overview

Question 1

PCN coverage

Answer 1

viridans group strep, Strep pyogenes, oral anaerobes, syphilis, leptospira

Question 2

ampicillin and amoxicillin coverage

Answer 2

same as PCN plus E.coli, lyme disease and a few gram negatives

Question 3

Gram negatives covered by amoxicillin

Answer 3

Helps- H.influenzae, E.coli, Listeria, Proteus, Salmonella

Question 4

Best initial therapy for otitis media, dental infection, endocarditis prophylaxis, lyme disease (less invasive), UTI in pregnant pt, Listeria monocytogenes, enterococcal infections

Answer 4

ampicillin, amoxicillin

Question 5

Drugs to treat skin infections (cellulitis, impetigo, erysipelas), endocarditis, meningitis, and bacteremia from staph, osteomyelitis and septic arthritis when sensitive

Answer 5

PRPs- oxacillin, cloxacillin, dicloxacillin and nafcillin

Question 6

Methicillin is never the right answer because

Answer 6

renal failure from allergic interstitial nephritis

Question 7

Piperacillin, ticarcillin, azlocillin, mezlocillin coverage

Answer 7

gram negative bacilli (E.coli, Proteus) from the large enterobacteriaciae group as well as pseudomonads.

Question 8

Best initial therapy for cholecystitis and ascending cholangitis, pyelonephritis, bactermia, hospital acquired and ventilator-associated pneumonia, neutropenia and fever

Answer 8

Piperacillin, ticarcillin, azlocillin, mezlocillin

Question 9

all cephalosporins cover

Answer 9

group A, B, C strep, viridans strep, E.coli, Klebsiella and proteus mirabilis

Question 10

listeria, MRSA and Enterococcus are resistant to all forms of

Answer 10

cephalosporins

Question 11

Used to treat methicillin sensitive staph, streptococci (except Enterococcus), some gram-negative bacilli such as E.coli, but not pseudomonas, osteomyelitis, spetic arthritis, endocarditis, cellulitis

Answer 11

first generation cephalosporin- cefazolin, cephalexin, cephradrine, cefadroxyl

Question 12

covers staph, strep, increased gram negative bacilli and anaerobes

Answer 12

second generation cephalosporins- Cefotetan, Cefoxitin, Cefaclor, Cefprozil

Question 13

Best initial therapy for PID combined with Doxy

Answer 13

Cefotetan or cefoxitin (2nd generation)

Question 14

Warning with Cefotetan and cefoxitin

Answer 14

may increase the risk of bleeding and give a disulfiramlike reaction with alcohol

Question 15

Cephalosporin choice for respiratory infections such as bronchitis, otitis media and sinusitis

Answer 15

Cefuroxime, loracarbef, cefprozil, cefaclor (2nd generation)

Question 16

First line tx for pneumococcus, including partially insensitive organisms- meningitis, CAP (in combination with macrolides), gonorrhea, lyme involving the heart or brain

Answer 16

Ceftriaxone (3rd generation)

Question 17

avoid ceftriaxone in

Answer 17

neonates due to impaired biliary metabolism

Question 18

Advantage to cefotaxime over ceftriaxone (3rd generation)

Answer 18

superior in neonates, spontaneous bacterial peritonitis

Question 19

ceftazidime

Answer 19

pseudomonal coverage

Question 20

Better staph coverate, used to tx neutropenia and fever, vent associated pneumonia

Answer 20

cefepime, 4th generation

Question 21

Adverse effects of cefoxitin and cefotetan

Answer 21

deplete prothrombin and increase risk of bleeding

Question 22

Adverse effects of ceftriazone

Answer 22

inadequate biliary metabolism

Question 23

Covers gram-negative bacilli, including many that are resistant, anaerobes, streptococci, and staphylococci. Used to treat neutropenia and fever.

Answer 23

Carbapenems

Question 24

carbapenem drugs

Answer 24

imipenem, meropenem, ertapenem, doripenem

Question 25

How does Ertapenem differ from the other carbapenems?

