| Drug and Dosage | Use | Action | Assessment: Side Effects |
|---|
| Amphotericin B (Fungizone)—IV 5 mg/250 mL dextrose over 4–6 hr (to 1 mg/kg body weight) | Severe fungal infections; histoplasmosis | Fungistatic or fungicidal; binds to sterols in fungal cell membrane, altering cell permeability | Febrile reactions; chills, nausea, vomiting; muscle/joint pain; renal damage; hypotension, tachycardia, arrhythmias; hypokalemia |
| NURSING IMPLICATIONS: Monitor for side effects, thrombophlebitis at IV site; blood urea nitrogen (BUN) >40; creatinine >3; stop drug because of nephrotoxicity |
| Ketoconazole (Nizoral)—PO 200–400 mg daily | Histoplasmosis, systemic fungal infections | Antifungal | Headache, fatigue, dizziness; nausea, vomiting; decreased libido, impotence; gynecomastia, especially in men |
| NURSING IMPLICATIONS: Administer with food; avoid concomitant use of antacids, histamine2 (H2) blockers; advise to report side effects |
| Nystatin (Nilstat, Mycostatin)—PO, rectal, vaginal 100,000–1,000,000 units 3–4 times daily | Skin, mucous membrane infections (Candida albicans); oral thrush, vaginitis; intestinal candidiasis | Fungistatic and fungicidal; binds to sterols in fungal cell membrane | Nausea, vomiting, Gl distress, diarrhea |
| NURSING IMPLICATIONS: Oral use—clear mouth of food; keep medication in mouth several minutes before swallowing; vaginal—usually requires 2 wk therapy; continue use during menses; consult physician before using anti-infective douches; determine predisposing factors to infection (diabetes, pregnancy, antibiotics, tight-fitting nylon pantyhose) |