Bacterial infections treatment: NAPLEX, NAPLEX - Bacterial Infections, ID Problem Set, NAPLEX - Bacterial Infections, NAPLEX: ID Bacterial Infections, NAPLEX ID Bacterial Infections, bugs, ID drug List (test 1), Infectious Disease I, NAPLEX Bacteria...

A patient is receiving vancomycin 2 grams IV Q12H for treatment of MRSA osteomyelitis. 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? A The vancomycin should be infused over a minimum of 2 hours B The vancomycin should be infused over a maximum of 2 hours C The vancomycin should be infused over a minimum of 1 hour D The vancomycin should be infused over a maximum of 1 hour E The vancomycin should be given via a bolus dose

A Vancomycin can cause serious side effects if infused too quickly. Given the patient is receiving 2 grams, vancomycin should be infused over a minimum of 2 hours. Often, the infusion is given over a longer time period.

A patient hospitalized is hospitalized for a skin infection. It is determined through testing that pathogen is S.Aureas. that is resistant to methicillin. Which of the following would appropriately cover MRSA A) Imipenem B) Vancomycin C) Cefepime D) Piperacillin

B) vancomycin Additional options include Daptomycin and Ceftaroline.

Hydrophilic Abx (5)

Beta-lactams AMG Glycopeptides Daptomycin Polymyxins

Tertiary or late latent syphilis treatment

Benzathine PEN G 2.4 million unit IM weekly x3 weeks

Syphilis treatment (primary, secondary, early latent)

Benzathine PenG 2.4 million units IM x1 dose (alt: doxy 100 mg po bid x 14 days in pen allergy)

T/F. Peptidoglycan, a target for most antibiotics in the cell wall of bacteria, is composed of NAG and NAM

True

T/F. The transportation of aminoglycosides into the cell is considered active transport.

True

T/F. Empiric therapy is given until organism can be identified.

True.

Upper resp pathogens vs lower community and hosp

Upper 1) Strep Pyogenes 2) Step pneumo 3) H influ 4) Morexella catarhalis Lower community 1) Strep pneumo 2) H influ 3) Atypicals: Legionella, Mycoplasma 4) Enteric GNR in alcoholics IC Lower Hosp 1) Staph aureus +/- MRSA 2) Pseudomonas aeru 3) Enteric GNR 4) Strep pneumo

__is the preferred treatment option of c.difficile mediated pseudomembranous colitis

Vancomycin PO

Gram positive, alpha-hemolytc, cocci bug that forms chains/pairs and is PRIMARILY responsible for bacterial endocarditis

Streptococcus viridans (Daptomycin)

Chlamydia treatment

Zithromax 1 g po x1 dose or doxy 100 bid x 7 days

neurosyphilis treatment

ag crystalline penicillin G 3-4 million units IV q4h x 10-14 days

What is the perioperative prophylaxis for colorectal surgeries

cefotetan** and cefoxitin** ampicillin/sulbactam*, ertapenem* OR metronidazole* + (cefazolin or ceftriaxone**)

gonorrhea treatment

ceftriaxone 250 mg IM x 1 dose + Zithromax 1 g po x 1 dose or doxy 100 bid x7 days

What structural component of NAM does transpeptidase recognize

dipeptide ( d/l-alanyl d/l-alanyl) Penicillin mimics the dipeptide.

Gram (negative/postive) bacteria are purple after treatment with crystal violet.

gram positive. This is due to the thick cell wall made of peptidoglycan.

Gram negative coccobacilli responsible for pneumonia, sinusitis, otitis media, and meningitis

haemophilus influenzae

Perioperative (before, during, and after surgery) Antimicrobial Prophylaxis below

jk

Surgeries involving the bowel or with a risk of anaerobic infection typically require antibiotics with anaerobic coverage such as cefotetan, cefoxitin, ertapenem, or (ceftriaxone + metronidazole)

jk

When using Augmentin high dose, should find formulation with _________________

less clavulanate due to diarrhea concerns. (Augmentin ES-600 for example)

trichomoniasis treatment

metronidazole 2 g po x1 dose (alt: metronidazole 500 mg bid x7 days)

Gram negative diplococci responsible for STI gonorrhoeae

neisseria gonorrhoeae

Gram negative diplococci responsible for meningitis

neisseria meningitidis

Upper resp bugs

strep pyogenes S pneumoniae H influenzae Moraxella catarrhalis

How do sugars get to the outside of a bacteria?

they attach to short AA chains that are more lipophilic which helps them cross to the outside of the cell for cell wall synthesis.

