Pharm Exam 2

the nurse is preparing to administer famciclovir 500 mg prescribed orally once a day to a patient admitted with exacerbated chronic obstructive pulmonary disease who has developed shingles. the nurse reviews laboratory test results that include estimated glomerular filtration rate 35 mL/min. what should the nurse do?

administer the drug as ordered

the MAR has azithromycin listed to be administered at 0800. breakfast arrives on the nursing unit around 0800, lunch at 1230, and dinner at 1730. the patient does not receive any antacids. what should the nurse do?

administer the drug at 0800, as azithromycin may be administered with food

a patient with a penicillin allergy is prescribed erythromycin ethylsuccinate 250 mg every 6 hours for pneumonia caused by Haemophilus influenzae. the medication administration record has the medication scheduled at 0600, 1200, 1800, and 2400. on the second day of therapy, the patient complains that he does not like taking the drug because it causes heartburn. what would be an appropriate intervention by the nurse?

administer the drug with food

the nurse is reviewing new laboratory results, including estimated glomerular filtration rate (eGFR) 82 mL/min for a patient receiving cefotetan 2 g every 12 hours. what should the nurse do?

administer the medication

vancomycin is being administered by mouth for pseudomembranous colitis caused by Clostridium difficile. the nurse receives laboratory results on the patient that include creatinine 2.2 mg/dL. what should the nurse do?

administer the medication

a patient is prescribed adefovir 10 mg by mouth once a day. results of recent laboratory tests include CrCl 62 mL/min. what nursing action is warranted?

administer the medication as prescribed

erythromycin uses

against gram positive and some negative bacteria (legionella pneumonia, pertussis, diphtheria, chlamydia)

a patient with a history of hypertension controlled by an angiotensin-converting enzyme inhibitor is prescribed linezolid for a vancomycin-resistant enterococcal (VRE) infection. the patient should be instructed to avoid consuming what substance while on this antibiotic?

aged cheese

which laboratory result, if present, would be a reason to withhold administering cefotetan to an adult male and to notify the prescriber?

alanine aminotransferase (ALT) 245 international units/L

a 35 yo. woman reports a yellow-green vaginal discharge. she is diagnosed with trichomoniasis and prescribed metronidazole. it is important for the nurse to teach the patient the importance of not consuming

alcohol

cefazolin has been prescribed at discharge for a patient with pelvic inflammatory disease. due to the possibility of a disulfiram-like reaction, during discharge teaching it is important for the nurse to teach the patient to avoid consuming what?

alcohol

#1 adverse effect of Penicillin G

allergic reactions

most common adverse effects of cephalosporins

allergic reactions (patients allergic to PCN have about a 1% risk of reaction with these)

which assessment is of greatest priority for the nurse to complete before administering a penicillin antibiotic?

allergy history

adamantanes

amantadine, rimantadine

the prescriber has asked the nurse to provide teaching for a 34 yo. female patient who has requested a prescription for rifaximin before a trip to Central America. teaching should include not administering the drug if the patient experiences what issues

amenorrhea, bloody stool, fever

bactericidal inhibitors of protein synthesis

aminoglycosides

ejection fraction

amount of blood pushed out the ventricles, direct relationship with cardiac output

the nurse would be concerned about the increased possibility of an allergic reaction when administering which antibiotic(s) if the patient's allergy record includes penicillin allergy?

ampicillin/sulbactam, piperacillin/tazobactam

which patient would most likely have an infection that is resistant to antibiotic therapy?

an adult who developed a wound infection while in the hospital after surgery

penicillinase-resistant penicillins

anti staphylococcal penicillins

warfarin

anti-coagulant

phenytoin

anti-convulsant

drugs or chemicals used to treat infectious diseases

antimicrobials

antimicrobial agent

any agent that can kill or suppress microorganisms

non-opportunistic diseases occur in

any host

retrovirus

any of a group of RNA viruses that insert a DNA copy of their genome into the host cell in order to replicate

people who should get a flu shot

anyone older than 6 mo. of age

what is the first thing the nurse should do when preparing to administer caspofungin?

assess the IV site

a patient who is prescribed tobramycin complains of a headache. what is the priority nursing action?

assess the onset, characteristics, and associated symptoms of the headache

a patient who has been receiving ketoconazole for 5 days experiences nausea and vomiting. what should be the initial response of the nurse?

assess the skin, abdomen, urine, and stool

an alert and oriented patient with a history of penicillin allergy is prescribed cephalexin. what is the priority action by the nurse?

assess the type of reaction that the patient had to the penicillin

a patient who is prescribed rilpivirine reports loss of interest in usual activities. which nursing action is of greatest priority?

assessing for thoughts of harming self

which action by the nurse would be a priority for preventing the most common complications of IV acyclovir therapy?

assessing the IV site before infusing the drug

when should flu vaccines be administered?

at least 2 weeks prior to flu season beginning

which step is most important for a female nurse to follow when administering valganciclovir?

avoid touching the drug

treatment of chlamydia

azithromycin, doxycycline

alternative to amphotericin B for most systemic mycoses

azoles

tetracycline is active against the ________ that cause anthrax

bacilli

autolysins

bacterial degradative enzymes involved in the normal remodeling of the bacterial cell wall

cephalosporin characteristics

bactericidal, resistant to B-lactamases, activate against a broad spectrum of pathogens, practically all are eliminated by the kidney, well tolerated, rare adverse effects

do immune-deficient patients need bacteriocidal or static drugs?

bacteriocidals, because their immune system won't catch up with bacteriostatic drugs

the nurse is reviewing the other OTC products taken by a patient who has been prescribed methenamine. which of these home treatments might reduce the urinary antiseptic action of methenamine?

baking soda in water for heartburn

systemic preparation of sulfonamides

based on duration of action

cyclic lipopeptide pharmacokinetics

becomes apart of the cell wall and then can't replicate

which is an acceptable reason for giving antibiotic prophylaxis?

before cardiac surgery

protection in flu vaccines

begins 1 to 2 weeks after vaccination, generally lasts 6 months or longer

what are carbapenems resistant to

beta-lactamases

which pre-drug administration assessment finding would be of most concern when a patient is prescribed telavancin?

bibasilar crackles

how do penicillins work

bind to penicillin binding proteins of the bacteria and disrupt the bacteria's cell wall synthesis causing bacterial cell lysis, rupture, and death

NNRTIs cause inhibition by

binding to active center of reverse transcriptase

antivirals suppress

biochemical processes unique to viral reproduction

which signs would most likely indicate the start of Stevens-Johnson syndrome when a patient is receiving sulfonamides?

blisters in the mouth

how does Enfuvirtide work

blocks entry of HIV into CD4 T cells

an HIV-positive patient is prescribed trimethoprim-sulfamethoxazole as treatment for active PCP infection. a priority nursing action is to monitor which laboratory tests?

blood urea nitrogen (BUN) and creatinine, complete blood count (CBC) and differential

use of daptomycin

bloodstream infection with S. aureus, and complicated skin structure infections caused by susceptible strains of gram-positive bacteria

facultative bacteria survive in what condition?

both anaerobic and aerobic

adverse effect of broad-spectrum antibiotic

bothersome diarrhea

kernicterus

brain damage caused by excessive jaundice

the nurse is reviewing test results for a patient who is prescribed itraconazole. which result would warrant immediate consultation with the prescriber?

brain natriuretic peptide (BNP) 745 pg/mL

MAO inhibition

breaks down chatecholamines

carbapenems

broad spectrum, synthetic b-lactam antibiotics that are structurally related to penicillins

tetracyclines

broad-spectrum antibiotics that inhibit micro-organism growth by preventing protein synthesis (bacteriostatic)

linezolid and dalfopristin/quinupristin can treat

bugs that are resistant to vancomycin

how were Penicillinase-resistant penicillins made

by altering the penicillin side chain, they are highly resistant to inactivation of beta-lactamases

how to NNRTIs differ from NRTIs

by structure and mechanism of action

how do cephalosporins kill bacteria

by weakening the cell wall and promoting bacterial lysis

chelating agents

calcium supplements, milk products, iron supplements, magnesium-containing laxatives, and most antacids

resistance tests

can be used to guide drug selection, especially when changing a regimen that has failed

superinfection common with cipro

candida (vaginal or pharynx), c. diff

drugs used for systemic opportunistic mycoses

candidiasis, aspergillosis, cryptococcosis, mucormycosis

azoles principal adverse effects

cardiosuppression and liver damage

the nurse is caring for a patient who has repeated episodes of UTIs caused by e-coli treated with TMP/SMZ. what is the priority nursing action to prevent reoccurrence of infection?

carefully wiping from front to back during perineal care

which are valid reasons for prescribing two different antibiotics?

