Pharm Chapter 11 - Antifungal Agents

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. Clients should be instructed to wash and dry affected areas before applying antifungal ointments. Soap is not prohibited and there is no reason to avoid sunlight. The frequency of administration varies, but there is no topical antifungal that can be safely used every two hours.

What antifungal medication has the same mechanism of action as amphotericin B but is used only in the topical treatment of candidiasis?

nystatin Nystatin is a topical and oral preparation that has the same mechanism of action as amphotericin B and is used only in the treatment of candidiasis.

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 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 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. 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.

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?" Topical agents should not be used over open or draining areas that would increase the risk of systemic absorption and toxicity. Allergy status is always important, but questions of applying the medication over open areas would be a safety priority; no aspect of the scenario suggests a hypersensitivity response. Previous use of herbal remedies may be relevant but is not a high priority. The mother's use of antifungals while pregnant is not relevant.

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."

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's best to check with your health care provider before applying any of the steroid ointment."

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

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 The azoles may cause hepatotoxicity, and the development of jaundice usually accompanies liver damage, which may necessitate discontinuing the drug. Fluconazole is not associated with weight gain, anemia, or hematuria.

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." The main concern with the administration of amphotericin B is the risk of nephrotoxicity. Thus, the statement that the medication may cause kidney damage is the most appropriate. The medication is not known to cause diabetes, liver necrosis, or pancreatitis.

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 Decreased urine output could be suggestive of renal damage, which must be addressed immediately. Diarrhea, headache and lack of appetite should be addressed by the nurse but are lower priorities.

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 Serum flucytosine levels greater than 100 mcg/mL are associated with toxicity.

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 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 A new onset of jaundice suggests hepatotoxicity related to amphotericin B. This is a significant and time-dependent finding that must be addressed quickly. This would be prioritized over a client's need for medication education. A rash related to topical antifungal use is suggestive of local irritation, not a generalized hypersensitivity reaction. Administration of a vaginal suppository would not take precedence over a client's new onset of hepatotoxicity.

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 Amphotericin B is a potent drug with many serious adverse effects so it is often used only when other medications are not effective. Nystatin and butenafine are topical agents and would not be used for a systemic infection. Terbinafine is an azole and would not be used if azoles do not work.

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. Posaconazole is an azole with activity against Candida and Aspergillus infections.

The nurse is preparing an infusion of amphotericin B for a patient who has a severe fungal infection. Which intervention is appropriate regarding the potential adverse effects of amphotericin B?

Before beginning the infusion, administering an antipyretic and an antiemetic drug Almost all patients given the drug intravenously experience fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. For this reason, pretreatment with an antipyretic (acetaminophen), antihistamines, and antiemetics may be conducted to decrease the severity of the infusion-related reaction. The other options are incorrect.

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

A patient is infected by invasive aspergillosis, and the medical history reveals that the patient has not been able to tolerate several antifungal drugs. The nurse anticipates an order for which medication to treat this infection?

Caspofungin (Cancidas) Caspofungin is used for treating severe infection by Aspergillus species (invasive aspergillosis) in patients who are intolerant of or refractory to other drugs.

During an intravenous (IV) infusion of amphotericin B, a patient develops tingling and numbness in his toes and fingers. What will the nurse do first?

Discontinue the infusion immediately. Once the intravenous infusion of amphotericin B has begun, vital signs must be monitored frequently to assess for adverse reactions such as cardiac dysrhythmias, visual disturbances, paresthesias (numbness or tingling of the hands or feet), respiratory difficulty, pain, fever, chills, and nausea. If these adverse effects or a severe reaction occur, the infusion must be discontinued (while the patient is closely monitored) and the prescriber contacted. The other options are incorrect.

The nurse is assessing a client with a vaginal candida infection who is seeking a prescription for clotrimazole. The nurse learns that the client has decreased renal function related to diabetes. What is the nurse's best action?

