Antifungal Agents

Antifungal Agents 1. The client is receiving ketoconazole. The nurse should be concerned about a drug-drug interaction based on what another comorbidity? a. T2D i. Ketoconazole interacts with hypoglycemics. 2. A client is receiving gentian violet as a topical treatment for a fungal infection. What instructions should the nurse include in the teaching plan? a. This medication can stain your skin and clothing. i. Stains skin and clothing a bright purple. 1. Avoid occlusive dressings – they prevent systemic absorption (very toxic when absorbed!) 3. Ketoconazole is available in oral form, a shampoo, and a cream. a. True 4. Amphotericin B is given by which route? a. IV i. And flucytosine. 5. The nurse is educating an 82yo client regarding amphotericin B (Fungizone). The nurse knows the client understands when he states he can develop which adverse effect? a. Damage to his kidneys. i. Amphotericin B = nephrotoxic. 6. A client is being treated with amphotericin B. Which statement indicates that the client has understood the teaching? a. “The medication may cause kidney damage.” i. The main concern with administration of amphotericin B is the risk of nephrotoxicity. 7. 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. i. Any client prescribed an antiviral or antifungal drug needs to complete the entire drug prescription religiously and not miss any doses. If a dose is missed, there is no need to replace if it is time for next dose (do not double up). Clients need to be informed to seek advice of HCP if they experience adverse effects and should be reminded to hydrate throughout therapy and not take heavy fatty meals if they suffer from GI distress. 8. Azole antifungals require caution under certain conditions. For which of the following patients would the nurse be most cautious when administering ketoconazole? SATA a. A woman who is 4 weeks postpartum b. A 78yo with cirrhosis. i. Many azoles are associated with liver toxicity and can cause severe effects on a fetus or nursing baby. (Assume unless assessed otherwise she is nursing) 9. A pharmacology student is learning about amphotericin B. This drug can be administered through which route? a. IV i. It is NOT administered SubQ or IM. 10. A nurse is caring for a client who asks why she has been prescribed Posaconazole following transplantation. The nurse responds that Posaconazole is used as prophylaxis to prevent: a. Aspergillus infection. i. Posaconazole is used against Candida and Aspergillus infections. 11. What serious adverse effect is most associated with amphotericin B? a. Nephrotoxicity. i. Amphotericin B = nephrotoxicity ii. Azole drugs = hepatotoxicity. 12. The azole antifungals are contraindicated in clients with what condition? a. Increased liver enzymes. i. Should only be given if expected benefits outweigh risks of liver injury. 13. What antifungal medication has the same mechanism of action as amphotericin B but is used only in the topical treatment of candidiasis? a. Nystatin i. Topical and oral preparation. Only used to treat candidiasis. 14. An older adult client has been diagnosed with candidiasis and prescribed fluconazole. Which of the client’s health status should warrant close monitoring by the nurse? a. The client has atrial fibrillation and takes warfarin daily. i. Fluconazole causes increased levels of warfarin which may constitute a risk for hemorrhage. 15. 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? a. Tell the client not to administer the medication and to come be assessed by the provider. i. Topical antifungals should not be applied over open or broken skin. Because of the safety risk associated with putting the medication on open skin, the nurse is justified in having the client temporarily withhold the medication pending assessment by the provider. 16. A client has been prescribed Sulconazole for the treatment of tinea pedis. What nursing diagnosis should the nurse identify when planning this client’s care? a. Risk for impaired skin integrity related to local irritation. i. Sulconazole is a topical antifungal. 17. The nurse is caring for several clients who have fungal infections. Which client should the nurse prioritize for informing the provider? a. A client receiving amphotericin B whose torso appears jaundiced. i. A new onset of jaundice suggests hepatotoxicity related to amphotericin B. This is a significant and time-dependent finding that must be addressed quickly. 18. 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? a. “Are there any open wounds on the areas where you’re putting the ointment?” i. Topical agents should not be used over open or draining areas that would increase the risk of systemic absorption and toxicity (safety priority). 19. The nurse is caring for a client diagnosed with a life-threatening systemic fungal infection who is not responding to treatment with an azole. What medication should the nurse anticipate, the provider may order next? a. Amphotericin B i. Amphotericin B is a potent drug with many serious adverse effects, so it is often used only when other medications are not effective. 1. Nystatin and butenafine are topical agents and would not work for a systemic infection. 2. Terbinafine is an azole. 20. A client has been diagnosed with a fungal infection and ben prescribed a topical antifungal medication. What assessment question should the nurse ask when addressing the possible etiology of the fungal infection? a. “Have you been prescribed any antibiotics in the recent past?” i. A course of antibiotics can often precipitate a fungal infection. 