Week 7: Anti-Infectives Flashcards
1
Q
14 Prototype Anti Infective Drugs
A
- Penicillin
2.Cephalosporins - Aminoglycosides
- Tetracycline
- erythromycin
- ciprofloxacin (Cipro)
- metronidazole (Flagyl)
- Sulfa Drugs
- Isoniazid (INH)
- Rifampin (Rifadin)
- Amphotericin B (Fungizone)
- Acyclovir (Zovirax)
- zidovudine (Retrovir)
- saquinavir (Fortovase)
2
Q
Selective Toxicity
A
a trait of a compound where it focuses on a specific organism or cell without injuring the host cells or body - does not cause unintended damage
3
Q
Anti infectives interfere with what things?
A
Cell walls (bacteria have rigid cell walls, mammal cells dont)
Necessary Enzymes
Bacterial protein synthesis
4
Q
Broad Spectrum v Narrow Spectrum
A
Broad agents kill off lots of organisms but narrow spectrums kill only one class or subclass of organism
We may end up treating with broad spectrum until we know exacts but broad spectrum opens up the possibility for microbial resistance
5
Q
Bactericidal
A
Kills Bacteria
6
Q
Bacteriostatic
A
Does not kill bacteria but prevents them from multiplying
Things will come to a halt and then the immune system finishes the job
7
Q
What is important to do after C&S testing
A
match the bug to the drug!
8
Q
Superinfection
A
“Secondary Infection”
A supra/secondary infection on top of a regular infection you already had
9
Q
What are some common secondary infections
A
AAD Diarrhea
Urinary Pain, Infection
Vaginal Infections
Thrush
10
Q
What is the most common secondary infection
A
AAD - Antibiotic Associated Diarrhea
11
Q
How to avoid resistance in bacteria
A
avoid inappropriate use!!!
use narrow spectrum drugs when possible
send cultures and samples FIRST (before using anti infective agents)
do not discontinue ant infectives prematurely
anti infective use in animals, like livestock
12
Q
Prophylaxis
A
Prevention through early drug use
not used as often as it once was
13
Q
Prophylaxis with anti infectives is mainly for what situations
A
Surgery (but gets discontinued promptly)
Valvular Heart Disease (Endocarditis)
Immunosuppressed Patients
14
Q
Penicillin
A
One of the first major classes of anti infective agents
A class of anti infectives with various preparations
Bacteriocidal
15
Q
What is the action of penicillin
A
BACTERIOCIDAL - it interferes with bacterial cell wall synthesis and allows it to take up so much water -> increase osmotic pressure -> bursts
16
Q
Penicillin is bacteriostatic of bactericidal
A
Bactericidal
17
Q
Penicillin mostly affects what type of bacteria
A
gram positive bacteria
18
Q
What sort of bacterial cells does penicillin influence
A
new and newly forming ones not already mature cells
19
Q
Penicillin drugs usually end in what suffix
A
-cillin
20
Q
What is the most common ADR of penicillin
A
GI Symptoms
21
Q
What is the major ADR of concern with Penicillin
A
ANAPHYLACTIC REACTIONS
Includes: Vascular Collapse, Cardiac Arrest, Laryngeal Edema, Bronchospasm
A fairly high incidence of allergic rxns exist
22
Q
What is penicillin densitization
A
a treatment designed to help the body overcome penicillin allergies
23
Q
What is a mechanism bacteria have developed to stop the effect of penicillin
A
some bacteria produce penicillinase (usually Beta lactamase) which will block the action of penicillin
24
Q
How have we overcome the defense of penicillinase in resistant bacteria
A
We mix penicillin with a beta lactamase inhibitor like K Clavulanate (together makes Augmentin) to inhibit that effect and allow penicillin to work
25
What is the important Beta Lactamase Inhibitor often mixed with penicillin
Potassium (K) Clavulanate
26
Cephalosporins
A type of antimicrobial that is the most extensively used type of antimicrobial used worldwide
Has 5 generations of types with each successive one getting more improvements
27
What is often seen in the name of a cephalosporin drug
"Cef" or "Ceph" in the generic name
28
What is often used as an alternative to penicillin
Cephalosporins (To prevent allergic reactions)
29
What is the most extensively used antimicrobial worldwide
cephalosporins
30
Are cephalosporins bactericidal or bacteriostatic
Bactericidal
31
Action of Cephalosporins
Bactericidal - related to penicillin structurally and pharmacologically so it inhibits mucopeptide synthesis of the bacteria cell wall
New cell walls cannot form
32
What is interesting about the absorption of cephalosporins
Can be given oral or IV but it is better absorbed on an empty stomach
33
ADRs of Cephalosporins
Allergic Rxn, Rash
N/V/D
Phlebitis
Superinfection
Sometimes: Kidney Damage, Bone Marrow Depression, Mild Hepatotoxicity, Acute Colitis
Some cause bleeding tendencies by decreasing prothrombin levels or interfering with platelet aggregation
34
What is the unique ADR of cephalosporins
Phlebitis - inflammation of veins; may be at the IV site - more common with cephalosporins
35
What is important to keep in mind even if you are using cephalosporins instead of penicillin
There is a partial cross allergy that exists for those hypersensitive to penicillin, 1% of the population, that are also allergic to cephalosporins if they are allergic to penicillin
36
Cephalosporins are commonly used as...