How do PCNs get into the cell walls of gram negative bacteria.

through porins because they are hydrophilic.

If using prophylaxis, when should we discontinue the agent after surgery? (most surgeries don't require prophylaxis)

within 24 hours

Heart/endocard pathogens

1) staph aureus +/- MRSA 2) Staphylococcus epidermidis 3) Strep 4) Entercocci

A patient comes into clinic complaining of sore throat, fever, and difficult swallowing. Patient tests (+) for streptococcus pyogenes and is diagnosed as having streptococcal pharyngitis. Which of the following is the MOST appropriately cover this bug A) Antipseudomonal penicllins B) penicillin V C) Azteonam D) Ceftriaxone

*B) Penicillin V and G are 1st choice for the treatment of strep throat (STREP species period)* Other drugs include 1st, 3rd, and 4th generation cephalosporins, Carbapenems (not recommended), Lipoglycopeptides (not preferred), and antipseudomonal penicillins (empirically) Why these are wrong (below) A) Antipseudomonal penicllins- broad spectrum primarily used to treat pseudomonas infections and bactericides fragilis (piperacillin) C) Azteonam- good for gram (-) species such as Enterobacteriaceae, pseudomonas, H. influenza, N. gonorrhea D) Ceftriaxone- not first choice. Has better response against gram (-) bugs.

Penicillinase Resistant Penicillins

-Isoxyazolyl Penicillins (Cloxacillin, Dicloxacillin, Oxacillin) - Methicilin - Nafcillin

Intrasbdoiminal pathgoens

1) Enteric GNR 2) Enterococci/Streptococci 3) Bacteriodes species

Mouth pathogens

1) Mouth flora 2) Anaerobic GNR 3) Viridans group strep

Skin/soft tissue pathogens

1) Staph aureus 2) Strep pyogenes 3) Staph epidermidis 4) Pasturella multocida +/- aerobic/anaerobic GNR (in diabetics)

CNS pathogens

1) Step pneumo 2) Neisseria meningitidis 3) H. influ 4) Group B strep/ E coli in young 5) Listeria young/old

Two serious side effects of aminoglycosides.

1. nephrotoxicity 2. Ototoxicity

Aminoglycosides recognize the (30s/60s) portion of bacterial ribosomes.

30s. This causes an alteration in translation which leads to cell death (cidal)

strengths and ingredients are in Bactrim SS tablets

400 mg sulfamethoxazole and 80 mg trimethoprim

When should treatment be initiated before surgery for most drugs? what about quinolones or vancomycin?

60 minutes before surgery, 120 minutes before quinolones or vancomycin

Which of the following will cover listeria monocytes (Select all that apply) A) Ceftin B) Amoxil C) Natural penicllins D) Keflex

B) Amoxicillin or Ampicillin C) Natural penicillins G and V

Which of the following oral antibiotic suspensions should not be refrigerated? (Select ALL that apply.) A) Biaxin B) Cleocin C) Diflucan D) Cipro E) Ceftin

A) Biaxin B) Cleocin C) Diflucan D) Cipro

Timothy Morten is a 42 year-old male who has been started on Biaxin for treatment of pneumonia. Counseling on Biaxin should include the following points? (Select ALL that apply.) A) Common side effects (2-3%) include diarrhea, abdominal pain, nausea or abnormal (metallic) taste. B) Biaxin XL tablets should be taken with on an empty stomach. C) Biaxin liquid suspension should be refrigerated. D) This medicine can make the skin more sensitive to the sun, and the patient can burn more easily. Use sunscreen and protective clothing. E) There are interactions with this drug and other medicines. Please discuss with a pharmacist to make sure this will not pose a problem.

