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NAPLEX Review UWorld > ID Part 3 > Flashcards

ID Part 3 Flashcards

1
Q

Which of the following statements are true regarding Zyvox? (Select ALL that apply.)

A. Myelosuppression can occur with the use of Zyvox.

B. It is cleared primarily by the kidney requiring dose adjustments in the setting of renal impairment.

C. There is a risk for serotonin syndrome if used with SSRI antidepressants.

D. Nephrotoxicity is a common toxicity with prolonged use.

E. It has excellent bioavailability, thus can transition from intravenous to oral formulations in a 1:1 fashion.

A

Myelosuppression can occur with the use of Zyvox.

There is a risk for serotonin syndrome if used with SSRI antidepressants.

It has excellent bioavailability, thus can transition from intravenous to oral formulations in a 1:1 fashion.

Zyvox is primarily cleared by the liver, not the kidney. It is an MAO inhibitor.

It is contraindicated within 2 weeks of MAO inhibitors. It should be used with other serotonergic drugs only when clearly indicated. Ideally, an SSRI would be stopped before starting linezolid.

Myelosuppression (e.g., thrombocytopenia) is a duration-related toxicity.

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2
Q

Oxazolidinones Meds

A

Linezolid (Zyvox)

Tedizolid (Sivextro)

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3
Q

Oxazolidinones Coverage

A

Similar to Vancomycin + VRE

Vancomycin covs gram (+) bacteria (including MRSA)

Linezolid & Daptomycin DOC for VRE

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4
Q

Linezolid Indications

A

Skin/soft-tissue infections (SSTIs)

VRE infections

Pneumonia

Bloodstream infections

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5
Q

Tedizolid Indication

A

SSTI only

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6
Q

Oxazolidinones Bioavailability

A

IV:PO ratio = 1:1

Both comes in IV & PO

Don’t shake linezolid (Zyvox) sus

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7
Q

Linezolid CI

A

MAO inhibitor use w/in 14 days

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8
Q

Linezolid Warnings

A

Duration related myelosuppression (thrombocytopenia) - monitor CBC weekly

Optic neuropathy

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9
Q

Oxazolidinones & Serotonin Syndrome

A

Both are weak MAO inhibitors

Caution w/ serotonergic drugs (e.g., SSRIs, SNRIs, TCAs, meperidine, buspirone)

Avoid tyramine-containing foods

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10
Q

CPis a 22-year-old female who has been started on Macrobid for a five day treatment course for a urinary tract infection. Counseling on Macrobid should include the following points?

A. Do not take antacids or calcium supplements at the same time as your Macrobid dose.

B. This medication should be taken four times daily in evenly spaced intervals (every 6 hours).

C. This medication may cause the urine to turn dark yellow or brown in color.

D. This medication can make the skin more sensitive to the sun. Use sunscreen and protective clothing.

E. This drug should be taken on an empty stomach.

A

This medication may cause the urine to turn dark yellow or brown in color.

Nitrofurantoin (Macrobid) is dosed twice daily, hence the brand name MacroBID.

Nitrofurantoin does not have chelation interactions and does not cause photosensitivity.

It is associated with GI upset and should be taken with food.

The urine discoloration is harmless.

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11
Q

Nitrofurantoin

Common Dosing regimen

A

Macrobid 100 mg BID x 5 d

Macrodantin QID

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12
Q

Nitrofurantoin

Warnings

A

Avoid in G6PD deficiency

Can cause hemolytic anemia (+ Coombs test)

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13
Q

What is the DOC for uncomplicated UTI?

A

Nitrofurantoin

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14
Q

Nitrofurantoin

Do not use when?

A

CrCl < 60

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15
Q

Nitrofurantoin

Counseling

A

Take w/ food

Can discolor urine (brown)

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16
Q

Wt: 105 lbs

The physician asks the pharmacist on rounds to assist with transitioning the patient to oral Bactrim20 mg/kg/day in preparation for hospital discharge. What is the correct dose?

A. Bactrim SS 2 tabs BID

B. Bactrim SS 2 tabs TID

C. Bactrim DS 1 tab TID

D. Bactrim DS 2 tabs BID

E. Bactrim DS 2 tabs TID

A

Bactrim DS 2 tabs TID

105 pounds = 47.7 kg. 47.7 kg x 20 mg/kg = 954 mg Bactrim/day.

