Antifungal, Antihelmintic, and Ectoparasitic Meds Flashcards
A patient is receiving amphotericin B to treat a systemic fungal infection. To prevent renal damage, it is most important for the nurse to do what?
- Administer the medication through a central venous access device
- Administer potassium supplements
- Administer 1000 mL of 0.9% saline
- Administer the medication orally
Administer 1000 mL of 0.9% saline
Rationale: Amphotericin B causes renal injury in most patients. Kidney damage can be minimized by infusing 1 L of saline on the days amphotericin is infused.
A patient who takes warfarin is prescribed itraconazole [Sporanox] to treat a fungal infection. The nurse will teach the patient to do what?
- Take the medication with famotidine [Pepcid] to reduce gastric upset
- Prepare for long-term intravenous administration of itraconazole
- Avoid taking esomeprazole [Nexium] with itraconazole therapy
- Double the dose of warfarin
Avoid taking esomeprazole [Nexium] with itraconazole therapy
Rationale: Drugs that reduce gastric acidity (for example, antacids, histamine2 [H2] antagonists, and proton pump inhibitors) can greatly reduce absorption of oral itraconazole. Accordingly, these agents should be administered at least 1 hour before itraconazole or 2 hours after. (Because proton pump inhibitors have a prolonged duration of action, patients using these drugs may have insufficient stomach acid for itraconazole absorption, regardless of when the proton pump inhibitor is given.) Itraconazole is administered by mouth. Patients who take warfarin and itraconazole are likely to have increased prothrombin times. Clotting studies should be performed, and warfarin doses should be adjusted accordingly.
Which statement by a new nurse about intravenous administration of amphotericin B indicates the nurse needs more education?
- Almost all patients receiving amphotericin B experience some degree of nephrotoxicity.
- Patients receiving amphotericin B should be under close supervision in a hospital.
- Heparin can be used in the infusion site to prevent phlebitis associated with amphotericin B therapy.
- Diphenhydramine plus acetaminophen can minimize rigors associated with amphotericin B therapy.
- Diphenhydramine plus acetaminophen can minimize rigors associated with amphotericin B therapy.
Rationale: Meperidine or dantrolene is used to treat rigors associated with amphotericin B therapy. Diphenhydramine plus acetaminophen can minimize fever, chills, rigors, nausea, and headache associated with amphotericin B therapy. The other statements are true.
Which statement about the treatment of helminth infestations does the nurse identify as true?
- Many worm infestations are asymptomatic and self-limiting.
- Treatment with antihelmintic drugs should be avoided.
- Most of the antihelmintics cause serious or life-threatening adverse effects.
- The best way to prevent helminth infestations in countries where funds are limited is to teach people to avoid eating beef and pork.
Many worm infestations are asymptomatic and self-limiting.
Rationale: When cost is not an issue, treatment for helminth infestation is clearly indicated. Antihelmintics generally are devoid of serious adverse effects. In countries where funds are limited, preventive public health measures directed at improving hygiene and eliminating carrier status may be more cost-effective than treating each infested individual.
A patient with scabies is prescribed permethrin [Elimite]. The nurse will administer this medication in which way?
- As an oral solution in three divided doses.
- As a topical cream applied to the entire body and rinsed after 8 hours
- By diluting in water and soaking the affected area for 15 minutes.
- By spraying the mattress, bed linens, and clothing.
As a topical cream applied to the entire body and rinsed after 8 hours
Rationale: Permethrin for scabies is applied to the entire body and massaged into the skin; after a period of 8 to 14 hours, the topical cream is removed by washing the head and body.
Which statement about ivermectin does the nurse identify as true?
- The drug kills parasites by suffocating them.
- Only one dose of the medication is necessary.
- Resistance to ivermectin is common.
- Ivermectin is taken by mouth.
Ivermectin is taken by mouth.
Rationale: Ivermectin is the only oral medication for ectoparasitic infestations. The drug kills parasites by disrupting nerve and muscle function. A single dose can be highly effective against both mites and lice. Because ivermectin does not kill ova, a second dose is usually needed. Resistance to ivermectin is uncommon.
Name four examples of systemic fungal infections:
Coccidiodomycosis, Histoplasmosis, Crytococcus, Aspergillosis
What is another name for Coccidiodomycosis?
Valley Fever
How is Amphotericin B given?
IV only
Is the kidney damage reversible or permanent with Amphotericin B?
Reversible
What electrolyte imbalance occurs with Amphotericin B?
Low K and Mg
T/F: Amphotericin B is compatible with normal saline.
False, will form precipitate
Change line and prime with D5
Amphotericin B SEs
Nephrotoxic, electrolyte imbalance, anemia
Amphotericin B also comes in 3 different _______ formulas which are more expensive but have less side effects
Lipid
What does it look like to get Amphoterrible?
- Central line!
