Chapter 09: Anti-Infectives: Antiviral Drugs Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition,100% CORRECT

Document Content and Description Below

Chapter 09: Anti-Infectives: Antiviral Drugs Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition MULTIPLE CHOICE BASIC CONCEPTS 1. What does the t... erm “host” mean? a. The person infected by a virus. b. The type of virus known as a retrovirus. c. The type of virus known as a common virus. d. The type of infection that occurs only in immunosuppressed people. ANS: A A host is the person infected by a virus whose cells allow viral replication. DIF: Cognitive Level: Remembering REF: p. 137 2. Why do most people become ill with a specific viral infection only once? a. Once a virus is killed by the body, it is gone from the earth forever. b. During a viral infection, the body changes the virus to be less virulent. c. Antiviral drugs change the viral DNA so it cannot infect the same person again. d. During a specific viral infection, the person’s immune system improves protection against that virus. ANS: D Viruses are foreign invaders. When a person is infected with them to the extent that they become sick, the immune system learns to make antibodies against them. Then, on another exposure to the same virus, the antibodies take defensive steps to remove or eliminate the viruses before the person becomes sick again. DIF: Cognitive Level: Remembering REF: p. 147 3. Which statement about antiviral drugs is true? a. They are all most effective at killing viruses. b. They are all effective against any type of infection. c. They all work by slowing the replication of viruses. d. They are all only effective in people with strong immune systems. ANS: C Drugs are not able to “kill” a virus in the human body. Antiviral drugs are only “virustatic” in that they can only suppress viral replication. Only a person’s immune system can kill, inactivate, or eliminate viruses. DIF: Cognitive Level: Remembering REF: p. 147 4. Which antiviral drug is only given by oral inhalation? a. Cyclovir (Zovirax) b. Zanamivir (Relenza) c. Oseltamivir (Tamiflu) d. Amantadine (Symmetrel) ANS: B Acyclovir is given intravenously or as an orally swallowed drug. Oseltamivir and amantadine are swallowed orally. DIF: Cognitive Level: Remembering REF: p. 140 5. Which specific virus causes mononucleosis? a. Cytomegalovirus b. Hantavirus c. Epstein-Barr virus d. West Nile virus ANS: A Hantavirus causes hantavirus pulmonary syndrome. Epstein-Barr virus causes chronic fatigue syndrome and some types of lymphomas, not mononucleosis. West Nile virus causes an infection with encephalitis and/or meningitis problems, not mononucleosis. DIF: Cognitive Level: Remembering REF: p. 141 6. Which antiviral drug is most likely to have more severe central nervous system side effects, including worsening of glaucoma? a. Acyclovir b. Amantadine c. Valacyclovir d. Zanamavir ANS: B Amantadine crosses the blood-brain barrier and concentrates in the brain tissues. None of the other drugs concentrate in brain tissues. DIF: Cognitive Level: Remembering REF: p. 143 7. Which antiviral drug is highly likely to cause birth defects when taken by a pregnant woman? a. Acyclovir b. Zanamivir c. Rimantadine d. Ribavirin ANS: D The likelihood for acyclovir to increase the risk for birth defects or fetal harm is low. Zanamivir is orally inhaled and poorly absorbed, not a risk for birth defects. Rimantadine has a moderate likelihood of increasing the risk for birth defects. Ribavirin is a known teratogen and has a very high likelihood of increasing the risk for birth defects and fetal harm. DIF: Cognitive Level: Remembering REF: p. 144 8. What is the major difference between retroviruses and common viruses? a. Retroviruses cannot be killed by antiviral therapy, but common viruses can. b. A retrovirus usually can cause disease over and over again in the same person. c. A retrovirus carries the enzyme reverse transcriptase, and common viruses do not. d. Retroviruses will respond to antibacterial drugs as well as to all the antiviral drugs. ANS: C Retroviruses carry a series of enzymes with them that allow them to incorporate into human DNA and use the host’s DNA to help replication. This gives them a very high efficiency of infection. Common viruses, although some are very virulent, do not have those enzymes and their efficiency of infection is lower. DIF: Cognitive Level: Remembering REF: p. 146 9. Which class of antiretroviral drugs works by preventing new viral particles from