1_______!#~@Page
of 1610/5/2026,
@~~!@#)_________!#~@Page
5:02:10
1 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated071322.docx
5:02:10
1 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated0
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_s
NR566 Midterm Study Guide
Be familiar with the interactive activities throughout course modules. You could see
variations of those same questions on your exams.
Week 1
• Community Acquired Pneumonia (CAP)
o Common pathogens
▪ Streptococcus pneumonia – most common!
▪ Mycoplasma pneumoniae
▪ Influenza
▪ Haemophiles influenza (gram -) COPD and smokers
▪ Pseudomonas aeruginosa – CF patients
o First line treatment for previously healthy adults
• Amoxicillin
• Macrolides (erythromycin, azithromycin)
• Doxycycline – A tetracycline
▪ What to give if first drug didn’t work (resistant strains)
• fluroquinolones
o Treatment for M. Pneumoniae in pediatric patient (Specific/example antibiotic
from drug class will be provided)
• PO macrolide such as erythromycin, azithromycin, clarithromycin
PLUS a tetracycline
o Treatment of CAP in pregnancy
• PCN, cephalosporins, erythromycin
o If someone has been treated with an antibiotic in the previous 90 days of
contracting CAP,
▪ a fluroquinolone
• Treatment of chlamydial pneumonia in infant (options will include dose, but if you know
the correct drug, the dose will come with it on the exam so no need to memorize dose)
▪ Macrolide – Azithromycin 5-12 mg/kg in children
• Broad vs narrow spectrum agents
o When to use which one
▪ Broad spectrum = pathogen is unknown or infection with multiple types of
bacteria
▪ Narrow spectrum = used against specific bacterium types when we
KNOW the pathogen
• Empiric antibiotics (broad spectrum)
o What are they
▪ Therapy initiated based on:
• patient’s history
• typical pathogens
• gram stain results
• local susceptibility reports on which antibiotics work best in certain
geographic locations.
1_______!#~@Page
of 1610/5/2026,
@~~!@#)_________!#~@Page
5:02:10
1 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated071322.docx
5:02:10
1 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated0
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_s
,2_______!#~@Page
of 1610/5/2026,
@~~!@#)_________!#~@Page
5:02:10
2 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated071322.docx
5:02:10
2 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated0
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_s
NR566 Midterm Study Guide
▪ Initiated BEFORE obtaining cultures / culture results
o When to prescribe
▪ Given to critically ill patients before results of cultures obtained
▪ Ambulatory patients based on clinical presentation
▪ Multiple drugs to increase pathogen coverage
• Clostridium difficile associated diarrhea
o How to treat
▪ Metronidazole (Flagyl)
▪ Vancomycin
o Drug class known for ALL drugs in class to promote development of C. Diff.
▪ Cephalosporins
▪ Aminoglycosides
• One question from article in required reading list:
o Ungureanu, G., Alexa, I.-D., & Ungureanu, M.-C. (2018). Unnecessary Medicine,
an Issue with Major Ethical Implications. Internal Medicine / Medicina Interna,
15(5), 65–74.
