Topic 12

Antibiotics Can Protect The Queens Men Servants and Guards

A= Aminoglycosides (Gentamicin, Tobramycin, Amikacin) C= Cephalosporins (1st-5th gen), carbenzapim T=Tetracyclines (tetracycline, doxycycline) Q= Quinolones (Ciprofloxacin, Levofloxacin) M=Macrolides (Erythromycin, Azithromycin, clarithromycin) S= Sulfonylureas (Bactrim) G= Glycopeptide (Vancomycin)

A pregnant patient with fever, flank pain, and chills has a history of two previous bladder infections before getting pregnant. She is allergic to several antibiotics. She reports having taken methenamine successfully in the past. What will the nurse tell her? a. "This agent is not effective against infections of the upper urinary tract." b. "This antiseptic agent is safe for use during pregnancy and has no drug resistance." c. "This drug is linked to many serious birth defects and is not recommended during pregnancy." d. "You will need to take this medication with meals to avoid gastric upset."

ANS: A Methenamine is safe for use during pregnancy and would be an excellent choice for this patient if she had a lower urinary tract infection. However, it is not an effective agent for upper urinary tract infection, because it is a prodrug that must break down into ammonia and formaldehyde to be effective. There is not enough time for formaldehyde to form in the kidneys, so it is not effective in the upper tract. Nitrofurantoin is linked to serious birth defects and also must be given with food to prevent gastrointestinal problems.

A patient newly diagnosed with tuberculosis asks the nurse why oral medications must be given in the clinic. The nurse will tell the patient that medications are given in the clinic so that: a. clinic staff can observe adherence to drug regimens. b. nurses can monitor for drug toxicities. c. providers can adjust doses as needed. d. the staff can ensure that the U.S. Food and Drug Administration (FDA) regulations are met.

ANS: A Adherence to drug regimens is a serious problem in the treatment of TB. Directly observed therapy (DOT) combined with intermittent dosing helps ensure adherence and increases the chance of success. Patients report drug side effects to providers; it is not necessary to give drugs in the clinic to monitor this. Doses are adjusted based on response to treatment and not on DOT. The FDA regulations do not require DOT.

A patient is about to begin therapy with ethambutol. The nurse knows that, before initiating treatment with this drug, it is important to obtain which test(s)? a. Color vision and visual acuity b. Complete blood cell (CBC) count c. Hearing testing and a tympanogram d. Hepatic function tests

ANS: A Optic neuritis is a dose-related adverse effect of ethambutol. Patients receiving this drug should have color vision and visual acuity testing before therapy starts and periodically thereafter. A CBC, hearing evaluations, and hepatic function testing are not recommended.

A patient will be discharged from the hospital with a prescription for TMP/SMZ [Bactrim]. When providing teaching for this patient, the nurse will tell the patient that it will be important to: a. drink 8 to 10 glasses of water every day. b. eat foods that are high in potassium. c. take the medication with food. d. take folic acid supplements.

ANS: A TMP/SMZ can injure the kidneys, because it causes deposition of sulfonamide crystals in the kidneys. Patients should be advised to drink 8 to 10 glasses of water a dayto maintain a urine flow of 1200 mL in adults. Trimethoprim can cause hyperkalemia, so consuming extra potassium is unnecessary. The medication should be taken on an empty stomach. It is not necessary to consume extra folic acid, because mammalian cells use dietary folate and do not have to synthesize it; it is the process of folic acid synthesis that is altered by sulfonamides.

A patient has a systemic candidal infection, and the provider has ordered oral fluconazole [Diflucan] 400 mg on day 1 and 200 mg once daily there after. What will the nurse do? a. Administer the drug as ordered. b. Contact the provider to discuss cutting the dosing in half. c. Contact the provider to discuss giving 400 mg on all days. d. Contact the provider to discuss giving the drug intravenously.

ANS: A The dosing for fluconazole for systemic candidal infections is 400 mg on the first day and 200 mg/day each day there after. Dosing for oral or esophageal candidal infections is half that for systemic infections. It is not correct to give 400 mg on all days of therapy. Fluconazole is as effective when given orally as it is when given intravenously

A 20-year-old female patient has suprapubic discomfort, pyuria, dysuria, and bacteriuria greater than 100,000/mL of urine. Which are the most likely diagnosis and treatment? a. Uncomplicated lower urinary tract infection treatable with short-course therapy b. Complicated lower urinary tract infection treatable with single-dose therapy c. Uncomplicated upper urinary tract infection requiring 14 days of oral antibiotics d. Complicated upper urinary tract infection requiring parenteral antibiotics

ANS: A These are symptoms of uncomplicated cystitis, which is a lower urinary tract infection that can be treated with a short course of antibiotics. Short-course therapy is more effective than single-dose therapy and is preferred. A complicated lower urinary tract infection would be associated with some predisposing factor, such as renal calculi, an obstruction to the flow of urine, or an indwelling catheter. Upper urinary tract infections often include severe flank pain, fever, and chills

Which superficial mycosis is generally treated with oral antifungal agents? a. Tinea capitis b. Tinea corporis c. Tinea cruris d. Tinea pedis

ANS: A Tinea capitis must be treated with oral agents for 6 to 8 weeks. Tinea corporis, tinea cruris, and tinea pedis may be treated topically

A patient who is taking drugs to treat HIV has tuberculosis and has been on a four-drug regimen for 3 months without improvement in symptoms. Which drug will the nurse anticipate that the provider will add to this patient's regimen? a. bedaquiline [Sirturo] b. capreomycin [Capastat Sulfate] c. ethionamide [Trecator] d. pyridoxine

ANS: A Bedaquiline is a newer, highly effective anti-TB drug that does not accelerate the metabolism of HIV drugs and is used for multi-drug resistant TB. Capreomycin is a second-line drug used for drug-resistant TB, but is not as effective as bedaquiline. Ethionamide is a second-line drug that is less well tolerated of all anti-TB agents and is used only when there is no alternative. Pyridoxine is given to prevent peripheral neuritis in patients taking isoniazid.

A patient with a history of congestive heart failure and renal impairment has esophageal candidiasis. Which antifungal agent would the nurse anticipate giving to this patient? a. Amphotericin B [Abelcet] b. Fluconazole [Diflucan] c. Itraconazole [Sporanox] d. Voriconazole [Vfend]

ANS: B Fluconazole is a drug of choice for treating systemic candidal infections. Amphotericin is nephrotoxic and should not be used in patients with existing renal disease. Itraconazole is a possible alternative agent for treating candidiasis but has serious cardiac side effects. Voriconazole is a drug of first choice for treating aspergillosis but not for candidiasis.

