Pharm ch 9

A client has been prescribed INH for the treatment of tuberculosis. The nurse teaches the client about dietary restrictions while taking this medication. What is the most important instruction?

"Do not drink beer or red wine while taking this medication because a serious adverse reaction can occur."

A pregnant woman calls the clinic and asks if it is suitable to use ofloxacin otic drops that she used prior to pregnancy for a current ear infection. What would be an appropriate response from the nurse?

"The effects of ofloxacin in pregnancy are not known, so the drug should not be used while pregnant."

Vancomycin Side Effects & Toxicity

-Thrombophlebitis -nephrotoxicity -ototoxicity -Diffuse Flushing Called Red Man Syndrome prevented with antihistamines and slow IV infusion

Fluoroquinolone toxicities

-myalgia in kids -QT Prolongation -Tendon rupture in adults -diarrhea -skin rash -headache -teratogen -damage to cartilage

A client with a positive sputum culture for TB has been started on streptomycin antitubercular therapy. Upon review of the laboratory results, the nurse notes that the client may be experiencing toxicity if which of the following results is abnormal

BUN and creatinine

Pyrazinamide should be used cautiously in which of the following clients? Select all that apply.

Clients with hepatic impairment Clients with HIV infection Clients with diabetes Clients with renal impairment

Aminoglycosides are an example of antiinfectives that are classified as bacteriostatic.

False

A nurse is caring for a patient undergoing the second phase of standard TB treatment. The nurse knows that which of the following combinations of drugs need to be administered to the client?

Rifampin and isoniazid

The class of drugs that treats infections by inhibiting folic acid synthesis is called

Sulfonamides (sulfa drugs)

A Gram stain is used to identify gram-positive bacteria by retaining a stain within its cell wall.

True

Cephalosporins can be classified as either bactericidal or bacteriostatic depending on which specific drug and dose are used.

True

Which of the following are examples of a secondary infection? Select all that apply.

Vaginal candidiasis Oral candidiasis C. difficile colitis

An aminoglycoside antibiotic might be the drug of choice in treating a. serious infections caused by susceptible strains of Gram-negative bacteria. b. otitis media in an infant. c. cystitis in a woman who is 4 months pregnant. d. suspected pneumonia before the culture results are available.

a

In general, all patients receiving antibiotics should receive teaching that includes which of the following points? a. The need to complete the full course of drug therapy b. The possibility of oral contraceptive failure c. When to take the drug related to food and other drugs d. The need for assessment of blood tests e. Advisability of saving any leftover medication for future use f. How to detect superinfections and what to do if they occur

a,c,f

A bacterium that depends on oxygen in order to survive is called

aerobic

Which of the following groups of antibiotics is notable for side effects such as nephrotoxocity and ototoxicity?

aminoglycosides -Aminoglycosides are a class of antibiotic that inhibit the 30S subunit of the bacterial ribosome, leading to cell death or bactericidal activity. They are active against gram negative rods. Examples include gentamicin, neomycin and amikacin. Important side effects include nephrotoxicity and ototoxicity.

Gangrene is an example of a(n) _______________ bacteria that do not use oxygen to survive.

anaerobic

Gram-negative bacteria

are mostly found in the GI and GU tracts.

Antibiotics that are used together to increase their effectiveness and limit the associated adverse effects are said to be a. broad spectrum. b. synergistic. c. bactericidal. d. anaerobic.

b

Cipro, a widely used antibiotic, is an example of a. a penicillin. b. a fluoroquinolone. c. an aminoglycoside. d. a macrolide antibiotic.

b

The penicillins a. are bacteriostatic. b. are bactericidal, interfering with bacteria cell walls. c. are effective only if given intravenously. d. do not produce cross-sensitivity within their class.

b

A young woman is found to have a soft-tissue infection that is most responsive to tetracycline. Your teaching plan for this woman should include which of the following points? a. Tetracycline can cause gray baby syndrome. b. Do not use this drug if you are pregnant because it can cause tooth and bone defects in the fetus. c. Tetracycline can cause severe acne. d. You should use a second form of contraception if you are using oral contraceptives because tetracycline can make them ineffective. e. This drug should be taken in the middle of a meal to decrease GI upset. f. You may experience a vaginal yeast infection as a result of this drug therapy.

b,f

Which of the following is a medication given alongside certain penicillins to prevent breakdown of the antibiotic?

beta-lactamase inhibitors -Beta-lactamase inhibitors are a type of medication given alongside certain penicillins to prevent breakdown of the antibiotic by the bacterial enzyme beta-lactamase. Beta-lactamase inhibitors include clavulanic acid, sulbactam, and tazobactam.

