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2.1) My Cards > 1. MTB Step 3 - Antibiotics > Flashcards

1. MTB Step 3 - Antibiotics Flashcards

Cards Complete: Day 1: 4/19/19* Day 2: 4/22/19* Day 3: 4/29/19* Day 4: 5/19/19 Day 5: 6/18/19

1
Q

What (4) Locations of the body does Staphylococcus aureus most commonly infect?

A
  1. Bone
  2. Heart
  3. Joint
  4. Skin
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2
Q

What are (3) IntraVenous (IV) Antibiotics used to treat SENSITIVE Staphylococcus aureus (MSSA) infection?

A
  1. Nafcillin (IV)
  2. Oxacillin (IV)
  3. Cefazolin (IV)
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3
Q

What are (2) Oral (PO) Antibiotics used to treat SENSITIVE Staphylococcus aureus (MSSA) infection?

A
  1. Dicloxacillin (PO)
  2. Cephalexin (PO)
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4
Q

Which Generation do the (2) Cephalosporins used to treat MSSA (Cefazolin IV and Cephalexin PO) belong to?

A

First-generation Cephalosporins (Cefazolin, Cephalexin)

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5
Q

What are (6) first-line Antibiotics used to treat SEVERE Methicillin-Resistant Staphylococcus aureus(MRSA)?

A
  1. Vancomycin
  2. Linezolid
  3. Daptomycin
  4. Ceftaroline
  5. Tigecycline
  6. Telavancin
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6
Q

Oritavancin, Telavancin, and Dalbavancin are L_ong-Acting Antibiotics_ (equal to Vancomycin) for the treatment of what?

A

Methicillin-Resistant Staphylococcus aureus (MRSA)

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7
Q

Which (2) Antibiotics treat both MRSA and Vancomycin-Resistant Enterococci (VRE)?

A
  1. Linezolid
  2. Tedizolid
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8
Q

What are (3) first-line Antibiotics used to treat MINOR Methicillin-Resistant Staphylococcus aureus(MRSA)?

A
  1. Trimethoprim/Sulphamethoxazole (TMP/SMX)
  2. Clindamycin
  3. Doxycycline
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9
Q

What are (2) Adverse Effects of Linezolid that are NOT found with Tedizolid?

A
  1. Interferes with MAO Inhibitors
  2. Thrombocytopenia (Low Platelets)
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10
Q

Myopathy and Rising CPK are Adverse Effects of which Antibiotic?

A

Daptomycin

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11
Q

Which Class of Antibiotics are SAFE to use as a Substitute in a patient who gets a Rash in response to taking Penicillin?

A

Cephalosporins

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12
Q

Which (_2_) Antibiotics should be used as a Substitute in a patient who gets Anaphylaxis in response to taking Penicillin?

A
  1. Clindamycin
  2. Linezolid
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13
Q

What are (4) Antibiotics used as a Substitute to treat MINOR Staphylococcus aureus infections in patients Allergic to Penicillin (rash or anaphylaxis)?

A
  1. Azithromycin
  2. Clarithromycin
  3. Clindamycin
  4. TMP/SMX
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14
Q

The following defines what Antibiotic mechanism?:

Antibiotics that Inhibit bacterial cell wall synthesis by binding to the D-Ala-D-Ala terminus of the peptidoglycan in the growing cell wall.

A

Bactericidal:

Examples: Telavancin, Dalbavancin, and Oritavancin​

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15
Q

What Antibiotic has a MOA as a Folate Antagonist?

A

TMP/SMX

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16
Q

What is the MOA for the antibiotic Linezolid?

A

Inhibits Protein Synthesis

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17
Q

What is the MOA for All Cephalosporins?

A

They Inhibit cell wall growth by binding the penicillin-binding protein.

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18
Q

ALL of the same Antibiotics that are used to treat Staphylococcus Infections will also cover what other Types of Infections?

A

STREPTOCOCCUS Infections:

IV: Oxacillin/nafcillin, or cefazolin

Oral: Dicloxacillin or cephalexin

Minor infection: Trimethoprim/sulfamethoxazole (TMP/SMX), clindamycin, doxycycline

Severe infection: Vancomycin, Linezolid, Tedizolid, Daptomycin, Ceftaroline, Tigecycline, or Telavancin.

Long-Acting:Oritavancin, Telavancin, and Dalbavancin

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19
Q

In addition to All of the Antibiotics used to treat Staphylococcus Infections, what are (3) extra Antibiotics used to treat Streptococcus Infections?

A
  1. Penicillin
  2. Ampicillin
  3. Amoxicillin
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20
Q

Citrobacter**, **Enterobacter**, **Escherichia coli**, **Morganella**, **Pseudomonas, and Serratia are all in what category of Bacteria?

