Antibiotics Flashcards
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
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.
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
(C) Changes in chemical structure of target penicillin-binding proteins
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.
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
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
(C) Has greater activity against H pylori
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
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
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
(C) Cause misreading of the code on the mRNA template
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
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
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
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
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.
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
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
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
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
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
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
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
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
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
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
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
(C) Ketoconazole
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