Infectious Diseases Flashcards
BJ is on tobramycin IV Q8H for treating a G- infection and his levels are reported as a peak of 8.3 mcg/mL and a trough of 2.5 mcg/mL. Which of the following recommendations should the pharmacist make to the medical team?
a. Increase the dose
b. Decrease the dose
c. Extend the dosing interval
d. Shorten the dosing interval
e. Continue the current regimen
c
What are the peak and trough level goals for tobramycin?
Peak: 5-10 mcg/mL
Trough: < 2 mcg/mL
RS is a 62 y/o male with multiple medical problems including colon cancer, s/p surgical resection of his colon and chemo, who’s now presenting with AKI (SCr has increased from 0.8 to 1.6 mg/dL) and a complicated Pseudomonas bloodstream infection. The medical team would like to use 2 drugs with activity against Pseudomonas until cultures and susceptibilities are available. Allergies include penicillin (angioedema) and simvastatin (hx of rhabdomyolysis). Which of the following regimens represents the best choice?
a. Cefepime + gentamicin
b. Ertapenem + levofloxacin
c. Aztreonam + ciprofloxacin
d. Meropenem + tobramycin
e. Piperacillin-tazobactam + moxifloxacin
c
DH is a 42 y/o male being treated with quinupristin/dalfopristin for a complicated VRE and MRSA infection. Which of the following are common toxicities of quinupristin/dalfopristin?
a. Infusion reactions, electrolyte abnormalities, nephrotoxicity
b. Arthralgias/myalgias, nephrotoxicity, neurological disturbances
c. Infusion reactions, arthralgias/myalgias, hyperbilirubinemia
d. Hyperbilirubinemia, neurological disturbances, arthralgias/myalgias
e. Neurological disturbances, nephrotoxicity, infusion reactions
c
CP is a 22 y/o female who’s been started on Macrobid for a 5-day treatment course for a UTI. Counseling on Macrobid should include the following points?
a. Don’t take antacids or calcium supplements at the same time as your Macrobid dose.
b. The med should be taken 4x daily in evenly spaced intervals (Q6H).
c. The med may cause the urine to turn dark yellow or brown in color.
d. The med can make the skin more sensitive to the sun. Use sunscreen and protective clothing.
e. This drug should be taken on an empty stomach.
c
SV is a 49 y/o female who’s picking up a prescription for levofloxacin for an E coli UTI that’s resistant to nitrofurantoin and Bactrim. Her med hx is significant for dyslipidemia, diabetes, afib, and osteoporosis. She’s currently taking atorvastatin, amiodarone, Januvia, Byetta, metformin, calcium citrate, and vit D. Which of the following can be caused by potential drug interactions in this med regimen?
a. QT prolongation
b. Impaired absorption of levofloxacin
c. Hypoglycemia or hyperglycemia
d. Peripheral edema, fluid retention d/t quinolone addition
e. Additive nephrotoxicity
a, b, c
TM is a 42 y/o male who’s been started on Biaxin for tx of pneumonia. Which of the following meds does NOT pose a drug interaction with the AB tx?
a. Amiodarone
b. Methadone
c. Simvastatin
d. Sucralfate
e. Voriconazole
d
Amiodarone - QT prolongation
Methadone - Biaxin causes increased concentrations of methadone; QT prolongation
Simvastatin - contraindicated
Voriconazole - Biaxin can cause increased concentrations of voriconazole; QT prolongation
A med student on the team caring for a patient with CAP suggests using a “respiratory fluoroquinolone” to treat his infection. Which of the following correctly lists respiratory quinolones and explains why they are called “respiratory quinolones?”
a. Gemifloxacin and moxifloxacin have enhanced G- and anaerobic activity
b. Ciprofloxacin and levofloxacin have superior G+ and anaerobic coverage
c. Levofloxacin and moxifloxacin have superior coverage of S. pneumoniae
d. Ciprofloxacin and levofloxacin have enhanced G+ and anaerobic activity
e. Levofloxacin and moxifloxacin have enhanced G- and atypical coverage
c
A patient has a MRSA wound infection. She has HF and impaired renal function with a CrCl of 40 mL/min. Her current meds include Toprol XL, Zestril, and Lasix. She’s going to receive IV vancomycin while in the hospital. Choose the correct statement:
a. Vancomycin shouldn’t be used in patients with HF
b. She should receive the vancomycin orally d/t the risk of further renal insufficiency
c. She’s at an elevated risk of ototoxicity
d. The trough isn’t important; only vancomycin peaks should be monitored
e. She should receive ceftazidime instead of vancomycin
c
Vancomycin can increase the risk of ototoxicity when used with other ototoxic drugs (aminoglycosides, cisplatin, loop diuretics).
