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Chapter 29. Invasive Fungal Infections

TI is a 44-year-old patient with an aspergillosis infection. She is to receive treatment with amphotericin B. Which one of the following adjunctive measures is used to lessen the occurrence of nephrotoxicity associated with amphotericin B?

a. Test dose of amphotericin B

b. Diphenhydramine premedication

c. Normal saline boluses

d. Furosemide

Answer c is correct. Although not proven via large-scale controlled trials, data from animal and small human studies suggest a decrease in nephrotoxicity. Patients will often receive a 500-mL IV bolus of normal saline solution before starting the amphotericin B infusion. Saline doses are also often administered after the dose of amphotericin B.

Answer a is incorrect. This may help identify patients who might develop an infusion-related adverse effect (fevers, chills, rigors, or hypotension) or anaphylaxis. Most experts do not advocate this anymore due to the poor predictive value. However, during initial dosing, the drug should be administered under close monitoring.

Answer b is incorrect. This is believed to reduce the occurrence of infusion-related adverse effects (fevers, chills, and rigors). Other medications that might be used to treat/prevent the infusion-related reactions include acetaminophen, nonsteroidal anti-inflammatory medications, and hydrocortisone. If the patient continues with severe rigors despite the premedication, meperidine may be used.

Answer d is incorrect. Use of furosemide can often contribute to renal insufficiency in patients receiving amphotericin B.

PT is a 33-year-old human immunodeficiency virus (HIV) patient. He has a high HIV viral load and low CD4. He has been nonadherent with medication and provider appointments. PT is admitted to the medical center for a change in mental status. He is undergoing a complete work-up to identify the cause. An India ink stain is reported as positive. Which one of the following organisms is likely to manifest a positive India ink stain on a CSF sample?

a. Candida albicans

b. Candida glabrata

c. Aspergillus fumigatus

d. Cryptococcus neoformans

Answer d is correct. The India ink stain adheres to the capsule around C. neoformans.

Answers a, b, and c are incorrect. Cryptococcus is evaluated via an India ink stain. The other organisms do not respond to the India ink stain.

When preparing an IV formulation of amphotericin B deoxycholate, the lyophilized amphotericin B powder must first be reconstituted with sterile water. What type of IV fluid must the reconstituted amphotericin B be placed in for IV ...

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