A patient receiving a fluoroquinolone should be cautioned to anticipate a. increased salivation. b. constipation. c. photosensitivity. d. cough.

c

The fluoroquinolones a. are found freely in nature. b. are associated with severe adverse reactions. c. are widely used to treat Gram-positive infections. d. are broad-spectrum antibiotics with few associated adverse effects.

c

The goal of antibiotic therapy is a. to eradicate all bacteria from the system. b. to suppress resistant strains of bacteria. c. to reduce the number of invading bacteria so that the immune system can deal with the infection. d. to stop the drug as soon as the patient feels better.

c

Which of the following is not a caution for the use of cephalosporins? a. Allergy to penicillin b. Renal failure c. Allergy to aspirin d. Concurrent treatment with aminoglycosides

c

Which of the following groups of antibiotics has a beta-lactam ring in the molecular structure?

carbrapenems (imipenem &meropenem) -Carbapenems, such as imipenem and meropenem, are a class of broad spectrum antibiotics. They share a beta-lactam molecular structure with the other cell wall inhibiting antibiotics and similarly work by preventing cell wall formation. Carbapenems are active against most bacteria including gram positive, gram negative, and anaerobic species. Cilastin is often given alongside these medications because it prevents their breakdown by the kidneys.

Which of the following best classifies penicillins, cephalosporins, and carbapenems?

cell wall inhibitors -Cell wall inhibitors are antibiotics whose mechanism of action involves disruption of the bacterial cell wall, typically by preventing the peptidoglycan building blocks from being cross-linked together. Without an intact cell wall, bacteria cannot maintain normal metabolic functions and will either stop proliferating or die. Antibiotics under this category include the penicillins, cephalosporins, monobactams, carbapenems, and vancomycin.

Which of the following groups of antibiotics has a beta-lactam ring in the molecular structure?

cephalosporins -Cephalosporins are a class of antibiotics that are similar to penicillins in that both share a beta-lactam molecular structure and inhibit cross-linking of the bacterial cell wall. Cephalosporins are generally more broad spectrum, and have multiple generations which help define their activity. First generation cephalosporins like cefazolin have good gram positive coverage. As the generations go up, generally, more gram negative coverage is added. For example, second generation cephalosporins like cefuroxime have improved gram negative coverage.

Which antibiotic binds to the 50S ribosomal subunit and may result in gray baby syndrome?

chloramphenicol -Chloramphenicol inhibits the 50S ribosomal subunit and has broad spectrum activity. However, due to significant side effects, it is not often used. Side effects include bone marrow suppression including aplastic anemia, as well as gray baby syndrome which is seen in exposed infants.

Which antibiotic binds to the 50S subunit of the bacterial ribosome and may result in the development of pseudomembranous colitis?

clindamycin -Clindamycin inhibits the 50S ribosomal subunit and is an important antibiotic for its activity against gram positive bacteria and anaerobes. It is useful in cases of group A streptococcal infection as well as certain cases of MRSA. It can also be used in aspiration pneumonia or other infections where anaerobic organisms are suspected. An important side effect can be the development of pseudomembranous colitis, which occurs secondary to overgrowth of C. difficile.

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?

decreased absorption

A client is allergic to penicillin and has been diagnosed with a genitourinary infection caused by Chlamydia trachomatis. Which medication will most likely be administered?

erythromycin

Fluoroquinolones are used to treat susceptible strains of gram-positive bacteria.

false

Which antibiotic class inhibits the bacterial enzyme topoisomerase II (DNA gyrase) and topoisomerase IV?

fluoroquinolones -Fluoroquinolones are a class of antibiotic whose mechanism of action involves inhibition of the bacterial enzyme topoisomerase II (DNA gyrase) and topoisomerase IV. Inhibition of these enzymes prevents bacteria from properly replicating their DNA, resulting in cell death. These antibiotics often end with the suffix "-floxacin" and include ciprofloxacin, levofloxacin, and moxifloxacin. They are broad spectrum with excellent gram negative activity, including coverage of Pseudomonas in some cases. Side effects can include tendon rupture, cartilage damage in younger patients, and QT prolongation.

Bacteria whose cell wall lose a stain or are decolorized by alcohol are called

gram-negative

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?

gram-negative infections

Gary is a construction worker who is diagnosed with leprosy and is prescribed rifampin. Gary is married, an alcoholic, and wears contact lenses. At the time of initiating the therapy, the nurse should inform the client:

he should wear glasses during the therapy.