leaving the infected cell? a. Entry inhibitors b. Fusion inhibitors c. Protease inhibitors d. Reverse-transcriptase inhibitors ANS: C In order for new viral particles to leave the infected cell to go on and infect new cells, they must use “chemical scissors” to cut up their genetic material in the right places. Protease inhibitors suppress the activity of this enzyme so that viral particles are unable to leave the infected cells even though the viruses have reproduced. DIF: Cognitive Level: Remembering REF: p. 151 10. Which problem is a sign or symptom of an allergic or anaphylactic response to an antiviral drug? a. Nausea b. Vivid dreams c. Intolerance to fatty foods d. Swelling of the face or throat ANS: D Allergic and anaphylactic symptoms include swelling of the face or throat, hives, itching, redness, low blood pressure, feeling a lump in the throat, an irregular heartbeat, a sense that something bad is happening, and light-headedness. DIF: Cognitive Level: Remembering REF: p. 139 11. Which drug can only be given by subcutaneous injection? a. Atazanavir (Reytaz) b. Enfuvirtide (Fuzeon) c. Maraviroc (Selzentry) d. Darunavir (Prezista) ANS: B Atazanivir, maraviroc, and darunavir are all administered as oral tablets or capsules. Only enfuvirtide must be administered subcutaneously. DIF: Cognitive Level: Remembering REF: p. 153 12. Which drug does not work on all strains of the human immunodeficiency virus (HIV) and therefore the patient must be tested before using the drug to make sure it will work? a. Atazanavir (Reytaz) b. Enfuvirtide (Fuzeon) c. Maraviroc (Selzentry) d. Raltegravis (Issentra) ANS: C Maraviroc prevents cellular infection by blocking the CCR5 receptor on CD4+ T cells. Because this drug is not effective against all HIV subtypes, the patient must first be tested to ensure that his or her HIV infection is likely to respond to this therapy. When the HIV subtype does not use the CCR5 receptor, the drug is not prescribed for that patient. DIF: Cognitive Level: Remembering REF: p. 154 13. Which drug increases the risk for muscle weakness in older patients who are also taking a “statin” type of lipid-lowering drug? a. Atazanavir (Reytaz) b. Enfuvirtide (Fuzeon) c. Maraviroc (Selzentry) d. Raltegravis (Issentra) ANS: D Although atazanavir and maraviroc can cause liver side effects, they do not potentiate the risk for muscle weakness when taken along with a statin. Enfuvirtide does not induce liver problems nor does it increase muscle weakness. DIF: Cognitive Level: Remembering REF: p. 153 14. What is the purpose of antiviral drug therapy? a. To make the patient immune to infection by viruses. b. To reduce infection by killing the virus causing disease. c. To reduce illness duration by controlling viral reproduction. d. To prevent opportunistic infections in immunosuppressed patients. ANS: C Antiviral drugs are only virustatic and reduce the number of viruses by preventing them from reproducing and growing. They are not virucidal and cannot kill the virus. By keeping the number of viruses low, antiviral drugs allow the body’s natural defenses to destroy, eliminate, or inactivate them. DIF: Cognitive Level: Remembering REF: p. 139 15. Which statement about human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) is true? a. Everyone with AIDS has HIV infection but not everyone with HIV infection has AIDS. b. Everyone with HIV infection eventually dies of it because the disease cannot be cured. c. With successful antiretroviral therapy, HIV-infected patients become HIV-antibody negative. d. When HIV disease becomes AIDS, the infection is in the blood and treatment must be given intravenously. ANS: A People infected with HIV develop antibodies to the virus and become HIV positive. Not everyone who is HIV positive will progress with the disease and develop AIDS, the most severe form of the disease. DIF: Cognitive Level: Remembering REF: p. 146 16. Which antiretroviral drug is now prescribed for preexposure prophylaxis to prevent human immunodeficiency virus (HIV) infection? a. Acyclovir b. Edurant c. Crixivan d. Truvada ANS: D Truvada, which is a combination of emtricitabine and tenofovir, has been found effective in preventing HIV infection among HIV-negative individuals who have sex with people who are HIV positive. DIF: Cognitive Level: Remembering REF: p. 155 ADVANCED CONCEPTS 17. How are viral infections different from bacterial infections? a. Bacterial infections can be spread from one person to another, whereas viral infections cannot be spread