The University of Alabama
Capstone College of Nursing
NUR 521 Advanced Pharmacology
Exam 4 Blueprint and Study Guide
General Tips for Exam Success: A review of anatomy and pathophysiology is included at the beginning of most
modules in the course. You will not see many direct questions about this information; however, this foundational
knowledge is necessary to understand how drugs work in the body and how the body responds to drugs. You will
be much more successful if you have a strong foundational knowledge and understanding of this information.
You are responsible for knowing the name, MOA, Use, Common AE, Serious AE, Dosing, Administration,
CI, Interactions, and Patient Education for all prototype drugs included in each module. Most of the exam
questions will focus on the prototype drugs presented in each module. You also need to know about the drug class
across the life span. There is content in each module that discusses use of each drug class in pediatric, pregnancy,
breastfeeding, and older adult populations. You will not necessarily need to know an exact dose for prescribing on
all of the prototype drugs, but if faculty stresses a certain dose in a lecture, you will be responsible for this
information. When attempting to narrow down the content, consider what you need to know to be a safe prescriber.
Also, listen for tips and what is emphasized in the lecture. This study guide is intended to help you focus your
studies, but it does not include a list of all necessary details about each individual drug. If any evidenced base
guidelines were presented in the module, I would be sure to review what information was discussed by faculty in
the lecture.
Module Exam Topic
Covered Question
, Allocatio
n
Module 10: 10 Antifungal
Antifungal, When would you prescribe an antifungal for a superficial versus a systemic fungal infection? Which drugs are
Antiviral, used to treat each type? Be able to identify specific organisms that antifungal medications treat.
and
Anthelminti Systemic Mycoses
cs o Opportunistic infections
o Candidiasis, aspergillosis, cryptococcosis, mucormycosis
o Non-opportunistic
o Sporotrichosis, blastomycosis, histoplasmosis, and coccidioidomycosis
Superficial Mycoses- infections that occur in isolated areas.
Treating mycoses can be difficult, resistance may be present, prolonged therapy may result.
Which antifungals are best to use in pediatric patients? Elderly patients?
o Infants: Nystatin is used to treat oral candidiasis in premature and full-term infants. Fluconazole is also
used safely to treat systemic circulation.
o Children: many antifungal agents are used safely in children, in lower doses. Side-effect profiles are
similar to those in adults.
o Older Adults: older adults have a higher risk for achlorhydria (absence of hydrochloric acid in the
gastric secretions) than do younger individuals and may not predictably absorb antifungal agents. In
addition, common drugs prescribed to older adults, including warfarin, phenytoin, and oral
hypoglycemic agents, are increased by azoles
Know which antifungal medications that you pretreat with? What meds do you pretreat with?
o Amphotericin B (Abelcet): Polyene Antifungal- Premed with Benadryl, Tylenol, and hydrocortisone.
Demerol for rigors
Know the CI for antifungal drugs. Think about this through the lens of the provider. What medical conditions
do you need to ask about before prescribing antifungal medications?
What will you teach your patient about antifungal medications? Go through each drug and determine the most
important teaching points.
Prototype Drugs:
,Amphotericin B (Abelcet): Polyene Antifungal
***Amphotericin is B is active against broad spectrum of pathogenic fungi and is the drug of choice for most
systemic mycoses. Unfortunately, amphotericin B is HIGHLY TOXIC: infusion reactions and renal damage
occur in many patients. Because of its potential for harm, amphotericin B should be employed only against
active infections that are progressive and potentially fatal.
systemic mycoses refer to a group of fungal infections that can affect multiple organs in the body and
often have the potential to spread from the initial site of infection to other parts of the body. These
infections are caused by fungi that typically exist in the environment and can infect humans when
spores are inhaled or come into contact with the skin. Unlike superficial fungal infections, which are
limited to the outer layers of the skin, hair, and nails, systemic mycoses can penetrate deeper tissues
and organs, leading to more severe and potentially life-threatening conditions.
MOA:
o Binds to components of the fungal cell membrane, increasing permeability leakage of intracellular cations
(K), reducing viability
o Fungistatic or fungicidal-depends on concentration of Amphotericin B and susceptibility of the fungus.
o Drug binds to fungal membranes that contain sterol, so ergosterol must be present on membrane
o *Amphotericin binds to components of fungal cell membrane, increasing permeability. The component of the
fungal membrane to which amphotericin B binds is esgosterol (ear gauge), a member of the sterol family
compounds. Hence, for a cell to be susceptible, its cytoplasmic membrane must contain sterols. Because
bacterial membranes lack sterols, bacteria are not affected.
