Exam #01 (ABO Review) Flashcards by mike ferenz

Which B-lactams are effective against MSSA gram+ bacteria?

A. Cefazolin
B. Cefepime
C. Ceftriaxone
D. Only A & B
E. All of the above

(D) Only A & B

Cefazolin (1st gen ceph) & Cefepime (4th gen ceph) have activity against MSSA.

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Which Abx is commonly used to treat strep throat and otitis media?

Amoxicillin

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What additional activity is added to Oxacillin and Nafcillin, different than natural PCN’s and aminopenicillins?

staphylococci (MSSA)

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Which class of Abx with activity against MSSA can cause phlebitis? What is a good alternative class of Abx with activity against MSSA but less chance of causing phlebitis?

Antistaphylococcal PCNs (oxacillin & nafcillin) can cause phlebitis.

1st generation cephalosporins are a good alternative
Cephalexin
Cefazolin

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Which of the following is NOT 2nd generation cephalosporin?

A. Cefuroxime
B. Cefoxitin
C. Cefotetan
D. Cefprozil
E. Cefotaxime

(E) Cefotaxime is a 3rd generation cephalosporin. The rest are 2nd generation cephalosporins

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Which generation(s) of cephalosporins is/are effective for CNS infections since they can cross the BBB?

3rd & 4th generation cephalosporins

3rd gen: Ceftriaxone, Ceftazidime, Cefotaxime, Cefdinir

4th gen: Cefepime

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Which Abx would be the best choice to treat an infection caused by Treponema pallidum?

PCN G (IV). Treponema pallidum is a spirochete that causes syphilis and PCN is the DOC for treating syphilis

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What are 2nd generation cephalosporins mostly indicated for?

Surgical prophylaxis. Specifically abdominal procedures since they cover enteric GNRs and anaerobes (only cefotetan & cefoxitin)

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Cefepime is the DOC for which indication?

febrile neutropenia

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Which Abx would be a poor choice in a patient with a Hx of seizures?

Imipenem

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Name (9) agents with activity against MRSA?

Ceftaroline
Aminoglycosides (in combination with a B-lactam)
Tetracyclines
TMP/SMX
Vancomycin
Clindamycin
Linezolid
Daptomycin
Streptogramins

Aminoglycosides: gentamycin, tobramycin, amakacin

Tetracyclines: doxycycline, minocycline, tigecycline

Streptogramins: Quinupristin/Dalfopristin

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Which class of Abx has the strongest association with Clostridium difficile associated diarrhea?

3rd generation cephalosporins: Ceftriaxone, Ceftazidime, Cefotaxime, Cefdinir

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Which (2) Abx are the DOC for Lyme disease?

Ceftriaxone

2. Doxycycline

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Which (2) Abx have activity against E. faecium?

Ceftaroline
Quinupristin/Dalfopristin

These agents do NOT have any activity against E. faecalis!!

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Which class of Abx has activity against Haemophilus influenza and Neisseria gonorrheae?

2nd generation cephalosporins: Cefuroxime, Cefprozil, Cefotetan, Cefoxitin

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Which of the following Abx would be the best choice for empiric therapy for nosocomial infection?

A. Penicillin G
B. Piperacillin/Tazobactam
C. Piperacillin
D. Cefepime
E. Both B & D

(E) Both B & D

Piperacillin/Tazobactam and Cefepime are good empiric choices for treating nosocomial infections.

Pip/Tazo covers multiple gram+, anaerobes, enteric GNRs, and pseudomonas

Piperacillin alone would be a POOR empiric choice for nosocomial infections b/c most GNRs (besides pseudomonas) are often resistant. However, combining it with a B-lactamase inhibitor, restores activity and makes it a good choice. Cefepime is just a beast by itself.

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Which (2) Abx would be the best empiric choice for mixed infections?

Pip/Tazo

2. Imipenem/Cilastatin

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Which (10) Abx have activity against MSSA?

Antistaphylococcal PCNs
1st generation cephalosporins
Cefepime
Ceftaroline
Carbapenems
Fluorquinolones (except Cipro)
Vancomycin
Linezolid
Daptomycin
Quinupristin/Dalfopristin

Antistaphylococcal PCNs: Oxacillin, Nafcillin

1st generation cephalosporins: Cefazolin, Cephalexin

Carbapenems: Imipenem/Cilastatin, Meropenem, Ertapenem

Fluoroquinolones: Levofloxacin, Moxifloxacin, Gemifloxacin

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Which (9) Abx have activity against pseudomonas infections?

Piperacillin +/- Tazo
Ceftazidime
Cefepime
Imipenem
Aztreonam
Levofloxacin
Ciprofloxacin
Aminoglycosides
Polymixins

Aminoglycosides: gentamycin, tobramycin, amakacin

Polymixins: Colistin, Polymixin B

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Which Abx would require monitoring of neutrophil count during therapy?

Piperacillin

Piperacillin can cause neutropenia

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Which class of Abx is notorious for inducing resistance among GNRs?

3rd generation cephalosporins: ceftriaxone, cefdinir, ceftazidime, cefotaxime

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Which class of Abx has the strongest association with C. diff associated diarrhea?

3rd generation cephalosporins: ceftriaxone, cefdinir, ceftazidime, cefotaxime

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Which Abx is different than others in its class b/c it lacks activity against gram+, but does have activity against pseudomonas?

Study These Flashcards

Ceftazidime

Which Abx has a side chain that is part of its structure that inhibits vitamin K production potentially leading to prolonged bleeding?

Study These Flashcards

Cefotetan

Which Abx is the DOC for febrile neutropenia?

Cefepime

Which Abx would be the best choice for a patient with a gram negative infection and B-lactam allergy?

Aztreonam

Which Abx's have activity against atypical bacteria?

