hivfin Flashcards

1
Q

SATA

Which of the following processes are involved in the antifungal action of flucytosine?

a) Inhibition of ergosterol biosynthesis
b) Inhibition of cytosine deaminase
c) Action of fungal enzyme for drug permeation
d) inhibition of DNA synthesis
e) Inhibition of fungal RNA synthesis

dukh

A

c) Action of fungal enzyme for drug permeation
d) inhibition of DNA synthesis
e) Inhibition of fungal RNA synthesis

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2
Q

Famciclovir:

a) Blocks formation of preintegration complex (PiC), transfer of HIV cDNA to host DNA &repair of gaps formed during strand transfer
b) Adenosine nucleoside triphosphate analog, the active metabolite interferes with viral RNA-dependent RNA polymerase
c) Prodrug of penciclovir - nucleoside analog DNA polymerase inhibitor used for the treatment of recurrent cold sores and genital herpes in healthy & HIV patients, and to manage herpes zoster.
d) Noncompetitively inhibits reverse transcriptase Foscarnet
e) Competitively inhibit reverse transcriptase causing chain termination after incorporation
into viral DNA. To be active they need to be phosphorylated intracellularly

dukh

A

c) Prodrug of penciclovir - nucleoside analog DNA polymerase inhibitor used for the treatment of recurrent cold sores and genital herpes in healthy & HIV patients, and to manage herpes zoster.

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3
Q

Side effects of ribavirin include:

a) Hypersensitivity, rashes, hepatotoxicity, fever, stevens-johnson syndrome
b) Pancreatitis, altered taste, paresthesias
c) Anemia, marrow suppression, teratogenic
d) NVD, elevated LFT’s/hepatotoxicity, dyscrasias
e) Hypersensitivity, dizziness, hepatic, psychiatric (delusions/hallucinations)

dukh

A

c) Anemia, marrow suppression, teratogenic

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4
Q

TP is a 53 yo female with diabetes who is admitted to the general medical ward for community-acquired pneumonia. The patient has an allergy to penicillin and cefazoline (bronchospasm) but has no other known allergies and no other significant past medical history. Which of the following would be the most appropriate empiric intravenous treatment of this patient’s pneumonia in the hospital?

a) Ceftriaxone plus azithromycin
b) Levofloxacin
c) Doxycycline
d) ampicillin/sulbactam plus azithromycin

therapeutics

A

a) Ceftriaxone plus azithromycin

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5
Q

Flucytosine
a) Forms membrane pores binding to ergosterol
b) Inhibit squalene epoxidase
c) Inhibit lanosterol 14 alpha demethylase
d) Inhibits RNA & DNA synthesis
e) Inhibit 1,2 beta glucan synthase

dukh

A

d) Inhibits RNA & DNA synthesis

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6
Q

SATA

MP is a 23 year old male recently diagnosed with HIV who has never been on antiretrovirals. His
current viral load is 176,864 copies/ml and CD cell count is 38 cells/mm3 (confirmed with a
repeat lab test). Three months ago when he was first diagnosed, his viral load was 108,654 and
his CD4 cell count was 106 cells/mm3. He has a genotype that demonstrates no antiretroviral
resistance and has no abnormal physical exam or lab findings (an HLAB-5701 lab test has not
been collected). He has no complaints and states that he feels well. He does not drink alcohol,
smoke or use illicit drugs. Other than his recent HIV diagnosis (risk factor MSM) he reports no
other significant PMH, NDKA (no known drug allergies) and is on no medications. He presents to
your clinic today stating that he is willing to do whatever is recommended with regard to his
antiretroviral treatment (ART) because he wants to manage his HIV appropriately. He is ready to
commit to initiating any treatment if this is appropriate .

Which of the following statements is true regarding opportunistic infection prophylaxis for MP at this time?

a) He does not require opportunistic infection prophylaxis at this time
b) He should be initiated on azithromycin, 1200mg po weekly, for the prevention of MAC
c) He should be initiated on Trimethoprim-Sulfamethoxazole, 1DS tab po daily, for prevention of PCP and toxoplasma infection
d) He should be initiated on Acyclovir for the prevention of herpes simplex

conry- therapeutics

A

b) He should be initiated on azithromycin, 1200mg po weekly, for the prevention of MAC

c) He should be initiated on Trimethoprim-Sulfamethoxazole, 1DS tab po daily, for prevention of PCP and toxoplasma infection

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7
Q

PG is a 26 year old female in her first trimester of pregnancy who develops ‘walking pneumonia’.
She has a penicillin allergy (angioedema) and is otherwise healthy. Which of the following oral
therapies would be most appropriate to treat her on an outpatient basis? (note: local resistance rate to all agents listed is <10%)
a) Doxycycline
b) Azithromycin
c) Levofloxacin
d) Amoxicillin

etzel- therapeutics

A

b) Azithromycin

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8
Q

Chloroquine

a) Inhibit electron transport chain and folate synthesis Atovaquone
b) Inhibit formation of hemozoin from heme, free heme lyses membranes
c) Inhibits nucleic acid, phospholipid and protein synthesis
d) Inhibit merozoite invasion, binds to a heme forming a complex toxic to the parasite

A

b) Inhibit formation of hemozoin from heme, free heme lyses membranes

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9
Q

JT is a 45yo, 70kg prison guard, who is diagnosed with active pulmonary tuberculosis and is placed on a 4 drug regimen of INH 300mg po daily, Rifampin 600 po mg daily, Ethambutol 1600mg daily and Pyrazinamide 1500mg po daily. After one month of therapy the patient complains of “blurred vision” and difficulty distinguishing colors. This adverse effect is most likely attributed to which of the following?

