Infectious Diseases I - Part 1

Miguel Suarez is a 62 year-old male with primary lung cancer admitted to the hospital for weakness. On hospital day 8 the patient was diagnosed with hospital-acquired pneumonia. The team would like to cover for Gram-negative pathogens with meropenem and an additional agent for MRSA coverage. Allergies include vancomycin (angioedema, hypotension) and clindamycin (diarrhea). Which of the following intravenous agents should the pharmacist recommend in this case?

Which of the following statements is correct regarding linezolid? (Select ALL that apply.)

Chief Complaint: “I’m out of my inhaler and I can’t breathe".History of Present Illness: Katherine Schute is a 30 year-old female who came to the ER for worsening shortness of breath and cough. She is out of her albuterol inhaler. She occasionally lives on the street, but has been staying in the local homeless shelter for 3 nights. She reports fatigue, but denies night sweats and hemoptysis. Her cough is nonproductive. Mild right lower extremity cellulitis extending from right ankle to right calf. Patient states she scraped her leg on a fence and it has not healed. Katherine Schute has not been treated with antibiotics. Allergies: NKDAPast Medical History: HIV x 5 years, PCP pneumonia 5 years ago when she was diagnosed with HIV, asthma, and dyslipidemiaMedications: Truvada 1 tablet daily, Tivicay 50 mg once daily, albuterol inhaler 1 puff 3-4 times daily as needed, Flovent Diskus 100 mcg BID, simvastatin 20 mg HS Physical Exam / Vitals: Height: 5’2” Weight: 105 pounds BP: 122/72 mmHg HR: 71 BPM RR: 18 BPM Temp: 103.2°F Pain: 3/10 General: Pleasant ill appearing female Lungs: decreased breath sounds bilaterally – right worse than left. Mild wheezing. CV: RRR – no murmurs GI: Normal bowel sounds Ext: Mild right lower extremity cellulitis with some purulent dischargeLabs:Na (mEq/L) = 129 (135 – 145) WBC (cells/mm^3) = 10.4 (4 – 11 x 10^3) K (mEq/L) = 3.5 (3.5 – 5) Hgb (g/dL) = 13.4 (13.5 – 18 male, 12 – 16 female)Cl (mEq/L) = 103 (95 – 103) Hct (%) = 40.1 (38 – 50 male, 36 – 46 female)HCO3 (mEq/L) = 24 (24 – 30) Plt (cells/mm^3) = 202 (150 – 450 x 10^3)BUN (mg/dL) = 12 (7 – 20) PMNs (%) = 92 (45 – 73)SCr (mg/dL) = 0.9 (0.6 – 1.3) Bands (%) = 7 (3 – 5) Glucose (mg/dL) = 118 (100 – 125) Eosinophils (%) = 3 (0 – 5)Ca (mg/dL) = 8.8 (8.5 – 10.5) Basophils (%) = 0 (0 – 1)Mg (mEq/L) = 1.8 (1.3 – 2.1) Lymphocytes (%) = 29% (20 – 40)PO4 (mg/dL) = 3.6 (2.3 – 4.7) Monocytes (%) = 2 (2 – 8) AST (IU/L) = 62 (10 – 40) ALT (IU/L) = 58 (10 – 40) Albumin (g/dL) = 3.1 (3.5 – 5)Tests: Chest X-ray: Bilateral infiltrates with ground glass appearance. Recommend chest CT for further evaluation. Plan: Obtain CD4+ count and viral load. Admit for IV antibiotics and additional diagnostic work-up. Question: Katherine Schute 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 medication for bacterial skin and skin structure infections that he heard about. He thinks Katherine Schute would be a good candidate for this drug. Which drug is he referring to?

A patient gives the pharmacist a prescription for Levaquin. Which of the following is an appropriate generic substitution for Levaquin?

Which of the following oral antibiotic suspensions should not be refrigerated? (Select ALL that apply.)

Katherine Schute is a 30 year-old female with HIV, asthma and dyslipidemia who has been receiving Bactrim IV for Pneumocystis jiroveci pneumonia (PCP). Her height is 5'2" and she weighs 105 pounds. The physician asks the pharmacist on rounds to assist with transitioning the patient to oral Bactrim 20 mg/kg/day in preparation for hospital discharge. What is the correct dose for Katherine Schute?

Richard Sneider is a 36 year-old male who has been started on Bactrim for treatment of an upper extremity cellulitis and abscess. Counseling on Bactrim should include the following points? (Select ALL that apply.)

A physician is unfamiliar with rifaximin and asks for information on the drug. Which of the following points would be accurate to describe rifaximin?