cases of infection with Mycobacterium tuberculosis, results of C&S indicate multiple organisms, severe infection in the immunocompromised patient

treatment of PID

caused by multiple organisms, so broad coverage and combination therapy are required

pseudomonas aeruginosa

causes pneumonia in immunocompromised patients

gonococcal infections in neonates

ceftriaxone one dose, topical eye antibiotic

outpatient treatment for PID

ceftriaxone or cefoxitin, should also include doxycycline, may be used with or without metronidazole

vancomycin

cell wall inhibitor, does NOT contain a beta-lactam ring

drugs work on

cell wall synthesis, cell membrane permeability, protein synthesis, nonlethal inhibitors of protein synthesis, synthesis of nucleic acids, antimetabolites, viral enzyme inhibitors

the nurse reached a patient who has been prescribed oral tetracycline that the medication should not be taken with which OTC medications

centrum silver, ferrous sulfate, TUMS

what is an often appropriate alternative of mild PCN allergy

cephalosporin

treatment of gonococcal infections

cephalosporins, quinolone

MRSA

certain bacterial strains known collectively as methicillin-resistant staphylococcus aureus

syphilis primary stage

chancre

influenza vaccines

changed yearly based on identification of strains by the CDC, FDA, and WHO

it would be logical that which populations should not receive influenza A or B nasal vaccine because it is a live attenuated virus and is administered by spraying into the respiratory tract?

children or adolescents receiving aspirin therapy, children younger than 5 years of age who have had recurrent episodes of wheezing with respiratory infections, people who are HIV-positive, people prescribed disease-modifying antirheumatic drugs for rheumatoid arthritis, people with asthma

people who should not get the flu shot

children younger than 6 mo., people with severe life-threatening allergies

most common bacterial STD in the US

chlamydia trachomatis

HIV is now considered a

chronic disease

drug choice for anthrax

cipro

fluoroquinolones prototype

ciprofloxacin (Cipro)

a patient received a neuromuscular blocking agent during surgery. in the post anesthesia care unit, the prescriber orders gentamicin 40 mg IV STAT. what is the most appropriate nursing action?

clarify the order

what drug causes fatal c. diff

clindamycin

topical drug of choice for dermatophytic infections and candidiasis of skin, mouth, and vagina

clotrimazole

major adverse effects of amino glycoside antibiotics include damage to the

cochlea, kidneys, vestibular apparatus

to achieve maximum absorption of itraconazole capsules, the nurse administers the drug with which liquid?

cola

Maraviroc use

combined use with other antiretroviral drugs to treat patients age 16 years and older who are infected with CCR5-tropic HIV-1 strains

what is the priority nursing action before administering an amino glycoside to a patient with an estimated glomerular filtration rate of 50 mL/min?

compare prescribed dose to recommended dose

symptoms in men with gonorrhoeae

complaints of burning sensation with urination and pus draining from penis

it would be a priority to monitor which laboratory test when a patient is prescribed a linezolid?

complete blood count (CBC) and differential

when performing shift assessment, the nurse notes a maculopapular rash over the trunk of a patient who has been taking a ceftriaxone for 4 days. what is the priority nursing action?

complete the assessment

a patient who is receiving IM ceftriaxone 250 mg x one plus azithromycin 1 g by mouth for disseminated gonococcal infection complains of a stiff neck. which of these nursing actions should be performed first?

complete the nursing assessment

ergosterol

compound on fungal cell membrane

neuromuscular blockade

concurrent use with neuromuscular blocking agents, general anesthetics, and in myasthenia gravis

older patient adverse effects with cipro

confusion, somnolence, psychosis, visual disturbances (CNS)

which assessment finding suggests hypokalemia and should be reported to the prescriber of moxifloxacin?

constipation and weakness

the nurse is preparing to administer an IV mini-bag of ceftriaxone in 50 mL of 5% dextrose to an infant. the infant has an IV of lactated Ringer's solution infusing at 35 mL/h. what should the nurse do?

consult with the prescriber

A consulting urologist orders ciprofloxacin 250 mg twice a day for a 72 year old woman with a UTI. The patient is also receiving ferrous sulfate 300 mg for anemia and calcium carbonate 400 mg 4 times a day for osteopenia. what should the nurse do?

consult with the provider for directions

the nurse would be concerned about toxicity if a patient receiving penicillin G had which laboratory result?

creatinine 2.6 mg/dL

the nurse is reviewing laboratory tests before preparing to administer a dose of amphotericin B. before administering the drug, it is a priority to review which lab result?

creatinine levels

CNS laboratory test

culture and sensitivity

a patient with a systemic fungal infection is prescribed amphotericin B and flucytosine. the nurse expects what drug interaction?

decreased risk of amphotericin toxicity

which assessment finding would be of greatest priority to report to the prescriber if identified in a patient who is receiving lamivudine, adefovir, or entecavir for hepatitis B because it suggests possible lactic acidosis?

deep, rapid breathing

Penicillins are able to _________ many bacteria when taken as prescribed

destroy

syphilis tertiary stage

develops 5 to 40 years after initial infection, fatal illness

Penicillins can cause _________ by altering the normal gastrointestinal (GI) flora

diarrhea

adverse effects of Linezolid

diarrhea, nausea, headache, myelosuppression

antibiotics have _________ penetrating an abscess

difficulty

tests to determine drug susceptibility

disk-diffusion test, serial dilution, gradient diffusion

how does selective toxicity work

disruption of bacterial protein synthesis and cell wall, inhibition of an enzyme unique to bacteria

ethacrynic acid

diuretic that's ototoxic so increases ototoxic effect if given with another ototoxic drug

PCN past allergic reaction

does not necessarily mean that an intense reaction will occur again

drugs with renal impairment

dosages must be lowered

what is the drug of choice for MRSA?

doxycycline

when to take trough levels for once-daily doses

draw a single sample 1 hour before the next dose

uses of Amphotericin B

drug of choice for most systemic mycoses

major groups of antifungal agents

drugs for: 1) systemic mycoses/infections 2) superficial mycoses/infections

bacteriostatic

drugs that can slow bacterial growth (until the immune system catches up) but do not cause cell death

the nurse is preparing to administer IV acyclovir. it would be a priority for the nurse to provide nursing interventions for which assessment finding?

dry, sticky oral mucous membranes

which of these assessment findings, if identified in a patient who is receiving nitrofurantoin, should the nurse report to the prescriber immediately?

dyspnea

which laboratory test result is of greatest priority to review before the nurse ministers nitrofurantoin?

eGFR

indicated for ringworm infections and superficial candidiasis

econazole

most oral tetracyclines should be taken on an ________ ___________

empty stomach

gentamicin and PCN

enhances bacterial effect bc gentamicin has to get into cell (but can't be given at the same)

the throat culture of a 6 yo. boy is positive for N. gonorrhoeae. what is the nursing priority in this situation?

ensuring the safety of the child

chlamydia in infants

erythromycin base or succinate for two weeks, eye ointment after birth

a patient is prescribed erythromycin. what is one reason why careful review of all drugs this patient is prescribed is important?

erythromycin can increase levels of warfarin and cause bleeding

what can aminoglycosides and gentamicin cause

nephrotoxicity and ototoxicity (inner ear), hypersensitivity reactions, neuromuscular blockade

adverse effects of amphotericin B

nephrotoxicity, hypokalemia (from kidney damage), bone marrow suppression, phlebitis

enzyme required for replication of the flu

neuraminidase

sulfonamides can cause the adverse effect of kernicterus. how does this present?

neurologic defects in neonates caused by deposition of bilirubin in the brain

superinfection

new infection that appears during the course of treatment for a primary infection, because they are caused by drug-resistant microbes, they are often hard to treat

how many flu vaccines on the market?

nine

how many protease inhibitors are there

nine

urinary tract antiseptics

nitrofurantoin (Macrobid), Methenamine, Pyridium

when administering drugs that are potentially nephrotoxic, the nurse should consult the prescriber before administering which OTC drugs?

non-steroidal anti-inflammatory drugs (NSAIDS)

antibiotics must

not be discontinued prematurely

the nurse is caring for a neonate whose mother has an active infection with N. gonorrhoeae. a priority nursing outcome for the neonate relating to possible infection during vaginal delivery is that the neonate will

not experience conjunctival discharge

a patient has been prescribed nitrofurantoin for recurrent UTIs. the nurse should teach the patient to do what?

not to take the drug if there is any chance that she might be pregnant, report any shortness of breath and coughing, report the onset of numbness or tingling, use caution when driving because the drug can cause drowsiness

methicillin

now obsolete due to staph bacterial resistance (PBP in the bacteria to which penicillinase-resistant PCN cannot bind), caused nephritis

the nurse should include in teaching to a patient who has been receiving linezolid to immediately report which symptom of a rare adverse effect that has been associated with prolonged therapy?

numbness of tingling in any extremity

the nurse has consulted the prescriber because a patient reports an allergy to the prescribed penicillin antibiotic. the prescriber is aware of the allergy, but the patient is experiencing a life-threatening infection and no other suitable antibiotic is available. what is the priority nursing action?