Bactrim is dosed from the TMP component and DS tabs have 160 mg TMP per tab.

KS would need 6 tabs per day (954 mg Bactrim / 160 mg TMP per tab) to treat her infection.

To avoid errors, mg/kg doses should reference the TMP component.

When using higher SMX/TMP doses like this, monitor the patient carefully for side effects.

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17
Q

KS is diagnosed with PCP and stabilized. She is ready for discharge. Her provider is concerned that the cellulitis has not healed as well as he had hoped. He asks the pharmacist about a single dose medication for bacterial skin and skin structure infections that he heard about. He thinks this patient would be a good candidate for this drug. Which drug is he referring to?

A. Vancomycin

B. Telavancin

C. Oritavancin

D. Tedizolid

E. Polymyxin

A

Oritavancin

Oritavancin (Orbactiv) and dalbavancin (Dalvance) are lipoglycopeptides with similar spectrum of activity to vancomycin: both have activity against Staphylococci (MSSA and MRSA) and Streptococci.

Oritavancin and dalbavancin are a one-time dose.

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18
Q

Lipoglycopeptides

Meds

A

Telavacin (Vibativ)

Oritavancin (Orbactiv, Kymyrsa)

Dalbavancin (Dalvance)

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19
Q

Lipoglycopeptides

Coverage

A

Similar to IV Vancomycin:
Gram (+) Cocci including MRSA

Does not cover VRE

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20
Q

Lipoglycopeptides

Approved for

A

Skin infections

Telvancin (Vibativ) approved for HAP/VAP

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21
Q

Lipoglycopeptides

Which one is approved for HAP/VAP?

A

Telvancin (Vibativ)

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22
Q

Lipoglycopeptides

Can cause what syndrome?

A

Red Man

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23
Q

Lipoglycopeptides

Which ones are single-dose regimens?

A

Oritavancin (Orbactiv, Kymyrsa)

Dalbavancin (Dalvance)

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24
Q

Lipoglycopeptides: Tealvancin (Vibativ)

Boxed Warnings

A

Fetal risk, Nephrotoxicity, ↑ mortality compared to vancomycin in Pneumonia trials (pts w/ CrCl ≤ 50)

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25
Q

Lipoglycopeptides: Telavancin (Vibativ)

CI

A

Concurrent use of IV UFH

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26
Q

Lipoglycopeptides: Telvancin (Vibativ)

Warnings

A

Falsely ↑ aPTT/PT/INR

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27
Q

Lipoglycopeptides: Oritavancin (Orbactiv, Kymyrsa)

CI

A

Use of IV UFH for 5d after

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28
Q

Lipoglycopeptides: Oritavancin (Orbactiv, Kymyrsa)

Warnings

A

↑ PT/INR (up to 12 hrs) &
↑ aPTT (up to 120 hrs)

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29
Q

Which two antibiotics should be separated from multivitamin supplements?

A. Flagyl andcefuroxime

B. Minocyclineand levofloxacin

C. Avelox and amoxicillin

D. Bactrim and Zithromax

E. Biaxin and Zyvox

A

Minocyclineand levofloxacin

Tetracyclines and quinolones should be separated from divalent cations (e.g., calcium, iron, magnesium, zinc) as they may inhibit absorption through chelation.

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30
Q

Which of the following statements is correct in regardto ceftriaxone?

A. It is considered a broad-spectrum antimicrobial agent with activity against Pseudomonas.

B. It is cleared unchanged by the kidney and requires dose adjustments in renal impairment.

C. It is adrug of choice for spontaneous bacterialperitonitis.

D. It should be avoided in patients who are pregnant.

E. It can be used with calcium containing IV products in neonates

A

It is adrug of choice for spontaneous bacterialperitonitis.

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31
Q

Which of the following medications is/are associated with seizures and/or decreasing the seizure threshold? (Select ALL that apply.)

A. Imipenem/Cilastatin

B. Ciprofloxacin

C. Cefuroxime

D. Penicillin G

E. Azithromycin

A

Imipenem/Cilastatin

Ciprofloxacin

Cefuroxime

Penicillin G

Ciprofloxacin and the other quinolones decrease the seizure threshold.

