Chapter 42: Antifungal Drugs

The nurse administers a nystatin (Mycostatin) troche to a patient who has AIDS-associated candidiasis. Which instruction should the nurse include in patient teaching? A. Let the discoid dissolve slowly in the mouth. B. Insert the medication deep in the vagina. C. Chew the tablet, sip water, and swish. D. Swish the medication for as long as possible.

A. Let the discoid dissolve slowly in the mouth. A nystatin troche is a discoid of nystatin; to administer it properly, the nurse instructs the patient to place the troche in the mouth and allow it to dissolve slowly without chewing or swallowing. Troches are indicated for oral use, and the nurse should tell the patient to avoid sipping water or swallowing. Nystatin suspension, not nystatin troche, is swished in the mouth.

The nurse administers IV fluconazole (Diflucan). Which action should the nurse implement in regard to the administration of this medication? A. Checking the IV site frequently for infiltration B. Infusing only the fluconazole in the IV tubing C. Checking the patient's vision during therapy D. Stopping the infusion for blisters, itching, or oozing

B. Infusing only the fluconazole in the IV tubing The nurse should avoid infusing fluconazole in the same IV tubing as other medications to prevent complications from the infusion because fluconazole is incompatible with many other medications and compatible with only a few. The nurse should check the IV site of any infusion for infiltration frequently. Checking the patient's vision is done during the administration of amphotericin B and terbinafine. Blisters, itching, and oozing may be seen with the administration of terbinafine.

A patient has recurrent tinea pedis. Which instruction should the nurse provide when teaching a patient who takes terbinafine (Lamisil) to enhance the therapeutic effectiveness of this medication? A. Take this medication an hour after eating. B. Wash the feet daily and dry the areas between the toes. C. Tinnitus, tingling, and numbness may occur. D. Report an irregular heartbeat or palpitations.

B. Wash the feet daily and dry the areas between the toes. Terbinafine is administered topically as a spray, cream, or gel for tinea pedis, a fungal infection of the feet, so the nurse instructs the patient to keep the feet clean and dry to help eliminate a hospitable environment for the dermatophyte. In doing so, the patient enhances the therapeutic effectiveness of the medication. Because terbinafine is indicated as a topical agent, the nurse avoids giving instructions related to timing of the medication. Dysrhythmias, tinnitus, tingling, and numbness are not associated with the use of terbinafine.

A patient whose body is rejecting a transplanted liver contracts refractory aspergillosis. Which antifungal agent indicated in the treatment of aspergillosis must be used with caution in this patient? A. Nystatin (Mycostatin) B. Voriconazole (Vfend) C. Caspofungin (Cansidas) D. Amphotericin B (Fungizone)

C. Caspofungin (Cansidas) Caspofungin is indicated in the treatment of aspergillosis; however, this patient is likely to have liver dysfunction as a result of the rejection. Therefore, the nurse must administer caspofungin cautiously to this patient by monitoring liver function parameters closely, assessing the patient frequently for indicators of dysfunction, and avoiding additional hepatotoxic agents. Nystatin is not used against systemic fungal infections. Voriconazole and amphotericin B are indicated in the treatment of aspergillosis but do not carry the same caution as caspofungin.

The nurse prepares to administer IV amphotericin B (Fungizone). What action should the nurse implement before administering this medication to prevent adverse effects of therapy? A. Gathering baseline data, including hemoglobin and information on allergy to penicillin B. Assessing the skin, bowel patterns, and appearance of the stool C. Checking the culture for growth of Sporothrix, Trichophyton, and Microsporum D. Administering acetaminophen (Tylenol) and diphenhydramine (Benadryl)

D. Administering acetaminophen (Tylenol) and diphenhydramine (Benadryl) The nurse should premedicate the patient with acetaminophen and diphenhydramine because amphotericin B administered IV produces fever, chills, malaise, nausea, and headache. These reactions are caused by the release of proinflammatory cytokines, including tumor necrosis factor, interleukin-1, and interleukin-6, from monocytes and macrophages. Checking the hemoglobin is a reasonable nursing intervention before the administration of any antifungal agent; checking for allergy to penicillin is a suitable action before griseofulvin therapy. The nurse should assess the patient's skin and bowel pattern before fluconazole therapy. Sporothrix, Trichophyton, and Microsporum are superficial mycoses; amphotericin is indicated in the treatment of severe systemic fungal infections.

Which action is the nurse's priority assessment before administering voriconazole (Vfend)? A. Determining whether the patient has suitable venous access B. Gathering the results of baseline renal and liver function studies C. Ensuring that 1 hour has passed since the patient's last meal D. Checking the culture for a susceptible species of fungus

D. Checking the culture for a susceptible species of fungus The nurse's priority is to check the culture before administering voriconazole to ensure that the medication is indicated. After confirming that the culture has revealed a susceptible species, the nurse ensures suitable IV access for the infusion if it is to be administered IV, checks the findings of renal and liver function studies to ensure that they remain within a predetermined normal range, and compares the time of administration to the time of the patient's last meal to ensure that 1 hour has passed.

A patient with profound heart failure receives multiple medications, including an antifungal agent for onychomycosis. Which medication should be discontinued and replaced with another agent indicated in the patient's treatment? A. Digoxin (Lanoxin) B. Furosemide (Lasix) C. Dobutamine (Dobutrex) D. Itraconazole

D. Itraconazole The nurse avoids using itraconazole for a patient with profound heart failure because itraconazole can impair left ventricular function in a dose-dependent manner; circulatory collapse may ensue if the drug is administered to this patient. Digoxin, furosemide, and dobutamine may all be suitable therapies to improve cardiac output in this patient.