NR 566 Midterm Study Review Questions with Verified Answers
(Correct Update)
Question 1: Fungal infections
Answer: Fungal infections (mycoses) can be categorized as systemic or superficial. Systemic mycoses
are further subdivided into two categories: opportunistic infections and non-opportunistic infections.
Opportunistic mycoses include Candidiasis, Aspergillosis, Cryptococcosis, and Mucormycosis.
Opportunistic mycoses occur primarily in debilitated or immunocompromised hosts. Non-opportunistic
mycoses include Sporotrichosis, Blastomycosis, Histoplasmosis, and Coccidioidomycosis. Unlike
opportunistic mycoses, non-opportunistic mycoses can occur in any host but are relatively uncommon.
Superficial mycoses can be classified into two groups: Candida species and dermatophytes. The
dermatophytes can be further divided into Epidermophyton, Trichophyton, and Microsporum species.
Question 2: Griseofulvin indications
Answer: Griseofulvin is used to treat the following conditions, especially when topical treatments have
failed or are inappropriate: Tinea capitis (ringworm of the scalp) Tinea corporis (ringworm of the body)
Tinea pedis (athlete's foot) Tinea cruris (jock itch/ringworm of the groin and thigh) Tinea barbae
(barber's itch) Tinea unguium or onychomycosis (ringworm of the nails)
Question 3: Terbinafine indications
Answer: Terbinafine (Lamisil) is a highly active antifungal agent against dermatophytes with less
activity against Candida species. MOA: Terbinafine inhibits squalene epoxidase with resultant
inhibition of ergosterol synthesis. Ergosterol synthesis is a key component of the fungal cell membrane.
Question 4: Terbinafine adverse effects
Answer: GI issues, taste differences, liver damage
Question 5: Amphotericin B drug class and indication:
Answer: Polyenes like amphotericin b are effective against many systemic fungal infections and are
available in IV formulations.
Question 6: Amphotericin B MOA:
Answer: MOA: Amphotericin B binds to the ergosterol component (member of the sterol family) of the
fungal membrane
Question 7: Amphotericin B Adverse effects:
Answer: Adverse effects: Contraindicated in clients with severe renal impairment. Black Box Warning:
Because of its toxicity, amphotericin B should only be administered for a potentially life-threatening
infection.
Page 1
,Question 8: Amphotericin B side effects:
Answer: Infusion reactions (pretreat!), nephrotoxic, bone marrow suppression (anemia)
Question 9: Antifungal treatment across the lifespan: INFANTS
Answer: Nystatin is indicated for treating oral candidiasis (thrush) in premature/full-term infants.
Fluconazole is used safely to treat systemic candidiasis in newborns. Itraconazole requires a lower dose
in pediatric clients, with 5mg/kg twice daily as a starting dose.
Question 10: Antifungal treatment across the lifespan: PRESCHOOL CHILDREN-
ADOLESCENTS
Answer: Many antifungal agents are safely utilized to treat systemic and superficial mycoses at reduced
recommended doses. Itraconazole requires a lower dose in pediatric clients, with 5mg/kg twice daily as
a starting dose.
Question 11: Antifungal treatment across the lifespan: PREGNANT AND BREASTFEEDING
PATIENTS
Answer: Many azole antifungal agents were previously classified as Pregnancy Risk Category C or D
agents. Caspofungin is embryotoxic in rats and rabbits and was previously classified as an Pregnancy
Risk Category C agent. Vulvovaginal Candidiasis occurs frequently during pregnancy. Only topical
(intravaginal) azole therapies applied for seven days are recommended during pregnancy. Oral
Fluconazole might be associated with spontaneous abortion and congenital anomalies and, therefore,
should not be used (CDC, 2021). Data regarding most antifungals and breastfeeding is lacking. Most
antifungals are considered safe in low doses, except for Ketoconazole. Due to this agent's high potential
for hepatoxicity, Ketoconazole should be avoided in breastfeeding clients. Consider altered
pharmacokinetics related to pregnancy.
Question 12: Antifungal treatment across the lifespan: OLDER ADULTS
Answer: The risk for achlorhydria (absent or reduced gastric hydrochloric production) is greater in older
adults. This condition could make the absorption of some antifungal agents unpredictable. Plasma levels
of commonly prescribed medications in older adults (such as warfarin, phenytoin, and oral
hypoglycemic agents) are increased by azoles. Medication reconciliation and safety with polypharmacy
practice should be prioritized. Consider the ability of the client and support system to safely
self-administer medications without skipping or doubling doses. Consider altered pharmacokinetics
based on agerelated changes. Consider polypharmacy and drug interactions
Page 2
, Question 13: Antiviral treatment across the lifespan: INFANTS
Answer: Antiretroviral Medications like efavirenz are not recommended for infants younger than three
months or weighing less than 3.5 kg due to increased risk of adverse effects and lack of adequate safety
data. Herpes Simplex Virus and Varicella-Zoster Valacyclovir may be given to neonates for HSV
suppressive therapy under careful consideration due to the lack of comprehensive studies in this age
group. Influenza Oseltamivir is approved for the treatment and prevention of influenza in clients one
year and older, with dosing based on body weight and consideration for renal function. COVID-19
Paxlovid is not authorized for use in children under 12 years of age or weighing less than 40 kg due to
potential safety concerns and lack of data.
