NR 566 Midterm Exam Review
Week 1
1. Community Acquired Pneumonia (CAP)
a. Common pathogens
S. pneumoniae, Mycoplasma spp., H. influenzae, and Staphylococcus
aureus Smokers and those with COPD
• Haemophilus influenzae (gram-negative)
Those with cystic fibrosis (CF)
• Pseudomonas aeruginosa (gram negative)
b. First line treatment for previously healthy
adults Amoxicillian, doxycycline, macrolides
i. What to give if first drug didn’t work
If a resistant organism is suspected, then the use of one of the
respiratory fluoroquinolones active against S. pneumoniae is warranted
c. Treatment for M. Pneumoniae in pediatric patient
(Specific/example antibiotic from drug class will be
provided)
For children, only macrolides (erythromycin, clarithromycin,
roxithromycin, and azithromycin) are used because of the potential side
effects of alternative drugs
d. Treatment of CAP in pregnancy
Penicillins and erythromycin may be prescribed safely throughout
pregnancy.
e. If someone has been treated with an antibiotic in the previous
90 days of contracting CAP, a quinolone would be a prudent
choice to prescribe.
i. Be familiar with drug examples within the antibiotic
classes. Examples of fluoroquinolones include ciprofloxacin (Cipro),
ofloxacin (Floxin), levofloxacin (Levaquin) and moxifloxacin
(Avelox).
2. Treatment of chlamydial pneumonia in infant (options will include
dose, but if you know the correct drug, the dose will come with it on
,the exam so no need to memorize dose)
, macrolides - erythromycin
3. Broad vs narrow spectrum agents
a. When to use which
one When causative agent is
known
4. Empiric antibiotics
a. What are they
Empiric therapy: start treatment without cultures or prior to receiving
the results of a culture. Use broad spectrum antibiotics.
b. When to prescribe
Critically ill patients receive immediate empiric antibiotics after the first
set of cultures obtained; do not wait for results.
Empiric (broad-spectrum) given for hospitalized patients until culture
results are available
5. Clostridium difficile associated diarrhea
a. How to treat
Vanco, flagyl, fidaxomicin (Dificid)
b. Drug class known for ALL drugs in class to promote
development of C. Diff.
cephalosporins (especially second and third generation), the
fluoroquinolones, ampicillin/amoxicillin, and clindamycin
(macrolides)
6. One question from article in required reading list:
a. Ungureanu, G., Alexa, I.-D., & Ungureanu, M.-C. (2018).
Unnecessary Medicine, an Issue with Major Ethical
Implications. Internal Medicine / Medicina Interna, 15(5), 65–
74.
7. Penicillin
a. Cross-sensitivity reactions with which drug
classes Cephalosporins
b. Prescribing in pregnant patients
Is safe. No fetal harm in 2nd and 3rd trimester.
Week 1
1. Community Acquired Pneumonia (CAP)
a. Common pathogens
S. pneumoniae, Mycoplasma spp., H. influenzae, and Staphylococcus
aureus Smokers and those with COPD
• Haemophilus influenzae (gram-negative)
Those with cystic fibrosis (CF)
• Pseudomonas aeruginosa (gram negative)
b. First line treatment for previously healthy
adults Amoxicillian, doxycycline, macrolides
i. What to give if first drug didn’t work
If a resistant organism is suspected, then the use of one of the
respiratory fluoroquinolones active against S. pneumoniae is warranted
c. Treatment for M. Pneumoniae in pediatric patient
(Specific/example antibiotic from drug class will be
provided)
For children, only macrolides (erythromycin, clarithromycin,
roxithromycin, and azithromycin) are used because of the potential side
effects of alternative drugs
d. Treatment of CAP in pregnancy
Penicillins and erythromycin may be prescribed safely throughout
pregnancy.
e. If someone has been treated with an antibiotic in the previous
90 days of contracting CAP, a quinolone would be a prudent
choice to prescribe.
i. Be familiar with drug examples within the antibiotic
classes. Examples of fluoroquinolones include ciprofloxacin (Cipro),
ofloxacin (Floxin), levofloxacin (Levaquin) and moxifloxacin
(Avelox).
2. Treatment of chlamydial pneumonia in infant (options will include
dose, but if you know the correct drug, the dose will come with it on
,the exam so no need to memorize dose)
, macrolides - erythromycin
3. Broad vs narrow spectrum agents
a. When to use which
one When causative agent is
known
4. Empiric antibiotics
a. What are they
Empiric therapy: start treatment without cultures or prior to receiving
the results of a culture. Use broad spectrum antibiotics.
b. When to prescribe
Critically ill patients receive immediate empiric antibiotics after the first
set of cultures obtained; do not wait for results.
Empiric (broad-spectrum) given for hospitalized patients until culture
results are available
5. Clostridium difficile associated diarrhea
a. How to treat
Vanco, flagyl, fidaxomicin (Dificid)
b. Drug class known for ALL drugs in class to promote
development of C. Diff.
cephalosporins (especially second and third generation), the
fluoroquinolones, ampicillin/amoxicillin, and clindamycin
(macrolides)
6. One question from article in required reading list:
a. Ungureanu, G., Alexa, I.-D., & Ungureanu, M.-C. (2018).
Unnecessary Medicine, an Issue with Major Ethical
Implications. Internal Medicine / Medicina Interna, 15(5), 65–
74.
7. Penicillin
a. Cross-sensitivity reactions with which drug
classes Cephalosporins
b. Prescribing in pregnant patients
Is safe. No fetal harm in 2nd and 3rd trimester.