1. Fluoroquinolones 2. Macrolides 3. Tetracyclines 4. Linezolid Fluoroquinolones: Cipro, Levo, Moxi, Gemifloxacin Macrolides: Clarithromycin, Azithromycin, Telithromycin Tetracyclines: doxycycline, minocycline, tigecycline

Administration of which Abx in neonates can lead to interaction with Ca++ forming crystals in lungs and kidneys?

Ceftriaxone - should be avoided in neonates

Which Abx useful in gram+ (including MRSA) infections has very good distribution to the lungs, but is inactivated by pulmonary surfactants rendering it ineffective?

Daptomycin

Which class of Abx MOA involves inhibiting DNA topoisomerase which leads to breaks in the DNA and cell death?

Fluoroquinolones

Which class of Abx is CI in pregnant women, can cause photosensitivity, and tendon rupture?

Fluoroquinolones

Which of the following Abx should not be co-administered with Ca, Fe, antacids, milk, or multivitamins b/c risk of chelating cations? ``` A. Levofloxacin B. Minocycline C. Doxycycline D. B & C Only E. All of the above ```

(E) All of the above All fluoroquinolones and tetracyclines chelate cations

True or False - ALL fluoroquinolones must be dose adjusted for renal dysfunction?

True - even though moxifloxacin is not excreted renally. The rest are excreted renally.

Which fluoroquinolone should NOT be used for UTI Tx?

Moxifloxacin b/c it's not excreted renally

What is the main spectra of activity for the Aminoglycosides? What if you combine it with a B-lactam or glycopeptide (vanco)?

gram(-) organisms (including pseudomonas) Combining it with a B-lactam adds gram(+) activity including MRSA

Which Abx would you most likely see dose dependent, irreversible ototoxicity? ``` A. Imipenem B. Fidaxomicin C. Minocycline D. Doxycycline E. Gentamycin ```

(E) Gentamycin Dose dependent, irreversible ototoxicity is a hallmark AE of the aminoglycoside Abx class.

Which Abx is exclusively used for treating C. diff infections?

Fidaxomicin

The older formulation of this Abx was associated with nephrotoxicity and colloquially called "Mississippi mud." However, the current formulation is clear with no toxic excipients

Vancomycin

Which Abx have AE of nephrotoxicity?

1. Aminoglycosides | 2. Polymyxins (Colistin)

Which Abx with activity against E. coli, Staph saprophyticus, and some enteric GNRs is CI in patients with CrCl of 50-60ml/min and carries an AE of pulmonary fibrosis with prolonged therapy

Nitrofurantoin

Which (2) Abx can be used to treat or prevent malaria from Plasmodium species?

1. Tetracyclines | 2. Clindamycin

Which (7) Abx/classes of Abx can be used for anaerobic infections (Clostridia, Bacteroides)?

1. B-lactam/B-lactamase inhibitor 2. 2nd gen ceph's (cefotetan & cefoxitin only) 3. Carbapenems 4. Moxifloxacin 5. Tigecycline 6. Metronidazole 7. Clindamycin

Which (2) classes of Abx are associated with the AE of QT prolongation?

1. Macrolides | 2. Fluoroquinolones

Which (7) Abx should you avoid if your patient has a GNR infection since these Abx have NO activity against GNRs?

1. Penicillin 2. Clindamycin 3. Vancomycin 4. Daptomycin 5. Metronidazole 6. Linezolid 7. Quinipristin/Dalfopristin

Which class of Abx is potent inhibitors of CYP enzymes (name the one exception)? Which class of Abx is potent inducers of CYP enzymes?

CYP inhibitor - Macrolides (except Azithromycin) CYP inducer - Rifamycins (Rifampin, Rifabutin, Rifaximin)

Which class of Abx that can be used for "weird diseases" has AE of photosensitivity, discoloration of developing teeth, and CI in pregnant women and children <8y/o?

Tetracylines

Which Abx useful against MRSA infections, can cause dose dependent bone marrow suppression and also has a significant drug interaction with warfarin leading to higher prothrombin times?

TMP-SMX

Which class of Abx that can cause taste disturbances and foamy urine are active against some vancomycin resistant isolates?

Lipoglycopeptides: | Telavancin, Oritavancin, Dalbavancin

True or False - Metronidazole has NO activity against aerobic bacteria?

True - Metronidazole must be activated to produce free radicals which damage bacterial DNA and lead to cell death. This activation can only be done by ANAEROBIC bacteria

Which Abx useful against anaerobic bacteria (both gram + & -) can leave a metallic taste in your mouth and can also increase INR while taking with warfarin?

Metronidazole

Which Abx is well distributed to the bladder and urine (but low distribution elsewhere) and therefore useful in treating UTI's can also cause pulmonary fibrosis from prolonged therapy?

Nitrofurantoin

Which Abx that has activity against MRSA and VRE carries AE of thrombocytopenia and serotonin syndrome (when given with SSRI b/c it's a weak MAOI)?

Linezolid

Which Abx that has activity against gram+ organisms (including MRSA and VRE) should you monitor CK b/c of potential AE of rhabdomyolisis?

Daptomycin

This prodrug useful against multi drug resistant gram- infections (including Carbapenem-resistant enterobacteriaceae CRE) has a common AE of nephrotoxicity?

Polymixins (Colistin prodrug -- Colistimethate is active metabolite)

Which Abx that produces orange-red secretions (urine, tears) during the course of therapy is the DOC for TB?

Rifampin

Which Abx is the DOC for mycobacterium avium complex (MAC)?

Rifabutin

Which Abx useful against E. faecium, MRSA, and VRE carries a common AE of fibromyalgia (occurs in 33-50% of all patients)?

Quinipristin/Dalfopristin

Exam #01 (ABO Review) Flashcards

(57 cards)