Prepare: Antibiotics

Starting Antibiotics.

• Which of the following actions is important before starting an antibiotic?

Beta-lactamase

• What is beta-lactamase?

Broad Spectrum

• Which of the following accurately describes a broad spectrum antibiotic?

Self Check: Starting Antibiotics

• An antibiotic is started based on which of the following factors? Select all that apply.

Self Check: Penicillin Resistance

• Which of the following causes penicillin resistance?

Self Check: Bacteriostatic

• When an antibiotic is bacteriostatic, it means which of the following?

Self Check: Severe Diarrhea

• Lori is experiencing severe diarrhea for the last 2 weeks. She has been on an antibiotic for four weeks due to a severe kidney infection. The diarrhea is best described as which of the following?

Self Check: Dental Cleaning

• John is scheduled for a dental cleaning tomorrow. He has been diagnosed with a heart murmur in the past. His cardiologist prescribed azithromycin 500mg orally x 1 dose about 1 hour before his cleaning. Why is he being prescribed this antibiotic?

Reflect: Antibiotics

Potential Interactions

• Match the potential interaction when giving an Antipsychotic drug with the following?

Concerns While Taking Drugs

• Joy is taking the erythromycin 500mg three times daily for 10 days. Which of the following do you need to be concerned about while she takes this drug? Select all that apply.

Treatment with Antibiotic

• Gloria is started on ciprofloxacin for symptoms of a urinary tract infection. She was seen by a telemedicine provider, and her urine was not collected. Which of the following is accurate about her treatment?

Stopping Antibiotics

• Dora started an antibiotic yesterday. Which of the following assessment findings indicate an immediate need to stop her antibiotic?

Preventative Action

• Match the safety concern with the preventative action.

Treating Infection

• Which of the following are ways that antibiotics treat infection?

Medication Education

• Amanda was prescribed azithromycin 250mg daily for 5 days. She takes estradiol for birth control, and uses warfarin 5mg daily for chronic atrial fibrillation. Which of the following suggests further education is needed?

Antibiotic Classes

• Which antibiotic class inhibits protein synthesis of the bacteria by binding to 50s ribosomal subunits in the bacteria?

Penicillin and Cephalosporins

Prepare: Penicillin and Cephalosporins

Common Side Effects

• What are common side effects of penicillin? Select all that apply.

Skin Infection

• Alice was prescribed cefalexin for a skin infection. When should she stop taking her antibiotic?

Penicillin Allergy

• If a patient has a penicillin allergy, what other antibiotic might they also react to?

Self Check: Penicillin and Cephalosporins

Cephalosporin Superiority

• Nancy was started on Cefepime, a 4th generation cephalosporin for urinary tract infection. Which of the following makes this superior to a first generation cephalosporin for her diagnosis?

Cephalosporin Medications

• When giving cephalosporin medications, which of the following statements is accurate?

Cephalosporin Advantages

• In reviewing the advantages to a 4th generation cephalosporin, which of the following are accurate statements?

Blurred Vision

• Since starting Amoxicillin, Doug is experiencing blurred vision? Which of the following is accurate?

Cephalexin

• Phillip started an antibiotic for a skin infection 2 days ago. The prescription says to take cephalexin 500mg every 6 hours for 10 days. His skin infection appears to be gone. Which of the following would be appropriate for him to do?

Reflect: Penicillin and Cephalosporins

Metabolism of Antibiotics

• Boris will be given a dose of cefazolin prior to an abdominal surgery he is having. He has a history of liver failure. Based on knowledge of the metabolism of this antibiotic, which of the following is accurate?

Complex Infections

• Alice is prescribed a cephalosporin antibiotic for a complex infection. After being on the antibiotic for a month, she states experiencing white oral plaques and a sore throat. This is likely caused by which of the following?

Strep Throat

• Julie has been given penicillin for strep throat. Which of the following statements is true when educating Julie about penicillin therapy?