Which of the following beta-lactam antibiotics can be given by mouth?
a. Zosyn
b. Augmentin
c. Cefazolin
d. Ceftriaxone
e. Penicillin G benzathine
f. Cefdinir
g. Keflex
b, f, g
Which of the following are potential tx options for a vancomycin resistant Enterococcus faecalis (VRE) surgical site infection s/p C-section?
a. Rifaximin
b. Cubicin
c. Merrem
d. Zyvox
e. Levaquin
b, d
HW is a 71 y/0 male who’s been in the ICU for several weeks and is now being treated for pneumonia, with a lower respiratory cx positive for Pseudomonas aeruginosa. His weight is 225 lbs and height is 6’0”. His current SCr is 2.4 mg/dL. Based on the culture sensitivities, the med team decides to start tobramycin at 2.5 mg/kg. They ask the pharmacist to write the order and administer the 1st dose at 8:00 AM. Which dose of tobramycin should be administered at 8:00 AM?
a. 560 mg
b. 410 mg
c. 340 mg
d. 220 mg
e. 100 mg
d
Choose the correct statement concerning azithromycin:
a. It has drug interactions similar to clarithromycin
b. It leaves a metallic taste in the mouth
c. It binds to the 50S ribosomal subunit
d. It binds to penicillin-binding proteins
e. It can be used if an allergy is noted to erythromycin
c
What is the IV:PO ratio for metronidazole?
1:1
Which of the following statements is correct regarding nafcillin?
a. Nafcillin is active against MRSA
b. Nafcillin is a vesicant
c. Nafcillin should be dose adjusted in renal impairment
d. Nafcillin is compatible with NS only
e. Nafcillin can’t be used in a sulfa allergic patient
b
Extended infusion piperacillin-tazobactam is a dosing strategy that optimizes which of the following pharmacodynamic parameters?
a. Peak:MIC ratio
b. AUC:MIC ratio
c. Peak concentration
d. Time above MIC (T > MIC)
e. Minimum bactericidal concentration
d
Which of the following meds should be avoided in children < 8 y/o d/t discoloration of teeth and bone growth retardation?
a. Televancin
b. Minocycline
c. Telithromycin
d. Tinidazole
e. Rifaximin
b
A patient with MDR Pseudomonas aeruginosa isolated from the urine cx is admitted to the hospital. The physician would like to avoid using a med that can worsen kidney function as the patient’s SCr has increased from 0.7 to 1.4 over the past week. Which of the following drugs would you recommend?
a. Clindamycin
b. Cetriaxone
c. Ceftolozane/tazobactam
d. Oritavancin
e. Tobramycin
c
A patient with an extensive hx of alcohol abuse comes into the hospital with classic signs and symptoms of an infection. Which of the following ABs presents a safety issue in light of his social hx?
a. Cefuroxime
b. Cefotaxime
c. Cefotetan
d. Cefprozil
e. Cefaclor
c
Cefotetan contains a side chain that can increase the risk of bleeding and can cause a disulfiram-like reaction with alcohol ingestion.
SN is prescribed Avelox for a CAP infection. What is the MOA for Avelox?
a. Binds to penicillin binding proteins to inhibit cell wall synthesis
b. Binds to the 30S ribosomal subunit, inhibiting protein synthesis
c. Inhibits DNA topoisomerase IV, thereby blocking DNA gyrase
d. Inhibits synthesis of Beta (1,3)-D-glucan
e. Binds to the 50S ribosomal subunit, inhibiting protein synthesis
c
Which of the following statements are correct regarding the use of Bactrim for toxoplasmosis prophylaxis?
a. It should be taken with 8 oz of water
b. It shouldn’t be used for toxoplasmosis prophylaxis
c. It can increase the risk of sunburn
d. It can cause a serious rash requiring immediate medical attention
e. It shouldn’t be used if the patient has a sulfa allergy
a, c, d, e
A physician asks the pharmacist about a single-dose medication for bacterial skin and skin structure infections that he heard about. Which drug is he referring to?
a. Vancomycin
b. Televancin
c. Oritavancin
d. Tedizolid
e. Polymixin
c
RF is a 58 y/o male who’s in the MICU with a severe Pseudomonas aeruginosa lung infection. He’s on ciprofloxacin and cefepime, and his infection doesn’t seem to be clearing. Which of the following meds could be used to cover the same pathogen in place of the current therapy?
a. Meropenem
b. Invanz
c. Zyvox
d. Minoglycine
e. Tygacil
a
All the carbapenems, except ______, cover Pseudomonas aeruginosa.
ertapenem (Invanz)
Which of the following groups of pathogens best represents clindamycin’s spectrum of activity?