Beta-lactams have been associated with seizures, especially if the drug accumulates (e.g., longer courses, renal failure).

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32
Q

HW is a 71-year-old male who has been in the intensive care unit for several weeks and is now being treated for pneumonia, with a lower respiratory culture positive forPseudomonas aeruginosa. His weight is 225 pounds and height is 6’0”. His current serum creatinine is 2.4 mg/dL. Based on the culture sensitivities, the medical team decides to start tobramycin at 2.5 mg/kg. They ask the pharmacist to write the order and administer the first dose at 8:00 AM. Which doseof tobramycin should be administered at 8:00 AM?

A. 560 mg

B. 410 mg

C. 340mg

D. 220 mg

E. 100 mg

A

220 mg

Aminoglycosides are dosed using adjusted body weight for obese patients.

2.5 mg/kg x 87.47 kg = 218.68 mg; round to 220 mg.

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33
Q

Which quinolone antibiotic is preferred for treatment of MRSA skin and soft tissue infections?

A. Delafloxacin

B. Ciprofloxacin

C. Levofloxacin

D. Moxifloxacin

E. Gemifloxacin

A

Delafloxacin

Brand: Baxdela

Delafloxacin has activity against MRSA and is indicated for skin and soft tissue infections.

Other quinolones should be avoided due to higher rates of resistance.

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34
Q

MT should be counseled to take the Levaquin2 hours before or 2 hours after which medication?

A. Zinc

B. Simvastatin

C. Warfarin

D. Aspirin

E. Hydrochlorothiazide

A

Zinc

Quinolones should not be given with zinc or other divalent cations, due to decreased absorption with chelation.

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35
Q

Preferred Initial ART Regimens in Most Tx-Naive Adults

A

Biktarvy

Triumeq

Dovato

Tivicay + Truvada

Tivicay + Descovy

Do not use if CrCl < 30

All contain an integrase inhibitor w/ a high barrier to resistance

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36
Q

Dovato

A

Dolutegravir + lamivudine

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37
Q

Dovato

Criteria for use

A

VL < 500,000

No HBV

No resistance to either component

Dolutegravir + lamivudine

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38
Q

Emtriva

Generic

A

emtricitabine

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39
Q

Complete HIV Antiretroviral Regimens

A

Base (Choose 1)

NRTI (2 in most cases)

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40
Q

Complete HIV Antiretroviral Regimens

Base

A

INSTi (eg, raltegravir)
OR
Boosted PI (eg, darunavir/ritonavir)
OR
NNRTI (eg, doravirine)

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41
Q

Complete HIV Antiretroviral Regimens

NRTI Backbone

A

Abacavir or Tenofovir
PLUS
Emtricitabine or lamivudine

42
Q

ART in Pregnancy

Already on ART

A

May continue pre-pregnancy ART regimen in most cases

43
Q

ART in Pregnancy

New starts

A

3 components recommended:
Dolutegravir or boosted darunavir, PLUS
Dual NRTI backbone (eg, emtricitabine/tenofovir)

44
Q

ART in Pregnancy

Perinatal transmission PPx

A

Maternal administration of IV zidovudine prior to delivery

Neonatal administration of ART (exact regimen & duration dependent on risk)

45
Q

Immune Reconstitution Inflammatory Syndrome (IRIS)

A

Worsening of an underlying condition after ART initiation & as the CD4 count begins to recover

Can be known or previously unidentified condition

More likely when ART initited at low CD4 counts

46
Q

Immune Reconstitution Inflammatory Syndrome (IRIS)

Key points

A

Continue ART

Treat underlying condition (eg, opportunistic infection)

Provide supportive care (eg, fluids, antipyretics)

47
Q

Which of the following statements is correctregarding piperacillin/tazobactam?

A. Tazobactam is added to inhibit beta-lactamase activity.

B. The brand name is Zofran.

C. It exhibits concentration-dependent killing.

D. The dosing is 0.375 grams/3 grams of piperacillin/tazobactam respectively.

E. It is available as an oral suspension and intravenous formulation.

A

Tazobactam is added to inhibit beta-lactamase activity.

Piperacillin/tazobactam (Zosyn) is available IV only and exhibits time-dependent killing.