directly. b. Bacterial infections can be cured by treatment with some anti-infective drugs, whereas viral infections are not cured by anti-infective therapy. c. Viruses only cause disease in a person who is immunocompromised, whereas bacteria can cause disease even among immunocompetent people. d. Viruses are the less mature form of a bacterium, so there is essentially no difference between viral infections and bacterial infections. ANS: B Viral infections are not “cured” but are self-limiting, meaning that in a person with a healthy immune system, the illness only lasts for a limited time. If the person’s immune system is working properly, the body fights off the infection by itself. If the person’s immune system is weak or if the body has other health problems, the person may die of the effects of the disease. DIF: Cognitive Level: Understanding REF: p. 138 18. What is the most important precaution to teach a patient who is prescribed any antiviral drug? a. “Take the drug exactly as prescribed and for as long as prescribed.” b. “Never take any antibacterial drugs while you are on antiviral therapy.” c. “Drink at least 3 L of water daily for the entire time you are taking this drug.” d. “Avoid unnecessary exposure to this drug by stopping it when you have no symptoms for 24 hours.” ANS: A For effective antiviral therapy the patient must take the drug long enough to ensure suppression of viral reproduction. If the patient stops taking the drug as soon as he or she feels better, symptoms of infection may recur and resistant viruses may develop. DIF: Cognitive Level: Applying or Higher REF: p. 139 19. A patient is prescribed intravenous (IV) acyclovir (Zovirax). Which question is most important to ask before giving the first dose of this drug? a. “Do you have a hearing problem or any trouble with your ears?” b. “Do you take medications for seizures?” c. “Are you allergic to sulfa drugs?” d. “Have you ever had asthma?” ANS: B Acyclovir reduces the effectiveness of phenytoin, a drug that is used to prevent seizures. The prescriber may need to adjust the phenytoin dosage while the patient is on antiviral therapy. DIF: Cognitive Level: Applying or Higher REF: pp. 140-141 20. What is the most important precaution to teach a patient who is prescribed oral valacyclovir (Valtrex)? a. “Avoid coffee and other caffeinated beverages.” b. “Wear long sleeves and a hat when going outdoors.” c. “Take this drug 1 hour before or 4 hours after eating a full meal.” d. “Drink at least 3 L of water daily for the entire time you are taking this drug.” ANS: D Valacyclovir consists of a type of chemical that can easily turn into crystals. Crystals that form and clump in the kidneys can cause kidney failure or kidney stones. Drinking at least 3 L of fluids daily while taking this drug can prevent crystallization in the kidneys. DIF: Cognitive Level: Applying or Higher REF: p. 141 21. A patient who has been prescribed amantadine (Symmetrel) has all of the following health problems. For which problem should you contact the prescriber before giving the first dose? a. Asthma b. Influenza c. Glaucoma d. Diabetes mellitus ANS: C Amantadine has central nervous system side effects and can worsen glaucoma. Although the drug may still be given to a person who has glaucoma, more frequent checking of intraocular pressure or adjustment in glaucoma drugs may be needed. DIF: Cognitive Level: Applying or Higher REF: p. 143 22. A 2-year-old patient with respiratory syncytial virus is prescribed aerosolized ribavirin (Virazole). Which visitor should you ensure is not in the patient’s room during the aerosol treatments? a. 16-year-old brother b. 81-year-old grandmother c. 32-year-old pregnant mother d. 36-year-old father who has diabetes ANS: C A major adverse effect of ribavirin is that it is a teratogen, an agent that has a very high likelihood of increasing the risks for birth defects and fetal damage. It should not be given to pregnant or breastfeeding women, and it should not be handled or inhaled by anyone who is pregnant. DIF: Cognitive Level: Applying or Higher REF: p. 144 23. A patient who is taking interferon is also prescribed ribavirin (Virazole). Which laboratory blood test result for this patient do you report immediately to the prescriber? a. Red blood cells (RBCs) 2.2 million/mm3 b. White blood cells (WBCs) 6000/mm3 c. Sodium 134 mEq/L d. International normalized ratio (INR) 1.6 ANS: A One of the many serious adverse effects of ribavirin is suppression of bone marrow cell division, leading