ABX And ANV

Question 1

What antibiotic causes “red man syndrome?”

Answer 1

Vancomycin

Question 2

A patient has just had a 10-day course of antibiotics and is complaining of profuse diarrhea for the past two days. What should the nurse do?

Answer 2

Alert the physician.

Question 3

The nurse should inform the patient to alert their physician if they experience diarrhea while taking an antibiotic, why?

Answer 3

Superinfection

Question 4

A patient is allergic to cephalosporins what medication should the nurse advise the patient to be cautious with?

Answer 4

Amoxicillin

Question 5

A nurse is teaching a female client who has a severe UTI about ciprofloxacin. Which of the following information about adverse reactions should the nurse include? (Select all that apply.)
A. Observe for pain and swelling of the Achilles tendon.
B. Watch for a vaginal yeast infection.
C. Expect excessive nighttime perspiration.
D. Inspect the mouth for cottage cheese-like lesions.
E. Take the medication with a dairy product.

Answer 5

Answer:
A. Observe for pain and swelling of the Achilles tendon.
B. Watch for a vaginal yeast infection.
D. Inspect the mouth for cottage cheese-like lesions

Question 6

A nurse is planning discharge teaching for a female client who has a new prescription for trimethoprim-sulfamethoxazole. Which of the following information should the nurse include?
A. Take the medication even if pregnant.
B. Maintain a fluid restriction while taking it.
C. Take it on an empty stomach.
D. Stop taking it when manifestations subside.

Answer 6

C. Take it on an empty stomach

Question 7

ABX

Answer 7

wear protective clothes & sunscreen.

Question 8

The nurse is caring for a patient on a medical-surgical unit who is raising green sputum. The prescriber has ordered a broad-spectrum antibiotic. Which intervention is the priority?
a. Administering the antibiotic immediately
b. Administering antipyretics as soon as possible
c. Delaying administration of the antibiotic until the culture results are available
d. Obtaining all cultures before the antibiotic is administered

Answer 8

d. Obtaining all cultures before the antibiotic is administered

Question 9

Antibiotic MOAs

Answer 9

Therapeutic actions disrupt bacterial cell function by targeting the biosynthesis of the cell wall
Interfere with protein synthesis and DNA synthesis
modify the cell membrane’s permeability, leading to the leakage of essential cellular components.

Question 10

Resistance

Answer 10

bacteria’s ability to adapt to an anti-infective drug over time and produce cells that are no longer affected by that particular drug. Resistance is a part of bacterial evolution and can be natural or acquired.

Question 11

Acquiring Resistance

Answer 11

Producing an enzyme that deactivates the antimicrobial drug
Changing cellular permeability to prevent the drug from entering the cell
Altering transport systems to exclude the drug from active transport into the cell
Altering binding sites on the membranes or ribosomes, which then no longer accept the drug
Producing a chemical that acts as an antagonist to the drug

Question 12

Preventing Resistance

Answer 12

Limit the use of antimicrobial agents to the treatment of specific pathogens sensitive to the drug being used
Make sure doses are high enough, and the duration of drug therapy is long enough
Be cautious about the indiscriminate use of anti-infectives

Question 13

Treatment of systemic infections includes:

Answer 13

Identification of the infecting pathogen via culture
Sensitivity testing to determine which drugs are capable of controlling the particular microorganism
Combination therapy
-Use of a smaller dosage of each drug
-Some drugs are synergistic
-In infections caused by more than one organism, each pathogen may react to a different anti-infective agent
-Sometimes, the combined effects of the different drugs delay the emergence of resistant strains

Question 14

Prophylaxis

Answer 14

Recommended for various groups, such as individuals traveling to regions where malaria is endemic. Additionally, patients undergoing gastrointestinal or genitourinary surgery, as well as those with known cardiac valve disease or requiring valve replacements, are advised to consider prophylactic measures.

