Infectious Disease I Exam 1 Part 2 Flashcards


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1

True or False: The approval of anti-bacterial medications has steadily decreased due to bacteria being able to become resistant to the drug.

True

2

True or False: Penicillins are excreted in the urine unchanged.

True

3

All beta-lactam antibiotics share what common feature?

beta-lactam ring

4

The beta-lactam ring is critical for what?

antimicrobial activity

5

What is the overall target of beta-lactam antibiotics that is associated with stopping infections?

inhibition of synthesis of bacterial cell walls

6

Viruses that infect bacteria are known as what?

bacteriophages

7

List things that structurally the bacterial cell wall is necessary for:

  • Maintaining the cell's characteristic shape
  • Countering the effects of osmotic pressure
  • Providing a rigid platform for surface appendages
  • Providing attachment sites for bacteriophages

8

What is a latticed polymer consisting of linear chains of the altering aminosugars NAG and NAM?

Peptidoglycan

9

The 4-5 amino acid short chains attached to NAM in peptidoglycan can be enzymatically cross-linked by what?

transpeptidase

10

True or False: If transpeptidase does not cross-link the amino acid chains of NAM, then the cell wall is unsupported.

True

11

Transpeptidase hydrolyzes which portion of the 4-5 amino acid chain?

DA-DA

12

Which type of bacteria has a thick layer of peptidoglycan (cell wall is 50-100 molecules thick)?

Gram positive

13

Gram positive bacteria's site of action will be where?

outside of the peptidoglycan layer

14

Which type of bacteria has a thin layer of peptidoglycan?

Gram negative

15

Gram negative organisms contain a single sheet of peptidoglycan (PG). How does this affect stability?

Less stable (must less rigid)

16

The PG layer in gram negative bacteria is found in between what?

inner and outer plasma membranes

17

Where is the site of action for antibiotics used against gram negative bacterial infections?

Periplasmic space

18

Beta-lactam antibiotics will block what?

transpeptidase (from cross-linking the amino acid chains)

19

Once beta-lactam antibiotics block transpeptidase, water diffuses into the cell in the hypertonic environment leading to what?

cell lysis

20

Beta-lactam antibiotics bind to and inhibit transpeptidase enzymes as well as other targets all related to transpeptidase known as what?

Penicillin-Binding Proteins (PBPs)

21

True or False: PBPs are important for maintenance of shape and for cell division.

True

22

When PBP (transpeptidase) binds to beta-lactam antibiotics what kind of bond is formed?

covalent bond (this inactivates the PBP)

23

True or False: PBP has a higher affinity for the drug rather than DA-DA.

True

24

Bacteria not being susceptible to a specific drug is known as what?

Intrinsic resistance

25

What is a gram negative bacteria that does not have pores/channels and therefore a lot of antibiotics cannot reach the site of action?

Pseudomonas aeruginosa

26

What kind of resistance occurs via mutations or homologous recombination?

Acquired resistance

27

A PBP sensitive gene combining with a PBP resistant gene and forming a recombinant PBP resistant gene is an example of what?

homologous recombination

28

Which bacteria are resistant via the acqusition of additional high molecular weight PBPs with low affinity for beta-lactams from unknown species?

MRSA

29

What can readily transfer from bacteria to bacteria leading to resistance?

plasmid DNA

30

Resistance can stem from what in addition to plasmid DNA transfer?

Transfer by viral delivery

31

Why is it important for a patient to finish their entire antibiotic regimen?

So that resistance doesn't develop from viral transfer or plasmid DNA transfer

32

Resistance can also occur as a result of inpenetration or efflux of antibiotic drugs from the bacteria. This is especially important in which species?

gram negative (i.e. pseudomonas aeruginosa)

33

What in the presence of beta-lactam antibiotics leads to hydrolyzing of the antibiotic's structure and therefore making the antibiotic inactive?

Water (this is why antibiotics for children are not reconstituted until picked up)

34

True or False: The hydrolysis of beta-lactam antibiotics leading to their inactivation is increased at higher temperatures.

