Midterm Exam: NR569/ NR 569 (New 2023/ 2024
Update) Differential Diagnosis in Acute Care
Practicum Exam Review| Week 1-4| Questions
and Verified Answers| 100% Correct -
Chamberlain
Classification of Antimicrobial Drugs
• There are two main classification schemes - ANSWER 1. Classification by
Susceptible Organism
Antibacterial Drugs
• Narrow Spectrum-Gram+ cocci/bacilli, Gram- aerobes, M. tuberculosis
• Broad Spectrum-Gram+ cocci and gram- bacilli
Antiviral Drugs
• Drugs for HIV infection
• Drugs for influenza
• Other antiviral drugs-acycolvir
Antifungal Drugs-amphotericin B; Azoles
2. Classification by Mechanism of Action
• Inhibitors of cell wall synthesis
• Drugs that disrupt the cell membrane
• Bactericidal inhibitors of protein synthesis
• Bacteriostatic inhibitors of protein synthesis
• Drugs that interfere with synthesis or integrity of bacterial DNA and RNA
• Antimetabolites
• Drugs that suppress viral replication
List the 10 classes of Antibiotics name examples
HINT (acronym):
Abx Can Terminate Protein Synthesis For Microbial Cells Like Germs - ANSWER
● Aminoglycosides-gentamicin, streptomycin
● Cephalosporins-Cephalexin (Keflex)
● Tetracyclines-tetra/doxyclycline
● Penicillins-PCN G/V, amoxicillin
● Sulfonamides-trimethoprim/sulfamethoxazole
● Fluoroquinolones-ciprofloxacin
● Macrolides-erythromycin, Azithromycin
● Carbapenems-imipenem, meropenem
● Lincosamides-Clindamycin
● Glycopeptides-Vancomycin
,Other ways to organize classes of Drugs
What is Beta Lactams? - ANSWER • they have a β-lactam ring in their structure,
the penicillins are known as β-lactam antibiotic
• The β-lactam family also includes the cephalosporins, carbapenems, and
aztreonam
• All of the β-lactam antibiotics share the same mechanism of action: disruption of
the bacterial cell wall
• they are bactericidal; bacteria must be actively growing for them to work
Other ways to organize classes of Drugs
- Bacteriostatic Inhibitors of Protein Synthesis include - ANSWER 1. Tetracycline
2. Macrolide
3. Clindamycin
Other ways to organize classes of Drugs
- Bactericidal antibiotics directly kill bacteria and include - ANSWER
aminoglycosides,
beta-lactams,
fluoroquinolones,
metronidazole,
most antimycobacterial agents,
streptogramins,
vancomycin.
Other ways to organize classes of Drugs
What are Antimetabolites? - ANSWER Sulfonamides, Trimethoprim &
Nitrofurantoin
Broad spectrum vs narrow spectrum - ANSWER Broad-spectrum
- Broad-spectrum penicillins: ampicillin and others
- Extended-spectrum penicillins: piperacillin and others
- Cephalosporins (third generation)
- Tetracyclines: tetracycline and others
- Carbapenems: imipenem and others
- Trimethoprim
- Sulfonamides: sulfisoxazole and others
- Fluoroquinolones: ciprofloxacin and others
narrow-spectrum
- Penicillin G and V
- Penicillinase-resistant penicillins: oxacillin and nafcillin
- Vancomycin
- Erythromycin
- Clindamycin
- Aminoglycosides: gentamicin and others
- Cephalosporins (first and second generations)
- Isoniazid
- Rifampin
- Ethambutol
- Pyrazinamide
,- Understand broad spectrum vs narrow spectrum agents
Broad-Spectrum:
1. Targets wider number of bacteria types. Acts on both
2. Commonly used against
3. Commonly used for (blank) therapy; when the pathogen is unknown or
4. A major con is disruption of
Narrow-Spectrum:
1. Effective against a specific
2. Used when infecting pathogens - ANSWER Broad-Spectrum:
1. gram- and gram + organisms
2. H. influenzae, E. coli, Proteus mirabilis, enterococci, N. gonorrhoeae
3. empiric; infection with multiple types of bacteria is suspected.
