Antibiotics and Antimicrobials

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Questions and Answers

A patient receiving a beta-lactam antibiotic develops a skin rash, shortness of breath, and swelling of the lips and tongue. Which of the following is the MOST likely adverse effect?

  • Nephrotoxicity
  • Allergic reaction (correct)
  • Ototoxicity
  • Gastrointestinal upset

A patient is prescribed vancomycin for a severe infection. To minimize the risk of 'Red Man Syndrome', what administration technique should the nurse employ?

  • Administer the drug as a bolus.
  • Administer the drug slowly via infusion. (correct)
  • Administer the drug via intramuscular injection.
  • Administer the drug rapidly over 30 minutes.

A young patient is prescribed tetracycline for acne. What potential adverse effect should be discussed with the patient and their parents?

  • Increased appetite
  • Decreased sensitivity to sunlight
  • Tooth discoloration (correct)
  • Improved bone density

A patient taking erythromycin complains of nausea, vomiting, and diarrhea. Which of the following is the MOST likely cause of these symptoms?

<p>Gastrointestinal upset (D)</p> Signup and view all the answers

A patient receiving gentamicin develops hearing loss and balance problems. What is the MOST likely adverse effect causing these issues?

<p>Ototoxicity (A)</p> Signup and view all the answers

A patient is prescribed sulfamethoxazole/trimethoprim (TMP/SMX). What adverse effect should the patient be educated about regarding sun exposure?

<p>Increased risk of sunburn (photosensitivity) (C)</p> Signup and view all the answers

A patient taking ciprofloxacin reports sudden pain in their Achilles tendon after physical activity. What is the MOST likely adverse effect?

<p>Tendon rupture (C)</p> Signup and view all the answers

A patient develops severe diarrhea and abdominal cramping after being treated with clindamycin. Which of the following conditions is MOST likely causing these symptoms?

<p><em>Clostridium difficile</em> colitis (C)</p> Signup and view all the answers

A patient taking metronidazole reports a persistent metallic taste in their mouth and is advised to avoid alcohol. Why is alcohol contraindicated with this medication?

<p>It may result in a disulfiram-like reaction. (D)</p> Signup and view all the answers

Which adverse effect is MOST associated with acyclovir and ganciclovir, requiring close monitoring of kidney function?

<p>Nephrotoxicity (B)</p> Signup and view all the answers

A patient taking oseltamivir (Tamiflu) for influenza reports experiencing new-onset confusion and agitation. What is the MOST appropriate action?

<p>Monitor for any neuropsychiatric effects. (C)</p> Signup and view all the answers

Which of the following adverse effects is associated with amphotericin B ('Ampho-terrible') and necessitates monitoring of serum electrolyte levels?

<p>Electrolyte imbalance (↓K, ↓Mg) (C)</p> Signup and view all the answers

A patient is prescribed fluconazole for a fungal infection. Which of the following organ systems is MOST likely to be affected by the adverse effects of this medication?

<p>Liver (B)</p> Signup and view all the answers

A patient is started on rifampin as part of tuberculosis treatment. What potential side effect should the patient be informed about that may affect the color of their bodily fluids?

<p>Red-orange discoloration of bodily fluids (C)</p> Signup and view all the answers

A patient receiving isoniazid (INH) for tuberculosis prophylaxis reports numbness and tingling in their hands and feet. What is the MOST likely cause of this?

<p>Peripheral neuropathy (A)</p> Signup and view all the answers

A patient taking pyrazinamide as part of their tuberculosis treatment experiences joint pain and elevated uric acid levels. Which adverse effect is MOST likely occurring?

<p>Hyperuricemia (C)</p> Signup and view all the answers

A patient being treated for tuberculosis with ethambutol reports blurred vision and difficulty distinguishing between colors. What specific adverse effect is the patient likely experiencing?

<p>Optic neuritis (A)</p> Signup and view all the answers

A patient with HIV is prescribed zidovudine. What hematological adverse effect is MOST commonly associated with this medication?

<p>Bone marrow suppression (A)</p> Signup and view all the answers

Efavirenz is prescribed to a female patient of childbearing age, what potential side effect is MOST important to discuss pre-treatment?

<p>Teratogenicity (B)</p> Signup and view all the answers

A patient taking ritonavir reports feeling nauseous and has been unable to keep down food. What is the MOST likely cause of these symptoms?

<p>Gastrointestinal upset (D)</p> Signup and view all the answers

A patient is prescribed morphine for severe pain. What is the MOST significant adverse effect that requires ongoing monitoring?

<p>Respiratory depression (D)</p> Signup and view all the answers

A pregnant patient is experiencing moderate pain. Which of the following opioid analgesics should be avoided due to potential risks to the fetus?

<p>Meperidine (C)</p> Signup and view all the answers

A patient has overdosed on an opioid medication. Which of the following medications is the MOST appropriate to administer?