A patient will receive oral ciprofloxacin [Cipro] to treat a urinary tract infection. The nurse provides teaching for this patient. Which statement by the patient indicates a need for further teaching? a. "I may have abdominal pain and nausea, but these are usually mild." b. "I should take this medication with food or milk to improve absorption." c. "I should stop taking the medication immediately if I experience heel pain." d. "I will need to use sunscreen every time I go outdoors."

ANS: B Dairy products inhibit the absorption of ciprofloxacin, so they should be avoided. Abdominalpain and nausea and vomiting are common and usually mild. Patients should stop taking the drug if heel pain occurs until tendonitis has been ruled out. Photosensitivity can occur, so sunscreen should be used.

A patient is being treated with amphotericin B [Abelcet] for a systemic fungal infection. After several weeks of therapy, the provider orders flucytosine [Ancobon] in addition to the amphotericin. The nurse understands that the rationale for this combination is that it: a. broadens the antifungal spectrum. b. improves the effectiveness of the amphotericin B. c. lowers the dose of amphotericin B and reduces toxicity. d. treats fungal central nervous system (CNS) infection

ANS: C Amphotericin potentiates the antifungal actions of flucytosine, and combining flucytosine with low-dose amphotericin can produce antifungal effects equivalent to those of high-dose amphotericin. By allowing a reduced dose of amphotericin, the combination also reduces the risk of amphotericin-induced toxicity. Flucytosine does not affect the effectiveness of amphotericin. The combination does not broaden the antifungal spectrum or alter the ability to treat CNS infections.

The parent of a 5-year-old child who has had four urinary tract infections in the past year asks the nurse why the provider doesn't just order an antibiotic for the child's current symptoms of low-grade fever, flank pain, and dysuria since these are similar symptoms as before. Which is the most important reason given by the nurse? a. "Your child may need to be hospitalized for treatment." b. "Your child may need a urine culture before and after treatment." c. "Your child may need tests to assess for urinary tract abnormalities." d. "Your child may need additional medications, such as urinary tract antiseptics."

ANS: C Children with recurrent urinary tract infections should be assessed for underlying urinary tract abnormalities to help determine a possible cause for recurrence. This child has mild fever and therefore may not require hospitalization. Urine cultures are important when treating patients with recurrent UTI prophylactically, but this is not the most important consideration. Urinary tract antiseptics are used to treat uncomplicated lower urinary tract infections.

A nurse is discussing intravenous amphotericin B treatment with a nursing student who is about to care for a patient with a systemic fungal infection. Which statement by the student indicates a need for further teaching? a. "A test dose of amphotericin B may be given to assess the patient's reaction." b. "If I see any precipitate in the IV solution, I should stop the infusion immediately." c. "Infusions of amphotericin B should be administered over 1 to 2 hours." d. "The IV site should be rotated frequently to reduce the risk of phlebitis."

ANS: C Infusions of amphotericin B should be given over 2 to 4 hours to minimize phlebitis and cardiovascular reactions; therefore, 1 to 2 hours is incorrect. Test doses are given to evaluate the patient's response. Any precipitate in the IV solution warrants immediate discontinuation of the IV. IV sites should be rotated frequently

A patient with histoplasmosis is being treated with itraconazole [Sporanox]. The nurse will teach this patient to report which symptoms? a. Gynecomastia and decreased libido b. Headache and rash c. Nausea, vomiting, and anorexia d. Visual disturbances

ANS: C Itraconazole is associated with rare cases of liver failure, some of which were fatal. Patients should be instructed to report signs of liver toxicity, including nausea, vomiting, and anorexia. Ketoconazole is associated with gynecomastia and libido changes. Headache and rash are associated with fluconazole. Visual disturbances may occur with voriconazole

A patient who is taking immunosuppressant medications develops a urinary tract infection. The causative organism is sensitive to sulfonamides and to another, more expensive antibiotic. The prescriber orders the more expensive antibiotic. The nursing student assigned to this patient asks the nurse why the more expensive antibiotic is being used. Which response by the nurse is correct? a. "Immunosuppressed patients are folate deficient." b. "Patients who are immunosuppressed are more likely to develop resistance." c. "Sulfonamides are bacteriostatic and depend on host immunity to work." d. "Sulfonamides intensify the effects of immunosuppression."

ANS: C Sulfonamides are usually bacteriostatic and require intact host defenses for complete elimination of infection. Immunosuppressed patients are not necessarily folate deficient. There is no increased likelihood of developing bacterial resistance in immunosuppressed patients. Sulfonamides do not affect immunosuppression.

A patient with type 2 diabetes mellitus takes glipizide. The patient develops a urinary tract infection, and the prescriber orders TMP/SMZ. What will the nurse tell the patient? a. Patients with diabetes have an increased risk of an allergic reaction. b. Patients taking TMP/SMZ may need increased doses of glipizide. c. The patient should check the blood glucose level more often while taking TMP/SMZ. d. The patient should stop taking the glipizide while taking the TMP/SMZ.

ANS: C Sulfonamides can intensify the effects ofsome drugs, including glipizide, which is a sulfonylureatype hypoglycemic medication. These drugs may require a reduction in dose to prevent toxicity. Patients should monitor their blood glucose more closely. There is no increase in allergic reactions to TMP/SMZ in patients who are diabetic. Patients taking TMP/SMZ may need reduced doses of glipizide but should not stop taking the drug.

A 30-year-old male patient reports having two to four urinary tract infections a year. What will the nurse expect to teach this patient? a. "Make sure you void after intercourse and drink extra fluids to stay well hydrated." b. "We will treat each infection as a separate infection and treat with short-course therapy." c. "You will need to take a low dose of medication for 6 months to prevent infections." d. "You will need to take antibiotics for 4 to 6 weeks each time you have an infection."

ANS: C This patient has reinfection of his urinary tract at a rate of more than three per year, which is an indication for long-term prophylaxis. Voiding after intercourse is a good teaching point for sexually active women to prevent urinary infections, but it is not a sufficient preventive measure for recurrent infections in men. Short-course therapy may be used for each occurrence of infection if the reinfection rate is less than three per year. Long-term treatment for individual infections is recommended if relapse occurs or if infections do not clear with shorter-term therapy

A child has ringworm of the scalp. A culture of the lesion reveals a dermatophytic infection. The nurse teaching the child's parents about how to treat this infection will include which statement? a. "Adverse effects of the medication include itching, burning, and erythema." b. "Apply the topical medication daily until at least 1 week after the rash is gone." c. "Your child will need to take this oral medication for 6 to 8 weeks." d. "You will use an antifungal shampoo to treat this infection."

