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Pharmacology for advance practice nursing 712 > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

In which time frame would an APN expect to see signs of allergic reactions after an antibiotic is initiated?

  1. From 20 minutes to 3 weeks
  2. From 3 weeks to 6 months
  3. From 6 months to 1 year
  4. From 1 year to 18 months
A
  1. From 20 minutes to 3 weeks

Rationales
Option 1:
Signs of allergic reactions may occur from minutes to weeks after the antibiotic is initiated and even after the course of therapy is completed. Although immediate hypersensitivity reactions are more likely to be life threatening, delayed reactions can also be serious.
Option 2:
This time frame is more delayed than an allergic reaction to an antibiotic is likely to be.
Option 3:
This time frame is more delayed than an allergic reaction to an antibiotic is likely to be.
Option 4:
This time frame is more delayed than an allergic reaction to an antibiotic is likely to be.
[Page reference: 724]

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2
Q

The APN has diagnosed the patient with atypical pneumonia and prescribes the patient empirical antibiotics. The patient asks how long it will take to feel better. Which response by the APN is most appropriate?

  1. “You should feel better within 48 to 72 hours.”
  2. “You should feel better within 12 to 24 hours.”
  3. “You should feel better within 24 to 48 hours.”
  4. “You should feel better within 6 to 12 hours.”
A
  1. “You should feel better within 48-72 hours.”

Rationales
Option 1: Initially, patients who are responding to empirical antibiotic therapy should show improved clinical condition in 48 to 72 hours.
Option 2: Initially, patients who are responding to empirical antibiotic therapy will not usually show improved clinical condition by 12 to 24 hours.
Option 3: Initially, patients who are responding to empirical antibiotic therapy will not usually show improved clinical condition by 24 to 48 hours.
Option 4: Initially, patients who are responding to empirical antibiotic therapy will not usually show improved clinical condition by 6 to 12 hours.
[Page reference: 1260]

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3
Q

A 33-year-old female has been diagnosed with genital herpes, and this is her first outbreak. Which recommended dose of antiviral will the APN prescribe to this patient?

  1. Acyclovir 200 mg 5 times per day for 10 days
  2. Acyclovir 500 mg 5 times per day for 10 days
  3. Acyclovir 200 mg 3 times per day for 10 days
  4. Acyclovir 500 mg 3 times per day for 10 days
A
  1. Acyclovir 200 mg 5 times per day for 10 days

Rationales
Option 1: Acyclovir 200 mg every 4 hours while awake, 5 times per day for 10 days is the recommended dose for treatment of the initial episode of genital herpes.
Option 2: The initial recommended dose of acyclovir is fewer than 200 mg.
Option 3: An accepted off-label dose of acyclovir is 400 mg, not 200 mg, 3 times per day for 10 days.
Option 4: An accepted off-label dose of acyclovir is 400 mg, not 500 mg, 3 times per day for 10 days.
[Page reference: 785]

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4
Q

The pregnant female should receive which vaccination during pregnancy?

  1. Measles, mumps, and rubella (MMR)
  2. Influenza
  3. Varicella
  4. Pneumococcal
A
  1. Influenza

Rationales
Option 1: The MMR vaccine cannot be given during pregnancy.
Option 2: The pregnant or postpartum patient should receive an influenza vaccine in the fall.
Option 3: The patient who has not previously had varicella should receive the varicella vaccine prior to planning a pregnancy.
Option 4: Any patient with a chronic medical condition should receive a pneumococcal vaccine.
[Page reference: 1263]

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5
Q

A patient with HIV was prescribed an antibiotic, and 7 days later the patient developed an erythema multiforme rash. Which antibiotic is most consistent with this side effect?

  1. Trimpex
  2. Macrobid
  3. Zithromax
  4. Biaxin
A
  1. Trimpex

Rationales
Option 1: Rashes and generalized skin eruptions are common adverse reactions for sulfonamides and trimethoprim (Trimpex). The incidence may be dose-related and is more prevalent in HIV-infected patients. Skin eruptions may include erythema multiforme, exfoliative dermatitis, toxic epidermal necrolysis, and Stevens–Johnson syndrome.
Option 2: Nitrofurantoin monohydrate macrocrystals (Macrobid) should be used with caution in those predisposed to its adverse effects: older patients and patients with anemia, renal impairment, electrolyte imbalance, diabetes, vitamin B deficiency, and debilitating diseases. It does not commonly cause rash.
Option 3: Rashes and generalized skin eruptions are not commonly noted with azithromycin (Zithromax), a macrolide.
Option 4: Rashes and generalized skin eruptions are not commonly noted with clarithromycin (Biaxin), a macrolide.
[Page reference: 758]

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6
Q

A 24-year-old patient was diagnosed with bacterial vaginosis. Which medication dosage is most appropriate for this patient?

