Ch 30 Pharm

Front 1

When ________ was introduced, it was effective against many organisms it had to be given parenterally because it was destroyed by gastric acid and injections where painful.

Back 1

Penicillin

Front 2

As a class, ____________ usually are more effective and infections caused by gram positive bacteria than in those caused by gram negative bacteria.

Back 2

Penicillins

Front 3

Allergy to a drug of another class with similar chemical structure is called __________________

Back 3

Cross allergenicity

Front 4

__________, ____________, and __________ are the drugs of choice for methicillin susceptible staphylococcus aureus.

Back 4

Diclaxacillin, nafcillin, oxacillin

Front 5

______________, _________________, and _________ have a broad spectrum of antimicrobial activity, especially against gram negative organisms such as Pseudomonas and Proteus species and Escheriachia coli

Back 5

Carbenicillin Ticarcillin and piperacillin

Front 6

Combination of ampicillin and sulbactam

Back 6

Unasyn

Front 7

Broad spectrum bactericidal beta lactam antimicrobials

Back 7

Carbapenems

Front 8

Widely used group of drugs that are derived from a fungus.

Back 8

cephalosporins

Front 9

Contains amoxicillin and clavulanate.

Back 9

Cephalosporins

Front 10

Has a broad spectrum of antibacterial activity and may be used as a single drug for empiric therapy before causative microorganisms are identified.

Back 10

Meropenem (Merrem)

Front 11

Which of the following medications blocks renal excretion of the penicillins and can be given concurrently with penicillins to increased serum drug levels?

a. Probenecid (Benemid)

b. Piperacillin tazobactam

c. Augmintin

d. Gentamicin

Back 11

a. Probenecid (Benemid)

Front 12

In the rare instance in which penicillin is considered essential which of the following procedures may be helpful in assessing hypersensitivity?

a. Administering the medication in a controlled environment.

b. Administering a loading dose of the medication.

c. Administering a skin test.

d. Administering the medication by the intravenous route only.

Back 12

c.

Front 13

As a class penicillin s usually are more effective in infections caused by which of the following types of bacteria?

a. Gram negative

b. Gram positive

c. Anaerobic

d. Aerobic

Back 13

b

Front 14

Choice of a beta lactam antibacterial depends on which of the following factors? (Select all that apply)

a. The organism causing the infection

b. Severity of the infection

c. Age of the patient

d. Sex of the patient

Back 14

a, b.

Front 15

Which of the following are beta lactam antibiotics? (select all that apply)

a. Pencillins

b. Cephalosporins

c. Monobactams

d. Sulfonamides

Back 15

a, b, c

Front 16

Mrs Konas is admitted to the critical care unit with sepsis related to a contaminated central line. The physician orders intravenous beta lactam antimicrobials. The patients current laboratory report reflects renal impairment. Which of the following would your expect the physician to do?

a. Maintain the drug dose

b. Increase the drug dose

c. Decrease the drug dose

d. Administer the drug via an IM route.

Back 16

c

Front 17

The beta lactam drugs are frequently given concomitantly with other antimicrobial drugs in critically ill patients Why?

a. They often have drug resistant organisms.

b. Their immune systems are impaired.

c. They are susceptible to drug resistant organisms.

d. They often have multiorganism or nosocomial infections.

Back 17

d

Front 18

Mr. Anza is placed on an IV regimen of aztreonam. You would expect the physician to order which of the following laboratory tests?

a. CBC

b. Hematocrit

c. Serum albumin

d. Liver Function

Back 18

d

Front 19

Mrs. Ponds is hospitalized for sepsis. She also receives hemodialysis three times a week. How much of hte initial dose of monbactam should be administered after each hemodialyisis session in addition to the maintenance doses?

a. 12.5%

b. 25%

c. 10%

c. 50%

Back 19

a

Front 20

Mr. Bates recieved the initial loading dose of aztreonam this morning. You receive his laboratory results and his CrCL is 28 ml/min. You call the physician regarding the laboratory results. Which of hte following would you expect the physician to do?

a. increase the dose of aztreonam

b. decrease the dose of aztreonam by 50%.

c. Maintain the current dose of aztreonam.

d. Doscontinue the aztreonam

Back 20

b

Front 21

Unless hemodialysis is started within 48hrs imipenem is contraindicated for clients wiht severe renal impairment. Which of the following laboratory measurements would indicate renal impairment?

a. Hematocrit

b. WBC

c. Serum albumin

d. Creatinine clearance

Back 21

d

Front 22

Penicillins and cephalosporins are used cautiously in neonates due to which of the following factors?

a. Immature liver function

b. Immature immune function

c. Immature kidney function

d. Immature pancreatic function

Back 22

c.