a. Atypicals and anaerobic pathogens
b. MDR G- pathogens (Acinetobacter, Pseudomonas) and skin flora (Streptococci, Staphylococci)
c. Enteric G- pathogens and anaerobic pathogens
d. Parasitic and fungal pathogens
e. Aerobic (Streptococci, Staphylococci) and anaerobic G+ pathogens
e
MB is a 51 y/o female who has been prescribed Biaxin for pneumonia. She had a heart attack 2 years ago. During hospitalization, she was found to have afib and was placed on warfarin. Her other meds include: simvastatin, citalopram, atenolol, and fish oil. The use of Biaxin in this patients increases her risk of:
a. QT prolongation
b. Hepatotoxicity
c. Myopathy
d. Tachycardia
e. VTE
a, b, c
Which of the following statements are correct with regard to Bactrim?
a. It’s a potent hepatic enzyme inducer resulting in reduced drug concentrations
b. It has excellent bioavailability, thus can transition from IV to PO formulations in a 1:1 fashion
c. It’s active against G+ pathogens, including Staphylococci, G- pathogens, and opportunistic pathogens
d. It should be avoided in a patient with G6PD deficiency
e. A negative Coombs test with Bactrim indicated hemolytic anemia
b, c, d
An otherwise healthy patient presents with a foot infection that developed 1 week after stepping on a child’s toy. The wound cx is growing G+ and G- bacteria; Pseudomonas isn’t suspected. The physician would like to use a cephalosporin for tx of the patient’s infection. Which of the following statements regarding cephalosporins is correct?
a. Cefazolin is an oral cephalosporin that’s considered to be the most effective therapy for mild-mod G- foot infections.
b. Cefixime is the only oral cephalosporin with G- and enteric anaerobic coverage.
c. Cephalexin is an oral, 2nd generation cephalosporin with sufficient G- and G+ coverage for moderate severity foot infections.
d. Cefuroxime is an oral, 2nd generation cephalosporin with adequate G- and G+ coverage for mild-mod foot infections.
e. Cefpodoxime is an IV, 3rd generation cephalosporin with adequate G+ and G- coverage for severe foot infections.
d
A patient is receiving Bactrim DS therapy. Which of the following strengths and ingredients are in Bactrim DS tablets?
a. 800 mg SMX and 160 mg TMP
b. 160 SMX and 800 TMP
c. 80 mg SMX and 16 mg TMP
d. 400 mg SMX and 80 mg TMP
e. 100 mg SMX and 50 mg TMP
a
Which of the following agents are associated with ototoxicity?
a. Ethambutol and rifampin
b. Nitrofurantoin and vancomycin
c. Gentamicin and vancomycin
d. Penicillin and ciprofloxacin
e. Daptomycin and gentamicin
c
Azithromycin is commonly used in the tx of all of the following EXCEPT:
a. Chlamydia
b. Mycoplasma pneumoniae
c. Mycobacterium avium complex
d. Toxoplasmosis
e. Travelers’ diarrhea
d
A pharmacy intern is giving a presentation on AB therapy for G+ infections. She will discuss common uses for penicillins. Which drug is INCORRECTLY paired with a common use?
a. Bicillin C-R for syphilis
b. Oxacillin for MSSA bacteremia
c. Amoxicillin/clavulanate for otitis media
d. Amoxicillin for endocarditis prophylaxis
e. Penicillin V potassium for strep throat
a
Penicillin G benzathine (Bicillin L-A) 2.4 million units IM is used for syphilis. It can be fatal if given IV instead of IM.
NA is a 42 y/o female who was a victim of a house fire. She acquired 3rd degree burns requiring skin grafting. Unfortunately, her course has been complicated by post-op Acinetobacter wound infection and AKI. She has no known drug allergies. Which of the following ABs would be considered 1st line in her case as a single agent?
a. Vancomycin
b. Meropenem
c. Ampicillin
d. Fosfomycin
e. Linezolid
b
Meropenem is the DOC for treating Acinetobacter
Which one of the following agents does not cover Pseudomonas aeruginosa?
a. Avycaz
b. Colistimethate
c. Zyvox
d. Cipro
e. Ceftazidime
c
A prescription for generic minocycline is filled. Which of the following statements regarding minocycline are correct?
a. This med has been associated with drug-induced lupus
b. Take on an empty stomach 1 hour before or 2 hours after meals
c. This med may increase the risk of sunburn
d. This med should be separated when given with antacids
e. This med doesn’t interact with other meds
a, c, d
Choose the correct statements concerning vancomycin PD/PK and therapeutic drug monitoring.
a. Vancomycin exhibits time-dependent killing
b. Targeting an AUC/MIC ratio of 400-600 is recommended for serious MRSA infections
c. Alternative agents should be considered if vancomycin MIC >/= 2 mcg/mL
d. A 1500 mg dose should be infused over 30 minutes
e. Vancomycin troughs should be drawn at steady state (generally before the 4th dose)
b, c, e
Hospitalized patients with MRSA SSTIs are often treated with IV therapy and transitioned to an oral agent to allow the ease of use and discharge from the hospital. Which AB requires a D-test to be performed prior to use for MRSA SSTIs?
a. Bactrim
b. Clindamycin
c. Minocycline
d. Linezolid
e. Delafloxacin
b
An induction test (D-test) should be performed on S. aureus that’s susceptible to clindamycin but resistant to erythromycin.
