Stewardship and Antimicrobials Flashcards
(30 cards)
1.Findings consistent with an infection include:
A. Fever
B. Elevated WBC count
C. Elevated procalcitonin
D. Left shift
E. All of the above
E
- refers to development of resistance occurring in a patient’s nontargeted
flora that can cause secondary infections.
A. Collateral damage
B. Nonadherence
C. De-escalation
D. Pharmacodynamics
E. Source control
A
- Which one of the following is true regarding the initial empiric selection of antimicrobial agents?
A. Empirical selection of antimicrobial therapy should be related to severity of
illness.
B. Given several antimicrobial choices, the antimicrobial most associated with
collateral damage is preferred.
C. In most cases, double coverage is synergistic, prevents the emergence of
resistance, improves outcomes, and is superior to monotherapy.
D. Antimicrobial cost should be the primary factor when deciding on empiric
therapy
E. Consideration of previous antimicrobial exposure is not necessary when choosing
empiric therapy.
A
- All but which one of the following factors is important to consider when selecting an
antibiotic dosing regimen?
A. Source-specific location of infection
B. Minimum inhibitory concentration (MIC) of the likely pathogens
C. Route of administration
D. Antimicrobial agent cost
E. Metabolism and elimination of the antimicrobial
D
- Causes of antimicrobial failure include:
A. Inadequate diagnosis
B. Development of a new infection with a resistant organism
C. Poor source control
D. Nonadherence
E. All of the above
E
- Which statement regarding a Gram stain is not correct?
A. Performed to identify if bacteria are present
B. If bacteria are present, they will be stained by Gram stain
C. Gram stain can determine morphological characteristics of bacteria
D. Presence of WBCs indicates inflammation
E. Gram stain can evaluate if a specimen is poorly collected or contaminated
B
- describes the relationship between drug exposure and pharmacologic effect
of antibacterial activity or human toxicology.
A. Pharmacokinetics
B. Concentration-dependent activity
C. Pharmacodynamics
D. Minimum inhibitory concentration (MIC)
E. Drug distribution
C
- Which of the following statements is true regarding normal flora?
A. An endogenous infection arises from one’s own normal flora.
B. Normally sterile sites include the cerebrospinal fluid, blood, and urine.
C. The large intestine contains more anaerobes than aerobes.
D. Normal flora of the skin includes streptococcal species.
E. All of the above
E
- Which of the following statements regarding a patient history is false?
A. Previous antimicrobial use may predispose a patient to resistant pathogens.
B. The history should focus on making the diagnosis.
C. Recent health care utilization is a determinant in selecting antimicrobial therapy.
D. dConcomitant medications may interact with the selected antimicrobial agent.
E. All of the above are true.
E
- Virulence refers to:
A. Bacteria that cause disease as well as colonizing flora.
B. The presence of bacteria that are not causing disease.
C. The presence of bacteria that are causing disease.
D. The pathogenicity or disease severity produced by an organism.
E. Antimicrobial therapy targeting bacterial colonization may lead to the emergence
of resistant bacteria.
D
- A left shift refers to:
A. An increase in immature neutrophils or bands.
B. Leukopenia that may occur secondary to certain medications.
C. An elevated WBC count.
D. An elevated CRP.
E. The WBC count and differential.
A
- Which of the following factors may influence selection of the antimicrobial agent, dose, and monitoring?
A. Concomitant medications
B. Renal/hepatic function
C. Pregnancy
D. Drug allergies
E. All of the above
E
- Which statement regarding the minimum inhibitory concentration (MIC) is true?
A. MIC is the highest concentration of antimicrobial that inhibits visible bacterial
growth.
B. It accurately predicts the in vivo outcome.
C. MIC, along with the breakpoint, determines whether the organism is susceptible, intermediate, or resistant to a specific antimicrobial agent.
D. Breakpoint is the concentration of the antimicrobial that can be achieved in the
urine after a standard dose of that agent.
E. If the MIC is below the breakpoint, the organism is considered resistant to that
agent.
C
- Host factors that should be considered when selecting an antimicrobial regimen include:
A. Concomitant medications
B. Drug allergies
C. Age
D. Anatomical location of infection
E. All of the above
E
- Which one of the following monitoring parameters is not routinely performed?