Front 23

Mr. Watts is admited to your unit for a total hip replacement. The surgeion orders a first generation cephalosporin as a surgical prophylaxis because of the nature of the organisms associtated postoperatvely with this type of procedure. What type of bacteria are they?

a. Gram negative

b. Anaerobic

c. Gram postivie

d. Aerobic

Back 23

c

Front 24

Mr. Ganes is admitted to your unit with P. aeruginosa sepsis. The physician orders aminoglycoside to be given concomitantly with penicillin intravenously. How do you administer these drugs?

a. You mix both drugs in normal saline solution.

b. You administer the drug in separate IV bags.

c. You administer the drugs dextrose 5% and 0.9% normal saline.

d. You administer the drugs every other day.

Back 24

b

Front 25

Probenecid (benemid) can be given concurrently with ___________ to increase serum drug levels.

Back 25

Penicillins

Front 26

Ms. Slate demonstrates symptons of shock after a single intravenous dose of penicillin. Treatment of the shock would include which of the following? (Select all that apply)

a. Epiniphire

b. a tounge blade

c. Oxygen

d. Trachostomy

Back 26

a, c, d

Front 27

_________ is the most common cause of druge incluced anaphylad

Back 27

Penicillin

Front 28

Most ____________ must be given every 4 to 6 hrs to maintain therapeutic blood levels, because the kidneys rapidly excrete them.

Back 28

Penicillins

Front 29

WHen given alone the antibiotic imipenem is rapidly broken down by an enzyme __________ in renal tubules and there fore reaches only new concentrations in the urine.

Back 29

Dehydropeptidase

Front 30

A client with sepsis is reading material given to him on the drug imipenem. He asks you why it is formulated with cilastatin and cannot be taken alone. Which of the following is the appropriate response?

a. Cilastatin prevents destruction of imipenem by an enzyme created by the renal tubules.

b. Cilastatin is preservative and prevents the destruction of impenem in the GI tract.

c. Cilastatin helps the imipenem to cross the blood brain barrier.

Back 30

a

Front 31

_________ drugs inhibit synthesis of bacterial cell walls by binding to proteins in bacterial cell membranes.

Back 31

Beta lactam

Front 32

This was the first antibiotic developed and was discovered from the ________ mold and serves as the prototype for this drug class.

Back 32

Penicillium or Penicillin

Front 33

True or false

Penicillin therapeutic levels are not usually obtained in intraocular and cerebrospinal fluids (CSE) unless inflammation is present because of normal cell membranes act as barriers to drug penetration.

Back 33

True

Front 34

True or false

An allergic reaction to one penicillin means the patient is allergic to all member of the penicillin class.

Back 34

True

Front 35

Administration of _________ or ___________ should be avoided in individuals with life threatening allergic reactions to penicillin

Back 35

Cephalosporins or Carbapenems

Front 36

Name the four Penicillins

Back 36

Penicillin G and V
Penicillin G Benzathine
Penicillin G Procaine (Wycillin)
Penicillin V (Veetids)

Front 37

Name the Penicillinase resistant (antistaphylococcal) penicillins:

Back 37

Dicloxacillin
Nafcillin
Oxacillin

Front 38

Name the Aminopenicillins:

Back 38

Apicillin (Principen)
Amoxicillin (Amoxil Trimox)

Front 39

Name the Extened Spectrum (Antipseudomonal) Penicillins

Back 39

Carbenicillin indanyl sodium (Geocillin)
Ticarcillin (Ticar)
Piperacillin (Pipracil)

Front 40

Name the Penicillin Beta Lactamase Inhibitor Combination:

Back 40

Ampicillin sulbactam (Unasyn)
Amoxicillin clavulanate (Augmentin)
Piperacillin tazobactam (Zosyn)
Ticarcillin clavulanate (Timentin)

Front 41

True or false

Penicillin G remins effective for a limited number of uses. Many strains of staphylococci and gonococci have acquired resistance to this drug preventing its use for treatment of infections caused b y these organisms.

