Pharmacology Chapter 91

The healthcare provider orders levofloxacin [Levaquin] 500 mg PO every day for 7 days. The available medication is levofloxacin 250-mg tablets. How many tablets should the patient take each day? 0.5 tablet 1 tablet 1.5 tablets 2 tablets

2 tablets Two tablets that are each 250 mg would equal the ordered 500-mg daily dose.

The nurse notices tan lines around the arms of a female patient who is taking levofloxacin [Levaquin]. Which action should the nurse take? No action is needed, because this is a temporary but expected side effect. Continue the antibiotic with an anti-inflammatory medication. Advise the patient to avoid sun exposure and wear sun screen when outside. Discontinue the medication.

Advise the patient to avoid sun exposure and wear sun screen when outside. Fluoroquinolones pose a risk of phototoxicity. Accordingly, patients should avoid sunlight and sunlamps, and should use protective clothing and a sunscreen if they must go outdoors.

The nurse identifies which medication as posing a significant risk of causing confusion, somnolence, psychosis, and visual disturbances in elderly patients? Metronidazole [Flagyl] Rifampin [Rifadin] Ciprofloxacin [Cipro] Daptomycin [Cubicin]

Ciprofloxacin [Cipro] In elderly patients, ciprofloxacin [Cipro] poses a significant risk of confusion, somnolence, psychosis, and visual disturbances. Metronidazole, rifampin, and daptomycin are not associated with confusion in elderly patients.

A patient who takes ciprofloxacin [Cipro] and runs 6 miles daily tells a nurse about heel and calf tenderness. The nurse anticipates the healthcare provider to take which action? No action is needed, because this is a temporary but expected side effect. Continue the antibiotic with an anti-inflammatory medication. Slow the running pace and walk more. Discontinue the medication, because severe damage can result.

Discontinue the medication, because severe damage can result. Fluoroquinolones may result in tendinitis and rupture by disrupting the extracellular matrix of cartilage. Because tendon injury is reversible if diagnosed early, fluoroquinolones should be discontinued at the first sign of tendon pain or inflammation.

A patient taking gemifloxacin develops a rash. The nurse anticipates the healthcare provider to take which action? No action is needed, because this is a temporary but expected side effect. Continue the antibiotic with an anti-inflammatory medication. Cut the dose of medication in half. Discontinue the medication.

Discontinue the medication. The incidence of rash with gemifloxacin is much higher than with other fluoroquinolones. Women under 40 years of age are at greatest risk. Symptoms are severe in about 10% of patients who develop a rash; in the rest, symptoms are mild to moderate. As a rule, gemifloxacin-induced rash resolves spontaneously in 1 to 2 weeks, although some patients require treatment with systemic glucocorticoids. If rash develops, gemifloxacin should be discontinued.

A patient who takes multiple antibiotics starts to experience diarrheal stools. The nurse anticipates administration of which antibiotic if a stool sample tests positive for Clostridium difficile? Rifaximin [Xifaxan] Metronidazole [Flagyl] Daptomycin [Cubicin] Gemifloxacin [Factive

Metronidazole [Flagyl] Metronidazole is the treatment of choice for antibiotic-associated colitis caused by C. difficile. Rifaximin, daptomycin, and gemifloxacin are not used in the treatment of C. difficile infection.

A patient is taking daptomycin [Cubicin]. The nurse should obtain a creatine phosphokinase (CPK) level when the patient shows what? Increased urination and urinary urgency Muscle pain and weakness Abdominal bloating and diarrhea Headache and visual disturbances

Muscle pain and weakness Daptomycin is one of the cyclic lipopeptides, a class of antibiotics that can kill gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). It may pose a small risk of myopathy (muscle injury). Patients should be warned about muscle injury and told to report any pain or weakness. In addition, CPK levels should be measured weekly. Increased urination and urinary urgency, abdominal bloating and diarrhea, and headache and visual disturbances are not associated with daptomycin.

After completing a course of ciprofloxacin [Cipro] for a skin infection, the patient says, "I took the whole bottle of pills, but my infection hasn't gotten any better." Which additional information should the nurse recognize as most significant? The patient takes antacids on a daily basis. The medication was stored in a cool, dry area. The patient did not use sunscreen while taking the ciprofloxacin [Cipro]. The patient took two doses of diphenhydramine [Benadryl] while on ciprofloxacin [Cipro] therapy.

The patient takes antacids on a daily basis. Antacids interfere with the absorption of quinolone antibiotics, such as ciprofloxacin [Cipro], and many other drugs; therefore, this patient has not received the full dosing regimen, which is required if ciprofloxacin is to be effective against the infection. Storing the drug in a cool, dry area and using sunscreen or diphenhydramine would not disrupt the effectiveness of ciprofloxacin.

The nurse identifies rifampin as useful in the treatment of which disorders? (Select all that apply.) Tuberculosis Active meningococcal infection Leprosy Prophylaxis of meningitis caused by Haemophilus influenzae C. difficile infection

Tuberculosis Leprosy Prophylaxis of meningitis caused by Haemophilus influenzae Rifampin is useful in the treatment of tuberculosis and can be used for prophylaxis of meningitis caused by H. influenzae. The treatment of leprosy is an unlabeled use. Rifampin is indicated for treatment of carriers of meningococcal infection, but not for active meningococcal infection. Rifampin is not indicated for the treatment of C. difficile infection.

Which approach should a nurse take when administering an oral dose of levofloxacin [Levaquin]? Give the medication with or without food. Administer the drug with an oral dose of a magnesium-based antacid. Premedicate the patient with diphenhydramine [Benadryl]. Administer the drug with milk products.

Give the medication with or without food. Levofloxacin should not be administered with milk products or antacids containing magnesium or aluminum, because this reduces absorption from the gastrointestinal (GI) tract. However, this does not happen with most foods. Premedicating with diphenhydramine is unnecessary.