Antibiotic Questions

Question 1

Which antibiotics must you monitor LFTs with?

Answer 1

2nd gen cephs
3rd gen cephs
Monobactams

Question 2

What monitoring occurs with Glycopeptides?

Answer 2

IV Vancomycin concentrations

Question 3

What do you need to monitor with Bactrim use?

Answer 3

SCr
BUN
K+ when initiating with other drugs known to cause hyperkalemia

Question 4

What do you need to monitor with Aminoglycosides?

Answer 4

peaks and troughs

Question 5

What links peptidoglycan together to form the cell walls of bacteria?

Answer 5

Penicillin binding protein

Question 6

What is the MOA of betalactams?

Answer 6

inhibits the cross linking of peptioglycan by inhibiting PBP

Question 7

What are the 4 different classes of Betalactams?

Answer 7

Penicillins
Cephalosporins
Monobactam
Carbapenems

Question 8

Are betalactams bacteristatic or bactericidal?

Answer 8

Bactericidal

Question 9

What PKPD parameters do betalactams have?

Answer 9

Time>MIC; low dose, high frequency

Question 10

What do all members of the betalactams group have?

Answer 10

a 4 member ring

Question 11

How do the members of the betalactam group differ?

Answer 11

The side ring that is attached to the main ring

Question 12

What side ring does Penicillins have?

Answer 12

5 member ring

Question 13

What side ring does Cephalosporins have?

Answer 13

6 membered ring

Question 14

What side ring does Monolactams have?

Answer 14

no side ring

Question 15

What side ring does Carbapanems have?

Answer 15

five membered ring

Question 16

What is penicillinase/betalactamase?

Answer 16

enzymes created by the bacteria to destroy betalactams

Question 17

What does Oxacillin cause?

Answer 17

liver damage

Question 18

What does Ticarcillin cause?

Answer 18

bleeding

Question 19

What is the trend of Cephalosporins?

Answer 19

as you continue through the generations, they GAIN Gram neg. coverage but LOSE Gram pos. coverage

Question 20

What do Cephalosporings not cover?

Answer 20

Enterococcus

Question 21

Which carbapenem has a DDI with valproic acid?

Answer 21

Meropenem

Question 22

Which carbapenem is formulated to protect the kidneys?

Answer 22

Imipenem/Cilastatin

Question 23

Which carbapenem doesn’t have coverage for pseudomonas?

Answer 23

Ertapenem

Question 24

What is monobactams niche?

Answer 24

doesn’t have cross reactivty with allergies to penicillins, cephs, or carbapenems so it can be used in patients with allergies to them

Question 25

What are the culprits for allergic reactions?

Answer 25

the side chains of betalactams

Question 26

What is the best option if a patient has an allergy to a betalactam?

Answer 26

Use a higher generation cephalosporin

Question 27

What generation cephalosporin should you use if patient has allergy to betalactam?

Answer 27

2nd gen. or higher

Question 28

What is a test dose?

Answer 28

1/10th of the full dose

Question 29

What should you do if the patient has a rash reaction to betalactams?

Answer 29

Give FULL DOSE of 3rd gen. ceph or higher | Give TEST DOSE of 1st/2nd gen. ceph

Question 30

What should you do if the patient has a hives or anaphylaxis reaction to betalactams?

Answer 30

Give TEST DOSE of 3rd gen. ceph or higher

Question 31

What do you do if a patient needs a 1st/2nd gen. ceph and has hives or anaphylaxis?

Answer 31

desensitize them by giving the patient 1 millionth of a dose then increasing that dose 10 fold every 30 minutes until you reach the full dose If patient has a reaction, give them benadryl but DON"T STOP the process

Question 32

What type of Vancomycin is used to treat C. Diff?

Answer 32

PO

Question 33

What are the doses of Vancomycin rounded to?

Answer 33

250 mg

Question 34

What must you do for IV Vancomycin?

Answer 34

check random and trough concentrations

Question 35

What is the target of IV Vancomycin for MRSA infections

Answer 35

Troughs 15-20 mcg/mL

Question 36

What is the target of IV Vancomycin for Non-MRSA infections?

Answer 36

Troughs 10-20 mcg/mL

Question 37

What is the trough?

Answer 37

The time before next dose when the drug concentration is lowest in the body

Question 38

Which tetracyclines should not be used in children under the age of 8 because of risk of vestibular toxicity?

Answer 38

Tetracycline | Doxycycline

Question 39

Which class of drugs must you avoid using in elderly and children due to risk of tendinopathies and delirium?

Answer 39

Fluoroquinolones

Question 40

Which macrolides are CYP inhibitors?

Answer 40

Clarithromycin | Erythromycin

Question 41

Which drug must be taken with food in order to decrease GI upset?

Answer 41

Clindamycin

Question 42

Which drug causes C. diff infection?

Answer 42

Clindamycin

Question 43

Which drug is used to treat C. diff from Clindamycin use?

Answer 43

Metronidazole

Question 44

Which drug can a patient NOT drink alcohol on?

Answer 44

Metronidazole

Question 45

Which drug is the DOC for anaerobes?

Answer 45

Metronidazole

Question 46

Which drugs are most often used in synergy to treat endocarditis and ophthalmic and otic solutions?

Answer 46

Aminoglycosides

Question 47

What must you monitor with aminoglycoside dosing?

Answer 47

peaks and troughs

Question 48

What is extended interval dosing for aminoglycoside dosing?

Answer 48

high dose, long interval maximizes peak concentrations random level determines frequency

Question 49

What patients can you NOT use extended interval dosing in?

Answer 49

patients with AKI, at risk for kidney injury or those with HD, or those using for synergy

Question 50

What is conventional dosing for aminoglycoside dosing?

Answer 50

smaller doses, dosed more frequently based on renal function using for synergy monitor peaks and troughs

Question 51

What patients can you use conventional dosing in?

Answer 51

those with AKI, at risk for kidney injury, or on HD

Question 52

What is the monitoring level for Amikacin?

Answer 52

``` Peaks = 20-30 Troughs = <5 ```

Question 53

What is the monitoring level for Gentamicin?

Answer 53

``` Peaks = 6-8 Troughs = <1 ```

Question 54

What is the monitoring level for Gentamicin in synergy?

Answer 54

``` Peaks = 3-4 Troughs = <1 ```

Question 55

What is the monitoring level for Tobramycin?

Answer 55

``` Peaks = 6-8 Troughs = <1 ```

Question 56

Which drug do you avoid use in patients with CrCl <50?

Answer 56

Nitrofurantoin

Question 57

Which drugs only treat UTI's?

Answer 57

Nitrofurantoin | Fosfomycin

Question 58

Which drug has DDIs with SSRI's, TCA's, and MOAI?

Answer 58

Oxazolidinones

Question 59

Which drug cannot be used to treat Pneumonia?

Answer 59

Daptomycin

Question 60

Which drug is used for refractory C. diff only?

Answer 60

Fidaxomicin

Question 61

Which drug can decrease the effectiveness of oral contraceptives?

Answer 61

Rifampin

Question 62

What do antibiotics cause?

Answer 62

yeast infections | diarrhea

Question 63

What can antibiotics predispose patients to developing?

Answer 63

C. diff