antibiotics and bugs

Question 1

treat ESCAPPM organisms?

ESCHAPPM is a mnemonic for the organisms with inducible beta-lactamase activity that is chromosomally mediated

Answer 1

carbapenems
fourth gen cephalosporins
ciprofloxacin or aminogycosides

Enterobacter
Serratia
Citrobacter
Hafnia
Aeromonas
Proteus
Providencia
Morganella Morganii

Question 2

Mechanism of rifampicin

Answer 2

inhibits bacterial DNA dependent RNA polymerase preventing transcription of DNA into mRNA

Question 3

Mechanism of isoniazid

Answer 3

mechanism of action: inhibits mycolic acid synthesis

Question 4

Pyrazinamide MOA

Answer 4

mechanism of action: converted by pyrazinamidase into pyrazinoic acid which in turn inhibits fatty acid synthase (FAS) I

Causes gout!!

Question 5

MOA of ethambutol

Answer 5

inhibits the enzyme arabinosyl transferase which polymerizes arabinose into arabinan

Question 6

MOA beta lactam (penicillins, cephalosporins, carbapenems, monobactams)

Answer 6

inhibit cell wall synthesis

Question 7

MOA glycopeptides eg vanc, teicoplanin

Answer 7

inhibit cell wall synthesis

Question 8

aminoglycoside MOA

Answer 8

inhibit protein synthesis (30S ribosomal subunit)

Question 9

tetracycline MOA

eg doxy

Answer 9

inhibit protein synthesis (30S ribosomal subunit)

Question 10

MOA chloramphenicol

Answer 10

inhibit protein synthesis (50S ribosomal subunit)

Question 11

MOA clindamycin

Answer 11

inhibit protein synthesis (50S ribosomal subunit)

Question 12

MOA macrolides

eg eryth, azith, roxith

Answer 12

inhibit protein synthesis (50S ribosomal subunit)

Question 13

MOA linezolid

Answer 13

inhibit protein synthesis (50S ribosomal subunit)

Question 14

MOA trimethoprim and sulphonamides

Answer 14

block folic acid synthesis

Question 15

MOA fluoroquinolones

Answer 15

DNA gyrase inhibition

Question 16

MOA Daptomycin

Answer 16

inhibit cell membrane function

Question 17

What is the main drawback of cephalosporins?

Answer 17

Do not cover enterococcus

Question 18

Which antibiotics are bactericidal? (5)

Answer 18

Beta lactams
Glycopeptides
Aminoglycosides
Fluoroquinolones
Colistin

Question 19

How are ESBLs encoded and transmitted?

Answer 19

Plasmids

Question 20

What are three examples of altered binding sites as a mechanism of resistance?

Answer 20

Rifampicin binding RNA polymerase
S pneumoniae and penicillin resistance
Methicillin resistance in S aureus and coag negative staph
Fluoroquinolone resistance by alteration of DNA gyrase

Question 21

Cephalosporins do not cover LAME organisms…

Answer 21

Listeria
Atypicals
MRSA (except ceftaroline 5th gen)
Enterococci

Question 22

Four notorious for C diff?

Answer 22

Amox
Amp
Clinda
Linco

Question 23

Indications for infection VZV in immunocompetent person?

Answer 23

Age over 50
severe rash
mod-sev pain
eye involvement or face

should initiate within 72 hours of the rash

Question 24

Melioid treatment?

Answer 24

First line is either ceftazidime or meropenem followed by BACTRIM

Imipinem second line

Question 25

Get actual tetnus?

Answer 25

IM tetanus immunoglobulin vent support muscle relaxants METRO NOT BENPEN

Question 26

Who gets a tetanus booster?

Answer 26

Uncertain history of immunisation three or more times? minor wounds- tetanus vax only all other- vax and Immunglob History of three or more doses of vax? less than 5 years ago- no worries 5-10 years ago and a minor wound- no worries 5-10 and a nasty wound or more than 10- vax

Question 27

Ertapenem is the carbapenem that does not cover///

Answer 27

pseudomonas

Question 28

What do carbapenems not cover

Answer 28

MRSA burkholderia cepacia not atypicals not stenotrophomonas maltophilia only ok for enterococcus causes SEIZURES

Question 29

WHy is nitrofurantoin creepy?

Answer 29

hepatitis haemolysis pulmonary toxicity polyneuropathy

Question 30

side effects linezolid

Answer 30

``` lactic acidosis!! serotonin syndrome bone marrow supression peripheral neuropathy optic neuropathy ```

Question 31

Which NNRTI avoid in suicidal history?

Answer 31

Efavirenz

Question 32

What will cover enterobacter and bacteroides for HITH?

Answer 32

Ertapenem Remember mero covers pseudo- erta does not Erta does not cover nocardia

Question 33

Why is there a rash in Dengue?

Answer 33

Immune complex formation

Question 34

If skin prick to penicillin positive, what is the chance you are also ceph positive sens?

Answer 34

2%

Question 35

What proportion of Pneumococcal meningitis patients have pneumonia

Answer 35

1/3