Answer 25

does not cover pseudomonas

Question 26

Exclusively used for gram-negative bacilli including Pseudomonas. Does not cross react with PCN.

Answer 26

Aztreonam

Question 27

Fluoroquinolone drugs

Answer 27

ciprofloxacin, gemifloxacin, levofloxacin, moxifloxacin

Question 28

Best therapy for CAP, including PCN resistant pneumococcus

Answer 28

Flouroquinolones

Question 29

For tx of gram negarive bacilli including most pseudomonads

Answer 29

Fluoroquinolones

Question 30

Best fluoroquinolone for cystitis and pyelonephritis

Answer 30

Cipro, moxifloxacin will not enter the urine in high enough concentration

Question 31

Fluoroquinolone use for diverticulitis and GI infections?

Answer 31

Moxifloxacin as single agent, others cover with Metronidazole for anaerobes

Question 32

Adverse effects of Fluoroquinolones

Answer 32

Bone growth abnormalities in children and pregnant patients, tendonitis and achilles tendon rupture, gatifloxacin removed because of glucose abnormalities

Question 33

Aminoglycoside drugs

Answer 33

Gentamicin, tobramycin, Amikacin

Question 34

Used for gram-negative bacilli (bowel, urine, bacteremia), Synergistic with beta-lactam antibiotics for enterococci and staphylococci

Answer 34

Aminoglycosides

Question 35

Do aminoglycosides work against anaerobes?

Answer 35

no, they require oxygen to work

Question 36

Adverse effects of Aminoglycosides

Answer 36

nephrotoxic and ototoxic

Question 37

Used to treat Chlamydia, limited lyme disease infections, Rickettsia, primary and secondary syphilis in pts allergic to PCN, Borrelia, Ehrlichia and mycoplasma

Answer 37

Doxycycline

Question 38

Doxy adverse effects

Answer 38

Tooth discoloration in children, Fanconi syndrome, photosensitivity, esophagitis/ulcer

Question 39

Nitrofurantoin indication

Answer 39

cystitis, especially in pregnant patients

Question 40

Trim/Sulfa indications

Answer 40

cystitis, pneumocystis pneumonia, MRSA of skin and soft tissue

Question 41

Trim/Sulfa Adverse effects

Answer 41

rash, hemolysis with G6PD deficiency and bone marrow suppression because it is a folate antagonist

Question 42

beta lactam/beta-lactamase combination benefit (Augmentin, Unisyn, Zosyn)

Answer 42

Adds coverage against sensitive staphylococci to these agents (not MRSA)

Question 43

Gram-positive Cocci: Staph and Strep, best initial tx

Answer 43

Oxacillin, cloxacillin, dicloxacillin, nafcillin, first generation cephalosporins (cefazolin, cephalexin), fluoroquinolones (except cipro), Macrolides (azithromycin, clarithromycin, erythromycin)- third line agents, less efficacy than axocillin or cephalosporins, erythromycin is also more toxic

Question 44

Oxacillin (Methicillin)- resistant staph tx

Answer 44

Vancomycin, Linezolid, Daptomycin, Tigecycline

Question 45

Linezolid adverse effects

Answer 45

reversible bone marrow toxicity, platelet inhibition

Question 46

Daptomycin effect

Answer 46

elevated CPK, not effective in lung tissue

Question 47

Minor MRSA infections of the skin are treated with

Answer 47

TMP/SMX, Clindamycin, Doxycycline

Question 48

Anaerobe tx for oral infection

Answer 48

PCN (G, VK, ampicillin, amoxicillin), clindamycin

Question 49

Anaerobe tx for GI infections

Answer 49

Metronidazole

Question 50

Gram negative bacilli (E.coli, Klebsiella, Proteus, Pseudomonas, Enterobacter, citrobacter coverage

Answer 50

Quinolones, aminoglycosides, carbapenems, piperacillin, ticarcillin, aztreaonam, cephalosporin

Question 51

Additional anaerobe coverage

Answer 51

piperacillin, carbapenesm and second generation cephalosporins