Fluconazole

INTRODUCTION

Indications

PO, IV: Fungal infections caused by susceptible organisms, including Oropharyngeal or esophageal candidiasis, Serious systemic candidal infections, Urinary tract infections, Peritonitis, Cryptococcal meningitis. Prevention of candidiasis in patients who have undergone bone marrow transplantation.

PO: Single-dose oral treatment of vaginal candidiasis. Unlabeled Use: Prevention of recurrent vaginal yeast infections.

Action

Inhibits synthesis of fungal sterols, a necessary component of the cell membrane. Therapeutic Effects: Fungistatic action against susceptible organisms. May be fungicidal in higher concentrations. Spectrum: Cryptococcus neoformans. Candida spp.

Adverse Reactions/Side Effects

Incidence of adverse reactions is increased in HIV patients

CNS: headache, dizziness, seizures. GI: HEPATOTOXICITY, abdominal discomfort, diarrhea, nausea, vomiting. Derm: EXFOLIATIVE SKIN DISORDERS, INCLUDING STEVENS-JOHNSON SYNDROME. Endo: hypokalemia, hypertriglyceridemia. Misc: allergic reactions, including anaphylaxis.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• 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 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 allergic reactions such as Stevens-Johnson syndrome.

• 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.

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings 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.

• Assess dizziness 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.

Interventions

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Employ universal precautions or isolation procedures as indicated for specific patients.

Patient/Client-Related Instruction

• Advise patient to take this drug as directed for the full course of treatment even if feeling better.

• Advise patient that this drug may cause problems in fat metabolism, including increased triglycerides. Remind patient that periodic blood tests may be needed to monitor plasma lipids.

• Instruct patient to report other troublesome side effects such as prolonged or severe ...