Antibiotics Flashcards by Ailah M

The primary mechanism of antibacterial action of the penicillins involves inhibition of

(A) Beta-lactamases
(B) Cell membrane synthesis
(C) N-acetylmuramic acid synthesis
(D) Peptidoglycan cross-linking
(E) Transglycosylation

(D) Peptidoglycan cross-linking

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Which of the following statements about beta-lactam antibiotics is false?

(A) Cephalexin and other first-generation cephalosporins do not cross the blood-brain barrier
(B) Ceftriaxone and nafcillin are both eliminated mainly via biliary secretion
(C) Instability of penicillins in gastric acid can limit their oral absorption
(D) Renal tubular reabsorption of amoxicillin is inhibited by probenecid
(E) Ticarcillin has activity against several gram negative rods

(D) Renal tubular reabsorption of amoxicillin is inhibited by probenecid

The elimination half-lives of many beta-lactam antibiotics are prolonged by probenecid, which inhibits their proximal tubular secretion.

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Resistance of pneumococci to penicillin G is due to

(A) Alterations in porin structure
(B) Beta-lactamase production
(C) Changes in chemical structure of target penicillin-binding proteins
(D) Changes in the d-Ala-d-Ala building block of peptidoglycan precursor
(E) Decreased intracellular accumulation of penicillin G

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In an 82-year-old patient whose Gram stain of the smear of cerebrospinal fluid had revealed gram-positive rods resembling diphtheroids, the antibiotic regimen for empiric treatment would include

(A) Ampicillin
(B) Cefoxitin
(C) Ceftriaxone
(D) Fosfomycin
(E) Vancomycin

(A) Ampicillin

Diphtheroid-like gram-positive rods in the cerebrospinal fluid smear of an elderly patient are indicative of L. monocytogenes. Listeria infections are more common in neonates, elderly patients, and those who have been treated withimmunosuppressive agents.

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The mechanism of antibacterial action of tetracycline involves

(A) Antagonism of bacterial translocase activity
(B) Binding to a component of the 50S ribosomal subunit
(C) Inhibition of DNA-dependent RNA polymerase
(D) Interference with binding of aminoacyl-tRNA to bacterial ribosomes
(E) Selective inhibition of ribosomal peptidyl transferases

(D) Interference with binding of aminoacyl-tRNA to bacterial ribosomes

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Clarithromycin and erythromycin have very similar spectra of antimicrobial activity. The major advantage of clarithromycin is that it

(A) Does not inhibit hepatic drug-metabolizing enzymes
(B) Eradicates mycoplasmal infections in a single dose
(C) Has greater activity against H pylori
(D) Is active against methicillin-resistant strains of staphylococci
(E) Is active against strains of streptococci that are resistantt o erythromycin

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The primary mechanism of resistance of gram-positive organisms to macrolide antibiotics including erythromycin is

(A) Changes in the 30S ribosomal subunit
(B) Decreased drug permeability of the cytoplasmic membrane
(C) Formation of drug-inactivating acetyltransferases
(D) Formation of esterases that hydrolyze the lactone ring
(E) Methylation of binding sites on the 50S ribosomal subunit

(E) Methylation of binding sites on the 50S ribosomal subunit

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Regarding prophylaxis against bacterial endocarditis in patients with prosthetic heart valve, which one of the following drugs taken orally is most appropriate?

(A) Amoxicillin 10 min before the procedure
(B) Clindamycin 1 h before the procedure
(C) Erythromycin 1 h before the procedure and 4 h after the procedure
(D) Vancomycin 15 min before the procedure
(E) No prophylaxis is needed

(B) Clindamycin 1 h before the procedure

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Regarding the mechanism of action of aminoglycosides, the drugs

(A) Are bacteriostatic
(B) Bind to the 50S ribosomal subunit
(C) Cause misreading of the code on the mRNA template
(D) Inhibit peptidyl transferase
(E) Stabilize polysomes

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Your 23-year-old female patient is pregnant and has gonorrhea. The medical history includes anaphylaxis following exposure to amoxicillin. The most appropriate drug to use is

(A) Azithromycin
(B) Cefixime
(C) Ceftriaxone
(D) Ciprofloxacin
(E) Doxycycline

(A) Azithromycin

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This drug has characteristics almost identical to those of gentamicin but has much weaker activity in combination with penicillin against enterococci.

