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Pharmacology Study Guide: Antibiotics and HIV Medications, Exams of Nursing

Virginia State University (VSU)Nursing

This study guide provides a concise overview of key concepts related to antibiotics and hiv medications, focusing on mechanisms of action, clinical uses, and potential adverse effects. It covers topics such as community-acquired pneumonia (cap) treatment, broad vs. Narrow spectrum antibiotics, and specific drug information for various infections. The guide also includes patient education points and considerations for special populations like pregnant patients and children. It is designed to aid in exam preparation and enhance understanding of antimicrobial pharmacology, offering practical insights into drug selection and management of infectious diseases. It also covers hiv medications, their risks, and how to measure the success of antiretroviral therapy.

Typology: Exams

2024/2025

Available from 08/29/2025

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NR566 Midterm Study Guide
Week 1
• Community Acquired Pneumonia (CAP)
oCommon pathogens
▪Adults: Streptococcus pneumoniae (gram positive, Haemophilus
influenzae, Atypical bacteria (Mycoplasma pneumoniae),
Chlamydophila pneumoniae, Legionella species, Staphylococcus
aureus.
▪Children: Streptococcus pneumoniae, Mycoplasma
pneumoniae, Respiratory syncytial virus (RSV), Haemophilus
influenzae.
oFirst line treatment for previously healthy adults (table 70.5)
▪First-line: (Macrolides (Azithromycin or Clarithromycin) or
tetracycline (Doxycycline or Penicillin-Amoxicillin, ampicillin;
tigecycline) or Telithromycin (only for CAP- contra
myasthenia gravis).
▪If the first drug didn’t work: Consider respiratory fluoroquinolones
(Gemifloxacin-for respiratory infection, Levofloxacin, Moxifloxacin-
prolong QT) or Beta-lactam + macrolide (e.g., Amoxicillin +
Azithromycin).
oTreatment for M. Pneumoniae in pediatric patient (Specific/example
antibiotic from drug class will be provided): Macrolides
(azithromycin, clarithromycin)
oTreatment of CAP in pregnancy: Penicillin's, cephalosporins, and
erythromycin
If someone has been treated with an antibiotic in the previous 90 days of
contracting CAP, a quinolone would be a prudent choice to prescribe.
▪ Be familiar with drug examples within the antibiotic classes:
Quinolones (levofloxacin, Moxifloxacin) are effective and cover
both typical and atypical pathogens, making them good choices
when there has been prior
antibiotic use.
• Treatment of chlamydial pneumonia in infant (options will include dose, but
if you know the correct drug, the dose will come with it on the exam so no
need to memorize dose)
oFirst-line treatment: Oral Erythromycin or Oral Azithromycin &
tetracycline
▪
▪ Both are macrolides effective against Chlamydia
trachomatis, the causative organism of chlamydial
pneumonia in infants.
• Broad vs narrow spectrum agents
oWhen to use which one :
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NR566 Midterm Study Guide

Week 1

  • Community Acquired Pneumonia (CAP) o Common pathogens ▪ Adults : Streptococcus pneumoniae (gram positive , Haemophilus influenzae , Atypical bacteria ( Mycoplasma pneumoniae) , Chlamydophila pneumoniae , Legionella species, Staphylococcus aureus. ▪ Children : Streptococcus pneumoniae , Mycoplasma pneumoniae , Respiratory syncytial virus (RSV) , Haemophilus influenzae. o First line treatment for previously healthy adults (table 70.5) ▪ First-line : (Macrolides (Azithromycin or Clarithromycin) or tetracycline (Doxycycline or Penicillin-Amoxicillin, ampicillin; tigecycline) or Telithromycin (only for CAP- contra myasthenia gravis). ▪ If the first drug didn’t work : Consider respiratory fluoroquinolones (Gemifloxacin-for respiratory infection, Levofloxacin , Moxifloxacin- prolong QT ) or Beta-lactam + macrolide (e.g., Amoxicillin + Azithromycin). o Treatment for M. Pneumoniae in pediatric patient (Specific/example antibiotic from drug class will be provided): Macrolides (azithromycin, clarithromycin) o Treatment of CAP in pregnancy: Penicillin's, cephalosporins, and erythromycin If someone has been treated with an antibiotic in the previous 90 days of contracting CAP, a quinolone would be a prudent choice to prescribe. ▪ Be familiar with drug examples within the antibiotic classes: Quinolones (levofloxacin, Moxifloxacin) are effective and cover both typical and atypical pathogens, making them good choices when there has been prior antibiotic use.
  • Treatment of chlamydial pneumonia in infant (options will include dose, but if you know the correct drug, the dose will come with it on the exam so no need to memorize dose) o First-line treatment: Oral Erythromycin or Oral Azithromycin & tetracycline ▪ ▪ Both are macrolides effective against Chlamydia trachomatis, the causative organism of chlamydial pneumonia in infants.
  • Broad vs narrow spectrum agents o When to use which one :

