Fluconazole is a critical antifungal medication used to treat and prevent a variety of fungal infections. Nurses play an essential role in its administration, monitoring, and patient education. This comprehensive guide outlines everything nurses need to know about fluconazole, including its classification, mechanism of action, indications, dosage, adverse effects, and key nursing considerations.
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Drug Overview
Classification
- Class: Antifungal, Azole derivative
- Generic Name: Fluconazole
- Brand Name: Diflucan
Mechanism of Action
Fluconazole inhibits the synthesis of ergosterol, an essential component of fungal cell membranes, by blocking the enzyme lanosterol 14-alpha-demethylase. This disruption increases membrane permeability, leading to fungal cell death.
Forms
- Oral tablets (50 mg, 100 mg, 150 mg, 200 mg)
- Oral suspension (10 mg/mL, 40 mg/mL)
- Intravenous (IV) solution (2 mg/mL)
Indications
Fluconazole is indicated for:
- Candidiasis: Oropharyngeal, esophageal, vaginal, and systemic infections caused by Candida species.
- Cryptococcal Meningitis: Treatment and suppression, especially in immunocompromised patients.
- Prophylaxis: Prevention of fungal infections in high-risk patients (e.g., chemotherapy, HIV/AIDS, bone marrow transplant).
- Other Fungal Infections: Certain dermatophyte infections when topical therapy fails.
Dosage and Administration
Dosage varies based on infection type, severity, patient age, weight, and renal function.
Adult Dosage
- Oropharyngeal Candidiasis: 200 mg on day one, then 100 mg daily for 2 weeks
- Esophageal Candidiasis: 200 mg on day one, then 100 mg daily for 3 weeks
- Vaginal Candidiasis: 150 mg single dose
- Systemic Candidiasis: 400 mg on day one, then 200 mg daily for 4+ weeks
- Cryptococcal Meningitis: 400 mg on day one, then 200–400 mg daily for 10–12 weeks
- Prophylaxis: 400 mg weekly
Pediatric Dosage
- Candidiasis: 6–12 mg/kg on day one, then 3–6 mg/kg daily
- Cryptococcal Meningitis: 12 mg/kg on day one, then 6–12 mg/kg daily
Administration Guidelines
- Oral: Take with or without food. Shake suspension well and measure with a dosing syringe.
- IV: Infuse over 1–2 hours using a dedicated line to avoid reactions.
Note: Adjust dosage in renal impairment based on creatinine clearance (CrCl):
- CrCl >50 mL/min: Full dose
- CrCl 11–50 mL/min: 50% dose
- CrCl <10 mL/min or dialysis: 25–50% dose
Nursing Considerations
Assessment
- Allergies: Check for hypersensitivity to azoles or drug components.
- Medical History: Assess for liver disease, kidney disease, or cardiac conditions.
- Baseline Labs: Obtain liver function tests (LFTs), renal function, and vital signs.
- Infection Signs: Evaluate symptoms (e.g., fever, lesions, discharge).
Administration
- Oral: Ensure accurate dosing; teach patients to take at the same time daily.
- IV: Monitor infusion rate, use a dedicated line, and check for phlebitis or infiltration.
Monitoring
- Therapeutic Effects: Look for reduced fever, pain, or lesion resolution.
- Adverse Effects:
- Common: Nausea, vomiting, abdominal pain, headache, rash
- Serious: Hepatotoxicity (jaundice, dark urine), QT prolongation (arrhythmias)
- Labs: Regularly monitor LFTs and renal function, especially with prolonged use.
Patient Education
- Complete Therapy: Emphasize finishing the full course to prevent recurrence.
- Side Effects: Instruct to report severe nausea, jaundice, or irregular heartbeats.
- Drug Interactions: Advise consulting a provider before new medications.
- Administration Tips: For suspension, use a dosing device; for IV, report infusion discomfort.
Adverse Effects
- Gastrointestinal: Nausea, vomiting, diarrhea, abdominal pain
- Neurological: Headache, dizziness
- Dermatological: Rash
- Severe:
- Hepatotoxicity (elevated LFTs, jaundice)
- Cardiotoxicity (QT prolongation, arrhythmias)
- Hypersensitivity (anaphylaxis, Stevens-Johnson syndrome, rare)
Nurses should monitor closely and report serious effects immediately.
Drug Interactions
Fluconazole interacts with:
- Warfarin: Increased bleeding risk; monitor INR.
- Phenytoin: Elevated levels; watch for toxicity.
- Cyclosporine: Increased levels; adjust dose.
- Statins: Risk of myopathy; consider alternatives.
- QT-Prolonging Drugs: Avoid co-administration (e.g., cisapride).
Review the medication list and alert the healthcare team to potential issues.
Special Populations
- Renal Impairment: Adjust dose per CrCl; monitor renal function.
- Hepatic Impairment: Use cautiously; monitor LFTs closely.
- Pediatrics: Weight-based dosing; assess for hepatotoxicity.
- Pregnancy: Category D; use only if benefits outweigh risks.
- Breastfeeding: Excreted in milk; weigh risks and benefits.
Follow-Up Care
- Schedule regular blood tests (LFTs, renal function) for long-term use.
- Evaluate infection resolution and adjust therapy as needed.
- Ensure patient follow-up appointments are maintained.
Conclusion
Fluconazole is an effective antifungal requiring meticulous nursing oversight. By mastering its administration, monitoring for adverse effects, and educating patients, nurses ensure safe and successful treatment of fungal infections.
