Antibiotics

Front 1

Which formulation of vancomycin is used for the treatment of C. difficle?

Back 1

PO because IV formulation is not absorbed in GIT

Front 2

What is the recommended infusion rate for Vancomycin to prevent red man syndrome?

Back 2

1 gram/hour

Front 3

Name the adverse effects associated with Vancomycin:

Back 3

1. Nephrotoxicity (trough >15 mg/L)

2. Neutropenia

3. Phlebitis

4. Red man syndrome

5. Ototoxicity (earlier formulations)

Front 4

What is the drug of choice for treating treponema pallidum (syphilis)?

Back 4

Penicillin G procaine --> crosses BBB

(Natural PCN)

Front 5

Which of the Natural PCNs cover Listeria monocytogenes?

Back 5

Penicillin Gs only

Front 6

What is the drug of choice for the treatment of E. faecalis & Listeria monocytogenes?

Back 6

Ampicillin

(Amino-PCN)

Front 7

Why was Methicillin d/c in the US?

Back 7

Interstitial nephritis (swelling in btwn kidney tubules)

Front 8

What is the class of drugs preferred for MSSA?

Back 8

Anti-staphylococcal PCNs:

a) Nafcillin

b) Oxacillin

c) Dicloxacillin

d) Cloxacillin

(Methicillin)

Front 9

Which of the anti-staphylococcal PCNs is associated with higher risk of hepatotoxicity & rash?

Back 9

Oxacillin

(Nafcillin would be a better choice; both IV)

Front 10

Which of the anti-staphylococcal PCNs require dose adjustments in BOTH hepatic & renal dysfunction?

Back 10

Nafcillin

Front 11

Which 2 cephalosporins work against Pseudomonas aeruginosa?

Back 11

Ceftazidime (3rd generation) & Cefepime (4th generation)

Front 12

Which of the cephalosporins is the only drug that works against MRSA & E. faecalis?

Back 12

Ceftaroline (5th generation)

Front 13

Which cephalosporin works against Neisseria gonorrhoeae?

Back 13

Ceftriaxone

Front 14

Which cephalosporins cross the BBB & can be used to treat meningitis?

Back 14

1st gen: NO

2nd gen: ONLY IV Cefuroxime

3rd gen: Ceftriaxone, Ceftazidime, Cefotaxime

4th gen: Cefepime

Front 15

Which 2 cephalosporins work against anaerobes such as Bacteroides fragilis?

(Hint: 2nd generation)

Back 15

1. Cefitetan

2. Cefoxitin

Front 16

What SE is associated with Ceftriaxone & how can it be avoided?

Back 16

obstructive biliary toxicity

(crystallization of calcium salt) --> REVERSIBLE

can be avoided by avoiding the mixture of ceftriaxone with calcium-containing products in neonates <28 days old

Front 17

Which of the carbapenems must be administered with Cilastatin due to degradation by renal dehydropeptidases?

Back 17

Imipenem

Front 18

Which of the carbapenems has the long t 1/2?

Back 18

Ertapenem

Front 19

Which of the carbapenems are FDA approved for tx of bacterial meningitis?

Back 19

Meropenem

Front 20

Which of the carbapenems is the only one that has NO coverage against Acinetobacter baumanni & Psudomonas aeruginosa?

Back 20

Ertapenem

has NO gram - coverage

Front 21

Which of the carbapenems has the highest seizure risk?

Back 21

Imipenem

(similar to GABA structure & antagonism at receptor site)

Front 22

Why are monobactams rarely used as monotherapy?

Back 22

Aztreonam:

Due to the fact that they only have gram (-) coverage against Pseudomonas aeruginosa (NO coverage against Acinetobacter baumanni)

Front 23

What are the drugs of choice for B-lactamase?

Back 23

1. B-lactam/B-lactamase inhibitors

2. Cephalosporins

Front 24

What are the drugs of choice for AmpC B-lactamase?

Back 24

induced by 3rd gen cephalosporins in the presence of SPICE organisms (gram -)

1. Cefepime (4th generation cephalosporin)

2. Carbapenems (ESBL)

Front 25

What are the drugs of choice for ESBL (extended-spectrum B-lactamase)?

