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P&T ID > Exam #01 (ABO Review) > Flashcards

Exam #01 (ABO Review) Flashcards

0
Q

Which B-lactams are effective against MSSA gram+ bacteria?

A. Cefazolin
B. Cefepime
C. Ceftriaxone
D. Only A & B
E. All of the above
A

(D) Only A & B

Cefazolin (1st gen ceph) & Cefepime (4th gen ceph) have activity against MSSA.

(C) Ceftriaxone (3rd gen ceph) has activity against streptococci and enteric GNRs, but NOT MSSA

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1
Q

Which Abx is commonly used to treat strep throat and otitis media?

A

Amoxicillin

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2
Q

What additional activity is added to Oxacillin and Nafcillin, different than natural PCN’s and aminopenicillins?

A

staphylococci (MSSA)

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3
Q

Which class of Abx with activity against MSSA can cause phlebitis? What is a good alternative class of Abx with activity against MSSA but less chance of causing phlebitis?

A

Antistaphylococcal PCNs (oxacillin & nafcillin) can cause phlebitis.

1st generation cephalosporins are a good alternative
Cephalexin
Cefazolin

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4
Q

Which of the following is NOT 2nd generation cephalosporin?

A. Cefuroxime
B. Cefoxitin
C. Cefotetan
D. Cefprozil
E. Cefotaxime
A

(E) Cefotaxime is a 3rd generation cephalosporin. The rest are 2nd generation cephalosporins

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5
Q

Which generation(s) of cephalosporins is/are effective for CNS infections since they can cross the BBB?

A

3rd & 4th generation cephalosporins

3rd gen: Ceftriaxone, Ceftazidime, Cefotaxime, Cefdinir

4th gen: Cefepime

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6
Q

Which Abx would be the best choice to treat an infection caused by Treponema pallidum?

A

PCN G (IV). Treponema pallidum is a spirochete that causes syphilis and PCN is the DOC for treating syphilis

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8
Q

What are 2nd generation cephalosporins mostly indicated for?

A

Surgical prophylaxis. Specifically abdominal procedures since they cover enteric GNRs and anaerobes (only cefotetan & cefoxitin)

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9
Q

Cefepime is the DOC for which indication?

A

febrile neutropenia

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10
Q

Which Abx would be a poor choice in a patient with a Hx of seizures?

A

Imipenem

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11
Q

Name (9) agents with activity against MRSA?

A
  1. Ceftaroline
  2. Aminoglycosides (in combination with a B-lactam)
  3. Tetracyclines
  4. TMP/SMX
  5. Vancomycin
  6. Clindamycin
  7. Linezolid
  8. Daptomycin
  9. Streptogramins

Aminoglycosides: gentamycin, tobramycin, amakacin

Tetracyclines: doxycycline, minocycline, tigecycline

Streptogramins: Quinupristin/Dalfopristin

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12
Q

Which class of Abx has the strongest association with Clostridium difficile associated diarrhea?

A

3rd generation cephalosporins: Ceftriaxone, Ceftazidime, Cefotaxime, Cefdinir

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13
Q

Which (2) Abx are the DOC for Lyme disease?

A
  1. Ceftriaxone

2. Doxycycline

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14
Q

Which (2) Abx have activity against E. faecium?

A
  1. Ceftaroline
  2. Quinupristin/Dalfopristin

These agents do NOT have any activity against E. faecalis!!

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15
Q

Which class of Abx has activity against Haemophilus influenza and Neisseria gonorrheae?

A

2nd generation cephalosporins: Cefuroxime, Cefprozil, Cefotetan, Cefoxitin

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16
Q

Which of the following Abx would be the best choice for empiric therapy for nosocomial infection?

A. Penicillin G
B. Piperacillin/Tazobactam
C. Piperacillin
D. Cefepime
E. Both B & D
A

(E) Both B & D

Piperacillin/Tazobactam and Cefepime are good empiric choices for treating nosocomial infections.

Pip/Tazo covers multiple gram+, anaerobes, enteric GNRs, and pseudomonas

Piperacillin alone would be a POOR empiric choice for nosocomial infections b/c most GNRs (besides pseudomonas) are often resistant. However, combining it with a B-lactamase inhibitor, restores activity and makes it a good choice. Cefepime is just a beast by itself.

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17
Q

Which (2) Abx would be the best empiric choice for mixed infections?

