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Antimicrobial Agents
Pharm final exam
| Question | Answer |
|---|---|
| Which ones are considered bacterialcidal (kills)? Pt's must have good immune systems, impairs cell wall, disrupts cell membranes, inhibits metabolism and growth, inhibits protein synthesis, or inhibits reproduction? | Bacterialcidal = Pt's must have a good immune system, impairs cell wall, inhibits protein synthesis, and disrupts cell membranes. |
| Which ones are considered bacterialstatic? Pt's must have good immune systems, impairs cell wall, disrupts cell membranes, inhibits metabolism and growth, inhibits protein synthesis, or inhibits reproduction? | Bacterialstatic = inhibits reproduction; inhibits metabolism and growth. |
| What is the primary reason for using antimicrobials? | To treat infections |
| When the infecting organism and the effective treatment are known, the treatment is ________? | Directed |
| When the infecting organism and/or the effective treatment is/are unknown treatment is _________. | Empiric |
| This scenario is directed or empiric?80 yr Dolly Madison is brought into the ER. She is SOB, R = 24, P = 100, T = 102. Crackles in both lung fields. She is confused and agitated? Give a rationale behind your answer. | Empiric b/c the MD's will have to place the Pt on a drug that's effective on many different organims caused by URI's b/c they are unsure of her infecting organism or the effective treatment. |
| Treating UTI's is considered direct treatment or empiric treatment? | Empiric |
| Which were the first antimicrobial agents that lead to resistance of many organisms? | Sulfa drugs |
| What conditions would preventative drug therapy be used? | Bacterial endocarditis, TB, periop infections, gonorrhea, syphilis, HIV, and complications of Strep A. |
| Why is preventative drug therapy used to prevent bacterial endocarditis? | Pt's who have valvular heart disease or vavle replacements are at risk for endocarditis if bacteria get into the blood stream. So, before any invasive procedures antibiotics are given. |
| When would preventative drug therapy be used for TB? | With ppl that are exposed to TB. This includes family memberss of recently diagnosed persons. Also, healthcare workers who have a positive TB skin test. |
| T/F: TB tests that are red and swollen means you have tuberculosis. If false give rationale behind your answer. | False: red and swelling doesn't mean someone actually has TB, but that they've been exposed to it and their body has produced antibodies. |
| T/F: Now, Pt's having surgical procedures are given a dose of antimicrobials for preventative care immediately before or even after the procedure. | True, antibiotics are usually given one hour before procedure |
| When might a Pt be given preventative drug therapy if they've been exposed to an STD? | To reduce the risk of contracting the disease. |
| When would someone be given preventative meds for HIV? | Health care providers who have been exposed to potentially infected body fluids usually are given the option to take anti-HIV drugs. as a preventative measure. |
| Even though most URI's improve without treatment, why is it so important to test for and treat strep A if c/o a ST? | B/c strep A infections can lead to rheumatic fever/heart disease and glomerulonephritis. |
| Define and describe Natural Resistance | The organism is born with resistance. Natural refers to protective characteristics that are present BEFORE drug exposure. |
| Describe acquired resistance | develops AFTER exposure to a drug |
| Penicillinase enzymes does what? This is an ex of natural or aquired resistance? | The enzymes destroys the Penicillin drug. It's an ex of natural resistance. |
| Which are these ex's of natural or acquired resistance: impermeable cell wall blocks drug entry by using slim layers or tough shells. The cell pump expels drug (antimicrobial makes it in the cell wall but organism bumps it out)? | Both the impermeable cell wall and the cell pump expelling the drug are BOTH ex's of NATURAL RESISTANCE. |
