Nystatin, micafungin, and terbinafine

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.

Nystatin, micafungin, and terbinafine — 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.