Exam #01 (ABO Review) Flashcards
Which B-lactams are effective against MSSA gram+ bacteria?
A. Cefazolin B. Cefepime C. Ceftriaxone D. Only A & B E. All of the above
(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
Which Abx is commonly used to treat strep throat and otitis media?
Amoxicillin
What additional activity is added to Oxacillin and Nafcillin, different than natural PCN’s and aminopenicillins?
staphylococci (MSSA)
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?
Antistaphylococcal PCNs (oxacillin & nafcillin) can cause phlebitis.
1st generation cephalosporins are a good alternative
Cephalexin
Cefazolin
Which of the following is NOT 2nd generation cephalosporin?
A. Cefuroxime B. Cefoxitin C. Cefotetan D. Cefprozil E. Cefotaxime
(E) Cefotaxime is a 3rd generation cephalosporin. The rest are 2nd generation cephalosporins
Which generation(s) of cephalosporins is/are effective for CNS infections since they can cross the BBB?
3rd & 4th generation cephalosporins
3rd gen: Ceftriaxone, Ceftazidime, Cefotaxime, Cefdinir
4th gen: Cefepime
Which Abx would be the best choice to treat an infection caused by Treponema pallidum?
PCN G (IV). Treponema pallidum is a spirochete that causes syphilis and PCN is the DOC for treating syphilis
What are 2nd generation cephalosporins mostly indicated for?
Surgical prophylaxis. Specifically abdominal procedures since they cover enteric GNRs and anaerobes (only cefotetan & cefoxitin)
Cefepime is the DOC for which indication?
febrile neutropenia
Which Abx would be a poor choice in a patient with a Hx of seizures?
Imipenem
Name (9) agents with activity against MRSA?
- Ceftaroline
- Aminoglycosides (in combination with a B-lactam)
- Tetracyclines
- TMP/SMX
- Vancomycin
- Clindamycin
- Linezolid
- Daptomycin
- Streptogramins
Aminoglycosides: gentamycin, tobramycin, amakacin
Tetracyclines: doxycycline, minocycline, tigecycline
Streptogramins: Quinupristin/Dalfopristin
Which class of Abx has the strongest association with Clostridium difficile associated diarrhea?
3rd generation cephalosporins: Ceftriaxone, Ceftazidime, Cefotaxime, Cefdinir
Which (2) Abx are the DOC for Lyme disease?
- Ceftriaxone
2. Doxycycline
Which (2) Abx have activity against E. faecium?
- Ceftaroline
- Quinupristin/Dalfopristin
These agents do NOT have any activity against E. faecalis!!
Which class of Abx has activity against Haemophilus influenza and Neisseria gonorrheae?
2nd generation cephalosporins: Cefuroxime, Cefprozil, Cefotetan, Cefoxitin
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
(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.
Which (2) Abx would be the best empiric choice for mixed infections?
- Pip/Tazo
2. Imipenem/Cilastatin
Which (10) Abx have activity against MSSA?
- Antistaphylococcal PCNs
- 1st generation cephalosporins
- Cefepime
- Ceftaroline
- Carbapenems
- Fluorquinolones (except Cipro)
- Vancomycin
- Linezolid
- Daptomycin
- Quinupristin/Dalfopristin
Antistaphylococcal PCNs: Oxacillin, Nafcillin
1st generation cephalosporins: Cefazolin, Cephalexin
Carbapenems: Imipenem/Cilastatin, Meropenem, Ertapenem
Fluoroquinolones: Levofloxacin, Moxifloxacin, Gemifloxacin
Which (9) Abx have activity against pseudomonas infections?
- Piperacillin +/- Tazo
- Ceftazidime
- Cefepime
- Imipenem
- Aztreonam
- Levofloxacin
- Ciprofloxacin
- Aminoglycosides
- Polymixins
Aminoglycosides: gentamycin, tobramycin, amakacin
Polymixins: Colistin, Polymixin B
Which Abx would require monitoring of neutrophil count during therapy?
Piperacillin
Piperacillin can cause neutropenia
Which class of Abx is notorious for inducing resistance among GNRs?
3rd generation cephalosporins: ceftriaxone, cefdinir, ceftazidime, cefotaxime
Which class of Abx has the strongest association with C. diff associated diarrhea?
3rd generation cephalosporins: ceftriaxone, cefdinir, ceftazidime, cefotaxime
Which Abx is different than others in its class b/c it lacks activity against gram+, but does have activity against pseudomonas?
Ceftazidime
Which Abx has a side chain that is part of its structure that inhibits vitamin K production potentially leading to prolonged bleeding?