• Penicillin
o Cross-sensitivity reactions with which drug classes
▪ Cross sensitivity exists with cephalosporins
▪ If sensitivity to PCN is low/high, sensitivity to cephalosporins will usually
be low/high
▪ Severe PCN allergy altern alternatives:
• Erythromycin
• Vancomycin
• Clindamycin
o Prescribing in pregnant patients
▪ Generally safe
▪ No fetal risk in 2nd or 3rd trimester
▪ Safest in pregnancy
• Cephalosporins
o Patient education needed
▪ Doses should be lowered in patients with renal insufficiency
▪ Allergic rxn is most common side effect
• Maculopapular rash
▪ Can NOT be taken with alcohol in any form
• Risk for a disulfiram like state
o n/v / headache/ palpitations/ hypotension
▪ Caution in patients taking anticoagulants (warfarin), NSAIDS
• Can promote bleeding b/c interferes with vitamin K metabolism
• Ex: cefotetan, cefazolin, ceftriaxone
o Prescribing in pregnant patients
▪ All are safe for use in pregnancy
• Tetracyclines
o Patient education needed
▪ Cannot be taken with:
• milk products
2_______!#~@Page
of 1610/5/2026,
@~~!@#)_________!#~@Page
5:02:10
2 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated071322.docx
5:02:10
2 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated0
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_s
,3_______!#~@Page
of 1610/5/2026,
@~~!@#)_________!#~@Page
5:02:10
3 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated071322.docx
5:02:10
3 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated0
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_s
NR566 Midterm Study Guide
• Antacids
• iron or calcium supplements
• Magnesium containing laxatives
** patient should take 1-2 hours before taking any of these
substances if necessary
▪ Often cause GI upset
• Can be taken with food
• Avoid taking at night to minimize esophageal ulceration
▪ Discoloration of teeth
• Avoid in pregnant women
• Avoid in children younger than 8
▪ Do NOT take if pregnant
• Bone growth suppression in premature infants
• Pregnant and postpartum = increased risk for hepatoxicity
▪ notify healthcare provider if diarrhea or candida noticed – may be
superinfection
▪ renal and hepatoxicity
• caution in patient with impairment
• caution in postpartum women with renal disease
▪ avoid prolonged sun exposure due to increased skin sensitivity
▪ Careful drug monitoring of INR
• Can increase levels of digoxin and warfarin
o Prescribing in pregnant patients
▪ Can cause fetal harm
▪ Not suitable for pregnant patients
• Macrolides
o Patient education needed
▪ Monitor in patients with prolonged QT
• Avoid in patients taking antidysrhythmic drugs
▪ Can take with food to avoid common GI upset
▪ Do not combine with CYP450 inhibitors especially:
• Theophylline
• Carbamazepine
• Warfarin
▪ Erythromycin = safe in pregnancy
• Aminoglycosides
o Patient education needed
▪ Reduce dose size or increase dosing interval in pt. with renal impairment
• B/c elimination is almost exclusively renal
▪ Monitor levels of BUN, creatinine, proteinuria, casts in urine, and dilute
urine
• Monitor especially in older adults
▪ May cause ototoxicity
• When used concurrently with loop diuretics
• Excessive dose > 10 days
• Educate patient to watch for tinnitus, vertigo, nausea or headache
3_______!#~@Page
of 1610/5/2026,
@~~!@#)_________!#~@Page
5:02:10
3 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated071322.docx
5:02:10
3 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated0
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_s
of 1610/5/2026,
@~~!@#)_________!#~@Page
5:02:10
1 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated071322.docx
5:02:10
1 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated0
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_s
NR566 Midterm Study Guide
Be familiar with the interactive activities throughout course modules. You could see
variations of those same questions on your exams.
Week 1
• Community Acquired Pneumonia (CAP)
o Common pathogens
▪ Streptococcus pneumonia – most common!
▪ Mycoplasma pneumoniae
▪ Influenza
▪ Haemophiles influenza (gram -) COPD and smokers
▪ Pseudomonas aeruginosa – CF patients
o First line treatment for previously healthy adults
• Amoxicillin
• Macrolides (erythromycin, azithromycin)
• Doxycycline – A tetracycline
▪ What to give if first drug didn’t work (resistant strains)
• fluroquinolones
o Treatment for M. Pneumoniae in pediatric patient (Specific/example antibiotic
from drug class will be provided)
• PO macrolide such as erythromycin, azithromycin, clarithromycin
PLUS a tetracycline
o Treatment of CAP in pregnancy
• PCN, cephalosporins, erythromycin
o If someone has been treated with an antibiotic in the previous 90 days of
contracting CAP,
▪ a fluroquinolone
• Treatment of chlamydial pneumonia in infant (options will include dose, but if you know
the correct drug, the dose will come with it on the exam so no need to memorize dose)
▪ Macrolide – Azithromycin 5-12 mg/kg in children
• Broad vs narrow spectrum agents
o When to use which one
▪ Broad spectrum = pathogen is unknown or infection with multiple types of
bacteria
▪ Narrow spectrum = used against specific bacterium types when we
KNOW the pathogen
• Empiric antibiotics (broad spectrum)
o What are they
▪ Therapy initiated based on:
• patient’s history
• typical pathogens
• gram stain results
• local susceptibility reports on which antibiotics work best in certain
geographic locations.