a) Pyrazinamide
b) Ethambutol
c) Rifampin
d) Isoniazid

A

b) Ethambutol

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10
Q

14) Isoniazid

a) Inhibits alanine racemase and d-ala-d-ala ligase
b) Inhibit messenger RNA synthesis
c) Inhibit mycobacterial growth, binding preferentially to mycobacterial DNA
d) Inhibits mycolic acid synthesis
e) Prodrug leading to inhibition of mycolic acid synthesis

A

d) Inhibits mycolic acid synthesis

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11
Q

Cycloserine

a) Inhibits mycolic acid synthesis
b) Inhibits mycobacterial growth, binding preferentially to mycobacterial DNA
c) Inhibit messenger RNA synthesis
d) Inhibits alanine racemase and d-ala-d-ala ligase
e) Prodrug leading to inhibition of mycolic acid synthesis

A

d) Inhibits alanine racemase and d-ala-d-ala ligase

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12
Q

Which of the following statements regarding the antiviral drug foscarnet is correct?

  1. Is a pyrophosphate analog
  2. Needs phosphorylation by viral thymidine kinase
  3. Inhibits viral DNA polymerase
  4. Gets deposited in the bones

a) Only 2,3,4 are correct
b) All of the statements are correct (1,2,3,4)
c) Only 1,3,4 are correct
d) Only 1,2,4 are correct
e) Only 1,2,3 are correct

A

c) Only 1,3,4 are correct

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13
Q

Divalent metal ions have a pharmacodynamic drug interaction with the following drug

a) Abacavir
b) Cobicistat
c) Amphotericin
d) Ritonavir
e) Dolutegravir

A

e) Dolutegravir

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14
Q

A pharmacist should counsel HIV-infected patients to take which of the following antiretrovirals on an empty stomach when they are being initiated on therapy?

a) Atripla (efavirenz/tenofovir disoproxil fumarate/emtricitabine)
b) Triumeq (dolutegravir/abacavir/lamivudine)
c) Stribild (elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate)
d) Genvoya (elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide)

A

a) Atripla (efavirenz/tenofovir disoproxil fumarate/emtricitabine)

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15
Q

Side effects of Saquinavir (Invirase), Lopinavir, Ritonavir (Norvir), Fosamprenavir, Indinavir (Crixivan), Atazanavir, Nelfinavir (Viracept), Tipranavir, Amprenavir include:

a) Hypersensitivity, rashes, hepatotoxicity, fever, Stevens-Johnson syndrome
b) Anemia, marrow suppression, teratogenic
c) Pancreatitis, altered taste, paresthesias
d) Hypersensitivity, dizziness, hepatic, psychiatric (delusions/hallucinations)
e) NVD, elevated LFT’s, hepatotoxicity, dyscrasias

A

c) Pancreatitis, altered taste, paresthesias

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16
Q

TB is the 4th leading cause of infectious disease deaths worldwide. Primary infection occurs in the lungs where a chronic inflammatory lesion, a granuloma, walls of the tubercle bacillus and prevents spread. However, the live but dormant TB can become
reactivated and spread to become cavitary tuberculosis and spread systemically to produce military TB. During this reactivation, the patient can be highly infectious to others.
Which of the following can increase the risk of TB reactivation? (Choose all that apply)

a) AIDS
b) Malnutrition
c) Age
d) Immunosuppressive therapy
e) Cancer

A

a) AIDS
b) Malnutrition
c) Age
d) Immunosuppressive therapy
e) Cancer

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17
Q

Amphotericin

a) Inhibits DNA & RNA synthesis
b) Forms membrane pores binding to ergosterol
c) Inhibit 1,2 beta glucan synthase
d) Inhibit lanosterol 14 alpha demethylase
e) Inhibit squalene epoxidase

A

b) Forms membrane pores binding to ergosterol

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18
Q

chlamydia is the most common sexually transmitted infectious disease. Which of the following may occur with a chlamydia infection? Choose all that apply.

a) Infection may be asymptomatic
b) Infection may lead to pelvic inflammatory disease
c) Infection may lead to ectopic pregnancy
d) Infection may ascend to the upper genital tract
e) Infection may lead to infertility

A

a) Infection may be asymptomatic
b) Infection may lead to pelvic inflammatory disease
c) Infection may lead to ectopic pregnancy
d) Infection may ascend to the upper genital tract
e) Infection may lead to infertility

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19
Q

A patient is diagnosed with an initial C.difficile infection. His Scr is 2.3mg/dL and WBC is 21,000 cells/mL. He is otherwise clinically stable. Which of the following is correct?

a) The patient has severe C.diff and should be treated with vancomycin 125 mg POq6h
b) The patient has severe C.diff and should be treated with a vancomycin pulsed-tapered regimen Only for recurrence
c) The patient has non-severe C.diff and should be treated with a vancomycin pulsed-tapered regimen
d) The patient has non-severe C.diff and should be treated with vancomycin 125 mg PO q6h

A

a) The patient has severe C.diff and should be treated with vancomycin 125 mg POq6h

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20
Q

Which of the following respiratory pathogens is spread through aerosolized droplets?
Choose all that apply.
a) TB
b) Legionella pneumophila
c) HIV
d) Streptococcus Pyogenes
e) SARS-CoV2 (COVID-19)

A

a) TB
b) Legionella pneumophila
d) Streptococcus Pyogenes
e) SARS-CoV2 (COVID-19)

