Infectious Diseases Flashcards by Payton Dennis

BJ is on tobramycin IV Q8H for treating a G- infection and his levels are reported as a peak of 8.3 mcg/mL and a trough of 2.5 mcg/mL. Which of the following recommendations should the pharmacist make to the medical team?

a. Increase the dose
b. Decrease the dose
c. Extend the dosing interval
d. Shorten the dosing interval
e. Continue the current regimen

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What are the peak and trough level goals for tobramycin?

Peak: 5-10 mcg/mL
Trough: < 2 mcg/mL

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RS is a 62 y/o male with multiple medical problems including colon cancer, s/p surgical resection of his colon and chemo, who’s now presenting with AKI (SCr has increased from 0.8 to 1.6 mg/dL) and a complicated Pseudomonas bloodstream infection. The medical team would like to use 2 drugs with activity against Pseudomonas until cultures and susceptibilities are available. Allergies include penicillin (angioedema) and simvastatin (hx of rhabdomyolysis). Which of the following regimens represents the best choice?

a. Cefepime + gentamicin
b. Ertapenem + levofloxacin
c. Aztreonam + ciprofloxacin
d. Meropenem + tobramycin
e. Piperacillin-tazobactam + moxifloxacin

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DH is a 42 y/o male being treated with quinupristin/dalfopristin for a complicated VRE and MRSA infection. Which of the following are common toxicities of quinupristin/dalfopristin?

a. Infusion reactions, electrolyte abnormalities, nephrotoxicity
b. Arthralgias/myalgias, nephrotoxicity, neurological disturbances
c. Infusion reactions, arthralgias/myalgias, hyperbilirubinemia
d. Hyperbilirubinemia, neurological disturbances, arthralgias/myalgias
e. Neurological disturbances, nephrotoxicity, infusion reactions

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CP is a 22 y/o female who’s been started on Macrobid for a 5-day treatment course for a UTI. Counseling on Macrobid should include the following points?

a. Don’t take antacids or calcium supplements at the same time as your Macrobid dose.
b. The med should be taken 4x daily in evenly spaced intervals (Q6H).
c. The med may cause the urine to turn dark yellow or brown in color.
d. The med can make the skin more sensitive to the sun. Use sunscreen and protective clothing.
e. This drug should be taken on an empty stomach.

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SV is a 49 y/o female who’s picking up a prescription for levofloxacin for an E coli UTI that’s resistant to nitrofurantoin and Bactrim. Her med hx is significant for dyslipidemia, diabetes, afib, and osteoporosis. She’s currently taking atorvastatin, amiodarone, Januvia, Byetta, metformin, calcium citrate, and vit D. Which of the following can be caused by potential drug interactions in this med regimen?

a. QT prolongation
b. Impaired absorption of levofloxacin
c. Hypoglycemia or hyperglycemia
d. Peripheral edema, fluid retention d/t quinolone addition
e. Additive nephrotoxicity

a, b, c

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TM is a 42 y/o male who’s been started on Biaxin for tx of pneumonia. Which of the following meds does NOT pose a drug interaction with the AB tx?

a. Amiodarone
b. Methadone
c. Simvastatin
d. Sucralfate
e. Voriconazole

Amiodarone - QT prolongation

Methadone - Biaxin causes increased concentrations of methadone; QT prolongation

Simvastatin - contraindicated

Voriconazole - Biaxin can cause increased concentrations of voriconazole; QT prolongation

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A med student on the team caring for a patient with CAP suggests using a “respiratory fluoroquinolone” to treat his infection. Which of the following correctly lists respiratory quinolones and explains why they are called “respiratory quinolones?”

a. Gemifloxacin and moxifloxacin have enhanced G- and anaerobic activity
b. Ciprofloxacin and levofloxacin have superior G+ and anaerobic coverage
c. Levofloxacin and moxifloxacin have superior coverage of S. pneumoniae
d. Ciprofloxacin and levofloxacin have enhanced G+ and anaerobic activity
e. Levofloxacin and moxifloxacin have enhanced G- and atypical coverage

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A patient has a MRSA wound infection. She has HF and impaired renal function with a CrCl of 40 mL/min. Her current meds include Toprol XL, Zestril, and Lasix. She’s going to receive IV vancomycin while in the hospital. Choose the correct statement:

a. Vancomycin shouldn’t be used in patients with HF
b. She should receive the vancomycin orally d/t the risk of further renal insufficiency
c. She’s at an elevated risk of ototoxicity
d. The trough isn’t important; only vancomycin peaks should be monitored
e. She should receive ceftazidime instead of vancomycin

Vancomycin can increase the risk of ototoxicity when used with other ototoxic drugs (aminoglycosides, cisplatin, loop diuretics).

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Which of the following beta-lactam antibiotics can be given by mouth?

a. Zosyn
b. Augmentin
c. Cefazolin
d. Ceftriaxone
e. Penicillin G benzathine
f. Cefdinir
g. Keflex

b, f, g

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Which of the following are potential tx options for a vancomycin resistant Enterococcus faecalis (VRE) surgical site infection s/p C-section?

a. Rifaximin
b. Cubicin
c. Merrem
d. Zyvox
e. Levaquin

b, d

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HW is a 71 y/0 male who’s been in the ICU for several weeks and is now being treated for pneumonia, with a lower respiratory cx positive for Pseudomonas aeruginosa. His weight is 225 lbs and height is 6’0”. His current SCr is 2.4 mg/dL. Based on the culture sensitivities, the med team decides to start tobramycin at 2.5 mg/kg. They ask the pharmacist to write the order and administer the 1st dose at 8:00 AM. Which dose of tobramycin should be administered at 8:00 AM?

a. 560 mg
b. 410 mg
c. 340 mg
d. 220 mg
e. 100 mg

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Choose the correct statement concerning azithromycin:

a. It has drug interactions similar to clarithromycin
b. It leaves a metallic taste in the mouth
c. It binds to the 50S ribosomal subunit
d. It binds to penicillin-binding proteins
e. It can be used if an allergy is noted to erythromycin

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What is the IV:PO ratio for metronidazole?

