Unit 4 review buzbee1
RSPT 1213 Unit 4 Antimicrobials Review
Name:
Date:
2008
1) Antibiotics are substances:
a) that are created by microbes that kill bacteria.
b) Frequently molds & fungi that exist by halting the growth of competing organisms
c) That kill bacterial, virus, internal parasites & fungi
d) a & b
2) Bactericidal antibiotics:
a) Kill bacteria
b) Hamper bacterial growth giving the body’s defenses chance to kill the bacteria.
3) Antibiotics work by:
a) disrupting the cell wall
b) inhibiting bacterial enzyme action
c) disrupting the bacterial protein sythesis
d) getting inside the cell and changing the messages the DNA sends
e) all but d
4) True/False Antibiotics can be classified as lethal disruptors or non-lethal protein disruptors.
5) True/False Antibiotics can be classified as gram + or gram – broad spectrum antibiotics.
6) True/False Humans have cell walls so antibiotic will not kill the host cells as it kills the
bacteria.
7) When you start antibiotics because a patient is immune-suppressed and you need to protect
them from a planned procedure, this form of care is called:
a) Empiric Treatment
b) Prophylactic treatment
8) When you start antibiotics because a person has been exposed to a dangerous drug this form
of care is called.
a) Empiric Treatment
b) Prophylactic treatment
9) The Doctor gives his patient a specific antibiotic because of the time of year and the age and
condition of his patient, this is called.
a) Empiric Treatment
b) Prophylactic treatment
10) When you don’t have time to get a culture and sensitivity you could treat the patient by:
a) Empiric Treatment
b) Prophylactic treatment
11) When do you need to start empiric treatment with a specific antibiotic
a) As soon as possible and stop if the cultures don’t agree with the preliminary diagnosis
b) After you get sputum or blood for cultures
c) Both
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12) Why is it important to know if your patient with pneumonia has serious prior medical
problems before picking the right antibiotic?
1) If someone has problems with his liver or kidneys, he may not process the chemicals and the
serum amounts could rise
2) If someone has allergies, he could be allergic to these drugs
13) Your patient on antibiotics is suffering from gastric upset. How can you minimize this
problem?
a) Have patient eat yogurt with active live cultures to replace stomach flora
b) Follow directions regarding taking this drug with a meal or drinking water
14) If your patient has been on one anti-TB antibiotic, and it doesn’t seem to work, what is the
next step?
a) Change drugs
b. add a new drug to the current one
15) If your patient is getting anti-TB medication for a possible exposure [a + PPD] what is the most
likely antibiotic he will get?
a) INH [Isoniazid]
c) Pyrazinamide
b) Rifampin
d) Streptomycin
16) Aminoglycoside:
a) Is a class of antibiotics that is used with Pseudomonas, Klebsiella Pneumoniae, E. Coli
b) Is a class of antibiotics that is used for newborn babies with sepsis
c) Is a class of antibiotics that is used for Mycoplasma Pneumoniae[walking pneumonia] & H.
influenzea TX & Prophylaxis for Bordetella pertussis [whooping cough]
d) a and b
e) a and c
17) Which of these classes of antibiotics is at high risk for massive allergic reactions that can result
in death?
a)
b)
Aminoglycoside
INH [Isoniazid]
c)
d)
Penicillin
Floroquinolones
18) Aerosolized Tobramyclin (Tobi ®) is indicated for what bacteria and for what patient
population?
a)
b)
c)
Teenagers with Mycoplasma Pneumoniae
Asthmatics with Mycoplasma Pneumoniae
Asthmatics with Pseudomonas Aeruginosa
d)
Cystic fibrosis patients with Pseudomonas
Aeruginosa
19) 80% of all children younger than 2 years of age will get Respiratory Syntactical Viral
pneumonia or bronchiolitis every winter. The drug for this disorder is:
a) Aminoglycoside
d) Ribavirin
b) INH [Isoniazid]
e) All but a
c) Pentamidine
20) What patient[s] are at increased risk for needing inhaled treatment for Respiratory
Syntactical Viral pneumonia
a) The baby under 6 weeks of age
b) The infant with a long-standing immunosuppression disorder
c) The infant with a long-standing cardiopulmonary disorder
d) All of these
e) All but b
Unit 4 review buzbee3
21) The mode of action of Aerosolized Tobramyclin (Tobi ®) is:
a) disrupting the cell wall
b) inhibiting bacterial enzyme action
c) disrupting the bacterial protein sythesis
d) getting inside the cell and changing the messages the DNA sends
e) all but d
22) List the recommendations regarding the type of SVN used to deliver Aerosolized
Tobramyclin (Tobi ®)
1.