Back 25

Carbapenems

(may consider aminoglycosides, polymyxin B, colistin & new drugs such as ceftolozane/tazobactam & ceftazidime/avibactam)

Front 26

What are the drugs of choice for carbapenemase?

Back 26

AVOID B-lactams all together

non-B-lactam antibiotics --> aminoglycosides, tigecylcine (glycycline), polymyxin B, colistin

(ceftazidime/avibactam can cover CRE)

Front 27

Which of the 4 classes of B-lactamases are there no effective drugs to treat?

Back 27

Class B (metallo-B-lactamase) & Class D (oxacillinase)

Front 28

Which of the B-lactamase inhibitors is a non-B-lactam/B-lactamase inhibitor and has the broadest spectrum of activity?

Back 28

Avibactam --> effective against classes A, C, and some D

(all other classes I-III are only effective against Class A B-lactamase which includes ESBL & KPC)

Front 29

Which of the B-lactam/B-lactamase inhibitors does not cover against anerobes such as Bacteroides fragilis?

Back 29

Ceftazidime/Avibactam (Avycaz)

Front 30

Which of the B-lactam/B-lactamase inhibitors does not cover against MSSA?

Back 30

Ceftolozane/Tazobactam (Zerbaxa)

Front 31

Which of the 2 B-lactam/B-lactamase inhibitors does not cover against Pseudomonas aeruginosa, ESBL, or CRE?

Back 31

1. Amoxicillin/ Clavulanic acid (Augmentin)

2. Ampicillin/ Sulbactam (Unasyn)

Front 32

Which of the 2 B-lactam/B-lactamase inhibitors only covers against Pseudomonas aeruginosa but not against ESBL & CRE?

Back 32

1. Ticarcillin/Clavulanic acid (Timentin)

2. Piperacillin/ Tazobactam

Front 33

Which of the B-lactam/B-lactamase inhibitors covers againt ALL 3 gram - pathogens --> Pseudomonas aeruginosa, ESBL, & CRE?

Back 33

Ceftazidime/Avibactam (Avycaz)

Front 34

Which of the 4 classes of hypersensitivity rxns is NOT a delayed reaction?

Back 34

Type I --> Ige-mediated

OOA: 30-60 min

"anaphylaxis"

may be due to NSAIDs, ASA, or PCN

Front 35

What is the reason for possible cephalosporin cross-reactivity?

Back 35

similarities between the side chains

Amoxicillin --> Cefadroxil & Cefprozil

Ampicillin --> Cephalexin & Cefaclor

Front 36

What is the reason for possible carbapenem cross-senstivity?

Back 36

hypothetical cross-reactivity mechanism

Front 37

Aztreonam cross-reactive hypersenstivity increases in which disease state? What is aztreonam similar in structure to?

Back 37

Cystic fibrosis

Ceftazidime

Front 38

Which class of antibiotics may be used as "synergy" with B-lactams against enterococci?

Back 38

Aminoglycosides

(Amikacin, Gentamicin, Tobramycin)

Front 39

Which of the aminoglycosides is LEAST susceptible to aminoglycoside-modifying enzymes & why?

Back 39

Amikacin because it has protective side chains

Front 40

What is the most common side effect of aminoglycosides and which one is the biggest offender?

Back 40

NEPHROTOXICITY --> nonliguric fall in CrCl (acute renal failure; drop in GFR)

Gentamicin

usually reversible after d/c or decreasing dose

Front 41

Which of the aminoglycosides are associated with auditory SEs (tinnitus, loss of high-frequency hearing)? (2)

Back 41

1. Amikacin

2. Tobramycin

Front 42

Which of the aminoglycosides are associated with cochlear & vestibular side effects (ataxia, vertigo, and loss of balance)?

Back 42

Gentamicin

Front 43

Aminoglycosides are CONTRAINDICATED in patients with this specific disease

Back 43

myasthenia gravis

aminoglycosides interfere with neuromuscular transmission and can cause neuromuscular BLOCKADE

Front 44

Which of the macrolides is effective against multi-drug resistant isolates (Streptococcus pyogenes)?

Back 44

Telithromycin- 3rd generation

Front 45

Which 2 macrolides are available as IV & PO?

