Chapter 23 (Infectious Diseases II: Bacterial Infections) Flashcards

Which of the following adverse effects are associated with isoniazid? (Select ALL that apply)

TT, a 54-year-old female with severe colitis secondary to ulcerative colitis, is being prepped for an elective partial colectomy. She has no known drug allergies. Which of the following preoperative antibiotic regimens provide an appropriate spectrum of activity to prevent a surgical site infection following this procedure? (Select ALL that apply)

MT is a 78-year-old female who visits her primary healthcare provider for follow-up of a right lower extremity infection that has continued to progress after 5 days of antibiotic treatment. She is accompanied by her daughter who assists with her medical care.

Past Medical History: mild Alzheimer disease dementia, hypertension, dyslipidemia, insomnia

Social History: resides in an assisted living facility

Allergies: NKDA

Which antibiotic should be prescribed to replace this patient's cephalexin treatment?

A 31-year-old pregnant female comes to the obstetrician office due to yellow-green, frothy vaginal discharge that has a foul odor. Other symptoms include pain with urination and during sexual intercourse. Vaginal swabs are positive for Trichomonas vaginalis and negative for Chlamydia trachomatis and Neisseria gonorrhoeae. Which treatment is recommended for this patient?

SZ is a 67-year-old female admitted to the hospital for worsening shortness of breath that the patient describes as much worse than her "typical heart failure episodes." Other symptoms include a productive cough with yellow sputum and fever.

Past Medical History: chronic obstructive pulmonary disease, heart failure (last EF 30%), hypertension, gastroesophageal reflux disease, peripheral arterial disease

Allergies: penicillin (rash and lip swelling)

Diagnostic Tests:
Chest x-ray: left lower lobe infiltrate

Which of the following is the best option for empiric treatment of SZ's acute medical issue?

OP, a 72-year-old female, is transported to the emergency department via ambulance after her son found her at home confused, feverish, and lethargic. The son states that the day prior, OP reported a cough, shortness of breath, and chills, which prompted him to check on her. In the emergency department, the patient is intubated and placed on a mechanical ventilator. Transfer to the intensive care unit is pending. OP has no known risk factors for MRSA or Pseudomonas aeruginosa.

Past Medical History: chronic obstructive pulmonary disease, hypothyroidism, osteoporosis

Allergies: no known drug allergies

Vital Signs: BP 85/60 mmHg, HR 115 bpm, RR 33 bpm, O₂ sat 81% on room air, T 102°F (38.9°C)

Diagnostic Tests:
Chest x-ray: left lower lobe infiltrate

Which of the following antibiotic orders should the ICU pharmacist anticipate dispensing for this patient?

A 62-year-old male was recently admitted to the hospital with spontaneous bacterial peritonitis (SBP). He has no known drug allergies. The infection was treated with cefotaxime for 7 days and the infection resolved. Today, the medical team is implementing a discharge plan. Which antibiotic should be included on the discharge medication list to prevent future episodes of SBP in this patient?

GM is a 46-year-old female who comes to the emergency department with a 2-day history of decreased appetite, 8 to 10 loose, watery stools per day, and abdominal cramping. She was treated for a nonsevere Clostridioides difficile infection 8 weeks ago with oral vancomycin. Laboratory tests today show a white blood cell count of 16,500 cells/mm³, hemoglobin of 16 g/dL, and a serum creatinine of 0.9 mg/dL. A stool PCR test is positive for Clostridioides difficile. Which treatment is appropriate at this time?

DJ is a 35-year-old female who comes to the clinic reporting a 3-day history of vaginal discharge. She reports having sexual intercourse 8 days ago.

Past Medical History: syphilis (1 year ago), allergic rhinitis

Social History: 3 sexual partners in the last year, drinks socially on weekends, never used tobacco products

Allergies: NKDA

Laboratory Tests:
Creatinine 0.8 mg/dL
Urine hCG negative
HIV-1 antibody negative
HIV-2 antibody negative
Chlamydia trachomatis negative
Neisseria gonorrhoeae positive
Rapid plasma reagin negative
Treponemal assay negative

Which treatment regimen is appropriate for this patient at this time?

