Mod 11- Antifungals Flashcards
T/F: Systemic antifungal agents are easily tolerated by patients with a low risk of toxicity
FALSE- can cause a lot of ADE and can be toxic to the liver
Itraconazole (Sporanox) should not be used in patients with ____________ failure.
hepatic / liver failure
T/F: Mycosis is an infection that is caused by a fungus
TRUE
T/F: Fluconazole (Diflucan) can be used as a prophylactic agent for reducing the incidence of candidiasis in bone marrow transplant recipients.
TRUE
Intestinal candidiasis can be treated with the oral medication ___________________.
Nystatin (generic)
T/F: Caspofungin (Cancidas) has been approved for the treatment of invasive aspergillosis that is unresponsive to other treatment.
TRUE
T/F: Antifungal agents can be used to treat bacterial superinfections that have been unresponsive to antibiotics.
FALSE
Common side effects of topical antifungals include _______________, ________________, ____________________, and _________________.
local irritation , burning , rash , swelling
Fungi that cause infections of the skin and mucous membranes are called _____________.
dermatophytes
Ketoconazole (generic) is a topical shampoo used to treat ________________
tinea corporis
T/F: Antifungals are proven both safe and effective for children?
FALSE- no safety
Which antifungals have pediatric dosing?
fluconazole
ketoconazole
terbinafine
griseofulvin
T/F: Antifungals are very toxic
TRUE
These systemic antifungals are hepatotoxic and teratogenic
drugs ending in “azole”
What is candida?
Yeast/ thrush
ADE of systemic antifungal echinocandins?
hepatotoxic
teratogenic
bone marrow suppression
What are the other systemic antifungals?
Amphotericin B- v strong & renal toxicity
Nystatin- used for oral candida
What assessments should we do for a systemic antifungal
renal and hepatic function
culture of the affected area
Signs of liver failure we need to educate our patient taking a systemic antifungal
Jaundice- yellowing of skin, eyes
bruising more easily d/t clotting factors made in liver
itching (puritis)- bilirubin deposits under the skin
darker urine from excreting bilirubin
encephalopathy if severe (confusion)
Only contraindications of topical antifungals
known allergy
ADE of topical antifungals:
irritation, burning, rash, swelling
Where shouldn’t you use a topical antifungal
over an open or draining area
and under an occlusive dressing or tight diapers b/c it heats, pressurizes, and moistens the medication. The pressure can press it into the skin causing systemic absorption
T/F: Ketoconazole is available in oral form, a shampoo, and a cream.
TRUE
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.”
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
Explanation:
Fluconazole causes increased levels of warfarin which may constitute a risk for hemorrhage.
What serious adverse effect is most associated with amphotericin B?
Nephrotoxicity
Explanation:
Systemic antifungal drugs may cause serious adverse effects. Nephrotoxicity is associated with amphotericin B; hepatotoxicity is associated with azole drugs.
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 client’s statement is suggestive of what nursing diagnosis?
deficient knowledge related to correct use of griseofulvin
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?
“Are there any open wounds on the areas where you’re putting the ointment?”
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 is being treated with amphotericin B. Which statement indicates that the client has understood the client teaching?
“The medication may cause kidney damage.”
Explanation:
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.
Anidulafungin is prescribed to treat what form of fungal infection?
candidiasis
Explanation:
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 Candida infections. Anidulafungin is not prescribed to effectively treat any of the other suggested fungal infections.
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
Explanation:
The azoles may cause hepatotoxicity, and the development of jaundice usually accompanies liver damage, which may necessitate discontinuing the drug.
A client has been placed on amphotericin B. The nurse caring for this client should administer this medication:
intravenously.
Explanation:
Amphotericin B is no longer administered orally; the most common route of administration is IV though intrathecal administration is used when fungus exists in the CSF.
The azole antifungals are contraindicated in clients with what condition?
Increased liver enzymes
Explanation:
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.
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 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 client asks the nurse if the client should use a topical antifungal. The nurse is aware that contraindications to topical antifungals are limited to clients with:
known allergy to any of the antifungal drugs.
A nurse is caring for a 29-year-old man who is being treated for meningitis. He is receiving flucytosine (5-FC). Which will the nurse monitor weekly?
Hematologic status
Explanation:
Flucytosine is toxic to rapidly proliferating tissues, such as the bone marrow and the lining of the GI tract. Therefore, common hematologic adverse effects include anemia, leukopenia, and thrombocytopenia. The nurse will also monitor renal and hepatic status.
Amphotericin B is ordered for a client with thrush. How does the drug combat the infection?
it acts on the fungal cell membrane.
Explanation:
Amphotericin B binds to sterols in the fungal cell membrane, opening pores in the structure and increasing its permeability. This allows leakage of the cellular components, which results in cell death.
The nurse is educating an 82-year-old client regarding amphotericin B (Fungizone). The nurse knows the client understand when the client states that he could develop which adverse effect?
Damage to his kidneys
A client is receiving amphotericin B. The nurse would assess the client closely for which adverse reaction?
renal impairment
Explanation:
Renal damage is the most serious adverse reaction to the use of amphotericin B and requires close monitoring.
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
Explanation:
Decreased urine output could be suggestive of renal damage, which must be addressed immediately.
Clients who receive amphotericin B should not take other nephrotoxic drugs. Which are considered nephrotoxic drugs? (Select all that apply.)
antineoplastics cyclosporine corticosteroids Explanation: Clients who receive amphotericin B should not take other nephrotoxic drugs such as nephrotoxic antibiotics or antineoplastics, cyclosporine, or corticosteroids unless absolutely necessary because of the increased risk of severe renal toxicity.
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 has decreased renal function following recent pyelonephritis
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?
Order dietary consultation as needed to ensure nutritional status.
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
Explanation:
Ketoconazole interacts with hypoglycemics, which are given for the treatment of type 2 diabetes.
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?
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 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.
The nurse is providing care for a diverse group of clients. Which client should the nurse monitor most closely for signs and symptoms of a fungal infection?
A client who is receiving combination therapy for acquired immunodeficiency syndrome (AIDS)
Explanation:
Clients who are immunosuppressed, such as those who have AIDS, are at particular risk for fungal infections. Many older adults also have high risks, but the risk among clients with AIDS is known to be particularly high. Post-operative clients and those with renal failure are not particularly high-risk.
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.
What would be most important for the nurse to monitor in a client receiving amphotericin B?
complete blood count
Explanation:
Amphotericin B is associated with bone marrow suppression, so it would be especially important for the nurse to monitor the client’s complete blood count for changes.
