Antibiotics part 1

Question 1

Drugs of natural or synthetic origin that have the capacity to kill or to inhibit the growth of microorganisms.

Answer 1

Antibiotic

Question 2

True or false: Antibacterial is synonymous with antibiotic.

Answer 2

True

Question 3

General term for natural or synthetic compounds which at certain concentrations inhibit growth of, or kill, microorganisms. Collective term.

Answer 3

Antimicrobial

Question 4

Use of antimicrobials to prevent infection, like prior to surgery or dental procedures.

Answer 4

Prophylactic

Question 5

Initiation of treatment prior to determination of a firm diagnosis. Ex: Initiation of antibiotics for a patient based on symptoms alone.

Answer 5

Empiric

Question 6

Treatment directed at a specific pathogen or organism.

Answer 6

Definitive

Question 7

What are some examples of things that are virtually impenetrable barriers to antibiotics?

Answer 7

Biliary stones, fluid cysts, vegetations

Question 8

Agents that inhibit bacterial replication without killing the organism. Most inhibit protein synthesis

Answer 8

Bacteriostatic

Question 9

Drugs which cause death and disruption of the bacterial cell, including drugs that primarily act on the cell wall, cell membrane, or bacterial DNA.

Answer 9

Bacteriocidal.

Question 10

Lowest concentration of agent to inhibit growth. Used to determine whether the organism is considered susceptible to that particular antibiotic.

Answer 10

Minimum Inhibitory Concentration (MIC)

Question 11

True or false: MIC may differ with different sites of infection.

Answer 11

True

Question 12

True or false: The goal is to pick the antibiotic with the lowest MIC.

Answer 12

FALSE

Question 13

True or false: The goal is to prescribe the antibiotic with the most narrow spectrum based on type of infection and organism present.

Answer 13

True

Question 14

T > MIC

Answer 14

Time-dependent. Beta lactams, clindamycin

Question 15

Cmax/MIC

Answer 15

Concentration dependent. Aminoglycosides

Question 16

AUC/MIC

Answer 16

Vancomycin, tetracyclines, azithromycin.

Question 17

What are the 5 mechanisms of antimicrobial action?

Answer 17

1. Inhibit cell wall synthesis
2. Inhibit metabolite synthesis
3. Inhibit DNA replication
4. Inhibit RNA synthesis
5. Inhibit protein synthesis

Question 18

CAPES

Answer 18

Citrobacter, acinetobacter, pseudomonas, enterobacter, serratia

Question 19

HNPEK

Answer 19

H. influenzae, Neisseria, Proteus, E.coli, Klebsiella

Question 20

CAPES and HNPEK are what type of bacteria?

Answer 20

gram negative

Question 21

Inhibit bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs). Bactericidal.

Answer 21

Beta-Lactam Antibiotics

Question 22

GI upset or rash (short term), bone marrow suppression, interstitial nephritis (long term), seizures (high doses) are adverse reactions of what?

Answer 22

Beta-Lactam Antibiotics

Question 23

What are the classes of beta lactam antibiotics?

Answer 23

Penicillin, Beta-Lactamase Combinations, Cephalosporins

Question 24

Narrow spectrum of action, bactericidal. Susceptible to beta-lactamase (penicillinase). Rapidly excreted. Minimal concentrations attained in CSF.

Answer 24

Penicillin (PCN)

Question 25

Bactericidal but resists action of beta-lactamase. Broad-spectrum.

Answer 25

Beta-Lactamase Combinations.

Question 26

True or false: Beta-Lactamase Combinations have better coverage of Pseudomonas than penicillin.

Answer 26

False

Question 27

Synthetic. Gain more gram-negative coverage and lose gram positive coverage as you increase the generation.

Answer 27

Cephalosporins

Question 28

True or false: Cephalosporins cover enterococcus.

Answer 28

False. (add ampicillin if suspected).

Question 29

Which generation of cephalosporins covers HNPEK and CAPES?

Answer 29

4th generation

Question 30

3rd generation cephalosporin

Answer 30

Ceftriaxone

Question 31

Which agent has a precaution with calcium containing IV fluids?

Answer 31

Ceftriaxone

Question 32

True or false: Ceftriaxone is distributed in the CSF.

Answer 32

True

Question 33

Which agent should be avoided in patients with gallbladder, biliary tract, liver, or pancreatic disease?

Answer 33

Ceftriaxone

Question 34

5th generation cephalosporin that covers MRSA.

Answer 34

Ceftaroline.

Question 35

Reaction in <1 hour. IgE mediated hypersensitivity. Anaphylaxis, skin test can be performed to evaluate probability of reaction.

Answer 35

Type 1 Allergic Reaction

Question 36

What are the two common culprits of Type 1 allergic rxns?

Answer 36

Penicillin and Sulfonamide antibiotics

Question 37

True or false: A pt can be desensitized by administering small amounts of drug to stabilize IgE.

Answer 37

True

Question 38

True or false: A patient needs to be desensitized once daily for the drug they are receiving to prevent a reaction.

Answer 38

False: needs to be done EACH TIME they receive the drug.

Question 39

Reaction in >72 hours. Not IgE mediated, no role for skin testing. Maculopapular or morbilliform rash.

Answer 39

Late Hypersensitivity reactions (types II, III, and IV)

Question 40

IgG mediated hypersensitivity. Mismatched blood transfusion is an example.

Answer 40

Type II

Question 41

Immune complex-mediated hypersensitivity. SLE is an example

Answer 41

Type III

Question 42

Cell-mediated hypersensitivity. Contact dermatitis, MS, Type 1 DM are examples.

Answer 42

Type IV

Question 43

What percentage of patients with a penicillin allergy have a cross-sensitivity to cephalosporins?

Answer 43

3-7%

Question 44

What percentage of patients with a cephalosporin allergy have a cross-sensitivity to penicillin?

Answer 44

25%

Question 45

RIsk (decreases/increases) with increasing generation.

Answer 45

Decreases

Question 46

Which agent contains a beta-lactam side chain and is used for last line therapy? All are IV products, and high doses lead to seizures.

Answer 46

Carbapenems

Question 47

What are conditions for using carbapenems?

Answer 47

Long term antibiotic use with continued fever or history of ESBL-producing organisms or suspicion.

Question 48

Which agent is used to treat gram-negative infections with patients with Type 1 hypersensitivity to beta-lactams?

Answer 48

Monobactam

Question 49

Which agent from CAPES and HNPEK do monobactams not cover?

Answer 49

Acinetobacter