Ch32 Pharm

Front 1

Urinary ___________ are used only in urinary tract infections UTI's.

Back 1

Antiseptics

Front 2

Urinary antiseptics may be bactericidal for sensitive organisms in the urinary tract because these drugs are concentrated in ___________ and reach high levels in urine

Back 2

Renal Tubes

Front 3

Tetracyclines penetrate microbial cells by __________ diffusion and an active transport system.

Back 3

Passive

Front 4

All tetracyclines (except doxcycline) and sulfonamides are contraindicated in pts with ________ ________.

Back 4

Renal failure

Front 5

Tetracyclines decompose with __________, exposure to light and extreme heat and humidity.

Back 5

time

Front 6

Older broad spectrum bacteriostatic drugs; rarely used for systemic infections because of microbial resistance and development of more effective or less toxic drugs

Back 6

Tetracyclines and sulfonamides

Front 7

Useful in the treatment of bronchitis

Back 7

Trimethoprim sulfamethoxazole (bactrim septra)

Front 8

Still used to treat bacterial infections caused by Brucella and Vibrio cholerae

Back 8

Tetracyclines

Front 9

One of the drugs of choice for Bacillus anthracis (anthrax) and Chlamydia trachomatis

Back 9

Doxycycline (Vibramycin)

Front 10

Given to relieve pain associated with UTI

Back 10

Phenazopyridine (pyridium)

Front 11

Name two organisms disease processes that are still treated with tetracyclines.

Back 11

The tetracyclines are similar in pharmacologic properties and antimicrobial activity. They are effective against a wide range of gram positive and gram negative organisms although they are usually not drug of choice. Bacterial infection cause by Brucella or by Vibrio cholerae are still treated with tetracyclines. The drugs also remain effective against rickettsiae chlamydiae some protozoans , spirochetes and others. Doxycycline (vibramycin) is one of the drugs of choice for Bacillus anthracis (anthrax) and Chlamydia trachomatis and it is used in respiratory tract infections caused by mycoplasma pneumoniae.

Front 12

Explain how tetracyclines are excreted.

Back 12

Tetracyclines are widely distributed into most body tissues and fluids. The older tetracyclines are excreted mainly in urine; doxycycline is eliminated mainly by the liver.

Front 13

Name two organisms or disease processes in which sulfonamides may be an effective treatment.

Back 13

Sulfonamides may be active against streptococcus pyogenes some staphylococcal strains haemophilus influenzae nocardia chlamydia trachomatis and toxopolasmosis.

Front 14

Describe the mechanism of action used by tetracyclines.

Back 14

Tetracyclines penetrate microbial cells by passive diffusion and via an active transport system. Inside the cell the bind to 30S ribosomes.

Front 15

For what types of UTI's are sulfonamides prescribed?

Back 15

Sulfonamides are commonly used to treat UTI's (ex. acute Escerichia coli and Proteus or Klebsiella organisms.) In acute pyelonephritis, other agents are preferred.

Front 16

Urinary antiseptics may be bactericidal for sensitive organisms in the urinary tract because these drugs are concentrated in which of the following structures?

a. Renal tubules

b. Bladder

c. Nephrons

d. Renal

Back 16

a.

Rationale: Urinary antiseptics may be bactericidal for sensitive organisms in the urinary tract because these drugs are concentrated in renal tubules and reach high levels in urine.

Front 17

Urinary antiseptics are not used in systemic infections for which of the following reasons?

a. They do not sustain therapeutic plasma levels

b. They do not attain therapeutic plasma levels.

c. They are not effective against systemic infection in general.

d. They attain therapeutic blood levels rapidly.

Back 17

b.

Rationale: Urinary antiseptics are not used in systemic infections because they do not attain therapeutic plasma levels.

Front 18

Sulfasalazine (Azulfidine) is contraindicated in people who are allergic to which of the following?

a. Salicylates (aspirin)

b. Diuretics

c. Nonopioid analgesics

d. NSAID's

Back 18

a.

