PHARM CH 19: Aminoglycosides and Fluoroquinolones

A nurse has been performing vigilant assessments of a patient who is receiving doses of intravenous gentamicin, each over 30 minutes. A blood sample for peak gentamicin levels should be drawn:

30 minutes after the drug has finished infusing.

Your patient is receiving a multiple-dose regimen of an aminoglycoside. On what serum drug levels will you base the patient's maintenance dose?

Peak and trough levels

Gentamicin work well against all of these infections EXCEPT: a. UTI b. Anthrax c. Pneumonia d. Bacteremia

b. Anthrax

Is ciprofloxacin narrow-spectrum or broad spectrum?

broad spectrum

A client developed a nosocomial (hospital-acquired), gram-negative infection when hospitalized. What is considered the antibiotic of choice for this type of infection? a. Cephalosporins b. Tetracyclines c. Aminoglycosides d. Fluoroquinolones

c. Aminoglycosides

Aminoglycosides would work well against all of these organisms except: a. Pseudomonas aeruginosa b. Eschericia coli c. Bacillus anthracis d. Serratia

c. Bacillus anthracis

What is the prototype of fluoroquinolones? a. Streptomycin b. Tobramycin c. Ciprofloxacin d. Gentamicin

c. Ciprofloxacin

Which of the following drugs would be classified as an aminoglycoside? a. Levofloxacin b. Clarithromycin c. Gentamicin d. Cefaclor

c. Gentamicin

Select all of the side effects of fluoroquinolones: a. Ototoxicity b. Furry tongue c. Headache d. Bradycardia e. Phototoxicity

c. Headache, e. Phototoxicity

Select all of the side effects of fluoroquinolones: a. Insomnia b. Arrhythmias c. Headache d. Dry skin e. Restlessness

c. Headache, e. Restlessness

Ciprofloxacin should not be taken at the same time as: a. ibuprofen b. naproxen c. aspirin

c. aspirin

Gentamicin is _____. a. fungicidal b. bacteristatic c. bactericidal

c. bactericidal

Ciprofloxacin adminstration: a. oral b. paternal c. topical d. all of the above

d. all of the above

Gentamicin + Cephalosporins = a. inactivates gentamicin b. synergistic ototoxicity c. prolonged respiratory depression d. increases risk of nephrotoxicity

d. increases risk of nephrotoxicity

Is gentamicin narrow-spectrum or broad spectrum?

narrow-spectrum

A client who takes zinc daily is diagnosed with a severe infection and is ordered levofloxacin (Levaquin). The nurse is aware that taking these two drugs may have what affect on the antibiotic? a. Decreased absorption b. Increased absorption c. Increased elimination d. Decreased elimination

a. Decreased absorption

Select all of the side effects of aminoglycosides: a. Depression b. Constipation c. Stomatitis d. N/V e. Increased appetite

a. Depression, c. Stomatitis, d. N/V

Select all of the side effects of aminoglycosides: a. Diarrhea b. Constipation c. Confusion d. Dry Mouth e. Palpitations

a. Diarrhea, c. Confusion, e. Palpitations

Select all of the side effects of fluoroquinolones: a. Diarrhea b. Dry mouth c. Constipation d. N/V e. Dizziness

a. Diarrhea, d. N/V, e. Dizziness

The nurse is caring for a patient who is receiving an aminoglycoside. What would be a priority assessment on this patient? a. Impairment of balance b. Visual disturbance c. Increase in renal output d. LFTs

a. Impairment of balance

Select all of the side effects of fluoroquinolones: a. N/V b. Glossitis c. Ototoxicity d. Constipation e. Abdominal pain

a. N/V, e. Abdominal pain

Levofloxacin works best against which infections (select all that apply): a. Sinusitis b. UTI c. Prostatitis d. Anthrax e. Skin Infections f. Pneumonia

a. Sinusitis, b. UTI, e. Skin Infections, f. Pneumonia

A client with a complex medical history is showing signs and symptoms of sepsis. What aspect of this client's health history would rule out the safe and effective use of an aminoglycoside antibiotic? a. The client has chronic renal failure b. The client has a history of not adhering to treatment c. The client has type 2 diabetes, controlled with oral antihyperglycemics

a. The client has chronic renal failure

The nurse should advise the client to avoid taking which medication at the same time as a fluoroquinolone? a. antacids b. antihypertensives c. antidiabetic agents d. oral contraceptives

