Antibiotics

Question 1

Most potent gram positive coverage of all PCN =
(Non/beta-lactamase) producing gram + ___, ___
Also ____.

Indications:

Answer 1

Natural penicillins: PCN VK, PCN G

Non-beta lactamase
COCCI (Staph, Strep, Enterococci)
ANAEROBES (Clostridium)

Meningococcus (although negative)

Strep pharyngitis
Oral/dental infections**
Syphilis**

Question 2

Only group of PCN’s effective vs beta-lactamase bugs on their own

(Narrow/broad) spectrum against ___.

Indications:

Answer 2

Penicillinase-resistant (“anti-staphylococcus”): Nafcillin, Dicloxacillin, Oxacillin

Narrow, Gram +, primarily vs beta-lactamase producing staphylococcus

Staph skin/soft tissue infection

Question 3

Amino-penicillins =
Gram (+/-) coverage
T/F: Active against beta-lactamase producing bugs.

Indications:

Answer 3

Amoxicillin, Ampicillin

Gram positive AND negative coverage
False. NOT for beta-lactamase. Active vs ENTEROCOCCUS

Indications:
UTIs in pregnancy
AOM
H. flu, E. coli, L. monocytogenes, GBS, Proteus, Salmonella

Question 4

Augmentin =
Unasyn =

Coverage:

Indication for each:

Answer 4

Amino-penicillins WITH beta-lactamase inhibitor:
Augmentin = amoxicillin + Clauvulanate
Unasyn = ampicillin + sulbactam

• Beta-lactamase (M. Catarrhalis, H. flu, E. coli, B. fragilis)
• Anaerobes

Augmentin: AOM, sinusitis, ABECB, Dental infections, bites
Unasyn: skin/soft tissue infections

Question 5

Broadest spectrum penicillin =

Reserved for ___

Answer 5

Piperacillin/Tazobactam (Zosyn)
Ticarcillin/Clavulanate (Timentin)

Suspected pseudomonal infection
E. coli, Proteus mirabilis, pseudomonas

Question 6

Abx that lowers seizure threshold

Answer 6

Carbapenems: Imipenem, Meropenem

Question 7

broadest spectrum of ALL abx

Answer 7

Carbapenems: Imipenem, Meropenem

Question 8

What generation of cephalosporin?

1. Ceftriaxone (Rocephin)
2. Cephalexin (Keflex)
3. Cefazolin (Ancef)
4. Cefepime (Maxipime)
5. Ceftaroline (Teflaro)
6. Cefaclor (Ceclor)
7. Cefuroxime
8. Cefoxitin (Mefoxin)

Answer 8

1. Ceftriaxone (Rocephin) : 3rd
2. Cephalexin (Keflex): 1st
3. Cefazolin (Ancef): 1st
4. Cefepime (Maxipime): 4th
5. Ceftaroline (Teflaro): 5th
6. Cefaclor (Ceclor): 2nd
7. Cefuroxime: 2nd
8. Cefoxitin (Mefoxin): 2nd

Increasing level of gram negative activity and loss of gram positive from 1st to 4th generation.

Question 9

Indications of cephalosporin:
1st gen:
3rd gen:
4th gen:
5th gen:

Answer 9

1st gen: skin, soft tissue infection (staph,strep), surgical prophylaxis

3rd gen: Meningitis**, Gonorrhea, CAP (GOOD CNS penetration)
Ceftazidime: coverage vs pseudomonas

4th gen: Pseudomonas

5th gen: BROADEST: Positive (MRSA), Negative

Question 10

Aztreonam =

Coverage:

Answer 10

Monobactam

Gram negative ONLY (including pseudomonas)

Question 11

Vancomycin coverage:

Mechanism of action:

Answer 11

Gram + only**, MRSA

MOA: inhibits phospholipids, peptidoglycans

Question 12

Bacitracin coverage:

Indication:

Answer 12

Gram +

Topical for wounds.
Nephrotoxic**

Question 13

Polymyxin coverage:

Indication:

Answer 13

Gram negative

Topical ophthalmic, otic
Nephrotoxic and neurotoxic**

Question 14

All of the following are cell wall synthesis inhibitors EXCEPT:
A. PCN
B. Macrolides
C. Cephalosporins
D. Carbapenems

Answer 14

B. Macrolides are protein synthesis inhibitors.

Question 15

Macrolides =

Answer 15

Erythromycin
Azithromycin
Clarithromycin

Question 16

CI of Macrolides

Answer 16

Patients on Niacin, Statins

Question 17

Best atypical coverage

Answer 17

Azithromycin

Mycoplasma, Chlamydia, Legionella

Question 18

Caution in patients taking warfarin, theophylline, carbamazepine, digoxin

Answer 18

Erythromycin d/t inhibit cytochrome p450, many drug-drug interactions

Question 19

SE of macrolides

Answer 19

GI

Especially erythromycin

Question 20

SE of tetracyclines

Answer 20

Photosensitivity*
Dental staining*
Hepatotoxicity*
GI disturbances

Do NOT use in <8 y/o

Question 21

Clindamycin coverage

Answer 21

Gram +

Most anaerobes above diaphragm

Question 22

MC cause of C. dif

Answer 22

Clindamycin

Question 23

Tetracyclines =

Answer 23

Doxycycline
Tetracycline
Minocycline

Question 24

Aminoglycosides =

Coverage:

SE:

Answer 24

Gentamicin, Tobramycin, Neomycin, Amikacin, Streptomycin

Gram NEGATIVE only

SE: Ototoxic, Nephrotoxic

Question 25

All of the following are protein synthesis inhibitors EXCEPT:
A. Macrolides
B. Chloramphenicol
C. Tetracycline
D. Fluoroquinolone
E. Aminoglycosides

Answer 25

D. Fluoroquinolones are DNA synthesis inhibitors

Question 26

Chloramphenicol
Coverage:
SE:

Answer 26

Broad spectrum, severe anaerobic infections, unresponsive
GOOD CSF penetration

Bone marrow suppression
Gray baby syndrome*

Question 27

Linezolid
Coverage:
MOA:

Answer 27

Gram POSITIVE ONLY. MRSA, Vancomycin resistent enterococcus, enterococcus faecium, faecalis

Protein synthesis inhibitor

Question 28

All of the following are fluoroquinolones EXCEPT:
A. Ciprofloxacin
B. Moxifloxacin
C. Gentamicin
D. LEvofloxacin

Answer 28

C. Gentamicin is a aminoglycoside

Question 29

CI in pregnancy

Answer 29

Fluoroquiinolones

Tetracyclines

Question 30

May exacerbate myasthenia gravis

Answer 30

Fluoroquinolones

Question 31

SE: Tendon rupture

Answer 31

Fluoroquinolones

Question 32

Red man’s syntrome

Answer 32

Vancomycin

Question 33

SE: prolonged QT

Answer 33

Macrolides

Fluoroquinolones

Question 34

Abx that may cause macopapular rash in pts w/ infectious mononucleosis

Answer 34

Ampicillin

Question 35

Tx of lung abscess

Answer 35

Clindamycin

Augmentin

Question 36

Considerations when taking tetracycline (3)

Answer 36

• Milk and aluminum-containing antacids: decrease absorption
• Warfarin: increase anticoagulant effect
• Oral contraceptives: decrease efficacy