NR566 Week 1 Open Book Quiz

Which patients should penicillins be used with extreme caution?

Patients with renal impairment, preexisting hearing impairment, and those receiving ototoxic and nephrotoxic drugs.

Patients with a history of severe allergic reactions to cephalosporins, or carbapenems. Patients with QT prolongation.

Patients using valproate to control seizures.

Question 3Using your textbook, match the antibiotic class to the patient care concern for pregnant persons.

All appear to be safe for use in pregnancy

Although there are no well-controlled studies in pregnant women, evidence we do have suggests there is no second or third trimester fetal risk.

Animal studies reveal that these drugs can cause fetal harm in pregnancy. Thus this class of drugs should be avoided in during pregnancy.

There is evidence that use of this drug class in pregnancy can harm the fetus so they should not be used.

Systemic drugs in this class may cause birth defects, especially if taken during the first semester. If taken near term, the infant may develop kernicterus.

 Question 4To treat otitis media, would you use a broad- spectrum or narrow spectrum antibiotic?

Broad-spectrum Narrow spectrum

Extended-spectrum

Question 5What baseline data is needed to prescribe trimethoprim/sulfamethoxazole? (Select all that apply)

Establish an infection appropriate for this drug class exists

Complete blood count with white cell differential for prolonged therapy Hepatic function if there is concern in may be compromised

Renal function if there is concern in may be compromised

Question 6Which antibiotic classes should have a culture and sensitivity prior to prescribing and which ones do not according to your textbook?

Question 7Using your textbook, match the antibiotic class to the patient care concern for children/adolescents.

Commonly used to treat bacterial infections, including otitis media and gonococcal and pneumococcal infections.

Common drug used to treat bacterial infections.

Should not be used in children younger than 8 years because they may cause permanent discoloration of the teeth.

Safe for use against bacterial infections but not commonly used in outpatient settings.

Question 8Using your textbook, match the antibiotic class to the patient care concern for breastfeeding patients.

Generally not expected to cause adverse effects in breastfed infants

Safe for use in breastfeeding mothers.

Data are lacking regarding transmission of some drugs in this class from mother to infant through breast milk.( PCN)

Should be avoided by breastfeeding women due to possible staining of teeth in breast fed infant.

 Secreted in breast milk. Breastfeeding women on these drugs should be warned that breastfeeding an infant younger than 2 months can cause kernicterus.

Probably safe to use during lactation. There is limited information regarding its use in this way.

Question 9Which antibiotic class is most likely to be given if there are no contraindications?

Penicillin Cephalosporin Tetracycline

Macrolide

Question 10Match the penicillin drug to the penicillin class.

Penicillin G

Penicillin V

Nafcillin

Oxacillin

 Dicloxacillin

Ampicillin

Amoxicillin

Piperacillin

Question 11Trimethoprim should be avoided in patients with which deficiency?

Vitamin C

 Vitamin A

Folate

 Iodine

Question 12Using your book and other resources you have available, match the antibiotic class to the prototype drug provided here.

 Penicillin G (PCN             

Cephalexin

 Imipenem

Doxycycline

Erythromycin

Gentamicin

Bactrim

Question 13Using your textbook, match the antibiotic class to the patient care concern for older adults.

Doses should be adjusted in older adults with renal dysfunction.

Can interact with drugs, including digoxin. In the older adult who takes many medications, check for interactions.

Caution must be used regarding decreased renal function in the older adult.

Older patients are more likely to experience adverse effects, and when experienced, the effects are more likely to be severe. Life-threatening effects-including neutropenia, Stevens-Johnson syndrome, and toxic epidermal necrolysis-occur more frequently in older adults.

Question 14Match the drug class to the needed patient education.

Instruct patients to report increase in stool frequency.                                   

Advise patients to avoid prolonged exposure to sunlight                              

Patients should be instructed that GI disturbances can be reduced by administering with meals.              

Patients must be instructed to report symptoms of ototoxicity 

Question 15Match the antibiotic class to the needed monitoring associated with that class.

Renal function in patients with renal disease      

Drug levels should be monitored during IV administration.          

Peaks and troughs as well as renal function        

CBC in patients with symptoms of blood disorders, CD4+ counts in patients with HIV and potassium 4 days after starting treatment in patients with possible hyperkalemia(

Question 16Locate the Prescribers’ Digital Reference website (pdr.net) to answer this question. A patient is prescribed Amoxicillin for an infection. They have a creatinine clearance of 24mL/min. What dose of amoxicillin should they be prescribed?

no dosage adjustment needed

 250-500mg PO every 12 hours 250-500 mg PO every 24 hours

875 mg Extended Release PO every 24 hours

Question 17Match the drug or drug class that is contraindicated for UTI in the patient population group listed.

Trimethoprim/sulfamethoxazole

Nitrofurantoin

Fluoroquinolones

Question 18In patients with a creatinine clearance of 15-30 mL/min taking Bactrim, how should the dosing be adjusted?

 Reduced by 50%

Reduced by 25%

Increased by 50%

 Increased by 25%

Question 19Which patients being treated with a penicillin are at high risk for toxicity? (Select all that apply)

renal impaired

 acutely ill

very young

 very old

active hepatitis

Question 20Using your textbook, match the antibiotic class to the patient care concern for infants.

Third-generation drugs are used to treat bacterial infections in neonates as well as infants. (CEPHALOSPORIN

Used safely in infants with bacterial infections, including syphilis, meningitis, and group A streptococcus.( PCN

Approved to treat bacterial infections in infants younger than 8 days. Dosing is based on weight and length of gestation.(AMINOGLYCOSIDES

Used in infants younger than 2 months can cause kernicterus, a potentially fatal condition. (sulfonamides

Question 21Match the antibiotic class to the associated high-risk patient.

Patients using valproate to control seizures should not be placed on imipenem

Use with caution in patients with renal impairment.

Contraindicated for patients with a history of allergic reactions to this drug class or severe reactions to penicillinContraindicated in pregnant women and in children younger than 8 years.

Use with caution in patients with QT prolongation.

Used with caution in patients with renal impairment, preexisting hearing impairment, and those receiving ototoxic and nephrotoxic drugs.

Contraindicated for nursing mothers, pregnant women in the first trimester and also those near term, and infants younger than 2 months.

Question 22Match the recommended treatment for UTI according to the assigned textbook for this course.

Ampicillin and gentamycin

Methenamine Hippurate

Methenamine mandelate

Short-term Fluoroquinolones

Question 23Which antibiotic drug class listed is known for all drugs within the class promoting the developments of a Clostridioidies difficile infection?

Tetracycline Macrolide

Aminoglycoside

Cephalosporin

Question 24If a patient is taking Bactrim and their creatinine clearance falls below 15 mL/min, what should the provider do?

Have patient continue the medication until it is complete. It depends on how many doses the patient has taken.

Stop the drug immediately.

 List the drug as an allergy and instruct the patient to stop taking it immediately.

Question 25What is the likely causative agent for acute otitis media? Staphylococcus Aureus

Pseudomonas

Streptococcus pneumoniae Streptococcus pyogenes

Question 26Using your textbook, match the antibiotic class to the therapeutic goal.

 Treatment of serious infections, including C. diff. infection, infection with methicillin-resistant S. aureus, and serious infections caused by susceptible organisms in patients allergic to penicillin.

Treatment of infections sensitive to this class, acne, and periodontal disease.

Treatment of respiratory infections, infections caused by H. pylori, disseminated Mycobacterium, and as alternatives to penicillin in patients with penicillin allergy.

Treatment of serious infections caused by gram-negative aerobic bacilli.

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