Quiz: Antibiotics, Antifungals, Antivirals, and immune system drugs Flashcards
1
Q
Hematopoiesis
A
The formation and maturation of blood cells; this occurs in the bone marrow
2
Q
Hematopoietic stem cells differentiate to become:
A
- Erythrocytes (RBC)
- Leukocytes (WBC)
- Thrombocytes (platelets)
3
Q
Leukopenia
A
Low white blood cells
4
Q
Leukocytosis
A
High white blood cell count
5
Q
Thrombocytopenia
A
Low platelets - have bleeding problems
6
Q
Immunity
A
The ability to resist and fight infection
- Requires help from both WBCs and the lymphatic system
- Recognition, processing, and destruction of foriegn invaders
- Removal of damaged cells
- Protection against proliferation of abnormal or malignant cells
7
Q
Antigens
A
Foreign or “nonself” substances that trigger the immune system
8
Q
Active immunity
A
The immune system is stimulated to produce antibodies by a pathogen or its vaccine
Generates memory B cells
9
Q
Passive immunity
A
When antibodies are “transferred” or “donated” from one person to another
- Protection is short-lived (does not generate B cells)
- Maternal antibodies cross the placenta
- Gamma globulin given after exposure to hepatitis
- Sera to treat botulism, tetanus, and rabies
- Anti-venom for snake pite
10
Q
Immunomodulator
A
- A general term referring to any drug or therapy that affects body defenses
- Some are used to stimulate body defenses so that microbes or cancer cells can be attacked (immunostimulant)
- Some are used to suppress body defences to prevent organ transplant regection or treat autoimmune diseases (immunosuppressant)
11
Q
Vaccination/immunization
A
The injection of a killed or weakened organism that produced immunity against that organism
12
Q
Booster
A
Follow-up vaccination to provide sustained protection
Vaccines that do not maintain life immunity need a “boost”
13
Q
Titer
A
The amount of antibody detected after the vaccine has been administered; shows if you have the antibody response (or not)
If it is below a certain level, a booster is needed
14
Q
Attenuated (live) vaccines
A
Microbes are alive but weakened so that they are unable to produce the disease (unless patient is immunocompromised)
- Can sometimes cause subclinical symptoms
- Examples: measles, mumps, rubella vaccines, oral polio, varicella
15
Q
Inactivated (killed) vaccines
A
Microbes are unable to replicate or cause disease
- Examples: influenza, hepatitis A vaccine
- Symptoms are the body building up the antibody response, not you getting sick
- Your system does get a little weaker while building antibody response an can make you more susceptible to fight off other infections
16
Q
Toxoid
A
Contains bacterial toxins that have been chemically modified to be incapable of causing disease
- Examples: diptheria, tetanus toxoid
- Toxoid comes from the bacteria and the immune system builds up a response to that toxin
- Typically needs a booster
17
Q
Recombinant
A
Contains partial viral subunits or bacterial proteins that are generated in a lab using biotechnology
- Example: heptatis B vaccine
18
Q
Common adverse effects of vaccinations
A
Discomfort and redness at site, aches, fever
19
Q
Contrainidcations of vaccines
A
- Illness
- Immune system is already working hard to build antibodies and will not be able to make additional antibodies for influenza
- Need to be fever free for 24 hours
- Pregnancy (depends on vaccination)
- Immunocompromised clients should not receive live vaccines
- Includes patients receiving systemic steroids (not able to build up antibody response)
- Bone marrow transplants after they are destabilized typically need to get re-immunized afterward
20
Q
Biologic Response Modifiers
A
- Cytokines secreted in response to antigens
- Chemical mediators
- Associated with immflammation and wound healing
- Stimulate (boost) the immune system to work more effectively
- Can be produced in lab by recombinant DNA technology
