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.
A patient is picking up a prescription for erythromycin ethylsuccinate (E.E.S.) oral suspension. Choose the correct statement:
Answer
A
This medication cannot be used if the patient has a penicillin allergy.
B
This medication should not be administered with food.
C
This medication is a major inhibitor of cytochrome P450 2C9.
D
This medication is effective for treating the flu.
E
This medication should be refrigerated.
E
This medication should be refrigerated.
HV is a 37 y/o male in the ICU after sustaining a gunshot wound on 1/10/16. He has had a complicated hospital course so far and is now being treated for ventilator associated pneumonia and bacteremia with Pseudomonas. He is 6’2” and weighs 192 pounds. He is currently on gentamicin 180 mg IV Q8H and Maxipime 1 gm IV Q8H. The pharmacokinetic service has ordered steady state gentamicin levels today. Both levels were drawn at the appropriate times with respect to the dose. The peak level is 9.2 mcg/mL and the trough level is 0.2 mcg/mL. What is the best recommendation to make regarding the gentamicin regimen?
Answer
A
Increase the dose and leave the interval the same.
B
Decrease the dose and leave the interval the same.
C
Leave the dose the same and change the interval to Q6H.
D
Increase the dose and change the interval to Q6H.
E
Do nothing, these are within target range for peak and trough gentamicin levels.
E
Do nothing, these are within target range for peak and trough gentamicin levels.
A patient is taking Moxatag for treatment of strep throat. Which of the following statements is correct regarding Moxatag?
Answer
A
Moxatag can be used in a patient whose creatinine clearance is 25 mL/min.
B
Moxatag should be administered within 1 hour of finishing a meal.
C
Moxatag should be stored in the refrigerator.
D
Moxatag is an extended release product delivered by the osmotic-controlled release oral delivery system (OROS).
E
Moxatag is safe to use in a patient who has a penicillin allergy.
B
Moxatag should be administered within 1 hour of finishing a meal.
Which of the following antibiotics require dose adjustment for severe renal dysfunction (CrCl < 30 mL/min)? (Select ALL that apply.)
Answer
A Doxycycline B Piperacillin/Tazobactam C Daptomycin D Nafcillin E Ciprofloxacin
B Piperacillin/Tazobactam C Daptomycin E Ciprofloxacin
EL, a 62 year-old female, is receiving metronidazole 500 mg intravenously every 12 hours for an intra-abdominal infection involving Bacteroides fragilis. Choose the correct statement for metronidazole when given intravenously:
Answer
A
This medication should be stored at room temperature.
B
This medication should be infused no faster than 2.5 mg/min.
C
Use a slow infusion rate or severe hypotension could result.
D
Do not use this medication if gout is present.
E
There is no interaction with warfarin or other anticoagulants.
A
This medication should be stored at room temperature.
Hospitalized patients with MRSA skin and soft tissue infections are often treated with IV therapy and transitioned to an oral agent to allow ease of use and discharge from the hospital. Prior to sending patients home on clindamycin, what test should be performed to ensure clindamycin’s effectiveness?
Answer
A Hodge test B D-test C E-test D Synergy test E Kirby-Bauer (disk diffusion) test
The “D-test” is used to confirm clindamycin susceptibility in MRSA. Refer to the 2017 RxPrep Course Book, page . The Hodge test detects carbapenemase production. Disk diffusion determines whether a bacteria is susceptible, intermediate or resistant and an E-test determines the minimal inhibitory concentrations of an antibiotic. Synergy tests determine if the effects of combining two antibiotics is greater than the sum of the individual agent.
Which of the following agents are associated with ototoxicity?
Answer
A Ethambutol and rifampin B Voriconazole and vancomycin C Gentamicin and vancomycin D Penicillin and ciprofloxacin E Daptomycin and gentamicin
C
Gentamicin and vancomycin
Which of the following organisms are considered to be anaerobes?
