Antifungals Drugs

Questions: Case Study Assignment: AntifungalsNaomi Unger, age 27, has recently returned from South America, where she was working as a Peace Corps volunteer. She complains of fatigue, cough, and a high unrelenting temperature for the past 5 days. She is diagnosed with aspergillosis pneumonia and is hospitalized. She is prescribed IV amphotericin B. She uses condoms as her birth control method and has not had sex for 5 months. Her menstrual periods are regular but she reports heavy blood loss. Data obtained from the nursing assessment include the following: Vital signs: temperature, 103.1F; pulse, 120; respiration, 28; blood pressure, 100/70 Weight: 110 pounds CBC: WBC, 18.3; RBC, 3.2; Hgb, 10 g/dL; Hct, 35% UA: Within normal limits Chemistry: sodium: 136 mEq/L; potassium: 4.0 mEq/L; chloride: 100 mEq/L; glucose: 100 mg/dL; BUN: 20 mg/dL; creatinine: 1.2 mg/dL; ALT 40; AST 36 ABGs: pH, 7.45; PCO2, 30; HCO3, 29; O2 Sat, 94% Chest x-ray: infiltrates to left upper and lower lobes Bronchial washing: positive for aspergillosisThe patient is currently on ferrous sulfate, 325 mg PO qd. Prescribed medication includes amphotericin B, intravenous, 250 mg/h over 2 hours.Case Study Questions1. Provide the rationale for why Ms, Unger is prescribed amphotericin B.2. What contraindications or precautions would eliminate the use of amphotericin B for Ms. Unger?3. What other drugs could be considered for the treatment of Ms. Ungers infection?4. What patient variables are most important to consider for Ms. Unger when assessing her drug therapy? 5. What aspects of core drug knowledge (pharmacotherapeutics, pharmacokinetics, and pharmacodynamics) are especially relevant to consider because they may interact with the patient variables? 6. Which of the findings from the nursing assessment demonstrate the effectiveness of drug therapy with amphotericin B? 7. Which of the findings from the nursing assessment demonstrate possible adverse effects from amphotericin B?8. What nursing actions are indi cated to maximize therapeutic effects? 9. What nursing actions are indicated to minimize adverse effects? 10. What teaching is required for Ms. Unger regarding her drug therapy? Include list of any additional data needed to determine appropriate teaching. Answers: 1. Ms. Unger is prescribed amphotericin B, because it shows high order of activity against different species of fungi. In this case study the patient is diagnosed with aspergillosis pneumonia, which is a fungal infection. Ms. Ungers bronchial washing results positive for aspergillosis. Amphotericin B binds with the substance ergosterol, which is a fungal cell wall membrane component. This medicines form leakage within the fungal cell membrane and that causes the fungal cell death. Hence it is recommended as a good antifungal agent. 2. The use of this drug would be eliminated if the patient is hypersensitive to Amphotericin B and if the patient is pregnant or a lactating mother or if the patient is suffering from renal impairment, severe pulmonary reactions or leukoencephalopathy. 3. The other drugs that could be considered for the treatment of Ms. Ungers infection include Voriconazole, Voriconazole in combination with Caspofungin, Itraconazole, Posaconazole. 4. Patient age, sex, race, medical or surgical comorbiditis, health status, lifestyle, habits, diet, inherited traits, culture, environment, pharmacogenomics, analgesic responses, pain perceptions and coping skills are the patient variables, which are most important to consider for Ms. Unger when assessing her drug therapy. These influence the effectiveness and safety of sophisticated and modern forms of the administration of analgesics or antimicrobial agents. 5. The aspects of core drug knowledge in terms of pharmacotherapeutics include: the required therapeutic effect of the drug; in terms of pharmacokinetics: the alterations, which take place to the drug while the substance is inside the human system and in terms of pharmacodynamics: the drug effects on the human system (Kee, Hayes McCuistion, 2012). 6. The nursing assessments which demonstrates the drug therapy effectiveness with amphotericin B includes cronchial washing positive for aspergillosis, infiltrates to left upper and lower lobes of the lungs, low red blood count which might represent pulmonary complication. 7. Possible adverse effects from amphotericin B may demonstrate numbness and tingling sensations in the fingers and toes. Prior to the initiation of the drug administration, the nursing professional should check for antiemetic drug and antipyretic drug. 8. The required nursing actions to increase the effectiveness of amphotericin B administration may include administration of amphotericin B intravenously under strict clinical surveillance by experienced personnel (Lilley, Savoca Lilley, 2011). Speedy intravenous infusion is associated with arrhythmias, hypokalemia, shock and hypotension; hence this medicine should be slowly administered. 9. The required nursing actions to diminish the adverse effects may include administration of an antiemetic and an antipyretic drug before starting the infusion, the nurse should also check for patient hypersensitivity particular for this drug, reduction of the recommended dosages and if the patient complains numbness and tingling sensation in her fingers and toes, the charged nurse should immediately stop the infusion. 10. The care professionals should make the patient understand when to start and to stop taking this drug. To determine appropriate patient teaching the care personnel can enquire the patient what has she understood regarding her therapy. The personnel can also provide her with a template that can include dos and donts, dosage timing and side effects of this dosage. References Kee, J., Hayes, E., McCuistion, L. (2012).Pharmacology. St. Louis, MO: Elsevier Saunders. Lilley, L., Savoca, D., Lilley, L. (2011).Pharmacology and the nursing process. Maryland Heights, MO: Mosby.