Chapter 11 Antifungal Agents PrepU
The physician is considering prescribing itraconazole for a client. The physician should order the drug only after confirming that the client is not: hypertensive. diabetic. taking pimozide. hypotensive.
taking pimozide.
An immunocompromised client with a diagnosis of candidiasis has failed to respond to conservative therapy and has consequently begun treatment with amphotericin B. The nurse is aware that this drug achieves a therapeutic effect by its influence on:
the permability of fungal cell walls
A nurse is instructing a 19-year-old female patient on the use of fluconazole for candida vaginitis. A teaching priority will be to:
use an alternative form of birth control, if taking an oral contraceptive
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:
wash and dry the affected area before applying the ointment
Get a Culture!
•A culture should be obtained prior to prescribing anti-fungal agents. •Patients on antifungal agents are typically immunosuppressed and should not be placed at additional risks for incorrect agent and toxic effects.
Most Common Systemic Antifungal Agents
•Caspofungin (Cancidas) (IV) -Approved for the treatment of invasive aspergillosis in patients who are refractory to other treatments •Flucytosine (Ancobon) (Oral) -Less toxic drug used for the treatment of systemic infections caused by Candida or Cryptococcus •Nystatin (Mycostatin, Nilstat) (Oral) -Used for the treatment of intestinal candidiasis; also available in a number of topical preparations
A client's fungal infection will be treated with amphotericin B. The nurse should question the prescription if what route of administration is specified?
subcutaneous
What serious adverse effect is most associated with amphotericin B?
nephrotoxicity
When assessing for potential signs and symptoms of cryptococcosis, the nurse should prioritize what assessment?
neurological assessment
What antifungal medication has the same mechanism of action as amphotericin B but is used only in the topical treatment of candidiasis? nystatin terbinafine fluconazole griseofulvin
nystatin
The primary health care provider prescribes flucytosine to treat a systemic fungal infection. The nurse would administer this drug by which route?
oral
A client is receiving amphotericin B. The nurse would assess the client closely for which adverse reaction?
renal impairment
A client is receiving amphotericin B. The nurse would assess the client closely for which adverse reaction? renal impairment intensive weight loss skin discoloration CNS disorders
renal impairment
A client has been administered amphotericin B. The nurse should monitor the client for the adverse effect of:
renal impairment.
A nurse is caring for a client who is receiving amphotericin B. Which medication could the nurse administer concomitantly to promote client comfort?
antipyretics -antipyretics reduce fever
The nurse is caring for a client who has a fungal infection and who has been prescribed fluconazole . The nurse should understand that the medication will eradicate the fungus by:
blocking the activity of a sterol in the fungal wall. Explanation: Fluconazole blocks the activity of a sterol in the fungal wall. Terbinafine inhibits the CYP2D6 enzyme system. Posaconazole and voriconazole inhibit the synthesis of ergosterol leading to an inability of the fungus to form a cell wall. The echinocandins work by inhibiting glucan synthesis.
Anidulafungin is prescribed to treat what form of fungal infection?
candidiasis
A parent has informed the nurse that she has been applying an OTC antifungal to her infant's buttocks and perineal region. What question related to safety should the nurse ask the parent?
"Are there any open wounds on the areas where you're putting the ointment?
A parent has informed the nurse that she has been applying an OTC antifungal to her infant's buttocks and perineal region. What question related to safety should the nurse ask the parent? "Are there any open wounds on the areas where you're putting the ointment?" "Did you take any antifungal medications while you were pregnant?" "Did you explore any herbal or alternative remedies before starting to use this ointment?" "Does your infant have any food allergies that you're aware of yet?"
"Are there any open wounds on the areas where you're putting the ointment?"
A parent has informed the nurse that she has been applying an over the counter antifungal to her infant's buttocks and perineal region for a rash. What question related to safety should the nurse ask the parent?
"Are there any open wounds on the areas where you're putting the ointment?"
Azole antifungals require caution under certain conditions. For which of the following patients would the nurse be most cautious when administering ketoconazole? Select all that apply.
-78-year-old with cirrhosis -woman who is 4 weeks postpartum
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?