True (this is why a lot of beta-lactam antibiotics for children are refrigerated)

35

What specific gene is expressed on plasmids and is the number one leading cause of resistance in beta-lactam antibiotics?

beta-lactamase

36

Beta-lactamases are shed continuously in which bacteria?

gram positive

37

Beta-lactamase is secreted only into the periplasmic space between the inner and outer membranes in which bacteria?

gram negative (little loss of beta-lactamase = doesn't need to be resynthesized to high degrees)

38

True or False: Drugs without zones of inhibition means those drugs are resistant.

True

39

The main function of what is preventing the colonization by pathogens?

Normal flora

40

Which bacteria causes 90% of all abdominal anaerobe infections?

Bacteroides fragilis

41

Which bacteria is very prevalent among cystic fibrosis patients due to the CF patients not being able to clear their lungs and developing pneumonia?

Pseudomonas aeruginosa

42

What 3 bacterium species are important for removing the conj. from oral contraceptives?

  • Clostridium perfringens
  • Clostridium septicum
  • Clostridium tetani

43

Individual patients who are compliant with their oral contraceptives have been shown to have decreases in plasma ethyl estradiol most notably with which antibiotics?

  • PENs
  • TETs

44

Which drugs ABSOLUTELY decrease OC effectiveness by inducing hepatic metabolism of estrogens?

  • Rifamycins (i.e. Rifampin)
  • Griseofulvin (anti-fungal)
    • these increase the metabolism of estrogens

45

Penicillin G and Penicillin V are effective against what bacteria in general?

gram positive

46

Penicillin G and Penicillin V are effective against what gram positive bacteria specifically?

Streptococcus pyogenes

47

Which penicillins have a highly narrow spectrum?

Penicillinase-resistant penicillins

48

Penicillinase-resistant penicillins are especially effective against which specific bacteria?

  • Staphylococcus aureus
  • Staphylococcus epidermis

49

Which penicillins have a broader spectrum than Pen G/Pen V and can include coverage for some gram negative bacteria?

Aminopenicillins

50

Which penicillins have the broadest spectrum?

Anti-pseudomonal Penicillins

51

Anti-pseudomonal Penicillins are effective against which specific bacteria?

Pseudomonas aeruginosa

52

What is a main problem associated with Penicillin G?

Not absorbed well from GI

53

True or False: Ingestion of food with ANY penicillin alters absorption.

True

54

Which penicillin is the ether derivative of penicillin G and has greater oral bioavailability?

Penicillin V

55

Penicillin G/V cover most streptococcus species. List the most common species that Pen G/V covers:

  • S. viridans
  • S. pyogenes
  • S. pneumoniae (many resistant)

56

S. viridians is most prevalent where in the body?

oral cavity (mouth)

57

S. viridans is most commonly associated with which specific infection?

Endocarditis (cardiac valve infection)

58

S. pyogenes is most commonly associated with which specific infection?

Strep throat

59

S. pneumoniae is most commonly associated with which particular infection?

Bacterial pneumonia

60

Besides streptococcus species, what are some other bacteria that are sensitive to Penicillin G/V?

  • Listeria monocytogenes
  • Borrelia burgdorferi

61

Is Listeria monocytogenes a gram positive or gram negative organism?

Gram +

62

Listeria monocytogenes is most commonly associated with what specific infection?

Listeriosis (from raw food)

63

Borrelia burgdorferi is most commonly associated with which specific infection?

Lyme disease

64

Streptococcal pharyngitis is caused by what bacteria?

S. pyogenes (strep throat, scarlet fever)

65

Which streptococcus sp. are associated with reduction of heme iron?

Alpha hemolysis

66

Which streptococcus sp. are associated with complete rupture of RBC?

Beta-hemolytic

67

True or False: Group A Streptococcus (GAS) and Group B Streptococcus (GBS) are beta-hemolytic.

True

68

What is a classical member of GAS?

S. pyogenes

69

S. pyogenes (strep throat) can progress to what particular infections?

  • Rheumatic fever
  • Scarlet fever

70

S. pyogenes most commonly causes what?

skin-soft tissue infections (SSTI)

71

S. pyogenes has a link to what?

OCD/PANDAS

72

What is a classical member of GBS?

S. agalactieae

73

S. agalactieae can lead to the development of what in neonates if present in the vaginal tract and left untreated?

meningitis (neonatal sepsis)

74

S. agalactieae can lead to the development of what in the elderly?

bacteremia

75

True or False: Pregnant women should have a GBS antigen test performed at 25-28 weeks.

