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Antibiotic Quiz
Test-like Questions
96
Biology
Professional
02/13/2012

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Term
Which drug effectively treats Gram negative infections in patients with Beta-lactam resistance?
Definition
The Monobactam, Aztreonam has broad activity, including Pseudomonas.
Term
Which Carbapenem is less active than the others, with NO Enterococcus activity and NO Psuedomonas coverage, but with broad anaerobic coverage and a unique Q24 hour dosing?
Definition
Ertapenem

Good gram negative coverage (except Pseudomonas)
Good gram positive coverage (except Enterococcus)
Good anerobic coverage (including B. fragilis)
Term
Which Carbapenem is associated with seizures at high doses in patients with decreased renal function?

What is it given with to ensure function?
Definition
Imipenem given with Cilastatin, which inhibits enzymes in brush border that hydrolyzes imipenem.
Term
Which is the most potent Carbapenem?
Definition
Doripenem

Doripenem>Meropenem>Imipenem>Ertapenem
Term
Which drugs are poorly bioavailable, but have very good MRSA activity (exclusively used for gram +) and can be used to treat C. difficile.
Definition
Vancomycin and Televancin (Glycopeptides)
Term
1) Which drugs cause "Red Man's Syndrome" and/or "Nephrotoxicity" upon rapid infusion?

2) Which drug causes foamy urine and taste disturbances?
Definition
1) Vancomycin and Televancin

2) Televancin
Term
Which Cephalosporin(s) are effective at treating MRSA?
Definition
Ceftaroline (3rd generation)

- Like "Ceftriaxone + MRSA"
Term
Which Cephalosporin(s) are effective at broad-spectrum anaerobic treatment?
Definition
1) Cefoxitine (2A) has poor MSSA activity, but treats B. fragilis
Term
Which Cephalosporin(s) cover broad-spectrum, gram negative, aerobic organisms?
Definition
Looking for something that covers Pseudomonas

1) Ceftazadime (3rd generation)
2) Cefepime (4th generation) w/ better MSSA
Term
Which drugs are the "gold standard" for N. gonorrhea, CA-meningitis and Neuro-Lyme?
Definition
Cephalosporins

1) Ceftriaxone (biliary excretion and sludging at high doses)

2) Cefotaxime
Term
Which Cephalosporin is unique in that it is excreted by the hepatobiliary system, and therefore has an extended half-life and a Q12-24h dosing schedule?
Definition
Ceftriaxone (3rd generation)

Gold standard for N. gonnorrhea, Neuro-Lyme and CA-meningitis.
Term
Which Cefalosporin would you give to treat a case of Otitis Media and Sinusitis from an H. influenzae bacterium?
Definition
Would not use 1st generation, because of poor gram negative coverage.

2nd Generation covers H. influenzae (Cefuroxime, Cefaclor, Cefprozil.

Don't give 3rd generation if you don't have to.
Term
Which Penicillins cover Streptococcus, but are resisted by most Staphylococcus forms?

What else can these drugs treat?
Definition
Natural Penicillins (G and V)

Also treat Treponema pallidum (Syphilis) and Enterococcus (when combined with aminoglycosides)
Term
Why might you use an Amino-penicillin instead of a Natural Penicillin?
Definition
Ampicillin or Amoxicillin

1) Gram + for Listeria
2) Gram - for E. coli, H. influenzae (non-resistant form) or Proteus mirabilis
3) Lyme disease
Term
Which Penicillin classes treat MSSA?
Definition
1) Aminopenicillin + B-lactamase inhibitor (Ampicillin/Sulbactam and Amoxicillin/Clavanulate)

2) Penicillinase-resistant (Nafcillin/Oxacillin and Dicloxacillin)

3) Ext-Spectrum + Beta-lactamse (Ticarcilline/Clavanulate or Piperacilline/Tazobactam
Term
Which Penicillin drugs can handle broad-spectrum, gram negative bacteria?
Definition
You are looking for Pseudomonas

1) Ext-spectrum with Beta-lactamse
(Ticarcillin/Clavulanate or Piperacillin/Tazobactam)

Also handles anaerobes (B. fragilis) and gram positive (MSSA), but can cause diarrhea.
Term
When might you prescribe Amoxicillin/Clavulanate?
Definition
This penicillin improves upon Aminopencillins by

1) covering Beta-lactamase producing H. influenzae, Klebsiella and E. coli.

