NR 566 Midterm Study Guide 2025

Common CAP pathogens - Correct Ans-S. Pneumoniae (most common) H. Influenzae (smokers/COPD) P. Aeruginosa (CF) CAP first line treatment - Correct Ans-Macrolides, Doxycyline, Amoxicillin what to give if 1st CAP treatment doesn't work? - Correct Ans-Respiratory Fluoroquinolone if not received abx in the past 3 months Mycoplasma pneumoniae - Correct Ans-atypical pneumonia; commonly seen in children pediatric atypical pneumonia treatment - Correct Ans-Macrolides (Erythromycin), if failed then Respiratory fluoroquinolone CAP treatment during pregnancy - Correct Ans-Amoxicillin, cephalosporins, or Erythromycin Treatment of chlamydial pneumonia in infant - Correct Ans-Macrolide (Azithromycin): 500mg orally on day 1 followed by 250 mg once daily on days 2-5 When to use broad/empiric spectrum antibiotics? - Correct Ans-Before cultures are resulted/ critically ill patient after first culture obtained, based on NP knowledge of patient history, local susceptibility/geographic location When to use narrow spectrum antibiotics? - Correct Ans-Used when the culture and sensitivity is resulted, and pathogen is known. how to treat C.diff - Correct Ans-Stop the antibiotic that may have caused it 1st: Vancomycin 125 mg PO QID x 10 days. 2nd: Metronidazole 500mg PO TID x 10 days address hydration Drug class known for ALL drugs in class to promote development of C. Diff - Correct Ans-2nd and 3rd generation Cephalosporins Penicillin: Cross-sensitivity reactions with which drug classes - Correct Ans-Cephalosporins & Carbapenems (Allergy may be mild or severe) Safe penicillin during pregancy - Correct Ans-Amoxicillin patient education for Cephalosporins - Correct Ans-Report to provider any loose stools, complete full course of antibiotics, s/s of allergy Cephalosporins in pregnancy - Correct Ans-All appear safe for use patient education for Tetracyclines - Correct Ans-photosensitivity (wear sunscreen!), complete full course, s/s of allergy Tetracyclines in pregnancy - Correct Ans-Can lead to fetal death; avoided for use Patient education for macrolides - Correct Ans-Take with meals to avoid GI upset, contraindicated w/ warfarin Aminoglycoside patient teaching - Correct Ans-Patients should report tinnitus, high-frequency hearing loss, persistent headache, nausea, dizziness or vertigo sulfonamides patient teaching - Correct Ans-Finish full course Increase fluid intake to 8-10 cups/day Take on empty stomach Avoid sun exposure/wear sunscreen Sulfonamides during pregnancy - Correct Ans-not to be used during 1st trimester, can cause kernicterus in infants Gentamicin renal dose adjustments - Correct Ans-decreased dosage for renal impaired tinea capitis treatment - Correct Ans-oral griseofulvin drug to treat aspergillosis (Fungal Pneumonia) - Correct Ans-Voriconazole Which Anthelmintics carry risk for hypotension with patients on antihypertensives? - Correct Ans-Ivermectin and Moxidectin Which Anthelmintics can cause bone marrow suppression and liver impairment? - Correct Ans-Mebendazole and Albendazole Which Anthelmintic is generally safe to give w/out baseline data? - Correct Ans- Which Anthelmintic is safe for use in pregnancy? - Correct Ans-Praziquantel, Moxidectin Risks associated with Didanosine - Correct Ans-pancreatitis, neuropathy, lactic acidosis, hepatotoxicity, optic disorders Risks associated with Saquinavir - Correct Ans-cardiac dysrhythmia, heart failure PR Interval impacts use of which HIV drugs? - Correct Ans-Protease inhibitors: Saquinavir, Atazanavir, Lopinavir, Ritonavir How to measure success with antiretroviral therapy for HIV? - Correct Ans-indicated by a reduction in plasma HIV RNA & increased CD4 T-Cells (immune system recovery) What does an increase in CD4 T-cell indicate? - Correct Ans-Restoration of some immune function When do use Foscarnet in HIV+ patients? - Correct Ans-treat HIV-infected patients with suspected or proven acyclovir-resistant HSV/VZV infections Metronidazole patient teaching - Correct Ans-Can cause metallic taste in mouth, avoid alcohol with the medication d/t risk of Disulfiram reaction (n/v/HA) Abacavir adverse effects - Correct Ans-Hypersensitivity (Stevens Johnson syndrome): fever, rash, myalgia, arthralgia, nausea, vomiting, diarrhea, abdominal pain, pharyngitis, dyspnea, and cough Monitoring needs for long-term antifungal use - Correct Ans-liver function Antifungals to use in immunocompromised patients - Correct Ans-oral Fluconazole or Ketoconazole Avoid Amphotericin B How to treat systemic fungal infections - Correct Ans-Amphotericin B or Azoles (in Immunocompromised) Ketoconazole and omeprazole concurrently: -What does the patient need to know? - Correct Ans-ketoconazole will decrease the effect of omeprazole oral by reducing stomach acidity Enterobius vermicularis: -What is it and who would you expect to have it? - Correct Ans-Pinworm: common in children Risks of Budesonide use in children - Correct Ans-Impaired growth of bones Voriconazole contraindication w/ phenobarbital - Correct Ans-Phenobarbital is a PY450 inducer & can reduce the levels of voriconazole cerumen impaction cause - Correct Ans-packing wax into ear through use of q-tips and other cleaning devices cerumen impaction treatment - Correct Ans-can be removed by irrigation w/ warm water/saline or OTC Debrox ear drops to soften for removal or suction Treatment of Otomycosis (fungal otitis externa) - Correct Ans-2% acetic acid solution 3-4x/day x 7 days. If this not work, 1% clotrimazole [Lotrimin] can be applied