Pharm #2
Why does antibiotic resistance occur?
the bacteria changes and that reduces or eliminated the effectiveness of drugs
What does minimum inhibitory concentration mean?
the lowest concentration of a drug which prevents the growth of bacteria
What are superinfections? When and why do they occur? What foods help prevent them?
they are secondary infections that usually develop while our body is fighting off a virus, such as a cold or the flu
Why do fungal infections occur and where are they most common?
they occur when yeast on the skin grows more actively; feet, ringworm, warm creased areas
For how long is a patient considered infectious after beginning anti-TB meds? When can they return to work and activities?
2 weeks after therapy begins
How long is TB therapy?
at least 6-9 months
Indications for psychotherapeutic drugs
depression, anxiety, dysthymic disorder, somatic complaints
How do you assess for lithium toxicity?
serum levels
The nurse is providing teaching to a patient taking an oral tetracycline antibiotic. Which statement by the nurse is correct? a. "Avoid direct sunlight and tanning beds while on this medication." b. "Milk and cheese products result in increased levels of tetracycline." c. "Antacids taken with the medication help to reduce gastrointestinal distress." d. "Take the medication until you are feeling better."
A
The nurse is reviewing the sputum culture results of a patient with pneumonia and notes that the patient has a gram-positive infection. Which generation of cephalosporin is most appropriate for this type of infection? a. First-generation b. Second-generation c. Third-generation d. Fourth-generation
A
3. A patient will be receiving nitrofurantoin (Macrodantin) treatment for a urinary tract infection. The nurse is reviewing the patient's history and will question the nitrofurantoin order if which disorder is present in the history? (Select all that apply.) a. Liver disease b. Coronary artery disease c. Hyperthyroidism d. Type 1 diabetes mellitus e. Chronic renal disease
A, E Nitrofurantoin is contraindicated in cases of known drug allergy and also in cases of significant renal function impairment, because the drug concentrates in the urine. Because adverse effects include hepatotoxicity, which is rare but often fatal, the nurse should also question the order if liver disease is present. The other options are not contraindications.
Which nursing diagnosis is appropriate for a patient who has started aminoglycoside therapy? a. Constipation b. Risk for injury (renal damage) c. Disturbed body image related to gynecomastia d. Imbalanced nutrition, less than body requirements, related to nausea
B Patients on aminoglycoside therapy have an increased risk for injury caused by nephrotoxicity. The other options are incorrect.
Why use a combination of meds for anti-HIV?
It allows it to disrupt HIV at the different stages of its replication
How to prevent and treat red man syndrome?
slow infusions prevent it and you can give dipenhydramine to reduce the effects
What foods are high in tyramine (MAOIs)?
strong or aged cheeses, smoked meats, beers, overripe fruit, soy products, and certain beans
During drug therapy for pneumonia, a female patient develops a vaginal superinfection. The nurse explains that this infection is caused by a. large doses of antibiotics that kill normal flora. b. the infection spreading from her lungs to the new site of infection. c. resistance of the pneumonia-causing bacteria to the drugs. d. an allergic reaction to the antibiotics.
A
When reviewing the medication orders for a patient who is taking penicillin, the nurse notes that the patient is also taking the oral anticoagulant warfarin (Coumadin). What possible effect may occur as the result of an interaction between these drugs? a. The penicillin will cause an enhanced anticoagulant effect of the warfarin. b. The penicillin will cause the anticoagulant effect of the warfarin to decrease. c. The warfarin will reduce the antiinfective action of the penicillin. d. The warfarin will increase the effectiveness of the penicillin.
A
A patient is receiving aminoglycoside therapy and will be receiving a beta-lactam antibiotic as well. The patient asks why two antibiotics have been ordered. What is the nurse's best response? a. "The combined effect of both antibiotics is greater than each of them alone." b. "One antibiotic is not strong enough to fight the infection." c. "We have not yet isolated the bacteria, so the two antibiotics are given to cover a wide range of microorganisms." d. "We can give a reduced amount of each one if we give them together."
A Aminoglycosides are often used in combination with other antibiotics, such as beta-lactams or vancomycin, in the treatment of various infections because the combined effect of the two antibiotics is greater than that of either drug alone.
