Ch 92 Antifungal Agents

Clients who receive amphotericin B should not take other nephrotoxic drugs. Which are considered nephrotoxic drugs? (Select all that apply.) A) Cyclosporine B) Corticosteroids C) Antiprotozoals D) Antineoplastics E) Anthelmintics

A, B, D. Clients who receive amphotericin B should not take other nephrotoxic drugs such as nephrotoxic antibiotics or antineoplastics, cyclosporine, or corticosteroids unless absolutely necessary because of the increased risk of severe renal toxicity.

The nurse would include which of the following in a teaching plan for a patient who is receiving an oral antifungal drug? A) It is important that you complete the full course of your drug therapy B) You can share this drug with other family members if they develop the same symptoms C) If you feel drowsy or dizzy, you should avoid driving or operating dangerous machinery D) If GI upset occurs, avoid eating and drinking so you don't vomit and lose the drug E) Use OTC drugs to counteract any adverse effects like headache, fever, or rash F) Notify your health care provider if you experience yellowing of the skin or yes, dark urine or light-colored stools, or fever and chills

A, C, F

A client is receiving amphotericin B. The nurse would assess the client closely for which adverse reaction? A) Renal impairment B) Skin discoloration C) CNS disorders D) Intensive weight loss

A. Renal damage is the most serious adverse reaction with the use of amphotericin B and requires close monitoring. Conditions such as CNS disorders, skin discoloration, and weight loss are not known to be common adverse effects of amphotericin B.

A patient with recurrent vaginal yeast infections is to receive Tioconazole. The nurse should instruct the patient to do what? A) Use the powder as needed B) Insert a full applicator at bedtime only once C) Apply the cream to the area twice daily D) Insert the suppository for at least 3 consecutive days

B.

The nurse is caring for several clients who have fungal infections. Which client should the nurse prioritize for informing the provider? A) A client who has a dose of miconazole vaginal suppository due in 15 minutes B) A client receiving amphotericin B whose torso appears jaundiced C) A client with candidiasis who has been prescribed nystatin and who requires education D) A client who reports the new onset of a rash where terbinafine is being applied

B. A new onset of jaundice suggests hepatotoxicity related to amphotericin B. This is a significant and time-dependent finding that must be addressed quickly. This would be prioritized over a client's need for medication education. A rash related to topical antifungal use is suggestive of local irritation, not a generalized hypersensitivity reaction. Administration of a vaginal suppository would not take precedence over a client's new onset of hepatotoxicity.

A client has been placed on amphotericin B. How will the nurse administer this medication? A) Intramuscularly B) Intravenously C) Subcutaneously D) Orally

B. Amphotericin B is no longer administered orally; the most common route of administration is IV though intrathecal administration is used when fungus exists in the CSF.

A patient is diagnosed with a Candida infection of the mouth. The nurse will document this as what? A) Dermatophytes B) Thrush C) Tinea cruris D) Ringworm

B. Thrush is a candida infection of the mouth, often identified by small white spots on the tongue most commonly seen in newborns or clients who are immunocompromised. Ringworm is caused by tinea infection, not candida, and is usually found on the skin and not in the mouth. Fungi known as dermatophytes include tinea infections, of which candida infections are only one small subgrouping. Tinea cruris is also called jock itch and occurs in the area of the genitalia, usually as the result of perspiration from athletic activities.

A parent has informed the nurse that she has been applying an OTC antifungal to her infant's buttocks and perineal region. What questions related to safety should the nurse ask the parent? A) Did you explore any herbal or alternative remedies before starting to use this ointment? B) Are there any open wounds on the areas where you're putting the ointment? C) Does your infant have any food allergies that you're aware of yet? D) Did you take any antifungal medications while you were pregnant?

B. Topical agents should not be used over open or draining areas that would increase the risk of systemic absorption and toxicity. Allergy status is always important, but questions of applying the medication over open areas would be a safety priority; no aspect of the scenario suggests a hypersensitivity response. Previous use of herbal remedies may be relevant but is not a high priority. The mother's use of antifungals while pregnant is not relevant.

When administering a systemic antifungal agent, the nurse incorporates understanding that all systemic antifungal drugs function to: A) Break apart the fungus nucleus B) Interfere with fungus DNA production C) Alter cell permeability of the fungus, leading to cell death D) Prevent the fungus from absorbing needed nutrients

C.

The nurse is caring for a patient diagnosed with a life-threatening systemic fungal infection that is not responding to treatment with an azole. What medication should the nurse anticipate the provider may order next? A) Terbinafine B) Butenafine C) Amphotericin B D) Nystatin

C. Amphotericin B is a potent drug with many serious adverse effects (as it is highly toxic) so it is often used only when other medications are not effective. Nystatin and butenafine are topical agents and would not be used for a systemic infection. Terbinafine is an azole and would not be used if azoles do not work.