a. antacids

When describing the action of fluoroquinolones to treat infection to a group of nursing students, which action would the instructor most likely include? a. bactericidal b. bacteriostatic c. fungicidal

a. bactericidal

A local bioterrorism medical team is responding to a possible anthrax attack. The team is instructed that a fluoroquinolone may be used to treat exposure to anthrax. The nurse should prepare to administer what antibiotic? a. ciprofloxacin b. gemifloxacin c. amoxicillin

a. ciprofloxacin

A patient is complaining of a ruptured Achilles tendon and crusting around their lid margins. They are most likely experiencing an adverse effect of ______. a. ciprofloxacin b. gentamicin c. penicillin

a. ciprofloxacin

Ciprofloxacin + Antacids a. decrease absorption b. increase toxicity c. increase absorption

a. decrease absorption

A patient on ciprofloxacin is complaining of rashes, hives, and wheezing. What is the expected physician orders? a. discontinue drug; notify provider b. nothing; this is an expected side effect c. continue the drug as prescribed

a. discontinue drug; notify provider

After teaching a group of students about the indications for use for aminoglycosides, the instructor determines that the teaching was successful when the students identify which type of infection as a primary indication? a. gram-negative infections b. gram-positive infections c. fungal infections d. viral infections

a. gram-negative infections

Gentamicin + Extended penicillins = a. inactivates gentamicin b. synergistic ototoxicity c. prolonged respiratory depression d. increases risk of nephrotoxicity

a. inactivates gentamicin

The nurse recognizes that what drug classification increases the risk of ototoxicity and nephrotoxicity when prescribed with gentamicin? a. loop diuretics b. benzodiazepines c. proton pump inhibitors d. tricyclic antidepressants

a. loop diuretics

Gentamicin + Diphenhydramine or Chlorphenermine = a. mask ototoxic symptoms b. synergistic ototoxicity c. prolonged respiratory depression d. increases risk of nephrotoxicity

a. mask ototoxic symptoms

Gentamicin should be taken: a. on an empty stomach b. with food c. with calcium-containing products

a. on an empty stomach

Precautions should be taken for patients on fluoroquinolones with (select all that apply): a. renal impairment b. hepatic impairment c. myasthenia gravis d. epilepsy e. parkinsons disease

a. renal impairment, b. hepatic impairment, d. epilepsy

The nurse is caring for a client who is receiving amikacin for the treatment of a serious Staphylococcus aureus infection. What assessment should the nurse prioritize? a. urine output and creatinine clearance b. vision assessment c. cardiac monitoring d. skin assessment and monitoring of liver enzyme levels

a. urine output and creatinine clearance

A patient on gentamicin complains of dizziness, tinnitus and a headache. You predict that this patient has which of the following? a. vestibular damage b. cerebellar damage c. hepatic damage

a. vestibular damage

You are preparing to discharge a patient who is taking ciprofloxacin. What guidance would you offer this patient to prevent crystalluria? a. "Limit fluids to a couple of glasses per day." b. "Drink at least 2 liters of fluids per day." c. "Take the medication as prescribed." d. "Do not take antacids."

b. "Drink at least 2 liters of fluids per day."

Gentamicin has a curare effect which (select all that apply): a. Promotes acetylcholine release b. Blocks acetylcholine receptors c. Widespread muscle relaxation b. Promotes muscle tension

b. Blocks acetylcholine receptors c. Widespread muscle relaxation

A patient is having widespread severe muscle weakness and a respiratory rate of 5 bpm. What would you expect the physician to order STAT? a. IV N-acetylcysteine b. IV calcium gluconate c. IV methylprednisolone d. IM calcium carbonate

b. IV calcium gluconate

Select all of the contraindications for gentamicin? a. Parkinson's disease b. Pre-existing hearing loss c. Myasthenia gravis d. Epilepsy

b. Pre-existing hearing loss, c. Myasthenia gravis

A client is prescribed ciprofloxacin for a urinary tract infection. The nurse is preparing to teach the client about the medication. What must the nurse include in the education plan? a. Take a missed dose, even if close to the next dose. b. Take precautions to prevent photosensitivity. c. Avoid foods high in sodium such as processed meats. d. Take the necessary vitamins along with the drug.

b. Take precautions to prevent photosensitivity.

