Infectious Disease Flashcards
A patient is receiving vancomycin 2 grams IV Q12H for treatment of MRSA osteomyelitis. The nurse asks how long to infuse the medication. Which is the best recommendation to give the nurse regarding the infusion of this vancomycin dose?
A: The vancomycin should be infused over a minimum of 2 hours
B: The vancomycin should be infused over a maximum of 2 hours
C: The vancomycin should be infused over a minimum of 1 hour
D: The vancomycin should be infused over a maximum of 1 hour
E: The vancomycin should be given via a bolus dose
B: The vancomycin should be infused over a maximum of 2 hours
Which of the following statements is correct regarding nafcillin?
A: Nafcillin does not have activity against methicillin-susceptible Staphylococcus aureus (MSSA).
B: Nafcillin is a vesicant.
C: Nafcillin should be dose adjusted in renal impairment.
D :Nafcillin is compatible with NS only.
E: Nafcillin cannot be used in a sulfa allergic patient.
B. If extravasation occurs, use cold packs and hyaluronidase injections to treat.
Which of the following statements are true regarding Zyvox? (Select ALL that apply.)
A: It has excellent Gram-positive coverage, including MRSA and VRE.
B: It is cleared primarily by the kidney requiring dose adjustments in the setting of renal impairment.
C: Monitor for serotonin syndrome when 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.
Zyvox-Linezolid
A. Excellent gram positive coverage including MRSA and VRE
C. Monitor for serotonin syndrome because it inhibits MAO
E. It has excellent bioavailability and can transition IV–>PO in a 1:1 fashion
It is cleared mostly hepatically so we aren’t worried about the kidneys
Which of the following statements are true regarding nitrofurantoin? (Select ALL that apply.)
A: Long term toxicities include pulmonary fibrosis.
B: Macrodantin should be dosed 100 mg orally twice daily
C: Educate patients to take with food to enhance absorption.
D: Indicated for uncomplicated UTI due to E. coli, Enterococcus, Klebsiella and/or Enterobacter.
E: Requires dose adjustments for moderate-severe renal impairment.
A: Long term toxicities include pulmonary fibrosis.
C: Educate patients to take with food to enhance absorption.
D: Indicated for uncomplicated UTI due to E. coli, Enterococcus, Klebsiella and/or Enterobacter.
Which of the following statements is correct regarding linezolid? (Select ALL that apply.)
A: Linezolid is associated with bone marrow suppression.
B: Linezolid is part of the streptogramin class of antibiotics.
C: Linezolid should be dose adjusted in renal impairment.
D: Linezolid is a weak MAO inhibitor.
E: Linezolid oral suspension should not be refrigerated.
A: Linezolid is associated with bone marrow suppression.
D: Linezolid is a weak MAO inhibitor.
E: Linezolid oral suspension should not be refrigerated.
DH is a 42 year-old male being treated with Synercid for a complicated VRE and MRSA infection. Which of the following are common toxicities of Synercid?
A: Infusion reactions, electrolyte abnormalities, nephrotoxicity
B: Arthralgias/myalgias, nephrotoxicity, neurological disturbances
C: Infusion reactions, arthralgias/myalgias, hyperbilirubinemia
D: Hyperbilurbinemia, neurological disturbances, arthralgias/myalgias
E: Electrolyte abnormalities, nephrotoxicity, infusion reactions
C: Infusion reactions, arthralgias/myalgias, hyperbilirubinemia
MM is an 82 year-old female with a Pseudomonas aeruginosa infection. On rounds the ICU pharmacist is asked to explain extended-interval, or once-daily, aminoglycoside dosing. Choose the correct statement:
A: Extended-interval dosing for gentamicin is 15 mg/kg/day.
B: Extended-interval dosing is less cost effective, but it helps to reduce nephrotoxicity risk.
C: The peak and trough levels should be measured around the third dose for extended-interval dosing.
D: If the random gentamicin serum level falls on the line of the Hartford Nomogram, the longer dosing interval should be chosen.
E: If the random gentamicin serum level is elevated, the dose should be decreased.
D: If the random gentamicin serum level falls on the line of the Hartford Nomogram, the longer dosing interval should be chosen.
DM is diagnosed with a Giardia infection. Which of the following medications would be best to recommend for treatment of giardiasis?
