Chapter 39: Antibiotics Part 2 pg 633

Question 1

multidrug-resistant organisms include….

Answer 1

MRSA,
VRE, (found in UTI)
and ESBL-
and KPC-producing organisms

Question 2

minimum
inhibitory concentration (MIC)

Answer 2

is a measure of the lowest concentration of drug needed to

kill a certain standard amount of bacteria.

Question 3

time-dependent killing

Answer 3

the amount of
time the drug is above the MIC is critical for maximal bacterial
kill.

Question 4

concentration-

dependent killing;

Answer 4

achieving a drug plasma
concentration that is a certain level above the MIC, even for
a brief period of time, results in the most effective bacterial
kill

Question 5

trough (lowest) levels are

Answer 5

routinely measured
to ensure adequate renal clearance of the drug and avoid
toxicity

Question 6

Samples for measurement

of peak levels and trough

Answer 6

peak levels are drawn 30 minutes after a 30-minute
infusion, and samples for measurement of trough levels are
drawn just before the next dose

Question 7

postantibiotic effect.

Answer 7

This is a period of
continued bacterial growth suppression that occurs after shortterm
antibiotic exposure, as in once-daily aminoglycoside dosing

Question 8

Aminoglycosides are never used alone

Answer 8

to treat gram-positive

infections.

Question 9

Aminoglycosides are inactive against

Answer 9

fungi, viruses, and most

anaerobic bacteria.

Question 10

Aminoglycosides are very potent antibiotics and are capable of

Answer 10

potentially serious toxicities, especially to the kidneys (nephrotoxicity)
and to the ears (ototoxicity), in which they can affect
hearing and balance functions

Question 11

Currently available aminoglycosides include

Answer 11

amikacin,

gentamicin, kanamycin, neomycin, streptomycin, and tobramycin.

Question 12

Neomycin is most commonly used for bacterial decontamination

of the GI tract

Answer 12

In hepatic encephalopathy, the
drug helps reduce the number of ammonia-producing bacteria
in the GI tract.

Question 13

Currently
available quinolone (fluoroquinolones) antibiotics include

Answer 13

include norfloxacin, ciprofloxacin,

levofloxacin, and moxifloxacin.

Question 14

black box warning

Answer 14

increased risk

of tendinitis and tendon rupture

Question 15

several drugs that interact with quinolones

Answer 15

antacids, calcium, magnesium,
iron, zinc preparations or sucralfate causes a reduction
in the oral absorption of the quinolone. Patients need to
take the interacting drugs at least 1 hour before or after taking
quinolones.

Question 16

red man syndrome

Answer 16

characterized by flushing

and/or itching of the head, face, neck, and upper trunk area

Question 17

Daptomycin (Cubicin

Answer 17

lipopeptides. Its mechanism of action is not completely
known, but it binds to gram-positive cells in a calcium-dependent
process and disrupts the cell membrane potential

Question 18

Colistimethate (Coly-Mycin) is a polypeptide antibiotic

Answer 18

often as one of the only drugs available to

treat KPC.

Question 19

Diagnostic and

laboratory studies that may be ordered include the following:

Answer 19

(1) AST and ALT levels for assessing liver function; (2)
urinalysis, BUN, and serum creatinine levels for assessing
renal function; (3) ECG, echocardiography, ultrasonography,
and/or cardiac enzyme levels for assessing cardiac
function; (4) culture and sensitivity of infected tissue or
blood samples for assessing sensitivity of the bacteria to the
antibiotic; and (5) white blood cell (WBC) count, hemoglobin
level, hematocrit, RBC count, platelet count, and clotting
values for baseline blood count levels.

Question 20

aminoglycosides, assess for

Answer 20

hypersensitivity and
preexisting conditions.
known for their ototoxicity and
nephrotoxicity
perform
baseline hearing tests and assessment of vestibular function

Question 21

linezolid

Answer 21

possible serotonin syndrome
assess for intake of tyraminecontaining
foods (e.g., aged cheese or wine, soy sauce, and
smoked fish or meat) because of the risk of elevated blood
pressure.

Question 22

Dosing is adjusted based on estimates

of creatinine clearance calculated

Answer 22

to monitor patient’s renal function and thus helps to prevent toxicity.

Question 23

Keep in

mind the following special considerations for gentamicin

Answer 23

(1) Intramuscular: Give deeply and slowly into muscle mass
(ventrogluteal) to minimize discomfort; and (2) Intravenous:
Check for incompatibilities with other drugs, and give
only clear or very slightly yellow solutions that have been
diluted with either normal saline (NS) or D5W, infusing at
the correct rate.

Question 24

Quinolones,

Answer 24

not to take these medications
with antacids, iron, zinc preparations, multivitamins, or sucralfate
because the absorption of the antibiotic will be decreased

take calcium or mag meds 1 hour before or after

Question 25

clindamycin topical forms

Answer 25

advise patients to avoid the
simultaneous use of peeling or abrasive acne products, soaps,
or alcohol-containing cosmetics to prevent cumulative effects;
however, some products combine clindamycin with anti-acne
medications (e.g., Acayna)

Question 26

Linezolid take with….

and avoid….

Answer 26

given with food or milk

Foods
that may increase blood pressure aged cheeses, wine, soy sauce,
smoked meats or fish, and sauerkraut due to their tyramine
content

Question 27

Nitrofurantoin

Answer 27

given
with plenty of fluids, food, or milk to decrease GI upset. Do
not crush tablets to help prevent tooth staining and GI upset

superinfection, hepatotoxicity and peropheral neuropathy

Question 28

The nurse will question the use of a floroquinolone antibiotic in a patient already prescribed which medication?

Answer 28

amidarone

Dangerous cardiac dysrhythmias are more likely to occur when quinolones are taken by patients receiving class IA and class III antiarrhythmic drugs such as disopyramide and amiodarone. For this reason, such drug combinations should be avoided.

Question 29

When planning care for a patient receiving once-daily intravenous gentamicin therapy, the nurse schedules a trough drug level to be drawn

Answer 29

Trough serum drug levels should be drawn at least 8 to 12 hours after the medication is infused.

Question 30

A patient is prescribed metronidazole (Flagyl) for a gynecologic infection, and she provides a list of medications she takes routinely to the nurse. Which medication would lead the nurse to question the order for Flagyl?

Answer 30

Flagyl is known to cause and increase in neurologic-associated medications and specifically can lead to lithium toxicity. A patient who reports taking lithium should be a red flag for the nurse to alert the provider due to the potential significant interaction.

Question 31

Quinolones are a class of antibiotics known for several significant complications

Answer 31

Quinolones are not used in prepubescent children due to the risk of cartilage development issues. Quinolones may also cause a cardiac effect that involves prolongation of the QT interval on the electrocardiogram. The use of these medications can result in tendonitis or rupture tendons in adults. Nephrotoxicity and ototoxicity are not associated with quinolones.