"Have you been prescribed any antibiotics in the recent past?"
A client with a fungal infection has been prescribed a miconazole vaginal suppository. What education should the nurse provide about safe and effective administration?
"If possible, lie down for 10 or 15 minutes after inserting the medication."
A student has presented to the campus medical clinic reporting signs and symptoms that suggest vaginal candidiasis. What assessment question should the nurse prioritize when assessing the safety and effectiveness of drug therapy?
"Is there any possibility that you could be pregnant?"
A student has presented to the campus medical clinic reporting signs and symptoms that suggest vaginal candidiasis. What assessment question should the nurse prioritize when assessing the safety and effectiveness of drug therapy? "Is there any possibility that you could be pregnant?" "When was the last time that you had a yeast infection?" "Are you allergic to aspirin or any other over-the-counter pain medications?" "Would you say that you generally eat a healthy diet?"
"Is there any possibility that you could be pregnant?"
A nurse is caring for a client who is recceiving fluconazole. Which statement by the nurse should be used in the teaching plan for the medication?
"It decreases the localized yeast production."
The nurse is working with a client with a cutaneous fungal infection. The client was prescribed a topical antifungal ointment. The client tells the nurse, "I went ahead and bought a steroid ointment at the drugstore because I read it might help with my skin infection." What is the nurse's best response?
"It is best to check with your health care provider before applying any of the steroid ointment."
A nurse is teaching an 82-year-old client about amphotericin B, an antifungal ordered by the physician. Which client statement would suggest that teaching has been effective?
"Taking this drug could damage my kidneys."
A client is being treated with amphotericin B. Which statement indicates that the client has understood the client teaching?
"The medication may cause kidney damage."
A client is being treated with amphotericin B. Which statement indicates that the client has understood the teaching?
"The medication may cause kidney damage."
A client is receiving gentian violet as topical treatment for a fungal infection. What instruction should the nurse include in the teaching plan?
"This medication can stain your skin and clothing."
A client is receiving gentian violet as topical treatment for a fungal infection. What instruction should the nurse include in the teaching plan? "This medication can stain your skin and clothing." "Take this medicine with good to minimize upset stomach." "Cover the area with plastic wrap to seal it off." "Apply a thin layer of the medicine to any open areas on your skin."
"This medication can stain your skin and clothing."
A client with migraine headaches typically uses ergot for relief. The client now has a systemic fungal infection for which voriconazole is prescribed. Which suggestion would be most appropriate for the nurse to give?
"Wait until you've finished the regimen of voriconazole before using the ergot again."
A client is prescribed terbinafine for treatment of onychomycosis of the toenail. What should the nurse teach the client about this treatment?
"You'll likely have to take this medication for around 3 months."
A client states, "My doctor said that I had mycosis, but I thought I had a fungal infection." Which response would be most appropriate?
"You're both correct because mycosis means a disease is caused by a fungus."
What medications are classified as echinocandin antifungals? (Select all that apply.)
-Anidulafungin (Eraxis) -Caspofungin (Cancidas) -Micafungin (Mycamine)
Fluconazole is the prototype for antifungals. Which are characteristics of fluconazole? (Select all that apply.)
-Binds to sterols in the fungal cell membrane -Metabolized in the liver and excreted in the urine -Treatment of oropharyngeal, esophageal, and vaginal candidiasis
Incidence of fungal infections has increased with the rising number of people who are immunocompromised. What groups are considered to have a compromised immune system? (Select all that apply.)
-Clients with acquired immune deficiency syndrome (AIDS) and AIDS-related complex (ARC) -Clients taking immunosuppressant drugs -Clients who have undergone transplantation surgery or cancer treatment -The elderly
What are trade names for clotrimazole vaginal preparations? (Select all that apply.)
-Mycelex-7 -Lotrimin 3
A nurse is caring for a client who is receiving fluconazole and amphotericin B. The prescriber has just added flucytosine to the treatment regime. Which information should be used in the teaching plan for the medication? Select all that apply.
-The medication is for the treatment of chromomycosis and aspergillosis. -Reduce dosage for clients with impaired renal function.
