Antibiotics (Final Exam-Spring Semester)

Question 1

For what pathogens would you want to use synergy (two abx together)?

Answer 1

Enterococcus endocarditis or bacteremia

Sepsis

Pseudomonal infections

Question 2

What is PAE and what drug is an example of this?

Answer 2

Post Antibiotic Effect - organism growth is suppressed for a period of time after drug concentration falls below MIC

Aminogylcosides –> why they are dosed once daily!

Question 3

What are the two types of antibiotic resistance?

Answer 3

Intrinsic and Acquired

Intrinsic: naturally occuring
Acquired: normally sensitive organism becomes resistant

Question 4

What is staphylococcus’ resistance pattern and what drugs will not treat it?

Answer 4

They produce beta-lactamase

Don’t use penicillins
Can use penicillinase-resistant PCN

Question 5

MRSA resistance pattern and what drugs cannot be used to tx?

Answer 5

Alterations in penicillin binding protein

Can’t use any penicillins, cephalosporins, some fluroquinolones

Question 6

Strep resistance pattern and what drugs cannot be used to tx?

Answer 6

Alterations in binding sites

Penicillins and macrolides

Question 7

Enterococcus resistance pattern and what drugs cannot be used to tx?

Answer 7

Alterations in target site

Vancomycin

Question 8

Pseudomonas resistance patterna nd what drugs cannot be used to tx?

Answer 8

Reduced permeability and Beta lactamase production (which is not inhibited by b-lactamase inhibitors)

PCN, cephalosporin, carbepenems, aminoglycosides, fluroquinolones

Question 9

Advantages of oral administration of abx?

Answer 9

Dec. cost
Patient's prefer it
Reduce exposure to pathogens via IV site
Increases pt motility
Potential for early discharge
Decreases personnel time

Question 10

MOA of beta lactams

Answer 10

Bind to penicillin binding proteins and inhibit cell wall synthesis –> cell death

Question 11

What are the 4 penicillins?

Answer 11

1. Natural penicillins
2. Aminopenicillins
3. Penicillinase Resistant Penicillins
4. Extended spectrum penicillins

Question 12

Cephalexin and Cefazolin are what generation cephalosporins?

Answer 12

1st generation

Question 13

Cefuroxime and Cefoxitin are what generation cephalosporins?

Answer 13

2nd generation

Question 14

Cefpodoxime and ceftriaxone are what generation cephalosporins?

Answer 14

3rd generation

Question 15

Cefepime is what generation cephalosporin?

Answer 15

4th generation

Question 16

Ceftaroline is what generation cephalosporin?

Answer 16

Newer generation

Question 17

You are giving penicillins to a patient. What drug interactions must you worry about?

Answer 17

Probenicid

It decreases renal tubular secretion of PCN causing inc. serum levels

Question 18

What should you warn a patient of when prescribing a 2nd generation penicillin?

Answer 18

GI upset or diarrhea…especially if giving amox/clavulanate

Question 19

Name the types of antibiotics that work to inhibit penicillin binding protein to inhibit cell wall synthesis and therefore promote cell death

Answer 19

Penicillins
Cephalosporins
Monobactams (Aztreonam)
Carbapenems

Question 20

If a patient is allergic to PCN (a true allergic reaction) then what antibiotics should be avoided?

Answer 20

Penicillin
Cephalosporins
Carbapenems

Question 21

You are treating a patient with vancomycin IV. Their labs come back and the culture shows vancomycin resistant enterococci. Would you switch this patient to a different antibiotic? If so, which one?

Answer 21

Daptomycin

Question 22

What are the two abx that can be used to tx VRSA?

Answer 22

Newer gen. cephalosporin –> ceftaroline (IV)

Daptomycin

Question 23

Your patient shows symptoms consistent w/ cellulitis. What tx do you initially give?

Answer 23

Penicillinase resistant PCN

• Docloxacillin
• Oxacillin (IV)
• Nafcillin (IV)

Question 24

A patient comes to the ER with community acquired pneumonia and also states that they stop breathing when given penicillin. What is a good drug choice to treat this patient?

Answer 24

Macrolide…I would use azithromycin

Question 25

Which abx bind to the 30S ribosomal subunit and therefore inhibit protein synthesis leading to cell death?

Answer 25

Tetracyclines

Aminoglycosides

Question 26

Which abx bind to the 50S ribosomal subunit and therefore inhibit protein synthesis leading to cell death?

Answer 26

Macrolides

Clindamycin

Question 27

What is the first line tx for CA-MRSA?

Answer 27

Sulfamethoxazole/Trimethoprom (Bactrim)

Question 28

What are some options in treating uncomplicated UTIs

Answer 28

Bactrim
Nitrofurantoin
Fluoroquinolone (Cipro, Levo, Oflo, Norf,) …..NOT Moxifloxacin

Question 29

What are some options in treating complicated UTIs

Answer 29

Bactrim

Fluoroquinolones (Ciprofloxacin, Ofloxacin, Norfloxacin, Levofloxacin)

Question 30

ED is a 68 year old man who presents to your pharmacy with a prescription for azithromycin for community acquired pneumonia. He tells you that he currently takes lisinopril because “his kidneys were starting to not work as well”. He also takes warfarin for his atrial fibrillation. Is azithromycin an appropriate treatment option in this patient?

Answer 30

Yes, azithromycin is appropriate

However, this pt will need to be closely monitored d/t his warfarin.
Azithromycin doesn’t need to be renally adjusted

Consider adding beta-lactam d/t his renal dysfunction (amoxicillin or amoxicillin-clavulanate)