Pharm Clinical Use Of Antimicrobials

Front 1

DOC chlamydophyla (C. pneumoniae)

Back 1

Macrolide or tetracycline

Front 2

DOC M. pneumoniae

Back 2

Macrolide or tetracycline

Front 3

DOC T. pallidum

Back 3

Penicillin G

Front 4

DOC Bacteroides

Back 4

Metronidazole

Front 5

DOC Campylobacter jejuni

Back 5

Macrolide

Front 6

DOC Enterobacter spp

Back 6

Carbapenem, cefepime

Front 7

DOC E. coli

Back 7

Cephalosporin (3rd generation)

Front 8

DOC G. vaginalis

Back 8

Metronidazole

Front 9

DOC K. pneumoniae

Back 9

Cephalosporin (3rd generation)

Front 10

DOC P. mirabilis

Back 10

Ampicillin

Front 11

DOC Enterococcus spp

Back 11

Ampicillin +/- gentamicin

Front 12

DOC S. aureus or epidermidis methicillin-susceptible

Back 12

Nafcillin

Front 13

DOC S. aureus or epidermidis methicillin-resistant

Back 13

Vancomycin +/- gentamicin +/- rifampin

Front 14

DOC S. pneumoniae penicillin-susceptible

Back 14

Penicillin G, amoxcillin

Front 15

DOC S. pneumoniae penicillin-resistant

Back 15

Vancomycin + ceftriazone or cefotaxime +/- rifampin

Front 16

DOC N gonorrhoeae

Back 16

Ceftriazone

Front 17

DOC M meningitidis

Back 17

Penicillin G

Front 18

DOC M catarrhalis

Back 18

Cefuroxime, fluoroquinolone

Front 19

DOC C difficile

Back 19

Metronidazole

Front 20

DOC C trachomatis

Back 20

Azithromycin or other macrolide

Front 21

DOC proteus-indole positive

Back 21

Cephalosporin (3rd generation)

Front 22

DOC S. typhi

Back 22

Ceftriazone or fluoroquinolone

Front 23

DOC Serratia spp

Back 23

Carbapenem

Front 24

DOC Shigella spp

Back 24

Fluoroquinolone

Front 25

***A hospitalized AIDS PT is receiving antiretroviral drugs but no antimicrobial prophylaxis. He develops sepsis with fever, suspected to be caused by a gram-negative bacillus. Treatment will include antibiotics, and the drugs under consideration include aminoglycosides, cephalosporins, fluoroquinolones, and imipenem.

Back 25

***

Front 26

***Antimicrobial treatment of this severely immune-depressed PT should NOT be initiated before?

Back 26

Specimens have been taken for laboratory tests and examination. After specimens have been taken, then start antimicrobial therapy before lab results are in.

Front 27

***If gentamicin is used systemically in the treatment of this PT, monitoring of serum drug level may be advised because the drug?

Back 27

Has a narrow therapeutic window. Aminoglycosides have low therapeutic window. Decrease renal function may rise levels of aminoglycosides to a toxic level.

Front 28

**A combination of drugs might be given to this PT to provide coverage against multiple organisms or to obtain a synergistic action. Examples of antimicrobial drug synergism established at the clinical level include?

Back 28

Amphotericin B and flucytosine in cryptococcal meningitis; carbenicillin and gentamicin in pseudomonal infection; rifampin and vancomycin in enterococcal infection (?); TMP-SMX in coliform infections.

Front 29

####A 27 year old pregnant PT with a history of pyelonephritis has developed a severe upper respiratory tract infection that appears to be due to a bacterial pathogen. The woman is hospitalized, and an antibacterial agent is to be selected for treatment.

Back 29

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Front 30

###Assuming that the physician is concerned about the effects of renal impairment on drug dosage in this PT, which drug would not require dosage modification in renal dysfunction?

Back 30

Erythromycin, clindamycin, chloramphenicol, rifampin, and ketoconazole are notable exceptions that do not need change in renal failure.

Also, cefoperazone, doxycycline, isoniazide, nafcillin.

Front 31

###Which antibacterial agent appears to be safe for the treatment of infections in the pregnant PT?

Back 31

Macroide azithromycin appears safe.

Aminoglycosides, sulfonamides, and tetracyclines are NOT safe.

Front 32

There is no evidence that antimicrobial prophylaxis is of established benefit in?

Back 32

Contacts of index case in mycoplasmal pneumonia. No documented cases.

Front 33

Which drug is likely to be of value in a bioterrorist attack that utilizes anthrax?

Back 33

Cefazolin, or cephalosporins.

Ciprofloxacin (or doxycycline) plus clindamycin and rifampin is recommended.

