Gram Negative (Carreno)

Question 1

3rd Generation Cephalosporin: Coverage

Answer 1

G+: Strep pneumo, MSSA

G-: E.coli, Kleb pneumo

Question 2

3rd Generation Cephalosporin: Distribution

Answer 2

Good CNS Penetration
Urine
Intra-abdomen
Lungs
Skin
**NO RENAL ADJUSTMENT

Question 3

4th Generation Cephalosporin: Coverage

Answer 3

G+: Strep pneumo, MSSA

G-: E.coli, Kleb pneumo, PSAR

Question 4

4th Generation Cephalosporin: Distribution

Answer 4

GI
Skin
Lungs
Urine
CNS
Blood

Question 5

Carbapenems

Answer 5

Imipenem-cilastatin
Meropenem
Doripenem
Ertapenem

Question 6

Carbapenem: Coverage (Antipseudomonal)

I/C, M, D

Answer 6

G+: Strep pneumo, MSSA, E.faecalis
G-: E.coli, Kleb Pneumo, PSAR
+ G- anaerobes
+ Acinetobacter

Question 7

Carbapenem: Distribution + ADEs (Antipseudomonal)

I/C, M, D

Answer 7

Most clinically relevant sites
-including PANCREAS
ADEs: SEIZURE, Renal dysfunction, Elderly

Question 8

Carbapenem: Coverage (Non-antipseudomonal)

E

Answer 8

G+: Strep pneumo, MSSA

G-: E.coli, Kleb pneumo

Question 9

Carbapenem: Distribution + ADEs (Non-antipseudomonal)

E

Answer 9

Most clinically relevant sites
-lungs may be ?

Renal Adj <30mL/min

Question 10

Aminogylcosides

Answer 10

MOA: Binds 30S subunit + prevents protein synthesis
Gentamycin
Tobramycin
Amikaicin
Streptomycin

Question 11

Aminoglycosides: Coverage

Answer 11

G+: Strep pneumo, MSSA, E.faecalis
G-: E.coli, Kleb pneumo, PSAR
ONLY AEROBES (requires Oxygen for uptake)

PSAR Activity: Amikacin > Tobra > Genta

Question 12

Aminogylcosides: Distribution

Answer 12

Low Vd
Blood
Urine
SUPERB FOR SEPSIS

Question 13

Aminoglycosides: ADEs (7)

Answer 13

Elderly
Renal Insufficiency
Dehydration
Livery Dysfunction (cirrhosis)
Concomitant Nephrotoxins
Therapy Duration
Ototoxicity

Question 14

Colistin: Coverage, Uses, ADE

Answer 14

MDR PSAR
Inhalation for Cystic Fibrosis
Nephrotoxicity with IV

Question 15

Clindamycin: Coverage

Answer 15

G+: Strep pneumo, MSSA/MRSA (skin)
G-: NONE
ANEROBE COVERAGE

Question 16

Clindamycin: Distribution

Answer 16

Excellent Bone + Skin Penetration
POOR CNS
**Associated with C.diff

Question 17

Trimethoprim/Sulfamethoxazole: Coverage

Answer 17

G+: Strep pneumo, MSSA/MRSA (skin)

G-: E.coli, Kleb pneumo (urine)

Question 18

Trimethoprim/Sulfamethoxazole: Penetration + ADE

Answer 18

Very widely distributed
Good for MRSA outpatient
Cheap
Bad for 3rd Trimester

Question 19

Tetracycline

Answer 19

Doxycycline (PO)

Minocycline (IV/PO)

Question 20

Tetracycline: Coverage

Answer 20

G+: Strep pneumo, MSSA/MRSA (skin)
**CA-MRSA uses (tetK resistance)
G-: E.coli, Kleb pneumo (respiratory)
**Other respiratory –> M.catarrhalis, H.influenza, atypicals

Question 21

Aztreonam Coverage + ADE

Answer 21

G+: NONE
G-: PSAR
**may cause B-lactam allergy

Question 22

Fosfomycin tromethamine: Coverage

Answer 22

Broad spectrum (some strains of PSAR)

Question 23

Outpatient CAP (Healthy, w/o Abs)

Answer 23

1. ) Z-Pak (azithromycyin)

2. ) Doxycycline

Question 24

Outpatient CAP (with co-morbidities)

Answer 24

1. ) Respiratory Fluoroquinolone

2. ) Beta-lactam + macrolide

Question 25

CAP Co-morbidities (3)

Answer 25

1. ) Alcoholism
2. ) Chronic diseases (i.e. HF, diabetes)
3. ) Immunosuppressant therapy

Question 26

Inpatient CAP: Medical Ward

Answer 26

1. ) Beta-lactam + macrolide
2. ) Respiratory fluoroquinolone

***if MRSA suspected –> add vancomycin or linezolid

Question 27

Inpatient CAP: ICU

Answer 27

1. ) Beta-lactam + macrolide
2. ) Beta-lactam + fluoroquinolone

***if MRSA suspected –> add vancomycin or linezolid

Question 28

Stopping Therapy: Rules (3)

Answer 28

1. ) Minimum 5-14d therapy
   * *14d minimum for MRSA
2. ) Afebrile for ≥ 48hr
3. ) ≤ CAP-associated sign (O2 sat < 90%, WBC 5-10K, fever)