Question 14: Antiviral treatment across the lifespan: SCHOOL AGED CHILDREN
Answer: Antiretroviral Medications Safety and effectiveness of drugs like rilpivirine have not been
established for children under 12 years. Dosage forms suitable for children, such as liquids or dispersible
tablets, may be necessary to ensure accurate dosing and adherence. Herpes Simplex Virus and
Varicella-Zoster Children 12 years or older may receive valacyclovir for cold sores, with dosage
adjustments based on clinical response and careful monitoring. Influenza Oseltamivir and zanamivir are
used for treatment and prophylaxis, with dosage adjustments based on weight and careful monitoring for
side effects. COVID-19 Paxlovid is not authorized for use in children under 12 years of age or weighing
less than 40 kg due to potential safety concerns and lack of data.
Question 15: Antiviral treatment across the lifespan: PREGNANT AND BREASTFEEDING
WOMEN
Answer: Zidovudine is the medication of choice for preventing transmission of HIV during labor and
delivery, even though it was previously classified as a Pregnancy Risk Category C agent. Breastfeeding
is generally contraindicated for clients with HIV due to the risk of viral transmission through breast
milk. Herpes Simplex Virus and Varicella-Zoster Acyclovir, famciclovir, and valacyclovir were
previously classified as Pregnancy Risk Category B agents, indicating no evidence of risk in humans.
However, consideration is needed due to potential risks and limited studies on breastfeeding clients.
Influenza Oseltamivir is generally considered safe, but zanamivir's safety profile is less clear due to its
inhalation route and potential effects on lung function. COVID-19 Data on the use of Paxlovid during
pregnancy is insufficient.
Question 16: Antiviral treatment across the lifespan: OLDER ADULTS
Answer: Antiretroviral Medications Potential for age-related changes in drug metabolism and
elimination necessitates careful monitoring for adverse effects. Herpes Simplex Virus and
Varicella-Zoster No specific contraindications, but lower doses are recommended for those with renal
impairment. Influenza Emphasis on early treatment initiation for oseltamivir and cautious use of
zanamivir in those with underlying airway diseases, with dosing adjustments for renal impairment.
COVID-19 Dose adjustments and monitoring are advised for those with renal or hepatic impairment.
General Consider the ability of the client and support system to safely self-administer medications
without skipping or doubling doses. Consider altered pharmacokinetics based on agerelated changes.
Consider polypharmacy and drug interactions.
Page 3
(Correct Update)
Question 1: Fungal infections
Answer: Fungal infections (mycoses) can be categorized as systemic or superficial. Systemic mycoses
are further subdivided into two categories: opportunistic infections and non-opportunistic infections.
Opportunistic mycoses include Candidiasis, Aspergillosis, Cryptococcosis, and Mucormycosis.
Opportunistic mycoses occur primarily in debilitated or immunocompromised hosts. Non-opportunistic
mycoses include Sporotrichosis, Blastomycosis, Histoplasmosis, and Coccidioidomycosis. Unlike
opportunistic mycoses, non-opportunistic mycoses can occur in any host but are relatively uncommon.
Superficial mycoses can be classified into two groups: Candida species and dermatophytes. The
dermatophytes can be further divided into Epidermophyton, Trichophyton, and Microsporum species.
Question 2: Griseofulvin indications
Answer: Griseofulvin is used to treat the following conditions, especially when topical treatments have
failed or are inappropriate: Tinea capitis (ringworm of the scalp) Tinea corporis (ringworm of the body)
Tinea pedis (athlete's foot) Tinea cruris (jock itch/ringworm of the groin and thigh) Tinea barbae
(barber's itch) Tinea unguium or onychomycosis (ringworm of the nails)
Question 3: Terbinafine indications
Answer: Terbinafine (Lamisil) is a highly active antifungal agent against dermatophytes with less
activity against Candida species. MOA: Terbinafine inhibits squalene epoxidase with resultant
inhibition of ergosterol synthesis. Ergosterol synthesis is a key component of the fungal cell membrane.
Question 4: Terbinafine adverse effects
Answer: GI issues, taste differences, liver damage
Question 5: Amphotericin B drug class and indication:
Answer: Polyenes like amphotericin b are effective against many systemic fungal infections and are
available in IV formulations.
Question 6: Amphotericin B MOA:
Answer: MOA: Amphotericin B binds to the ergosterol component (member of the sterol family) of the
fungal membrane
Question 7: Amphotericin B Adverse effects:
Answer: Adverse effects: Contraindicated in clients with severe renal impairment. Black Box Warning:
Because of its toxicity, amphotericin B should only be administered for a potentially life-threatening
infection.
Page 1
,Question 8: Amphotericin B side effects:
Answer: Infusion reactions (pretreat!), nephrotoxic, bone marrow suppression (anemia)
Question 9: Antifungal treatment across the lifespan: INFANTS
Answer: Nystatin is indicated for treating oral candidiasis (thrush) in premature/full-term infants.
