Antibiotics

Question 1

Drugs used for MRSA

Answer 1

Clindamycin
5th gen Cephalosphorins (Ceftaroline only)
Vancomycin*

Question 2

Patient with penicillin allergies (e.g. anaphylactic shock), what are the affected drug class to consider eliminating to be on the safe side?

Answer 2

Pencillin allergy, all pencillins not to be used if serious allergy,

together alongside penicillin you need to consider
- cephalosphorins
- carbapenems

only monobactam (another class of beta lactam) left to be used.

Question 3

Purpose of adding Oxapenams to the penicillin antibiotics?

Answer 3

main goal: oxapenams being beta-lactamase inhibitors enhance effectiveness of beta-lactam antibiotics

Prevent breakdown of beta-lactam rings by bacteria since penicillin becomes inactive

Question 4

A 27-year-old female runner was
injured in a long distance marathon.
She came to the emergency
department with pain and swelling
near the ankle. On examination,
there was small wound with a tender
swelling near the ankle joint. Further
tests revealed tendon rupture with
tendonitis setting in. What is the least likely antibiotics to be prescribed to this patient?

Answer 4

Fluoroquinolones (Ciprofloxacin, Moxifloxacin, Levofloxacin)

-black box warning of tendon ruptures and QTc prolongation

Question 5

Severe side effects of penicillin class to be monitored?

Answer 5

Serious allergic, Anaphylactic rxns, tgt with GI effects

minor effects –> hives/urticaria

Serious allergic rxns:
- Steven Johnson Syndrome
- Toxic epidermal necrolysis
-life-threatening anaphylaxis (features –> laryngeal edema, bronchoconstriction, hypotension, coined as “anaphylactic shock”)

for piperacillin –> thrombophlebitis to be careful of

Question 6

Side effects of floroquinolones to be monitored?

Answer 6

• GI effects (Diarrhoea, nausea, vomitting, dyspepsia)
• CNS Sx (headaches, insomnia, dizziness, agitations, rarely: hallucinations or suicidial ideations)
• Hypersensitivity
• QTc prolongation (Moxi >cipro, levo)
• Arthropathy, articular cartilage damage, joint swelling
• tendonitis and tendon ruptures (BLACK BOX)
• Alterations in blood glucose

Question 7

drugs used for skin rashes?

Answer 7

Antihistamines (2nd gen as supportive Tx):
-Loratadine
-Fexofanadine

Corticosteroids
- Betamethasone
- Mometasone

Question 8

drugs used for (decubitus) ulcers

Answer 8

• Piperacillin-Tazobactam (Penicillin)
• Ciprofloxacin (Floroquinolones)
• Clindamycin (Lincosamides)
• Vancomycin (Glycopeptide)

*keep ur vancomycin to the last

Question 9

Drugs used for cellulitis?

Answer 9

Clindamycin
Cephalexin (1st gen cephalosphorins)

Question 10

Serious side effects of Vancomycin?

Answer 10

Being a non beta-lactam;

Sx:
- thrombophlebitis, fevers, chills (10%)
- Red man syndrome (because of histamine release at high conc)–> slow infusion rate and give antihistamines
- Increased ototoxicity and nephrotoxicity when aminoglycoside given with vancomycin

Question 11

Example of a monobactam?

Answer 11

Aztreonam (its another class of drug in the beta lactam)

Question 12

Which generation antihistamine gives the drowsiness effect?

Answer 12

1st generation

Question 13

Which cephalosporins of all generations can be used for MRSA?

Answer 13

Only 5th generation. Ceftaroline

Question 14

Side effects of Clindamycin?

Answer 14

GI (diarrhoea, nausea, vomitting, constipation), headache, superinfections, pseudomembranous colitis, anaphylaxis, myopathy

Question 15

SAMPLE APPLICATION QUESTION:
Patient presents to the clinic with cellulitis (with all the Signs and Sx). Patient has a previous allergy to penicillins 1 year ago, displaying an anaphylactic shock. What drug do you prescribe for this patient?

Answer 15

Clindamycin.

Cephalexin is a first gen cephalosporin and is part of the drug considerations to eliminate when patient has a penicillin allergy.

Question 16

CONTINUATION TO SAMPLE QUESTION:

The same Patient presents to the clinic with cellulitis (with all the Signs and Sx). Patient has a previous allergy to penicillins 1 year ago, displaying an anaphylactic shock. He is discovered by the medical team that he has MRSA. What drug would you now use? Does it change from your previous answer?

Answer 16

No, still Clindamycin.

Clindamycin has actions against MRSA whereas cephalexin being a 1st gen cephalosporin has no actionable effects on MRSA. Additionally, patient is also allergic to penicillin class antibiotics.

Question 17

On the Stamford table of Spectrum of activity, what symbols on the table tells you the drug is useful and effective?

Answer 17

You should use those with “++ blue” or “+” but not those with “+- yellow”, “?”, “0” or those marked in red.

Question 18

Appropriate nursing teaching for patient with diarrhoea

Answer 18

Let them know it is normal but they must still finish the course.

Question 19

Drug class of Clindamycin?

Answer 19

Lincosamide. Protein synthesis inhibitor.

Question 20

Drug class of Moxifloxacin, Ciprofloxacin and Levofloxacin?

Answer 20

Fluoroquinolones. DNA Replication inhibitor.

Question 21

A patient was prescribed Piperacillin-Tazobactam. What drug class in general does this drug belong?

Answer 21

Penicillin (beta-lactams). It is also a cell-wall inhibitor.

Question 22

SAMPLE QUESTION:

Cephalexin was prescribed for a patient. He did not report for any allergies. What drug class does Cephalexin belong to?

Answer 22

Cephalosporins (Cef- and Ceph- drug class). Cephalexin belongs to the first generation Cephalosporins. It is part of the beta-lactam antibiotics. It is a cell wall inhibitor.

Question 23

Patient went in to the ED and the doctor decided to prescribe Vancomycin.

What drug class does Vancomycin belong to?

Answer 23

Glycopeptide. Inhibits transglycosylation, preventing polymerisation and further elongation and cross-linking of peptidoglycans.