A nurse calls the pharmacy to ask about crushing ciprofloxacin tablets and giving it via the nasogastric tube. The pharmacist should respond:

An otherwise healthy patient comes in with a foot infection and the wound culture is growing Gram-positive and Gram-negative bacteria. The physician would like to use a cephalosporin for treatment of the patient's infection. Which of the following statements regarding cephalosporins is correct?

Which of the following antimicrobial agents have activity against Bacteroides fragilis? (Select ALL that apply.)

A patient gave the pharmacist a prescription for Ceftin 500 mg BID #14. Which of the following is an appropriate generic substitution for Ceftin?

Which of the following auxiliary labels should be placed on a prescription for cephalexin oral suspension?

Damien Hill is a 42 year-old male being treated with Synercid for a complicated VRE and MRSA infection. Which of the following are common toxicities of Synercid?

Jack Reaper has been in the intensive care unit for the past two weeks. He was initially admitted for an asthma exacerbation requiring mechanical ventilation. Over the course of the hospitalization, he developed ventilator-associated pneumonia and was treated with broad-spectrum antibiotics. His blood cultures are now positive for E. faecium which is vancomycin-resistant (VRE). Which of the following antibiotics provide coverage for vancomyin-resistant E. faecium bacteremia?

Which of the following groups of pathogens best represents clindamycin's spectrum of activity?

Which of the following statements are correct regarding patient counseling advice on Bactrim? (Select ALL that apply.

Victor Kaleski is a 67 year-old female who has been started on Cipro suspension for treatment of a urinary tract infection because she has trouble swallowing pills. Which of the following counseling points are not appropriate for Mr. Kaleski?

Jackson Gardner, a 46 year-old male, is found to have vancomycin-resistant E. faecalis (VRE) on his recent blood cultures. Which of the following regimens is the best option for treatment of his VRE infection?

Susan O'Neill is prescribed Avelox for a community-acquired pneumonia infection. What is the mechanism of action for Avelox?

A patient gave the pharmacist a prescription for Z-Pak. Which of the following is the generic name and an appropriate dosing regimen for Z-Pak?

Celena Ng is a 22 year-old female who has been started on Macrobid for a seven day treatment course of a urinary tract infection. Counseling on Macrobid should include the following points? (Select ALL that apply.)

Nina Abrams 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. Ms. Abrams has no known drug allergies. Which of the following antibacterials would be considered first line in her case as a single agent?

Which of the following medications should be avoided in children younger than 8 years old due to discoloration of teeth and bone growth retardation?

Which of the following statements is correct regarding nafcillin?

Choose the correct term for the lowest drug concentration that will inhibit the growth of an organism:

Janis has a blood culture report showing Gram-positive cocci resembling Streptococci, enteric Gram-negative rods and anaerobes. Which of the following medications would provide adequate coverage for these organisms?

Lucas Johnson is receiving ampicillin for the treatment of a Proteus mirabilis bacteremia. The physician wants to know how ampicillin works. Which of the following best characterizes the pharmacodynamic properties of ampicillin?

A prescription for generic minocycline is filled. Which of the following statements regarding minocycline are correct? (Select ALL that apply.)

Harry Wood is a 71 year-old male who has been in the intensive care unit for several weeks and is now being treated for pneumonia, with a lower respiratory culture positive for Pseudomonas aeruginosa. His weight is 225 pounds and height is 6'0". His current serum creatinine is 2.4 mg/dL. Based on the culture sensitivities, the medical team decides to start tobramycin at 2.5 mg/kg. They ask the pharmacist to write the order and administer the first dose at 8:00 AM. Which of the following is the correct tobramycin regimen for this patient?

Which of the following statements are correct with regards to sulfamethoxazole/trimethoprim? (Select ALL that apply.)

Joseph Bernstein is on tobramycin IV every 8 hours for treating a gram negative infection and his levels are reported as a peak of 8.3 mcg/mL and a trough of 2.1 mcg/mL. Which of the following recommendations should the pharmacist make to the medical team?

Which of the following statements are true regarding Zyvox? (Select ALL that apply.)

Which two antibiotics should be separated from divalent cations (e.g., iron)?

Which of the following statements is incorrect regarding daptomycin?

