Infectious Diseases
A pharmacist is working in the emergency department. A medical intern asks how to treat a patient who has tested positive for syphilis. The intern explains that the patient does not know how long he has had the disease and has stated that he has had multiple sexual partners over the last few years. Which regimen would be best to treat this patient's syphilis?
Since the patient has had syphilis for an unknown duration, it is best to treat with penicillin G benzathine weekly for 3 weeks. Penicillin G benzathine 2.4 million units IM weekly x 3 weeks
Which of the following intravenous antimicrobial agents are compatible in D5W only?
Synercid and Bactrim
Alternative for endocarditis prophylaxis in a patient going in for dental work but with a beta-lactam allergy
Take clindamycin 600 mg 1 hour prior to dental appointment.
Ketek
Telithromycin
What class of abx should be separated from divalent cations as they may inhibit absorption through chelation.
Tetracyclines and fluoroquinolones
What abx class covers atypicals?
Tetracyclines, macrolides, and FQ
Which of the following strengths and ingredients are in Bactrim SS tablets?
The ratio of sulfamethoxazole to trimethoprim is always 5:1. The single strength tablet of Bactrim contains 400 mg sulfamethoxazole and 80 mg trimethoprim.
A patient is receiving vancomycin 2 grams IV Q12H for treatment of MRSA. The nurse asks how long to infuse the medication. Which is the best recommendation to give the nurse regarding the infusion of this vancomycin dose?
The vancomycin should be infused over a minimum of 2 hours
Which of the following statements regarding ciprofloxacin oral suspension are true?
This agent may prolong the QT interval. The patient's blood sugar may be affected. This medication should not be given through feeding tubes. This agent can cause peripheral neuropathies. This medication should be shaken prior to use.
Rocky Mountain spotted fever. Which of the following medications is the best treatment option for this patient?
Treatment of Rocky Mountain spotted fever involves careful removal of the tick from the skin and antibiotics to eliminate the infection. Doxycycline or tetracycline are the drugs of choice and are used for both confirmed and suspected cases.
What drugs are indicated for VRE skin infections.
Tygacil, Cubicin and Zyvox
Vancocin
Vancomycin
The preferred options for first episode of HSV-2 genital lesions include
acyclovir 400 mg PO three times daily (or 200 mg 5x/day) Valtrex 1 g PO twice daily x 7-10 days Famvir 250 mg PO TID. The duration of HSV-2, first episode, should be 7-10 days.
Concentration-dependent antibiotics include
aminoglycosides, fluoroquinolones, daptomycin and others.
Synercid can cause
arthalgias/myalgias, hyperbilirubinemia and infusion-related reactions.
Teflaro
ceftaroline
The only IV cephalosporin than can be given once daily with normal renal function is
ceftriaxone
Ceftin
cefuroxime
A 30 year-old female patient is 12 weeks pregnant and presents to the physician with symptoms of urinary urgency, burning and frequency. She is diagnosed with a urinary tract infection. Her only medications are a daily prenatal vitamin and a calcium supplement. She has no drug allergies. Which is the best medication to recommend for this patient?
cephalexin
A patient has been taking antibiotics for one week and develops severe diarrhea. Which of the following medications has a boxed warning regarding the risk of causing severe and possibly fatal colitis?
clindamycin (Cleocin)
Cubicin
daptomycin
All the carbapenems, except ____, cover Pseudomonas aeruginosa.
ertapenem (Ivanz)
The drugs of choice for the treatment of tularemia (rabbit fever) are
gentamicin and tobramycin, given 5 mg/kg/day divided Q8H for 7-14 days.
Common side effects associated with amphotericin B deoxycholate include
hypomagnesemia, hypokalemia, chills, rigors, hypotension, tachycardia, and nephrotoxicity.
Which of the following antimicrobials is most likely to be associated with lupus like syndrome?
isoniazid
Zyvox
linezolid
Solodyn
minocycline
Rifaximin is an antibacterial agent indicated for the treatment of
non-invasive E. coli and for reduction in the risk of overt hepatic encephalopathy. Since systemic drug absorption is minimal, it is not a strong hepatic enzyme inducer. Rifaximin can be used to treat traveler's diarrhea caused by non-invasive E. coli.
Long term of nitrofurantoin use can lead to serious and fatal:
pulmonary toxicity
Tygacil
tigecyline
Extended interval dosing fo Amikacin?
