Abx (random)

Question 1

What is the CRP and procalcitonin level for infection?

Answer 1

CRP >40
Procalcitonin >0.5 to start abx

Question 2

Why is doxycycline CI in pregnancy?

Answer 2

Cross placental barrier, concentrate in metal bones and dentition (teeth)

Question 2

What antibiotics are not suitable for pregnancy?

Answer 2

Tetracycline, fluoroquinolone, co-trimoxazole, aminoglycosides, nitrofurantoin (near term)

Question 3

Why is fluoroquinolone CI in pregnancy?

Answer 3

Arthropathy (in animal studies)

Question 4

Why is co-trimoxazole CI in pregnancy?

Answer 4

1st trimester: neural tube defects (folate antagonism of TMP)
3rd trimester: kernicterus

Question 5

What are examples of time-dependent antibiotics?

Answer 5

Beta-lactams

Question 6

What are examples of concentration-dependent antibiotics?

Answer 6

Aminoglycosides, fluoroquinolones, metronidazole

Question 7

What drugs can be used to treat CNS infections? (can cross BBB)

Answer 7

Ampicillin, 3rd & 4th gen cephalosporin, meropenem, vancomycin

Question 8

Why cannot use daptomycin for pneumonia?

Answer 8

It is inactivated by lung surfactants

Question 9

Which classes are bactericidal?

Answer 9

Beta-lactams
Glycopeptides (vancomycin)
Aminoglycosides
Fluoroquinolones

Question 10

Which classes are bacteriostatic?

Answer 10

Macrolides, clindamycin, tetracyclines, trimethoprim and sulphonamides, nitrofurantoin

Question 11

What are QTc prolonging abx?

Answer 11

Macrolides, fluoroquinolone, azoles

Question 12

What are nephrotoxic abx?

Answer 12

Aminoglycosides, vancomycin, amphotericin B

Question 13

What are abx that cause photosensitivity?

Answer 13

Tetracyclines, fluoroquinolone, sulfonamides, pyrazinamide

Question 14

What abx targets pseudomonas?

Answer 14

Pip-tazo, ceftazidime, cefepime, levofloxacin, ciprofloxacin, aminoglycosides, meropenem, imipenem, aztreonam (9)

Question 15

What abx targets atypicals?

Answer 15

Tetracyclines, macrolides, levofloxacin, moxifloxacin (4)

Question 16

What abx targets C diff?

Answer 16

Vancomycin (PO), metronidazole

Question 17

What abx targets MRSA?

Answer 17

Vancomycin, tigecycline, linezolid, ceftaroline (4)
(maybe) doxycycline, co-trimoxazole, clindamycin, levofloxacin, moxifloxacin (5)

Question 18

What abx covers ESBL bacteria?

Answer 18

Carbapenems, aminoglycosides

Question 19

Which carbapenem is the odd one out in terms of coverage?

Answer 19

Ertapenem: no enterococcus and pseudomonas cover

Question 20

What to monitor for vancomycin?

Answer 20

strict I/O, infusion reaction, U/E/Cr

Question 21

Peak and trough levels for vancomycin? Target AUC/MIC? Sampling times for peak and trough?

Answer 21

Peak <40
Trough 10-15 (15-20 for MRSA)
AUC/MIC 400-600
Sampling time: 1h after end of infusion (peak), immediately before starting infusion (trough)

Question 22

Peak and trough levels for aminoglycosides? Sampling times for peak and trough?

Answer 22

Gentamicin: peak 8-10, trough <2
Amikacin: peak 25-40, trough <10
Sampling time: 1h after end of infusion (peak), 1h before starting infusion (trough)

Question 23

Which abx cannot be used in G6PD deficient patients?

Answer 23

Nitrofurantoin, FQ, co-trimoxazole

Question 24

What are atypicals?

Answer 24

Legionella sp, Mycoplasma pneumoniae, Chlamydia pneumoniae

Question 25

Tigecycline coverage

Answer 25

MRSA, VRE, streptococci, ESBL (not pseudomonas, proteus)

Question 26

Which macrolide has the least CYP3A4 enzyme inhibition?

Answer 26

Azithromycin

Question 27

Which macrolide enhances gastric motility?

Answer 27

Erythromycin

Question 28

Which abx is used for triple therapy PUD?

Answer 28

Clarithromycin, metronidazole / amoxicillin (and PPI)

Question 29

Which abx causes ototoxicity?

Answer 29

Macrolides, vancomycin, aminoglycosides

Question 30

What abx are cleared hepatically?

Answer 30

Ceftriaxone, macrolides, clindamycin, moxifloxacin, metronidazole

Question 31

What abx are cleared renally?

Answer 31

Beta-lactams, vancomycin, tetracyclines (minocycline metabolised by kidney before excretion -> hepatic impairment dose adjustment), aminoglycosides, ciprofloxacin, levofloxacin, co-trimoxazole, nitrofurantoin

Question 32

Can linezolid be used for catheter-related bloodstream infections or catheter-site infections?

Answer 32

No

Question 33

Nitrofurantoin coverage?

Answer 33

E coli, Enterococcus (not pseudomonas or proteus)

Question 34

What antifungals are renally cleared?

Answer 34

Amphotericin B, 5-FU, fluconazole

Question 35

What causes bone marrow suppression as a side effect?

Answer 35

Linezolid, amphotericin B, 5-FU

Question 36

Antifungal CSF penetration?

Answer 36

Amp B (conventional) < Amp B (lipo) < 5-FU

Question 37

What antifungals are hepatically cleared?

Answer 37

Itraconazole, Voriconazole

Question 38

What are the common bugs involved in nosocomial infections?

Answer 38

ESKAPE (Enterococcus faecium, Staph Aureus MRSA, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp.)

Question 39

Which abx are bacteriostatic normally but bactericidal at high doses?

Answer 39

Macrolides, nitrofurantoin

Question 40

Side effects of 5-FU

Answer 40

hepatotoxicity, GI side effects, bone marrow suppression

Question 41

Side effects of Amphotericin B

Answer 41

- Fever and chills (1-3h after starting IV) - Nephrotoxicity (conventional causes renal vasoconstrictions and reduce GFR) -> hydrate pts - Electrolyte imbalances (hypoK) - Thrombophlebitis - Bone marrow suppression, anaemia

Question 42

Which abx do not have activity against Strep pneumoniae?

Answer 42

Cloxacillin, 1st gen cephalosporins, ceftazidime, aminoglycosides, ciprofloxacin