Rationale: Sulfasalazine (Azulfidine) is contraindicated in people who are allergic to salicylates.

Front 19

Sulfonamides are bacteriostatic against a wide range of gram positive and gram negative bacteria but they are becoming less useful for which of the following?

a. Decreased resistance

b. Increased susceptibility

c. Intermittent resistance

d. Increasing resistance.

Back 19

d.

Rationale: Sulfonamides are bacteriostatic against a wide range of gram positive and gram negative bacteria although increasing resistance is making them less useful.

Front 20

The tetracyclines are effective against a wide range of which of the following types of organisms?

a. Gram positive organisms

b. Gram negative organisms

c. Gram positive and gram negative organisms

d. Beta lactamase positive organisms.

Back 20

c.

Rationale: The tetracyclines are effective against a wide range of gram positive and gram negative organisms, although they are usually not drugs of choice.

Front 21

Mr Jay presents to the ER in pain. He is diagnosed with mild to moderate burns on his forearms secondary to exposure to hot pipes in his home. The physician orders which of the following topical medications?

a. Penicillin

b. Amoxicillin

c. Tetracycline

d. Sulfadiazine

Back 21

d.

Rationale: Sulfonamides are rarely used in critical care settings except that topical silver sulfadiazine (silvadene) is used to treat burn wounds.

Front 22

The treatment for choice for P. jiroveci pneumonia is which of the following?

a. Trimethorprim sulfamethoxazole

b. Tetracycline

c. Amoxicillin

d. Sulfadiazine.

Back 22

a.

Rationale: Trimethoprim sulfamethoxazole used to treat pneumocystis jiroveci pneumonia.

Front 23

Tetracyclines may be used to treat sepsis caused by which of the following? (select all that apply)

a. Rickettsial organisms

b. Chlamydial organisms

c. Streptococcal organisms

d. Legionella pneumophila

Back 23

a, b, d

Rationale: Tetracyclines may be used to treat sepsis caused by rickettsial, chlamydial, or mycoplasma infection caused by M. pneumoniae or legionella pneumophila.

Front 24

Tetracyclines are generally contraindicated in pregnant women because they may do which of the following? (select all that apply)

a. Cause fatal hepatic necrosis in the mother

b. Cause renal impairment in the mother.

c. Cause renal impairment in the fetus

d. Interfere with bone and tooth development in the fetus.

Back 24

a, d

Rationale: Tetracyclines are generally contraindicated in pregnant women because they may cause fatal hepatic necrosis in the mother as well as interfere with bone and tooth development in the fetus.

Front 25

Ms. Dagistino is diagnosed with hepatitis C as well as urinary tract infection. The organism is sensitive to tetracycline. The physician is reluctant to order tetracycline because hepatic impairment does which of the following?

a. Slows drug elimination

b. Increases drug elimination

c. Causes intermittent drug elimination

d. Eliminates absorption of the medication.

Back 25

a.

Rationale: Because tetracyclines are metabolized in the liver hepatic impairment or biliary obstruction slows drug elimination.

Front 26

In patients with renal impairment with of the following IV doses of teteracycline has been associated with death from liver failure?

a. >1.5g/day

b. >2g/day

c. >3g/day

d. <5g/day

Back 26

b.

Rationale: In patients with renal impairment high IV doses of tetracyclines >2g/day have been associated with death from liver failure.

Front 27

Sulfonamides cause ___________ jaundice in a small percentage of patients and should be used with caution in patients with hepatic impairment.

Back 27

Cholestatic

Front 28

A fluid intake of ______ liters daily is needed to reduce formation of crystals in stones in the urinary tract when taking tetracyclines.

Back 28

2L

Front 29

With the combination of trimethoprimsulfamethoxazole older adults are at increased risk for severe adverse effects including which of the following?

a. Severe skin reactions

b. Bone marrow depression

c. GI bleed

d. Leukocytosis

Back 29

a, b

Rationale: With the combination trimethoprim sulfamethoxazole, older adults are at risk for severe adverse effects. Severe skin reaction and bone marrow depression are most often reported. Folic acid deficiency may also occur, because both of the drugs interfere with folic acid metabolism.