During antibiotic therapy, the nurse will monitor closely for signs and symptoms of a hypersensitivity reaction. Which of these assessment findings may be an indication of a hypersensitivity reaction? (Select all that apply.) a. Wheezing b. Diarrhea c. Shortness of breath d. Swelling of the tongue e. Itching f. Black, hairy tongue
A, C, D, E
2. The nurse is administering intravenous vancomycin (Vancocin) to a patient who has had gastrointestinal surgery. Which nursing measures are appropriate? (Select all that apply.) a. Monitoring serum creatinine levels b. Restricting fluids while the patient is on this medication c. Warning the patient that a flushed feeling or facial itching may occur d. Instructing the patient to report dizziness or a feeling of fullness in the ears e. Reporting a trough drug level of 11 mcg/mL and holding the drug f. Reporting a trough drug level of 24 mcg/mL and holding the drug
A, C, D, F Constant monitoring for drug-related neurotoxicity, nephrotoxicity, ototoxicity, and superinfection remain critical to patient safety. Monitor for nephrotoxicity by monitoring serum creatinine levels. Ototoxicity may be indicated if the patient experiences dizziness or a feeling of fullness in the ears, and these symptoms must be reported immediately. Vancomycin infusions may cause red man syndrome, which is characterized by flushing of the neck and face and a decrease in blood pressure. In addition, adequate hydration (at least 2 liters of fluids every 24 hours unless contraindicated) is most important to prevent nephrotoxicity. Optimal trough blood levels of vancomycin are 10 to 20 mcg/mL; therefore, the drug should not be administered when there is a trough level of 24 mcg/mL.
A patient will be having oral surgery and has received an antibiotic to take for 1 week before the surgery. The nurse knows that this is an example of which type of therapy? a. Empirical b. Prophylactic c. Definitive d. Resistance
B
The nurse is reviewing the medication history of a patient who will be taking a sulfonamide antibiotic. During sulfonamide therapy, a significant drug interaction may occur with which of these drugs or drug classes? (Select all that apply.) a. Opioids b. Oral contraceptives c. Sulfonylureas d. Antihistamines e. phenytoin (Dilantin) f. warfarin (Coumadin)
B, C, E, F
1. The nurse who is administering aminoglycoside therapy must monitor the patient closely for signs of toxicity as manifested by which of these conditions? (Select all that apply.) a. Electrocardiogram changes b. Hearing loss c. Dizziness d. Constipation e. Decreasing hemoglobin level f. Rising serum creatinine level
B, C, F Patients on aminoglycoside therapy must be monitored for signs of nephrotoxicity (rising serum creatinine level) and ototoxicity (hearing loss, dizziness). The other options are not signs of toxicity.
A patient is receiving his third intravenous dose of a penicillin drug. He calls the nurse to report that he is feeling "anxious" and is having trouble breathing. What will the nurse do first? a. Notify the prescriber. b. Take the patient's vital signs. c. Stop the antibiotic infusion. d. Check for allergies.
C
A patient with a long-term intravenous catheter is going home. The nurse knows that if he is allergic to seafood, which antiseptic agent is contraindicated? a. chlorhexidine gluconate (Hibiclens) b. hydrogen peroxide c. povidone-iodine (Betadine) d. isopropyl alcohol
C
The nurse is monitoring a patient who has been on antibiotic therapy for 2 weeks. Today the patient tells the nurse that he has had watery diarrhea since the day before and is having abdominal cramps. His oral temperature is 101° F (38.3° C). Based on these findings, which conclusion will the nurse draw? a. The patient's original infection has not responded to the antibiotic therapy. b. The patient is showing typical adverse effects of antibiotic therapy. c. The patient needs to be tested for Clostridium difficile infection. d. The patient will need to take a different antibiotic.
C
The nurse is monitoring for therapeutic results of antibiotic therapy in a patient with an infection. Which laboratory value would indicate therapeutic effectiveness of this therapy? a. Increased red blood cell count b. Increased hemoglobin level c. Decreased white blood cell count d. Decreased platelet count
C
When reviewing the allergy history of a patient, the nurse notes that the patient is allergic to penicillin. Based on this finding, the nurse would question an order for which class of antibiotics? a. Tetracyclines b. Sulfonamides c. Cephalosporins d. Quinolones
C
1. When a patient is on aminoglycoside therapy, the nurse will monitor the patient for which indicators of potential toxicity? a. Fever b. White blood cell count of 8000 cells/mm3 c. Tinnitus and dizziness d. Decreased blood urea nitrogen (BUN) levels
C Dizziness, tinnitus, hearing loss, or a sense of fullness in the ears could indicate ototoxicity, a potentially serious toxicity in a patient. Nephrotoxicity is indicated by rising blood urea nitrogen and creatinine levels. Fever may be indicative of the patient's infection; a white blood cell count of 7000 cells/mm3 is within the normal range of 5000 to 10,000 cells/mm3.