Piggybacking Antibiotics

• Wally was ordered cefazolin 100mg diluted in 0.9% NaCL 100mL to run over 60 minutes. He currently has one intravenous site with 0.9% NaCL with Potassium Chloride 20 mEq running at 100mL/hr. Which of the following is most appropriate in delivering this piggyback antibiotic?

Further Teaching

• Sandy is prescribed cephalexin 500mg every 6 hours for 7 days for a skin infection. Which of the following statements suggest that further teaching may be required?

Penicillin Allergy

• When assessing patient for a possible penicillin allergy, which of the following symptoms would be consistent with a hypersensitivity reaction? Select all that apply.

Common Side Effects

• Larry has been started on cephalexin for a skin infection. In doing medication teaching, which of the following most common side effects could he expect? Select all that apply.

Antibiotic Generations

• Drag and drop the items to complete the table below.

Quinolones (Ciprofloxacin)

Prepare: Quinolones (Ciprofloxacin)

Stopping the Antibiotic

• Alice was prescribed ciprofloxacin 500mg q12 hours for 3 days for a urinary tract. When should she stop taking her antibiotic?

Antibiotic Class

• If a patient has a ciprofloxacin allergy, what antibiotic class might they react to?

Patient History

• Which patient history finding is important before administering ciprofloxacin?

Self Check: Quinolones (Ciprofloxacin)

Ciprofloxacin

• Nancy was started on ciprofloxacin for her complicated urinary tract infection? Which of the following makes this superior to other fluroquinolone antibiotics?

Abnormalities

• Ben has an automatic internal cardio-defibrillator (AICD) and is taking amiodarone for dysrhythmias. When started on ciprofloxacin, which of the following abnormalities puts him at higher risk for life threatening arrhythmia?

Why Was it Prescribed?

• Ciprofloxacin was selected to treat Elizabeth’s complicated urinary tract infection. This antibiotic was selected due to which of the following reasons:

Elevated Temperature and Dysuria

• A patient with a complicated urinary tract infection has been taking ciprofloxacin for three days. The patient continues to have an elevated temperature and dysuria. Which of the following should the healthcare professional consider?

Interactions

• When giving ciprofloxacin, which medications are known to interact with this medication? Select all that apply.

Reflect: Quinolones (Ciprofloxacin)

Possible Interactions

• When a client with chronic obstructive pulmonary disease is taking theophylline and also receives ciprofloxacin, which of the following interaction could occur?

Expected Interactions

• Jose has a seizure disorder that is well controlled with phenytoin. He was recently prescribed ciprofloxacin for a urinary tract infection. What might the nurse expect when these two drugs are given together? Select all that apply.

How It Works

• Belinda was prescribed ciprofloxacin for a complicated urinary tract infection. Fluroquinolones work by which of the following?

Serious Interactions

• Rita was prescribed ciprofloxacin for her urinary tract infection. She is currently taking fluoxetine, ibuprofen, warfarin, and lisinopril. When giving intravenous quinolones, the nurse needs to keep in mind that these drugs may have serious interactions with which drugs?

Intravenous Ciprofloxacin

• You are ordered to give ciprofloxacin intravenously through a piggyback. Currently you have another piggyback running through the same IV line. Which of the following would be incompatible in the IV line with ciprofloxacin?

Expected Actions

• Ciprofloxacin is ordered for a patient admitted with pyelonephritis. The allergy band says that the patient is allergic to all cephalosporins. The nurse verifies this. Which of the following expected actions will the nurse take next?

Prolonged QT Interval

• When giving ciprofloxacin, which medications are known to cause a prolonged QT interval with this medication?

Generic Drugs

• Complete the following table by dragging and dropping the brand and half-life to the proper generic drug.

Nursing Application – Antibiotics

Prepare: Nursing Application – Antibiotics

Antibiotic Therapy

• Doris presents to the urgent care with dysuria and insists that she has a urinary tract infection. The healthcare provider finds nothing to suggest this. During the discharge process, the patient tells the nurse that she is not leaving without a prescription for an antibiotic. Which of the following is true regarding antibiotic therapy?

Further Analysis

• The provider has prescribed amoxicillin 875mg one tablet twice daily for strep throat. Which of the following would require further analysis?.

