CIS - Waller: Pneumonia, etc.

Question 1

Most likely lobar CAP? And most appropriate treatment?

Answer 1

strep pneumo

empiric guidelines for outpatient CAP: azithromycin or doxy (for a previously healthy patient not at risk for drug resistance)

Question 2

gram stain of mycoplasma?

Answer 2

atypical, no stain

Question 3

CURB-65 risk factors lead to what?

Answer 3

increased mortality

Confusion
Uremia BUN > 20
Resp rate > 30
low BP under 90/ 60

Age over 65

Question 4

When do we do sputum cultures?

Answer 4

usually in an in-patient setting; by the time we do it in an outpatient setting it’s usually been taken care of.

Question 5

when do we use clindamycin?

Answer 5

anaerobic infetions

Question 6

when do we use trimeth-sulfameth

Answer 6

opportunitic infections of the immunocompromised

Question 7

when do we use ceftazidime?

Answer 7

serious gram neg infections, and it is anti-pseudomonal

Question 8

Binds DNA gyrase preventing relaxation of DNA supercoils

Answer 8

fluoroquinolines

Question 9

Blocks protein synthesis by inhibiting translocation

Answer 9

macrolides

Question 10

Disrupts cell membrane structure

Answer 10

polymyxins

Question 11

Prevents initiation of protein synthesis

Answer 11

aminoglycosides

Question 12

Prevents the attachment of aminoacyl tRNA to acceptor site

Answer 12

tetracyclins

Question 13

Sputum gram stain shows abundant neutrophils and gram-positive diplococci.

Answer 13

strep pneumo.

Most narrow spectrum drug is penicillin G. Most narrow outpatient would be amoxicillin

Question 14

how is penicillin G administered?

Answer 14

IV

not good for outpatient setting

Question 15

penicillin resistant guys are often also resistant to?

Answer 15

macrolides, 1st and 2nd generation cephalosporin

Question 16

for drug resistant strep pneumo give

Answer 16

fluoroquinolones, 3rd gen ceph, vancomycin, linezolid

Question 17

Inpatient, Non-Intensive Care Unit Recommendations

Answer 17

Respiratory FQ IV or PO (levofloxacin, moxifloxacin)
-OR-
B-lactam IV (ceftriaxone, cefotaxime, or ampicillin preferred) PLUS macrolide IV (azithromycin)

Question 18

During antibiotic therapy, which of the following parameters is not routinely monitored?
Adverse effects
Chest X-ray
Fever
Oral intake
Respiratory rate

Answer 18

chest x-ray

Question 19

Which of the following antimicrobial regimens does not cover atypical pathogens?

Azithromycin
Ceftriaxone
Doxycycline
Levofloxacin plus ceftriaxone
Moxifloxacin

Answer 19

Ceftriaxone

give it with a fluoroquinolone or macrolide in inpatient settings

Question 20

Most likely gram negative bacilli VAP?

Answer 20

pseudomonas aeruginosa

Question 21

If there is high risk of MRSA what do you want to make sure is in the treatment?

Answer 21

Vancomycin

Question 22

Binds the bacterial 50S ribosomal subunit

Answer 22

macrolides

Question 23

Blocks attachment of aminoacyl-tRNA to the A site

Answer 23

tetracyclines

Question 24

Causes misreading of mRNA information

Answer 24

aminoglycosides

Question 25

Inhibits folate synthesis

Answer 25

trimeth/ sulfameth

Question 26

Inhibits mycolic acid synthesis

Answer 26

isoniazid

Question 27

what increases warfarin concentration?

Answer 27

trimethoprim sulfamethoxazole

Question 28

What is the purpose of tazobactam in the antibiotic combination piperacillin/tazobactam?

Answer 28

Inhibits inactivation of piperacillin by B-lactamase-producing bacteria

Question 29

beta lactam with anaerobic activity?

Answer 29

Ampicillin/ sulbactam

Question 30

a protein synthesis inhibitor with anaerobic activity

Answer 30

clindamycin

Question 31

protein synthesis inhibitor with aerobic activity

Answer 31

gentamicin, e.g.

Question 32

mechanism of -azoles

Answer 32

Inhibition of ergosterol synthesis

Question 33

linezolid side effect

Answer 33

myelosuprression

Question 34

unique side effect of voriconazole

Answer 34

visual disturbances: flashes of light

Question 35

persistent cough following sore throat viral infection, dx?

Answer 35

acute bronchitis

use codeine (cough suppressant) and no antimicrobials.

Question 36

when do we use antimicrobials in acute exacerbation of bronchitis?

Answer 36

shortness of breath
increased sputum volume OR
purulent sputum

Question 37

Isoniazid (INH) MOA

Answer 37

MOA: inhibits synthesis of mycolic acids

Question 38

when is streptomycin given for TB?

Answer 38

severe, life-threatening

It’s only given IV

Question 39

Ethambutol (EMB) MOA

Answer 39

MOA: disrupts synthesis of arabinoglycan
Inhibits mycobacterial arabinosyl transferases (encoded by embCAB operon)

ADRs:
Retrobulbar neuritis (loss of visual acuity, red-green color blindness)
Rash
Drug fever

Question 40

most concerning side effect of TB drugs?

Answer 40

hepatotoxicity

look out for elevated serum aminotransferase activity

worry about jaundice, vomiting, nausea, fatigue

Question 41

biggest TB drug cause of hepatotoxicity?

Answer 41

Pyrazidamide

Question 42

Pyrazinamide (PZA)

Answer 42

disrupts mycobacterial cell membrane synthesis and transport functions
Macrophage uptake, conversion to pyrazinoic acid (POA-)
Efflux pump to extracellular milieu
POA- protonated to POAH, reenters bacillus

ADRS: hepatotoxicity, GI upset, hyperururicemia (consider leaving it out with gout)

Question 43

Isoniazid and acetylation

Answer 43

metabolized via phase 2 acetylation

slow acetylators –> accumulation

fast acetylators –> lower concentrations of isoniazid

Question 44

what vitamin deficiency leads to peripheral neuropathy?

Answer 44

B6

Question 45

important considerations before choosing an anti-TB regimen for HIV patients?

Answer 45

interactions between anti-retroviral therapy and rifampin; Rifampin is a P450 inducer, thus will decrease concentrations of the antivirals

Question 46

Rifampin MOA

Answer 46

MOA: inhibits RNA synthesis

Binds B-subunit of DNA-dependent RNA polymerase (rpoB)