Needs to be able to be sterilized
2.
May need to increase the flow rate
because the drug is thick
3.
Need to rinse off the drug with each
4.
Wear a mask when giving this drug
treatment because it is thick and
by inhalation and check the room for
sticky- would be a good idea to have
pregnant women-send them out
a different SVN for this drug
23) Why should the RCP wear a mask during administration of a Tobi?
so you will not get drug resistant bacteria or allergic reaction
24) What are the recommendations regarding Tobi with pregnant women?
Do not come into the room while it is being nebulizered;
Do not mix this drug because it can harm the fetus
25) Your CF patient needs Tobi, and a Beta II drug with his Mucolytics and he needs CPT& PD.
In what order do you do these therapies and explain why.
Give Beta II and mucolytics, then do CPT , then give in haled Tobi ® last because this drug cannot
be mixed with other drugs and because this drugs needs to be on the tissue rather than on the sputum
that will be coughed out
26) Your patient has runny nose, wheezing, and a +ELISA for RSV for the last three days. What
do you suggest?
a) Start inhaled 300 mg of Tobi BID
b) Start inhaled 300 grams of Pentamidine in 6 ml normal saline
c) Start inhaled 6 gram of Pentamidine in 6 ml sterile water
d) It is too late to start inhaled 6 grams Ribavirin in 300 ml sterile water
27) Correction Your patient has a sputum that is growing Pseudomonas Aeruginosa. What do you
suggest?
a) Start inhaled 300 mg of Tobi BID
b) Start inhaled 300 grams of Pentamidine in 6 ml normal saline
c) Start inhaled 6 gram of Pentamidine in 6 ml sterile water
d) It is too late to start inhaled 6 grams Ribavirin in 300 ml sterile water
Unit 4 review buzbee4
28) Your patient with HIV-AIDS has s/s of pneumocytis carinii pneumonia. You suggest:
a) Start inhaled 300 grams of Pentamidine in 6 ml normal saline Q 4 weeks
b) Start inhaled 600 mg of Pentamidine in 6 mL of sterile water Q day
c) Start 300 mg of Tobi with 2.5 mg albuterol BID
d) It is too late to start inhaled 6 grams Ribavirin in 300 ml sterile water
29) Explain why a side effect of Pentamidine is fatigue.
a) Each breath of Pentamidine needs to be a VC, the patient must inhale completely hold the
breath, then exhale completely. This must be maintained for about 20 minutes & the patient
may need several rest periods
30) Draw and label the Respigard II
See hand out
31) Discuss the need for the baffles in this device.
a) the baffle between the nebulizer cup mouthpiece is used to reduce the size of the particles so
they get to the alveoli
b) the baffle in the inspiratory limb between the room and the nebulizer is to allow the patient to
entrain room air, but not get medication into the room
c)
the baffle in the expiratory limb sends gas and medication into the bacteria filter before it can
leave the circuit
32) The PARI nebulizer is used to deliver what drug?
a) Pentamidine
b) Tobi
c)
Ribavirin
33) The Respigard II SVN is used to deliver what drug?
a) Pentamidine
c)
b) Tobi
Ribavirin
34) The SPAG is used to deliver what drug?
a) Pentamidine
b) Tobi
d)
c)
35) list the adverse hazards of all systemic antibiotics
1.
can make the patient have drug
2.
resistant bacteria; supra infections
Ribavirin
kills GI tract flora so GI upsets are
common
with resistant microbes
3.
allergic reactions because these are
4.
can cause liver damage
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created from fungus or molds
neurotoxic
5.
ototoxic
6.
35 If your patient getting Pentamidine gets bronchospasm, list three interventions you can
offer.

