Lehne - Chs. 92, 93 - Antifungals, Antivirals (Non-HIV)

The nurse identifies terbinafine (Lamisil) as useful for treating which conditions? (Select all that apply.) A. Onychomycosis B. Tinea corporis C. Oropharyngeal candidiasis D. Vulvovaginal candidiasis E. Tinea pedis

A, B, E Terbinafine (Lamisil) is highly active against dermatophytes and is used to eradicate fungal infection of the nails (onychomycosis) and as topical therapy for ringworm infections (tinea corporis, tinea pedis). It is not effective against oropharyngeal and vulvovaginal candidiasis.

A nurse administering flu vaccines at an annual clinic should recognize that which individuals should be vaccinated, as recommended by the Advisory Committee on Immunization Practices (ACIP)? (Select all that apply.) A. Women who will be pregnant during flu season B. All children 6 months and older and older adults C. Those who report severe allergy to chicken eggs D. Those who have a history of Guillain-Barré syndrome E. Those 6 months to 18 years old receiving aspirin therapy

A, B, E The ACIP recommends flu vaccination for all children 6 months and older and for older adults. Individuals at high risk of complications from the flu who also should be vaccinated include women who will be pregnant during flu season and children receiving long-term therapy with aspirin (to prevent Reye's syndrome). Influenza vaccines are produced from viruses grown in eggs and should be avoided in persons with allergies to chicken eggs. Influenza vaccine may carry a small risk of Guillain-Barré syndrome, a paralyzing neuromuscular disorder, and should be avoided in those who have experienced it.

When teaching a patient about therapy with Famciclovir, which statement(s) does the nurse include? (Select all that apply.) A. Famciclovir is generally well tolerated. B. Famciclovir is safe to use during pregnancy. C. Famciclovir is administered intravenously. D. Famiciclovir is used in the treatment of acute herpes zoster. E. Famiciclovir is contraindicated in the treatment of herpes simplex genitalis.

A, D Famiciclovir is generally well tolerated and is used in the treatment of acute herpes zoster as well as herpes simplex genitalis. The safety of Famiciclovir during pregnancy and breat-feeding and in children younger than 18 years has not been established. Famiciclovir is supplied in tablets for oral dosing.

A nurse is administering an oral dose of itraconazole (Sporanox) to a patient at 10:00 AM. The nurse should administer a prescribed dose of famotidine (Pepcid) at which time? A. 9:00-9:30 AM B. 10:00 AM C. 10:30 AM D. 11:00 AM

A. 9:00-9:30 AM Medications that lower gastric acidity, such as famotidine (Pepcid), can reduce absorption of oral itraconazole (Sporanox) Those agents should be given at least 1 hour before itraconazole or 2 hours after. The other time administrations would interfere with absorption of itraconazole.

Which approach should a nurse take to administer intravenous (IV) acyclovir (Zovirax) to an immunocompromised patient? A. Infuse IV fluids during administration of the dose and for 2 hours afterward. B. Administer IV acyclovir diluted in 20 mL normal saline (NS) over 10 minutes. C. Only infuse the drug if the white blood cell (WBC) count is above 2500/mm3. D. Ask the provider to change the route to subcutaneous (subQ) injection.

A. Infuse IV fluids during administration of the dose and for 2 hours afterward. Acyclovir can cause renal damage, and hydration of the patient during the infusion and for 2 hours afterward minimizes this risk. Acyclovir is not given by IV bolus or by intramuscular (IM) or subQ injection. It is used to treat infections in immunocompromised patients, but the dose is not changed or affected by the WBC count.

A nurse is preparing to administer ganciclovir (Cytovene) to a patient for treatment of Cytomegalovirus (CMV) pneumonitis. Which laboratory result should the nurse recognize as a contraindication to use of this drug? A. Neutrophil count below 500/mm3 B. Platelet count of 350,000/mm3 C. Serum calcium level of 9.5 mg/dL D. Reduced forced vital capacity (FVC)

A. Neutrophil count below 500/mm3 Ganciclovir is used to treat and prevent CMV infection in immunocompromised patients. Bone marrow suppression is a dose-limiting toxicity of ganciclovir; therefore, the drug is contraindicated in patients with neutrophil counts below 500/mm3 or platelet counts below 25,000/mm3. It does not affect the serum calcium level or FVC, a measure of lung function in patients who have airflow-restrictive disorders.

A nurse planning care for a patient who is receiving nystatin (Mycostatin) should establish which outcome on the care plan? A. Relief of nasal congestion B. Decrease in mouth pain C. Productive cough D. Absence of urticaria

B. Decrease in mouth pain Nystatin is an antifungal medication that is used for candidiasis of the skin, mouth, esophagus, intestine, and vagina. It can be administered orally and topically and will heal mouth lesions from oral candidiasis. Nystatin has no effect on nasal congestion and cough production. It does not cause urticaria.