Fluoroquinolones would work well against which infections (select all that apply): a. Conjunctivitis b. UTI c. Pneumonia d. Bacteremia

b. UTI, c. Pneumonia

Ofloxacin works best against which infections (select all that apply): a. Sinusitis b. UTI c. Prostatitis d. Anthrax e. Skin Infections f. Pneumonia

b. UTI, c. Prostatitis

Ciprofloxacin works best against which infections (select all that apply): a. Sinusitis b. UTI c. Prostatitis d. Anthrax e. Skin Infections f. Pneumonia

b. UTI, d. Anthrax

Select all of the side effects of aminoglycosides: a. Furry tongue b. Urticaria c. Anxiety d. Bruxism e. Restlessness

b. Urticaria

Aminoglycosides works against severe a. aerobic gram-positive infections b. aerobic gram-negative infections c. anaerobic gram-negative infections

b. aerobic gram-negative infections

Prior to administering fluoroquinolones, it is most important for the nurse to assess for which finding or condition? a. vital signs. b. allergies. c. hepatic function. d. respiratory function.

b. allergies.

_______ can cause decreased absorption of fluoroquinolones. a. calcium-containing foods b. antacids, iron salts and zinc c. caffeine and alcohol

b. antacids, iron salts and zinc

Which of the following is an adverse effect of aminoglycosides EXCEPT? a. nephrotoxicity b. arthropathy c. neurotoxicity d. ototoxicity

b. arthropathy

A patient on gentamicin has a headache. They should take ____ because it reduces risk of hearing loss. a. ibuprofen b. aspirin c. naproxen

b. aspirin

The nurse has a patient taking gentamicin, she should assess all of the following EXCEPT: a. assess 8th cranial nerve b. assess bone and cartilage function c. assess neuromuscular weakness d. assess elderly renal function

b. assess bone and cartilage function

Ciprofloxacin + Theophylline a. decrease absorption b. increase toxicity c. increase absorption

b. increase toxicity

When considering known adverse reactions to gentamicin therapy, the nurse should focus assessment of what body structure? a. eyes b. inner ears c. oral cavity d. lymph nodes

b. inner ears

What is the MOA of aminoglycosides? a. interferes cell wall synthesis b. interferes protein synthesis c. interferes DNA synthesis and replication

b. interferes protein synthesis

Gentamicin adminstration: a. oral b. paternal c. topical d. all of the above

b. paternal

Gentamicin + Loop diuretics = a. inactivates gentamicin b. synergistic ototoxicity c. prolonged respiratory depression d. increases risk of nephrotoxicity

b. synergistic ototoxicity

All of the following are signs and symptoms of a neuromuscular blockade EXCEPT? a. fatal respiratory depression b. tinnitus c. flaccid paralysis

b. tinnitus

The nurse instructs the client who is taking oral ciprofloxacin to avoid which food while taking this medication? a. Hamburger b. Chicken c. Cheese d. Tuna

c. Cheese

Select all of the side effects of aminoglycosides: a. Oral or vaginal candidiasis b. Bleeding c. Disorientation d. Bruxism e. Rash

c. Disorientation, e. Rash

The nursing student correctly identifies the class of drugs that exerts their bactericidal effect by interfering with the synthesis of bacterial DNA, thus preventing cell reproduction and leading to death of the bacteria, as which of the following groups? a. Penicillins b. Cephalosporins c. Fluoroquinolones d. Sulfonamides

c. Fluoroquinolones

Gentamicin is poorly absorbed in the _______. a. CNS b. respiratory tract c. GI tract

c. GI tract

Clients taking oral ciprofloxacin should avoid _______ foods while taking this medication. a. alkaline b. citrus c. calcium-containing

c. calcium-containing

A patient on ciprofloxacin is practicing safe sex and mentions taking oral contraceptives daily. What should the nurse tell her? a. the bc pill will cause an allergic reaction b. the bc pill will decrease the effectiveness of ciprofloxacin c. ciprofloxacin will decrease the effectiveness of the bc pill

c. ciprofloxacin will decrease the effectiveness of the bc pill

A client with a gram-negative bacterial infection has been prescribed a fluoroquinolone. During the preadministration assessment, the nurse should ensure that which laboratory tests, if prescribed, are obtained before the first dose of fluoroquinolones is administered to the client? a. renal and hepatic function tests b. complete blood count c. culture and sensitivity test d. urinalysis

