Questions 1-80 (PDF)

1. What does the CDC recommend as the only regimen for treatment of gonorrhea? - Dual treatment with ceftriaxone and azithromycin. 2. Why does the CDC no longer recommend the use of fluoroquinolones for gonococcal disease? - Because resistance to this antimicrobial has developed. 3. What are the m...

1. What does the CDC recommend as the only regimen for treatment of gonorrhea? - Dual treatment with ceftriaxone and azithromycin. 2. Why does the CDC no longer recommend the use of fluoroquinolones for gonococcal disease? - Because resistance to this antimicrobial has developed. 3. What are the multiple indications for ciprofloxacin? - Acute sinusitis, lower respiratory infections, pneumonia, skin and soft tissue infections, prostatitis, and urinary tract infections. 4. What is the current recommendation for first-line treatment of suspected Bacillus anthracis infections? - Ciprofloxacin until culture and susceptibility results are available. 5. What precautions should be taken when using fluoroquinolones in older adults with normal renal function? - They should be accompanied by an adequate fluid intake and urine output to prevent drug crystals from forming in the urinary tract. 6. What precautions should be taken when using fluoroquinolones in older adults with impaired renal function? - Caution and reduced dosages are warranted. 7. What are some reported renal effects of ciprofloxacin? - Azotemia, crystalluria, hematuria, interstitial nephritis, nephropathy, and renal failure. 8. How can nephrotoxicity be reduced when using ciprofloxacin? - By using lower dosages, having longer intervals between doses, receiving adequate hydration, and avoiding substances that alkalinize the urine. 9. Is dosage adjustment necessary for ciprofloxacin in patients with hepatic impairment? - No, but caution should be exercised in patients with hepatic diseases such as cirrhosis. 10. Why is ciprofloxacin commonly used in the critical care setting? - Because of its broad spectrum of coverage. 11. What can cause resistance to fluoroquinolones in P. aeruginosa? - Overuse of the drug class. 12. Which organisms are most susceptible to the fluoroquinolones? - Aerobic gram-negative organisms, especially Enterobacteriaceae, Moraxella catarrhalis, Haemophilus, and Neisseria species. 13. What is the recommended spacing for administering ciprofloxacin with antacids, multivitamins, sucralfate, or other products containing calcium, iron, or zinc? - 4 to 6 hours. 14. What are the interactions of trimethoprim and sulfamethoxazole? - Trimethoprim and sulfamethoxazole inhibit specific cytochrome P450 enzymes, leading to concurrent multiple drug and herb interactions. 15. How does TMP-SMZ interact with warfarin? - TMP-SMZ inhibits warfarin metabolism and is associated with a threefold increased risk of GI bleeding when compared with other antibiotics. 16. What are the interactions of TMP-SMZ with sulfonylureas? - TMP-SMZ can cause hypoglycemia when taken along with sulfonylureas. 17. What interactions can occur between TMP-SMZ and anticonvulsants? - TMP-SMZ can lead to toxicity when taken in combination with anticonvulsants. 18. How does TMP-SMZ interact with methotrexate? - TMP-SMZ can cause pancytopenia when taken with methotrexate. 19. How is TMP-SMZ commonly administered? - TMP-SMZ is commonly administered orally, with or without food, and with a full glass of water. 20. In what case is TMP-SMZ administered parenterally? - In patients with severe pneumonia caused by P. jirovecii, TMP-SMZ is administered parenterally. 21. What precautions should be taken when administering TMP-SMZ parenterally? - The medication should be diluted and administered over 60 to 90 minutes. It should not be mixed with other drugs, and IV lines should be flushed to remove any residual drug prior to administration. 22. What should the nurse assess for when a patient is taking TMP-SMZ for a UTI? - The nurse should assess for decreased symptoms of the UTI, such as the elimination of pain when voiding, cloudy urine, and fever. 23. What should the nurse assess for when a patient is taking TMP-SMZ for Pneumocystis pneumonia? - The nurse should assess for resolution of symptoms, including nonproductive cough, shortness of breath, or fever. 24. What should the nurse observe for when TMP-SMZ is given for prophylaxis of pneumocystosis? - The nurse should observe for the development of symptoms. 25. What should the nurse assess when it comes to a patient's intake and output while taking TMP-SMZ? - If the intake is greater than the output, assessment of renal function is necessary. 26. What adverse effects should the nurse assess for while a patient is taking TMP-SMZ? - The nurse should assess for hyperkalemia, anemia, changes in the complete blood count indicative of blood dyscrasias, signs of superinfection, and hypersensitivity reactions. 27. What potential allergic reactions should the nurse assess for when administering Septra? - The nurse should assess for hives, skin redness, itching, wheezing, shortness of breath, and possible anaphylaxis. 