| Which ones are considered aquired resistance: *survival of the fittest *genetic mutation *genetic transfer *altered metabolic pathways | All are considered ex's of aquired resistance |
| Survival of the fittest | weakest organims die first when exposed to an antimicrobial; strongest survive and reproduce strong offspring |
| Resistant organisms can share genetic material with non-resistant organims so that they too become resistant. This is an ex of survival of the fittest? genetic mutation? Genetic adaptation/transfer? altered metabolic pathways? | Genetic adaptation/transfer |
| Gram+ vrs gram-? Which is harder to eliminate? | Gram negative |
| Why would interrupteed therapy lead to resistant organisms? | Strongest survive-- weak die first then strong remain alive, thrive, and reproduce. Pt may have a relapse |
| With customized therapy, under what circumstances are antimicrobials indicated? | When the infection is significant and when prophylaxis (preventative) is appropriate. |
| A drug with a very _______ spectrum of effectiveness is preferred. | Narrow |
| ___________ spectrum drugs should be used sparingly to reduce development of resistance and the risk of superinfections. | Broad |
| ________ enhance warfarin thereby increasing the Pt's risk of bleeding. | Macrolides |
| T/F: Organisms that quickly develop resistance are more able to adapt to multiple drugs. | FASLE! They will be LESS able to adapt to multiple drugs. |
| Who is more likely to need combination therapy? | Immunosuppressed Pt's, and when synergistic effects are desired (two drugs working together may enhance the effects of each of them). |
| If a Pt is using multiple drugs, what is that Pt at risk for? | Adverse reactions of more than one drug |
| When are combination drugs appropriate? | Multiple organisms, resistant organisms, immune suppressed pt's, and synergistic effects. |
| What are the common 4 adverse effects of antimicrobials? | allergic rx's, superinfections, photosensitivity, and direct toxicity. |
| What type of drugs are common with allergic rx's? | Penicillins, cephalosporins, and sulfonamides. |
| Allergic rx's are a result from __________. This means that a person has been exposed to an antigen by a drug, and developed antibodies against it. When exposed to the antigen again, an immune response occurs. | Sensitization |
| What are the three types of allergic reactions? | Skin rx's, anaphylaxis, and serum sickness. |
| What happens physiologically in the body during anaphylaxis? | Immune response that causes bronchial constriction, massive dilation of blood vessels (low BP), and increased capillary permeability (edematous). |
| How long can it take for serum sickness to develop after taking the drug? | Weeks or months |
| What symptoms will the Pt experience if they have serum sickness? | Fever, swollen joints, and enlarged lymph glands. |
| Penicillins and cephalosporins belong to a class called beta lactams. A person who develops an allergy to one also may be allergic to the other. This is an ex of what? | Cross sensitivity |
| What kinds of drugs can cross sensitivity occur with? | Penicillins, cephalosporins, sulfonamides, thiazide diuretics, and sulfonylureas. |
| What causes superinfections? | Caused by elimination of normal flora by antimicrobials which permits pathogens to flourish. |
| What are the common organims of superinfections? | gm negatives, fungi, clotridiums, and pseudomonas. |
| Where are the common sites for superinfections? | mouth, GI tract (C Diff), and vagina(yeast infections). |
| increased creatinine is a S&S of? | nephrotoxicity |
| Ataxia and tinnitus are S&S's of which part of the body? | Ototoxicity |
| Jaundice is a S&S of toxicity of which organ? | Liver |
| n/v is a s&s of which body system? | GI |
| numbness is a sign of toxicity of which body system? | Nephrotoxicity |
| venous inflammation is a S&S indicating what? | Phebitis |
| Fatigue and pallor indicate what kind of toxicity? | Hematologic |