  1. Tinidazole 2 g oral dose once daily for 2 days taken with food
  2. Tinidazole 1 g oral dose once daily for 2 days taken with food
  3. Tinidazole 1 g oral dose once daily for 7 days taken with food
  4. Tinidazole 2 g oral dose once daily for 7 days taken with food
A
  1. Tinidazole 2g oral dose once daily for 2 days taken with food

Rationales
Option 1: The recommended dose of tinidazole in nonpregnant females with bacterial vaginosis is a 2 g oral dose once daily for 2 days taken with food or a 1 g oral dose once daily for 5 days taken with food.
Option 2: The recommended dose of tinidazole in nonpregnant females with bacterial vaginosis is more than 1 g once daily.
Option 3: The recommended dose of tinidazole in nonpregnant females with bacterial vaginosis is more than 1 g once daily for fewer than 7 days.
Option 4: The recommended dose of tinidazole in nonpregnant females with bacterial vaginosis lasts for fewer than 7 days.
[Page reference: 810-811]

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7
Q

The APN understands that the patient prescribed ethambutol must be followed up with by specialists in which department?

  1. Ophthalmology
  2. Cardiology
  3. Gynecology
  4. Urology
A
  1. Opthalmology

Rationales
Option 1: Ethambutol is an effective drug, but its main limitation is ocular toxicity, which causes optic neuritis leading to blurred vision, color blindness, and visual field constriction.
Option 2: Ethambutol is not indicated to have increased risk of cardiological problems.
Option 3: Ethambutol is not indicated to have increased risk of gynecological problems.
Option 4: Ethambutol is not indicated to have increased risk of urological problems.
[Page reference: 1312]

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8
Q

Oral ribavirin, combined with interferon, is used to treat infection of which virus?

  1. Influenza A
  2. HIV-1
  3. Respiratory syncytial virus (RSV)
  4. Hepatitis C virus (HCV)
A
  1. Hepatitis C virus

Rationales
Option 1: Ribavirin is active against influenza A, but its oral form combined with interferon is not used to treat it.
Option 2: Ribavirin is active against H1V-1, but its oral form combined with interferon is not used to treat it.
Option 3: Ribavirin is active against RSV, but its oral form combined with interferon is not used to treat it.
Option 4: Oral ribavirin plays a key role when combined with interferon for the treatment of HCV.
[Page reference: 782]

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9
Q

Fluoroquinolones fall under which pregnancy category?

  1. Category B
  2. Category X
  3. Category A
  4. Category C
A
  1. Category C

Rationales
Option 1: Fluoroquinolones are not Pregnancy Category B. Use is of fluoroquinolones is not recommended in pregnant women because there are no adequate, well-controlled studies in this population.
Option 2: Fluoroquinolones are not Pregnancy Category X. Use is of fluoroquinolones is not recommended in pregnant women because there are no adequate, well-controlled studies in this population.
Option 3: Fluoroquinolones are not Pregnancy Category A. Use is of fluoroquinolones is not recommended in pregnant women because there are no adequate, well-controlled studies in this population.
Option 4: Fluoroquinolones are Pregnancy Category C. Use is not recommended in pregnant women because there are no adequate, well-controlled studies in this population, and teratogenesis has been demonstrated in animals. Use during pregnancy only if there is a clear benefit that justifies the risk to the fetus.
[Page reference: 736]

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10
Q

The APN diagnosed a 54-year-old patient with onychomycosis. Which medication regimen is most appropriate for this patient?

