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Antibiotics affecting the Bacterial Cell Wall (ch. 39)

Terms in this set (44)

what type of drug is penicillin?
beta lactam
what spectrum(s) drug is penicillin
narrow spectrum, broad spectrum, and extended spectrum
what is the prototype of penecillin
penicillin G
what gram (+/-) is penicillin g effective against?
mostly gram positive
how is penicillin g usually administered
IV
what is the most serious adverse reaction of penicillin g
allergic reactions
what are the most common adverse effects of penicillin g?
GI
what drug is similar to penicilin in structure and activity?
cephalosporins
penicillin allergic patients have an increased risk of being allergic to what drug?
cephalosporins
what is the prototype of cephalosporins
cefazolin
what are the most common side efffects of cefazolin?
hypersensitivity, GI, neurotoxicity is possible (more likely if patient is recieving aminoglycoside antibiotics too)
what could happen in the incidence of a cefazolin and alcohol interaction
disulfiram-like reaction may occur
what type of drug is vancomycin?
monobactam
what does vancomycin do in addition to the altering of the bacterial cell wall?
it inhibits synthesis of RNA
why is vancomycin only used in serious infections when other antibiotics have failed?
because of serious toxicity
what are the most common side effects of vancomycin
nephrotoxicity, ototoxicity, and significant histamin release "red neck" syndrome
how should vancomycin be administered (rate and route)
IV, slowly, at least over 60 mins
Which of the following classes of antibiotics is most likely to induce an allergic reaction?
a. Aminoglycosides
b. Macrolides
c. Penicillins
d. Cephalosporins
c. Penicillins
Generally speaking, penicillin-G is ineffective in the management of
a. most gram-negative bacteria infections.
b. gram-positive anaerobic infections.
c. gram-positive spirochete infections.
d. endocarditis prophylaxis.
a. most gram-negative bacteria infections.
Which of the following routes is inappropriate for administration of penicillin?
a. Oral
b. Subcutaneous
c. Intramuscular
d. Intravenous
b. Subcutaneous
Before the administration of penicillin, it is important to
a. check the CBC results.
b. determine if any previous reactions to antibiotics have occurred.
c. ask the patient to void.
d. check the patient's pregnancy status.
b. determine if any previous reactions to antibiotics have occurred.
Penicillin has a cross sensitivity to which of
the following drug classes?
a. Aminoglycosides
b. Cephalosporins
c. Erythromycins
d. Tetracyclines
b. Cephalosporins
Extended-spectrum penicillins are extremely effective against
a. gonorrhea.
b. Streptococcus.
c. Pseudomonas.
d. Staphylococcus.
c. Pseudomonas.

The extended penicillins are also known as "antipseudomonal penicillins" because they are effective against Pseudomonas.
Beta-lactamase inhibitors are given in conjunction with penicillin to
a. change the protein binding sites.
b. increase the spectrum of activity.
c. target the enzyme that may decrease the efficacy of penicillin.
d. decrease the potential for adverse effects.
c. target the enzyme that may decrease the efficacy of penicillin.

Beta-lactamase can inactivate the beta- lactam ring, which is responsible for the activity of these antibiotics. Beta-lacta- mase inhibitors stop the inactivation of the beta-lactam ring, thus allowing the penicillin to eradicate the microbe.
What is the major difference between the different "generations" of cephalosporin agents?
a. Pharmacodynamics
b. Spectrum of activity
c. Emergence of drug resistance
d. Ability to induce allergic responses
b. Spectrum of activity
Generally speaking, cephalosporin antibiotics should be taken for
a. 7 to 10 days.
b. 2 to 3 days.
c. 1 to 5 days.
d. 10 to 21 days.
a. 7 to 10 days.
Hypersensitivity to cephalosporins frequently presents with
a. shortness of breath.
b. hives.
c. nausea and vomiting.
d. maculopapular rash.
d. maculopapular rash.


Hypersensitivity presents most frequently as a maculopapular rash that develops several days after the onset of therapy.
Vancomycin is used in the management of
a. sexually transmitted diseases.
b. urinary tract infection.
c. serious systemic bacterial infections.
d. cellulitis.
c. serious systemic bacterial infections.
The most serious adverse effects to vancomycin are
a. sinus tachycardia and hypotension.
b. ototoxicity and nephrotoxicity.
c. hepatotoxicity and neurotoxicity. d. histamine release and phlebitis.
b. ototoxicity and nephrotoxicity.