Question 15

1920
1935

Answer 15

work on synthetic anti drug and penicillin discovery
sulfanomides

Question 16

Bactericidal Vs Bacteriostatic

Answer 16

kill the cell vs prevent
reproduction of the cell

Question 17

signs of infection:

Answer 17

Fever
Lethargy
Slow-wave sleep induction
Classic signs of inflammation (redness, swelling, heat, and pain)

Question 18

Aminoglycosides

Answer 18

gram-negative aerobic bacilli
Protein Synth - Bateriocidal
Absorbed better IM, Excreted Kidney

○ Amikacin
○ Gentamicin
○ Neomycin
○ Streptomycin
○ Tobramycin

ototoxicity and nephrotoxicity

Question 19

Carbapenems

Answer 19

Gram-positive and Gram-negative
bacteria
bactericidal - cell wall synth
IM or IV, unchanged in urine

• Doripenem (Doribax)
• Ertapenem (Invanz)
• Imipenem-cilastatin (Primaxin)
• Meropenem (Merrem IV)
• Meropenem-vaborbactam (Vabomere)

colitis and c diff

Question 20

Cephalosporins

Answer 20

Cidal or static - cell wall synth

First generation: cefadroxil, cephalexin
Second: cefaclor, cefoxitin,
cefprozil, cefuroxime
Third: cefdinir, cefotaxime,
cefpodoxime, ceftazidime, ceftizoxime ,
ceftriaxone (Rocephin)
Fourth: Ceftolozane-tazobactam
Fifth: Ceftaroline

Well absorbed GI, met liver, excrete urine

GI Upset

Question 21

Fluoroquinolones

Answer 21

Bactericidal - DNA replication
gram-negative bacteria. Includes: urinary
track, respiratory track, and skin infections

Pharmacokinetics: Absorbed in GI tract, metabolized
in the liver, excreted in urine and feces and cross the
placenta and enter breast milk

Most common: Headache, dizziness, insomnia and depression

Question 22

Penicillins and Penicillinase-Resistant Antibiotics

Answer 22

Penicillin G benzathine, penicillin G potassium, penicillin G procaine,
penicillin V, amoxicillin, and ampicillin
broad spectrum
Bactericidal - cell wall

rapidly absorbed from the GI tract,
reaching peak levels in 1 hour. excreted unchanged in the
urine and enter breast milk

Allergies, GI reaction

Question 23

Sulfonamides

Answer 23

inhibit folic acid synth - Bacteriostatic
* sulfadiazine* sulfasalazine* cotrimoxazole
Pharmacokinetics
○ Well absorbed from the GI tract
○ Metabolized in the liver, excreted in the urine and are teratogenic

Allergies, GI effects, renal tox,

Question 24

Tetracyclines

Answer 24

semisynthetic antibiotics
Tetracycline, demeclocycline, doxycycline, minocycline
Inhibits protein synth - bacteriostatic
Pharmacokinetics
○ Adequately absorbed from the GI tract
○ Concentrated in the liver, excreted unchanged in the urine
○ Cross the placenta and pass into breast milk
Take on an empty stomach
GI upset, teeth and bones

Question 25

Antimycobacterials

Answer 25

Contain pathogens causing TB and leprosy Antituberculosis drugs Rifampin, pyrazinamide, ethambutol, streptomycin, rifapentine Leprostatic drugs Dapsone, thalidomide DNA Synth inhibitor Pharmacokinetics- ○ Well absorbed from the GI tract ○ Metabolized in the liver, excreted in the urine, cross the placenta and enter breast CNS effects and GI irritation

Question 26

Other Antibiotics

Answer 26

● Ketolides: Tellthromycin (Ketek) ● Lincosamides: Clindamycin (Cleocin), lincomycin (Lincocin) ● Lipoglycopeptides: telavancin (Vibativ), dalbavancin (Dalvance), oritavancin (Orbactiv), vancomycin (Vancocin) ● Macrolides: erythromycin (Ery-Tab, Eryc, and others), azithromycin (Zithromax), clarithromycin (Biaxin), fidaxomicin (Dificid) ● Ocazolidinones: Tedizolid (Sivextro), linezolid (Zyvox) ● Monobactam antibiotic: aztreonam (Axactam)

