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ANCC Review > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

Penicillins

A

Amoxicillin, dicloxacillin, penicillin, amoxicillin/clavulanate (augmentin)

  • Tolerated well in pregnancy
  • Infant safe
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2
Q

Amoxicillin

A
  • pneumonia
  • otitis media
  • syphilis (PCN-G IM)
  • Group A strep throat
  • sinusitis
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3
Q

Dicloxacillin

A
  • Mastitis
  • second line for mastitis is clindamycin or other macrolide (‘-mycin)
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4
Q

Sulfonamides

A
  • These drugs have “sulfa” in them
  • Most commonly used is: trimethoprim/ sulfamethoxazole (Bactrim)
  • Can also be used for
  • Urinary Tract Infections
  • Purulent Cellulitis (BCD)
  • PJP prophylaxis in AIDS patients
    Below the waist skin complaints

Drug Interactions:

Warfarin (increases INR)
Astemizole (Hismanal)

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5
Q

ONE BIG safety concern for Sulfonamides

A

Stevens-Johnson Syndrome
A notorious reaction that people can have when they take sulfonamide antibiotics, but can also occur with other medications too
* Starts with flu-like symptoms
* Then a painful, bleeding, peeling rash erupts on the entire body
* THIS IS A MEDICAL EMERGENCY!!!

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6
Q

Cephalosporins

A
  • Contains “ceph-“ or “cef-“ in the name
  • cephalexin (Keflex)
  • Pregnancy safe
  • These are okay to use if the patient has a PCN allergy if it was NOT an anaphylactic reaction.
  • Used for:
  • Skin complaints
  • Post-operative wounds
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7
Q

Fluoroquinolones

A

“-floxacin”
* Respiratory Fluoroquinolone
* levofloxacin (Levaquin)
* This is used in patients with pneumonia if they have respiratory co-morbidities or recent antibiotic use!

Other Fluoroquinolones
* ciprofloxacin (Cipro)
* Urinary Tract Infections
* Diverticulitis
. Travelers Diarrhea
box warning - achilles tendon rupture

Contraindications:
Children (<18 years of age)
Myasthenia gravis
Pregnancy, breastfeeding
Elderly
History of cardiovascular disease, aneurysm, and hypertension

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8
Q

Black Box warning for Fluoroquinolone’s (“-floxacin”)

A

Achilles Tendon Rupture

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9
Q

Tetracyclines

A
  • Ending in “-cycline”
  • Side effects that can be seen
  • Nausea
  • Vomiting
  • Diarrhea
  • Try to avoid in pregnancy..
    except In…
  • Rocky Mountain Spotted
    Fever and Lyme Disease

Uses:
Rocky Mountain Spotted Fever
Lyme Disease
Purulent Cellulitis (BCD)
Pneumonia (if criteria met)

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10
Q

Vancomycin (Vancocin)

A

Used for serious infections
Risk for nephron and otoxicity
“Red Man Syndrome” can occue

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11
Q

Nitrofurantoin (Macrobid)

A

UTI

-and prevention of UTI for chronic

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12
Q

Clindamycin (Cleocin)

A

Used for serious infections:
* Purulent Cellulitis
* (BCD)
High risk for superinfection
* C.Diff
2nd line option for Mastitis
**Hidradenitis suppurativa

Clindamycin is a lincosamide

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13
Q

Metronidazole (Flagyl)

A

Used for:
* Trich
* BV
* H.Pylori

SE: GI upset, metallic taste, avoid taking w/alcohol

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14
Q

Rifampin (Rifadin)

A

Used for:
* TB
* Bacterial meningitis

SE: turns excretions RED
* Need to monitor LFT’s

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15
Q

Sinusitis

A

AUGust Colds

Augmentin or Cephlasporins

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16
Q

Strep Throat

A
  • Strip in the PM
  • Penicillins or Macrolides (“-mycin”)
17
Q

Purulent Cellulitis

A

MRS “A” -BCD

Usually caused by MRSA
* Bactrim
* Clindamycin
* Doxycycline

18
Q

Dog/Cat Bites

A

Dog bitten = Augmentin

How long after a dog/cat bite do we suture? WE DON’T!
NEVER suture a dog bite.

19
Q

Pregnancy safe Antibiotics

A

CAMP
* Cephalosporins
* Amoxicillin
* Macrolides/Macrobid
* Penicillins

20
Q

Pneumonia

A

MAD Lung MA!

