pharm 2 midterm

aminoglycosides used primarily against

AEROBIC gram NEGATIVE baccili

When administering an aminoglycoside to a patient with myasthenia gravis, it is most important for the nurse to assess what?A. Deep tendon reflexesB. Breath soundsC. Eyelid movementD. Muscle strength

B. Breath sounds Aminoglycosides can inhibit neuromuscular transmission, causing potentially fatal respiratory depression. Patients with myasthenia gravis (MG) are at an increased risk. Deep tendon reflexes, eyelid movement, and muscle strength are important assessments for a patient who has MG, but they are not as important as airway and breathing ability.

A patient who has acquired immunodeficiency syndrome (AIDS) is receiving trimethoprim/sulfamethoxazole (Bactrim). Which response should a nurse expect if the medication is achieving the desired effect?A. Increase in CD4 T cellsB. Increased appetite and weight gainC. Resolution of pneumoniaD. Decrease in joint pain

C. Resolution of pneumonia Trimethoprim/sulfamethoxazole is the treatment of choice for Pneumocystis pneumonia (PCP)

The nurse identifies tigecycline (Tygacil) as a derivative of what?A. PenicillinsB. CephalosporinsC. TetracyclinesD. Macrolides

C. Tetracyclines Tigecycline is the first representative of a new class of antibiotics, the glycyclines. It is a tetracycline derivative made to overcome drug resistance and is active against many drug-resistant strains. It has adverse effects similar to those of the tetracyclines.

Which enteral aminoglycoside would the nurse expect to be ordered preoperatively for a patient having intestinal surgery?A. GentamicinB. TobramycinC. AmikacinD. Neomycin

D. Neomycin In general, aminoglycosides are poorly absorbed in the gastrointestinal (GI) tract. Neomycin is given orally to suppress bowel flora before surgery of the intestine and is not used parenterally because of its high nephrotoxicity and ototoxicity. Gentamicin, tobramycin, and amikacin are administered parenterally only.

Which statements about ototoxicity and aminoglycosides does the nurse identify as true? (Select all that apply.) A. The risk of ototoxicity is related primarily to excessive peak levels. B. The first sign of impending cochlear damage is headache. C. The first sign of impending vestibular damage is tinnitus . D. Ototoxicity is largely irreversible. E. Use of aminoglycosides for less than 10 days is recommended to avoid ototoxicity.

D. Ototoxicity is largely irreversible. E. Use of aminoglycosides for less than 10 days is recommended to avoid ototoxicity. The risk of ototoxicity with aminoglycoside use is related primarily to excessive trough levels. The first sign of impending vestibular damage is headache. The first sign of cochlear damage is tinnitus. The other two statements are true.

Ciprofloxacin belongs to what class of antibiotic? Possible Answers: Macrolides Beta lactams Tetracyclines Fluoroquinolones

Fluoroquinolones

Aminoglycosides are primarily used for infections by what type of pathogen? Possible Answers: Gram negative bacteria only Both Gram negative and Gram positive bacteria Gram positive bacteria only Yeast and fungi

Gram negative bacteria only

Penicillin is used to treat what type of microbe? Possible Answers: Gram negative bacteria only Gram positive and Gram negative Gram positive bacteria only Fungal infections

Gram positive bacteria only Penicillins belong to a larger class of antibiotics known as beta-lactams. These antibiotics inhibit cell-wall synthesis and are exclusively used to treat Gram positive bacteria. They are not effective against Gram negative bacteria or fungi.

Primary agent for the treatment of TB

INH (laniazid)

Which aminoglycoside is most commonly used in the treatment of cystic fibrosis patients infected with Pseudomonas aeruginosa? Amikacin Streptomycin Tobramycin Gentamicin

Tobramycin

Aminoglycosides are poorly absorbed from the gut and must therefore be delivered via parenteral routes. True False

True - aminoglycosides are poorly absorbed from the gut because they are highly polar molecules. Most are administered via the IV or IM route though some drugs - such as tobramycin - can also be administered via the inhalational route, too, as can, therefore, be used in the treatment of cystic fibrosis.

what does the nurse closely monitor for in a patient prescribed chloramphenicol

bone marrow suppression gray syndrome aplastic anemia

Liraglutide, a drug for obesity, works by

suppressing appetitie! It decreases gastric emptying, makes you feel full and decreases oral intake

which antibiotic inhibits 30s subunit?

