MoA + drug class
Unasyn
B-lactam
Cell wall inhibitors
Theis enzyme class cause clinically relevant resistant E. coli spp
Extended spectrum beta-lactamases (ESBL)
You were referred a critically ill patient who was on enrofloxacin at 5 mg/kg IV q12h at the referral clinic. You explain to the intern managing the case that this is incorrect because..
Fluoroquinolones are concentration dependent. Recommend dosing at high end of reference range to optimize bactericidal activity, and frequency is q24h.
Goal - maintain Cmax > MIC
You started a patient with pneumonia on amikacin. Detail a regimen for monitoring for adverse effects.
BUN/ creatinine q24 - 48h
UA for casts, proximal tubular injury (glucosuria, proteinuria, hematuria) q 24-48h
This mechanism explains how aminoglycosides enter bacteria, making them ineffective against anaerobes.
What is oxygen-dependent active transport into bacterial cells?
Vancomycin
Glycopeptide
Inhibits bacterial cell wall synthesis
This organism is a common cause of severe hospital-acquired pneumonia and is often multidrug resistant.
Pseudomonas aeruginosa
Once daily dosing of a time-dependent antimicrobial is a faux pas because..
Failure to maintain time above MIC
In highly protein bound antimicrobials, hypoalbuminemia results in this which increases the risk of toxicity
Increased free drug fraction
This is a primary metabolite of enrofloxacin
Ciprofloxacin
Amikacin
Aminoglycoside
Inhibit bacterial protein synthesis by binding to the 30S ribosome subunit
This gram positive bug is resistant to all B-lactams
Enterococcus sp.
Don't treat your teensy Yorkie with a suspected EHPSS with this drug (at the recommended dose) for GI parasites
Metronidazole
Hepatic metabolism - increased risk of neurotoxicity
Amphoterecin-B's nephrotoxicity is due to this mechanism
Binds to cholesterol in the PCT --> renal vasoconstriction and RTA
This component of fungal cell membranes is a primary target of antifungal drugs
Ergosterol
Levofloxacin
Fluoroquinolone
Inhibit bacterial DNA gyrase and topoisomerase IV
Methicillin-resistant Staphylococcus bacteria have widespread resistance conferred by which gene?
mecA
The reason that Rifampin should not be used as a sole drug
Resistant develops within two days
In-vitro antagonism with floroquinolones - do not use together
Your patient in on the ventilator for fulminant MG, and you remember reading that you need to avoid a certain antimicrobial class in neuromuscular disease
Aminoglycosides
Impaired Ca release at NMJ
Based on recent hospitalization and suspicion for ESBL E. coli, you empirically prescribe this drug
Carbapenem (meropenem)
Linezolid
Oxazolidinone
Inhibits bacterial protein synthesis
These are common mechanisms of resistance to antimicrobial agents
Increased efflux pumps
Target modification
Enzymatic mutation
This drug should be avoided in patients with pre-existing ICGN
TMS - adverse effect profile includes hypersensitivity reactions
How to treat NMB associated with the above mentioned drug?
Cholinesterase inhibitors and Ca++ supplementation
Based on recent hospitalization and suspicion for MDR Enterococcus, you empirically prescribe this parenteral drug
Vancomycin