Ototoxicity can take the form of cochlear toxicity or vestibular toxicity. Nephrotox- icity is more likely to occur in patients receiving other nephrotoxic drugs.
Your patient is prescribed penicillin V for a dental infection. Which of the following instructions would you give?
a. "Take the medication with food for best results."
b. "Although it is ordered 4 times a day, you can double the dose and take it twice a day."
c. "You can take it every other day if you experience GI distress."
d. "Take the medication 1 hour before or 2 hours after a meal.
d. "Take the medication 1 hour before or 2 hours after a meal.

Penicillin should be taken on an empty stomach.
Your 86-year-old patient has pneumonia and is prescribed penicillin. She has a history of renal insufficiency. Which of the following lab tests should be done before initiating therapy?
a. Pulmonary function tests
b. BUN and creatinine
c. ALT and AST
d. Urinalysis
b. BUN and creatinine
Your patient comes to the clinic and receives a diagnosis of infection. When asked about allergies, the patient stated, "I have an allergy to penicillin, but I can take ampicillin." With your knowledge about these drugs, you know that

a. this is a possibility because they are two different types of penicillins.
b. the patient should not take any form of drug with "cillin" in its name if he has an allergy to penicillin.
c. as long as they are not taken together, it is alright for your patient to take either drug.
d. the patient should substitute with another type of antibiotic.
d. the patient should substitute with another type of antibiotic.

Patients allergic to one penicillin are allergic to all penicillins. The nurse does not have the authority to change a prescriber's order to another type of antibiotic.
Your patient has just received an injection of IM procaine penicillin. Within 30 seconds, the patient becomes confused and agitated and runs from the exam room. You suspect
a. the patient has been taking some type of illicit drugs.
b. an allergy to penicillin.
c. a toxic response of penicillin.
d. a procaine reaction.
d. a procaine reaction.

Unusual behaviors such as those described indicate a procaine reaction. Allergy to penicillin usually manifests in shortness of breath, rash, hives, urticaria, etc.
6 Your patient has an order for IV cefazolin (Kefzol). As you take the medication out of the refrigerator, you note that the solution was reconstituted yesterday. You should
a. allow the solution to warm for 15 minutes, then administer.
b. give the infusion now.
c. call the pharmacy and have a replacement sent.
d. warm the solution in the microwave, then administer
c. call the pharmacy and have a replacement sent.

Reconstitution of this drug yesterday makes it "outdated," so it should not be used.
Your patient has been receiving IV cefazolin for the past 24 hours, and the next dose is now due. You note that the culture and sensitivity test results indicate the infection is resistant to cephalosporins. You should
a. hang the cefazolin, and write a note in the progress notes.
b. hang the cefazolin.
c. hold the cefazolin, contact the health care provider, and get an order for a new antibiotic.
d. hold the cefazolin and tell the next shift to discuss the test results with the physi- cian when he or she makes rounds in the evening.
c. hold the cefazolin, contact the health care provider, and get an order for a new antibiotic.
Your patient is receiving IV vancomycin. To minimize adverse effects, the health care provider has ordered peak-and-trough blood levels. When is the optimal time for you to obtain the peak blood level?
a. 30 minutes before the next infusion
b. 20 minutes after the onset of the infusion
c. 1 hour before the next infusion
d. 1 hour after the completion of the infusion
d. 1 hour after the completion of the infusion

Peak levels of the drug circulate 1 hour after the completion of the infusion.
Your patient is scheduled to receive IV vancomycin. To safely administer this medication, you should infuse it
a. over 20 minutes.
b. over 60 minutes.
c. over 2 to 3 hours.
d. within 10 minutes.
b. over 60 minutes.
Your patient with a GI infection is prescribed vancomycin by mouth. The patient states, "My friend had this drug, but she got it in her veins. Isn't that a better way to get it?" What is your response?
a. "Since your problem is in your GI system, giving the drug this way will have a localized action on the infection."
b. "Why don't you ask the doctor that question."
c. "I'm sure your friend received a different drug."
d. "I have no idea."
a. "Since your problem is in your GI system, giving the drug this way will have a localized action on the infection."
To maximize the therapeutic effect of penicillin G, you should administer
a. the drug with milk.
b. the doses only during normal waking hours.
c. IV forms directly from the refrigerator.
d. the drug for at least 2 days after the patient feels better.
d. the drug for at least 2 days after the patient feels better.