2) Broad-specturm anaerobes (B. fragilis)

** want to avoid extended-specrum unless you expect gram negative infection **
Term
Which Penicillin(s) are unique in that they do not involve renal excretion?
Definition
The Penicillinase-resistant drugs have hepatic elimination and need not be adjusted for renal malfunction!

These include Nafcillin/Oxacillin and Dicloxacillin and are useful specifically against gram positive (MSSA)
Term
Which Penicillins cover a broad-spectrum of Anaerobic bacteria?
Definition
Looking for the B. fragilis. Anything with a Beta-lactamase inhibitor will do!

1) Ampicillin/Sulbactam, Amoxicillin/Clavanulate

2) Ticarcilline/Clavanulate and Pipercilline/Tazobactam
Term
Which drug(s) are good against MRSA and MRSE, as well as most gram negative bacteria (not Pseudomonas), but can lead to Skin rashes?
Definition
Inhibitors of DNA/RNA synthesis (Trimethoprim/Sulfamethoxazole)

Dosing is dependent on Trimethoprim component!
Term
True or False. MTP/SMX dosing is dependent on Trimethoprim component.
Definition
True
Term
Which drug should you use to treat Nocardiosis?
Definition
Trimethoprim/Sufamethoxazole
Term
What drug can sometimes cause organge-red discoloration of trears, sweath urine ect. as well as nephrotoxicity?
Definition
Rifampin (DNA/RNA synthesis) often given for TB or prosthetic-related infections.

MANY DRUG-DRUG INTERACTIONS
Term
Which drug should be avoided as monotherapy for Staph/Strep?
Definition
Rifampin (DNA/RNA synthesis) has many Drug-Drug interactions.

Orange-red fluids and Hepatotoxicity
Term
Which drugs are given against C. dificile infections (gram + anaerobe)?
Definition
1) Vancomycin (Glycopeptide for MRSA and MRSE)

2) Fidaxomicin (RNA/DNA synthesis inhibitor)
Term
Which DNA/RNA synthesis inhibitor is most effective as a Monotherapy for Staph?
Definition
Trimethoprime/Sulfamethoxazole is good against MRSA/MRSE but not Strep or Enterococcus

Note- Fidaxomicin is only good for C. dif and Rifampin should not be given as a monotherapy because if Drug:Drug interactions
Term
When should you prescribe Quinolones?
Definition
- Moderately well for Strep (Levo/Moxi for S. pneumo)
- NO for staph
- Cipro/Levo broad (including Pseudomonas) Moxi (not Pseudomonas)
- Moxi for B. fragilis
- Atypicals (Chlamydia spp. Mycoplasma, Legionella)
Term
Which Quinolone is effective against a broad spectrum of Anaerobes (including B. fragilis)?
Definition
Moxifloxacin

Also good against:
1) S. pneumoniae
2) Moderately for Aerobic gram negative
3) Atypicals (Chlamydiae, Mycoplasma, Legionella spp.)
Term
Which Quinolone(s) is affective against a broad spectrum of Gram negative aerobes?
Definition
Ciprofloxacin and Levofloxacin (incl. Pseudomonas)

Moxifloxacin (without Pseudomonas)
Term
Which Quinolone(s) is affective against S. pneumo?
Definition
1) Levofloxacin and Moxifloxacin

- Ciprofloxacin does NOT WORK
Term
Which atypical bacteria are effectively treated by Quinolones?
Definition
1) Chlamydia

2) Mycoplasma

3) Legionella spp.
Term
What side effects are associated with Quinolone usage?
Definition
1) CNS: headache, dizziness, insomnia, seizures

2) Tendinitis with rupture (don't take with CS)

3) C. dificile (HIGH RISK)
Term
What are Quinolones most normally used to treat?
Definition
1) UTIs
2) Respiratory tract
3) GI
4) Bone
5) Join infections
Term
Which Aminoglycocide is most potent for gram negative aerobes?
Definition
Amikacin>Tobramycin>Gentamycin

1) Work with cell-wall-active agents to target enterococcus (penicillin, for example).

