Amphotericin B Deoxycholate

INTRODUCTION

Indications

IV: Treatment of progressive, potentially fatal fungal infections. The cholesteryl sulfate, lipid complex, and liposome formulations should be considered for patients who are intolerant (e.g., renal dysfunction) or refractory to amphotericin B deoxycholate. Amphotericin B liposome: Management of suspected fungal infections in febrile neutropenic patients: Treatment of visceral leishmaniasis, Treatment of cryptococcal meningitis in HIV patients.

Action

Binds to fungal cell membrane, allowing leakage of cellular contents. Toxicity (especially acute infusion reactions and nephrotoxicity) is less with lipid formulations. Therapeutic Effects: Can be fungistatic or fungicidal (depends on concentration achieved and susceptibility of organism). Spectrum: Active against Aspergillus, Blastomyces, Candida, Coccidioides, Cryptococcus, Histoplasma, Leishmania (liposomal formulation only), Mucor.

Adverse Reactions/Side Effects

CNS: anxiety, confusion, headache, insomnia. Resp: dyspnea, hypoxia, wheezing. CV: chest pain, hypotension, tachycardia, edema, hypertension. GI: diarrhea, hyperbilirubinemia, liver enzyme elevation, nausea, vomiting, abdominal pain. GU: nephrotoxicity, hematuria. F and E: hyperglycemia, hypocalcemia, hypokalemia, hypomagnesemia. Hemat: anemia, leukopenia, thrombocytopenia. Derm: pruritis, rashes. Local: phlebitis. MS: arthralgia, myalgia. Misc: HYPERSENSITIVITY REACTIONS, chills, fever, acute infusion reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough dyspnea) or skin reactions (rash, angioedema, pruritis, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Monitor signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, and bleeding gums), or unusual weakness and fatigue that might be due to anemia or other blood dyscrasias. Report these signs to the physician.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report tachycardia or other rhythm disturbances, or symptoms of increased arrhythmias, including palpitations, chest pain, shortness of breath, fainting, and fatigue/weakness.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Assess any signs of thrombophlebitis, including localized pain, redness, or swelling in the affected area. Report these signs to the physician.

• Monitor any breathing problems, and report wheezing, shortness of breath, hypoxia, or labored/difficult breathing. Assess pulmonary function by measuring lung volumes, breath sounds, respiratory rate, and other symptoms (See Appendices I, J, K) to document changes in respiratory status.

• Monitor signs of hypoglycemia (weakness, malaise, irritability, fatigue) ...