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Chapter 42: Antifungal Test, Infusion, Pharmacology for Nurses: Practical Applications

The key terms in the Pharmacology course include Antifungal Test, Chapter 42, Infusion, amphotericin B infusion, Nurse, Adverse Effects, Patient, Pharmacology for Nurses: Practical Applications

The nurse is administering an amphotericin B infusion. Which actions by the nurse are appropriate? (Select all that apply.)

Knowing that muscle twitching may indicate hypokalemia

Knowing that the intravenous solution for amphotericin B will be cloudy

Administering the medication by rapid IV infusion

Administering premedication for fever and nausea

If adverse effects occur, reducing the IV rate gradually until they subside

Using an infusion pump for IV therapy

Discontinuing the drug immediately if the patient develops tingling and numbness in the extremities

Monitoring the IV site for signs of phlebitis and infiltration

If the patient develops tingling and numbness in the extremities (paresthesias), discontinue the drug immediately. An infusion pump is necessary for the infusion, and the nurse will monitor the IV site for signs of phlebitis and infiltration. Premedication to reduce the adverse effects of fever, malaise, and nausea may be ordered. The IV solution must be clear and without precipitates; and muscle weakness, not twitching, may indicate hypokalemia. The medication must be administered at the rate recommended and stopped, not slowed, if adverse reactions occur.

A patient is taking nystatin (Mycostatin) oral lozenges to treat an oral candidiasis infection resulting from inhaled corticosteroid therapy for asthma. Which instruction by the nurse is appropriate?

“Rinse your mouth with mouthwash after taking the inhaler.”

“Let the lozenge dissolve slowly and completely in your mouth without chewing it.”

“Chew the lozenges until they are completely dissolved.”

“Rinse your mouth with water before taking the inhaler.”

Nystatin may be given orally in the form of lozenges, or troches, which need to be slowly and completely dissolved in the mouth for optimal effects; tablets are not to be chewed or swallowed whole. The other options are incorrect. Patients taking an inhaled corticosteroid must rinse their mouths with water thoroughly after taking the inhaler.

A patient is infected by invasive aspergillosis, and the medical history reveals that the patient has not been able to tolerate several antifungal drugs. The nurse anticipates an order for which medication to treat this infection?

Fluconazole (Diflucan)

Micafungin (Mycamine)

Nystatin (Mycostatin)

Caspofungin (Cancidas)

Caspofungin is used for treating severe infection by Aspergillus species (invasive aspergillosis) in patients who are intolerant of or refractory to other drugs.

The nurse is administering one of the lipid formulations of amphotericin B. When giving this drug, which concept is important to remember?

There is no difference in cost between the newer and older forms.

The lipid formulations may be given in oral form.

The lipid formulations are associated with fewer adverse effects than the older drugs.

The doses are much lower than the doses of the older drugs.

Newer lipid formulations of amphotericin B have been developed in an attempt to decrease the incidence of its adverse effects and increase its efficacy. However, the lipid formulations are more costly.

During therapy with amphotericin B, the nurse will monitor the patient for known adverse effects that would be reflected by which laboratory result?

Serum potassium level of 5.8 mEq/L

Platelet count of 300,000/microliter

White blood cell count of 7000 cells/mm3

Serum potassium level of 2.7 mEq/L

The nurse needs to monitor for hypokalemia, a possible adverse effect of amphotericin B. The other options are incorrect.

The nurse is preparing an infusion of amphotericin B for a patient who has a severe fungal infection. Which intervention is appropriate regarding the potential adverse effects of amphotericin B?

Before beginning the infusion, administering an antipyretic and an antiemetic drug

If fever, chills, or nausea occur during the infusion, administering medications to treat the symptoms

Gradually increasing the infusion rate until the expected adverse effects occur

Discontinuing the infusion immediately if fever, chills, or nausea occur

Almost all patients given the drug intravenously experience fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. For this reason, pretreatment with an antipyretic (acetaminophen), antihistamines, and antiemetics may be conducted to decrease the severity of the infusion-related reaction. The other options are incorrect.