ANS: C Tinea capitis is difficult to treat with topical medications; oral griseofulvin, taken for 6 to 8 weeks, is standard therapy. Itching, burning, and erythema are side effects of topical agents. Patients treating tinea corporis, tinea cruris, or tinea pedis are taught to apply medication until 7 days after the rash disappears. Antifungal shampoos are not effective for treating tinea capitis

A nurse is caring for a patient who takes an ACE inhibitor and an ARB medication who will begin taking TMP/SMZ to treat a urinary tract infection. Which serum electrolyte will the nurse expect to monitor closely? a. Calcium b. Chloride c. Potassium d. Sodium

ANS: C Trimethoprim suppresses renal excretion of potassium, increasing the risk of hyperkalemia. Patients at greatest risk are those taking high doses of trimethoprim and those taking other drugs that elevate potassium, including ACE inhibitors and ARB medications. Trimethoprim does not affect other serum electrolytes

A patient will begin treatment with posaconazole [Noxafil] to treat oropharyngeal candidiasis that has not responded to fluconazole. The provider has ordered 200 mg three times daily. Which action by the nurse is correct? a. Administer the drug as ordered. b. Contact the provider to discuss decreasing the dose to twice daily. c. Discuss a 400-mg twice-daily drug regimen with the provider. d. Suggest to the provider that this dose may be too high for this indication

ANS: C When given for treatment of oropharyngeal candidiasis that is refractory to treatment with itraconazole or fluconazole, the dose is 400 mg twice daily. A dosage regimen of 200 mg three times daily is used for prophylaxis of invasive fungal infections and decreasing this to twice daily is not correct.

A pregnant patient is treated with trimethoprim/sulfamethoxazole (TMP/SMZ) [Bactrim] for a urinary tract infection at 32 weeks' gestation. A week later, the woman delivers her infant prematurely. The nurse will expect to monitor the infant for: a. birth defects. b. hypoglycemia. c. rash. d. kernicterus.

ANS: D Kernicterus is a disorder in newborns caused by deposition of bilirubin in the brain. Sulfonamides promote kernicterus by displacing bilirubin from plasma proteins. Sulfonamides should not be given to infants under 2 months of age or to pregnant women after 32 weeks' gestation. Sulfonamides do not cause birth defects or hypoglycemia. Serious rashes may occur but are not the primary concern in the newborn.

A patient who has drug-sensitive tuberculosis has completed 2 months of the standard four- drug therapy and asks the nurse how long he will have to take medication. Which response by the nurse is correct? a. "As long as you remain symptomatic, you will not have to take more medication." b. "The four-drug regimen will continue for 3 more months." c. "You will have to take maintenance drugs indefinitely." d. "You will need to take only two drugs for the next 4 months."

ANS: D Patients with drug-sensitive tuberculosis take four drugs for 2 months during the induction phase, followed by two drugs for 4 months in the continuation phase. Drug therapy does not stop after the induction phase, even for asymptomatic patients. Although drug therapy is prolonged, it is not indefinite.

A nurse is caring for an African-American patient who has been admitted to the unit for long term antibiotic therapy with sulfonamides. The patient develops fever, pallor, and jaundice. The nurse would be correct to suspect that the patient has developed: a. Stevens-Johnson syndrome. b. kernicterus. c. hepatotoxicity. d. hemolytic anemia

ANS: D Sulfonamides can cause hemolytic anemia in patients of African-American and Mediterranean origin, usually because of a genetic deficiency. Red cell lysis can produce fever, pallor, and jaundice, and patients should be observed for these signs. The patient's signs and symptoms are not characteristics of Stevens-Johnson syndrome or hepatotoxicity. The patient's signs and symptoms are not characteristic of kernicterus, which occurs in newborns.

An older male patient comes to the clinic with complaints of chills, malaise, myalgia, localized pain, dysuria, nocturia, and urinary retention. The nurse would most likely suspect that the patient has: a. acute cystitis. b. urinary tract infection. c. pyelonephritis. d. prostatitis.

ANS: D The nurse should suspect prostatitis, which is manifested by high fever, chills, malaise, myalgia, and localized pain, and may also be manifested by dysuria, nocturia, and urinary urgency, frequency, and retention. Clinical manifestations of acute cystitis include dysuria, urinary urgency and frequency, suprapubic discomfort, pyuria, and bacteriuria. Urinary tract infections are very general and are classified by their location. Pyelonephritis is characterized by fever, chills, severe flank pain, dysuria, and urinary frequency and urgency, as well as by pyuria and bacteriuria

Which patient with a urinary tract infection will require hospitalization and intravenous antibiotics? a. A 5-year-old child with a fever of 100.5° F, dysuria, and bacteriuria b. A pregnant woman with bacteriuria, suprapubic pain, and fever c. A young man with dysuria, flank pain, and a previous urinary tract infection d. An older adult man with a low-grade fever, flank pain, and an indwelling catheter

ANS: D The patient with an indwelling catheter and signs of pyelonephritis shows signs of a complicated UTI, which is best treated with intravenous antibiotics. Three other patients show signs of uncomplicated urinary tract infections that are not severe and can be treated with oral antibiotics.

A nurse is caring for a patient who has a superficial fungal infection and notes that the provider has ordered 200 mg of ketoconazole [Nizoral] 200 mg PO once daily. Which action by the nurse is correct? a. Administer the drug as ordered. b. Contact the provider to discuss twice-daily dosing. c. Discuss a 400-mg daily drug regimen with the provider. d. Request an order for a different antifungal medication.

ANS: D Because of the risk of serious and potentially fatal hepatic necrosis with oral ketoconazole, it is not recommended for use in treating superficial fungal infections. Another antifungal medication should be ordered.

