Anti-bacterials

Question 1

ESBL treatment

Answer 1

Imipenem + Cilastatin
(cilastatin inhibit DHP → prevent hydrolysis of imipenem @ brush border of PCT)

Question 2

Bacteriostatic vs Bacteriocidal

Answer 2

Bacteriostatic
1) 30s: Tetracyclines, Glycylcycline
2) 50s: Macrolides, Clindamycin, Linezolid
3) Anti-TB: Ethambutol
4) Folate Acid Synthesis: Sulfonamide, Trimethoprim, Cotrimoxazole

Everything else bactericidal

Question 3

Oral only

Answer 3

1) Penicillin V
2) 1st and 2nd Gen cephalosporin: cephalexin, cefuroxime (except cefazolin)
3) Aztreonam (monobactam)
4) Neomycin (Aminoglycosides)

Question 4

IV/IM only

Answer 4

1) Penicillin G
2) Sulbactam (the one to take with ampicillin)
3) Piptazo
4) 3-5th Gen Cephs + Cefazolin
5) Carbapenems (Imi, Mero, Erta)
6) Tigecycline (Glycylcycline)
7) Aminoglycosides (except neomycin)

Question 5

Both Renal and Hepatic
(req. mostly only renal adjustment)

Answer 5

1) Linezolid
2) Pyrazinamide
3) Folate synthesis inhibitors: Sulfonamide, Trimethoprim, Cotrimoxazole

Question 6

Hepatic/Unchanged vs Renal

Answer 6

1) Ceftriaxone
2) Tetracyclines: Doxy and Minocycline
3) Tigecycline
4) 50s: Macrolides, Clindamycin (except Linezolid)
5) Anti-TB: Rifampicin, Isoniazid
6) Fluoroquinolone: Moxifloxacin

Question 7

Hepatic adjustments

Answer 7

1) Ceftriaxone
2) Tigecycline
3) Moxifloxacin

Question 8

Renal adjustments

Answer 8

1) All cell wall (except penicillinase R & Ceftriaxone)
2) Tetracycline
3) Aminoglycosides
4) Fluroquinolones (except moxifloxacin)
5) Folate acid synthesis inhibitors
6) Pyrazinamide

Question 9

Unsafe in pregnancy

Answer 9

1) 30s: Tetracycline, Glycylcycline, Aminoglycosides
2) Nucleic acid: Fluoroquinolones, Sulfonamide, Cotrimoxazole (except trimethoprim)
3) Nitrofurantoin

Question 10

CYP inducer

Answer 10

Rifampicin

Question 11

CYP inhibitor

Answer 11

1) Macrolides (except Azithromycin)
2) Isoniazid
3) Ciprofloxacin
4) Sulfonamide
5) Cotrimoxazole

Question 12

Nephrotoxicity

Answer 12

1) Vancomycin
2) Aminoglycosides

Question 13

Hepatotoxicity

Answer 13

1) Co-amoxiclav
2) Tigecycline
3) Macrolides
4) Nitrofurantoin
5) Isoniazid
6) Pyrazinamide

Question 14

Ototoxicity

Answer 14

1) Vancomycin
2) Aminoglycosides
3) Macrolides

Question 15

Neurotoxicity

Answer 15

1) Penicillins
2) Carbapenems
3) Metronidazole

Question 16

Peripheral neuropathy

Answer 16

1) Linezolid
2) Fluroquinolones
3) Nitrofurantoin
4) Isoniazid (give pyridoxine)
5) Ethambutol
6) Metronidazole

Question 17

CDAD

Answer 17

1) Aminopenicillins
2) Cephalosporins
3) Tetracyclines
4) Tigecycline
5) Clindamycin
6) Ciprofloxacin

Question 18

Hypersensitivity (Anaphylaxis, SJS, TEN)

Answer 18

1) Penicillin
2) Cephalosporins
3) Carbapenems
4) Neomycin
5) Co-trimoxazole

Question 19

Prolonged QT interval

Answer 19

Macrolides, fluroquinolones

Question 20

Thrombophlebitis

Answer 20

1) Cephalosporins
2) Vancomycin

Question 21

Serotonin syndrome

Answer 21

1) Linezolid
2) Isoniazid

Question 22

Colour changes

Answer 22

1) Nitrofurantoin (Brown urine)
2) Rifampicin (Orange tears and sweat)
3) Metronidazole (Dark/rust coloured urine)

Question 23

Bone marrow suppression

Answer 23

1) Linezolid
2) Cotrimoxazole

Question 24

Generally what to use against no R bacteria?

Answer 24

Penicillin

Question 25

Generally what to use against penicillinase producing strains?

Answer 25

Cloxacillin/Zosyn

Question 26

Generally what to use against penicillin R Gram negs?

