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.