Metronidazole
LJ is receiving ampicillin for the treatment of a Proteus mirabilis bacteremia. The physician wants to know how ampicillin works. Which of the following best characterizes the pharmacodynamic properties of ampicillin?
A: Ampicillin exhibits concentration-dependent bacterial killing
B: Ampicillin exhibits concentration-above-MIC-dependent killing
C: Ampicillin exhibits colonic concentration bacterial killing
D: Ampicillin exhibits post antibiotic effect for bacterial killing
E: Ampicillin exhibits time-dependent bacterial killing
E: Ampicillin exhibits time-dependent bacterial killing
Extended-infusion piperacillin-tazobactam is a dosing strategy that optimizes which of the following pharmacodynamic parameters?
Answer
A Peak:MIC ratio B AUC:MIC ratio C Peak concentration D Time above MIC (T > MIC) E Minimum bactericidal concentration
Time above MIC
Joseph Bernstein is on tobramycin IV every 8 hours for treating a gram negative infection and his levels are reported as a peak of 8.3 mcg/mL and a trough of 2.1 mcg/mL. Which of the following recommendations should the pharmacist make to the medical team?
Answer
A Increase the dose of tobramycin B Reduce the dose of tobramycin C Extend the dosing interval of tobramycin D Reduce the dose and extend the interval of tobramycin E Shorten the dosing interval of tobramycin
Extend the dosing interval
The peak of tobramycin is within range, but the trough level is too high (it should be less than 2 mcg/mL and ideally less than 1.5 mcg/mL). By extending the dosing interval, the trough level will decrease and the toxicity risk is lowered.
Which of the following statements is incorrect regarding daptomycin?
Answer
A
It exhibits concentration-dependent killing.
B
The intravenous formulation is incompatible with D5W.
C
It is associated with myopathy/muscle toxicity, thus monitor for creatine kinase.
D
It requires dose adjustments for moderate to severe renal impairment.
E
The oral formulation has excellent bioavailability.
The oral formulation has excellent bioavailability.
JG, a 46 year-old male, is found to have vancomycin-resistant E. faecalis (VRE) on his recent blood cultures. Which of the following regimens is the best option for treatment of his VRE infection?
Answer
A Daptomycin B Vancomycin C Colistimethate D Quinupristin-dalfopristin E Cephalexin
Daptomycin
A patient is taking nitrofurantoin for treatment of a urinary tract infection. Which of the following statements regarding nitrofurantoin are correct?
Answer
A
This medication may cause the urine to turn blue in color.
B
This medication can be used in patients with severe renal impairment.
C
This medication is not absorbed when taken concurrently with food.
D
This medication can be used for complicated cystitis.
E
This medication may rarely cause serious pulmonary problems.
This medication may rarely cause serious pulmonary problems.
JP has a blood culture report showing Gram-positive cocci resembling Streptococci, enteric Gram-negative rods and anaerobes. Which of the following medications would provide adequate coverage for these organisms?
Answer
A Ertapenem B Rifaximin C Metronidazole D Fosfomycin E Ciprofloxacin
Ertapenem
NA is a 42 year-old female who was a victim of a house fire. She acquired third degree burns requiring skin grafting. Unfortunately her course has been complicated by post-operative Acinetobacter wound infection and acute kidney injury. Ms. Abrams has no known drug allergies. Which of the following antibacterials would be considered first line in her case as a single agent?
Answer
A Vancomycin B Meropenem C Ampicillin D Fosfomycin E Linezolid Next About
Meropenem is drug of choice for acinetobacter
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?
Answer
A Vancomycin B Vibativ C Oritavancin D Tedizolid E Polymyxin
Oritavancin
Which of the following statements are correct with regards to sulfamethoxazole/trimethoprim? (Select ALL that apply.)
Answer
A
It is a potent hepatic enzyme inducer resulting in reduced drug concentrations.
B
It has excellent bioavailability, thus can transition from intravenous to oral formulations in a 1:1 fashion.
C
It is active against many Gram-positive pathogens, including Staphylococci, Gram-negative pathogens, and opportunistic pathogens.
D
It is cleared partially by the kidney and requires renal dose adjustments in severe renal impairment.
E
It is a preferred agent in pregnancy, especially for urinary tract infections.
B
It has excellent bioavailability, thus can transition from intravenous to oral formulations in a 1:1 fashion.
C
It is active against many Gram-positive pathogens, including Staphylococci, Gram-negative pathogens, and opportunistic pathogens.