to fewer RBCs and anemia. This patient’s RBC level is only about half of normal. DIF: Cognitive Level: Applying or Higher REF: p. 144 24. Which precaution about zanamivir (Relenza) therapy do you teach a patient who also uses a bronchodilator for asthma control? a. “Drink at least 3 L of water daily while using this drug.” b. “Use the bronchodilator 15 minutes before taking the zanamivir.” c. “Avoid taking the zanamivir within 2 hours of using the bronchodilator.” d. “Take your pulse daily while on this drug because when taken with a bronchodilator heart rhythm problems are common.” ANS: B Zanamivir is an inhalation drug. When a patient also takes a bronchodilator for asthma, chronic obstructive pulmonary disease, or any other airway problem, the manufacturer recommends using the bronchodilator at least 5 minutes before zanamivir to ensure a wider airway and improved inhalation of the antiviral drug. DIF: Cognitive Level: Applying or Higher REF: p. 146 25. For what reason does adefovir dipivoxil have a black box warning? a. It induces type 2 diabetes mellitus. b. It increases the severity of hepatitis B symptoms. c. It is highly toxic to both the liver and the kidneys. d. It has a high likelihood of increasing the risk for birth defects and fetal damage. ANS: C Adefovir dipivoxil, which is used to treat hepatitis B, is highly toxic to the liver and kidneys. Hepatitis B symptoms are only increased when the drug is stopped suddenly, not while it is being used. It does not increase the risk for birth defects and does not cause diabetes mellitus. DIF: Cognitive Level: Understanding REF: p. 142 26. Which common side effects should you watch for when a patient is taking adefovir dipivoxil? a. Numbness and tingling in extremities b. Nausea, vomiting, and abdominal pain c. Dizziness and light-headedness d. Increased confusion ANS: B The most common side effects of adefovir dipivoxil are nausea and abdominal pain. DIF: Cognitive Level: Understanding REF: p. 142 27. What specific precaution would you teach the family of a patient prescribed amantadine? a. “Be sure that the patient performs mouth care four to six times daily.” b. “Remind the patient that monthly follow-up lab tests will be needed.” c. “Contact the prescriber immediately for any worsening of depression or thoughts of suicide.” d. “Ensure that the patient takes in at least 1000 mL more fluids that he or she puts out.” ANS: C Tell the patient and family to report to the prescriber immediately any worsening of depression or thoughts of suicide. DIF: Cognitive Level: Applying or Higher REF: p. 143 28. How are retroviruses different from common viruses? a. Retroviruses respond to antibacterial drugs but common viruses do not. b. Retroviruses have a greater efficiency of infection than common viruses. c. Common viral infections can be cured while retroviral infections can only be controlled. d. Common viruses can infect anyone whereas retroviruses can only cause infection in an immunosuppressed host. ANS: B A retrovirus is a special virus that always uses RNA as its genetic material, and carries with it the enzymes reverse transcriptase, integrase, and protease, which allow a much higher efficiency of cellular infection than common viruses. This means that disease may result even when low levels of retroviruses enter the body. DIF: Cognitive Level: Understanding REF: p. 146 29. A patient is prescribed to begin highly active antiretroviral therapy (HAART). What is the most important question to ask this patient before beginning therapy? a. “Do you have any symptoms now of active infection?” b. “Is there any possibility that you are pregnant?” c. “Are you currently sexually active?” d. “What other drugs do you take?” ANS: D Before giving an antiretroviral drug, always obtain a list of all other drugs the patient also takes, because antiretroviral drugs interact with many other drugs. Check with the pharmacist for possible interactions and the need to consult the prescriber about dosage or changing the patient’s other drugs. DIF: Cognitive Level: Applying or Higher REF: p. 148 30. A patient taking highly active antiretroviral therapy (HAART) for a year has the following blood laboratory test values. Which value do you report to the prescriber immediately? a. White blood cell count 3500 cells/mm3 b. Lactate dehydrogenase 990 IU/L c. Sodium 132 mEq/L d. Hematocrit 32% ANS: B All of these blood values are abnormal; however, only the lactate dehydrogenase level is very high (four times normal). This value indicates