24: Drugs used in treating infectious diseases

Question 1

1. Factors that place a patient at risk of developing an antimicrobial-resistant organism include:
2. Age over 50 years
3. School attendance
4. Travel within the U.S.
5. Inappropriate use of antimicrobials

Answer 1

4. Inappropriate use of antimicrobials

Question 2

2. Infants and young children are at higher risk of developing antibiotic-resistant infections due to:
3. Developmental differences in pharmacokinetics of the antibiotics in children
4. The fact that children this age are more likely to be in daycare and exposed to pathogens from other children
5. Parents of young children insisting on preventive antibiotics so they don’t miss work when their child is sick
6. Immunosuppression from the multiple vaccines they receive in the first 2 years of life

Answer 2

2. The fact that children this age are more likely to be in daycare and exposed to pathogens from other children

Question 3

3. Providers should use an antibiogram when prescribing. An antibiogram is:
4. The other name for the Centers for Disease Control guidelines for prescribing antibiotics
5. An algorithm used for prescribing antibiotics for certain infections
6. The reference also known as the Pink Book, published by the Centers for Disease Control
7. A chart of the local resistance patterns to antibiotics developed by laboratories

Answer 3

4. A chart of the local resistance patterns to antibiotics developed by laboratories

Question 4

4. There is often cross-sensitivity and cross-resistance between penicillins and cephalosporins because:
5. Renal excretion is similar in both classes of drugs.
6. When these drug classes are metabolized in the liver they both produce resistant enzymes.
7. Both drug classes contain a beta-lactam ring that is vulnerable to beta-lactamase-producing organisms.
8. There is not an issue with cross-resistance between the penicillins and cephalosporins.

Answer 4

3. Both drug classes contain a beta-lactam ring that is vulnerable to beta-lactamase-producing organisms.

Question 5

5. Jonathan has been diagnosed with strep throat and needs a prescription for an antibiotic. He says the last time he had penicillin he developed a red, blotchy rash. An appropriate antibiotic to prescribe would be:
6. Penicillin VK, because his rash does not sound like a serious rash
7. Amoxicillin
8. Cefadroxil (Duricef)
9. Azithromycin

Answer 5

4. Azithromycin

Question 6

6. Sarah is a 25-year-old female who is 8 weeks pregnant and has a urinary tract infection. What would be the appropriate antibiotic to prescribe for her?
7. Ciprofloxacin (Cipro)
8. Amoxicillin (Trimox)
9. Doxycycline
10. Trimethoprim-sulfamethoxazole (Septra)

Answer 6

2. Amoxicillin (Trimox)

Question 7

7. Pong-tai is a 12-month-old child who is being treated with amoxicillin for acute otitis media. His parents call the clinic and say he has developed diarrhea. The appropriate action would be to:
8. Advise the parents that some diarrhea is normal with amoxicillin and recommend probiotics daily.
9. Change the antibiotic to one that is less of a gastrointestinal irritant.
10. Order stool cultures for suspected viral pathogens not treated by the amoxicillin.
11. Recommend increased fluids and fiber in his diet.

Answer 7

1. Advise the parents that some diarrhea is normal with amoxicillin and recommend probiotics daily.

Question 8

8. Lauren is a 13-year-old child who comes to clinic with a 4-day history of cough, low-grade fever, and rhinorrhea. When she blows her nose or coughs the mucous is greenish-yellow. The appropriate antibiotic to prescribe would be:
9. Amoxicillin
10. Amoxicillin/clavulanate
11. TMP/SMZ (Septra)
12. None

Answer 8

4. None

Question 9

9. Joanna had a small ventricle septal defect (VSD) repaired when she was 3 years old and has no residual cardiac problems. She is now 28 and is requesting prophylactic antibiotics for an upcoming dental visit. The appropriate antibiotic to prescribe according to current American College of Cardiology and American Heart Association guidelines is:
10. None, no antibiotic is required for dental procedures
11. Amoxicillin 2 grams 1 hour before the procedure
12. Ampicillin 2 grams IM or IV 30 minutes before the procedure
13. Azithromycin 1 gram 1 hour before the procedure

Answer 9

1. None, no antibiotic is required for dental procedures

Question 10

10. To prevent further development of antibacterial resistance it is recommended that fluoroquinolones be reserved for treatment of:
11. Urinary tract infections in young women
12. Upper respiratory infections in adults
13. Skin and soft tissue infections in adults
14. Community-acquired pneumonia in patients with comorbidities

Answer 10

4. Community-acquired pneumonia in patients with comorbidities

Question 11

11. Fluoroquinolones have a Black Box Warning regarding ________ even months after treatment.
12. Renal dysfunction
13. Hepatic toxicity
14. Tendon rupture
15. Development of glaucoma

Answer 11

3. Tendon rupture

Question 12

12. Janet was recently treated with clindamycin for an infection. She calls the advice nurse because she is having frequent diarrhea that she thinks may have blood in it. What would be the appropriate care for her?
13. Encourage increased fluids and fiber.
14. Assess her for pseudomembranous colitis.
15. Advise her to eat yogurt daily to help restore her gut bacteria.
16. Start her on an antidiarrheal medication.