Front 34

%%%A 51 yo PT is scheduled for a vaginal hysterectomy. An antimicrobial drug will be used for prophylaxis against postoperative infection. It is proposed that cefazolin, a first generation cephalosporin, be given intravenously at the normal therapeutic dose immediately before surgery and continued until the PT is released from the hospital.

Back 34

%%%

Front 35

%%%Which statement about the proposed drug management of this PT is not accurate?

Back 35

Nosocomial (hospital-acquired) infection will be prevented by treatment throughout the period of hospitalization. Opportunistic infection (disturbances in GI flora) increases in hospitalized PTs if prophylaxis is prolonged.

Front 36

%%%If the PT had been scheduled for elective colonic surgery, optimal prophylaxis against infection would be achieved by mechanical bowel preparation and the use of?

Back 36

Oral neomycin and erythromycin for elected bowel surgery.

Second generation are more active against bowel anaerobes such as Bacteroides fragilis for 'dirty' surgical procedures. For bowel perforation, second or third generation is appropriate.

Front 37

Which drug increases the hepatic metabolism of other drugs?

Back 37

Rifampin.

Clarithromycin, erythromcyin, ketoconazole, and ritonavir inhibits hepatic metabolism of other drugs.

Front 38

Which antimicrobial drug does not require supplementation of dosage following hemodialysis?: ampicillin, cefazolin, ganciclovir, tobramycin, vancomycin.

Back 38

Vancomycin is not removed during hemodialysis.

Also, amphotericin B, cefonicid, cefoperzone, ceftriaxone, erythromcyin, nafcillin, tetracyclines, and vancomycin.

Front 39

The persistent suppression of bacterial growth that may occur after limited exposure to some antimicrobial drugs is called?

Back 39

Postantibiotic effect, such as aminoglycosides and fluoroquinolones.

Front 40

If ampicillin and pieracillin are used in combination in the treatment of infections resulting from Pseudomonas aeruginosa, antagonism may occur. The most likely explanation is that?

Back 40

Ampicillin, and other beta-lactam antibiotics, induces beta-lactamase production.

Enterobacter and Pseudomonas aeruginosa have inducible beta-lactamases.

Front 41

In a PT suffering from pseudomembranous colitis due to C. difficile with established hypersensitivity to metronidazole, the most likely drug to be of clinical value is?

Back 41

Vancomycin.

Front 42

What are bacteriostatic drugs?

Back 42

Macrolides (clindamycin, azithromycin, clarithromycin), sulfonamides, trimethoprim, chloramphenicol, tetracyclines

Front 43

What are bactericidal drugs?

Back 43

Aminoglycosides, beta-lactams, fluoroquinolones, metronidazole, and most antimycobacterial agents, cephalosporin, streptogramins, and vancomycin.

Front 44

Some bactericidal agents (aminoglycosides and fluoroquinolones) cause?

Back 44

Concentration-dependent killing. Maximizing peak blood levels increases the rate and extent of their bactericidal effects. High dose, once a daily administration.

Front 45

Some bactericidal agents (beta-lactams, vancomycin) cause?

Back 45

Time-dependent killing. Their killing action is independent of drug concentration and continues while blood levels are maintained above the minimal bactericidal concentration.

Front 46

The following drugs should be avoided if possible in pregnancy and/or neonates, why: SAFE Moms Take Really Good Care


aminoglycosides, tetracyclines, sulfonamides, chloramphenicol, and fluoroquinolones

Back 46

Sulfonamides: by displacing bilirubin from serum albumin, may cause kernicterus in the neonate.

Aminoglycosides: ototoxicity

Fluoroquinolones: effects on growing cartilage.

Erythromycin: acute cholestatic hepatitis in mom (and clarithromycin--embryotoxic)

Metronidazole: mutagenesis

Tetracyclines: tooth enamel dysplasia and inhibition of bone growth.

Ribavarin (antiviral): teratogenic

Griseofluvin (antifungal): teratogenic

Chloramphenicol: may cause gray baby syndrome.

Front 47

What is the synergistic effect of trimethoprim and sulfamethoxazole (TMP-SMX)?

Back 47

Blocks the formation of tetrahydrofolic acid?

Front 48

What is the synergistic effect of clavulanic acid, sulbactam, and tazobactam with penicillinase-sensitive beta-lactam drugs?

Back 48

Clavulanic acid, sulbactam, and tazobactam inhibits penicillinase to all the beta-lactam to work more efficient.

Front 49

What is the synergistic effect of aminoglycosides with beta-lactams?

Back 49

Beta-lactams inhibit cell-wall synthesis, allowing permeability of aminoglycosides to certain bacteria.