A client being treated for tuberculosis (TB) is determined to be drug resistant. Which medications will no longer be effective in the treatment of the tuberculosis?

isoniazid (INH) and rifampin (RIF)

Which antibiotic has only gram-positive coverage and may cause bone marrow suppression or peripheral neuropathy?

linezolid -Linezolid inhibits the 50S ribosomal subunit and is only effective against gram positive bacteria. It is useful for treating cases of methicillin-resistant Staph aureus (MRSA) or vancomycin-resistant Enterococci (VRE). Side effects can include bone marrow suppression or peripheral neuropathy.

Which of the following groups of antibiotics binds to the 50S subunit of the bacterial ribosome and includes drugs such as erythromycin and azithromycin?

macrolides -Macrolides are a class of antibiotic which bind to the 50S subunit of the bacterial ribosome and prevent protein production. This results in bacteriostatic activity and prevents bacteria from replicating. Macrolides include erythromycin, azithromycin and clarithromycin. They can treat multiple types of infections including Mycoplasma and Chlamydia.

Which of the following groups of antibiotics best classifies aztreonam?

monobactams -Monobactams are another class of beta-lactam cell wall inhibiting antibiotics, and the only relevant member of this class is aztreonam. Aztreonam only has coverage against gram negative bacteria, in contrast to many other beta-lactam antibiotics. It is useful for patients with penicillin allergies

Which of the following groups of antibiotics has a beta-lactam ring in the molecular structure?

penicillins -Penicillins are a group of antibiotics typified by the presence of a beta-lactam ring in their molecular structure. Normally, bacteria create their cell wall by producing peptidoglycan subunits which are then cross-linked together by transpeptidase enzymes, also known as penicillin binding proteins. Penicillins bind to these enzymes, as their name suggests, and prevents the cell wall from being cross-linked together. This leads to bacterial cell death. There are different subclasses of penicillins. For example, oxacillin and nafcillin are resistant to the bacterial enzyme penicillinase and have activity against Staph aureus. Ticarcillin and piperacillin, conversely, have activity against Pseudomonas.

A bacteriostatic substance is one that

prevents the growth of specific bacteria that are sensitive to the substance.

What event triggers the development of a superinfection?

proliferation of antibiotic-resistant microorganisms

Which of the following best classifies aminoglycosides, macrolides, and clindamycin

protein synthesis inhibitors -Protein synthesis inhibitors are antibiotics whose mechanism of action involves targeting ribosomes within bacteria and stopping production of vital proteins. The bacterial ribosome is composed of two parts named the 50S subunit and 30S subunit, and different antibiotics target different parts. Most are bacteriostatic, although some such as aminoglycosides are bactericidal.

Which antibiotic class disrupts folate metabolism in bacteria and is often combined with trimethoprim?

sulfonomides -Sulfonamides are a class of antibiotic whose mechanism of action involves inhibition of bacterial DNA replication. Normally, bacteria require two enzymes in the folate pathway to carry out DNA synthesis: dihydropteroate synthase and dihydrofolate reductase. Sulfonamide antibiotics such as sulfamethoxazole inhibit the first enzyme, dihydropteroate synthase. Trimethoprim is often added to sulfonamides because it inhibits the second enzyme, dihydrofolate reductase. This combination results in broad spectrum activity against gram positive and negative organisms, including MRSA.

When antibiotics are given in combination so that their combined effects are greater than if they were given individually, they are considered to be

synergistic

The nurse is caring for a 6-year-old child who has pyelonephritis. The use of what group of antibiotics would be contraindicated due to the client's age?

tetracyclines

Photosensitivity and teeth discoloration in children are most likely side effects associated with which of the following?

tetracyclines -Tetracyclines are another class of protein synthesis inhibitors and work by binding to the 30S bacterial subunit. Examples include tetracycline itself, doxycycline and minocycline. Tetracyclines are broad spectrum antibiotics and can treat various infections such as Lyme disease, Mycoplasma pneumonia, or Chlamydia infections. Side effects include photosensitivity and, in children, discoloration of teeth.

When patients are allergic to penicillin, erythromycin has proven to be an effective alternative.

true

A nurse is reviewing the medical record of a client who is prescribed tetracycline. Which drug, if found being used by the client, would alert the nurse to the need for a decreased dosage of that drug?

warfarin rationale:The concomitant use of tetracycline with warfarin, an anticoagulant, increases the risk of bleeding, necessitating a reduction in the dosage of warfarin. Vancomycin is used in specific cases of bacterial and resistant infections. Atorvastatin is for hyperlipidemia, and losartan is an antihypertensive. Tetracycline has no drug interaction with these drugs.

Aminoglycosides must be used cautiously in children as in adults. Dosage must be accurately calculated according to which factors?

weight and renal fxn