liver impairment. Nearly all antiretroviral drugs can cause liver impairment. This value must be reported immediately so that liver function can be explored and any needed changes in drug therapy made before irreversible liver damage occurs. DIF: Cognitive Level: Applying or Higher REF: p. 148 31. A patient has human immunodeficiency virus (HIV) disease and is taking a “cocktail” consisting of protease inhibitors, nucleoside analogue reverse-transcriptase inhibitors, and nonnucleoside analogue reverse-transcriptase inhibitors. Which statement made by the patient indicates that more teaching about the drug therapy is needed? a. “Using three drugs at the same time enhances suppression of viral replication.” b. “There is no problem using these drugs during the last trimester of my pregnancy.” c. “Because this drug combination kills HIV, I do not need to worry about transmitting the virus.” d. “If the virus becomes resistant to this cocktail, another combination of drugs may be required to reduce my viral load.” ANS: C Protease inhibitors suppress viral replication and release. They do not kill the virus, and currently no therapy for HIV infection kills the virus. The patient needs to understand that even on antiretroviral therapy, the disease can be spread through exchange of body fluids and precautions still must be taken. DIF: Cognitive Level: Applying or Higher REF: p. 147 32. Which test results indicate that a patient’s antiretroviral therapy is effective? a. White blood cell count 5000 cells/mm3 b. Blood urea nitrogen level 15 mg/dL c. Blood positive for human immunodeficiency virus (HIV) antibodies d. CD4+ to CD8+ ratio increased ANS: D HIV selectively infects and causes the destruction of CD4+ cells (T-helper cells). An increase in ratio of this population of cells compared with CD8+ cells in a patient with HIV disease indicates the drug regimen is effective in suppressing viral replication. DIF: Cognitive Level: Applying or Higher REF: p. 148 33. A human immunodeficiency virus (HIV)-positive patient taking highly active antiretroviral therapy informs you that she is now pregnant. What advice regarding drug therapy do you give this patient? a. “Stop taking these drugs for your entire pregnancy.” b. “Stop taking these drugs for the first trimester and start again for the second and third trimesters.” c. “Continue to take these drugs throughout your pregnancy exactly as they have been prescribed.” d. “It will be necessary to double your dosages of these drugs to ensure your unborn baby is adequately protected.” ANS: C Antiretroviral drugs for HAART are recommended to be taken by pregnant women who are known to be HIV positive because the virus can cross the placenta and infect the fetus. These drugs, when taken as prescribed, can reduce the chances of fetal infection from about 30% to about 8%. Dosages are based on the woman’s viral load, not on weight or pregnancy status. DIF: Cognitive Level: Applying or Higher REF: p. 149 34. What is the most important question to ask before giving the first dose of darunavir to a patient newly prescribed this drug? a. “Do you have a hearing problem or any trouble with your ears?” b. “Do you take medications for seizures?” c. “Are you allergic to sulfa drugs?” d. “Have you ever had asthma?” ANS: C The formulation of darunavir contains sulfa. A patient who is allergic to sulfa drugs is likely to also be allergic to darunavir and have a serious reaction to the drug. DIF: Cognitive Level: Applying or Higher REF: p. 152 35. A child is prescribed emtricitabine (Emtriva) 120 mg orally. The drug on hand is emtricitabine suspension 10 mg/mL. How many milliliters do you prepare for a correct dose? a. 2 b. 6 c. 12 d. 20 ANS: C Want 120 mg in X mL/Have 10 mg in 1 mL. 120/10 = 12 mL = 120 mg. DIF: Cognitive Level: Understanding REF: p. 149 36. A patient who is taking zidovudine (Retrovir) reports diarrhea. Which dietary change should you suggest for this patient? a. “Avoid fatty and fried foods.” b. “Increase your intake of fiber.” c. “Take an antacid 30 minutes before each meal.” d. “Restrict your intake of fluids to 1 L/day.” ANS: A Fatty foods tend to reduce intestinal absorption and make drug-induced diarrhea worse. Although fiber can prevent some types of diarrhea, it is of no benefit for diarrhea associated with antiviral drug therapy. DIF: Cognitive Level: Applying or Higher REF: p. 149 37. A patient who has been taking lamivudine (Epivir) for 6 months reports reduced sensation in the fingers and toes. What is your best