Question 1

An 80-year-old patient who has COPD takes TMP/SMX for acute exacerbations,which occur three or four times each year.To monitor this patient for adverse drug reactions,the primary care NP should order:&#10;A) liver function tests.&#10;B) blood urea nitrogen and creatinine.&#10;C) serum bilirubin levels.&#10;D) a complete blood count (CBC) with differential.

Accepted Answer

The most frequently reported severe adverse reactions in elderly patients include bone marrow depression and decreased platelets.A CBC with differential is indicated to monitor for this.Evaluation of liver and renal function should be performed before beginning treatment because adverse effects are more common in patients with decreased renal and liver function.

Question 2

When prescribing TMP/SMX to children,the primary care NP should recall that:&#10;A) dosing is based on the trimethoprim component of the drug.&#10;B) TMP/SMX should not be prescribed for children younger than 2 years.&#10;C) folic acid supplements must be given to children who take this medication.&#10;D) the medication should be given three or four times per day because of rapid metabolism.

Accepted Answer

When determining the dose of TMP/SMX,the dose is based on the trimethoprim component of the drug.Children older than 2 months of age may take this medication.Folic acid supplements are not indicated.The medication is given twice daily in all age groups.

Question 3

The primary care NP teaches a patient about TMP/SMX before prescribing it to treat a urinary tract infection (UTI).Which statement by the patient indicates a need for further teaching?&#10;A) &#34;I will take this medication with food.&#34;&#10;B) &#34;I should drink a full glass of water with each dose.&#34;&#10;C) &#34;I should stay out of direct sunlight and use sunscreen.&#34;&#10;D) &#34;I should report any ringing in my ears or a sore throat.&#34;

Accepted Answer

TMP/SMX should be taken on an empty stomach,so this statement is incorrect and indicates the need for further teaching.The other statements all are correct.

Question 4

A patient has been taking trimethoprim-sulfamethoxazole (TMP/SMX)for 14 days.The patient calls the primary care nurse practitioner (NP)to report fever,rash,and enlarged lymph nodes.The NP should suspect:

A) serum sickness reaction.
B) immediate sensitivity reaction.
C) cytotoxic hypersensitivity reaction.
D) cell-mediated hypersensitivity reaction.

Accepted Answer

Serum sickness reaction can occur days to weeks after administration of the drug and is characterized by fever,rash,and lymphadenopathy.Immediate sensitivity reaction includes anaphylaxis,urticaria,and angioedema and occurs within 30 minutes of drug administration.Cytotoxic hypersensitivity reaction causes hemolytic anemia,neutropenia,and thrombocytopenia and develops 7 to 14 days after drug administration.Cell-mediated hypersensitivity reaction causes maculopapular rash,Stevens-Johnson syndrome,and toxic epidermal necrolysis and takes 48 to 72 hours to develop.

Question 5

A patient is seen in the clinic with a 1-week history of frequent watery stools.The primary care NP learns that a family member had gastroenteritis a week prior.The patient was treated for a UTI with a sulfonamide antibiotic 2 months prior.The NP should suspect:

A) Clostridium difficile-associated disease (CDAD).
B) viral gastroenteritis.
C) serum sickness reaction.
D) recurrence of the UTI.

Accepted Answer

Cases of CDAD have been reported 2 months after a course of antibiotics,and CDAD should be suspected in all patients who present with diarrhea after antibiotic use.Viral gastroenteritis is possible,but the possibility of CDAD must be investigated.Serum sickness reaction is not usually associated with diarrhea and generally occurs within weeks of drug administration.

Question 6

A patient is taking sulfisoxazole.The patient calls the primary care NP to report abdominal pain,nausea,and insomnia.The NP should:&#10;A) change to TMP/SMX.&#10;B) tell the patient to stop taking the drug immediately.&#10;C) reassure the patient that these are minor adverse effects of this drug.&#10;D) order a CBC with differential, platelets, and a stool culture.

Accepted Answer

These side effects are considered common minor side effects of sulfonamide medications.They occur with all drugs in this class,so changing to TMP/SMX is not indicated.The patient should continue taking the medication.It is not necessary to perform laboratory tests.

Question 7

A primary care NP prescribes TMP/SMX for a patient who is experiencing an exacerbation of COPD.The patient calls the NP 2 days later to report increased fever,cough,and shortness of breath.The NP should tell the patient:

A) to stop taking the medication.
B) that symptoms such as sore throat and arthralgia are more worrisome.
C) to continue the medication because these are signs of the disease process.
D) that sulfisoxazole (Gantrisin) will be prescribed instead to minimize side effects.

Accepted Answer

Fever,cough,and shortness of breath are included on a list of symptoms that may be early signs of serious reactions.Patients experiencing these symptoms should stop taking the medication immediately.Sore throat and arthralgia should also be reported but are not more worrisome than the symptoms this patient is experiencing.The patient should not continue the medication.Changing to another sulfonamide is incorrect because similar symptoms would occur.

Deck 65: Sulfonamides