- Used to treat viral infections, autoimmune diseases, and cancers
- Targer response to a specific piece of the immune system (less systemic)
- Examples:
- Interferons
- Interleukins
- BCG (vaccine to treat certain types of bladder cancer)
- Granulyte Colony Stimulating Factors/filgrastim (stimulates WBC production)
21
Q
Interferons
A
- Are cytokines that have been infected with a virus
- they attach to uninfected cells and signal them to secrete antiviral proteins
- “Interfere” with the ability of viral infections to spread; enhance activity of leukocytes (immune system)
- Antiviral, anticancer, anti-inflammatory properties
- Associated with serious adverse effects: depression, suicidal ideation, psychosis, cardiovascular disease, pulmonary/hepatic/renal impairments, and more
22
Q
Therapeutic class of Interferon alfa-2b
A
Immunostimulant
23
Q
Pharmacologic class of Interferon alfa-2b
A
Interferon, biologic response modifier
24
Q
Indications of Interferon alfa-2b
A
Certain cancers (hair cell leukemia, melanoma, non-Hodgkin’s lymphomas, Kaposi’s sarcoma), viral infections (HPV, chronic hepatitis B and C)
25
MOA of Interferon alfa-2b
Suppresses cell proliferation, enhances phagocytic activity, augments cytotoxicity of lymphocytes for target cells, inhibits virus replication
26
Adverse effects of Interferon alfa-2b
Flu-like symptoms ver common (diminish over time), depression, suicidal ideation, hepatoxicity, pancytopenia (decreased WBC, RBC, platelets)
27
Black box warning for Interferon alfa-2b
May cause or aggravate life-threatening neuropsychiatric, autoimmune, ischemia, and infectious disorders
Discontinue if persistent severe or worsening signs or symptoms
28
Nursing implications for Interferon alfa-2b
Give at night, typically orally or parenterally (enhance tolerability), may pre-medicate with acetaminophen, educate clients about adverse effects (both physical and psychological), avoid concurrent use with other sedating medications
Monitor liver functions
Monitor CBC results - pancytopenia
If taking antidepressants with this, it increases the likelihood of depression/suicidal thoughts
29
Interleukins
* Interleukins are cytokines secreted by lymphocytes, monocytes, and macrophages
* Play an important role in immune cell differentiation and activation
* Interleukins can have pro-inflammatory and anti-inflammatory effects
* IL-2 (Proleukin) used for metastic renal carcinoma
* IL-I I (Neumega) stimulates platelet production
* Patients are typically premedicated
* Often have allergic symptoms
30
Immunosuppressants
* Suppress the immune system by affecting lymphocyte function
* used to prevent rejection after organ/bone marrow transplant and for treatment of severe autoimmune diseases (body creates antibodies against its own cells; rheumatoid arthritis, lupus, psoriasis, thyroiditis)
* Puts client at risk for serious infections (opportunistic infections)
* May require prophylactic therapy with anti-infectives
* Incrase the risk of developing cancer
* Immune system identifies cancer, when suppressing the immune system, it can no longer due this
* Typically a combination of immunosuppressants is used to prevent transplant rejection
* Examples:
* Corticosteroids
* Antimetabolites
* Calcineurin inhibitors
* Monoclonal antibodies
31
Nursing implications for immunosuppressants
* Be aware that these drugs have specific instructions for administration and monitoring of drug levels
* May need to be administered with a certain type of juice, not able to be given through certain lines, etc.
* Monitor for signs of infection (susceptible to infections that a healthy immune system would normally fight off)
* Often do not show typical signs/symptoms of infection
* Watch for fever; may not have redness, pus (because there are no white blood cells to produce it)
* May have a low temperature
* Monitor for adverse effects (neurological changes, renal impariment, abnormal lab values, etc.)