A) Common side effects (2-3%) include diarrhea, abdominal pain, nausea or abnormal (metallic) taste. E) There are interactions with this drug and other medicines. Please discuss with a pharmacist to make sure this will not pose a problem. Common side effects of Biaxin are GI side effects and abnormal taste. Biaxin XL should be taken with food. Biaxin suspension should not be refrigerated. Macrolides are not associated with photosensitivity, but are associated with drug interactions secondary to inhibition of hepatic enzymes (CYP3A4). Biaxin = Clarithromycin

Counseling on Macrobid should include the following points? (Select ALL that apply.) A) Continue to take this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. B) This medication should be taken four times daily in evenly spaced intervals (every 6 hours). C) This medication may cause the urine to turn dark yellow or brown in color. This is usually a harmless, temporary effect and will disappear when the medication is stopped. D) This medicine can make the skin more sensitive to the sun, and the patient can burn more easily. Use sunscreen and protective clothing. E) Rarely this medication may rarely cause very serious lung problems. Seek medical attention if experiencing severe symptoms of lung problems.

A) Continue to take this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. C) This medication may cause the urine to turn dark yellow or brown in color. This is usually a harmless, temporary effect and will disappear when the medication is stopped. E) Rarely this medication may rarely cause very serious lung problems. Seek medical attention if experiencing severe symptoms of lung problems. Nitrofurantoin (Macrobid) is dosed twice daily, hence the brand name MacroBID. Nitrofurantoin does not cause photosensitivity.

An female patient comes in with symptoms of mailase. A blood culture was take and results show the specimen is gram (+), catalase & coagulase positive. She is diagnosed with TSS. Which drug will most likely cover this specimen. A) Unipen B) Cefotetan C) Zinacef D) Ceftin

A) Unipen which is naficillin, a penicillinase-resistant penicillin whose use is limited only to bugs that have PBP due there steric hindrance. The rest of the options are second generation cephalosporins which aren't recommended. Additional options include 1st,3rd,& 4th (enhanced activity) cephalosporins, carbapenems, lipoglycopeptides, and antipseudomonal penicillins.

Gram-positive cocci that form clustered groups and are catalase positive A) Strep Enterococcus B) Staphylococcus C) Bacillus Clostridium D) Corynebacterium Listeria

B) Staphylococcus

Which of the following is not in gram-poitive morphology A) rods B) diplococci C) clusters D) chains

B) diplococci are more characteristic of gram-negative bacteria.

JC comes to the emergency department with a large wound that is oozing pus on her lower right leg. She has diabetes and did not want to see a doctor earlier because she does not have medical insurance. It is presumed that the infection is due to community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Which of the following oral medications can be used to treat CA-MRSA? (Select ALL that apply.) A: Clindamycin B: Sulfamethoxazole/trimethoprim C: Ciprofloxacin D: Linezolid E: Quinupristin/dalfopristin

A: Clindamycin B: Sulfamethoxazole/trimethoprim D: Linezolid *explanation*:Ciprofloxacin does not have activity against CA-MRSA and quinupristin-dalfopristin is not available as an oral agent.

PD has contracted trichomoniasis. Which of the following options would be preferred treatments for trichomoniasis? A: Metronidazole 2 grams PO x 1 B: Ciprofloxacin 1 gram PO x 1 C: Azithromycin 2 grams PO x 1 D: Penicillin G benzathine 2.4 million units IM x 1 E: Penicillin G benzathine 2.4 million units IM x 3 weekly doses

A: Metronidazole 2 grams PO x 1 *Explanation*:Trichomoniasis, caused by the parasite Trichomonas vaginalis, can be treated with metronidazole or tinidazole 2 grams PO x 1. Sexual partners should be treated as well.

A patient with a urinary tract infection has asked for advice on a product for painful urination. Her doctor wrote the name phenazopyridine down on a sheet of paper. Which of the following patient counseling points are correct regarding phenazopyridine? (Select ALL that apply.) A: Take this medication with food and 8 oz of water to minimize stomach upset. B: She can purchase the over the counter product Azo. C: She should use the product as long as she has symptoms. D: This medication is effective in treating a bacterial urinary tract infection. E: This product will cause red-orange coloring of the urine and can stain clothing.