For which patients is it safe to administer echinocandin antifungals? Select all that apply.
-a 40-year-old Olympic athlete -a 65-year-old patient with hypothyroidism
Incidence of fungal infections has increased with the rising number of people who are immunocompromised. Which clients are considered to have a compromised immune system? Select all that apply.
-a 55-year-old client with acquired immune deficiency syndrome (AIDS) -a 72-year-old taking prednisone -a 22-year-old undergoing chemotherapy treatments -an 85-year-old diagnosed with diabetes
A 42-year-old woman with a systemic fungal infection is admitted to the hospital. The nurse practitioner prescribes ketoconazole. The nurse preparing to administer this medication understands that azole antifungals require caution under certain conditions. To which patient would the nurse be especially cautious about administering this drug? Select all that apply.
-client with hepatic dysfunction -a pregnant woman with a history of headaches
Antifungal drugs are available that do not fit into either the azole or echinocandin groups. Which fall into the other group? Select all that apply.
-griseofulvin (generic) -amphotericin B (Abelcet) -flucytosine (Ancobon) -nystatin (Mycostatin)
A client is receiving flucytosine. The nurse is reviewing the client's serum drug level. Which serum drug level would lead the nurse to suspect that the client is developing toxicity?
110 mcg/mL
A client is receiving flucytosine. The nurse is reviewing the client's serum drug level. Which serum drug level would lead the nurse to suspect that the client is developing toxicity? 22 mcg/mL 45 mcg/mL 88 mcg/mL 110 mcg/mL
110 mcg/mL
The nurse is caring for a client who has a systemic infection and who has been prescribed griseofulvin. After administering a dose at 0900, the nurse should expect the drug levels to peak at what time?
1300 hours
The nurse cautions a client taking sulconazole to limit therapy to which duration?
6 weeks Naftifine, oxiconazole, sertaconazole nitrate, and terbinafine should not be used longer than 4 weeks.
Fungus
A cellular organism with a hard cell wall that contains chitin and many polysaccharides, as well as a cell membrane that contains ergosterols.
The nurse is caring for several clients who have fungal infections. Which client should the nurse prioritize for informing the provider?
A client receiving amphotericin B whose torso appears jaundiced
The nurse is providing care for a diverse group of clients. Which client should the nurse monitor most closely for signs and symptoms of a fungal infection?
A client who is receiving combination therapy for acquired immunodeficiency syndrome (AIDS)
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.
A pharmacology student is learning about amphotericin B. This drug can be administered via which route? A. IV B. IM C. SQ D. IF
A. Amphotericin B can be given intravenously. It is not administered via the subcutaneous or intramuscular routes.
The nurse is working with a client with a cutaneous fungal infection. The client was prescribed a topical antifungal ointment. The client tells the nurse, "I went ahead and 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. "It's best to check with your health care provider before applying any of the steroid ointment." B. "Actually, that ointment would probably make your infection worse, not better." C. "You can't safely take any over-the-counter drugs while you're taking a prescription drug." D. "Any ointment that you're able to buy without a prescription likely isn't going to help much."
A. 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.
Which statement would be correct for a client regarding the administration of an antifungal medication? A. Instruct the client to complete the entire drug therapy even if a dose is missed. B. Advise that for persistent headache, unrelieved by acetaminophen, the client should increase the dosage of acetaminophen. C. Instruct the client to take a forgotten dose as soon as it is remembered, even if it is time for the next dose. D. Instruct the client to take frequent meals of fat and protein when GI distress occurs.
A. Any client who is prescribed an antiviral or an antifungal drug needs to be advised to complete the entire drug therapy religiously and not to miss any drug dose. However, he or she need not take the missed dose if it is already time for the next dose. Clients should be informed that they should seek the advice of the prescriber if they experience any adverse effects such as redness, headache, swelling, or an aggravated lesion on the body. Clients should be advised to remain well hydrated throughout the therapy and not take heavy, fatty meals if they suffer from GI distress.