<p>Naloxone (C)</p> Signup and view all the answers

A patient is taking acetaminophen regularly for chronic pain. What is the maximum daily dose of acetaminophen to avoid hepatotoxicity?

<p>4 grams (A)</p> Signup and view all the answers

A patient taking ibuprofen for arthritis reports stomach pain and dark stools. What is the MOST likely cause of these symptoms?

<p>Gastrointestinal upset (ulcer or bleed) (B)</p> Signup and view all the answers

A patient with gout is prescribed allopurinol. What potential adverse effect should the patient be monitored for?

<p>Hypersensitivity (D)</p> Signup and view all the answers

Which of the following adverse effects is associated with colchicine, used in the treatment of gout?

<p>Gastrointestinal upset (C)</p> Signup and view all the answers

A patient taking sumatriptan for migraine headaches reports chest tightness and pressure. What is the MOST likely cause of this symptom?

<p>Vasoconstriction (B)</p> Signup and view all the answers

Which of the following medications is MOST likely to cause peripheral neuropathy as an adverse effect?

<p>Isoniazid (B)</p> Signup and view all the answers

Which antibiotic is most likely to cause tooth discoloration as a significant adverse effect, particularly in young children?

<p>Tetracycline (B)</p> Signup and view all the answers

Which of the following medications used to treat infections carries the highest risk of causing Clostridium difficile colitis?

<p>Clindamycin (D)</p> Signup and view all the answers

Which medication is notable for causing a disulfiram-like reaction when combined with alcohol?

<p>Metronidazole (A)</p> Signup and view all the answers

Which of the following antiviral medications requires careful monitoring for electrolyte imbalances and potential nephrotoxicity?

<p>Acyclovir (C)</p> Signup and view all the answers

Which of the following drugs is commonly associated with red-orange discoloration of bodily fluids?

<p>Rifampin (C)</p> Signup and view all the answers

Which drug used in the treatment of TB is most likely to cause optic neuritis as a side effect?

<p>Ethambutol (D)</p> Signup and view all the answers

Which of the following medications used to treat HIV can lead to bone marrow suppression?

<p>Zidovudine (B)</p> Signup and view all the answers

Among the common pain relievers, which one is known for its potential to cause liver damage with high doses or overuse?

<p>Acetaminophen (A)</p> Signup and view all the answers

What is the main mechanism by which sumatriptan alleviates headaches?

<p>Vasoconstriction (C)</p> Signup and view all the answers

Flashcards

Beta-Lactams Adverse Effects

Allergic reactions, GI upset, seizures (high dose, renal impairment). Cephalosporins have cross-allergy with penicillins.

Vancomycin Adverse Effects

Nephrotoxicity, ototoxicity, Red Man Syndrome (infusion reaction).

Tetracycline Adverse Effects

Tooth discoloration, bone growth inhibition, photosensitivity.

Macrolides (Erythromycin) Adverse Effects

GI upset, QT prolongation, CYP3A4 interactions.

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Aminoglycosides (Gentamicin) Adverse Effects

Nephrotoxicity, ototoxicity

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Sulfonamides (TMP/SMX) Adverse Effects

Rash (SJS), hyperkalemia, crystalluria, photosensitivity.

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Fluoroquinolones (Ciprofloxacin) Adverse Effects

Tendon rupture, QT prolongation, CNS effects.

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Clindamycin Adverse Effects

C. diff colitis.

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Metronidazole Adverse Effects

Metallic taste, disulfiram reaction with alcohol.

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Acyclovir / Ganciclovir Adverse Effects

Nephrotoxicity (hydrate!), bone marrow suppression (Ganciclovir).

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Oseltamivir (Tamiflu) Adverse Effects

Nausea, vomiting, rare neuropsych symptoms.

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Amphotericin B (Ampho-terrible) Adverse Effects

Nephrotoxicity, electrolyte imbalance (↓K, ↓Mg), infusion reactions.

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Azoles (Fluconazole, Itraconazole) Adverse Effects

Hepatotoxicity, CYP interactions.

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Rifampin Adverse Effects

Red-orange fluids, hepatotoxicity.

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Isoniazid Adverse Effects

Peripheral neuropathy, hepatotoxicity.

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Pyrazinamide Adverse Effects

Hyperuricemia, hepatotoxicity.

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Ethambutol Adverse Effects

Optic neuritis.

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Zidovudine Adverse Effects

Bone marrow suppression.

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Efavirenz Adverse Effects

CNS side effects, teratogenic.

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Ritonavir Adverse Effects

CYP inhibitor, GI upset.

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Opioids (Morphine, Fentanyl, etc.) Adverse Effects

Respiratory depression, constipation, sedation.

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Acetaminophen Adverse Effects

Hepatotoxicity (max 4g/day).

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Ibuprofen Adverse Effects

GI upset, nephrotoxicity.