(A) Amikacin
(B) Erythromycin
(C) Netilmicin
(D) Spectinomycin
(E) Tobramycin

(E) Tobramycin

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Which statement about “once-daily” dosing with aminoglycosides is not accurate?

(A) Dose adjustment is less important in renal dysfunction
(B) It is convenient for outpatient treatment
(C) Less nursing time is required for drug administration
(D) Often less side effects than multiple (conventional) dosing regimens
(E) Underdosing is less of a problem

(A) Dose adjustment is less important in renal dysfunction

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Trimethoprim-sulfamethoxazole is established to be effective against which of the following opportunistic infections in the AIDS patient?

(A) Cryptococcal meningitis
(B) Herpes simplex
(C) Oral candidiasis
(D) Toxoplasmosis
(E) Tuberculosis

(D) Toxoplasmosis

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A 65-year-old woman has returned from a vacation abroad suffering from traveler’s diarrhea, and her problem has not responded to antidiarrheal drugs. A pathogenic gram-negative bacillus is suspected. Which drug is most likely to be effective in the treatment of this patient?

(A) Ampicillin
(B) Ofloxacin
(C) Sulfadiazine
(D) Trimethoprim
(E) Vancomycin

(B) Ofloxacin

The second-generation fluoroquinolones are very effective in diarrhea caused by bacterial gram-negative pathogens, including E coli, Shigella, and Salmonella.

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Whichof the following drugs will be reliably effective against both gonococci and C trachomatis and safe to use in G6PD patient?

(A) Cefixime
(B) Ciprofloxacin
(C) Spectinomycin
(D) Sulfamethoxazole-trimethoprim
(E) None of the above

(E) None of the above

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Which statement about the fluoroquinolones is accurate?

(A) Antacids increase their oral bioavailability
(B) Contraindicated in patients with hepatic dysfunction
(C) Fluoroquinolones are drugs of choice in a 6-year-oldchild with a urinary tract
(D) Gonococcal resistance to fluoroquinolones may involve changes in DNA gyrase
(E) Modification of moxifloxacin dosage is required in patients when creatinine clearance is less than 50 mL/min

(D) Gonococcal resistance to fluoroquinolones may involve changes in DNA gyrase

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Which adverse effect is most common with sulfonamides?

(A) Fanconi’s aminoaciduria syndrome
(B) Hematuria
(C) Kernicterus in the newborn
(D) Neurologic dysfunction
(E) Skin rash

(E) Skin rash

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Which drug is effective in the treatment of nocardiosis and, in combination with pyrimethamine, is prophylactic against Pneumocystis jirovecii infections in AIDS patients?

(A) Amoxicillin
(B) Erythromycin
(C) Levofloxacin
(D) Sulfadiazine
(E) Trimethoprim

(D) Sulfadiazine

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Supplementary folinic acid may prevent anemia in folate deficient persons who use this drug; it is a weak base achieving tissue levels similar to those in plasma

(A) Ciprofloxacin
(B) Levofloxacin
(C) Linezolid
(D) Sulfamethoxazole
(E) Trimethoprim

(E) Trimethoprim

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The agent most likely to interfere with the action of oral contraceptives is

(A) Amikacin
(B) Ethambutol
(C) Isoniazid
(D) Pyrazinamide
(E) Rifampin

(E) Rifampin

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A patient with AIDS and a CD4 cell count of 100/μL has persistent fever and weight loss associated with invasive pulmonary disease due to M avium complex (MAC). Optimal management of this patient is to

(A) Choose an antibiotic based on drug susceptibility of the cultured organism
(B) Initiate a two-drug regimen of INH and pyrazinamide
(C) Prescribe rifabutin because it prevents the development of MAC bacteremia
(D) Start treatment with the combination of azithromycin, ethambutol, and rifabutin
(E) Treat with trimethoprim-sulfamethoxazole

(D) Start treatment with the combination of azithromycin, ethambutol, and rifabutin

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Which statement about antitubercular drugs is accurate?