Fluconazole is used safely to treat systemic candidiasis in newborns. Itraconazole requires a lower dose
in pediatric clients, with 5mg/kg twice daily as a starting dose.
Question 10: Antifungal treatment across the lifespan: PRESCHOOL CHILDREN-
ADOLESCENTS
Answer: Many antifungal agents are safely utilized to treat systemic and superficial mycoses at reduced
recommended doses. Itraconazole requires a lower dose in pediatric clients, with 5mg/kg twice daily as
a starting dose.
Question 11: Antifungal treatment across the lifespan: PREGNANT AND BREASTFEEDING
PATIENTS
Answer: Many azole antifungal agents were previously classified as Pregnancy Risk Category C or D
agents. Caspofungin is embryotoxic in rats and rabbits and was previously classified as an Pregnancy
Risk Category C agent. Vulvovaginal Candidiasis occurs frequently during pregnancy. Only topical
(intravaginal) azole therapies applied for seven days are recommended during pregnancy. Oral
Fluconazole might be associated with spontaneous abortion and congenital anomalies and, therefore,
should not be used (CDC, 2021). Data regarding most antifungals and breastfeeding is lacking. Most
antifungals are considered safe in low doses, except for Ketoconazole. Due to this agent's high potential
for hepatoxicity, Ketoconazole should be avoided in breastfeeding clients. Consider altered
pharmacokinetics related to pregnancy.
Question 12: Antifungal treatment across the lifespan: OLDER ADULTS
Answer: The risk for achlorhydria (absent or reduced gastric hydrochloric production) is greater in older
adults. This condition could make the absorption of some antifungal agents unpredictable. Plasma levels
of commonly prescribed medications in older adults (such as warfarin, phenytoin, and oral
hypoglycemic agents) are increased by azoles. Medication reconciliation and safety with polypharmacy
practice should be prioritized. Consider the ability of the client and support system to safely
self-administer medications without skipping or doubling doses. Consider altered pharmacokinetics
based on agerelated changes. Consider polypharmacy and drug interactions
Page 2
, Question 13: Antiviral treatment across the lifespan: INFANTS
Answer: Antiretroviral Medications like efavirenz are not recommended for infants younger than three
months or weighing less than 3.5 kg due to increased risk of adverse effects and lack of adequate safety
data. Herpes Simplex Virus and Varicella-Zoster Valacyclovir may be given to neonates for HSV
suppressive therapy under careful consideration due to the lack of comprehensive studies in this age
group. Influenza Oseltamivir is approved for the treatment and prevention of influenza in clients one
year and older, with dosing based on body weight and consideration for renal function. COVID-19
Paxlovid is not authorized for use in children under 12 years of age or weighing less than 40 kg due to
potential safety concerns and lack of data.
Question 14: Antiviral treatment across the lifespan: SCHOOL AGED CHILDREN
Answer: Antiretroviral Medications Safety and effectiveness of drugs like rilpivirine have not been
established for children under 12 years. Dosage forms suitable for children, such as liquids or dispersible
tablets, may be necessary to ensure accurate dosing and adherence. Herpes Simplex Virus and
Varicella-Zoster Children 12 years or older may receive valacyclovir for cold sores, with dosage
adjustments based on clinical response and careful monitoring. Influenza Oseltamivir and zanamivir are
used for treatment and prophylaxis, with dosage adjustments based on weight and careful monitoring for
side effects. COVID-19 Paxlovid is not authorized for use in children under 12 years of age or weighing
less than 40 kg due to potential safety concerns and lack of data.
Question 15: Antiviral treatment across the lifespan: PREGNANT AND BREASTFEEDING
WOMEN
Answer: Zidovudine is the medication of choice for preventing transmission of HIV during labor and
delivery, even though it was previously classified as a Pregnancy Risk Category C agent. Breastfeeding
is generally contraindicated for clients with HIV due to the risk of viral transmission through breast
milk. Herpes Simplex Virus and Varicella-Zoster Acyclovir, famciclovir, and valacyclovir were
previously classified as Pregnancy Risk Category B agents, indicating no evidence of risk in humans.
However, consideration is needed due to potential risks and limited studies on breastfeeding clients.
Influenza Oseltamivir is generally considered safe, but zanamivir's safety profile is less clear due to its
inhalation route and potential effects on lung function. COVID-19 Data on the use of Paxlovid during
pregnancy is insufficient.
Question 16: Antiviral treatment across the lifespan: OLDER ADULTS
Answer: Antiretroviral Medications Potential for age-related changes in drug metabolism and
elimination necessitates careful monitoring for adverse effects. Herpes Simplex Virus and
Varicella-Zoster No specific contraindications, but lower doses are recommended for those with renal
impairment. Influenza Emphasis on early treatment initiation for oseltamivir and cautious use of
zanamivir in those with underlying airway diseases, with dosing adjustments for renal impairment.
COVID-19 Dose adjustments and monitoring are advised for those with renal or hepatic impairment.
General Consider the ability of the client and support system to safely self-administer medications
without skipping or doubling doses. Consider altered pharmacokinetics based on agerelated changes.
Consider polypharmacy and drug interactions.
Page 3