obtain orders for treatment of a possible allergic reaction

a prescriber's orders for a new admission include urine culture and sensitivity and ciprofloxacin 400 mg IV every 12 hours. what is a priority nursing responsibility?

obtain the urine culture specimen before administering the antibiotic

symptoms in women with gonorrhoeae

often asymptomatic or mild cervicitis, serious infection may result in sterility

all patients are at risk for developing tendon rupture when prescribed a fluoroquinolone. which patients have an increased risk?

older adult patients, patients who are prescribed glucocorticoids, patients who are post-solid organ transplantation

when administering adefovir, which assessment would suggest that therapy could be toxic?

oliguria

how should an enteric-coated erythromycin base be administered?

on an empty stomach, whole, not chewed, with a full glass of water

why do we want to give ceftriaxone for patients with gonococcal infections

once and done

over time, what develops resistance

organisms

how might acquired resistance to antimicrobial drugs happened?

organisms may have been highly responsive and then became less susceptible to one or more drugs

topical antiviral drugs used for herpes labialis

penciclovir, docosanol

"the shot"

penicillin

drug of choice for all stages of syphilis

penicillin G

prototype of natural penicillins

penicillin G

PBP

penicillin binding proteins

beta-lacatamase inhibitor

penicillinase

cephalosporins are analogous to

penicillins (beta-lactam antibiotics)

these drug classes all weaken the cell wall

penicillins, cephalosporins, carbapenems, monobactams

gentamicin has interactions with

penicillins, ototoxic drugs, nephrotoxic drugs, skeletal muscle relaxants

the nurse would consult the prescriber regarding oral administration of linezolid oral suspension if the nurse discovered the patient has a history of which disorder?

phenylketonuria

the nurse reviews current laboratory test results before administering piperacillin/tazobactam. it would be a priority to report which laboratory result to the prescriber?

platelets 100,000/mL

systemic antifungals

polyene antibiotics, azoles, echinocandins, pyrimidines

a patient who takes glyburide for type 2 diabetes mellitus is prescribed trimethoprim-sulfamethoxazole for a urinary tract infection. because of the possibility of intensifying the effect of the glyburide, the nurse should assess for

sweating and irritability

the nurse is administering cipro to a patient who receives theophylline for asthma. because of the potential drug interactions, the nurse should monitor theophylline levels and assess for

tachycardia

weight-bearing exercise and adequate calcium intake are most important if antiretroviral therapy includes

tenofovir

usually going to be "second-line" drugs

tetracyclines

bacteriostatic inhibitors of protein synthesis

tetracyclines, macrolides, oxazolidinones, streptogramins

what is a potential problem of patients' self-prescribing OTC miconazole for vaginal discharge?

the cause may not be a yeast infection

where does the nurse obtain the most accurate information about nursing care of STIs?

the centers for disease control and prevention

why does long-acting clindamycin cream require only one dose vaginally to treat bacterial vaginosis?

the cream adheres to the vaginal mucosa for several days

what organ is most antibiotics harmful to

the kidneys

the recommended treatment for acute epididymitis is different depending on the age of the patient because usually

the method and organism of infection is different

why was PCN named penicillin?

the mold belonged to the genus penicillium

MRSA unique mechanism of resistance

the production of PBPs with a low affinity for PCN and all other beta-lactamase antibiotics

the nurse is taking a history from the spouse of a patient who was admitted in a septic state and prescribed an aminoglycoside antibiotic. which question is most important to ask the patient's spouse about the patient's history?

what medications is your spouse currently taking?

which assessment finding would be a priority to report to the prescriber if it occurred after administration of a large IV dose of penicillin?

wheezing

which new assessment finding would be most significant if noted in an infant who is receiving inhaled ribavirin for RSV?

wheezing throughout the lung fields

a child is prescribed amoxicillin. when asked if their son is allergic to penicillin, the child's parents state that the child has never received any medication except immunizations. why is it important to assess for an allergic response despite this history?

people can have an initial exposure to penicillin present in foods

which assessment finding would best indicate that antiretroviral therapy is currently effective?

plasma HIV RNA below 20-75 copies/mL

the nurse is administering trimethoprim to a patient who has a history of alcohol use disorder. because folate deficiency is associated with alcohol use disorder, the nurse should assess for symptoms of possible adverse effects of trimethoprim, which include

pallor and sore throat

c. difficile definition

passage of 3 or more unformed stools within 24 hours, and a positive stool test

due to cross sensitivity

patients allergic to one penicillin should be considered allergic to all penicillins

a hospitalized HIV-positive patient who is prescribed indinavir complains of sharp, colicky flank pain. in addition to notifying the prescriber, which nursing intervention would be most appropriate?

strain urine

Penicillin G is drug of choice for

strep pneumonia, meningitis, pharyngitis and endocarditis, helpful in prophylaxis in preventing syphilis

sulfonamide used for systemic intermediate preparations

sulfamethoxazole

sulfonamide used for systemic short acting preparations

sulfisoxazole

organisms with microbial drug resistance aka

super bugs

which statement about superinfections does the nurse identify as true?

superinfection is defined as a new infection that appears during the course of treatment for a primary infection

if chlamydia in children

suspect child abuse

when to sample trough levels for divided doses

take a sample just before the next dose

what is true about nitrofurantoin and methenamine?

therapeutic levels are achieved only in urine

why can protease inhibitors alter other drugs

they are metabolized by the P450 system

why do aminoglycosides have to be given IV

they are not absorbed in the GI tract

an HIV-positive patient who is receiving maraviroc reports to the nurse that he has vomited and is experiencing severe abdominal pain. assessment reveals a generalized pruritic rash. which action is appropriate?

withhold the maraviroc and contact the prescriber

a patient is prescribed an antibiotic to treat a urinary tract infection. what statement by the patient indicates a need for further teaching?

"I can stop the medication as soon as the symptoms have disappeared"

polyene systemic antifungal drugs

Amphotericin B

broad-spectrum PCNs

Ampicillin Amoxicillin

use of trimethoprim

initial therapy of acute, uncomplicated UTIs

first-generation cephalosporins are not effective against ___________________

methicillin-resistant MRSA

a patient taking lopinavir/ritonavir oral solution should not be prescribed which other drugs

metronidazole, disulfiram

topical drug of choice for dermatophytic infections and for cutaneous and vulvovaginal candidiasis

miconazole

the _________ becomes resistant, not the __________

microbe (organism), patient

some _________ can change so that they stop taking antibiotics into the cell

microbes

which organism was previously susceptible to penicillin, but has developed resistance to penicillin G?

Gonorrhea caused by Neisseria gonorrhoeae

small risk in flu vaccines for

Guillain-Barre syndrome

mores serious infections that can develop in the blood stream and lungs during MRSA which can be fatal

HCA-MRSA, CA-MRSA

when would UTI occurrence in males be likely

with associated complications (septicemia, pyelonephritis)

Raltegravir use

with other antiretroviral agents to treat adults infected with HIV-1

the extent of antibiotic use affects resistance

The more that antibiotics are used, the faster drug-resistant organisms emerge

which of these laboratory tests would be a priority for the nurse to assess when a patient is receiving an aminoglycoside?

creatinine

which action, when administering enfluviritide, would increase the risk of a severe injection-site reaction?

injecting the drug deep into a muscle

HCA-MRSA

spread in health care environment, risks include advanced age, surgery, dialysis, ICU, prolonged antibiotic therapy, indwelling catheters

what is the priority reason why the nurse teaches a patient who is prescribed sulfamethoxazole to take this medication with a full glass of water?

minimize crystal formation in the urine

the nurse is preparing to administer IV ciprofloxacin to a patient with septic arthritis after arthroscopic surgery. it would be a priority to review which ordered diagnostic test result as soon as it is available?

culture and sensitivity

________ reduces symptoms of rheumatoid arthritis

minocycline

the nurse is teaching a patient about the need for multiple-drug therapy for HIV. which statement, if made by the patient, would indicate a need for further teaching?

"the virus recognizes the antibiotic and is able to change to prevent being destroyed"

a college student who has been diagnosed with her first genital herpes infection is discussing the condition and prescribed topical acyclovir treatment with the college health center nurse. which statement, if made by the patient, would suggest that the patient needs teaching about this condition and drug therapy?