  1. Itraconazole 100 mg PO once daily with meal for 12 consecutive weeks
  2. Itraconazole 200 mg PO once daily with meal for 12 consecutive weeks
  3. Terbinafine 200 mg PO once daily with meal for 12 consecutive weeks
  4. Terbinafine 100 mg PO once daily with meal for 12 consecutive weeks
A
  1. Itraconazole 200 mg PO once daily with meal for 12 consecutive weeks

Rationales
Option 1: Itraconazole 100 mg PO once daily is too low a dosage for this patient.
Option 2: Itraconazole 200 mg PO once daily with meal for 12 consecutive weeks is the appropriate medication and dosage.
Option 3: Terbinafine 250 mg PO once daily for 6 weeks may be prescribed for onychomycosis.
Option 4: Terbinafine 250 mg PO once daily for 6 weeks may be prescribed for onychomycosis.
[Page reference: 799]

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11
Q

When does the World Health Organization (WHO) endorse starting antiretroviral therapy (ART) in a newly-diagnosed patient with HIV?

  1. Within 7 days to the same day of newly-diagnosed HIV patient
  2. Within 20 days of newly-diagnosed HIV patient
  3. After the viral load numbers
  4. Within 6 months of newly-diagnosed HIV patient
A
  1. Within 7 days to the same day of newly-diagnosed HIV patient

Rationales
Option 1: The WHO endorsed starting ART within 7 days of new diagnosis (WHO, 2017), including same day, citing improved viral suppression.
Option 2: The WHO endorsed starting ART within 7 days of new diagnosis (WHO, 2017), including same day, citing improved viral suppression.
Option 3: The WHO endorsed starting ART within 7 days of new diagnosis (WHO, 2017), including same day, citing improved viral suppression.
Option 4: The WHO endorsed starting ART within 7 days of new diagnosis (WHO, 2017), including same day, citing improved viral suppression.
[Page reference: 1125]

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12
Q

A health-care provider was exposed to HIV by a needle stick. The APN understands that post-exposure prophylaxis (PEP) is effective only if the exposure occurred within which time frame?

  1. 48 hours
  2. 72 hours
  3. 24 hours
  4. 12 hours
A
  1. 72 hours

PEP is effective only if the exposure occurred within 72 hours (or 3 days).
[Page reference: 1142]

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13
Q

The 43-year-old patient comes into the clinic with flu-like symptoms. The patient’s onset of symptoms is less than 48 hours. The APN will prescribe oseltamivir and understands that the half-life is which of the following?

  1. 20 to 24 hours
  2. 6 to 10 hours
  3. 2.5 to 5 hours
  4. 12 to 16 hours
A
  1. 6-10 hours

Rationales
Option 1: The half-life for peramivir is 20 hours.
Option 2: The half-life for oseltamivir is 6 to 10 hours.
Option 3: The half-life for zanamivir is 2.5 to 5.1 hours.
Option 4: The half-life for oseltamivir is not 12 to 16 hours.
[Page reference: 791]

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14
Q

Which pathogen is associated with asthma exacerbation?

  1. M. pneumoniae
  2. S. aureus
  3. H. influenzae
  4. P. aeruginosa
A
  1. M. Pneumoniae

Rationales
Option 1: M. pneumoniae may be associated with asthma exacerbation. The patient may have been treated with amoxicillin for “bronchitis” without improvement. A chest x-ray reveals bronchovascular markings with areas of atelectasis.
Option 2: S. aureus is not associated with asthma exacerbation.
Option 3: H. influenzae is not associated with asthma exacerbation.
Option 4: P. aeruginosa is not associated with asthma exacerbation.
[Page reference: 1267]

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15
Q

Current treatment of HIV infection functions through which mechanism of action?

  1. Reduction in transmissibility
  2. Pre-exposure prophylaxis
  3. Eradication of infection
  4. Viral suppression
A
  1. Viral suppression

Rationales
Option 1: Reducing transmissibility of HIV is a goal of treatment but is not the mechanism of action.
Option 2: Pre-exposure prophylaxis is a method for preventing HIV infection but is not the mechanism of action of treatment.
Option 3: Eradication of infection is currently not possible.
Option 4: Until there is a cure for HIV, the best treatment for HIV includes viral suppression with adherence to effective and safe antiretroviral therapy.
[Page reference: 1122]

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16
Q

Which factor is most important in preventing influenza?

  1. Wearing a mask
  2. Wearing gloves
  3. Annual vaccination
  4. Good hygiene
A
  1. Annual vaccination

Rationales
Option 1: Wearing a mask may help prevent influenza in some cases, but this is not the most important factor in preventing influenza.
Option 2: Wearing gloves may help prevent influenza in some cases, but this is not the most important factor in preventing influenza.
Option 3: The Centers for Disease Control and Prevention (CDC) recommends that everyone over the age of 6 months have an influenza annual vaccination.
Option 4: Good hygiene may help prevent influenza in some cases, but this is not the single most important factor in preventing influenza.
[Page reference: 792]

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17
Q

A 76-year-old patient was diagnosed with a first episode of herpes zoster. Which medication regimen is most appropriate for the APN to prescribe?