Tazobactam is a beta-lactamase inhibitor that expands its spectrum of activity to include anaerobes and more resistant organisms.

The correct dosing formulation is 3 g/0.375 g of piperacillin/tazobactam, respectively.

48
Q

Common Resistant Pathogens

Mnemonic

A

Kill Each And Every Strong Pathogen

Klebsiella pneumoniae (ESBL, CRE)

E. coli (ESBL, CRE)

Acinetobacter baumannii

Enterococcus facecalis & faecium (VRE)

Staphylococcus aureus

Pseeudomonas aeruginosa

49
Q

A prescription for generic minocycline is filled. Which of the following statements regarding minocycline are correct? (Select ALL that apply.)

A. This medication has been associated with drug-induced lupus.

B. Take on an empty stomach 1 hour before or 2 hours after meals.

C. This medication may increase the risk of sunburn.

D. This medication should be separated when given with antacids.

E. This medication does not interact with other medications.

A

This medication has been associated with drug-induced lupus.

This medication may increase the risk of sunburn.

This medication should be separated when given with antacids.

Minocycline should not be used in children younger than 8 years old or in patients who are pregnant due to the risk of tooth discoloration, bone growth retardation and reduced skeletal development.

Phosphate binders like fosrenol also decrease minocycline absorption.

50
Q

Tetracyclines

Drugs

A

Doxycyline (Vibramycin)

Minocycline (Minocin, Solodyn)

Eravacycline (Xerava)

Omadacycline (Nuzyra)

Sarecycline (Seysara)

Tetracycline

51
Q

Tetracyclines

Coverage

A

Gram (+): Staph, Strep, Entero, Propionibacterium

Gram (-): including respiratory flora (Haemophilus, Moraxella, atypicals)

Other: Rickettsiae, Bacillus antracis, Treponema pallidum & other spirochetes)

52
Q

Tetracyclines

Doxycycline Coverage

A

Respiratory tract infections (e.g., CAP)
Tickborne/rickettsial diseases
Spirochetes
Sexually transmitted infections (e.g., chlamydia)

53
Q

Tetracyclines

Common Uses

A

CA-MRSA skin infections

Acne

Minocycline is preferred for acne

54
Q

Tetracyclines

Doxycycline Common Uses

A

First line for
* Tickborne illnesses (Lyme disease, Rocky Mountain Spotted Fever)
* Chlamydia

Treatment option for
* CAP,
* COPD exacerbations,
* Bacterial sinusitis (if antibiotic indicated),
* VRE UTI

55
Q

Tetracyclines

Tetracycline Common Uses

A

H. pylori Tx regimens

56
Q

Tetracyclines

Warnings

A

Avoid in Children < 8 y/o (supresses bone growth & discolors teeth)
&
Pregnancy & breastfeeding

Causes Photosensitivity

57
Q

Tetracyclines

Intxn

A

Inhibit absorption

Antacids & other polyvalent cations (eg, Mg, Al, PO4, Ca, Fe, Zinc)
Multivitamins
Sucrafate
Bismuth Subsalicylate
Bild Acid Renins

58
Q

Tetracyclines

IV:PO

A

1:1

Doxycyline, minocycline

59
Q

Which antibiotic induces drug induced lupus erythematosus (DILE)?

A

Minocycline (Minocin, Solodyn)

60
Q

Which are

Hydrophilic Agents

A

Beta-Lactams

Aminoglycosides

Glycopeptides

Daptomycin

Polymyxins

61
Q

Hydrophilic Agents

Proporties

A

Small Vd

Renal elimination

Low intracellular concentrations

Increased clearance in sepsis

Poor-moderate bioavailability

62
Q

Which are

Lipophilic Agents

A

Quinolones

Macrolides

Rifampin

Linezolid

Tetracycline

Chloramphenicol

63
Q

Lipophilic Agents

Properties

A

Large Vd

Hepatic metabolism

Achieve intracellular concentrations

Clearance changed minimally in sepsis

Excellent bioavailability

64
Q

Recommended Initial HIV ART for most pts

A

INSTI plus 2 NRTIs:
Bictegravir/tenofovir alafenamide/emtricitabine (Biktarvy)
Dolutegravir/abacavir2/lamivudine (Triumeq)
Dolutegravir (Tivicay) plus:
* Emtricitabine/tenofovir alafenamide (Descovy)
* Emtricitabine/tenofovir disoproxil fumarate (Truvada)

INSTI plus 1 NRTI: Dolutegravir/lamivudine (Dovato)

Do not use INSTI + 1 NRTI if pretreatment HIV RNA > 500,000 copies/mL, there is known hepatitis B coinfection, or HIV genotyping is not available.

