Meningitis Quiz

Question 1

When delivering antibiotics to a patient with reduced renal clearance the antibiotic is often dosed less frequently. When compared to patients having normal renal function (for a given dose), increasing the dose interval often results in:

A) A greater range between peak and trough and longer time interval between peak and trough effects
B) The patient with reduced renal function gets to steady state much faster
C) Antibiotics are unnecessary as the buildup of metabolic products in renal dysfunction is bacteriocidal
D) Makes no difference

Answer 1

A

Question 2

Define pharmacokinetics

Answer 2

Absorption, distribution, and elimination. What your BODY does to the drug

Question 3

Define pharmacodynamics

Answer 3

Pharmacologic effects. What the DRUG does to your body

Question 4

Define bacteriostatic

Answer 4

Inhibits bacterial growth

Question 5

Define bacteriocidal

Answer 5

The antibacterial is lethal to bacteria

Question 6

T or F: Four factors that affect CNS penetration are: molecule size, lipid solubility, protein binding, and inflammation.

Answer 6

True

Question 7

When ceftriaxone and ceftazidime enter the CNS they result in:

A) Low CSF concentrations and high MICs to CNS pathogens
B) AUC/MIC = about 50% of the typical bonus paid to wall street executives
C) High CSF concentrations and low MICs to CNS pathogens
D) Prohibited by insurance companies

Answer 7

C – MIC = minimum inhibitory concentration

Question 8

A 24 y/o M presents with fever, altered mental status, and neck stiffness. After performing a physical exam, there is concern for possible meningitis, so a lumbar puncture is performed. Which of the following is the BEST initial regimen?

A) Vancomycin, ceftriaxone, and acyclovir
B) Vancomycin, ampicillin, ceftriaxone, acyclovir, and dexamethasone
C) Vancomycin, cefepime, and dexamethasone
D) Vancomycin, ceftriaxone, acyclovir, and dexamethasone

Answer 8

D – vanco covers the common gram positive pathogens (strep pneumo), ceftriaxone covers the common gram negative pathogens (H flu, n. meningiditis), acyclovir covers HSV (MC viral pathogen), and dexamethasone prevents hearing loss if administered prior to strep pneumo ONLY

Question 9

How would your empiric therapy have been different if the CSF returned the following:

WBC 500 cells/mm3 (with 50% lymphocytes)
Protein 60md/dL
Glucose 70 mg/dL
HSV pcr positive
Gram-stain negative

A) Continue acyclovir and stop the antibiotics
B) Discontinue vancomycin only
C) Discontinue ceftriaxone and acyclovir
D) Discontinue dexamethasone and acyclovir

Answer 9

A

Question 10

The LP results return for patient JM with the following results: 15,000 WBC w 85% neutrophils, protein 150 mg/dL, glucose 35 mg/dL, and HSV PCR negative. Gram stain and culture are pending. Which regimen is the BEST option for JM?

A) Acyclovir alone
B) Vancomycin, ceftriaxone, and dexamethasone
C) Vancomycin and ceftriaxone
D) Vancomycin, ampicillin, ceftriaxone, and dexamethasone

Answer 10

B

Question 11

The CSF culture found haemophilus influenzae, beta-lactamase positive. Which regimen is the BEST option for JM?

A) Acyclovir alone
B) Ceftriaxone alone
C) Ampicillin and dexamethasone
D) Ceftriaxone and dexamethasone

Answer 11

B – H flu is gram NEGATIVE

Question 12

Ampicillin is added to the empiric bacterial meningitis regimen for immunocompromised patients for the purpose of covering which organism?

A) Strep pneumo
B) Neisseria meningitides
C) Listeria monocytogenes
D) Pseudomonas aeruginosa

Answer 12

C