ID-I: Background and ABX by Drug Class

Question 1

What are the treatment guidelines for ID

Answer 1

IDSA, CDC

Question 2

Appearance of G+ stain

Answer 2

Thick cell wall and stain is dark purple or blue from crystal violet

Question 4

Appearance of G- stain

Answer 4

Thin cell wall and stain that takes up safranin (pink)

Question 5

G+ pairs and chains

Answer 5

Strep
Enterococcus

Question 6

G+ Rods

Answer 6

Listeria
Corynebacterium

Question 7

G+ Anaerobes

Answer 7

Peptostreptococcus
Propionibacterium
C. diff

Question 8

Atypical pathogens

Answer 8

Chlamydia
Legionella
Mycoplasma pneumoniae
Mycobacterium

Question 9

G- cocci

Answer 9

Neisseria

Question 10

G- rods enteric

Answer 10

Proteus
E coli
Klebsiella
Serratia
Enterobacter
Citrobacter

Question 10

G- rods not in gut

Answer 10

Pseudomonas
Kaemophilus
Providencia

Question 11

G- curved or spiral

Answer 11

H. pylori
Campylobacter
Treponema
Borrelia
Leptospira

Question 12

G- coccobacilli

Answer 12

Acinetobacter
Bordetella
Moraxella

Question 13

G- Anaerobes

Answer 13

Bacteroides
Provotella

Question 14

What is intrinsic resistance

Answer 14

The resistance is natural to organism (Stenotrophomonas)

Question 15

What is selection pressure?

Answer 15

Resistance occurs when ABX kill susceptible bacteria leaving behind more resistant strains to multiply

Question 16

What is acquired resistance?

Answer 16

Bacterial DNA containing resistant genes can be transferred between species or picked up from fragments

Question 17

Common resistant pathogens?

Answer 17

E coli (ESBL, CRE)
Staph aureus (MRSA)
Klebsiella pneumoniae (ESBL, CRE)
Acinetobacter
Pseudomonas
Enterococcus (VRE)

Question 18

Folic acid synthesis inhibitors

Answer 18

Sulfonamides
Trimethoprim
Dapsone

Question 19

Cell wall inhibitors

Answer 19

Beta lactase
Monobactams
Vancomycin, dalbavancin, telavancin, oritavancin

Question 20

Protein synthesis inhibitors

Answer 20

AG
Macorlides
Tetracyclines
Clindamycin
Linezolid, tedizolid

Question 21

Cell membrane inhibitors

Answer 21

Polymixins
Daptomycin
Telavancin
Oritavancin

Question 22

DNA/RNA inhibitors

Answer 22

Quinolones
Metronidazole, tinidazole
Rifampin

Question 23

Hydrophilic drugs

Answer 23

Beta-lactam
AG
Vanc
Daptomycin
Polymixins

Question 24

Lipophillic drugs

Answer 24

Quinolones Macrolides Rifampin Linezolid Tetracyclines

Question 25

Properties of hydrophilic drugs

Answer 25

1. Small Vd → less tissue penetration 2. Renally eliminated 3. Low intracellular concentrations → not good for atypical 4. Poor F → IV:PO is not 1:1

Question 26

Properties of lipophilic drugs

Answer 26

1. Large Vd → good tissue penetration 2. Hepatically metabolized 3. Higher intracellular concentrations → good for atypicals 4. Excellent F IV:PO is 1:1`

Question 27

Properties of concentration dependent

Answer 27

Cmax:MIC AG, quinolones, daptomycin Goal: high peak (↑ killing), low trough (↓ toxicity) Dosing: large dose, long interval

Question 28

Properties of exposure-dependent

Answer 28

AUC:MIC Vance, macrolides, tetracyclines, polymyxins Goal: exposure over time Dosing: Varies

Question 29

Properties of time-dependent

Answer 29

Time > MIC Beta-lactams Goal: maintain drug level >MIC for most dosing intervals Dosing: shorter dosing intervals, extended or continuous infusions

Question 30

BBW for Pen G benzathine

Answer 30

Not for IV use → cardio respiratory arrest

Question 31

ADRs of penicillins

Answer 31

Seizures due to accumulation, GI upset, diarrhea, rash (SJS/TEN), allergic reaction, hemolytic anemia

Question 32

What penicillin does not require renal adjustment

Answer 32

Antistaph

Question 33

How to administer naficillin

Answer 33

Is a vesicant, if extravasation occurs use cold packs and hyaluronidase injections

Question 34

How should IV ampicillin and unasyn be prepared

Answer 34

Diluted in NS

Question 35

First line for strep throat

Answer 35

Penicillin VK

Question 36

First line for acute otitis media? Dosing?