Back 45

1. Azithromycin

2. Solithromycin

Front 46

Which of the macrolides covers against gram - organisms such as Shigella, Salmonella, & N. gonorrhoeae?

Back 46

Azithromycin (2nd generation)

Front 47

Which of the the macrolides does not cover against chlamydia trachomatis?

Back 47

Telithromycin (3rd generation)

Front 48

Which generation macrolides work against non-tuberculosis mycobacteria?

Back 48

generations 1 & 2

Erythromycin

Clarithromycin

Azithromycin

Front 49

Which of the macrolides works effectively against atypical organisms (Legionella pneumophilia, chlamydia, mycoplasma pneumonia + mycobacterium avium(MAC))?

Back 49

Solithromycin (4th generation)

Front 50

Which of the macrolides requires renal dose adjustment?

Back 50

Clarithromycin

Telithromycin

Solithromycin

(CTS)

Front 51

Which of the macrolides has the most CYP3A4 inhibition?

Back 51

Erythromycin > Clarithromycin> Azithromycin

Front 52

Which of the macrolides has a BBW for being CI in ptx with myasthenia gravis?

Back 52

Telithromycin

Front 53

Which of the macrolides is associated with the worst GI effects?

Back 53

Erythromycin

Front 54

Name the common SEs seen in 1st & 2nd generation macrolides

Back 54

1. GI upset

2. cholestatic hepatitis

2. QTc prolongation

Front 55

Which macrolide is the only one NOT associated with QTc prolongation (>500ms)?

Back 55

Solithromycin

Front 56

Name 3 side effects of Solithromycin

Back 56

1. Hepatotoxicity

2. Visual disturbance

3. loss of consciousness (due to side chain)

Front 57

Which fluoroquinolone cannot be used for tx of UTIs?

Back 57

Moxifloxacin --> doesnt concentrate in the urine

Front 58

Which 3 Fluroquinolones are considered as "respiratory fluroquinolones" (can be used to treat. Strep. pneumoniae)

Back 58

LGM

1. Levofloxacin

2. Gemifloxacin

3. Moxifloxacin

Front 59

Which fluoroquinolone can be used for treatment of N. gonorrhoeae?

Back 59

Gemifloxacin

Front 60

Which fluoroquinolone is NOT active against Mycoplasma pneumoniae?

Back 60

Gemifloxacin

Front 61

Which fluoroquinolone is NOT active against Legionella & Chlamydia?

Back 61

Ciprofloxacin

Front 62

Which 2 fluoroquinolones can be used against Pseudomonas aeruginosa?

Back 62

CL

1. Ciprofloxacin

2. Levofloxacin

Front 63

Which fluoroquinolone has some coverage for anaerobes such as B. fragilis?

Back 63

Moxifloxacin

Front 64

Which 2 fluoroquinolones are only available as PO?

Back 64

1. Gemifloxacin

2. Ofloxacin

Front 65

Which 2 fluoroquinolone have the highest BA?

Back 65

1. Levofloxacin

2. Moxifloxacin

Front 66

Which fluoroquinolone does NOT require renal dose adjustment?

Back 66

Moxifloxacin

Front 67

What is a BBW for fluoroquinolones?

Back 67

tendonitis & tendon rupture (corticosteroid use, >60 yrs, and kidney/heart/lung transplant)

Front 68

What do fluoroquinolones interact with and how can it be avoided?

Back 68

divalent & trivalent cations (antacids, MVI, supplements, & MILK)

administer FQs 2 hours BEFORE or 6 hours AFTER

Front 69

Which tetracycline is only available as PO?

Back 69

Tetracycline

Front 70

What is another class of antibiotics other than Cefteraline that cover MRSA?

Back 70

Tetracyclines

1. Doxycycline

2. Minocycline

3. Tetracycline

Front 71

Which 2 tetracyclines are long-acting?

Back 71

1. Doxycycline

2. Minocycline

Front 72

What are the 3 gram (-) organisms that tetracyclines cover?

Back 72

1. Borella burgoferi

2. Rickettsia ricketsii

3. Stenotrophomonas maltophilia

Front 73

Which tetracycline is the SAFEST for renal imapirment & has the lowest risk of teeth/bone deposition?