2) Decent against strep/staph

3) Broad-spectrum including pseudomonas
Term
Why are Aminoglycosides most often prescribed?
Definition
1) Usually in combination as "double coverage" for severe gram-negative infections

** Pharmacokinetic monitoring necessary to maximize efficacy (high peaks) and minimize toxicity (low peaks)
Term
Why is Pharmacokinetic monitoring necessary when prescribing Aminoglycosides?
Definition
Gentamicin, Tobramycin, Amikacin

1) Maximize efficacy (high peaks) due to NO bioavailability

2) Minimize toxicity (low peaks) such as Nephrotoxicity and Ototoxicity
Term
Which drug(s) exhibit an extensive "intracellular" distribution and are effective against Atypical bacteria including Legionella, Mycoplasma and Chlamydia?
Definition
Macrolides (Azithromycin and Clarithromycin) used for otitis, sinusitis and CA-pneumonia caused by atypical bacteria.

Also good against Gram-negative aerobes such as H. influenzae, N. gonorrhea and M. catarrhalis, as well as Campylobacter and H. pylori.
Term
What is the primary use of Erythromycin?
Definition
Macrolide used for pro-kinetic GI effects
Term
What is the major difference between Clarithromycin and Azithromycin?
Definition
Both used for CA-Pneumonia from atypical pathogens.

1) Clarithromycin is prone to drug:drug interactions an can cause Torsades de pointes (ventricular tachycardia)

2) Azithromycin does not have these issues
Term
Which drugs are especially sensitive to milk in the diet, calcium supplements and iron supplements?
Definition
Tetracyclines (Tetracycline, Doxycycline and Minocycline) used to treat upper respiratory infections for Strep pneumonia, Staph and Enterococcus.

These cations decrease drug absorption.
Term
Why might you prescribe Tetracycline, Doxycycline or Minocycline?
Definition
** Usage often limited because of low gram-negative activity**

1) Potent against Gram-positive Aerobics (including Enterococcus!).

2) Good against aerobes such as H. influenzae, N. Gonorrhea and M. Catarrhalis

3) Good against atypicals, Rickettsial infections and Lyme disease
Term
What are major side effects associated with Tetracycline use?
Definition
Tetracycline, Doxycycline or Minocycline

1) GI, esophageal ulceration (take with fluid and remain upright)

2) Gray-brown to yellow teeth in children

3) Photosensitivity
Term
Why is Tigecycline used in the clinic?
Definition
The only Glycylcycline. It overcomes efflux pump resistance

BROAD ACTIVITY

1) MRSA and VRE
2) Aerobic Gram-negatives except Pseudomonas
3) B. fragilis (Anaerobic)
Term
Which drugs should not be used to treat bacteremia, because of their low serum levels?
Definition
1) Macrolides (Azithromycin and Clarithromycin)

2) Tetracyclines (Tetracycline, Doxycycline, Minocycline)

3) Glycylcycline (Tigecycline)

4) Lincosamide (Clindamycin)
Term
Why would you prescribe Clindamycin?
Definition
Rarely used because of high chance of C. difficile.

However, Biliary and fecal excretion makes it good in cases of renal insufficiency.

1) Superficial MRSA
2) Good anaerobic (30% resistance in B. fragilis)
Term
Why would you prescribe Linezolid?
Definition
In patients with resistant gram (+) infections, because of its vast activity (MRSA and VRE).