A nurse develops a plan of care for a patient who has an outbreak of recurrent genital herpes and is taking oral acyclovir (Zovirax). Which outcome should be included? A. Minimal scarring from lesions B. Less frequent eruption of lesions C. Prevention of transmission to contacts D. Complete eradication of the virus

B. Less frequent eruption of lesions Acyclovir is used to treat herpes simplex infections caused by type 2 herpes simplex virus (HSV-2). For patients with recurrent herpes genitalis, oral therapy reduces the frequency with which lesions appear. It does not eradicate the virus or produce cure. Acyclovir does not prevent transmission of the virus to sexual contacts. It does not affect scarring from lesions.

A patient has been diagnosed with respiratory syncytial virus. The nurse anticipatates administration of which drug(s)? (Select all that apply.) A. Ganciclovir B. Oseltamivir C. Ribavirin (inhaled) D. Palivizumab E. Entecavir

C, D Ribavirin (inhaled) and Palivizumab are used for the treatment of RSV. Ganiciclovir is useful in the treatment of cytomegalovirus. Oseltamivir is used for the treatment of Influenza A and B. Entacavir is a nucleoside analog used in the treatment of HBV.

What is the priority instruction a nurse gives to a male patient who is scheduled to receive ribavirin (Rebetol) combined with peg-interferon-alfa-2a for treatment of hepatitis C? A. "Combining these two medications will greatly increase response rates." B. "An antidepressant can be prescribed to alleviate symptoms of depression." C. "If you are sexually active, use two reliable forms of birth control to prevent pregnancy." D. "It is very important that you have blood counts checked every 2 weeks."

C. "If you are sexually active, use two reliable forms of birth control to prevent pregnancy." Because ribavirin is embryolethal when taken by female patients and causes sperm abnormalities when taken by males, it is a priority that pregnancy be avoided during its use. Pregnancy must be avoided both by female patients and by female partners of men taking ribavirin. Couples should use two reliable forms of birth control during treatment and for 6 months afterward. It is less important that the patient know that ribavirin is not effective against hepatitis C unless it is combined with interferon alfa. Less important information to provide than avoiding pregnancy includes: hemolytic anemia is an adverse effect; frequent blood checks are advised; and depression is an adverse effect of peg-interferon-alfa-2a for which antidepressants can be prescribed.

When providing teaching for a patient starting flucytosine (Ancobon) therapy, the nurse identifies what as the priority concern? A. "You will have weekly blood draws to monitor your liver function." B. "Another very strong medication may be needed in addition to this one." C. "You'll need to report any symptoms of bruising, fever, and fatigue." D. "The dose is 10 pills, so take a few at a time over a 15-minute interval."

C. "You'll need to report any symptoms of bruising, fever, and fatigue." Flucytosine (Ancobon) is used for serious infections caused by Candida and Cryptococcus neoformans. Bone marrow suppression may cause fatal agranulocytosis, so symptoms of bruising, fever, and fatigue could indicate life-threatening conditions. The other statements are true; however, they are not the priority concern. Flucytosine (Ancobon) is usually combined with amphotericin B. Treatment may require ingestion of 10 capsules 4 times per day. Taking these pills for a short time helps to reduce nausea. Hepatotoxicity is mild and reversible; liver function is monitored while the patient is receiving treatment.

A patient is scheduled to receive intravenous amphotericin B. Which medication should a nurse administer as pretreatment before the infusion? A. 10 units of regular insulin intravenously B. 20 mg famotidine (Pepcid) in 50 mL of 5% dextrose C. 50 mg of diphenhydramine (Benadryl) and 650 mg of acetaminophen D. 1 g of calcium gluconate in 100 mL of normal saline

C. 50 mg of diphenhydramine (Benadryl) and 650 mg of acetaminophen Almost all patients given intravenous amphotericin B develop fever, chills, and nausea. Pretreatment with diphenhydramine and an analgesic, such as acetaminophen, can minimize or prevent these adverse effects. It is not beneficial to administer calcium gluconate, insulin, or famotidine as pretreatment.

The nurse identifies which medication as the drug of choice for most infections caused by herpes simplex viruses and varicella-zoster virus? A. Ganiciclovir B. Amantadine C. Acyclovir D. Oseltamivir

C. Acyclovir Acyclovir is the drug of choice for most infections caused by herpes simplex viruses and varicella-zoster virus. Ganiciclovir is the drug of choice for prophylaxis and treatment of CMV infection in immunocompromised patients, including those with AIDS. Amantadine and Oseltamivir are drugs of choice for the treatment and prophylaxis of influenza.