Answer
A
Enterobacter, Clostridium, Peptostreptococcus
B
Enterococcus, Bacteroides, Staphylococcus
C
Bacteroides, Peptostreptococcus, Clostridium
D
Staphylococcus, Bacteroides, Clostridium
E
Staphylococcus, Enterobacter, Enterococcus
C
Bacteroides, Peptostreptococcus, Clostridium
Which of the following classes of antibiotics exhibit concentration-dependent killing?
Answer
A Tetracyclines B Carbapenems C Fluoroquinolones D Macrolides E Streptogramins
Concentration-dependent antibiotics include aminoglycosides, fluoroquinolones, daptomycin and others. See figure in the 2017 RxPrep Course book, page 366.
MT comes to the pharmacy to pick up her prescription for Levaquin 500 mg tabs once daily for 7 days. You notice her profile states that she is taking simvastatin, hydrochlorothiazide, amlodipine, rabeprazole, warfarin and aspirin. She is purchasing zinc tablets for her cold. Counseling should include the following: (Select ALL that apply.)
A: Take with full glass of water
B. May cause sensitivity to sun
C: May interact with warfarin
D: Take either 2 hours before or 2 hours after Zinc product
A: Take with full glass of water
B. May cause sensitivity to sun
C: May interact with warfarin
D: Take either 2 hours before or 2 hours after Zinc product
LS is receiving gentamicin 200 mg IV Q8H for treatment of E. coli bacteremia secondary to UTI. The peak level comes back at 3.8 mcg/mL and her trough level was undetectable. What is the best recommendation to make regarding the gentamicin regimen?
Answer
A Increase the gentamicin dose B Decrease the gentamicin dose C Increase the dosing interval to Q12H D Decrease the dosing interval to Q6H E Increase the dose and the dosing interval
A
Increase the gentamicin dose
A pharmacy intern is giving a presentation on antibiotic therapy for Gram-positive infections. She is preparing a slide on penicillins. Which of the following points would be incorrect information to include?
Answer
A
Penicillins can raise the seizure threshold.
B
A possible side effect of penicillins is rash.
C
Most penicillins require dose reductions in patients with renal insufficiency.
D
Penicillins are safe to use in pregnancy.
E
Penicillin is not active against Mycoplasma.
A
Penicillins can raise the seizure threshold.
(Penicillins can actually lower the seizure threshold)
Which of the following are potential treatment options for vancomycin-resistant Enterococcus faecalis (VRE) skin-soft tissue infection status post C-section? (Select ALL that apply.)
Answer
A Tygacil B Cubicin C Merrem D Sivextro E Levaquin
A Tygacil B Cubicin D Sivextro
Choose the correct statement concerning vancomycin pharmacodynamics/pharmacokinetics and therapeutic drug monitoring. (Select ALL that apply).
Answer
A
Vancomycin exhibits concentration-dependent kill.
B
Treating pneumonia requires higher troughs (15-20 mcg/mL) as vancomycin has relatively poor lung penetration.
C
Alternative agents should be considered if the MIC of an organism is ≥ 2 mcg/mL.
D
Treating meningitis requires a higher trough (15-20 mcg/mL) as vancomycin has poor CNS penetration.
E
Vancomycin troughs should be drawn at steady state (generally before the fourth dose).
B
Treating pneumonia requires higher troughs (15-20 mcg/mL) as vancomycin has relatively poor lung penetration.
C
Alternative agents should be considered if the MIC of an organism is ≥ 2 mcg/mL.
D
Treating meningitis requires a higher trough (15-20 mcg/mL) as vancomycin has poor CNS penetration.
E
Vancomycin troughs should be drawn at steady state (generally before the fourth dose).
Which of the following medications is/are associated with seizures and/or decreasing the seizure threshold? (Select ALL that apply.)
