ATI Pharm Made Easy: Infection

-Cefotetan -Metronidazole (Flagyl) Rationale: -Cefotetan is correct. Cefotetan, a second-generation cephalosporin, can cause a reaction similar to what disulfiram causes when patients take it and also drink alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension. -Metronidazole is correct. Metronidazole, an antiparasitic drug, can cause a reaction similar to what disulfiram causes when patients take it and also drink alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension.

1. A primary care provider is considering the various pharmacologic options for a patient who has a gynecologic infection and a history of alcohol use disorder. Which of the following medications can cause a reaction similar to disulfiram (Antabuse) if the patient drinks alcohol while taking it? (Select all that apply.)

Vancomycin (Vancocin) Rationale: Vancomycin, a potentially toxic antibiotic, is used primarily for serious infections either in patients who are allergic to penicillin or in those whose infecting bacteria are resistant to penicillin, such as MRSA. Although methicillin is no longer available, the term methicillin-resistant generally refers to a lack of susceptibility to all penicillins, cephalosporins, tetracyclines, beta-lactams, and many other antimicrobial drugs.

10. A primary care provider is prescribing drug therapy for a patient whose sputum culture results indicate methicillin-resistant Staphylococcus aureus (MRSA). Which of the following drugs should be administered?

Swish the suspension in the mouth before swallowing it. Rationale: The health care professional should tell the patient to swish the nystatin oral suspension inside the mouth for at least 2 min and then swallow it. This allows the drug to coat the inside of the mouth, where it exerts its therapeutic effect against Candida albicans lesions.

11. A health care professional is caring for a patient who is about to begin using nystatin (Mycostatin) to treat oral Candida albicans that resulted from tetracycline therapy. Which of the following instructions should the health care professional include about using the antifungal preparation?

-Jaundice -Numbness of the hands -Dizziness Rationale: -Jaundice is correct. Isoniazid, an antimycobacterial drug, can cause liver toxicity, especially in patients who abuse alcohol. The health care professional should monitor liver enzymes during therapy, and tell the patient to report indications of liver damage, such as jaundice, abdominal pain, and fatigue. -Numbness of the hands is correct. Isoniazid can cause peripheral neuropathy. The health care professional should tell the patient to report numbness, pain, or tingling in the hands or feet. Administering pyridoxine (vitamin B6) can help minimize these effects. -Dizziness is correct. Isoniazid can cause dizziness, ataxia, and seizures. The health care professional should tell the patient to report these CNS effects.

12. A health care professional is caring for a patient who is about to begin taking isoniazid (INH) to treat tuberculosis. The health care professional should tell the patient to report which of the following adverse effects of the drug? (Select all that apply.)

-Acetaminophen (Tylenol) -Diphenhydramine Rationale: -Acetaminophen is correct. Infusion reactions to IV amphotericin B start 1 to 2 hr after the infusion begins and subside within 4 hr. The health care professional can help prevent these effects by administering acetaminophen prior to the infusion. -Diphenhydramine is correct. The health care professional can help prevent adverse reactions by administering diphenhydramine prior to the infusion.

13. A health care professional is preparing to administer amphotericin B IV to a patient who has a systemic fungal infection. Which of the following drugs should the health care professional administer prior to the infusion to prevent or minimize adverse reactions during amphotericin B administration? (Select all that apply.)

Cardiac dysrhythmias Rationale: Erythromycin, a macrolide, can cause ECG changes, including a prolonged QT interval, and put the patient at risk for a potentially fatal ventricular dysrhythmia. The health care professional should monitor the patient's ECG, and tell the patient to report palpitations, fainting, or dizziness. The drug is inappropriate for patients who have a history of QT prolongation.

14. When administering erythromycin to a patient who has pneumococcal pneumonia, the health care professional should monitor for which of the following adverse effects of the drug?

Pseudomembranous enterocolitis Rationale: Severe diarrhea, often containing mucus and blood, can indicate pseudomembranous colitis. Treatment includes stopping drug therapy and replacing fluids and electrolytes. Patients should report severe diarrhea and blood in the stools promptly.

15. A patient who is taking tetracycline orally to treat a chlamydia infection contacts the health care professional to report severe blood-tinged diarrhea. Recognizing the adverse effects of tetracycline, the health care professional should suspect which of the following?