A
  1. Pip/Tazo

2. Imipenem/Cilastatin

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18
Q

Which (10) Abx have activity against MSSA?

A
  1. Antistaphylococcal PCNs
  2. 1st generation cephalosporins
  3. Cefepime
  4. Ceftaroline
  5. Carbapenems
  6. Fluorquinolones (except Cipro)
  7. Vancomycin
  8. Linezolid
  9. Daptomycin
  10. Quinupristin/Dalfopristin

Antistaphylococcal PCNs: Oxacillin, Nafcillin

1st generation cephalosporins: Cefazolin, Cephalexin

Carbapenems: Imipenem/Cilastatin, Meropenem, Ertapenem

Fluoroquinolones: Levofloxacin, Moxifloxacin, Gemifloxacin

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19
Q

Which (9) Abx have activity against pseudomonas infections?

A
  1. Piperacillin +/- Tazo
  2. Ceftazidime
  3. Cefepime
  4. Imipenem
  5. Aztreonam
  6. Levofloxacin
  7. Ciprofloxacin
  8. Aminoglycosides
  9. Polymixins

Aminoglycosides: gentamycin, tobramycin, amakacin

Polymixins: Colistin, Polymixin B

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20
Q

Which Abx would require monitoring of neutrophil count during therapy?

A

Piperacillin

Piperacillin can cause neutropenia

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21
Q

Which class of Abx is notorious for inducing resistance among GNRs?

A

3rd generation cephalosporins: ceftriaxone, cefdinir, ceftazidime, cefotaxime

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22
Q

Which class of Abx has the strongest association with C. diff associated diarrhea?

A

3rd generation cephalosporins: ceftriaxone, cefdinir, ceftazidime, cefotaxime

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23
Q

Which Abx is different than others in its class b/c it lacks activity against gram+, but does have activity against pseudomonas?

A

Ceftazidime

24
Q

Which Abx has a side chain that is part of its structure that inhibits vitamin K production potentially leading to prolonged bleeding?

A

Cefotetan

25
Q

Which Abx is the DOC for febrile neutropenia?

A

Cefepime

26
Q

Which Abx would be the best choice for a patient with a gram negative infection and B-lactam allergy?

A

Aztreonam

27
Q

Which Abx’s have activity against atypical bacteria?

A
  1. Fluoroquinolones
  2. Macrolides
  3. Tetracyclines
  4. Linezolid

Fluoroquinolones: Cipro, Levo, Moxi, Gemifloxacin

Macrolides: Clarithromycin, Azithromycin, Telithromycin

Tetracyclines: doxycycline, minocycline, tigecycline

28
Q

Administration of which Abx in neonates can lead to interaction with Ca++ forming crystals in lungs and kidneys?

A

Ceftriaxone - should be avoided in neonates

29
Q

Which Abx useful in gram+ (including MRSA) infections has very good distribution to the lungs, but is inactivated by pulmonary surfactants rendering it ineffective?

A

Daptomycin

30
Q

Which class of Abx MOA involves inhibiting DNA topoisomerase which leads to breaks in the DNA and cell death?

A

Fluoroquinolones

31
Q

Which class of Abx is CI in pregnant women, can cause photosensitivity, and tendon rupture?

A

Fluoroquinolones

32
Q

Which of the following Abx should not be co-administered with Ca, Fe, antacids, milk, or multivitamins b/c risk of chelating cations?

A. Levofloxacin
B. Minocycline
C. Doxycycline
D. B & C Only
E. All of the above
A

(E) All of the above

All fluoroquinolones and tetracyclines chelate cations

33
Q

True or False - ALL fluoroquinolones must be dose adjusted for renal dysfunction?

A

True - even though moxifloxacin is not excreted renally. The rest are excreted renally.

34
Q

Which fluoroquinolone should NOT be used for UTI Tx?

A

Moxifloxacin b/c it’s not excreted renally

35
Q

What is the main spectra of activity for the Aminoglycosides? What if you combine it with a B-lactam or glycopeptide (vanco)?

A

gram(-) organisms (including pseudomonas)

Combining it with a B-lactam adds gram(+) activity including MRSA

36
Q

Which Abx would you most likely see dose dependent, irreversible ototoxicity?