A client with chronic renal failure has been prescribed clotrimazole for the treatment of a fungal infection. How should the client's health history affect the treatment plan? A. The presence of kidney disease has no significant effect on the use of clotrimazole B. Hemodialysis will remove serum clotrimazole so dosages must be adjusted accordingly C. The client will require a reduced dose due to impaired excretion D. Kidney disease rules out the safe and effective use of clotrimazole
A. Because clotrimazole is not absorbed systematically, there is no need to consider the client's renal function during treatment. Excretion does not occur.
A client is receiving gentian violet as topical treatment for a fungal infection. What instruction should the nurse include in the teaching plan? A. "This medication can stain your skin and clothing." B. "Take this medicine with good to minimize upset stomach." C. "Cover the area with plastic wrap to seal it off." D. "Apply a thin layer of the medicine to any open areas on your skin."
A. Explanation: Gentian violet stains the skin and clothing bright purple. Occlusive dressings should be avoided to prevent systemic absorption; gentian violet is very toxic when absorbed. Gentian violet should not be applied to open lesions. It is topical, not oral.
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 to 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.
The client is diagnosed with a Candida infection of the mouth. How will the nurse document this finding? A. Thrush B. Ringworm C. Dermatophytes D. Tinea cruris
A. 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.
Which nursing diagnosis would be most appropriate for a client being treated with an antifungal?
Acute pain related to GI, CNS, and local effects of the drug
The critical care nurse is administering intravenous anidulafungin to a client for the treatment of candidemia. The client's blood urea nitrogen and creatinine levels have been rising in recent days due to adverse effects of other medications. What is the nurse's best action?
Administer the medication as prescribed because it is not excreted renally
The nursing students are learning about the administration of medications in the skills laboratory. How would the nursing students learn to administer vaginal preparations of antifungal agents?
Administered high into the vagina
The incidence of fungal infections has recently dropped due to the advances in drug therapy.
False
Candida
fungus that is normally found on mucous membranes. can cause yeast infections or thrush of gastrointestinal tract and vagina in immunosuppressed patients.
The nurse is caring for a client 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?
Amphotericin B
Question: The nurse is caring for a patient with a fungal infection. Which of the following would be considered an adverse effect of an antifungal medication? A. Burning or irritation in the sexual partner B. Abnormal kidney function tests C. Upper abdominal pain D. Urinary retention
Answer: A. Burning or irritation in the sexual partner Rationale: Adverse effects: Troche: nausea, vomiting, abnormal liver function tests; topical: stinging, redness, urticaria, edema; vaginal: lower abdominal pain, urinary frequency, burning or irritation in the sexual partner
Question: Please answer the following statement as true or false. Nystatin, taken orally, is used for the treatment of intestinal candidiasis.
Answer: True Rationale: Nystatin (Mycostatin, Nilstat) (Oral) Used for the treatment of intestinal candidiasis; also available as a topical preparation.
A client receiving drug therapy for a fungal infection reports being nauseated and requests that the dose be decreased or medication changed. Which statement should form the basis of the nurse's response to the client's request?
Antifungal drugs that are effective for this disease without being excessively toxic to human cells are limited.
A client, being treated for a fungal infection, reports being nauseating and requests that the dose be decreased or medication changed. Which statement should form the basis of the nurse's response to the client's request?
Antifungal drugs that are effective for this disease without being excessively toxic to human cells are limited.
A client, being treated for a fungal infection, reports being nauseating and requests that the dose be decreased or medication changed. Which statement should form the basis of the nurse's response to the client's request? There are several other drugs available that are just as effective. Antifungal drugs are relatively inexpensive. Antifungal drugs that are effective for this disease without being excessively toxic to human cells are limited. The drugs that are effective are given intravenously and generally cause medical complications.
Antifungal drugs that are effective for this disease without being excessively toxic to human cells are limited.
A nurse is caring for a client who is receiving amphotericin B. Which medication could the nurse administer concomitantly to promote client comfort?
Antipyretics
A nurse is caring for a client who asks why she has been prescribed posaconazole following kidney transplantation. The nurse responds that posaconazole is used as prophylaxis to prevent:
Aspergillus infection.