▪ When to use broad-spectrum: Broad-spectrum antibiotics (e.g., Fluoroquinolones , Tetracyclines ) are used when the causative pathogen is unknown, or there’s a high risk of multidrug-resistant organisms. ▪ When to use narrow-spectrum:

▪ Prescribing in pregnant patients: Contraindicated due to risks of fetal harm, including tooth discoloration and inhibition of bone growth. Should not be given after the fourth month of gestation ▪ In children, discoloration occurs when tetracyclines are given between the ages of 4 and 8 years ▪ “I should not take this medication with milk or other dairy products.”

  • Macrolides (Erythromycin, Azithromycin. Clarithromycin) o Patient education needed: ▪ Take food to reduce GI upset, especially with erythromycin. ▪ Report palpitations (risk of QT prolongation). ▪ Clarithromycin can cause distorted taste
  • Aminoglycosides (Gentamicin, Tobramycin, Amikacin) o Patient education needed: Risk of ototoxicity (headache, dizziness, ringing ear) and nephrotoxicity. Report any hearing loss or balance issues (headache & dizziness). Drink plenty of fluids to maintain renal function. Less risk if large daily dose is given. Eliminate by the kidney o When resistance to gentamicin and tobramycin is common, amikacin is the drug of choice for initially treating aminoglycoside-sensitive infections. o Can be used to treat infection in infants younger than 8 days old.
  • Sulfonamides (Doxycycline, tetracycline, minocycline) o Patient education needed ▪ Take plenty of water to avoid kidney stones and ensure adequate hydration (8 -10 glasses daily). ▪ Risk of photosensitivity; use sunscreen. ▪ Call provider if you develop rash while taking this drug ▪ Sulfonamides can cause hemolytic anemia (fever, pallor, jaundice) in African Americans and the Mediterranean. o Prescribing in pregnant patients ▪ Avoid in the third trimester (after 32 weeks) due to the risk of neonatal jaundice and kernicterus. Do not give to kids < months or breast feeding mom.
  • Gentamicin o Renal adjustments ▪ Adjust dose in patients (eg older adults) with renal impairment to avoid nephrotoxicity. Close monitoring of renal function (creatinine clearance) is essential.

Week 2

  • How to treat tinea capitis (don’t need specific drug or dose, focus on drug classes) ▪ Oral Griseofulvin (oral) for 6-8 weeks. Med causes itching, burning & erythema

▪ Terbinafine (oral) ▪ Itraconazole (oral) ▪ Topical antifungals do NOT work for tinea capitis ▪