1:1

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Which of the following statements is correct regarding nafcillin?

a. Nafcillin is active against MRSA
b. Nafcillin is a vesicant
c. Nafcillin should be dose adjusted in renal impairment
d. Nafcillin is compatible with NS only
e. Nafcillin can’t be used in a sulfa allergic patient

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Extended infusion piperacillin-tazobactam is a dosing strategy that optimizes which of the following pharmacodynamic parameters?

a. Peak:MIC ratio
b. AUC:MIC ratio
c. Peak concentration
d. Time above MIC (T > MIC)
e. Minimum bactericidal concentration

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Which of the following meds should be avoided in children < 8 y/o d/t discoloration of teeth and bone growth retardation?

a. Televancin
b. Minocycline
c. Telithromycin
d. Tinidazole
e. Rifaximin

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A patient with MDR Pseudomonas aeruginosa isolated from the urine cx is admitted to the hospital. The physician would like to avoid using a med that can worsen kidney function as the patient’s SCr has increased from 0.7 to 1.4 over the past week. Which of the following drugs would you recommend?

a. Clindamycin
b. Cetriaxone
c. Ceftolozane/tazobactam
d. Oritavancin
e. Tobramycin

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A patient with an extensive hx of alcohol abuse comes into the hospital with classic signs and symptoms of an infection. Which of the following ABs presents a safety issue in light of his social hx?

a. Cefuroxime
b. Cefotaxime
c. Cefotetan
d. Cefprozil
e. Cefaclor

Cefotetan contains a side chain that can increase the risk of bleeding and can cause a disulfiram-like reaction with alcohol ingestion.

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SN is prescribed Avelox for a CAP infection. What is the MOA for Avelox?

a. Binds to penicillin binding proteins to inhibit cell wall synthesis
b. Binds to the 30S ribosomal subunit, inhibiting protein synthesis
c. Inhibits DNA topoisomerase IV, thereby blocking DNA gyrase
d. Inhibits synthesis of Beta (1,3)-D-glucan
e. Binds to the 50S ribosomal subunit, inhibiting protein synthesis

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Which of the following statements are correct regarding the use of Bactrim for toxoplasmosis prophylaxis?

a. It should be taken with 8 oz of water
b. It shouldn’t be used for toxoplasmosis prophylaxis
c. It can increase the risk of sunburn
d. It can cause a serious rash requiring immediate medical attention
e. It shouldn’t be used if the patient has a sulfa allergy

a, c, d, e

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A physician asks the pharmacist about a single-dose medication for bacterial skin and skin structure infections that he heard about. Which drug is he referring to?

a. Vancomycin
b. Televancin
c. Oritavancin
d. Tedizolid
e. Polymixin

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RF is a 58 y/o male who’s in the MICU with a severe Pseudomonas aeruginosa lung infection. He’s on ciprofloxacin and cefepime, and his infection doesn’t seem to be clearing. Which of the following meds could be used to cover the same pathogen in place of the current therapy?

a. Meropenem
b. Invanz
c. Zyvox
d. Minoglycine
e. Tygacil

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All the carbapenems, except ______, cover Pseudomonas aeruginosa.

ertapenem (Invanz)

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Which of the following groups of pathogens best represents clindamycin's spectrum of activity? a. Atypicals and anaerobic pathogens b. MDR G- pathogens (Acinetobacter, Pseudomonas) and skin flora (Streptococci, Staphylococci) c. Enteric G- pathogens and anaerobic pathogens d. Parasitic and fungal pathogens e. Aerobic (Streptococci, Staphylococci) and anaerobic G+ pathogens

MB is a 51 y/o female who has been prescribed Biaxin for pneumonia. She had a heart attack 2 years ago. During hospitalization, she was found to have afib and was placed on warfarin. Her other meds include: simvastatin, citalopram, atenolol, and fish oil. The use of Biaxin in this patients increases her risk of: a. QT prolongation b. Hepatotoxicity c. Myopathy d. Tachycardia e. VTE

a, b, c

Which of the following statements are correct with regard to Bactrim? a. It's a potent hepatic enzyme inducer resulting in reduced drug concentrations b. It has excellent bioavailability, thus can transition from IV to PO formulations in a 1:1 fashion c. It's active against G+ pathogens, including Staphylococci, G- pathogens, and opportunistic pathogens d. It should be avoided in a patient with G6PD deficiency e. A negative Coombs test with Bactrim indicated hemolytic anemia

b, c, d

An otherwise healthy patient presents with a foot infection that developed 1 week after stepping on a child's toy. The wound cx is growing G+ and G- bacteria; Pseudomonas isn't suspected. The physician would like to use a cephalosporin for tx of the patient's infection. Which of the following statements regarding cephalosporins is correct? a. Cefazolin is an oral cephalosporin that's considered to be the most effective therapy for mild-mod G- foot infections. b. Cefixime is the only oral cephalosporin with G- and enteric anaerobic coverage. c. Cephalexin is an oral, 2nd generation cephalosporin with sufficient G- and G+ coverage for moderate severity foot infections. d. Cefuroxime is an oral, 2nd generation cephalosporin with adequate G- and G+ coverage for mild-mod foot infections. e. Cefpodoxime is an IV, 3rd generation cephalosporin with adequate G+ and G- coverage for severe foot infections.

A patient is receiving Bactrim DS therapy. Which of the following strengths and ingredients are in Bactrim DS tablets? a. 800 mg SMX and 160 mg TMP b. 160 SMX and 800 TMP c. 80 mg SMX and 16 mg TMP d. 400 mg SMX and 80 mg TMP e. 100 mg SMX and 50 mg TMP

Which of the following agents are associated with ototoxicity? a. Ethambutol and rifampin b. Nitrofurantoin and vancomycin c. Gentamicin and vancomycin d. Penicillin and ciprofloxacin e. Daptomycin and gentamicin

Azithromycin is commonly used in the tx of all of the following EXCEPT: a. Chlamydia b. Mycoplasma pneumoniae c. Mycobacterium avium complex d. Toxoplasmosis e. Travelers' diarrhea

A pharmacy intern is giving a presentation on AB therapy for G+ infections. She will discuss common uses for penicillins. Which drug is INCORRECTLY paired with a common use? a. Bicillin C-R for syphilis b. Oxacillin for MSSA bacteremia c. Amoxicillin/clavulanate for otitis media d. Amoxicillin for endocarditis prophylaxis e. Penicillin V potassium for strep throat

a Penicillin G benzathine (Bicillin L-A) 2.4 million units IM is used for syphilis. It can be fatal if given IV instead of IM.

