Drug Topics - January 2009 - (Page 40) Continuing Education COMMUNITY-ACQUIRED MRSA TE ST QU E S TIO NS Write your answers on the form appearing on page 41 (photocopies of the answer form are acceptable) or on a separate sheet of paper. Mark the most appropriate answer. 1. As an infection control of cer in your community, you have been asked to come up with ways to decrease the rate of CA-MRSA in your area. With your limited resources, which of the following patient populations could you target for education? a. Hospitalized patients b. Elderly patients c. Long-term-care residents d. Athletes 2. What is the mechanism of S. aureus methicillin resistance? a. Ef ux pump b. Target-site alteration (PBP) c. Drug inactivation or modi cation d. Metabolic pathway alteration 3. Which of the following SCCmec types is seen in community-acquired MRSA strains? a. SCCmec I b. SCCmec II c. SCCmec III d. SCCmec IV 4. As the infection control of cer in the community, you teach about risk factors for CA-MRSA. You cover all of the following except: a. Crowding b. Lack of cleanliness c. Indwelling catheter placement d. Compromised skin 5. The production of which of the following S. aureus virulence factors may lead to necrotizing infections? a. Bio lm b. Polyssacharide capsule c. Panton-Valentine leukocidin (PVL) d. Acquired resistance 6. An ER pharmacist is starting to see an increase in CA-MRSA skin and softtissue infections. Which of the following treatment options is considered rst-line when patients also present with an abscess? a. Surgical intervention and drainage b. Daptomycin c. Tigecycline d. Clindamycin 7. A 34-year-old college student presents with cellulitis on his leg. Because he participates in sports, it has been decided to cover him for CA-MRSA. His vital signs and his serum creatinine are normal, and he has no known drug allergies. In the following list of medications, which one does NOT offer good coverage for CA-MRSA? a. Trimethoprim-sulfamethoxazole b. Clindamycin c. Leva oxacin d. Doxycycline 8. The infectious-disease physician you are working with generally likes to use antibiotics that are bacteriocidal. In the list below, which of the following antibiotics demonstrates bacteriostatic activity against CA-MRSA? a. Daptomycin b. Vancomycin c. Clindamycin d. Trimethoprim-sulfamethoxazole 9. The infectious-disease physician is putting together a community antibiogram to guide local ERs in appropriate antibiotic selection for CA-MRSA. He is using the initial sensitivity patterns obtained from cultures. What is the limitation in his data? a. Doxycycline has the potential for inducible resistance b. Trimethoprim-sulfamethoxazole has the potential for inducible resistance c. Tigecycline has the potential for inducible resistance d. Clindamycin has the potential for inducible resistance 10. The presence of the ermB gene confers resistance to which of the following antibiotics? a. Levo oxacin b. Clindamycin c. Tigecycline d. Methicillin 11. A physician is trying to determine which antibiotic would be best in a 56year-old male. He is a self-employed tax advisor and it is three weeks before tax day. He has no known drug allergies and is otherwise healthy. Which of the following would be a good reason to select doxycycline for this patient? a. A susceptibility rate of 100 percent against CA-MRSA b. Bactericidal against CA-MRSA c. Easy dosing schedule d. Good for severe infections 12. A 72-year-old female who lives at home and is an active gardener presents to the ER with cellulitis. She takes lisinopril for her hypertension and calcium to prevent osteoporosis. Her vitals and labs are: BP 123/82, HR 78, temperature 87°F, potassium 4.8 mg/dl, and serum creatinine of 1.3 mg/dl. Which of the following antibiotics would you need to use caution with to avoid hyperkalemia? a. Clindamycin c. Trimethoprim/sulfamethaxazole b. Doxycycline d. Linezolid 13. You have to call a physician from your pharmacy because she prescribed linezolid for CA-MRSA and it is not covered by the patient’s insurance. The physician asks you about other treatment options. When asked about the bene ts of using rifampin, you answer that it has: a. Minimal development of resistance b. Only a few drug interactions c. Bacteriostatic activity d. Increased penetration into bio lms 14. Which of the following statements regarding linezolid is true? a. Linezolid is only available in an intravenous formulation b. Linezolid possesses bacteriostatic activity against many multiply drug-resistant gram-positive organisms c. Linezolid has not had any development of resistance d. Linezolid has been shown to have a decreased concentration in the epithelial lining uid in the lungs 15. Which of the following antibiotics has historically been the rst-line inpatient treatment of methicillin-resistance Staphylococcus aureus infections? a. Tigecycline b. Quinupristin/dalfopristin c. Vancomycin d. Clindamycin 16. A 66-year-old patient with CA-MRSA pneumonia is admitted to the hospital because of the severity of his illness and co-morbid conditions. The physician asks you which antibiotic