  • Specific drug to treat aspergillosis: Voriconazole (an oral or intravenous azole antifungal)
  • Anthelmintic drugs o Which ones carry risk for hypotension with patients on antihypertensives? ▪ Ivermectin: May exacerbate hypotension, particularly in patients taking antihypertensives. ▪ Moxidectin: Similar to ivermectin, may pose a risk of hypotension. o Which ones can cause bone marrow suppression and liver impairment? ▪ Albendazole: Can cause bone marrow suppression (e.g., granulocytopenia, agranulocytosis) and liver impairment. ▪ Mebendazole May also cause bone marrow suppression and liver impairment. o Which is generally safe to give without obtaining baseline data? Pyrantel Pamoate : Generally safe and does not require extensive baseline data. However, caution is needed for patients with liver impairment. o After taking the anthelmintic drug, recheck stool in 1-3 weeks. o Safe for use in pregnancy ▪ Praziquantel: Considered relatively safe for use during pregnancy, especially in the second and third trimesters. ▪ Moxidectin: Appears to have a decreased risk for teratogenesis, but human data are still limited.
  • HIV Medications o Risks with didanosine: Adverse Effects : Pancreatitis (N+V, abdominal pain-, Increased serum amylase and triglycerides, decreased serum calcium), peripheral neuropathy, and lactic acidosis. o Risks with saquinavir: Adverse Effects : Gastrointestinal symptoms, cardiac arrhythmias, and potential for drug interactions due to its effects on the liver enzyme system. o PR Interval impacts the use of which HIV drugs? Saquinavir : This can cause PR interval prolongation and may need to be monitored closely. o How to measure success with antiretroviral therapy for HIV: Indicators : Success is generally measured by an undetectable viral load and an increase in CD4 T- cell count. o What does an increase in CD4 T-cell indicate? Significance : Increased CD4 T- cell count indicates a positive response to antiretroviral therapy and improved immune function. o When do use foscarnet in HIV+ patients? Indications : Used for the treatment of cytomegalovirus (CMV) retinitis and acyclovir-resistant herpes simplex virus infections in HIV-positive patients. Foscarnet causes hypocalcemia (parethesis, numbness in extremities, perioral tingling); check levels
  • Metronidazole
  • Abacav ir ▪ Avoid Alcohol: Patients should avoid alcohol during treatment and for 48 hours after completing the course due to the risk of a disulfiram-like reaction. ▪ Possible Side Effects: Instruct patients about potential side effects such as nausea, a metallic taste, and gastrointestinal upset. ▪ Complete the Course: Emphasize the importance of completing the full course of therapy, even if symptoms improve. o Adverse effects ▪ Lactic acidosis and hepatomegaly with steatosis. ▪ Hypersensitivity Reaction : Risk of hypersensitivity reactions, including fever, rash, gastrointestinal symptoms, and respiratory symptoms. Testing for the HLA-B*5701 allele is recommended before initiating therapy to assess the risk of hypersensitivity. ▪ If hypersensitivity develops, DISCONTINUE MEDICATION
  • Monitoring needs for long-term antifungal use ▪ Liver Function: Itraconazole (N + V, & anorexia): bilirubin every 3-4 mths (jaundice). ▪ Renal Function: Monitor renal function, especially for drugs with known nephrotoxic potential (e.g. amphotericin B – draw serum creatinine and BUN every 3-4 days). ▪ Blood Cell Counts: Monitor CBC for potential bone marrow suppression.
  • Antifungals to use in immunocompromised patients ▪ Azoles: Ketoconazole( gynecomastia & libido changes), Fluconazole (if patient have HF or renal impairment, headache & rash), itraconazole (taken with cola to increase the med absorption), voriconazole (visual changes) ▪ Echinocandins: Caspofungin, micafungin, anidulafungin ▪ Polyene: Amphotericin B (severely critical) ▪ For prophylaxis use in immunocompromised patients: Posaconazole (for Aspergillus & candida infection)
  • How to treat systemic fungal infections ▪ Initial treatment often involves broad-spectrum antifungals like amphotericin B(pretreat with Tylenol, diphenhydramine & meperidine or dantrolene for the rigors to reduce infusion reaction) or echinocandins. Nephrotoxic. Reaction, fever, chills, rigors. ▪ Tailored therapy: adjust based on the identified pathogen and patient response. ▪ Use in life threatening infections only. Headaches, lower back pain, leg pain, and abdominal pain occur with intrathecal administration of amphotericin B. Patients taking amphotericin may experience hypokalemia and may need potassium supplements.

