Pharm - Chapter 42 - Antifungal Drugs
Which patients are susceptible to developing severe systemic fungal infections? Select all that apply. 1 A patient with cancer who is receiving chemotherapy 2 A patient who is using opioids to manage cancer-related pain 3 A patient who is receiving immunosuppressive agents for lupus 4 A patient who has acquired immune deficiency syndrome (AIDS) 5 A patient who is using thrombolytic agents for myocardial infarction
1 A patient with cancer who is receiving chemotherapy 3 A patient who is receiving immunosuppressive agents for lupus 4 A patient who has acquired immune deficiency syndrome (AIDS) Risk factors for the development of severe systemic fungal infections include use of chemotherapy in cancer patients, the use of immunosuppressive agents, and having AIDS. The use of opioids and thrombolytic agents does not predispose a patient to severe systemic fungal infection because they do not affect the body's immune system.
How can the nurse determine whether a patient will tolerate an amphotericin B infusion? 1 Administer a test dose 2 Desensitize the patient 3 Administer it with corticosteroids 4 Administer it with an antihistamine
1 Administer a test dose To assess a patient's ability to tolerate amphotericin B, a test dose of 1 mg should be administered over 20 to 30 minutes. Desensitization is a therapeutic procedure used to manage patients who have hypersensitivity reactions (in this case to amphotericin B) but require the drug. Administration of corticosteroids and antihistamines are measures used to prevent amphotericin B infusion reactions.
Which condition is the common drug-induced adverse effect of caspofungin? 1 Leukopenia 2 Bradycardia 3 Hypertension 4 Nephrotoxicity
1 Leukopenia Caspofungin has potential drug-induced adverse effects, such as leukopenia. It also causes tachycardia and hypotension, but not bradycardia or hypertension. Nephrotoxicity is an adverse effect of amphotericin B.
Which antifungal drug is applied topically for the treatment of candidal diaper rash? 1 Nystatin 2 Terbinafine 3 Caspofungin 4 Voriconazole
1 Nystatin Nystatin is a polyene antifungal drug that is often applied topically for the treatment of candidal diaper rash. Terbinafine is an allylamine antifungal drug and is used for the treatment of superficial dermatologic infections, including tinea pedis. Caspofungin is used for the treatment of severe Aspergillus infection. Voriconazole is used for the treatment of severe fungal infections caused by Aspergillus spp.
Which antifungal drug is prescribed to children in units rather than in milligrams and is not dosed based on the child's weight? 1 Nystatin 2 Terbinafine 3 Fluconazole 4 Amphotericin B
1 Nystatin Nystatin is prescribed in units, and dosing is not based on weight; instead there is standard dosing. Terbinafine is not prescribed to children. Fluconazole and amphotericin B are administered on the basis of the weight of the child.
A patient who is receiving an oral anticoagulant is started on fluconazole to treat a fungal infection. Which possible drug interaction could occur in this patient? 1 Risk of bleeding 2 Risk of thrombosis 3 No drug interaction 4 Fluconazole toxicity
1 Risk of bleeding Fluconazole increases the effects of anticoagulants, and thus the patient is at risk of bleeding. Fluconazole does not increase the risk of thrombosis. The interaction of fluconazole and anticoagulants does not cause fluconazole toxicity.
Which possible effect will the nurse anticipate in a patient who has received amphotericin B along with thiazide diuretics? 1 Severe hypokalemia 2 Additive nephrotoxicity 3 Increased adrenal cortex response to corticotrophin 4 Prolongation of the QT interval on an electrocardiogram
1 Severe hypokalemia Administration of amphotericin B along with thiazide diuretics causes severe hypokalemia because both drugs may cause loss of fluids and electrolytes. Administration of amphotericin B along with nephrotoxic drugs causes additive nephrotoxicity. Administration of amphotericin B along with thiazide diuretics causes a decreased adrenal cortex response to corticotrophin. Administration of voriconazole along with quinidine causes prolongation of the QT interval on an electrocardiogram.
Which tissue types are the common primary tissues that are affected by infection with the Trichophyton spp.? Select all that apply. 1 Skin 2 Scalp 3 Brain 4 Lungs 5 Blood
1 Skin 2 Scalp Trichophyton spp. infections are superficial or topical infections that affect the skin and scalp. Cryptococcus neoformans infections affect the meninges of the brain. Infections by Aspergillus spp. affect the lungs. Severe infections caused by Candida albicans may affect the blood.