15 mg/kg/day
Oseltamivir should be started within ____of symptoms onset. Patients who are candidates should receive 5 days of therapy.
2 days
Extended Interval (formerly known as "Once Daily Dosing") for gentamicin and tobramycin is
4-7 mg/kg/day
The target peak range for gentamicin is
5-10 mcg/mL
correct dose of oseltamivir for the treatment of influenza in an adult:
75 mg BID x 5 days
Choose an acceptable treatment option for daily suppressive therapy for a herpes simplex genital infection:
Acyclovir 400 mg PO BID
Drug of choice for child with acute otitis media, which is most commonly caused by resistant Streptococcus pneumoniae.
Amoxicillin 80-90 mg/kg/day, divided Q 12 hours
Which of the following are available as chewable tablets?
Amoxicillin, amoxicillin/clavulanate, and cefixime
What IV abx are stable for < 24 hours at room temperature once reconstituted, thus are not suitable for continuous infusion delivery.
Ampicillin Bactrim Merrem
Which oral suspensions need to be refrigerated?
Augmentin Ceftin Keflex
Which oral suspension antibiotics should not be refrigerated?
Biaxin should not be refrigerated. Refrigeration can cause thickening and the product may crystallize.
How do you choose the correct dosing with Bactrim?
By looking at TMP dose
She was found to be infected with gonorrhea. Which of the following statements is the best recommendation for this patient
She should be treated with ceftriaxone 250 mg IM x 1 and azithromycin 1 gram PO x 1.
Doribax
Doripenem
Which cephs would be the least safe option for an alcoholic?
Cefotetan has a chemical structure (a N-MTT side chain) that puts patients at risk for a disulfiram-like reaction if alcohol is consumed.
Which of the following oral medications can be used to treat CA-MRSA?
Clindamycin Sulfamethoxazole/trimethoprim Linezolid
A patient with an active tuberculosis infection will receive ethambutol therapy as part of their combination drug therapy. The patient will require counseling regarding the possibility of the following adverse effect:
Ethambutol can cause optic neuritis, which can decrease visual acuity and may cause blindness. Patients should be counseled to report any changes in vision to their physician promptly.
DOC for peri-operative antibiotic prophylaxis is recommended for patients undergoing surgery:
First and second generation cephalosporins are typically the drugs of choice for most procedures
Antiviral agents active against cytomegalovirus (CMV) include which of the following:
Ganciclovir, valganciclovir, foscarnet and cidofovir
Micafungin, an echinocandin, can cause what kind of sxs?
Histamine-mediated symptoms such as rash, pruritus, facial swelling, flushing, and hypotension. To decrease the potential of a histamine reaction, infuse over 1 hour. Micafungin is Pregnancy Category C and is only available intravenously
What are the only options listed above with Legionella coverage
Levofloxacin and clarithromycin are the only options listed above with Legionella coverage
Counseling pts of nitrofurantoin:
Nitrofurantoin (Macrobid) is dosed twice daily, hence the brand name MacroBID. Nitrofurantoin does not cause photosensitivity This medication may cause your urine to turn dark yellow or brown in color. This is usually a harmless, temporary effect and will disappear when the medication is stopped. Rarely this medication may rarely cause very serious lung problems. Seek medical attention if you are experiencing severe symptoms of lung problems.
KS is diagnosed with PCP and stabilized. She is ready for discharge. Her provider is concerned that the cellulitis has not healed as well as he had hoped. He asks the pharmacist about a single dose glycopeptide for bacterial skin and skin structure infections that he heard about. He thinks KS would be a good candidate for this drug. Which drug is he referring to?
Oritavancin Oritavancin and dalbavancin are lipoglycopeptides that were FDA-approved in 2014. Both have activity against Staphylococci (MSSA and MRSA) and Streptococci. Oritavancin is a one-time dose and dalbavancin is given as two doses (one week apart).
Covers Pseudomonas
Primaxin (Imipenem/cilastatin) Coly-Mycin M Timentin (Ticarcillin/Clavulanic acid ) Meropenem
What is pyranzinamide?
Pyrazinamide is an antitubercular agent used in the initial treatment of tuberculosis. It is contraindicated in patients with acute gout and severe hepatic damage.
Synercid
Quinupristin/dalfopristin
