Caspofungin is a drug in a new class of agents known as glucan synthesis inhibitors (also called echinocandins). Its major use is in the patient who hasn’t responded to other antifungal therapies, such as amphotericin B or itraconazole.
Pharmacokinetics
After being given intravenously, caspofungin is highly proteinbound, with little distribution into RBCs. The drug is slowly metabolized and is excreted in urine and stool.
药动学
静脉给药后，卡泊芬净为高蛋白结合性，RBC分布极少。该药代谢慢，经尿和粪便排出。
Pharmacodynamics
Caspofungin inhibits the synthesis of beta (1,3) D-glucan, an integral component of the fungal cell wall.
药效学
卡泊芬净抑制beta (1, 3)D葡聚糖，后者是真菌细胞壁不可分割的一部分。
Pharmacotherapeutics
Caspofungin is used to treat invasive aspergillosis in the patient who hasn’t responded to, or can’t tolerate, other antifungals. It hasn’t been studied as an initial treatment for invasive aspergillosis.
Drug interactions
• Patients taking caspofungin and tacrolimus may need higher doses of tacrolimus because caspofungin decreases the blood tacrolimus level.
• Inducers of drug clearance, such as phenytoin, carbamazepine, efavirenz, nevirapine, and nelfinavir, may lower caspofungin clearance.
• Concurrent use of caspofungin and cyclosporine may result in elevated liver enzyme levels and decreased caspofungin clearance, so use together isn’t recommended.
Test 1. A client visits the health care provider for treatment of tinea pedis (athlete's foot). Which medication would the nurse MOST likely instruct the client to take to treat this condition?
A. Terbinafine (Lamisil)
B. Voriconazole (Vfend)
C. Caspofungin (Cancidas)
D. Amphotericin B (Amphocin)
2. Amphotericin B (Fungizone) IV is given to a client with aspergillosis, a fungal infection. In order to prevent its side effects, the nurse anticipate administering which of the following prior, except?
A. Hydrocortisone.
B. Ketoconazole.
C. Diphenhydramine
D. Meperidine
本期ISPN Review答案： 1. A. Terbinafine 2. B. Ketoconazole.
Azole antifungals (eg, ketoconazole) decreases the effectiveness of amphotericin b. Options A and C: Fever, shaking, chills, flushing, loss of appetite, dizziness, nausea, vomiting, headache, shortness of breath, or fast breathing may occur 1 to 3 hours after the infusion is started. Medications such as acetaminophen, diphenhydramine, corticosteroids such as hydrocortisone) may be necessary to prevent these side effects. Option D: Meperidine (25 to 50 mg IV) has been shown in some patients to decrease the duration of shaking chills and fever that may accompany the infusion of amphotericin B.
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