Pharmacology Quiz: Diuretics and Pain Management
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Questions and Answers

Which of the following is not a condition commonly associated with the need for diuretic administration?

  • Dependent edema
  • Anuria (correct)
  • Acute heart failure
  • Uncontrolled hypertension

A patient with a history of heart failure is experiencing a sudden increase in edema. Which term best describes the condition where excessive fluid has accumulated in the body tissues?

  • Dependent edema
  • Anuria
  • Anasarca (correct)
  • Ascites

A patient is prescribed a diuretic. Which of the following lab values would be most important for the nurse to monitor to assess for the most common side effects?

  • Serum electrolytes (correct)
  • Blood glucose
  • Liver function tests (LFTs)
  • Complete blood count (CBC)

What is the meaning of the term 'ceiling threshold' in pharmacology, especially in the context of diuretics?

<p>The near-maximum response of a drug that is yielded by a certain dose. (A)</p> Signup and view all the answers

In the clinical case study provided, what are the primary reasons for Agnes Bass's presentation to the emergency department?

<p>Acute heart failure and uncontrolled hypertension (A)</p> Signup and view all the answers

Which term describes intense pain that occurs despite a regular medication regimen for pain?

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

What is the main goal of abuse-deterrent formulations of opioids?

<p>To prevent the drug from being crushed or dissolved (C)</p> Signup and view all the answers

A patient has been prescribed methadone as part of treatment for opioid use disorder. This is an example of what type of treatment?

<p>Agonist substitution treatment (D)</p> Signup and view all the answers

What does the term 'ceiling effect' refer to in the context of drug therapy?

<p>The limit to a drug's ability to produce a further effect above a certain dose (D)</p> Signup and view all the answers

Which situation describes 'drug diversion'?

<p>Using a medication in a manner or dose other than prescribed (A)</p> Signup and view all the answers

Which of the following vital signs would cause the nurse the most concern for Darlene Hoffman, the client mentioned in the case study?

<p>O2 saturation 94% on 2 L/min nasal cannula (D)</p> Signup and view all the answers

What is Neonatal Abstinence Syndrome?

<p>Withdrawal symptoms in newborns due to in utero substance exposure (C)</p> Signup and view all the answers

According to the provided text, what is NOT an area of focus when learning about opioid drug therapy?

<p>Knowing treatment options for individuals with a family history of addiction (D)</p> Signup and view all the answers

What is the primary characteristic that differentiates an opioid-naive patient from an opioid-tolerant patient?

<p>The opioid-tolerant patient has consistently used a certain dose of opioids for a week or more. (C)</p> Signup and view all the answers

What is the main purpose of a Risk Evaluation and Mitigation Strategy (REMS) program concerning opioid analgesics?

<p>To provide educational resources about opioid medications to prescribers. (C)</p> Signup and view all the answers

According to the provided information, what does 'tolerance' refer to in the context of opioid use?

<p>A decreased effect from the opioid that requires a higher dose to achieve the initial response. (A)</p> Signup and view all the answers

What is the best description of the multidimensional nature of pain?

<p>Pain varies in quality, intensity, and origin, and can affect a person's mental health and overall quality of life. (B)</p> Signup and view all the answers

What is the origin of the drug Isotonitazene?

<p>It is produced by clandestine labs in China. (A)</p> Signup and view all the answers

What medical intervention can counteract the effects of an isotonitazene overdose?

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

What is a key concern related to opioid drugs taken by pregnant women?

<p>The neonate may experience myoclonus, tremors, and hyperreflexia. (C)</p> Signup and view all the answers

If a patient is using a device to inject pain medication, what is that usage typically called?

<p>Patient-controlled analgesia (A)</p> Signup and view all the answers

Why is the use of prescription opioids outside of a licensed physician's orders concerning?

<p>There is a risk of death without professional guidance to take the medications. (C)</p> Signup and view all the answers

Pain can be classified by its origin, duration, and what other characteristic?

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

Which characteristic is typically associated with macrolide anti-infective agents?

