ID I: BACKGROUND

Question 1

What antibiotic has a BBW for c diff?

Answer 1

clindamycin

Question 2

Small Vd (poor tissue penetration)

Renel elimination

Low intracellular concentration, not active vs atypical

Increase CL/distribution during sepsis

Poor-moderate bioavailability

Answer 2

HYDROPHILLIC AGENTS

beta-lactams

AG

glycopeptides

daptomycin

polymyxins

Question 3

What abx are lipophilic agents?

Answer 3

Quinolones

Macrolides

Rifampin

Linezolid

Tetracyclines

Question 4

What possible organisms?

Gram stain: purple

cocci pairs & chains:

Answer 4

strep pneumoniae

streptococcus spp (including strep pyogenes)

enterococcus spp (including VRE)

Question 5

AG + beta-lactams are commonly used in synergy treating what

Answer 5

gram positive infections (infective endocarditis)

Question 6

Which abx are hydrophilic agents?

Answer 6

beta-lactams

AG

glycopeptides

daptomycin

polymyxins

Question 7

Intra-abdominal organisms?

Answer 7

Enteric GNR (Proteus, E. coli, Klebsiella, Enterobacter) Enterococci/streptococci bacteroides species

Question 8

The preferred agent for MSSA soft tissue, bone and joint, endocarditis and bloodstream infections?

Answer 8

anti staphylococcal penicillins

Question 9

What drugs are concentration dependent (Cmax:MIC)

Answer 9

AG

Quinolones

Daptomycin

LARGE dose!!! High peak!! continues to kill after fallen below MIC

Question 10

gram stain provides what information?

Answer 10

quick, preliminary results (not an actual organism) so it will give a description – rod, gram -/+

Question 11

What possible organisms?

Gram stain: pink

cocci:

Answer 11

Neissera spp

Question 12

Skin soft tissue organisms?

Answer 12

APE pasturella +/- anaerobic GNR diabetes

staph aureus

strep pyogenes

staph epidermidis

pasturella multocida +/- anaerobic GNR (diabetes)

Question 13

HNPEK

Answer 13

haemophilus,

neisseria,

proteus,

e coli,

klebisella

Question 14

What possible organisms?

Gram stain: purple

anaerobes:

Answer 14

peptostreptococcus

Actinomyces spp

clostridium (clostridiodes)

Question 15

What drugs are time dependent (Time>MIC)

Answer 15

Beta lactams (penicillins, cephalosporins, carbapenems)

*want drug level >MIC for most of dosing interval

Question 16

What organisms are in the heart/endocarditis?

Answer 16

SESE + MRSA

Staphylococcus aureus (including MRSA)

Staphylococcus epidermidis

Streptococci

Enterococci

Question 17

Lower respiratory (hospital) organisms?

Answer 17

staph aureus (MRSA)

pseudomonas aurginosa

Enteric GNR (Proteus, E. coli, Klebsiella, Enterobacter)

Strep pneumoniae

Question 18

Mouth organisms?

Answer 18

Mouth flora - peptostreptococcus, actinomyces

Anaerobic GNR (Prevotella)

Viridans group streptococcu

Question 19

what is CRE?

Answer 19

carbapenem-resistant enterobacteriaceae

MDR gram negative (klebsiella, e coli)

tx: polymyxins

Question 20

Large Vd (good tissue penetration)

Hepatic metabolism

high intracellular concentrations (active against atypical)

CL/distribution is changed minimally in sepsis

Excellent bioavailability 1:1

Answer 20

LIPOPHILLIC AGENTS

Quinolones

Macrolides

Rifampin

Linezolid

Tetracyclines

Question 21

What possible organisms?

Gram stain: pink

curved or spiral shaped

Answer 21

H pylori

Campylobacter

Treponema spp

Borrelia spp

Leptospira spp

Question 22

DNA/RDNA inhibitors

Answer 22

Quinolones (DNA gyrase, topoisomerase IV)

Metronidazole, tinidazole

Rifampin

Question 23

What organisms are in the CNS/Meningitis?