65
Q

Clindamycin Brand

A

Cleocin

Topical: Clocin-T, Clindagel

66
Q

Clindamycin Coverage

A

Staph (including CA-MRSA), Strep & Anaerobes

67
Q

Clindamycin Renal

A

No dose adjustment

68
Q

D-test

A

Induction test on Saureus susceptible to clindamycin but resistant to erythromycin

Flattened zone indicates clindamycin resistance (don’t use)

69
Q

Clindamycin Box Warning

A

C. diff

70
Q

Metronidazole Coverage

A

Anaerobes & Protozoal

71
Q

Metronidazole IV:PO

A

1:1

72
Q

Metronidazole CI

A

Pregnancy

Alcohol (disulfiram rxn)

73
Q

Metronidazole SE

A

Metalic Taste

74
Q

Metronidazole Drug Intxn

A

↑ INR w/ warfarin

75
Q

Which antibiotics are

Cmax:MIC (concentration-dependent)

A

Aminoglycosides

Quinolones

Daptomycin

76
Q

Which antibiotics are

AUC:MIC

A

Vancomycin

Macrolides

Tetracyclines

Polymyxins

Technically also concentration dependent but AUC is not usually measure in practice

77
Q

Which antibiotics are

Time > MIC (time-dependent)

A

Beta-lactams

78
Q

OTC HIV testing

Brand

A

OraQuick In-Home HIV Test

Other might be available but might require labs

79
Q

OTC HIV testing

Sample & timing

A

Oral fluid sample to detect the presence of HIV antibodies
Perform ≥ 3 months from exposure to avoid false negative

80
Q

OTC HIV testing

Testing procedure

A

Swab upper & lower gums with test stick
Insert test stick into tube containing testing solution
After 20 minutes, read the results:
* One line indicates a positive control (ie, valid test)
* Two lines indicates a positive HIV result

Positive results require follow-up laboratory confirmation for diagnosis

81
Q

Aminoglycoside Boxed Warning

A

Nephrotoxicity

Ototoxicity

Neuromuscular blockage

82
Q

Maraviroc (Selzentry)

A

CCR5 Antagonist

Hepatotoxicity (boxed warning)

Hypersensitivity reactions (including SJS/TEN)

Orthostatic hypotension (in patients with renal impairment)

Tropism test required prior to starting

CYP3A4 substrate

83
Q

Fostemsavir (Rukobia)

A

Attachment Inhibitor

Must maintain effective HBV treatment if coinfected

Can ↑ SCr (especially if underlying renal disease)

Is a substrate of CYP3A4: check for drug interactions!

84
Q

Ibalizumab-uiyk (Trogarzo)

A

Post-Attachment Inhibitor

IV injection

Infusion-related reactions (observe for 1 hour after 1st infusion)

Other side effects: diarrhea, dizziness, nausea, rash

85
Q

Enfuvirtide (Fuzeon)

A

Fusion Inhibitor

SC injection

Risk of bacterial pneumonia, hypersensitivity reactions

Injection site reactions: pain, erythema, nodules & cysts, ecchymosis

Other side effects: nausea, diarrhea, fatigue

86
Q

Lenacapavir (Sunlenca)

A

Initial: PO loading dose then

Then SC injections Q6 months

Safety & Monitoring
* Contraindicated with strong CYP3A4 inducers
* Injection site reactions: erythema, induration, nodule, pain, swelling

87
Q

DOC for Acinetobacter

A

Meropenem

88
Q

Vancomycin

Target AUC/MIC ratio for serious MRSA infections

A

400-600

89
Q

An antibiogram is: (Select ALL that apply.)