"using the ointment as soon as I get a sore will stop the outbreak"

adverse effects of tetracyclines

(1) G.I. Irritation (2) superinfection (3) photosensitivity (4) hepatic toxicity - especially in pregnancy (5) Renal toxicity -esp. in patients with kidney disease (6) depression of skeletal growth (esp. in premature infants) (7) dental enamel staining

purine nucleoside analogs mechanism

- DNA polymerase inhibitor - Suppress synthesis viral DNA - Incorporated into DNA

adverse effects of cipro

- GI irritation - CNS (headache, dizziness, confusion, restlessness - phototoxicity - superinfection - tendon rupture

Zidovudine (Retrovir)

- NRTI - inhibits replication by suppressing synthesis of DNA

adverse effects of zidovudine

- hematologic toxicity - lactic acidosis with hepatomegaly - myopathy - GI effects - CNS reactions

which infection would be classified as a superinfection?

monilial vaginal infection that develops during antibiotic therapy

how does the nurse prevent ototoxicity

monitor trough levels

broad-spectrum antibiotics kill _______ competing organisms than do narrow-spectrum drugs and do the most to facilitate emergence of ___________

more, resistance

metronidazole uses

- protozoal infections - infections caused by obligate anaerobes - Helicobacter pylori - C. diff

pyridium

- relieves urinary tract pain, burning, irritation, improves comfort - not an antibiotic (will not change course of infection) - turns urine reddish-orange

why is azithromycin ideal for chlamydia treatment

once and done

fidaxomicin use

only for diarrhea associated with C. diff infection

when ahminoglycosides are prescribed IV as a once-daily dose, it is important to monitor trough levels

1 hour before the next dose

what is vanco reserved for treating?

severe infections such as MRSA, C. diff, and others

the nurse reviews the laboratory results of a female patient who is prescribed voriconazole 200 mg by mouth. which laboratory result warrants withholding the drug and immediately notifying the prescriber?

human chorionic gonadotropin (hCG) 172 international units/mL

People can drastically reduce their chance of catching methicillin-resistant Staphylococcus aureus (MRSA) by simple _________ __________

hygiene measures

risk with MAO inhibitors

hypertensive

what is the most important role of the nurse when treatment failure occurs?

identifying factors that may have contributed to treatment failure

valacyclovir (valtrex) uses

shingles, genital herpes, cold sores, chickenpox

chelation

if given with one of the certain minerals, it will precipitate and not be absorbed

then nurse is preparing to administer daptomycin. who should the nurse withhold the medication and contact the prescriber?

if the patient reports sudden severe muscle pain

when would tetracyclines be first line drugs

if there is an allergy or resistance to the other first choice

infusion reaction from amphotericin B occurs

1-3 hours after start of infusion and last for about 1 hour

at what point is the patient most likely to experience fever, chills, rigors, nausea, and headache when receiving amphotericin B?

1-3 hours after the infusion begins

accelerated PCN reaction time

1-72 hours after

what should all patient who are candidates for penicillin therapy be asked

if they have PCN allergy

prototype of carbapenems

imipenem-cilastatin (Primaxin)

types of penicillin reactions

immediate, accelerated, delayed reaction

opportunistic diseases are in

immunocompromised host

immunoglobin that mediates anaphylaxis

immunoglobin E

how was PCN discovered?

in 1928, while studying staphylococcus variants in the laboratory of st. mary's hospital in london

transmission of HIV

in blood and all body fluids

types of penicillinase resistant penicillins

1. oxacillin 2. dicloxacillin 3. nafcillin 4. methicillin

advantage of azithromycin

short course of treatment

Penicillin G dosage in neurosyphilis

18-24 million units daily for 14 days, continuous infusion

_________ million doses of antibiotics are given in hospitals each day

190

when did modern antimicrobials arise?

1930's and 1940's

how to you administer cipro

orally or IV

penicillin G referred to as

simply Penicillin

Penicillin G dosage in early syphilis

single IM dose benzathine PCN 2.4 million units

fosfomycin

single PO dose for uncomplicated UTIs in women

ceftriaxone 1 g intramuscular is ordered for a 130 lb woman. the drug is reconstituted to a solution of 250 mg/mL. how should the nurse administer it?

2 mL each in the right and left ventrogluteal muscles

syphilis secondary stage

2 weeks after chancre heals, secondary syphilis develops

the germ that causes MRSA is commonly found on the ________

skin

what assesses current risk of PCN allergy

skin tests

gentamicin half life

2-3 hours

immediate PCN reaction time

2-30 minutes after drug is administered

which goal is the most appropriate when a patient is prescribed metronidazole for c-diff?

soft, formed stool

mechanisms for acquired resistance

spontaneous mutation, conjugation

Penicillin G dosage in late syphilis

2.4 million unions IM, every week for 3 weeks

percentage of UTIs in young sexually active women

25%-35% develop at least one a year

what type of organisms are susceptible to penicillins?

organisms that have a cell wall and are actively growing

HIV integrase use

inserts its DNA into mamilial cells

nursing interventions when administering cephalosporins include

instruct the patient to immediately report pain or warmth of IV site, store oral suspensions in the refrigerator

drug interactions of sulfonamides

intensifies: - warfarin - phenytoin - hypoglycemics

when used to treat colonized Methicillin-resistant staphylococcus aureus (MRSA), mupirocin is administered in which way?

intranasally

topical treatment of tinea infections

oxiconazole and sulconazole

a patient is admitted to the hospital with a diagnosis of PID. she asks the nurse why her prescriber has recommended hospitalization and IV antibiotics instead of antibiotic therapy at home. what is the basis of the nurse's response?

inadequately treated PID is more likely to cause scarring of the fallopian tubes

a nursing measure to prevent the most common adverse effect of daptomycin is to

include increased fiber and fluids in the patient's diet

PID

includes endometritis, pelvic peritonitis, tuba-ovarian abscess, and inflammation of the fallopian tubes

decreased excretion =

increase drug levels in the body

prototype of macrolides

erythromycin

when should samples of peak levels be taken

30 minutes after giving an IM injection or after completing a 30-minute IV infusion

percentage of UTI in older women in nursing homes

30%-50% have bacteria at any given time

which drug may prevent absorption of itraconazole, no matter when it is administered?

esomeprazole

tendon rupture with cipro

especially in children younger than 18, or people older than 60, patients on glucocorticoids, or organ transplant recipients

which result would be of greatest priority to report to the prescriber of cefotaxime?

estimated glomerular filtration rate (eGFR) 48mL/min

the nurse is aware that the risk of ototoxicity is significantly increased if a hypertensive patient is also receiving which medication?

ethacrynic acid

history of PCN by 1941

experiments were conducted on patients desperately ill with staphylococcal and streptococcal infections, some whom were on the oxford police force

drugs used for non-opportunistic systemic mycoses

sporotrichosis, blastomycosis, histoplasmosis, coccidioidomycosis

in most infections, the level of antibiotic at the site of infection needs to be

4-8 times the MIC

the nurse reached that to be well absorbed, which form of clarithromycin must be administered with food?

extended-release tablets

conjugation

extrachromosomal DNA is transferred from one bacterium to another, gram-negative bacteria, multiple drug resistance

cost of microbial drug resistance per year

5-24 billion

which laboratory result, if identified in a patient who is receiving dalfopristin/quinupristin, should the nurse report to the prescriber immediately?

ALT 250 IU/L

second-generation cephalosporins have _________ resistance to B-lactamases produced by gram-negative organisms

increased

which situation would warrant assessing for candida infection when the nurse is caring for a 6 mo., breast-fed infant who is prescribed cipro for pyelonephritis?

infants suckling is interrupted by crying

what are extended spectrum PCNs used primarily for

infections with pseudomonas aeruginosa

it would be a priority to report which symptoms in a patient who is prescribed the -azole antifungal drug fluconazole?

fever and blisters in the mouth

PCN cross sensitivity to cephalosporins

few patients, about 1%

used for oral therapy of vulvovaginal candidiasis, oropharyngeal candidiasis, and onchomycosis

fluconazole

thrombophlebitis

inflammation of a vein associated with a clot formation

the nurse assesses a 6 yo. child who is receiving cipro for a complicated UTI. what is a priority concern?

fluid and electrolyte balance

what is bacterial growth determined by

food and space

if possible granulo/thrombo cytopenia is possible what laboratory tests need to be done

CBC

drug interactions in dalfopristin/quinupristin

CYP3A4

why would you have to give acyclovir through IV

for faster treatment with no limitations of absorption

Clarithromycin

for respiratory tract, skin, and other diseases

antimicrobial effects of antibiotic combinations

Additive, potentiative, antagonistic

tinea corporis

fungal infection of the body

tinea pedis

fungal infection of the foot; athlete's foot

tinea cruris

fungal infection of the groin

empiric therapy

Antibiotic therapy for patients before causative organism is positively identified

drug of choice for chlamydia

Azithromycin (bc one time dose)

monobactam prototype

Aztreonam (Azactam)

what viruses can cause chronic hepatitis

B, C, and D

lab tests for aminoglycosides to watch for adverse effects

BUN, creatinine, serum levels

transpeptidases

Bacterial enzymes involved in the cross-linking of linear peptidoglycan chains, the final step in bacterial cell wall synthesis