A. Temperature
B. Reculture of specimens
C. Renal function
D. WBC count with differential
E. Follow-up on culture and susceptibility reports
B
- ____________ refers to the discontinuation of antibiotics that are providing a spectrum of activity greater than necessary to treat the infection.
A. Pharmacodynamics
B. De-escalation
C. Collateral damage
D. Source control
B
- Which microbe is part of the microbiome of the skin?
A. Escherichia coli
B. Enterococcus sp.
C. Staphylococcus epidermidis
D. Pseudomonas aeruginosa
C
- ___________ describes the relationship between drug exposure and pharmacologic effect of antibacterial activity or human toxicology.
A. Pharmacokinetics
B. Concentration-dependent activity
C. Pharmacodynamics
D. Minimum inhibitory concentration (MIC)
C
- A left shift refers to:
A. An increase in immature neutrophils or bands.
B. Leukopenia that may occur secondary to certain medications.
C. An elevated WBC count.
D. The WBC count and differential.
C
- Which MIC-breakpoint pair would be interpreted as susceptible?
A. Piperacillin/tazobactam MIC 4 mcg/mL—breakpoint 64 mcg/mL
B. Levofloxacin MIC 8 mcg/mL—breakpoint 4 mcg/mL
C. Cefazolin MIC 32 mcg/mL—breakpoint 32 mcg/mL
A
- Which antimicrobial class exhibits concentration-dependent activity?
A. Penicillins
B. Carbapenems
C. Aminoglycosides
D. Cephalosporins
C
- A 47-year-old woman is diagnosed with acute bacterial sinusitis is prescribed
amoxicillin/clavulanate 875 mg PO BID for 7 days. Her allergies include anaphylaxis to
penicillin. Her SCr is 0.6 mg/dL (53 µmol/L). She also takes amlodipine for hypertension, omeprazole for GERD, and levothyroxine for hypothyroidism. Why is this therapy inappropriate for this patient?
A. Drug-drug interactions
B. Inappropriate antibiotic for indication
C. Penicillin allergy
D. Inappropriate dosing interval based on renal function
C
- A 77-year-old woman presents to the ED with complaints of fatigue, chills, and a headache that began approximately 36 hours prior to admission. She also states that she had a temperature of 38.8C. The working diagnosis is pyelonephritis. The patient has a history of 3 to 5 symptomatic
urinary tract infections per year with the most recent being treated 2 months ago with trimethoprim/sulfamethoxazole. Her past medical history includes hypertension, atrial fibrillation, hypothyroidism, and osteoporosis. Current medications include metoprolol succinate 50 mg daily, warfarin 5 mg daily, levothyroxine 75 mcg daily, and alendronate 70 mg once weekly. The patient has no known drug allergies. Pertinent labs include WBC 16.5 × 10 3 /µL
(85% neutrophils, 7% bands, 7% lymphocytes, and 1% monocytes), SCr 1.7 mg/dL (150.3 µmol/L) (was 0.9 mg/dL [79.6 µmol/L] 3 months ago) with an estimated creatinine clearance of 30 mL/min.
Which antibiotic would be the most appropriate based on patient history?
A. Nitrofurantoin
B. Fosfomycin
C. Ceftriaxone
D. Trimethoprim/sulfamethoxazole
C
- A 77-year-old woman presents to the ED with complaints of fatigue, chills, and a headache that began approximately 36 hours prior to admission. She also states that she had a temperature of 38.8C. The working diagnosis is pyelonephritis. The patient has a history of 3 to 5 symptomatic
urinary tract infections per year with the most recent being treated 2 months ago with trimethoprim/sulfamethoxazole. Her past medical history includes hypertension, atrial fibrillation, hypothyroidism, and osteoporosis. Current medications include metoprolol succinate 50 mg daily, warfarin 5 mg daily, levothyroxine 75 mcg daily, and alendronate 70 mg once weekly. The patient has no known drug allergies. Pertinent labs include WBC 16.5 × 10 3 /µL
(85% neutrophils, 7% bands, 7% lymphocytes, and 1% monocytes), SCr 1.7 mg/dL (150.3 µmol/L) (was 0.9 mg/dL [79.6 µmol/L] 3 months ago) with an estimated creatinine clearance of 30 mL/min.
The physician orders levofloxacin. What dose of levofloxacin would be most appropriate in this patient?
A. 750 mg daily
B. 500 mg daily
C. 250 mg daily
D. 400 mg daily
C