NA is a 42 y/o female who was a victim of a house fire. She acquired 3rd degree burns requiring skin grafting. Unfortunately, her course has been complicated by post-op Acinetobacter wound infection and AKI. She has no known drug allergies. Which of the following ABs would be considered 1st line in her case as a single agent? a. Vancomycin b. Meropenem c. Ampicillin d. Fosfomycin e. Linezolid

b Meropenem is the DOC for treating Acinetobacter

Which one of the following agents does not cover Pseudomonas aeruginosa? a. Avycaz b. Colistimethate c. Zyvox d. Cipro e. Ceftazidime

A prescription for generic minocycline is filled. Which of the following statements regarding minocycline are correct? a. This med has been associated with drug-induced lupus b. Take on an empty stomach 1 hour before or 2 hours after meals c. This med may increase the risk of sunburn d. This med should be separated when given with antacids e. This med doesn't interact with other meds

a, c, d

Choose the correct statements concerning vancomycin PD/PK and therapeutic drug monitoring. a. Vancomycin exhibits time-dependent killing b. Targeting an AUC/MIC ratio of 400-600 is recommended for serious MRSA infections c. Alternative agents should be considered if vancomycin MIC >/= 2 mcg/mL d. A 1500 mg dose should be infused over 30 minutes e. Vancomycin troughs should be drawn at steady state (generally before the 4th dose)

b, c, e

Hospitalized patients with MRSA SSTIs are often treated with IV therapy and transitioned to an oral agent to allow the ease of use and discharge from the hospital. Which AB requires a D-test to be performed prior to use for MRSA SSTIs? a. Bactrim b. Clindamycin c. Minocycline d. Linezolid e. Delafloxacin

b An induction test (D-test) should be performed on S. aureus that's susceptible to clindamycin but resistant to erythromycin.

JR has been in the ICU for the past 2 weeks. He was initially admitted for an asthma exacerbation requiring mechanical ventilation, and a central line was placed to assist with the administration of IV meds. On day 15, he develops a fever, and his white count rises up to 14,000. A chest x-ray doesn't identify any infectious etiology. Blood Cxs are positive for E. faecium, which is VRE. Which of the following ABs are appropriate to treat vancomycin-resistant E. faecium bacteremia? a. Cubicin b. Vancocin c. Macrobid d. Invanz e. Avelox

a Cubicin (daptomycin)

All of the following agents have excellent bioavailability suitable for a 1:1 IV to PO conversion EXCEPT: a. Zyvox b. Flagyl c. Avelox d. Vancocin e. Vibramycin

CN has been receiving IV gentamicin for the last 10 days. Which of the following are side effects associated with gentamicin? a. Cardiotoxicity b. Neurotoxicity c. Pulmonary toxicity d. Nephrotoxicity e. Ototoxicity

b, d, e

Which of the following can interfere with coagulation lab assays? a. Bactrim b. Daptomycin c. Linezolid d. Oritavancin e. Televancin

b, d, e

A hospitalized patient with no known drug allergies has cellulitis, and the physician ordered vancomycin 1,000 mg IV Q12H and imipenem-cilastatin 1,000 mg IV Q8H. The meds were administered at the same time over 30 minutes. During the infusion, the patient experienced a profound drop in BP. Her upper body, mostly in the trunk area, was covered with an erythematous rash. What is the likely cause of the patient's symptoms? a. Rhabdomyolysis b. Vancomycin flushing reaction c. Drug-induced lupus erythematous d. CYP2C9 drug interaction e. Photosensitivity reaction

b Infusion reaction due to a rapid administration of vancomycin. Symptoms include rash, pruritus, erythema, and less frequently, hypotension or angioedema. Infusions should be limited to no more than 1 g per hour.

Which of the following statements is correct regarding piperacillin/tazobactam? a. Tazobactam is added to inhibit beta-lactamase activity b. The brand name is Zofran c. It exhibits concentration-dependent killing d. The dosing is 0.375 g/3 g of piperacillin/tazobactam, respectively e. It's available as an oral suspension and IV formulation

Which group of agents cover atypical pathogens? a. Levaquin, doxycycline, Augmentin b. Flagyl, erythromycin, Ceftin c. Bactrim, Keflex, Amoxil d. Cefdinir, Cipro, Biaxin e. Doxycycline, Zithrmoax, Avelox

Which of the following statements is correct regarding linezolid? a. Linezolid is associated with bone marrow suppression b. Linezolid covers MRSA but not VRE c. Linezolid should be dose adjusted in renal impairment d. Linezolid is a strong CYP1A2 inhibitor e. Linezolid is associated with hemolytic anemia in patients with G6PD deficiency\

MP presents to the urgent care clinic with a large cellulitis wound on his left lower extremity. The patient has a hx of MRSA infection 2 months prior, and the practitioner wants to prescribe something orally that covers MRSA. Which of the following meds fit this description? a. Tygacil b. Zyvox c. Cubicin d. Quinupristin/Dalfopristin e. Televancin

b The other meds are only available IV.

Which of the following statements is correct regarding the appropriate use of metronidazole? a. Side effects include a metallic taste in the mouth b. The IV:PO dosing ratio is 0.5:1 c. Metronidazole is an azole antifungal agent d. Metronidazole is available in IV and PO formulations only e. Alcohol shouldn't be consumed for 7 days after the last dose

a Amebicide, antiprotozoal antibiotic Topical and vaginal formulations are also available. Alcohol should be avoided during therapy and 3 days after the last dose to avoid flushing, abdominal cramping, and N/V.