A female patient comes to the pharmacy counter to pick up a prescription for nitrofurantoin. She is also purchasing a box of Azo Urinary Pain Relief. Which of the following are appropriate counseling points for the over-the-counter medication being purchased? (Select ALL that apply)

JJ is a 48-year-old male who comes to the urgent care clinic with cough, purulent sputum, and chills. He has not traveled recently and has no known sick contacts.

Past Medical History: alopecia, hypertension, type 2 diabetes mellitus, glaucoma, insomnia

Allergies: sulfa (hives, anaphylaxis)

Medications:
Amlodipine 2.5 mg daily
Lisinopril 10 mg daily
Metformin 1,000 mg twice daily
Latanoprost 1 drop both eyes at bedtime
Melatonin 3 mg nightly

Vital Signs: BP 138/90 mmHg, HR 102 bpm, RR 18 bpm, T 102.6°F (39.2°C)

Diagnostic Tests:
Chest x-ray: left lower lobe infiltrate consistent with pneumonia

Which antibiotic is recommended for the outpatient management of JJ's condition?

KH, a 24-year-old male who is sexually active with multiple men, comes to the office for a routine annual physical examination. His records indicate he has received all necessary vaccinations, including the human papillomavirus vaccine series. Routine screening for HIV, hepatitis C, and syphilis are negative. Urethral and rectal swabs sent for nucleic acid amplification testing are positive for Chlamydia trachomatis and negative for Neisseria gonorrhoeae. Which treatment is recommended for this patient?

HP is a 30-year-old, 15-week pregnant female who comes to her obstetrician for a regularly scheduled prenatal visit. A urine sample collected and sent for culture shows 10⁶ CFU/mL of Escherichia coli, susceptible to all tested antibiotics. She has no urinary symptoms and "feels good." Her vital signs are normal, and she has no known drug allergies. Which treatment is recommended for this patient?

A 44-year-old male is evaluated after he was exposed to an individual with active pulmonary tuberculosis. He is asymptomatic and has no history of bacille Calmette-Guérin vaccination. Which of the following diagnostic test results would be expected in a patient with latent tuberculosis? (Select ALL that apply)

RD is a 56-year-old female who comes to the emergency department because of an ulcer on the sole of her left foot. The ulcer has been present for a few weeks but has now started draining pus. Other symptoms include fever and malaise. The patient missed her last appointment with her primary healthcare provider and admits to medication nonadherence.

Past Medical History: type 2 diabetes mellitus, peripheral neuropathy, obesity, hypertension, dyslipidemia

Allergies: NKDA

Physical Exam: left plantar foot ulcer with slightly malodorous purulent discharge, surrounding erythema, and edema; no evidence of bone involvement

Which antibiotic is most appropriate to empirically treat this patient's infection?

PC is a 69-year-old female who comes to the emergency department with increased shortness of breath, productive cough, and increased production of sputum that is yellow/green in color. She has had no hospitalizations or antibiotic use in the past 6 months.

Past Medical History: hypertension, chronic obstructive pulmonary disease (FEV₁ 60%), hyperthyroidism

Social History: previously smoked cigarettes (30 pack-year), quit 5 years ago

Allergies: no known drug allergies

Medications:
Amlodipine 10 mg PO daily
Ramipril 10 mg PO daily
Spiriva Respimat 2 inhalations daily

Vital Signs: BP 138/90 mmHg, HR 92 bpm, RR 24 bpm, O₂ sat 89% on room air, T 99.7°F (37.6°C)

Diagnostic Tests:
Chest x-ray: no evidence of pleural effusion or pneumonia

Which antibiotic is most appropriate to manage this patient's acute condition?

A 36-year-old male was newly diagnosed with active pulmonary tuberculosis 2 months ago. He has completed an initial 8 weeks of treatment with isoniazid, rifampin, pyrazinamide, and ethambutol and is now being evaluated at a follow-up visit. His baseline sputum culture results at the time of diagnosis showed no evidence of drug resistance. The patient has tolerated the current 4-drug regimen, and his baseline symptoms of fever, cough, and night sweats have resolved. Which of the following represents an appropriate treatment plan for this patient?

SS is a 3-year-old boy with a rash on the left corner of his mouth and around the left side of his nose. The rash first appeared three days ago as a few localized spots. Now there are pustules in some areas and portions of the rash are covered with a golden-colored crust. The patient is otherwise asymptomatic and has no known drug allergies. What is the most appropriate treatment for his condition?