4. native bacteria and the development of antimicrobial resistance
Narrow-Spectrum:
1. bacteria type
2. is known
- Understand empiric treatment and when to use:
1. It is used when
2. is initiated based on two main things:
3. Can be used in severe illnesses when
4. What is the protocol for these pts
5. IV vs. PO?
6. Bactericidal vs. Bacteriostatic - ANSWER 1. when cultures are not available or
results are not back yet
2a. NP's knowledge of the patient's history, typical pathogens, gram stain results,
and
2b. local susceptibility reports on which abx work best in certain geographic
locations.
3. Critically ill pts need immediate empiric antibiotics
4. after first set of cultures is obtained, do not wait for results. Give empiric (broad-
spectrum) abx
5. IV-for Critical or severe infections
PO for Mild/moderate or pts; Switch from IV to PO once the patient is stable
6. Bactericidal antibiotics directly kill bacteria
preferred for immunocompromised patients such as those with diabetes, HIV, cancer
or overwhelming infections
What types of infections are usually viral and do not warrant antibacterial agents? -
ANSWER community-acquired, mostly viral, upper respiratory tract infections;
- these infections are usually viral patients are exposed to all the risks of abx but
have no chance of receiving benefits
Penicillins-Examples
1. Narrow-spectrum PCNs (penicillinase sensitive)
2. Narrow-spectrum penicillins: (penicillinase-resistant)
3. Broad-spectrum penicillins (aminopenicillins)
4. Extended-Spectrum Penicillins (Antipseudomonal Penicillins) - ANSWER 1.
Penicillin G, Penicillin V
, 2. Nafcillin, Oxacillin, Dicloxacillin
3. Ampicillin, Amoxicillin
4. piperacillin
Indications for use of PCNs
1. Penicillin G, Penicillin V (Narrow/PCN-ase S)
2. Nafcillin, Oxacillin, Dicloxacillin (Narrow/PCN-ase R)
3. Ampicillin, Amoxicillin (Broad)
4. piperacillin (extended) - ANSWER 1. streptococcal pharyngitis, N.
Meningitis/gonorrhoeae; active against most gram +/- cocci and spirochetes-T.
pallidum
2. use for all PCN-ase R Staph infections ie: S. aureus and S. epidermidis, NOT
MRSA
3. Amoxicillin-1st line for ENT/Skin/UTIs ie: AOM and sinusitis, Amoxicillin +
clavulanate first line for Severe AOM & animal/human bites, Ampicillin-1st line for
infants with UTIs
4. used mainly for P. aeruginosa; often combined with β-lactamase inhibitor (Zosyn),