Answer
A Imipenem/Cilastatin B Ciprofloxacin C Cefuroxime D Penicillin G E Azithromycin
A Imipenem/Cilastatin B Ciprofloxacin C Cefuroxime D Penicillin G
(B-lectams in general cause or lower the seizure threshold)
CM comes to the clinic and is diagnosed with syphilis. Choose the correct statement:
Answer
A
Syphilis is due to an infection caused by the organism Syphilis pallidum.
B
The treatment for early syphilis is Bicillin C-R.
C
Primary syphilis presents as a painful, oozing lesion several days after infection.
D
The treatment for neurosyphilis is doxycycline.
E
Doxycycline is an alternative for primary syphilis if the patient was allergic to penicillin.
E
Doxycycline is an alternative for primary syphilis if the patient was allergic to penicillin.
PC works as a home health nurse. She visits patients with tuberculosis (TB) and watches them take their medication. Choose the correct statements: (Select ALL that apply.)
Answer
A
The primary purpose is to increase adherence and reduce the risk to the public health.
B
Medications for active TB, if used in this type of program, can be dosed two to three times weekly instead of daily.
C
Rifampin cannot be used in a DOT program.
D
DOT is not necessary for TB as this infection is not fatal.
E
This is called directly observed therapy (DOT).
A
The primary purpose is to increase adherence and reduce the risk to the public health.
B
Medications for active TB, if used in this type of program, can be dosed two to three times weekly instead of daily.
E
This is called directly observed therapy (DOT).
ES is a 64 year-old male who has prostatitis and reports sulfonamide and quinolone allergies. The cultures are growing Proteus mirabilis. The medicine team wants him to receive 2 week of intravenous antibiotics as an outpatient before transitioning him to orals. They ask the pharmacist to recommend something that could be given once daily in this patient, who has normal renal function. Which of the following antibiotics would meet this criteria?
Answer
A Ceftaroline B Cefuroxime C Ceftazidime D Cefepime E Ceftriaxone
E
Ceftriaxone
JM is a 50 year-old man recently diagnosed a Clostridium difficile infection. He has a serum white blood cell count of 16,500 cells/mm^3 and a SCr of 1.7 mg/dL (his baseline is 1.0 mg/dL) with 6-8 loose bowel movements per day. What is the most appropriate therapy for Mr. Moriarty?
Answer
A Metronidazole 500 mg IV Q6H B Metronidazole 500 mg PO TID C Vancomycin 125 mg PO QID D Vancomycin 500 mg PO QID E Vancomycin 125 mg PO QID and metronidazole 500 mg IV Q8H
C
Vancomycin 125 mg PO QID
How long should peri-operative antibiotic prophylaxis be continued for most surgeries?
Answer
A 5 days B 7 days C 10 days D 24 hours or less E 48 hours
D
24 hours or less
Chief Complaint: Trauma
History of Present Illness: MV is a 43 year-old male brought to the ED on 12/4 after a skiing accident with closed head trauma, facial lacerations and pulmonary contusion with underlying rib fracture on the right side of chest. Patient has been intubated in ICU since admission for airway support. Due to extensive injuries and difficulty weaning off the ventilator, MV remains intubated on hospital day 7. Past medical history includes a fractured tibia as a child and social history includes social alcohol use and occasional marijuana use.
Allergies: NKDA
Physical Exam / Vitals:
Height: 5’9” Weight: 209 pounds
BP: 102/59 mmHg HR: 100 BPM RR: 28 BPM Temp: 102°F Pain: 6/10
Labs on 12/10:
Na (mEq/L) = 137 (135 – 145) WBC (cells/mm^3) = 19.1 (4 – 11 x 10^3)
K (mEq/L) = 3.8 (3.5 – 5) Hgb (g/dL) = 14.6 (13.5 – 18 male, 12 – 16 female)
Cl (mEq/L) = 99 (95 – 103) Hct (%) = 40.5 (38 – 50 male, 36 – 46 female)
HCO3 (mEq/L) = 28 (24 – 30) Plt (cells/mm^3) = 170 (150 – 450 x 10^3)
BUN (mg/dL) = 18 (7 – 20) AST (IU/L) = 37 (10 – 40)
SCr (mg/dL) = 1.2 (0.6 – 1.3) ALT (IU/L) = 33 (10 – 40)
Glucose (mg/dL) = 122 (100 – 125) Albumin (g/dL) = 4.2 (3.5 – 5)
Ca (mg/dL) = 8.7 (8.5 – 10.5)
Mg (mEq/L) = 1.9 (1.3 – 2.1)
PO4 (mg/dL) = 3.1 (2.3 – 4.7)
Tests on 12/10:
Chest X-ray: New patchy consolidation and infiltrate.