Which of the following statements has a risk for additive QT prolongation when combined with amiodarone? a. Zithromax b. Penicillin V potassium c. Invanz d. Nitrofurantoin e. Cleocin

Choose the correct statement that best describes the activity of cefuroxime: a. 1st gen - better G+ (covers MSSA) than G- activity b. 2nd gen - better G- activity compared to 1st gen with similar G+ activity c. 3rd gen - better G- activity than 2nd gen, less Staph (G+) activity compared to 2nd gen but better Strep (G+) activity d. 4th gen - excellent G- activity; G+ activity that's similar to 1st gen e. 5th gen - best G+ activity (covers MRSA), G- activity similar to ceftriaxone

1st generation cephalosporins

cefazolin, cephalexin

2nd generation cephalosporins

cefuroxime, cefotetan, cefaclor, cefoxitin, cefprozil

3rd generation cephalosporins (Group 1)

cefdinir, ceftriaxone, cefotaxime, cefixime

4th generation cephalosporins

cefepime

3rd generation cephalosporins (Group 4)

ceftazidime (Fortaz)

5th generation cephalosporins

ceftaroline (Teflaro)

JP has a blood cx report showing G+ cocci resembling Streptococci, Klebsiella pneumoniae, and anaerobes. Which of the following meds would provide adequate coverage for these organisms? a. Ertapenem b. Rifaximin c. Metronidazole d. Fosfomycin e. Ciprofloxacin

a Rifaximin, metronidazole, and fosfomycin have a narrower spectrum. Ciprofloxacin doesn't have reliable strep coverage, nor does it cover anaerobes.

Which of the following oral AB suspensions require refrigeration after reconstitution? a. Biaxin b. Augmentin c. Keflex d. Cefdinir e. Penicillin VK

b, c, e

RM is a 63 y/o female who comes to the pharmacy with a new prescription for linezolid 600 mg PO Q12H x 7 days for a complicated skin infection that occurred after an abdominal hysterectomy. She takes calcium carbonate, metoprolol succinate, lisinopril, venlafaxine, hydrocodone/acetaminophen PRN post-op pain, and ibuprofen PRN back pain. The patient is at risk of a DDI between the new med and which of her current meds?

Venlafaxine Increased risk of serotonin syndrome

The Gram stain of a patient's blood cx reveals G+ cocci in chains. Which organisms is consistent with this observation? a. H. influenzae b. Pseudomonas aeruginosa c. Acinetobacter baumannii d. Staph aureus e. Strep pyogenes

What drugs cover Pseudomonas aeruginosa?

1. Zosyn 2. Cefepime 3. Ceftazidime 4. Ceftazidime/avibactam 5. Ceftolozane/tazobactam 6. Carbapenems (except ertapenem) 7. Ciprofloxacin, levofloxacin 8. Aminoglycosides 9. Aztreonam 10. Colistimethate, polymyxin B

A patient is being transitioned from ciprofloxacin IV to ciprofloxacin PO suspension. All of the following statements regarding ciprofloxacin PO suspension are correct EXCEPT: a. This agent may prolong the QT interval b. The patient's blood sugar may be affected c. This med should only be given through a feeding tube d. This agent can cause peripheral neuropathies e. This med should be shaken prior to use

Of the following PO suspension ABs, which one should not be refrigerated? a. Augmentin b. Pen VK c. Ceftin d. Keflex e. Omnicef

Which quinolone AB is preferred for tx of MRSA SSTIs? a. Delafloxacin b. Ciprofloxacin c. Levofloxacin d. Moxifloxacin e. Gemifloxacin

a Other quinolones should be avoided d/t higher rates of resistance.

Which ABs have activity against MRSA?

1. Bactim 2. Doxycycline, minocycline 3. Clindamycin 4. Linezolid, tedizolid 5. Vancomycin 6. Daptomycin 7. Ceftaroline 8. Televancin, Oritavancin, Dalbavancin 9. Quinupristin/Dalfopristin 10. Tigecycline

A 23 y/o sexually active male visits his PCP concerned about multiple soft, nonpainful, mildly pruritic, skin-colored papules that have developed on the shaft of his penis. He's diagnosed with genital warts. What tx is recommended? a. Clindamycin PO b. Imiquimod cream c. Metronidazole gel d. Mupirocin ointment e. Tinidazole PO

b Oral clindamycin and metronidazole gel --> bacterial vaginosis in females Mupirocin ointment --> impetigo Tinidazole --> alternative for bacterial vaginosis and trichomoniasis

A 36 y/o male was newly diagnosed with active pulmonary TB 2 months ago. He's completed an initial 8 weeks of tx with isoniazid, rifampin, pyrazinamide, and ethambutol and is now being evaluated at a follow-up visit. His baseline sputum cx results at the time of dx showed no evidence of drug resistance. The patient has tolerated the current 4-drug regimen, and his baseline symptoms of fever, cough, and night sweats have resolved. Which of the following represents an appropriate tx plan for this patient? a. Continue current tx for an additional 4 months b. Continue ethambutol and pyrazinamide for 7 months c. Continue isoniazid and rifampin for 4 months d. Continue isoniazid monotherapy for 7 months e. D/c all antimicrobials at this time

A 78 y/o female is admitted to the hospital after a fall. She's scheduled to undergo total hip arthroplasty for a fractured femur and will receive cefazolin for surgical site infection prophylaxis. What is the recommended timing of the 1st dose of cefazolin for this procedure? a. 1 hour before the 1st incision b. 1 hour after the 1st incision c. 2 hours before the 1st incision d. 2 hours after the 1st incision e. 4 hours before the 1st incision

A patient with newly diagnosed latent TB comes to the pharmacy with a prescription for rifampin 600 mg daily x 4 months. Which of the following drug safety issues should the pharmacist mention when counseling about this med? a. Acute gouty attacks b. Drug interactions c. Liver damage d. Orange-red body fluid discoloration e. Vision damage

b, c, d

A 44 y/o male is evaluated after he was exposed to an individual with active pulmonary TB. He is asymptomatic and has no hx of bacille Calmette-Guérin vaccination. Which of the following diagnostic test results would be expected in a patient with latent TB? a. Abnormal chest x-ray b. Normal chest x-ray c. Positive acid-fast bacilli sputum smear d. Positive interferon-gamma release assay blood test e. Positive intradermal tuberculin skin test reaction

b, d, e

A previously health 7 month old child (weight: 20 lbs) is prescribed Augmentin for acute otitis media. The pharmacist will prepare a suspension containing 400 mg of amoxicillin and 57 mg of clavulanate per 5 mL. Which volume and frequency would provide the correct dose for this indication? a. 2.5 mL BID b. 5 mL BID c. 7.5 mL BID d. 10 mL BID e. 15 mL once daily

