A provider has ordered oral voriconazole (Vfend) for a patient ...

[wenmo]

A provider has ordered oral voriconazole (Vfend) for a patient who has a systemic fungal infection. The nurse obtains a medication history and learns that the patient takes phenobarbital for seizures.
 
  The nurse will contact the provider to discuss which possibility?
  a. Administering intravenous voriconazole
  b. Reducing the dose of phenobarbital
  c. Reducing the dose of voriconazole
  d. Using a different antifungal agent

Question 2

A patient is receiving intravenous voriconazole (Vfend). Shortly after the infusion starts, the patient tells the nurse, Colors look different, and the light hurts my eyes. What will the nurse do?
 
  a. Observe the patient closely for the development of hallucinations.
  b. Reassure the patient that these effects will subside in about 30 minutes.
  c. Stop the infusion and notify the provider of CNS toxicity.
  d. Tell the patient that this is an irreversible effect of the drug.

[dudman123]

Answer to Question 1

ANS: D
Voriconazole can interact with many drugs. It should not be combined with drugs that are powerful P450 inhibitors, including phenobarbital, because these can reduce the levels of voriconazole. Administering the voriconazole IV will not increase the serum level. It is not correct to reduce the dose of either drug.

Answer to Question 2

ANS: B
Reduced visual acuity, increased brightness, altered color perception, and photophobia are reversible visual disturbances that can occur in 30 of patients receiving voriconazole. These usually begin within 30 minutes of dosing and then diminish over the next 30 minutes. They are not precursors to other effects, such as hallucinations. They do not indicate CNS toxicity. They are reversible.

[wenmo]

Excellent

[sarah_brady415]

TYSM