The nurse checks the patient's laboratory work prior to administering a dose of vancomycin (Vancocin) and finds that the trough vancomycin level is 24 mcg/mL. What will the nurse do next? a. Administer the vancomycin as ordered. b. Hold the drug, and administer 4 hours later. c. Hold the drug, and notify the prescriber. d. Repeat the test to verify results.
C Optimal blood levels of vancomycin are a trough level of 10 to 20 mcg/mL. Measurement of peak levels is no longer routinely recommended, and only trough levels are commonly monitored. Blood samples for measurement of trough levels are drawn immediately before administration of the next dose. Because of the increase in resistant organisms, many clinicians use a trough level of 15 to 20 mcg/mL as their goal. These trough levels mean that even just before the next dose is due, when drug levels should be low, the drug levels are actually too high.
A patient who has been hospitalized for 2 weeks has developed a pressure ulcer that contains multidrug-resistant Staphylococcus aureus (MRSA). Which drug would the nurse expect to be chosen for therapy? a. metronidazole (Flagyl) b. ciprofloxacin (Cipro) c. vancomycin (Vancocin) d. tobramycin (Nebcin)
C Vancomycin is the drug of choice for the treatment of MRSA. The other drugs are not used for MRSA.
During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and decreased appetite. Which statement is the nurse's best advice to the patient? a. "Take it with cheese and crackers or yogurt." b. "Take each dose with a glass of milk." c. "Take an antacid with each dose as needed." d. "Drink a full glass of water with each dose."
D
The nurse is preparing to use an antiseptic. Which statement is correct regarding how antiseptics differ from disinfectants? a. Antiseptics are used to sterilize surgical equipment. b. Disinfectants are used as preoperative skin preparation. c. Antiseptics are used only on living tissue to kill microorganisms. d. Disinfectants are used only on nonliving objects to destroy organisms.
D
A 79-year-old patient is receiving a quinolone as treatment for a complicated incision infection. The nurse will monitor for which adverse effect that is associated with these drugs? a. Neuralgia b. Double vision c. Hypotension d. Tendonitis and tendon rupture
D A black-box warning is required by the U.S. Food and Drug Administration for all quinolones because of the increased risk for tendonitis and tendon rupture with use of the drugs. This effect is more common in elderly patients, patients with renal failure, and those receiving concurrent glucocorticoid therapy (e.g., prednisone). The other options are not common adverse effects.
A patient has been diagnosed with Klebsiella pneumoniae carbapenemases (KPC). The nurse expects to see orders for which drug? a. dapsone (Cubicin), a miscellaneous antibiotic b. ciprofloxacin (Cipro), a quinolone c. linezolid (Zyvox), an oxazolidinone d. colistimethate sodium (Coly-Mycin), a polypeptide antibiotic
D Colistimethate (Coly-Mycin), commonly referred to as colistin, is now being used again, often as one of the only drugs available to treat KPC. The other options are incorrect.
The nurse is administering a vancomycin (Vancocin) infusion. Which measure is appropriate for the nurse to implement in order to reduce complications that may occur with this drug's administration? a. Monitoring blood pressure for hypertension during the infusion b. Discontinuing the drug immediately if red man syndrome occurs c. Restricting fluids during vancomycin therapy d. Infusing the drug over at least 1 hour
D Infuse the medication over at least 1 hour to reduce the occurrence of red man syndrome. Adequate hydration (at least 2 liters of fluid in 24 hours) during vancomycin therapy is important for the prevention of nephrotoxicity. Hypotension may occur during the infusion, especially if it is given too rapidly.
The nurse is reviewing the medication orders for a patient who will be receiving linezolid (Zyvox) therapy. Which other medication or medication class, if ordered, would be a potential interaction concern? a. Calcium channel blockers b. Phenytoin c. Anticoagulants d. Selective serotonin reuptake inhibitor antidepressants
D Linezolid may cause serotonin syndrome when used concurrently with serotonergic drugs such as the selective serotonin-reuptake inhibitor antidepressants. The other drugs and drug classes do not cause interactions.
What does dose related mean in regards to methylphenidate?
It depends on the patients body weight?
Why must you ensure that a patient is HIV negative before prescribing PrEP?
if they are positive they should be on PEP not PrEP
What is the purpose of obtaining trough and peak levels? When do you draw them?
trough- lowest level concentration in the blood, draw just prior to administration peak- highest concentration in the blood of the drug
What are the common drugs that interact with many antibiotics?
warfarin, alcohol, oral contraceptives, penicillins, cephalosporins, aminoglycosides, tetracyclines, etc.
