Antibiotics

Question 1

MSSA

Answer 1

Anti staph PCN
First gen cephalosporins
Fluoroquinolones

Question 2

MRSA

Answer 2

Ceftroline, vanco, bactrim, clindamycin, linezolid; doxycycline, daptomycin for skin, soft tissue or right side endocarditis

Question 3

Strep pneumoniae

Answer 3

PCN, aminopenicillins, 3rd generation cephalosporins, fluoroquinolones, macrolides, clindamycin

Question 4

Strep A and B

Answer 4

PCN, aminopenicillins, first generation cephalosporins, fluoroquinolones, macrolides, clindamycin

Question 5

Enterococcus

Answer 5

PCN, aminopenicillins are best, for UTI nitrofuratoin

Question 6

HI, enterobacter, neisseria meningitis, serratia, proteus, E. coli, klebsiella

Answer 6

Antipseudo PCN like zosyn, first generation cephalosporins, carbapenems, monobactams, fluoroquinolones, aminoglycosides

Question 7

Pseudomonas and acinetobacter

Answer 7

Amino PCN, anti pseudo PCN, ceftazidime, cefepime, carbapenems, aminoglycosides, cipro

Question 8

Extended spectrum beta lactase or ESBL

Answer 8

Carbapenems, aminoglycosides, polymixins, 3rd generation cephalosporins like ceftazidime, azactam

Question 9

Stenotrophomonas

Answer 9

Anti pseudo PCN, polymixins, bactrim

Question 10

Broad spectrum for

Answer 10

Gram negative- zosyn
Gram positive- vanco

Question 11

Anaerobe coverage

Answer 11

C diff, bacterioides, peptostrepococcus, fusobacterium, prevotella
Clindamycin for infection above the diaphragm and skin
Metronidazole or flagyl for infection below the diaphragm
Carbapenems and anti pseudo PFN for everything coverage
C. Diff metronidazole, or flagyl, or PO vanco

Question 12

Atypical

Answer 12

Mycoplasma, chlamydia, and legionella
Fluoroquinolones for especially for legionella, macrolides and doxycycline

Question 13

PNA

Answer 13

CAP- strep pneumonia, HI, or atypical like mycoplasma or listeria-fluoroquinolones, or a beta lactam with ceftriaxone with a macrolide or doxycycline
HAP- resistance like pseudomonas or MRSA-vanco, anti pseudomonas like zosyn or ceftazidime, cefepime, or aminoglycosides

Question 14

GI

Answer 14

Diver, appendicitis, pancreatitis, peritonitis, colitis, cholecystitis
Gram negative coverage
Ecoli, klebsiella, anaerobes
Carbapenems, antispeudomonal PCN, flagyl, and add with fluoroquinolone, ceftriaxone, or cefepime

Question 15

Skin

Answer 15

MSSA and strep A- diclox, cephalexin PO, nafcillin, or cefazolin for IV
MRSA/strep- bactrim, doxycycline, or clindamycin for PO, vanco for IV

Question 16

UTI

Answer 16

Pyelo, acute cystitis
Proteus, E. coli, klebsiella, enterobacter
Ceftriaxone, cipro, and ampicillin, bactrim, macrobid, fosfomycin
Complicated UTI- MRSA, pseudomonas, enterococcus-anti pseudo like zosyn, cefepime, aminoglycosides, vanco, amino PCN

Question 17

Bone and joint

Answer 17

Septic joint or osteomyelitis
MRSA-vanco
Pseudomonas-cefepime and ceftazidime

Question 18

CNS infections

Answer 18

Meningitis- community acquire- strep pneumonia, HI, neisseria-vanco, ceftriaxone, ampicillin for listeria and immunocompromised
Hospital acquired- MRSA VANCO, pseudomonas-cefepime

Question 19

Blood stream infection

Answer 19

Central line- MRSA vanco, gram negative zosyn
Septic shock- vanco for positive; zosyn or Merrem for negative, doxy or levaquin for atypical