____________ is the only cephalosporin with activity against MRSA

Ceftaroline

most widely used antibiotics

Cephalosporins

other macrolides

Clarithromycin (Biaxin) Azithromycin (Zithromax)

metronidazole inhibits

DNA synthesis in certain microbes

tinea capitis

fungal infection of the scalp

low doses of doxycycline can be used to prevent destruction of ___________ connective tissue

gingival

adverse effects of nitrofurantoin

GI upset, brown/rust color urine, peripheral neuropathy

what do we do sometimes to avoid penicillinase from breaking down PCN's

give PCN with another antibiotic

how antibiotic use promotes resistance

Drugs make conditions favorable for overgrowth of microbes that have acquired mechanisms for resistance, kill off competing organisms that would make organisms resistant

bacteriocidal

Drugs that are directly lethal to bacteria at clinically achievable concentrations

preferred agent for treating HIV, only NNRTI for first-line HIV therapy

Efavirenz (Sustiva) - NNRTIs

only HIV fusion inhibitor

Enfuvirtide (Fuzeon)

80% of uncomplicated and community-acquired UTIs caused by

Escherichia coli

adverse effects of fluconazole

GI irritation symptoms

e-mycin adverse effects

GI irritation, prolongs QT interval, cholestatic hepatitis, superinfections, phlebitis

why do cephalosporins need to be given IV or IM

GI sensitivity, must monitor for thrombophlebitis

host factors

Host defenses Site of infection Previous allergic reactions Genetic factors

administration of daptomycin

given only once daily through IV, no laboratory work needed

second leading STD in US

gonorrhoeae

causes of PID

gonorrhoeae, chlamydia

what are most hospital-acquired UTIs caused by

Klebsiella, Proteus, Enterobacter, Pseudomonas, staphylococci, enterococci, E. coli

many people have _______ in their nose and don't know

MRSA

multi-drug resistant infections

MRSA, VRE

Non-Nucleoside Reverse Transcriptase Inhibitors

NNRTIs

Nucleoside Reverse Transcriptase Inhibitors

NRTIs

0.4 - 7% of people have some type of

PCN allergy

which are among the safest antibiotics

PCNs, they are not very toxic

public health action plan to combat antimicrobial resistance Focus Area II:

Prevention and Control

public health action plan to combat antimicrobial resistance Focus Area IV:

Product Development

HIV integrase strand transfer inhibitors

Raletgravir (Isentress)

extended spectrum PCN good at killing

gram negative bacteria

public health action plan to combat antimicrobial resistance Focus Area I:

Surveillance

disulfiram reaction

Symptoms include flushing of the skin, accelerated heart rate, shortness of breath, nausea, vomiting, throbbing headache, visual disturbance, mental confusion, postural syncope, and circulatory collapse

Enfuvirtide is widely known as

T-20

what is frequently the treatment of choice for oral therapy of UTIs

TMP-SMZ and nitrofurantoin

Staphylococcus aureus

gram positive bacteria, often colonizes on the skin and nostrils of healthy people

what type of bacteria is harder to treat

gram-negative

serious side effects of ganciclovir

granulocytopenia, thrombocytopenia

extended spectrum penicillins

Ticarcillin Piperacillin

what is syphilis caused by

Treponema pallidum

history of PCN in 1942

US began its PCN use with the first clinical trials at Yale and the Mayo Clinic

what is an example of a complicated UTI?

UTI caused by prostatic hypertrophy

uses of TMP-SMZ

UTI, Pneumocystis carinii, shigellosis, OM, bronchitis, pertussis

what are sulfonamides mostly used for

UTIs

principal indication of dalfopristin/quinupristin

VRE

drug of choice for MRSA

Vancomycin

how is Amphotericin B highly toxic

infusion reaction and renal damage occur in many patients, must be given IV, no oral administration

many drugs that are prescribed for HIV infection _________ enzymes needed for viral reproduction

inhibit

disadvantages of azoles

inhibit P450 drug-metabolizing enzymes and can increase levels of many other drugs

Penicillins are only active against bacteria that are undergoing ______ and ___________

growth, development

Cephalosporins are often resistant to ____________

beta-lactamases

neuraminidase inhibitors

inhibits enzyme needed for viral replication, Oseltamivir, Zanamivir

the nurse would withhold ganciclovir and notify the prescriber if patient lab test results included

hCG 2775 mIU mL

chancre

hard, red, protruding, painless sore

the nurse is caring for a patient who is receiving gentamicin twice a day. peak and trough levels were drawn after the fourth dose. results were peak 3 mcg/mL and trough 0.6 mcg/mL. what should the nurse do?

continue nursing care

a patient who is receiving ceftazidime has three loose, brown bowel movements in 24 hours. what should the nurse do?

continue to administer the drug and notify the prescriber of the change in BMs

how could someone have a PCN allergy without being on the medication?

could have been exposed through foods and water

mechanism of oseltamivir

inhibits enzyme required for replication of the flu

what test results should the nurse monitor when caring for a patient who is at risk for a G6PD deficiency who is prescribed a sulfonamide antibiotic?

hemoglobin and hematocrit

first members of streptogramins

dalfopristin/quinupristin

a patient experiences sudden onset shaking chills after receiving a dose of amphotericin B. which drug, ordered as-needed for this patient, should the nurse administer?

dantrolene

delayed reaction PCN reaction time

days or weeks after

allergy to penicillin can __________ over time

decrease

four basic actions of microbial drug resistance

decrease the concentration of a drug at its site of action (intracellularly), inactivate a drug, alter the structure of drug target molecules, produce a drug antagonist

what is the major advantage of tigecycline in treating VRE?

decreased development of antibiotic resistance

what is a major goal of therapy with famciclovir for genital herpes?

decreasing length of active episodes

what viruses can cause acute hepatitis

hepatitis A, B, C, D, E, and G

non-HIV viral infections

hepatitis, influenza, varicella-zoster, herpes

adverse effect of dalfopristin/quinupristin

hepatotoxicity

peak levels must be

high enough to kill bacteria

topical preparations of sulfonamides

high incidence of hypersensitivity (not used routinely)

why do PCNs have good selective toxicity?

mammalian cells lack a cell wall and PCNs act specifically on enzymes that affect cell wall integrity, the PCNs have virtually no direct effects on the cells of the host

the nurse is preparing to administer 8 am medications to a patient who is to receive nafcillin 2 g via secondary IV infusion. the drug is dissolved in 100 mL of normal saline solution. the drug handbook states that the drug should be infused over 30-90 minutes. just before the nurse hangs the nafcillin, the nurse is informed the patient is to be placed on a cart to go off unit for a diagnostic test in 30-45 minutes. the patient is expected to be off the floor for 30 minutes. what should the nurse do?

hold the drug infusion until the patient returns from the test

why would doxycycline not be prescribed for a female patient for whom pregnancy status is unknown?

it can damage fetal bones

a physician who is on call for another physician gives a verbal order for TMP/SMZ for a patient. the nurse would consult the prescriber about this order if the patient had a history of what condition?

megaloblastic anemia

PCN undergoes minimal

metabolism and is excreted relatively unchanged by the kidneys

the nurse is administering itraconazole to a patient who also is prescribed simvastatin. because of the effect of itraconazole on hepatic isoenzyme CYP3A4, the combination increased the risk of rhabdomyolysis from simvastatin. the nurse should monitor the patient for what symptoms?

muscle pain and dark urine

laboratory results for a patient who is prescribed foscarnet including fasting blood glucose (FBG) 90 mg/dL, aspartate aminotransferase (AST) 87 units/L, potassium 3.6 mEq/L, calcium 8.2 mg/dL, and magnesium 2 mEq/L. the nurse should assess for what symptom of electrolyte imbalance?

muscle spasms

what must be done before someone can take a narrow-spectrum drug

must have culture done to make sure the drug will actually be effective

fungal disease

mycosis

piperacillin

narrow spectrum, can cause bleeding due to disrupt in platelet function

adverse effects of daptomycin

possible muscle injury

a patient is prescribed a tetracycline antibiotic. which patient information is a reason for the medication to be withheld by the nurse and the prescriber consulted?

pregnancy status of the patient is unknown

the patient has been receiving macenide application to second-degree burns on the anterior of a 7-year-old patient's arms, upper legs, and trunk. what is the priority nursing action, aimed at preventing the common adverse effect relating to application of this drug?

prevent pain

prophylaxis

prevention of disease

parents ask why their son has been prescribed amoxicillin and clavulanate if amoxicillin has been ineffective in the past. the nurse's response is based on the addition of clavulanate

prevents penicillinase from inactivating the amoxicillin

mechanism of amantidine

prevents virus entry into cells, and uncoating of virus

antibiotic has to be

produced from another microbe

gentamicin and ototoxic drugs

produces ethacrynic acid

amantidine

prophylaxis and treatment of influenza A

what teaching can the nurse provide regarding administration of antibiotics that helps decrease the development of resistance?

when prescribed, take the full course as directed even if symptoms are gone

a common symptom of suprainfection that can occur with extended cipro therapy is

white patches in the mouth

uses of cipro

wide variety of infections throughout most of the body

a patient who was admitted with severe abdominal pain has been diagnosed with Helicobacter pylori-associated peptic ulcer. Tetracycline 500 mg, metronidazole 250 mg, and bismuth subsalicylate 524 mg have been prescribed 4 times a day. the nurse notes that the patient's 24-hour fluid intake has been approximately 2500 mL and urine output has been 600-800 mL for each of the past two days. what should the nurse do?

withhold the medication and notify the prescriber of the changes

your patient on amiodarone for hypertrophic cardiomyopathy and self-medicating with St. John's wort has recently been diagnosed with HepC genotype 2. he asks why he can't take one of the combination NS5A or 5B inhibitors. what is your response?

you may develop symptomatic bradycardia, NS5A inhibitors are not effective for your genotype

if you get the flu virus but you had the flu shot

you will have a more mild case of it

a 32-yo. woman develops septic arthritis. when obtaining a history, it is important to evaluate for which previous infection?

