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Exam 3: NURS617/ NURS 617 (Latest 2024/ 2025 Update) Pharmacotherapeutics Guide| Qs & As| Grade A| 100% Correct (Verified Answers)- Southeastern Louisiana

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Exam 3: NURS617/ NURS 617 (Latest 2024/ 2025 Update) Pharmacotherapeutics Guide| Qs & As| Grade A| 100% Correct (Verified Answers)- Southeastern Louisiana Q: Causes of Failure of Antimicrobial Therapy Answer: 1. Inadequate efficacy against the offending organisms 2. Inadequate bioavailability of the selected agent 3. Inadequate host defense mechanisms 4. Inadequate duration of drug therapy 5. Superinfection or bacterial resistance Q: Causes of Failure of Antimicrobial Therapy 1. Inadequate efficacy against the offending organisms Answer: - Incorrect identification of the offending organism - Use of a drug to which organisms have previously become resistant - Use of a microbiostatic agent when a microbicidal agent is necessary Q: Causes of Failure of Antimicrobial Therapy 2. Inadequate bioavailability of the selected agent Answer: - Use of an incorrect dose - Use of an incorrect route of administration - Use of an incorrect dosing interval - Use of an incorrect antimicrobial therapeutic plan, one that does not take into consideration the pharmacokinetic variables that exist in the treated patient Q: Causes of Failure of Antimicrobial Therapy 3. Inadequate host defense mechanisms Answer: - Failing to recognize that the patient has insufficient immune responses needed to assist in antimicrobial efficacy, such as those with AIDS, malnutrition, immunosuppression, cancer, patients on glucocorticoids, patients with large abscesses, patients with overwhelming sepsis, and patients harboring necrotic tissues. Q: Causes of Failure of Antimicrobial Therapy 4. Inadequate duration of drug therapy Answer: Changing drugs without evidence of treatment failure - Treating with costly drugs (that the patient cannot afford to buy) when less expensive drugs would have been appropriate - Treating with highly toxic drugs when less harmful drugs would have been appropriate - Failure to allow for variances in patient compliance for a variety of reasons Q: Causes of Failure of Antimicrobial Therapy 5. Superinfection or bacterial resistance Answer: Use of broad-spectrum antibiotics when more targeted, narrow-spectrum agents are more appropriate - Other inappropriate uses of antimicrobial agents Q: General Considerations for the Use of Antibiotics Answer: Classes of Antibiotic Drugs - based on mechanisms of action of the antibiotics 1. Blockade of peptidoglycan synthesis is the major component of a bacterial cell wall. Bacterial cell wall destruction allows water to enter the intracellular milieu of the bacteria, causing them to swell, lyse (explode) and die. Inhibition of cell wall synthesis is bacteriocidal. 2. Disruption of bacterial cell plasma membranes by binding to lipoproteins in the membrane. This mechanism only occurs on the outer membrane of some gram-negative bacterial organisms and is usually bactericidal. 3. Binding to bacterial ribosomes and blocking some bacterial protein synthesis. Depending on the specific protein synthetic mechanisms blocked, the agent can be bactericidal (i.e., the aminoglycosides). However, Most antibiotics that work by this mechanism are bacteriostatic. 4. Blocking bacterial DNA replication, probably by interfering with a specific enzyme (DNA gyrase). This mechanism is usually bactericidal but can be bacteriostatic depending on the dose. 5. Prevention of nucleic acid synthesis by blocking mRNA and secondarily preventing selected protein synthesis. This mechanism is usually bactericidal. 6. Blocking folic acid synthesis: This is an essential metabolite in bacterial metabolism that the bacterium must synthesize. By blocking the synthesis of folic acid, several metabolic processes are inhibited. This process is usually bacteriostatic. Q: BACTERIAL ANTIBIOTIC RESISTANCE - Resistance to antibiotics can be: (A) Intrinsic - Answer: Resistance that has always existed in the structure of the bacteria; it is always inherent in the genetics of that particular species. (For example, gram-negative bacteria are now and have always been resistant to specific antibiotic agents.) Q: BACTERIAL ANTIBIOTIC RESISTANCE - Resistance to antibiotics can be: (B) Acquired Answer: Resistance that originates in an individual bacterium as a result of a chromosomal mutation or the transfer of chromosomal fragments of DNA (plasmids or transposons) between bacteria that is induced in them because of current or prior exposure to an antibiotic agent. Acquired resistance usually results from selective antibiotic exposure, which can result from either appropriate or inappropriate usage of the antibiotic agent. Q: MECHANISMS OF ANTIBIOTIC RESISTANCE Answer: 1. Impermeability of the bacterial cell wall to the antibiotic 2. Active efflux of the antibiotic from the bacterium before the pharmacodynamics of the antibiotic can become effective 3. Plasmid-mediated alteration or inactivation of the antibiotic by bacterially-synthesized enzymes 4. Alteration of the bacteria's target site; an action of the bacterium itself. 5. Bypass of an antibiotic-obstructed metabolic pathway 6. Structural change of an antibiotic-binding site 7. Structural change of a bacterial cell component that is usually altered by the antibiotic Q: Classification of Bacterial Organisms GRAM POSITIVE AEROBES (these bacteria require oxygen to survive) -Cocci Answer: o staphylococcus o streptococcus o pneumococcus Q: Classification of Bacterial Organisms GRAM POSITIVE AEROBES (these bacteria require oxygen to survive) -Bacilli Answer: o corynebacterium o listeria - in quiz o bacillus anthracis (Anthrax) Q: GRAM POSITIVE ANAEROBES (these bacteria can live in deep tissues with low levels of oxygen) Answer: - clostridium - peptococcus - peptostreptococcus Q: GRAM NEGATIVE AEROBES - Cocci Answer: o neisseria

