Question 1

Why is ethambutol always used in combination with other antitubercular drugs?

Accepted Answer

Ethambutol is only bacteriostatic.When taken alone,it cannot eradicate the tuberculosis bacteria and cure the disease.

Question 2

A patient who is prescribed pyrazinamide and ethambutol for active tuberculosis (TB)also has gout.What adjustments will this patient's condition require?

Accepted Answer

Both pyrazinamide and ethambutol increase uric acid production and increase the risk for gout attacks.Drinking more water can help prevent the uric acid crystals from precipitating in joints or kidneys.

Question 3

A male patient who has been prescribed isoniazid (INH,Nydrazid)reports that his breasts have enlarged since starting therapy.What is your best response?

Accepted Answer

Breast enlargement in men (gynecomastia)is a common side effect of isoniazid.This physical change can be very distressing and embarrassing to men,and they should be reassured that the problem is temporary.Even though it is distressing,breast enlargement is not a reason to stop drug therapy.

Question 4

Which drug must a patient be taught to avoid during TB drug therapy?

Accepted Answer

Teach all patients on TB drug therapy to avoid alcoholic beverages and acetaminophen for the entire therapy period.Both alcohol and acetaminophen are toxic to the liver and so are the antitubercular drugs.Taking all of these drugs and either acetaminophen or drinking alcohol greatly increases the risk for permanent liver damage.

Question 5

Which statement about tuberculosis (TB)is true?

Accepted Answer

TB is the most common bacterial infection worldwide.However,it requires an overwhelming exposure in a susceptible host to develop the disease.Therefore many more people are exposed to and take in the bacteria than who actually go on to develop the disease.

Question 6

Which antifungal drug causes some degree of renal impairment in everyone who receives it?

Accepted Answer

Although some antifungal drugs have the potential to affect renal function if given at higher doses or for prolonged periods,only amphotericin causes renal impairment in everyone who receives it even if they only receive one dose.

Question 7

Which drug is NOT one of the "first-line" antitubercular drugs?

Accepted Answer

The four first-line drugs to treat tuberculosis are isoniazid,ethambutal,rifampin,and pyrazinamide.Amphotericin is an antifungal drug.

Question 8

What type of fungal infections can be treated with topical antifungal agents?

Accepted Answer

Antifungal drugs that are applied topically do not penetrate tissues and only work against fungi that are on the surface.

Question 9

Which antitubercular drug causes the urine to turn reddish orange?

Accepted Answer

Rifampin is associated with discoloration of the urine,which turns a reddish orange or a reddish brown color.The cause of this discoloration is not known but may be related to the drug's action of increasing the renal excretion of bile acids.

Question 10

Which antifungal drug causes "red man syndrome?"

Accepted Answer

Amphotericin B causes massive vasodilation,especially if given too fast,which results in whole body flushing and a red appearance.

Question 11

Which statement made by a patient indicates the need for more teaching about first-line drug therapy for tuberculosis (TB)?

Accepted Answer

Usually TB is no longer contagious and clinical improvement is seen after drugs have been taken for 2 to 3 consecutive weeks.However,the organism growth has only been suppressed and the immune system and drugs have not had sufficient time to eradicate it.Stopping treatment after only a month will allow the disease to again become active and the organisms can become resistant to these drugs.The patient must continue taking the drugs for 6 months or longer,exactly as prescribed.

Question 12

How long is the minimum course of drug therapy for an immunocompetent patient with active tuberculosis?

Accepted Answer

A patient who has nondrug-resistant tuberculosis must remain on the prescribed medications for at least 6 months.The organism is slow growing and is harder to control than other types of bacteria.

Question 13

Which antitubercular drug is avoided in the treatment of children who have tuberculosis?

Accepted Answer

Ethambutol can cause serious eye problems that may lead to blindness in people of any age.Its use is avoided in children because they may not recognize vision changes caused by the drug soon enough to avoid permanent vision changes or blindness.

Question 14

A patient with which findings requires drug therapy for active tuberculosis (TB)?

Accepted Answer

A positive skin test for TB only means that the patient was infected with TB at one time.A TB scar also only indicates old,inactive disease.Cavitation and productive cough along with a positive skin test are indicators of active disease that can be spread to others,and this person must be treated.The person with a negative skin test and chest x-ray but with other symptoms probably has another type of respiratory infection.

Question 15

Why are most standard antibacterial drugs ineffective against tuberculosis?

Accepted Answer

Because the TB organism is slow growing,many common antibacterial drugs are not effective in controlling or killing it.Combination drug therapy with agents effective against the TB organism is needed to treat TB and prevent its transmission.

Question 16

Which antifungal drug to treat ringworm is given to children as granules that are sprinkled over soft,nonacidic foods?

Accepted Answer

Micafungin and amphotericin B are administered intravenously.Although flucytosine can be administered orally,it is not available as granules and is not prescribed for ringworm.

Question 17

Which class of antifungal agents should never be given with grapefruit juice?

Accepted Answer

The activity of azole antifungal drugs can be reduced by grapefruit juice in large quantities.Patients should not take an azole with grapefruit juice and should limit their total grapefruit juice intake to no more than 24 ounces/day.

Question 18

A patient received a tuberculosis skin test injection of purified protein derivative (PPD)72 hours ago.Which assessment finding of the test site should be interpreted as a positive reaction?

Accepted Answer

A positive reaction to a TB skin test requires that the skin around the injection site be indurated,not just red.Induration is caused by infiltration of the skin around the test site with many white blood cells,making the area red and swollen,and the tissue much harder than the surrounding normal skin.Bruising is a result of bleeding into the injection site,not infiltration and induration from white blood cells.

Question 19

A patient with active tuberculosis who has been taking isoniazid (INH,Nydrazid)and rifampin (RIF,Rifadin)reports having urine that is an orange color.What your best action?

Accepted Answer

Rifampin normally turns urine an orange color.No intervention is needed;however,the color change can be very distressing to patients.The patient should be reassured that this color change is normal and be taught how to manage this change so that clothing does not become stained.

Question 20

What is the major way in which tuberculosis is spread from one person to another?

Accepted Answer

The tuberculosis (TB)bacteria are spread when bacteria-filled droplets travel through the air when a person with TB coughs,laughs,sneezes,sings,or whistles.These droplets can be inhaled by another person who then may develop the disease.Bacteria-filled droplets in the air are known as "aerosol transmission." It is possible to spread TB in other ways but aerosol transmission is by far the most common.

Quiz 10: Anti-Infectives: Antitubercular and Antifungal Drugs

Why is ethambutol always used in combination with other antitubercular drugs?

A patient who is prescribed pyrazinamide and ethambutol for active tuberculosis (TB) also has gout.What adjustments will this patient's condition require?

A male patient who has been prescribed isoniazid (INH,Nydrazid) reports that his breasts have enlarged since starting therapy.What is your best response?