| Rashes and blisters indicate what kind of toxicity? | Dermatologic |
| Which indicates a local rx and which indicates a systemic rx? *Redness, swelling, and itching *respiratory distress, drop in BP, edema? | redness/swelling/itching = local; resp distress/low BP/edema = systemic |
| How long should Pt's wait after receiving an injection at an outpatient facility? | 30 mins |
| What is the first S&S of a drug that crosses the blood-brain barrier or is neurotoxic? | Drowsiness |
| Assessment: chking for decreased urine vol and increased creatinine. Interventions: "push" fluids unless contraindicated. This assessment and intervention is for which type of toxicity? | Nephrotoxicity |
| What are some interventions for phlebitis? | change IV site, dilute IV drugs as ordered, and flush IV tubing after drug administration |
| What are S&S of phlebitis? | inflammation of blood vessel, redness, warmth or coldness. |
| What should the nurse tell the Pt who gets an upset stomach when taking their medication after eating? | To take on an empty stomach |
| Urine dilution is a good or bad sign when considering nephrotoxicity? | good sign |
| Beta lactams: Penicillins and Cephalosporins adverse effects are? | hypersensitivity, superinfection: vaginitis, pseudomembraneous colitis, severe diarrhea (C Diff), bleeding,thrombophlebitis at IV infusion site, and Jarisch-Herxheimer rx. |
| If phlebitis is present when should the nurse change IV sites? | After discussing with physician |
| What is Jarisch-Herxheimer rx? | When IM Penicillin is used for Syphillis Pt will experience flu like symptoms. Typically resolves within a day or two. THIS IS NORMAL and happens b/c the bacteria when destroyed releases endotoxins. The endotoxins cause the ill side effects. |
| Natural penicillins = Na and K preps. What kind of Pt's will given this cautiously? | Renal disease Pt's or Pt's with heart problems. |
| Which type of penicillin is normally given to kids for ear infections? What is an adverse side effect from this drug? | ampicillin; can cause severe diarrhea |
| This type of penicillin enhances the drug effect to more types of organism and has sodium issues. Which penicillin am I describing? | Extended spectrum penicillins |
| This type of penicillin is uses original penicillin form = another form. What type am I referring to? | Penicillin/beta-lactamase inhibitor combos |
| Types of cephalosporins have four generations. Describe the 1st generation. | Gram = (favors more) and does not cross blood-brain barrier. |
| Describe 2 & 3 generation of cephalosporins. | do cross blood-brain barrier |
| Describe 4th generation cephalosporin | gram negative |
| What are the adverse effects of the aminoglycoside prototype: gentamicin (Garamycin)? | Nephrotoxicity, ototoxicity, and neurotoxicity: do NOT give to Pt's with MG or Parkinson's disease. |
| What is unique about the aminoglycoside: gentamicin (Garamycin)? | Effects can be reversed if meds are stopped promptly |
| What are the adverse effects of Fluoroquinolones: ciproflaxin (Cipro)? | Hepatotoxic, GI tract, Kidneys:Crystalluria- has the potential to re-crystalize in urine = tubule obstruction, Joint cartilage is an adverse effect to kids not adults so only give in risk-benefit situation |
| What is the number one nursing intervention for Crystalluria caused by Cipro (a fluoroquinolone)? | increase fluids |
| Since Cipro can cause crystalluria, and the normal pH of urine is acidic.... when do the crystals form best, is acidic or alkaline urine? | Alkaline |
| What are the adverse effects of tetracyclines prototype: Vibramycin? | Nephrotoxicity, hepatatoxicity, neutropenia, thrombocytopenia, and anemia will happen with LONG term therapy. Teeth, bones, and nails will be effected. |
| What happens if Vibramycin is given to an infant or child? | Teeth discoloration can occur-- may be permanent if child is 6 months and up |
| What happens if a pregnant woman in her 2nd trimester until the infant is 6 months of age if she takes Vibramycin? | Temporary teeth discoloration |