an alternative to penicillin
37
Vancomycin
Only drug in its own class that also impacts the cell wall, but also inhibits RNA synthesis
used for serious and resistant infections like MRSA and VRE
It impacts gram positive organisms but is highly regulated because of resistance
ADRs: Hearing and Kidney Damage, Histamine Release leading to Red Man Syndrome, Anaphylaxis, Ototoxicity
38
Aminoglycosides
Class of antimicrobials that are not seen as often as penicillin or cephalosporins but are used for serious infections
ex: Gentamicin, Streptomicin, Neomycin, Amikacin, Tobramycin
39
Is there a suffix or prefix specific to aminoglycosides
no, mycin is commonly seen but it is not specific to this class alone
40
Action of Aminoglycosides
Bactericidal or Bacteriostatic!
Instead of working on cell walls, it directly impacts protein synthesis instead - it impacts 30S Subunits of the ribosomes
41
Are aminoglycosides narrow or broad spectrum
narrow they are used for serious infections of gram negative bacteria to impact their protein synthesis
42
What is the therapeutic level of gentamycin (a type of aminoglycoside)
4-8 mg/L
This is just for gentamycin, all aminoglycosides have different levels
43
Why do we monitor peaks and trough levels very carefully for aminoglycosides
Potential Kidney Damage - we want above MEC but below maximum
Other ADRs as well
44
What anti microbial is very important to have drug levels drawn and administration timing exact because of potential impacts
Aminoglycosides
45
Aminoglycosides effect what type of organism
serious aerobic gram negative ones - that could cause sepsis
46
ADRs of Aminoglycosides
1. Potential Kidney Damage (Proteinuria)
2. Vestibular Issues (vertigo and loss of balance)
3. Auditory issues (deafness)
Other: high doses cause neuromuscular issues causing resp. paralysis ; Enhance blockade of skeletal muscle relaxants
47
It may not be a good idea to give aminoglycosides with what
skeletal muscle relaxants
48
Why are aminoglycosides used less nowadays
because they have serious side effects and there are newer drugs that can be used without these side effects
49
What is important to know about giving an aminoglycoside to a geriatric patient, premature patient, or renal failure patient
These factors increase the incidence of ototoxicity
50
Why may we not give aminoglycosides to someone with renal insufficiency
it can cause further kidney damage!
51
What is the problem with IV form aminoglycosides
there are many incompatibilities with other drugs in this form
52
Neomycin
a type of aminoglycoside
it is a topical one that works locally at area of instillation
it may be used to sterilize the GI tract to prevent gram negative sepsis within a surgery
53
When thinking of aminoglycoside ADRs, think ___, ___, and ____
Kidneys (Nephrotoxicity), Ears (Ototoxicity), Neurons (Neurotoxicity)
54
Why is the neurotoxicity of aminoglycosides less of an immediate concern as compared to the nephrotoxicity or ototoxicity
Because while there is high potential, it only occurs in higher doses which are rarely if ever given
55
Tetracyclines
class of antimicrobial drugs
used for a variety of infections when penicillin cannot be used, but is more pleasant in use than aminoglycosides
ex: Doxycycline, Achromycin, Terramycin
56
When might a tetracycline be given
if someone is allergic to penicillin/cephalosporin, and in substitute to a more serious aminoglycoside (more pleasant ADR wise)
57
Tetracyclines are ___ use, why?
broad; they are used for many conditions including:
Acne
Chlamydia
Rocky Mtn Spotted Fever
Rickettsial Disease
Psittacosis
Cholera
Lyme Disease !!!!
H Pylori !!!