BT is a 28-year-old female with a 2-day history of increased urinary frequency and burning with urination. She has suprapubic tenderness but no flank pain. Her vital signs are normal. A urinalysis is positive for white blood cells, leukocyte esterase, and nitrites, and a urine culture is pending. BT has a history of Escherichia coli urinary tract infections, the last of which was treated 2 months ago with sulfamethoxazole/trimethoprim. She has no known drug allergies. Which antibiotic is the best choice to empirically treat the infection while awaiting culture results?

WP is a 70-year-old male who comes to the emergency department with a 3-day history of abdominal tenderness, decreased appetite, and 6 to 7 watery stools per day. Laboratory and diagnostic studies show a white blood cell count of 17,000 cells/mm³, serum creatinine of 1.8 mg/dL (baseline: 0.8 mg/dL), and stool test positive for Clostridioides difficile. Six weeks ago, WP experienced a first episode of C. difficile infection, which was treated with a 10-day course of oral vancomycin 125 mg four times daily. Which of the following are recommended treatment options for this patient? (Select ALL that apply)

A 5-year-old girl is evaluated for a new-onset rash. Four days ago, a few small "bumps" appeared around the corners of the patient's mouth, which soon developed into "blisters" that burst to form thick honey-colored crusts. The rash is mildly itchy and is spreading quickly, with multiple lesions now evident around the mouth, cheeks, and nose. Vital signs are normal. Which of the following is the most appropriate treatment for this condition?

SQ is 56-year-old female who comes to the emergency department due to a 2-day history of fever, chills, fatigue, cough, and nausea. She has had no recent hospitalizations. Her last healthcare visit was with her primary care provider 4 months ago.

Past Medical History: hypertension, dyslipidemia, obesity, type 2 diabetes mellitus, hypothyroidism, major depression

Allergies: no known drug allergies

SQ will be admitted to the general internal medicine service. Which antibiotic regimen is most appropriate to treat the acute infection?

MR is a 55-year-old female who comes to the emergency room with right upper quadrant abdominal pain, a temperature of 102.9°F (39.4°C), chills, and jaundiced skin. She has a past medical history of hypertension, obesity, and hypertriglyceridemia. Notable laboratory findings include an elevated white blood cell count and hyperbilirubinemia. A right upper quadrant ultrasound reveals common bile duct dilation and multiple gallbladder stones. The patient is diagnosed with acute cholangitis. Medication orders for IV fluids and broad-spectrum antibiotics are sent to the pharmacy. The patient has no known drug allergies. Which antibiotic regimen is the best option to empirically treat this patient's infection?

A previously healthy 14-month-old child (weight: 24 lbs) is prescribed Augmentin for acute otitis media. The pharmacist will prepare a suspension containing 600 mg of amoxicillin and 42.9 mg of clavulanate per 5 mL. Which volume and frequency would provide an appropriate dose for this indication?

AT is a 25-year-old male who comes to the emergency department with abdominal pain that began 48 hours ago. The pain is localized to the right lower quadrant, is currently described as severe and sharp, and has resulted in two episodes of vomiting in the past 6 hours. The patient has no chronic medical conditions and has had no recent surgeries or hospitalizations.

Allergies: penicillin (anaphylaxis)

Vital Signs: BP 110/62 mmHg, HR 92 bpm, RR 18 bpm, T 103.1°F (39.5°C), pain score 9/10

Abdominal Examination: guarding and rebound tenderness noted in the right lower quadrant

Diagnostic Tests:
CT scan of the abdomen with contrast: fluid-filled abscess in the right lower quadrant

Additional Information: Intra-abdominal infection caused by a perforated appendix. Schedule percutaneous drainage of abscess and send fluid sample for Gram stain and culture. Start intravenous fluids and antibiotics.

Which antibiotic regimen is most appropriate for this patient?

GH is a 64-year-old male who is scheduled for an elective cardiac pacemaker implantation. He has a documented penicillin allergy noted to cause anaphylaxis. Which antibiotic should the operating room pharmacist dispense for administration prior to the procedure?