A 65-year-old patient who receives glucocorticoids for arthritis is admitted to the hospital for treatment of a urinary tract infection. The prescriber has ordered intravenous ciprofloxacin [Cipro]. Before administering the third dose of this drug, the nurse reviews the bacterial culture report and notes that the causative organism is Escherichia coli. The bacterial sensitivity report is pending. The patient complains of right ankle pain. What will the nurse do? a. Withhold the dose of ciprofloxacin and notify the provider of the patient's symptoms. b. Instruct the patient to exercise the right foot and ankle to minimize the pain. c. Question the patient about the consumption of milk and any other dairy products. d. Request an order to increase this patient's dose of glucocorticoids

ANS: A A rare but serious adverse effect associated with fluoroquinolones is tendon rupture, and those at highest risk are children, patients older than 60 years, transplant patients, and any patients taking glucocorticoids. Any pain in either heel should be reported and the drug should be discontinued. Patients should be instructed not to exercise until tendonitis has been ruled out. Dairy products can reduce the absorption of ciprofloxacin, so this is not a concern with this patient. Because the pain may be caused by tendonitis associated with ciprofloxacin, it is not correct to request an increase in the glucocorticoid dosing

A patient with a urinary tract infection is given a prescription for TMP/SMZ. When reviewing the drug with the patient, the nurse learns that the patient has type 1 diabetes mellitus and consumes alcohol heavily. What will the nurse do? a. Contact the provider to request a different antibiotic for this patient. b. Obtain frequent blood glucose determinations while giving TMP/SMZ. c. Suggest that the patient take a potassium supplement while taking TMP/SMZ. d. Tell the patient to avoid excessive fluid intake while taking TMP/SMZ.

ANS: A Alcoholics are likely to be folate deficient and have an increased risk of megaloblastic anemia when taking TMP/SMZ, so withholding this drug in this population is recommended. TMP/SMZ shares hypersensitivity reactions with oral sulfonylurea-type hypoglycemics that are used with type 2 diabetes mellitus, so it is not necessary to assess the blood glucose level more often. TMP/SMZ can cause hyperkalemia, so potassium supplements are contraindicated. Patients taking TMP/SMZ should consume more fluids to maintain renal blood flow and prevent renal damage

A patient comes to a clinic for tuberculosis medications 2 weeks after beginning treatment with a four-drug induction phase. The patient's sputum culture remains positive, and no drug resistance is noted. At this point, the nurse will expect the provider to: a. change the regimen to a two-drug continuation phase. b. continue the four-drug regimen and recheck the sputum in 2 weeks. c. obtain a chest radiograph and consider adding another drug to the regimen. d. question the patient about adherence to the drug regimen.

ANS: B In patients with positive pretreatment sputum test results, sputum should be evaluated every 2 to 4 weeks until cultures are negative and then monthly thereafter. In the absence of drug resistance, treatment with the same regimen should continue. Sputum cultures should become negative in over 90% of patients in 3 or more months. The induction phase should last 2 months, so this patient should remain on a four-drug regimen. It is not necessary to order a chest radiograph or to add another drug at this stage of treatment. The patient is stable and has not developed symptoms that cause concern, so the patient does not need to be questioned about adherence.

A patient is about to begin treatment for latent tuberculosis. The patient is an alcoholic, has difficulty complying with drug regimens, and has mild liver damage. What will the nurse tell this patient? a. "You must stop drinking before adequate treatment can begin." b. "You must take isoniazid with close monitoring of hepatic function." c. "You must take rifampin daily for 4 months." d. "You will begin a regimen of isoniazid and rifampin."

ANS: B Isoniazid has an increased incidence of hepatotoxicity, especially when given with alcohol. Patients who consume alcohol or who have liver damage should receive isoniazid with caution and should have close monitoring of liver function. It is unrealistic to ask the alcoholic to stop drinking to undergo treatment. Rifampin is toxic to the liver, especially in alcoholics. Giving both drugs would only increase the risk of hepatotoxicity.

A patient who is taking ketoconazole tells the nurse that her periods have become irregular. What will the nurse tell her? a. This indicates that she should begin taking oral contraceptives. b. This is caused by a reversible effect on estradiol synthesis. c. This is a serious side effect that warrants discontinuation of the drug. d. This is a sign of hepatic toxicity, and the drug dose should be lowered.

ANS: B Ketoconazole inhibits steroid synthesis in humans, and in females it reduces estradiol synthesis, causing menstrual irregularities. It is not an indication that oral contraceptive pills (OCPs) are needed. Because it is reversible, there is no indication for withdrawing the drug until treatment is complete. Menstrual irregularities are not a sign associated with hepatotoxicity.

A nurse is caring for a patient who is receiving amphotericin B [Abelcet] for a systemic fungal infection. In spite of receiving diphenhydramine and acetaminophen before initiation of treatment, the patient has fever and chills with rigors. The nurse will contact the provider to discuss the addition of which drug? a. Aspirin b. Dantrolene c. Hydrocortisone d. Omeprazole

ANS: B Patients receiving amphotericin frequently experience infusion reactions, with fever, chills, rigors, nausea, and headache. Pretreatment with diphenhydramine and acetaminophen can reduce mild reactions. If rigors occur, the patient should receive dantrolene or meperidine. Aspirin would be effective for pretreatment but can increase kidney damage. Hydrocortisone is also effective, but it causes immune suppression. Omeprazole is not indicated

A patient is about to begin treatment for latent tuberculosis with a short course of daily rifampin. The patient asks why rifapentine [Priftin] cannot be used, because it can be given twice weekly. What will the nurse tell this patient about rifapentine? a. It is more toxic than rifampin. b. It is not approved for treatment of latent TB. c. It is not well absorbed and thus not as effective. d. It will stain contact lenses orange

ANS: B Rifapentine is indicated only for pulmonary TB. Rifapentine's toxicity is similar to that of rifampin. Rifapentine is well absorbed. Both drugs stain contact lenses.

A pregnant female patient with bacteriuria, suprapubic pain, urinary urgency and frequency, and a low-grade fever is allergic to sulfa, ciprofloxacin, and amoxicillin. The nurse knows that the best alternative for treating this urinary tract infection is with: a. cephalexin [Keflex]. b. fosfomycin [Monurol]. c. methenamine [Hiprex]. d. nitrofurantoin [Macrodantin].

ANS: C Methenamine is an excellent second-line drug for this patient and is indicated because of the patient's multiple drug sensitivities. It is safe in pregnancy, and there is no drug resistance. Nitrofurantoin has potential harmful effects on the fetus and should not be used during pregnancy. Single-dose regimens are not recommended in pregnant women. Cephalexin can have cross reactivity with amoxicillin

A patient has been taking isoniazid for 4 months for latent tuberculosis. The patient reports bilateral tingling and numbness of the hands and feet, as well as feeling clumsy. The nurse expects the provider to: a. discontinue the isoniazid. b. lower the isoniazid dose and add rifampin. c. order pyridoxine 100 mg per day. d. recheck the tuberculin skin test to see whether it worsens.