Neisseria gonorrhoeae

when planning nursing interventions and teaching for the most common adverse effects of efavirenz, which nursing problem should be the focus for the nurse?

safety

HIV treatment in pregnancy

same principles of antiretroviral therapy in non pregnant adults

tetracycline tooth discoloration and decay

should not be given to pregnant women or children under the age of 8

serum levels dosing

single large doses each day or 2 or 3 smaller doses

the nurse is aware that the most significant factor in determining the effectiveness of oseltamivir in treating influenza is

starting therapy as soon as symptoms occur

tetracycline can caused esophageal ulceration. what can the nurse teach to minimize the risk of this adverse effect?

stay upright for at least 30 minutes after taking the medication

bacterial cell membranes lack

sterols

mechanisms of bacterial resistance in PCNs

- inability of PCN to reach their targets (PBPs) - inactivation of PCN by bacterial enzymes - production of PBPs that have a low affinity for PCNs

uses of tetracyclines

- infections with susepctible organisms - chlamydia trachomatis (doxycycline) - peptic ulcers - acne - anthrax - mycoplasma pneumonia - lyme disease (doxy) periodontal disease

trimethoprim/sulfamethoxazole (TMP-SMZ)

- inhibits consecutive steps in tetrahydrofolic acid synthesis - less resistance when used together - broad spectrum against gram positive and negative organisms

trimethoprim

- inhibits dihydrofolate which suppresses bacterial synthesis of DNA and RNA proteins

drug interaction with metronidazole

- inhibits warfarin metabolism - alcohol causes disulfiram reaction

adverse effects of Raltegravir

- insomnia - headache - rare hypersensitivity - FDA pregnancy risk: Category C

Penicillin (PCN)

- known as a beta-lactam because of characteristic four-membered lactic ring - they are bacteriacidal agents

why is itraconazole an alternative to amphotericin B for systemic mycoses

- less toxic and only somewhat less effective - slower effects - more useful in suppressing chronic infections than in treating severe, acute infections

antiviral therapy

- limited - difficult to suppress viral replication without doing significant harm to the host

sulfonamides microbial resistance

- many bacterial species have developed resistance - especially high among gonococci, meningococci, streptococci, and shigellae - resistance by multiple mechanisms

identifying the infectious organism

- match the drug with the bug - gram-stained preparation - determining drug susceptibility

cytomegalovirus (CMV)

- member of the herpesvirus group - can remain dormant for life - 50% to 80% of Americans age 40 years or older harbor the virus - transmitted by body fluids

ainoglycosides

- narrow spectrum - bactericidal - disrupts protein synthesis by binding to ribosomes

gentamicin

- narrow spectrum antibiotic - bactericidal - (Garamycin)

fidaxomicin

- narrow-spectrum - bactericidal - macrocyclic antibiotic - inhibits RNA polymerase

interferon alfa

- natural in the body - alpha, beta, and gamma - alpha used to treat hepatitis - none can be administered orally - conventional interferons

properties of individual penicillins

- natural penicillins - penicillinase-resistant penicillins - broad spectrum penicillins - extended spectrum penicillins - penicillins combined with beta-lacatamase inhibitor

adverse effects of metronidazole

- neurotoxicity - nausea - disulfiram-type reaction - overgrowth of candida (superinfection)

echinocandins systemic antifungal drugs

- newest class of antifungal drugs - must be given IV - narrow antifungal spectrum

methenamine

- no resistance - readily absorbed - eliminated by the kidneys - relatively safe and generally well tolerated

Monobactams

- only one available - used for UTIs - contains a beta ring, not fused to a second ring - narrow spectrum - active against gram (-) bacteria - resistant to beta-lactamases

how do PCNs cause cell death

- penicillins inhibit the bacteria's transpeptidases which prevents the bacteria from being able to build cell wall - penicillins activate release of autolysins in bacteria, which break down the bacterial cell wall

adverse effects of ganciclovir

- reproductive toxicity - CNS symptoms - Nausea, fever, rash, anemia, liver dysfunction

how do some antiretroviral drugs inhibit enzymes required for HIV

- reverse transcriptase inhibitors - integrase inhibitors - protease inhibitors

UTIs

- second most common infection - sexually active young women - older adult women in nursing homes - less frequent in males

oseltamivir

- suppresses influenza A and B

ganciclovir

- synthetic antiviral agent

telavancin

- synthetic derivate of vancomycin - does not have a B-lactam ring - active only to gram + organisms - reserved for Vanco resistant microbes

tetracycline four available systemic therapies

- tetracycline - demeclocycline - doxycycline - minocycline

adverse effects of Efavirenz

- transient advere CNS effects in 50% of patients - rash - teratogenicity

pyrimidine analog (flucytosine) systemic antifungal drugs

- used for serious infections - development of resistance common - narrow antifungal spectrum - hematologic adverse effects as well as hepatotoxicity

famciclovir (famvir)

- used to treat acute herpes zoster or genital herpes infections - benefits are equivalent to those of acyclovir - adverse effects are minimal

antibiotic must be present

-At the site of infection -For a sufficient length of time

first choice for HSV (herpes simplex virus both genitalis and mucocutaneous) or VZV (varicella-zoster virus) infection

Acyclovir

misuses of antimicrobial drugs

-Attempted treatment of viral infections -Treatment of fever of unknown origin -Improper dosage -Treatment in the absence of adequate bacteriologic information -Omission of surgical drainage

prophylactic use of antimicrobials

Agents are given to prevent infection rather than to treat an established infection: - Surgery - Bacterial endocarditis - Neutropenia - Other indications

pharmacokinetics of tetracyclines

absorption can be affected by chelation

purine nucleoside analogs

acyclovir (Zovirax)

drugs for influenza

adamantanes and neuraminidase inhibitors

how to reduce drug and food interactions with cipro

administer 6 hours before or 2 hours after taking chelating agents

a patient with hospital-acquired pneumonia has just been prescribed cefotaxime and probenecid. the patient has no history or evidence of gout. what should the nurse do?

administer both medications as ordered

The nurse finds the pharmacy prepared mini bag of metronidazole in the patient's medication drawer and notes that it has been mixed to a concentration of 5 mg/mL. what should the nurse do?

administer the drug

the nurse is preparing to administer trimethoprim 50 mg prescribed orally every 12 hours. laboratory test results include estimated glomerular filtration rate 30 mL/min. what should the nurse do?

administer the drug

how do cephalosporins work?

inhibit bacterial cell wall synthesis by: - binging to specific PBP - blocking transpeptidase step of peptidoglycan synthesis - activation of autolytic enzymes

e-mycin drug interactions

inhibits metabolism of many drugs

adverse effects of Enfuvirtide

injection-site reactions, pneumonia, hypersensitivity reactions

the medication administration record lists clotrimazole troche to be administered at 0900. the nurse administers this medication by

instructing the patient to let it dissolve in the mouth

two classifications of antimicrobial drugs

susceptible organism, mechanism of action

it would be of greatest priority to consult the prescriber of enfuvirtide if the patient experienced

weakness and tingling in extremities

metronidazole works ______ with penicillins

well

the results of the 1942 PCN clinical trial

were so impressive that the US Surgeon General of the US Army authorized a trial in a military hospital, and soon used throughout the medical services of the US Armed Forces

before amphotericin B, systemic fungal infections

were usually considered fatal

delaying emergence of drug resistance

- Promote adherence to appropriate prescribing guidelines - Reduce demand for antibiotics among healthy adults and parents of young children - Emphasize adherence to prescribed antibiotic regimens

three beta-lactamase inhibitors used in the US

- Sulbactam - Tazobactam - Clavulanic acid

acyclovir (zovirax)

- active only against members of the herpesvirus family

aminoglycoside and gentamicin uses

- against aerobic gram-negative bacilli - can be used to sterilize gut

azoles systemic antifungal drugs

- alternative drug - lower toxicity - can be given PO - inhibit P450 - raise gastric pH

drug and food interactions with cipro

- aluminum and magnesium antacids, iron and zinc salts, sucralfate, products that contain calcium (reduced absorption and increased levels of theophylline and warfarin)

penicillins combined with a beta-lactamase inhibitor

- ampillin/sulbactam (unasyn) - amoxicillin/clavulanate (augmentin, clavulin) - ticarcillin/clavulanate (timentin) - piperacillin/tazobactam (zosyn, tazocin)

fluconazole

- azole group - fungistatic - inhibits ergosterol - good PO absorption (IV and PO dosage the same) - single dose for vaginal candidiasis

itraconazole

- azole group of antifungal agents - inhibits ergosterol

metronidazole (Flagyl)