A 24-year-old female comes to the pharmacy health clinic with symptoms of nasal congestion, runny nose, and a feeling of pressure in her face for the past 5 days. The nasal drainage is described as yellow and thin. The patient has no fever, cough, shortness of breath, sore throat, myalgia, or headache. She has been using OTC decongestants but is asking for an antibiotic to accelerate resolution of her symptoms. Which of the following treatments is recommended for this patient at this time?

JS is a 68-year-old male who arrives at the emergency department with new-onset confusion in the past 24 hours, as well as fever, chills, and cough with purulent sputum that began 2 days ago. JS has had no recent exposure to antibiotics or any recent hospitalizations. At this time, he is stable enough to be admitted to the internal medicine unit.

Past Medical History: hypertension, depression, dyslipidemia

Allergies: no known drug allergies

Medications:
Lisinopril 20 mg once daily
Atorvastatin 40 mg once daily
Sertraline 100 mg once daily

Vital Signs: BP 105/70 mmHg, HR 110 bpm, RR 22 bpm, T 101.7°F (38.7°C)

Diagnostic Tests:
Chest x-ray: right lower lobe infiltrate

Which of the following antibiotic regimens is appropriate to empirically treat community-acquired pneumonia in this patient?

Empiric antibiotics and steroids have been ordered for a 45-year-old patient with suspected community-acquired bacterial meningitis. Cultures and a lumbar puncture are pending. If antibiotics are expected to be administered at 1400, which of the following is correct regarding the selection and timing of steroids in this patient?

A 21-year-old male college student is brought to the emergency department by his roommate, who found him in their dorm room lethargic and confused. The patient skipped classes today due to a severe headache and has had one episode of emesis since arriving at the hospital.

Social History: does not smoke tobacco, drinks on weekends (beer)

Allergies: NKDA

Vital Signs: BP 102/64 mmHg, HR 104 bpm, RR 20 bpm, T 102.2°F (39°C), Ht 70″, Wt 181 lbs

Laboratory Tests:
White blood cells 15,000 cells/mm³
Platelets 200,000 cells/mm³
Blood urea nitrogen 18 mg/dL
Serum creatinine 0.8 mg/dL

Diagnostic Tests: lumbar puncture pending

Which empiric antibiotic regimen is most appropriate for this patient?

TL is a 19-year-old female who comes to the university health clinic with increased vaginal discharge for the last 2 days. The discharge is thin, gray, and has a fishy odor. A vaginal swab shows a pH of 5.2 and findings consistent with bacterial vaginosis. Which treatment is recommended?

Medication orders for active pulmonary tuberculosis are sent to the pharmacy for a 27-year-old female. While processing the orders, the pharmacist receives an alert, warning of a drug interaction between rifampin and an existing medication previously prescribed to this patient. Which of the following medications would prompt an alert?

PT is a previously healthy 32-year-old female who comes to the emergency department with severe pain in her right lower leg. She reports getting an infection from a cut that occurred while hiking in the woods two days ago. The infection has spread quickly and become extremely painful in the last 24 hours.

Allergies: NKDA

Home Medications: none

Vital Signs: BP 95/60 mmHg, HR 110 bpm, RR 18 bpm, O₂ sat 96% (room air), T 102.4°F (39.1°C), Ht 5′ 4″, Wt 58 kg, pain 10/10 (right lower leg)

Physical Exam: right lower extremity with significant erythema without sharp margins, edema extending beyond the border of erythema, and some areas with a purple discoloration of the skin; the area is hardened with pain disproportionate to its appearance

Microbiology: blood cultures pending

Additional Information: suspected necrotizing fasciitis, consult surgery for urgent tissue debridement and obtain cultures in the operating room, start empiric IV antibiotics

Which empiric antibiotic regimen is appropriate for this infection?

GS, a 68-year-old male, was recently admitted to the general medical unit of a hospital with a bleeding gastric ulcer caused by excessive use of NSAIDs. Three days after admission, he develops a fever and crackles are noted on pulmonary examination.

Past Medical History: diverticulosis, osteoarthritis, peripheral artery disease, MRSA skin abscess (4 months ago)

Allergies: penicillin (anaphylaxis)

Medications:
Protonix 40 mg PO BID
Acetaminophen 325 mg, 1–2 tablets PO Q6H PRN

Diagnostic Tests:
Chest x-ray: right lower lobe infiltrate
Induced sputum sample: Gram stain and culture pending
Nasal swab: positive for MRSA

Which empiric antibiotic regimen is most appropriate for this patient?

