Anti-infectives I

Question 1

Penicillin G IV is also called……and used to treat what infection?

Answer 1

Benzathine LA for Syphilis

Question 2

PCN V PO is also called…and is used to treat what infection?

Answer 2

Procaine for Strep Pneumo

Question 3

A nick name for PCN in 1929 when PCN first came out was….

Answer 3

magic bullet

Question 4

What is the MOA of PCN?

Answer 4

Stops cell wall synthesis and kills bacteria (bacteriacidal)

Question 5

What is the coverage of PCN?

Answer 5

Gram +, limited activity against anaerobes (above the diaphragm)

Question 6

Do you take PCN with food or on empty stomach?

Answer 6

Empty

Question 7

What are some AEs of PCN?

Answer 7

take on empty stomach
have to take ATC, q6h,
diarrhea
rash

Question 8

How is PCN eliminated?

Answer 8

renally

Question 9

Name 4 Antistaphylococcal PCN? Which one is the DOC?

Answer 9

Methicillin (IV)
Oxacillin (IV)
Cloxacillin (PO)
Dicoxacillin (PO)…DOC

Question 10

What bacteria do the antistaphylococcal PCNs cover? and what is a serious infection that is most often caused by this bug?

Answer 10

staph aureas

cellulitis

Question 11

Name 2 aminoPCNs. What do they cover?

Answer 11

Ampicillin
Amoxicillin
Gram +, some anaerobes, AND some added activity against specific gram - (E. Coli, H. Flu, M. Cat)

Question 12

What infection are the aminoPCNs commonly used for?

Answer 12

UTIs and Otitis Media

Question 13

Which aminoPCN is more commonly used?

Answer 13

Amoxicillin b/c it has enhanced absorption AND you can take it with food.

Question 14

Which aminoPCN has added coverage? what does it cover?

Answer 14

Ampicillin

entercoccus and listeria

Question 15

How are the aminoPCNs eliminated?

Answer 15

renally

Question 16

What combo makes Augmentin?

Answer 16

Amoxicillin/clavulanic acid

Question 17

What is Augmentin’s MOA? Which bacteria does it cover specifically?

Answer 17

Beta-lactamase inhibitors inhibit the enzyme in bacteria that allow them to destroy Abx. They increase the spectrum of Abx.
SA, H. Flu, M. Cat

Question 18

What are the 4 cautions of PCNs?

Answer 18

1. Caution with OCP
2. Anaphylaxis
3. Drug Fever
4. C. Diff

Question 19

What do the extended spectrum PCNs cover?

Answer 19

Poor gram +

Gram - coverage, including PA

Question 20

What are the 2 extended spectrum PCNs?

Answer 20

Ticarcillin/Claculonate (Timentin)

Piperacillin/Tazobactam (Zosyn)

Question 21

What other group has similar coverage to extended spectrum PCNs?

Answer 21

Fluoroquinolones

Question 22

Name 2 First Generation Cephalosporins and their coverage.

Answer 22

Cefazolin
Cephalexin
Gram + (like the aminoPCNs) + klebsiella

Question 23

What do the Second Generation Cephalosporins cover? what other Abx is similar?

Answer 23

Gram + (not as well as 1st), gram - (not as well as 3rd)

Similar to Macrolides w/o atypicals

Question 24

What do the Third Generation Cephalosporins cover? Name one and describe why ED PAs may use it?

Answer 24

Excellent Gram -

Ceftriaxone 1g per day….all day coverage

Question 25

What are the newest Ceph drugs? What do they target?

Answer 25

3rd Ceph-Bactam Combo products
Target drug resistant Gram - strains, improved PA coverage
Very limited Gram + coverage

Question 26

What are 2 cautions with Cephalosporins?

Answer 26

1. Anaphylaxis - 5-15% cross-sensitivity to PCN

2. C. Diff

Question 27

Why might you use Carbapenams? What do they cover?

Answer 27

When the patient is resistant to other Abx (ID case)

BROAD SPECTRUM

Question 28

Name 2 Carbapenams. What is the #1 problem with these drugs? which one is less likely to cause this?

Answer 28

Imipenem/Cilastatin (Primaxin) - Guerillacillin
Meropenam - less likely, but $$$
Lowers Sz threshold

Question 29

If someone is allergic to PCN (SOB), is it safe to give them a Carbapenam? What about a ceph?

Answer 29

No, 5-15% cross sensitivity with PCN and Ceph

Question 30

If someone has renal failure, but is resistant to most Abx, what drug may be reasonable?

Answer 30

Cilastatin (Carbapenam - broad spectrum that does not cause as much nephrotoxicity

Question 31

T or F: Vancomycin is a macrolide.

Answer 31

False

Question 32

Vancomycin covers what bugs really well?

Answer 32

Gram + (Cadillac)

No Gram - coverage

Question 33

What is an AE of Vancomycin?

Answer 33

nephrotoxicity - increases serum Cr

Question 34

What is VRSA?

Answer 34

Vancomycin resistant staph aureas - scary!

Question 35

T or F: Vanc is only available IV.

What infection now calls for Vanc?

Answer 35

F. It is available PO and that is what is used to treat C. DIff because it is very hydrophilic.

Question 36

Name 3 Macrolides.

Answer 36

Erythomycin
Clarithromycin
Azithromycin (Zithromax)

Question 37

What do the macrolides cover?

What other group of Abx are they similar to?

Answer 37

Various Gram + and Gram - AND atypicals (legionella, Mycobacterium, Chlamydia)
2nd generation ceph

Question 38

A patient is allergic to PCN but has a strep pyogenes infection, what is your go to?

Answer 38

Macrolide –Azithromycin

Question 39

Clarithromycin has improved coverage of _____ when compared to Erythromycin.

Answer 39

H. flu, which causes CAP

Question 40

What is a possible AE of Clarithromycin?

Answer 40

metallic taste disturbance with the suspension

Question 41

What is the half life of Azithromycin?

Answer 41

long, 11-14 hours

it provides 3 weeks of drug levels

Question 42

Standard dose for Z-PAK?

Is it different than IV formulation?

Answer 42

500 mg PO Day 1, then 250mg PO x4 days

500mg x 5 days as single agent

Question 43

If an HIV patient’s CD4 levels drop below 50, what should you prescribe them and why?

Answer 43

600mg twice per week azithromycin for MAC PPX