action? a. Document the report as the only action. b. Hold the dose and notify the prescriber. c. Remind the patient to continue the drug as usual and take a multiple vitamin daily. d. Reassure the patient that this is an expected drug side effect and to use injury precautions. ANS: D Peripheral neuropathy with loss of sensation in the extremities is a common and expected side effect of therapy. Drug therapy is not stopped for this effect. The patient needs to implement precautions to prevent injury from not having full sensation for touch, temperature, and pressure. DIF: Cognitive Level: Applying or Higher REF: p. 149 38. Which health problem must you be specifically alert for in pregnant women who are prescribed any nucleoside analogue reverse-transcriptase inhibitor (NRTI)? a. Headache b. Lactic acidosis c. Diabetes mellitus d. Nausea/vomiting ANS: B NRTIs increase the risk for lactic acidosis in pregnant women. This problem is not a common occurrence for other patients. Lactic acidosis is the buildup of lactic acid in muscle and other tissues when not enough oxygen is present to allow metabolism to occur normally. Signs and symptoms of lactic acidosis are muscle aches, tiredness and difficulty remaining awake, abdominal pain, hypotension, and a slow, irregular heartbeat. DIF: Cognitive Level: Understanding REF: p. 150 39. A patient who has been taking efavirenz (Sustiva) reports a sore throat, fever, and blisters. What is your best action? a. Hold the dose and notify the prescriber. b. Document the report as the only action. c. Remind the patient that these are symptoms of opportunistic infection. d. Reassure the patient that these are common and expected side effects of the drug. ANS: A Efavirenz is a nonnucleotide analogue reverse-transcriptase inhibitor (NNRTI). A sore throat, fever, different types of rashes, blisters, or multiple bruises are all signs of serious adverse effects of drugs from this class. The drug should be stopped and the prescriber contacted. DIF: Cognitive Level: Applying or Higher REF: p. 150 40. Which food, drink, or herbal supplement do you warn a patient who is prescribed nevirapine (Viramune) to avoid? a. Caffeinated beverages b. Grapefruit juice c. St. John’s wort d. Dairy products ANS: C Nevirapine is a nonnucleoside analogue reverse-transcriptase inhibitor (NNRTI). The effectiveness of drugs from this class is greatly reduced by the herbal supplement St. John’s wort. DIF: Cognitive Level: Applying or Higher REF: p. 150 41. How do protease inhibitor (PI) drugs prevent viral replication? a. They are counterfeit bases that prevent reverse transcriptase from synthesizing the DNA needed for viral replication. b. They inactivate the enzyme that allows the viral genetic material to be integrated into the human host’s cellular DNA. c. They prevent the production of proteins needed for viral particles to leave the cell and infect other cells. d. They prevent initial infection by blocking the receptor the virus uses to enter target cells. ANS: C Protease inhibitors prevent viral replication and release of viral particles. Human immunodeficiency virus produces its proteins, including those needed to move viral particles out of the host cell, in one long (human immunodeficiency virus [HIV]) strand. For the proteins to be active, this large protein must be broken down into separate smaller proteins through the action of the viral enzyme HIV protease. Protease inhibitors, when taken into an HIV-infected cell, make the protease enzyme work on the drug rather than on the initial large protein. Thus active proteins are not produced and viral particles cannot leave the cell to infect other cells. DIF: Cognitive Level: Understanding REF: p. 151 42. A patient who has been taking indinavir (Crixivan) for a year has just been told that the organism is now resistant to this drug. The patient expresses worry to you that this means the disease will now progress to acquired immunodeficiency syndrome (AIDS) and death will soon follow. What is your best response? a. “Your health care provider can change this drug to the intravenous form, which prevents viral replication even in HIV that has developed drug resistance.” b. “Although the HIV is now resistant to this drug, other antiretroviral drugs are likely to be effective in controlling your disease.” c. “The HIV easily becomes drug resistant. That is why the drug combinations are switched so often.” d. “That is a possibility because these drugs do not kill the virus. It is best to be prepared.” ANS: B