(A) Antimycobacterial actions of streptomycin involve inhibition of arabinosyltransferases
(B) Cross-resistance of M tuberculosis to isoniazid and pyrazinamide is common
(C) Ocular toxicity of ethambutol is prevented by thiamine
(D) Pyrazinamide treatment should be discontinued immediately if hyperuricemia occurs
(E) Resistance to ethambutol involves mutations in the emb gene

(E) Resistance to ethambutol involves mutations in the emb gene

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Once-weekly administration of which of the following antibiotics has prophylactic activity against bacteremia caused by M avium complex in AIDS patients?

(A) Acedapsone
(B) Azithromycin
(C) Clarithromycin
(D) Kanamycin
(E) Rifabutin

(B) Azithromycin

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Interactions between this drug and cell membrane components can result in the formation of pores lined by hydrophilicgroups present in the drug molecule.

(A) Caspofungin
(B) Flucytosine
(C) Griseofulvin
(D) Nystatin
(E) Terbinafine

(D) Nystatin

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Which statement about fluconazole is accurate? (A) Does not penetrate the blood-brain barrier (B) Drug of choice in treatment of aspergillosis (C) Induces hepatic drug-metabolizing enzymes (D) Has the least effect of all azoles on drug metabolism (E) Oral bioavailability is less than that of ketoconazole

(D) Has the least effect of all azoles on drug metabolism

If amphotericin B is administered, the patient should be premedicated with ``` (A) Diphenhydramine (B) Ibuprofen (C) Prednisone (D) Any or all of the above (E) None of the above ```

(D) Any or all of the above

Coccidioidimycosis patient should be treated immediately with ``` (A) Amphotericin B (B) Caspofungin (C) Ketoconazole (D) Terbinafine (E) None of these drugs ```

(E) None of these drugs Pulmonary symptoms of coccidioidomycosis are usually self-limiting, and drug therapy is not commonly required in an otherwise healthy patient. Tender red nodules on extensor surfaces constitute a good prognostic sign. Erythema nodosum is a delayed hypersensitivity response to fungal antigens. No organisms are present in the lesions, and it is not a sign of disseminated disease.

Which is the drug of choice if thie patient is suffering from persistent lung lesions or disseminated disease caused by Coccidioides immitis? ``` (A) Amphotericin B (B) Flucytosine (C) Itraconazole (D) Micofungin (E) Terbinafine ```

(C) Itraconazole Until recently, amphotericin B was the recommended therapy, but fluconazole or itraconazole are now generally preferred.

Which drug is least likely to be effective in the treatment of esophageal candidiasis if it is used by the oral route? ``` (A) Clotrimazole (B) Griseofulvin (C) Ketoconazole (D) Itraconazole (E) Nystatin ```

(B) Griseofulvin

Serious cardiac effects have occurred when this drug was taken by patients using the antihistamines astemizole or terfenadine ``` (A) Amphotericin B (B) Griseofulvin (C) Ketoconazole (D) Terbinafine (E) Voriconazole ```

Which of the following drugs has acute pancreatitis as an ADR? ``` (A) Acyclovir (B) Didanosine (C) Ketoconazole (D) Ritonavir (E) Zidovudine ```

(B) Didanosine

In an accidental needlestick, an unknown quantity of blood from an AIDS patient is injected into a resident physician.The most recent laboratory report on the AIDS patient shows a CD4 count of 20/μL and a viral RNA load of greater than 10^7 copies/mL. The most appropriate course of action regarding treatment of the resident is to (A) Determine whether HIV transmission has occurred by monitoring the patient’s blood (B) Treat with a single high dose of zidovudine (C) Treat with full doses of zidovudine for 4 wk (D) Treat with single doses of zidovudine and indinavir (E) Treat with zidovudine plus lamivudine plus ritonavir for 4 wk

(E) Treat with zidovudine plus lamivudine plus ritonavir for 4 wk

More than 90% of this drug is excreted in the urine in intact form. Because its urinary solubility is low, patients should be well hydrated to prevent nephrotoxicity. Which drug is described? ``` (A) Acyclovir (B) Efavirenz (C) Indinavir (D) Trifluridine (E) Zidovudine ```

