Today we're looking at the classification Azole, antifungals. And if you've been with me for any
length of time watching my pharmacology videos, you know, I love a good word.
And these five letters here, surprisingly, pack quite a punch. Now, I can't wait to share with
you everything that I've put together to help you understand how these drugs are used for
the body when we would use them and what we need to teach our patients about them.
But I also can't wait to share with you the ways in which I use these five letters to pull
forward a lot of that so you can spend your time focused on the patient and not memorizing silly
wild out there crazy things, but we just get right to the heart of the medication.
I just want to you know what you walk through this video, you're going see that the camera
focuses and then becomes unfocused. I was unaware of this when I made the video, but I didn't want
to redo it all. So just stick with me through it. There's going to be a lot of amazing content
here and I'll do better in the next one. My name is Tammy This is nurse minder, and today we're
focusing on the classification Azole antifungals. Now be sure to watch right to the end because
there's always an NCLEX question. To help you put all of this information, synthesize it and
test yourself at the end. Now Azole antifungal is is one of the largest classifications or
largest groupings of antifungal, they treat everything from head to toe, inside out.
So our first clue is a Z, A to Z. So we're actually treating our shoes, this one here.
A to Z, everything from head to toe inside out. It's a large spectrum and is the largest so if
you ever get a test question and it says which one of these is the largest group of
antifungals you know, as the A's always it's all a that's going to come in handy later.
The second clue right off the hop is that A Z O L E is actually found inside the drug name.
We have fluconazole, in fact, you'll notice con is all is the extended form. What you're
going to see in most of these drug names con as all ketoconazole so there is a
way to recognize them really quickly. couple exceptions. They're down here isavuconazonium,
but it's embedded in the word so it's not the ending but it's embedded in and then we just
have one that you have to memorize. Instead of having to memorize all of these names. You just
have to recognize terbinafine or turbinafine as an antifungal under the azole family.
Here's a trick. Here's a way to help you memorize it. It is a fine antifungal A F
to treat. And it's going to be toe fingernail and toe fungus, and tinea capitis, which we'll
talk about a little bit but this tea is a clue. Alright, so when you've memorized
when you don't have to memorize all of the drugs because you recognize the ending azole
and then you just have to memorize one term a fine antifungal, AF antifungal. Now, as always,
we need to know how do these drugs work? Well, there's another clue inside our word, O L E.
That is the ending of the word sterile ester… Ergosterole sorry. They work by binding to
the sterols or to the Ergosterole to cause cell death. Using our A to Z theme again, everything
its wide range. We also know there's going to be a wide range of delivery methods. It can be an
oral medication and IV medication, a topical and even a shampoo. There are some clues in many of
the words to help you know which ones are which. So in general, all of these are oral medications.
Some of these can also be delivered in intravenous, which means you can start a patient
on an intravenous antifungal and transition them to the oral medication when they go home.
Here's some of the clues are IV medications, so we know they're all available in oral form. But
our IV medications. The clue is some of the words have letters I and V in them already.
So voriconazole has IV in it, isavuconazonium has I V in it.
There's two more on here that are also given IV - fluconazole. And if you think of when
you come into the hospital with the flu, you're likely getting an IV to get fluids for hydration.
And then this one is a memorization that posaconazole I'm thinking poser. So they're not
necessarily showing who they truly are. So there's no IV in here to tell me this is the only one
you'd have to remember as being also intravenous along with voriconazole and isavuconazonium.
So they have IV in it, flu, you're getting an IV and then we got the posa’s
Now just remember Keto is special for a lot of reasons. One of them is it also comes as a
shampoo and a topical formation to treat fungal infections. There is a special thing here about
terbinafine and that it can be sprinkled is capsules for children. So there is one more
anomaly here and that it can be a sprinkled capsule. Now speaking of patients, we know we
have little ones to old ones. And you'll see that I've got a smiley face here besides fluconazole
ketoconazole and terbinafine. These are the three azole antifungals that have pediatric dosing.