tetracyclines

the nurse should be concerned if a patient taking metrondazole states:

they are in the first trimester of pregnancy.

true or false carbapenem is is an extremely broad antimicrobial spectrum and is the most effective beta lactam antibiotic against anaerobes

true

the nurse knows that which of the following is an adverse effect to rifabutin, a tuberculosis antibiotic headache constipation muscle pain uveitis

uveitis

The nurse should include which instructions when teaching a patient about tigecycline therapy? (Select all that apply.)A. "Use sunscreen when you are outside."B. "If you have diarrhea more than five times a day, notify your healthcare provider."C. "Avoid using this drug if you are pregnant."D. "Stop taking the drug if you experience nausea."E. "Stop taking the drug if you experience vomiting."

A. "Use sunscreen when you are outside."B. "If you have diarrhea more than five times a day, notify your healthcare provider."C. "Avoid using this drug if you are pregnant."Nausea and vomiting may occur. The patient should not stop taking the medication; rather, the healthcare provider should be notified so that an alternative plan can be discussed. The other three instructions should be included in the patient teaching.

A patient is receiving penicillin G (Bicillin C-R). Which assessment should the nurse monitor as an indicator of an undesired effect? A. Cardiac rhythm B. Serum sodium level C. Lung sounds D. Red blood cell (RBC) count

A. Cardiac rhythm penicillin G can cause hyperkalemia with large IV doses which affects heart rhythm.

Before administering an aminoglycoside, it is most important for the nurse to assess the patient for a history of what?A. Myasthenia gravisB. AsthmaC. HypertensionD. Diabetes mellitus

A. Myasthenia gravis Aminoglycosides can inhibit neuromuscular transmission, causing flaccid paralysis and potentially fatal respiratory depression. These drugs should be used with extreme caution in patients with myasthenia gravis.

A nurse is providing education about tetracycline (Sumycin). Which statement by the patient best demonstrates understanding of the administration of this medication? A."I should not take this medication with milk or other dairy products." B. "I should not worry if I experience an acnelike rash with this medication." C. "I should take an antacid, such as Tums, if I experience gastrointestinal distress." D. "I should take this antibiotic with a calcium supplement to improve absorption."

A."I should not take this medication with milk or other dairy products."

Aminoglycosides are most effective against which kind of microorganism? Aerobic gram-negative bacteria Anaerobic gram-negative bacteria Aerobic gram-positive bacteria Anaerobic gram-positive bacteria

Aerobic gram-negative bacteria

Fluoroquinolones such as ciprofloxacin may cause which of the following serious side effects? Irreversible peripheral neuropathy Seizures Sudden tendon rupture All of these Liver failure

All of these

Which of the following class of antibiotics is associated with ototoxicity and hearing loss? Aminoglycosides Quinolones Glycopeptides Beta-lactam antibiotics

Aminoglycosides Aminoglycoside antibiotics such as streptomycin and gentamicin have been associated with vestibular toxicity and hearing loss. Aminoglycosides remain in inner ear fluids longer than serum and can have a latent ototoxic effect, causing hearing loss even after the antibiotic has been discontinued. None of the other antibiotics listed are associated with ototoxicity.

Before administering trimethoprim, it is most important for the nurse to assess the patient for a history of what?A. Heart failureB. AlcoholismC. DiabetesD. Emphysema

B. Alcoholism Trimethoprim inhibits bacterial synthesis of folic acid. It is avoided in patients when folate deficiency is likely, such as in alcoholism, because bone marrow suppression may occur. Heart failure, diabetes, and emphysema are unrelated to adverse effects with trimethoprim.

What does the nurse identify as an adverse effect of clindamycin (Cleocin) therapy?A. Cyanosis and gray discoloration of the skinB. Frequent loose, watery stools with mucus and bloodC. Reduction in all blood cells produced in the bone marrowD. Elevated bilirubin, with dark urine and jaundice

B. Frequent loose, watery stools with mucus and bloodClostridium difficile-associated diarrhea (CDAD) is the most severe toxicity associated with clindamycin and is characterized by profuse, watery stools. The cause is superinfection of the bowel with Clostridium difficile, an anaerobic gram-positive bacillus. Gray syndrome, which usually occurs in infants and those with aplastic anemia, is an adverse effect of chloramphenicol (Chloromycetin).

