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NR566 MIDTERM CERTIFICATION TEST 2026
COMPREHENSIVE STUDY GUIDE
◉ Inducers (increase medication metabolism) Answer: Carbamazepine Rifampin Alcohol Phenytoin Griseofulvin Phenobarbital Sulfonylureas "CRAP GPS" ◉ What is narrow vs broad spectrum antibiotics? Answer: - narrow- spectrum antibiotics are active against only a few species of microorganisms
- broad-spectrum antibiotics are active against a wide variety of microbes ◉ Do we usually order narrow or broad spectrum before receive culture results? Answer: broad
◉ Which one is more likely to facilitate emergence of drug-resistant organisms and superinfections? Answer: broad ◉ Penicillin in pregnancy Answer: - B lactam antibiotics (contain B- lactam ring)
- bacteria resistant by enzyme, which attacks the B lactate ring
- safe in pregnancy
- good against gram + bacteria
- targets bacterial cell wall ◉ Cephalosporins in pregnancy Answer: - B lactam antibiotics (1- 3 generations)
- safe in pregnancy (B) - >? congenital heart defects ◉ Tetracyclines in pregnancy Answer: - inhibits protein synthesis
- teratogenic
- avoided entirely during pregnancy (X) - > weakening, hypoplasia, and discoloration of long bones and teeth ◉ Aminoglycosides in pregnancy Answer: - inhibits bacterial protein synthesis
- works against aerobic bacteria
◉ Carbapenem in pregnancy Answer: - synthetic B lactam antibiotics
- ex. Imipenem
- borad spectrum
- no sufficient testing to determine safety in pregnancy ◉ Streptomycin and Kanamycin in pregnancy Answer: - avoided entirely in pregnancy (X)
- may cause hearing loss ◉ Inhibitors of metabolism Answer: - sulfonamides
- trimethoprim ◉ Inhibitors of cell wall synthesis Answer: - B lactase
- Daptomycin
- Fosfomycin
- Lipoglycopeptides
- Vancomycin ◉ Inhibitors of protein synthesis Answer: - Aminoglycosides
- Chloramphenicol
- Clindamycin
- Macrolides
- Oxazolidinones
- Tetracyclines ◉ Inhibitors of nucleic acid function or synthesis Answer: - Fluoroquinolones
- Rifampin ◉ Inhibitors of cell membrane function Answer: - Amphotericin B
- Isoniazid
- Polymyxins ◉ Which antibiotics drug classes are contraindicated in pregnancy and why? Answer: - Fluoroquinolones should be avoided due to potential cartilage damage risk.
- Tetracyclines should be avoided due to potential tooth damage and staining ◉ What is the difference between bactericidal and bacteriostatic drug? Answer: - Bactericidal drugs are directly lethal to bacteria at clinically achievable concentrations
- Bacteriostatic drugs can slow bacterial growth but do not cause cell death
◉ Bactericidal examples Answer: Vancomycin Penicillins Fluoroquinolones Aminoglycosides Cephalosporins Carbapenems Metronidazole ◉ What classes of antibiotics are resistant to C-diff? Answer: aminoglycosides or cephalosporins ◉ What are generally the best antibiotics to treat C-diff? Answer: Flagyl and vancomycin ◉ What is antibiotic stewardship? Answer: plan to combat antimicrobial resistance ◉ When is empiric therapy appropriate? Answer: patient has severe infection and would benefit to start while cultures are pending ◉ What is the most common bacteria in CAP? Answer:
◉ What are the drugs of choice for s. pneumonia? Answer: ◉ What is the most common bacteria in UTI? Answer: ◉ What is first-line treatment for H. Pylori? Answer: ◉ What can Sulfonamides cause in infants? Answer: can produce kernicterus, a severe neurologic disorder caused by displacement of bilirubin from plasma proteins ◉ What can Gentamicin cause in infants? Answer: if used in pregnancy, Gentamicin cause irreversible hearing loss in infant ◉ What can tetracyclines cause in infants and children? Answer: staining of teeth ◉ Are antibiotics safe when breastfeeding? Answer: - As a general guideline, antibiotics and all other drugs should be avoided by women who are breastfeeding
- Amoxicillin is safe for use in breastfeeding ◉ What is the MOA of Beta-Lactam antibiotics? (penicillin) Answer: disruption of the bacterial cell wall
◉ Antibiotics that cover MRSA Answer: Clindamycin Vancomycin Ceftaroline Doxycycline Bactrim Daptomycin ◉ What part of the body does MRSA typically infect? Answer: usually involves the skin and soft tissues, causing abscesses, boils, cellulitis, and impetigo ◉ How do can we eradicate MRSA in the carrier? Answer: intranasal application of a topical antibiotic—mupirocin or retapamulin—can be effective ◉ What other measures can we take and advise our patients to do to reduce the risk of transmission of MRSA? Answer: - good hand hygiene—washing with soap and water or applying an alcohol- based sanitizer
- showering after contact sports, cleaning frequently touched surfaces, keeping infected sites covered
- not sharing towels and personal items
◉ What antibiotics are used for serious infections? Answer: trimethoprim/sulfamethoxazole, minocycline, doxycycline, and clindamycin Alternatives (should be reserved for severe infections and treatment failures): vancomycin, daptomycin, and linezolid ◉ Penicillins Answer: - most common cause of drug allergies
- interfere with the last step of bacterial cell wall synthesis Contraindications:
- allergy
- pregnancy
- renal insufficiency Adverse effects:
- hypersensitivity
- diarrhea
- nephritis
- neurotoxicity
- hematologic toxicities