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21
Q

Which of the following antiretroviral regimens should prompt a pharmacist to question/contact the prescriber due to an inappropriate combination of antiretrovirals for an antiretroviral-naive patient?

a) Tivicay (Dolutegravir) + Descovy (tenofovir alafenamide/emtricitabine)
b) Tivicay (Dolutegravir) + Truvada (tenofovir disoproxil fumarate/emtricitabine)
c) Crixivan (Indinavir) + low dose Norvir (Ritonavir) + Emtriva (Emtricitabine) + Epivir (Lamivudine)
d) Isentress (Raltegravir) + Descovy (tenofovir alafenamide/emtricitabine)

A

c) Crixivan (Indinavir) + low dose Norvir (Ritonavir) + Emtriva (Emtricitabine) + Epivir (Lamivudine)

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22
Q

CV is a 57 year old male grade-school teacher with diabetes and poorly controlled asthma. He develops fever, chills, coughing, myalgia, and fatigue for one-day duration. CV is diagnosed with influenza. At this time, which of the following agents would be considered he best option for the outpatient (ambulatory) management of his influenza?

a) Inhaled oseltamivir
b) Not therapy is indicated at this time
c) Oral oseltamivir
d) Intravenous Paramivir

A

c) Oral oseltamivir

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23
Q

Pentamidine

a) Inhibit merozoite invasion, binds to heme forming a complex toxic to the parasite
b) Inhibit formation of hemozoin from heme, free heme lyses membranes
c) Inhibit electron transport chain and folate synthesis
d) inhibits nucleic acid, phospholipid and protein synthesis

A

d) inhibits nucleic acid, phospholipid and protein synthesis

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24
Q

MP is a 23 year old male recently diagnosed with HIV who has never been on antiretrovirals. His current viral load is 176,864 copies/ml and CD cell count is 38 cells/mm3 (confirmed with a repeat lab test). Three months ago when he was first diagnosed, his viral load was 108,654 and his CD4 cell count was 106 cells/mm3. He has a genotype that demonstrates no antiretroviral resistance and has no abnormal physical exam or lab findings (an HLAB-5701 lab test has not been collected). He has no complaints and states that he feels well. He does not drink alcohol, smoke or use illicit drugs. Other than his recent HIV diagnosis (risk factor MSM) he reports no other significant PMH, NDKA (no known drug allergies) and is on no medications. He presents to your clinic today stating that he is willing to do whatever is recommended with regard to his antiretroviral treatment (ART) because he wants to manage his HIV appropriately. He is ready to commit to initiating any treatment if this is appropriate.
Which of the following antiretroviral combinations is the most appropriate and recommended regimen for MP at this time based on current HIV treatment guidelines?

a) Odefsey (Rilpivirine/tenofovir alafenamide/emtricitabine)
b) Complera (Rilpivirine/tenofovir disoproxil fumarate/emtricitabine)
c) Triumeq (dolutegravir/abacavir/lamivudine)
d) Tivicay (Dolutegravir) + Descovy (tenofovir alafenamide/emtricitabine)

A

d) Tivicay (Dolutegravir) + Descovy (tenofovir alafenamide/emtricitabine)

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25
Q

Atovaquone
a) Inhibits nucleic acid, phospholipid and protein synthesis
b) Inhibit merozoite invasion, binds to heme forming a complex toxic to the parasite
c) Inhibit formation of hemozoin from heme, from heme lyses membranes
d) Inhibit electron transport chain and folate synthesis

A

d) Inhibit electron transport chain and folate synthesis

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26
Q

LJ is a 23 year old male presenting to clinic for his routine STD screen. His last screen, 6 months ago, was negative for all STDs. In the past 6 months, LJ reports having multiple male and female sex partners and inconsistent condom use. He states that he has a painless ulcer on his penis X (can’t read) number of weeks ago but feels fine otherwise. Results from his current screen come back as follows: Chlamydia (+), Gonorrhea (+), Syphilis (+), HIV (-). Which of the following is the most appropriate treatment recommendation for LJ?

a) Azithromycin 1g PO x 1 dose + benzathine penicillin 2.4MU x 3 doses
b) Ceftriaxone 1g IM x 1 dose + azithromycin 1g PO x 1 dose
c) Cefixime 400 mg PO x 1 dose + benzathine penicillin 2.4 MU x 1 dose
d) Ceftriaxone 1g IM x 1 dose + azithromycin 1g PO x 1 dose + benzathine penicillin 2.4 MU x 1 dose
e) Ceftriaxone 1g IM x 1 dose + azithromycin 1g PO x 1 dose + benzathine penicillin 2.4 MU x 3 doses

A

d) Ceftriaxone 1g IM x 1 dose + azithromycin 1g PO x 1 dose + benzathine penicillin 2.4 MU x 1 dose

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27
Q

Which of the following statements is true regarding the use of PrEP?

a) PrEP is indicated for HIV negative patients with a recent exposure to HIV and is administered for 28 days after the exposure.
b) PrEP consists of a antiretroviral treatment regimen that consists of three antiretrovirals from at least two different pharmacological classes.
c) PrEP should be taken on a daily basis by the patient to maximize it’s efficacy and the patient should have repeat HIV testing every three months while taking PrEP
d) all

A

c) PrEP should be taken on a daily basis by the patient to maximize it’s efficacy and the patient should have repeat HIV testing every three months while taking PrEP

