Week 1 Exam: NR566 / NR 566 (Latest 2026 / 2027) Advanced Pharmacology for Care of the Family | Questions & Answers | Grade A | 100% Correct – Chamberlain

Week 1 Exam: NR566 / NR 566 (Latest 2026 / 2027) Advanced Pharmacology for Care of the Family | Questions & Answers | Grade A | 100% Correct – Chamberlain Amphotericin B is a _________ antibiotic is it well absorbed in the GI tract? polyene no; poorly absorbed. PO therapy won't work. must be given IV! undergoes binding to sterol-containing membranes of tissues Amphotericin B must be given __ IV Amphotericin B should be used in _______ ___________ ________ _________ impairment occurs in all pts life threatening infections Renal when it comes to ____________ _, kidney damage = total dose in tx amphotericin B highly nephrotoxic if Amphotericin B dose _ g, permanent damage is likely to occur, can be decreased by infusing 1 L of saline 4 if plasma creatinine is ____, decrease dose 3.5 high levels of Itraconazole can cause fatal __________ ____________ if taking ____________ and ____________: monitor levels! ventricular dysrhythmias digoxin, cyclosporine if taking Itraconazole with __________: PT time should be monitored! can be _______ by azoles if taking Itraconazole with _____________: check blood sugar can be ________ by azoles, causing severe hypoglocemia warfarin; increased sulfonylureas; increased itraconazole is a ______ spectrum ____________ Azoles are often used as alternatives to _____________ _ for most systemic fungal infections, systemic and superficial mycoses broad antifungal Amphotericin B old people have higher risk for ___________, decreasing ability to absorb antifungal meds. achlorhydria (no gastric acid in stomach) Do not take Itraconazole with meds that raise gastric pH: __________, __ ________, ____ antacids, H2 antagonists, PPIs these meds can decrease the absorption of Itraconazole Caspofungin is a ___________ often used in __ form echinocandin IV Caspofungin can be used to treat: -invasive aspergillosis (fungal lung infection) -systemic _________ infections -Candidemia -Candida-related ____________ -peritonitis - pleural space _________ - intraabdominal abscesses Candida esophagitis infections _______________ is approved for empiric tx of neutropenic fever DT fungal infections caspofungin adverse effects of Caspofungin: _______ at IV site _______, ______, HoTN, N/V/D phlebitis fever, chills Caspofungin can cause effects mediated by __________ release like: rash, flushing, __________ histamine pruritis other hematologic adverse effects caused by caspofungin are anemia and ____________ ___________ impairment, too. can increase liver enzymes and creatinine leukopenia hepatic ____________ is the first PO antifungal product for tx of infections caused by dermatophytes Griseofulvin _____________ tx superficial dermatophytic infections of skin and nails that don't respond to topical therapy is it active against Candida species? Griseofulvin NO, nor is it useful against systemic mycoses Terbinafine is an ___________; inhibits synthesis of __________ and disrupts fungal membrane allylamine ergosterol __________ is used to tx tinea capitis, aka ringworm. tx: is PO, for _-_ weeks more effective than standard PO ____________ Terbinafine 2-4 weeks griseofulvin Terbinafine is used to tx _____________, a fungal infection in the toenails and fingernails caused by Tinea unguium. the infection causes nail thickening, deformity onychomycosis __________ is used off label for tx of tinea infections and _____________: fungal disease spread in soil and plants Terbinafine sporotrichosis tinea ______ is the most common fungal infection responds well to topical creams like _________ and ___________ teach pt to change _______ often, wear absorbent cotton socks, and dry feet after shower pedis clotrimazole, econazole socks What is the primary med of choice to tx systemic mycoses? amphotericin B highly toxic! only use __________ _ in infections like systemic mycoses that are progressive and fatal what is the treatment regimen for systemic mycoses with amphotericin B? amphotericin B IV infusion daily or every other day for several months what is the primary med of choice in tx of infections caused by HSV and varicella zoster virus? acyclovir acyclovir works by converting to ______- _________ (GMP) by thymidine kinase GMP converts to GTP (guanosine triphosphate), then adds to growing DNA strand, ___________ growth acyclo-guanosine monophosphate blocking is CMV sensitive to acyclovir? why or why not? no because acyclovir is a poor substrate to thymidine kinase produced by virus List the 3 administration forms acyclovir comes in po, IV, topical PO acyclovir can treat ___________ infections in the gums and _________. and is used for HSV_ for face and oropharynx in ____________ pts can be used prophylactically for herpes ___________ aka cold sores primary; mouth 2; immunocompromised labialis __ form of acyclovir is often used in severely immunocompromised pts and to tx ________ ____________ _____ in immunocompromised pts IV varicella zoster virus high PO doses of _________ can be given to tx shingles aka herpes zoster can also be used in tx of ________ herpes acyclovir genital PO bioavailability of acyclovir is ___ no significant absorption in __________ use low topical decrease acyclovir dose in pts with kidney impairment. half-life is over 20 hours in unhealthy kidney __________ aka Tamiflu is approved for _____ prevention in pts 1 year old and older and for tx of flu in pts 2 weeks old and older Oseltamivir; flu ________ can be used to treat ____ and be given prophylactically in pregnant pts Oseltamivir flu Oseltamivir stops ____________: enzyme needed for replication in stopping this enzyme, virus particles cant leave infected cell membrane, stopping _____ spread neuraminidase viral Oseltamivir is effective against ___________ _ and _ influenza A and B When can Oseltamivir be used? list the 3 indications : can be used prophylactically in relatives of pt with flu residents in nsg homes high risk members of community Relatives of infected flu pt should take ____________ within __ hours of exposure for the next __ days Oseltamivir 48 10 Oseltamivir can be given __ PO Palivizumab is a ___________ _____, aka Synagis It's used to prevent ____ infection in preemies, at risk kids up to 24 months of age monoclonal antibody RSV Palivizumab is given via __ route, required _________ throughout RSV season IM monthly flu vaccine is given annually because ____ viruses change constantly, flu ;so new vaccines are made against strains deemed most likely to cause disease in upcoming flu season flu vaccines are contraindicated in pts with _________, _______________ allergic reaction to flu vaccine or vaccine component. Also contraindicated in pts with ____ that developed within _ weeks of getting flu vaccine severe, anaphylactic GBS (Guillain-Barre) 6 list the 3 NRTI meds 1. a 2. l 3. e abacavir lamivudine emtricitabine NRTIs, or __________/___________ __________ ____________ inhibitors are the first drugs used against HIV effective against both HIV _ and _, but more so _ nucleoside/nucleotide reverse transcriptase 1 and 2 1 NRTIs stop HIV replication by converting to active form in cell, then acting as a _______ for reverse transcriptase once added to growing DNA strand -- growth ______ substrate blocked ____________ toxicity is an adverse effect that can occur when taking NRTIs, NRTIs disrupt __________ DNA synthesis --- impaired function this can cause ________ acidosis! mitochondrial mitochondrial lactic lactic acidosis is a black box warning! can be fatal hepatic ______ is an adverse effect that can occur when taking NRTIs DT __________ dysfunction- it reduces breakdown of _____ acids by mitochondria steatosis mitochondrial fatty other s/s are pancreatitis, myopathies Protease inhibitors prevent ____ ___________ by blocking protease HIV maturation PIs stop protease from cleaving HIV polyproteins rendering virus _________ and _____________ immature; noninfectious PIs can cause _____________, DM development, lipodystrophy, increase in transaminases and _________ bleeding in pts with hemophilia hyperglycemia increased avoid giving ___________ and _________ to pts with hyperlipidemia caused by PIs because CYP450 is inhibited by protease inhibitors, increasing statins to dangerous levels simvastatin, lovastatin increased bleeding in hemophilic pts by PIs happens in ________ and ______ tissues joints, soft an increase in transaminases can indicate what? caused by PIs liver injury use caution in pts with chronic liver disease can protease inhibitors be given as monotherapy? NO, must be combined with 1, preferably 2, reverse transcriptase inhibitors! _____________ and ___________ are often recommended PIs other PIs are: 3. f 4. t 5.l 6.r atazanavir, darunavir fosamprenavir tipranavir lopinavir ritonavir ________ or ________ can be given to infants at 14 days of life ___________ can be given to infants at as young as 3 months old who weigh 5kg (PIs) lopinavir ritonavir atazanavir ___________ and _________ are approved for pts 4 wks (PIs) fosamprenavir, ritonavir _____ is recommended for all HIV-infected pregnant pts to ____________viral load and risk for perinatal transmission _____________ and ________ are the safest to give to pregnant pts ART decrease ritonavir, nelfinavir can a HIV positive mom breasfeed? NO INSTIs, aka ___________ ______ _________ inhibitors "tegravirs" target HIV by stopping HIV integration into ____ integrase strand transfer inhibitors DNA ___________, an enzyme, is