28. What should the patient be instructed to do when taking TMP-SMZ? - The patient should take TMP-SMZ with 8 ounces of water, before or after meals, and drink a minimum of 2 to 3 L of fluid per day. 29. What are the adjuvant medications used to treat urinary tract infections? - The adjuvant medications used to treat UTIs include trimethoprim, nitrofurantoin, phenazopyridine. 30. How are urinary antiseptics effective in treating UTIs? - Urinary antiseptics reach high levels in urine and are bactericidal for sensitive organisms in the urinary tract. 31. What is the purpose of administering nitrofurantoin with food? - Administering nitrofurantoin with food aids in absorption and decreases the onset of adverse effects. 32. What are the contraindications for taking nitrofurantoin? - Contraindications for taking nitrofurantoin include renal insufficiency and pregnancy (first trimester and between week 38 and delivery). 33. What are the significant adverse effects of nitrofurantoin? - The significant adverse effects of nitrofurantoin include nonspecific ST- and T-wave changes, bundle branch block, as well as CNS changes such as fever, malaise, depression, headache, lethargy, and vertigo. 34. What drug may cause the urine to turn brown? - Nitrofurantoin 35. What may reduce the absorption and subsequent urinary secretion of nitrofurantoin? - Magnesium-containing antacids 36. What drug may lead to hepatic and pulmonary toxicities when used concurrently with fluconazole? - Nitrofurantoin 37. What is the purpose of administering phenazopyridine? - To provide pain relief related to burning, urgency, frequency, and irritation of the lower urinary tract mucosa 38. What is the metabolic site for phenazopyridine? - Liver 39. Why is it necessary to administer phenazopyridine with food? - To decrease GI distress 40. What color will a patient's urine turn when taking phenazopyridine? - Reddish orange 41. What does a yellow skin indicate when taking phenazopyridine? - Accumulation of phenazopyridine in the patient's system 42. What symptoms should be reported when taking phenazopyridine? - Sore throat, fever, bruising, or bleeding 43. What are the contraindications to phenazopyridine? - Renal insufficiency and hepatitis 44. What is the purpose of prescribing trimethoprim? - Treatment of susceptible infections and UTIs 45. What is the recommended use of trimethoprim in the treatment of P. jirovecii pneumonia? - Unlabeled use 46. How does trimethoprim inhibit bacterial cell growth? - Interfering with folic acid reduction to tetrahydrofolate 47. What are the contraindications to trimethoprim? - Known folate deficiency, fragile X syndrome, and creatinine clearance less than 15 mL/minute 48. What adverse effects are associated with trimethoprim? - Rash, pruritus, nausea, vomiting, thrombocytopenia, and leukopenia 49. What is the prototype fluoroquinolone? - Ciprofloxacin 50. What has led to antimicrobial resistance to fluoroquinolones? - Extensive use of these antibiotics 51. What is the bioavailability of ciprofloxacin? - 70% 52. Where does ciprofloxacin achieve therapeutic concentrations? - Most body fluids 53. What is the main route of elimination for ciprofloxacin? - Kidneys 54. What is the mechanism of action of ciprofloxacin? - Interfering with enzymes required for synthesis of bacterial DNA 55. What type of bacteria is ciprofloxacin most potent against? - Gram-negative 56. What are the indications for fluoroquinolones? - Infections of the respiratory, genitourinary, and GI tracts, as well as infections of other microorganisms 57. What is the mechanism of action of sulfonamides? - Sulfonamides act as antimetabolites of para-aminobenzoic acid (PABA), inhibiting the production of bacterial intracellular proteins. 58. How do sulfonamides inhibit bacterial growth? - Sulfonamides compete with para-aminobenzoic acid (PABA) for an enzyme involved in folic acid production, causing formation of nonfunctional derivatives of folic acid. 59. Do sulfonamides kill mature, fully formed bacteria? - No, sulfonamides only halt the multiplication of new bacteria but do not kill mature, fully formed bacteria. 60. What are the clinical indications for TMP-SMZ? - TMP-SMZ is used for the treatment of Pneumocystis jiroveci infection, severe UTIs, Shigella enteritis, and Enterobacteriaceae. 61. What are some other organisms treated with TMP-SMZ? - Viridans streptococcus, Staphylococcus epidermidis, Salmonella, Klebsiella, Nocardia, and Pseudomonas can be treated with TMP-SMZ. 62. What precautions should be taken when administering TMP-SMZ to older adults? - Renal function and the risk of hyperkalemia should be assessed before administering TMPSMZ to older adults. 63. Why should patients with renal impairment avoid taking TMP-SMZ? - Renal impairment can lead to acute renal failure when the drugs or their metabolites precipitate in renal tubules and cause obstruction. 64. How should patients with renal impairment prevent complications when taking TMP-SMZ? - Increasing fluid intake to 1.5 to 3 liters daily can reduce the formation of crystals and stones in the urinary tract. 