chapter 42 anti fungal drugs – Flashcards
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The nurse is assessing a patient who is about to receive antifungal drug therapy. Which problem would be of most concern? a Endocrine disease b Hepatic disease c Cardiac disease d Pulmonary disease
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b
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While monitoring a patient who is receiving intravenous amphotericin B, the nurse expects to see which adverse effect(s)? a Hypertension b Bradycardia c Fever and chills d Diarrhea and stomach cramps
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c
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When administering antifungal drug therapy, the nurse knows that an issue that contributes to many of the drug interactions with antifungals is the patient's a history of cardiac disease. b history of gallbladder surgery. c ethnic background. d cytochrome P-450 enzyme system.
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d
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During an infusion of amphotericin B, the nurse knows that which administration technique may be used to minimize infusion-related adverse effects? a Forcing of fluids during the infusion b Infusing the medication quickly c Infusing the medication over a longer period of time d Stopping the infusion for 2 hours after half of the bag has infused, then resuming 1 hour later
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c
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When teaching a patient who is taking nystatin lozenges for oral candidiasis, which instruction by the nurse is correct? a "Chew the lozenge carefully before swallowing." b "Dissolve the lozenge slowly and completely in your mouth." c "Dissolve the lozenge until it is half the original size, and then swallow it." d "These lozenges need to be swallowed whole with a glass of water."
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b
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When monitoring a patient who is receiving caspofungin, the nurse will look for which serious adverse effects? (Select all that apply.) a Blood dyscrasias b Hypotension c Pulmonary infiltrates d Tinnitus e Hepatotoxicity
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a, b, e,
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The order reads, "Give nystatin (Mycostatin) suspension, 500,000 units by mouth (swish and swallow) 4 times a day for 1 week." The medication is available in a suspension of 100,000 units per mL. How many milliliters will the nurse give per dose?
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5 mL
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A patient has developed an aspergillosis infection. Which tissue does the aspergillosis affect? A.Skin B.Nails C.Blood D.Lungs
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Correct answer: D Rationale: The primary tissue affected by aspergillosis is the lungs.
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A patient is diagnosed with onychomycosis. The nurse anticipates use of which medication for the treatment of this condition? A. (Lamisil) B. voriconazole (Vfend) C. fluconazole (Diflucan) D. amphotericin B (Amphocin, Fungizone)
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Correct answer: A Rationale: Terbinafine (Lamisil) is indicated for the treatment of onychomycosis (fungal infection of fingernail or toenail). Voriconazole (Vfend) is indicated for the treatment of invasive aspergillosis and other major fungal infections in patients who do not tolerate or respond to other antifungal drugs. Fluconazole (Diflucan) is indicated for the treatment of vaginal candidiasis, oropharyngeal and esophageal candidiasis, systemic candidiasis, and cryptococcal meningitis. Amphotericin B (Amphocin, Fungizone) is indicated for the treatment of systemic infections with broad spectrum of fungi.
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A patient is receiving amphotericin B lipid complex. The nurse knows that an advantage of the lipid formulations of this drug is that they A. have a lower cost. B. can be administered quickly. C. take longer to be absorbed. D. cause fewer adverse effects.
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Correct answer: D Rationale: Lipid formulations of amphotericin B have been developed in an attempt to decrease the incidence of its adverse effects and increase its efficacy. There are currently three lipid preparations of amphotericin B: amphotericin B lipid complex (Abelcet), amphotericin B cholesteryl complex (Amphotec), and liposomal amphotericin B (AmBisome). These lipid dosage forms have a much higher cost than conventional amphotericin B and for this reason are often used only when patients are intolerant of or have an infection refractory to nonlipid amphotericin B.
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Fifteen minutes after an infusion of amphotericin B was started, the patient begins to complain of fever, chills, muscle pain, and nausea. His heart rate has increased slightly, but his blood pressure is down to 100/68. What is the nurse's priority? A. Notify the prescriber immediately. B. Recognize an impending anaphylactic reaction and stop the infusion. C. Assess for other symptoms of this expected infusion- related reaction. D. Slow the infusion to reduce these adverse effects.
