Anti-Infective II

Question 1

What do Tetraclycines cover?

Answer 1

many Gram +, Gram -, aerobic, anaerobic, spirochetes, mycoplasms, rickettsiae (RMSF), chlymydiae, protozoa

Question 2

What is the Tx for Lyme’s Dz?

Answer 2

Tetracycline - doxycycline

Question 3

Name 3 tetraclyclines. Which one is the most potent?

Answer 3

tetracycline
doxycycline - most potent
minocycline

Question 4

A patient asks you if its okay to take tetracycline at the same time as their MVI. What should you say?

Answer 4

Tetracyclines should not be combined with chelating agents like MVI, milk, iron, antacids.

Question 5

What patients should not be given tetracyclines? Why not?

Answer 5

pregnant women and children under 8

they bind to calcium - teeth yellowing and deformities

Question 6

Is it okay to take an expired tetracycline?

Answer 6

no, they can cause fanconi-like syndrome - renal damage

Question 7

What is the problem with someone taking tetracycline while on vacation at the beach?

Answer 7

it causes photosensitivity and can lead to 2nd and 2rd degree burns.

Question 8

What is minocycline used for (2)?

Answer 8

anti-inflammatory activity - acne, RA

PPX of Neisseria Meningitidis

Question 9

Name 4 fluoroquinolones. What is the common ending?

Answer 9

Ciprofloxacin
Levofloxacin 
Ofloxacin
Norfloxacin
"-floxacin"

Question 10

MOA of fluroquinolones?

Answer 10

bind to and inhibit bacterial DNA-gyrase so that bacteria cannot replicate

Question 11

What does Cipro cover? What was Cipro’s claim to fame?

Answer 11

Excellent gram -, crappy gram -, Chlamydia and anthrax.

PO coverage of pseudomonas aeruginosa (Gram -)

Question 12

Like the ________ Cipro has great gram - coverage, crappy gram + coverage and covers PA.

Answer 12

Extended spectrum PCNs

Question 13

_______ provides better gram + coverage than Cipro, but has limited PA coverage.

Answer 13

Ofloxacin

Question 14

_______ is the l-isomer of ofloxacin, has better tissue penetration lending it to _____ dosing, and very good coverage of __________ (CAP).

Answer 14

Levofloxacin
QD dosing
strep pneumo

Question 15

Norfloxacin is used most common to treat _______. It primarily concentrates in the _________, leading to low serum levels.

Answer 15

UTIs

Kidneys

Question 16

You must avoid _________ when on fluoroquinolones.

Answer 16

Chelating agents.

Question 17

Along with fluoroquinolones, what other Abx should you avoid chelating agents with?

Answer 17

tetracyclines

Question 18

Lexofloxacin and Ofloxacin are different from Cipro in what way?

Answer 18

They are used for community acquired infections - better gram + coverage.

Question 19

What patient populations should you not prescribe fluoroquinolones to?

Answer 19

Pregnant women and children under 18.

It can cause cartilage and soft tissue malformation.

Question 20

Marathon runner has a sharp pain in calf after completing a course of Abx. What drug could have caused an injury?

Answer 20

Fluoroquinolones - rupture tendons is a BBW

Question 21

T or F. Fluoroquinolones are cheap.

Answer 21

False - $$$

Question 22

What combo makes up Bactrim?

Answer 22

Trimethoprim/Sulfamethoxazole

Question 23

MOA for bactrim?

Answer 23

Inhibits the conversion of PABA–>Folinic Acid, thus inhibit DNA synthesis.

Question 24

What does bactrim cover? What does it not cover?

Answer 24

BROAD SPECTRUM - gram -/+

No coverage of anaerobes or PA

Question 25

What is bactrim commonly used for? What other Abx's is also used for this?

Answer 25

UTIs | Norfloxacin and AminoPCN

Question 26

HIV patient has CD4 count of

Answer 26

Bactrim | PPX for PCP (Pneumocystis carinii Pneumonia)

Question 27

What is a typical dose of Bactrim?

Answer 27

DS = SMX/TMP 800/160

Question 28

What is a consideration when dosing IV bactrim?

Answer 28

IV dosing always based on TMP content. | IV dose has short half life.

Question 29

What pregnancy category is Bactrim? Is it safe for children?

Answer 29

Preg Category C | Do not use in infants

Question 30

What is kernicterus and what drug should be avoided for fear of this condition?

Answer 30

Very high serum bilirubin levels that can lead to neurological damage and mental retardation in infants. Avoid Bactrim in infants

Question 31

Patient comes in with a severe rash that is now present in her mouth. She's been on a course of Abx for 2 days for a UTI. What is a possible Abx that could have caused this?

Answer 31

Rash --> SJS brought on by a sulfa medication | Bactrim - Trimethoprim/Sulfamethoxazole

Question 32

Name 2 Abx that patients should avoid the sun while taking.

Answer 32

Tetracyclines and Bactrim

Question 33

T or F. Bactrim is cheap.

Answer 33

T

Question 34

T or F. Bactrim is highly PPB.

Answer 34

T

Question 35

If someone is allergic to sulfa medication (severe rash), is it okay to prescribe Bactrim?

Answer 35

No - could develop into SJS.

Question 36

Patient is diagnosed with SJS, but has now developed a staph/strep infection. What should you prescribe?

Answer 36

Anti-staphylococcal PCN - Methicillin

Question 37

What two Abx should HIV patients take when CD4 counts drop?

Answer 37

Bactrim and Azithromycin

Question 38

What does Metronidazole (Flagyl) cover?

Answer 38

Anaerobes, some protozoa (water), trichmoniases

Question 39

Flagyl was formerly the DOC for what infection?

Answer 39

C. Diff

Question 40

Metronidazole as ________ PO absorption.

Answer 40

excellent

Question 41

What should patients avoid while taking metronidazole? What may happen when taking it?

Answer 41

alcohol - it inhibits aldehyde dehydrogenase so aceta aldehyde builds up causing a disulfiram rxn - alcohol isn't broken down fully and makes you sick if taken with alcohol.

Question 42

What is the DOC for community acquired MRSA? What lesion does this infection resemble?

Answer 42

Bactrim | Spider bite

Question 43

What are the two Abx that can cause a metallic taste?

Answer 43

Metronidazole and clarithromycin

Question 44

T or F. Bactrim and Metronidazole are cheap.

Answer 44

T

Question 45

What is the second generation metronidazole? What is it used for? Dose?

Answer 45

Tinidazole: long half life - singe dose | Amebiasis, giardiasis, trichomoniasis