- bactericidal (taken up into the cell to be activated)

Nitrofurantoin

- bacteriostatic in low concentrations - bactericidal in high concentrations

mechanism of action for amphotericin B

- binds to ergosterol in fungal cell membrane - increases permeability - cell leaks intracellular cations (especially potassium) - fungistatic or fungicidal

Ciprofloxacin

- broad spectrum antibiotic - inhibits bacterial DNA gyrate which disrupts DNA replication and cell division - bactericidal

sulfonamides

- broad spectrum antibiotics - suppresses bacterial growth by inhibiting folic acid synthesis

Amphotericin B

- broad-spectrum antifungal agent - highly toxic

azoles

- broad-spectrum antifungal drugs - lower toxicity - can be given orally

itraconazole adverse effects

- cardiosuppression (decreases ejection fraction) - GI irritation - Hepatotoxicity - Rash, headache, abdominal pain, edema

people who should not get the live flu shot

- children younger than 2 yo. - adults older than 50 yo. - pregnant women - history of allergic reaction - children 2-17 yo. receiving aspirin or salicylate medications - immunocompromised - children 2-4 yo. with asthma or h/o wheezing in past 12 mo.

types of STDs

- chlamydia trachomatis - nongonococcal urethritis - gonococcal infections - PID - acute epididymitis - syphilis - AIDS - trichomoniasis - chancroid - herpes simplex - bacterial vaginosis - condyloma acuminata - proctitis - pediculosis pubis and scabies - HPV

drug selection for empiric therapy is based on

- clinical evaluation - knowledge of microbes most likely to have caused infection

daptomycin (Cubicin)

- cyclic lipopeptide - kills virtually all gram-positive bacteria, including MRSA - no significant drug interactions

precautions and indications of flu vaccine

- egg allergy - minor illnesses with or without fever do not preclude vaccines - acute febrile illness would preclude vaccines

adverse effects of interferon alfa

- flu-like symptoms - neuropsychiatric effects, especially depression - fatigue, thyroid dysfunction, heart damage, bone marrow suppression manifesting as neutropenia and thrombocytopenia

how do some antiretroviral drugs block viral entry into cells

- fusion inhibitors - CCR5 antagonists

s/s of chlamydia

- genital tract infections - proctitis - conjunctivitis - ophthalmia and pneumonia in infants - PID and infertility

Neisseria gonorrhoeae

- gram-negative diplococcus - transmitted almost exclusively by sexual contact - 700,000 new cases each year

uses of purine nucleoside analogs

- herpes simplex viruses - varicella-zoster virus

uses of ganciclovir

- herpes simplex viruses including CMV - prevention and treatment of CMV infection in immunocompromised patients, including transplant patients, those with HIV infection, and those receiving immunosuppressive drugs

adverse effects of protease inhibitors

- hyperglycemia/diabetes - fat redistribution - hyperlipidemia - reduced bone density - increased bleeding in people with hemophilia - reduced bone mineral density - elevation of serum transaminase

adverse effects of sulfonamides

- hypersensitivity reactions (Stevens-Johnson syndrome) - hemolytic anemia - kernicterus - crystalluria - phlebitis

selection of antibiotics

-Identify organism -drug sensitivity of organism -host factors -drug may be ruled out owing to (allergy, inability to penetrate the site of infection, patient variables)

monitoring of antimicrobial therapy

-Monitor clinical responses and lab results -frequency of monitoring should increase with severity of infection -clinical indicators of success -serum drug levels for toxicity

Linezolid

-Oxazolidinone -Inhibit protein synthesis - Bacteriostatic - MOA inhibition

protease inhibitor drug ending

-navir

c. difficile

1) gram-positive, spore-forming bacteria found in the bowel 2) preceded by the use of antibiotics 3) superinfection 4) acquired by ingesting C. diff spores

Vancomycin adverse effects

1) ototoxicity 2) nephrotoxicity 3) Red Man's Syndrome

live, attenuated flu vaccine administration

nasal spray

types of antimicrobial agents

natural or synthetic

antibiotics that promote resistance

Broad-spectrum agents do the most to facilitate the emergence of resistance

almost all antibiotic adverse effect

nausea, vomiting, diarrhea, GI upset

because of myelosuppresion in Linezolid this laboratory test much be done frequently

CBC

Maraviroc (Selzentry)

CCR5 antagonist

target cells of HIV

CD4 T cells (helper lymphocyte)

it would be a priority to report which laboratory result to the prescriber if a patient is prescribed valacyclovir?

CD4 less than 100/mm^3

which isoenzyme of Creatine phosphokinase would be most helpful when monitoring for the rare but serious adverse effect if a patient is prescribed daptomycin and simvastatin?

CPK-3

third-generation cephalosporins are considerably more active against gram-___________ aerobes

negative

which laboratory results of an adult male patient suffuse bone marrow suppression caused by amphotericin B?

Hgb 10 g/dL, hematocrit 30%, MCV 89 mcg^3, MCH 28 pg/cell, MCHC 36 g/dL

inactivated flu vaccine administration

IM

which international normalized ratio (INR) result would be a reason to contact the prescriber in a patient with atrial fibrillation taking warfarin who has also been prescribed a sulfonamide?

INR 3.5

metronidazole administration

IV and PO

treatment of hospitalized patients with PID

IV cefoxitin or cefotetan and doxycycline, follow with oral doxycycline

Amphotericin B administration

IV only

Penicillin G dosage in congenital syphilis

IV or IM with PCN G or benzathine PCN

acyclovir adverse effects

IV: phlebitis, reversible neurotoxicity, neurotoxicity Oral: GI, vertigo (preferred route) Topical: stinging sensations

public health action plan to combat antimicrobial resistance Focus Area III:

Research

when imipenem and valproate are prescribed for a patient, what is the priority nursing concern?

safety

antibiotic

a chemical produced by one microbe that can harm other microbes

history of PCN by 1940

a crude preparation was found to produce dramatic therapeutic effects when administered parenterally to mice with streptococcal infections

how did Alexander fleming observe PCN first

a mold contaminating one of his cultures caused the bacteria in its vicinity to undergo lysis

where did cephalosporins originate from?

a natural fungus called Cephalosprium acremonium

which patient should receive prophylactic antibiotic therapy?

a patient who is scheduled for a hysterectomy

mammalian cells don't have what?

a rigid cell wall

a patient receiving standard antiretroviral therapy with three drugs develops a sore throat and cough. the nurse should consult the prescriber immediately if the therapy includes which drug?

abacavir

selective toxicity

ability to disrupt microbe and not the mammalian cells, toxic to microbes but harmless to host

hemolytic anemia

abnormal breakdown of RBCs

what are the known adverse effects of raltegravir?

facial edema and angioedema, flulike symptoms, painful rash that blisters followed by shedding of the epidermis

Red Man's Syndrome

facial flushing and hypotension due to rapid infection, thought to be caused by histamine release

the prescriber has informed a patient who has been prescribed a nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) of the risk of hepatic steatosis. the patient asks the nurse "what is hepatic steatosis?" the nurse should explain that this is a possible severe adverse effect involving

fatty degeneration of the liver

adverse effects of infusion reaction of amphotericin B

fever, chills, rigors, nausea, headache, caused by release of pro inflammatory cytokines

a female patient has been prescribed an antibiotic for 3 days. what are some advantages of shorter-course therapy?

fewer adverse effects, less potential for antibiotic resistance, lower cost, greater likelihood of patients completing therapy as prescribed

how many types of antiretroviral drugs are there

five

methenamine used

for chronic infection of lower urinary tract

how are cephalosporins subdivided?

from the first generation to fifth

penetration of cerebrospinal fluid by fourth-generation cephalosporins is _______

good

where is cytomegalovirus infection common in

healthcare workers

nosocomial infections

hospital acquired infections (HAI)

it would be a priority to report which test result if a patient is prescribed tetracycline?

human chorionic gonadotropin (hCG) 5325 mIU/mL

HIV

human immunodeficiency virus (1 and 2)

patients who are prescribed NNRTIs should be instructed to not self-prescribe the herbal product St. Johns wort. what is the possible effect of this combination?

increase in metabolism and excretion of the NNRTI

from the first generation to the fifth in cephalosporins

increase in: 1) activity against gram-negative bacteria and anaerobes 2) resistance to destruction by beta-lactamases 3) in ability to reach the CSF

the nurse reviews the CBC of a patient who is prescribed flu cytosine and notes neutrophils 27%. this patient is especially at risk for which issue?

infection

STDs

infectious or parasitic diseases that are transmitted primarily through sexual contact

it is important for the nurse to assess for suicidal ideation if a patient is prescribed which drug?