True

76

If a woman possesses GBS in the vaginal tract, the infection should be treated throughout labor and delivery with what?

Pen

77

Which streptococcus species is associated with soft tissue and requires alternative therapies to treat?

Streptococcal cellulitis

78

Which streptococcus species is associated with a "flesh-eating" infection?

Necrotizing fascilitis (Streptococcal gangrene)

79

Which penicillins are resistant to hydrolysis from the beta-lactamase enzyme?

Semi-Synthetic Penicillinase-Resistant Penicillins

80

List some common Semi-Synthetic Penicillinase-Resistant Penicillins:

  • Methicillin
  • Oxacillin
  • Nafcillin
  • Dicloxacillin
  • Cloxacillin

81

Semi-Synthetic Penicillinase-Resistant Penicillins are narrow spectrum agents used for what specific infections?

  • S. aureus (MSSA)
  • S. epidermidis (MSSE)

82

Any S. aureus that is resistant to the penicillin/cephalosporin agents is known as what?

MRSA

83

True or False: MRSA and MRSE express a high molecular weight PBP with very low affinity for beta-lactams.

True

84

What are the 2 categories that MRSA infections are divided into?

  • HA-MRSA (secondary to hospitilization, surgery, long-term care, dialysis, invasive device, etc.)
  • CA-MRSA

85

Community-associated MRSA (CA-MRSA) typically presents as what kind of infection?

skin, soft-tissue

86

Methicillin resistance is the result of the bacteria's acquisition of what gene?

mecA gene

87

S. aureus and MRSA organisms produce three types of toxin. What are these 3?

  • cytotoxins
  • pyrogenic toxin superantigens
  • exfoliative toxins

88

When toxins are synthesized in S. aureus and MRSA infections, there is a host response involving the recruitment of what?

polymorphonuclear leukocytes

89

What component of methicillin's structure protects it from being degraded from beta-lactamase?

bulky methoxy side chains (protect the carbonyl from a beta-lactamase attack)

90

Methicillin has a narrow spectrum to which infection due to it's bulky groups allowing for binding of staphylococcus sp. PBPs only?

MSSA

91

True or False: Nafcillin is highly resistant to beta-lactamase.

True

92

What is the spectrum associated with Nafcillin (which infections are covered)?

  • MSSA
  • MSSE

93

List some common brand names of Nafcillin:

  • Nafcil
  • Unipen
  • Nalpen

94

Which drugs are isoxazolyl penicillins?

  • Oxacillin
  • Cloxacillin
  • Dicloxacillin

95

In regards to isoxazolyl penicillins, adding what groups to their structures increases their overall potency?

Chloro groups (Cl)

96

Which penicillins have a broader spectrum of activity and include some gram negative organisms?

Aminopenicillins

97

List some drugs that belong to the aminopenicillin class:

  • ampicillin
  • amoxicillin

98

True or False: Ampicillins have no resistance to beta lactamase.

True

99

True or False: An organism resistant to Pen G/V should be considered resistant to aminopenicillins.

True

100

What are some brand names of ampicillin?

  • Omnipen
  • Polycillin

101

What group on aminopenicillins increases their hydrophilicity and therefore can cause a penetration to gram negative pores?

NH2

102

Ampicillin has increased acid stability versus Pen G/V so therefore better oral absorption (30-50%). What happens to the unabsorbed drug?

Stays in the GI tract (causing GI upset)

103

True or False: Ampicillin is preferred as injection.

True

104

Ampicillin mimics how many amino acids?

3

105

What component on Amoxicillin contributes to 95-100% absorption and therefore less GI upset?

The addition of the OH group

106

What are some brand names of Amoxicillin?

  • Amoxil
  • Trimox

107

Amoxicillin has similar activity to ampicillin, but greater coverage with what bacteria?

H. pylori

108

Aminopenicillins (Ampicillin/Amoxicillin) can be used to treat which respiratory illnesses?

  • sinusitis
  • otitis media
  • bronchitis

109

Aminopenicillins are effective in covering which bacteria that can cause respiratory infections?

  • S. pyogenes
  • S. pneumoniae
  • H. influenzae

110

S. pneumoniae is covered especially well by which drug?

Amoxicillin

111

Aminopenicillins are used in the treatment of what specific infection that can be caused by gram negative bacteria?