Answer 23

SNL HG

S. pneumoniae

N. meningitis

H. influenzae

Group B streptococcus/E. coli (young)

Listeria (young/old)

Question 24

MOA: Cell membrane inhibitors

Answer 24

polymyxins

daptamycin

telavancin oritavancin

Question 25

What possible organisms? Gram stain: pink rods --\> colonize gut

Answer 25

Proteus mirabilis Escherichia coli Klebsiella spp Serratia spp Enterobacter cloacae Citrobacter spp

Question 26

Lower respiratory (community) organisms?

Answer 26

streptococcus pneumoniae Haemophilus influenzae Atypicals: legionella, mycoplasma Enteric GNR (Proteus, E. coli, Klebsiella, Enterobacter) -- alcoholic, IC

Question 27

thin cell wall take up the safranin counterstain pink or reddish

Answer 27

gram negative piNk

Question 28

What are the different types of antibiotic resistance?

Answer 28

intrinsic selection pressure (VRE) enzyme inactivation (ESBL, CRE)

Question 29

What organisms are in the upper respiratory?

Answer 29

SMHS Streptococcus. pyogenes Streptococcus. pneumoniae Haemophilus. influenzae Moraxella catarrhalis

Question 30

What are common resistant pathogens?

Answer 30

Kill Each And Every Strong Pathogen Klebsiella pneumoniae (ESBL, CRE) E coli (ESBL, CRE) Acinetobacter baumannii Enterococcus faecalis, Enterococcus faecium (VRE) S. aureus (MRSA) Pseudomonas aeruginosa

Question 31

What possible organisms? Gram stain: purple cocci clusters:

Answer 31

staphylococcus spp. (including MRSA, MSSA)

Question 32

What color do atypical stain?

Answer 32

they don't, they don't have a cell wall

Question 33

How are drugs that are concentration-dependent killing dosed?

Answer 33

less frequently, higher dose to maximize concentration above the MIC

Question 34

What is used to treat ESBL infections?

Answer 34

carbapenems or cephalosporin/beta-lactamase inhibitors

Question 35

MOA: cell wall inhibitors

Answer 35

BMV Beta-lactams [penicillins, cephalosporins, carbapenems] Monobactams Vancomycin [dalbavancin, telavancin, oritavancin]

Question 36

PEK

Answer 36

proteus e coli klebisella

Question 37

How are drugs that are time-dependent killing dosed?

Answer 37

more frequently, longer duration administration to maximize time above MIC

Question 38

Urinary tract organisms?

Answer 38

E. coli, Proteus, Klebsiella Staphylococcus saprophyticus streptocci enterocci

Question 39

What possible organisms? Gram stain: purple diplococci:

Answer 39

strep pneumoniae

Question 40

What possible organisms? Gram stain: purple Rods:

Answer 40

gram positive rods: listeria monocytogenes

Question 41

What possible organisms? Gram stain: did not stain well

Answer 41

ATYPICALS!!! \*think doxy Chlamydia spp legionella spp mycoplasma pneumoniae mycobacterium tuberculosis

Question 42

What possible organisms? Gram stain: pink Anaerobes:

Answer 42

Bacteroides fragilis Prevotella spp

Question 43

thick cell wall dark purple or bluish stain from the crystal violet stain

Answer 43

gram positive organisms Purple

Question 44

What possible organisms? Gram stain: pink rods --\> do not colonize in gut

Answer 44

pseudomonas aeruginosa haemophilus influenzae providencia spp

Question 45

MOA: folic acid synthesis inhibitors

Answer 45

STD Sulfonamides Trimethoprim Dapsone

Question 46

MOA: Protein synthesis inhibitors

Answer 46

MATCLQ AG Macrolides Tetracyclines Clindamycin Linezolid, tedizolid Quinupristin/Dalfopristin

Question 47

What should be considered when deciding empiric treatment?

Answer 47

local resistance patterns (antibiogram) antibiotic use guidelines likely organisms basked on location

Question 48

What possible organisms? Gram stain: pink coccibacilli:

Answer 48

Acinetobacter baumannii Bordetella pertussis Moraxella catarrhalis

Question 49

CAPES

Answer 49

Citrobacter Acinetobacter Providencia Enterobacter Serratia

Question 50

Bone & joint organisms?

Answer 50

staph aureus staph epidermis streptococci neiserra gonorrhoeae GNR (only in specific situations)