  1. Acyclovir 800 mg 5 times per day for 7 to 10 days
  2. Acyclovir 800 mg 5 times per day for 10 to 12 days
  3. Acyclovir 800 mg 3 times per day for 7 to 10 days
  4. Acyclovir 800 mg 3 times per day for 10 to 12 days
A
  1. Acyclovir 800 mg 5 times per day for 7-10 days

Rationales
Option 1: Oral acyclovir 800 mg taken every 4 hours while awake, 5 times per day for 7 to 10 days, is the recommended dose for initial episode of herpes zoster.
Option 2: Acyclovir does not need to be taken for 10 to 12 days to treat herpes zoster.
Option 3: Acyclovir needs to be taken more frequently than 3 times per day to treat herpes zoster.
Option 4: Acyclovir needs to be taken more frequently than 3 times per day but for less than 10 to 12 days to treat herpes zoster.
[Page reference: 785]

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18
Q

Which of these is the first step of viral replication?

  1. Adsorption to and penetration into susceptible cells
  2. Uncoating of viral nucleic acid
  3. Synthesis of early, regulatory proteins
  4. Synthesis of RNA or DNA
A
  1. Adsorption to and penetration into susceptible cells

Rationales
Option 1:
Adsorption to and penetration into susceptible cells is the first step of viral replication.
Option 2:
Uncoating of viral nucleic acid is the second step of viral replication.
Option 3:
Synthesis of early, regulatory proteins is the third step of viral replication.
Option 4:
Synthesis of RNA or DNA is the fourth step of viral replication.
[Page reference: 781]

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19
Q

A 19-year-old patient was diagnosed with bacterial conjunctivitis. Which antibiotic would be most appropriate for this patient?

  1. Cipro tablets
  2. Ocuflox solution
  3. Levaquin tablets
  4. Cleocin solution
A
  1. Ocuflox solution

Rationales
Option 1:
An eye drop is most appropriate. Cipro is not indicated for bacterial conjunctivitis.
Option 2:
Ocuflox solution would be the eye drop antibiotic prescribed in this case.
Option 3:
An eye drop is most appropriate. Levaquin is not indicated for bacterial conjunctivitis.
Option 4:
Cleocin solution is not indicated for bacterial conjunctivitis.
[Page reference: 740]

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20
Q

A 23-year-old female patient presents to the clinic with a 24-hour history of zoster outbreak. When would therapy with a nucleoside analog be initiated for greatest effect?

  1. Within 3 days
  2. Within 4 days
  3. Within 2 days
  4. Within 5 days
A
  1. Within 3 days

Rationales
Option 1:
Therapy with nucleoside analogues should be initiated within 3 days of the outbreak of the rash in herpes zoster.
Option 2:
Therapy would be losing effect after 4 days following outbreak of rash.
Option 3:
Therapy is most effective if initiated within 48 hours of the outbreak of the rash.
Option 4:
Therapy would be losing effect after 5 days following outbreak of rash.
[Page reference: 784]

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21
Q

The 53-year-old patient just completed a 14-day course of antibiotic and developed Clostridium difficile colitis. Which antibiotic most likely caused this patient to have Clostridium difficile colitis?

  1. Zithromax
  2. Biaxin
  3. Cleocin
  4. Prilosec
A
  1. Cleocin

Rationales
Option 1:
An azalide such as Zithromax does not have the highest incidence of Clostridium difficile colitis.
Option 2:
A macrolide such as Biaxin does not have the highest incidence of Clostridium difficile colitis.
Option 3:
There is a high incidence of Clostridium difficile colitis associated with clindamycin (Cleocin).
Option 4:
Prilosec is not an antibiotic but a proton pump inhibitor (PPI).
[Page reference: 741]

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22
Q

An APN is prescribing oseltamivir for the onset of flu-like symptoms to a 44-year-old patient. Which dosage is appropriate for this patient?