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28
Q

LL is a 23 year old sexually active female reporting dysuria, urinary frequency, and abnormal vaginal discharge. Upon testing, she is diagnosed with Gonorrhea. Her pregnancy test is negative and she has no known drug allergies. Which of the following recommendations is most appropriate for LL?

a) Initiate ceftriaxone 250mg IM in a single dose plus azithromycin 1g PO in a single dose
b) Initiate azithromycin 1g PO in a single dose
c) Initiate cefixime 400mg PO in a single dose plus azithromycin 1g PO in a single dose
d) Initiate gentamicin 240mg IM in a single dose

A

a) Initiate ceftriaxone 250mg IM in a single dose plus azithromycin 1g PO in a single dose

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29
Q

Which of the following statements regarding NRTI’s is true?

a) Most NRTI’s are hepatically eliminated thus require dosage adjustment for hepatic insufficiency
b) Most NRTI’s are renally eliminated thus require dosage adjustment for renal insufficiency
c) The NRTI’s have poor bioavailability thus should be administered with food
d) No dosage adjustment is needed for renal or hepatic insufficiency

A

b) Most NRTI’s are renally eliminated thus require dosage adjustment for renal insufficiency

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30
Q

Which of the following is the most likely infectious agent in diaper rash?
a) Toxoplasma gondii
b) Coccidioides immitis
c) Candida albicans
d) Aspergillus fumigatus
e) Cryptococcus neoformans

A

c) Candida albicans

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31
Q

Aspiration pneumonia is generally polymicrobial and is caused by Streptococcus pneumonia and oral anaerobes. Which of the following oral medications are best suited to treat community acquired aspiration pneumonia?

a) Ciprofloxacin
b) Vancomycin
c) Amoxicillin/clavulanic acid
d) Daptomycin

A

c) Amoxicillin/clavulanic acid

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32
Q

Which of the following infections in a pregnant women can infect her child in utero and produce a range of similar birth defects and lesions, including microcephaly and cerebral calcifications,
known as TORCH complex? Choose all that apply.

a) Herpes virus
b) Cytomegalovirus
c) Toxoplasmosis
d) Zika virus
e) Rubella

A

a) Herpes virus
b) Cytomegalovirus
c) Toxoplasmosis
d) Zika virus
e) Rubella

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33
Q

Which of the following antifungal drugs belongs to echinocandins and inhibits glucan synthesis?

a) Griseofulvin
b) Terbinafine
c) Flucytosine
d) Micafungin
e) Nystatin

A

d) Micafungin

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34
Q

Side effects of oseltamivir (Tamiflu), zanamivir (Relenza) include:

a) Anemia, marrow suppression, teratogenic
b) NVD, elevated LFT’s/hepatotoxicity, dyscrasias
c) Hypersensitivity, rashes, hepatotoxicity, fever, stevens-johnson syndrome
d) Pancreatitis, altered taste, paresthesias
e) Hypersensitivity, dizziness, hepatic, psychiatric (delusions/hallucinations)

A

e) Hypersensitivity, dizziness, hepatic, psychiatric (delusions/hallucinations)

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35
Q

Ribavirin
a) Guanosine nucleoside used to treat some forms of Hepatitis C. Inhibits replication of DNA & RNA viruses. Inhibits inosine monophosphate dehydrogenase, reducing GTP
b) Blocks HIV protein gp120 from interacting with receptor, prevents entry
c) Inhibits viral DNA polymerase, RNA polymerase and Reverse Transcriptase
d) Neuraminidase inhibitor

A

a) Guanosine nucleoside used to treat some forms of Hepatitis C. Inhibits replication of DNA & RNA viruses. Inhibits inosine monophosphate dehydrogenase, reducing GTP

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36
Q

Foscarnet

a) Guanosine nucleoside used to treat some forms of Hepatitis C. Inhibits replication of DNA & RNA viruses. Inhibits inosine monophosphate dehydrogenase, reducing GTP
b) Blocks HIV protein gp120 from interacting with receptor, prevents entry
c) Inhibits viral DNA polymerase, RNA polymerase and Reverse Transcriptase
d) Neuraminidase inhibitor

A

c) Inhibits viral DNA polymerase, RNA polymerase and Reverse Transcriptase

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37
Q

Which of the following patients should NOT be initiated on HIV antiretroviral therapy based upon the information provided at the present time?

a) 32 year old patient recently diagnosed HIV positive whose CD4 count is 50 cells/mm3 and whose viral load (HIV-RNA) is 192,000 copies/ml.
b) 29 year old patient recently diagnosed HIV positive whose CD4 count is 480 cells/mm3 and whose viral load (HIV-RNA) is 3,423 copies/ml.
c) 25 year old patient recently diagnosed HIV positive whose CD4 count is 350 cells/mm3 and whose viral load (HIV-RNA) is 124,000 copies/ml who states they are completely unwilling to start or adhere to therapy at this time
d) 22 year old patient recently diagnosed HIV positive.

