Infectious Diseases I: Beta Lactams

Question 1

Natural penicllins coverage

Answer 1

mainly gram + cocci

entercoccus and anaerobes (mouth flora)

Question 2

Aminopenicillins coverage

Answer 2

Gram + cocci
Gram - bacilli: (HNPEK)
Haemophilus
neisseria
proteus
e.coli
klebsiella

Question 3

Adding beta-lactamase inhibitors adds..

Answer 3

MSSA coverage
incr gram - coverage
gram - anaerobes (B. fragilis)

Question 4

Nafcillin/oxacillin/dicloxacillin coverage

Answer 4

MSSA coverage

no entercoccuus

Question 5

zosyn coverage

Answer 5

expanded gram - coverage
Citrobacter, acinetobacter, Providencia, Enterobacter, Serratia (CAPES)
Pseudomonas

Question 6

Bicillin L-A

Answer 6

penicillin G benzathine
only IM
can cause cardiorespiratory arrest if given IV

Question 7

Pfizerpen-G

Answer 7

Penicillin G aqueous

Question 8

Common AE’s for penicillins

Answer 8

GI upset
diarrhea
rash
seizures with accumulation (renal dysfunction, long-term use)

Question 9

dosing frequency of Pfizerpen-G

Answer 9

q4-6h

Question 10

Moxatag

Answer 10

amoxicillin XR

Question 11

Unasyn dosing frequency

Answer 11

ampicillin/sulbactam

q6h

Question 12

Better oral bioavailability: amoxicillin or ampicillin?

Answer 12

amoxicillin

Question 13

Zosyn prolonged infusions

Answer 13

infuse over 4 hours

q8h

Question 14

When should amoxil 875 mg and amox XR 775 mg be avoided?

Answer 14

When crcl < 30

Question 15

Oral antistaphylococcal pcn

Answer 15

dicloxacillin

Question 16

Increased clavulanate is associated with…

Answer 16

increased diarrhea

Question 17

Drug of choice for syphilis

Answer 17

Bicillin L-A 2.4 mil units IM x1

Question 18

PCNs increase conc of which drug

Answer 18

methotrexate

Question 19

PCNs decrease conc of which drug

Answer 19

mycophenolate

Question 20

Dicloxacillin and nafcillin can increase INR (t/f)

Answer 20

False, actually decrease INR by increasing metabolism of warfarin

Question 21

Coverage of 1st gen cephalosporins

Answer 21

gram + cocci (MSSA)

Some gram - rods (proteus, e. coli, klebsiella) PEK

Question 22

Coverage of 2nd gen cephalosporins

Answer 22

s. pnem, haemophilus, neisseria, proteus, e coli, klebsiella (HNPEK)

Some (cefotetan, cefoxitin) have anaerobic coverage

Question 23

Coverage of 3rd gen cephalosporins

Answer 23

Ceftriaxone, Cefotaxime: more-resistant strep, enhanced gram - coverage

Ceftazadime: no gram +, covers psudomonas
+ b-lactamase inhibitor: MDR psuedomonas and other gram -

Question 24

Coverage of 4th gen cephalosporins

Answer 24

broad gram - coverage (pseudomonas)
gram + coverage similar to ceftriaxone

4th gen = cefepime

Question 25

Ceftaroline

Answer 25

"5th generation" similar coverage to ceftriaxone covers MRSA

Question 26

cephalosporins do NOT cover..,..

Answer 26

enterococcus | atypicals

Question 27

1st gen cephalosporins

Answer 27

cefadroxil (PO) cefazolin (IV) Cephalexin

Question 28

Common uses of cephalexin

Answer 28

MSSA skin infections | strep throat

Question 29

Common uses of cefazolin

Answer 29

surgical prophylaxis

Question 30

2nd gen cephalosporins

Answer 30

``` Cefaclor (PO) Cefprozil (po) Cefuroxime (po/iv/im) Cefotetan (iv/im) Cefoxitin (iv/im) ```

Question 31

Which 2nd gen cephalosporins cover gram - anaerobes?

Answer 31

Cefotetan Cefoxitin *start with cefo-*

Question 32

Ceclor

Answer 32

cefaclor

Question 33

Ceftin

Answer 33

cefuroxime

Question 34

Common use of cefuroxime

Answer 34

otitis media CAP Sinus infection

Question 35

Cefotan

Answer 35

cefotetan can cause disulfiram-like reaction

Question 36

Common use of cefotetan and cefoxitin

Answer 36

surgical prophylaxis for colorectal surgeries | covers anaerobes

Question 37

3rd gen cephalosporins

Answer 37

``` cefdinir (PO) cefditoren (PO) Cefixime (po) Cefpodoxime (po) Ceftibuten (po) Ceftriaxone (iv/im) Cefotaxime (iv/im) Ceftazidime (iv/im) ```

Question 38

Avycaz

Answer 38

ceftazidime/avibactam cover MDR gram - some carbapenem-resistant enterobacteriaceae

Question 39

Zerbaxa

Answer 39

ceftolozane/tazobactam | cover MDR gram -

Question 40

Rocehphin

Answer 40

ceftriaxone

Question 41

Claforan

Answer 41

Cefotaxime

Question 42

Cephalosporin that does NOT require renal adjustment

Answer 42

ceftriaxone

Question 43

Maxipime

Answer 43

Cefepime | only 4th gen cephalosporin

Question 44

Teflaro

Answer 44

Ceftaroline 5th gen covers MRSA broadest gram + coverage

Question 45

separate oral cephalosporins (cefuroxime, cefdinir, cefpodoxime) and acid-reducing agents by how many hours?

Answer 45

2 hours from short-acting agents | avoid H2RAs and PPIs

Question 46

Carbapenems are considered narrow spectrum agents (t/f)

Answer 46

False, broad-spectrum | usually reserved for MDR gram - infections

Question 47

All carbapenems have similar coverage except for....

Answer 47

ertapenem

Question 48

Ertapenem does not cover...

Answer 48

Pseudomonas Acinetobacter Enterococcus

Question 49

What do carbapenems NOT cover?

Answer 49

``` atypicals VRE MRSA C. diff stenotrophomonas ```

Question 50

Carbapenems are associated with this CNS adverese effect?

Answer 50

seizures (esp. imipenem/cilastatin) | use caution with pts with epilepsy and other drugs that lower seizure threshold

Question 51

Doribax | renal adjustment cut-off

Answer 51

Doripenem dosed q8h Crcl < 50

Question 52

Primaxin | renal adjustment cut-off

Answer 52

Imipenem/cilastatin dosed q6-8h Crcl< 70

Question 53

Merrem | renal adjustment cut-off

Answer 53

Meropenem dosed q8h crcl< 50

Question 54

Invanz | renal adjustment cut-off

Answer 54

Ertapenem dosed q daily crcl < 30

Question 55

Invanz must be diluted with....

Answer 55

Normal saline

Question 56

carbapenems cover ESBL producing organisms (t/f)

Answer 56

true

Question 57

Aztreonam is classified as...

Answer 57

a Monobactam

Question 58

Aztreonam coverage

Answer 58

Gram - ONLY | including pseudomonas

Question 59

Aztreonam brand name

Answer 59

Azactam Cayston (inhaled form for CF)