A: Take this medication with food and 8 oz of water to minimize stomach upset. B: She can purchase the over the counter product Azo. E: This product will cause red-orange coloring of the urine and can stain clothing. *explanation*:Phenazopyridine (Azo, generics) is a urinary analgesic. Phenazopyridine should not be used longer than two days because an antibacterial agent should be working and the painful symptoms should have subsided. If the pain has not subsided, the patient should return to the physician. Phenazopyridine causes a harmless, red-orange coloring of the urine and other body fluids. Contact lenses and clothes could be stained. Take with food and 8 oz of water to minimize stomach upset.

First line treatment for Acute Otitis media? Ratio should be?

Amoxicillin 80-90 mg/kg/day in 2 divided doses 90/mg/kg/day of Amoxicillin with 6.4 mg.kg.day of calvulanate (ratio should be 14:1) in 2 divided doses

Amoxil

Amoxicllin

Omnipen

Ampicillin

Aminopenicillins

Ampicillin Amoxicillin

NA is a 42 year-old female who was a victim of a house fire. She acquired third degree burns requiring skin grafting. Unfortunately her course has been complicated by post-operative Acinetobacter wound infection and acute kidney injury. She has no known drug allergies. Which of the following antibacterials would be considered first line in her case as a single agent? A Vancomycin B Meropenem C Ampicillin D Fosfomycin E Linezolid

B Meropenem is a drug of choice for treating Acinetobacter.

An infectious diseases pharmacist is designing an empiric antibiotic regimen for a patient. The pharmacist suspects Legionella may be a causative organism. Select the following antibiotics that would provide coverage for Legionella. (Select ALL that apply.) A: Augmentin B: Biaxin C: Levofloxacin D: Clindamycin E: Cefdinir

B: Biaxin C: Levofloxacin *explanation*:Legionella is a Gram-negative bacterium (sometimes grouped with atypical organisms) that can cause CAP or HAP. Levofloxacin and Biaxin are the only options listed above with Legionella coverage.

Which of the following statements are correct with regards to sulfamethoxazole/trimethoprim? (Select ALL that apply.) A It is a potent hepatic enzyme inducer resulting in reduced drug concentrations. B It has excellent bioavailability, thus can transition from intravenous to oral formulations in a 1:1 fashion. C It is active against many Gram-positive pathogens, including Staphylococci, Gram-negative pathogens, and opportunistic pathogens. D This drug should be used with caution in a patient with G6PD deficiency. E A negative Coombs test with sulfamethoxazole/trimethoprim indicates hemolytic anemia.

BCE TMP/SMX is a potent CYP 2C9 inhibitor (not inducer). It has 1:1 conversion from IV:PO dosing. It is a broad spectrum agent with excellent Gram-positive, Gram-negative (not Pseudomonas) and opportunistic pathogen coverage. It is partially cleared by the kidney and should be dosed reduced for CrCl < 30 mL/min. A positive Coombs test in the labs (along with decreasing hemoglobin/hematocrit) would indicate the presence of hemolytic anemia and Bactrim should be discontinued.

A patient comes into clinic complaining of sore throat, fever, and difficult swallowing. Patient tests (+) for streptococcus pyogenes and is diagnosed as having streptococcal pharyngitis. The bug is resistant to penicillins. Which of the following is the MOST appropriate therapy A) amoxicillin B) augmentin C) Ceftaroline D) Cephalexin

C) Ceftaroline - Has good coverage of Pen resistant bug species.

Common bacterial pathogens = Lower Respiratory (hospital)

Staph aureus (including MRSA) Pseudomonas aeruginosa Enteric GNR --> Proteus, E.coli, Klebsiella, Enterobacter Strep pneumonaie

What are the common pathogens from surgical infections

Staphylococci and streptococci

Treatment of AOM if 48-72 hour failure of augmentin?