Get a short-acting Beta II bronchodilator for PR N

Decrease the flow rate from 5-7 to 4-5

Decrease the dose from 300 Q4 weeks to 150 or even lower Q 2 weeks
36. Complete this table
Inhaled
indications
drug
Pentamidine TX or prevent PCP in immune suppressed
patients
Dose/frequency
hazards
TX 600 mg/6ml Q day x
bronchospasm and
14-21 days
coughing and fatigue
For prevention
300 mg/ 6ml Q 4 weeks
Ribavirin
TX RSV pneumonia or bronchiolitis in kids
6 gram/300 ml sterile water
under 2 YO
Q day x 18 hr for three
bronchospasm and
coughing
days
conjunctivitis and rash
damage fetus
anemia & reticulocytosis
Tobi
TX Pseudomonas Aeruginosa. in patient
300mg/unit dose BID [no
with CF or COPD
more than 12 hours apart]
bronchospasm and
coughing
for 28 days followed by 28
allergic reaction, buildup
days off
of drug resistance in
patient, caretakers
Mucolytics Review sheet
Name:
1.
date:
2008
True/False The normal person creates 100 ml/day of mucus, because most of it reabsorbs
only 10 ml gets the glottis where it is expectorated.
2. Mucus
a.
b.
c.
contains:
water
glycoprotein,
oligosaccharide side chains
d. a & b only
e. a, b and c
3. True/False The mucus molecule looks a lot like a bottle brush with the handle being protein
and the bristles being the oligosaccharide side chains.
4. True/False Dornase Alpha is a recombinant enzyme developed from Chinese hamster
stomach cells that digests intracellular DNA.
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5.
The molecules’ side chains interweave with one another just like a bunch of bottle brushes
and these strands of mucus are cross linked by:
a.
disulfide bonds.
c.
sulfhydryl bonds
b.
Phospholipids bonds
d.
all of these
6. The mode of action of Acetylcysteine (Mucomyst ®)
a. Wetting down the mucus; adding to the water portion
b. Exchanging the sulfhydryl bond for disulfide bonds
c. Exchanging the disulfide bones for sulfhydryl bonds
d. Disrupting the protein of the glycoprotein ‘backbone’
e. All of these
7.
Correction The mode of action of Dornase Alpha [Pulmozyme®]
a. Wetting down the mucus; adding to the water portion
b. Exchanging the sulfhydryl bond for disulfide bonds
c. Exchanging the disulfide bones for sulfhydryl bonds
d. Disrupting the DNA
e. All of these
8. The mode of action of sterile water and sterile saline is
a. Wetting down the mucus; adding to the water portion
b. Exchanging the sulfhydryl bond for disulfide bonds
c. Exchanging the disulfide bones for sulfhydryl bonds
d. Disrupting the protein in sputum
e. None of these
9. The mode of action of IV or oral fluid replacement is:
a. Wetting down the mucus.
b. Wetting down the mucus; adding to the water portion by pushing fluid into the
tissue from the airway
c. Cholinergic stimulation of mucus glands to produce more mucus
d. Exchanging the disulfide bones for sulfhydryl bonds
e. Disrupting the protein
10. The mode of action of hypertonic saline is:
a. Wetting down the mucus; adding to the water portion by pulling fluid from the
tissue
b. Wetting down the mucus; adding to the water portion by pushing fluid into the
tissue
c. Exchanging the sulfhydryl bond for disulfide bonds
d. Exchanging the disulfide bones for sulfhydryl bonds
e. Disrupting the protein
11. The mode of action of spicy foods is:
a. Wetting down the mucus; adding to the water portion by pulling fluid from the
tissue
b. Wetting down the mucus; adding to the water portion by pushing fluid into the
tissue
c. Cholinergic stimulation of mucus glands to produce more mucus
d. Exchanging the disulfide bones for sulfhydryl bonds
e. Disrupting the protein of the glycoprotein ‘backbone’
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12. The dose of Dornase Alpha [Pulmozyme®] is:
a. 300 mg/ 6 ml
b. 150 mg/6ml
c. 2.5 mg in unit dose
d. 2-6 ml of 10% or 20%
e. 6 grams/300 ml sterile
water
13. Side effects of Dornase Alpha [Pulmozyme®] include:
a. sore throat and hoarseness, increased sputum,
b. coughing can aggravate hemoptysis
c. anemia
d. all of these
e. all but C
f. all but B
14.
wheezing
You have a patient who has a neuromuscular problem which prevents him from
performing an IC of 12-15 ml/kg IBW. He gets SVN with a short-acting Beta II
antagonist with Mucomyst 10%, what side effect could he be at high risk for
suffering?
a. He could start to wheeze
b. He could get a sour throat
c. He might get more liquefied secretions than he can handle