Antimicrobial selection

Question 1

What parts of human body are sterile

Answer 1

CSF, blood, urine
usually lower respiratory tract

Question 2

colonization vs infection

Answer 2

colonization= bacteria NOT causing disease
infection= bacteria causing disease

Question 3

labs for infection

Answer 3

WBC w/ diff
CRP
ESR
procalcitonin

Question 4

what’s a left shift

Answer 4

elevated neutrophils
released to fight infection. AKA bandemia
WBC can be normal w/ left shift

Question 5

what lab tests are markers of clinical response

Answer 5

*Not for abx initiation/dx
ESR and CRP
procalcitonin can tell when abx can be safely d/c’d

Question 6

procalicitonin is produced in response to …

Answer 6

bacterial infection

Question 7

dosing strategy ex for maximizing efficacy of time-dependent abx like beta lactams

Answer 7

extending infusion time

Question 8

fluoroquinolones for acute infection guideline

Answer 8

avoid use in uncomplicated infection d/t increased risk of adverse effects

Question 9

STEP when choosing abx meaning

Answer 9

safety, tolerability, efficacy, price/preference

Question 10

why IV abx if hypotensive

Answer 10

decreased blood flow to GI tract can impact absorption

Question 11

antimicrobial associated with red man syndrome and not a risk of C diff

Answer 11

glycopeptides
vancomycin, teicoplanin, and ramoplanin; second-generation semi-synthetic glycopeptide antibiotics include oritavancin, dalbavancin, and telavancin.

Question 12

penicillins main SE

Answer 12

hypersensitivity, GI, interstitial nephritis, leukopenia/thrombocytopenia, Coomb’s anemia, C diff, electrolyte imbalance, seizure

Question 13

cephalosporins exs and main SE

Answer 13

cefazolin, cephalexin, cefuroxime, cefoxitin, ceftriaxone, ceftazidime, cefepime, ceftaroline

similar to PCN w/o seizure and WITH hepatic risk

hypersensitivity, GI, interstitial nephritis, leukopenia/thrombocytopenia, Coomb’s anemia, C diff, hepatitis

Question 14

what class is vancomycin & SE

Answer 14

glycopeptides
red man syndrome, renal dysfunction, WBC/platelet

Question 15

tetracycline ex and SE

Answer 15

lymecycline, methacycline, minocycline, rolitetracycline, doxycycline, tigecycline, ervacycline, sarecycline, and omadacycline

*GI, hepatic, photosensitivity, visual disturb, vertigo, C diff

**doxy for renal pts.

Question 16

macrolides ex and SE

Answer 16

zithromycin, clarithromycin, and erythromycin

GI, prolonged QT, hepatitis, ototoxicity, torsade de pointes, rash, myasthenia gravis

Question 17

clindamycin (a macrolide) SE

Answer 17

*GI, C diff, rash

Question 18

fluoroquinolones ex and SE

Answer 18

levofloxacin (Levaquin), ciprofloxacin (Cipro), ciprofloxacin extended-release tablets, moxifloxacin (Avelox), ofloxacin, gemifloxacin (Factive) and delafloxacin (Baxdela)

** GI, HA, photosensitivity, QT prolong, tendon rupture, neuropathy, seizure, stevens-johnson, C diff

Question 19

sulfonamides & trimethoprim SE

Answer 19

GI, hyperkalemia, bone marrow suppression, serum sickness, hepatitis, photosensitvity, stevens-johnson, pancreatitis, neuro/nephro tox

Question 20

metronidazole SE

Answer 20

GI, HA, metallic taste, dark urine, neuropathy, disulfiram rxn w/ ETOH, insomnia,

Question 21

most common agent for surgical prophylaxis

Answer 21

cephalosporin

Question 22

beta lactams ex

Answer 22

penicillins, cephalosporins and related compounds

Question 23

if allergy to penicillin should pt receive beta lactams

Answer 23

for IgE mediated rxn YES can be safely administered but NOT if non-IgE rxn like Stevens-johnson, toxic epidermal necrolysis, interstitial nephritis

Question 24

cross-reactivity cephalosporins/PCN

Answer 24

less than 1%
if PCN allergy, cephalosporins with dissimilar side chains, carbapenems, monobactams can be safely administered

Question 25

most common drug interactions with antimicrobials

Answer 25

warfarin, OCP, phenytoin, digoxin, multivalent cations (Ca, Mg, zinc), sucralfate

Question 26

what ABX need to be avoided in pregnancy

Answer 26

fluoroquinolones, tetracyclines, sulfamides

Question 27

ex of normal flora on skin, mouth, upper respiratory, intestines, stomach,

Answer 27

skin- staph au.
lower respiratory- sterile
upper respiratory- strep sp., strep pneumoniae, staph sp., neisseria sp
mouth- anaerobes, viridans strep
stomach- strep sp., lactobacillus
intestines- lactobacillus, strep sp., enterococcus, clostridium, pseudomonas,