◉ Is vancomycin active against gram + or - bacteria? Answer: gram + ◉ Is renal dosing for vancomycin necessary? Answer: - if patient has renal impairment, dosage must be reduced - if patient has 50% increase in serum creatinine level, dosage should be reduced ◉ Vancomycin is the drug of choice for which infections? Answer: infections caused by MRSA or S. epidermidis and severe C-diff ◉ What is the definition of C-diff? Answer: - the passage of three or more unformed stools in 24 hours or less
- plus a positive stool test for C. diff. or its toxins ◉ What is the MOA of Telvancin? Answer: - inhibits bacterial cell wall synthesis
- binds to the bacterial cell membrane and disrupts membrane function ◉ Is Telvancin active against Gram (-) or (+) bacteria? Answer: Gram
- only (S. aureus, streptococci groups, Enterococcus fecalis, IV use tx complicated skin infections ◉ What are the most common Telvancin adverse effects? Answer: taste disturbance, nausea, vomiting, and foamy urine
◉ What reaction can occur if Vancomycin or Telvancin is infused too fast? Answer: "red man syndrome," characterized by flushing, rash, pruritus, urticaria, tachycardia, and hypotension ◉ We should take caution in patients taking drugs with Telvancin such as? Answer: caution in patients taking other drugs that can damage the kidneys (e.g., NSAIDs, angiotensin-converting enzyme inhibitors, and aminoglycosides) and in patients taking drugs that prolong the QT interval (e.g., clarithromycin and ketoconazole) ◉ What class of antibiotics does Aztroenam belong to? Answer: Monobactams ◉ What is the MOA of Aztroenam? Answer: inhibits bacterial cell wall synthesis and promotes cell lysis and death ◉ Is Azteoenam narrow or broad spectrum? Answer: narrow antimicrobial spectrum, being active only against gram-negative aerobic bacteria ◉ What is Fosomycin approved for? Answer: approved for single- dose therapy in women with uncomplicated urinary tract infections
◉ What is doxycycline and minocycline used for? Answer: periodontal disease ◉ What education for doxycycline and minocycline should we give our patients? Answer: Avoid calcium/iron supplements, antacids, magnesium/milk products as will chelate drug into nonabsorbable form Adverse effects:
- irritate GI tract
- discolor teeth (avoid <8yrs old)
- superinfection
- hepatic/renal toxicity
- sunburn easily
- diarrhea may indicate a potentially life-threatening - superinfection of the bowel
- high-dose intravenous therapy has been associated with - severe liver damage ◉ Should tetracycline be renal dosed? Answer: patients with kidney disease should not use these drugs
◉ What medication when administered with tetracycline need close blood level monitoring Answer: - can increase digoxin levels through increasing absorption in the GI tract
- increase international normalized ratio (INR) levels by altering the vitamin K−producing flora in the gut
- patients on digoxin or warfarin should undergo careful drug level monitoring ◉ What are names of medications under Macrolids class? Answer: azithromycin and clarithromycin—are derivatives of erythromycin ◉ Erythromycin MOA Answer: binds to the 50S ribosomal subunit and thereby blocks the addition of new amino acids to the growing peptide chain ◉ Which CYP450 enzyme is erythromycin metabolized by? Answer: eliminated primarily by hepatic mechanisms, including metabolism by CYP3A ◉ What is the most serious potential adverse effect of erythromycin? Answer: sudden cardiac death from QT prolongation ◉ Due to the inhibition of hepatic cytochrome P450 drug metabolizing enzymes, which drugs have the potential for elevated
◉ Linzeolidis active against what multi-drug resistant gram positive pathogens? Answer: vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) ◉ What are the serious potential adverse effects of Linzeolid? Answer: - reversible myelosuppression
- manifesting as anemia
- leukopenia
- thrombocytopenia
- pancytopenia
- Rarely, prolonged therapy has been associated with neuropathy
- Patients taking the drug for more than 5 months have developed reversible optic neuropathy and irreversible peripheral neuropathy ◉ What monitoring should be done weekly while taking Linzeolid? Answer: CBCs ◉ What are the serious potential drug interactions with Linzeolid? Answer: MAO, SSRI, hypertensive crisis or serotonin syndrome ◉ Are aminoglycosides bactericidal or bacteriostatic? Answer: bactericidal
◉ Aminoglycosides MOA Answer: - disrupt protein synthesis, resulting in rapid bacterial death
- bind to the 30S ribosomal subunit
- causing (1) inhibition of protein synthesis, (2) premature termination of protein synthesis, and (3) production of abnormal proteins (secondary to misreading of the genetic code) ◉ What are some of the sensitive organisms to aminoglycosides? Answer: Escherichia coli, kebsiella pneumoniae, Serratia marcescens, Proteus mirabilis, and Pseudomonas aeruginosa ◉ T or F: Aminoglycosides can kill anaerobes Answer: F ◉ Sulfonamides MOA Answer: suppress bacterial growth by inhibiting the synthesis of tetrahydrofolate, a derivative of folate
- in the absence of tetrahydrofolate bacteria are unable to synthesize DNA, RNA, and proteins ◉ Are sulfonamides active against gram + or gram - bacteria? Answer: broad spectrum of microbes comprising gram-positive cocci (including methicillin-resistant Staphylococcus aureus), gram- negative bacilli