Mycoplasma Pneumonia
58
What is the problem with use of tetracyclines
if they are used to much it leads to resistance
59
Action of Tetracycline
Inhibits protein synthesis by binding to the ribosomal sub unit - so it only affects rapidly multiplying organisms
60
Is tetracyclines bactericidal or bacteriostatic
Bacteriostatic normally, but it is bactericidal at higher doses
61
Tetracyclines are relatively _______
non-toxic
62
ADRs of Tetracyclines
1. Photosensitivity
2. Child Tooth Mottling
Other: Sensitization, Anaphylaxis, GI discomfort, Dizziness, Ataxia, Nephropathy
63
Why does tetracyclines cause child tooth mottling
because if the child's permanent teeth are still developing, tetracyclines will bind to calcium and leave permanent staining in the teeth
64
What is important to know about when absorption interference and tetracyclines
do NOT take with food - especially dairy products or antacids because they will chelate the drug and decrease absorption
however, they will readily bind with calcium, Mg, Aluminum, zinc and iron
65
How does Doxycycline differ from other tetracyclines
dairy products and antacids will not decrease its absorption - non affected
66
What patients have tetracycline contraindicated
those with renal dysfunction
*it does not cause it but it does linger*
67
_____ are a type of anti microbial used for so many conditions
Tetracyclines
68
Macrolide Antimicrobial
Macrolides are a family of drugs
they inhibit bacterial protein synthesis like aminoglycosides and tetracycline
69
What is the prototype drug for macrolides
erythromycin (E-Mycin, Ery-Tab)
70
Erythromycin
macrolide antimicrobial prototype
71
What is the action of erythromycin
blocks ribosomal sub unit to prevent new AA to chain --> Inhibits protein synthesis
72
erythromycin is similar to what drugs and is often used as the preferred substitute
penicillin
73
Is erythromycin bactericidal or static
Bacteriostatic normally, but can be bactericidal against certain organisms or at high doses
74
erythromycin works well against what organisms
gram positive bacteria (like penicillin - but it also affects some negative)
75
What is one of the safest antibiotics available
Macrolides like erythrmoycin
76
ADRs of Erythromycin
GI Symptoms - NVD, cramping, cholestatic hepatitis, suprainfection of bowel, thrombophlebitis
A PRETTY SAFE GROUP, NO MAJOR ADRS
77
It is important to note what about the dosage of erythromycin
the oral version amount varies very drastically depending on age of the patient
78
erythromycin is commonly used for what infections
respiratory, skin, and skin structure infections
79
What is unique about liver metabolism and erythromycin
it inhibits cytochrome P450 enzymes so it will increase plasma levels of several drugs in the body as a result since its inhibiting some metabolism
80
What class are azithromycin and clarithromycin
macrolides
*both have less GI impact than erythromycin*
81
Is Clindamycin a macrolide like erythromycin
NO - but it does inhibit protein synthesis in a similar way, but can cause diarrhea (PMC) that can be fatal
82
Fluoroquinolone
class of antimicrobials
includes Ciprofloxacin and Levofloxacin
83
What is the suffix for all fluoroquinolone drugs
-floxacin
84
Fluoroquinolones like Ciprofloxacin and Levofloxacin work well against what kind of bacteria
AEROBIC GRAM NEGATIVE (some effect on positive as well)
85
What type of drug has supplanted many kinds of aminoglycosides since there is less ADRs associated with it
Fluoroquinolones
86
What are the 2 important prototype drugs to know for Fluoroquinolones
1. ciprofloxacin (Cipro)
2. levofloxacin (Levaquin)
87
What is particularly unique about fluoroquinolones
it has a unique post antibiotic effect - so it seems to have an effect even long after the treatment has ended
88
ciprofloxacin
Cipro
fluoroquinolone prototype
antimicrobial
89
levofloxacin
Levaquin
fluoroquinolone prototype
antimicrobial
90
Action of ciprofloxacin and levofloxacin
it inhibits bacterial DNA gyrase, an enzyme needed for bacterial DNA replication
This is rapidly bactericidal and has both gram negative and positive activity while causing the unique post-antibiotic effect that is prolonged
91
ADRs of levofloxacin and ciprofloxacin
1. Peripheral Nerve Damage (Neuropathy)
2. Cartilage Toxicity (Tendon Damage) / Joint Disease
Other: GI, CNS dizziness, confusion, sometimes seizure
GENERALLY THIS DRUG IS WILL TOLERATED WITH ONLY MILD SIDE EFFECTS!!!!