JR has been in the ICU for the past 2 weeks. He was initially admitted for an asthma exacerbation requiring mechanical ventilation, and a central line was placed to assist with the administration of IV meds. On day 15, he develops a fever, and his white count rises up to 14,000. A chest x-ray doesn’t identify any infectious etiology. Blood Cxs are positive for E. faecium, which is VRE. Which of the following ABs are appropriate to treat vancomycin-resistant E. faecium bacteremia?
a. Cubicin
b. Vancocin
c. Macrobid
d. Invanz
e. Avelox
a
Cubicin (daptomycin)
All of the following agents have excellent bioavailability suitable for a 1:1 IV to PO conversion EXCEPT:
a. Zyvox
b. Flagyl
c. Avelox
d. Vancocin
e. Vibramycin
d
CN has been receiving IV gentamicin for the last 10 days. Which of the following are side effects associated with gentamicin?
a. Cardiotoxicity
b. Neurotoxicity
c. Pulmonary toxicity
d. Nephrotoxicity
e. Ototoxicity
b, d, e
Which of the following can interfere with coagulation lab assays?
a. Bactrim
b. Daptomycin
c. Linezolid
d. Oritavancin
e. Televancin
b, d, e
A hospitalized patient with no known drug allergies has cellulitis, and the physician ordered vancomycin 1,000 mg IV Q12H and imipenem-cilastatin 1,000 mg IV Q8H. The meds were administered at the same time over 30 minutes. During the infusion, the patient experienced a profound drop in BP. Her upper body, mostly in the trunk area, was covered with an erythematous rash. What is the likely cause of the patient’s symptoms?
a. Rhabdomyolysis
b. Vancomycin flushing reaction
c. Drug-induced lupus erythematous
d. CYP2C9 drug interaction
e. Photosensitivity reaction
b
Infusion reaction due to a rapid administration of vancomycin. Symptoms include rash, pruritus, erythema, and less frequently, hypotension or angioedema. Infusions should be limited to no more than 1 g per hour.
Which of the following statements is correct regarding 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 g/3 g of piperacillin/tazobactam, respectively
e. It’s available as an oral suspension and IV formulation
a
Which group of agents cover atypical pathogens?
a. Levaquin, doxycycline, Augmentin
b. Flagyl, erythromycin, Ceftin
c. Bactrim, Keflex, Amoxil
d. Cefdinir, Cipro, Biaxin
e. Doxycycline, Zithrmoax, Avelox
e
Which of the following statements is correct regarding linezolid?
a. Linezolid is associated with bone marrow suppression
b. Linezolid covers MRSA but not VRE
c. Linezolid should be dose adjusted in renal impairment
d. Linezolid is a strong CYP1A2 inhibitor
e. Linezolid is associated with hemolytic anemia in patients with G6PD deficiency\
a
MP presents to the urgent care clinic with a large cellulitis wound on his left lower extremity. The patient has a hx of MRSA infection 2 months prior, and the practitioner wants to prescribe something orally that covers MRSA. Which of the following meds fit this description?
a. Tygacil
b. Zyvox
c. Cubicin
d. Quinupristin/Dalfopristin
e. Televancin
b
The other meds are only available IV.
Which of the following statements is correct regarding the appropriate use of metronidazole?
a. Side effects include a metallic taste in the mouth
b. The IV:PO dosing ratio is 0.5:1
c. Metronidazole is an azole antifungal agent
d. Metronidazole is available in IV and PO formulations only
e. Alcohol shouldn’t be consumed for 7 days after the last dose
a
Amebicide, antiprotozoal antibiotic
Topical and vaginal formulations are also available.
Alcohol should be avoided during therapy and 3 days after the last dose to avoid flushing, abdominal cramping, and N/V.
Which of the following statements has a risk for additive QT prolongation when combined with amiodarone?
a. Zithromax
b. Penicillin V potassium
c. Invanz
d. Nitrofurantoin
e. Cleocin
a
Choose the correct statement that best describes the activity of cefuroxime:
a. 1st gen - better G+ (covers MSSA) than G- activity
b. 2nd gen - better G- activity compared to 1st gen with similar G+ activity
c. 3rd gen - better G- activity than 2nd gen, less Staph (G+) activity compared to 2nd gen but better Strep (G+) activity
d. 4th gen - excellent G- activity; G+ activity that’s similar to 1st gen
e. 5th gen - best G+ activity (covers MRSA), G- activity similar to ceftriaxone
b