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    《ISPN学习》总第506期
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    《ISPN学习》总第536期
    日期:2019-09-16 07:55:41    




    《ISPN学习》2019年09月16日总第536期
     
    相识是缘,相知是福;
    风雨兼程,不忘初心;
    有您相伴,奥医感恩。
     
    From the Programs
    From the Programs [课程选粹]栏目登载奥医网站课程材料精选,旨在帮助读者了解奥医ISPN/NCLEX-RN考试复习课程内容,并加深对考试相关内容的学习、掌握[课程详情见网站或点击阅读原文]您的需要就是我们的努力方向。谢谢)
     
     
    RN-ISPN综合复习课程上线
    《RN-ISPN综合复习讲座》4月15日起陆续上线,每周两讲,预计11月底完成。有需要者请联系ISPN周老师咨询、报名,并感谢各位向有需要的亲朋好友推荐本讲座。详情请登录网站(www.omedin.com)“备考资讯”栏目查询、试听。相关介绍在QQ群“国际护士ISPN”(群号:384099249)及微信公众号ISPN周老师(ISPN-CG)同步发布。谢谢!
     
     
     
    想提高专业英语听力吗?想边练听力边增加护理专业知识吗?Listening -- Elementary》(专业英语听力 – 初级)可助你一臂之力。
     
     
    ISPN  Review        
    Polyenes
    多烯类药

     
    Pharmacotherapeutics
    药物治疗学
     
    Amphotericin B usually is administered to treat severe systemic fungal infections and meningitis caused by fungi sensitive to the drug. It’s never used for noninvasive forms of fungal disease because it’s highly toxic. It’s usually the drug of choice for severe infections caused by Candida, Paracoccidioides brasiliensis, Blastomyces dermatitidis, Coccidioides immitis, Cryptococcus neoformans, and Sporothrix schenckii. It’s also effective against Aspergillus fumigatus, Microsporum audouinii, Rhizopus, Candida glabrata, Trichophyton, and Rhodotorula.

    两性霉素B通常用于治疗药物敏感性真菌引起的严重系统性真菌感染和脑膜炎。鉴于其极端毒性,该药从不用于非侵入性霉菌疾病。对于念珠菌、巴西副球孢子菌、皮炎芽生菌、粗球孢子菌、新型隐球菌和申克孢子丝菌引起的严重感染,其首先药物通常为两性霉素B。该药还对烟曲霉菌、奥杜盎小孢子菌、根霉菌、光滑念珠菌、发癣菌和红酵母菌等有效。
     
    Last-ditch effort
    Because amphotericin B is highly toxic, its use is limited to the patient who has a definitive diagnosis of life-threatening infection and is under close medical supervision.
     
    最后说明
    由于两性霉素B具有高毒性,其使用仅限于确诊为有威胁生命性感染的患者,并在密切医学监督下进行。

     
    Topical concerns
    Nystatin is used primarily to treat candidal skin infections. Different forms of nystatin are available for treating different types of candidal infections. Topical nystatin is used to treat candidal skin or mucous membrane infections, such as oral thrush, diaper rash, vaginal and vulvar candidiasis, and candidiasis between skin folds.
     
    局部使用问题
    制霉菌素主要用于治疗念珠菌引起的皮肤感染。治疗不同类型的念珠菌感染采用不同剂型的制霉菌素。外用制霉菌素用于治疗念珠菌性皮肤或粘膜感染,如鹅口疮、阴道和外阴念珠菌病、皮肤皱襞念珠菌病等。

     
    Drug interactions
    Nystatin doesn’t interact significantly with other drugs, but amphotericin B may have significant interactions with many drugs.
    • Because of the synergistic effects between flucytosine and amphotericin B, these two drugs commonly are combined in therapy for candidal or cryptococcal infections, especially for cryptococcal meningitis.
    • The risk of kidney toxicity increases when amphotericin B is taken with aminoglycosides, cyclosporine, or acyclovir.
    • Corticosteroids, extended-spectrum penicillins, and digoxin may worsen the hypokalemia (low blood potassium levels) produced by amphotericin B, possibly leading to heart problems. Moreover, the risk of digoxin toxicity is increased.
    • Amphotericin B plus nondepolarizing skeletal muscle relaxants (such as pancuronium bromide) increase muscle relaxation.
    • Electrolyte solutions may inactivate amphotericin B when diluted in the same solution. Amphotericin B preparations must be mixed with dextrose 5% in water; they can’t be mixed with saline solution.
    • Magnesium and potassium levels and kidney function must be monitored frequently in patients receiving amphotericin.
     