Cefotetan
Which Abx is the DOC for febrile neutropenia?
Cefepime
Which Abx would be the best choice for a patient with a gram negative infection and B-lactam allergy?
Aztreonam
Which Abx’s have activity against atypical bacteria?
- Fluoroquinolones
- Macrolides
- Tetracyclines
- Linezolid
Fluoroquinolones: Cipro, Levo, Moxi, Gemifloxacin
Macrolides: Clarithromycin, Azithromycin, Telithromycin
Tetracyclines: doxycycline, minocycline, tigecycline
Administration of which Abx in neonates can lead to interaction with Ca++ forming crystals in lungs and kidneys?
Ceftriaxone - should be avoided in neonates
Which Abx useful in gram+ (including MRSA) infections has very good distribution to the lungs, but is inactivated by pulmonary surfactants rendering it ineffective?
Daptomycin
Which class of Abx MOA involves inhibiting DNA topoisomerase which leads to breaks in the DNA and cell death?
Fluoroquinolones
Which class of Abx is CI in pregnant women, can cause photosensitivity, and tendon rupture?
Fluoroquinolones
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
(E) All of the above
All fluoroquinolones and tetracyclines chelate cations
True or False - ALL fluoroquinolones must be dose adjusted for renal dysfunction?
True - even though moxifloxacin is not excreted renally. The rest are excreted renally.
Which fluoroquinolone should NOT be used for UTI Tx?
Moxifloxacin b/c it’s not excreted renally
What is the main spectra of activity for the Aminoglycosides? What if you combine it with a B-lactam or glycopeptide (vanco)?
gram(-) organisms (including pseudomonas)
Combining it with a B-lactam adds gram(+) activity including MRSA
Which Abx would you most likely see dose dependent, irreversible ototoxicity?
A. Imipenem B. Fidaxomicin C. Minocycline D. Doxycycline E. Gentamycin
(E) Gentamycin
Dose dependent, irreversible ototoxicity is a hallmark AE of the aminoglycoside Abx class.
Which Abx is exclusively used for treating C. diff infections?
Fidaxomicin
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
Vancomycin
Which Abx have AE of nephrotoxicity?
- Aminoglycosides
2. Polymyxins (Colistin)
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
Nitrofurantoin
Which (2) Abx can be used to treat or prevent malaria from Plasmodium species?
- Tetracyclines
2. Clindamycin
Which (7) Abx/classes of Abx can be used for anaerobic infections (Clostridia, Bacteroides)?
- B-lactam/B-lactamase inhibitor
- 2nd gen ceph’s (cefotetan & cefoxitin only)
- Carbapenems
- Moxifloxacin
- Tigecycline
- Metronidazole
- Clindamycin
Which (2) classes of Abx are associated with the AE of QT prolongation?
- Macrolides
2. Fluoroquinolones
Which (7) Abx should you avoid if your patient has a GNR infection since these Abx have NO activity against GNRs?
- Penicillin
- Clindamycin
- Vancomycin
- Daptomycin
- Metronidazole
- Linezolid
- Quinipristin/Dalfopristin
Which class of Abx is potent inhibitors of CYP enzymes (name the one exception)? Which class of Abx is potent inducers of CYP enzymes?
CYP inhibitor - Macrolides (except Azithromycin)
CYP inducer - Rifamycins (Rifampin, Rifabutin, Rifaximin)
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?
Tetracylines
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?
TMP-SMX
Which class of Abx that can cause taste disturbances and foamy urine are active against some vancomycin resistant isolates?
Lipoglycopeptides:
Telavancin, Oritavancin, Dalbavancin
True or False - Metronidazole has NO activity against aerobic bacteria?
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
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?
Metronidazole
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?
Nitrofurantoin
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)?
Linezolid
Which Abx that has activity against gram+ organisms (including MRSA and VRE) should you monitor CK b/c of potential AE of rhabdomyolisis?
Daptomycin
This prodrug useful against multi drug resistant gram- infections (including Carbapenem-resistant enterobacteriaceae CRE) has a common AE of nephrotoxicity?
Polymixins (Colistin prodrug – Colistimethate is active metabolite)
Which Abx that produces orange-red secretions (urine, tears) during the course of therapy is the DOC for TB?
Rifampin
Which Abx is the DOC for mycobacterium avium complex (MAC)?
Rifabutin
Which Abx useful against E. faecium, MRSA, and VRE carries a common AE of fibromyalgia (occurs in 33-50% of all patients)?
Quinipristin/Dalfopristin
