Ch. 32 Antituberculars, Antifungals, Peptides, and Metronidazole

Fluconazole (Antifungal): Side effects/ adverse reactions

-Anorexia, N/V/D, stomach cramps, rash, HA, -Vaginal: rash, burning, sensation

Isoniazid INH (Antitubercular): Side effects/ adverse reactions

-GI distress, constipation -Blurred vision, photosensitivity -Tinnitus, dizziness -Peripheral neuropathy (Give Vit B6) -Psychotic behavior, seizures -Blood dyscrasias, hepatotoxicity

Fluconazole (Antifungal): drug interactions

-Increase PT when taking warfarin -Increases phenytoin -Increases hypoglycemia when taking oral sulfonylureas

Isoniazid INH (Antitubercular): Drug interactions

-Increases effect of INH: Alcohol, rifampin, cycloserine, phenytoin -Decreases phenytoin effect when concurrent -Decreases absorption: Antacids -Alcohol: Increases risk of neuropathy, hepatotoxicity

A patient has developed active tuberculosis and is prescribed isoniazid and rifampin. Which information will the nurse include in teaching the patient about taking this drug? (Select all that apply.)

-Isoniazid should be given 1 hour before or 2 hours after meals. -Have periodic eye examinations as ordered by the health care provider. -Compliance with drug regimen is essential. -Report numbness, tingling, and burning of hands and feet. Rationale: Isoniazid should be given 1 hour before or 2 hours after meals for better absorption. Periodic eye examinations should be done as these drugs may cause visual disturbances. Compliance with drug regimen is essential to prevent drug resistance. Numbness, tingling, or burning of hands and feet should be reported. Rifampin may turn body fluids a harmless reddish orange color.

Isoniazid INH (Antitubercular): Patient Teaching

-Take INH 1 hour before meals or 2 hours after meals. -Must follow complete regimen -Collect sputum specimen in early morning. -Take pyridoxine (vitamin B6) to prevent peripheral neuropathy. -Check liver enzymes, CBC. -Need frequent eye examinations -Report numbness, tingling, burning. -Teach sun precautions, to avoid antacids.

Fluconazole (Antifungal): Action

Increases permeability of the fungal cell membrane

Which teaching for the patient who is taking fluconazole (Diflucan) is a priority for the nurse?

Advise that hypoglycemia may occur with concurrent oral sulfonylureas. Rationale: Hypoglycemia may occur in patients who are concurrently taking fluconazole and a sulfonylurea. Vitamin B6 may prevent peripheral neuropathy for individuals taking isoniazid. Isoniazid should be taken 1 hour before or 2 hours after meals. Gingival hyperplasia may occur as an adverse effect of acyclovir.

When teaching a patient about isoniazid (INH) and rifampin drug therapy, which statement will the nurse include?

Avoid exposure to direct sunlight." Rationale: The patient should be taught to avoid direct sunlight. The patient should be taught that INH should be administered 1 hour before or 2 hours after meals. Pyridoxine (vitamin B6) is used with INH therapy to decrease peripheral neuropathy. Rifampin use causes the urine to turn a red-orange color.

Fluconazole Drug class Trade Name

Drug Class: Antifungal Trade Name: Diflucan

Isoniazid Drug Class Trade Name

Drug Class: Antitubercular Trade Name: INH, Nydrazid, Isotamine

Isoniazid INH (Antitubercular): Action

Inhibits bacterial cell wall synthesis

Which drug is associated with disulfiram reaction?

Metronidazole (Flagyl) Rationale: The patient taking metronidazole should avoid alcohol and alcohol-containing medications for at least 48 hours after treatment is completed. Drug interaction with alcohol may produce a disulfiram reaction (facial flushing, severe headache, tachycardia, palpitations, hypotension, dyspnea, sweating, slurred speech, abdominal cramps, nausea, and vomiting).

Fluconazole (Antifungal): Uses

To treat Candida infections and cryptococcal meningitis

Isoniazid INH (Antitubercular): Uses

To treat TB, prophylactic measures against TB

A middle-aged adult is diagnosed with tuberculosis. Which is true of treatment for this diagnosis?

Usually two to three agents are needed. Rationale: Single-drug therapy for TB is not effective. Usually two to three drugs are needed. The total treatment plan is usually 6 to 9 months. Although unusual, resistance can occur. The patient should be taught methods to prevent and report side effects and adverse reactions to therapy.

The nurse is aware that most patients receiving metronidazole (Flagyl) are being treated for infections of the

gastrointestinal system. Rationale: Metronidazole (Flagyl) acts by impairing DNA function of susceptible bacteria. This drug is used primarily to treat various disorders associated with organisms in the GI tract. It is prescribed to treat intestinal amebiasis, trichomoniasis, inflammatory bowel disease, anaerobic infections, and bacterial vaginosis and is used as perioperative prophylaxis (prevention of infection) in colorectal surgery.

When caring for a patient receiving amphotericin B, it is most important for the nurse to assess the patient for the development of

hypokalemia. Rationale: Patients taking amphoterocin B should be assessed for the development of hypokalemia.

A patient is diagnosed with a Candida infection in the mouth. The nurse anticipates that the patient will be treated with

nystatin (Mycostatin). Rationale: Nystatin in oral suspension is commonly used to treat Candida infection in the mouth. -It looks like curds in the mouth like cottage cheese in the mouth