UTI

112

What are some gram negative bacteria that can cause UTIs that are treated with aminopenicillins?

  • E. Coli (80% of cases = MOST COMMON)
  • Proteus mirabilis

113

What is a gram positive bacteria that can cause a UTI and be treated with aminopenicillins?

Enterococcus sp.

114

Aminopenicillins can also be used in the treatment of meningitis in combination with other classes. List some bacteria that cause meningitis that aminopenicillins are effective against:

  • Listeria monocytogenes
  • Streptococcus sp.

115

Is Listeria monocytogenes a gram positive or gram negative bacteria?

gram positive

116

Aminopenicillins have been shown to be effective in the treatment of Lyme disease. Which bacteria cause Lyme disease?

Borrelia burgdorferi and mayonii

117

Borrelia burgdorferi and mayonii are both gram positive or gram negative?

gram negative

118

Infection and inflammation of the middle ear is known as what?

Otitis media

119

What type of otitis media produces pus, fluid, and inflammation?

Acute

120

What type of otitis media is associated with fluid persisting in the ear, fluid escaping, and there is no sign of an active infection?

OM with effusion

121

Otitis media that persistently reoccurs is known as what?

Chronic OM

122

Otitis media can stem from primary upper airway infections, allergies, or common cold causing congestion and swelling of the what in the middle ear?

eustachian tube

123

What are the 2 main purposes of the eustachian tubes?

  1. Relieve Pressure
  2. Drainage

124

What are the most common microbial organisms that cause otitis media?

  • Streptococcus pneumoniae
  • Haemophilus influenzae

125

True or False: In approximately 66% of cases, otitis media infections resolve on their own within 72 hours and therefore a child might not need antibiotic therapy.

True

126

Which drug should be used to treat otitis media if it has not been given to a patient in the last 30 days?

Amoxicillin

127

If amoxicillin has been used within the last 30 days, or was ineffective for 2-3 days, which drug is given to treat otitis media?

Amox/clavulanate (Augmentin)

128

Clavulanate is a potent irreversible inhibitor of what?

beta-lactamase

129

Beta-lactamase inhibitors can be thought of as "suicide substrates". What does this mean?

These drugs give themselves up for the good of the rest (give the antibiotics greater activity)

130

What is another beta-lactamase inhibitor used with ampicillin?

Sulbactam

131

What is the brand name of ampicillin/sulbactam injection?

Unasyn

132

Which bacteria is very commonly associated with hospital devices (catheters, inplantable devices, etc.)?

Acinetobacter baumannii (Acinetobacter sp.)

133

Acinetobacter baumannii (Acinetobacter sp.) can be effectively treated with which antibiotic?

Ampicillin/sulbactam (Unasyn)

134

Which penicillins are the most broad spectrum in terms of treating infections?

Antipseudomonal penicillins

135

Antipseudomonal penicillins are unique penicillins, because the cover which particular infection?

pseudomonas aeruginosa

136

Antipseudomonal penicillins can be subdivided into what main 2 penicillin categories (based on their structure)?

  • Carboxypenicillins
  • Ureidopenicillins

137

Which drug is a carboxypenicillin?

Ticarcillin

138

What is the brand name of Ticarcillin?

Ticar

139

True or False: Carboxypenicillins and Ureidopenicillins are NOT sensitive to beta-lactamase.

False; ARE sensitive

140

Which drug is a ureidopenicillin?

Piperacillin

141

Piperacillin has unique coverage to what specific bacteria?

Bacteroides fragilis

142

Piperacillin can be used in combination with tazobactam. What is tazobactam?

Beta-lactamase inhibitor

143

What is the brand name of Piperacillin/tazobactam?

Zosyn

144

90% of abdominal anaerobic infections are caused by what?

Bacteroides fragilis

145

What is by far the most common adverse event associated with penicillins?

hypersensitivity

146

ALL penicillins are excreted renally. What is another side effect that could be expected based on this information?

Nephrotoxicity

147

Which penicillins can cause platelet dysfunction and therefore alter clotting?

Antipseudomonal penicillins

148

Penicillins or penicilloyls can attach to what in the body leading to an IgE mediated reaction?