(A) Acyclovir

Antimalarial drug that is also a DMARD

Chloroquine

Antimalarial drug that is also used in amebic liver abscess

Chloroquine

Antimalarial drug that complexes with DNA to prevent strand separation hence blocking DNA replication and transcription

Quinine

Severe complication of P. falciparum malaria that is sometimes fatal complication in quinine-sensitized persons

Blackwater fever Intravascular hemolysis, massive hemoglobinuria, ARF

DOC for malaria in pregnant patient

Quinine

Alternative to quinine in acute attacks of falciparum malaria

Mefloquine

Chemoprophylaxis for multi-drug resistant malaria

Doxycycline

Tetracycline that is used as antimalarial

Doxycycline

Antimalarial drug that has an ADR of nightmares

Halofantrine and Lumefantrine

Drug of choice for uncomplicated malaria in the Philippines

Artemether-Lumefantrine

DOC for asymptomatic cyst carriers of E. Histolytica

Diloxanide furoate

DOC for Cryptosporidiosis

Nitazoxanide

DOC for prophylaxis and treatment of pneumocysticosis

Co-trimoxazole

Enzyme inhibited by pyrimethamine

Dihydrofolate reductase (same with trimethoprim)

DOC for the prophylaxis and treatment of Toxoplasmosis

Pyrimethamine-Sulfadiazine

First line drug for early west african sleeping sickness

Pentamidine

First line drug for west african sleeping sickness with CNS involvement

Eflornithine

First line drug for early east african sleeping sickness

Suramin

First line drug for east african sleeping sickness with CNS involvement

Melarsoprol

Suicide inhibitor of ornithin decarboxylase

Eflornithine

DOC for Chagas disease

Nifurtimox

Inhibits trypanothione reductase

Nifurtimox

DOC for leishmaniasis

Na stibogluconate

An agent used to inhibit bacterial growth in vitro and in vivo

Antiseptic

An agent used to kill microorganisms in an inanimate environment

Disinfectant

Procedures that kill microorganisms on instruments and dressings; methods include autoclaving, dry heat, and exposure to ethylene oxide

Sterilization

Infections caused by gram-negative bacilli have occurred when this cationic surfactant has been used as a skin antiseptic. ``` (A) Acetic acid (B) Benzalkonium chloride (C) Lindane (D) Hexachlorophene (E) Thimerosal ```

(B) Benzalkonium chloride they form a film on the skin under which microorganisms can survive. Bacterial growth may also occur in solutions of povidone-iodine

Which compound is the safest drug to use topically to treat scabies and pediculosis? ``` (A) Benzoyl peroxide (B) Chlorhexidine (C) Lindane (D) Permethrin (E) Silver sulfadiazine ```

(D) Permethrin

Methenamine salts are used as urinary antiseptics. The reason they lack systemic antibacterial action is that they are (A) Converted to formaldehyde only at low pH (B) Metabolized rapidly by hepatic drug-metabolizing enzymes (C) More than 98% bound to plasma proteins (D) Not absorbed into the systemic circulation after oral ingestion (E) Substrates for active tubular secretion

(D) Not absorbed into the systemic circulation after oral ingestion

Which statement about the actions of antimicrobial agents is false? (A) Metronidazole has activity against C difficile. (B) Neonatal gonococcal ophthalmia can be prevented by silver nitrate (C) Polymyxins act as cationic detergents to disrupt bacterial cell membranes (D) Resistance to nitrofurans emerges rapidly, and there is cross-resistance with sulfonamides (E) Salicylic acid has useful antidermatophytic activity when applied locally

(D) Resistance to nitrofurans emerges rapidly, and there is cross-resistance with sulfonamides

Which antiseptic promotes wound healing? ``` (A) Cetylpyridinium chloride (B) Chlorhexidine (C) Hexachlorophene (D) Phenol (E) None of the above ```

(E) None of the above No antiseptic in current use is able to promote wound healing, and most agents do the opposite. In general, cleansing of abrasions and superficial wounds with soap and water is just as effective as and less damaging than the application of topical antiseptics. Phenol is only used as a disinfectant of inanimate objects!