A client has been prescribed a topical antifungal ointment to treat a fungal infection between her breasts. When providing education about this medication, the nurse should encourage the client to: A) Ensure the affected area is not exposed to sunlight during treatment B) Avoid the use of soap on the affected area until treatment is complete C) Wash and dry the affected area before applying the ointment D) Apply the ointment a maximum of every two hours

C. Patients should be instructed to wash and dry affected areas before applying antifungal ointments. Soap is not prohibited and there is no reason to avoid sunlight. The frequency of administration varies, but there is no topical antifungal that can be safely used every two hours.

The nurse is working with a patient who has a cutaneous fungal infection and who has been prescribed a topical antifungal ointment. The patient tells the nurse, "I bought a steroid ointment at the drugstore because I read it might help with my skin infection." What is the nurse's best response? A) You can't safely take any OTC drugs while you're taking a prescription drug B) Actually, that ointment would probably make your infection worse, not better C) It's best to check with your health care provider before applying any of the steroid ointment D) Any ointment that you're able to buy without a prescription likely isn't going to help much

C. The client should inform the provider before using any OTC medications. These are not always contraindicated or ineffective, but the client should confirm this with the provider.

A client is being treated with amphotericin B. Which statement indicates that the client has understood the client teaching? A) "The medication may cause diabetes." B) "The medication will cause pancreatitis." C) "The medication may cause kidney damage." D) "The medication will cause liver necrosis."

C. The main concern with the administration of amphotericin B is the risk of nephrotoxicity. Thus, the statement that the medication may cause kidney damage is the most appropriate. The medication is not known to cause diabetes, liver necrosis, or pancreatitis.

The nurse is describing fungi that cause infections of the skin and mucous membranes, appropriately calling these which of the following? A) Mycoses B) Meningeal fungi C) Dermatophytes D) Worms

C. The superficial mycoses are caused by two groups of organisms: (1) Candida species and (2) dermatophytes. Dermatophytic infections, commonly referred to as ringworm, are generally confined to the skin, hair, and nails (p. 1107).

A patient with a severe case of athlete's foot is seen with lesions between the toes, which are oozing blood as serum. After teaching the patient, the nurse determines that the instruction was effective if the patient states which of the following? A) "I have to wear black socks and must be careful not to change them very often because it could pull more skin off of my feet" B) "I need to apply a thick layer of the antifungal cream between my toes, making sure that all of the lesions are full of cream" C) "I should wear white socks and keep my feet clean and dry. I shouldn't use the antifungal cream in areas where I have open lesions" D) "After I apply the cream to my feet, I should cover my feet in plastic wrap for several hours to make sure the drug is absorbed"

C. Tinea pedis, also known as ringworm of the foot, or "athlete's foot," is one of the four principal dermatophytic infections and is the most common fungal infection. It generally responds well to topical therapy. Patients should be advised to wear absorbent cotton socks, change their shoes often, and dry their feet after bathing (p. 1107).

Which statement best describes topical antifungal agents? A) They are most effective when applied in a thick manner B) They are associated with many drug-drug interactions C) They are too toxic to be used systemically D) They rarely cause local irritation and burning.

C. Topical antifungal agents are agents that are too toxic to be used systemically but are effective in the treatment of local infections. Typically, topical agents should be applied as a thin film. These agents can cause serious local irritation, burning, and pain. Systemic, not topical, antifungal agents are associated with many drug-drug interactions.

Which of the following would the nurse recommend that a woman with repeated vaginal yeast infections keep on hand? A) Tolnaftate B) Butenafine C) Clotrimazole D) Naftifine

C. Topical clotrimazole is a drug of choice for dermatophytic infections and candidiasis of the skin, mounth, and vagina (p. 1109).

The nurse is teaching peers about fungal infections and describes the cell membrane of a fungal cell: A) Has a soft cell wall B) Contains monosaccharides C) Contains mycosis D) Contains ergosterol

D.

A client has been diagnosed with a fungal infection and been prescribed a topical antifungal medication. What assessment question should the nurse ask when addressing the possible etiology of the fungal infection? A) "Were you prone to acne when you were younger?" B) "Have you received any vaccinations in the past few weeks?" C) "When was the last time you visited a hospital or clinic?" D) "Have you been prescribed any antibiotics in the recent past?"

D. A course of antibiotics can often precipitate a fungal infection. Hospital visits, immunizations and a history of acne are not identified as risk factors or causes of fungal infections.

A patient with chronic renal failure has been prescribed clotrimazole for the treatment of a fungal infection. How should the patient's health history affect the treatment plan? A) The patient will require a reduced dose due to impaired excretion B) Kidney disease rules out the safe and effective use of clotrimazole C) Hemodialysis will remove serum clotrimazole so dosages must be adjusted accordingly D) The presence of kidney disease has no significant effect on the use of clotrimazole

D. Because clotrimazole is not absorbed systematically, there is no need to consider the client's renal function during treatment. Excretion does not occur.

True or False: A topical antifungal cream should be gently rubbed into the affected area that has been washed with soap and water and patted dry.

True