he should use. You state all of the following except because of the limited activity in the lung tissue. a. Vancomycin b. Daptomycin c. Linezolid d. Trimethoprim/sulfamethazole 17. Which of the following is true regarding the uses of tigecycline? a. It is used in skin and soft-tissue infections b. It is used in bloodstream infections c. It is used in urinary tract infections d. It is used in endocarditis 18. Ceftibiprole was speci cally developed for the treatment of MRSA infections because it possesses which of the following characteristics? a. Strong af nity for PBP2a b. Narrow spectrum of activity c. Decreased ef ux-pump-mediated resistance d. Once-weekly dosing 19. In rare cases, VIG has been used for the treatment of severe infections caused by community-acquired MRSA strains possessing which of the following virulence factors? a. Bio lm production b. Polyssacharide capsule c. Panton-Valentin leukocidin d. Coagulase production 20. Mindful of the increasing rate of CA-MRSA, a small-town hospital is exploring ways to improve infection control. Which of the following methods is the most effective at preventing the spread of CA-MRSA? a. Chlorhexadine body washes b. Personal hygiene c. Prophylactic antibiotic therapy d. Mupirocin nasal ointment 40 DRUG TOPICS Januar y 2009 W W W.D R U GTO P I C S .C O M http://WWW.DRUGTOPICS.COM
Table of Contents Feed for the Digital Edition of Drug Topics - January 2009 Drug Topics - January 2009 Contents Letters Up Front Up Front in Depth Community Practice Drug Pipeline: What to Watch in 2009 OTC Community-Aquired MRSA Infections New Products Viewpoint Drug Topics - January 2009 Drug Topics - January 2009 - Drug Topics - January 2009 (Page Cover1) Drug Topics - January 2009 - Drug Topics - January 2009 (Page Cover2) Drug Topics - January 2009 - Drug Topics - January 2009 (Page 1) Drug Topics - January 2009 - Drug Topics - January 2009 (Page 2) Drug Topics - January 2009 - Drug Topics - January 2009 (Page 3) Drug Topics - January 2009 - Contents (Page 4) Drug Topics - January 2009 - Contents (Page 5) Drug Topics - January 2009 - Contents (Page 6) Drug Topics - January 2009 - Contents (Page 7) Drug Topics - January 2009 - Contents (Page 8) Drug Topics - January 2009 - Contents (Page 9) Drug Topics - January 2009 - Contents (Page 10) Drug Topics - January 2009 - Contents (Page H1) Drug Topics - January 2009 - Contents (Page H2) Drug Topics - January 2009 - Contents (Page H1) Drug Topics - January 2009 - Contents (Page H2) Drug Topics - January 2009 - Contents (Page H3) Drug Topics - January 2009 - Contents (Page H4) Drug Topics - January 2009 - Contents (Page H5) Drug Topics - January 2009 - Contents (Page H6) Drug Topics - January 2009 - Contents (Page H7) Drug Topics - January 2009 - Contents (Page H8) Drug Topics - January 2009 - Contents (Page 13) Drug Topics - January 2009 - Up Front (Page 14) Drug Topics - January 2009 - Up Front (Page 15) Drug Topics - January 2009 - Up Front (Page 16) Drug Topics - January 2009 - Up Front (Page 17) Drug Topics - January 2009 - Up Front in Depth (Page 18) Drug Topics - January 2009 - Up Front in Depth (Page 19) Drug Topics - January 2009 - Community Practice (Page 20) Drug Topics - January 2009 - Community Practice (Page 20a) Drug Topics - January 2009 - Community Practice (Page 20b) Drug Topics - January 2009 - Community Practice (Page 21) Drug Topics - January 2009 - Drug Pipeline: What to Watch in 2009 (Page 22) Drug Topics - January 2009 - Drug Pipeline: What to Watch in 2009 (Page 23) Drug Topics - January 2009 - Drug Pipeline: What to Watch in 2009 (Page 24) Drug Topics - January 2009 - Drug Pipeline: What to Watch in 2009 (Page 25) Drug Topics - January 2009 - Drug Pipeline: What to Watch in 2009 (Page 26) Drug Topics - January 2009 - Drug Pipeline: What to Watch in 2009 (Page 27) Drug Topics - January 2009 - OTC (Page 28) Drug Topics - January 2009 - OTC (Page 29) Drug Topics - January 2009 - OTC (Page 30) Drug Topics - January 2009 - OTC (Page 31) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 32) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 33) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 34) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 35) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 36) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 37) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 38) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 39) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 40) Drug Topics - January 2009 - Community-Aquired MRSA Infections (Page 41) Drug Topics - January 2009 - New Products (Page 42) Drug Topics - January 2009 - New Products (Page 43) Drug Topics - January 2009 - New Products (Page 44) Drug Topics - January 2009 - New Products (Page 45) Drug Topics - January 2009 - New Products (Page 46) Drug Topics - January 2009 - New Products (Page 47) Drug Topics - January 2009 - Viewpoint (Page 48) Drug Topics - January 2009 - Viewpoint (Page Cover3) Drug Topics - January 2009 - Viewpoint (Page Cover4)
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