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Allopurinol Adverse Effects

Hypersensitivity, rash.

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Colchicine Adverse Effects

GI upset, myopathy.

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Sumatriptan Adverse Effects

Chest pressure, serotonin syndrome.

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Study Notes

Antibiotics

Beta-Lactams (Penicillins, Cephalosporins, Carbapenems)

  • Adverse effects include allergic reactions, GI upset, and seizures, especially with high doses or renal impairment
  • Memory trick: "Beta makes your Belly and Brain Bounce" for GI upset and seizures
  • Be aware of cross-allergy between cephalosporins and penicillins

Vancomycin

  • Adverse effects are nephrotoxicity, ototoxicity, and Red Man Syndrome, the latter being an infusion reaction
  • Memory trick: "VAN go slow or you'll glow" to infuse slowly and avoid Red Man Syndrome

Tetracycline

  • Adverse effects consist of tooth discoloration, bone growth inhibition, and photosensitivity
  • Memory trick: "Tetra Teeth Tan Trouble" to remember teeth stains and sun sensitivity

Macrolides (Erythromycin)

  • Adverse effects include GI upset, QT prolongation, and CYP3A4 interactions
  • Memory trick: "E for EKG" to watch QT interval, and "Macrolides Make you HURL"

Aminoglycosides (Gentamicin)

  • Adverse effects involve nephrotoxicity and ototoxicity
  • Memory trick: "A Mean GNAT" for Gentamicin, Nephrotoxicity, Aminoglycoside, and Tinnitus

Sulfonamides (TMP/SMX)

  • Adverse effects: Rash (SJS), hyperkalemia, crystalluria, and photosensitivity
  • Memory trick: "Sulfa SSSSucks for Skin, Sun, Stones"

Fluoroquinolones (Ciprofloxacin)

  • Adverse effects include tendon rupture, QT prolongation, and CNS effects
  • Memory trick: "Flox like a tendon pop"

Clindamycin

  • Adverse effects: C. diff colitis
  • Memory trick: "Clean-da-gut but causes Clostridium!"

Metronidazole

  • Adverse effects: Metallic taste and disulfiram reaction with alcohol
  • Memory trick: "Metro = Metallic + no Merlot"

Antivirals

Acyclovir / Ganciclovir

  • Adverse effects of Acyclovir is Nephrotoxicity (hydrate!) and Ganciclovir is bone marrow suppression
  • Memory trick for Acyclovir: "A kidney concern"
  • Memory trick for Ganciclovir: "Guts (marrow) get hit"

Oseltamivir (Tamiflu)

  • Adverse Effects: Nausea, vomiting, rare neuropsych symptoms
  • Memory trick: "Tamiflu can Mess with Mind and Meals"

Antifungals

Amphotericin B (Ampho-terrible)

  • Adverse effects include nephrotoxicity, electrolyte imbalance (↓K, ↓Mg), and infusion reactions
  • Memory trick: "Ampho-terrible for your kidneys"

Azoles (Fluconazole, Itraconazole)

  • Adverse effects: Hepatotoxicity, CYP interactions
  • Memory trick: "Azoles = A Liver Load"

Antituberculars (RIPE)

  • R - Rifampin: Causes red-orange fluids and hepatotoxicity; memory trick: "Rifampin = Red fluids"
  • I - Isoniazid: Causes peripheral neuropathy and hepatotoxicity; memory trick: "INH = Injures Nerves and Hepa"
  • P - Pyrazinamide: Causes hyperuricemia and hepatotoxicity; memory trick: "Pee = Uric acid up"
  • E - Ethambutol: Causes optic neuritis; memory trick: "E = Eye problems"

Antiretrovirals (HIV)

  • Zidovudine: Causes bone marrow suppression
  • Efavirenz: Causes CNS side effects and is teratogenic
  • Ritonavir: CYP inhibitor, causes GI upset
  • General tip: Always monitor for resistance, adherence, and food interactions

Pain Management

Opioids (Morphine, Fentanyl, etc.)

  • Adverse effects are respiratory depression, constipation, and sedation
  • Memory trick: "Morphine Means Minimal Movement"
  • Meperidine and Codeine are to be avoided in pregnancy
  • Naloxone is a reversal agent

Non-Opioids

  • Acetaminophen: Causes hepatotoxicity, with a max dose of 4g/day
  • Ibuprofen: Causes GI upset and nephrotoxicity
  • Memory trick: "Ibuprofen = I Burn gut and I Block kidneys"

Gout

  • Allopurinol: Hypersensitivity, rash
  • Colchicine: GI upset, myopathy
  • memory trick: “Colchicine = Colon Chaos”

Headache

  • Sumatriptan: Causes chest pressure and serotonin syndrome
  • Memory trick: "Suma-Squeeze" (vasoconstriction = chest pain)

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