PharmTest1

Question 1

Penicillin-G

Answer 1

-Narrow Spectrum ABT - B Lactam

TX: PNA/URI Contraindications: Renal patient, pregnant, lactating

Adverse RX: allergy, N&V, Diarrhea, super infections

Interactions: Beta Blockers (increase anaphylaxis) Contraceptives

Nursing Implications: Watch for loose stools, keep epi-pen ready, watch BUN/Creat, keep refrigerated, C&S before administration

Question 2

Is Penicillin G appropriate for a pregnant woman

Answer 2

No. What’s wrong with you? Preg Cat. C

Question 3

Penicillin G ________ may be given IV

Answer 3

Aqueous. Other forms lead to cardiac arrest

Question 4

Cefazolin

Answer 4

Cefazolin (Ancef, Kefzol)

Treats skin, bone, GI, GU infections. Pre-op Prophylaxis

Contraindications: Use caution with PCN allergies due to cross sensitivities

Adverse effects: GI issues, Pseudomembranous Colitis, nephrotoxicities, superinfection

Nursing: Stop alcohol usage, including OTC medications

Question 5

“Disulfram” reaction

Answer 5

A response brought on by alcohol usage with some medications -

• N/V
• Chest pain/palpitations
• SOB,
• respiratory depression
• Flushing of the skin,
• diaphoresis
• confusion
• Cephalosporins/Cefazolin

Question 6

Vancomycin

Answer 6

-Only drug in class -

Toxic -

Effective on Gram (+) infections -Oral form is effective on Pseudomembranous colitis, Septicemia, endocarditis, bone and joint infections -

Contraindications: Pregnancy, hypersensitivity -

Adverse Effects: Ototoxicity, Nephrotoxicity, Red man syndrome -

Drug interactions: Statins

Question 7

Red Man Syndrome

Answer 7

S/e of running Vancomycin too fast.

Excess histamine release:

• flushing of head and neck,
• hypotension,
• diaphoresis,
• vascular collapse.

SLOW DOWN INFUSION

Question 8

Is Vanco appropriate for pregnancy?

Answer 8

Nope.

Question 9

Gentamycin

Answer 9

-Amninoglycoside -

Bactericidal, inhibits protein synth Tx: serious infections, Pelvic inflammatory disease, surgical prophylaxis

Adverse Rx: nephrotoxicity, “all of the penia’s”, apnea, ototoxicity

Black Box warnings: do not give with any medication which is also ototoxic, or nephrotoxic

NEUROTOXIC, NEPHROTOXIC, OTOTOXIC, NO BABIES

Question 10

Ototoxic Medications causing hearing issues

Answer 10

Gentamycin,

Vancomycin,

MY FUCKING EARS

Question 11

Clindamycin

Answer 11

• Gram - and gram +
• NO BABIES

**Adverse rx- **C-diff (fatal)

**Nursing implications- **give with food

Question 12

Erythromycin

Answer 12

Tx: PID (gonorrhoeae), Legionnaires disease, Chlamydia, Pertussis

Incompatible with dextrose IV solutions.

Adverse Reactions: arrhythmia, pseudomembranous colitis, anaphylaxis Interactions: Increases serum levels of many medications. NO GRAPEFRUIT

Nursing considerations: monitor hepatic function, overgrowth of other bacteria and fungi

Question 13

Tetracycline

Answer 13

Tx: Gonorrhea, syphilis, acne (topical), Helicopacter pyloir

Adverse Reactions: “all of the penia’s”, tooth discoloration in young children, superinfection of other bacteria, N/V/D, photosensitivity, and rash, Candida

Interactions: antacids/laxatives/antidiarrheals/iron (reduce abt absorption) Digoxin (monitor for dig toxicicty), NO MILK.

DISCOLORS TEETH. BINDS TO CALCIUM

Question 14

Drinking milk on the beach is to be avoided with:

Answer 14

Tetracycline.

Question 15

Grapefruit is to be avoided with:

Answer 15

Erythromycin

Question 16

Expired ______ is toxic

Answer 16

Tetracycline

Question 17

Chloramphenicol

Answer 17

**Class: **Man made ABT

Broad spectrum abt- harsh abt

Influenza, brain abcesses, acute typhoid fever

Adverse Effects (AE): HA, N/V/D Blindness, HA, anemias due to bone marrow suppression

Bacterostatic/bacterocidal

Decreases clearance of many drugs, and many drugs decrease its clearance. Use caution.