Therapeutic Goal: get rid of infection
Use:
o Broad spectrum
o DOC for most systemic mycoses
o Aspergillus spp
o Brown-black molds
o Leishmania spp
Baseline Data:
o Check patient’s renal function
o CBC
Contraindications:
o Hypersensitivity
, o Caution in renal impairment
Dosing and Administration:
o Treatment is prolonged (6-8 weeks)
o IV dosing only
o Renal dosing
o If creatinine >3.5 mg/dL, dose reduce (normal creatine is 0.7-1.3 mg/dL
o Premed with Benadryl, Tylenol, and hydrocortisone, and Demerol to help prevent Rigors (severe chills
with violent shivering). Some of the adverse effects are chills, fever, flu-like symptoms, and this helps to
prevent this.
Adverse Effects:
o SERIOUS AE
o Infusions reactions fever, chills, rigors, N, HA (this is why we pre-med!)
*These reactions are caused by release of proinflammatory cytokines. Symptoms begin 1-3 hours after starting
the infusion and persist for about an hour. Mild reactions can be reduced by pretreatment with diphenhydramine
(Benadryl) plus acetaminophen (Tylenol). If other measures fail, hydrocortisone can be used to decrease fever
and chills. However, because glucocorticoids can reduce the patient’s ability to fight infection, routine use of
hydrocortisone should be avoided.
o Phlebitis – inflammation of the veins because the infusion is so toxic.
o Nephrotoxicity (occurs in most patients and related to cumulative dose)
*Amphotericin is toxic to cells of the kidneys. Renal impairment occurs in practically all patients. The extent of
kidney damage is related to total dose administered over the full course of treatment. In most cases, renal
function normalizes after Amphotericin use stops. However, if the total dose exceeds 4 g, residual impairment
is likely. Kidney damage is minimized by infusing 1 L of saline on the day’s amphotericin is given. Other
nephrotoxic drugs should be avoided. The evaluate renal injury, tests of the kidney function should be
performed every 3-4 days and intake, and output should be monitored. If plasma creatine rises above 3.5
mg/dL, Amphotericin dosage should be reduced.
o Bone marrow suppression (anemia)
*Amphotericin can cause hematologic effects or otherwise known as bone marrow suppression resulting in
anemia. Hematocrit determinations should be conducted to monitor red blood cell status).
o Electrolyte imbalances after infusion
BBW:
o Because of its toxicity, amphotericin should be used only in the setting of a potentially life-threatening
Capstone College of Nursing
NUR 521 Advanced Pharmacology
Exam 4 Blueprint and Study Guide
General Tips for Exam Success: A review of anatomy and pathophysiology is included at the beginning of most
modules in the course. You will not see many direct questions about this information; however, this foundational
knowledge is necessary to understand how drugs work in the body and how the body responds to drugs. You will
be much more successful if you have a strong foundational knowledge and understanding of this information.
You are responsible for knowing the name, MOA, Use, Common AE, Serious AE, Dosing, Administration,
CI, Interactions, and Patient Education for all prototype drugs included in each module. Most of the exam
questions will focus on the prototype drugs presented in each module. You also need to know about the drug class
across the life span. There is content in each module that discusses use of each drug class in pediatric, pregnancy,
breastfeeding, and older adult populations. You will not necessarily need to know an exact dose for prescribing on
all of the prototype drugs, but if faculty stresses a certain dose in a lecture, you will be responsible for this
information. When attempting to narrow down the content, consider what you need to know to be a safe prescriber.
Also, listen for tips and what is emphasized in the lecture. This study guide is intended to help you focus your
studies, but it does not include a list of all necessary details about each individual drug. If any evidenced base
guidelines were presented in the module, I would be sure to review what information was discussed by faculty in
the lecture.
Module Exam Topic
Covered Question
, Allocatio
n
Module 10: 10 Antifungal
Antifungal, When would you prescribe an antifungal for a superficial versus a systemic fungal infection? Which drugs are
Antiviral, used to treat each type? Be able to identify specific organisms that antifungal medications treat.
and
Anthelminti Systemic Mycoses
cs o Opportunistic infections
o Candidiasis, aspergillosis, cryptococcosis, mucormycosis
o Non-opportunistic
o Sporotrichosis, blastomycosis, histoplasmosis, and coccidioidomycosis
Superficial Mycoses- infections that occur in isolated areas.
Treating mycoses can be difficult, resistance may be present, prolonged therapy may result.