Back 41

True

Front 42

True or false
Penicillin G remains the drug of
choice for the treatment of streptococcal pharyngitis for prevention of recurrent attacks in patient who have had previous acute rheumatic fever due to group A Streptococcus for treatment of neuosyphilis.

Back 42

True

Front 43

_______ is not effective orally because it is inactivated by gastric acid.

Back 43

Penicillin G

Front 44

A black box warning alerts health care providers that inadvertent IV administration of ____________ may result in cardiopulmonary arrest and death

Back 44

Penicillin G benzathine

Front 45

____________ is derived form penicillin G and has the same antibacterial spectrum. It is not destroyed by gastric acid and is only given by the oral route. It is well absorbed and produces therapeutic blood levels.

Back 45

Penicillin V (Veetids)

Front 46

These drugs are formulated to resisted penicillinases that inactivate other penicillins and are the drug of choice for patients with MRSA.

Back 46

Dicloxacillin
Naficillin
Oxacillin

Front 47

______________ is abroad spectrum semisynthetic penicillin that is bactericidal for several types of gram positive and gram negative bacteria. Effective against enterococci, Proteus mirabilis, Salmonella, Shigella and Escherichia coli

Back 47

Ampicillin (Principen)

Front 48

_____________ is excreted mainly by the kidneys thus it is useful in some urinary tract infections. Because some is excreted in bile it is useful in biliary tract infections not caused by biliary obstruction. It is also used in the treatment of bronchitis sinusitis and otitis media

Back 48

Ampicillin (Principen)

Front 49

__________ is similar to ampicillin except it is only available orally. Also, it causes less gastrointestinal distress.

Back 49

Amoxicillin (Amoxil, Trimox)

Front 50

____________, ________ or _______________ have a broad spectrum of antimicrobial activity especially against gram negative organisms such as pseudomonas and proteus species and E coli. For pseudomonal infection these drugs are usually given along with an aminoglycoside or a floroquinolone.

Back 50

Carbenicillin (Geocillin)
Ticarcillin
Piperacillin

Front 51

___________ is a combination of ampicillin and sulbactam

Back 51

Unasyn

Front 52

__________ is a combination of amoxicillin and clavulanate

Back 52

Augmentin

Front 53

_________ is a combination of ticarcillin and clavulanate.

Back 53

Timentin

Front 54

________ is a combination of peperacillin and tazobactam in an IV formulation.

Back 54

Zosyn

Front 55

____________are widely used group of drugs derived from a fungus.

Back 55

Cephalosporins

Front 56

True of false

Cephalosporins are broad spectrum agents with activity against both gram positive and gram negative bacteria. They are generally less active against gram positive organisms but more active against gram negative ones.

Back 56

True

Front 57

What cephalosporin can be used if the meninges are inflamed?

Back 57

Cefuroxime

Front 58

Most cephalosporins are excreted through the kidneys. The exception is ____________ and is primarily metabolized in the liver to an active metabolite desacetylcefotaxime and is eliminated by the kidneys.

Back 58

Cefotaxime

Front 59

True or false

Ceftriaxone is a third generation cephalosporin that is used to treat Neisseria Gonorrhoeae.

Back 59

True

Front 60

This cephalosporin is used to treat sepsis; in severe infection of the lower respiratory and urinary tracts skin and soft tissue.

Back 60

Cefepime

Front 61

True or false

A contraindication to the use of a cephalosporin is a previous severe anaphylactic reaction to a penicillin. Because cephalosporins are chemically similar to penicillins.

Back 61

True

Front 62

___________ is the drug of choice for surgical prophylaxis in most surgical procedures.

Back 62

Cefazolin

Front 63

________ 4th generation cephalosporin is used for treament of UTI's caused by Escherichia coli or Klebsiella pneumonia

Back 63

Cefepime (Maxipime)

Front 64

_______ are broad spectrum bactericial beta lactam antimicrobials. Like other beta lactam drug they inhibit synthesis of bacterial cell walls by binding with penicillin binding proteins.