A

c) 25 year old patient recently diagnosed HIV positive whose CD4 count is 350 cells/mm3 and whose viral load (HIV-RNA) is 124,000 copies/ml who states they are completely unwilling to start or adhere to therapy at this time

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38
Q

terbinafine, naftifine

a) Forms membrane pores binding to ergosterol
b) Inhibit squalene epoxidase
c) Inhibit 1,2 beta glucan synthase
d) Inhibits RNA & DNA synthesis
e) Inhibit lanosterol 14 alpha demethylase

A

b) Inhibit squalene epoxidase

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39
Q

A 41 year old female patient wants to learn about the different vaccines, she is currently taking immunosuppressive therapy for her kidney transplant. Which of the following is likely to be contraindicated in such patient?

a) Inactivated vaccine
b) Live attenuated vaccine
c) Toxoid
d) Conjugate Vaccine

A

b) Live attenuated vaccine

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40
Q

MP is a 23 year old male recently diagnosed with HIV who has never been on antiretrovirals. His current viral load is 176,864 copies/ml and CD cell count is 38 cells/mm3 (confirmed with a
repeat lab test). Three months ago when he was first diagnosed, his viral load was 108,654 and his CD4 cell count was 106 cells/mm3. He has a genotype that demonstrates no antiretroviral
resistance and has no abnormal physical exam or lab findings (an HLAB-5701 lab test has not been collected). He has no complaints and states that he feels well. He does not drink alcohol,
smoke or use illicit drugs. Other than his recent HIV diagnosis (risk factor MSM) he reports no other significant PMH, NDKA (no known drug allergies) and is on no medications. He presents to
your clinic today stating that he is willing to do whatever is recommended with regard to his antiretroviral treatment (ART) because he wants to manage his HIV appropriately. He is ready to
commit to initiating any treatment if this is appropriate.
Which of the following represents the most appropriate assessment of MP

a) Antiretroviral naive, HIV positive male with current opportunistic infection who is ready P’s current state of to initiate ART
b) Antiretroviral naive, HIV positive male with unstable and uncontrolled HIV infection that has progressed to AIDS and who is ready to initiate ART
c) Antiretroviral experienced, HIV positive male with unstable and uncontrolled HIV infection that has progressed to AIDS and who is ready to initiate ART
d) Antiretroviral naive, HIV positive male with stable and controlled HIV infection that has not yet progressed to AIDS and who is ready to initiate ART

A

b) Antiretroviral naive, HIV positive male with unstable and uncontrolled HIV infection that has progressed to AIDS and who is ready to initiate ART

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41
Q

Which occurs in more than 25% of pneumococcal patients that can lead to meningitis or endocarditis?
A. Pleuritis
B. Bacteremia
C. Pyothorax
D. Empyema

A

B. Bacteremia

42
Q

During the acute phase of HIV infection, the gut-associated lymphoid tissue experiences a profound depletion in what cell type?
A. Neutrophils
B. CD4 T cells
C. G lymphocytes
D. CD8

A

B. CD4 T cells

43
Q

JK is a 5 yp suffering from malignancy, & receiving immunosuppressive chemotherapy. Based on info which vaccine NOT recommended?

A. MMR
B. IPV
C. DtaP
D. Pneumococcal

A

A. MMR

44
Q

CASE STUDY

KB is a 28 year old male recently diagnosed with HIV who has never been on antiretrovirals. His current viral lodal is 192,654 copies/ml and CD cell count is 46 cells/mm3 (confirmed with a repeat lab test). Three months ago when he was first diagnosed, his viral load was 108,654 and his CD4 cell count was 106 cells.mm3. he has a gentotype that demonstrated no antiretroviral resistance and has no abnormal physical exam or lab findings. He has no complaints and states that he feels well. He does not drink alcohol, smoke or use illicit drugs. Other than his recent HIV diagnosis (risk factor MSM) he reports no other significant PMH, NDKA (no known drug allergies) and is on no medications. He presents to your clinic today stating that he willing to do whatever is recommended with regard to his antiretroviral treatment (ART) because he wants to manage his HIV appropriately. He is ready to commit to initiating any treatment if this is appropriate

  1. Which of the following statements true regarding opportunistic infection prophylaxis for TV? SATA
    A. He does not require prophylaxis at this time
    B. He should be initiated on azithromycin
    C. He should be initiated on acyclovir
    D. He should be initiated on trimethoprim-sulfamethoxazole
  2. Which of the following represents the most appropriate assessment of TV’s current state of health?
    a. Antiretroviral experienced patient with unstable and uncontrolled HIV infection that has progressed to AIDs who is ready to initiate ART
    b. Antiretroviral naïve, HIV positive male with current opportunistic infection who is ready to initiate ART
    c. Antiretroviral naïve, HIV positive male with unstable and uncontrolled HIV infection that has progressed to AIDS and who is ready to initiate ART
    d. Antiretroviral naïve, HIV positive male with stable and controlled HIV infection that has not yet progressed to AIDS and who is ready to initiate ART
  3. Which of the following antiretroviral combinations is the most appropriate and recommended regimen for KB at this time based on current HIV treatment guidelines?
    a. Efavirenz + Lamivudine + Emtricitabine
    b. Atazanavir + Low dose ritonavir + Lamivudine + Emtricitabine
    c. Genvoya
    d. Rilpivirine + Tenefovir + Stavudine
A
  1. B. He should be initiated on azithromycin
    D. He should be initiated on trimethoprim-sulfamethoxazole
    -
    c. Antiretroviral naïve, HIV positive male with unstable and uncontrolled HIV infection that has progressed to AIDS and who is ready to initiate ART
    -
    c. Genvoya
45
Q

A 65 year old patient comes to your pharmacy requesting to receive several vaccines to maintain his health during this fall season. He has no history of receiving any vaccine within the previous years. He requests to receive pneumococcal vaccine, inactivated influenza vaccine, tdap, and the inactive shingles vaccine. Which of the following vaccines combinations CANNOT be administered simultaneously?

a) Tdap and pneumococcal vaccine
b) Inactive influenza vaccine and Tdap
c) Pneumococcal vaccine and inactive influenza
d) None of the above. All vaccines mentioned can be administered to the patient during the same visit to the pharmacy

A

d) None of the above. All vaccines mentioned can be administered to the patient during the same visit to the pharmacy

46
Q

TT is a 27 yo female, 27th week of pregnancy. No disease, no allergies, which vaccine is recommended?