Question 27

Agents for Influenza A and Respiratory Viruses

Answer 27

Indications – Prevent shedding of the viral protein coat ● Pharmacokinetics – Absorbed readily, excreted unchanged in the urine, metabolized in the urine and liver, feces and cellular level. Excreted primarily via urine but also feces. ● Contraindications – Allergy, renal impairment, pregnancy, or lactating ● Adverse Effects– Dizziness, insomnia, nausea, orthostatic hypotension and urinary retention ● Drug-Drug Interactions – Primarily Anticholinergic agents

Question 28

Agents for Herpes and Cytomegalovirus

Answer 28

Agents for Herpes and Cytomegalovirus Indications – Inhibit viral DNA replication Pharmacokinetics – Readily absorbed in the kidney and GI tract, metabolized in the liver and excreted primarily in the urine and feces Contraindications – Known allergies to antiviral agents, highly toxic in pregnancy and lactation and renal disease Adverse Effects– Nausea, vomiting, headache, rash, and hair loss, paresthesias, neuropathy and renal dysfunction Drug-Drug Interactions – Nephrotoxic drugs, zidovudine

Question 29

Agents for HIV and AIDS

Answer 29

● Nonnucleoside reverse transcriptase inhibitors ● Nucleoside reverse transcriptase inhibitors (NRTIs) ● Protease inhibitors ● Fusion inhibitors ● CCR5 coreceptor antagonists ● Integrase inhibitors

Question 30

Nonnucleoside Reverse Transcriptase Inhibitors

Answer 30

● Indications – Bind directly to HIV reverse transcriptase, blocking both RNA- and DNA-dependent DNA polymerase activities ● Pharmacokinetics – Rapidly absorbed from the GI tract, metabolized in the liver, excreted in the urine and feces ● Contraindications – Pregnancy and lactation ● Adverse Effects – GI-related, dizziness, blurred vision, headache ● Drug-Drug Interactions – ○ Delavirdine: antiarrhythmics, clarithromycin, dapsone, anti-TB drugs, Ca channel blockers, warfarin, quinidine, indinavir, saquinavir, dapsone ○ Efavirenz: midazolam, rifabutin, triazolam, ergot derivatives

Question 31

Nucleoside Reverse Transcriptase Inhibitors

Answer 31

Indications – Compete with naturally occurring nucleosides within the cell that the virus would use to build the DNA chain Pharmacokinetics – Rapidly absorbed in the GI tract, metabolized by liver, excreted in urine and feces; except Didanosine requires buffered form Contraindications – pregnancy (except zidovudine), hepatic dysfunction, renal impairment, bone marrow suppression Adverse Effects – Signs of hypersensitivity, pancreatitis, hepatomegaly, neurological problems, bone marrow suppression Drug-Drug Interactions – Tenofovir, lamivudine/salcitabine, antibiotics, antifungals

Question 32

Protease Inhibitors

Answer 32

Indications – Block protease activity within the HIV virus ● Pharmacokinetics – Rapidly absorbed in the GI tract, metabolized in the liver and excreted in urine and feces ● Contraindications – Pregnancy and lactation and mild to moderate hepatic dysfunction ● Adverse Effects- GI effects, changes in liver function, elevated cholesterol and triglyceride levels may occur as well as Stevens-Johnson syndrome risk ● Drug-Drug Interactions- Nonsedating antihistamines, sedatives/hypnotics, antiarrhythmics

Question 33

Fusion Inhibitors

Answer 33

● Indications – Prevents the fusion of the virus with the human cellular membrane ● Pharmacokinetics – Given sub-q; metabolized in the liver it is recycled in tissues, not excreted ● Contraindications – Use cautiously with lung disease and pregnancy ● Adverse Effects– Insomnia, depression, peripheral neuropathy, nausea, diarrhea, pneumonia, injection site reactions ● Drug-Drug Interactions – No reported drug interactions