Proteins (body recognizes as foreign)

149

True or False: It is important to clean counting trays after dispensing penicillins or cephalosporins due to the potential for sensitizing a patient to that drug.

True (sensitizing a patient could lead to an allergic reaction later)

150

Which drugs are derived from sewage and therefore will be very smelly when urinated out?

Cephalosporins

151

Which bacteria are cephalosporins inactive against?

  • L - L. monocytogenes
  • A - Atypical organisms (Mycoplasma pneumoniae; Chlamydia sp.)
  • M - MRSA/MRSE
  • Enterococci

152

Which cephalosporin is the exception when covering MRSA?

Ceftaroline

153

Which cephalosporins penetrate very well into the CSF and therefore are useful in the treatment of bacterial meningitis?

  • cefuroxime (Duricef)
  • cefotaxime (Claforan)
  • ceftriaxone (Rocephin)
  • cefepime (Maxipime)
  • ceftizoxime (Cefizox)

154

1st generation cephalosporins have good activity against which bacteria?

gram positive

155

True or False: 1st generation cephalosporins have appropriate coverage against MRSA.

False; MSSA

156

1st generation cephalosporins have modest activity against gram negative bacteria that can cause UTIs. Name some of these bacteria:

  • E. Coli
  • K. pneumoniae
  • P.mirabilis

157

List the 1st generation cephalosporins:

  • Cephalexin
  • Cefadroxil
  • Cefazolin

158

What is the brand name of Cephalexin?

Keflex

159

What is the brand name of Cefadroxil?

Duricef

160

What is the brand name of Cefazolin?

Ancef

161

Which first generation cephalosporin is commonly used as prophylaxis of infection (especially in a surgical setting)?

Cefazolin (Ancef)

162

Which 1st generation cephalosporin has an amine group just like ampicillin?

Cephalexin (Keflex)

163

Which 1st generation cephalosporin has the amine and para hydroxyl group like amoxicillin?

Cefadroxil (Duricef)

164

The 2nd generation cephalosporins have somewhat increased gram negative activity. Particularly against which gram negative bacteria?

bacteroides fragilis

165

List the 2nd generation cephalosporins:

  • Cefuroxime
  • Cefuroxime Axetil
  • Ceftoxitin
  • Cefotetan

166

What functional group on 2nd generation cephalosporins decreases attack by beta-lactamases?

syn-oriented methoxyimino group

167

Which 2nd generation cephalosporins possess the syn-oriented methoxyimino group?

  • Cefuroxime
  • Cefuroxime Axetil

168

What are the brand names for cefuroxime?

  • Kefurox
  • Zinacef

169

What is the brand name of Cefuroxime Axetil?

Ceftin

170

What is the brand name of Ceftoxitin?

Mefoxin

171

What is the brand name of Cefotetan?

Cefotan

172

Cefuroxime Axetil (Ceftin) is the prodrug of Cefuroxime. What does this allow for?

oral absorption

173

2nd generation cephalosporin penetrate into the CSF and are active against the 3 organisms that most commonly cause bacterial meningitis. What are these 3 organisms?

  • H. influenzae
  • N. meningitidis
  • S. pneumoniae

174

Which cephalosporin is more active than any other ceph against anaerobes, especially bacteroides fragilis?

Cefotoxitin (Mefoxin)

175

Which cephalosporin has similar anaerobic activity to cefotoxin, good B. fragilis activity?

Cefotetan (Cefotan)

176

True or False: Cefoxitin (Mefoxin) and Cefotetan (Cefotan) possess the syn-oriented methoxyimino group in order to resist beta-lactamases.

False; do not possess (their increased steric bulk is what yields resistance to beta-lactamases)

177

3rd generation cephalosporins have similar activity against gram + cocci to the 1st generation and increase gram negative. However, 3rd generation cephalosporins are much more active against which bacteria?

Enterobacteriaceae

178

True or False: 3rd generation cephalosporins are resistant to common beta-lactamases.

True

179

Which 3rd generation cephalosporins are similar to cefuroxime in that they possesses a syn-methoxyimino group that protects it from beta-lactamases?

  • Cefotaxime
  • Ceftriaxone

180

What is the brand name of cefotaxime?

Claforan

181

What is the brand name of ceftriaxone?

Rocephin

182

What is the outstanding feature associated with ceftriaxone (Rocephin)?