Answer 36

Amoxicillin Pediatric: 80-90 mg/kg/day Augmentin Pediatric: 90 mg /kg/day

Question 37

Drug of choice of infective endocarditis prophylaxis?

Answer 37

Amoxicillin 2 g PO once 30-60 min before procedure * Amoxicillin is used used due to oral flora coverage

Question 38

Indications for Pen G (Bicillin LA)

Answer 38

Syphillis

Question 39

How long is Zosyn extended infusions?

Answer 39

4 hrs

Question 40

What causes diarrhea in Augmentin?

Answer 40

Clavlanate

Question 41

Cephalosporin don't have coverage against what?

Answer 41

Enterococcus

Question 42

Why is Ceftriaxone CI in neonates?

Answer 42

Biliary slugging and kernicterus especially with calcium-containing IV products

Question 43

What are typ1 allergy

Answer 43

Swelling, angioedema, anaphylaxis

Question 44

What ABX cause disulfiram like reactions

Answer 44

Metronidazole and Cefotetan

Question 45

ADRs of cephalosporins

Answer 45

Seizures, GI upset, diarrhea, rash (SJS/TEN), allergic reactions, hemolytic anemia

Question 46

What cephalosporins require no renal adjustments

Answer 46

Ceftriaxone

Question 47

What cephalosporin comes in chewable tablets

Answer 47

Cefixime (3rd gen)

Question 48

Cephalosporins with Anaerobic coverage

Answer 48

Cefotetan and Cefoxitin

Question 49

Cephalosporins with Pseudomonas coverage

Answer 49

Ceftazidime and Cefepime

Question 50

What is not covered by carbapenems

Answer 50

Atypicals, MRSA, VRE, C diff, Steno

Question 51

What is the difference between ertapenem and other carbapenems in terms of coverage?

Answer 51

Meropenem and Imipenem/Cilastatin covers Acinetobcter, Pseudomonas, Enterococcus

Question 52

Ertapenem is only stable in what solution?

Answer 52

NS

Question 53

ADRs of carbapenems

Answer 53

Seizures: Imipenme/cilastatin > Ertapenem > Meropenem - failure to renally adjust, higher doses

Question 54

When is Aztreonam used?

Answer 54

Penicillin allergy CAPES and Pseudomonas

Question 55

What is not covered by Aztreonam

Answer 55

G+ and anaerobes

Question 56

Beta lactams that don't require renal adjustmnts

Answer 56

Ceftriaxone Antistaph

Question 57

What is the difference between traditional and extended AG dosing

Answer 57

Traditional: uses lower doses more frequently (normal real function) Extended: higher doses less frequently → less accumulation of drug, lower risk of nephrotox, and decreased cost

Question 58

Coverage of AG

Answer 58

G- and Pseudomonas G+ as synergy

Question 59

How do you dose AG

Answer 59

120% IBW): use AdjBW

Question 60

What is the dosing of traditional for AG

Answer 60

Tobra and Gent: 1-2.5mg/kg/dose - 1 is for G+ synergy - 2.5 is for G- infections Amikacin: 5-7.5 mg/kg/dose

Question 61

What is the extended dose for AG?

Answer 61

Tobra and gent: 4-7 mg/kg/dose (7 is most common)

Question 62

What are the peak targets of AG in trad dosing

Answer 62

Gent G+ synergy: 3-4 Gent G- and Tobra: 5-10 Amikacin: 20-30 mcg/mL

Question 63

What are the trough targets of AG in trad dosing

Answer 63

Gent G+ synergy: <1 Gent G- and Tobra: <2 Amikacin: <5 mcg/mL

Question 64

When should troughs and peaks be drawn for AGs

Answer 64

Trough: 30 min before 4th dose Peak: 30 min after 4th dose

Question 65

What is drawn for extended interval using of AG

Answer 65

Random between 6-14 hrs

Question 66

BBW of AGs

Answer 66

Nephro and ototoxicity Neuromuscular blockade Avoid with other neurotoxic drugs Fetal harm Caution in really impaired, older adults, and those taking nephrotoxic drugs

Question 67

MOA of FQ

Answer 67

Inhibit bacterial topoisomerase IV and DNA gyrase

Question 68

What are responsible FQ? why?

