Antibiotic Coverage

Question 1

What is the form of Penicillin V Potassium?

Answer 1

PO

Question 2

Which Gram-positive cocci are covered by Natural PCN?

Answer 2

• Streptococci
• Enterococci

Question 3

What is the black box warning associated with Penicillin G?

Answer 3

Penicillin G is not for IV use - can cause cardio-respiratory arrest and death

Question 4

What are the contraindications for Augmentin?

Answer 4

• History of cholestatic jaundice or hepatic dysfunction associated with previous use
• Severe renal impairment (CrCl < 30 ml/min) for Augmentin XR or 875 mg

Question 5

What side effects are associated with Penicillins?

Answer 5

• Seizures due to accumulation
• GI upset, diarrhea
• Rash (SJS/TEN)
• Anaphylaxis reactions
• Hemolytic anemia (positive Coombs test)
• Renal failure, increased LFTs

Question 6

What should be monitored when using Penicillins?

Answer 6

• Renal function
• CBC
• LFTs

Question 7

What is the form of Penicillin G Aqueous?

Answer 7

IV

Question 8

What is the coverage of Amoxicillin?

Answer 8

• Gram(-): HNPEK

Question 9

What is the form of Ampicillin?

Answer 9

IV/PO/IM

Question 10

What does Amoxicillin/Clavulanate (Augmentin) add to its coverage?

Answer 10

• MSSA
• More resistant species of HNPEK
• Gram(-) anaerobes (B. fragilis)

Question 11

What is the form of Piperacillin/Tazobactam (Zosyn)?

Answer 11

IV

Question 12

What is the unique coverage of Zosyn?

Answer 12

• CAPES
• Pseudomonas

Question 13

What does Dicloxacillin cover?

Answer 13

• MSSA (preferred)
• Streptococci
• Staphylococci

Question 14

What is a key point about antistaphylococcal PCNs?

Answer 14

Do NOT require renal dose adjustments

Question 15

What is the first-line treatment for pharyngitis?

Answer 15

Penicillin VK

Question 16

What is the drug of choice for syphilis?

Answer 16

Penicillin G

Question 17

What interaction does Probenecid have with beta-lactams?

Answer 17

Can increase levels of beta-lactams by interfering with renal excretion

Question 18

What is the coverage of Cefazolin?

Answer 18

• Gram(+) cocci: strep and staph
• MSSA
• Gram(-): PEK

Question 19

What are the contraindications for Ceftriaxone?

Answer 19

• Neonates - biliary sludging, kernicterus
• Calcium-containing IV products in neonates

Question 20

What is a warning associated with Cefotetan?

Answer 20

Can cause disulfiram-like reaction with alcohol ingestion

Question 21

What is the coverage of Ceftriaxone?

Answer 21

• S. pneumoniae
• MSSA Staphylococci
• Gram(+) anaerobes
• Resistant HNPEK

Question 22

What is the coverage of Cefepime?

Answer 22

• S. pneumoniae
• MSSA Staphylococci
• HNPEK
• CAPES
• Pseudomonas

Question 23

What is the coverage of Meropenem?

Answer 23

• Most gram(+), gram(-), ESBL-producing bacteria, anaerobes

Question 24

What does Aztreonam cover?

Answer 24

• Many gram(-)
• Pseudomonas
• CAPES

Question 25

What is the mechanism of action of Aminoglycosides?

Answer 25

Binds to ribosome, interferes with bacterial protein synthesis

Question 26

What is a key side effect of Gentamicin?

Answer 26

* Nephrotoxicity * Ototoxicity

Question 27

What is the coverage of Ciprofloxacin?

Answer 27

* Enhanced gram(-) activity: Pseudomonas

Question 28

What is a black box warning for Ciprofloxacin?

Answer 28

Tendon inflammation and/or rupture

Question 29

What are the contraindications for Ciprofloxacin?

Answer 29

Tizanidine

Question 30

What is the coverage of Levofloxacin?

Answer 30

* Enhanced gram(-) activity: Pseudomonas * Enhanced coverage of S. pneumoniae and atypicals

Question 31

What is the form of Delafloxacin?

Answer 31

Tablet Injection

Question 32

What are the drug interactions for quinolones?

Answer 32

* Antacids and other polyvalent cations * Increases warfarin effects * Increases sulfonylureas, insulin, hypoglycemic drug effects

Question 33

What is the effect of antacids and other polyvalent cations on quinolone inhibition?

Answer 33

Chelation inhibits quinolone inhibition (separate administration required) ## Footnote This includes cations such as Mg, Al, Phos, Va, Iron, and Zinc.

Question 34

Which two substances decrease serum concentration of quinolones?

Answer 34

Lanthanum carbonate and sevelamer ## Footnote These substances require separate administration from quinolones.

Question 35

How does levofloxacin and moxifloxacin affect warfarin?

Answer 35

Increases warfarin effects ## Footnote This necessitates monitoring of INR levels.

Question 36

What effect do levofloxacin and moxifloxacin have on hypoglycemic drugs?

Answer 36

Increases effects of sulfonylureas, insulin, and other hypoglycemic drugs ## Footnote Caution should be exercised when using these medications together.

Question 37

What precautions should be taken when using levofloxacin and moxifloxacin in patients with cardiovascular disease?

Answer 37

Caution in CVD, hypokalemia, and hypomagnesemia ## Footnote These conditions may increase the risk of adverse effects.

Question 38

What type of drugs should be used with caution alongside levofloxacin and moxifloxacin?

Answer 38

QT-prolonging drugs ## Footnote This includes azole fungals, antipsychotics, methadone, and macrolides.

Question 39

What effect do probenecid and NSAIDs have on quinolone levels?

Answer 39

Can increase quinolone levels ## Footnote This may lead to enhanced effects and increased risk of side effects.

Question 40

What is a significant characteristic of ciprofloxacin regarding CYP1A2?

Answer 40

Strong CYP1A2 inhibitor ## Footnote This can increase levels of caffeine, theophylline, and tizanidine by reducing their metabolism.