21. A client’s previous medical history includes mycosis. What conclusion should the nurse draw from this fact? a. The client has had a disease that was caused by a fungus. i. Mycosis is unrelated to immune disorders. Mycosis refers to a fungal infection that can be localized, superficial or systemic. 22. 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? a. Order dietary consultation as needed to ensure nutritional status. 23. An 80yo woman is receiving treatment with oral fluconazole for a fungal infection. Following yesterdays 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? a. Provide food along with the fluconazole when administering it in the future. i. Fluconazole has potential to cause gastric distress. This may be mitigated by administering with food. 24. 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? SATA a. Clients taking immunosuppressant drugs. b. Clients who have undergone transplantation surgery or cancer treatment. c. The elderly d. Clients with AIDS and AIDS related complex (ARC) 25. Antifungal drugs are available that do not fit into either the azole or echinocandin groups. Which drug does not fall into the other group? a. Terbinafine. i. Antifungal drugs available that do not fit into azole or echinocandin class: amphotericin B, flucytosine, griseofulvin and nystatin. Terbinafine = azole 26. The nurse is administering amphotericin B by IV. The nurse observes the client for which immediate adverse reactions? SATA a. Nausea and vomiting b. Tachypnea c. Fever and chills i. Immediate adverse reactions related to amphotericin B can occur within the first 15 to 20 minutes of the infusion. It is important to assess for N/V, Fever, chills, tachypnea, and hypotension. 27. A client with a fungal infection has been prescribed a miconazole vaginal suppository. Which education should the nurse provide about safe and effective administration? a. “If possible, lie down for 10-15 minutes after inserting the medication.” i. Vaginal suppositories should be inserted high in the vagina, with the client lying recumbent during administration. Antifungal Agents 28. 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 statement is suggestive of what nursing diagnosis? a. Deficient knowledge related to correct use of griseofulvin. i. Take medication exactly as prescribed. Client’s statement suggests he does not appreciate or understand this fact. 29. The nurse is caring for a client receiving amphotericin B. Which condition should the nurse assess for this client? a. Phlebitis. i. During IV administration, there could be pain at the injection site with the possibility of phlebitis or thrombophlebitis. 30. 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 with the client’s condition? a. The client’s aspartate aminotransferase (AST) and aminotransferase (ALT) levels are elevated. i. An increase in AST and ALT can indicate hepatotoxicity, which is a serious adverse effect of ketoconazole. 31. 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? a. “Is there any possibility that you could be pregnant?” i. Pregnancy would have a major bearing on the plan of drug therapy because most antifungals are either contraindicated or require cautious use during pregnancy. Consequently, this assessment question would be prioritized over the others, even though it is necessary to assess previous illnesses, nutritional status, and allergies. 32. A client’s systemic fungal infection has not responded appreciably to conservative treatment, so the client has been prescribed amphotericin B. What aspect of the client’s pre-illness medication regimen should the nurse discuss with the provider? a. Prednisone. i. Combining amphotericin B with corticosteroids creates a significant risk for nephrotoxicity. 33. 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? a. Inspection of the client’s mouth and throat. i. Micafungin is used in the treatment of clients with esophageal candidiasis. Consequently, the nurse should assess the mucous membranes of the client’s mouth and throat. 34. Anidulafungin is prescribed to treat what form of fungal infection? a. Candidiasis. i. Anidulafungin is a semisynthetic antifungal medication that inhibits glucan synthase, an essential component in the fungal cell wall. It is used to treat esophageal candidiasis and other Candidiasis infections. 35. Guidelines for the use of topical antifungals in children are frequently the same as those in 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? a. Fluconazole. 36. What would be most important for the nurse to monitor in a client receiving amphotericin B? a. Complete Blood Count i. Amphotericin B is associated with bone marrow suppression, it would be especially important for the nurse to monitor the client’s CBC for changes. Amphotericin B can cause GI irritation with nausea, vomiting, and potentially severe diarrhea so monitoring bowels would be ok, but not the most important action. 37. 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? a. The client’s urine output is 75 mL over 6 hours. i. Decreased urine output could e suggestive of renal damage. 38. 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 change in medication therapy? a. Decreased creatinine clearance. i. Fluconazole is routinely administered to older clients with Candida infections. It is necessary to monitor the creatinine clearance and hepatic enzymes. Decreased creatinine clearance may indicate hepatotoxicity and thus warrant a change in medication.