- Give 500mL -1 liter of Normal Saline over an hour or more
- Premedicate w/Tylenol + diphenhydramine (Benadryl)
- Change IV tubing set up to D5
- Give Amphotericin over 4 hours
- If Rigors (shaking chills) give meperidine (Demerol) or Dantrolene
- Give 500mL -1 liter of Normal Saline over an hour or more
- Replace Potassium and Magnesium
- Each KCL bag infuses over 2 hours X 4 bags (8 hours) • Each Magnesium infuses over 2-4 hours
What do you premedicate with before you give Amphotericin B?
Tylenol + diphenhydramine
If the patient gets rigors with Amphotericin B, what can you give?
Meperidine (Demerol) or Dantrolene
After Amphotericin B is infused, each KCl bag is given over ___ hours.
2 hours
After Amphotericin B is infused, each Mg bag is given over ___ hours.
2-4
What are some administration SEs with Amphotericin B?
Fever, chills, phlebitis
Why is there a transfusion reaction occurring when giving Amphotericin B?
Pro-inflammation cytokines have been stimulated
Total infusion time for Amphotericin B?
~18 hours
Name to the ‘azole’ prototypes (systemic agent):
Itraconazole (Sporanox) and fluconazole (Diflucan)
Adverse effects of itraconazole?
- GI upset (n/v/d)
- Cardiac suppression
- Liver injury
Why should you not give itraconazole to patients with heart failure?
Because one of the SEs is cardiac suppression, which means the heart will decrease rate and contractility
What can you have your patient take with itraconazole to better help it absorb?
Cola! This medication absorbs better in an acidic environment.
What medications should you be careful giving with itraconasole (re: absorption).
Anything that raises gastric pH: H2 blockers, prilosec, zantac, tagamet, etc.
If your patient needs to take a medication that will raise their gastric pH, when should they take the itraconazole?
1 hours before meds.
What is the second ‘azole’ prototype (not itraconazole)?
Fluconazole (Diflucan)
What is interesting about the fluconazole IV and PO dosages?
They are the same!
SEs of fluconazole?
- GI upset
- SJ rash
How long is the half life of fluconazole?
30 hours! This is why often it only takes one dose to knock out a yeast infection.
How can the ‘azoles’ be given?
Orally, topically, parentrally
T/F there are a lot of drug/drug interactions with ‘azoles’?
True. CYP450 pathway shit.
What are superficial mycoses?
Superficial mycoses are fungal infections of the skin, hair, and nail that invade only the stratum corneum and the superficial layers of the skin.
What are the 2 groups of organisms that cause most superficial mycoses?
Candida species Dermatophytic infections (eg ringworm)
Where are candida species usually found?
Usually in mucus membranes and moist skin. Chronic infections may involve scalp, skin, or nails.
Where are dermatophytic infections found?
Usually confined to hair, nails, skin.
What is onychomycosis?
A fungal infection of the nails that causes discoloration, thickening, and separation from the nail bed.
How are these superficial mycoses treated?
Creams, ointments, suppository, troche, swish and spit. Many are OTC.
Name two common drugs used to treat superficial mycoses
Clotrimazole and nystatin
What are a helminth?!
Parasitic worms
Helminth infestations are often [symptomatic/asymptomatic]
Asymptomatic
What is the most frequent site of helminth infections?
Intestines
Often helminth infections subside on their own when what happens?
The adult dies.
Helminth fighting prototype and drug of choice for most intestinial roundworms and mixed infestations?
Mebendazole
How does mebendazole work?
Prevents uptake of glucose by susceptible worms, causing a slow death
What is a benefit about mebendazole re: absorption?
It is poorly absorbed in our system, so we tolerate it well
How long does it take for mebendazole clearance?
3 days
Adverse effects of mebendazole?
Rare but can have abdominal pain and diarrhea with large infestations.
What are ectoparasites?
Parasites that live on the surface of the host
What is the medical term for lice?
Pediculosis
Where do lice live?
On the scalp. They lay nits (eggs) on the hair.
How are lice spread?
By contact. They do not jump or fly.
What are scabies?
Mite infestation
What causes the irritation with scabies?
The mites have burrowed under the skin.
Where do scabies show up on our body?
Wrists, elbows, web of fingers, genital region
How are scabies transmitted?
Direct contact (other people, or objects)
When is itching the worst with scabies?
Bedtime
What is the drug used to treat both scabies and pediculosis?
Permethrin (Nix, Elimite)
How does it kill the fuckers?
It causes paralysis. Highly toxic to adult mites and lice, not so much to the ova.
What formulation do you use for scabies?
5% (Elimite)
What formulation do you use for lice?
1% (Nix)
Adverse effects of permethrin?
Exacerbation of itching, erythema, edema, burning stinging numbness
How do you treat scabies?
Cover the whole body (minus face) with permethrin, wash off after 8 hours
How do you treat lice?
Apply lotion to hair (also behind ears and neck), leave ten minutes. Rinse and use fine tooth comb to remove nits.
What is a good thing to help educate people about scabies tx?
It can take 1-2 weeks for itching to subside. People might think it’s not working.
