View source for Nystatin, micafungin, and terbinafine

{{Drugbox
| name = Nystatin, micafungin, and terbinafine
| therapeutic = Antifungal
| pharmacologic = Polyene (nystatin), echinocandin (micafungin), allylamine (terbinafine)
| onset = Nystatin local; terbinafine accumulates in nails over weeks.
| halflife = Terbinafine long tissue retention; no routine level.
| routes = PO (oral), IV, Topical
| highalert = No
| blackbox = None
| antidote = Supportive care.
| pregnancy = Nystatin low risk; terbinafine generally deferred.
}}

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''Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and '''must be verified against current manufacturer labeling before clinical use'''. This is educational content, not prescribing guidance.''
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'''Nystatin, micafungin, and terbinafine''' &mdash; Antifungal; Polyene (nystatin), echinocandin (micafungin), allylamine (terbinafine).

== Identification ==
* '''Therapeutic class:''' Antifungal.
* '''Pharmacologic class:''' Polyene (nystatin), echinocandin (micafungin), allylamine (terbinafine).

== Pharmacology ==
* '''Mechanism of action:''' Nystatin disrupts membrane (topical and oral for candidiasis, not absorbed); micafungin inhibits fungal cell wall glucan (IV for invasive candidiasis); terbinafine inhibits ergosterol synthesis (for dermatophytes and nail infections).
* '''Onset / peak / duration:''' Nystatin local; terbinafine accumulates in nails over weeks.
* '''Half-life / therapeutic level:''' Terbinafine long tissue retention; no routine level.

== Clinical use ==
* '''Indications:''' Oral and cutaneous candidiasis (nystatin), invasive candidiasis (micafungin), onychomycosis and tinea (terbinafine).
* '''Usual dose, route, frequency:''' Nystatin swish and swallow or topical; micafungin IV daily; terbinafine PO daily.
* '''Maximum dose / adjustments:''' Terbinafine caution in hepatic and renal impairment.

== Safety ==
* '''Contraindications:''' Terbinafine in chronic or active liver disease.
* '''Black box warning:''' None.
* '''Interactions:''' Terbinafine inhibits CYP2D6 (affects some beta blockers, antidepressants); micafungin few.
* '''Pregnancy / lactation:''' Nystatin low risk; terbinafine generally deferred.
* '''High-alert:''' No.

== Adverse effects ==
* '''Common side effects:''' Local irritation (nystatin), GI upset, taste disturbance (terbinafine).
* '''Serious effects to report:''' Hepatotoxicity (terbinafine), severe rash, infusion reaction (micafungin).
* '''Antidote / reversal:''' Supportive care.

== Nursing process ==
* '''Assessment before administration:''' LFTs (terbinafine), infection site.
* '''Interventions during therapy:''' Nystatin held in the mouth before swallowing; long terbinafine course for nails.
* '''Monitor:''' LFTs (terbinafine), infection resolution.
* '''Evaluation / expected outcome:''' Resolution of fungal infection.

== Patient teaching ==
* '''Patient teaching:''' Swish nystatin and hold before swallowing; terbinafine nail therapy takes months; report yellowing of skin.
* '''Notify provider if:''' Yellowing of skin, persistent taste loss, rash.
* '''Administration tips:''' Nystatin after meals for oral thrush; terbinafine with consistent timing.

[[Category:Antifungals]]