Ceftriaxone 50 mg/kg IM/IV for 3 days

For the surgical procedures below, list the common antibiotics used: Cardiac or vascular surgeries: Hip fracture/total joint replacement: Colon (colorectal): Hysterectomy:

Cardiac or vascular surgeries: Cefazolin or cefuroxime Hip fracture/total joint replacement: Cefazolin Colon (colorectal): Cefotetan, cefoxitin, ampicillin/sulbactam, ertapenem or Metronidazole + (cefazolin or ceftriaxone) Hysterectomy: Cefotetan, cefazolin or ampicillin/sulbactam

What is given for perioperative prophylaxis

Cefazolin

In general what is the DOC for most procedures?

Cefazolin (1st or 2nd generation cephalosporins)

What is the recommended prophylaxis for cardiac or vascular surgeries

Cefazolin** cefuroxime

Treatment for AOM if PCN allergy?

Cefdinir Cefuroxime Cefpodoxime Ceftriaxone

Which of the following statements regarding cephalosporins is correct? A) Cefazolin is an oral cephalosporin that is considered to be the most effective therapy for mild-moderate Gram-negative foot infections. B) Cefixime is the only oral cephalosporin with Gram-negative and enteric anaerobic coverage. C) Cephalexin is an oral, second-generation cephalosporin with sufficient Gram-negative and Gram-positive coverage for moderate severity foot infections. D) Cefuroxime is an oral, second-generation cephalosporin with adequate Gram-negative and Gram-positive coverage for mild-moderate foot infections. E) Cefpodoxime is an intravenous, third-generation cephalosporin with adequate Gram-positive and Gram-negative coverage for severe foot infections.

D) Cefuroxime is an oral, second-generation cephalosporin with adequate Gram-negative and Gram-positive coverage for mild-moderate foot infections. Cefazolin is an intravenous cephalosporin. Cefixime is not effective for enteric anaerobes. Cephalexin is a first generation cephalosporin and cefpodoxime is an oral, third-generation cephalosporin. Cefuroxime is a second generation cephalosporin and is effective in treating Streptococci, MSSA and Gram-negative bacteria associated with mild-moderate foot infections.

Which of the following is correctly associated? A) A site: acceptor site B) P site: binds the amino acids "peptidal site) C) E site: exit site D) all of the above

D) all of the above

Which of the following bacteria types will be intrinsically resistant to aminoglycosides. A) bacteria that live in acidic environments B) bugs that are anaerobic C) H. pylori D) all of the above

D) all of the above In a low pH environment, there would be no need to produce protons because the gradient would already exist. (e.g. H.pylori) With anaerobic bacteria, there is no requirement for oxygen therefore they do know have this Oxygen & pH dependent electron gradient pump.

What are the bacteria that must be covered in colorectal surgery

Staphylococci, streptococci, broad Gram neg, anaerobic

Common bacterial pathogens = Lower Respiratory (community)

Strep pneumonaie Haemophilus influenzae Atypicals: Legionella, Mycoplasma Enteric GNR (alcoholics, IC) --> Proteus, E.coli, Klebsiella, Enterobacter

QJ is a 72 year old male who slipped on his icy driveway and fractured his hip as he was going to the pharmacy to pick up a prescription for mupirocin nasal ointment. He will go to the OR for surgical repair. He was scheduled to have knee replacement surgery the next week and was about to begin an MRSA decolonization regimen prior to this scheduled procedure. He has no known allergies. Which antibiotic regimen should he receive for surgical prophylaxis? A: Clindamycin 600 mg IV x1 B: Clindamycin 600 mg IV x1 plus cefazolin 1g IV x1 C: Levofloxacin 500 mg IV x1 D: Vancomycin 1 gram IV x1 E: Cefotetan 1g IV x1

D: Vancomycin 1 gram IV x1

Which of the following statements is incorrect regarding daptomycin? A It exhibits concentration-dependent killing. B The intravenous formulation is incompatible with D5W. C It is associated with myopathy/muscle toxicity, thus monitor for creatine kinase. D It requires dose adjustments for moderate to severe renal impairment. E The oral formulation has excellent bioavailability.

E Daptomycin requires dose adjustments for CrCl < 30 mL/min. It is associated with myopathy and rarely rhabdomyolysis. Creatine kinase should be monitored weekly (more often if renal impairment or on statin). Daptomycin is only available in intravenous formulation which is compatible with normal saline, not with dextrose.