92
Why does levofloxacin and ciprofloxacin have a black box warning
Because it can cause permanent peripheral nerve damage (neuropathy) and tendon damage/Joint Disease
93
Never give ciprofloxacin or levofloxacin to what group of patients and why
those under 18 because they are at higher risk for joint disease and ruptures of tendons like the Achilles tendon
94
What should be done if a patient has pain in the tendons while taking a fluoroquinolone
stop immediately and see a doctor
95
What decreases ciprofloxacin and levofloxacin absorption
antacids, iron salts, sucralfate, and dairy products
*so these things can only be taken 6 hours before or 2 hours after Cipro - separate these from taking at the same time
96
How can ciprofloxacin lead to bleeding
it elevates warfarin levels if they are taking it
97
What unique infection can be reduced by fluoroquinolone use
Anthrax- a bioterrorism infection
98
Amebicide
tissue and luminal anaerobic antimicrobial class
99
What is the prototype drug for Amebicides
metronidazole (Flagyl)
100
Action of metronidazole (Flagyl)
Inhibits bacterial DNA synthesis in ANAEROBIC BACTERIA
It kills trophozoites on contact and deprives cells of normal DNA repair while interrupting RNA synthesis
101
ADRs of metronidazole
1. GI - Nausea, HA, METALLIC TASTE, NVD
2. CNS - insomnia, weakness, vertigo, paresthesia, rash, dry mouth
102
What is important to know when taking metronidazole
it turns the urine a reddish brown color so dont be frightened
103
What is an Antabuse effect and what drug has it
Antabuse is a medicine effect that deters drinking alcohol by causing someone to become violently ill if they do
The Amebicide metronidazole (Flagyl) also has this effect
104
What is one unique IV administration instruction, incompatibility, and use fact about metronidazole?
It is NOT REFRIDGERATED like other IV drugs
105
What sort of infections might metronidazole be given
serious ANAEROBIC infections - like some abdominal infections not involving the GI tract
Trichomoniasis
106
Sulfonamides
"Sulfa Drugs"
Antimicrobial class
includes trimethoprim-sulfamethoxazole, etc
107
When are sulfonamides primarily used
for UTIs, but also other respiratory and other infections.
However, MOSTLY FOR UTI
108
Action of Sulfonamides
inhibits bacterial METABOLISM OF FOLIC ACID
109
Are sulfonamides bacteriostatic or bactericidal
bacteriostatic
110
Forms of sulfonamides
oral or IV
111
ADRs of sulfonamides
1. GU - crystalluria, dehydration
2. GI
Other: Rashes, PHOTOSENSITIVITY, contact dermatitis, rash, anemia, hypersensitivity
112
Why is it so important to keep those on sulfa drugs so well hydrated with non acidic fluids
Because the drug can cause crystals in the urine if things are acidic or dehydrated and this can lead to hematuria or obstructions
113
The drug of choice for UTIs are what
sulfa drugs
114
What is important to know regarding Cranberry Juice, UTIs, and Sulfa Drugs
Cranberry juice is good for PREVENTING UTIs by keeping things acidic
However, once you have a UTI you need to stay hydrated and urine dilute/non acidic so the cranberry juice will not help
If you are drinking cranberry juice with sulfa drugs it can increase incidence of crystaluria
115
Commonly sulfonamides are given with ____ for what reason
trimethoprim
this is for a synergistic effect and a 2 prong attack on infection
116
Antituberculosis Drugs
class of drugs that are anti-mycobacteria / tuberculosis
117
Prototype drug of Antituberculosis Drugs
isoniazid (INH)
118
Is isoniazid usually given alone
no usually tuberculosis treatment involves 3-4 drugs including something like rifampin
119
Action of isoniazid (INH)
inhibits mycolic acid production (what is needed for the mycobacterium tuberculosis cell wall) which kills dividing organisms and can lead to death from immune response for mature ones
120
Is isoniazid (INH) bacteriostatic or bactericidal
both:
It is bactericidal in dividing mycobacterium
It is bacteriostatic during an organisms resting phase
121
Why does drug treatment with antituberculosis drugs go on for so long
because mycobacterium tuberculosis is very slow growing
122
ADRs of isoniazid (INH)
1. NEUROTOXICITY - paresthesia, seizure, dizziness, HA, peripheral neuropathy
2. HEPATIC DYSFUNCTION/TOXICITY
other: HA, allergic reaction, vertigo
123
What is given with isoniazid (INH) and other antitubculosis drugs to prevent the neurotoxicity and peripheral neuropathy that can occur
Vitamin B - it will help prevent this and also fight deficiency anemia
124
Why should you never drink alcohol with isoniazid?
because the ADR already includes hepatic dysfunction which can compound with alcohol to cause worse damage
125
What is the most important anti-tuberculosis drug
isoniazid (INH)
126
Does isoniazid (INH) only get used for active tuberculosis treatment?