A nurse is providing teaching to a group of patients regarding flu season in the United States. Which statement should the nurse include in the teaching? A. In the United States, flu season usually peaks in October or November. B. To insure full protection, the best time to vaccinate is September. C. For people who missed the best time, vaccinating as late as April may be of help. D. The influenza vaccine may not be administered at the same time as the pneumococcal vaccine.

C. For people who missed the best time, vaccinating as late as April may be of help. Peak flu season in the United States is usually January or February. To ensure full protection, the best time to vaccinate is October or November. For people who missed the best time, vaccinating as late as April may be helpful. Influenza vaccine may be given at the same time as other vaccines, including pneumococcal vaccine.

It is most important for the nurse to assess a patient taking itraconazole (Sporanox) for the development of what? A. Hair loss B. Skin rash C. Pedal edema D. Joint pain

C. Pedal edema Itraconazole (Sporanox) has negative inotropic actions and may cause a transient decrease in the ventricular ejection fraction, thus precipitating heart failure. Pedal edema is a symptom of heart failure, and the nurse should assess for it. Skin rash, hair loss, and joint pain are unrelated to the use of itraconazole.

A nurse should recognize that for maximum therapeutic effects against the influenza virus, oseltamivir (Tamiflu) should be taken when? A. Two days or more after symptom onset B. When lung crackles are present C. Within 12 hours of symptom onset D. Only when fever is above 102 °F

C. Within 12 hours of symptom onset Oseltamivir is a neuraminidase inhibitor that is effective against the influenza A and influenza B viruses. Its benefits decline greatly when treatment is delayed. Dosing must begin early—no later than 2 days after symptom onset. If treatment is started within 12 hours of symptom onset, symptom duration is reduced by more than 3 days. Specific symptoms, such as lung crackles and fever above 102 °F, are not criteria for receiving oseltamivir.

A nurse is teaching a patient who is scheduled to start taking itraconazole (Sporanox). Which statement by the patient would indicate understanding of the teaching? A. "I'll take diphenhydramine (Benadryl) before this medication so I don't have a reaction." B. "It's important to remember to wear sunscreen while taking this medicine." C. "I'll avoid citrus foods, such as oranges and grapefruits, while taking this medication." D. "If I notice my skin turning yellow or feel any nausea, I'll notify my healthcare provider."

D. "If I notice my skin turning yellow or feel any nausea, I'll notify my healthcare provider." Itraconazole may cause liver injury, and although a causal link has not been identified, patients need to be informed about symptoms to report. These include jaundice, nausea, and right upper abdominal pain. It is not necessary to take diphenhydramine, wear sunscreen, or avoid citrus products while taking itraconazole.

A patient is receiving amphotericin B. It is most important for the nurse to monitor which laboratory result? A. Serum pH B. Protein level C. Glucose level D. Creatinine level

D. Creatinine level Amphotericin B is toxic to cells of the kidneys. To evaluate renal injury, the plasma creatinine level should be monitored every 3 or 4 days, as well as intake and output. It is not necessary to monitor the serum protein or glucose levels or the serum pH in patients taking amphotericin B.

Which antifungal agent is used as a one-time oral dose to treat vaginal yeast infections? A. Nystatin (Mycostatin) B. Caspofungin (Cancidas) C. Voriconazole (Vfend) D. Fluconazole (Diflucan)

D. Fluconazole (Diflucan) Fluconazole (Diflucan) has almost 100% bioavailability and therefore is often sufficient as a single dose to treat vaginal yeast infections. Caspofungin (Cancidas) cannot be administered orally. It is used in patients unresponsive to amphotericin B. Nystatin (Mycostatin) is administered as an oral or topical application for candidiasis. Voriconazole (Vfend) is used in the treatment of aspergillosis.

A patient is receiving weekly subcutaneous injections of peg-interferon-alfa-2a (Pegasys) for chronic hepatitis C. A nurse teaches the patient that which adverse effect will diminish with continued therapy? A. Black, sticky, tarry stools B. Lower leg muscle weakness C. Dyspnea and wheezing D. Flulike symptoms

D. Flulike symptoms The most common adverse side effect of peg-interferon-alfa-2a, a long-acting interferon used to treat chronic hepatitis C, is flulike symptoms characterized by fever, fatigue, myalgia, headache, and chills. Symptoms are likely to diminish with continued therapy over time. Black, tarry stools; lower leg muscle weakness; dyspnea; and wheezing are not adverse effects of peg-interferon-alfa-2a.

A patient is receiving amphotericin B. The nurse identifies which medication as useful in preventing adverse effects of amphotericin B? A. Furosemide (Lasix) B. Insulin C. Vitamin K D. Potassium

D. Potassium Renal injury from amphotericin B may cause severe hypokalemia. Serum potassium levels should be monitored more frequently and potassium supplements given to correct low plasma levels. Furosemide, insulin, and vitamin K do not prevent any adverse effects of amphotericin B.