Clinical Questions

Question 1

Outpatient CAP

Answer 1

Healthy: Amoxil 1 g TID
- Doxycyline
- Macrolide (ZPak, Clarithromycin) is local Pneumo resistance is <25%

High Risk: Beta-lactam + Macrolide or Doxy
- Augmentin or cephalosporin (cefpodoxime, cefuroxime) + Resp. FQ (Moxi and Levo)

Question 2

Inpatient CAP

Answer 2

Non-severe (general unit): Beta-lactam (ampicillin/sulbactum, ceftriaxone, ceftaroline) + doxy or macrolide
- Resp FQ (Moxi, Levo) monotherapy

Severe (ICU):
- Beta-lactam + Macrolide
- Beta-lactam + FQ
- FQ + Azetreona

Question 3

HAP/VAP

Answer 3

Pseudomonas + MSSA: Cefipime, Zosyn, Levoquin

MRSA: Vanco or linezolid

Pseudomonas risk of MDR: Zosyn+Cipro+Vanc, Cefipime+Gent+Linezolid

Pseudomonas: Levo, Cipro, Azetreonam, Aminoglycoside, Zosyn, cefepime, ceftazidime, merrem

Question 4

INR Increase and Decrease

Answer 4

Increase: Bactrim, amiodarone, fluconazole, metronidazole
Decrease: Carbamazepine, phenobarbital, phenytoin, rifampin

CYP2C9

Question 5

INR goals

Answer 5

2-3: most indications
2.5-3.5: 2 mechanical heart valves, mechanical mitral valve, antiphos syndrome

Question 6

COunseling on warfarin

Answer 6

1. Limit eating foods high in vitamin K
2. Monitor for bleeding, bruising, skin necrosis
3. CI: pregnancy
4. Reduce things that increase bleeding NSAIDs, SSRI, SNRI (no INR changes)

Question 7

Angents that prolong QTc

Answer 7

1. Rhythm class (Ia, c, III)
2. Malarials, MAcrolides, FQ
3. SSRI, TCS, Mirtazipine, trazadone, venlafaxine
4. Antiemetics