BE CAREFUL
1) Serotonin Syndrome (MAO-I action)
2) Myelosuppression (thrombocytopenia)
Term
Which drug would you give patients with resistant gram (+) infections as a last alternative?
Definition
The Oxazolidinone, Linezolid

Myelosuppression and Serotonin Syndrome make this a last line of defense.
Term
Which drug is the "drug of choice" for moderate severity C. difficile disease?
Definition
Metronidazole (DNA-damaging), which is highly potent against Anaerobes (B. fragilis and C. dificile, in particular).
Term
Which "DNA Damaging Agent" is widely used as treatment for anaerobic infections?
Definition
Metranidazole

- Can cause GI, metallic taste and peripheral neuropathy side effects

- Also used against C. dificile
Term
Which treatment for gram + organisms is used exclusively for UTIs and can cause a wide range of Pulmonary side effects?
Definition
The DNA-damaging agent, Nitrofurantoin (Good Gram + including VRE).

- Also effective against most E. coli strains, but cannot be used for systemic infections, because of low serum levels.
Term
What might you prescribe for a refractory/resistant bloodstream infection involving Gram + microbes?
Definition
Could you the lipopeptide, Daptomycin.

- Treats MSSA, MRSA, MRSE, resistant-Streptococcus and Enterococcus (including VRE) but NOT for pneumonia.

- Can cause muscle pain/weakness (creatinine phosphokinase elevations) and rash.
Term
What side effects would you expect when prescribing Daptomycin for refractory hematologic, gram + infections?
Definition
1) Rash

2) Muscle weakness/pain (Creatinine phosphokinase elevations)
Term
What is the drug of "last resort" for multi drug-resistant gram-negative infections?
Definition
The cell-membrane-damaging Polymyxins (Polymyxin B and Colistin), which treat Pseudomonas and other gram negative species.

- Dose-related, reversible nephrotoxicity and Neurotoxicity make it a last resort.
Term
What are the best Broad-spectrum options for treating Anaerobic infections.
Definition
B. fragilis is the marker of "broad-spectrum activity"

1) PENICILLINS
- Ampicillin/Sulbactam
- Amoxicillin/Clavulanate
- Tacarcillin/Clavulanat
- Piperacilin/Tazobactam

2) Cephalosporins
- Cefoxitin (2B)

3) Carbapenems (ALL)
- Immipenem
- Meropenem
- Doripenem
- Ertapenem

4) Quinolones
- Moxifloxacin

5) Glycocycline
- Tigecycline

6) Lincosamide
- Clindamycin

7) DNA Damaging Agents
- Metronidazole
Term
What are the best Broad-spectrum options for treating Aerobic Gram-negative infections?
Definition
Pseudomonas is the sign for this broad-specturm Get MICs and PD to TACCL PA 1) Penicillin - Tacarcillin/Clavulanate -Piperacillin/Tazobactam 2) Cephalosporin -Ceftazadime (III) - Cefepime (IV) 3) Monobactam - Aztreonam 4) Carbapenems - Immipenem/Meropenem/Diropenem 5) Quinolones -Ciprofloxacin/Levofloxacin 6) Aminoglycosides - Gentamycin
Term
What drug options are there to treat MRSA?
Definition
Drugs To Treat Very Lethal Commensuals

1) Daptomycin

2) Trimethoprim/Sulfamethoxazole

3) Tigecycline (VRE also)

4) Vancomycin/Televancin (also MRSE)

5) Linezolid

6) Ceftaroline (3rd gen)
Term
What drug options are there to treat VRE?
Definition
Learn VRE Drugs for Test

1) Linezolid
2) Daptomycin
3) Tigecyclin
Term
Which drugs treat the "Atypicals"?
Definition
1) Macrolides (Clarithromycin/Azithromycin)
2) Quinolones (Ciprofloxacin, Morifloxicin, Levofloxacin)
3) Tetracyclines (Tetracycline, Doxycycline, Minocycline)
Term
Which drugs discussed have concerns for Nephrotoxicity?
Definition
1) Aminoglycosides (Gentamycin, Tobramycin, Amikacin)
2) Polymyxins (Polymyxin B, Colistin)
3) Vancomycin
Term
Which drugs discussed have concerns for C. dif infection?
Definition
1) Clindamycin
2) Flouroquinolones
Term
Which drugs discussed have concerns for CNS/Seizures?
Definition
1) Imipenem (Carbapenem)
2) Flouroquinolones
Term
Which drugs discussed have concerns for Myopathy?
Definition
1) Daptomycin
Term
Which drugs discussed have concerns for Rash?
Definition
1) Beta-lactams
2) Vancomycin (Red Man's)
3) TM/SFX
Term
Which drugs discussed have concerns for Pulmonary Fibrosis?
Definition
Nitrofurantoin