| What are some common things that Vibramycin interacts with? | Iron, antacids, and dairy products. |
| What are the adverse effects of Macolides prototype: erthromycin (E-Mycin)? | Liver and colon (severe diarrhea) is effected. |
| What does E-Mycin interact with causing harmful effects on the body. | Ca channel blockers --> cardiotoxicity, HIV blockers, and grape fruit juice |
| What are the three prototypes of sulfonamides? | sulfisoxizole (Gantrisin), trimethoprim, and sulfamethoxazole (Bactrim/Septra) |
| What are the adverse effects of the sulfonamides like Gantrisin, trimethoprim, and Bactrim/Septra? | Crystalluria- these crystals from in a more acidic urine, CNS: HA, depression, hearing an balance disturbances (8th cranial nerve), and drowsiness. |
| What can be given to Pt's using sulfonamides to prevent crystalluria? | Getting prescribed more alkali meds. |
| What is the anti-infective prototype: oxazolidinones (Zyvox) used for? | To treat MRSA/vancomycin resistant infections |
| Describe chloramphenicol (an anti-infective) | broad spectrum, very toxic, limited usefullness. Toxicity leading to:blood dyscrasias (altered blood substance like supressing), neurotoxic by cross blood-brain barrier, and Gray syndrome (gray ashy color in babies --> shock) |
| What is vancomycin (Vancocin) used to treat and what are it's adverse effects? | Used to treat MRSA. Adverse effects: neutropenia, nephrotoxicity, ototoxicity, and Red Man Syndrom (redness starting around neck and chest; NOT fatal: pre-medicate with benadryl, if occurs stop, and then slowly continue to give medication) |
| Describe teicoplanin (Targocid) | it's an anti-infective, for VRE, has no major side/adverse effects |
| What type of bacteria is metronidazole (Flagyl) used for? | anaerobic bacteria |
| Describe methenamine mandelate (Mandelamine) | It's a urinary agent/antiseptic/sulonamide-- for current, re-current infections. For effectiveness urine pH must be less than 5.5 |
| Describe phenazopyridine (Pyridium) | Urinary agent/analgesic- produces bright redish-orange color in urine (have to take with an antibiotic to be effective, can color contact lens as well; will only treat symptoms) |
| What are the primary adverse effects of TB drugs? | hepatotoxicity, and NEUROtoxicity |
| Describe if TB were to be treated with one, what would happen in order to make this drug effective? | The dose would need to be increased |
| What poses a Pt at risk who is on more than one TB drug? | The risk for adverse effects increase since more than one drug is being adminsitered. |
| Describe isoniazid (INH, Laniazid) | Primary TB drug used in combo for active TB; alone for prevention. |
| What are the side effects of(INH, Laniazid)? | Increased risk of hepatoxicity if taken w/ alcohol or other hepatotoxic drugs. Risk of hypertensive crisis w/ sympathomimetics and food containing tyramine. CNS side effects include depression, convulsions, & confusion. |
| What prevents neurologic effects with isoniazid (INH, Laniazid)? | Vitamin B6 |
| What types of food contain tyramine? The drugs causes a risk of hypertensive crisis when taken with sympathomimetics or tyramine containing foods? | Wine, cheese, and sausage contain tyramine. The TB drug isoniazid (INH, Laniazid) can cause hypertensive crisis. |
| Since acetylators effect isoniazid (INH, Laniazid) a TB drug, what happens if the acetylators are rapid or slow and what effect does it give with the drug? | Rapid acetylators = increased hepatotoxicitySlow acetylators = increased neuropathy |
| What does acetylator refer to? | Metabolism of the drug |
| Describe rifampin (Rifadin); rifapentine (1/2 wk dosing); Rifamate = INH + rifampin | Primary TB drug. Can suppress blood cell production which can lead to anemia and decreased blood cells. Imparts red color to body fluids including soft contact lenses. |
| Describe ethambutol? | Primary TB drug. Dosage is based on weight. CNS adverse effects. |
| Describe streptomycin | primary TB drug. Is NOT effective if used only against TB. Only effective when used in combination of other drugs. Can be discontinued when cultures are negative. |
