Voriconazole

INTRODUCTION

Indications

Serious systemic fungal infections, including candidemia, esophageal candidiasis, candidal deep tissue and skin infections, abdominal, kidney, bladder wall and wound infections, and aspergillosis.

Action

Inhibits fungal ergosterol synthesis leading to production of abnormal fungal plasma membrane. Therapeutic Effects: Antifungal activity.

Adverse Reactions/Side Effects

CNS: dizziness, hallucinations, headache. EENT: visual disturbances, eye hemorrhage. CV: changes in blood pressure, tachycardia, peripheral edema. GI: HEPATOXICITY, abdominal pain, diarrhea, nausea, pancreatitis, vomiting. Derm: photosensitivity, rash. F and E: hypokalemia, hypomagnesemia. Misc: ALLERGIC REACTIONS, INCLUDING STEVENS-JOHNSON SYNDROME, chills, fever, infusion reactions.

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.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report tachycardia or other rhythm disturbances, or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• 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.

• Monitor signs of low potassium levels (hypokalemia) such as muscle weakness, aches, or cramps, and signs of low magnesium levels (hypomagnesemia), such as lethargy, irritability, insomnia, muscle tremors, and confusion. Notify physician of these signs.

• 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.

• Report allergy-like responses (wheezing, laryngeal edema, urticaria, other skin reactions) that occur during and after administration (infusion related reactions).

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.

• Because of the risk of arrhythmias and abnormal BP responses, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (BP, heart rate, fatigue levels), and terminate ...