MAD- (no resp. comorbidities or recent antibiotic use)
* Macrolides
* Amoxicillin
* Doxycycline

Lung (recent antibiotic use or resp. comorbidity)
Levofloxacin

Macrolide + Augmentin

21
Q

H.Pylori

A

CAP
Treat My Belly Pain

Triple therapy: (CAP)
-Clarithromycin +. Amoxil + PPI
(can use Mertonidazoldek (flagyl) if allergic to -cillins)

Quadruple therapy: (Treat My Belly Pain)
-Tetracycline + Metronidazoldek + Bismuth Salt + PPI

typically presents:

related to gastritis or a peptic ulcer and may include:
-An ache or burning pain in your stomach (abdomen)
-Stomach pain that may be worse when your stomach is empty.

22
Q

STI Antibiotics

A
  • Cuties All Get Cooties To be Freaky, Sneaky, and Playful
  • Chlamydia=Azithromycin
  • Gonorrhea=Ceftriaxone
  • Trich =Flagyl
  • Syphilis = Penicillin G
23
Q

Otitis Externa

A

Ofloxacin drops (can also add cortisporin drops

24
Q

A 24-year-old female patient presents to the clinic reporting purulent, green, frothy vaginal discharge. Upon further assessment, the nurse practitioner obtains a vaginal swab and visualizes flagella under the microscope. The nurse practitioner knows to treat this condition with which of the following antibiotics?

A
  • Metronidazole (Flagyl)
    Rationale: The correct answer is metronidazole (Flagyl). The nurse practitioner is aware that seeing flagella under the microscope is indicative of trichomoniasis, which is treated with metronidazole (Flagyl). Penicillin G (Bicillin) is used to treat Syphilis, ceftriaxone (Rocephin) is used to treat gonorrhea, and azithromycin (Zithromax) is used to treat chlamydia
25
Q

A 26-year-old female patient presents to the clinic for her four week postpartum visit. The patient reports a painful and tender right breast. Upon further assessment, the nurse practitioner palpates a warm and boggy breast and diagnoses the patient with mastitis. The patient has a history of an anaphylactic reaction to penicillin. Which of the following would be the best option to treat her mastitis?

Dicloxacillin (Diclocil)
Clindamycin (Cleocin)
Sulfamethoxazole-trimethoprim (Bactrim) doxycycline (Vibramycin)

A
  • clindamycin (Cleocin)
    Rationale: The correct answer is clindamycin (Cleocin). The patient reported a severe penicillin allergy, and dicloxacillin (Diclocil) is a penicillin-based medication. Clindamycin (Cleocin) is a great second-line option for mastitis as it is safe for both the breastfeeding mother and her newborn child. Caution is warranted here due to the risk of GI superinfection with Clostridium difficile, so the patient should be educated to report any new signs and symptoms of diarrhea to the provider immediately. Sulfamethoxazole-trimethoprim (Bactrim) should only be used if MRSA is suspected or confirmed, and doxycycline (Vibramycin) is not indicated in the treatment of mastitis.
26
Q

A patient has been diagnosed with tuberculosis and will need to be on rifampin (Rifadin) for 9 months. Which of the following lab tests should be obtained routinely while the patient is taking this medication?

A
  • Liver function tests
    Rationale: The correct answer is liver function tests. Rifampin is metabolized in the liver and is a drug that can be severely hepatotoxic. Patients on long-term rifampin (Rifadin) will need serial liver function panels. Rifampin (Rifadin) has no overall effect on amylase, lipase, glycosylated hemoglobin, or triglyceride levels.
27
Q

A 15-year-old female patient presents to the clinic with a classic presentation of strep throat. When the nurse practitioner prescribes the patient antibiotics, the patient states that penicillin makes her itchy. Which of the following medications would be the most appropriate alternative for this patient?

A
  • cephalexin (Keflex)
    Rationale: The correct answer is cephalexin (Keflex). The first-line drug treatment for strep throat related to group A streptococcus is penicillin or amoxicillin. However, since the patient reported an non-anaphylactic allergy to this medication class, an alternative medication from the cephalosporin drug class would be appropriate. Other alternative options include medications from the macrolide drug class, such as azithromycin and clarithromycin. Ciprofloxacin, doxycycline, and sulfamethoxazole/trimethoprim are not indicated in the treatment of group A strep.
28
Q

A middle-aged man calls into the clinic today stating that he recently started an antibiotic, and today he received a first degree sunburn while gardening for a couple of hours outside. Which of the following antibiotics is he likely taking based on this finding?