A

Tdap

47
Q

Products capable of conferring passive immunity?

a) MMR
b) IVIG
c) Tetanus toxoid
d) Conjugated pneumococcal vaccine

A

b) IVIG

48
Q

Which of the following drugs binds to HIV reverse transcriptase at a site other than its nucleoside-binding site?

A. Nevirapine
B. Abacavir
C. Ritonavir
D. Maraviroc
E. Zidovudine

A

A. Nevirapine

49
Q

Which of the following drug can also inhibit mitochondrial (gamma) polymerase resulting in toxicities?

A. Raltegravir
B. Maraviroc
C. Zidovudine
D. Oseltamivir
E. Nevirapine

A

C. Zidovudine

50
Q

Oseltamivir MOA primarily based on?

A. Mimicking sialic acid
B. Preventing viral integration
C. Acting as a protease
D. Blocking m2
E. Inhibiting viral DNA polymerase

A

A. Mimicking sialic acid

51
Q

Which of the following antiprotozoal drugs acts by DNA strand breaks?

A. Paromomycin aminoglycoside class luminal amebicide
B. Metronidazole
C. Iodoquinol heme toxicity
D. Chloroquine

A

B. Metronidazole

52
Q

Which of the following statements about cidofovir is false?

A. Requires thymine kinase for activity
B. Needs phosphorylation by host to inhibit DNA polymerase
C. Active for both herpes and CMV
D. Contraindicated with aminoglycosides
E. Cytosine analog

A

A. Requires thymine kinase for activity

53
Q

HLA-B5701 testing is done to identify hypersensitivity of?

A. Abacavir
B. Tenofovir
C. Itraconazole
D. Acyclovir
E. Efavirenz

A

A. Abacavir

54
Q

Which of the following antiviral drugs inhibits thymidylate synthase?

A. Acyclovir
B. Foscamet
C. Docosanol
D. Trifluridine
E. Valganciclovir

A

D. Trifluridine

55
Q

Which not used in combo with artemisinins?

A. Lumefantrine
B. Chloroquine
C. Amodiaquine
D. Mefloquine

A

B. Chloroquine

56
Q

Which of the following drugs inhibits bacterial RNA polymerase?

A. Kanamycin
B. Ceftriaxone
C. Caspofungin
D. Rifampin
E. Baloxavir

A

D. Rifampin

57
Q

HIV reverse transcriptase enzyme does NOT have the following activities SELECT ALL THAT APPLY

A. Protease
B. RNA polymerase
C. DNA polymerase
D. Integrase
E. RNAse

A

A. Protease
D. Integrase

58
Q

Which antimalarial drug acts by inhibiting the electron transport chain of parasites?
A. Proguanil
B. Chloroquine
C. Primaquine
D. Artesunate
E. Atovaquone

A

E. Atovaquone

59
Q

One of the major problems encountered with amphotericin-B is

A. Most fungi resistant
B. Nephrotoxicity
C. Narrow therapeutic spectrum
D. Extensive D-D interactions

A

B. Nephrotoxicity

60
Q

Which of the following 2 categories of azole antifungals are used systemically due to their better metabolic profile and less toxicities?

A. Imidazoles
B. Triazoles

A

B. Triazoles

61
Q

Amphotericin-B binds to which of the following fungal components?

A. Mannan polymers
B. All of the choices
C. Cell membrane
D. Beta glucan polymer

A

C. Cell membrane

62
Q

Which of the following is true for Fostemsavir used in HIV? SATA

A. Binds to viral gp120
B. Drug that prolongs QT interval
C. Phosphorylation is needed for activity
D. Binds to CD4 receptor
E. Is a prodrug

A

A. Binds to viral gp120
B. Drug that prolongs QT interval
E. Is a prodrug

63
Q

Iatrogenic activation of what intestinal anaerobic organism can produce psueudomembranous colitis?

a. Entertoxigenic Escherichia Coli (ETEC)
b. Staphylococcus aureus
c. Clostridium difficle
d. Clostridium perfringens

A

c. Clostridium difficle

64
Q

A 62 year old man with chronic pulmonary disease develops a respiratory infection. Staphylococcus aureus was isolated from a deep sputum culture. What factors must be considered when determining an antibiotic regimen for this patient? Select all that apply

a. Lung penetration of the antibiotic
b. Pregnancy and lactation
c. Drug allergies and renal function
d. The susceptibility the pathogen isolated

A

a. Lung penetration of the antibiotic
c. Drug allergies and renal function
d. The susceptibility the pathogen isolated

65
Q

According to Center of Disease Control and Prevention, what is the most commonly reported notifiable infectious disease in the USA?

A. Syphilis
B. Chlamydia
C. Gonorrhea
D. HIV

A

B. Chlamydia

66
Q

An antimalarial drug that is most active for the latent liver hypnozoite stage of the malaria parasite is

A. Artemether
B. Primaquine
C. Mefloquine
D. Chloroquine
E. Lumefantrine

A

B. Primaquine

67
Q

What opportunistic fungus can cause pneumonia in low CD4+ count HIV patients?

