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INTRODUCTION

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itraconazole (it-tra-kon-a-zole)

Sporanox

Classification

Therapeutic: antifungals (systemic)

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Indications
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Histoplasmosis. Blastomycosis. Aspergillosis. Dermatophyte infection of fingernails or toenails in nonimmunocompromised patients (oral capsules only). Oropharyngeal esophageal candidiasis.

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Action
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Inhibits enzymes necessary for integrity of the fungal cell membrane. Therapeutic Effects: Fungistatic effects against susceptible organisms. Spectrum: Active against Histoplasma capsulatum, Blastomyces dermatitidis, Cryptococcus neoformans, Aspergillus fumigatus, Trichophyton spp., Candida, and other fungi that cause nail infections (tinea unguium).

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Adverse Reactions/Side Effects
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CNS: dizziness, drowsiness, fatigue, headache, malaise. EENT: tinnitus. CV: CHF, edema, hypertension. GI: HEPATOXICITY, nausea, abdominal pain, anorexia, diarrhea, flatulence, vomiting. GU: albuminuria, decreased libido, erectile dysfunction. Derm: TOXIC EPIDERMAL NECROLYSIS, photosensitivity, pruritus, rash. Endo: adrenal insufficiency. F and E: hypokalemia. MS: rhabdomyolysis. Misc: allergic reactions including anaphylaxis, fever.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for signs of hepatotoxicity, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Notify physician of these signs immediately.

  • Monitor rashes or other severe skin reactions such as exfoliation, hives, itching, raised patches of red or white skin (welts), burning, acne, and abnormal sweating. Notify physician immediately because certain skin responses may indicate serious hypersensitivity reactions.

  • Monitor other signs of allergic reactions and anaphylaxis, including pulmonary symptoms such as tightness in the throat and chest, wheezing, cough, and dyspnea. Notify physician immediately if these reactions occur.

  • Assess signs of congestive heart failure (dyspnea, rales/crackles, peripheral edema, jugular venous distention, exercise intolerance). Report these signs to the physician.

  • Assess blood pressure (BP) and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension).

  • Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

  • Assess any muscle pain, tenderness, or weakness, especially if accompanied by fever, malaise, and dark-colored urine. Advise patient that these symptoms may represent drug-induced myopathy, and that myopathy can progress to severe muscle damage (rhabdomyolysis). Report any unexplained musculoskeletal symptoms to the physician immediately.

  • Monitor any muscle weakness, aches, or cramps that might indicate low potassium levels (hypokalemia). Notify physician immediately if these signs occur.

  • Report signs of adrenal insufficiency, including hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, and restlessness.

  • Assess dizziness or drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

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Interventions
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  • Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread ...

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