also used for H. influenzae, E. coli, enterococci, N. gonorrhoeae,
MOA for PCNs - ANSWER • disruption of the bacterial cell wall
• they are bactericidal; bacteria must be actively growing for them to work
Contraindications and high-risk patients of PCNs
1. What is the main contraindication in general?
2. Penicillin G, Penicillin V
3. Ampicillin, Amoxicillin (Broad)
4. piperacillin (extended) - ANSWER 1. PCN allergy- it can range from a minor
rash to anaphylaxis; it can decrease over time but if severe should NOT be used; if
no other alternative pts can undergo skin testing but this still carries a risk
2. The next most common ADR is non-allergic rash; Probenecid (antigout med)
prolongs the half-life of PCNs and increases risk for toxicity
3. rash and diarrhea are most common
4. can cause bleeding by disrupting plt function
• Dosage should be reduced in patients with renal impairment
Monitoring needs for PCNs
1. Monitoring for renal impairment which can cause
2. Identifying High-Risk Patients
3. Baseline data - ANSWER 1. PCNs to accumulate to toxic levels. Also monitor
for allergy symptoms, C.diff diarrhea
2. Penicillins should NOT be used in patients with a history of severe allergic
reactions to penicillins, cephalosporins, or carbapenems
3. Obtain a culture
Patient-Centered Care Across the Life Span-Penicillins
Infants
• Penicillins are used safely in infants with
Children/adolescents
• Penicillins are a common drug used to treat
Pregnant women
Update) Differential Diagnosis in Acute Care
Practicum Exam Review| Week 1-4| Questions
and Verified Answers| 100% Correct -
Chamberlain
Classification of Antimicrobial Drugs
• There are two main classification schemes - ANSWER 1. Classification by
Susceptible Organism
Antibacterial Drugs
• Narrow Spectrum-Gram+ cocci/bacilli, Gram- aerobes, M. tuberculosis
• Broad Spectrum-Gram+ cocci and gram- bacilli
Antiviral Drugs
• Drugs for HIV infection
• Drugs for influenza
• Other antiviral drugs-acycolvir
Antifungal Drugs-amphotericin B; Azoles
2. Classification by Mechanism of Action
• Inhibitors of cell wall synthesis
• Drugs that disrupt the cell membrane
• Bactericidal inhibitors of protein synthesis
• Bacteriostatic inhibitors of protein synthesis
• Drugs that interfere with synthesis or integrity of bacterial DNA and RNA
• Antimetabolites
• Drugs that suppress viral replication
List the 10 classes of Antibiotics name examples
HINT (acronym):
Abx Can Terminate Protein Synthesis For Microbial Cells Like Germs - ANSWER
● Aminoglycosides-gentamicin, streptomycin
● Cephalosporins-Cephalexin (Keflex)
● Tetracyclines-tetra/doxyclycline
● Penicillins-PCN G/V, amoxicillin
● Sulfonamides-trimethoprim/sulfamethoxazole
● Fluoroquinolones-ciprofloxacin
● Macrolides-erythromycin, Azithromycin
● Carbapenems-imipenem, meropenem
● Lincosamides-Clindamycin
● Glycopeptides-Vancomycin
,Other ways to organize classes of Drugs
What is Beta Lactams? - ANSWER • they have a β-lactam ring in their structure,
the penicillins are known as β-lactam antibiotic
• The β-lactam family also includes the cephalosporins, carbapenems, and
aztreonam
• All of the β-lactam antibiotics share the same mechanism of action: disruption of
the bacterial cell wall
• they are bactericidal; bacteria must be actively growing for them to work
Other ways to organize classes of Drugs
- Bacteriostatic Inhibitors of Protein Synthesis include - ANSWER 1. Tetracycline
2. Macrolide
3. Clindamycin
Other ways to organize classes of Drugs
- Bactericidal antibiotics directly kill bacteria and include - ANSWER
aminoglycosides,
beta-lactams,
fluoroquinolones,
metronidazole,
most antimycobacterial agents,
streptogramins,
vancomycin.
Other ways to organize classes of Drugs
What are Antimetabolites? - ANSWER Sulfonamides, Trimethoprim &
Nitrofurantoin
Broad spectrum vs narrow spectrum - ANSWER Broad-spectrum
- Broad-spectrum penicillins: ampicillin and others
- Extended-spectrum penicillins: piperacillin and others
- Cephalosporins (third generation)
- Tetracyclines: tetracycline and others
- Carbapenems: imipenem and others
- Trimethoprim
- Sulfonamides: sulfisoxazole and others
- Fluoroquinolones: ciprofloxacin and others
narrow-spectrum
- Penicillin G and V
- Penicillinase-resistant penicillins: oxacillin and nafcillin
- Vancomycin
- Erythromycin
- Clindamycin
- Aminoglycosides: gentamicin and others
- Cephalosporins (first and second generations)
- Isoniazid
- Rifampin
- Ethambutol
- Pyrazinamide
,- Understand broad spectrum vs narrow spectrum agents
Broad-Spectrum:
1. Targets wider number of bacteria types. Acts on both
2. Commonly used against
3. Commonly used for (blank) therapy; when the pathogen is unknown or
4. A major con is disruption of
Narrow-Spectrum:
1. Effective against a specific
2. Used when infecting pathogens - ANSWER Broad-Spectrum:
1. gram- and gram + organisms
2. H. influenzae, E. coli, Proteus mirabilis, enterococci, N. gonorrhoeae
3. empiric; infection with multiple types of bacteria is suspected.