Stop the cefotetan infusion. Rationale: The health care professional should stop the infusion, remove the IV catheter, assess for tissue damage, and treat it accordingly. The health care professional should then initiate IV access via another site, and continue cefotetan therapy slowly and with a diluted solute.

16. While administering IV cefotetan to a patient to treat bacterial meningitis, the health care professional finds the IV insertion site warm and reddened. Which of the following actions should the health care professional take?

Call emergency services immediately. Rationale: Amoxicillin can cause a severe anaphylactic reaction. A patient who has breathing difficulties should call emergency services or seek immediate care. The health care professional should prepare to administer epinephrine and an antihistamine, such as diphenhydramine, to treat an anaphylactic reaction.

17. A patient who is taking amoxicillin (Amoxil) to treat a respiratory infection contacts the health care professional to report a rash and wheezing. Which of the following instructions should the health care professional provide?

Creatinine Rationale: Cephalexin, a first-generation cephalosporin, is excreted by the kidneys. The health care professional should evaluate renal function prior to and during treatment with the drug. Patients who have renal insufficiency should receive a reduced dose of the drug or another drug that does not affect renal function, such as ceftriaxone (Rocephin).

18. A health care professional is caring for a patient who is about to begin taking cephalexin (Keflex) to treat bacterial meningitis. The health care professional should explain to the patient the need to monitor which of the following laboratory tests?

Suprainfection Rationale: Imipenem, a carbapenem, can cause a suprainfection, Candida albicans in the mouth, throat, or vagina. It can also cause glossitis, an inflammation or infection of the tongue. Patients taking the drug should report any mouth pain or vaginal discharge and itching because they could need treatment with an antifungal drug.

19. A patient who is taking imipenem (Primaxin) to treat a bacterial infection contacts the health care professional to report an inability to eat because of mouth pain. Recognizing the adverse effects of imipenem, the health care professional should suspect which of the following?

Bleeding Rationale: Trimethoprim/sulfamethoxazole, a sulfonamide combination, can increase the effects of warfarin and increase the patient's risk for bleeding. The health care professional should request another prescription to treat the infection, or, if the patient must take the drug, ask the provider to prescribe a lower warfarin dose and monitor prothrombin time carefully. The patient should report any sign of bleeding, such as easy or unexplained bruising.

2. A health care professional is caring for a patient who is taking warfarin (Coumadin) and is about to begin taking trimethoprim/sulfamethoxazole (Bactrim) to treat a urinary tract infection. The health care professional should question the drug regimen because taking these two drugs concurrently can increase the patient's risk for which of the following?

Furosemide (Lasix) Rationale: Gentamicin, an aminoglycoside, and furosemide, a high-ceiling diuretic, are ototoxic drugs. Concurrent use multiplies the patient's risk for hearing loss.

20. A health care professional is caring for a patient who is about to receive gentamicin to treat a systemic infection. The health care professional should question the use of the drug for a patient who is also taking which of the following drugs?

Use additional contraception. Rationale: Rifampin, an antimycobacterial drug, can increase the metabolism of oral contraceptives, reducing their effectiveness. Patients taking oral contraceptives and rifampin should use additional contraceptive methods to prevent an unwanted pregnancy. Some antifungal drugs can also reduce the effectiveness of oral contraceptives.

21. A health care professional is caring for a patient who takes an oral contraceptive and is about to begin rifampin (Rifadin) therapy to treat tuberculosis. The health care professional should include which of the following instructions?

Take an antacid at least 2 hr after taking the drug. Rationale: The health care professional should recommend the patient try an antacid, but only after at least 2 hr have passed since taking ciprofloxacin, a fluoroquinolone. This is because antacids decrease the absorption of the drug.

22. A patient who is taking ciprofloxacin (Cipro) to treat a respiratory tract infection contacts the health care professional to report dyspepsia. The health care professional should recommend which of the following instructions?

BUN Rationale: Acyclovir, an antiviral drug, can cause renal toxicity because of drug accumulation in renal tubules. The health care professional should monitor the patient's urine output, BUN, and creatinine levels, and increase fluid intake to hydrate and flush the kidneys.

