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Flashcards in 5/8 Antibiotics Review Deck (33)
1

Pt with foreign body in place, and coag-neg staph growing?

normally we would dismiss coag-neg staph as a contaminant, but a foreign body makes us think it is something growing on the surface.

Assume it is MRSA; treat with Vanco

2

Neisseria?

Ceftriaxone (3rd gen)

(3rd generation; Neisseria has 3 letters that are repeated!)

3

C Diff: one sigle drug?

Metronidazole

4

If suspect Listeria in meningitis, add what to cover it?

Ampicillin

5

for staph, which is better: PCN or Ampicillin?

PCN

6

MSSA bacteremia?

Nafcillin

7

Piperacillin: good against what?

SPACEK

esp pseudomonas

8

Zosyn covers everything except what?

except MRSA

the devil drug

(=Pip + Tazobactam)

9

Anaerobic gram neg rods: name 3?

what are they likely to have?

Prevotella, Fusobacterium, Bacteriodes

likely to have beta-lactamase

10

UTI from E Coli?

Ampicilin

11

Diverticular abscess (ie below the diaphragm)?

Unisyn (Amp + Sulbactam)

Combination PCN + beta-lactamase inh.

12

Prophy for someone about to have abd surg?

Cefazolin (1st)

13

Cellulitis w PCN allergy?

Cefazolin (1st)

14

CA Pneumonia? 

Ceftriaxone (3rd)

15

Pyelonephritis?

Ceftriaxone (3rd)

16

Why can't we use just Ceftazadime (3rd - IV) for VAP?

it covers SPACEKs but not other causes of HAP (S pneumo, S aureus, MRSA, MSSA)

Add vanco.

17

2 equivalent regimens for VAP/HAP?

Vanco/Ceftazadime

Vanco/Piperacillin/Tazobactam

(need to cover SPACEK and anaerobes)

18

Why does he think that Cefapime is the devil?

Covers very widely.

Covers Staph, strep, E Coli, SPACEK.....

19

Your roommate (who has smelly socks) develops a cellulitis of the right foot, but is otherwise healthy and clinically stable.

What organisms cause this? 

What drugs kill them? 

What organisms cause this? Group A Strep

What drugs kill them? Penicillins

20

A sexually active mother of three complains of dysuria, urinary frequency, and incomplete voiding. She’s otherwise healthy and her examination including her vitals are normal. You diagnose uncomplicated cystitis, a.k.a. a UTI.

Why isn’t penicillin adequate therapy for a UTI?


Because it doesn’t kill Enterococcus. 




Because it is oral. 






Because it kills most Nocardia. 








Because it doesn’t kill most E. coli. 










Because you don’t treat UTI’s.
 

A sexually active mother of three complains of dysuria, urinary frequency, and incomplete voiding. She’s otherwise healthy and her examination including her vitals are normal. You diagnose uncomplicated cystitis, a.k.a. a UTI.

Why isn’t penicillin adequate therapy for a UTI?


Because it doesn’t kill Enterococcus. 


Because it is oral. 


Because it kills most Nocardia. 


Because it doesn’t kill most E. coli. 


Because you don’t treat UTI’s. 

21

A sexually active mother of three complains of dysuria, urinary frequency, and incomplete voiding. She’s otherwise healthy and her examination including her vitals are normal. You diagnose uncomplicated cystitis, a.k.a. a UTI.

Why is ceftazidime overkill for an uncomplicated UTI?


Because it doesn’t kill Enterococcus. 




Because it is oral. 






Because it kills the SPACE bugs. 








Because it doesn’t kill most E. coli. 










Because it kills M. tuberculosis.
 

A sexually active mother of three complains of dysuria, urinary frequency, and incomplete voiding. She’s otherwise healthy and her examination including her vitals are normal. You diagnose uncomplicated cystitis, a.k.a. a UTI.

Why is ceftazidime overkill for an uncomplicated UTI?


Because it doesn’t kill Enterococcus. 




Because it is oral. 






Because it kills the SPACE bugs. 








Because it doesn’t kill most E. coli. 










Because it kills M. tuberculosis.
 