KN, a 42-year-old male, is admitted to the hospital with acute abdominal pain secondary to appendicitis. He is scheduled for an appendectomy.

Past Medical History: allergic rhinitis, hypertension

Allergies: NKDA

Medications:
Chlorthalidone 25 mg daily
Claritin 10 mg daily
Tylenol 500 mg Q4–6H PRN
Red yeast rice 1,200 mg BID
Omega-3 fatty acids 1,000 mg daily

Vital Signs: BP 140/92 mmHg, HR 96 bpm, RR 20 bpm, T 100.8°F (38.2°C), Ht 5' 11", Wt 225 lbs

Plan
1. NPO, including oral medications
2. D5NS with 40 mEq KCl per liter, infuse at 125 mL/hr
3. Cefoxitin 2 grams for surgical prophylaxis
4. Morphine 2 mg IV Q4H PRN

What is the recommended timing of the first antibiotic dose?

AW is a 68-year-old female who visits her primary care provider due to swelling and redness on her left calf. The patient initially noticed an insect bite on her calf a few days ago. The area of redness and swelling has grown and there is now a painful "lump" present.

Past Medical History: hypothyroidism, hypertension, osteoporosis, throat cancer (5 years ago, in remission)

Allergies: sulfa (hives)

Medications:
Losartan 50 mg PO daily
Levothyroxine 75 mcg PO daily
Prolia 60 mg SC every 6 months
Caltrate 600+D3 one soft chew daily

Vital Signs: BP 138/76 mmHg, HR 86 bpm, RR 12 bpm, T 100.5°F (38.1°C), Ht 5′ 1″, Wt 52 kg

Physical Exam: 2.5-cm area of erythema on the left posterior lower extremity, with underlying fluctuance and induration of the surrounding skin; tender to touch but no drainage noted

Additional Information: Abscess incision and drainage performed with 5 mL of purulent fluid collected. Culture and susceptibility pending. Start empiric antibiotics.

Which antibiotic should be prescribed for this patient?

MS is a 62-year-old male who was diagnosed with hospital-acquired pneumonia (HAP) 3 days ago. He has no known drug allergies. A respiratory sample was collected prior to initiating empiric antibiotic treatment with cefepime, levofloxacin, and vancomycin. The patient's symptoms have since improved and the medical team is ready to de-escalate antibiotic therapy based on the final culture and susceptibility results shown below. Which antibiotic regimen is most appropriate for continued treatment of HAP in this patient?

CM is a 29-year-old sexually active male who comes to the emergency department after finding a painless, 2-cm ulcer on his penis. He does not have a fever or urethral discharge but discloses that he currently engages in unprotected sex. The patient has an allergy to amoxicillin (throat swelling).

Laboratory Tests

HIV-1 antibody negative

Rapid plasma reagin positive

Treponemal assay positive

After counseling CM regarding medication adherence, he should be started on which treatment?

TR is a 31-year-old male who works as a nurse in the intensive care unit. He finds out today that a patient he recently cared for has tested positive for pulmonary tuberculosis (TB) and he was exposed before the appropriate infection control precautions were in place. TR is tested for TB and an interferon-gamma release assay returns positive. He does not have any symptoms and his chest x-ray is normal. Which of the following is an appropriate treatment for this patient?

WP, a 56-year-old female, is being evaluated after she was recently exposed to a patient with active pulmonary tuberculosis.

Past Medical History: hypertension, dyslipidemia, gastroesophageal reflux disease, major depression, type 2 diabetes mellitus

Allergies: metformin

Medications:
Diovan 160 mg PO daily
Chlorthalidone 25 mg PO daily
Rosuvastatin 10 mg PO daily
Nexium 20 mg PO daily
Celexa 20 mg PO daily
Linagliptin 5 mg PO daily
Jardiance 25 mg PO daily

Laboratory Tests:
Interferon-gamma release assay: positive

Which of the following laboratory tests should be ordered before the patient starts the prescribed latent tuberculosis treatment?