Answer 26

Aminopenicillins → Antipseudomonal → Monobactam / carbapenem

Question 27

Generally what to use against beta lactamase producing strains? eg. Pseudomonas, Klebsiella

Answer 27

Co-amoxiclav / Zosyn + Anti-pseudomonal (piptazo)

Question 28

Generally what to use against ESBL strains? eg. Acinetobacter

Answer 28

1) Carbapenems (Mero and Imi) 2) Tigecycline

Question 29

Generally what to use against altered PBP strains? eg. MRSA, Neisseria gonorrhoeae

Answer 29

MRSA: Vancomycin, Linezolid N. gonorrhoeae: Protein synthesis inhibitors (eg. Aminoglycosides, tetracyclines, macrolides, clindamycin, linezolid)

Question 30

What to give in place of penicillin (allergy)?

Answer 30

1) Monobactam (Aztreonam) 2) Glycopeptides (Vancomycin) 3) anything else

Question 31

What are aminoglycosides mainly used for?

Answer 31

G- coverage (6 NOs)

Question 32

What are tetracyclines mainly used for?

Answer 32

Atypicals + Doxycyclin for soft tissue MRSA + Tigecycline for MRSA and VRE

Question 33

What are macrolides mainly used for?

Answer 33

In place of penicillins (braod spec + atypicals)

Question 34

What is clindamycin mainly used for?

Answer 34

1) Anerobic everywhere expect GUT and GU 2) Anti-toxin properties

Question 35

What is linezolid mainly used for?

Answer 35

Last resort against MRSA and VRE

Question 36

What are Fluoroquinolones mainly used for?

Answer 36

1) Ciprofloxacin: G- 2) Levofloxacin: G-, G+, Atypical, Anaerobe 3) Moxifloxacin: G+, Atypical, Anaerobe - Pseudomonas

Question 37

What is cotrimoxazole mainly used for?

Answer 37

1) G+ including MRSA 2) G- except pseudomonas 3) UTI (non pregnant) 4) Pneumocystis jirovecii and toxoplasmosis

Question 38

What is nitrofurantoin mainly used for?

Answer 38

1) uncomplicated UTIs 2) 2nd line complicated UTIs

Question 39

What is metronidazole mainly used for?

Answer 39

GIT/other Anaerobe coverage 1) Anaerobes 2) CDAD 3) H. pylori

Question 40

What can be used against anaerobes?

Answer 40

1) Metronidazole 2) Clindamycin (except GIT) 3) Cloxacillin, Zosyn, Piptazo 4) Carbapenems 5) Moxifloxacin

Question 41

What can be used against atypicals?

Answer 41

1) Tetracyclines 2) Macrolides 3) Moxifloxacin 4) Penicillin G for Treponema pallidum

Question 42

Empirical treatment for CAP

Answer 42

Coamoxiclav/ Ceftriaxone Atypical → Azithromycin + Doxycycline Worsen → Levo/Moxifloxacin + ↑ BL dose

Question 43

Empirical treatment for HAP

Answer 43

1) Coamoxiclav / Ceftriaxone / Levo/moxifloxacin - BL cover weaker G+/- - Quinolone cover pseudomonas + atypicals 2) Piptazo / Ceftazidime/Cefepime / Imi/meropenem - Stronger for nastier G- (eg. ventilator-associated pneumonia) - ESBLs: Pseudomonas, Klebsiella, Acinetobacter 3) Linezolid/Vancomycin - For MRSA

Question 44

Adult meningitis empirical treatment

Answer 44

1) Ceftriaxone + Vancomycin - Ceft: N. meningitidis, Misc G- bacilli - Vanco: MRSA 2) Ceftazidime/gentamicin + Vanco

Question 45

Neonate/Child/Immunocompromised meningitis empirical treatment

Answer 45

1) Ampicillin + Ceftriaxone / Vanco + Cotrimoxazole + Ciprofloxacin (penicillin allergy) - Amp: Strep agalactiae, Listeria, Haemophilus - Ceft: E. coli, meningitidis, Strep pneumo, misc. G- bacilli 2) Ceftazidime/gentamicin + Vanco/rifampicin (+ ampicillin)

Question 46

Uncomplicated UTI/cystitis empirical treatment (E. coli, S. saprophyticus)

Answer 46

Non-pregnant: 1) Nitrofurantoin / Cotrimoxazole 2) Ciprofloxacin / Coamoxiclav / 1-3 gen cephs / fosfomycin Pregnant 1) Coamoxiclav / 1-3rd cephs 2) + Fosfomycin + Nitrofurantoin (if not at term)

Question 47

Complicated UTI/pyelonephritis empirical treatment (stones, catheters, ESBL, E.coli, Kleb, Proteus, Enterococci)

Answer 47

Non-pregnant 1) Ciprofloxacin / Cotrimoxazole 2) Carbapenems / Aminoglycosides Pregnant 1) Piptazo + Meropenem

Question 48

H-pylori treatment

Answer 48

CAO 1) Clarithromycin 2) Amoxicillin / Metronidazole 3) Omeprazole 2nd line: BMTO 1) Bismuth 2) Metronidazole 3) Tetracyclines 4) Omeprazole

Question 49

TB treatment

Answer 49

1) Rifampicin 2) Isoniazide 3) Pyrazinamide 4) Ethambutol / Streptomycin (if R) RIPE for 2 mths daily RI for 4 mths 3x/week