ANS: C Patients sometimes develop peripheral neuropathy, characterized by paresthesias, clumsiness, and muscle aches. If these occur, they may be reversed by administering pyridoxine (vitamin B6). It is not necessary to discontinue the isoniazid. Lowering the isoniazid dose and adding rifampin is not indicated. Rechecking the TST is not indicated.

A patient will begin taking an immunosuppressant medication. The nurse learns that the patient has a history of frequent candidal infections. The nurse will expect the provider to order which drug as prophylaxis? a. Fluconazole [Diflucan] b. Ketoconazole c. Posaconazole [Noxafil] d. Voriconazole [Vfend]

ANS: C Posaconazole is used as prophylaxis for invasive Aspergillus and Candida infections in immunocompromised patients. Fluconazole, ketoconazole, and voriconazole are not used prophylactically

A patient with second-degree burns is treated with silver sulfadiazine [Silvadene]. A nursing student asks the nurse about the differences between silver sulfadiazine and mafenide [Sulfamylon], because the two are similar products, and both contain sulfonamides. What does the nurse tell the student about silver sulfadiazine? a. It causes increased pain when the medication is applied. b. It has a broader spectrum of antimicrobial sensitivity. c. It has antibacterial effects related to release of free silver. d. It suppresses renal excretion of acid, causing acidosis.

ANS: C Silver sulfadiazine has antibacterial effects primarily related to the release of free silver and not to the sulfonamide portion of the molecule. Unlike mafenide, silver sulfadiazine reduces pain when applied. Silver sulfadiazine and mafenide have similar antibacterial effects. Because silver sulfadiazine does not suppress renal excretion of acid, it has fewer systemic effects

A nursing student asks a nurse about flucytosine [Ancobon]. Which statement by the nurse is correct? a. "Flucytosine has a broad antifungal spectrum." b. "Irreversible neutropenia and thrombocytopenia may occur with this drug." c. "Resistance is common with this medication." d. "Severe hepatic injury is common and limits this drug's use."

ANS: C The development of resistance during flucytosine therapy is common and is a serious clinical problem. Flucytosine has a narrow antifungal spectrum. Neutropenia and thrombocytopenia may occur but are reversible. Severe hepatic injury is rare; mild and reversible hepatic dysfunction is common

A patient with bronchitis is taking TMP/SMZ, 160/800 mg orally, twice daily. Before administering the third dose, the nurse notes that the patient has a widespread rash, a temperature of 103° F, and a heart rate of 100 beats/minute. The patient looks ill and reports not feeling well. What will the nurse do? a. Administer the dose and request an order for an antipyretic medication. b. Withhold the dose and request an order for an antihistamine to treat the rash. c. Withhold the dose and notify the provider of the symptoms. d. Request an order for intravenous TMP/SMZ, because the patient is getting worse.

ANS: C The most severe hypersensitivity reaction with TMP/SMZ is Stevens-Johnson syndrome, which manifests with fever, malaise, and rash. The drug should be discontinued immediately if a rash occurs. Requesting an antipyretic while giving the drug is incorrect. Giving antihistamines is not indicated. Giving TMP/SMZ intravenously would make the reaction worse

A patient presents to the emergency department with complaints of chills, severe flank pain, dysuria, and urinary frequency. The patient has a temperature of 102.9° F, a pulse of 92 beats/minute, respirations of 24 breaths/minute, and a blood pressure of 119/58 mm Hg. The nurse would be correct to suspect that the patient shows signs and symptoms of: a. acute cystitis. b. urinary tract infection. c. pyelonephritis. d. prostatitis.

ANS: C The nurse should suspect pyelonephritis. Pyelonephritis is characterized by fever, chills, severe flank pain, dysuria, urinary urgency and frequency, and pyuria and bacteriuria. Clinical manifestations of acute cystitis include dysuria, urinary urgency and frequency, suprapubic discomfort, pyuria, and bacteriuria. Urinary tract infections (UTIs) are very general and are classified by their location. These symptoms are specific to pyelonephritis. Prostatitis is manifested by high fever, chills, malaise, myalgia, localized pain, and various UTI symptoms, but not by severe flank pain

A healthcare worker who is asymptomatic has a screening TST result of 10 mm of induration during a pre-employment physical. What will the nurse reading this test tell the patient? a. "This is a negative test, so you are cleared for employment." b. "You have latent TB and will need to take isoniazid for 6 to 9 months." c. "You need to have a chest radiograph and a sputum culture." d. "You will begin taking a four-drug regimen to treat tuberculosis."

ANS: C This patient has a moderate risk and a positive skin test result. Before beginning treatment for latent TB, active TB must be ruled out with chest X-rays and sputum cultures. This is not a negative test result in a moderate-risk individual. Latent TB needs to be confirmed with diagnostic testing. Treatment will not begin until tests have confirmed the diagnosis

A young, nonpregnant female patient with a history of a previous urinary tract infection is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of 3 days' duration. She is afebrile. A urine culture is positive for more than 100,000/mL of urine. The nurse caring for this patient knows that which treatment is most effective? a. A 14-day course of amoxicillin with clavulanic acid [Augmentin] b. A 7-day course of ciprofloxacin[Cipro] c. A single dose of fosfomycin [Monurol] d. A 3-day course of trimethoprim/sulfamethoxazole [Bactrim]

ANS: D Short-course therapy is recommended for uncomplicated, community-acquired lower urinary tract infections. The short course is more effective than a single dose, and compared with longer-course therapies, it is less costly, has fewer side effects, and is more likely to foster compliance. Amoxicillin with clavulanic acid is a second-line drug used for pyelonephritis. Fosfomycin is a second-line drug and can be useful in patients with drug allergies

A nurse is obtaining a drug history from a patient about to receive sulfadiazine. The nurse learns that the patient takes warfarin, glipizide, and a thiazide diuretic. Based on this assessment, the nurse will expect the provider to: a. change the antibiotic to TMP/SMZ. b. increase the dose of the glipizide. c. monitor the patient's electrolytes closely. d. monitor the patient's coagulation levels.