A. Another name for a culture and susceptibility report

B. A collection of culture and susceptibility reports over a period of time

C. Used to select empiric therapy

D. Used to help establish local resistance trends

E. Provides information on the MIC of specific bacteria

A

A collection of culture and susceptibility reports over a period of time

Used to select empiric therapy

Used to help establish local resistance trends

The culture and susceptibility report is for a single patient specimen and provides MIC information.

The antibiogram is a collection of C & S reports over a period of time (typically 1 year) that provides the percent of isolates that are susceptible.

It is used to help select therapy before the susceptibility report isavailable and to establish local guidelines (based on local resistance patterns).

90
Q

Metronidazole is likely to be useful in which of the following infections? (Select ALL that apply.)

A. Urinary tract infection

B. Bacterial vaginosis

C. Trichomoniasis

D. Community-acquired pneumonia

E. Peritonitis after a perforated colon

A

Bacterial vaginosis

Community-acquired pneumonia

Peritonitis after a perforated colon

Metronidazole is an agent with anaerobic activity (including B. fragilis) and antiprotozoal activity.

Community-acquired pneumonia and urinary tract infections do not typically involve these pathogens.

91
Q

BT is a 28-year-old female with a 2-day history of increased urinary frequency and burning with urination. She has suprapubic tenderness but no flank pain. Her vital signs are normal. A urinalysis is positive for white blood cells, leukocyte esterase, and nitrites, and a urine culture is pending. BT has a history of Escherichia coli urinary tract infections, the last of which was treated 2 months ago with sulfamethoxazole/trimethoprim. She has no known drug allergies. Which antibiotic is the best choice to empirically treat the infection while awaiting culture results?

A. Amoxicillin

B. Bactrim DS

C. Fosfomycin

D. Metronidazole

E. Zithromax

A

Fosfomycin

The first-line empiric treatment for acute cystitis (a lower urinary tract infection) is nitrofurantoin, fosfomycin, or sulfamethoxazole/trimethoprim.

An antibiotic that has not been used within the past 3 months should be selected.

92
Q

Acute cystitis

Microbiology

A

Escherichia coli (most common)
Other gram-negative pathogens (eg, Proteus spp., Klebsiella spp.)
Staphylococcus saprophyticus

93
Q

Acute cystitis

Clinical features

A

Dysuria
Increased urinary frequency and/or urgency
Suprapubic tenderness

94
Q

Acute cystitis

Diagnosis

A

Urinalysis with pyuria (WBC > 10 cells/mm3), bacteria& positive leukocyte esterase and/or nitrites
Urine culture for organism identification & susceptibility

95
Q

TM is a 42-year-old male who has been started on clarithromycin for treatment of pneumonia.Which of the following medications does not pose a drug interaction with the antibiotic treatment?

A. Amiodarone

B. Methadone

C. Simvastatin

D. Sucralfate

E. Voriconazole

A

Sucralfate

Clarithromycin (as well as erythromycin) is a strong CYP3A4 inhibitor andis contraindicated with simvastatin (and lovastatin) and can cause increased concentrationsof methadone and voriconazole.

Macrolides are associated with QT interval prolongation, which would be additive with amiodarone, methadone and voriconazole.

Macrolides do not have chelation issues with sucralfate.

96
Q

A 23-year-old sexually active male visits his primary care physician concerned about multiple soft, nonpainful, mildly pruritic, skin-colored papules that have developed on the shaft of his penis. He is diagnosed with genital warts. What treatment is recommended?

A. Clindamycin PO

B. Imiquimod cream

C. Metronidazole gel

D. Mupirocin ointment

E. Tinidazole PO

A

Imiquimod cream

Human papillomavirus is a sexually transmitted disease that causes anogenital warts.

Imiquimod cream is an immune activator that can help resolve the appearance of the warts.

97
Q

Genital warts

Etiology

A

Sexual transmission of HPV strains 6 & 11

98
Q

Genital warts

Clinical features

A

Single or multiple pink or skin-colored lesions
Lesions range from smooth, flattened papules to cauliflower-like growths

99
Q

Genital warts

Treatment

A

Common patient-applied therapies:
* Imiquimod cream (immune activator)
* Podofilox solution or gel (causes wart necrosis)

Provider-administered: cryotherapy, surgical removal

100
Q

Genital warts

Prevention

A

Vaccination: HPV-9 (Gardasil 9) recommended for age 9–26
Barrier contraception

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