* Hypertension
* Client education: stress importance of regular visits with provider
32
Immunosuppressants: corticosteroids
* Often used for short term therapy/exacerbations
* Acute reaction
* Examples: prednisone, methylprednisolone
33
Immunosuppressant: antimetabolites
* Inhibits T-lymphocyte activation and proliferation
* Examples: sirolimus, azathroprine
34
Immunosuppressants: calcineurin inhibitors
* Thought to inhibit T-lymphocyte activation and proliferation
* Post transplant
* Examples: cyclosporine, tacrolimus
35
Immunosuppressants: monoclonal antibodies
* Attack specific targets (T cell receptors)
* Fast acting
* Examples: basiliximab, daclizumab, infliximab
36
Connie Culp
* Most notable full face transplant recipient in the IS
* She survived a shotgun blast to the face
* Received face transplant surgery at the CC in 2008
* A lot of preparation to prepare the face for the transplant
* Many patients say it is worth the risks
37
Lindsey McFarland
* Received the frist uterus transplant in the US at the CC in 2016
* Unfortunately, the transplant failed shortly afterwards due to fungal infection
* She already had children and put herself at risk to recieve the uterus
* They will take the uterus out after they give birth (up to 2 times) to reduce the risks
38
Hematopoietic Growth Factors
Hormones that stimulate some aspect of blood formation:
* Epoetin alfa (Epogen) stimulates RBCs
* HTN, risk for CV event
* Dialysis patients (may only be with treatments)
* Filgrastim (Neupogen) stimulates neutrophils (WBCs)
* Bone pain, flu-like symptoms
* Oprelvekin (Neumega) stimulates platelet production
* Fluid retention, visual changes
* Not used as frequently
39
Treating Anemia
* cynocobalamin (B12)
* Pernicious anemia, strict vegetarians
* Folic acid
* Insufficient dietary intake, ETOH abuse
* Pregnancy - deficiency causes neural tube defects
* Ferrous sulfate
* Iron deficiency is the most common type of anemia
* Vegetarians are at risk, GI bleeds
* Vitamin C enhances absorption
40
Batericidal
Kills bacteria
41
Bacteriostatic
Slows the growth of bacteria, allowing the body's natural defences to eliminate the organism
42
Antibiotic Resistance
Mutations that develop during bacterial cell growth may increase its ability to survive in harsher conditions (superbugs)
Antibiotics used to cure the bacterial infection are ineffective
43
Examples of antibiotic resistant bacteria
* MRSA: methicillin resistant staphylococcus aureus
* VRE: vancomycin resistant enterococcus
* CRE: carbapenem resistant enterobacteriaceae
44
Antibiograms
An antibiogram is generated by a hospital or healthcare system and summaraizes antibiotic susceptibility of specific organisms
This helps providers choose appropriate antibiotic therapy and monitor trends in resistance
45
Chemical Classification of Antibiotics
* Penicillins
* Cephalosporins
* Tetracyclines
* Macrolides
* Aminoglycosides
* Fluroquinolones
* Sulfonamides
* Others
46
Penicillins (PCN)
* Batericidal - disrupt cell wall synthesis
* Beta lactam ring is responsible for antibacterial activity
* Pretty safe drug (wide range of toxicity)
* Many bacteria have become resistant to it
* Certain bacteria produce an enzyme that splits the ring (beta lactamase/penicillinase), rendering the penicillin ineffective
* Certain penicillins or drug combinations inhibit the beta lacatamase enzyme, protecting them from destruction, making the penicillin more effective
* Examples: amoxicillin, ampicillin, nafcillin, oxacillin
47
Drug classes that suffer the issue of the beta lactamase enzyme
* Penicillins
* Carbapenem
* Cephalosporins
* Monobactams
48
Therpeutic class of penicillin G potassium
Antibacterial
49
Pharmacologic class of penicillin G potassium
cell wall inhibitor/penicillin
50
Indications of penicillin G potassium