A nurse monitors a patient who is receiving an aminoglycoside (gentamicin) for symptoms of vestibular damage. Which finding should the nurse expect the patient to have first?A. UnsteadinessB. VertigoC. HeadacheD. Dizziness

B. HeadacheGentamicin causes irreversible ototoxicity, which results in both impaired hearing and disruption of balance. Headache is the first sign of impending vestibular damage (balance) and may last 1 to 2 days. Unsteadiness, vertigo, and dizziness appear after headache.

Which statements about CDAD associated with clindamycin therapy does the nurse identify as true? (Select all that apply.)A. Leukopenia commonly occurs.B. It is a potentially fatal condition.C. Patients usually experience abdominal pain.D. Anticholinergics are effective in treating the diarrhea.E. Clindamycin therapy should be discontinued and vancomycin started.

B. It is a potentially fatal condition.C. Patients usually experience abdominal pain.E. Clindamycin therapy should be discontinued and vancomycin started.

What is the MOST common drug used to treat oral candidiasis? A. Oseltamivir (Tamiflu) B. Nystatin (Mycostatin) C. Amantadine (Symmetrel) D. Griseofulvin (Fulvicin P/G)

B. Nystatin (Mycostatin)

Which cardiovascular finding does the nurse identify as a possible adverse effect of erythromycin (Ery-Tab) therapy?A. Heart rate of 52 beats per minuteB. Prolonged QT intervalC. Jugular vein distentionD. Grade III diastolic murmur

B. Prolonged QT interval

The nurse is assessing a patient who is receiving a sulfonamide for treatment of a urinary tract infection. To monitor the patient for the most severe response to sulfonamide therapy, the nurse will assess for what? A. Diarrhea B. Skin rash and lesions C. Hypertension D. Bleeding

B. Skin rash and lesions The nurse's priority is to monitor for hypersensitivity reactions. The most serious response to sulfonamide therapy is Stevens-Johnson syndrome, which manifests as symptoms of the skin and mucous membranes, lesions, fever, and malaise. In rare cases, hematologic effects occur, requiring periodic blood studies.

The nurse knows that there is an increased risk of ototoxicity in a patient receiving an aminoglycoside if which level is high?A. ConcentrationB. TroughC. PeakD. Dose

B. TroughWhen trough levels remain elevated, aminoglycosides are unable to diffuse out of inner ear cells, thus exposing the cells to the medication for an extended time.

the nurse should teach the patient taking clindamicin

C-diff is an adverse effect PO should be taken with a full glass of water and food is ok rapid iv admin can cause EKG changes, hypotension and cardiac arrest

When providing patient teaching for oral sulfonamide therapy, the nurse should instruct the patient to take the sulfonamide in what way?A. At mealtime, when food is availableB. With soy or nonmilk productsC. Between meals with a full cup of waterD. On awakening before breakfast

C. Between meals with a full cup of water Oral sulfonamides should be taken on an empty stomach and with a full glass of water. To minimize the risk of renal damage, adults should maintain a daily urine output of 1200 mL. Sulfonamides should not be taken with soy or nonmilk products or food or before breakfast without liquids.

A client prescribed azithromycin (Zithromax) expresses concern regarding GI upset that was experienced when previously prescribed an erythromycin antibiotic. What is the nurse's best response?A. "Take an over-the-counter antiemetic to lessen the nausea."B. "Stop taking the drug if you experience heartburn and diarrhea."C. "I will call the health care provider and request a different antibiotic."D. "This drug is like erythromycin with less gastrointestinal adverse effects."

D. "This drug is like erythromycin with less gastrointestinal adverse effects."

A patient who is receiving an aminoglycoside develops flaccid paralysis and impaired breathing. Which medication does the nurse anticipate administering?A. Magnesium sulfate (Epsom salt)B. Potassium chloride (K-Dur)C. Sodium bicarbonate (Citrocarbonate)D. Calcium gluconate (Kalcinate)

D. Calcium gluconate (Kalcinate)Flaccid paralysis and impaired breathing are signs of impaired neuromuscular transmission, which may occur with aminoglycosides, especially if they are administered concurrently with a neuromuscular blocking agent. Impaired transmission can be reversed with intravenous infusion of a calcium salt (calcium gluconate).

