Chapter 4 - Antimicrobials

Question 1

Excellent oral absorption (5)

Answer 1

Fluoro
Clinda
Bactrim
Doxy
Linezolid

Question 2

Pseudomonas ABx

Answer 2

Pip-tazo (zosyn), tic-clav
Ceftaz, Cefepime
Levo, Cipro
Carbapenem (not erta)
Aztreonam
Aminoglyc
Polymyxin B

Question 3

MRSA ABx (6)

Answer 3

Vanc, Daptomycin, Linezolid, Ceftaroline (IV)
Bactrim, Clinda, Tetracyclines, oral Linezo

Don’t use fluoro on its own for MRSA (resistance develops)

Question 4

Two bugs not covered by ertapenem but covered by other carbapenems

Answer 4

Pseudo, Entercocc

Question 5

Increased C Diff Risk

Answer 5

Clinda
Ceph
Fluoro
Carbapen

Less frequent: macrolide, pen, sulfa

Question 6

Why use liposomal AMP-B

Answer 6

Less nephrotoxicity

Question 7

When to definitely use bacteriocidal

Answer 7

Immunocompromised

Question 8

Route of administration of ABx for patients in shock

Answer 8

IV (erratic oral absorption)

Question 9

Penicillins: MOA

Answer 9

Cidal

Inhibit cell wall synthesis

Question 10

Spectrum of Natural and Amino Penicillins

Answer 10

(Penn G, V) (Amoxicillin, Ampicillin)

GPC, GNC, some GNR
Spirochetes, Actinomyces
Aminopenn include H Flu

Susceptible to B lactamase

Question 11

Spectrum of Anti-Staph Penn

Answer 11

(Oxacillin, Nafcillin, Dicloxacillin)

MSSA, Strep, Anaerobic GPC
No GN coverage

Question 12

Spectrum of Tic-Clav (Trimentin) and Zosyn

Answer 12

More gram negative, but Trimentin is less active against penicillin-resistant Strep

Zosyn best coverage of pens, even works against some B-lactamases

Question 13

First Gen Ceph

Answer 13

IV Cefazolin, PO Cephalexin

GPC (Staph/Strep)

Question 14

2 Gen Ceph

Answer 14

Cefuroxime (Zinacef), Cefoxitin (IV)
Ceftin, Cefprozil, Cefaclor, Loracarbef (PO)

More Gm neg (H Flu, Moraxella)
Not for enterobacter

Question 15

3 Gen Ceph

Answer 15

Ceftriaxone, Ceftazidime (IV)

Cefixime, Ceftidorin (PO)

Question 16

4 Gen Ceph

Answer 16

Cefepime

Includes Pseudo

Question 17

5 Gen Ceph

Answer 17

Ceftaroline

Excellent MRSA
Similar GN as 3rd Gen

Question 18

Penicillin Allergy: Skin testing, use Ceph?

Answer 18

10% have positive skin test
3.4% with + also react to cephalosporin

Do skin testing, if +, avoid/desense/graded
If no skin testing: If penn allergy is severe, avoid Ceph or do graded challenge/rapid desense

Question 19

Fluoroquinolone mechanism and coverage

Answer 19

Cidal
Inhibit DNA synthesis

GNR (Enterobacter, H Flu)
Gm + Resp (Neisseria, Moraxella)
Atypical Pneumo (legionella, mycoplasma, chlamydia)

Question 20

Special Cipro coverage

Answer 20

Broad GN (Pseudo)
Not good for Strep (so don’t use much for h/n infxn)

Question 21

Special Levo/Moxi/Gatifloxacin

Answer 21

Best Strep coverage

Levo also Pseudo

Question 22

Macrolides: Members, MOA, Spectrum

Answer 22

Static, INH RNA protein Synthesis

Erythro: GM + and -
Azithro/Clarithro: even broader, fewer GI AE

Question 23

Clindamycin

Answer 23

Static, binds 50S ribosome

Gm + (MRSA, Strep)
Anaerobes (esp oral)

Question 24

Symptoms of C Diff

Answer 24

Watery diarrhea
May be preceded by leukocytosis
Fever, bloody, Abd pain if severe

Question 25

Bactrim

Answer 25

Cidal, INH Folate synth

MRSA, Strep/Mor/H Flu, Enteric GNR

AE: GI, Rash (SJS), nephrotoxic

Question 26

Tetracyclines

Answer 26

Doxy, Mino, Tetra, Tiga
Static INH protein synth

Respiratory (S Pneumo/H Flu/Mycoplasma), Gm+/-
Tiga (IV) for GM-

Question 27

Antifungals

Answer 27

Flucon- Candida
Voricon- Asperg

Mica/Caspofungin- Invasive Candida

AMP B

Question 28

Bacteriocidal ABx

Answer 28

Pen, Ceph, Carba
Fluoro (INH gyrase)
Vanc (bind D-ala-D-ala)
Aminoglyc (30S)

Question 29

Bacteriostatic ABx

Answer 29

Macrolide (50S)
Clinda (50S)
Bactrim (Folate)
Tetracycline (protein synth)