1_______!#~@Page
of 1610/5/2026,
@~~!@#)_________!#~@Page
5:02:10
1 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated071322.docx
5:02:10
1 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated0
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_s
,2_______!#~@Page
of 1610/5/2026,
@~~!@#)_________!#~@Page
5:02:10
2 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated071322.docx
5:02:10
2 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated0
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_s
NR566 Midterm Study Guide
▪ Initiated BEFORE obtaining cultures / culture results
o When to prescribe
▪ Given to critically ill patients before results of cultures obtained
▪ Ambulatory patients based on clinical presentation
▪ Multiple drugs to increase pathogen coverage
• Clostridium difficile associated diarrhea
o How to treat
▪ Metronidazole (Flagyl)
▪ Vancomycin
o Drug class known for ALL drugs in class to promote development of C. Diff.
▪ Cephalosporins
▪ Aminoglycosides
• One question from article in required reading list:
o Ungureanu, G., Alexa, I.-D., & Ungureanu, M.-C. (2018). Unnecessary Medicine,
an Issue with Major Ethical Implications. Internal Medicine / Medicina Interna,
15(5), 65–74.
• Penicillin
o Cross-sensitivity reactions with which drug classes
▪ Cross sensitivity exists with cephalosporins
▪ If sensitivity to PCN is low/high, sensitivity to cephalosporins will usually
be low/high
▪ Severe PCN allergy altern alternatives:
• Erythromycin
• Vancomycin
• Clindamycin
o Prescribing in pregnant patients
▪ Generally safe
▪ No fetal risk in 2nd or 3rd trimester
▪ Safest in pregnancy
• Cephalosporins
o Patient education needed
▪ Doses should be lowered in patients with renal insufficiency
▪ Allergic rxn is most common side effect
• Maculopapular rash
▪ Can NOT be taken with alcohol in any form
• Risk for a disulfiram like state
o n/v / headache/ palpitations/ hypotension
▪ Caution in patients taking anticoagulants (warfarin), NSAIDS
• Can promote bleeding b/c interferes with vitamin K metabolism
• Ex: cefotetan, cefazolin, ceftriaxone
o Prescribing in pregnant patients
▪ All are safe for use in pregnancy
• Tetracyclines
o Patient education needed
▪ Cannot be taken with:
• milk products
2_______!#~@Page
of 1610/5/2026,
@~~!@#)_________!#~@Page
5:02:10
2 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated071322.docx
5:02:10
2 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated0
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_s
,3_______!#~@Page
of 1610/5/2026,
@~~!@#)_________!#~@Page
5:02:10
3 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated071322.docx
5:02:10
3 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated0
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_s
NR566 Midterm Study Guide
• Antacids
• iron or calcium supplements
• Magnesium containing laxatives
** patient should take 1-2 hours before taking any of these
substances if necessary
▪ Often cause GI upset
• Can be taken with food
• Avoid taking at night to minimize esophageal ulceration
▪ Discoloration of teeth
• Avoid in pregnant women
• Avoid in children younger than 8
▪ Do NOT take if pregnant
• Bone growth suppression in premature infants
• Pregnant and postpartum = increased risk for hepatoxicity
▪ notify healthcare provider if diarrhea or candida noticed – may be
superinfection
▪ renal and hepatoxicity
• caution in patient with impairment
• caution in postpartum women with renal disease
▪ avoid prolonged sun exposure due to increased skin sensitivity
▪ Careful drug monitoring of INR
• Can increase levels of digoxin and warfarin
o Prescribing in pregnant patients
▪ Can cause fetal harm
▪ Not suitable for pregnant patients
• Macrolides
o Patient education needed
▪ Monitor in patients with prolonged QT
• Avoid in patients taking antidysrhythmic drugs
▪ Can take with food to avoid common GI upset
▪ Do not combine with CYP450 inhibitors especially:
• Theophylline
• Carbamazepine
• Warfarin
▪ Erythromycin = safe in pregnancy
• Aminoglycosides
o Patient education needed
▪ Reduce dose size or increase dosing interval in pt. with renal impairment
• B/c elimination is almost exclusively renal
▪ Monitor levels of BUN, creatinine, proteinuria, casts in urine, and dilute
urine
• Monitor especially in older adults
▪ May cause ototoxicity
• When used concurrently with loop diuretics
• Excessive dose > 10 days
• Educate patient to watch for tinnitus, vertigo, nausea or headache
3_______!#~@Page
of 1610/5/2026,
@~~!@#)_________!#~@Page
5:02:10
3 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated071322.docx
5:02:10
3 of 1610/5/2026,
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_study_guide_updated0
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132332_660c06d491f3c_nr566_midterm_s