Teaching the Patient

• During discharge planning, the nurse prepares to teach the patient about their amoxicillin prescription. Which of the following indicates the patient may need more instruction?

Self Check: Assessment

Gladys's Case Study

• Gladys is a 56 year old female who presented to the clinic with complaints of dysuria. A urinalysis revealed a urinary tract infection. Her urine was sent to the lab to obtain a culture and sensitivity, which should be available in about four days. The nurse is reviewing her current medication list for possible interactions using the Drug Interaction Checker in preparation for discharge teaching on Amoxicillin. Which of the following information is the nurse concerned about?

Gladys’s History

• After identifying Glady is allergic to amoxicillin, the primary health care provider gives her a prescription for ciprofloxacin 500mg twice daily for 5 days. The nurse reviews her history in preparation for discharge teaching. Which of the following would require further analysis and possible nursing action?

Self Check: Diagnosis and Assessment

Gladys’s Discharge

• In doing Gladys’s discharge instructions, which of the following indicates she may need more information? Select all that apply.

Gladys’s Discharge Continued

• As part of Gladys’s discharge instructions, which of the following would the nurse expect to include?

Self Check: Implement and Evaluate

Gladys’s Evaluation

• The nurse receives Gladys’s culture and sensitivity results from the lab. She has been on the ciprofloxacin for two days. She states her symptoms are unchanged. The report indicates the following:

In evaluating Gladys’s response to the antibiotic, which of the following do you consider?

Reflect: Nursing Application – Antibiotics

Treating Pnemonia

The nurse is reviewing the orders for a patient who has been admitted for treatment of pneumonia. The patient is being started on doxycycline 500mg every 12 hours for 10 days. The nurse notes patient’s allergy band says, “doxy”. Asking what happens when the patient took doxycycline in the past, the patient states that they had an upset stomach. What is the nurse’s first action at this time?

Answer the following questions about George based on the information provided in each question.

• George is admitted to the hospital with pneumonia. His WBC count is elevated, he has a fever of 101.5, and he is short of breath. The provider immediately orders a sputum culture and sensitivity to determine which bacteria might be causing the pneumonia. The results will not be back for 3 days. Levofloxacin 750mg IV is ordered to start now. The nurse knows that the rationale for this antibiotic order is which of these?
• George is discharged from the hospital and is prescribed tetracycline 500mg four times daily for continued treatment of his pneumonia. When the nurse teaches this patient about drug-related precautions, which is the most important information to convey?
• George develops a cellulitis from a previous intravenous site he had during hospitalization. A second-generation cephalosporin is ordered for a new skin infection. A day after starting, the patient develops a rash. Which nursing action is appropriate?

History of Heart Problems

• While assessing a woman who is receiving levofloxacin for pneumonia, the nurse notices that the patient has a history of heart problems. The nurse will monitor for which potential cardiac effect of fluroquinolone therapy?

Linda

Answer the following questions about Linda based on the information provided in each question.

• Linda is prescribed erythromycin for a urinary tract infection. During patient education regarding this oral macrolide, the nurse will include which information? Select all that apply.
• Linda has been on erythromycin for almost the entire course, but calls the nurse practitioner to complain of severe vaginal itching. She has also noticed a thick, whitish vaginal discharge. The nurse practitioner suspects which of these?

Bacteriostatic

• The nurse is reviewing the orders for a bacteriostatic antibiotic. Which statements best describes a bacteriostatic compound?

Antivirals: Non-HIV

Prepare: Antivirals - Non-HIV

Goals of Non-HIV Antiviral Therapy

• How does taking medications to treat a viral illness promote healing of the individual who is ill?

Broad Spectrum Antiviral

• Of the available non-HIV antiviral medication which is effective across the broadest spectrum of viruses?

Treating with Antivirals

• Drag and drop each disease to classify whether they can or cannot be treated with antivirals.

Self Check: Virus Mutation

• The simple structure of an RNA based viral genome allows for instability during replication that leads to viral mutation and makes the virus more difficult to treat with medications.