A client tells the nurse that she has taken several doses of over-the-counter fluconazole to treat a "yeast infection." When assessing the client's risk for drug toxicity, what aspect of the client's health status should the nurse prioritize? A. The client has type 2 diabetes and takes oral hypoglycemics B. The client client has decreased renal function following recent pyelonephritis C. The client has lost over 30 lbs. in the past four months through diet and exercise D. The client experienced a transfusion reaction to packed red blood cells several years ago
B. Fluconazole is excreted largely unchanged in the urine, so decreased renal function creates a significant risk for toxicity. This aspect of the client's health history would likely create a greater risk than recent weight loss, type 2 diabetes or a history of transfusion reaction.
Which of the following is considered a contraindication of Ketoconazole ? A. Patients with renal problems B. Patients with fertility problems C. Patients with hepatic problems D. Patients with GI problems
B. Patients with fertility problems Rationale: Contraindications - not drug of choice for patients with endocrine or fertility problems.
A client is receiving flucytosine. The nurse is reviewing the client's serum drug level. Which serum drug level would lead the nurse to suspect that the client is developing toxicity? A. 22 mcg/mL B. 45 mcg/mL C. 110 mcg/mL D. 88 mcg/mL
C. Serum flucytosine levels greater than 100 mcg/mL are associated with toxicity.
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.
A client develops itching and burning of the vaginal vault while taking an anti-infective to treat strep throat. What fungal agent has caused the burning and itching?
Candida albicans
Caspofungin has been prescribed for a client diagnosed with invasive aspergillosis. The nurse should teach the client to promptly report what symptom associated with an adverse reaction?
Cardiac distress
The nurse is teaching peers about fungal infections and describes the cell membrane of a fungal cell how?
Contains ergosterol
The nurse is educating an 82-year-old client regarding amphotericin B (Fungizone). The nurse knows the client understand when the client states that he could develop which adverse effect?
Damage to his kidneys
A client is being treated for a fungal infection. The client reports that the medications are nauseating and requests that the dose be decreased or medication changed. The nurse should include what client education about the disease and treatment?
Drugs that are effective for this disease without being excessively toxic to human cells are limited.
A client with a fungal infection has been prescribed ketoconazole 250 mg PO daily. The client reports nausea and anorexia the day after starting the medication. What is the nurse's best action?
Encourage the client to try eating small, frequent meals rather than three larger meals
Guidelines for the use of topical antifungals in children are frequently the same as those for adults. However, safety and dosage recommendations have not been established for most oral and IV antifungals in the pediatric population. Which antifungal drug is suitable for pediatric use?
Fluconazole
A client has a history of deep vein thrombosis, for which he is taking warfarin. When providing education for this client, who is now also taking fluconazole to treat a localized candidal infection, the nurse should instruct the client that:
Fluconazole increases the effects of warfarin. Have routine lab tests done.
Tinea
Fungus called ringworm that causes such infections as athlete's foot, jock itch, and others.
A client taking an oral antifungal agent reports gastrointestinal upset. Which would be most appropriate to suggest?
Having the client take the drug with food
A nurse is caring for a 29-year-old man who is being treated for meningitis. He is receiving flucytosine (5-FC). Which will the nurse monitor weekly?
Hematologic status
A nurse is caring for a 29-year-old man who is being treated for meningitis. He is receiving flucytosine (5-FC). Which will the nurse monitor weekly? Blood pressure Hematologic status Visual acuity Blood glucose
Hematologic status
A pharmacology student is learning about amphotericin B. This drug can be administered via which route?
IV
A pharmacology student is learning about amphotericin B. This drug can be administered via which route? IV IM SQ IF
IV
A pharmacology student is learning about amphotericin B. This drug can be administered via which route? IV IM SQ IF
IV
The azole antifungals are contraindicated in clients with what condition?
Increased liver enzymes
The nurse is caring for a client who has been prescribed micafungin, 150 mg IV daily. What assessment should the nurse prioritize in this client's care?
Inspection of the client's mouth and throat
Which statement would be correct for a client regarding the administration of an antifungal medication?
Instruct the client to complete the entire drug therapy even if a dose is missed
Which statement would be correct for a client regarding the administration of an antifungal medication?