Back 73

Doxycycline

Front 74

Which tetracycline is the most lipophilic?

Back 74

Minocycline --> may be used for tx of meningitis but achieves LOW levels

Front 75

What do tetracyclines interact with and how can it be avoided?

Back 75

chelation with cations will decrease the absorption of tetracycines

administer tetracyclines at least 1-2 hours BEFORE or 4 hours AFTER cations

Front 76

Which 2 tetracyclines are associated with hepatotoxicity & nephrotoxicity?

Back 76

1. Tetracycline

2. Minocycline (possible nephrotoxicity)

Front 77

Which tetracycline is associated with neurotoxicity?

Back 77

Minocycline --> reversible

Front 78

What is a major side effect of tetracyclines and in population are tetracyclines contraindicated in?

Back 78

1. tooth discoloration (permanent)

2. bone development retardation (reversible)

CI in pregnant women & children <8 years during bone & teeth development

Front 79

What was an added benefit of glycyclines (derivative of tetracyclines)?

Back 79

Tigecycline

added VRE gram + coverage & activity against CRE & ESBL gram - coverage

Front 80

Hemolytic anemia may occur in ptx wth glucose-6-phosphate dehydrogenase (G6PD) deficiency if administered with this class of antibiotics?

Back 80

SULFONAMIDES

Trimethoprim/sulfamethoxazole (Bactrim)

Front 81

What sulfonamide is the DOC for S. maltophilia?

Back 81

Trimethoprim/sulfamethoxazole (Bactrim)

Front 82

Which drugs do sulfonamides interact with? (3)

Back 82

inhibition of CYP2C8 & CYP2C9 -->

1. Warfarin (increased risk of bleeding)

2. Phenytoin (increased levels)

3. sulfonylureas / glinides (hypoglycemia)

Front 83

Which of the lipoglycopeptides INCLUDES S. pneumoniae gram + coverage?

Back 83

Telavancin

Front 84

Which of the lipoglycopeptides has coverage against BOTH MRSA and enterococci species?

Back 84

Oritavancin

Front 85

Which of the lipoglycopeptides does NOT require renal dose adjustment?

Back 85

Oritavancin

Front 86

Which of the lipoglycopeptides are given as a SINGLE dose (1,200 mg x 3 hr infusion)?

Back 86

Oritavancin

Front 87

Which 2 lipoglycopeptides are CI with use of IV unfractionated heparin?

Back 87

1. Oritavancin (within 120 hours or 5 days after Ortiavancin administration)

2. Telavancin

Front 88

Which of the lipoglycopeptides is ALSO used for hospital-acquired pneumonia (HAP) & ventricular-associated pneumonia (VAP) other than being used for complicated skin & skin structure ifxn?

Back 88

Telavancin

Front 89

Which of the lipoglycopeptides is the safest?

Back 89

Dalbavancin -ADRs:

1. GI

2. headache

3. ALT elevation

4. red man syndrome w/ rapid infusion (<30 min)

Front 90

Which lipoglycopeptide is associated with QT prolongation?

Back 90

Telavancin

may also cause insomnia, metallic taste, foamy urine, & nephrotoxicity

Front 91

Which lipoglycopeptides may artificially prolong PT or INR results?

Back 91

1. Oritavancin --> artificially prolong INR & PT for up to 12 hours and aPTT up to 120 hours (5 days)

2. Telavancin --> aPTT increased for up to 0-18 h

Front 92

Which of the lipoglycopeptides are not associated with red man syndrome?

Back 92

Oritavancin

(Dalbavancin < 30 min infusion vs. Telavancin < 1 hour infusion)

Front 93

Which of the oxazolidinones (Linezolid, Tedizolid) covers Norcardia?

Back 93

Linezolid ONLY

Front 94

Name 3 side effects associated with Linezolid

Back 94

1. bone marrow suppression (anemia, thrombocytopenia) if therapy > 14 days

2. peripheral & optic neuropathy if therapy > 28 days

3. lactic acidosis can occur at any point of therapy

Front 95

What does Linezolid have a DDI with?

