Antimicrobials - CWI

Question 1

What does de-escalation mean?

Answer 1

Go from broad to more targeted therapy

Question 2

Does aztreonam cover Gram+ or Gram-? Which microbe is most important?

Answer 2

Gram-

Pseudomonas

Question 3

What is it called when you inhibit or kill and organism without damaging the host cells?

Answer 3

Selective toxicity

Question 4

What is the difference between bacteriostatic and bacteriocidal?

Answer 4

Bacteriostatic - drug reversibly impairs replication

Bactericidal - drug destroys organism

Question 5

What is the difference between concentration-dependent and concentration-independent?

Answer 5

Concentration-dependent - killing increases as concentration increases - one large dose
Concentration-independent - dose needs to be above MIC for as long as possible

Question 6

What are the two pain 1st generation cephlosporins?

Answer 6

Cefazolin

Cephalexin

Question 7

Which beta-lactam can be given when a person has a true penicillin allergy?

Answer 7

Axtreonam

Question 8

Which category do 1st generations typically work on best? Which two specifically?

Answer 8

Gram +
MSSA
Penicillin susceptible S. pneumoniae

Question 9

What is a general trend of all carbapenems?

Answer 9

Broad spectrum

Question 10

What is the only 4th generation cephalosporin?

Answer 10

Cefepime

Question 11

What is the main organism targeted by penicillinase resistant? Which strain specifically?

Answer 11

S. aureus, MSSA

Question 12

What do beta-lactamases do? How do we get around this?

Answer 12

Beta-lactamases bind to PBP, reducing affinity for antimicrobial agent
Give betalactamase inhibitors - inhibit beta-lactamases so drug can get through cell wall/membrane

Question 13

What are 4 penicillinase resistant antimicrobials?

Answer 13

Methicillin
Oxacillin
Nafcillin
Dicloxacillin

Question 14

What group does Cefoxitin mainly cover? Which two are only covered by cefoxitin?

Answer 14

Anaerobes

Baceroises and Clostridium

Question 15

What is the only monobactam?

Answer 15

Aztreonam

Question 16

What is MIC?

Answer 16

Minimum inhibitory concentration - lowest concentration of antimicrobial agent required to prevent visible growth of microorganism

Question 17

What are two types of natural penicillins?

Answer 17

Penicillin VK

Penicillin G

Question 18

Which carbapenem is in group 1? Whicha re in group 2 (MOD)?

Answer 18

Group 1 - ertapenem

Group 2 - meropenam, imipenem, doripenem

Question 19

What are two major AD for vancomysin?

Answer 19

Red-man Syndrome (release of histamine causes red rash on face and torso)
Nephrotoxicity/Ototoxicity

Question 20

What are the three main organisms targeted by vancomycin?

Answer 20

S. aureus (MSSA and MRSA)
Enterococcus
C. Diff

Question 21

What are two main 2nd generation cephlosporins?

Answer 21

Cefoxitin and Cefuroxime

Question 22

What are two aminopenicillins?

Answer 22

Amoxicillin

Ampicillin

Question 23

Is daptomycin in the same family as vanc? What is a contraindication? What must be monitored during use?

Answer 23

Pulmonary infections (inactivated by surfactant)
Monitor CPK during therapy

Question 24

Is colistin used often? What are two ADE?

Answer 24

No
Neuromuscular paralysis
Nephrotoxicity

Question 25

What is the main organism targeted by natural penicillins?

Answer 25

S. pyogenes - Group A Strptococcus

Question 26

How does Oritavancin differ in dose from Vancomyosin and Televancin? What is the half life?

Answer 26

1 large dose | Half-life = 245 hours

Question 27

What are two pain drugs in 3rd generation cephalosporins? What do each treat best?

Answer 27

Ceftriaxone - community aquired pneumonia | Ceftazidime - pseudamonas

Question 28

What is the only fifth generation? What specific microbe is it used against?

Answer 28

Ceftaroline | MRSA

Question 29

What two microbes does Colistin mainly work against?

Answer 29

Acinetobacter | Pseudomonas

Question 30

What are three betalactamases?

Answer 30

Clavulanate, Sulbactam, Tazobactam

Question 31

Is cefepime stable or unstable against beta-lactamases?

Answer 31

Stable

Question 32

What is the ADE for cefepime?

Answer 32

Delerium

Question 33

What are two main organisms targeted by amoxicillin and ampicillin?

Answer 33

``` Enterococcus faecalis Strep pneumoniae (high dose) ```

Question 34

What is the main ADE of aztreonam?

Answer 34

Nephtrotoxicity

Question 35

When is IV vanc used? When is oral?

Answer 35

IV - systemic infections | Oral - C. Diff

Question 36

What is the ADE of ceftriaxone?

Answer 36

Biliary sludging

Question 37

Which carbapenem has the highest risk of seizure?

Answer 37

Imipenem

Question 38

Is cefepime narrow or broad spectrum? What group is it used for typically?

Answer 38

Broad | Gram-

Question 39

What do beta-lactams bind to on the bacteria cell wall/membrane?

Answer 39

Penicillin Binding Protein (PBP)

Question 40

What are two unique ADE of penicillin VK and G?

Answer 40

Black hairy tongue | Hemolytic anemia

Question 41

Which beta-lactam/beta-lactamase inhibitor combination works against pseudomonas?

Answer 41

Piperacillin/Taxobactam

Question 42

Which 5 organisms are not covered by carbapenaems? Which additional 6th is not covered by ertapenem?

Answer 42

``` MRSA VRE C. Diff Stenotrophomonas Nocardia Pseudomonas - ertapenem only ```

Question 43

What are the three types of antimicrobial therapy used today? What do each target/do?

Answer 43

Empiric - educated guess Definitive/Targeted - known organism Prophylactic - ahead, just in case

Question 44

Does Televancin have the same coverage as vancomyosin? How is it given?

Answer 44

Yes | 1 large dose daily - concentration dependent

Question 45

How does dalbavancin differ in dose from Vanc, Televancin, and oritavancin?

Answer 45

1 1500mg dose or 1 1000 mg dose and 1 500mg dose 1 week later

Question 46

What are two unique ADE of Televancin?

Answer 46

Metallic tase | Foamy Urine

Question 47

What is an AD of penicillinase resistant?

Answer 47

Interstitial nephritis

Question 48

What other drugs effect may increase when taking 2nd and 3rd generation cephlosporins?

Answer 48

Warfarin

Question 49

What are general trends made about cephalospoin generations?

Answer 49

Lower - better gram + coverage | Higher - better gram - coverage