Human immunodeficiency virus (HIV) can develop drug resistance relatively quickly, especially to protease inhibitors. This does not mean that the organism is resistant to all antiretroviral drugs and that the disease will then progress to AIDS. By changing the combination of drugs frequently, even an organism that has developed resistance to one antiretroviral drug can still have its replication suppressed and the disease can be controlled. Simply telling the patient that HIV easily becomes drug resistant may be a true statement, but it does not address the patient’s concerns about the disease’s progression. DIF: Cognitive Level: Applying or Higher REF: p. 151 43. A patient on HAART that includes neviripine (Viramune) has all of the following side effects. Which one should you report to the prescriber immediately? a. Nausea b. 2 lb weight loss c. Clay-colored stools d. Dizziness on standing ANS: C The clay-colored stools are associated with liver dysfunction. Because this drug can cause liver damage, it is important to stop this drug as soon as possible. DIF: Cognitive Level: Applying or Higher REF: p. 148 44. A pediatric patient is prescribed nelfinavir (Viracept) 450 mg orally. The available drug is 50 mg/scoop. How many level scoops do you measure into the patient’s pudding to administer the correct dose? a. 9 scoops b. 6 scoops c. 3 scoops d. 2 scoops ANS: A Want 450 mg in X scoops/Have 50 mg in 1 scoop. 450/50 = 9 scoops. DIF: Cognitive Level: Applying or Higher REF: p. 150 45. Which precaution is most important to teach an older patient who is prescribed atazanavir (Reyataz)? a. “Be sure to take this drug at least 1 hour before or 4 hours after taking an antacid.” b. “Weigh yourself daily and notify your prescriber if you gain more than 2 lb in 1 week.” c. “Check your pulse for a full minute daily and notify your prescriber if it becomes irregular or slow.” d. “Check your calves daily for swelling or redness. If these symptoms appear, go to the emergency department immediately.” ANS: C Atazanavir can impair electrical conduction in the heart and lead to heart block, especially in older adults or people who have an abnormally slow heart rate. DIF: Cognitive Level: Applying or Higher REF: p. 151 46. Which precaution is most important to teach a patient who is prescribed enfuvirtide (Fuzeon)? a. “After the drug is mixed, store it away from light.” b. “Use sterile technique to draw up and inject the drug.” c. “Do not take this drug if there is any possibility that you are pregnant.” d. “Mix the drug with tap water, then rinse the drug’s original container and add that fluid to the drug mixture.” ANS: B Enfuvirtide is given twice daily by subcutaneous injection. The patient self-injects this drug at home and must use sterile technique. Injection site infections are common. DIF: Cognitive Level: Applying or Higher REF: p. 144 47. A 40-year-old patient infected with human immunodeficiency virus (HIV) asks why the new drug maraviroc (Selzentry) is not being prescribed for her. What is your best response? a. “This drug is very expensive and your insurance may not cover it.” b. “This drug can cause birth defects and should not be prescribed for anyone who is pregnant or might become pregnant.” c. “This drug is very toxic to the heart and lungs. It is prescribed only for patients who are young and have no other health problems.” d. “This drug is not effective against all HIV subtypes and the HIV causing your infection does not have the target for this drug.” ANS: D Maraviroc prevents cellular infection by blocking the CCR5 receptor on CD4+ T cells. Because this drug is not effective against all HIV subtypes, the patient must first be tested to ensure that his or her HIV infection is likely to respond to this therapy. When the HIV subtype does not use the CCR5 receptor, the drug is not prescribed for that patient. DIF: Cognitive Level: Applying or Higher REF: p. 154 48. Which precaution is most important to teach older adults who are prescribed maraviroc (Selzentry)? a. “If an injection site infection occurs, do not reuse that site until the skin has healed completely.” b. “Take the drug with food or milk to reduce the likelihood of GI side effects.” c. “Change positions slowly when moving from a sitting to a standing position.” d. “Store the drug at room temperature.” ANS: C Orthostatic hypotension is more likely to develop in older adults taking maraviroc, increasing the risk for falls. Patients need to change positions slowly and use handrails when going up or