TT, a 54 y/o female with severe colitis secondary to UC is being prepared for an elective partial colectomy. She has NKDA. Which of the following pre-op AB regimens provide an appropriate spectrum of activity to prevent a surgical site infection following this procedure? a. Ampicillin/sulbactam b. Cefazolin c. Cefazolin + metronidazole d. Cefoxitin e. Clindamycin

a, c, d

SD is a 48 y/o female preparing to start Humira for RA. Required pre-tx screening for latent TB reveals a positive interferon-gamma release assay. A chest x-ray is negative, and the patient reports no signs or symptoms of active pulmonary TB. Which tx should this patient initiate before starting Humira? a. Isoniazid monotherapy daily x 3 months b. Isoniazid + rifampin daily x 3 months c. Isoniazid + rifapentine weekly x 9 months d. Rifampin monotherapy daily x 9 months e. Rifampin + pyrazinamide weekly x 3 months

A 24 y/o female comes to the pharmacy health clinic with symptoms of nasal congestion, runny nose, and a feeling of pressure in her face for the past 5 days. The nasal drainage is described as yellow and thin. The pt has no fever, cough, SOB, sore throat, myalgia, or HA. She's been using OTC decongestants but is asking for an AB to accelerate resolution of her symptoms. Which of the following treatments is recommended for this pt at this time? a. Amoxicillin b. Azithromycin c. Cefdinir d. Doxycycline e. Symptomatic relief only

DP is a 49 y/o male who visits his dentist for severe tooth pain. After exam, the dentist informs him that he needs a tooth extraction. Which AB tx is preferred in this pt prior to the procedure? a. Amoxicillin 2 g PO once b. Ampicillin 500 mg IM once c. Azithromycin 1,200 mg PO once d. Clindamycin 600 mg PO once e. ABs are not indicated

A 22 month old male is brought to the office d/t a fever of 102.6 F, irritability, and tugging of his right ear for the past 2 days. The pt is diagnosed with a 1st occurrence of AOM. He has NKDA. Which tx is appropriate for this pt at this time? a. Amoxicillin b. Cephalexin c. Doxycycline d. Observation for 48-72 hours without ABs e. Penicillin V potassium

TM is a 32 y/o male who comes to his PCP with symptoms of thick, yellow-green nasal discharge, nasal "stuffiness," and a feeling of pressure in his face and ears. He also describes more frequent HAs. The pt initially thought he had a cold and self-treated with OTC meds, but his condition worsened and has persisted for ~12 days. TM has NKDA. A decision is made to prescribe ABs. Which of the following is a 1st line tx for TM's condition? a. Amoxicillin/clavulanate b. Clarithromycin c. Clindamycin d. Levofloxacin e. SMX/TMP

A 14 day old female infant (delivered at term) is brought to the ED d/t a high fever. She's lethargic, flushed, and difficult to rouse. The parents report that the infant vomited after a feeding ~6 hours ago and has been too drowsy to attempt feeding since. In the ED, a physical exam is concerning for meningitis; lab tests and an LP are pending. Which empiric AB regimen should be initiated? a. Ampicillin + cefotaxime b. Ampicillin + ceftriaxone c. Cefotaxime + gentamicin d. Ceftriaxone + vancomycin e. Meropenem + vancomycin

A 54 y/o male is diagnosed with active pulmonary TB and hospitalized in the internal medicine unit. Which of the following strategies are recommended to prevent transmission of TB? a. Isolate the pt in a negative pressure room b. Isolate the pt in a positive pressure room c. Place the pt in a single-occupancy room d. Wear a fitted N95 respirator mask when inside the pt's room e. Wear a gown when inside the pt's room

a, c, d

Empiric ABs and steroids have been ordered for a 45 y/o pt with suspected community-acquired bacterial meningitis. Cultures and an LP are pending. If ABs are expected to be administered at 1400, which of the following is correct regarding the selection and timing of steroids in this pt? a. Dexamethasone, administer at 1400 b. Dexamethasone, administer at 1500 c. Prednisone, administer at 1400 d. Prednisone, administer at 1500 e. Steroids are not indicated for bacterial meningitis

JV is a 46 y/o male who comes to the hospital with cough, blood-tinged sputum, night sweats, and unintentional weight loss of 15 lbs over the past 2 months. A chest x-ray shows a cavitation in the right upper lobe, and Mycobacterium tuberculosis is identified on an induced sputum cx. Which combo drug regimen is the preferred initial therapy for this pt? a. Bedaquiline, moxifloxacin, and streptomycin b. Ethambutol and pyrazinamide c. Isoniazid, ethambutol, pyrazinamide, and rifampin d. Isoniazid, ethambutol, pyrimethamine, and rifampin e. Isoniazid, pyridoxine, and rifampin

A 36 y/o female (weight: 60 kg, height: 62 inches) visits her gyno for an annual exam. She has no concerning symptoms but mentions having different sexual partners in the last year. Screening tests are positive for Neisseria gonorrhoeae and negative for Chlamydia trachomatis. The pt has NKDA. Which tx is most appropriate? a. Azithromycin 1 g PO x 1 dose b. Ceftriaxone 500 mg IM x 1 dose c. Clindamycin 450 mg PO TID x 7 days d. Doxycycline 100 mg PO BID x 7 days e. Metronidazole 2 g PO x 1 dose

A 25 y/o female comes to the urgent care clinic with a dry, irritable cough. She reports that her illness started 12 days ago with fatigue, runny nose, and a dry cough. Although her other symptoms have improved, the cough has worsened, becoming "hacking" in nature and more frequent, with some episodes lasting 1-2 minutes. While examining the pt, the physician notes an inspiratory "whoop" after the cough. A sputum PCR is positive for Bordetella pertussis. The pt has an allergy to sulfa (hives). Which tx is preferred? a. Azithromycin b. Clindamycin c. Linezolid d. SMX/TMP e. Symptomatic tx only

