NURSING 556-PRESCRIBING FOR NP'S
QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS 2024
Leading risk factors for having a drug resistant pathogen include: - ANSWER 1. recent use of abx
2. age younger than 2 or older than 65
3. day care center attendance
4. multiple co-morbidities
5. recent hospitalization
6. immunosuppression
Major goals of antibiotic therapy are: - ANSWER kill the organism, not the host, least amount of side
effects
What is a bacteriocidal drug? - ANSWER capable of killing bacteria
What is a bacteriostatic drug? - ANSWER capable of inhibiting growth or reproduction of bacteria
What is empirical therapy? - ANSWER the decision making process where the clinician selects the agent
based on the characteristics of infection, clinical eval
What does drug synergy or synergistic effect mean with regard to antibiotics? - ANSWER this is the
interaction between drugs where the effects are stronger than their mere sum. Leads to broader
spectrum of organism coverage
What is inherent resistance regarding bacteria and drugs? - ANSWER the bacteria is innately resistant to
the drug
What is acquired resistance regarding bacteria and drugs? - ANSWER this is resistance caused by
innappropriate use and prescribing of abx. This is the resistance caused by humans
,What are narrow spectrum antibiotics? - ANSWER only active on a few organisms
What are broad spectrum antibiotics? - ANSWER active on a variety of organisms
What are the factors for antibiotic selection? - ANSWER 1. maximal antibiotic effects
2. minimal harm to the host
3. greater efficacy, narrow spectrum and have lower toxicity
What is one of the major pathways for drug metabolism in the body? - ANSWER cytochrome pathway
What is the importance of the CYP P450 pathway? - ANSWER -one of the most common drug
metabolism reactions, uses enzymes to metabolize drugs which results in mixed function oxidase
reactions.
-enzymes catalyze metabolism of large number of diverse drugs and chemicals that are highly lipid
soluble.
How does phase 1 metabolism work? - ANSWER -reaction that prepares a drug molecule for further
metabolism through oxidation, reduction and hydrolysis.
-introduces or unmasks polar groups that improve water solubility and prepare drug molecules for
further metabolic reactions.
-can create metabolites with lesser or greater pharmacological activity.
How does phase II reaction work? - ANSWER called a conjugation reaction because the drugs are
metabolized and something is added to it to synthesize a new compound. This conjugation makes the
metabolites more water soluble and more easily excreted by the kidneys.
How does a drug become an enzyme inducer? - ANSWER
What is the main purpose of phase 1 and II reactions? - ANSWER choose one of the following:
1. to prepare and tag molecules for excretion
2. to speed absorption
,3. to help with drug distribution
4. to confuse the drugs in the body and limit their effects.
In what ways can drugs and foods affect drug metabolism? - ANSWER drugs/food can be inducers:
increased enzyme induction of another drug that uses the same pathway leading to increased enzyme
activity.
drugs/food can be inhibitors: can inhibit the activity of a drug when using the same enzyme pathway (ex
grapefruit juice and statins)
What are the three primary targets of antibiotics? - ANSWER 1. the bacterial cell wall
2. bacterial protein synthesis (food)
3. bacterial DNA replication
What kind of drug is PCN? - ANSWER beta-lactam abx
How do PCNs work? - ANSWER baceteriocidal: bind to the plasma binding proteins (PBPs) to inhibit cell
wall synthesis, so most effective on bacteria with cell walls
If someone has an allergy to PCN, what are alternative drugs that can be used? - ANSWER macrolide abx:
erythromycin
3rd gen cephalosporins
Since PCN and cephalosporins are both beta-lactamases, if someone is allergic to PCN can they still be
prescribed a cephalosporin? - ANSWER Yes, just not a 1st generation cephalosporin because they are
both beta-lactam abx and 1st gen rings are very similar.
What is the first line treatment for group A beta hemolytic strep (GABHS), or strep throat? - ANSWER
PCN V or PCN VK or amoxicillin
Drugs in the broad spectrum PCN group - ANSWER Ampicillin and Amoxicillin. Same antimicrobial
spectrum as PCN G but some gram -
, Common side effect of amoxicillin in children - ANSWER generalized pink, non-itchy rash. not an allergy.
What are the PCN + Beta-lactamase inhibitors? - ANSWER Combo drug that has a beta lactamase
inhibitor with a PCN-sensitive PCN (natural)
How do beta-lactamase inhibitors work? - ANSWER The inhibit the beta-lactamase enzyme. This allows
the antibiotic to be more effective. Makes the drug more broad spectrum.
What is the drug of choice for bacterial sinusitis? - ANSWER Amoxicillin/Clavulanate (PCN + Beta-
lactamase inhibitor)
What is a major side effect of amoxicillin/clavulanate - ANSWER severe GI upset
Benefits of Cephalosporins over PCN - ANSWER increasing activity against gram - bacteria
increasing resistance to destruction by beta-lactamases
increasing ability to reach the CSF
How is PCN excreted? - ANSWER by the kidneys, use caution in those with renal disease
How are cephalosporins excreted? - ANSWER by the kidneys
How do the different generations of cephalosporins differ? - ANSWER the higher the gen, the more gram
- coverage, the lower the gram +coverage, and the more resistant to b-lactamases.
