fluconazole
Print| Trade Name(s): Fluconazole; Diflucan | |
| Group 3: Reproductive Hazard | AHFS Class: Azoles |
| Formweb: fluconazole | |
| Info Links: Chemotherapy Extravasation Policy | |
| Activity | Glove | Gown | Eye | Mask (N95/PAPR) | CSTD |
| Administration |  |
If splashing possible |
If inhalation possible | ||
| Waste/Disposal of drug | |
If splashing possible |
If inhalation possible |
Nursing Non-Antineoplastic or Reproductive Risk Drug PPE and Work Practices (Link to a file uploaded to Rhazdrugs or to a file on your intranet, or a shared drive.)
| Activity | Glove | Gown | Eye | Mask (N95/PAPR) |
| Administration | | |||
| Waste/Disposal of Drug | |
Nursing Non-Antineoplastic or Reproductive Risk Drug PPE and Work Practices (Link to a file uploaded to Rhazdrugs or to a file on your intranet, or a shared drive.)
| Activity | Glove | Gown | Eye | Mask (N95/PAPR) |
| Administration | |  If powder is present from non-intact tablet or capsule | ||
| Waste/Disposal of drug | |
Handling of bodily fluids and/or contaminated materials
| Drug Form | Glove | Gown | Eye | Mask (N95/PAPR) | Shoe |
| Intact tablet or capsule from UD package | | ||||
| Non-intact, repackaged tablet or capsule | | ||||
| Oral liquid drug or feeding tube | | ||||
| Topical drug |  |  If splashing possible |  If splashing possible | If inhalation possible | |
| Powder, solution for inhalation | | | | | |
| Vial; ampule; pre-filled syringe | | If splashing possible | If inhalation possible | ||
| Intravenous solutions | | If splashing possible | If inhalation possible | ||
| Irrigation solutions | | If splashing possible | If inhalation possible |
| Form | Receipt Packaging | Environment | Glove | Storage | Labeling |
| All Forms | No additional action | No additional action | | May be stored within normal inventory, neutral or positive | Cautionary Labeling |
Pharmacy Non-Antineoplastic or Reproductive Risk Drugs PPE and Work Practices
| Glove | Gown | Eye | Resp | Shoe | Head | Hood/Cabinet | CSTD |
(outer layer should be sterile) | |  |  |  |
LAFW |
Pharmacy Non-Antineoplastic or Reproductive Risk Drugs PPE and Work Practices
| Activity | Glove | Gown | Eye | Mask (N95/PAPR) | Shoe |
| Counting | | ||||
Manipulating (Complete in HD non-sterile room) | | | |
Pharmacy Non-Antineoplastic or Reproductive Risk Drugs PPE and Work Practices
| Form | Prep Instructions | Pneumatic Tube |
| Intact tablet/capsule from UD package | Sealed plastic bag, single pair of gloves, cautionary labeling |  |
| Non-intact, repackaged tablet or capsule | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Oral liquid drug or feeding tube | Sealed plastic bag, single pair of gloves, cautionary labeling |  |
| Topical drug | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Powder, solution for inhalation | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Vial; ampule; pre-filled syringe | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Intravenous solution | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Irrigation solution | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Dosage Form | Risk of Exposure | Packaging | Pharmacy Manipulation | Nurse Manipulation |
| Oral Solid | May occur when counting | Unit Dose Solid | Packaging or Counting Only | May occur when crushing or splitting |
| Oral Liquid | May occur when packaging | Bulk Liquid Bottle or Oral UD Cup | Dispense intact product or Packaging into oral syringe | May occur when administering |
| Injectable | May occur when compounding and administration | IV Bag | Dispense in intact packaging or admixture in LAFW | May occur when connecting or disconnecting tubing. |
| Injectable | May occur when compounding and administration | Syringe | Dispense in intact packaging or admixture in LAFW |
| |  | | |  | |  |
| Chemotherapy rated/tested (tested to ASTM D6978-05 (2013), Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs) | Disposable
| Should be worn in situations where eye, mouth, or nasal splashing is possible (i.e., during a bladder instillation of a hazardous drug) | Goggles protect the eyes, but not the face, against spraying. | Certified N95 | Powered air purifying respirator | required for compounding sterile and nonsterile hazardous drugs | required for compounding sterile and nonsterile hazardous drugs |
| Powder-free | Shown to resist permeation by hazardous drugs
| N95 offers no protection against gases and vapors. | For events such as large spills when an IV bag breaks or a line disconnects and leaks, or where there is known or suspected airborne exposure to vapors or gases | Double booties required for HD preparation areas, top layer is doffed before exiting the HD buffer room. | |||
| Inspect for visible defects | Must close in the back (no open front) | Surgical masks do NOT provide respiratory protection from drug exposure | Hazardous drugs with potential to vaporize at room temperature: • Carmustine • Cisplatin •Cyclophosphamide • Etoposide • 5-Fluorouracil • lfosfamide • Thiotepa | ||||
| Double gloving is recommended for all activities involving hazardous drugs except for handling intact, unit-dose oral agents, when one pair of chemotherapy-tested gloves is acceptable | Long sleeves with closed cuffs that are elastic or knit | ||||||
| When wearing double gloves, tuck the cuff of the inner glove under the gown sleeve and the cuff of the outer glove over the gown sleeve. | No seams or closures that could allow hazardous drugs to pass through | ||||||
| During medication manipulation/compounding the outer layer should be sterile | In preparation areas gowns should be changed every 2-3 hours or immediately after a spill or splash | ||||||
Change gloves every 30 minutes unless permeation testing has noted shorter time limits
| Gowns worn in hazardous drug handling areas must NOT be worn to other areas |
Sequence for Donning & Doffing PPE
References: Oncology Nursing Society, NIOSH
Fluconazole is a very selective inhibitor of fungal cytochrome P450 dependent enzyme lanosterol 14-α-demethylase. This enzyme works to convert lanosterol to ergosterol, which is necessary for fungal cell wall synthesis. Specifically, the free nitrogen atom of the azole ring of fluconazole binds an iron atom within the heme group of the enzyme. This prevents the activation of oxygen and, as a result, the demethylation of lanosterol, which stops the process of ergosterol biosynthesis. Methylated sterols accumulate in the fungal cellular membrane, resulting in an arrest of fungal cell growth 7.
Fluconazole resistance may arise from an alteration in the quality or quantity of the target enzyme (lanosterol 14-α-demethylase), reduced access to this target, or a combination of these mechanisms 8.
Reference: Drug Bank
- Harmful if swallowed.
- Causes skin irritation.
- Causes serious eye irritation.
- May damage fertility or the unborn child.
- May cause damage to organs.
Reference: SDS - Cayman Chemical
Only met the NIOSH criteria as a developmental and/or reproductive hazard