Answer 68

Levo and Moxi due to Strep pneumo coverage

Question 69

Pseudomonas FQ

Answer 69

Cipro and Levo

Question 70

What is good about Moxifloxacin coverage

Answer 70

Enhanced G+ and anaerobic coverage, but can't treat UTIs due to inadequate renal penetration

Question 71

FQ with MRSA coverage

Answer 71

Delafloxacin

Question 72

FQ that requires no renal adjustment

Answer 72

Moxifloxacin

Question 73

BBW of FQ

Answer 73

Tendon rupture Peripheral neuropathy CNS (seizures, caution with patient with CNS disorders) Terotogenic

Question 74

ADRs of FQ

Answer 74

QTc prolongation: Moxi > Levo > Cipro Hypoglycemia and hyper Psychiatric disturbances Photosensitivity

Question 75

Counseling of Cipro PO suspension

Answer 75

Shake before ingestion Due not put in NG or feeding tube due to oil-based suspension However, Cipro tablets can be crushed and mixed with water and given via feeding tube

Question 76

MOA of macrolides

Answer 76

Binds to 50S ribosomal hsubunit

Question 77

Coverage of macrolides

Answer 77

Atypicals, Strep pneumonia, Haemophilus, and Morxella

Question 78

Ci of Macrolides

Answer 78

Clarithro and Erythromycin should not be on lovastatin or simvastatin

Question 79

ADR of macrolides

Answer 79

QTc prolongation Clarithormycin: caution in CAD → ↑ mortality GI upset, taste perversion, skin reaction, ototoxicity Hepatotoxicity

Question 80

Dosing of a ZPak

Answer 80

500 mg on day 1, then 250 mg days 2-5

Question 81

MOA of tetracyclines

Answer 81

Reversibly bind to 30S ribosomal subunits

Question 82

Warning of tetracyclines

Answer 82

Children <8 Photosensitive Minocycline: DILE

Question 83

Tetracyclines that don't need renal adjustment

Answer 83

Doxy and Mino

Question 84

Counseling of tetracycline

Answer 84

IV:PO is 1:1 Take with 8oz of water Doxy: sit up for 30 minutes after Avoid antacids and polyvalent cations

Question 85

Coverage of tetracycline

Answer 85

Resp flora: H flu, Morexella, Atypicals MRSA, VRE

Question 86

MOA of Sulfonamides

Answer 86

SMX: inhibits DHA formation TMP: inhibits DHA reduction to THF → inhibiting folic acid pathway

Question 87

Coverage of Bactrim

Answer 87

MRSA HPEK Enterobacter Shigella, Steno, Salmonella Opportunistic (Nocardia, Pneumocystis, Toxoplasmosis)

Question 88

What is not covered by Bactrim

Answer 88

Pseudomonas, enterococci, atypicals, and anaerobes

Question 89

Describe dosing of Bactrim

Answer 89

Based on TMP component SMX:TMP 5:1

Question 90

CI of Bactrim

Answer 90

Sulfa allergy

Question 91

ADR of Bactrim

Answer 91

Skin reactions (SJS/TEN/TTP) Hemolytic anemia Photosensitivity Crystalluria Increased K

Question 92

Strength of SS and DS Bactrim

Answer 92

SS: 400/80 DS: 800/160

Question 93

DDI of Bactrim

Answer 93

Can ↑ INR if combined with warfarin

Question 94

What is first line of MRSA

Answer 94

Vanc

Question 95

When should an alternative be used for MRSA

Answer 95

Vanc MIC is ≥2

Question 96

Coverage of Vanc

Answer 96

G+ only

Question 97

How is Vanc dosed

Answer 97

Systemic infection: 15-20 mg/kg Q8-12H CrCl 20-49: Q24H CrCl <20: pulse dosing C diff: 125 mg PO QID

Question 98

ADR of Vanc

Answer 98

Ototoxicity, nephrotoxicity Vanc infusion reactions: do not infuse >1g/hr

Question 99

How to monitor vanc

Answer 99

AUC/MIC and SS trough should be drawn 30 min before 4th or 5th dose Serious infection: 15-20 mcg/mL or AUC 400-600 Other infection: 10-15

