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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
Q

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?

A
  1. Gentamicin
  2. Amikacin
  3. Tobramycin
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26
Q

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

A
  1. Imipenem
  2. Meropenem
  3. Ertapenem (only carbapenem that does not cover Pseudomonas)
  4. Doripenem
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27
Q

What (3) things do Carbapenems cover?

A
  1. Anaerobes (excellent coverage)
  2. Streptococci
  3. MSSA
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28
Q

What Antibiotic covers MRSA and is broadly active against Gram-Negative Bacilli (Rods)?

A

Tigecycline (weaker than other anti-MRSA antibiotics)

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29
Q

What Antibiotic is strongly active against MultiDrug-Resistant (MDR) Gram-Negative Bacilli (Rods)?

A

Polymyxin/Colistin

  • Used because of Renal Toxicity
  • Look for, “Failed therapy for Ventilator-Associated Pneumonia (VAP)” in case.
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30
Q

What is (1) Fluoroquinolone than can be used to treat Pneumonia?

A

Gemifloxacin

31
Q

What do Penicillins, Cephalosporins, Carbapenems, and the Monobactam (Aztreonam only) all have in common?

A

They are all Beta-Lactam antibiotics

32
Q

What is the MOA of all (4) Classes of Beta-Lactam antibiotics (penicillins, cephalosporins, carbapenems, monobactam[astreonam])?

A

They all inhibit the cell wall by binding the penicillin-binding protein (PBP).

33
Q

The following (4) antibiotics are in what category?:

  1. Clavulanate
  2. Sulbactam
  3. Tazobactam
  4. Avibactam
A

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
Q

What does combining Beta-Lactamase Inhibitors (i.e., Clavulanate, Sulbactam, Tazobactam) with Beta-Lactam antibiotics (Penicillins or Cephalosporins) do to their effectiveness?

A

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
Q

What does the following Penicillin/Beta-Lactamase Inhibitor drug combination cover?:

Ampicillin-Sulbactam

A

Staphylococcus (but Not MRSA)

  • Need the Sulbactam because Ampicillin alone does not cover Staph
36
Q

What do the following (2) Penicillin-BLI drug combinations cover?

  1. Piperacillin-Tazobactam
  2. Ticarcillin-Clavulanate
37
Q

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
A

Resistant Haemophilus infections:

​​Examples:

  • Resistant SINUSITIS
  • Resistant ORAL INFECTIONS (including ABSCESS)
  • Resistant OTITIS MEDIA
  • Resistant HUMAN or ANIMAL Bites
38
Q

What is an Adverse Effect of Imipenem?

39
Q

Which Species of Anaerobes are considered Gastrointestinal Anaerobes?

A

Bacteroides

40
Q

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)?
A
  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
Q

Which Species of Anaerobe is considered Respiratory Anaerobes?

A

Anaerobic Streptococcus (Peptostreptococci)

42
Q

What is the Best Drug to treat Respiratory Anaerobes (anaerobic strep)?

A

Clindamycin

43
Q

Which (5) Medications/Medication Classes have NO Anaerobic coverage?

A
  1. Aminoglycosides
  2. Aztreonam
  3. Fluoroquinolones
  4. Oxacillin/Nafcillin
  5. Cephalosporins (all except cefoxitin & cefotetan)

**AA FOC**

44
Q

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?

A

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
Q

Which (3) Antiviral Drugs are equal in efficacy for the Treatment of Herpes Simplex & Varicella Zoster?

A
  • Acyclovir
  • Valacyclovir
  • Famciclovir
46
Q

Which (3) Antiviral Drugs are essentially equal in efficacy for the Treatment of Cytomegalovirus (CMV), and also treat Herpes Simplex & Varicella Zoster?

A
  • Valganciclovir
  • Ganciclovir
  • Foscarnet
47
Q

Which Antiviral Drug used to treat CMV is considered the Best Long-Term therapy for CMV Retinitis?

A

Valganciclovir

48
Q

What are (2) Adverse Effects of both Valganciclovir & Ganciclovir?

A
  1. Neutropenia
  2. Bone Marrow Suppression
49
Q

What is (1) Adverse Effect of Foscarnet?