Instruct the client to complete the entire drug therapy even if a dose is missed.
A pharmacology student is learning about amphotericin B. This drug can be administered via which route?
Intravenous (IV)
Which antifungal agent is available for systemic and topical use?
Ketoconazole
Laboratory monitoring for clients on all systemic antifungal drugs should include what test?
LFTs (liver function tests)
A client with a cutaneous fungal infection has been prescribed naftifine. When reviewing the prescriber's instructions, what should the nurse explain to the client? Make sure you don't use this for more than one month." "Make sure to avoid taking any corticosteroid medications while you're on this drug." "If your schedule allows it, apply the ointment four or five times a day." "It's important to stay out of the sun until you've finished treatment."
Make sure you don't use this for more than one month."
A client with candidemia is receiving anidulafungin intravenously. What assessment should the nurse prioritize when assessing this client for adverse effects?
Monitoring the client for signs of hepatotoxicity
The nurse at a long-term care facility is admitting a new resident who is an older adult. The resident's current medication regimen includes nystatin 1,000,000 units PO t.i.d. The nurse should recognize the need to prioritize what aspect of this resident's care?
Mouth care
What serious adverse effect is most associated with amphotericin B?
Nephrotoxicity
What serious adverse effect is most associated with amphotericin B? Nephrotoxicity Hypovolemia Cardiogenic shock Septic shock
Nephrotoxicity
The nurse is treating a client for a systemic fungal infection with an oral fungicide. What would be an important nursing action for the nurse to perform?
Order dietary consultation as needed to ensure nutritional status.
The nurse is caring for a client receiving amphotericin B. Which condition should the nurse assess for in this client?
Phlebitis
An 80-year-old woman is receiving treatment with oral fluconazole for a fungal infection Following yesterday's and today's dose, she reports an upset stomach to the charge nurse. How should the nurse at the facility best respond to the woman's report?
Provide food along with the fluconazole when administering it in the future.
An 80-year-old woman who resides in a care facility is receiving treatment with oral fluconazole for a fungal infection. Following yesterday's and today's dose, she reports an upset stomach. How should the nurse at the facility best respond to the woman's report?
Provide food along with the fluconazole when administering it in the future.
The nurse is caring for a client who has been admitted to the hospital with histoplasmosis. The client's admission orders include ketoconazole 300 mg IV daily. What is the nurse's best action? Question the care provider about the route Question the care provider about the dose and frequency Confirm that the client does not have allergies to penicillins or NSAIDs Review the client's indicators of renal function and administer the medication
Question the care provider about the route
The nurse is administering an antifungal medication. What is the most relevant testing required for the client taking this medication?
Renal testing
The nurse is administering an antifungal medication. What is the most relevant testing required for the client taking this medication? HIV testing Neurologic testing Renal testing Ophthalmologic testing
Renal testing
The critical care nurse is caring for a client whose systemic fungal infection is being treated with amphotericin B. The nurse's review of the client's most recent laboratory results indicates a white cell count of 2050/µL (2.05 ×109/L). What is the nurse's best action?
Report the client's possible bone marrow suppression to the client's provider
A client with a systemic fungal infection has been prescribed ketoconazole 350 mg PO daily. What assessment should the nurse prioritize before administration?
Review of liver enzyme levels
A client with a systemic fungal infection has been prescribed ketoconazole 350 mg PO daily. What assessment should the nurse prioritize before administration? Review of liver enzyme levels Assessment of cranial nerve function Review of blood urea nitrogen and creatinine levels Review of potassium, sodium and chloride levels
Review of liver enzyme levels
A client has been prescribed sulconazole for the treatment of tinea pedis. When nursing diagnosis should the nurse identify when planning this client's care?
Risk for impaired skin integrity related to local irritation
When administering the azoles in the home setting, the home health nurse should prioritize educational interventions that address what nursing diagnosis?
Risk for infection related to antifungal therapy
When administering the azoles in the home setting, the home health nurse should prioritizeeducational interventions that address what nursing diagnosis? Risk for injury related to antifungal therapy Risk for acute confusion related to antifungal therapy Risk for infection related to antifungal therapy Risk for falls related to antifungal therapy
Risk for infection related to antifungal therapy
Ergosterol
Steroid type protein found in the cell membrane of fungi. Similar in configuration to adrenal hormones and testosterone.