A
  • doxycycline (Vibramycin)
    Rationale: The correct answer is doxycycline (Vibramycin). Photosensitivity is a relatively common side effect of the tetracycline drug class. Photosensitivity signs and symptoms include manifestations such as sunburn and blistering. This side effect may last up to several months after cessation of tetracycline use so patient education is imperative. Penicillin, cephalosporin, and fluoroquinolone drug classes have no associated photosensitivity.
29
Q

Metronidazole (Flagyl) can be used to treat all of the following conditions except:

A
  • Erysipelas
    Rationale: The correct answer is erysipelas. Traditionally, erysipelas is treated with penicillin. If an allergy is present, then a first generation cephalosporin can be prescribed instead. Metronidazole (Flagyl) does not provide coverage for the typical bacterias that cause erysipelas and cellulitis, but would be indicated in the treatment of trichomoniasis, diverticulitis, and liver abscesses
30
Q

A 65-year-old female patient with a history of heart failure presents to the clinic with a new diagnosis of osteoarthritis in her right knee. She has been having difficulty managing the pain, and it is limiting her daily activities. Which of the following medications will be most appropriate for this patient?

acetaminophen
Diclofenac sodium
naproxen
indomethacin

A
  • acetaminophen (Tylenol)
    Rationale: the correct answer is acetaminophen (Tylenol). Diclofenac sodium, naproxen, and indomethacin are all NSAIDs. These medications should not be used in patients diagnosed with heart failure due to sodium and fluid retention which can further exacerbate the condition. Tylenol is not part of this drug class, and can be utilized to help manage the patient’s pain.
31
Q

Which of the following medications are considered first-line treatment for a patient diagnosed with rheumatoid arthritis?

A
  • methotrexate (Trexall)
    Rationale: the correct answer is methotrexate (Trexall). This is a part of the disease-modifying antirheumatic drug (DMARD) class. These medications can slow disease progression and help preserve joint function. DMARDs are typically prescribed only by rheumatologists, not by nurse practitioners working in primary care, and therefore patients needing these medications should be referred.
32
Q

A female patient is in the clinic for her annual follow up. She has a history of rheumatoid arthritis, but is otherwise healthy. She reports taking her methotrexate (Trexall) as prescribed by her rheumatologist. The nurse practitioner orders a CBC as a part of her annual lab work. Which of the following anemias is the nurse practitioner monitoring for, which can be common in those taking this particular medication?

folate
vitamin B12
iron
lead

A
  • Folic acid deficiency
    Rationale: The correct answer is a folic acid deficiency. As this medication can deplete folate levels, patients who take methotrexate (Trexall) should have their folate levels monitored and take a folate supplement. Methotrexate (Trexall) has no effect on vitamin B12, iron, or lead levels.
33
Q

conditions that DO NOT get antibiotics

A

BROnchitis
ALLergic rhinitis
Uveitis
mONOnucleosis (unless pertussis)

ALL ONO BRO’s- U dont need meds!”

34
Q

methotrexate (Trexall)

TX for?

Can cause?

A

RA

can cause Folic Acid anemia

this drug TREX them ALL- said the druggy in the ally. Great- he’ll prolly do acid next

35
Q

alternative antibiotics for penicillin-allergic patients

A

A good alternative antibiotic for these patients with gram-positive bacterial infections are:

*macrolides such as azithromycin × 5 days (Z-Pack) or
*clarithromycin (Biaxin) PO twice a day.
*Clindamycin (Cleocin) is also an alternative, but it is associated with slightly higher risk of C. difficile colitis.

*If age 18 years or older, quinolones with gram-positive activity (levofloxacin, gatifloxacin) are an option for some infections.

36
Q

If a patient has both mono and strep throat, avoid using _____ or _______. Instead, use _____ (if not allergic) or a macrolide to treat the patient.

A

Use Penicillin.

avoid using amoxicillin or ampicillin if a patient has mononucleosis, because of the risk of an amoxicillin “drug rash” that is not due to an allergy

37
Q

Of patients with true penicillin allergy, a small percentage (0.17%–8.4%) will also react to a

A

cephalosporin.

38
Q

Consider macrolide-resistant____________ if the patient was on a macrolide in the past 3 months

A

S. pneumoniae

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