Front 30

High concentration of tetracyclines ______ protein synthesis in human cells

Back 30

Inhibit

Front 31

Tetracyclines should not be used in children younger than 8 yrs of age because of their effects on which of the following?

a. Teeth and bones

b. Kidneys

c. Blood

d. Liver

Back 31

a.

Rationale: Tetracyclines should not be used in children younger than 8yrs of age because of their effects on teeth and bones.

Front 32

If a fetus or young infant receives a sulfonamide by placental transfer, in breast milk or by direct administration the drug displaces bilirubin form binding sites on albumin. As a result the fetus experiences which of the following?

a. Hyperbilirubinemia

b. Hyperkalemia

c. Hypernatremia

d. Kernicterus

Back 32

a.

Rationale: If a fetus or young infant receives a sulfonamide by placental transfer in breast milk or by binding sites on albumin. As a result, bilrubin may accumulate in the blood stream (hyperbilrubinemia) and in life central nervous system (kernicterus) and may cause life threatening toxicity.

Front 33

With sulfonamide therapy alkaline urine increases drug solubility and helps prevent __________

Back 33

Crystalluria

Front 34

Sulfonamides are often used to treat UTI's in children older than what age?

a. 6months

b. 4 months

c. 2 months

d. 12 months

Back 34

c.

Rationale: Sulfonamides are often used to treat UTI in children older than 2 months of age

Front 35

Tetracyclines must be used cautiously in the presence of which of the following?

a. Cerebral vascular accident

b. Liver impairment

c. Cardiovascular disease

d. Kidney impairment

Back 35

b, d

Rationale: Teracyclines must be used cautiously in the presence of liver or kidney impairment.

Front 36

Prototype drug for the Tetracyclines
Marketed under generic and numerous trade names

Back 36

Tetracycline
(Achromycin)

Front 37

The tetracycline most likely to cause photo sensitivity
Primarily used to treat inappropriate secretion of antidiuretic hormone
No longer recommended for treatment of gonorrhea

Back 37

Demeclocycline
(Declomycin)

Front 38

Well absorbed from the gastro intestinal tract.Oral administration yields serum drug levels equivalent to those obtained by parenteral administration.

Highly lipid soluble; therefore,reaches therapeutic levels in CSF,the eye,and the prostategland

Can be given in smaller doses and less frequently than other tetracyclines because of long serum half-life (approximately 18 h)

Excreted by kidneys to a lesser extent than other tetracyclines and is considered safe for clients with impaired renal function

Back 38

Doxycycline
(Vibramycin)

Front 39

Well absorbed after oral administration

Like doxycycline,readily penetrates CSF,the eye,and the prostate gland

Metabolized more than other tetracyclines,and smaller amounts are excreted in urine and feces

Back 39

Minocycline
(Minocin)

Front 40

Poorly absorbed

Does not alter normal bacterial flora in the intestine. Effectiveness in ulcerative colitis may be due to antibacterial (sulfapyridine) and antinflammatory (aminosali-cylic acid)metabolites

Back 40

Sulfasalazine
(Azulfidine)

Front 41

Rapidly absorbed,rapidly excreted
■
Highly soluble and less likely to cause crystalluria than most othersulfonamides

Back 41

Sulfisoxazole

Front 42

May exhibit synergistic effectiveness against many organisms(verify susceptibility first),including strepto-cocci
(S.viridans),staphylococci (S.epidermidis,S.aureus),Escherichiacoli,Salmonella,Shigella,Serratia,Klebsiella,Nocar-dia,
and others.Most strains of
Pseudomonas
are resistant

Back 42

Combination AgentTrimethoprim-sulfamethox-azole
(Bactrim,Septra,others)Dosage based onTrimethoprimComponent