Self Check: MOA Non-HIV Antivirals

• How do non-HIV antiviral medications kill or suppress viruses? Select all that apply.

Self Check: Dosing – sofosbuvir

• Use the drop down menus to fill in the missing information related to dosing of sofosbuvir.

Self Check: Pharmacokinetics – ribavirin

Pharmacokinetics – ribavirin

• Complete the pharmacokinetic information for ribavirin by dragging the missing information to the correct place on the table.

Self Check: Antivirals for Hepatitis

• Antiviral medications that treat hepatitis include lamivudine and simeprevir.

Reflect: Antivirals - Non-HIV

Outcomes of Non-HIV Antiviral Therapy

• A patient diagnosed with a herpes simplex infection asks, “When will the virus be completely out of my body?” What is the best response by the nurse?

Antivirals and Pregnancy

• Ribavirin may be present in the body for six months after exposure. At least two types of reliable contraception must be used beginning with the first dose until six months after treatment ends.

sofosbuvir: Drug-Drug Interactions

• An individual recently prescribed sofosbuvir asks if they can keep taking St. John’s Wort before going to bed since sofosbuvir is taken in the morning. What is the best response by the health care professional?

Side Effects of Non-HIV Antivirals

• Viruses reproduce in human cells, but selective killing is difficult. Consequently many human cells that are healthy, in addition to virally infected cells, may be killed in the process. This results in more serious toxicities for these drugs.

Indications for ribavirin

• During a telehealth visit after taking ribavirin to treat hepatitis C, the patient shares that her grandson is taking the same medication as a breathing treatment. She would like to know if she should be doing the same. What is the best response by the nurse?

Viral Mutations and Patient Education

• The nurse administering influenza vaccines is asked why a flu shot is needed every year. What information will the nurse include when responding?

Antiviral Medications Treat Viruses

• The parent of an adolescent recently prescribed topical acyclovir to treat herpes simplex virus asks why the child is not taking an oral antibiotic like ciprofloxacin. What is the nurse’s best response?

Types of Non-HIV Antiviral Medications

• Drag the medications to the classification in which each belongs.

Drugs to Treat Herpesviruses

Prepare: Drugs to Treat Herpesviruses

acyclovir: Therapeutic Effects

• When teaching a patient who is taking acyclovir for genital herpes, which statements by the health care professional are accurate? Select all that apply.

acyclovir: Interactions

• When obtaining a medication history from a client diagnosed with genital herpes, which medication is the individual most likely to be taking?

Therapeutic Effects: acyclovir

• Oral forms of acyclovir are most effective for initial herpes infections to decrease pain and shorten healing time.

Self Check: acyclovir

Mechanism of Action: acyclovir

• What is the mechanism of action of acyclovir?

Routes of Administration: acyclovir

• Using a drug guide for reference, indicate which herpes infections are treated with the listed administration forms of acyclovir by placing a check in the correct cell. Each infection may be treated with more than one route of administration. Select all that apply.

Varicella Vaccination

• A new varicella vaccine, zoster vaccine live, has been approved to prevent the development of what condition in adults older than the age of 60 years?

Pharmacokinetics: acyclovir

• Complete the acyclovir pharmacokinetics table by dragging the missing values to the correct cell.

Self Check: Patient Teaching - acyclovir Dosing

• During a telehealth visit an individual taking acyclovir shares that they missed their last does and asks if they should take the missed dose now. What is the best response by the health professional?

Reflect: Drugs to Treat Herpesviruses

acyclovir: Drug-Drug Interaction

• The nurse notes in the patient’s medication history that the patient with a new prescription for acyclovir is currently taking theophylline. Based on this finding, what is the best action for the nurse to take?

Drug-Drug Interaction: acyclovir

• The healthcare professional caring for a patient taking acyclovir seeks clarification from the healthcare provider who prescribed which new medication?

Contraindications: acyclovir

• Which conditions present a contraindication to the use of acyclovir? Select all that apply.