| Describe pyrazinamide? | Primary TB drug. If allergic to INH may be allergic to this druga as well b/c of cross sensitivity. This drug increases uric acid. If Pt has gout they should NOT take this medication. |
| When are second line drugs used in place of primary TB drugs? | If the Pt cannot take the primary drugs and/or if the TB organism is resistant against all primary drugs. |
| What are the MDR (Multi drug resistant)-TB drugs? | amikacin, kanamycin, ciproflaxin, and levoflaxin. Requires concurrent administration or 4-6 drugs for long periods of time (2 yrs or longer) |
| What are the drugs recommended by the CDC to use against TB? Describe the course of drug therapy. | INH, rifampin, pyrazinamide, streptomycin or ethambutol. Take for 6 months or 3 months AFTER cultures are negative. |
| what are XDR-TB drugs and how long is treatment? | Extreme drug resistant. Treatment is two times as long, requires hospitalization, and the use of IV drugs. |
| Describe antiviral drugs | primarily effective in releiving symptoms or slowing progress |
| Describe amantadine (Symmetrel) | Antiviral drug; used to treat influenze A (crosses blood-brain barrier), Adverse effects: orthostatic hypotension, constipation, HF, confustion, insomnia, and leukocytopenia (decreased WBC's). Must begin taking w/in 48 hrs of onset of flu symptoms |
| Describe acyclovir (Zovirax)aka Valtrex | Antiviral drug; decreases frequency and severity of outbreak of herpes simplex. Adverse effects: blood dyscrasias. High doses can be nephrotoxic. Pt should start taking when symptoms occur,avoid intercouse when lesions present,use protection other times. |
| Describe ribavirin (Viraosle) | Antiviral; tx's RSV infants & young children; tx's chronic hepatitis C. PO/inhalation route. Effects:cardiac arrest, hypotension, anemia. Can't use aerosal if on vent. Increases resp distress w/ aerosol.Avoid pregnancy 6 mons after tx = teratogenicity |
| What are the therapeutic goals of antiretrovirals? | Slow the progression of HIV infection and prevent HIV after exposure |
| T/F? Antiretrovirals that work against HIV are not curative but suppress the growth of HIV. | TRUE |
| Describe the NRTI: Zidovudine (Retrovir) | antiretroviral; can cause seizures, anemia, granulocytopenia (suppresses blood cells), dizziness, & fainting. Has many drug-drug interactions. Consult Dr before taking other meds including OTC. |
| Describe the NRTI: tenofovir (Viread) | Antiretroviral; used for HIV and hep B. AE: 1st dose hypotension (give @ bedtime to prevent), dysrhythmias, & bronchospasm. |
| Describe the NNRTI: Delaviridine (Rescriptor) | antiretroviral; may increase liver enzymes; faster metabolism of other drugs = those other drugs will have decreased therapeutic levels. |
| Describe the protease inhibitor Indinavir (Crixivan). | antiretroviral; can cause kidney stones (drink atleast 1500 mL fluid daily), hyperglycemia may occur, take safety precautions if drowsy, do NOT take close to high-fat, high-protein meals. |
| What is the proper assessment for HIV infection? | Assess baseline data: vitals, weight/nutritional status, S&S of disease, and lab tests. |
| What are some antiretroviral education a nurse should teach a Pt? | Take meds in even intervals, do NOT dbl up, drug interactions (tylenol, aspirin, milk of mg), transmission still possible, keep up with follow up appts. |
| describe amphotercin B (Fungizone) | Tx of systemic infection, antifungal, premedicate with meperidine (demerol)-will eliminate shaking, corticosteriods, & aspirin as ordered. Monitor renal function b/c it can cause renal damage! AE: chills, fever, muscle/joint pain, n/v, K & Mg depletion. |
| describe Nystatin (Mycostatin) | antifungal; treats local infection like vaginal yeast candidiasis and thrush; rare adverse effect but if so skin rash. D/C if dysrthymias occur, can get superinfection if taken with antibiotics. |
Created by:
jalvarez1210
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