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Correct answer: C Rationale: Almost all patients who receive amphotericin B experience fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. For this reason, antihistamines, acetaminophen (an antipyretic), and antiemetics may be given as pretreatment to reduce these expected effects.
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A patient is taking nystatin (Mycostatin) in an oral troche form for oral candidiasis. Which instruction is correct? A. Allow the troche to dissolve slowly in the mouth. B. Swish the medication in the mouth and then swallow it. C. Chew the troche thoroughly to activate the medication. D. Swallow the troche whole without chewing.
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Correct answer: A Rationale: Oral troche or lozenge forms of this medication should be allowed to dissolve slowly in the mouth without chewing.
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What is the most common drug used to treat oropharyngeal candidiasis? A. nystatin (Mycostatin) B. oseltamivir (Tamiflu) C. amantadine (Symmetrel) D. griseofulvin (Fulvicin P/G)
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A Nystatin is an antifungal ointment that is used for a variety of candidal infections. It is applied topically as a cream, ointment, or powder. It is also available as a troche and an oral liquid or tablet.
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What is the most important action for the nurse to complete before administration of intravenous amphotericin B? A. Administer the drug along with potassium aliquots to prevent hypokalemia. B. Premedicate the patient with an antipyretic, antihistamine, and antiemetic as prescribed. C. Administer insulin as prescribed to prevent severe hyperglycemia. D. Administer intravenous dextrose as prescribed to prevent severe hypoglycemia.
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B Almost all patients given intravenous amphotericin B develop fever, chills, nausea and vomiting, and hypotension. Pretreatment with an antipyretic, antihistamine, and antiemetic can minimize or prevent these adverse reactions.
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Which anti fungal drug can be given intravenously to treat severe yeast infections as well as a one-time oral dose to treat vaginal yeast infections? A. nystatin (Mycostatin) B. caspofungin (Cancidas) C. voriconazole (Vfend) D. fluconazole (Diflucan)
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D Fluconazole is an antifungal drug that does not cause the severe side effects of amphotericin when given intravenously. It also has almost 100% bioavailability and therefore a single dose is often sufficient to treat vaginal yeast infections.
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A patient visits the health care provider for treatment of tinea pedis (athlete's foot). Which medication would the nurse most likely instruct the patient on to treat this condition? A. terbinafine (Lamisil) B. voriconazole (Vfend) C. caspofungin (Cancidas) D. amphotericin B
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A Terbinafine (Lamisil) is classified as an allylamine antifungal drug and is currently the only drug in its class. It is available in a topical cream, gel, and spray for treating superficial dermatologic infections, including tinea pedis (athlete's foot), tinea cruris (jock itch), and tinea corporis (ringworm).
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A nurse needs to be aware that the anti fungal drug with the most common adverse events is which drug? A. griseofulvin B. fluconazole C. ketoconazole D. amphotericin B
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D The major adverse effects caused by antifungal drugs are encountered most commonly in conjunction with amphotericin B treatment. Drug interactions and hepatotoxicity are the primary concerns in patients receiving other antifungal drugs, but the intravenous administration of amphotericin B is associated with a multitude of adverse effects.
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The nurse would question an order for voriconazole (Vfend) if the patient was taking which medication? A. quinidine B. prednisone C. captopril (Capoten) D. clindamycin (Cleocin)
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A The nurse would question an order for quinidine, since both voriconazole and quinidine are metabolized by the cytochrome P-450 enzyme system. The drugs will compete for the limited number of enzymes, and one of the drugs will end up accumulating.
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The nurse has provided education to a patient about fungal skin infections. The nurse needs to reinforce teaching when the patient includes what disorder in the discussion of fungal skin infections? A. Vaginal yeast infection B. Athlete's foot C. Impetigo D. Thrush
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C Impetigo is a bacterial skin infection and would not be classified as a fungal skin infection. If the patient included this in the discussion, further teaching is needed. All other skin infections listed are fungal and would be treated with antifungal medications.