Long half-life (8 1/2 hours)

183

Ceftriaxone (Rocephin) is often the agent of choice in the pen-sensitive treatment of what infection?

bacterial meningitis

184

What are the 3 main causitive organisms associated with bacterial meningitis?

  • N. meningitis
  • H. influenzae
  • S. pneumoniae

185

The 3 main causitive organisms of bacterial meningitis (N. meningitis, H. influenzae, and S. pneumoniae) are normally present in which area of the body?

throat (back of the throat)

186

All 3 main causitive organisms of bacterial meningitis (N. meningitis, H. influenzae, and S. pneumoniae) are encapsulated by a what?

polysaccharide capsule (this allows them to invade immune system)

187

What part of the brain makes the CSF in which all 3 main causitive organisms of bacterial meningitis (N. meningitis, H. influenzae, and S. pneumoniae) can invade the ventricles of the brain leading to bacterial meningitis?

Choroid plexus

188

True or False: Bacterial meningitis is mainly an auto-inflammatory disease.

True

189

What are often the first symptoms associated with the presentation of bacterial meningitis?

  • High fever
  • Headache
    • result from increased intracranial presssure

190

List some other symptoms associated with bacterial meningitis:

  • fatigue
  • vomiting
  • altered mental status (i.e. confusion)
  • intolerance to light
  • stiff neck (from swollen/inflamed meninges)
  • purpura (red dots/rashes around the body)

191

Which 3rd generation cephalosporins have the syn-directed protective groups to decrease beta-lactamase effects?

  • Cefixime
  • Cefdinir
  • Cefpodoxime

192

What is the brand name of Cefixime?

Suprax

193

What is the brand name of cefidinir?

Omnicef

194

What is the brand name of cefpodoxime proxetil?

Vantin

195

Which 3rd generation cephalosporin chelates GI iron?

Cefdinir (Omnicef)

196

Due to Cefdinir (Omnicef) chelating GI iron, what is a major side effect?

feces will change color (red color)

197

True or False: Cefdinir (Omnicef) does not require refrigeration.

True

198

Which 3rd generation cephalosporin has a complex syn-side chain that offers it protection from chromosomal and plasmid beta-lactamases?

Ceftazidime

199

What is the brand name of ceftazidime?

Fortaz

200

Ceftazidime (Fortaz) has excellent activity against which bacteria?

pseudomonas

201

Which species of bacteria are anaerobic gram positive rods?

Clostridium

202

Which bacteria have spores that can form live bacteria if they are swallowed (the spores are resistant to acid and heat)?

C. difficile

203

C. difficile infections are associated with what?

antibiotic overuse (can occur with ANY antibiotic)

204

C. difficile infections lead to inflammation of the colon known as what?

pseudomembranous colitis

205

In C. difficile infections, what is the most common side effect?

severe diarrhea

206

C. difficile infections are highly associated with the use of which antibiotics?

Fluoroquinolones

207

True or False: The risk for C. difficile infections are increased with repeated antibiotic use and antibiotic combos.

True

208

The suppression of gastric acid production also increases the risk of C. difficile infections. List some drugs that are associated with gastric acid suppression and can increase the risk of C. difficile infections:

  • H2-receptor antagonists (2x risk)
  • PPIs (3x risk)

209

C. difficile infections are associated with toxins. What is the overall target of these toxins?

RhoGTPases

210

RhoGTPases are important for what?

actin polymerization (actin is important for normal GI functions)

211

Which enzyme on C. difficile toxins transfers a sugar onto RhoGTPases and inactivates the RhoGTPase and inhibits the production of actin?

Glucosyltransferase

212

In C. difficile infections, tight junctions in the GI tract are disrupted leading to increased permeability (water does not get absorbed appropriately). This leads to what main side effect in C. difficile infections?

diarrhea

213

What is the immediate approach to treating C. difficile infections?

discontinuing the offending antibiotic (20-25% of cases will resolve within 48-72 hours)

214

Why should antiperistaltic and opiate agents be avoided in C. difficile infections?

these drugs SLOW peristalsis and the toxin remains in the GI tract

215

What help to prevent alterations to the normal flora in the gut?