A patient is diagnosed with an oral candida infection. Which intervention will the nurse expect to implement? 1 Teach the patient how to take nystatin. 2 Instruct the patient to brush the teeth and gargle hourly. 3 Administer valacyclovir hydrochloride and monitor lips and gums. 4 Start an intravenous line so the patient does not have to eat by mouth.
1 Teach the patient how to take nystatin. Nystatin is an antifungal ointment that is used for a variety of candidal infections. The patient needs to be taught how to "swish and swallow" to treat this infection. There is no need to brush the teeth hourly or administer valacyclovir, and starting an intravenous line is an extreme measure.
For which is reason is the lipid dosage form of amphotericin B used only when patients are intolerant to nonlipid amphotericin B? 1 The lipid dosage form of amphotericin B is costly. 2 The lipid dosage form of amphotericin B is less effective. 3 The lipid dosage form of amphotericin B has a high incidence of adverse effects. 4 The lipid dosage form of amphotericin B requires the preadministration of antihistamines and corticosteroids.
1 The lipid dosage form of amphotericin B is costly. The lipid dosage form of amphotericin B is costlier than conventional amphotericin B, so it is used only when patients are intolerant to nonlipid amphotericin B. The lipid dosage form of amphotericin B is safer and more effective and shows fewer adverse drug interactions than conventional amphotericin B. Nonlipid amphotericin B requires preadministration of antihistamines and corticosteroids to decrease the severity of infusion-related reactions, but lipid formulations do not.
A patient with athlete's foot asks the nurse about the pathogenesis of fungal infections. Which information would the nurse include in the response? Select all that apply. 1 "Fungal infections are not fatal." 2 "Fungi can grow on skin and nails." 3 "Fungal infection may manifest as a mild illness." 4 "Fungal infections always spread through the oral route." 5 "Severe systemic fungal infections occur in immunocompromised people."
2 "Fungi can grow on skin and nails." 3 "Fungal infection may manifest as a mild illness." 5 "Severe systemic fungal infections occur in immunocompromised people." Dermatomycoses are fungal infections that develop on the skin, nails, or hair; they can range from mild, localized infections to serious, sometimes fatal systemic illness. Systemic fungal infections usually occur in patients with compromised immunity, such as those with acquired immune deficiency syndrome or patients who are receiving immunosuppressive drugs after an organ or bone marrow transplant. Infection may occur after oral ingestion, inhalation, or uncontrolled growth of normal skin flora.
Which instruction will the nurse include in the discharge teaching for a patient receiving tetracycline? 1 "Take the medication until you feel better." 2 "Use sunscreen and protective clothing when outdoors." 3 "Keep the remainder of the medication in case of recurrence." 4 "Take the medication with food or milk to minimize gastrointestinal upset."
2 "Use sunscreen and protective clothing when outdoors." Photosensitivity is a common side effect of tetracycline. Exposure to the sun can cause severe burns. The medication is taken when sick, not well. The medication should not be taken with milk and should be completely finished.
A patient is prescribed enteric-coated aspirin for joint pain management. Which statement does the nurse make to the patient while administering enteric-coated aspirin? 1 "You should chew the tablet properly." 2 "You should swallow the tablet with water." 3 "You should crush the tablet and mix with food." 4 "You should dissolve the tablet in water and then ingest."
2 "You should swallow the tablet with water." The enteric coating of the aspirin tablet prevents the release of the drug in the stomach; instead, it dissolves in the duodenum. Because aspirin does not come in contact with the stomach, this dosage form prevents gastric ulceration. While administering enteric-coated aspirin, the patient should take certain precautionary measures. The patient should swallow the tablet with water. The tablet should not be chewed because chewing breaks the protective layer of the tablet. The patient should avoid crushing the tablet and mixing with food because crushing the tablet breaks the outer layer of the tablet. The patient should avoid dissolving the tablet in water before administration because this reduces the effect of the medicine.