  1. 75 mg PO bid for 5 days and start within 48 hours of symptoms
  2. 75 mg PO bid for 4 days and start within 48 hours of symptoms
  3. 75 mg PO bid for 3 days and start within 48 hours of symptoms
  4. 75 mg PO bid for 2 days and start within 48 hours of symptoms
A
  1. 75 mg PO BID for 5 days and start within 48 hours of symptoms
Rationales
Option 1:
75 mg PO bid for 5 days and start within 48 hours of symptoms is the correct dosage and time frame.
Option 2:
Four days is not the correct time frame.
Option 3:
Three days is not the correct time frame.
Option 4:
Two days is not the correct time frame.
[Page reference: 792]
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23
Q

Fluoroquinolones are considered to be which type of agent?

  1. Bacteriostatic
  2. Bactericidal
  3. Cytotoxic
  4. Enteric
A
  1. Bactericidal

Rationales
Option 1:
Fluoroquinolones are not considered bacteriostatic agents.
Option 2:
Fluoroquinolones are bactericidal through interference with enzymes required for the synthesis and repair of bacterial DNA.
Option 3:
Fluoroquinolones are not considered cytotoxic agents.
Option 4:
Fluoroquinolones are not considered enteric agents.
[Page reference: 735]

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24
Q

Which medication is approved for C. parvum in children 11 years old or younger?

  1. Tinidazole
  2. Nitazoxanide
  3. Ivermectin
  4. Metronidazole
A
  1. Nitazoxanide

Rationales
Option 1:
Tinidazole is not approved for treatment of the diarrhea caused by C. parvum in children 11 years old or younger, although it is in the same group as a drug that is.
Option 2:
Nitazoxanide is the only drug approved for treatment of the diarrhea caused by C. parvum in children 11 years old or younger. Its safety and efficacy have not been established for older children or adults, but doses are provided in the literature for these age groups.
Option 3:
Ivermectin is not approved for treatment of the diarrhea caused by C. parvum in children 11 years old or younger.
Option 4:
Metronidazole is not approved for treatment of the diarrhea caused by C. parvum in children 11 years old or younger, although it is in the same group as a drug that is.
[Page reference: 811]

25
Q

If a patient has not clinically improved within 72 hours of starting an antibiotic, then the APRN must consider which possibility?

  1. The pathogen is not being treated appropriately.
  2. The antibiotic should be discontinued.
  3. Another antibiotic needs to be added.
  4. A probiotic needs to be added.
A
  1. The pathogen is not being treated appropriately

Rationales
Option 1:
If no improvement in clinical status occurs within 72 hours, the practitioner needs to consider that the pathogen is not being treated appropriately. Two possibilities exist. One is that the antibiotic chosen is not treating the pathogen. Another consideration is that the pathogen is resistant to the antibiotic chosen.
Option 2:
Discontinuing the antibiotic without using another may increase resistance.
Option 3:
Adding an antibiotic without discontinuing the current one may increase resistance.
Option 4:
Adding a probiotic would not help treatment.
[Page reference: 1263]

26
Q

A 66-year-old patient with diabetes and chronic heart disease has been diagnosed with atypical pneumonia. Which antibiotic would be most appropriate for this patient?

  1. Zithromax
  2. Levaquin
  3. Macrobid
  4. Keflex
A
  1. Levaquin

Rationales
Option 1:
Presence of comorbidities such as chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressant conditions or use of immunosuppressant drugs; use of antimicrobials within the previous 3 months; or other risk for drug-resistant Streptococcus pneumoniae (DRSP) infection requires a respiratory fluoroquinolone.
Option 2:
Presence of comorbidities such as chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressant conditions or use of immunosuppressant drugs; use of antimicrobials within the previous 3 months; or other risk for drug-resistant Streptococcus pneumoniae (DRSP) infection requires a respiratory fluoroquinolone, such as Levaquin.
Option 3:
Presence of comorbidities such as chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressant conditions or use of immunosuppressant drugs; use of antimicrobials within the previous 3 months; or other risk for drug-resistant Streptococcus pneumoniae (DRSP) infection requires a respiratory fluoroquinolone.
Option 4:
Presence of comorbidities such as chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressant conditions or use of immunosuppressant drugs; use of antimicrobials within the previous 3 months; or other risk for drug-resistant Streptococcus pneumoniae (DRSP) infection requires a respiratory fluoroquinolone.
[Page reference: 1261]

27
Q

Doxycycline is not used during pregnancy because it may cause which effect in neonates?