Question 100

BBW of lipoglycopeptides

Answer 100

Fetal risk Nephrotoxicity

Question 101

CI of lipoglycopeptides

Answer 101

Telavancin and Ortivance: Avoid IV UFH Ortivancin: avoid for 120 fr (5days) due to interference with aPPT (false elevation)

Question 102

ADR of lipoglycopeptides

Answer 102

Infusion reactions Ortivancin and telavancin: falsely elevated aPTT/PT/INR but doesn't ↑ bleeding risk Telvancin: Etc prolongation Dalvance: ↑ ALT

Question 103

Dosing of lipoglycpeptides

Answer 103

Oritavancin and Dalvance: 1 single doses

Question 104

ADR of Daptomycin

Answer 104

Myopathy and rhabdo (DC is CPK is >1000, hold statins) Falsely elevate PT/INR and ↑ CPK Monitor weekly

Question 105

Why is Cubicin not indicated for pneumonia

Answer 105

Inactivates by lung surfactant

Question 106

How is Cubicin prepared

Answer 106

Compatible with LR and NS

Question 107

CI of linezolid

Answer 107

MOAI within 2 week

Question 108

ADR and warning of linezolid

Answer 108

Myelosuppression (thrombocytopenia) Optic neuropathy >28 days Serotonin syndrome (Avoid tyramine foods or serotonin drugs) Hypoglycemia Monitor CBC weekly

Question 109

Dosing of linezolid

Answer 109

No renal adjustment IV:PO is 1:1 Do not shake suspension

Question 110

What is tigecycline

Answer 110

Broad spectrum: MRSA, VRE, G- bacteria, anaerobes, and atypicals No activity against: Pseudomonas, Proteus, Providncia

Question 111

BBW of tigecycline

Answer 111

Increased risk of death Don't use for blood stream infections du to lipophillicity Solution should be yellow-orange

Question 112

BBW of polymixins

Answer 112

Dose-dependent nephrotoxicity Neurotoxicity Respiratory paralysis from neuromuscular blockade

Question 113

Nephrotoxic drgs

Answer 113

Aminoglycosides Amp B Cisplatin Cyclosporine Loops NSAIDs Contrast dyes Tacrolimus Vanc

Question 114

Activity of clindamycin

Answer 114

MRSA and aerobes and most G+

Question 115

BBW of Clinda

Answer 115

C diff

Question 116

ADR and Dosing of Clinda

Answer 116

ADR: N/V/D D-test to confirm S. aureus resistance: flattened zone is positive Not renally adjusted

Question 117

Activity of metronidazole

Answer 117

Anaerobes and protozoal oganisms

Question 118

CI of Flagyl

Answer 118

Pregnant (1st trimester) Alcohol or PEG during or within 3 days of tx discontinuation

Question 119

ADR of Metronidzole

Answer 119

Metallic taste, peripheral neuropathy

Question 120

DDI of metronidzole

Answer 120

↑ INR with warfarin

Question 121

ADR of Lefamulin

Answer 121

QTc prolongation

Question 122

What is fidaxomicin

Answer 122

C. diff

Question 123

What is fosfomycin

Answer 123

Uncomplicated UTI

Question 124

CI of Nitrofurantoin

Answer 124

CrCl <60

Question 125

ADR of Nitrofurantoin

Answer 125

Hemolytic anemia GI upset (take with food) Brown urine

Question 126

Difference between Macrobid and Macrodantin

Answer 126

Macrobid: BID Macrodantin: QID

Question 127

ABX that can cause hemolytic anemia

Answer 127

Penicillin, cephalosporins, Bactrim, Nitrofurantoin

Question 128

ABX that should be rfrigerated

Answer 128

Pen VK Augmentin

Question 129

ABX where refrigeration is recmmended

Answer 129

Amoxicillin: improves taste Tamiflu: Improves shelf life

Question 130

Do not fridge ABX

Answer 130

Cefdinir Metronidazole Moxifloxacin Bactrim

Question 131

Non-renal adjusted ABX

Answer 131

Antistaph penicillins Azithromycin and erythomycin Ceftriaxone Clindamycin Doxycline Metronidazole Moxifloxacin Linezolid