needed for HIV replication. by stopping ____________, INSTIs stop HIV DNA insertion, stopping ___________ integrase integrase replication INSTIs are often combined with other meds to tx _______ HIV 1 list INSTIs meds: 1. b 2. c 3. r bictegravir cabotegravir raltegravir INSTIs can cause insomnia, ___________, and increase in __________ ___________ levels. and can also increase risk for suicidal ideation and __________ in psychiatric pts rhabdomyolysis creatine phosphokinase depression CCR5 antagonists are aka ____________ _____ 5 ____________ examples are m_______ and e__________ chemokine receptor 5 antagonists maraviroc, enfuvirtide what do CCR5 antagonists do? block HIV entry into CD4 T cells it binds to CCR5, blocking viral entry Albendazole is active against many _________ and ___________ parasites cestode nematode Albendazole stops polymerization of ________ and stops cytoplasmic microtubules ---- stopping uptake of _________ tubulin glucose Mebendazole also stops ________ uptake by ______ ______ prevention --- immobilization -- slow death glucose worms glucose it takes _ days after Mebendazole treatment for complete parasite clearance. does this med influence glucose uptake or utilization by humans? 3 NO Enterobiasis aka ____________ are the most common helminthic infestation pinworms grow in ________ and large intestine, with a ____ month lifespan pinworms ileum, 2 main clinical manifestation of enterobiasis is perianal itching most common mode of transmission all family members must be treated! list tx choices for enterobiasis: 1. a 2. m 3. p_________ p_______ albendazole mebendazole pyrantel pamoate What are the major antibiotic drug classes Beta-lactams: penicillins Beta-lactams: Cephalosporins fluoroquinolones tetracyclines and macrolides sulfonamides, trimethoprim, &nitrofurantoin What is the primary goal of antibiotic therapy kill bacteria without harming host tissue Bactericidal antibiotics directly kill bacteria bacteriostatic antibiotics Antibiotics that do not actually kill bacteria but rather inhibit bacterial proliferation while the hosts immune system does the killing which antibiotics are preferred for immunocompromised patients: bactericidal or bacteriostatic bactericidal which antibiotics are preferred for patients with an overwhelming infection: bactericidal or bacteriostatic bactericidal broad spectrum antibiotics affect a broad range of gram-positive or gram-negative bacteria narrow spectrum antibiotics Effective against specific bacteria which is used for empiric therapy: narrow or broad broad spectrum Risks of Broad Spectrum disruption of normal floral increases risk of development of antibiotic resistance which antibiotics increase the risk of antibiotic resistance: narrow or broad spectrum and why Broad spectrum because they kill more competing organisms than narrow spectrum drugs is narrow or broad spectrum antibiotics preferred narrow is preferred when possible. broad spectrum only used when pathogen is unknown or when multiple types of bacteria is suspected Bactericidal drugs Aminoglycosides Beta-lactams fluoroquinolones Metronidazole Vancomycin streptogramins most antimycobacterial agents (rifampin, isoniazid, streptomycin, etc) bacteriostatic drugs clindamycin macrolides sulfonamides tetracyclines When is empiric therapy used? when treatment is started without cultures or when culture results are not back yet who needs empiric therapy critically ill pts after first set of cxs hospitalized pts until css are available ambulatory pts based on clinical presentation Penicillins MOA inhibit cell wall synthesis; bactericidal penicillins primarily excreted how in urine what needs to be monitored when giving penicillins renal function what happens if renal insufficiency occurs while giving penicillins prolonged half-life leading to toxicity Penicillin distribution -Well distributed to most body tissues -Penetration to CSF and eye tissues poor in absence of inflammation narrow-spectrum penicillinase sensitive drugs penicillin G penicillin V narrow-spectrum penicillinase sensitive susceptible pathogens streptococci, Neisseria, anaerobes narrow-spectrum penicillinase resistant drugs naficillin oxacillin dicloxacillin narrow-spectrum penicillinase resistant susceptible pathogens S. Aureus streptococci Broad-spectrum penicillins Ampicillin Amoxicillin broad-spectrum penicillins susceptible pathogens E.coli proteus mirrabillis enterococci neisseria gonorrheae Extended spectrum penicillins Piperacillin extended-spectrum penicillins susceptible pathogens E.Coli, proteus mirabillis, enterococci, nesseria gonorrhoeae, pseudomonas, enterbacter, klebsiella Penicillin/Beta lactamase combinations Ampcillin/sulbactam (unasyn) amoxicillin/clavulanate (augmentin) piperacillin/tazobactam (zosyn) If