D
It is cleared partially by the kidney and requires renal dose adjustments in severe renal impairment.
TM is a 42 year-old male who has been started on Biaxin for treatment of pneumonia. Counseling on Biaxin should include the following points? (Select ALL that apply.)
Answer
A
Common side effects (2-3%) include diarrhea, abdominal pain, nausea or abnormal (metallic) taste.
B
Biaxin XL tablets should be taken with on an empty stomach.
C
Biaxin liquid suspension should be refrigerated.
D
This medicine can make the skin more sensitive to the sun, and the patient can burn more easily. Use sunscreen and protective clothing.
E
There are interactions with this drug and other medicines. Please discuss with a pharmacist to make sure this will not pose a problem.
A
Common side effects (2-3%) include diarrhea, abdominal pain, nausea or abnormal (metallic) taste.
E
There are interactions with this drug and other medicines. Please discuss with a pharmacist to make sure this will not pose a problem.
A physician is unfamiliar with rifaximin and asks for information on the drug. Which of the following points would be accurate to describe rifaximin?
Answer
A
Rifaximin can be used to treat traveler’s diarrhea caused by non-invasive E. coli.
B
Rifaximin requires renal dose adjustments.
C
Rifaximin is a strong hepatic enzyme inducer similar to rifampin.
D
Rifaximin is an antiprotozoal agent.
E
Rifaximin is an effective first-line agent for treating C. difficile infections.
A
Rifaximin can be used to treat traveler’s diarrhea caused by non-invasive E. coli.
Which of the following antimicrobials require dose adjustment in patients with renal impairment?
Answer
A Avelox and Rocephin B Cubicin and Doribax C Zyvox and Cleocin D Flagyl and Zithromax E Synercid and Dificid
B
Cubicin (Daptomycin)
Doribax (Doripenem)
Jeannie is being transitioned from ciprofloxacin intravenous to ciprofloxacin oral suspension. Which of the following statements regarding ciprofloxacin oral suspension are true? (Select ALL that apply.)
Answer
A
This agent may prolong the QT interval.
B
The patient’s blood sugar may be affected.
C
This medication should not be given through feeding tubes.
D
This agent can cause peripheral neuropathies.
E
This medication should be shaken prior to use.
A
This agent may prolong the QT interval.
B
The patient’s blood sugar may be affected.
C
This medication should not be given through feeding tubes.
D
This agent can cause peripheral neuropathies.
E
This medication should be shaken prior to use.
TN is a 42 y/o male patient who has been hospitalized in the ICU of a major trauma center for 25 days. He had a motor vehicle accident and required several complicated surgeries. He subsequently developed an intrabdominal infection and pneumonia. He has received antibiotic therapy over the 25 days with different combinations of Zosyn, Merrem, gentamicin, Maxipime, and ciprofloxacin to treat multi-drug resistant (MDR) gram negatives. He is currently receiving amikacin and ciprofloxacin. See below for TN’s culture and sensitivities taken today:
Culture and Susceptibility Report for Pseudomonas aeruginosa: Amikacin - S Ciprofloxacin - R Gentamicin - R Tobramycin - R Levofloxacin - R Piperacillin/tazobactam - R Cefepime - R Imipenem - R SMX/TMP - R
Culture and Susceptibility Report for Acinetobacter baumannii Amikacin - R Ciprofloxacin - R Gentamicin - R Tobramycin - R Levofloxacin - R Piperacillin/tazobactam - R Cefepime - R Imipenem - R SMX/TMP - R
Which of the following strategies is best to manage TN’s MDR infection?
Answer
A
Stop all antibiotics, there is nothing that can be done.
B
Change antibiotic regimen to amikacin and Cresemba.
C
Change antibiotic regimen to Avelox and INVanz.
D
Change antibiotic regimen to amikacin and Coly-Mycin M.
E
Change antibiotic regimen to Sivextro and Flagyl.
D
Change antibiotic regimen to amikacin and Coly-Mycin M.
A patient comes into the clinic with classic signs and symptoms of an infection. Which of the following antibiotics presents a safety issue in light of his social history, which includes extensive alcohol abuse?
Answer
A Cefuroxime B Cefotaxime C Cefotetan D Cefprozil E Cefaclor
Cefotetan has a chemical structure (a N-MTT side chain) that puts patients at risk for a disulfiram-like reaction if alcohol is consumed.