Probiotics (those kept cold are best = more viable cultures and need high culture concentration ~ 2 billion)

216

True or False: 4th generation cephalosporins can provide coverage to multiple resistant strains.

True

217

4th generation cephalosporins have excellent activity for which bacteria?

  • streptococci
  • MSSA

218

Which cephalosporin is a 4th generation?

Cefepime

219

What is the brand name of cefepime?

Maxipime

220

What hydrolyze the extended spectrum cephalosporins?

Extended Spectrum-beta-lactamases (ESBLs)

221

What are the viable options for treatment associated with ESBLs?

Carbapenems

222

5th generation cephalosporins have coverage for which infections?

  • MRSA
  • VRSA
  • linezolid-resistant SA

223

True or False: 5th generation cephalosporins are NOT active against ESBL expressing bugs.

True

224

Do 5th generation cephalosporins cover pseudomonas?

No

225

Which drug is a 5th generation cephalosporin?

Ceftaroline Fosamil

226

What is the brand name of Ceftaroline Fosamil?

Teflaro

227

Which drug is a new generation cephalosporin that has excellent activity against P. aeruginosa?

Ceftolozane-Tazobactam

228

What is the brand name of Ceftolozane-Tazobactam?

Zerbaxa

229

Which drug is a cephalosporin siderophore approved for MDR (multi-drug resistant) gram negative cUTI?

Cefiderocol

230

True or False: There is a higher all cause mortality warning associated with Cifiderocol.

True

231

Cefiderocol has unique binding feature to what?

iron (can be brought into gram negative bacteria like pseudomonas due to iron uptake system)

232

True or False: Cefiderocol has no gram positive activity.

True

233

Which drugs are considered the broadest spectrum beta-lactams?

carbapenems

234

Imipenem is a carbapenem and is a component of which drug?

Primaxin

235

Due to cleavage in the kidney, Imipenem is dosed (1:1) with which drug to make Primaxin?

cilastain

236

What is the brand name of Imipenem/cilastatin + Relebactam?

Recarbio

237

Imipenem/cilastatin + Relebactam (Recarbio) is only used for which infections?

  • cUTI
  • cIAI

238

Most carbapenems cover everything but what?

MRSA

239

Which carbapenem has good coverage of acinetobacter?

Meropenem

240

What is the brand name of Meropenem?

Merrem IV

241

Meropenem + vaborbactam is indicated for what?

cUTI

242

Which carbapenem lacks good acinetobacter coverage?

Doripenem

243

What is the brand name of Doripenem?

Doribax

244

Which carbapenem is most potent?

Doripenem

245

Which carbapenem does not provide coverage to P. aeruginosa, Acinetobacter, and Enterococcus?

Ertapenem

246

What is the brand name of ertapenem?

Invanz

247

Any enterobacteriaceae can harbor resistance to carbapenems. What is this known as?

Carbapenem Resistant Enterobacteriaceae (CRE)

248

CRE is caused by bacteria possessing which enzyme?

Carbapenemase

249

Treatment for CRE is limited to which drugs?

  • colistin
  • tigecycline
  • Avycaz
  • plazomicin
  • rifampin

250

What is the generic name for Avycaz?

Ceftazidime-Avibactam

251

True or False: Avycaz (Ceftazidime-Avibactam) is active against CRE, including KPC.

True

252

Which beta-lactam antibiotic is a monolactam?

Aztreonam

253

What is the brand name of aztreonam?

Azactam

254

Aztreonam (Azactam) is strictly efficient in treating what type of infections?

gram negative

255

Aztreonam (Azactam) shares a common R group with which medication?

Ceftazidime

256

True or False: A patient with an allergy to ceftazidime should NOT be given aztreonam.

True (cross-sensitivity rxn due to same R group)

257

Ampicillin shares the same R group as which cephalosporin (this cephalosporin should not be used due to a cross-sensitivity reaction if the reaction to ampicillin was severe)?

Cephalexin (Keflex)

258

Amoxicillin shares the same R group as which cephalosporin (this cephalosporin should not be used due to a cross-sensitivity reaction if the reaction to amoxicillin was severe)?

Cefadroxil (Duricef)

259

Which drugs belong to the lipoglycopeptide class?

  • vancomycin
  • telavancin
  • dalbavancin
  • oritavancin

260

What are the brand names associated with vancomycin?