A

Gram-Negative Bacilli (Rods)

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21
Q

What are (2) Cephalosporins used to treat Infections from Gram-Negative Bacilli (Rods)?

A
  1. Cefepime
  2. Ceftazidime
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22
Q

What are (2) Penicillins used to treat Infections from Gram-Negative Bacilli (Rods) in addition to treating Streptococci and Anaerobes?

A
  1. Piperacillin
  2. Ticaracillin
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23
Q

What is (1) Monobactam used to treat Infections from Gram-Negative Bacilli (Rods)?

A
  1. Aztreonam
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24
Q

What are (4) Fluoroquinolones used to treat Infections from Gram-Negative Bacilli (Rods)?

A
  1. Ciprofloxacin
  2. Levofloxacin (excellent pneumococcal drug)
  3. Moxifloxacin (excellent pneumococcal drug)
  4. Gemifloxacin (excellent pneumococcal drug)
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25
What are (**3**) **Aminoglycosides** used to treat _Infections_ from ***Gram-Negative Bacilli (Rods)*** that also work synergistically with other agents to treat ***Staphylococcus*** and ***Enterococcus*** infections?
1. **Gentamicin** 2. **Amikacin** 3. **Tobramycin**
26
What are (**4**) **Carbapenems** used to treat _Infections_ from ***Gram-Negative Bacilli (Rods)***?
1. **Imipenem** 2. **Meropenem** 3. **Ertapenem** (only carbapenem that does not cover *Pseudomonas*) 4. **Doripenem**
27
What (**3**) things do **Carbapenems** cover?
1. **Anaerobes** (*excellent coverage*) 2. **Streptococci** 3. **MSSA**
28
What _Antibiotic_ covers ***MRSA*** and is broadly active against ***Gram-Negative Bacilli (Rods)***?
**Tigecycline** (*weaker than other anti-MRSA antibiotics*)
29
What **Antibiotic** is strongly active against _MultiDrug-Resistant_ (MDR) ***Gram-Negative Bacilli (Rods)***?
**Polymyxin/Colistin** * Used because of ***Renal Toxicity*** * Look for, "Failed therapy for ***Ventilator-Associated Pneumonia*** (***VAP***)" in case.
30
What is (**1**) **Fluoroquinolone** than can be used to _treat_ ***Pneumonia***?
**Gemifloxacin**
31
What do **Penicillins**, **Cephalosporins**, **Carbapenems**, and the Monobactam (**Aztreonam** *only*) all have in common?
**They are all Beta-Lactam antibiotics**
32
What is the _MOA_ of all (**4**) Classes of **Beta-Lactam antibiotics** (*penicillins, cephalosporins, carbapenems, monobactam[astreonam]*)?
**They all inhibit the cell wall by binding the penicillin-binding protein (PBP).**
33
The following (**4**) antibiotics are in what category?: 1. **Clavulanate** 2. **Sulbactam** 3. **Tazobactam** 4. **Avibactam**
**Beta-Lactamase Inhibitors** Confers a broader spectrum of antimicrobial activity to Penicillin ***Mech of Action:** BLIs are similar in structure to the Beta-Lactam ring of Penicillin. The enzyme Beta-Lactamase destroys the BLI instead of the Penicillin. This is why BLIs are known as "_SUICIDE INHIBITORS_".*
34
What does combining **Beta-Lactamase Inhibitors** (i.e., *Clavulanate, Sulbactam, Tazobactam*) with **Beta-Lactam** antibiotics (*Penicillins* or *Cephalosporins*) do to their effectiveness?
**Broadens their Spectrum to include coverage against:** * *Staphylococci (however _Not_ MRSA)* * Some *Gram-Negative Bacilli (Rods)* ***Examples:*** * *Amoxicillin-Clavulanate* * *Ampicillin-Sulbactam* * *Piperacillin-Tazobactam* * *Ticaracillin-Clavulanate* * *Ceftolozane-Tazobactam* * *Ceftazidime-Avibactam*
35
What does the following **Penicillin/Beta-Lactamase Inhibitor** drug combination cover?: **Ampicillin-Sulbactam**
***Staphylococcus (****but _Not_ MRSA****)*** * *Need the Sulbactam because Ampicillin alone does not cover Staph*
36
What do the following (**2**) **Penicillin-BLI** _drug combinations_ *cover*? 1. **Piperacillin-Tazobactam** 2. **Ticarcillin-Clavulanate**
**Anaerobes**
37