  1. Growth stunt
  2. Discoloration of deciduous teeth
  3. Cardiac malformation
  4. Decrease in lung surfactant
A
  1. Discoloration of deciduous teeth

Rationales
Option 1:
Doxycycline is not noted to cause growth stunt in neonates.
Option 2:
Doxycycline, a tetracycline, is not used during pregnancy because it may cause discoloration of deciduous teeth in neonates.
Option 3:
Doxycycline is not noted to cause cardiac malformation in neonates.
Option 4:
Doxycycline is not noted to cause decreased lung surfactant in neonates.
[Page reference: 1263]

28
Q

Which condition is a major side effect of oral ketoconazole?

  1. Hepatotoxicity
  2. Dry mouth and metallic taste
  3. Renal dysfunction
  4. Heart failure
A
  1. Hepatotoxicity

Rationales
Option 1: Ketoconazole oral tablets may cause hepatotoxicity leading to death or need for liver transplant and should only be used when no other effective antifungal therapy is available (U.S. Food and Drug Administration [FDA], 2013).
Option 2: Dry mouth and a metallic taste may also develop with metronidazole.
Option 3: Oral and intravenous acyclovir therapy has been associated with renal dysfunction.
Option 4: Itraconazole, not ketoconazole, has been rarely associated with development of heart failure and should be used cautiously in patients with preexisting heart failure or ventricular dysfunction.
[Page reference: 795]

29
Q

The APN has diagnosed S. pneumoniae in an adolescent. Which antibiotic is most appropriate for the APN to prescribe?

  1. High-dose amoxicillin (90 mg/kg daily, divided in two doses)
  2. Low-dose amoxicillin (45 mg/kg daily, divided in two doses)
  3. High-dose azithromycin (90 mg/kg daily, divided in two doses)
  4. Low-dose azithromycin (45 mg/kg daily, divided in two doses
A
  1. High-dose amoxicillin (90 mg/kg daily, divided into two doses)

Rationales
Option 1: If S. pneumoniae is the suspected organism based on the clinical picture in previously healthy, appropriately immunized infants, preschool, school-aged, and adolescent children, high-dose amoxicillin (90 mg/kg daily, divided in two doses) is the drug of choice for 7 to 10 days of outpatient treatment.
Option 2: If S. pneumoniae is the suspected organism based on the clinical picture in previously healthy, appropriately immunized infants, preschool, school-aged, and adolescent children should be given a higher dose of amoxicillin.
Option 3: If S. pneumoniae is the suspected organism based on the clinical picture in previously healthy, appropriately immunized infants, preschool, school-aged, and adolescent children, azithromycin is not the drug of choice.
Option 4: If S. pneumoniae is the suspected organism based on the clinical picture in previously healthy, appropriately immunized infants, preschool, school-aged, and adolescent children, azithromycin is not the drug of choice.
[Page reference: 1266]

30
Q

A 23-year-old patient was diagnosed with Trichomonas vaginal infection. Which medication is most appropriate for this patient?

  1. A single dose of 2 g metronidazole
  2. A single dose of 1 g metronidazole
  3. A single dose of 5 g tinidazole
  4. A single dose of 500 mg tinidazole
A
  1. A single dose of 2 g metronidazole

Rationales
Option 1:
One-day treatment with metronidazole is 2 g as a single dose or tinidazole 2 g orally in a single dose; 7-day treatment is 500 mg twice a day.
Option 2:
One-day treatment with metronidazole is more than 1 g as a single dose.
Option 3:
One-day treatment with tinidazole is less than 5 g orally in a single dose.
Option 4:
One-day treatment with tinidazole is more than 500 mg orally in a single dose.
[Page reference: 1286]

31
Q

Voriconazole is used in the treatment of which condition?

  1. Invasive aspergillosis
  2. Oropharyngeal candidiasis
  3. Onychomycosis
  4. Tinea capitis
A
  1. Invasive aspergillosis

Rationales
Option 1:
Voriconazole is used in the treatment for invasive aspergillosis.
Option 2:
Posaconazole is used in the treatment of oropharyngeal candidiasis.
Option 3:
Terbinafine and itraconazole are used in treatment of onychomycosis.
Option 4:
Terbinafine is used in the treatment of tinea capitis.
[Page reference: 801]

32
Q 
An option for the treatment of C-Diff would be?
A) Oral metronidazole
B) Oral vancomycin
C) Oral penicillin
D) Oral fidaxomicin
E) A, B, and D
F) None of the above
A

E) oral metronidazole, vancomycin, or fidaxomicin are all valid first line therapy options for c-diff.