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Examl3:lNURS617/lNURSl617l(Latestl
Update)lPharmacotherapeuticslGuide|lQsl&l
As|lGradelA|l100%lCorrectl(Verifiedl
Answers)-lSoutheasternlLouisiana

Q:lCausesloflFailureloflAntimicrobiallTherapyl
Answer:
1.lInadequatelefficacylagainstltheloffendinglorganisms
2.lInadequatelbioavailabilityloflthelselectedlagent
3.lInadequatelhostldefenselmechanisms
4.lInadequateldurationlofldrugltherapy
5.lSuperinfectionlorlbacteriallresistance

Q:lCausesloflFailureloflAntimicrobiallTherapy
1.lInadequatelefficacylagainstltheloffendinglorganismsl

Answer:
-lIncorrectlidentificationlofltheloffendinglorganism
-lUseloflaldrugltolwhichlorganismslhavelpreviouslylbecomelresistant
-lUseloflalmicrobiostaticlagentlwhenlalmicrobicidallagentlislnecessary

Q:lCausesloflFailureloflAntimicrobiallTherapy
2.lInadequatelbioavailabilityloflthelselectedlagentl

Answer:
-lUseloflanlincorrectldose
-lUseloflanlincorrectlroutelofladministration
-lUseloflanlincorrectldosinglinterval
-
lUseloflanlincorrectlantimicrobialltherapeuticlplan,lonelthatldoeslnotltakelintolconsiderationlthel
pharmacokineticlvariableslthatlexistlinltheltreatedlpatient

,Q:lCausesloflFailureloflAntimicrobiallTherapy
3.lInadequatelhostldefenselmechanismsl

Answer:
-
lFailingltolrecognizelthatlthelpatientlhaslinsufficientlimmunelresponseslneededltolassistlinlantim
icrobiallefficacy,lsuchlaslthoselwithlAIDS,lmalnutrition,limmunosuppression,lcancer,
patientslonlglucocorticoids,lpatientslwithllargelabscesses,lpatientslwithloverwhelminglsepsis,lan
dlpatientslharboringlnecroticltissues.

Q:lCausesloflFailureloflAntimicrobiallTherapy
4.lInadequateldurationlofldrugltherapyl

Answer:
Changingldrugslwithoutlevidencelofltreatmentlfailure
-
lTreatinglwithlcostlyldrugsl(thatlthelpatientlcannotlaffordltolbuy)lwhenllesslexpensiveldrugslwo
uldlhavelbeenlappropriate
-lTreatinglwithlhighlyltoxicldrugslwhenllesslharmfulldrugslwouldlhavelbeenlappropriate
-lFailureltolallowlforlvarianceslinlpatientlcompliancelforlalvarietyloflreasons

Q:lCausesloflFailureloflAntimicrobiallTherapy
5.lSuperinfectionlorlbacteriallresistancel

Answer:
Useloflbroad-spectrumlantibioticslwhenlmoreltargeted,lnarrow-
spectrumlagentslarelmorelappropriate
-lOtherlinappropriatelusesloflantimicrobiallagents

Q:lGenerallConsiderationslforlthelUseloflAntibioticsl
Answer:
ClassesloflAntibioticlDrugsl-lbasedlonlmechanismsloflactionloflthelantibiotics
1.lBlockadeloflpeptidoglycanlsynthesislislthelmajorlcomponentloflalbacteriallcelllwall.lBacterial
lcelllwallldestructionlallowslwaterltolenterlthelintracellularlmilieuloflthelbacteria,lcausingltheml
tolswell,llysel(explode)landldie.lInhibitionloflcelllwalllsynthesislislbacteriocidal.