65. What precautions should be taken when administering TMP-SMZ to patients with hepatic impairment? - TMP-SMZ should be administered with caution in patients with altered liver function. 66. What are the adverse effects of TMP-SMZ? - Adverse effects of TMP-SMZ include GI effects, hematologic effects, dermatologic effects, and renal effects. 67. What are the contraindications for TMP-SMZ? - Contraindications for TMP-SMZ include hypersensitivity to sulfonamides, trimethoprim, salicylates, or megaloblastic anemia related to folate deficiency. 68. What precautions should be taken when administering TMP-SMZ? - Culture and sensitivity testing should be completed prior to administering TMP-SMZ. Potassium levels should be monitored, and the drug should be discontinued at the first sign of a rash. 69. What are the most frequent adverse effects of ciprofloxacin? - GI side effects (nausea, vomiting, abdominal discomfort) 70. What are some other adverse effects of ciprofloxacin? - Dizziness, mild headache, allergic and skin reactions, photosensitivity reactions 71. What are the serious concerns with the use of fluoroquinolones? - Tendon rupture and tendinitis 72. What are the risks associated with fluoroquinolones? - Peripheral neuropathy, central nervous system and cardiac effects, dermatologic and hypersensitivity reactions 73. Who is at greater risk for adverse effects of fluoroquinolones? - People older than 60 years of age, those with heart, kidney, and lung transplants, and those taking corticosteroid medications 74. What is the BLACK BOX WARNING for fluoroquinolones? - Increased risk of tendinitis, tendon rupture, peripheral neuropathy, central nervous system and cardiac effects, dermatologic and hypersensitivity reactions 75. What is the contraindication for ciprofloxacin use? - Hypersensitivity and concurrent use of tizanidine 76. Can ciprofloxacin be used during pregnancy? - Yes, it can be used for the prophylaxis and treatment of pregnant women with anthrax exposure, but should be used for other infections only if no safer, effective drug therapy is available 77. What are the potential drug interactions with ciprofloxacin? - Drugs like amiodarone (antidysrhythmic) that prolong the QT interval, theophylline (reduces theophylline clearance), iron, multivitamins, calcium, magnesium, aluminum salt, sucralfate (reduce ciprofloxacin absorption) 78. What should patients avoid while taking oral ciprofloxacin? - Dairy products or other calcium-containing foods 79. How should ciprofloxacin be administered in patients receiving enteral feedings? - Enteral feedings should be discontinued for 1-2 hours prior to and after ciprofloxacin administration 80. What should the nurse do if severe hypersensitivity reactions occur with fluoroquinolone administration? - Discontinue the antibiotic immediately 81. How should the IV formulation of ciprofloxacin be administered? - Over 60 minutes through a verified patent IV line to reduce the risk of vein irritation 82. What are the characteristics of the ideal medication for treatment of UTI in women? - An antibacterial agent that eradicates bacteria from the urinary tract with minimal effects on fecal and vaginal flora, affordable, few adverse effects and low resistance. 83. Which organism is most likely responsible for initial, uncomplicated UTIs in women? - E. coli or other fecal flora. 84. What are the various treatment regimens for uncomplicated lower UTIs in women? - Single-dose administration, short-course (3-day) regimens, or 7-day regimens. 85. Why is a shortened course of antibiotic therapy preferred for uncomplicated UTIs? - Most cases are cured after 3 days of treatment. 86. What are some medications commonly used to treat UTIs? - Listed in Table 49-1. 87. When should longer medication courses be indicated for UTIs? - In men, pregnant women, and women with pyelonephritis and other types of complicated UTIs. 88. What should be done if infection recurs after completing antimicrobial therapy? - Another short course (3 to 4 days) of full-dose antimicrobial therapy followed by a regular bedtime dose of an antimicrobial agent may be prescribed. 89. What is the recommended course of antibiotic agents for outpatient treatment of acute uncomplicated pyelonephritis? - A 2-week course of antibiotic agents. 90. What should be done if a relapse occurs after initial acute pyelonephritis treatment? - The patient may need antibiotic therapy for up to 6 weeks. 91. Why is hydration with oral or parenteral fluids essential in patients with UTIs? - To facilitate 'flushing' of the urinary tract and reduce pain and discomfort. 92. Which combination is useful in treating UTIs? - Trimethoprim–sulfamethoxazole (TMP-SMZ) combination (Bactrim, Septra). 93. What did a meta-analysis of nine studies on cranberry intake for recurrent UTI reveal? - Cranberry significantly reduced the rate of recurrent UTI, while antibiotics were more effective but had more severe adverse effects. 94. Are antibiotics more effective than cranberry for the treatment of recurrent UTI? - Yes, antibiotics were found to be more effective.