22

What is the equivalent of Ceftazadime for pts who are allergic to PCN?

Azeotreonam

23

Your first patient of third year has febrile neutropenia without a clear source. Your resident says she remembers resistant Gram negative rods are potential pathogens in this crowd, so she wants to start empiric antibiotic therapy to cover them.

Which of these do not cover resistant GNRs?


Ceftriaxone 




Meropenem 






Aminoglycosides 








Ciprofloxacin 










Piperacillin / tazobactam 












Ceftazidime 














Cefepime
 

Your first patient of third year has febrile neutropenia without a clear source. Your resident says she remembers resistant Gram negative rods are potential pathogens in this crowd, so she wants to start empiric antibiotic therapy to cover them.

Which of these do not cover resistant GNRs?


Ceftriaxone 


Meropenem 


Aminoglycosides 


Ciprofloxacin 


Piperacillin / tazobactam 


Ceftazidime 


Cefepime 

24

When would you use Cipro (quinolone) for a UTI?

If there is resistance to Bactim

Bactirm is cheaper

25

Why are moxyfloxacin and levofloxacin good against pneumonia?

Cover strep pneumo

26

Why might we give Vanco in a meningitis situation but not in pneumonia, if we suspect that each may be caused by MRSA?

Meningitis far more dangerous - cannot take the chance on MRSA.

Pneumonia - if they don't get well on first-line they can come back in for Vanco.

27

31 year old medical student vomits while taking his final exam. Three days later, he develops a fever, cough and dyspnea. You’re worried about pneumonia.

#1: FYI: you should get a chest x-ray.

What is the first-line, assuming he is well enough to remain home (not in hosp)?

Azithromycin

28

Why are ceftriaxone plus azithromycin the standard treatment for patients hospitalized with pneumonia?

(why not only azithromycin?)

 

If patient is in hospital, add Ceftraixone covers resistant pneumo.

If very concerned/sick, add Vanco.

Pneumonia: Azithro --> Ceftriaxone --> Vanco

29

His post-test pre-pneumonia emesis makes aspiration a concern. Which bugs might be important?


Pseudomonas aeruginosa 




MRSA 






Bacteroides fragilis 








M. tuberculosis 










Haemophilus influenzae
 

His post-test pre-pneumonia emesis makes aspiration a concern. Which bugs might be important?


Pseudomonas aeruginosa 


MRSA 


Bacteroides fragilis 


M. tuberculosis 


Haemophilus influenzae 

30

31 year old medical student vomits while taking his final exam. Three days later, he develops a fever, cough and dyspnea. You’re worried about pneumonia.

His post-test pre-pneumonia emesis makes aspiration a concern. Which of the following drugs DOES NOT KILL ANAEROBES?


Clindamycin 




Ceftriaxone 






Metronidazole 










Beta-lactams paired with a beta-lactamase inhibitor
 

31 year old medical student vomits while taking his final exam. Three days later, he develops a fever, cough and dyspnea. You’re worried about pneumonia.

His post-test pre-pneumonia emesis makes aspiration a concern. Which of the following drugs DOES NOT KILL ANAEROBES?


Clindamycin 


Ceftriaxone 


Metronidazole 


Beta-lactams paired with a beta-lactamase inhibitor 

31

Dental abscess -> what drug?

Clindamycin (for peptostreptococcus)

32

Bacterial abscess in abd: what drug?

amp/sulbactam (Unisyn) + metronidazole (for C diff)

33

A college student comes in, embarrassed: “there’s something on my butt, and it hurts.” You diagnose a boil, likely from Staph. aureus. You are worried about MRSA.

What drugs are inactive against MRSA?


Linezolid 




Ceftriaxone 






Vancomycin 








Daptomycin 










Trimethroprim-sulfamethoxazole
 

A college student comes in, embarrassed: “there’s something on my butt, and it hurts.” You diagnose a boil, likely from Staph. aureus. You are worried about MRSA.

What drugs are inactive against MRSA?


Linezolid 




Ceftriaxone (remember ceftaroline is the only cephalosporin that covers MRSA) 






Vancomycin 








Daptomycin 










Trimethroprim-sulfamethoxazole