Question 20

Neurotoxicity ADE

Answer 20

Seizures, encephalopathy, myoclonus, serotonin syndrome
PCN, cephalosporins, carbapenems at high doses, polymixins, linezolid

Question 21

Pancytopenia ADE

Answer 21

Hemolytic anemia- PCN
Suppress bone marrow- cephalosporins, bactrim, linezolid

Question 22

Respiratory ADE

Answer 22

Fibrosis-polymixins, nitrofurantoin

Question 23

Nephrotoxic ADE

Answer 23

PCN, cephalosporins, bactrim
Aminoglycosides, vanco

Question 24

MG Considerations

Answer 24

Fluoroquinolones, aminoglycosides, macrolides and clindamycin can exacerbate to crisis

Question 25

Teratogenic

Answer 25

Bactrim, fluoroquinolones, tetracycline

Question 26

Cardiac ADE

Answer 26

QT prolog or torsades Fluoroquinolones or macrolides

Question 27

Coumadin interaction

Answer 27

Fluoroquinolones, macrolides and bactrim need to monitor INR

Question 28

Hemolytic anemia ADE

Answer 28

Check haptoglobin and LDH PCN, cephalosporins, bactrim, fluoroquinolones, nitrofurantoin

Question 29

Phototoxicity ADE

Answer 29

Doxycycline or bactrim

Question 30

PCN ADE

Answer 30

Bronchoconstriction Rashes Hives Anaphylactic shock

Question 31

Cephalosporins ADE

Answer 31

Vitamin K deficiency Pancreatitis Biliary sludge AKI

Question 32

Vancomycin ADE

Answer 32

Phlebitis Red man syndrome SJS DRESS AKI

Question 33

Daptomycin ADE

Answer 33

Rhabdo check CK levels

Question 34

Macrolides ADE

Answer 34

GI dysfunction Arrhythmia Cholestasis Rash Eosinophilia

Question 35

Doxycycline ADE

Answer 35

Esophagitis Teeth discoloration

Question 36

Clindamycin ADE

Answer 36

C diff

Question 37

Linezolid ADE

Answer 37

Lactic acidosis

Question 38

Fluoroquinolones ADE

Answer 38

Hyper and hypoglycemia Tendon rupture

Question 39

Bactrim ADE

Answer 39

Hyper kalemia

Question 40

Antivirals

Answer 40

Flu-amantadine for flu A-ataxia and QT prolong Baloxavir for flu A, and r B but must be given in 48 hours Oseltamivir and zanamivir for flu A or B

Question 41

HSV

Answer 41

HSV- acyclovir or valcyclovir-AKI, pancytopenia VZV-acyclovir or valacyclovir-AKIc pancytopenia CMV-ganciclovir, cidofovir, or foscarnet-foscarnet can lower SX threshold and electrolytes imbalance

Question 42

Candidiasis

Answer 42

Oral-nystatin swish and spit, clotrimazole lozenge Esophagus-fluconazole or itraconazole Skin- nystatin powder Systemic- micafungin, fluconazole, amphotericin B Consult ophthalmology

Question 43

Aspergillus

Answer 43

Pneumonitis or tracheitis Voriconazole micafungin or ampho B

Question 44

Cryptococcus

Answer 44

Lung infection or meningitis Ampho B and flucytosine for 2 weeks then fluconazole

Question 45

Histoplasmosis

Answer 45

Bird or bat droppings Pneumonia, meningal involvement, skin or bone lesions Fluconazole or ampho B

Question 46

Antifungal ADE

Answer 46

Ampho B-renal function, phlebitis, bone marrow suppression or anemia, arrhythmia, QT prolong Micafungin-hepatotoxicity, skin flushing Azoles- hepatotoxicity, gynecomastia, hypokalemia, QT prolong, torsades, visual dysfunction, AI especially ketoconazole Warfarin- increase risk of bleeding

Question 48

Hemodynamic support for sepsis

Answer 48

Dobutamine-with or without vasopressin in the presence of cardiac dysfunction Steroids-refractory shock despite volume and vasopressors, hydrocortisone do not exceed 200mg/day