PEAK AND TROUGH

GRAY BABY SYNDROME

Question 18

Gray Baby Syndrome

Answer 18

• Vomiting
• Ashen gray color of the skin
• Limp body tone
• Hypotension (low blood pressure)
• Cyanosis blue discolouration of lips and skin.
• Hypothermia
• Cardiovascular collapse

CHLORAMPHENICOL

Question 19

Ciprofloxacin

Answer 19

(Cipro)

**Classification: **Quinolones/ Fluoroquinolones

**Use: **Bone, joint, URI, skin, UTI, ANTHRAX, PLAGUE, Aerobic only

**Contraindications: **Younger than 18, Pregnancy

**Adverse Reactions: **Seizure, SJS, TENS, “Penia’s” Cdiff, Tendon rupture

**Interactions: **antacids, iron, Steroids

**Nursing: **Monitor for crystaluria, rash

Question 20

Can cipro be given to pregnant women

Answer 20

No

Pregnancy Category C

Question 21

UA is required before treatment, for

Answer 21

• Pregnant women
• women over the age of 55
• Men
• Patients with reoccuring symptoms

Question 22

SMZ-TMP

Suflamethoxazole-Trimethoprim

Answer 22

(Bactrim/Septra/Sulfatrim)

Classification: Sulfonomide

Use: Ear infx, URI, PNA, Shigellosis

Contraindications: Sensitivites, Pregnancy, infants yonguer than 2m, Hepatic injury

Adverse Reactions: Seizures, CDiff, N/v/d, “Penias” rashes

Interactions: Increases concentrations of dig, coumadin, dilantin,

Nursing: Double check dosage, Renal and liver test, excess caution in patients with HIV. Increase fluids

Question 23

Is Bactrim DS appropriate for pregnant women?

Answer 23

Nope, not for late term

Question 24

INH

Answer 24

(Isoniazide)

Use: Treatment or prevention of TB,

Contraindications: Liver patient

Adverse Reactions:Hepatoxoxicity, Peripheral neuropathy, encephalopathy

Interactions: Seizure meds, ETOH, antacids, benzos, disulfram, tordolol, coumadin

Nursing: Monitor s/s liver damage, very toxic, NO BOOZE

Question 25

When undergoing tx for TB, what should patient avoid?

Answer 25

Alcohol, fish, cheese, beer, chocolate

Question 26

Rimfampin

Answer 26

Use: FDA approved: TB, mengiococcal infx

Offlabel: Leprosy, MRSA, osteomylitis

Contraindications: Hypersensitive, hepatic issues

Adverse Reactions: Discolored urine, sweat, saliva, N/V/D

Interactions: Increases EXCRETION of other drugs

Nursing: Monitor hep function, oral contraceptives, Give Rimfampin over 3 hours

EMPTY STOMACH

Question 27

Can Rifampin be given to pregnant women

Answer 27

Only if benefits outweigh risk. Monitor closely.

Question 28

Amphotericin B

Answer 28

“Amphoterrible”

Use: Tretment of systemic, life threatening, fungal or protazoal infections

Contraindications: Anemia, HYPOCALCEMIA/MAGNESIA, VERY NEPHROTOXIC

Adverse Reactions:Hundreds. Chills, fever, HA, hypotension, v-fib

Interactions: Antinoplastic agents, cyclosporine, aminogycloosides

Nursing: Monitor s/s liver damage, very toxic

Question 29

Diflucan

Answer 29

(Fluconazole)

Overview:

Used to treat candidiasis and prophylaxis for fungal diseases in immunocompromised patients.

Used for candidiasis and cryptococcal meningitis

Widely distributed,

Contraindications/Precautions:

No absolute contraindications exist to fluconazole.