interferon alfa

it is important for the nurse to monitor which laboratory test when a patient is prescribed azithromycin or erythromycin and warfarin?

international normalized ration (INR)

a patient is admitted to a medical unit and prescribed IV ampicillin/sulbactam after a specimen was sent for culture and sensitivity (C&S) from the ER. the nurse knows the priority reason for notifying the prescriber of culture results as soon as they are available is that ampicillin/sulbactam

is a broad-spectrum antibiotic, and there may be an effective narrow-spectrum antibiotic

a patient is receiving 50 mg of nitrofurantoin at bedtime for prophylaxis of recurrent cystitis. this means that the patient

is taking low doses of the drug to prevent reinfection

what is true of itraconazole?

it is capable of impairing the liver metabolism of other drugs

cefuroxime is prescribed for a patient diagnosed with pneumonia caused by Klebsiella pneumococci, type 2 DM, Gastroesophageal reflux disease (GERD), and Chronic Kidney Disease (CKD). why is this antibiotic a good choice for this patient?

it may be administered orally, it's effective against K. pneumococci, it's inexpensive, and it has a once-a-day dosing

why is folic acid crucial in pregnancy

it prevents neural tube issues in the fetus

the nurse would be concerned that a patient who is receiving micafungin is experiencing a histamine reaction and might have an anaphylactic reaction if the patient reports a sudden feeling of

itching

adverse affects of trimethoprim

itching, rash, GI irritation, hematologic anemia, decreased WBC count, not used in pregnancy due to folic acid inhibition

used for oral therapy of onchomycosis of the toenails or fingernails

itraconazole

oral and topical therapy of superficial mycoses

ketoconazole

characteristics of anaphylaxis

laryngeal edema, bronchial constriction, hypotension

PCN G characteristic

least toxic of all antibiotics

CA-MRSA

less dangerous, many people are asymptomatic carriers

what is a benefit of TMP/SMZ over the components used alone?

less resistance has developed

how is Stevens-Johnson syndrome treated

like a burn (risk of infection due to lots of pain and weeping from no epidermis)

Azithromycin

like e-mycin, for respiratory infections

the nurse is assessing for adverse effects of IV tobramycin. which change would be a priority to report to the prescriber?

limp, weak muscles

trough levels must be

low enough to minimize toxicity

uses for nitrofurantoin

lower tract UTIs

hypoglycemics

lowers blood sugars

erythromycin

macrolide, broad-spectrum, OK to use if allergic to penicillin

when a patient is prescribed a fluoroquinolone that is known to cause prolongation of the QT interval on ECG, the nurse should monitor the electrolytes for which result that is most likely to increase risk of this adverse effect?

magnesium less than 1.3 mEq/L, potassium less than 3.5 mEq/L

what does the nurse do when assisting with skin testing for penicillin allergy with the minor determinant mixture (MDM)?

make respiratory support and epinephrine available

goal of antibiotic treatment

maximize anti microbial benefit with minimum harm to the host

differences in the cellular chemistry of mammals and microbes

microbes have rigid walls, mammalian cells do not

how many Americans are infected with hepatitis

millions

the nurse should assess for adverse effects of lightheadedness and dizziness when a patient is receiving which medication?

minocycline

indications of antibiotic combinations

mixed infections, prevention of resistance, decreased toxicity, enhanced bacterial action

HIV drug resistance most of the time

most cases emerges over the course of treatment as a result of nonadherence to the prescribed

principles of treating HIV-seropositive pregnant women include

prophylaxis is recommended for the infant/neonate, benefits of treatment normally outweigh risks

the nurse would be most concerned that a patient may not adhere to therapy with which class of antiviral drugs if the patient verbalized that body image is an important priority?

protease inhibitor (PI)

among the most effective antiretroviral drugs

protease inhibitors

Penicillins must bind to special _______ on the outer surface of ______________ membrane to be effective

proteins, cytoplasmic

microscopic examination of gram-stained preparations has the advantages of

providing rapid results, being a simpler test

spontaneous mutation

random changes in a microbe's DNA, resistance to one drug

which drug must be taken 12 hours apart from rilpivirine?

ranitidine

when a patient who is receiving nevirapine or delavirdine complains of conjunctivitis or muscle and joint pain, it would be a priority to assess for

rash

if a bacterium changes its ___________, an antibiotic may not be able to bing to the microbe and exert effects

receptors

which laboratory test result would be a priority to report the prescriber of a sulfonamide?

red cell distribution width 18.4%

what do gram-negative microbes stain as

red stain due to thin cell wall

what did modern antimicrobials do?

reduced morbidity and mortality from infection

why do we use protease inhibitors with an NRTI

reduces viral load to an undetectable level

clinical indicators of success in monitoring antimicrobial therapy

reduction of fever, resolution of signs/symptoms related to the affected organ

when emptying a urinal from an HIV-seropositive patient, the nurse splashes urine on intact skin. what should the nurse do?

report the incident immediately to a supervisor

Linezolid (Zyvox) uses

reserved for multi-drug resistant infections

_________ to tetracycline is ___________

resistance, increasing

bacteria can become ___________ to antibiotics by producing enzymes that inactivate the antibiotic

resistant

a neonate was delivered vaginally to a mother with an active chlamydia trachomatis infection. relating to this exposure, what is the priority system wen caring for the neonate?

respiratory

HIV drug resistance rarely

results from primary infection with drug-resistant HIV variant

mother-to-child transmission HIV

risk for transmission can be greatly reduced by ART, which minimizes maternal viral load

a friend tells the nurse that a sexual partner has informed her that he has gonorrhea. she has a refillable prescription of cipro for recurrent cystitis. she tells the nurse she knows that she has used this drug in the past for gonorrhea. what is the most important reason why the nurse should discourage using this cipro?

this drug is no longer effective against Neisseria gonorrhoeae

syphilis develops in _______ stages

three

"wash-out"

time when ears and kidneys would get a break from aminoglycosides

Ototoxicity symptoms

tinnitus, hearing loss, severe headache, ataxia, balance disturbances

HIV reverse transcriptase use

to convert RNA to DNA

why did we have to tweak PCN so much

to fit into protein binding sites of bacteria

the carbapenem antibiotic imipenem is a combination of the antibiotic and cilastatin. what is the purpose of the additive cilastatin

to prevent inactivation by an enzyme present in the kidney

a diabetic patient is receiving clindamycin for gas gangrene. which drug, if also taken by this patient, could decrease bowel motility and prevent the body's attempt to rid the colon of C-diff?

tolterodine

how do you get ototoxicity and nephrotoxicity from vanco

too rapid of IV administration

Stevens-Johnson syndrome aka

toxic epidermal necrolysis

the nurse teaches that the primary cause of recurrent STIs caused by the same organism is failure to

treat the sexual partner

topical antiviral drugs used for ocular herpes infections

trifluridine, ganciclovir

administration of Enfuvirtide

twice-daily subQ (makes it harder for HIV to adhere to CD4 T cell)

carbapenems use

typically for infections considered critical

because of the risk of prolonged QT interval and torsades de points, the nurse would consult the prescriber before administering erythromycin to a patient who has experienced

unexplained fainting

what should the nurse teach regarding condom use to a patient who is currently in a long-term relationship and who has been prescribed continuous oral acyclovir therapy for recurrent genital herpes?

use a condom with every sexual contact except if conception is desired; conception should be planned when symptoms are absent

the nurse is discussing planned care with the CNA who is assigned to a patient receiving ganciclovir. because of the possible serious adverse effects, which precaution would the nurse include in instructions regarding care?

use an electronic razor to shave the patient

how to viruses reproduce

use biochemical machinery of host cells

if chlamydia while pregnant

use erythromycin base or azithromycin

an HIV-positive patient who has recently been prescribed efavirenz calls the prescriber's office and reports experiencing drowsiness and dizziness. an appropriate recommendation by the telephone triage nurse is for the patient to do what?

use safety precautions and take efavirenz at beditme

theophylline uses

used in therapy for COPD and asthma

infection with MRSA

usually involves the skin and soft tissues, causing abscesses, boils, cellulitis, and impetigo

Guillain-Barre syndrome

usually reversible, symmetrical paralysis

primary strategy for influenza management

vaccine

what should trough levels be when drawn

very low -- preferably close to zero

what do gram-positive microbes stain as

violet stain due to thicker cell wall = better staining

most common liver disorder

viral hepatitis

which nursing assessment finding would be most significant if a patient was receiving didanosine?

vomiting

what to do before and after application of topical drugs

wash your hands

a patient is prescribed tetracycline for Chlamydia trachomatis. which change in assessment findings would be a priority to report to the prescriber?

watery stool

benefits of combining beta-lactamase inhibitor with PCN

we can extend the antimicrobial spectrum of the PCN

how do antibiotics work

weakens cell wall, sucking out bacterial cell material and causes it to burst

because of the risk of hyperkalemia when prescribed trimethoprim, it is a priority for the nurse to teach the patient to report what symptom?

weakness