Patient Education: acyclovir

• When teaching a patient who is taking acyclovir for genital herpes, which statements by the healthcare professional are accurate? Select all that apply.

acyclovir: Adverse Effects

• During treatment with acyclovir, the nurse instructs the patient to monitor for which potential adverse effects? Select all that apply.

Dosing Information: Acyclovir

• Complete the acyclovir dosing information by dragging the missing values to the correct cell.

Adverse Effects: acyclovir

• An older adult taking oral acyclovir is encouraged to remain hydrated to decrease which adverse effect of the medication?

acyclovir: Expected Outcomes

• Which statements made by an individual with a prescription for acyclovir to treat genital herpes indicates to the nurse they understand the expected outcomes therapy? Select all that apply.

Drugs to Treat Influenza

Prepare: Drugs that Treat Influenza

Patient Education: oseltamivir

• When teaching a patient who is taking oseltamivir for influenza, which statement by the health professional is accurate?

Mechanism of Action: oseltamivir

• What is oseltamivir’s mechanism of action?

Indications for Use: oseltamivir

• While admitting an individual to the hospital with pneumonia, the health professional notes that the patient began taking oseltamivir two days ago. Based on knowledge of this medication, the health professional concludes the pneumonia is a complication of which condition?

Self Check: oseltamivir (Tamiflu)

Contraindications and Adverse Effects: oseltamivir

• Choose whether each of the following is a contraindication or adverse effect of oseltamivir.

Dosing: Antivirals for Influenza

• Which antiviral medication indicated for the treatment of influenza is available as a single dose administered orally?

Decreasing Influenza A & B

• When providing health education at a senior center, the health professional will include information about which medication used to decrease the duration of influenza A and B?

Pharmacokinetcs: oseltamivir

• Complete the oseltamivir pharmacokinetics table by dragging the missing values to the correct cell.

Self Check: Patient Safety – oseltamivir

Medication Adherence

• Click on the words or phrases below that indicate the individual speaking may be taking their prescribed influenza medication incorrectly.

Reflect: Drugs that Treat Influenza

Antiviral Medications

• A patient calls the clinic wanting to know what she can take "because I was exposed to the flu over the weekend at a family reunion and I do not want to get sick." Which antiviral medication(s) might be prescribed in this situation? Select all that apply.

Patient Education: oseltamivir Adverse Effects

• Patients taking oseltamivir should be advised to report hallucinations or confusion to their health care provider immediately.

oseltamivir: Time to Treatment

• Tonya has been tired, aching, and feverish with a sore throat and cough for the past 18 hours. She called her healthcare provider’s office for an appointment, but none are available. Based on her symptoms, her provider is concerned she may have the flu and recommends going to a nearby urgent care center today. Why should Tonya be seen as soon as possible in the urgent care? Select all that apply.

Dosing Information: oseltamivir

• Complete the dosing information for oseltamivir by dragging the missing values to the correct cell.

Treatment with oseltamivir

• During treatment with oseltamivir, Tonya should contact her healthcare provider if she experiences which adverse effects? Select all that apply.

Indications for Use: oseltamivir

• Two days after starting oseltamivir, Tonya is admitted to the hospital with pneumonia. Based on knowledge of this medication and the pathophysiology of pneumonia, the health professional concludes Tonya is experiencing a complication of which condition?

oseltamivir and GI Irritation

• Tonya has a new prescription for oseltamivir and asks for advice on how to take this medication to decrease potential irritation of her peptic ulcer disease. What is the best response to her inquiry?

Administering oseltamivir

• Due to her sore throat, Tonya also asks if it is safe to open the capsule and mix the medication in pudding. What is the best response by the healthcare provider?

Nursing Application: Antivirals: Non-HIV

Prepare: Nursing Application - Antivirals - Non-HIV

Naming Convention: Non-HIV Antiviral Medications

• Many medications in the non-HIV antiviral class have names that end with the suffix -vir.

Priority Assessment and Non-HIV Antiviral Medications

• Which priority assessments should be completed before administering antiviral medication? Select all that apply.

Primary Condition Treated

• Drag and drop each drug into the correct class based on the primary condition treated.