Which antifungals are best to use in pediatric patients? Elderly patients?
o Infants: Nystatin is used to treat oral candidiasis in premature and full-term infants. Fluconazole is also
used safely to treat systemic circulation.
o Children: many antifungal agents are used safely in children, in lower doses. Side-effect profiles are
similar to those in adults.
o Older Adults: older adults have a higher risk for achlorhydria (absence of hydrochloric acid in the
gastric secretions) than do younger individuals and may not predictably absorb antifungal agents. In
addition, common drugs prescribed to older adults, including warfarin, phenytoin, and oral
hypoglycemic agents, are increased by azoles
Know which antifungal medications that you pretreat with? What meds do you pretreat with?
o Amphotericin B (Abelcet): Polyene Antifungal- Premed with Benadryl, Tylenol, and hydrocortisone.
Demerol for rigors
Know the CI for antifungal drugs. Think about this through the lens of the provider. What medical conditions
do you need to ask about before prescribing antifungal medications?
What will you teach your patient about antifungal medications? Go through each drug and determine the most
important teaching points.
Prototype Drugs:
,Amphotericin B (Abelcet): Polyene Antifungal
***Amphotericin is B is active against broad spectrum of pathogenic fungi and is the drug of choice for most
systemic mycoses. Unfortunately, amphotericin B is HIGHLY TOXIC: infusion reactions and renal damage
occur in many patients. Because of its potential for harm, amphotericin B should be employed only against
active infections that are progressive and potentially fatal.
systemic mycoses refer to a group of fungal infections that can affect multiple organs in the body and
often have the potential to spread from the initial site of infection to other parts of the body. These
infections are caused by fungi that typically exist in the environment and can infect humans when
spores are inhaled or come into contact with the skin. Unlike superficial fungal infections, which are
limited to the outer layers of the skin, hair, and nails, systemic mycoses can penetrate deeper tissues
and organs, leading to more severe and potentially life-threatening conditions.
MOA:
o Binds to components of the fungal cell membrane, increasing permeability leakage of intracellular cations
(K), reducing viability
o Fungistatic or fungicidal-depends on concentration of Amphotericin B and susceptibility of the fungus.
o Drug binds to fungal membranes that contain sterol, so ergosterol must be present on membrane
o *Amphotericin binds to components of fungal cell membrane, increasing permeability. The component of the
fungal membrane to which amphotericin B binds is esgosterol (ear gauge), a member of the sterol family
compounds. Hence, for a cell to be susceptible, its cytoplasmic membrane must contain sterols. Because
bacterial membranes lack sterols, bacteria are not affected.
Therapeutic Goal: get rid of infection
Use:
o Broad spectrum
o DOC for most systemic mycoses
o Aspergillus spp
o Brown-black molds
o Leishmania spp
Baseline Data:
o Check patient’s renal function
o CBC
Contraindications:
o Hypersensitivity
, o Caution in renal impairment
Dosing and Administration:
o Treatment is prolonged (6-8 weeks)
o IV dosing only
o Renal dosing
o If creatinine >3.5 mg/dL, dose reduce (normal creatine is 0.7-1.3 mg/dL
o Premed with Benadryl, Tylenol, and hydrocortisone, and Demerol to help prevent Rigors (severe chills
with violent shivering). Some of the adverse effects are chills, fever, flu-like symptoms, and this helps to
prevent this.
Adverse Effects:
o SERIOUS AE
o Infusions reactions fever, chills, rigors, N, HA (this is why we pre-med!)
*These reactions are caused by release of proinflammatory cytokines. Symptoms begin 1-3 hours after starting
the infusion and persist for about an hour. Mild reactions can be reduced by pretreatment with diphenhydramine
(Benadryl) plus acetaminophen (Tylenol). If other measures fail, hydrocortisone can be used to decrease fever
and chills. However, because glucocorticoids can reduce the patient’s ability to fight infection, routine use of
hydrocortisone should be avoided.
o Phlebitis – inflammation of the veins because the infusion is so toxic.
o Nephrotoxicity (occurs in most patients and related to cumulative dose)
*Amphotericin is toxic to cells of the kidneys. Renal impairment occurs in practically all patients. The extent of
kidney damage is related to total dose administered over the full course of treatment. In most cases, renal
function normalizes after Amphotericin use stops. However, if the total dose exceeds 4 g, residual impairment
is likely. Kidney damage is minimized by infusing 1 L of saline on the day’s amphotericin is given. Other
nephrotoxic drugs should be avoided. The evaluate renal injury, tests of the kidney function should be
performed every 3-4 days and intake, and output should be monitored. If plasma creatine rises above 3.5
mg/dL, Amphotericin dosage should be reduced.
o Bone marrow suppression (anemia)
*Amphotericin can cause hematologic effects or otherwise known as bone marrow suppression resulting in
anemia. Hematocrit determinations should be conducted to monitor red blood cell status).
o Electrolyte imbalances after infusion
BBW:
o Because of its toxicity, amphotericin should be used only in the setting of a potentially life-threatening