When added to **Ampicillin** and **Amoxicillin**, what _additional GRAM NEGATIVE coverage_ does adding the BLIs **Clavulanate** and **Sulbactam** ( HINT: *Resistant strain*) and what are (**4**) _Common Infections_ *caused* by this **Bacteria**? 1. *i.e., **Amoxicillin-Clavulanate*** 2. *i.e., **Ampicillin-Sulbactam***
**Resistant *Haemophilus* infections:** ***​​Examples:*** * *Resistant **SINUSITIS*** * *Resistant **ORAL INFECTIONS** (including **ABSCESS**)* * *Resistant **OTITIS MEDIA*** * *Resistant **HUMAN** _or_ **ANIMAL Bites***
38
What is an _Adverse Effect_ of **Imipenem**?
**Seizures**
39
Which _Species of Anaerobes_ are considered **Gastrointestinal Anaerobes**?
***Bacteroides***
40
Describe the: 1. the _BEST Medication_ for treating ***Gastrointestinal/Abdominal Anaerobes***. 2. the (**3**) _Medications_ that are _equal in efficacy_ to the Best Medication. 3. the _ONLY_ **Cephalosporins** to treat **Gastrointestinal Anaerobes** (*Bacteroides*)?
1. **Metronidazole** = Best Medication for abdominal anaerobes 2. **Carbapenems, Piperacillin, Ticarcillin** = equal in efficacy for abdominal anaerobes compared to Metronidazole 3. **Cefoxitin, Cefotetan** = the only cephalosporins that cover anaerobes, period
41
Which _Species of Anaerobe_ is considered **Respiratory Anaerobes**?
**Anaerobic *Streptococcus* (***Peptostreptococci***)**
42
What is the _Best Drug_ to treat **Respiratory Anaerobes** (*anaerobic strep*)?
**Clindamycin**
43
Which (**5**) _Medications/Medication Classes_ have *NO* **Anaerobic** coverage?
1. **Aminoglycosides** 2. **Aztreonam** 3. **Fluoroquinolones** 4. **Oxacillin/Nafcillin** 5. **Cephalosporins** (*all except cefoxitin & cefotetan*) ## Footnote ***\*\*AA FOC\*\****
44
***QUESTION:*** "A man is admitted for Endocarditis. His blood cultures grow *Staph.* *aureus*, and Vancomycin infusion is started while awaiting sensitivity testing. He develops Red Skin, particularly on the neck. What should you do?
**Slow the rate of Vancomycin infusion.** ***Vancomycin*** is associated with "Red Man Syndrome," which is Red, flushed skin from Histamine release. This happens from Rapid infusion of Vancomycin. There is no specific therapy, and you do not need to switch the medication. If the rate of infusion is slowed, the reaction will not occur. ***Telavancin*** does NOT cause Red Man Syndrome
45
Which (**3**) _Antiviral Drugs_ are equal in efficacy for the *Treatment* of ***Herpes Simplex*** & ***Varicella Zoster***?
* **Acyclovir** * **Valacyclovir** * **Famciclovir**
46
Which (**3**) _Antiviral Drugs_ are essentially equal in efficacy for the *Treatment* of ***Cytomegalovirus (CMV)***, and also treat ***Herpes Simplex*** & ***Varicella Zoster***?
* **Valganciclovir** * **Ganciclovir** * **Foscarnet**
47
Which _Antiviral Drug_ used to treat ***CMV*** is considered the *Best Long-Term therapy* for ***CMV Retinitis***?
**Valganciclovir**
48
What are (**2**) _Adverse Effects_ of both **Valganciclovir** & **Ganciclovir**?
1. **Neutropenia** 2. **Bone Marrow Suppression**
49
What is (**1**) _Adverse Effect_ of **Foscarnet**?
1. **Renal Toxicity**
50
**HEPATITIS** What are (**5**) oral _Antiviral Drug Combinations_ used to treat ***Chronic Hepatitis C*** infection that are ALL better than, have greater efficacy than, and have fewer adverse effects than **Interferon** and **Ribavirin**?
1. **Sofosbuvir-Ledipasvir** 2. **Elbasvir-Grazoprevir** 3. **Daclatasvir-Sofosbuvir** 4. **Velpatasvir-Sofosbuvir** 5. **Ombitasvir-Paritaprevir-Dasabuvir** * ***-asvir*** * ***-evir*** * ***-uvir***
51
Which _Antiviral Drug Combination_ will cover ALL the *Genotypes* of ***Hepatitis C***?
**Velpatasvir-Sofosbuvir**
52
Which (**3**) _Antiviral Drugs_ in the class *Neuraminidase Inhibitors* are used to treat ***Influenza A*** & ***B***?
1. **Oseltamivir** 2. **Zanamivir** 3. **Peramivir**
53
What _Antiviral Drug_, used to treat ***Hepatitis C*** *(in combination with* **Interferon**) & ***Respiratory Syncytial Virus (RSV)***, has an *Adverse Effect* of **Anemia**, and is _only used to treat_ ***HCV*** when the _other medications have failed_?