23. A health care professional is caring for a patient who is about to begin taking acyclovir (Zovirax) to treat a herpes simplex infection. The health care professional should monitor which of the following laboratory values for the patient?

Urine output Rationale: Gentamicin, an aminoglycoside, can cause nephrotoxicity. The health care professional should monitor BUN and creatinine and for an increased output of diluted urine. It is also essential to monitor serum gentamicin levels and maintain a therapeutic range.

24. A health care professional is caring for a patient who is about to begin gentamicin therapy to treat an infection. The health care professional should monitor the patient for which of the following?

Dehydration Rationale: Acyclovir, an antiviral drug, can cause renal toxicity, especially in patients who are dehydrated. Hydration during and after IV infusion of the drug can help keep it from precipitating in the renal tubules.

25. A health care professional is caring for a patient who is about to begin receiving acyclovir (Zovirax) IV to treat a viral infection. The health care professional should recognize that cautious use of the drug is essential if the patient also has which of the following?

Renal impairment Rationale: Aztreonam, a monobactam, requires cautious use with patients who have renal dysfunction because the kidneys eliminate it virtually intact. The primary care provider should prescribe a lower dose for the patient or prescribe a different antimicrobial drug.

3. A primary care provider should prescribe a lower dose of aztreonam (Azactam) for a patient who has a respiratory tract infection and also has which of the following?

Erythromycin Rationale: Erythromycin, a macrolide, is an acceptable alternative to penicillin for patients who have bacterial infections and are allergic to penicillin. The drug is effective against most gram-positive bacteria, including streptococci, and some gram-negative bacteria.

4. Which of the following drugs should a provider prescribe for a patient who has streptococcal pharyngitis and is allergic to penicillin?

Gynecomastia Rationale: Ketoconazole, an azole antifungal drug, can cause a temporary decrease in sexual hormone synthesis, resulting in gynecomastia, reduced libido, low sperm counts, and menstrual irregularities.

5. A health care professional is caring for a patient who is about to begin taking ketoconazole to treat a fungal infection. The health care professional should tell the patient to report which of the following adverse effects of the drug?

Tendon pain Rationale: Ciprofloxacin, a fluoroquinolone, can cause an Achilles tendon to rupture, especially in patients who take glucocorticoids or in older adults. The health care professional should tell the patient to report tendon pain, and stop taking the drug.

6. A health care professional is caring for a patient who is taking ciprofloxacin (Cipro) to treat a urinary tract infection and has rheumatoid arthritis, for which he takes prednisolone (Prelone). Recognizing the adverse effects of ciprofloxacin, the health care professional should tell the patient to report which of the following?

Seizure disorder Rationale: Metronidazole, an antiparasitic drug, can cause ataxia, vertigo, and seizures. It requires cautious use with patients who have a history of seizure activity, liver or renal failure, or heart failure.

7. A health care professional is caring for a patient who is about to begin taking metronidazole (Flagyl) to treat an anaerobic intra-abdominal bacterial infection. The health care professional should recognize that cautious use of the drug is indicated if the patient also has which of the following?

-Wear sunglasses outdoors. -Avoid driving. -Take the drug with food. Rationale: -Wear sunglasses outdoors is correct. Chloroquine, an antimalarial drug, can cause photophobia. Sunglasses can help reduce the risk of eye damage and irritation because of this effect. -Avoid driving is correct. Chloroquine can cause blurred vision. It is best for patients taking the drug to avoid driving and other activities that require visual acuity until they know how the drug will affect them. -Take the drug with food is correct. Chloroquine can cause nausea and diarrhea. Taking the drug with food can help minimize these effects.

8. A health care professional is caring for a patient who is about to begin taking chloroquine (Aralen) to prevent malaria. When talking with the patient about taking the drug, the health care professional should include which of the following instructions? (Select all that apply.)

Cough Rationale: Nitrofurantoin, a urinary tract antiseptic, can cause respiratory symptoms, such as cough, shortness of breath, chest pain, and fever. These can indicate an acute allergic reaction and warrant immediate discontinuation of drug therapy.

9. A health care professional is caring for a patient who is about to begin taking nitrofurantoin (Macrodantin) to treat a urinary tract infection. The health care professional should tell the patient to report which of the following adverse effects of the drug?