<p>Broad spectrum of antibacterial activity. (A)</p> Signup and view all the answers

What is the primary mechanism of action of erythromycin?

<p>Inhibiting protein synthesis by binding to the 50S ribosomal subunits. (B)</p> Signup and view all the answers

How does food intake typically affect the absorption of oral erythromycin?

<p>Food intake can impact absorption. (C)</p> Signup and view all the answers

Which of the following is a typical use of topical applications of erythromycin?

<p>Prevention of chlamydial conjunctivitis. (B)</p> Signup and view all the answers

What is the main reason why erythromycin is less commonly used now compared to newer macrolides?

<p>Erythromycin has drug interactions and there are newer macrolides available. (C)</p> Signup and view all the answers

What is the approximate time frame for peak plasma concentration after an intravenous administration of erythromycin?

<p>Less than 1 hour. (D)</p> Signup and view all the answers

Which of the following organisms are NOT typically susceptible to macrolides?

<p>Enterococcus faecium. (B)</p> Signup and view all the answers

Which of the following describes the type of metabolic process for erythromycin?

<p>Hepatic metabolism via cytochrome P450 3A4. (B)</p> Signup and view all the answers

Which of the following is a potential use for macrolides?

<p>Treatment of bacterial infections. (A)</p> Signup and view all the answers

Besides erythromycin, which other medications belong to the class of macrolides?

<p>Clarithromycin and fidaxomicin. (B)</p> Signup and view all the answers

What is the primary rationale behind the increasing use of single daily doses of aminoglycosides?

<p>To reduce the incidence of nephrotoxicity and ototoxicity. (A)</p> Signup and view all the answers

What does the term 'concentration-dependent bactericidal effect' mean in the context of aminoglycosides?

<p>The rate and extent of bacterial killing is most efficient when drug concentrations are maximized. (A)</p> Signup and view all the answers

Why is it important to monitor serum drug levels during aminoglycoside therapy?

<p>To maintain therapeutic drug levels while minimizing the risk of toxicity. (B)</p> Signup and view all the answers

Which of the following best describes the term 'extended-interval dosing' for aminoglycosides?

<p>Administering the drug once daily for better therapeutic efficacy. (A)</p> Signup and view all the answers

What are the two key adverse effects associated with aminoglycoside therapy?

<p>Nephrotoxicity and ototoxicity. (D)</p> Signup and view all the answers

How can the risk of nephrotoxicity and ototoxicity from aminoglycoside therapy be reduced?

<p>By using extended-interval dosing (once-daily dosing). (D)</p> Signup and view all the answers

What is a 'peak level' in the context of drug administration?

<p>The highest concentration of a drug in the patient's bloodstream after administration. (A)</p> Signup and view all the answers

What is the importance of the judicious use of aminoglycosides and fluoroquinolones?

<p>To minimize the development of antibiotic resistance. (B)</p> Signup and view all the answers

What is the primary mode of transmission for Mycobacterium tuberculosis?

<p>Airborne droplets from an infected person (B)</p> Signup and view all the answers

What is a key characteristic that differentiates multidrug-resistant tuberculosis (MDR-TB) from drug-sensitive TB?

<p>MDR-TB is resistant to at least one first-line antitubercular drug and both isoniazid and rifampin. (C)</p> Signup and view all the answers

In the progression of tuberculosis, what typically occurs during the 'latent' phase?

<p>The immune system encapsulates the bacteria, preventing growth. (C)</p> Signup and view all the answers

What distinguishes extensively drug-resistant tuberculosis (XDR-TB) from multidrug-resistant tuberculosis (MDR-TB)?

<p>XDR-TB is resistant to isoniazid and rifampin, at least one fluoroquinolone, and one injectable second-line drug. (D)</p> Signup and view all the answers

If a patient presents with jaundice as a side effect of drug therapy, what could this indicate?

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

What is the purpose of Directly Observed Therapy (DOT) in tuberculosis treatment?