Streptococcus, pneumococcus, and staphylococcus; gonorrhea, syphilis
51
MOA of penicillin G potassium
Inhibits cell wall synthesis, having bactericidal effect
52
Adverse effects of penicillin G potassium
Diarrhea, N/V, anaphylaxis (low incidence), superinfection, pain at injection site
53
Nursing implications of penicillin G potassium
Can be given IM or IV (penicilin V is given PO), may decrase the effectiveness of oral contraceptives
Observe client for 20 minutes after giving IM
Allergy to one penicillin increases the risk of allergy to other penicillins
May have cross sensitiivty with cephalosporins (1-7%)
Often kills natural flora and can cause increased risk of additional infections
54
Cephalosporins
* Largest class of antibiotics
* Bactericidal - disrupt cell wall synthesis
* Contain beta lactam ring
* 5 generations of cephalosporins
* Differ in susceptibility patterns and resistance to beta lactamases
* Examples: cefazolin, cephalexin, cefuroxime, cefepime, ceftaroline, ceftriaxone
55
Therapeutic class of cefotaxime
Antibacterial
56
Pharmacologic class of cefotaxime
Cell wall inhibitor/3rd generation cephalosporin
57
Indications of cefotaxime
Serious infection (respiratory, urinary, CNS, skin, bones, blood)
58
MOA of cefotaxime
Contain a beta-lactam ring that is responsible for their antimicrobial activity; act by attaching to penicillin-binding proteins to inhibit bacterial wall synthesis
59
Adverse effects of cefotaxime
Diarrhea, N/V, anaphylaxis (low incidence), superinfection, pain at the injection site
60
Nursing implications of cefotaxime
Given IM or IV, avoid alcohol (causes severe N/V), take entire course of medication (do not stop early, even if you feel better - this is true of any antibiotic)
61
Tetracyclines
* Bacteriostatic: inhibit bacterial protein synthesis
* Limited use: many resistant bacterial strains
* Common indications: H. pylori, Lyme disease, chlamydia, intra-abdominal infection, skin infection
* Adverse effects: diarrhea, N/V, photosensitivity, superinfection (vaginal, oral, intestinal) - yeast infections
* Nursing implications: decreases effectiveness of oral contraceptives, pregnancy category D (harmful to developing fetuses and children - discoloration of teetch), do not take with milk or calcium products, do not use with children
* Examples: doxycycline, minocycline, tetracycline, tigecycline
* Commonly used in the 1950s; not commonly used now
62
Macrolides
* Bactericidal or bacteriostatic (depends on the dose and the organism) - inhibits bacterial protein sysnthesis
* Often usef for infections resistant to penicillins or penicillin allergies
* Examples: azithromycin, clarithromycin, erythromycin
* VANCOMYCIN IS NOT A MACROLIDE
63
Therapeutic class of azithromycin (Zithromax)
Antibacterial
64
Pharmacologic class of azithromycin (Zithromax)
Protein synthesis inhibitor/macrolide
65
Indications of azithromycin (Zithromax)
Respiratory infection, gonorrhea, otitis media (ear infection), sinusitis, and more
66
MOA of azithromycin (Zithromax)
Interferes with protein synthesis
67
Adverse effects of azithromycin (Zithromax)
Diarrhea, N/V, prolonged QT interval (how long it takes the ventricles to depolarize and repolarize) on ECG (can lead to dysrhythmia), increased liver enzymes
68
Nursing implications of azithromycin (Zithromax)
May receive loading dose on Day 1, long half life (shorter duration of therapy) may improve compliance
69
Aminoglycosides
* Bactericidal - inhibit bacterial protein synthesis
* Indicated in serious aerobic gram negative infections
* Often used in combination with other antibiotics
* For serious infections or providing a large range of protection
* Toxicity is a concern with this drug class
* Ototoxicity: may result in permanent hearing impariment
* Nephrotoxicity: usually reversible
* Use extreme caution when using with other ototoxic or nephrotoxic drugs
