Miscellanous abx spectra

Question 1

Examples of fluoroquinolones

Answer 1

Ciprofloxacin
Levofloxacin
Moxifloxacin
Delafloxacin

Question 2

Fluoroquinolone activity is bacteri____

Answer 2

bactericidal

Question 3

Bug coverage of ciprofloxacin

Answer 3

Entero
Non entero
H. influ
Pseudomonas
Atypicals

Question 4

What are the two respiratory fluoroquinolones?

Answer 4

Levofloxacin
Moxifloxacin

Question 5

Bug coverage of levofloxacin

Answer 5

Entero
H. influ
Strep
Aypicals
Pseudomonas
MSSA

Question 6

Levofloxacin can/cannot be used for pyelonephritis because ______

Answer 6

Can NOT be used for pyelonephritis (only UTIs) because of its high urinary excretion

Question 7

Bug coverage of moxifloxacin

Answer 7

Entero
H. influ
Strep
Atypicals
Pseudomonas
MSSA

Question 8

Moxifloxacin can/cannot be used for UTIs because ______

Answer 8

Can NOT be used for UTIs because it has limited penetration into urine

Question 9

Bug coverage of delafloxacin

Answer 9

Entero
H. influ
Strep
Atypicals
MSSA
MRSA
Pseudomonas
VSE

Question 10

Adverse effects of fluoroquinolones

Answer 10

Arthropathy/tendonitis (avoid in pregnancy and peds)
Peripheral neuropathy
QT prolongation
Liver toxicity/hepatitis
Confusion (caution elderly)
Photosensitivity
C. diff infection

Question 11

List the risk factors for fluoroquinolone tendinitis

Answer 11

> 60 yo
Corticosteroid use
Solid organ transplant
Pediatric
Strenuous activity
Renal failure
Tendon disorder

Question 12

When should fluoroquinolones be avoided in patients with heart conditions?

Answer 12

Prolonged QTs: Males > 450, Females > 460
Uncorrected hypokalemia
Patients on quinidine, procainamide, amiodarone, sotalol

Question 13

List the pertinent drug interactions of fluoroquinolones

Answer 13

Chelation with cations
Hypoglycemia with diabetes medications
Increased risk TdP with antiarrhythmics

Question 14

Bug coverage of TMP/SMX

Answer 14

MSSA
MRSA
H. influ
Entero
Strep

Question 15

Adverse effects of TMP/SMX

Answer 15

Hypersensitivity
GI upset
Nephrotoxicity
Risk kernicterus in fetus (avoid in last month of pregnancy)

Question 16

What are the pertinent drug interactions with TMP/SMX?

Answer 16

AVOID warfarin and methotrexate
(2C8/2C9 inhibition)

Question 17

Bug coverage of rifampin

Answer 17

Mycobacterium
MRSA
MSSA
Strep

Question 18

Rifampin is never given as ______

Answer 18

monotherapy

Question 19

Adverse effects of rifampin

Answer 19

Hypersensitivity
Liver dysfunction/hepatitis
Discoloration of body fluids
Leukopenia

Question 20

Rifampin is a potent ______ of CYP enzymes

Answer 20

Inducer – do a thorough med review!

Question 21

List the commonly encountered interactions with rifampin

Answer 21

Azoles
Cyclosporine
Tacrolimus/sirolimus
Warfarin
Oral contraceptives
HIV antivirals
Statins

Question 22

Which antibiotic is used for the prophylaxis and treatment of UTIs

Answer 22

Nitrofurantoin (E. coli)

Question 23

Adverse effects of nitrofurantoin

Answer 23

Reduced efficacy in CrCl < 50
Pneumonitis/pulmonary fibrosis
Avoid in pregnancy > 38 weeks due to fetal hemolytic anemia

Question 24

Which antibiotic is a prodrug that is susceptible in anaerobes only?

Answer 24

Metronidazole

Question 25

Bug coverage of metronidazole

Answer 25

Anaerobes
H. pylori

Question 26

Adverse effects of mitronidazole

Answer 26

Metallic taste
Peripheral neuropathy
Confusion/seizures

Question 27

Pertinent drug interactions of metronidazole

Answer 27

Disulfram– caution OTC products, IV forms, alcohol

Warfarin – increased risk bleed