Common bacterial pathogens = Upper Respiratory

Strep pyogenes Strep pneumonaie Haemophilus influenzae Moraxella catarrhalis

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? A: Ceftriaxone 250 mg IM x 1 B: Azithromycin 1 gram PO x 1 C: Aqueous penicillin G 3-4 million units IV Q4H x 10 days D: Penicillin G benzathine 2.4 million units IM x 1 E :Penicillin G benzathine 2.4 million units IM weekly x 3 weeks

E :Penicillin G benzathine 2.4 million units IM weekly x 3 weeks *explanation*:Since the patient has had syphilis for an unknown duration, it is best to treat with penicillin G benzathine weekly for 3 weeks.

Which of the following is an appropriate fluid for microbe sampling A) blood B) CSF C) pleural cavity D) joint fluid E) all of the above

E) all of the above Additional include Peritoneal cavity. Sites w/ normal microbiota include respiratory tract, GI tract, genitourinary tracts, wounds, skin

Which of the following groups of pathogens best represents clindamycin's spectrum of activity? A Atypicals and anaerobic pathogens B Multidrug-resistant Gram-negative pathogens (Acinetobacter, Pseudomonas) and skin flora (Streptococci, Staphylococci) C Enteric Gram-negative pathogens and anaerobic pathogens D Parasitic and fungal pathogens E Aerobic (Streptococci, Staphylococci) and anaerobic Gram-positive pathogens

E. Clindamycin has excellent coverage for Gram-positive pathogens (Streptococci, Staphylococci, but not Enterococci) and anaerobic pathogens.

Common bacterial pathogens = CNS/meningitis

Strep. pneumoniae Neisseria meningitidis Haemophilus influenzae Group B Strep/E. coli (young) Listeria (young/old)

Lipophilic Abx have diminished or enhanced penetration into bone, lung and brain tissue compared to Hydrophilic Abx?

Enhanced

Gram negative bug that is the MOST common culprit of UTI

Enterobacterase coli (E. coli)

T/F. PCNs are very effective on pseudomonas.

False. There are no porins which means that PCNs cannot get through which makes them intrinsically resistant to PCN.

Common Resistant Pathogens Kill Each And Every Strong Pathogen

Klebisella (ESBL, CRE) Escherichia coli (ESBL, CRE) Acinetobacter baumannii Enterococcus faecalis/faecium (VRE) Staph. aureus (MRSA) Pseudomonoas

Common bacterial pathogens = Mouth

Mouth flora --> Peptostreptococcus, Actinomyces Anaerobic GNR --> Prevotella Viridans group Strep

Coverage of Natural PCN

Other Strep E. faecalis Oral anaerobes

Coverage of Ampicillin/Amoxicillin

Other Strep E. faecalis Resp. CA gram neg. Oral anaerobes

Amino glycosides enter into the bacteria by means of the _____pump.

Oxygen & pH dependent electron gradient pump. Causes antiportation of aminoglycosides in exchanged for H+ produced by utilizing oxygen as an energy source.

Principle target of B-lactams

Transpeptidase (PBP). Enzyme is important for shape and replication

First line bacterial pharyngitis treatment? If BL allergy?

Penicillin Clinda 10 days, Azithro 5 days, Clarithromycin 10 days

Natural penicillins

Penicillin G/V

Common Mouth bugs

Peptostreptococcus actinomyces

Lipophilic Abx (6)

Quinolones Macrolides Rifampin Linezolid Tetracyclines Chloramphenicol

Lower resp bugs

S pneumoniae H influenzae Legionella, Mycoplasma Pseudomonas (noscomial)

Common CNS bugs

S pneumoniae Neisseria meningitidis H influenzae Group B Strep

SSTI bugs

Staph strep pasteurella

Endocarditis bugs

Staph aureus Staph epidermidis Strep enterococci

Why don't gram negative bacteria hold a purple color after treatment with crystal violet?

They have two plasma membranes with a small peptidoglycan layer in the middle. Since the outer layer does not contain peptidoglycan, it does not hold the crystal violet. After treatment with safranin, these cells appear red/pink.