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Which is most important for the nurse to monitor in a patient receiving an antifungal medication? (Select all that apply.) A. Daily weights B. Mental status C. Intake and output D. Blood urea nitrogen (BUN) E. Creatinine Correct
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A C D
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What disorders are considered contradictions for use of antifungal medications? (Select all that apply.) A Heart failure B Liver failure C Kidney failure D Pancreatic failure E Respiratory failure
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B D - THESE ANSWERS DONT MAKE SENSE WITH RATIONAL!!!!! I think it should be B and C??? Drug allergy, liver failure, kidney failure, and porphyria (for griseofulvin) are the most common contraindications for antifungal drugs.
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"Single-celled fungi that reproduce by budding" "a. Thrush b. Molds c. griseofulvin d. Mycosis e. Polyenes f. Fungi g. Imidazoles h. amphotericin B i. nystatin j. Yeast"
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Yeast
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"One of the major chemical groups of anti- fungal drugs; includes amphotericin B and nystatin"
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Polyenes
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"A very large, diverse group of eukaryotic, thallus-forming microorganisms that re- quires an external carbon source"
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Fungi
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"Another of the major groups of antifungal drugs; includes ketoconazole"
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Imidazoles
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"A term for fungal infection of the mouth"
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Thrush
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"One of the older antifungal drugs that acts by preventing susceptible fungi from reproducing"
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griseofulvin
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"The drug of choice for many severe, sys- temic fungal infections; also, the oldest antifungal drug"
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amphotericin B
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"An anti fungal drug commonly used to treat candidal diaper rash"
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nystatin
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"An infection caused by fungi"
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Mycosis
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"Multicellular fungi characterized by long, branching filaments called hyphae, which entwine to form a mycelium"
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Molds
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"An infant has thrush. The nurse expects to adminis- ter which drug for the treatment of thrush? a. amphotericin B (Fungizone) b. fluconazole (Diflucan) c. nystatin (Mycostatin) d. miconazole (Monistat)"
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c
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"During an infusion of amphotericin B, the nurse monitors for which adverse effects? (Select all that apply.) a. Nausea b. Fever c. Malaise d. Constipation e. Chills f. Hypertension
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a b c e
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"A patient calls the gynecologic clinic because she has begun to menstruate while taking vaginal cream for a vaginal infection. She asks the nurse, "What should I do about taking this vaginal medicine right now?" Which is the nurse's best response? a."You need to stop the medication until the men- strual flow has stopped." b."Just take the medication at night only." c."You should stop the medication for 3 days, then start it again." d."It's okay to continue to take the medication.""
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d
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"A patient will be receiving a one-dose treatment for vaginal candidiasis. The nurse expects to administer which drug? a. ketoconazole (Nizoral) b. fluconazole (Diflucan) c. griseofulvin d. terbinafine (Lamisil)"
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b
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"The nurse is administering an antifungal drug to a patient who has a severe systemic fungal infection. Which drug is most appropriate for this patient? a. amphotericin B (Fungizone) b. fluconazole (Diflucan) c. griseofulvin d. flucytosine"
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a
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"The nurse is administering a new order for am- photericin B (Fungizone) and reviews the patient's current medications. Which medications, if also or- dered, may cause an interaction with the amphoteri- cin B? (Select all that apply.) a. digoxin (Lanoxin), a cardiac glycoside b metoprolol (Lopressor), a beta blocker c. warfarin (Coumadin), an oral anticoagulant d. levothyroxine (Synthroid), a hormone replacement e. hydrochlorothiazide, a thiazide diuretic"
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a e
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"The order reads, "Give amphotericin B (Fungizone) 20 mg in 300 mL D5W over 6 hours." The nurse will set the infusion pump to what rate? "
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"50 mL/hour"
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"A patient is to receive voriconazole (Vfend) as fol- lows: 6 mg/kg q12h × 2 doses, then change to 4 mg/ kg q12h. The patient weighs 242 pounds. How much will the patient receive for each 6 mg/kg dose? The 4 mg/kg dose?"
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"660 mg; 440 mg"