GR is a 72 y/o female with a PMH of T2DM, CKD, HTN, and dyslipidemia. She was admitted to the hospital 4 days ago with hyperosmolar hyperglycemic state, resulting from several missed days of insulin. Today, she developed new-onset SOB, fever, and an elevated WBC count. A chest x-ray reveals consolidations in the left lower lobe. She has not received IV ABs in the past 90 days, and a MRSA nasal swab is negative. Which of the following ABs, when used as monotherapy, provide the desired spectrum of activity for this infection? a. Aztreonam b. Cefepime c. Ceftriaxone d. Piperacillin/tazobactam e. Tobramycin

b, d

A 5 y/o girl is evaluated for a new-onset rash. 4 days ago, a few small "bumps" appeared around the corners of the pt's mouth, which soon developed into "blisters" that burst to form thick honey-colored crusts. The rash is mildly itchy and is spreading quickly, with multiple lesions now evident around the mouth, cheeks, and nose. Vital signs are normal. Which of the following is the most appropriate tx for this condition? a. Oral amoxicillin b. Oral cephalexin c. Topical docosanol d. Topical hydrocortisone e. Warm compresses only

b Impetigo

Which of the following describes a pt with AOM who meets criteria for initial management with 48-72 hours of observation? a. 5 months old, unilateral infection, max temp 101 F b. 12 months old, unilateral infection, max temp 101 F c. 18 months old, bilateral infection, max temp 102.6 F d. 3 years old, bilateral infection, max temp 101 F e. 4 years old, unilateral infection, max temp 102.6 F

b, d Try observation for 2-3 days if symptoms are non-severe (otalgia < 48 hrs, no otorrhea, temp < 102.2 F) and: - Age 6-23 months: Symptoms in 1 ear only - Age >/= 2 years: Symptoms in 1 or both ears

KH, a 24 y/o male who's sexually active with multiple men, comes to the office for a routine annual physical exam. His records indicate he's received all necessary vaccines, including the HPV vaccine series. Routine screening for HIV, hep C, and syphilis are negative. Urethral and rectal swabs sent for nucleic acid amplification testing are positive for Chlamydia trachomatis and negative for Neisseria gonorrhoeae. Which tx is recommended for this pt? a. Ceftriaxone 500 mg IM x 1 dose b. Clindamycin 300 mg PO BID x 7 days c. Doxycycline 100 mg PO BID x 7 days d. Erythromycin 500 mg PO QID x 7 days e. Metronidazole 2 g PO x 1 dose

c Non-pregnant: Doxycycline 100 mg BID x 7 days Pregnant: Azithromycin 1 g PO x 1 dose

BT is a 28 y/o female with a 2-day hx of increased urinary frequency and burning with urination. She has suprapubic tenderness but no flank pain. Her vital signs are normal. A UA is positive for WBCs, leukocyte esterase, and nitrites, and a urine cx is pending. BT has a hx of E. coli UTIs, the last of which was treated 2 months ago with SMX/TMP. She has NKDA. Which AB is the best choice to empirically treat the infection while awaiting cx results? a. Amoxicillin b. Bactrim DS c. Fosfomycin d. Metronidazole e. Zithromax

c Bactrim DS has a lower threshold for resistance compared to other 1st line acute cystitis treatments and should not be selected if it's been used within the past 3 months.

A pt comes to the pharmacy reporting new-onset blurred vision that began within the past week. According to his pharmacy profile, the following meds were dispensed recently: Dolutegravir 50 mg 1 tab PO BID Emtricitabine 200 mg/TDF 300 mg 1 tab PO QD SMX/TMP 400 mg/80 mg 1 tab PO QD Pyrazinamide 500 mg 4 tabs PO QD Ethambutol 400 mg 4 tabs PO QD Rifampin 600 mg 2 caps PO QD Isoniazid 300 mg 1 tab PO QD Doxycycline monohydrate 100 mg 1 tab PO BID Which AB is most likely responsible for the pt's symptoms?

Ethambutol

A 31 y/o pregnant female comes to the obstetrician office d/t yellow-green, frothy vaginal discharge that has a foul odor. Other symptoms include pain with urination and during sexual intercourse. Vaginal swabs are positive for Trichomonas vaginalis and negative for Chlamydia trachomatis and Neisseria gonorrhoeae. Which tx is recommended for this pt? a. Azithromycin 2000 mg PO x 1 dose b. Ceftriaxone 1000 mg IM x 1 dose c. Clindamycin 100 mg intravaginally x 3 days d. Metronidazole 0.75% intravaginally x 5 days e. Metronidazole 500 mg PO BID x 7 days

GT is a 68 y/o male who seeks medical care for a painful bump on the back of his neck. A PE shows a 2.5 cm tender red nodule with an overlying pustule and emerging hair, which is determined to be a furuncle. The pt's vital signs are BP 125/80, HR 85, RR 16, and T 101 F. In addition to I&D, which empiric AB is appropriate for this condition? a. Amoxicillin b. Cefpodoxime c. Moxifloxacin d. Penicillin V potassium e. SMX/TMP

e SMX/TMP DS 1-2 tabs PO BID Doxycycline 100 mg PO BID

A 57 y/o male comes to his PCP d/t a painless ulcer on his penis that he first noticed 5 days ago. The pt has no hx of STIs but has been sexually active with multiple partners while using condoms inconsistently in the past 12 months. PE confirms the presence of a 2 cm penile chancre and mild swelling of the lymph nodes in the groin but is otherwise unremarkable. A rapid plasma reagin and treponemal test are positive. The pt has NKDA. What is the most appropriate tx for this pt? a. Azithromycin 1 g PO once b. Ceftriaxone 500 mg IM once c. Doxycycline 100 mg PO BID x 7 days d. Penicillin G aqueous 3 million units IV Q4H x 10 days e. Penicillin G benzathine 2.4 million units IM once