ANS: D Sulfonamides interact with several drugs and through metabolism-related interactions can intensify the effects of warfarin. Patients taking both should be monitored closely for bleeding tendencies. Changing to the combination product will not help, because sulfonamides are still present. Sulfonamides intensify glipizide levels, so this drug may actually need to be reduced. Trimethoprim, not sulfonamides, raises potassium levels

A patient is beginning treatment for active tuberculosis (TB) in a region with little drug resistant TB. Which treatment regimen will be used initially? a. Isoniazid and pyrazinamide b. Isoniazid, pyrazinamide, and ethambutol c. Rifampin, pyrazinamide, and ethambutol d. Isoniazid, rifampin, pyrazinamide, and ethambutol

ANS: D The induction phase oftreatment for patients in a region without drug resistance isthe same as for patients who are human immunodeficiency virus (HIV) negative or HIV positive and includes isoniazid, rifampin, pyrazinamide, and ethambutol. It is not correct to begin with two drugs. The three-drug regimen is used for inductions in areas with resistance to either isoniazid or rifampin.

A nurse reads a tuberculin skin test on a patient and notes a 6- to 7-mm area of induration. The patient is a young adult who has recently immigrated from a country with a high prevalence of tuberculosis. The patient has no other risk factors. The nurse will expect the provider to: a. begin treating this patient with a two-drug regimen of isoniazid and rifampin. b. order a chest radiograph and a sputum culture to assess for active tuberculosis. c. order a nucleic acid amplification test of the patient's sputum. d. reassure the patient that this is not considered a positive test result.

ANS: D This patient has a moderate risk of tuberculosis; the area of induration would have to be 10 mm or greater to be considered a positive skin test result. Without other clinical signs, there is no indication to treat this patient or to perform diagnostic testing, so a chest x-ray or sputum cultures are not recommended.

A patient who is taking nitrofurantoin calls the nurse to report several side effects. Which side effect of this drug causes the most concern and would require discontinuation of the medication? a. Anorexia, nausea, and vomiting b. Brown-colored urine c. Drowsiness d. Tingling of the fingers

ANS: D Tingling ofthe fingers can indicate peripheral neuropathy, which can be an irreversible side effect of nitrofurantoin. The other side effects are not serious and can be reversed

A nurse is performing a physical assessment on a patient with tuberculosis who takes rifampin [Rifadin]. What would be an expected finding? a. Crystalluria b. Myopathy c. Peripheral neuropathy d. Red-orange-tinged urine

ANS: D Urine tinged red-orange is a normal finding associated with rifampin's adverse effects. Peripheral neuropathy, myopathy, and crystalluria are not manifestations of adverse effects of rifampin

A patient who is receiving intravenous ciprofloxacin for pneumonia develops diarrhea. A stool culture is positive for Clostridium difficile. The nurse will expect the provider to: a. add metronidazole [Flagyl]. b. increase the dose of ciprofloxacin. c. restrict dairy products. d. switch to gemifloxacin.

ANS: A C. difficile is resistant to fluoroquinolones; metronidazole is the drug of choice to treat this infection. Metronidazole is lethal only to anaerobic organisms, so the ciprofloxacin should be continued to treat the pneumonia. Increasing the dose of ciprofloxacin is not indicated, because C. difficile is resistant to ciprofloxacin. Gemifloxacin is approved for use in respiratory infections.

A nurse is preparing to administer an antibiotic to a patient with methicillin-resistant Staphylococcus aureus (MRSA). The nurse would expect the health care provider to order which antibiotic? a. Daptomycin [Cubicin] b. Levofloxacin [Levaquin] c. Norfloxacin [Noroxin] d. Ciprofloxacin [Cipro]

ANS: A Daptomycin is active against MRSA. Levofloxacin and norfloxacin are not approved to treat MRSA. Ciprofloxacin is a poor choice for staphylococcal infections, including MRSA

A patient is being treated for a systemic fungal infection with amphotericin B [Abelcet] and will be discharged home from the hospital to complete every-other-day infusions of the medication for 6 to 8 weeks. The nurse provides discharge teaching before dismissal. Which statement by the patient indicates a need for further teaching? a. "I may experience headaches and pain in my lower back, legs, and abdomen." b. "I may need to take potassium supplements while taking this drug." c. "I should take acetaminophen and diphenhydramine before each infusion." d. "I will need to have blood drawn for serum creatinine and BUN levels every 3 to 4 days."

ANS: A Headaches, lower back pain, leg pain, and abdominal pain occur with intrathecal administration of amphotericin B. Patients taking amphotericin may experience hypokalemia and may need potassium supplements. Acetaminophen and diphenhydramine should be taken to minimize infusion reaction effects. Renal function should be monitored every 3 to 4 days during treatment

Before giving methenamine [Hiprex] to a patient, it is important for the nurse to review the patient's history for evidence of which problem? a. Elevated blood urea nitrogen and creatinine b. History of reactions to antibiotic agents c. Possibility of pregnancy d. Previous resistance to antiseptic agents

ANS: A Methenamine should not be given to patients with renal impairment, because crystalluria can occur. There is no cross-reactivity between methenamine and antibiotic agents. Methenamine is safe for use during pregnancy. There is no organism drug resistance to methenamine

The nurse is preparing to administer amphotericin B intravenously. The nurse will expect to pretreat the patient with which medications? a. Acetaminophen [Tylenol], diphenhydramine [Benadryl], and meperidine [Demerol] b. Aspirin, diphenhydramine [Benadryl], and meperidine [Demerol] c. Ibuprofen [Motrin], diphenhydramine [Benadryl], and meperidine [Demerol] d. Morphine sulfate [Morphine] and acetaminophen]Tylenol]

ANS: A Optimum pretreatment before the administration of amphotericin B comprises acetaminophen, diphenhydramine, and meperidine (for rigors). Motrin is not suggested as pretreatment. Aspirin is an option, but it may increase kidney damage. Morphine is not indicated in the pretreatment regimen

A patient has a positive urine culture 1 week after completion of a 3-day course of antibiotics. The nurse anticipates that the prescriber will: a. begin a 2-week course of antibiotics. b. evaluate for a structural abnormality of the urinary tract. c. initiate long-term prophylaxis with low-dose antibiotics. d. treat the patient with intravenous antibiotics.