**Ribavirin**
54
What are (**6**) _Antiviral Drugs_ used to *treat **CHRONIC Hepatitis B***?
1. **Adefovir** 2. **Tenofovir** 3. **Entecavir** 4. **Lamivudine** 5. **Interferon** 6. **Telbivudine** ## Footnote ***"ATE LIT"***
55
Which (**2**) _Fungal Agents_ does **Fluconazole** *treat*?
1. ***Candida*** (except *C. krusei* & *C. glabrata*) * Oral Candidiasis * Vaginal Candidiasis 2. ***Cryptococcus***
56
Which _Antifungal Drug_ is largely *Equal* to **Fluconazole** but is More Difficult to use (*therefore, rarely the best initial therapy for anything*)?
**Itraconazole**
57
Which _Antifungal Drug_ is considered the *Best* against ***Aspergillus***, also *Covers **Candida***, and has an *Adverse Effect* of, "some vision disturbance?"
**Voriconazole**
58
Which _Antifungal Drug_ is *Equivalent* to **Voriconazole**?
**Isavuconazole**
59
Which _Fungal Agent_ does the *Antifungal Drug* **Posaconazole** cover?
**Mucormycosis** (*Mucorales*)
60
What are (**3**) _Antifungal Drugs_ in the *Class* **Echinocandins**?
1. **Caspo*_fungin_*** 2. **Anidula*_fungin_*** 3. **Mica*_fungin_***
61
The _Antifungal Drugs_ in the *Class* **Echinocandins** are *excellent* for treating what?
**Neutropenic Fever:** A ***single oral temperature*** of 38.3º C (***101º F***) _or_ a ***temperature of greater than*** 38.0º C ( ***100.4º F***) sustained ***for more than 1 hour*** in a patient with **neutropenia**. Better than *Amphotericin* for **neutropenia** & **fever** (less mortality).
62
Which _Class_ of **Antifungal Drugs** does *NOT* cover ***Cryptococcus***?
**Echinocandins** (*Caspofungin, Anidulafungin, Micafungin*)
63
Explain why the _Antifungal Drugs_ in the *Class* **Echinocandins** have _no significant_ human toxicity/_adverse effects_?
They affect/**inhibit** the **1,3 Glucan synthesis step**, which **does NOT exist in humans.**
64
What are (**2**) _*Topical* Antifungal Drugs_ used to treat ***Onychomycosis*** that are *NOT* as effective as **Terbinafine** for ***Nail fungal infections***?
1. **Efinaconazole** 2. **Tavaborole**
65
The _Antifungal Drugs_ **Fluconazole** & **Caspofungin** can be used in the *treatment* of what?
**Candidemia**
66
What _Adverse Effect_ can *ALL* **Antifungals** ending in *-azole* cause?
**Liver Toxicity** (*at High Dose*)
67
Which _Antifungal Drug_ is Effective against *ALL **Candida***, ***Cryptococcus***, and ***Aspergillus***?
**Amphotericin**
68
Even though **Amphotericin** is effective against ALL ***Candida***, ***Cryptococcus***, and ***Aspergillus***, what are the _Last 2 Main Indications_ for this *Antifungal Drug*?
1. **Cryptococcus** 2. **Mucormycosis**
69
Which (**3**) _Antifungal Drugs_ are *Superior* to **Amphotericin** for treating ***Aspergillus***?
1. **Voriconazole** 2. **Isavuconazole** 3. **Caspofungin**
70
Which _Antifungal Drug_ is Superior to **Amphotericin** for treating ***Neutropenic Fever***?
**Caspofungin** (*echinocandin*)
71
Which _Antifungal Drug_ is *Equal* to **Amphotericin** for efficacy in the treatment of ***Candida***, but has *far fewer* Adverse Effects?
**Fluconazole**
72
What are (**4**) _Adverse Effects_ of the *Antifungal Drug* **Amphotericin**?
1. **Renal Toxicity** (*elevated Creatinine*) * Amphotericin is directly toxic to the tubules. Distal tubule toxicity results in renal tubular acidosis. Distal RTA gives excess K and Mg loss and H ion retention. When renal toxicity is described, the answer is "Switch to Liposomal Amphotericin. 2. **Hypokalemia** 3. **Metabolic Acidosis** (*from Distal RTA*) 4. **Fever, Shakes, Chills**
73
What are (**5**) **Antibiotics Medications** or **Class of Medication** considered _SAFE_ in ***Pregnancy***?
1. **Penicillins** 2. **Cephalosporins** 3. **Aztreonam** 4. **Erythromycin** 5. **Azithromycin**

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