No. if used with other drugs it is fighting an active case, but if given alone it is used for prophylaxis from exposure to Tb
127
While isoniazid is for tuberculosis only, what other drug has anti tuberculosis effects as well as being a macrocyclic antibiotic
rifampin (Rifadin, Rimactane)
128
rifampin
a macrocyclic antibiotic that also can be used as an anti tuberculosis drug
Trade; Rifadin and Rimactane
129
Action of rifampin
Inhibits RNA synthesis
130
Is rifampin bactericidal or bacteriostatic
bactericidal
131
ADRs of rifampin
THERE ARE NONE IN GREAT FREQUENCY
SE: Hypersensitivity, NV, jaundice, rash, fever, liver damage!, flu like symptoms
132
rifampin is usually very well....
tolerated - few ADRs
133
How does rifampin dosage differ depending on use and person
for Tb it is given in a much larger amount, and its given in smaller doses for other infections or in children
134
What is a unique side effect of rifampin to let the contact know about
it causes orange-red color urine, feces, saliva, sputum, tears, and sweat
Can cause soft contacts to become a pink orange red color or sweat on a white shirt may appear this color as well
135
What does it mean that rifampin is a potent inducer of microsomal system
it can cause a decreased half life for other drugs
136
Why is it important to take caution when giving rifampin with oral anticoagulants and steroids
1. It will decrease anticoagulation / weaken drug impact
2. It enhances steroid catabolism so if someone is taking an oral contraceptive they can be left open to pregnancy
137
What other infections can rifampin be used with
leprosy
legionnaires disease
H flu
sometimes Staph and meningococci
138
Why is it important to know if someone is on rifampin before giving a contrast media
because the drug can reduce biliary excretion of the visualizer of the gall bladder
139
Of the 14 prototype drugs, what ones are not ant-bacterials
Amphotericin B (Fungizone) - antifungal
Acyclovir (Zovirax) - antiviral, herpes
zidovudine (Retrovir) - anti HIV
saquinavir (Fortovase)- anti HIV
140
Antifungals
class of antimicrobial that works on fungal infections
141
What is the prototype drug for antifungals
amphotericin B (Fungizone)
142
In what case is amphotericin B used
In systemic and potentially fatal fungal infections - it has severe effects and is difficult to give but is effective
143
Action of amphotericin B
it changes permeability of cytoplasmic membranes of the fungi sensitive organism leading to essential cell components leaking out and causing cell death
144
What is the preferred route for amphotericin B
IV usually, oral route has poor absorption
145
ADRs of amphotericin B
MANY SEVERE ONES:
1. HIGHLY NEPHROTOXIC
2. RIGORS
3. Lyte imbalances and hypokalemia
Other: Neurologic symptoms, ototoxicity, thrombocytopenia, flushing, generalized pain, phlebitis, anorexia, anemia, convulsions, anaphylaxis, hepatotoxicity
146
___% of patients taking amphotericin B have impaired renal function that is non reversible if the drug is not stopped in time
80% (experience renal impacts)
147
It is important to do what daily when you have a patient taking amphotericin B
check creatinine levels daily
148
amphotericin B requires other medicines sometimes to deal with ADRs and SE so it is sometimes called ____ by nurses
Amphoterrible
149
Amphotericin B is what with most other drugs
incompatible
150
With amphotericin there are many specific what
directions for administration - such as protecting it from light (comes in a brown bag)
151
Diflucan (fluconazole)
a newer antifungal looking to replace amphotericin B but it does not have the same spectrum of activity and therefore is not the magic bullet we wanted
152
Nystatin
an antifungal that comes as a liquid that you swish and spit or swish and swallow for thrush or esophageal fungal infections
153
Antiviral, Herpes prototype drug
acyclovir (Zovirax)
154
What is acyclovir limited to
limited to types of herpes (this includes chickenpox, herpes, shingles, etc - but no other viral infections)
155
Action of acyclovir
Inhibits viral replication by preventing viral DNA synthesis in HERPES VIRUSES ONLY
156
What routes of administration is acyclovir given
IV, topical, or oral depending on if herpes is systemic or local
157
ADRs of acyclovir if taken orally
Nausea
