Pharmacological and Parenteral Therapies Q 109
The nurse is caring for the client receiving Amphotericin B. Which of the following indicates that the client has experienced toxicity to this drug?
A. Changes in vision
B. Nausea
C. Urinary frequency
D. Changes in skin color
Correct Answer: D. Changes in skin color
Clients taking Amphotericin B should be monitored for liver, renal, and bone marrow function because this drug is toxic to the kidneys and liver, and causes bone marrow suppression. Jaundice is a sign of liver toxicity and is not specific to the use of Amphotericin B. Due to the similarity of mammalian and fungal membranes, which both contain sterols (the therapeutic target for amphotericin B), amphotericin B can exhibit cellular toxicity.
Option A: Changes in vision are not related. Other potential uncommon side effects include demyelinating encephalopathy in patients with bone marrow transplant with total body irradiation or who are receiving cyclosporine.
Option B: Nausea is a side effect, not a sign of toxicity. Monitoring is a recommendation to evaluate for the presence of side effects. Initially, a daily electrolyte panel, including potassium and magnesium concentrations until the dose increases to its therapeutic level, and after that, weekly electrolyte concentrations are sufficient. Clinicians should obtain potassium concentrations immediately if the patient presents with any signs of hypokalemia, such as muscle weakness, cramps, drowsiness, or ECG changes of hypokalemia.
Option C: Urinary frequency is a side effect. Renal toxicity correlates with conventional amphotericin B use and can lead to renal failure and requirement for dialysis. But the azotemia often stabilizes with therapy and renal damage is reversible after discontinuation of amphotericin B.