ANS: A Patients who develop a subsequent urinary tract infection after treatment are treated in a stepwise fashion, beginning with a longer course of antibiotics. The next steps would be to begin a 4- to 6- week course of therapy, followed by a 6-month course of therapy if that is unsuccessful. If urinary tract infections are thought to be caused by other complicating factors, an evaluation for structural abnormalities may be warranted. Unless the infections are severe or are complicated, intravenous antibiotics are not indicated.

A patient with HIV who takes protease inhibitors develops tuberculosis and will begin treatment. Which drug regimen will be used for this patient? a. Isoniazid, pyrazinamide, ethambutol + rifabutin b. Isoniazid, pyrazinamide, ethambutol c. Isoniazid, rifampin, pyrazinamide, ethambutol d. Isoniazid + rifabutin

ANS: A Patients with HIV who take protease inhibitors are susceptible to drug interactions with rifampin, which accelerates the metabolism of protease inhibitors. Rifabutin can be substituted for rifampin in patients with HIV, because the degree of acceleration of this metabolism is less. A three-drug regimen would increase drug resistance, as would a two-drug regimen

A patient with a history of renal calculi has fever, flank pain, and bacteriuria. The nurse caring for this patient understands that it is important for the provider to: a. begin antibiotic therapy after urine culture and sensitivity results are available. b. give prophylactic antibiotics for 6 weeks after the acute infection has cleared. c. initiate immediate treatment with broad-spectrum antibiotics. d. refer the patient for intravenous antibiotics and hospitalization.

ANS: A Patients with renal calculi are more likely to have complicated urinary tract infections that have less predictable microbiologic etiologies. Because the symptoms are mild, it is important first to obtain a culture and sensitivity to assist with antibiotic selection. If symptoms worsen, a broad spectrum antibiotic may be started until sensitivity information is available. Intravenous antibiotics are indicated for severe pyelonephritis. Long-term prophylaxis is not indicated unless this patient develops frequent reinfection

A hospitalized patient is being treated for tuberculosis with a drug regimen that includes pyrazinamide. The patient complains of pain in the knee and shoulder joints. The nurse will contact the provider to request an order for: a. ibuprofen. b. renal function tests. c. discontinuation of the pyrazinamide. d. measurement of uric acid levels.

ANS: A Polyarthralgias occur in 40% of patients during the initial phase of treatment with pyrazinamide and can be managed with a nonsteroidal anti-inflammatory drug (NSAID). Renal function tests and uric acid levels are not indicated. Unless the pain cannot be managed with NSAIDs, there is no need to reduce the dose of pyrazinamide.

A patient who is being treated for HIV infection has a 5-mm area of induration after a routine TST. The patient's chest radiograph is normal, and there are no other physical findings. The nurse will expect this patient to begin treatment with which drugs? a. Isoniazid and rifabutin b. Isoniazid and rifampin c. Isoniazid and rifapentine d. Isoniazid and pyrazinamide

ANS: A Rifabutin is used off-label as an alternative to rifampin to treat TB in patients with HIV, because it has less impact on the metabolism of protease inhibitors. The effects of rifapentine on protease inhibitors are similar to those of rifampin. Pyrazinamide is not indicated.

A patient with high-risk factors for tuberculosis will begin therapy for latent TB with isoniazid and rifampin. The nurse learns that this patient takes oral contraceptives. The nurse will counsel this patient to discuss with her provider. a. another birth control method b. reducing the rifampin dose c. reducing the isoniazid dose d. increasing the oral contraceptive dose

ANS: A Rifampin induces cytochrome P450 enzymes and can accelerate the metabolism of many drugs, including oral contraceptive pills (OCPs). Women taking OCPs should consider a nonhormonal form of birth control. Reducing the dose of rifampin or isoniazid is not indicated. Increasing the OCP dose is not recommended

A patient is receiving intravenous voriconazole [Vfend]. Shortly after the infusion starts, the patient tells the nurse, "Colors look different, and the light hurts my eyes." What will the nurse do? a. Observe the patient closely for the development of hallucinations. b. Reassure the patient that these effects will subside in about 30 minutes. c. Stop the infusion and notify the provider of CNS toxicity. d. Tell the patient that this is an irreversible effect of the drug.

ANS: B Reduced visual acuity, increased brightness, altered color perception, and photophobia are reversible visual disturbances that can occur in 30% of patients receiving voriconazole. These usually begin within 30 minutes of dosing and then diminish over the next 30 minutes. They are not precursors to other effects, such as hallucinations. They do not indicate CNS toxicity. They are reversible

Which patient should begin treatment for tuberculosis? a. A patient with HIV and a tuberculin skin test result of a 4-mm region of induration b. A recent immigrant from a country with a high prevalence of TB with a 10-mm region of induration c. A patient with no known risk factors who has a job-related tuberculin skin test result of a 12-mm area of induration d. An intravenous drug abuser with a tuberculin skin test result of a 5-mmregion of induration

ANS: B The immigrant is considered to be at moderate risk, meaning that a 10-mm area of induration ona tuberculin skin test (TST) is considered a positive result. After being evaluated for active TB, this patient should be treated for latent TB. A patient with HIV is considered high risk, but this patient has a negative TST result of less than 5 mm. For a low-risk patient receiving a screening TST for a job, the area of induration must be 15 mm or greater to be considered a positive result. An IV drug abuser is in the moderate-risk category; an area of induration of 10 mm or greater is needed to be considered a positive TST result

.A patient is taking oral ketoconazole [Nizoral] for a systemic fungal infection. The nurse reviews the medication administration record and notes that the patient is also taking omeprazole [Prilosec] for reflux disease. What action should the nurse take? a. Administer the omeprazole 1 hour before the ketoconazole. b. Administer the omeprazole at least 2 hours after the ketoconazole. c. Confer with the prescriber about a potential hazardous interaction. d. The nurse should not administer omeprazole to a patient receiving ketoconazole.

ANS: B The nurse should administer the omeprazole at least 2 hours after the ketoconazole to prevent a drug-to-drug interaction. Drugs that reduce gastric acidity should be administered no sooner than 2 hours after ingestion of ketoconazole, because they reduce absorption of the drug. There is no need to confer with the prescriber or to refuse to administer the drugs, because ketoconazole and omeprazole do not have a potentially hazardous interaction.

A nursing student asks a nurse to explain the differences between amphotericin B [Abelcet] and the azoles group of antifungal agents. Which statement by the nurse is correct? a. "Amphotericin B can be given orally or intravenously." b. "Amphotericin B increases the levels of many other drugs." c. "Azoles have lower toxicity than amphotericin B." d. "Only the azoles are broad-spectrum antifungal agents."