- DNA-damaging agent used against gram + (including VRE) and gram - E. coli.
Term
Which drugs discussed have concerns for Myelosuppresion?
Definition
1) Linezolid (also seretonin syndrome)

- Drug good for ALL gram + (VRE and MRSA), but reserved for patients with resistant gram + infections.
Term
Which antibiotics are concentration-dependent?
Definition
These should be given at higher doses, less often.

1) Aminoglycosides (Gentamycin, Tobramycin, Amikacin) have potent gram-negative activity against Pseudomonas, but they have poor bioavailability and can cause Nephro/Ototoxicity

2) Flouroquinolones (Ciprofloxacin, Levofloxacin, Moxifloxacin)
Term
What forms of resistance are exhibited for Flouroquinolones?
Definition
1) Target mutations in DNA gyrase

2) Permeability issues with OprD porin mutations (gram-negative)

3) Efflux pump
Term
What does it mean for an antibiotic to have an MIC of 4 ug/ml?
Definition
it take that much per ml to result in NO VISIBLE GROWTH
Term
What is the meaning of Bioavailability and which drugs are good/bad?
Definition
1) Level of drug in blood when given orally/IV

Ex) Flouroquinolones are good (0.9)
Ex) Vancomycin is poor (0.2)- Give it IV!
Term
Which drugs have good/poor Distribution?
Definition
1) Tobramicin and other Aminoglycosides are BAD and don't get to CNS

2) Rifampin, which acts against a DNA-dependent RNA polymerase and is associated with many drug:drug interactions has good CNS distribution (0.9 L/kg)
Term
Which important drugs are time-dependent?
Definition
Given at lower doses more often.

1) Beta-lactams
2) Linezolid
Term
Which antibiotics could be considered "one-sided" in that they preferentially target gram (+) bacteria?
Definition
1) Vancomycin
2) Daptomycin
3) Linezolid
4) Rifampin
5) Pennicillinase-resistant PCNs
6) Fidoxamicin
7) Penicillin
Term
Which antibiotics could be considered "one-sided" in that they preferentially target gram (-) bacteria?
Definition
1) Polymyxn
2) Ceftavidime
3) Ciprofloxacin
4) Aztreonam
Term
Which antibiotics cover Bacteroides?
Definition
These Many Meds Can Confidently Cover Bacteroides

1) Tigecycline
2) Moxifloxacin
3) Metranizadole
4) Carbapanems
5) Cefoxitin
6) Clindamycin
7) Beta-lactam+ beta-lactamases
Term
What drugs could you use to treat the Atypical bacterial infections?
Definition
Cough May Lessen with Three Fair Meds

Chlamydiae
Mycoplasma
Legionella

Tetracyclines (tetra, doxi, mino)
Flouroquinolones (cipro, levo, moxifloxacin)
Macrolides (azithromycin, clarithromycin)
Term
What are the most effective treatments against C. dificile infection?
Definition
1) Clindamycin

2) Flouroquinolones
Term
Which drugs can cause rashes?
Definition
1) Trimethorpine/Sulfamethoxazole
2) B-lactams
3) Vancomycin (red man's)
Term
Which Flouroquinolone does not require renal adjustment?
Definition
Moxifloxicin (treat Strep pneumo and Anaerobes, as well as atypicals)
Term
Which drugs are commonly used agents for CNS Infections (moderate penetration)
Definition
1) 3rd/4th gen Cephalosporins
2) Meropenem
3) Vancomycin
Term
Which drugs have low Vd (not useful for CNS)?
Definition
Am Pm = Day Night