Question 34

CCR5 Coreceptor Antagonist

Answer 34

Indications – Blocks the receptor site on the cell membrane to which the HIV virus needs to interact to enter the cell Pharmacokinetics –Rapidly absorbed from the GI tract, metabolized in the liver, and excreted primarily through the feces Contraindications –Hypersensitivity to any component of the drug, nursing mothers and liver disease Adverse Effects– Dizziness and changes in consciousness Drug-Drug Interactions – Increased serum levels and toxicity when combined with cytochrome P450 CYP3A inhibitors and inducers

Question 35

Integrase Inhibitors

Answer 35

Indications –inhibit the activity of the virus-specific enzyme integrase, an encoded enzyme needed for viral replication. Pharmacokinetics –Rapidly absorbed from the GI tract, metabolized in the liver, and excreted primarily through the feces Contraindications –Hypersensitivity to any component of the drug and nursing mothers Adverse Effects– Headache, dizziness, and an increased risk for the development of rhabdomyolysis and myopathy Drug-Drug Interactions – decreased serum levels of either drug if combined with rifampin

Question 36

Anti-Hepatitis B Agents

Answer 36

Indications- Inhibits reverse transcriptase in the hepatitis B virus and causes DNA chain termination Pharmacokinetics- Rapidly absorbed from the GI tract, metabolized in the liver and excreted in the urine Contraindications- Known allergy, pregnancy, lactation and known renal and liver dysfunction Adverse Effects- Most significant are headache, dizziness, nausea, diarrhea, and elevated liver enzymes Drug-Drug Interactions- increased risk of renal toxicity if these drugs are taken with other nephrotoxic drugs

Question 37

Anti-Hepatitis C Agents

Answer 37

protease inhibitors Can be used in combination with ribavirin or ribavirin and peginterferon to treat chronic hepatitis C

Question 38

Locally Active Antiviral Agents

Answer 38

Indications – Act on viruses by interfering with normal viral replication and metabolic processes Pharmacokinetics – Not absorbed systemically Contraindications – Allergy to the drug Adverse Effects – Local burning, stinging, and discomfort

Question 39

Who is at risk for fungal infections?

Answer 39

Immunocompromised Patients: -on steroids -HIV/AIDs -transplant recipients -immunosuppressive drugs -elderly

Question 40

Azole Antifungals

Answer 40

Indications – Systemic & topical fungal infections, less toxic than amphotericin B but also less effective, bind to sterols and can cause cell death, inhibit glucan synthesis Pharmacokinetics – Absorbed rapidly from the GI tract, metabolized in the liver and excreted in urine and feces Contraindications – Hepatic and renal dysfunction, pregnancy and lactation and drugs that prolong the QTc interval Adverse Effect- Liver toxicity and tetrogenic effects Drug-Drug Interaction- Many

Question 41

Echinocandin Antifungals

Answer 41

Indications – Another group of antifungals, inhibit glucan synthesis leading to death of the cell wall Pharmacokinetics – Given IV, rapid onset, metabolized degradation and excreted in feces Contraindications – Hepatic /renal dysfunction, pregnancy and lactation Adverse Effects - Liver toxicity, tetrogenic effects and bone marrow supression Drug-Drug Interaction- Cyclosporine

Question 42

Topical Antifungals

Answer 42

Indication- Work to alter the cell permeability of the fungus, causing prevention of replication and fungal death, indicated only for local treatment of mycoses, including tinea infections Pharmacokinetics- Not systemic Contraindications- Limited to known allergy to any of these drugs Adverse Effects - Irritation, burning, rash, and swelling at the site Drug-Drug Interactions - Unknown

Question 43

Fluconazole

Answer 43

oral and vaginal candidiasis cryptococcal meningitis systemic fungal prophylaxis cell membrane Oral or IV met in liver, excreted in urine HA, NA, VM, DA, AB Pain, rash

Question 44

Clotrimazole

Answer 44

Tx or Pv of oral candidiasis Vaginal Candidiasis Tinea pedis, corpis, cruris binds to sterols in cell membrane not absorbed systemically ADME unk