McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 1 1  Antifungal agents

DISCUSSION Because of P.P.’s appearance, a complete physical

Ensure temperature control, lighting control, mouth care and skin care. Provide small, frequent meals and monitor nutritional status. Provide support and reassurance for dealing with drug effects and discomfort. Provide teaching regarding drug name, dosage, adverse effects, precautions and warning signs to report. Evaluation Evaluate drug effects: relief of signs and symptoms of fungal infection. Monitor for adverse effects: GI alterations, dizziness, confusion, headache, fever, renal or hepatic dysfunction, local pain, discomfort. Monitor for drug–drug interactions as indicated for each drug. Evaluate effectiveness of teaching program and of comfort and safety measures. TEACHING FOR P.P. • Ketoconazole is an antifungal drug that works to destroy the fungi that have invaded the body. Because of the way that antifungal drugs work, they may need to be taken over a long period of time. • It is very important to take all of the prescribed medication. • Common adverse effects of this drug include the following: • Headache and weakness —Change positions slowly. An analgesic may be ordered to help alleviate the headache. If you feel drowsy, avoid driving or dangerous activities. • Stomach upset, nausea and vomiting —Small, frequent meals may help. Take the drug with food if appropriate because this may decrease the gastrointestinal upset associated with these drugs. (Ketoconazole must be taken on an empty stomach at least 2 hours before taking a meal, antacids, milk products or any other drugs.) Try to maintain adequate nutrition. • Report any of the following to your healthcare provider: severe vomiting, abdominal pain, fever or chills, yellowing of the skin or eyes, dark urine or pale stools, or skin rash. • Avoid over-the-counter medications. If you feel that you need one of these, check with your healthcare provider first. • Take the full course of your prescription. Never use this drug to self-treat any other infection and never give this drug to any other person. • Tell any doctor, nurse or other healthcare provider involved in your care that you are taking this drug. • Keep this drug and all medications out of the reach of children.

examination should be performed before drug therapy is initiated. It is necessary to know baseline functioning to evaluate any underlying problems that may exist. Poor nutrition and total starvation result in characteristic deficiencies that predispose individuals to opportunistic infections and prevent their bodies from protecting themselves adequately through inflammatory and immune responses. In this case, the fact that liver changes often occur with poor nutrition is particularly important; such hepatic dysfunction may cause deficient drug metabolism and lead to toxicity. An intensive program of teaching and support should be started for P.P., who should have an opportunity to vent her feelings and fears. She needs help accepting her diagnosis and adapting to the drug therapy and nutritional changes that are necessary for the effective treatment of this infection. She should understand the possible causes of her infection (poor nutrition and the loss of normal flora secondary to antibiotic therapy); the specifics of her drug therapy, including timing and administration; and adverse effects and warning signs that should be reported. P.P. should be monitored closely for adverse effects and should return for follow-ups regularly while taking the ketoconazole. Nutritional counselling or referral to a dietician for thorough nutritional teaching may prove beneficial. The actual resolution of the fungal infection may occur only after a combination of prolonged drug and nutritional therapy. Because the required therapy will affect P.P.’s lifestyle tremendously, she will need a great deal of support and encouragement to make the necessary changes and to maintain compliance. A healthcare provider, such as a nurse who P.P. trusts and with whom she can regularly discuss her concerns, may be an essential element in helping to eradicate the fungal infection. CARE GUIDE FOR P.P.: ANTIFUNGAL AGENTS Assessment: History and examination Assess history of allergy to any antifungal drug. Also check history of renal or hepatic dysfunction and pregnancy or breastfeeding status. Focus the physical examination on the following: Local: culture of infected site Skin: colour, lesions, texture GU: urinary output GI: abdominal, liver evaluation Haematological: renal and hepatic function tests Implementation Culture infection before beginning therapy. Provide comfort and implement safety measures (e.g. provide assistance and raise side rails).