ANS: C The azoles class of antifungals is less toxic than amphotericin B. Amphotericin B may only be given parenterally. The azoles, not amphotericin B, inhibit hepatic P450 drug-metabolizing enzymes, so they increase the levels of many other drugs. Both classes are broad-spectrum antifungal agents

A patient who is taking calcium supplements receives a prescription for ciprofloxacin [Cipro] for a urinary tract infection. The nurse will teach this patient to: a. consume extra fluids while taking the ciprofloxacin to prevent hypercalciuria. b. stop taking the calcium supplements while taking the ciprofloxacin. c. take the two medications together to increase the absorption of both. d. take the calcium either 6 hours before or 2 hours after taking the ciprofloxacin.

ANS: D Cationic compounds, including calcium supplements, can reduce the absorption of ciprofloxacin, so proper interval dosing is necessary. Consuming extra fluids is not indicated. With proper interval dosing, it is not necessary to discontinue the calcium while giving the ciprofloxacin. These two medications should not be given together

The nurse is caring for a patient who will begin receiving intravenous ciprofloxacin [Cipro] to treat pyelonephritis. The nurse learns that the patient has a history of myasthenia gravis. Which action by the nurse is correct? a. Administer the ciprofloxacin and monitor the patient for signs of muscle weakness. b. Ask the provider whether the ciprofloxacin can be given orally. c. Request an order for concurrent administration of metronidazole [Flagyl]. d. Suggest that the provider order a different antibiotic for this patient.

ANS: D Ciprofloxacin and other fluoroquinolones can exacerbate muscle weakness in patients with myasthenia gravis and should not be given to these patients. It is not correct to administer the drug and monitor for this effect. Giving the drug by a different route will not alter this effect. Metronidazole is given when C. difficile occurs.

A patient is about to begin treatment with isoniazid. The nurse learns that the patient also takes phenytoin [Dilantin] for seizures. The nurse will contact the provider to discuss: a. increasing the phenytoin dose. b. reducing the isoniazid dose. c. monitoring isoniazid levels. d. monitoring phenytoin levels.

ANS: D Isoniazid is a strong inhibitor ofthree cytochrome P450 enzymes, and inhibition of these enzymes can raise the levels ofother drugs, including phenytoin. Patients taking phenytoin should have the levels of this drug monitored, and the dose should be reduced if appropriate. Reducing the dose of isoniazid is not indicated. It is not necessary to monitor isoniazid levels.

A provider orders intravenous moxifloxacin [Avelox] for a patient who has sinusitis. Before administering the drug, the nurse will review this patient's chart for: a. a history of asthma. b. concurrent use of digoxin. c. concurrent use of warfarin. d. recent serum electrolyte levels.

ANS: D Moxifloxacin prolongs the QT interval and poses a risk of serious dysrhythmias. Patients with hypokalemia have an increased risk, so serum electrolyte levels should be monitored. Having a history of asthma is not significant. Moxifloxacin does not alter digoxin or warfarin levels.

A nurse is preparing to administer oral ofloxacin to a patient. While taking the patient's medication history, the nurse learns that the patient takes warfarin and theophylline. The correct action by the nurse is to request an order to: a. reduce the dose of ofloxacin. b. increase the dose of ofloxacin. c. increase the dose of theophylline. d. monitor coagulation levels.

ANS: D Ofloxacin increases plasma levels of warfarin, so coagulation tests should be monitored. The ofloxacin dose should not be reduced or increased. Ofloxacin does not affect theophylline levels.

A nurse teaches a patient about sulfonamides. Which statement by the patient indicates a need for further teaching? a. "I need to drink extra fluids while taking this medication." b. "I need to use sunscreen when taking this drug." c. "I should call my provider if I develop a rash while taking this drug." d. "I should stop taking this drug when my symptoms are gone."

ANS: D Patients should always be advised to complete the prescribed course of the antibiotic even when symptoms subside. Patients should also understand the need to drink 8 to 10 glasses of water a day, to use sunscreen, and to notify the provider if they develop a rash

A patient has come to the clinic with tinea corporis, and the prescriber has ordered clotrimazole. When educating the patient about this medication, the nurse will include which statement? a. "Apply the medication over the entire body twice daily for 2 weeks." b. "Sun exposure will minimize the drug's effects." c. "This drug is effective after a single application." d. "Use the medication for at least 1 week after the symptoms have cleared."

ANS: D The nurse should advise the patient to continue therapy for at least 1 week after the symptoms have cleared up. The medication should be applied only to the affected areas. Sun exposure will not delay the effects of clotrimazole. The drug must be applied twice daily for several weeks.

A nurse is discussing microbial resistance among sulfonamides and trimethoprim with a nursing student. Which statement by the student indicates a need for further teaching? a. "Bacterial resistance to trimethoprim is relatively uncommon." b. "Resistance among gonococci, streptococci, and meningococci to sulfonamides is high." c. "Resistance to both agents can occur by spontaneous mutation of organisms." d. "Resistance to sulfonamides is less common than resistance to trimethoprim."

ANS: D There is less microbial resistance to trimethoprim than there is to sulfonamides. Bacterial resistance to trimethoprim is relatively uncommon. Gonococcal, streptococcal, and meningococcal resistance to sulfonamides is especially high. For both agents, resistance can develop by spontaneous mutation

A provider has ordered oral voriconazole [Vfend] for a patient who has a systemic fungal infection. The nurse obtains a medication history and learns that the patient takes phenobarbital for seizures. The nurse will contact the provider to discuss which possibility? a. Administering intravenous voriconazole b. Reducing the dose of phenobarbital c. Reducing the dose of voriconazole d. Using a different antifungal agent

ANS: D Voriconazole can interact with many drugs. It should not be combined with drugsthat are powerful P450 inhibitors, including phenobarbital, because these can reduce the levels of voriconazole. Administering the voriconazole IV will not increase the serum level. It is not correct to reduce the dose of either drug.

A patient has an invasive aspergillosis infection. Which antifungal agent is the drug of choice for this infection? a. Amphotericin B b. Fluconazole [Diflucan] c. Posaconazole [Noxafil] d. Voriconazole [Vfend]

ANS: D Voriconazole has replaced amphotericin B as the drug of choice for treating invasive aspergillosis. Fluconazole, which is fungistatic, is not used to treat aspergillosis. Posaconazole is used for prophylaxis of aspergillosis in immunocompromised patients.