<p>To ensure the patient is taking every dose of their medication correctly. (B)</p> Signup and view all the answers

What would be a sign that active TB is developing?

<p>The immune system is not able to control the <em>M. tuberculosis</em>. (D)</p> Signup and view all the answers

Which of the following is NOT a common sign or symptom typically seen in the clinical case of Tuberculosis?

<p>Severe muscle pain. (A)</p> Signup and view all the answers

How long can the initial infection typically occur, after exposure to M. tuberculosis bacteria?

<p>2 to 10 weeks (D)</p> Signup and view all the answers

Which of the following statements accurately distinguishes between Mycobacterium tuberculosis and Mycobacterium intracellulare?

<p><em>M. tuberculosis</em> multiplies in the lungs, whereas <em>M. intracellulare</em> causes a similar but different disease and is found in water and soil. (D)</p> Signup and view all the answers

What is the primary function of beta-lactamase?

<p>To break down the beta-lactam ring, rendering the antibiotic ineffective. (C)</p> Signup and view all the answers

Which of the following best describes the term 'cross-allergenicity'?

<p>An allergy to one drug that may indicate an allergy to another drug of a similar chemical structure. (C)</p> Signup and view all the answers

What does 'extended-spectrum' refer to, in the context of antibacterial activity?

<p>Bactericidal activity against a wide range of bacteria. (D)</p> Signup and view all the answers

What is meant by 'minimum inhibitory concentration' in relation to antibiotics?

<p>The lowest concentration of an antibiotic that visibly inhibits bacterial growth. (B)</p> Signup and view all the answers

Which of the following is a characteristic of a superinfection?

<p>It is an infection that occurs after previous infections, usually by resistant organisms. (C)</p> Signup and view all the answers

Why might a penicillin be combined with a beta-lactamase inhibitor?

<p>To allow the penicillin to be more effective against bacteria that produce beta-lactamase. (D)</p> Signup and view all the answers

According to the provided table, which of the following is a prototype of the carbapenem drug class?

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

What is the MOST critical nursing implication, regarding patient safety, when administering beta-lactam antibiotics?

<p>Questioning the patient about any history of allergies, especially to penicillins, before the initial dose. (C)</p> Signup and view all the answers

What is the main purpose for tapering the dosage of prednisone in Emma Mae's treatment?

<p>To prevent withdrawal symptoms (D)</p> Signup and view all the answers

Which of the following is NOT a characteristic of corticosteroids?

<p>They are incapable of causing adverse effects (A)</p> Signup and view all the answers

Which physiological effect is primarily associated with the action of aldosterone?

<p>Regulation of sodium reabsorption (A)</p> Signup and view all the answers

What condition might be indicated if a patient is displaying symptoms of Addisonian crisis?

<p>Primary adrenocortical insufficiency (A)</p> Signup and view all the answers

Which nursing implication is vital when administering corticosteroids?

<p>Monitor for signs of infection due to immunosuppression (C)</p> Signup and view all the answers

What is a common adverse effect of prolonged corticosteroid use?

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

Which of the following might necessitate the use of corticosteroids?

<p>Severe allergic reactions (A)</p> Signup and view all the answers

What might exacerbate the need for corticosteroids in certain patients?

<p>Presence of chronic infectious diseases (A)</p> Signup and view all the answers

What is the primary role of prostaglandins in the human body?

<p>Contribute to the etiology of pain, fever, and inflammation (B)</p> Signup and view all the answers

Which of the following is a common manifestation of inflammation?

<p>Swelling and redness in the affected area (D)</p> Signup and view all the answers

What is the prototype medication for salicylates?

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

Which medication is categorized as a selective COX-2 inhibitor?

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

What is a known adverse effect of acetaminophen?

<p>Liver damage with high doses (C)</p> Signup and view all the answers

What nursing implication is essential when administering propionic acid derivatives like ibuprofen?

<p>Assess for gastrointestinal bleeding (A)</p> Signup and view all the answers

Which dietary consideration is particularly important for a patient with a BMI of 30 awaiting surgery?