A client with topical mycosis was prescribed oxiconazole for topical administration and has been using the medication for 10 days. The client now reports an open wound on the same region. What is the nurse's best action?
Tell the client not to administer the medication and to come be assessed by the provider
Antifungal drugs are available that do not fit into either the azole or echinocandin groups. Which drug does not fall into the other group?
Terbinafine
A client tells the nurse that she has taken several doses of over-the-counter fluconazole to treat a "yeast infection." When assessing the client's risk for drug toxicity, what aspect of the client's health status should the nurse prioritize? The client client has decreased renal function following recent pyelonephritis The client has type 2 diabetes and takes oral hypoglycemics The client has lost over 30 lbs. in the past four months through diet and exercise The client experienced a transfusion reaction to packed red blood cells several years ago
The client client has decreased renal function following recent pyelonephritis
An older adult client has been diagnosed with candidiasis and prescribed fluconazole. What aspect of the client's health status should warrant close monitoring by the nurse?
The client has atrial fibrillation and takes warfarin daily
A client tells the nurse that she has taken several doses of over-the-counter fluconazole to treat a "yeast infection." When assessing the client's risk for drug toxicity, what aspect of the client's health status should the nurse prioritize?
The client has decreased renal function following recent pyelonephritis
A client's previous medical history includes mycosis. What conclusion should the nurse draw from this fact?
The client has had a disease that was caused by a fungus
The nurse is caring for a client whose fungal infection is being treated with ketoconazole. What change in the client's health status should the nurse prioritize when updating the provider on the client's condition?
The client's aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels are elevated
A client is being treated for histoplasmosis with amphotericin B. The nurse has completed a comprehensive assessment of the client and should report what assessment finding?
The client's urine output is 75 mL over six hours
A client asks why it is necessary to receive IV fluid hydration prior to initiation of amphotericin B infusion. The nurse's best response should be based on what information concerning amphotericin B infusions?
The risk of nephrotoxicity can be reduced by hydrating the client before infusion.
An adult client who is critically ill with histoplasmosis has been prescribed amphotericin B 60 mg PO daily. What aspect of this order should the nurse discuss with the prescriber?
The route -Amphotericin B is only available for intravenous administration.
Which statement best describes topical antifungal agents?
They are too toxic to be used systemically
Which statement best describes topical antifungal agents?
They are too toxic to be used systemically.
The client is diagnosed with a Candida infection of the mouth. How will the nurse document this finding?
Thrush
The client is diagnosed with a Candida infection of the mouth. How will the nurse document this finding? Thrush Ringworm Dermatophytes Tinea cruris
Thrush
Ketoconazole is available in oral form, a shampoo, and a cream True False
True
Ketoconazole is available in oral form, a shampoo, and a cream. True False
True
The client is receiving ketoconazole. The nurse should be concerned about a drug-drug interaction on the basis of what other comorbidity?
Type 2 diabetes
Azoles
a group of drugs used to treat fungal infections
The nurse is providing health education to a client with vaginal candidiasis. The client's health provider has prescribed tioconazole. What should the nurse teach the client?
a one time dose will likely cure the infection
A nurse is explaining the use of griseofulvin to a patient. It will be important for the nurse to assess for the patient's use of:
alcohol
A group of students are studying for a test on antifungal agents. The students demonstrate understanding of the material when they identify which as an example of an echinocandin antifungal?
caspofungin
What would be most important for the nurse to monitor in a client receiving amphotericin B?
complete blood count (CBC)
An older adult resident of a long-term care facility has been diagnosed with a fungal infection and has been prescribed fluconazole. What change in the client's laboratory values may necessitate a change in medication therapy?
decreased creatinine clearance
An adult client, recently diagnosed with a tinea infection, has begun treatment with griseofulvin. During a scheduled clinic visit, the client states to the nurse, "I'm pretty good at reading my body's signals, so I make sure to take a bit extra when I think my infection is getting worse." This client's statement is suggestive of what nursing diagnosis?
deficient knowledge related to correct use of griseofulvin
Mycosis
disease caused by a fungus
A client is undergoing treatment with amphotericin B. The client feels like a medication reaction is taking place about 1 hour into the infusion and reports fevers and chills. The nurse should:
inform the client that this is a common reaction. Obtain orders to treat the client's fever and provide comfort measures for the chills
A client with recurrent vaginal yeast infections is to receive tioconazole. The nurse should instruct the client to do what?
insert a full applicator at bedtime only once.