A patient with AIDS has an extremely high viral RNA titer. While blood is being drawn from this patient, the syringe is accidentally dropped, contaminating the floor, which is made of porous material. The best way to deal with this is to (A) Clean the floor with a 10% solution of household bleach (B) Clean the floor with soap and water (C) Completely replace the contaminated part of the floor (D) Neutralize the spill with a solution of potassium permanganate (E) Seal the room and decontaminate with ethylene oxide

(A) Clean the floor with a 10% solution of household bleach

Neuropathies are more likely to occur with this agent when it is used in patients with renal dysfunction. The drug may cause acute hemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. ``` (A) Chlorhexidine (B) Halazone (C) Methenamine (D) Metronidazole (E) Nitrofurantoin ```

(E) Nitrofurantoin

Antibacterial effect that persists after drug concentration falls below the minimum inhibitory concentration

Postantibiotic effect (PAE)

DOC for Campylobacter jejuni

Macrolide

DOC for proteus mirabilis

Ampicillin

DOC for shigella

Fluoroquinolones Alt: azithromycin, co-trimoxazole, ampicillin, ceftriaxone

DOC for serratia

Carbapenem

Which drug increases the hepatic metabolism of other drugs? ``` (A) Clarithromycin (B) Erythromycin (C) Ketoconazole (D) Rifampin (E) Ritonavir ```

(D) Rifampin

If ampicillin and piperacillin are used in combination in the treatment of infections resulting from Pseudomonas aeruginosa, antagonism may occur. The most likely explanation is that (A) Ampicillin is bacteriostatic (B) Ampicillin induces beta-lactamase production (C) Autolytic enzymes are inhibited by piperacillin (D) Piperacillin blocks the attachment of ampicillin to penicillin-binding proteins (E) The 2 drugs form an insoluble complex

(B) Ampicillin induces beta-lactamase production

In a patient suffering from pseudomembranous colitis due to C difficile with established hypersensitivity to metronidazole the most likely drug to be of clinical value is ``` (A) Amoxicillin (B) Chloramphenicol (C) Doxycycline (D) Levofloxacin (E) Vancomycin ```

(E) Vancomycin

Which statement about antiprotozoal drugs is accurate? (A) Chloroquine is an inhibitor of plasmodial dihydrofolate reductase (B) Mefloquine destroys secondary exoerythrocytic schizonts (C) Primaquine is a blood schizonticide and does not affect secondary tissue schizonts (D) Proguanil complexes with double-stranded DNA-blocking replication (E) Trimethoprim-sulfamethoxazole is the drug of choice for Pneumocystis jiroveci pneumonia

(E) Trimethoprim-sulfamethoxazole is the drug of choice for Pneumocystis jiroveci pneumonia

Plasmodial resistance to chloroquine is due to (A) Change in receptor structure (B) Decreased accumulation of the drug in the food vacuole (C) Increased activity of DNA repair mechanisms (D) Increased synthesis of dihydrofolate reductase (E) Induction of drug-inactivating enzymes

(B) Decreased accumulation of the drug in the food vacuole

A traveler in a geographical region where chloroquine-resistant P falciparum is endemic used a drug for prophylaxis but nevertheless developed a severe attack of P vivax malaria. The drug used for prophylaxis was probably ``` (A) Atovaquone (B) Iodoquinol (C) Mefloquine (D) Proguanil (E) Tetracycline ```

Which drug should be used for oral treatment of the acute attack of P vivax malaria but does not eradicate exoerythrocytic forms of the parasite? ``` (A) Chloroquine (B) Mefloquine (C) Primaquine (D) Pyrimethamine-sulfadoxine (E) Quinidine ```

(A) Chloroquine

Which drug should be given later to eradicate schizonts and latent hypnozoites in the patient’s liver? ``` (A) Artesunate (B) Dapsone (C) Halofantrine (D) Primaquine (E) Quinine ```

(D) Primaquine

After a backpacking trip in the mountains, a 24-year-old man develops diarrhea. He acknowledges drinking stream water without purification, and you suspect he is showing symptoms of giardiasis. Because you know that laboratory detection of cysts or trophozoites in the feces can be difficult, you decide to treat the patient empirically with ``` (A) Chloroquine (B) Emetine (C) Pentamidine (D) Tinidazole (E) TMP-SMZ ```

