ID 1

Question 1

Penicillin G/VK/benzathine - coverage?

Answer 1

• Gram positives (Strep, Staph, Actinomyces)
• Oral anaerobes (Actinomyces)
• Neisseria meningitidis
• Treponema Pallidum (Syphilis)
• Spirochetes (Leptospira)

Question 2

Ampicillin & Amoxicillin – coverage?

Answer 2

Same as Penicillin + …- H. influenzae- E. coli- Listeria- Proteus- Salmonella

Question 3

Amp/Amoxicillin are best initial Tx for what?

Answer 3

• Otitis media (Sinusitis, Pharyngitis)- Dental infection & endocarditis proph- Lyme disease limited to rash, joint, 7th CN involvement- UTI in pregnant women- Listeria monocytogenes- Enterococcal infections

Question 4

Penicillinase-resistant penicillins (PRPs)?

Answer 4

Oxacillin, Cloxacillin, Dicloxacillin, & Nafcillin

Question 5

PRPs are used to treat what?

Answer 5

• Skin infections: cellulitis, impetigo, erysipelas- Endocarditis, meningitis, & bacteremia from staph- Osteomyelitis & septic arthritis only wen organism is proven sensitive

Question 6

PRPs are not active against __ or __.

Answer 6

MRSA & Enterococcus

Question 7

What’s always used instead of Methicillin? Why?

Answer 7

Oxacillin or Cephalosporin- b/c methicillin causes renal failure from allergic interstitial nephritis

Question 8

Penicillins that cover gram-negative activity & pseudomonas?

Answer 8

Piperacillin, Ticarcillin, Azlocillin, Mezlocillin

Question 9

Piperacillin/Ticarcillin, etc. are best initial Tx for what?

Answer 9

Cholecystitis & ascending cholangitis- Pyelonephritis- Bacteremia- HA- & VA- pneumonia- Neutropenia & fever

Question 10

3 organisms that’re resistant to all forms of cephalosporins?

Answer 10

Listeria, MRSA, & Enterococcus

Question 11

What organisms do all cephalosporins cover?

Answer 11

• Group A, B, C, & viridans Streptococcus- E. coli- Klebsiella- Proteus mirabilis

Question 12

Macrolides?

Answer 12

Azithromycin, Clarithromycin, Erythromycin (more toxic)

Question 13

1 indication for Nitrofurantoin?

Answer 13

Cystitis (esp. in pregnant women)

Question 14

Name the 1st gen Cephalosporins

Answer 14

Cefazolin, Cephalexin, Cephradrine, Cefadroxyl

Question 15

1st gen cephalosporins – use?

Answer 15

Staph (meth = ceph sensitive)- Streptococci (except enterococcus)- Some gram-neg bacilli, like E. coli (NOT pseudamonas)- Osteomyelitis, septic arthritis, endocarditis, cellulitis

Question 16

Name the 2nd gen Cephalosporins

Answer 16

Cefotetan, Cefoxitin, Cefaclor, Cefprozil, Cefuroxime, Loracarbef

Question 17

2nd gen cephalosporins – use?

Answer 17

Same as first + add coverage for anaerobes & more gram-neg bacilli

Question 18

Name the 3rd gen Cephalosporins

Answer 18

Ceftriaxone, Cefotaxime, Ceftazidime

Question 19

Ceftriaxone – use?

Answer 19

1st line in Pneumococcus- Meningitis- CA pneumonia (in combo w/ macrolides)- Gonorrhea- Lyme involving heart or brain

Question 20

In whom should you avoid Ceftriaxone & why?

Answer 20

Neonates b/c of their impaired biliary metabolism

Question 21

Cefotaxime – use?

Answer 21

• Superior to Ceftriaxone in neonates- Spontaneous bacterial peritonitis

Question 22

Ceftazidime – what differentiates it from other 3rd-gen cephalosporins?

Answer 22

Has pseudomonal coverage

Question 23

Which 3rd-gen Cephalosporin(s) have/has pseudomonal coverage?

Answer 23

Ceftazidime

Question 24

Which is the 1st cephalosporin to cover MRSA?

Answer 24

Ceftaroline

Question 25

Name the 4th-gen Cephalosporins

Answer 25

Cefepime

Question 26

Cefepime -- use?

Answer 26

Has better staphylococcal coverage than 3rd gen cephalosporins. Used to treat:- Neutropenia & fever- Ventilator-ass'd pneumonia

Question 27

Cephalosporins -- adverse effects?

Answer 27

Cefoxitim & Cefotetan -- deplete prothrombin & increase risk of bleedingCeftriaxone -- causes inadequate biliary metabolism

Question 28

Which of the Carbapenems does NOT cover Pseudomonas?

Answer 28

Ertapenem

Question 29

Carbapenems -- coverage?

Answer 29

Gram-negative bacilli (including many that are resistant, anaerobes, strep, & staph)- used to treat neutropenia & fever

Question 30

Only drug in the class of Monobactams?

Answer 30

Aztreonam

Question 31

Aztreonam -- type of drug?

Answer 31

Monobactam antibiotic

Question 32

Aztreonam -- coverage?

Answer 32

Gram-negative rods only (including Pseudomonas) - NO activity against gram-positives or anaerobes - NO cross-rxn w/ Penicillin

Question 33

Name 4 Fluoroquinolones

Answer 33

Ciprofloxacin, Gemifloxacin, Levofloxacin, Moxifloxacin

Question 34

Ciprofloxacin -- used for what?

Answer 34

Cystitis & Pyelonephritis

Question 35

Best therapy for C-A pneumonia?

Answer 35

UMass = Azithromycin IV + Ceftriaxone IVMTB2 = Fluoroquinolones (Levofloxacin)(including penicillin-resistant pneumococcus)

Question 36

What do Fluoroquinolones cover?

Answer 36

- CA-pneumonia (best Tx)- Cipro for cystitis & pyelonephritis- Diverticulitis & GI infections (all but Moxi need combo w/ Metronidazole for Diverticulitis. Ciprofloxacin, gemifloxacin, & levofloxacin must be combined with metronidazole because they don't cover anaerobes)- Gram-neg bacilli (including most pseudomonas)- Gram-pos cocci (Staph & Strep)

Question 37

Which of the Fluoroquinolones can be used by itself for Diverticulitis?

Answer 37

Moxifloxacin -- b/c it covers anaerobes- others must be combined w/ Metronidazole

Question 38

Quinolones -- adverse effects?

Answer 38

- Bone growth abnormalities in children & pregnant women- Tendonitis & Achilles tendon rupture

Question 39

Aminoglycosides -- use?

Answer 39

Gram-negative rods -- severe (bowel, urine, bacteremia)- Synergistic w/ β-lactam antibiotics for enterococci & staph- Neomycin for bowel surgery- NO effect against anaerobes (need O2 to work)

Question 40

Aminoglycosides -- adverse effects?

Answer 40

Nephrotoxic & Ototoxic

Question 41

Doxycycline -- adverse effects?

Answer 41

Tooth discoloration (children), Fanconi syndrome (Type II RTA proximal), photosensitivity, esophagitis/ulcer

Question 42

Β Lactam/Beta-lactamase combos -- uses?

Answer 42

- cover anaerobes - 1st choice for mouth & GI abscessβ-lactamase adds coverage against sensitive staphylococci