<p>Follow a calorie reduction diet (B)</p> Signup and view all the answers

In the context of drug therapy for pain, what is a critical component of the nursing process?

<p>Conducting thorough pain assessments and monitoring effectiveness (A)</p> Signup and view all the answers

What term describes the presence and growth of microorganisms on host tissues?

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

Which type of pneumonia is contracted by a person outside of a healthcare facility?

<p>Community-acquired pneumonia (C)</p> Signup and view all the answers

Which term refers to the technique used to identify pathogens by utilizing features of culture and serology?

<p>Detection of antigens (C)</p> Signup and view all the answers

What does 'bacteriostatic' refer to in the context of antimicrobial therapy?

<p>It inhibits bacterial growth and replication (C)</p> Signup and view all the answers

Which type of infection is defined as one acquired in hospitals and healthcare facilities?

<p>Hospital-acquired infection (B)</p> Signup and view all the answers

What is a significant risk associated with the overuse of antimicrobials?

<p>Development of drug-resistant organisms (C)</p> Signup and view all the answers

What type of microorganisms are considered opportunistic?

<p>Microorganisms in normal flora that become pathogenic under favorable conditions (D)</p> Signup and view all the answers

What is the primary role of anti-inflammatory agents?

<p>To prevent inappropriate or persistent immune response (A)</p> Signup and view all the answers

Flashcards

Opioid-naive

Patients who haven't taken significant opioid medications for a week or longer. They are considered new to opioids.

Opioid-tolerant

Patients who have consistently taken a substantial amount of opioid medication for a week or longer.

Patient-controlled analgesia (PCA)

A system where patients can self-administer pain medication through a controlled intravenous pump.

Risk evaluation and mitigation strategy (REMS)

A program required by the FDA for manufacturers of opioid medications, providing education to prescribers to minimize abuse and promote safe use.

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Tolerance

The phenomenon where the effectiveness of an opioid drug decreases over time, requiring higher doses for the same effect.

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Pain

An unpleasant sensory and emotional experience linked to actual or potential tissue damage.

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Pain origin

Classifying pain based on where it originates (e.g., muscles, organs, nerves).

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Pain duration

Classifying pain based on how long it lasts (e.g., acute, chronic).

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Neonatal Abstinence Syndrome

A set of symptoms in newborns due to opioid exposure during pregnancy.

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Isotonitazene

A potent synthetic opioid that can be highly dangerous.

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Abuse-deterrent formulations

A form of opioid medication that is designed to be difficult to crush or dissolve, making it less likely to be misused.

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Agonist substitution treatment

Using a weaker opioid, like buprenorphine or methadone, to replace a stronger opioid like heroin, gradually reducing the dosage.

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Breakthrough pain

Sudden, severe spikes in pain that occur despite ongoing pain management.

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Ceiling effect

The point at which increasing a drug's dosage no longer leads to a stronger effect. At a certain point, the effectiveness plateaus.

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Drug diversion

The illegal sharing or use of prescription drugs for purposes other than prescribed.

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Anasarca

Generalized, severe edema that affects the entire body.

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Anuria

The absence of urine production.

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Ascites

Fluid buildup in the abdominal cavity, causing distention.

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Dependent edema

Localized edema occurring in the lower extremities, often in the feet and ankles, due to gravity.

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Edema

Excessive fluid accumulation in body tissues.

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Tuberculosis (TB)

An infectious disease primarily affecting the lungs, caused by Mycobacterium tuberculosis, which can also involve lymph nodes, kidneys, and the gastrointestinal tract.

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Latent TB Infection

A form of TB where the immune system has encapsulated M. tuberculosis bacteria, preventing active growth of the bacteria. Most individuals with latent TB infection do not develop active TB disease.

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Active TB Disease

A form of TB where the immune system is unable to control M. tuberculosis leading to active disease, often with symptoms like fever, cough, night sweats, and weight loss.

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Multidrug-resistant tuberculosis (MDR-TB)

A type of TB resistant to at least one first-line antitubercular drug and both isoniazid and rifampin.