Back 95

Monoamine oxidase inhibitors

**d/c SSRi for 14 days before initiating Linezolid

(5 weeks with Fluoxetine)

risk of serotonin syndrome

Front 96

What is a serious side effect of Tedizolid (2)?

Back 96

1. bone marrow suppression (anemia, thrombocytopenia, neutropenia)

**not recommended in ptx with ANC <1,000 cells/mm3

2. peripheral neuropathy if therapy > 28 days

Front 97

What is a food interaction with oxazolidinones (Tedizolid, Linezolid)?

Back 97

avoid tyramine-containing foods (aged cheeses, cured meats, wine, draft beers, soy sauce)

Front 98

Why cant daptomycin (cyclic lipopeptide) be used for the treatment of pneumonia?

Back 98

Daptomycin will be destroyed by surfactants in the lungs

Front 99

Name 3 side effects of Daptomycin:

Back 99

1. elevated creatinine phosphokinase (CPK) --> risk of rhabdomyolysis (sx within 7 days & reside within 3 days of d/c)

2. elevated LFTs

3. falsely prolonged INR with no anticoagulation effect (draw INR 24h after Daptomycin dose)

Front 100

Why is administration of quinupristin/dalfopristin difficult?

Back 100

it must be infused via central line

NOTE: if administered through peripheral line will lead to irritation at injection site

Front 101

Which enterococci gram + organism does quinupristin/dalfopristin cover?

Back 101

E. faecium

Front 102

What is a BBW for Clindamycin?

Back 102

Clostridium difficile colitis

Front 103

What is the Clindamycin D-test?

Back 103

used to test for macrolide resistant isolates of S. aureus that will either express resistance to clindamycin or resistance to only macrolides

Front 104

What is the BA of Metronidazole?

Back 104

100%

1:1 conversion from IV to PO

Front 105

In what population is Metronidazole CI in?

Back 105

pregnancy

1st trimester

Front 106

What type of coverage does Metronidazole have & what is its place in therapy?

Back 106

NO g+ or g- coverage

only against anaerobes

thus used in combo with Aztreonam (gram - only) to add anaerobic coverage

Front 107

What does Metronidazole have a DDI with and how can it be avoided?

Back 107

Disulfiram

d/c disulfiram 2 weeks prior to the use of Metronidazole

and do not drink alcohol products or take propylene glycol containing products for at least 3 days after therapy

Front 108

What drugs are considered for last-line against multi-drug resistant organisms?

Back 108

Polymyxin B & Colistin (Polymyxin E)

Front 109

What is the spectrum of activity for Polymyxin B & Colistin (Polymyxin E)?

Back 109

NO G+ coverage

NO anaerobe coverage

Gram - coverage: ESBL & CRE organisms

Front 110

What is clistimethate sodium a prodrug of?

Back 110

Colistin (Polymyxin E)

**requires renal dose adjustment and dosing is based on colistin base activity (CBA)

Front 111

What is a serious side effect associated with Nitrofurantoin?

Back 111

acute respiratory rxn (reversible hypersensitivity rxn that can occur within hours to weeks of exposure)

sx: fever, cough, dyspnea, myalgia, rash

occurs in ptx > 40 years

sx improve within 15 days of d/c

Front 112

Name the 2 formulations of Nitrofurantoin:

Back 112

1. Macrobid- nitrofurantoin monohydrate + nitrofurantoin macrocrystals (given BID due to slow release)

2. Macrodantin- nitrofurantoin macrocrystals ONLY (given QID due to normal release)

Front 113

Why is fosfomycin tolerable for tx of UTI?

Back 113

single dose which achieves high concentrations in the urine over 24 hours

Front 114

Why is Rifampin never used as monotherapy?

Back 114

due to the rapid emergence of resistance

Front 115

What is a unique characteristic that Rifampin can be used for?

Back 115

it is capable of penetrating staphylococcal biofilms and can prevent biofilms from forming within minutes thus it is used for prosthetic joints

Front 116

What is a common side effect seen with Rifampin?

Back 116

orange pigment in urine, tears, & sweat

Front 117

What is Rifampin's role with the CYP3A4 system?

Back 117

CYP3A4 INDUCER