Endotracheal aspirate culture: Gram stain shows a large amount of Gram-positive cocci.
Plan: Acetaminophen per feeding tube for fever, empiric antibiotics for ventilator-associated pneumonia, to include meropenem + vancomycin + gentamicin (extended-interval dosing).
Question
What dose of gentamicin (rounded to the nearest TEN mg) should be initiated in MV as part of the empiric antibiotic regimen?
Answer
A 140 mg IV every 24 hours B 500 mg IV every 24 hours C 560 mg IV every 24 hours D 670 mg IV every 24 hours E 160 mg IV every 24 hours
C
560 mg IV every 24 hours
Chief Complaint: Trauma
History of Present Illness: MV is a 43 year-old male brought to the ED on 12/4 after a skiing accident with closed head trauma, facial lacerations and pulmonary contusion with underlying rib fracture on the right side of chest. Patient has been intubated in ICU since admission for airway support. Due to extensive injuries and difficulty weaning off the ventilator, MV remains intubated on hospital day 7. Past medical history includes a fractured tibia as a child and social history includes social alcohol use and occasional marijuana use.
Allergies: NKDA
Physical Exam / Vitals:
Height: 5’9” Weight: 209 pounds
BP: 102/59 mmHg HR: 100 BPM RR: 28 BPM Temp: 102°F Pain: 6/10
Labs on 12/10:
Na (mEq/L) = 137 (135 – 145) WBC (cells/mm^3) = 19.1 (4 – 11 x 10^3)
K (mEq/L) = 3.8 (3.5 – 5) Hgb (g/dL) = 14.6 (13.5 – 18 male, 12 – 16 female)
Cl (mEq/L) = 99 (95 – 103) Hct (%) = 40.5 (38 – 50 male, 36 – 46 female)
HCO3 (mEq/L) = 28 (24 – 30) Plt (cells/mm^3) = 170 (150 – 450 x 10^3)
BUN (mg/dL) = 18 (7 – 20) AST (IU/L) = 37 (10 – 40)
SCr (mg/dL) = 1.2 (0.6 – 1.3) ALT (IU/L) = 33 (10 – 40)
Glucose (mg/dL) = 122 (100 – 125) Albumin (g/dL) = 4.2 (3.5 – 5)
Ca (mg/dL) = 8.7 (8.5 – 10.5)
Mg (mEq/L) = 1.9 (1.3 – 2.1)
PO4 (mg/dL) = 3.1 (2.3 – 4.7)
Tests on 12/10:
Chest X-ray: New patchy consolidation and infiltrate.
Endotracheal aspirate culture: Gram stain shows a large amount of Gram-positive cocci.
Plan: Acetaminophen per feeding tube for fever, empiric antibiotics for ventilator-associated pneumonia, to include meropenem + vancomycin + gentamicin (extended-interval dosing).
Question
Which of the following regimens is the best empiric therapy to treat the patient’s ventilator associated pneumonia?
Answer
A Vancomycin + Tobramycin + Cefepime B Daptomycin + Tobramycin + Levofloxacin C Ceftaroline + Linezolid + Piperacillin/Tazobactam D Telavancin + Ceftriaxone + Colistin E Nafcillin + Tobramycin + Ciprofloxacin
A
Vancomycin + Tobramycin + Cefepime