Now here's a fun way to help you remember the side effects now they are pretty common side effects,
not likely to require a memorization aid. But if you think of, okay, like a Mexican party,
we have pinatas. Now as pinatas, you're hitting them, you got your head up all
the time. So you start to get a headache. You eat that candy, you have abdominal pain, maybe nausea,
vomiting, diarrhea, what a GI side effects with fluconazole or with antifungal is in the azole
family. So just thinking Ole! Its’ Ole! and we can think of those really common side effects
that are most likely to be experienced by our patients. Pinata headache, candy, sore tummy,
don't feel so well. And the one last thing to add would be a rash the skin that can develop a rash.
Alright, we're gonna come back now to look at Ketoconazole and its specifics because
I have a little story that goes along with the Pinata ole ole ole.
That's going to help you recall some of the treatment or some of the diagnoses that it treats,
and then we're going to leapfrog off of that one to show you how another drug comes into play.
So here's the story. We're trying to get at this pinata. But now we're looking at this pinata and
we're trying to think what diseases Am I treating with an azole antifungal. Here's the story. I am
getting exasperated trying to open this pinata. Yeah. So aspergillosis in this exasperation,
I might break down and cry for a little while. cryptococcosis And then I'm gonna get my pull my
socks back up. And you know what? I'm getting a little cocky. I'm gonna get in there. I'm gonna
blast this Pinata coccidiodiomyosis, someone's gonna have to say this one, coccidioidomycosis,
blastomycosis. So, I'm exasperated, I cry, I get a little cocky. I'm going to blast this Pinata,
history tells me , there's got to be candy in there. candidiasis. And at the end of it all,
I'm just so perplexed. I don't know how to break that Pinata ah, scratch my head and find what I
have dandruff. So that's just a real quick fun story to tie in with the pinata theme. So when
you look at azole’s. We're going to now look at it as is and think of the O L E as the piano
party Mexican. And we'll be able to recall some of these diagnoses and attach them to ketoconazole.
Okay. It's a fun one right! like this word packs a punch. Like I said, Now, when, first of all,
most of these respiratory illnesses, they come from inhaling the spores found in mold that can
be in your home or it can be out in the woods like in those wet soft spaces of decaying woodlands.
It's also in bird droppings. bird droppings is critical key here because cryptococisis when
it migrates from the lungs to the brain, and I choose the word migrate on purpose,
it's going to help you remember, you're going to then need to treat it with fluconazole it
flew like a bird to the brain. And it becomes cryptococcal meningitis.
Alright, so that's the Ketoconazoles. Oh, it's a key antifungal in the azole family. We now
know fluconazole is also going to be added in or the drug of choice if we have cryptococcal
meningitis because the cryptococcosis has moved from the lungs to the brain.
fluconazole is also used for candidiasis that yeast thrust infection in the mouth and in
The vagina. Okay. Now just a few I'm going to touch on here. posaconazole is a prophylactic.
So remember P for prophylactic, in patients who are immunocompromised and terbinafine,
remember, this is the outlier, the one that we have to memorize as being in azole antifungal,
a fine antifungal for toenail fungus. So onychomycosis. This is your fingers or your toes,
and tinea capitis, which is ringworm of the scalp, okay? Those are your abnormalities
to just put a little attention to and then the rest of it will just fall into place.
Now there's one more thing that is super critical to know about azole antifungals.
There's some critical contraindications and they understanding why they're
contraindications requires us to look at the enzymes. So for example,
they can cause liver toxicity. If they've got bleeding issues, we want to know about that. So
why is that cardiac issues would be something to look at when they're on an antifungal. Why? This
has to do with the enzyme family CYP 450. And trust me, I'm going to fit this into the word
now, I am going to link a video in the description box below Dirty Medicine has
done a fabulous YouTube video explaining some of these things. So CYP 450, first of all is a family
of enzymes that you utilize to metabolize or break down the medications that you take. They
also have a few other functions in the body while we're going to focus on metabolism. They also are
responsible for the synthesis and breakdown of hormones like estrogen and testosterone.