Back 64

Carbapenems

Front 65

This carbapenem, ___________________ is given IM injection with Lidocaine to reduce pain. Can cause seizures and CNS toxicity.

Back 65

Imipenem cilastatin (Primaxin)

Front 66

This Carbapenem, ____________ is used to treat community acquired pneumonia intra abdominal skin and skin structure, acute pelvic, and urinary tract infections.

Back 66

Ertapenem (Invanz)

Front 67

The Monobactam___________ is active against gram negative bacteria but does not cause kidney damage or hearing loss

Back 67

Aztreonam (Azactam)

Front 68

True or false

Penicillin V, amoxicillin, and Augmentin can be taken with food.

Back 68

True

Front 69

What are patient teaching guide lines for taking oral penicillin?

Back 69

1. Take each dose with a full glass of water; do not take with orange juice, or other acidic fluids they will destroy the drug.

2. Take at even intervals around the clock.

3. Shake liquid penicillins well to mix thoroughly and measure the dose accurately.

4. Discard liquid penicillin after 1 week if stored at room temp., or 2wks if refrigerated. Liquid forms deteriorate and should not be taken after their expiration date.

5. Report any skin rash, hives, itching, severe diarrhea, shortness of breath, fever, sore throat, black tongue, or any unusual bleeding. These symptoms may indicate an allergy to penicillin.

6. Augmentin: Take with meals to increase absorption and decrease gastrointestinal upset.

Front 70

When teaching how to take oral cephalosporins what are some things to keep in mind?

Back 70

1. Take most oral drugs with food or milk to prevent stomach upset.

2. Take cefpodoxime (Vantin) and cefuroxime (ceftin) with food to increase absorption.

3. Do not take cefaclor, cefdinin (Omnicef) or Cefpodoxime (Vamtin) with antacids containing aluminum or magnesium (ex. Maalox, Mylanta) or with pepcid, tagament, or zantac. These drugs decrease absorption of these antibiotics and make them less effective. If necessary to take one of the drugs take it 2hr before or 2hr after a dose of these antibiotics.

4. Shake liquid preparations well to mix thoroughly and measure the dose accurately.

5. Report the occurrence of diarrhea especially if it is severe or contains blood pus, or mucus. Cephalosporins can cause antibiotic associated colitis and the drug may need to be stopped.

5. Inform the prescribing physician if you are breast feeding these drugs enter breast milk.

Front 71

True or false

First generation cephalosporins are used for surgical prophylaxis especially with prosthetic implants, because gram postivie organisms such as staphylococci cause most infections of surgical sites. Cefazolin (Kefzol) if often the drug of choice.

Back 71

True

Front 72

True or false

Second generation cephalosporins are also used for surgical prophylaxis but for gynecologic and colorectal surgery. Also, the are used for treatment of intra abdominal infection such as pelvic inflammatory disease, diverticulitis, and penetrating wounds of the abdomen.

Back 72

True

Front 73

True or false

Third generation cephalosporins are recommended for serious infection caused by susceptible organisms that are resistant to first and second generation cephalosporins. They are often used to treat E. coli, Proteus, Klbsiella, and Serratia.

Back 73

True

Front 74

True or false

If Penicillin is considered essential, a skin test may be helpful in assessing hypersensitivity.

Back 74

True

Front 75

______________ can be given concurrently with penicillins to increase serum drug levels. The drug also acts by blocking renal excretion of the penicillins.

Back 75

Probenecid (Benemid)

Front 76

When a patient is taking ________________ hypernatremia may occur

Back 76

Ticarcillin

Front 77

Hyperkalemia may occur with large IV doses of this ___________

Back 77

Penicillin G Potassium

Front 78

In patients with renal impairment ________ metabolic acidosis may occur with ticarcillin because potassium loss in enhanced by high sodium intake.

Back 78

Hypokalemic metabolic acidosis

Front 79

___________ may cause decreased platelet aggregation.

Back 79

Ticarcillin

Front 80

__________ and _________ may cause hypoprothrombinemia

Back 80

Cefoperazone and cefotetan

Front 81

What drugs increase the effects of penicillins?

Back 81

Gentamicin and aminoglycosides