Adverse Effects (AE):

Diarrhea, nausea, vomiting, abdominal pain, headache, rash, and dizziness Alopecia, Most serious AE: Stevens-Johnson syndrome

Drug Interactions:

Many drug–drug interactions are possible due to P-450 system

Teratogenic effects with higher doses in animal studies

Question 30

Chloroquine

Answer 30

Therapeutic Class: Anti-Infective

Pharm. Class: Antimalarial

Action: Interferes w/ DNA & protein synthesis

Overview: Used primarily for malaria: secondarily for amebiasis, rheumatoid arthritis, and lupus

Contraindications/Precautions: Hypersensitivity, pre-existing eye disease Adverse Effects (AE):

Common- EKG changes, n&v, abd pain, hypotension

Serious- vision hearing issues, toxicity occurs quickly- arrest, retinopathy and aplastic anemia

Prophylactic Tx mostly – 1/week beginning 2 weeks before trip, and continue 4-6 weeks after. Stop too soon and could develop malaria.
Mosquitoes carry virus, also could get from contaminated blood.H -

Chloroquine - blurred vision, retinopathy, GI upset, headaches, hair loss, can’t take with Alcohol, can’t take if lack G6P6 enzyme (some Middle Easterns), makes urine/sweat/tears red-brown.

Question 31

Acyclovir

Answer 31

Overview:

Used for the management of herpes simplex virus, herpes zoster virus, Epstein-Barr virus, and cytomegalovirus

Drug treats the symptoms it is not a cure

Tx- Herpes viruses/Epstein-Barr/CMV/Varicella

70% excreted unchanged in urine

Contraindications/Precautions:

Hypersensitive and elderly (renal issues), cross-sensitivity to ganciclovir

Adverse Effects (AE):

Often well tolerated

Common AE- light-headed, N&V, anorexia, abd pain, HA

Serious AE- confusion, tremors, seizure, coma, renal dysfunction

Drug Interactions:

Theophylline’s and probenecid (less renal excretion thus more acyclovir in blood- more AE from acyclovir)

Nursing Implications/Patient Education:

Advise the patient to drink at least 8-oz glasses of water a day.

Administer IV acyclovir over 60 minutes.

Acyclovir treats the symptoms of the disease

Emphasize that acyclovir does not prevent the transmission of infection to another person and does not cure the infection.

Maximizing therapeutic effects:

Admin the drug at regular intervals

Minimizing AE:

Ensure hydration to avoid nephrotoxicity

Anti-virals are for Non-HIV viruses.
Agents act against a narrow spectrum of viruses, & hence their utility is limited to a few types of infections
Development of anti-virals is new. About 20 available in the US.
Herpes Simplex and Varicella Zoster (Shingles)
Routes: IV, oral and topical forms
Hand washing after topical applications
AE seizures
Patients with renal impairment need to stay hydrated
Nephrotoxicity and CNS toxicity.
Patient educ: Acyclovir treats the symptoms of the disease, it does not cure the disease or prevent transmission.

Question 32

Zidovudine

Answer 32

(Retrovir)

**Class: **Antiretroviral

**Treats: **HIV, along with a coctail of other drugs. Also used to prevent HIV from passing from mother to infant

Considerations: Take on empty stomach with fluids, sitting up. Take on a rigid schedule. May lead to liver and bone marrow damage

Adverse Rx: Lactic acidosis, seizures, gum bleeding, pancreatitis, penias.

Question 33

Use backup birth control with:

Answer 33

Ciprofloxacin

Question 34

You should do what to prevent the primary complication of Acyclovir?

Answer 34

HYDRATE to avoid Kidney damage

Question 35

Ciprofloxacin is appropriate for Gram _____ organisms

Answer 35

Negative

Question 36

Ciprofloxacin’s greatest adverse reaction is

Answer 36

Tendinitis and tendon rupture

Question 37

C-Diff is a serious complication of -

Answer 37

Erythromycin

Clindomycin

Erythromycin

Question 38

Give ________ 2 hours before or after Penicillin

Answer 38

Gentamycin

Question 39

_______ Should be administered cautiously in patients over the age of 35, due to risk of ______ injury

Answer 39

Isoniazid, Liver

Question 40

If patient is on MetoproLOL, you would question which order?

Answer 40

Penicillin

Question 41

When administering Penicillin, and this other antibiotic, give them at least two hours apart

_____________

Answer 41

Gentamycin and Penicillin should not be given together

Question 42

People allergic to PCN should also avoid

Answer 42

Cephalosporins

• Cefazolin
• Keflex

Imipenem