A. Pseudomonas aeruginosa
B. Pneumocystis carinii
C. Pneumocystis jirovoci
D. Mycobacterium avium complex

A

C. Pneumocystis jirovoci

68
Q

If a Gram-positive bacteria have positive catalase and coagulase test then they are likely

A. Streptococcus pneomoniae
B. Streptococcus pyogenes
C. Escherichia Coli
D. Staphylococcus aureus
E. Staphylococcus epidermidis

A

D. Staphylococcus aureus

69
Q

Antiretroviral drug Abacavir belongs to the class of

A. Non-nucleoside reverse transcriptase inhibitor
B. Integrase inhibitors
C. Protease inhibitor
D. Fusion inhibitors
E. Nucleoside reverse transcriptase inhibitors

A

E. Nucleoside reverse transcriptase inhibitors

70
Q

The drug Famcyclovir is a prodrug that forms acyclovir in the body upon metabolism

A. True
B. False

A

false

71
Q

Which of the following antifungal drugs belong to allylamines?

A. terbinafine
B. micafungin
D. griseofulvin
E. flucytosine

A

A. terbinafine

72
Q

Which of the following enzyme activity is absent in HIV reverse transcriptase?

a. RNA dependent DNA polymerase
b. DNA dependent RNA polymerase
c. RNAse
d. DNA dependent DNA polymerase

A

b. DNA dependent RNA polymerase

73
Q

Which of the following accurately explains the rationale for using a low dose ritonavir with another protease inhibitor in antiretroviral therapy?

a. The low dose ritonavir serves as a pharmacokinetic enhancer raising the blood level of the other protease inhibitor to optimizer treatment success.
b. There is no rationale for using such drugs together as it represents therapeutic duplication.
c. The use of low dose ritonavir helps minimize the risk for seizures in HIV infected patients
d. The combination of two protease inhibitors provides double the efficacy in the management of HIV.

A

a. The low dose ritonavir serves as a pharmacokinetic enhancer raising the blood level of the other protease inhibitor to optimizer treatment success.

74
Q

Which of the following is the most likely infectious agent in ringworm?

a. Ascaric lumbreoides
b. Trichinella spiralis
c. A ringworm
d. A dermatophyte

A

d. A dermatophyte

75
Q

ES is a 68 yo male with a history of copd and hypertension who develops an atypical pneumonia after returning from a retired bankers convention in a resort hotel. The patient is diagnosed with legionella pneumonia. Based upon the diagnosis, which of the following antimicrobials would be most appropriate for this patient (assume he has normal renal and hepatic function)?

a. Moxifloxacin
b. Daptomycin
c. Imipenem
d. Vancomycin

A

a. Moxifloxacin

76
Q

Which of the following is TRUE with regards to the HPV vaccine (Gardasil 9)?

a. The vaccine should be administered to all patients started at one year of age
b. The vaccine is a live vaccine and is contraindicated in immunocompromised patients
c. The vaccine can be administered to both female and male patients
d. The vaccine has no efficacy in preventing HPV inducing anogenital warts

A

c. The vaccine can be administered to both female and male patients

77
Q

Which of the following statements is true regarding the use of Truvada for HIV prevention (PrEP)?

a. Patients should have repeat HIV testing every three months while taking truvada for PrEP
b. Truvada should be taken on a daily basis by the patient to maximize its efficacy
c. Truvada should be used a part of a comprehensive prevention therapy
d. All of the above

A

d. All of the above

78
Q

The HIV protease inhibitors class shows all these characteristics except

a. Have numerous drug drug interactions
b. Have less affinity for human proteases
c. They are non competitive inhibitors of HIV reverse transcriptase
d. Prevent maturation of viral proteins
e. They are peptidomimetic

A

c. They are non competitive inhibitors of HIV reverse transcriptase

79
Q

HIV protease enzyme cleaves its substrates between

a. Cysteine and phenylalanine
b. Proline and glutamate
c. Phenylalanine and aspartate
d. Aspartate and glutamate
e. None of the above

A

e. None of the above (phenylalanine +proline)

80
Q

CK is a 32 yo pregnant female (15 weeks pregnant) who is suffering from walking pneumonia. The patient is going to be treated on an outpatient basis. Which of the following medications would be most appropriate for this patient’s walking pneumonia at this time?

a. Ciprofloxacin
b. Azithromycin
c. Doxycycline
d. Amoxicillin

A

b. Azithromycin

81
Q

The mechanism of action of imidazole antifungals involves:

a. Inhibition of fungal bets (1,3)-glucan synthase
b. Inhibition of fungal DNA synthesis
c. Inhibition of protein synthesis
d. Inhibition of fungal 14-alpha-sterol demethylase

A

d. Inhibition of fungal 14-alpha-sterol demethylase

82
Q

HIV drug Maraviroc mechanism of action is that

a. it inhibits formation of six helix bundle of HIV glycoproteins that are important in fusion
b. it binds to CCR5 and prevents binding of HIV glycoproteins
c. it inhibits HIV reverse transcriptase non competitively
d. it inhibits HIV protease
e. it inhibits HIV reverse transcriptase competitively

A

b. it binds to CCR5 and prevents binding of HIV glycoproteins

83
Q

Ms. Davis is a 42 year old female is in relatively good health who teaches the 3rd grade Lincoln high school . She had one student in her class coughing and sneezing all day the previous Friday. On Tuesday morning Ms. Davis finds out that that the student who was ill is suffering from influenza A. Realizing that she has not received the flu vaccine, Ms. Davis wishes to receive antiviral treatment. What antiviral prophylaxis is recommended for her at this time?

a. No prophylaxis is recommended for Ms. Davis at this time
b. Amantadine 100 mg po daily
c. Zanamivir 2 inhalations daily for 10 days
d. Oseltamavir 75 mg po daily for 10 days