This helps to ensure that all of the organisms have been killed so that a re- infection does not occur. Administer oral penicillin G on an empty stomach. Doses should be evenly spaced throughout the 24-hour period. Take IV forms of penicil- lin G out of the refrigerator for 15 min- utes before administering.
Your patient is to be discharged on cefazolin, a cephalosporin. The nurse should teach the patient to avoid which of the following while taking this drug?
a. Wine
b. Potassium chloride elixirs (such as Kay Ciel)
c. Cough medicine
d. All of the above
e. None of the above
d. All of the above

Alcoholic beverages and products con- taining alcohol should be avoided because a disulfiram-like reaction (or alco- hol intolerance) may occur, making the patient feel quite ill. Elixirs always have alcohol in them, and OTC cough medi- cines frequently have alcohol in them.
Your patient is receiving vancomycin as treatment for endocarditis. To minimize adverse effects from the drug therapy, the nurse should administer the drug by
a. IV push.
b. slow IV infusion.
c. subcutaneous injection.
d. the oral route.
b. slow IV infusion.

Vancomycin should be administered over at least 60 minutes to decrease the risk
of ototoxicity and red man syndrome. Intravenous push would be too concen- trated and too fast and would produce adverse effects. Vancomycin is extremely irritating to the tissues and should never be given SC. Poor absorption occurs from the oral route; this route is seldom used and is not appropriate for serious infec- tions outside of the GI tract.
You are to administer the first IV dose of penicillin G to treat a patient's pneumonia. To minimize adverse effects, you should
a. determine if a sputum culture and sensitivity has been obtained.
b. ask her if she has any drug allergies.
c. monitor her closely during drug administration.
d. All of the above
e. None of the above
d. All of the above


Before beginning antibiotic therapy,
a culture and sensitivity should be obtained, if at all possible, to determine the exact organism present and which drug therapy will be effective in eradi- cating the organism. A sputum culture would be appropriate for pneumonia. It is important to always verify with patients that they are not allergic to a medication when you administer the first dose. This is especially true with penicillins because anaphylactic reactions are possible
drug allergy responses. Because of pos- sible drug allergies, observe the patient closely during the first 30 minutes of drug administration for signs of adverse effects.
You are to administer procaine penicillin to a patient in the outpatient department who has syphilis. To maximize therapeutic effects and minimize adverse effects, you should
a. administer the drug into the deltoid muscle.
b. keep the drug in the refrigerator until the time of administration.
c. locate anatomic landmarks to determine the injection site.
d. All of the above
e. None of the above
c. locate anatomic landmarks to determine the injection site.

Procaine penicillin is administered by IM injection. As with all penicillins, it is important to identify an injection site accurately to prevent accidental admin- istration into a vein or nerve. Accidental injection into a vein may precipitate a reaction with the procaine that is in the drug. Procaine penicillin, like all penicil- lins, should be administered deep into a large muscle. The deltoid is too small to be appropriate. Because procaine peni- cillin is thick and viscous, it is adminis- tered more easily if it is removed from the refrigerator about 15 minutes before administration.
Your patient has a mixed infection and is receiving cefazolin, a cephalosporin, and gentamicin, an aminoglycoside antibiotic. To minimize adverse effects, the nurse should most closely monitor which lab value?
a. Hematocrit
b. aPTT
c. BUN
d. Cefazolin blood levels
c. BUN


Blood urea nitrogen (BUN) is a measure- ment of kidney function. Nephrotoxicity is more likely to occur when the patient takes more than one drug that may cause nephrotoxicity; in this case, those drugs are cefazolin and gentamicin. The nurse should also monitor creatinine levels
to assess renal function. Hematocrit is not affected by cefazolin therapy. Blood coagulation time, aPTT (active partial thromboplastin time), is altered only if the patient is receiving oral anticoagu- lants, such as warfarin, and cefazolin. Cefazolin is not a drug that the blood levels indicate a therapeutic or toxic level, and cefazolin levels are not mea- sured. However, gentamicin levels are monitored.
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