Anti Infectives

After teaching a client who is prescribed oral erythromycin, the nurse determines that the teaching was successful when the client states which of the following?

"I should drink a full 8-oz glass of water when I take the medicine." Food in the stomach decreases the absorption of oral macrolides such as erythromycin. Therefore, the drug should be taken on an empty stomach with a full, 8-oz glass of water, 1 hour before or at least 2 to 3 hours after meals. The client may experience diarrhea with this drug, but it should not be bloody. Bloody diarrhea is associated with pseudomembranous colitis, which needs to be reported to the health care provider immediately. Due to its long half-life, azithromycin is usually ordered as a once-daily dose.

A client has been prescribed tetracycline for the treatment of acne. How would the nurse explain the action of the drug?

"Tetracycline interferes with the growth of the bacteria causing the pimples." Tetracycline interferes with the production of free fatty acids and suppresses the growth of bacteria in sebum. These actions decrease the inflammatory, pustular lesions associated with severe acne. None of the other options accurately describe the action of tetracycline.

A client taking Bactrim DS one tablet twice daily for 14 days should be counseled about which of the following adverse reactions? Select all that apply.

Anorexia Crystalluria Photosensitivity A client should be advised about potential adverse reactions that can occur while taking a sulfonamide. These adverse reactions include nausea, vomiting, anorexia, stomatitis, chills, fever, crystalluria, and photosensitivity.

Which drug is most commonly used orally to treat infections caused by Candida albicans?

Fluconazole (Diflucan) The azoles, are a large group of antifungals used to treat systemic and topical fungal infections. The azoles include fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), posaconazole (Noxafil), terbinafine (Lamisil). and voriconazole (Vfend). Although azoles are considered less toxic than some other antifungals, such as amphotericin B, they may also be less effective in very severe and progressive infections.

A patient with hypertension has a fungal infection and has been prescribed fluconazole for the fungal infection and losartan for hypertension. Which risk is associated with such concomitant drug usage?

Increased risk of adverse effects of losartan Increased risk of adverse effects of losartan is associated with the concomitant use of fluconazole and losartan. Decreased hypotensive effect of losartan is seen with use of indomethacin and does not occur with the concomitant use of these drugs. Increased risk of hypoglycemia and increased risk of hypersensitivity do not occur with the concomitant use of these drugs

A 75-year-old patient with a history of renal impairment is admitted to the primary health care center with a UTI and has been prescribed a cephalosporin. Which of the following interventions is most important for the nurse to perform when caring for this patient?

Monitoring blood creatinine levels. An elderly patient is more susceptible to the nephrotoxic effects of the cephalosporins. Since renal impairment is present, it is important for the nurse to closely monitor the patient's blood creatinine levels. The nurse should conduct a test for occult blood if blood and mucus occur in the stool and monitor the fluid intake if there is a decrease in urine output. The nurse does not need to monitor for increased glucose levels unless the patient has a history of diabetes.

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

Tetracyclines Tetracyclines can potentially damage developing teeth and bones and thus should be used cautiously or avoided in children under the age of 8 years. Penicillins are safe to give to children and commonly used. Cephalosporins are safe to administer to pediatric clients. Aminoglycosides would not be administered to children lightly, but they can be administered when the benefits outweigh the risks, such as an infection that is resistant to other drugs.

A client with a urinary tract infection has been prescribed Bactrim, a medication that is a combination of sulfamethoxazole and trimethoprim. What is the most likely rationale for the use of a combination antibiotic?

The drugs' combined effect exceeds the sum of their individual effects. Some drugs are synergistic, which means that they are more powerful when given in combination. Combination drugs do not normally exist to promote absorption and they are not always a combination of narrow- and broad-spectrum. An inability to perform culture and sensitivity testing would not directly require combination therapy.

A health care center is conducting a seminar on cephalosporins drugs. During the question-and-answer period, the audience wants examples of conditions that can be treated by cephalosporins. Which of the following infections should the nurse state as examples?

UTI Cephalosporins are used to treat urinary tract infections, skin infections, and hospital-acquired pneumonias. Cephalosporins are not used to treat hemolysis or jaundice. Nausea and diarrhea are some of the adverse reactions that can occur when a patient is on cephalosporins therapy.

Which of the following is a superinfection that may occur in a client being given a cephalosporin? Select all that apply.

Vaginal candidiasis Pseudomembranous colitis Therapy with cephalosporins may result in a bacterial or fungal superinfection (i.e., vaginal candidiasis or pseudomembranous colitis).

A disulfiram-like reaction may occur if which substance is consumed within 72 hours after administration of certain cephalosporins?

alcohol A disulfiram-like reaction may occur if alcohol is consumed within 72 hours after administration of certain cephalosporins. Foods such as cheese, bananas, and meat do not have any effect on cephalosporins; however, food can help with GI upset.

The nurse is caring for a client who has been diagnosed with Mycoplasma pneumoniae. What drug should the nurse expect to administer?

doxycycline Doxycycline is one of the drugs of choice for Bacillus anthracis (anthrax) and Chlamydia trachomatis and is used in respiratory tract infections caused by Mycoplasma pneumoniae. Phenazopyridine hydrochloride is a urinary analgesic that is administered to provide pain relief related to burning, urgency, frequency, and irritation of the lower urinary tract mucosa. Trimethoprim-sulfamethoxazole (TMP-SMZ) is useful in urinary tract infections due to Enterobacteriaceae and Pneumocystis jiroveci infection. Since M. pneumoniae is gram negative, penicillin would not be prescribed.

A female client is being treated for Mycoplasma pneumoniae pneumonia. She is allergic to penicillin and is being given azithromycin (Zithromax) in capsule form. The nurse will inform the client that she will need to take the capsule

on an empty stomach Because the absorption of azithromycin capsules is decreased in the presence of food, azithromycin capsules should be taken on an empty stomach rather than after a meal. Unlike azithromycin capsules, azithromycin tablets have an increased absorption when given with a meal with high fat content and may be given with or without food.

An influenza outbreak has spread through a long-term care residence, affecting many of the residents with severe malaise, fever, and nausea and vomiting. In an effort to curb the outbreak, the nurse has liaised with a health care provider to see if residents may be candidates for treatment with what drug?

oseltamivir phosphate Oseltamivir phosphate is used to treat active influenza. Saquinavir mesylate is a protease inhibitor. Lamivudine is used to treat hepatitis B. Ribavirin treats respiratory syncytial virus (RSV)

The health care provider has recommended that a client begin taking a calcium supplement. When providing education, the nurse would caution the client to take the supplement may interfere with the absorption of what antibiotic?

tetracycline Clients should be instructed not to take a calcium supplement with tetracycline or ciprofloxacin, since it may interfere with absorption of either antibiotic. Oral calcium does not interfere with the absorption of penicillin, aztreonam, or cefaclor.