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Extensively drug-resistant tuberculosis (XDR-TB)

A rare form of TB resistant to isoniazid, rifampin, any fluoroquinolone, and at least one injectable second-line drug.

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Directly observed therapy (DOT)

A method of medication administration where a nurse (or responsible adult) observes a patient taking a dose of antitubercular drug.

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Jaundice

A common side effect of some medications, often seen with liver damage, characterized by yellowing of the skin and body tissues.

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First-line Antitubercular Drugs

A group of drugs used to treat TB.

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Second-line Antitubercular Drugs

Drugs used to treat MDR-TB when first-line treatments fail.

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Mycobacterium avium complex (MAC)

A complex of Mycobacteria, including common bacteria like Mycobacterium avium, often found in water and soil.

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Corticosteroid

Steroid hormone produced by the adrenal cortex.

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Addison disease

Primary adrenocortical insufficiency leading to inadequate production of cortisol and aldosterone.

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Aldosterone

A mineralocorticoid hormone secreted by the adrenal cortex, increasing sodium reabsorption by the kidneys and indirectly regulating blood levels of potassium, sodium, and bicarbonate.

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Addisonian crisis

A serious condition mimicking hypovolemic and septic shock, characterized by inadequate cortisol and aldosterone production.

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Exogenous Corticosteroids

Exogenous corticosteroids are used to treat various conditions by mimicking the effects of naturally occurring cortisol.

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Tapering Dose Schedule

The tapering dose schedule gradually reduces the dosage of corticosteroids to minimize withdrawal symptoms and potential side effects.

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Adrenal Suppression

The use of exogenous corticosteroids can suppress the production of natural corticosteroids, leading to adrenal insufficiency if discontinued abruptly.

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Increased Risk of Infections

Patients on long-term corticosteroid therapy are particularly vulnerable to infections due to the immune-suppressing effects of these medications.

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Pathogen

A microorganism that can cause disease.

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Inflammation

The body's response to injury or infection, characterized by redness, swelling, heat, pain, and loss of function.

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Colonization

The process of microorganisms, like bacteria, growing and multiplying on host tissues.

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Community-acquired infection

A type of infection contracted by someone outside of a healthcare setting.

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Hospital-acquired infection

An infection acquired in a healthcare facility, such as a hospital.

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Antimicrobial agent

A substance that can inhibit or kill bacteria.

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Empiric therapy

The use of antibiotics to treat an infection before a specific diagnosis is confirmed.

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Anti-inflammatory agents

A group of drugs that reduce inflammation, including aspirin, NSAIDs, and corticosteroids.

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Beta-lactamase

An enzyme produced by some bacteria that breaks down the beta-lactam ring of certain antibiotics, rendering them ineffective and leading to antibiotic resistance.

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Minimum inhibitory concentration (MIC)

The lowest concentration of an antimicrobial drug that prevents visible growth of a microorganism in a laboratory setting.

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Extended-spectrum

The property of an antibiotic to be effective against a wide range of bacteria.

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Superinfection

An infection that occurs after a previous infection, often caused by microorganisms resistant to the initial antibiotic treatment.

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Cross-allergenicity

An allergy to a drug of a different class but with a similar chemical structure. For example, someone allergic to penicillin may also be allergic to cephalosporins.

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Beta-lactam antibiotics

A group of antibiotics that share a common chemical structure, the beta-lactam ring, which inhibits bacterial cell wall synthesis.

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Beta-Lactamase Inhibitor

Drugs used to prevent the breakdown of penicillin by beta-lactamase, allowing penicillin to work more effectively.

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Combining penicillin with a beta-lactamase inhibitor

Combining a penicillin antibiotic with a beta-lactamase inhibitor to enhance the effectiveness of the penicillin.

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Concentration-dependent bactericidal effect

The relationship between a drug's concentration and its ability to kill bacteria. Higher concentrations lead to faster and more effective bacterial killing. The goal is to maximize drug levels.