c. culture and sensitivity test

A patient on gentamicin has a headache and tinnitus. What should the nurse do? a. continue the medication as prescribed b. nothing; these are expected side effects c. discontinue drug; notify the provider

c. discontinue drug; notify the provider

Precautions should be taken for patients on fluoroquinolones with (select all that apply): a. has stomatitis b. hearing loss c. history of CVA d. Alzheimer disease e. has colitis

c. history of CVA, e. has colitis

A patient on gentamicin should do which of the following? a. increase sodium intake b. decrease fluid intake c. increase fluid intake

c. increase fluid intake

The client has been prescribed a fluoroquinolone. The nurse knows that nursing interventions for clients taking fluoroquinolones include which? a. restrict fluid intake. b. restrict sodium intake. c. increase fluid intake.

c. increase fluid intake.

What is the MOA of fluoroquinolones? a. interferes cell wall synthesis b. interferes protein synthesis c. interferes DNA synthesis and replication

c. interferes DNA synthesis and replication

High concentrations of gentamicin accumulate in the: a. stomach and kidneys b. CNS and kidneys c. kidneys and inner ear

c. kidneys and inner ear

All are contraindications for fluoroquinolones EXCEPT: a. pregnancy b. oral/paternal admin for elderly c. oral/paternal admin for under 18 d. lactating

c. oral/paternal admin for under 18

Which of the following is an adverse effect of aminoglycosides EXCEPT? a. peripheral neuropathy b. neurotoxicity c. phototoxicity d. neuromuscular blockade

c. phototoxicity

Gentamicin + General aesthetics = a. inactivates gentamicin b. synergistic ototoxicity c. prolonged respiratory depression d. increases risk of nephrotoxicity

c. prolonged respiratory depression

Gentamicin + NSAIDs (indomethacin) = a. inactivates gentamicin b. synergistic ototoxicity c. reduces GFR d. increases risk of nephrotoxicity

c. reduces GFR

A patient on ciprofloxacin has white spots on their tongue, fatigue, and bruises all over their body. The nurse should suspect: a. moderate ciprofloxacin toxicity b. neuromuscular blockage c. superinfection

c. superinfection

The client has been taking a fluoroquinolone and now reports that he has a white patch in his mouth. What is the best response of the nurse? a. "You are allergic to the medication. Stop taking it immediately." b. "That is the medication working. Continue to take as directed." c. "You are experiencing an adverse affect of the medication. Those symptoms will decrease over time." d. "You may be experiencing an additional infection. I will discuss this with your health care provider."

d. "You may be experiencing an additional infection. I will discuss this with your health care provider."

Which of the following drugs is likely to be administered as a first-line treatment for anthrax exposure? a. Tobramycin b. Norfloxacin c. Gentamicin d. Ciprofloxacin

d. Ciprofloxacin

A client is prescribed levofloxacin for an acute sinus infection. The nurse knows that this anti-infective medication belongs to which drug category? a. Penicillins b. Cephalosporins c. Tetracyclines d. Fluoroquinolones

d. Fluoroquinolones

What is the prototype of aminoglycosides? a. Streptomycin b. Tobramycin c. Amikacin d. Gentamicin

d. Gentamicin

A young lifeguard has been prescribed moxifloxacin (Avelox). The nurse understands that the focus on education would be which adverse reaction? a. Weakness b. Fatigue c. Muscle cramping d. Phototoxicity

d. Phototoxicity

Which of the following is an adverse effect of ciprofloxacin? a. nephrotoxicity b. neurotoxicity c. ototoxicity d. joint disease

d. joint disease

Oral ciprofloxacin should be taken: a. 30 minutes after eating b. with food c. with calcium-containing products d. on an empty stomach

d. on an empty stomach

IV ciprofloxacin should be administered ________. a. over 30 minutes through large vein b. over 60 minutes through small vein c. over 30 minutes through small vein d. over 60 minutes through large vein

d. over 60 minutes through large vein

Select all of the side effects of fluoroquinolones: a. Lacrimation b. Constipation c. Conjunctivitis d. Muscle weakness e. Burning eyes

e. Burning eyes

Select all of the side effects of fluoroquinolones: a. Hearing loss b. Tinnitus c. Increased urinary output d. Loss of smell e. Lid margin crusting

e. Lid margin crusting

Is gentamicin more effective by itself or with other antibiotics?

with other antibiotics