And for vitamin D metabolism. So how do we remember that here we go girls and boys? Azole
has 450 in it. How cool is that? Okay, so c y p 450 is an enzyme that is often found in the liver.
It's also in other parts of the body. And when it detects that there's a medication in the body,
it will bind to it so that it can begin to break it down. So it can be transformed into
smaller components that are water soluble,
so can be excreted through the body through urine and feces.
The CYP 450 can be activated to work faster or slower.
The azole antifungals decrease, so they inhibit
this process right here. And so it takes longer for the drug to be metabolized, which the so what
does this mean for our medications when we take an azole antifungal, if it is inhibiting the work of
the CYP 450 enzyme, there are other medications that take the same pathway for metabolism.
So for example, warfarin, some of our cardiac drugs. And so if they're taken
in conjunction with these other medications, we are slowing down the metabolism of those
other medications as well. Hence why when we look at telling our patients
about the fact that if they have increased bleeding, they notice more bleeding time or
they're noticing some cardiac issues. We want to know that because it may actually
be impacting the other medications that they're taking. And we'll have to change
the time of the medication, the dose of the medication, either the one that antifungal,
or the other medication is impacting, and we sometimes need to just change the medication
Review everything. This five letter word shows us. We know that the words will end in azole,
fluconazole, ketoconazole, itraconazole, so they're really easy to identify as an anti fungal.
We know A to Z, head to toe for larger spectrum of antifungals out there. We know there's an end
in azole we're going to take the Ole to help us remember side effects, headaches, abdominal pain,
nausea, vomiting, diarrhea and rash. We're going to take the ole to remember some of
the respiratory illnesses that ketoconazole’s will treat aspergillosis cryptococcosis? mycosis
blastomycosis candidiasis histoplasmosis right. So that whole story that's in your head now that
you can remember and recall all of those diseases. Those come from molds in our house in the outside
in bird poop. And then if cryptococcosis migrates to the brain, we're going to use fluconazole to
treat cryptococcal meningitis. So it gets a lot from this one word already. And then we're adding
CYP450 as the enzyme that it inhibits. So we know that azole antifungal’s will inhibit the enzyme
CYP450 , which is responsible to break down or medication so we can get rid of them. And
they don't build up to toxic levels, which is why before giving an azole antifungal,
when somebody is on a medication for cardiac, or for diabetes,
or for anything, we need to check to see if there's a drug to drug interaction.
Because if there isn't interaction, we know that it inhibits the ability of the body to break down
and get rid of the other drugs. And then that means we have a buildup of potential toxicity.
It binds to the sterols or the ergosterols to cause cell death. So there's another clue
in the ole the OLS. Now it's not an NCLEX question. You are admitting a 14 month old
child to the pediatric intensive care unit for diagnosis of cryptococcal meningitis,
which of the following drugs do you anticipate the physician will order? Select one,
ketoconazole, terbinafine, posaconazole, or fluconazole. So pause this video and when
you're ready, come on back and I'll share the answer. If you selected fluconazole,
congratulations, you recognize that ketoconazole would have been great if it was cryptococcosis.
But because it migrated to the brain, and we have meningitis, we need fluconazole. Great job.
Thanks for watching. If you liked this video, hit subscribe and follow for more videos. I'll
help you take a word and see so much more to help you get through those tests faster, but
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let me know in the comments below how this is helping you I read every comment and I do respond.
And here's a challenge in the comments below. Think of the word Azole. And write
down everything that you can remember now as it relates to giving this medication,
it should be a lot and if it's not go back and watch it again and see what you can pick up on.
And just a reminder for those of you who are looking for content to help you
with the relational part of nursing, I have a separate channel called communication for the
workplace with Tammy and I talk about all of the challenges and conflict workplace bullying that
may be getting in the way of you feeling safe and doing your job so be sure to head on over
there. You'll find the link in the description box below. And until next time, make it a great day.