(see p. 718)

33
Q

What is the definition of Suprainfection: “Superinfection”?

A

A new infection that occurs during the course of treatment for a primary infection. (Ex: C-Diff, Candidal Vaginitis)
Antibiotics eliminate the inhibitory influence of normal flora
Difficult to treat
Can be caused by drug resistant organisms
(See p. 718)

34
Q 
Penicillins are active against what type of organisms?
A) aerobic, gram-negative organisms
B) aerobic, gram-positive organisms
C) both A & B
D) none of the above
A

B) aerobic, gram-positive organisms

35
Q

Beta-lactams include which antibiotics:
A) cephalosporins, aminopenicillins, lincosamides, fluoroquinolones
B) penicillins, macrolides, azalides, fluoroquinolones
C) penicillins, fidaxomicin, sulfonamides, lincosamides
D) penicillins, cephalosporins, carbapenems, monobactams

A

D) penicillins, cephalosporins, carbapenems, monobactams

36
Q

True or False…Mycobacterial infections are among the most difficult to cure because mycobacteria grow slowly and relatively resistant to drugs that are largely dependent on how rapidly cells are dividing.

A

True.
Additionally, mycobacterial infections have a lipid-rich cell wall relatively impermeable to many drugs, are usually intracellular and inaccessible to drugs that do not have a good intracellular penetration, have the ability to to into a dormant state and easily develop resistance to any single drug.

37
Q

Antimycobacterials

A

Multiple drug combinations are used in the treatment of TB. 1st line treatment drugs include isoniazide, rifampin, rifadin, rimactane, ethambutol, pyrazinamide and second-line drugs used for drug-resistant or recurrent disease, para-aminosalicylic acid, ethionamide, capreomycin, cycloserine, kanamycin, ofloxacin…see p. 769

38
Q

Glycopeptides pharmacodynamics

A

Vancomycin-used for severe gram-positive infections, such as MRSA resistant to first-line antibiotics, inhibit cell wall synthesis (Bactericidal).
-Poor oral absorption, given IV

39
Q

Adverse drug reactions: Glycopeptides

A

Ototoxicity (transient or permanent), nephrotoxicity, ‘red man’ syndrome if infused too fast: flushing, rash, pruritus, urticaria, tachycardia, hypotension

40
Q

Glycopeptides: Clinical Use and Dosing

A
  • Serious gram-positive infections resistant to other medications
  • oral vancomycin is used to treat C. Diff infection
41
Q

Glycopeptides monitoring

A

Monitor-hearing and renal function

Education-administration, ADRs

42
Q

Bacteriostatic antibiotics

A

macrolides, tetracyclines, trimethoprim, and sulfonamides

43
Q

Bactericidal antibiotics

A

cephalosporins, aminoglycosides, fluoroquinolones, vancomycin, daptomycin, and metronidazole

44
Q

Tetracyclines pharmacodynamics/pharmacokinetics

A

Pharmacodynamics:

  • Tetracycline, doxycycline, minocycline
  • Bind reversibly to the 30S subunit of the bacterial ribosome
  • Usually bacteriostatic, can be bactericidal

Pharmacokinetics:

  • Food decreases absorption
  • Milk and calcium decrease absorption
45
Q

Tetracyclines: Precautions and contraindications

A
  • Do not prescribe to pregnant women (category D), lactating women or children less than age 8 (before adult teeth are formed)
  • Note: many drug interactions
46
Q

Tetracyclines: Clinical use and Dosing

A

Clinical use and dosing:

  • Doxycycline is considered first-line therapy for C. trachomatis
  • Acne vulgaris, Lymes disease
  • Community acquired pneumonia
  • Some H. pylori regimens include tetracycline.