Med orders for active pulmonary TB are sent to the pharmacy for a 27 y/o female. While processing the orders, the pharmacist receives an alert, warning of a drug interaction between rifampin and an existing med previously prescribed to this pt. Which of the following meds would prompt an alert? a. Allopurinol b. Apixaban c. Chlorthalidone d. Methotrexate e. Ramipril

b Some notable interactions include: Protease inhibitors, warfarin, oral contraceptives Do not use rifampin with apixaban, rivaroxaban, or dabigatran

BC is a 54 y/o male who comes to the clinic for a routine physical. During the visit, the pt mentions that he's scheduled for a root canal with his dentist tomorrow. He has an allergy to ampicillin (anaphylaxis). a. Amoxicillin 2 g b. Cephalexin 2 g c. Clindamycin 600 mg d. Doxycycline 100 mg e. Vancomycin 125 mg

d 1st line: Amoxicillin 2 g PO If able to take PO meds but allergic to penicillin: - Azithromycin or clarithromycin 500 mg or - Doxycycline 100 mg

A 52 y/o male develops chills, a fever of 101 F, and an elevated WBC count of 14,200. Blood cultures are positive for Enterococcus faecalis, and an ECG shows a mitral valve vegetation. The pt is receiving high-dose penicillin G and gentamicin. Which of the following best describes why this combo of ABs is being used to treat the infection? a. To broaden the spectrum of activity b. To enhance the intracellular drug penetration c. To inhibit the efflux of ABs out of the cell d. To prevent AB inactivation by a bacterial enzyme e. To reduce urinary excretion of active metabolites

MR is a 55 y/o female who comes to the ER with RUQ abdominal pain, a temp of 102.9 F, chills, and jaundiced skin. She has a PMH of HTN, obesity, and hypertriglyceridemia. Notable lab findings include an elevated WBC count and hyperbilirubinemia. A RUQ ultrasound reveals common bile duct dilation and multiple gallbladder stones. The pt is diagnosed with acute cholangitis. Med orders for IV fluids and broad-spectrum ABs are sent to the pharmacy. The pt has NKDA. Which AB regimen is the best option to empirically treat this pt's infection? a. Ceftriaxone + metronidazole b. Clindamycin c. Levofloxacin d. SMX/TMP e. Tobramycin

Which of the following is a boxed warning for ketoconazole? a. Increase risk of causing HF b. Severe hepatotoxicity c. Antabuse-like reaction when taken with alcohol d. Increased risk of death in elderly patients e. Risk of hypoglycemia

Which of the following is the most appropriate tx for postherpetic neuralgia? a. Shingrix b. Acetaminophen c. Zoloft d. Keppra e. Lidoderm patch

Which of the following is the MOA of Diflucan? a. It binds to ergoterol in the cell membrane altering cell membrane permeability b. It interferes with fungal RNA and protein synthesis c. It inhibits the synthesis of beta (1,3)-D-glucan d. It decreases ergosterol synthesis and cell membrane formation e. It interferes with microtubule formation by binding tubulin

Which of the following counseling points are correct for Vfend? a. Take with meals, preferably breakfast and dinner b. It can cause lymphoma with prolonged use c. It can cause visual changes; care is advised when driving and driving at night should be avoided d. It can damage the liver and LFTs may need to be monitored e. It's associated with many drug interactions

c, d, e Voriconazole is taken on an empty stomach 1 hour before or 1 hour after meals.

DS has just received a prescription for baloxavir marboxil (Xofluza). He has been feeling incredibly weak from the flu or the past 24 hours. DS has asthma and has been wheezing since he became ill. How many days will the pt need to take this medication? a. 3 days b. 1 day c. 10 days d. 5 days e. Antiviral tx isn't appropriate

b Xofluza is a one-time dose for the flu that's given within 48 hours of symptoms onset

Choose the correct MOA for oseltamivir: a. Binds to the ribosomal unit in viral RNA b. Stimulates phagocytosis c. Inhibits neuraminidase d. Prevents viral shredding e. Inhibits hemagglutinin

GP is receiving ampho B deoxycholate for the tx of mucormycosis. Which of the following side effects are most likely to occur with tx? a. Hyponatremia, hypocalcemia, hypokalemia b. Hyponatremia, hypokalemia, chest tightness c. Hypocalcemia, hyperkalemia, leukopenia d. Hypomagnesemia, hypokalemia, rigors e. Hyperkalemia, hypermagnesemia, hypotension

A pt is being discharged from the hospital. The pt was getting fluconazole 400 mg IV daily for the tx of his fungal infection. The physician would like to continue with PO fluconazole therapy. What is the equivalent PO dose? a. 800 mg b. 600 mg c. 400 mg d. 200 mg e. 100 mg

c The fluconazole IV to PO ratio is 1:1

Antiviral agents active against CMV include which of the following: a. Valganciclovir, valacyclovir, acyclovir b. Atazanavir, valganciclovir, foscarnet c. Foscarnet, acyclovir, cidofovir d. Valganciclovir, foscarnet, cidofovir e. Acyclovir, valacyclovir, ganciclovir

A 20 y/o male with HIV/AIDs is admitted to the medicine floor. An esophageal culture is performed and reveals germ-tube positive yeast which is identified as Candida albicans. The team wishes to avoid sending him home with an IV line and asks if there's an acceptable agent to treat Candida albicans that's available in both IV and PO forms. Which agent could be recommended? a. Flucytosine b. Micafungin c. Nystatin d. Terbinafine e. Fluconazole

e -Fluconazole is the DOC for esophageal candidiasis -Micafungin has activity against Candida albicans, but is only available in injectable form

Which azole antifungal requires an acidic environment for absorption? a. Fluconazole b. Voriconazole c. Ketoconazole d. Isavuconazonium e. Posaconazole

c If a PPI or H2RA must be used while on ketoconazole, taking an acidic beverage (such as non-diet soda) can improve absorption by providing an acidic environment