Chief Complaint: “I’m out of my inhaler and I can’t breathe".History of Present Illness: Katherine Schute is a 30 year-old female who comes to the ER today for worsening shortness of breath and cough. She is out of her albuterol inhaler. She occasionally lives on the street, but has been staying in the local homeless shelter for 3 nights. She reports fatigue, but denies night sweats and hemoptysis. Her cough is nonproductive. Ms. Schute has mild right lower extremity cellulitis extending from right ankle to right calf. Patient states she scraped her leg on a fence and it has not healed. Katherine Schute has not been treated with antibiotics. Allergies: NKDAPast Medical History: HIV x 5 years, PCP pneumonia 5 years ago when she was diagnosed with HIV, asthma, and dyslipidemiaMedications: Truvada 1 tablet daily, Tivicay 50 mg once daily, albuterol inhaler 1 puff 3-4 times daily as needed, Flovent Diskus 100 mcg BID, simvastatin 20 mg QHS Physical Exam / Vitals: Height: 5’2” Weight: 105 pounds BP: 122/72 mmHg HR: 71 BPM RR: 18 BPM Temp: 103.2°F Pain: 3/10 General: Pleasant, ill-appearing female Lungs: decreased breath sounds bilaterally – right worse than left. Mild wheezingCV: RRR – no murmurs GI: Normal bowel sounds Ext: Mild right lower extremity cellulitis with some purulent drainageLabs:Na (mEq/L) = 129 (135 – 145) WBC (cells/mm^3) = 10.4 (4 – 11 x 10^3) K (mEq/L) = 3.5 (3.5 – 5) Hgb (g/dL) = 13.4 (13.5 – 18 male, 12 – 16 female)Cl (mEq/L) = 103 (95 – 103) Hct (%) = 40.1 (38 – 50 male, 36 – 46 female)HCO3 (mEq/L) = 24 (24 – 30) Plt (cells/mm^3) = 202 (150 – 450 x 10^3)BUN (mg/dL) = 12 (7 – 20) PMNs (%) = 92 (45 – 73)SCr (mg/dL) = 0.9 (0.6 – 1.3) Bands (%) = 7 (3 – 5) Glucose (mg/dL) = 118 (100 – 125) Eosinophils (%) = 3 (0 – 5)Ca (mg/dL) = 8.8 (8.5 – 10.5) Basophils (%) = 0 (0 – 1)Mg (mEq/L) = 1.8 (1.3 – 2.1) Lymphocytes (%) = 29% (20 – 40)PO4 (mg/dL) = 3.6 (2.3 – 4.7) Monocytes (%) = 2 (2 – 8) AST (IU/L) = 62 (10 – 40) ALT (IU/L) = 58 (10 – 40) Albumin (g/dL) = 3.1 (3.5 – 5)Tests: Chest X-ray: Bilateral infiltrates with ground glass appearance. Recommend chest CT for further evaluation. Plan: Obtain CD4+ count and viral load. Admit for IV antibiotics and additional diagnostic work-up. Question: Based on chest X-ray, Katherine Schute will be treated empirically for PCP. An order is received for Bactrim 20 mg/kg/day IV divided Q6H. What is the correct dose for Ms. Schute?

Manny Paquio comes to the urgent care center with a large cellulitis wound. The patient has a history of MRSA infection 2 months prior and the practitioner wants to prescribe something orally that covers MRSA. Which of the following medications fit this description?

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 patient gave the pharmacist a prescription for Solodyn 1 tab daily #30. Which of the following is an appropriate generic substitution for Solodyn?

Extended-infusion piperacillin-tazobactam is a dosing strategy that optimizes which of the following pharmacodynamic parameters?

A patient has been taking antibiotics for one week and develops severe diarrhea with painful abdominal cramps. Which of the following medications has a boxed warning regarding the risk of causing severe and possibly fatal colitis?

Which of the following statements are true regarding nitrofurantoin? (Select ALL that apply.)

Which of the following statements is correct regarding the appropriate use of metronidazole?

A patient is receiving Bactrim SS therapy. Which of the following strengths and ingredients are in Bactrim SS tablets?

Zack Childs is a 52 year-old male with type 2 diabetes who has been started on doxycycline for treatment of acute sinusitis. Which of the following counseling points is not appropriate for a patient starting doxycycline therapy?

Molly Meyer is an 82 year-old female with a Pseudomonas aeruginosa infection. The clinical pharmacist is rounding with the infectious disease team. The pharmacist is asked to explain the potential advantages of extended-interval, or once-daily, aminoglycoside dosing. Choose the correct statement:

A hospitalized patient with no known drug allergies has cellulitis and the physician ordered vancomycin 1,000 mg IV Q12H and imipenem-cilastatin 1,000 mg IV Q8H. Both medications were administered at the same time. The patient had a profound drop in blood pressure. Her upper body, mostly in the trunk area, was covered with an erythematous rash. The patient's breathing became labored. What is the likely cause of the patient's symptoms?

Which of the following oral suspensions should be refrigerated? (Select ALL that apply.)

A patient is taking nitrofurantoin for treatment of a urinary tract infection. Which of the following statements regarding nitrofurantoin are correct?

A patient gave the pharmacist a prescription for Augmentin 875 mg Q12H #20. Which of the following is an appropriate generic substitution for Augmentin?

Danny Oswald is diagnosed with a Giardia infection. Which of the following medications would be best to recommend for treatment of giardiasis?

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.)