A

a. No prophylaxis is recommended for Ms. Davis at this time

84
Q

What feature if possessed by Streptococcus pneumonia or Hemophilis influenziae, enable these organisms to avoid host defenses and cause pneumonia?
a. Pili
b. Fibriae
c. Capsule
d. Intracellular residence

A

c. Capsule

85
Q

Ms. Burke is a 62 yo male with no significant medical history who comes into your pharmacy for his annual flu shot (inactivated influenza virus vaccine). He returns to your pharmacy the following day and requests to receive the zoster vaccine ( live ) as he has suffered from chicken pox in the past and does not want to get shingles. Which of the following statements is TRUE?

a. He is not a candidate for the zoster vaccine since it can only be administered to patients 65 years of age and older
b. He is not a candidate for the vaccine as he is a immune to varicella since he suffered from chickenpox as a child
c. He can receive the zoster vaccine at this time. There is no interaction with the flu vaccine that he received the previous day.
d. He can receive the zoster vaccine but he must wait at least 4 weeks because he received a vaccine the previous day.

A

c. He can receive the zoster vaccine at this time. There is no interaction with the flu vaccine that he received the previous day.

86
Q

Which of the following individuals would be a good candidate to received flumist (the intranasal, attenuated influenza vaccine)?

a. A 5 month only with no disease or congenital abnormalities
b. A 52 year old paramedic with DM (well controlled)
c. None of above individuals should receive flumist
d. A 27 year old hospital volunteer with no significant medical history

A

c. None of above individuals should receive flumist

87
Q

Non-nucleoside reverse transcriptase inhibitors can inhibit human mitochondrial (gamma) polymerase

a. True
b. False

A

false

88
Q

TJ is a 55 yo patient with diabetes and hypertension who presents to the hospital with fever (102 degrees F), coughing, dyspnea, and shaking chills. A chest x ray is taken and shows a lower lobe consolidation consistent with pneumonia. A sputum sample is taken and the patient is admitted to general medical ward for the treatment of community acquired pneumonia. The patient has no allergies and has normal renal function. Which of the following would be appropriate empiric regimen for this patients pending culture results?

a. Ceftriaxone 1 gram intravenously every 24 hours
b. Ciprofloxacin 400 mg intravenously every 12 hours
c. Azithromycin 500 mg intravenously every 24 hours
d. Moxifloxacin 400 mg intravenously every 24 hours

A

d. Moxifloxacin 400 mg intravenously every 24 hours

89
Q

Which of the following blood tests is an important lab that should be drawn prior to initiating abacavir to assess risk for potentially dangerous adverse drug reaction?

a. HLAB-5701
b. Lactic Acid Level
c. HhbA1C
d. Tropism assay

A

a. HLAB-5701

90
Q

Which of the following patients should NOT receive MMR vaccine?

a. A patient who is 24 weeks pregnant
b. A 32 yo patient receiving chemotherapy
c. A 53 yo IVDU with advanced HIV infection (CD4 count <50)
d. All of the above

A

d. all of the above

91
Q

Which of the following combination drugs does not contain integrase inhibitor?
a. Complera
b. Genvoya
c. Triumeq
d. Stribild

A

a. complera

92
Q

Which of the following statements is false with regards to zanamivir?

a. The drug is effective against both influenza A and influenza B
b. The drug is less effective if therapy is delayed and initiated after the first 48 hours of illness symptom
c. The drug should only be used by inhalation through FDA approved inhalation device that is included in the product packaging
d. The drug can be safely used by patients with COPD and other respiratory conditions

A

d. The drug can be safely used by patients with COPD and other respiratory conditions

93
Q

Which of the following HIV NRTI needs only two phosphorylation steps to inhibit HIV reverse transcriptase?

a. Abacavir
b. Zidovudine
c. Stavudine
d. Tenofovir
e. Lamivudine

A

d. Tenofovir

94
Q

Antiviral amantadine acts primarily by
a. Inhibiting viral neuraminidase
b. Terminating viral DNA chain elongation
c. Inhibiting viral DNA polymerase
d. Blocking M2 proton channel

A

d. Blocking M2 proton channel

95
Q

Which vaccine is indicated to be administered during every pregnancy?

a. MMR
b. Tdap
c. Rotavirus
d. Varicella vaccine

A

b. Tdap

96
Q

What if likely natural host for legionella pneumophila?

a. Fresh water ameba
b. Philadelphia eagles
c. Bellevue Stratford hotel
d. Pulmonary macrophages

A

a. Fresh water ameba

97
Q

A pharmacist should counsel HIV infected patients to take which of the following antivirals with food?

a. Videx eg
b. Complera
c. Atripla
d. Triumeq

A

b. Complera

98
Q

Fungal protein synthesis inhibition is the mechanism of action of this antifungal

a. Tavaborole
b. Nystatin
c. Tolnaflate (this one is inhibiting fungal wall synthesis)
d. Terbinafine
e. Clotrimazole

A

a. Tavaborole

99
Q

An opportunistic systemic fungal infection in AIDS should be treated with

a. Initial triazole followed by flucytosine
b. Initial amphotericin B followed by triazole
c. Initial triazole followed by amphotericin b
d. Initial flucytosine followed by triazole

A

b. Initial amphotericin B followed by triazole

100
Q

What is the common nucleoside NRTI found in Truvada, Atripla and Complera?
a. Efavirenz
b. Tenofovir disoproxil
c. Lamivudine
d. Rilpivirine

A

b. Tenofovir disoproxil