HA
Amnesia
158
ADRs of acyclovir if taken IV
N/V
Local Phlebitis
Rash
Diaphoresis
Hypotension
NEPHROTOXICITY
159
ADRs of acyclovir if taken topically
local irritation
transient burning
160
What is important to know about hose acyclovir actually helps with herpes
It decreases duration and severity OF ACUTE HERPES EPISODES - not a cure for the conditions
It just shortens the length of time with the actual infection episode / flare
161
What is the prototype drug that is both Anti HIV and a reverse transcriptase inhibitor
zidovudine (Retrovir)
162
What is the prototype drug that is both Anti HIV and a Protease Inhibitor (PI)
saquinavir (Fortovase)
163
What was zidovudine known as back in the 1980s
AZT
164
What was the first Anti HIV drug developed
zidovudine (retrovir) / AZT
165
Action of zidovudine
It inhibits HIV replication because it has a greater affinity for viral reverse transcriptase than human DNA polymerase thus inhibiting viral replication without blocking human replication
A Reverse Transcriptase Inhibitor for HIV
166
What is important to know about the absorption of zidovudine
it has a first pass of 35% so only 65% is bioavailable
167
ADRs of zidovudine
1. DEPRESSION OF FORMED ELEMENTS IN PERIPHERAL BLOOD (granulocytopenia and severe anemia)
2. SEVERE HEADACHE
Other: Nausea, insomnia, myalgia, symptoms seen also in placebo patients not listed
168
Why is zidovudine given in high frequent (5x daily) doses before labor and then immediately given IV during labor to pregnant women?
This is an attempt to prevent Vertical transmission of HIV to the infant
The IV form will be given until the umbilical cord is clamped
169
What may be required for patients as a result of taking zidovudine
multiple blood transfusions to fight the anemia
170
Is zidovudine often given alone
No, it is often given with at least 2 other drugs
ex: Combivir (Retrovir and Epivir) is given 2x daily to reduce the massive drug cocktail those with HIV have to take
171
Most anti-virals have what in their name
"vir"
172
saquinavir (Fortovase)
a newer drug that is a protease inhibitor and anti-HIV drug
173
Action of saquinavir
Binds to the active portion of HIV protease which inhibits function of HIV proteins and enzymes leaving the virus immature and noninfectious
174
ADRs of saquinavir
1. Risk for hyperglycemia, new onset DM, DM exacerbations, hyperlipidemia, fat redistribution, bone loss, and transaminase level elevation
2. Pancytopenia and thrombocytopenia
Other: GI effects
175
What is the drug that led to HIV becoming more of a chronic illness rather than a death sentence
saquinavir (Fortovase) - very effective
176
Most people do not die of HIV nowadays, they die from what
the heart complications that can occur from infection and treatment
177
It is very important to not do what when taking saquinavir
NEVER TAKE WITH FOOD - the food with increase the level of protease inhibitors
178
saquinavir inhibits ____ which can ____ protease inhibitor levels
P450 (liver metabolism enzyme); increases protease inhibitor level (dont take with food)
179
Agents that induce P450 can ___ levels of protease inhibitors and include what things?
decrease levels - rifampin, phenobarbital, st johns wort
180
To minimize ADRs from Isoniazid (INH) the nurse should monitor?
A. AST and ALT levels --> they are liver enzymes and this causes liver damage
B. Creatinine clearance
C. BUN
D. Vital Capacity
A. AST and ALT levels --> They are liver enzymes and this will cause liver damage
181
Patients treated with aminoglycoside therapy (such as with gentamicin) should be monitored for?
A. Hepatotoxicity and ototoxicity
B. Peripheral neuropathy and cardiotoxicity
C. Ototoxicity and nephrotoxicity
D. Cardiotoxicity and nephrotoxicity
C: Ototoxicity and Nephrotoxicity
182
Before administering any penicillin,. It is important to check?
A. The CBC
B. The urine culture results
C. The most recent blood glucose
D. If there have been any previous reactions to antibiotics
D. If there have been any previous rxns to antibiotics
183
When treating with Bactrim (sulfamethoxazole and trimethoprim, a sulfa drug) you will teach the client to…
A. Protect from sunlight
B. Increase fluid intake
C. Avoid large amounts of cranberry juice and other acidic fluids
D. All of the above
D. All of the above