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Extended-interval dosing

A dosing regimen for aminoglycosides involving once-daily administration. This method minimizes nephrotoxicity and ototoxicity while maintaining effectiveness.

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Nephrotoxicity

Harmful effects on kidney function caused by drugs or chemicals.

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Ototoxicity

Harmful effects on the ear structures, especially the cochlea and auditory nerve.

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Peak level

The highest concentration of a drug in the patient's bloodstream, measured after administration.

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Aminoglycosides and Fluoroquinolones

Aminoglycosides are a class of antibiotics used to treat serious bacterial infections. They are potent but can cause nephrotoxicity and ototoxicity. Fluoroquinolones are another class of antibiotics effective against a wider range of bacteria.

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Judicious use of antibiotics

To reduce the likelihood of developing antibiotic resistance, which occurs when bacteria adapt and become less susceptible to a drug, it is essential to use aminoglycosides and fluoroquinolones judiciously. This means prescribing them only when necessary and for the shortest effective duration.

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Monitoring patient response

Monitoring the patient's response to drug therapy includes assessing for clinical improvement, such as a reduction in fever, pain, and other symptoms. It also involves checking for adverse effects, such as nephrotoxicity and ototoxicity, through laboratory tests like serum creatinine levels and audiometry.

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Prostaglandins

A group of hormone-like substances that play a crucial role in various physiological processes, including pain, fever, and inflammation.

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Fever

An abnormally high body temperature that indicates an underlying illness or infection.

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Osteoarthritis

A common disorder caused by the breakdown of cartilage in joints, leading to pain, swelling, and stiffness. It is commonly treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and is often a cause of chronic pain, especially in older adults.

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Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

A class of medications commonly used to relieve pain, reduce fever, and minimize inflammation. They work by inhibiting the production of prostaglandins, which are responsible for these symptoms.

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Acetaminophen

A specific type of NSAID, known for its effectiveness in reducing fever and pain, but with less anti-inflammatory action compared to other NSAIDs. It is usually safe for short-term use, but long-term use can lead to liver damage if taken in high doses.

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Propionic Acid Derivatives

A group of NSAIDs that are effective for treating pain and inflammation. They have a longer duration of action compared to some other NSAIDs. Examples include ibuprofen, naproxen, and ketoprofen.

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Oxicam Derivatives

A class of NSAIDs known for their strong anti-inflammatory properties and are often used for chronic pain conditions. One example is meloxicam.

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Macrolides

A class of antibiotics including erythromycin, clarithromycin, and fidaxomicin, known for their broad antibacterial activity and ability to reach various body tissues and fluids. They can control bacterial growth (bacteriostatic) or kill bacteria (bactericidal) depending on the type of infection.

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Gray syndrome

A serious adverse reaction in newborns who receive chloramphenicol. It can cause significant health problems and even death.

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Methicillin-resistant Staphylococcus aureus (MRSA)

A type of staphylococcus bacteria resistant to many broad-spectrum antibiotics like penicillin and erythromycin. It can cause infections in healthcare settings and is often found in healthcare workers' noses.

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Methicillin-sensitive Staphylococcus aureus (MSSA)

Strains of Staphylococcus aureus that are still susceptible to methicillin and other antibiotics.

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Oxazolidinones

A group of antibiotics that work by preventing the growth of aerobic Gram-positive bacteria by blocking the production of their proteins.

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Streptogramins

A group of antibacterial drugs produced by a type of bacteria called Streptomyces graminofaciens. They work by interfering with bacterial protein synthesis.

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Vancomycin infusion reaction / Hypersensitivity infusion reaction

A serious reaction that can occur when dalbavancin or vancomycin is administered too quickly. It involves a rapid drop in blood pressure, flushing, and a skin rash.

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Vancomycin-resistant Enterococci (VRE)

Type of bacterial infection that is resistant to vancomycin, a powerful antibiotic. It's a major concern, especially in hospitals.

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Vancomycin-resistant Enterococcus faecium (VREF)

A specific type of Enterococcus faecium bacteria that is resistant to vancomycin.

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