C H A P T E R 1 1
Antifungal agents
159
DISCUSSION
Because of P.P.’s appearance, a complete physical
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).
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.