    药物相互作用
    制霉菌素与其他药物无重大相互作用,但两性霉素B与很多药物存在重大相互作用。
    • 由于氟胞嘧啶和两性霉素B之间的协同效应,这两种药物常常结合使用,以治疗念珠菌或隐球菌感染,特别是隐球菌性脑膜炎。
    • 两性霉素B与氨基糖苷类、环孢菌素或阿昔洛韦一起使用时,肾毒性风险增加。
    • 皮质甾类、广谱青霉素和地高辛可加重两性霉素引起的低钾血症,可能导致心脏问题。且地高辛毒性增强。
    • 两性霉素B加非去极化骨骼肌松弛药(如泮库溴铵)增强肌松弛效果。
    • 稀释于相同溶液时,电解质溶液可以使两性霉素B失活。两性霉素B制剂必须与D5W混合,不能溶入生理盐水溶液。
    • 使用两性霉素患者必须经常监测其镁、钾水平和肾功能。

     
    Oral history
    Oral nystatin is used to treat GI infections.
     
    口服史
    口服制霉菌素用于治疗GI感染。

     
     
    Vocabulary for Today    
    amphotericin B – n. 两性霉素B
    Candida – n. 念珠菌
    Paracoccidioides brasiliensis – n. 巴西副球孢子菌
    Blastomyces dermatitidis – n. 皮炎芽生菌
    Coccidioides immitis – n. 粗球孢子菌
    Cryptococcus neo- formans – n. 隐球菌
    Sporothrix schenckii – n. 申克孢子丝菌
    Aspergillus fumigatus – n. 烟曲霉菌
    Microsporum audouinii – n. 奥杜盎小孢子菌
    Rhizopus – n. 根霉菌属
    Candida glabrata – n. 光滑念珠菌
    Trichophyton – n. 发癣菌
    Rhodotorula – n. 红酵母菌
    flucytosine – n. 氟胞嘧啶
    nondepolarizing – a. 非去极化的
    pancuronium bromide – n. 泮库溴铵
     
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    Video            
    Polyenes
     
    Test                 
    1. Which of the following antifungal agents is associated with bone marrow suppression and renal failure?
    A. Miconazole
    B. Itraconazole
    C. Ketoconazole
    D. Flucytosine
    2. The health education nurse provides instructions to a group of clients regarding measures that will assist in preventing skin cancer. Which instructions should the nurse provide? Select all that apply.
    A. Sunscreen should be applied every 8 hours.
    B. Use sunscreen when participating in outdoor activities.
    C. Wear a hat, opaque clothing, and sunglasses when in the sun.
    D. Avoid sun exposure in the late afternoon and early evening hours.
    E. Examine your body monthly for any lesions that may be suspicious.
     
    (本期答案见页底)
     
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    本期ISPN Review答案
    1. D. Flucytosine
    All of the drugs are antifungal agents but only flucytosine has been associated with bone marrow suppression and synergizes with other drugs which suppress bone marrow functions. Miconazole and ketoconazole may produce hepatotoxicity, gastro-intestinal upset and headaches. Amphotericin B may produce nephrotoxicity while itraconazole is associated with gastro-intestinal upset and rare liver dysfunction.
    2. B, C, E
    The client should be instructed to avoid sun exposure between the hours of brightest sunlight: 10 a.m. and 4 p.m. Sunscreen, a hat, opaque clothing, and sunglasses should be worn for outdoor activities. The client should be instructed to examine the body monthly for the appearance of any cancerous or any precancerous lesions. Sunscreen should be reapplied every 2 to 3 hours and after swimming or sweating; otherwise, the duration of protection is reduced.
     





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