a patient has a mild allergy to penicillin what is an appropriate drug alternative cephalosporin if a patient has a severe allergy to penicillins what is an appropriate drug alternative NOT CEPHALOSPORINS vancomycin erythromycin clindamycin Lifespan considerations for penicillins : Infant, children, pregnant women, breastfeeding, older adults Infant: safe children: safe/common pregnant: evidence suggests no second or third trimester fetal risk breastfeeding: amoxicillin is safe data lacking for other penicillins older adult: dose adjustment for renal dysfunction high risk patients for penicillins pts w/ hx of severe reaction to penicillins, cephalosporins, or carbapenems Which drugs are chemically related to penicillins cephalosporins Beta Lactams (cephalosporins) moa bactericidal w/low toxicity 1st generation cephalosporins drugs Cefazolin cephalexin(keflex) 1st generation cephalosporins main use skin and soft tissue infection 2nd generation cephalosporins cefoxitin, cefaclor, cefuroxime 3rd generation cephalosporins ceftriaxone, cefotaxime, ceftazidime 4th generation cephalosporins Cefepime (Maxipime) 5th generation cephalosporins Ceftaroline (Teflaro) 1st generation cephalosporins susceptible pathogens gram positive staphylococci and streptococci 2nd-5th generations cephalosporins susceptible pathogens broad spectrum gram positive and gram negative bacteri 1st generation cephalosporins clinical use strep pharyngitis skin infections surgical prophylaxis 2nd generation cephalosporin clinical use otitis sinusitis resp tract infections 3rd generation cephalosporin clinical use meningitis 4th generation cephalosporin clinical use hospital acquired pneumonia complicated intra-abdominal and urinary tract infections 5th generation cephalosporin clinical use MRSA infections all cephalosporins can promote______ instruct patient to report increase in ____________ CDIFF Stool frequency which generation cephalosporins are used to treat bacterial infections in neonates and infants 3rd are cephalosporins safe for use in children/adolescents yes, commonly used to treat bacterial infections in children which drug has a black box warning for use in pregnancy secondary to risk for adverse developmental outcome Televancin are cephalosporins safe in pregnancy yes are cephalosporins safe for breastfeeding yes older adult considerations for cephalosporins and carbapenems adjust dose for decrease renal function Do carbapenems cover MRSA? nope Carbapenems MOA inhibit cell wall synthesis; bactericidal carbapenems Imipenem Meropenem Ertapenem Doripenem Carbapenems route of administration IV how do carbapenems effect emergence of resistance carbapenems are extremely broad-spectrum and effective at killing both gram positive and gram negative bacilli which can lead to emergence of resistance which is actually a global healthcare problem that is being talked about how can you help prevent emergence of resistance with carbapenems reserve prescribing to only patients who cannot be treated with a more narrow-spectrum agent Vancomycin MOA inhibits cell wall synthesis -bacteriocidal vancomycin susceptible organisms gram positive bacteria like s. aureus, staph epidermidis, penicillin resistant pneumococcui and CDIFF how is vancomycin normally given? except in which case? IV due to poor GI absorption except for CDIFF infections which it can be given orally Major adverse effect of vancomycin renal toxicity when should vancomycin be discontinued significant kidney damage occurs indicated by a 50% increase in serum creatinine levels which antibiotics are most likely to cause Cdiff clindamycin 2nd and 3rd gen cephalosporins fluroquinolones (Cipro and levaquin) initial episode mild or moderate of CDIFF treatment vancomycin 125mg PO QID X10days or fidaxomicin 200mg PO BID X10days initial episode or severe CDIFF treatment vancomycin 500mg PO QID First CDIff recurrence tx vancomycin as a tapered and pulsed regimen vancomycin high risk individual patients with renal impairment Tetracycline MOA inhibit protein synthesis (bacteriostatic) tetracycline uses - Vibrio cholera - severe Acne - Chlamydia - Ureaplasma - M. pneumoniae - Tularemia - H. pylori - B. burgdorferi - Rickettsia What should tetracyclines not be taken with? calcium supplements milk products iron supplements magnesium laxatives most anatacids tetracycline effects on bones and teeth teeth- yellow/brown discoloration, hypoplasia of enamel bones-if taken while pregnant will suppress growth of long bones of infant tetracyclines and sun exposure tetracyclines increase sensitivity of skin to ultraviolet light; reduce sun exposure tetracyclines considerations for children do not use in children younger than 8 due to discoloration of permanent teeth tetracyclines considerations for pregnant