Answer 12

2. Assess her for pseudomembranous colitis.

Question 13

13. Keng has chronic hepatitis that has led to mildly impaired liver function. He has an infection that would be best treated by a macrolide. Which would be the best choice for a patient with liver dysfunction?
14. Azithromycin (Zithromax)
15. Clarithromycin (Biaxin)
16. Erythromycin (E-mycin)
17. None of the above

Answer 13

3. Erythromycin (E-mycin)

Question 14

14. Jamie has glucose-6-phosphate dehydrogenase deficiency (G6PD) and requires an antibiotic. Which class of antibiotics should be avoided in this patient?
15. Penicillins
16. Macrolides
17. Cephalosporins
18. Sulfonamides

Answer 14

4. Sulfonamides

Question 15

15. If a patient is allergic to sulfonamide antibiotics, he or she will most likely have cross-sensitivity to:
16. Loop diuretics
17. Sulfonylureas
18. Thiazide diuretics
19. All of the above

Answer 15

4. All of the above

Question 16

16. Tetracyclines such as minocycline are safe to use in:
17. Pregnant women
18. Adolescents
19. Patients with renal dysfunction
20. Patients with hepatic dysfunction

Answer 16

2. Adolescents

Question 17

17. Tetracyclines should not be prescribed to children younger than 8 years due to:
18. Risk of developing cartilage problems
19. Development of significant diarrhea
20. Risk of kernicterus
21. Adverse effects on bone growth

Answer 17

4. Adverse effects on bone growth

Question 18

18. Nicole is a 16-year-old female who is taking minocycline for acne. She comes to the clinic complaining of a headache. What would be the plan of care?
19. Advise acetaminophen or ibuprofen as needed for headaches.
20. Prescribe sumatriptan (Imitrex) to be taken at the onset of the headache.
21. Evaluate her for pseudotremor cerebri.
22. Assess her caffeine intake and sleep patterns.

Answer 18

3. Evaluate her for pseudotremor cerebri.

Question 19

19. Patricia has been prescribed doxycycline for a chlamydia infection. She is healthy and her only medication is an oral combined contraceptive. Patricia’s education would include:
20. Use a back-up method of birth control (condom) until her next menses.
21. Doxycycline may cause tendonitis and she should report any joint pain.
22. Her partner will need treatment if her infection doesn’t clear with the doxycycline.
23. Doxycycline is used for one-dose treatment of STIs; take the whole prescription at once.

Answer 19

1. Use a back-up method of birth control (condom) until her next menses.

Question 20

20. To prevent the development of peripheral neuropathy in patients taking isoniazid for tuberculosis the patient is also prescribed:
21. Niacin (vitamin B3)
22. Pyridoxine (vitamin B6)
23. Riboflavin (vitamin B2)
24. Thiamine (vitamin B1)

Answer 20

2. Pyridoxine (vitamin B6)

Question 21

21. Sadie is an 82-year-old patient who has herpes zoster (shingles) and would benefit from an antiviral such as valacyclovir. Prior to prescribing valacyclovir she will need an assessment of:
22. Complete blood count to rule out anemia
23. Liver function
24. Renal function
25. Immunocompetence

Answer 21

3. Renal function

Question 22

22. When prescribing acyclovir, patients should be educated regarding the:
23. High risk of developing diarrhea
24. Need to drink lots of fluids during treatment
25. Risk for life-threatening rash such as Stevens-Johnson
26. Eccentric dosing schedule

Answer 22

2. Need to drink lots of fluids during treatment

Question 23

23. Nicholas has been diagnosed with type A influenza. Appropriate prescribing of oseltamivir (Tamiflu) would include:
24. Starting oseltamivir within the first 48 hours of influenza symptoms
25. Advising the patient he can stop the oseltamivir when his symptoms resolve
26. Educating the patient that oseltamivir will cure influenza
27. Prophylactic treatment of all family members

Answer 23

1. Starting oseltamivir within the first 48 hours of influenza symptoms

Question 24

24. Monitoring for patients who are on long-term antifungal therapy with ketoconazole includes:
25. Platelet count
26. BUN and creatinine
27. White blood cell count
28. AST, ALT, alkaline phosphatase, and bilirubin

Answer 24

4. AST, ALT, alkaline phosphatase, and bilirubin

Question 25

25. When prescribing metronidazole (Flagyl) to treat bacterial vaginosis, patient education would include:
26. Metronidazole is safe in the first trimester of pregnancy.
27. Consuming alcohol in any form may cause a severe reaction.
28. Sexual partners need concurrent therapy.
29. Headaches are a sign of a serious adverse reaction and need immediate evaluation.

Answer 25

2. Consuming alcohol in any form may cause a severe reaction

Question 26

26. Every antibiotic drug class has resistant organisms that influence prescribing decisions.
27. True
28. False

Answer 26

1. True