down steps. DIF: Cognitive Level: Applying or Higher REF: p. 154 49. A patient prescribed raltegravir (Isentress) reports all of the following problems or changes since starting this drug. Which problem or change do you report to the prescriber? a. Abdominal cramps and bloating b. Muscle aches and weakness c. Urinating more at night d. Loss of taste for sweets ANS: B This drug can cause the adverse reaction of rhabdomyolysis, which is destruction of skeletal muscle. The symptoms of this problem are muscle aches and weakness. When a patient develops this problem, the drug should be stopped. DIF: Cognitive Level: Applying or Higher REF: p. 152 50. What precaution is most important to teach a patient newly prescribed to take Truvada? a. “Continue to use safer sex practices.” b. “Avoid caffeine and any fatty or fried foods.” c. “Be sure to drink at least 3 L of fluids daily.” d. “If you develop muscle or joint aches, notify your prescriber immediately.” ANS: A Truvada is a drug used for pre-exposure prophylaxis among HIV negative people who are having sex with HIV positive people. If a person develops HIV disease and becomes positive while taking this drug, the risk for the HIV to become highly drug resistant greatly increases. Patients should be taught to use safer sex practices even though they are taking this drug prophylactically. DIF: Cognitive Level: Applying or Higher REF: p. 155 MULTIPLE RESPONSE ADVANCED CONCEPTS 1. Which antiretroviral drugs have greater effectiveness when administered with ritonavir? (select all that apply) a. Edurant (rilpivirine) b. Emtriva (emtricitabine) c. Invirase (saquinavir) d. Lexiva (fosamprenavir) e. Prezista (darunavir) f. Reyataz (atazanavir) g. Tivicay (dolutegravir) h. Ziagen (abacavir) ANS: C, D, E, F When administered with these drugs, ritonavir slows their metabolism and elimination. This action allows the drugs to remain in the blood at a higher level, which increases their effectiveness. DIF: Cognitive Level: Applying or Higher REF: p. 151 2. Which patient outcomes are major goals of antiretroviral therapy? (select all that apply) a. Prevention of opportunistic infections b. Conversion to an HIV-negative antibody status c. Reduction of the number of viral particles in the patient’s blood d. Increase in CD4+ cells e. Decrease in CD8+ cells f. Prevention of disease spread ANS: A, C, D, F The human immunodeficiency virus (HIV) retrovirus selectively infects the helper/inducer T cells, known as CD4+ cells, which coordinate the patient’s immune response. When these cells are destroyed, the person has little protection from opportunistic infection. Successful antiretroviral therapy reduces the number of viral particles in the blood and increases the CD4+ cell numbers in the blood. These actions reduce the risk for opportunistic infection and reduce the likelihood of HIV disease spread by the patient. Antiretroviral therapy does not affect the number of CD8+ cells and does not change the patient’s antibody status. DIF: Cognitive Level: Understanding REF: p. 148 COMPLETION ADVANCED CONCEPTS 1. A child who is HIV positive and weighs 40 lb is prescribed to receive atazanavir (Reyataz) at a dose of 7 mg/kg. The drug on hand is a premixed oral suspension of 50 mg/60 mL. How many milliliters will you prepare as the correct dose? ANS: 105.7 1 kg = 2.2 lb. Child’s weight in kilogram is 18.18 (40/2.2 = 18.18). 7 mg  18.18 kg = 127.26 mg round to 127.3 mg. Determine how many milligrams are in 1 mL by dividing 50 mg by 60 mL, which equals 1 mg in 0.83 mg/ mL. Multiply 127.3 mg by 0.83 mL, which equals 105.65 mL, round up to 105.7 mL. DIF: Cognitive Level: Applying or Higher REF: p. 151 2. A patient is prescribed to receive 300 mg of ribavirin by oral suspension. The drug on hand is ribavirin oral suspension with a concentration of 50 mg/mL. How many milliliters will you prepare as the correct dose? ANS: 6 Want 300 mg; Have 50 mg/mL. Because the milliliter concentration of this drug is already known, divide the dose you want (300 mg) by the dose you have (50 mg) to get 6. 6 mL is the correct dose. DIF: Cognitive Level: Applying or Higher REF: p. 140 3. A patient is prescribed 45 mg of enfuvirtide by subcutaneous injection. The available drug is a premixed solution of enfuvirtide with a concentration of 90 mg/mL. ANS: 0.5 Because the milliliter concentration of the drug is known, divide 45 mg by 90 mg, which is 0.5 mL. DIF: Cognitive Level: Applying or Higher REF: p. 153 [Show More]

Last updated: 1 year ago

Preview 1 out of 33 pages