Macrolide prototype

Erythromycin

The nurse cares for a patient with tuberculosis who is taking isoniazid and rifampin. About which data found in the patient's health history is the nurse most concerned?1Hepatitis B2Asthma attacks3Rheumatic fever4Allergy to penicillin

Hepatitis B Isoniazid (INH) and rifampin are tuberculosis medications that are metabolized in the liver and are extremely toxic. They are contraindicated in the patient with a history of liver disease, including any form of hepatitis. A history of asthma, rheumatic fever, or allergy to penicillin is not a contraindication to the administration of INH and rifampin.

The nurse is concerned when a patient on tetracyclines states I am 30 I am pregnant i am allergic to shellfish I take ca and iron supplements i take the medication with water i am on oral contraceptives

I am pregnant: contraindicated in pregnancy i take ca and iron supplements: forms non absorbable compounds i am on oral contraceptives: decreases effectiveness!

A patient began taking antitubercular drugs a week ago. The nurse reviews the patient's medical record and learns that the patient has a 10-year history of consuming one standard drink of alcohol three times a week. The patient states, "In the last week, my urine turned orange and I am very worried about it." How should the nurse respond?1Inform the patient that it is one of the side effects of the antitubercular drug rifampin.2Recognize that the tuberculosis may have spread to the liver, and further medical consultation is required.3Recognize that the liver may be damaged due to alcohol, and so a liver function test should be performed.4Instruct the patient to stop taking antitubercular drugs immediately and consult the primary health care provider.

Inform the patient that it is one of the side effects of the antitubercular drug rifampin

A patient who has tuberculosis (TB) is being treated with combination drug therapy. The nurse explains that combination drug therapy is essential because:Recommendations for the initial treatment of tuberculosis1It minimizes the required dosage of each of the medications.2It helps reduce the unpleasant side effects of the medications.3It shortens amount of time that the treatment regimen will be needed.4It discourages the development of resistant strains of the TB organism

It discourages the development of resistant strains of the TB organismRecommendations for the initial treatment of tuberculosis (TB) include a four-drug regimen until drug susceptibility tests are available. After susceptibility is established, the regimen can be altered, but patients should still receive at least two drugs to prevent emergence of drug-resistance organisms. Dosage, side effects, and duration of the regimen are not reasons for combination drug therapy in a patient with

the nurse should teach the patient that taking what drugs with linezolid (zyvox) is contraindicated

MAOI: HTN crisis SSRI: serotonin syndrome

Which of the following statements about aminoglycosides is false?They have short half-lives They are bactericidal They exacerbate weakness in myasthenia gravis patients None of the Above

None of the Above

which of the following antibiotics is least likely to cause C. difficile overgrowth and C. difficile associated diarrhea? Possible Answers: Amoxicillin Clindamycin Vancomycin Ampicillin

Vancomycin; it usually treats it

A patient who has a vancomycin-resistant enterococci (VRE) infection is receiving linezolid (Zyvox). Which laboratory result indicates that the patient is having an adverse effect? A. White blood cell (WBC) count of 1200 units/LB. Hemoglobin (Hgb) level of 18 g/dLC. Potassium level of 3.0 mEq/dL

White blood cell (WBC) count of 1200 units/LB. Linezolid can cause reversible myelosuppression, manifesting as anemia, leukopenia, or even pancytopenia. The potassium and blood glucose levels are not affected by linezolid.

the nurse identifies what as a intermediate acting tetracycline?

demeclocycline

what is used as an alternative to those with a pcn allergy

erythromycin, a macrolide

bulk forming laxatives work in the same way that _________ works

fiber supplements

what drug is used in combo with amph b and why

fluctyosine, a pyrimidine analog, is used in combo to treat severe systemic mycosis and to prevent resistance

which of the following is the drug of choice for anthrax? metrondizole tetracycline macrolides fluoroquinoles

fluoroquinoles (ciprofloxacan)

vancomycin is only for

gram positive bacteria

which antifungal med treats dermatophytic infections

griseofluvin

select all that apply: adverse effects of pyrazinamide, a tuberculose antibiotic hepatotoxicity vision changes constipation diarrhea hyperuricemia arthralgias rash

hepatotoxicity diarrhea hyperuricemia arthralgias

Tetracycline MOA

inhibits transfer of RNA to mRNA

which medication is given as an alternative for amph b? itraconoazole ketoconazole nystatin tetracycline

ketoconale because it may be given oral and is thought to be less toxic

penicillin v

only penicillin that can be given PO. others are not stable in stomach acid.