* Drug levels are often monitored
* Examples amikacin, gentamicin, neomycin, tobramycin
70
Fluoroquinolones
* Bactericidal - inhibit bacterial DNA synthesis
* Broad spectrum
* 4 generations of fluoroquinolones (newer generations less toxic)
* Generally used as alternative to other antibiotics
* Indicated for respiratory, GI, GYN, skin and soft tissue infections
* Well absorbed orally
* Examples: ciprofloxacin, levofloxacin, moxifloxacin
71
Therapeutic class of ciprofloxacin (Cipro)
Antibiotic
72
Pharmacologic class of ciprofloxacin (Cipro)
Bacterial DNA synthesis inhibitor/2nd generation fluoroquinolone
73
Indications of ciprofloxacin (Cipro)
Respiratory, bone, GI, ophthalmic, sinus, and prostate infections
74
MOA of ciprofloxacin (Cipro)
Inhibits bacterial DNA synthesis; more effective against gram negative
75
Adverse effects of ciprofloxacin (Cipro)
Diarrhea, N/V, headache, tendonitis/tendon rupture
76
Nursing implications of ciprofloxacin (Cipro)
Do not take with antacids, vitamins, or minerals (affects absorption); incresaes anticoagulant effects of warfarin (check PNR/INR levels more frequently), avoid caffiene (tachycardia, increases anxiety); may increase muscle weakness in those with myasthenia gravis (counter-indicated)
77
Sulfonamides
* Bacteriostatic - suppress bacterial growth by inhibiting folic acid
* Broad spectrum
* Not used as frequently
* Examples: silver sulfadiazine (burn patients), trimethoprim-sulfamethoxazole (bactrum)
78
Therapeutic class of trimethoprim-sulfamethoxazole (Bactrim)
Antibiotic
79
Pharmacologic class of trimethoprim-sulfamethoxazole (Bactrim)
Folic acid inhibitor, sulfonamide
80
Indications of trimethoprim-sulfamethoxazole (Bactrim)
Urinary tract infections, bronchitis, otitis media, pneumocystis carinii pneumonia (PCP/PJP)
81
MOA of trimethoprim-sulfamethoxazole (Bactrim)
Inhibit bacterial DNA synthesis; more effective against gram negative
82
Adverse effects of trimethoprim-sulfamethoxazole (Bactrim)
N/V, hypersensitivity/allergy (rash, itching, fever), Stevens-Johnson syndrome, hyperkalemia
83
Nursing implications of trimethoprim-sulfamethoxazole (Bactrim)
Use with caution with preexisting renal disease, maintain adequate hydration to prevent crystalluria, increase anticoagulant effects with warfarin, when giving IV only infuse through D5W (dextrose solution)
84
Vancomycin (glycopeptide)
* Severe infection with gram positive organisms (staph, strep, MRSA, clostridium difficile infection
* Nephrotoxic, ototoxic
* Red man syndrom - not al allergic reaction
* Related to histamine release and rate of administration
85
Linezolid (oxazolidinone)
MRSA
86
Daptomycin (oxazolidinone)
skin/soft tissue infections
87
Daptomycin (cyclic lipopeptide)
Serious skin and soft tissue infections
88
Tuberculosis
* Mycobacterium tuberculosis
* 25% of world has latent TB
* Worldwide leading cause of death for HIV+
* Typically effets lungs, but can be found in other tissues
* First line medications - PO
* Ethambutol
* Isoniazid (INH)
* Pyrazinamide
* Rifampin
* Two phase approach to treatment
* Initial phase: two months of above meds (lots of side effects)
* Continuation phase: four months of isoniazid and rifampin
* Multi-drug resistant infections are common
* Treatment can take years, especially with resistance
89
Adverse effects of ethambutol
N/V
90
Adverse effects of isoniazid (INH)
Parasthesias (numbness, tingling of fingers and toes), neurotoxicity (dizziness, memory loss, episodes of psychosis), hepatotoxicity (monitor liver function)
91
Adverse effects of pyrazinamide
Gout, increased uring acid crystals (swelling)
92
Adverse effects of rifampin
N/V, gastric pain, orange (red) discoloration of body fluids (can stain contact lenses)
93
What fungus is responsible for the majority of fungal infections?