A patient has been prescribed tenofovir. After taking the drug for 3 days, the patient contacts the nurse to report experiencing muscle pain and weakness. Which action would the nurse take? 1 Reassure the patient that the symptom is time limited and will resolve. 2 Instruct the patient to hold doses of the medication until further notice. 3 Reassure the patient that this is an expected side effect of the medication. 4 Instruct the patient to self-medicate with a nonsteroidal antiinflammatory medication.
2 Instruct the patient to hold doses of the medication until further notice. The patient would not take any more doses of the medication until the health care provider can evaluate the patient. Muscle pain and weakness may be related to lactic acidosis, a serious adverse effect of the medication. The nurse's scope of practice does not allow for adjusting the patient's medication regimen.
Which precaution would the nurse follow while administering caspofungin to a patient with impaired liver function? 1 Injecting the caspofungin slowly 2 Reducing the dose of caspofungin 3 Replacing caspofungin with another drug 4 Administering caspofungin along with antihistamines
2 Reducing the dose of caspofungin Caspofungin is an echinocandin antifungal drug that is used for the treatment of severe Aspergillus infection. The dose of caspofungin is reduced in a patient who has impaired liver function to prevent further liver damage. The dose does not need to be injected slowly. The best precaution is to reduce the dose of caspofungin and not to replace it or give another drug along with it.
Which action would the nurse take before administering intravenous (IV) amphotericin B? 1 Set up an IV solution with potassium. 2 Administer insulin as prescribed to prevent severe hyperglycemia. 3 Administer an antipyretic, antihistamine, and antiemetic as prescribed. 4 Administer intravenous dextrose as prescribed to prevent severe hypoglycemia.
3 Administer an antipyretic, antihistamine, and antiemetic as prescribed. Nearly all patients given IV amphotericin B develop fever, chills, nausea and vomiting, and hypotension. Pretreatment with an antipyretic, antihistamine, and antiemetic can minimize or prevent these adverse reactions. There is no need to treat with IV potassium or administer insulin or IV dextrose.
The patient has been started on a medication regimen that includes sulfamethoxazole/trimethoprim. The nurse notes that the source of the patient's infection has been determined to be viral in origin. Which action is the nurse's highest priority? 1 Administer the medication as ordered by the health care provider. 2 Ensure that the information is documented in the chart. 3 Contact the health care provider to discuss the medication. 4 Ask the patient if he knows how he contracted the infection.
3 Contact the health care provider to discuss the medication. The health care provider should be contacted regarding the ordering of sulfamethoxazole/trimethoprim for this patient because it has not been shown to be effective in treating viral infections. Administering the medication as ordered is not helpful to the patient condition. It is necessary to document all information but is not the highest priority at this time. Asking the patient how he contracted the infection will not help this situation.
Which common factor contributes to the many drug interactions with antifungal agents? 1 History of cardiac disease 2 History of endocrine disorder 3 Cytochrome P-450 enzyme system 4 Increased metabolism of hypoglycemic drugs
3 Cytochrome P-450 enzyme system Many drugs, including antifungal drugs, are metabolized by the cytochrome P-450 enzyme system. Coadministration of two drugs that are both broken down by this system results in accumulation of one of the drugs in the body, which leads to undesirable side effects. A history of cardiac disease and endocrine disorder may not contribute to drug interactions with antifungal agents. Antifungal agents interact with hypoglycemic drugs and reduce their metabolism.
A patient is prescribed azithromycin for the treatment of a respiratory tract infection. Which parameters need to be assessed in the patient to ensure safe drug administration? Select all that apply. 1 Skin turgor 2 Visual acuity 3 Liver function 4 Baseline hearing status 5 Baseline cardiac function
3 Liver function 4 Baseline hearing status 5 Baseline cardiac function Azithromycin is a macrolide antibiotic. Liver function is assessed in the patient because macrolide antibiotics may cause hepatotoxicity and jaundice. The patient's baseline hearing status should be assessed because the treatment may induce hearing loss and tinnitus. The patient's baseline cardiac function should be assessed because macrolide antibiotics may lead to palpitations, chest pain, and electrocardiogram changes in the patient. Macrolide antibiotics do not affect skin turgor or visual acuity; therefore, these parameters do not need to be assessed.