women avoid in pregnancy can cause fetal harm tetracyclines considerations for breastfeeding avoid; can cause permanent staining of teeth in infant tetracycline considerations for older adults check for interactions of other drugs the patient is taking as tetracycline interacts with many drugs including digoxin Macrolides MOA inhibit protein synthesis (bacteriostatic) Macrolides Azithromycin Clarithromycin Erythromycin (oldest) Erythromycin Antimicrobial Spectrum most gram positive and some gram-negative Erythromycin uses alternative to penicillin G in pts with penicillin allergy treatment of choice for diphtheria high risk patients for macrolides pts w/prolonged QT interval clindamycin moa inhibits protein synthesis, bacteriostatic clindamycin is highly known for causing what CDAD C diff associated diarrhea Aminoglycosides MOA Inhibit bacterial protein synthesis Bactericidal aminoglycosides antimicrobial spectrum aerobic gram-negative bacilli , klebsiella pneumoniae, Pseudomonas aeruginosa Aminoglycosides gentamycin tobramycin amikacin aminoglycosides distribution extracellular fluid and renal tissue (leading to nephrotoxicity) ahminoglycosides considerations for pregnancy can harm fetus aminoglycosides in breastfeeding gentamicin safe aminoglycosides in older adults caution with decreased renal funtion how to avoid nephrotoxicity with aminoglycosides reduce dosage of increase dosing interval black box warning for aminoglycosides irreversible ototoxicity and nephrotoxicity Sulfonamides MOA inhibit folic acid synthesis (bacteriostatic) sulfonamides antimicrobial spectrum Broad spectrum gram positive cocci gram negative bacili protozoa fungi sulfonamides considerations for infants do not use younger than 2 months- can cause kernicterus Sulfonamides in pregnancy cause birth defects especially in first trimester, can also cause kernicterus in infant sulfonamides and breastfeeding can cause kernicterus in infant younger than 2 months as its secreted in breast milk sulfonamides and older adults more likely to have neutropenia, toxic epidermal necrolysis sulfonamides can cause_____so you need to _________ per day crystalline aggregates in the kidneys drink 8-10 non caffeinated drinks per day Trimethroprim MOA inhibits dihydrofolate reductase bacteriostatic or bactericidal Trimethoprim/Sulfamethoxazole inhibit 2 difference actions resulting in better ability to stop synthesis. trimthoprim/sulfamethoxazole is selectively toxic to ____and active against___ microbes wide range of gram-positive and gram-negative bacteria resistance to tmp/smz is lower than either drug alone in patients with renal impairment (creatinine _____ to___) dosage of sulfonamides should be decreased by _____%. if creatinine falls below______ it should be______ 15-30, 50% 15, discontinued trimethroprim contraindicated in patients with folate deficiency Trimethroprim/Sulfamethoxazole monitor patients cbc cd4+ count if HIV potassium if hyperkalemia is suspected most common causative agent of CAP in general population streptococcus pneumonia(gram positive) mycoplasma pneumonia (atypical mainly children) influenza resp syncytial virus most common causative agent of CAP in smokers or COPD haemophilius influenzae (gram neg) most common causative agent of CAP in cystic fibrosis Pseudomonas aeruginosa(gram neg) Fluroquinolones MOA inhibit DNA synthesis; bactericidal Fluroquinolones -oxacin Fluroquinolone uses wide variety, broad spectrum, includes skin, soft tissue, GI, bones, joints, anthrax prevention but not Staph infections fluroquinolones in children cipro and levofloxacin only approved quinolone for children. concern for tendon injury fluroquinolones in pregnancy limited data risk vs benefit must be weighed fluroquinolones in breastfeeding unknown, choose other medication if possible fluroquinolones in older adults well tolerated fluoroquinolone black box warning tendon rupture and exacerbation of muscle weakness in patients with myasthenia gravis chlamyidal pneumonia treatment in infant Chlamydia is typically treated with tetracyclines but not pneumonia. A macrolide would be the best choice here (erythromycin). what types of infections are usually viral and don't warrant antibacterial agents common cold mumps chickenpox what is the gold standard for diagnosing CAP chest x-ray first line treatments for CAP for patients with no comorbiditites oral amoxicillin doxycycline macrolides when would a fluoroquinolone be given to treat CAP if the patient had been treated with an antimicrobial agent in the last 90 days macrolides in pregnancy safe macrolides in children safe treatment of choice for Mycoplasma pneumoniae macrolides (azithromycin) safe for children and adults what is the empiric therapy of choice for CAP combinations beta-lactam plus macrolide