(D) Tinidazole

This drug can clear trypanosomes from the blood and lymph nodes and is active in the late CNS stages of African sleeping sickness. ``` (A) Emetine (B) Melarsoprol (C) Nifurtimox (D) Pentamidine (E) Suramin ```

(B) Melarsoprol

Metronidazole is not effective in the treatment of (A) Amebiasis (B) Infections due to Bacteroides fragilis (C) Infections due to Pneumocystis jiroveci (D) Pseudomembranous colitis (E) Trichomoniasis

DOC for whipworm infections

Mebendazole

ADR of mebendazole

Agranulocytosis, alopecia

DOC for hydatid disease

Albendazole

DOC for filariasis

Diethylcarbamazine

DOC for eye worm disease

Diethylcarbamazine

Reaction that occurs when DEC ir ivermectin is used in onchocerciasis

Mazzotti reaction (fever, headache, dizziness, rashes, pruritus, tachycardia, hypotension, joint pains, muscles and lymph glands)

DOC for strongyloides

Ivermectin

DOC for onchocerciasis

Ivermectin

Stimulates nicotinic receptors at NMJ of nematodes

Pyrantel pamoate

DOC for trichinosis

Thiabendazole

DOC for trematodes and cestodes

Praziquantel

Praziquantel is contraindicated in what parasitic disease

Ocular cysticercosis (may cause irreparable eye damage)

Which drug should be used prophylactically to prevent onchocerciasis? ``` (A) Albendazole (B) Diethylcarbamazine (C) Ivermectin (D) Oxamniquine (E) Pyrantel pamoate ```

A nonindigenous person who develops onchocerciasis in an endemic region and receives drug treatment is likely to experience a severe reaction. Symptoms include headache,weakness, rash, muscle aches, hypotension, and peripheral edema. Which statement concerning this reaction is accurate? (A) Extensive fluid replacement is essential (B) Symptoms are more intense in indigenous adults than nonindigenous adults (C) The reaction is due to treatment with suramin (D) The reaction is due to killing of microfilariae (E) The symptoms are characteristic of treatment with diethylcarbamazine

(D) The reaction is due to killing of microfilariae

Which statement about pyrantel pamoate is accurate (A) Acts as an antagonist at GABA receptors (B) Equivalent in efficacy to niclosamide in the treatment of tapeworm infections (C) Eradicates adult worms in the colon but not the eggs (D) Hepatotoxicity is dose-limiting (E) Synergistic with praziquantel in cestode infections

A 22-year-old man from South Korea has recently moved to Minnesota. He has symptoms of clonorchiasis (anorexia,upper abdominal pain, eosinophilia), presumably contracted in his homeland where the Oriental liver fluke is endemic. He also has symptoms of diphyllobothriasis (abdominal discomfort, diarrhea, megaloblastic anemia), probably caused by consumption of raw fish from lakes near the Canadian border. Which drug is most likely to be effective in the treatment of both clonorchiasis and diphyllobothriasis in this patient? ``` (A) Albendazole (B) Ivermectin (C) Niclosamide (D) Praziquantel (E) Pyrantel pamoate ```

(D) Praziquantel

Which helminthic infection does not respond to treatment with praziquantel? ``` (A) Hydatid disease (B) Opisthorchiasis (C) Paragonimiasis (D) Pork tapeworm infection (E) Schistosomiasis ```

(A) Hydatid disease

Which drug enhances the actions of GABA in nematodes causing muscle paralysis? ``` (A) Albendazole (B) Diethylcarbamazine (C) Ivermectin (D) Oxamniquin (E) Pyrantel pamoate ```

Which parasite is susceptible to niclosamide? (A) Ascaris lumbricoides (roundworm) (B) Echinococcus granulosus (hydatid disease) (C) Fasciola hepatica (sheep liver fluke) (D) Necator americanus (hookworm) (E) Taenia solium (pork tapeworm)

(E) Taenia solium (pork tapeworm)

Which adverse effect occurs with the use of albendazole during intestinal nematode therapy? ``` (A) Cholestatic jaundice (B) Corneal opacities (C) Hirsutism (D) Peripheral neuropathy (E) None of the above ```

(E) None of the above Almost free of adverse effects