A patient who is about to undergo an open cholecystectomy is administered intravenous ceftriaxone. Which antibiotic treatment is the patient likely getting? 1 Empiric 2 Definitive 3 Prophylactic 4 Colonization
3 Prophylactic A prophylactic antibiotic treatment is administered before the actual onset of an infection. Surgery places a patient at a major risk for infection. Therefore antibiotic treatment given before surgery is a prophylactic treatment against infection. Empiric treatment is given before the causative organism is identified for infection. Definitive treatment is provided when the causative organism is known and the antibiotic treatment is focused on the causative organism. Colonization refers to the residing bacteria on the skin or other body parts.
Which antifungal drug is contraindicated during pregnancy? 1 Nystatin 2 Imidazole 3 Voriconazole 4 Amphotericin B
3 Voriconazole Voriconazole is used for the treatment severe fungal infections and is the only antifungal drug that is contraindicated in pregnant patients because it may cause fetal toxicity. Nystatin, imidazole, and amphotericin B are safe to use during pregnancy and therefore are not contraindicated.
Which medication is the antifungal drug of choice for the treatment of many severe systemic fungal infections? 1 Nystatin 2 Griseofulvin 3 Ketoconazole 4 Amphotericin B
4 Amphotericin B Amphotericin B is the drug of choice for the treatment of many severe systemic fungal infections and is effective against a wide range of fungi. Although nystatin acts in a similar manner to amphotericin B, its use is limited because of its toxic effects when given in dosages required to accomplish the same antifungal actions as amphotericin B. Griseofulvin has no effect on filamentous fungi such as Aspergillus, and its use has been largely replaced by the newer antifungal drug classes. Ketoconazole inhibits many dermatophytes and fungi that cause systemic mycoses, but it is not active against Aspergillus organisms or Phycomycetes.
The health care provider orders ritonavir for a patient who has acquired immune deficiency syndrome. The nurse would inform the patient about which adverse effect of ritonavir therapy? 1 Pancreatitis 2 Photophobia 3 Bone marrow suppression 4 Bony appearance of the face
4 Bony appearance of the face Ritonavir is a protease inhibitor, which causes adverse effects such as bony appearance of the face and a hump on the posterior side of the neck. Pancreatitis, photophobia, and bone marrow suppression are not adverse effects of ritonavir.
A nurse has a sample of the medicine nystatin. Which type of patient will receive this medication? 1 Patients with aspergillosis infection 2 Patients with cryptococcus infection 3 Patients with histoplasmosis infection 4 Patients with oral candidiasis infection
4 Patients with oral candidiasis infection Nystatin is not available for parenteral administration; therefore, its use is restricted to managing oral and pharyngeal candidiasis. The excessively high dose of oral nystatin required to treat aspergillosis, cryptococcosis, and histoplasmosis, would result in unacceptable toxicity, making it inappropriate treatment for these fungal infections.
While assessing a patient who began treatment with an antifungal drug 1 week earlier, the nurse notes an interval weight gain of 6 pounds. Upon notifying the primary health care provider of this change, which diagnostic testing would the nurse anticipate? 1 Pulmonary function tests 2 Cardiac enzyme and CRP levels 3 Liver enzyme and bilirubin levels 4 Serum blood urea nitrogen and creatinine levels
4 Serum blood urea nitrogen and creatinine levels A gain of 6 pounds in a week after the initiation of antifungal therapy indicates the possibility of medication-induced renal dysfunction. The patient should be assessed for renal function, and appropriate medical attention should be provided. Hepatic, cardiac, and pulmonary problems are uncommon causes of acute weight gain in patients receiving antifungal drug therapy.
Which form of the antifungal drug terbinafine is used primarily to treat onychomycoses of the fingernails or toenails? 1 Gel 2 Spray 3 Cream 4 Tablet
4 Tablet Terbinafine is an allylamine antifungal drug and is the only drug in its class. Onychomycoses of the fingernails or toenails are primarily treated using the oral form of terbinafine. Gel, spray, and cream forms are used for the treatment of superficial dermatologic infections.
In which anatomic region(s) in human beings can fungi be found as part of the normal flora? Select all that apply. 1 Liver 2 Lungs 3 Spleen 4 Vagina 5 Intestine
4 Vagina 5 Intestine Certain fungi are part of the normal flora in the vagina and intestines of human beings. Fungi can also be part of normal flora in the mouth and on the skin. The presence of fungi in the liver, lungs, or spleen is not normal and should be investigated for possible infection.