1) Aminoglycosides
2) Polymyxins
3) Daptomycin
4) Nitrofurantoin
Term
Which drugs are Bacteristatic?
Definition
1) Tetracyclines
2) Macrolides
3) Clindamycin
4) Linezolid
5) Tigecycline
Term
Which drugs are Bactericidal?
Definition
1) Beta-lactams
2) Aminoglycosides
3) Vancomycin
4) Flouroquinolones
5) Monobactams
6) Daptomycin
Term
How can resistance arise to Beta-lactam drugs?
Definition
1) Altered PBPs (gram +)
2) Efflux pumps
3) Loss of porins (gram -)
4) Beta-lactamases (periplasmic space of gram - and outside cell wall of gram +)
Term
How does Vancomycin/Televancin treat MRSA?
Definition
Vancomycin binds D-Ala and interrupts chain synthesis (before cross-linking)

Televancin may also interrupt cell membrane
Term
How can resistance to Vancomycin arise?
Definition
1) Altered binding site (D-ala-D-ala may change to D-ala-D-serine).

2) Thickened cell wall may prevent Vancomycin from reaching target inside.
Term
What do Aminoglycosides, Macrolides, Tetracyclines, Linezolid, Clindamycin and Tigecycline have in common?
Definition
All inhibitors of protein synthesis at Ribosome.

1) 50S- Linezolid (initiation), Macrolides/Clindamycin (translocate peptididyl-rRNAs to inhibit elongation)

2) 30S
- Tetracyclin/Tigecycline (block access of tRNA to ribosome)
- Aminoglycoside (bind 16sRNA leading to mistranslation)
Term
Which drugs disrupt protein synthesis by binding the 30S ribosome subunit?
Definition
1) Tetracyclin/Tigecycline (block access of tRNA to ribosome)

2) Aminoglycoside (bind 16S rRNA leading to mistranslation)
Term
Which drugs disrupt protein synthesis by binding to the 50s ribosome subunit?
Definition
1) Linezolid (initiation)

2) Macrolides/Clindamycin (translocate peptididyl-rRNAs to inhibit elongation)
Term
What do Trimethoprim/Sulfamethoxazole, Rifampin, Flouroquinolones and Fidoxamycin have in common?
Definition
They are all inhibitors of RNA/DNA synthesis.

TM/SMX (purine synthesis)
Rifampin (inhibits DdRp)
FQ (Topoisomerase)
Fidoxamicin (inhibit bacterial RNA Poli)
Term
How is Trimethoprin/Sulfamethoxazole treatment adjusted for in cases of renal failure?
Definition
EXCELLENT BIOAVAILABILITY

Trimethoprine portion is altered, because it is renally excreted.

SMX is excreted by the liver.
Term
What side effects are associated wtih Trimethoprin/Sulfamethoxazole treatment?
Definition
1) Skin- 3-4%, especially with HIV

2) Renal- Creatinine/Potassium

3) Hematological
Term
Which drugs are DNA damaging agents?
Definition
1) Nitrofurantoin (Pro-drug that is reduced to form oxygen radicals)
**resistance with reductase-inhibitory mutations**

2) Metronidazole (Pro-drug that is anaerobically reduced and binds DNA)
**resistance is rare**
Term
Which drugs are cell membrane damaging agents?
Definition
1) Daptomycin (binds potassium efflux pump and causes depolarization).

2) Polymyxins (Inserts into membranes, interacts with phospholipids and acts as cationic detergent).
Term
Which drugs are Hepatically eliminated?
Definition
1) Tigecycline

2) Rifampin

3) Nafcillin/Oxacillin

4) Ceftriaxone

5) Clindamycin

6) Metranidazole
Term
Which drugs have very good oral absorption and are negatively effected by di and tri-valent cations?
Definition
1) Tetracyclines

2) Flouroquinolones
Term
Which drug is only used to treat cystitis, due to its low systemic levels?
Definition
Nitrofurantoin (DNA-damaging agent).
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