A
  1. Renal Toxicity
50
Q

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?

A
  1. Sofosbuvir-Ledipasvir
  2. Elbasvir-Grazoprevir
  3. Daclatasvir-Sofosbuvir
  4. Velpatasvir-Sofosbuvir
  5. Ombitasvir-Paritaprevir-Dasabuvir
  • -asvir
  • -evir
  • -uvir
51
Q

Which Antiviral Drug Combination will cover ALL the Genotypes of Hepatitis C?

A

Velpatasvir-Sofosbuvir

52
Q

Which (3) Antiviral Drugs in the class Neuraminidase Inhibitors are used to treat Influenza A & B?

A
  1. Oseltamivir
  2. Zanamivir
  3. Peramivir
53
Q

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?

54
Q

What are (6) Antiviral Drugs used to treat CHRONIC Hepatitis B?

A
  1. Adefovir
  2. Tenofovir
  3. Entecavir
  4. Lamivudine
  5. Interferon
  6. Telbivudine

“ATE LIT”

55
Q

Which (2) Fungal Agents does Fluconazole treat?

A
  1. Candida (except C. krusei & C. glabrata)
    • Oral Candidiasis
    • Vaginal Candidiasis
  2. Cryptococcus
56
Q

Which Antifungal Drug is largely Equal to Fluconazole but is More Difficult to use (therefore, rarely the best initial therapy for anything)?

A

Itraconazole

57
Q

Which Antifungal Drug is considered the Best against Aspergillus, also Covers Candida, and has an Adverse Effect of, “some vision disturbance?”

A

Voriconazole

58
Q

Which Antifungal Drug is Equivalent to Voriconazole?

A

Isavuconazole

59
Q

Which Fungal Agent does the Antifungal Drug Posaconazole cover?

A

Mucormycosis (Mucorales)

60
Q

What are (3) Antifungal Drugs in the Class Echinocandins?

A
  1. Caspofungin
  2. Anidulafungin
  3. Micafungin
61
Q

The Antifungal Drugs in the Class Echinocandins are excellent for treating what?

A

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
Q

Which Class of Antifungal Drugs does NOT cover Cryptococcus?

A

Echinocandins (Caspofungin, Anidulafungin, Micafungin)

63
Q

Explain why the Antifungal Drugs in the Class Echinocandins have no significant human toxicity/adverse effects?

A

They affect/inhibit the 1,3 Glucan synthesis step, which does NOT exist in humans.

64
Q

What are (2) Topical Antifungal Drugs used to treat Onychomycosis that are NOT as effective as Terbinafine for Nail fungal infections?

A
  1. Efinaconazole
  2. Tavaborole
65
Q

The Antifungal Drugs Fluconazole & Caspofungin can be used in the treatment of what?

A

Candidemia

66
Q

What Adverse Effect can ALL Antifungals ending in -azole cause?

A

Liver Toxicity (at High Dose)

67
Q

Which Antifungal Drug is Effective against ALL Candida, Cryptococcus, and Aspergillus?

A

Amphotericin

68
Q

Even though Amphotericin is effective against ALL Candida, Cryptococcus, and Aspergillus, what are the Last 2 Main Indications for this Antifungal Drug?

A
  1. Cryptococcus
  2. Mucormycosis
69
Q

Which (3) Antifungal Drugs are Superior to Amphotericin for treating Aspergillus?

A
  1. Voriconazole
  2. Isavuconazole
  3. Caspofungin
70
Q

Which Antifungal Drug is Superior to Amphotericin for treating Neutropenic Fever?

A

Caspofungin (echinocandin)

71
Q

Which Antifungal Drug is Equal to Amphotericin for efficacy in the treatment of Candida, but has far fewer Adverse Effects?

A

Fluconazole

72
Q

What are (4) Adverse Effects of the Antifungal Drug Amphotericin?

A
  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
Q

What are (5) Antibiotics Medications or Class of Medication considered SAFE in Pregnancy?

A
  1. Penicillins
  2. Cephalosporins
  3. Aztreonam
  4. Erythromycin
  5. Azithromycin

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