Candida albicans
94
Common routes of exposure for fungal infections
Inhalation and contaminated soils
95
Fungal infections can be:
* Superficial: scalp, skin, nails, mucous membranes
* Systemic: spread throughout systems of the body
96
Therapeutic class of nystatin (mycostatin)
Topical antifungal
97
Pharmacologic class of nystatin (mycostatin)
polyene
98
Indications of nystatin (mycostatin)
Candida infection of vagina, skin, or mouth; prophylaxis
99
MOA of nystatin (mycostatin)
break down of fungal cell membrane
100
Adverse effects of nystatin (mycostatin)
minor skin irritations,; given orally (swish and swallow) may cause N/V, diarrhea
101
Nursing implications of nystatin (mycostatin)
Do not eat or drink for 30 min after "swish and swallow"
Nystatin poweder is best for moist areas (as opposed to cream)
With vaginal infections, abstain from intercourse until treatment is complete
102
Systemic fungal infections
* More common in immunocompromised
* Often life threatening
* Rquires more prolonge couse of treatment
103
Common systemic antifungal drugs
* Azole drugs (itraconazole, voriconazole, ketoconazole, clotrimazole); exception metronidazole is an antibiotic
* Amphotericin B
* Caspofungin
* Micafungin
104
Therapeutic class of fluconazole (Diflucan)
Systemic antifungal
105
Pharmacologic class of fluconazole (Diflucan)
Triazole
106
Indications of fluconazole (Diflucan)
Candida infection, cryptococcal infection
107
MOA of fluconazole (Diflucan)
Inhibits fungal sterol synthesis (sterols are a component of the fungal cell wall)
108
Adverse effects of fluconazole (Diflucan)
N/V, headahce, rash
109
Nursing indications of fluconazole (Diflucan)
May be given IV or PO (with or without food)
Fluconazole and other azoles are teratogenic and should not be used during pregnancy
110
Therapeutic class of aphotericin B (ambisome)
Systemic antifungal
111
Pharmacologic clas of aphotericin B (ambisome)
Polyene
112
Indications of aphotericin B (ambisome)
Effective against most fungi; for severe infections
113
MOA of aphotericin B (ambisome)
Break down of fungal cell membrane
114
Adverse effects of aphotericin B (ambisome)
Fever and chills (common), nephrotoxicity, hypokalemia, N/V, diarrhea
115
Nursing implications for aphotericin B (ambisome)
* Given IV (not absorbed from the GI tract)
* Irritating to veins
* Topical formulation for superficial infections
* Liposomal formulations availabel to decrease toxicity
* Avoid concurrent use with other medications which can impair renal function (aminoglycosides, vancomycin, furosemide)
* Start with a test dose
* May require premedication to decrease adverse effects (acetaminophen, diphenhydramine, corticosteroids, fluid bolus)
116
Goals of pharmacotherapy for viral infections
Prevent viral infection
Treat active infection
Boost immune system to keep viruses in latent state
117
Influenza
* Flu season: October to May
* 70-85% of influenza deaths are in those \>65
* Influenza vaccine causes the body to produce antibodies against certain strains of the virus
* Influenza antiviral drugs are an important adjunct to the vaccine, and can be used to treat or prevent the disease
* Early treatment with antiviral drugs can shorten the duration of illness and reduce death in hospitalized
118
Therapeutic class of oseltamivir (Tamiflu)
Antiviral
119
Pharmacologic class of oseltamivir (Tamiflu)
Neuraminidase inhibitor
120
Indications of oseltamivir (Tamiflu)
Influenza A and B, prophylaxis
121
MOA of oseltamivir (Tamiflu)
Inhibit influenza virus neuraminiase which affects viral partical release
122
Adverse effects of oseltamivir (Tamiflu)
N/V, diarrhea
123
Nursing implications of oseltamivir (Tamiflu)
Best if given within 48 hours of symptom onset (shortens the duration of symptoms)
May prevent infection if given prior to exposure
Decreased nausea if given with food
124
HSV Type I
Eyes, mouth, lips
125
HSV Type 2
Genital
126
Cytomegalovirus (CMV)
Multibody systemsl; usually seen in immunocompromised
Herpes virus
127
Varicella Zoster (VZV)
Chickenpox (varicella)
Shingles (Zoster)
Herpes virus
128
Epstein-Barr (EBV)
Mononucleosis and Burkitt's lymphoma
Herpes virus
129
Therapeutic class of acyclovir (Zovirax)
Antiviral
130
Pharmacologic class of acyclovir (Zovirax)
Nucleoside analog
131
Indications of acyclovir (Zovirax)