Which drug is first line for gonorrhea? - ANSWER ceftriaxone (Rocephin)
What is a common 1st gen cephalosporin? - ANSWER Cephalexin (keflex)
What is a common 2nd gen cephalosporin? - ANSWER cefuroxime (Ceftin)
QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS 2024
Leading risk factors for having a drug resistant pathogen include: - ANSWER 1. recent use of abx
2. age younger than 2 or older than 65
3. day care center attendance
4. multiple co-morbidities
5. recent hospitalization
6. immunosuppression
Major goals of antibiotic therapy are: - ANSWER kill the organism, not the host, least amount of side
effects
What is a bacteriocidal drug? - ANSWER capable of killing bacteria
What is a bacteriostatic drug? - ANSWER capable of inhibiting growth or reproduction of bacteria
What is empirical therapy? - ANSWER the decision making process where the clinician selects the agent
based on the characteristics of infection, clinical eval
What does drug synergy or synergistic effect mean with regard to antibiotics? - ANSWER this is the
interaction between drugs where the effects are stronger than their mere sum. Leads to broader
spectrum of organism coverage
What is inherent resistance regarding bacteria and drugs? - ANSWER the bacteria is innately resistant to
the drug
What is acquired resistance regarding bacteria and drugs? - ANSWER this is resistance caused by
innappropriate use and prescribing of abx. This is the resistance caused by humans
,What are narrow spectrum antibiotics? - ANSWER only active on a few organisms
What are broad spectrum antibiotics? - ANSWER active on a variety of organisms
What are the factors for antibiotic selection? - ANSWER 1. maximal antibiotic effects
2. minimal harm to the host
3. greater efficacy, narrow spectrum and have lower toxicity
What is one of the major pathways for drug metabolism in the body? - ANSWER cytochrome pathway
What is the importance of the CYP P450 pathway? - ANSWER -one of the most common drug
metabolism reactions, uses enzymes to metabolize drugs which results in mixed function oxidase
reactions.
-enzymes catalyze metabolism of large number of diverse drugs and chemicals that are highly lipid
soluble.
How does phase 1 metabolism work? - ANSWER -reaction that prepares a drug molecule for further
metabolism through oxidation, reduction and hydrolysis.
-introduces or unmasks polar groups that improve water solubility and prepare drug molecules for
further metabolic reactions.
-can create metabolites with lesser or greater pharmacological activity.
How does phase II reaction work? - ANSWER called a conjugation reaction because the drugs are
metabolized and something is added to it to synthesize a new compound. This conjugation makes the
metabolites more water soluble and more easily excreted by the kidneys.
How does a drug become an enzyme inducer? - ANSWER
What is the main purpose of phase 1 and II reactions? - ANSWER choose one of the following:
1. to prepare and tag molecules for excretion
2. to speed absorption
,3. to help with drug distribution
4. to confuse the drugs in the body and limit their effects.
In what ways can drugs and foods affect drug metabolism? - ANSWER drugs/food can be inducers:
increased enzyme induction of another drug that uses the same pathway leading to increased enzyme
activity.
drugs/food can be inhibitors: can inhibit the activity of a drug when using the same enzyme pathway (ex
grapefruit juice and statins)
What are the three primary targets of antibiotics? - ANSWER 1. the bacterial cell wall
2. bacterial protein synthesis (food)
3. bacterial DNA replication
What kind of drug is PCN? - ANSWER beta-lactam abx
How do PCNs work? - ANSWER baceteriocidal: bind to the plasma binding proteins (PBPs) to inhibit cell
wall synthesis, so most effective on bacteria with cell walls
If someone has an allergy to PCN, what are alternative drugs that can be used? - ANSWER macrolide abx:
erythromycin
3rd gen cephalosporins
Since PCN and cephalosporins are both beta-lactamases, if someone is allergic to PCN can they still be
prescribed a cephalosporin? - ANSWER Yes, just not a 1st generation cephalosporin because they are
both beta-lactam abx and 1st gen rings are very similar.
What is the first line treatment for group A beta hemolytic strep (GABHS), or strep throat? - ANSWER
PCN V or PCN VK or amoxicillin
Drugs in the broad spectrum PCN group - ANSWER Ampicillin and Amoxicillin. Same antimicrobial
spectrum as PCN G but some gram -
, Common side effect of amoxicillin in children - ANSWER generalized pink, non-itchy rash. not an allergy.
What are the PCN + Beta-lactamase inhibitors? - ANSWER Combo drug that has a beta lactamase
inhibitor with a PCN-sensitive PCN (natural)
How do beta-lactamase inhibitors work? - ANSWER The inhibit the beta-lactamase enzyme. This allows
the antibiotic to be more effective. Makes the drug more broad spectrum.
What is the drug of choice for bacterial sinusitis? - ANSWER Amoxicillin/Clavulanate (PCN + Beta-
lactamase inhibitor)
What is a major side effect of amoxicillin/clavulanate - ANSWER severe GI upset
Benefits of Cephalosporins over PCN - ANSWER increasing activity against gram - bacteria
increasing resistance to destruction by beta-lactamases
increasing ability to reach the CSF
How is PCN excreted? - ANSWER by the kidneys, use caution in those with renal disease
How are cephalosporins excreted? - ANSWER by the kidneys
How do the different generations of cephalosporins differ? - ANSWER the higher the gen, the more gram
- coverage, the lower the gram +coverage, and the more resistant to b-lactamases.
Which drug is first line for gonorrhea? - ANSWER ceftriaxone (Rocephin)
What is a common 1st gen cephalosporin? - ANSWER Cephalexin (keflex)
What is a common 2nd gen cephalosporin? - ANSWER cefuroxime (Ceftin)
