse Effects
• Nausea, vomiting , diarrhea, severe enterocolitis
• Reversible neutropenia, thrombocytopenia, bone
marrow depression
• Alopecia
• Elevation in hepatic enzymes
• (some adverse effects related to 5-Fu formed by
intestinal organisms from5-FC)
 Antifungal Drugs Used For Topical Fungal
Infections
1. Topical azole derivatives
2. Nystatin& Amphotericin
3. Terbinafine
4. Tolnaftate
5. Naftifine
6. Griseofulvin
Topical Antifungal Agents
• Used in superficial fungal infections , such as :
• Dermatophytosis ( ring worm), candidiasis,
fungal keratitis.
• They are not effective in mycoses of the nails
& hair or subcutaneous mycoses.
• The preferred formulation for cutaneous
application is cream or solution.
Azoles for topical use
• In the form of vaginal creams, suppositories, tablets for
vaginal candidiasis given once daily .

CLOTRIMAZOLE
• Absorption is less than 0.5% from intact skin, 3-
10% from vagina (its activity remains for 3 days ).
• Used in dermatophytes , cutaneous candidiasis &
vulvovaginal candidiasis.
• Causes : Erythema, edema, , urticaria & mild
vaginal burning sensation.
TOLNAFTATE
• Effective in most cutaneous mycosis.
• Ineffective against Candida.
• Used in tinea pedis ( cure rate 80% ).
• Used as cream, gel, powder, topical solution.
• Applied twice daily.

NAFTIFINE
• Broad spectrum fungicidal .
• Available as cream or gel.
• Effective for treatment of tinea cruris.
Terbinafine:
Ergosterol Biosynthesis inhibitors
- Topical and Oral.
- Active against many dermatophytes. DOC-
onychomycoses).
- Highly lipophilic. Highly protein binding
- Extensively metabolized.
• Better tolerated ,needs shorter duration of therapy.
• Inhibits fungal squalene epoxidase, decreases
• The synthesis of ergosterol .(Accumulation of squalene
,which is toxic to the organism causing death of fungal cell).
TERBINAFINE: CONTINUATION
• Fungicidal ,its activity is limited to candida albicans
& dermatophytes.
• 6 weeks for finger nail infection & 12 weeks for toe
nail infections .
• Well absorbed orally , bioavailability decreases due
to first pass metabolism in liver.
TERBINAFINE : CONTINUATION
• Accumulates in skin , nails, fat.
• Severely hepatotoxic, liver failure even death.
• Accumulate in breast milk , should not be given to nursing
mother.
• GIT upset (diarrhea, dyspepsia, nausea )
• Taste & visual disturbance.
 TOPICAL ANTIFUNGAL DRUGS
Nystatin
-A polyene antibiotic useful only for local candidiasis.
-Administration: cutaneous, vaginal, oral.

Haloprogin
-The drug is fungicidal to various species of dermatophytes and candida.
-Principal use: in tinea pedis (cure rate » 80% )

Tolnaftate
-The drug is effective against most dermatophytes and Malassezia furfur
but not against Candida
-In tinea pedis the cure rate is » 80%
Antifungal azoles
-Azoles are reported to cure dermatophyte infections in 60-100% of cases
-The cure rate of mucocutaneous candidiasis is > 80% and that of tinea
versicolor > 90%.
-Administration: cutaneous, vaginal.
-Cutaneous application rarely causes erythema, edema, vescication,
desquamation and urticaria
-Vaginal application may cause mild burning sensation and abdominal pain.
SUMMARY
You have just learned:
1. The Mechanism of actions, indications, adverse
reactions and the nursing responsibilities when
administering antibacterial medications.
2. The main effects of Antifungal medications, its
examples and the differences among different
classes of this drug based on the mechanism of
action.
MAIN REFERENCES :NCM106
➢ FOCUS ON NURSING PHARMACOLOGY BY: AMY KARCH (2013)
http://docshare04.docshare.tips/files/27843/278436401.pdf

➢ Pharmacology for Nurses, A Pathophysiological Approach, 4th Edition-

Michael Adams
https://www.pdfdrive.com/pharmacology-for-nurses-a-
pathophysiological-approach-
4th-edition-michael-adams-d33410964.html

➢ Clinical Pharmacology made Incredibly Easy!®, Third Edition

https://www.pdfdrive.com/clinical-pharmacology-made-incredibly-
easy-third-edition- d17907753.html
Thank you