HSV-1, HSV-2; prophylaxis or treatment of acute infection
132
MOA of acyclovir (Zovirax)
Decreased duration and severity of episode by inhibiting viral DNA synthesis (does not cure disease and there is no effect on virus in latent phase)
133
Adverse effects of acyclovir (Zovirax)
N/V, diarrhea, headache, irritation of blood vessels, and nephrotoxicity when given IV
134
Nursing implications of acyclovir (Zovirax)
May be given topical, PO, or IV
135
HIV/AIDS
* Cellular immune deficiency characterized by the depletion of helper T lymphocytes (CD4+ cells); the loss of CD4+ cells results in the development of opportunistic infections and neoplastic processes (cancer)
* The lower the CD4+ count, the more susceptible to infection
* Therapy starts when CD4+ count is \<350 and continues for life
* Combination drugs have been use to reduce the risk of acquiring disease in high risk population
136
Goals of pharmacotherapy in HIV/AIDS
* Prolong survival
* Improve quality of life
* Preserve immune function (protect against opportunistic infection)
* Suppress viral load
* Prevent maternal-child transmission
137
Standard HIV/AIDS therapy
* Antiretroviral therapy (ART)
* Combination of 3-4 drugs
* Drug classes
* Nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs, NtRTIs)
* Nonnucleoside reverse transcriptase inhibitors (NNRTIs)
* Protease inhibitors (PIs)
* Entry inhibitors (inclues fusion inhibitors and CCR5 antagonists)
* Integrase inhibitors
* Lots of drug-drug interactions
* CYP450 system
* Very complex
* Targets different cycles of the disease process
* Avoid alcohol whyile taking the medications
138
Side effects of ART
Fatigue, N/V, diarrhea, headache, fever, muscle pain, occasional dizziness, insomnia
Lipid abnormalities, hepatoxicity, neuropathy, osteoporosis, cardiovascular disease
139
Which of the following antibiotic classes have a beta lactam ring in their chemical structure?
a. Penicillins and macrolides
b. Penicillins and cephalosporins
c. Macrolides and carbapenems
d. Cephalosporins and carbapenems
b. Penicillins and cephalosporins
140
Adverse effects of cephalosporins include all of the following except:
a. Diarrhea
b. Vomiting
c. Ototoxicity
d. Nausea
c. Ototoxicity
141
Which class of antibiotics is known for causing a yellowish discoloration of teeth in children?
a. Tetracyclines
b. Aminoglycosides
c. Penicillins
d. Sulfonamides
a. Tetracyclines
142
Which measure helps to prevent antibiotic resistance?
## Footnote
a. Discontinuing antibiotics as soon as symptoms resolve
b. Using broad spectrum antibiotics whenever possible
c. Liveral prescription of antibiotics upon patient’s request
d. Infection control procedures to prevent the spread of pathogen
d. Infection control procedures to prevent the spread of pathogen
143
The purpose of tazobactam, in the antibiotic Zosyn (piperacillin/tazobactam) is to:
a. Inhibit the beta-lactamase or penicillinase enzyme
b. Decrease toxicity by encasing it in a lipid molecule
c. Add a 2nd class of antibiotic to broaden the spectrum
d. Limit the adverse effects of nausea and vomiting
a. Inhibit the beta-lactamase or penicillinase enzyme
144
This class of antibiotics is associated with nephrotoxicity and ototoxicity. Ex: gentamicin
a. Macrolides
b. Aminoglycosides
c. Fluoroquinolones
d. None of the above
b. Aminoglycosides
145
This systemic antifungal medication often requires a test-dose and premedications
a. Vancomycin
b. Metronidazole
c. Amphotericin B
d. Fluconazole
c. Amphotericin B
146
Oseltamivir (Tamiflu) is best given:
a. During hospitalization and without signs of improvement
b. Within 48 hrs of symptom onset; ideally as soon as possible
c. At bedtime to avoid orthostatic hypotension
d. At the same time as the influenza vaccine
b. Within 48 hrs of symptom onset; ideally as soon as possible
147
A medication used to decrease the duration and severity of a herpes simplex 2 infection is:
a. Nystatin (Mycostatin)
b. Sulfamethoxazole/trimethoprim (Bactrim)
c. Ciprofloxacin (Cipro)
d. Acyclovir (Zovirax)
d. Acyclovir (Zovirax)
148
Goals of ART therapy in a patient with HIV, include all of the following except:
a. Decrease CD4 (helper T lymphocyte) count
b. Improve quality of life
c. Decrease viral load
d. Decrease risk of opportunistic infections
a. Decrease CD4 (helper T lymphocyte) count