Educate the client about the safe used of the medication if it is prescribed Clotrimazole is a topical antifungal and is not absorbed systemically. Consequently, the client's decreased renal function is not a major consideration. The client's risk for nephrotoxicity is not affected.

A patient with a severe fungal infection has orders for voriconazole (Vfend). The nurse is reviewing the patient's medical record and would be concerned if which assessment finding is noted?

History of cardiac dysrhythmias Voriconazole is contraindicated when co-administered with certain other drugs metabolized by the cytochrome P-450 enzyme 3A4 (e.g., quinidine) because of the risk for inducing serious cardiac dysrhythmias.

If a patient is taking fluconazole (Diflucan) with an oral anticoagulant, the nurse will monitor for which possible interaction?

Increased effects of oral anticoagulants Azole antifungal drugs increase the effects of oral anticoagulants. As a result, increased bleeding may occur. The other options are incorrect.

The azole antifungals are contraindicated in clients with what condition?

Increased liver enzymes The azole antifungals are relatively contraindicated in clients with increased liver enzymes, active liver disease, or a history of liver damage from other drugs. They should be given only if expected benefits outweigh risks of liver injury.

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.

What is the action of amphotericin B when prescribed for a fungal infection of the urinary tract?

It binds to ergosterol resulting in changes in the cell membrane.

During therapy with amphotericin B, the nurse will monitor the patient for known adverse effects that would be reflected by which laboratory result?

Serum potassium level of 2.7 mEq/L The nurse needs to monitor for hypokalemia, a possible adverse effect of amphotericin B. The other options are incorrect.

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 Anidulafungin is potently hepatotoxic and the nurse's plan for assessment should reflect this risk. Cardiac, neurologic and renal effects are less commonly encountered.

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 Cryptococcosis may involve the lungs, skin, and other body organs. In clients with AIDS or other immunosuppressant disorders, it often involves the CNS and produces mental status changes, headache, dizziness, and neck stiffness. Neurologic assessment is consequently a priority. All the suggested assessments are appropriate, but none are as relevant as the neurologic assessment when considering the signs of cryptococcosis.

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. Fluconazole has the potential to cause gastric distress, a problem that may be mitigated by administering the drug with food. Infusion reactions do not occur with the administration of fluconazole and it is likely unnecessary to arrange for IV administration, to stop the drug, or to immediately inform the resident's physician.

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 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 Sulconazole is a topical antifungal. As such, there is no significant risk for liver or kidney damage. The drug does not cause CNS depression, though there is a possibility of localized skin irritation where it is applied.

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

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 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.

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 Fluconazole causes increased levels of warfarin which may constitute a risk for hemorrhage. The client' use of levothyroxine is not problematic, nor is the fact that the client is a vegetarian and has a low body mass index.

The nurse is administering one of the lipid formulations of amphotericin B. When giving this drug, which concept is important to remember?

The lipid formulations are associated with fewer adverse effects than the older drugs. Newer lipid formulations of amphotericin B have been developed in an attempt to decrease the incidence of its adverse effects and increase its efficacy. However, the lipid formulations are more costly.

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."

The client is diagnosed with a Candida infection of the mouth. How will the nurse document this finding?

Thrush

The client is receiving ketoconazole. The nurse should be concerned about a drug-drug interaction on the basis of what other co-morbidity?

Type 2 diabetes

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

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 Ketoconazole interacts with hypoglycemics, which are given for the treatment of type 2 diabetes. There is no obvious reason why a client's pain, penicillin allergy or venous ulcer would preclude the safe and effective use of ketoconazole.

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

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 Many of the azoles are associated with liver toxicity and can cause severe effects on a fetus or nursing baby. Although the scenario does not say whether or the patient is nursing a baby, because of the severe effects of this drug on a nursing baby, the assumption until the patient is assessed otherwise is that she is. All other choices are not applicable.

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 been placed on amphotericin B. The nurse caring for this client should administer this medication:

intravenously.