A. Imipenem
B. Fidaxomicin
C. Minocycline
D. Doxycycline
E. Gentamycin
A

(E) Gentamycin

Dose dependent, irreversible ototoxicity is a hallmark AE of the aminoglycoside Abx class.

37
Q

Which Abx is exclusively used for treating C. diff infections?

A

Fidaxomicin

38
Q

The older formulation of this Abx was associated with nephrotoxicity and colloquially called “Mississippi mud.” However, the current formulation is clear with no toxic excipients

A

Vancomycin

39
Q

Which Abx have AE of nephrotoxicity?

A
  1. Aminoglycosides

2. Polymyxins (Colistin)

40
Q

Which Abx with activity against E. coli, Staph saprophyticus, and some enteric GNRs is CI in patients with CrCl of 50-60ml/min and carries an AE of pulmonary fibrosis with prolonged therapy

A

Nitrofurantoin

41
Q

Which (2) Abx can be used to treat or prevent malaria from Plasmodium species?

A
  1. Tetracyclines

2. Clindamycin

42
Q

Which (7) Abx/classes of Abx can be used for anaerobic infections (Clostridia, Bacteroides)?

A
  1. B-lactam/B-lactamase inhibitor
  2. 2nd gen ceph’s (cefotetan & cefoxitin only)
  3. Carbapenems
  4. Moxifloxacin
  5. Tigecycline
  6. Metronidazole
  7. Clindamycin
43
Q

Which (2) classes of Abx are associated with the AE of QT prolongation?

A
  1. Macrolides

2. Fluoroquinolones

44
Q

Which (7) Abx should you avoid if your patient has a GNR infection since these Abx have NO activity against GNRs?

A
  1. Penicillin
  2. Clindamycin
  3. Vancomycin
  4. Daptomycin
  5. Metronidazole
  6. Linezolid
  7. Quinipristin/Dalfopristin
45
Q

Which class of Abx is potent inhibitors of CYP enzymes (name the one exception)? Which class of Abx is potent inducers of CYP enzymes?

A

CYP inhibitor - Macrolides (except Azithromycin)

CYP inducer - Rifamycins (Rifampin, Rifabutin, Rifaximin)

46
Q

Which class of Abx that can be used for “weird diseases” has AE of photosensitivity, discoloration of developing teeth, and CI in pregnant women and children <8y/o?

A

Tetracylines

47
Q

Which Abx useful against MRSA infections, can cause dose dependent bone marrow suppression and also has a significant drug interaction with warfarin leading to higher prothrombin times?

A

TMP-SMX

48
Q

Which class of Abx that can cause taste disturbances and foamy urine are active against some vancomycin resistant isolates?

A

Lipoglycopeptides:

Telavancin, Oritavancin, Dalbavancin

49
Q

True or False - Metronidazole has NO activity against aerobic bacteria?

A

True - Metronidazole must be activated to produce free radicals which damage bacterial DNA and lead to cell death. This activation can only be done by ANAEROBIC bacteria

50
Q

Which Abx useful against anaerobic bacteria (both gram + & -) can leave a metallic taste in your mouth and can also increase INR while taking with warfarin?

A

Metronidazole

51
Q

Which Abx is well distributed to the bladder and urine (but low distribution elsewhere) and therefore useful in treating UTI’s can also cause pulmonary fibrosis from prolonged therapy?

A

Nitrofurantoin

52
Q

Which Abx that has activity against MRSA and VRE carries AE of thrombocytopenia and serotonin syndrome (when given with SSRI b/c it’s a weak MAOI)?

A

Linezolid

53
Q

Which Abx that has activity against gram+ organisms (including MRSA and VRE) should you monitor CK b/c of potential AE of rhabdomyolisis?

A

Daptomycin

54
Q

This prodrug useful against multi drug resistant gram- infections (including Carbapenem-resistant enterobacteriaceae CRE) has a common AE of nephrotoxicity?

A

Polymixins (Colistin prodrug – Colistimethate is active metabolite)

55
Q

Which Abx that produces orange-red secretions (urine, tears) during the course of therapy is the DOC for TB?

A

Rifampin

56
Q

Which Abx is the DOC for mycobacterium avium complex (MAC)?

A

Rifabutin

57
Q

Which Abx useful against E. faecium, MRSA, and VRE carries a common AE of fibromyalgia (occurs in 33-50% of all patients)?

A

Quinipristin/Dalfopristin

P&T ID (2 decks)

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