4. native bacteria and the development of antimicrobial resistance
Narrow-Spectrum:
1. bacteria type
2. is known
- Understand empiric treatment and when to use:
1. It is used when
2. is initiated based on two main things:
3. Can be used in severe illnesses when
4. What is the protocol for these pts
5. IV vs. PO?
6. Bactericidal vs. Bacteriostatic - ANSWER 1. when cultures are not available or
results are not back yet
2a. NP's knowledge of the patient's history, typical pathogens, gram stain results,
and
2b. local susceptibility reports on which abx work best in certain geographic
locations.
3. Critically ill pts need immediate empiric antibiotics
4. after first set of cultures is obtained, do not wait for results. Give empiric (broad-
spectrum) abx
5. IV-for Critical or severe infections
PO for Mild/moderate or pts; Switch from IV to PO once the patient is stable
6. Bactericidal antibiotics directly kill bacteria
preferred for immunocompromised patients such as those with diabetes, HIV, cancer
or overwhelming infections
What types of infections are usually viral and do not warrant antibacterial agents? -
ANSWER community-acquired, mostly viral, upper respiratory tract infections;
- these infections are usually viral patients are exposed to all the risks of abx but
have no chance of receiving benefits
Penicillins-Examples
1. Narrow-spectrum PCNs (penicillinase sensitive)
2. Narrow-spectrum penicillins: (penicillinase-resistant)
3. Broad-spectrum penicillins (aminopenicillins)
4. Extended-Spectrum Penicillins (Antipseudomonal Penicillins) - ANSWER 1.
Penicillin G, Penicillin V
, 2. Nafcillin, Oxacillin, Dicloxacillin
3. Ampicillin, Amoxicillin
4. piperacillin
Indications for use of PCNs
1. Penicillin G, Penicillin V (Narrow/PCN-ase S)
2. Nafcillin, Oxacillin, Dicloxacillin (Narrow/PCN-ase R)
3. Ampicillin, Amoxicillin (Broad)
4. piperacillin (extended) - ANSWER 1. streptococcal pharyngitis, N.
Meningitis/gonorrhoeae; active against most gram +/- cocci and spirochetes-T.
pallidum
2. use for all PCN-ase R Staph infections ie: S. aureus and S. epidermidis, NOT
MRSA
3. Amoxicillin-1st line for ENT/Skin/UTIs ie: AOM and sinusitis, Amoxicillin +
clavulanate first line for Severe AOM & animal/human bites, Ampicillin-1st line for
infants with UTIs
4. used mainly for P. aeruginosa; often combined with β-lactamase inhibitor (Zosyn),
also used for H. influenzae, E. coli, enterococci, N. gonorrhoeae,
MOA for PCNs - ANSWER • disruption of the bacterial cell wall
• they are bactericidal; bacteria must be actively growing for them to work
Contraindications and high-risk patients of PCNs
1. What is the main contraindication in general?
2. Penicillin G, Penicillin V
3. Ampicillin, Amoxicillin (Broad)
4. piperacillin (extended) - ANSWER 1. PCN allergy- it can range from a minor
rash to anaphylaxis; it can decrease over time but if severe should NOT be used; if
no other alternative pts can undergo skin testing but this still carries a risk
2. The next most common ADR is non-allergic rash; Probenecid (antigout med)
prolongs the half-life of PCNs and increases risk for toxicity
3. rash and diarrhea are most common
4. can cause bleeding by disrupting plt function
• Dosage should be reduced in patients with renal impairment
Monitoring needs for PCNs
1. Monitoring for renal impairment which can cause
2. Identifying High-Risk Patients
3. Baseline data - ANSWER 1. PCNs to accumulate to toxic levels. Also monitor
for allergy symptoms, C.diff diarrhea
2. Penicillins should NOT be used in patients with a history of severe allergic
reactions to penicillins, cephalosporins, or carbapenems
3. Obtain a culture
Patient-Centered Care Across the Life Span-Penicillins
Infants
• Penicillins are used safely in infants with
Children/adolescents
• Penicillins are a common drug used to treat
Pregnant women
