Mrs. Oza, age 69, has hypertension and has one functioning kidney. She loves chocolates and enjoys an alcoholic beverage twice a week. Her hobby is gardening and she goes for long walks despite having arthritis. Which one of the following pieces of information is likely to have the greatest significance if she is prescribed vancomycin?

She only has one functioning kidney

She remains outdoors for long periods of time

She has hypertension

She enjoys an alcoholic beverage twice a week

Answer and Explanation

The Correct Answer is A

A. She only has one functioning kidney:

This choice is the most significant consideration when prescribing vancomycin to Mrs. Oza. Vancomycin is primarily eliminated from the body through the kidneys. Individuals with reduced kidney function, such as Mrs. Oza with only one functioning kidney, have a higher risk of vancomycin-associated nephrotoxicity (kidney damage). Therefore, her renal status is crucial information for determining the appropriate dosage of vancomycin and monitoring for any signs of kidney impairment during treatment.

B. She remains outdoors for long periods of time:

While spending time outdoors for long periods may have implications for Mrs. Oza's overall health, it is not directly relevant to the prescription of vancomycin. This information may be important for considering sun exposure, hydration, and other factors related to her arthritis and general well-being, but it does not specifically impact the pharmacokinetics or pharmacodynamics of vancomycin.

C. She has hypertension:

Mrs. Oza's hypertension is a relevant medical condition to consider in her overall health management. However, hypertension alone does not directly affect the prescription of vancomycin. Hypertension may influence the choice of antihypertensive medications or other aspects of her medical care, but it does not have a direct impact on the renal clearance or potential nephrotoxicity of vancomycin.

D. She enjoys an alcoholic beverage twice a week:

While alcohol consumption can interact with certain medications and impact overall health, it is not the most significant consideration when prescribing vancomycin to Mrs. Oza. Moderate alcohol consumption is unlikely to directly affect the pharmacokinetics or pharmacodynamics of vancomycin. However, excessive alcohol intake may contribute to liver dysfunction, which could indirectly influence drug metabolism. Nonetheless, in Mrs. Oza's case, her reduced renal function is a more critical factor to consider when prescribing vancomycin.

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Correct Answer is B

Explanation

A. Penicillins:

Penicillins are a class of antibiotics commonly used to treat various bacterial infections. While they are generally well-tolerated and have a low incidence of adverse effects, they are not typically associated with cartilage toxicity or tendon rupture, including the Achilles tendon.

B. Fluoroquinolones:

Fluoroquinolones are broad-spectrum antibiotics known for their effectiveness against a wide range of bacteria. However, they are associated with several significant adverse effects, including cartilage toxicity and tendon rupture. These adverse effects, particularly tendon rupture, are most commonly observed in weight-bearing tendons such as the Achilles tendon. Fluoroquinolones should be used cautiously, especially in populations at higher risk for tendon injuries.

C. Aminoglycosides:

Aminoglycosides are another class of antibiotics used to treat severe bacterial infections. While they have their own set of potential adverse effects, such as nephrotoxicity and ototoxicity, they are not associated with cartilage toxicity or tendon rupture.

D. Sulfonamides:

Sulfonamides are antibiotics that inhibit bacterial growth by interfering with the synthesis of folate. While they can cause various adverse effects, including skin reactions and hematologic abnormalities, they are not associated with cartilage toxicity or tendon rupture.

A. "Are you having any difficulty breathing?" B. "Have you noticed any blood in your stool?" C. "Are you having difficulty with your hearing?" D. "Do you have a headache?”

Correct Answer is A

Explanation

A. "Are you having any difficulty breathing?":

Difficulty breathing is a critical symptom that may indicate a severe allergic reaction, such as anaphylaxis, which can be life-threatening. It is essential to assess for difficulty breathing immediately as it requires urgent intervention to ensure the patient's airway is clear and to administer appropriate treatment.

B. "Have you noticed any blood in your stool?":

While blood in the stool could indicate gastrointestinal bleeding, it is not typically associated with allergic reactions to antibiotics. This symptom is more commonly associated with other conditions such as gastrointestinal ulcers, infections, or inflammatory bowel disease. While important to assess, it is not as immediately concerning as difficulty breathing in the context of a suspected allergic reaction.

C. "Are you having difficulty with your hearing?":

Difficulty with hearing is not a common symptom of allergic reactions to antibiotics. It may be associated with other conditions such as ear infections or ototoxicity from certain medications. While it is important to assess any changes in hearing, it is not typically an immediate concern in the context of a suspected allergic reaction.

D. "Do you have a headache?":

Headaches are a common symptom that can occur for various reasons, including stress, tension, dehydration, or as a side effect of medications. While headaches can sometimes occur as a side effect of certain drugs, they are not typically associated with severe allergic reactions such as anaphylaxis. Therefore, while it is important to assess for headaches, it is not as immediately concerning as difficulty breathing in the context of a suspected allergic reaction.

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Naxlex Comprehensive Predictor Exams

Which class of antibiotic is associated with cartilage toxicity and rupture of the Achilles tendon?

Correct Answer is B

Explanation

Mr. Carter has been recently started on an antibiotic, and has developed a rash and pruritis. You suspect an allergic reaction and immediately assess him for other more serious symptoms. What question would be most important to ask Mr. Carter?

Correct Answer is A

Explanation

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