Acetaminophen and diphenhydramine should be taken to minimize infusion reaction effects. Renal function should be monitored every 3 to 4 days during treatment.

Week 3

  • Excessive cerumen in ear o Causes: use of cotton swabs, fingers, or objects that push wax further into the canal, natural production of cerumen, age- related factors (cerumen becomes drier and harder with age). o Treatment: Ear drops (carbamide peroxide-debrox) to soften wax, gentle irrigation with warm water or saline, and manual removal by a healthcare provider.
  • To treat otomycosis: clean the ear canal thoroughly and apply acidifying drops, such as a 2% acetic acid solution, three to four times a day for seven days. o If acidification is insufficient, use an antifungal drug such as 1% clotrimazole (Lotrimin), applied twice daily for 7 days. ▪ Consider oral antifungals like itraconazole or fluconazole
  • How to treat acute otitis media (general information for both infection and symptoms): Antibiotics (if bacterial): Amoxicillin is the first-line treatment unless contraindicated. Analgesics for symptom relief: ibuprofen or acetaminophen for pain and fever. Observation: in some cases, watchful waiting for 48-72 hours before starting antibiotics maybe appropriate. o Treatment in pediatric patient (drug and dose per kg found in textbook): Amoxicillin: 40-45 mg/kg/day divided into two doses for 10 days. If amoxicillin is not suitable (e,g, allergy or recent use): amoxicillin- clavulanate or cephalosporins can be used.
  • Allergic Rhinitis o Monoclonal antibody drug treatment option: Omalizumab (Xolair): A antibody that binds to IgE and prevents allergic responses
  • How to treat glaucoma in someone with COPD or asthma: Prostaglandin analogs, like latanoprost, which lowers intraocular pressure without causing bronchoconstriction (safe for COPD/asthma patients). Avoid: Beta-blockers, as they may worsen asthma or COPD symptoms.
  • Latanoprost o Side effects: increased pigmentation of the iris, eyelash growth, ocular irritation (mild), and possible darkening of the eyelid skin.
  • Glucocorticoids o Therapeutic action in allergic reactions: To prevent the

production of prostaglandins, leukotrienes, and thromboxane.

  • Antihistamines (ending ine) o Mechanism of action ▪ Blocks histamine-1 receptors and thus decrease itching, sneezing, and rhinorrhea; do not reduce congestion.
  • Cromolyn o Mechanism of action

and avoid night driving if affected. ▪ Protect skin from sunlight and avoid sunlamps.

▪ Stop tetracycline before starting isotretinoin ▪ Regular blood tests required. ▪ Use two effective birth control methods; notify provider of missed periods (med teratogenic). ▪ Do not donate blood during and one month after treatment. ▪ Avoid vitamin A supplements and alcohol. ▪ Report severe headaches, vision changes, depressive symptoms, or new problems immediately (adverse effects).

  • When to prescribe an intranasal glucocorticoid: Prescribe for moderate to severe allergic rhinitis. It is most effective for controlling all symptoms, including nasal congestion, sneezing, itching, and rhinorrhea.

nervousness, insomnia, and potential abuse or dependency, BP, dry mouth & constipation

  • How to discontinue phentermine and/or topiramate: tapered down to avoid withdrawal and weight gain.
  • Topiramate

o Therapeutic effect: (Increases satiety) inducing a sense of fullness, reducing food intake, and assisting with weigh loss.

  • Orlistat (lipase inhibitor) o Patient education needed: fecal incontinence, oily rectal leakage, abdominal cramps, light colored stools, dark urine, fatigue, jaundice, anorexia, fatty stool, need to take multivitamin (A, D, E, K), avoid high-fat meals. ▪ If pt taking levothyroxine, taking both can cause hypothyroidism (administer them 4 hrs apart) ▪ Affect gastric & pancreas*