,2.lDisruptionloflbacteriallcelllplasmalmembraneslbylbindingltollipoproteinslinlthelmembrane.lT
hislmechanismlonlyloccurslonlthelouterlmembraneloflsomelgram-negativelbacterial
organismslandlislusuallylbactericidal.
3.lBindingltolbacteriallribosomeslandlblockinglsomelbacteriallproteinlsynthesis.lDependinglonlt
helspecificlproteinlsyntheticlmechanismslblocked,lthelagentlcanlbelbactericidall(i.e.,lthe
aminoglycosides).lHowever,lMostlantibioticslthatlworklbylthislmechanismlarelbacteriostatic.
4.lBlockinglbacteriallDNAlreplication,lprobablylbylinterferinglwithlalspecificlenzymel(DNAlgy
rase).lThislmechanismlislusuallylbactericidallbutlcanlbelbacteriostaticldependinglonltheldose.
5.lPreventionloflnucleiclacidlsynthesislbylblockinglmRNAlandlsecondarilylpreventinglselectedl
proteinlsynthesis.lThislmechanismlislusuallylbactericidal.
6.lBlockinglfoliclacidlsynthesis:lThislislanlessentiallmetabolitelinlbacteriallmetabolismlthatlthel
bacteriumlmustlsynthesize.lBylblockinglthelsynthesisloflfoliclacid,lseverallmetaboliclprocessesl
arelinhibited.lThislprocesslislusuallylbacteriostatic.

Q:lBACTERIALlANTIBIOTIClRESISTANCE
-lResistanceltolantibioticslcanlbe:
(A)lIntrinsicl-l

Answer:
Resistancelthatlhaslalwayslexistedlinlthelstructureloflthelbacteria;litlislalwayslinherentlinlthelge
neticsloflthatlparticularlspecies.l(Forlexample,lgram-negativelbacterialare
nowlandlhavelalwayslbeenlresistantltolspecificlantibioticlagents.)

Q:lBACTERIALlANTIBIOTIClRESISTANCE
-lResistanceltolantibioticslcanlbe:
(B)lAcquiredl

Answer:
Resistancelthatloriginateslinlanlindividuallbacteriumlaslalresultloflalchromosomallmutationlorlt
heltransferloflchromosomallfragmentsloflDNAl(plasmidslorltransposons)lbetweenlbacterialthatli
slinducedlinlthemlbecauseloflcurrentlorlpriorlexposurelto
anlantibioticlagent.lAcquiredlresistancelusuallylresultslfromlselectivelantibioticlexposure,lwhich
lcanlresultlfromleitherlappropriatelorlinappropriatelusageloflthelantibioticlagent.

Q:lMECHANISMSlOFlANTIBIOTIClRESISTANCEl
Answer:
1.lImpermeabilityloflthelbacteriallcelllwallltolthelantibiotic

, 2.lActiveleffluxloflthelantibioticlfromlthelbacteriumlbeforelthelpharmacodynamicsloflthelantibi
oticlcanlbecomeleffective
3.lPlasmid-mediatedlalterationlorlinactivationloflthelantibioticlbylbacterially-
synthesizedlenzymes
4.lAlterationloflthelbacteria'sltargetlsite;lanlactionloflthelbacteriumlitself.
5.lBypassloflanlantibiotic-obstructedlmetaboliclpathway
6.lStructurallchangeloflanlantibiotic-bindinglsite
7.lStructurallchangeloflalbacteriallcelllcomponentlthatlislusuallylalteredlbylthelantibiotic

Q:lClassificationloflBacteriallOrganisms
GRAMlPOSITIVElAEROBESl(theselbacterialrequireloxygenltolsurvive)
-Coccil

Answer:
olstaphylococcus
olstreptococcus
olpneumococcus

Q:lClassificationloflBacteriallOrganisms
GRAMlPOSITIVElAEROBESl(theselbacterialrequireloxygenltolsurvive)
-Bacillil

Answer:
olcorynebacterium
ollisterial-linlquiz
olbacilluslanthracisl(Anthrax)

Q:lGRAMlPOSITIVElANAEROBESl(theselbacterialcanllivelinldeepltissueslwithllowllevelslo
floxygen)l

Answer:
-lclostridium
-lpeptococcus
-lpeptostreptococcus

Q:lGRAMlNEGATIVElAEROBES
-lCoccil

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