Rational drug selection:
-Doxycycline and minocycline can be taken with food

47
Q

Tetracyclines: Education

A

-Administration, ADRs, avoiding pregnancy

48
Q

Sulfonamides, Trimethoprim, Nitrofurantoin, and Fosfomycin: Pharmacodynamics

A

Pharmacodynamics:

  • Sulfonamides block folic acid synthesis, trimethoprim inhibits DNA synthesis (sulfamethoxazole/trimethoprim)
  • Usually bacteriostatic
  • Nitrofurantoin inhibits protein synthesis / cell wall synthesis
  • Inhibit both gram-positive and gram-negative bacteria
  • E. coli, S. pyogenes, S. pneumoniae, H. influenzae, and some protozoa
  • Resistance an issue
49
Q

Sulfonamides, Trimethoprim, Nitrofurantoin: ADRs and precautions

A
  • ADRs: GI – anorexia, n/v, diarrhea, stomatitis; rashes (Stevens-Johnson syndrome, increased hypersensitivity reactions, photosensitivity; CNS – headache, dizziness, drug interactions Crystalluria
  • Kernicterus – deposition of bilirubin in brains of newborns, sulfonamides displace bilirubin from plasma protiens
  • DO NOT USE IN INFANTS LESS THAN 2 MONTHS AND PREGNANT WOMEN NEAR TERM (Sulfa)
  • Avoid in glucose-6-phosphate dehydrogenase (G6PD) deficiency (Sulfa)
  • Use cautiously in renal impairment
50
Q

Sulfonamides, Trimethoprim, Nitrofurantoin, and Fosfomycin: Clinical use and dosing

A
  • Most commonly used in UTI infections as a combined product or nitrofurantoin (empiric)
  • MRSA is susceptible in some areas

Rational drug selection:
-Low-cost alternative in children older than 2 months and in those with PCN allergies

Education:
Drink plenty of water (2L)
Avoid sunlight and tanning beds

51
Q

Macrolides and Azalides: Pharmacodynamics/Pharmacokinetics
Erythromycin, azithromycin, clarithromycin
Typically bacteriostatic but can be bactericidal

A

Pharmacodynamics:
-Inhibits RNA-dependent protein synthesis
-Effective against gram + and gram –
-Variability amongst antimicrobials in the class
Pharmacokinetics:
-well absorbed from duodenum

52
Q

Macrolides and Azalides: ADRs and drug interactions

A

ADRs
Dose-related GI: n/v, abdominal pain, cramping, diarrhea
Skin: urticaria, bullous eruptions, eczema, Stevens-Johnson syndrome (erythromycin)

Drug interactions:
Inhibitors of CYP3A4

53
Q

Macrolides and Azalides: Clinical dosing and rational drug selection

A

Clinical Dosing:

  • Drug of choice for community-acquired pneumonia (mycoplasma)
  • Chlamydia
  • Pertussis
  • Helicobacter Pylori infections (clarithromycin)
  • Chronic bronchitis

Rational drug selection:

  • Often as alternatives for patients with PCN allergies
  • Increasing resistance
54
Q

Macrolides and Azalides: Monitoring and Education

A

Monitoring:

  • For altered response to concurrent medications metabolized by CYP3A4 or -CYP2C9
  • Hepatic/renal impairment
  • Hearing loss

Patient education:

  • ADRs
  • Drug interactions
  • Dosing
55
Q

Lincosamides: Clindamycin (Cleocin): Pharmacodynamics/Pharmacokinetics

A

Pharmacodynamics:

  • Inhibits protein synthesis
  • No gram-negative activity
  • Gram-positive activity: Corynebacterium acnes, Gardnerella vaginalis, some MRSA

Pharmacokinetics:
-Oral dosing completely absorbed; not affected by gastric acid

56
Q

Lincosamides: Clindamycin (Cleocin): ADRs

A

ADRs: Black Box warning for severe colitis; dermatological: rash, burning, itching, erythema; transient eosinophilia, neutropenia, thrombocytopenia

57
Q

Lincosamides: Clindamycin (Cleocin): Clinical use and dosing/rational drug selection

A

Clinical use and dosing:
First-line therapy for MRSA in some areas
Infections in PCN-allergic patients
Drug-resistant Streptococcus pneumoneae infections
Dental infections

Rational drug selection:
Considered second-line therapy; narrow spectrum of aerobic activity
First-line therapy in special populations (pregnant women and children)

58
Q

Lincosamides: Clindamycin (Cleocin): Monitoring/education

A

Monitoring:
Stop medication if significant diarrhea occurs.

Patient education:
Finishing therapy
ADRs: diarrhea

Pharmacology for advance practice nursing 712 (24 decks)

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