  • Vancocin
  • Vancoled

261

True or False: Vancomycin is a very lipophilic drug.

False; hydrophilic

262

Due to vancomycin being very hydrophilic, this means what for the absorption of vancomycin?

poor oral absorption (virtually none)

263

Due to oral vancomycin having very poor absorption, it can be useful in treating which infection in particular?

C. difficile

264

Vancomycin is associated with which particular infusion reaction?

"Red Man Syndrome" (infusion MUST be slow to help avoid)

265

What is the side effect we are most concerned with in regards to Vancomycin?

nephrotoxicity (ototoxicity is also common)

266

Describe the MOA associated with Vancomycin:

Vancomycin forms 5 hydrogen bonds to the terminal DA-DA and inhibits transpeptidase from forming peptide backbone (cell wall does not form)

267

How do bacteria (i.e. Staphylococcus aureus) become resistant to Vancomycin (VRSA)?

mutate by changing the terminal amino acid sequence (not allowing vancomycin to form 5 hydrogen bonds to DA-DA)

268

The spectrum of Vancomycin is restricted to which kind of organisms?

Gram + (particularly gram + cocci)

269

Vancomycin is most associated in the treatment of what?

MRSA

270

True or False: Vancomycin can be useful in the treatment of multi-resistant strep.

True

271

Vancomycin can be used at higher concentrations in the treatment of bacterial meningitis. Why are higher concentrations needed?

to cross BBB

272

Telavancin is a vancomycin derivative. What is the brand name of telavancin?

Vibativ

273

Telavancin contains what unique structure?

lipophilic tail

274

True or False: Vancomycin is more potent compared to Telavancin.

False; Telavancin is more potent (2-8x)

275

What are the most commonly associated side effects associated with televancin?

  • N/V/D
  • taste disturbance
  • foamy urine

276

Telavancin can interfere with what test?

coagulation (can make INR look off)

277

True or False: Telavancin can cause C. difficile associated diarrhea even though it is a treatment for C. difficile infections.

True

278

In addition to forming 5 hydrogen bonds with DA-DA like Vancomycin, what is an additional MOA of telavancin?

Lipid tail of Televancin will stick into bacterial membrane --> causing membrane depolarization and leakage of the membrane --> cell lysis

279

What are additional lipoglycopeptide antibiotics that share the same 2 MOAs with telavancin?

  • Dalbavancin (Dalvance)
  • Oritavancin (Orbactiv)

280

True or False: Dalbavancin (Dalvance) is most active against MSSA/MRSA and E. faecalis, but not VRE.

True

281

What is specifically unique about oritavancin (Orbactiv)?

10 day half-life (given as one-time dose over 3 hours)

282

Oritavancin (Orbactiv) precipitates in normal saline so it is administered via IV mixed with what?

D5W

283

Which drug uses Ca2+ to stick it’s tail through the membranes --> K+ leaks outside leading to depolarization of the membranes and lysis?

Daptomycin

284

What is the brand name of daptomycin?

Cubicin

285

Daptomycin (Cubicin) has only activity against which organisms?

gram positive

286

Uniquely daptomycin (Cubicin) has activity against enterococci species including what?

VRE

287

Daptomycin (Cubicin) is indicated for what?

right-sided endocarditis

288

Daptomycin (Cubicin) is inactivated to a good degree by what?

pulmonary surfactants in the lungs

289

Which agent is considered an agent of last resort and is effective/covers CRE?

Colistin(Polymxin E)/Colistimethate

290

Colistin(Polymxin E)/Colistimethate covers mostly what kinds of organisms?

gram negative

291

Colistin(Polymxin E)/Colistimethate is used as last resort due to the concern of what?

nephrotoxicity

292

Colistin(Polymxin E)/Colistimethate would be most associated with which infection?

VAP (Ventilator Associated Pneumonia)

293

Which antibiotics are considered broad-spectrum agents and are only used in topical formulations?

  • Bacitracin A
  • Polymyxin B

294

Which drug inhibits the bactoprenol transporter from allowing NAG and NAM to come outside of the cell (therefore inhibiting cell wall synthesis)?

Bacitracin A

295

The fatty acid portion of which drug dissolves in the hydrophobic region of the membrane and disrupts the membrane integrity?

Polymyxin B