A client has been placed on amphotericin B. The nurse caring for this client should administer this medication:
intravenously
The azoles are a large group of antifungals used to treat systemic and topical fungal infections. Which are considered azoles? (Select all that apply.) caspofungin acetate itraconazole ketoconazole terbinafine fluconazole
itraconazole ketoconazole terbinafine fluconazole
An adult client has begun treatment with fluconazole. The nurse should recognize the need to likely discontinue the drug if the client develops which sign or symptom?
jaundice
An adult client has begun treatment with fluconazole. The nurse should recognize the need to likely discontinue the drug if the client develops which sign or symptom? jaundice weight gain iron deficiency anemia hematuria
jaundice
A client asks the nurse if the client should use a topical antifungal. The nurse is aware that contraindications to topical antifungals are limited to clients with:
known allergy to any of the antifungal drugs.
How Fungus Differs from Bacteria
•Fungus -Composed of a rigid cell wall made up of chitin and various polysaccharides, and a cell membrane containing ergosterol. -Protective layers of the fungal cell make the organism resistant to antibiotics.
Topical antifungal agents
•Indication- Work to alter the cell permeability of the fungus, causing prevention of replication and fungal death, indicated only for local treatment of mycoses, including tinea infections •Pharmacokinetics- Not systemic •Contraindications- Limited to known allergy to any of these drugs •Adverse Reactions- Irritation, burning, rash, and swelling at the site •Drug-to-drug Interactions: Unknown
Echinocandin Antifungals
•Indications - Another group of antifungals, inhibit glucan synthesis leading to death of the cell wall •Pharmacokinetics - Given IV, rapid onset, metabolized degradation and excreted in feces •Contraindications - Hepatic /renal dysfunction, pregnancy and lactation •Adverse effect- Liver toxicity, tetrogenic effects and bone marrow supression •Drug-to-Drug Interaction- Cyclosporine
Azoles -treats systemic fungal infections
•Indications - Newer class of drugs used to treat systemic fungal infections, less toxic than amphotericin B but also less effective, bind to sterols and can cause cell death, inhibit glucan synthesis •Pharmacokinetics - Absorbed rapidly from the GI tract, metabolized in the liver and excreted in urine and feces •Contraindications - Hepatic and renal dysfunction, pregnancy and lactation and drugs that prolong the QTc interval •Adverse effect- Liver toxicity and tetrogenic effects •Drug-to-Drug Interaction- Many
Flucytosine
•Indications - Prevent the fungal cells from reproducing by altering the cell membrane •Pharmacokinetics - IV form only, metabolism not well understood, excreted in the urine •Contraindications - Pregnancy, lactation and renal impairment •Adverse Effect - Toxic effects on the liver and kidneys and bone marrow suppression •Drug-to-drug Interaction- Nephrotoxic antibiotics or antineoplastics, cyclosporine, or corticosteroids
Amphoteracin B
•Indications - Very potent - reserved for progressive potential fatal fungal infections •Pharmacokinetics - IV form only, metabolism not well understood, excreted in the urine •Contraindications - Pregnancy, lactation and renal impairment •Adverse Effect - related to their toxic effects on the liver and kidneys, severe renal impairment and bone marrow suppression •Drug-to-drug Interaction- Nephrotoxic antibiotics or antineoplastics, cyclosporine, or corticosteroids
Patients at risk for fungal infections
•Patients with AIDS and AIDS-related complex (ARC) •Patients taking immunosuppressant drugs •Patients who have undergone transplantation surgery or cancer treatment •Members of growing elderly population no longer protected from environmental fungi