A 59 y/o male is admitted to the hospital with a CrCl of 35 mL/min and a fungal infection. Which of the following antifungal meds would require a dose adjustment? a. Ketoconazole b. Voriconazole c. Clotrimazole d. Fluconazole e. Isavuconazonium

d Fluconazole is the only azole that requires renal dose adjustment

All of the following statements regarding ampho B are correct EXCEPT: a. Doses of conventional ampo B >/= 1.5 mg/kg/day can cause cardiopulmonary arrest b. It's a fungicidal agent with broad antifungal spectrum of activity c. Lipid forms have a greater risk for nephrotoxicity than conventional forms d. The conventional form require premedication to reduce infusion-related reactions e. All forms can cause hypomagnesemia and hypokalemia

A healthy 23 y/o woman presents to her OBGYN office complaining of a vaginal yeast infection. The pt prefers a PO tx option. Which of the following is the most appropriate PO tx of her yeast infection? a. 1 time dose of fluconazole b. Flucytosine x 7 days c. Nystatin x 3 days d. 1 time dose of terbinafine e. Clotimazole x 7 days

a The pt prefers a PO med regimen to treat her vaginal candidiasis. A 1 time dose of fluconazole 150 mg orally is an appropriate option.

An 85 y/o man is hospitalized with a fungal infection. He has CKD stage 3 and chronic pain (on methadone). Micafungin 100 mg IV is given. During the infusion, the man develops a drop in BP, pruritis, and flushing. What's the most likely cause of this reaction? a. The micafungin dose should have been renally adjusted b. Micafungin is causing a histamine-release reaction c. Micafungin increased the methadone levels, resulting in an adverse reaction d. Acetaminophen and meperidine should have been given prior to micafungin e. It's unlikely that this reaction is d/t methadone or micafungin

Which dosing instructions for the use of OTC docosanol are correct? a. Take 1 tab daily until healed b. Apply 5x daily at the first sign of an outbreak c. Take 1 tab 5x daily at the first sign of an outbreak d. Apply once daily for 7 days e. Apply BID for 10 days

A 31 y/o critically-ill pt with diabetes is admitted to the ICU with respiratory compromise and AKI. She's diagnosed with pulmonary Aspergillosis. Which of the following antifungal agents would be most appropriate to initiate? a. Vfend b. Flucytosine c. Zosyn d. AmBisome e. Cancidas

a The DOC for Aspergillosis is voriconazole. Isavuconazonium (Cresemba) is also indicated for the tx of Aspergillosis. AmBisome is a less preferred alternative and should be avoided in the setting of AKI d/t its risk for nephrotoxicity.

DE is a 61 y/o male who's experiencing a blistery rash that wraps around the right side of his torso. He reports that the rash is tingling with shooting pain. The appearance of the rash is consistent with herpes zoster. Which med is appropriate to treat this condition? a. Valtrex b. Diflucan c. Mycamine d. Abreva e. Cytovene

D/t the risk of life-threatening arrhythmias, coadministration of dofetilide is contraindicated with which med? a. Ampho B b. Itraconazole c. Caspofungin d. Oseltamivir e. Famciclovir

b In combo with certain drugs, itraconazole has been associated with QT prolongation and ventricular arrhythmias.

All of the following disease-tx pairs is correct EXCEPT: a. Oropharyngeal candidiasis --- itraconazole b. Pneumocystis pneumonia --- IV pentamidine c. Cryptococcal meningitis --- liposomal ampho B + foscarnet d. Mycobacterium avium complex --- clarithromycin + ethambutol e. Cytomegalovirus --- ganciclovir

c Preferred tx for cryptococcal meningitis is ampho B (conventional or liposomal) + flucytosine

CV is a 39 y/o male with HIV and CMV retinitis. His response to valganciclovir was poor, and additional viral testing shows the development of resistance to valganciclovir. Which of the following alternatives would be expected to have activity in this case? a. Ganciclovir b. Cidofovir c. Foscarnet d. Acyclovir e. Atovaquone

b, c Valganciclovir is an oral prodrug of ganciclovir, so a virus that's resistant to one cannot be treated with the other.

A 37 y/o female with HIV presented to her outpatient clinic. She was noted to have white plaques on her tongue and cheek. What tx should be initiated? a. Atovaquone b. Cidofovir c. Fluconazole d. Clarithromycin e. Nystatin

A 45 y/o male with HIV has a CD4 count of 93 and a positive toxoplasma IgG. Which of the following opportunistic infections should he receive prophylaxis against at this time? a. Pneumocystis pneumonia b. Toxoplasma gondii c. Mycobacterium avium complex d. Cytomegalovirus e. Cryptococcal meningitis f. Candidiasis

a, b No prophylaxis is recommended for candidiasis

What's the preferred regimen for the tx of Toxoplasmosis gondii encephalitis? a. Bactrim + prednisone b. Ampho B + flucytosine c. Azithromycin + ethambutol d. Pyrimethamine + leucovorin + sulfadiazine e. Dapsone + pyrimethamine + leucovorin

RB is a 38 y/o male who's HIV-pos with a CD4 count of 37. He's not currently taking antiretroviral therapy but is taking Bactrim prophylaxis. Which med should also be prescribed at this time? a. Rifampin 600 mg PO daily b. Pyrimethamine 50 mg PO daily c. Azithromycin 1200 mg PO weekly d. Fluconazole 400 mg PO daily e. Dapsone 100 mg PO daily

c Azithromycin is the preferred med for prophylaxis of MAC. It should only be started if the CD4 count < 50 and antiretroviral therapy isn't being started immediately

Which of the following increases the risk of opportunistic infections? a. PO methotrexate for rheumatoid arthritis b. Monthly infliximab infusions for UC c. A 5-day steroid taper for a COPD exacerbation d. An inhaled corticosteroid for asthma e. Paclitaxel infusions in patient with an ANC of 450

a, b, e An immunocompromised state can result from chemo tx, chronic immunosuppressants for autoimmune conditions, and use of systemic steroids (for at least 14 days at a dose equivalent to prednisone 20 mg daily). Inhaled corticosteroids don't have significant systemic absorption and don't cause an immunocompromised state.

A pt is started on dapsone + pyrimethamine + leucovorin for primary prophylaxis of Pneumocystis pneumonia. What's the purpose of leucovorin in this regimen? a. To reduce the risk of hemolytic anemia with dapsone b. To provide synergistic activity against Pneumocystis spp. c. To decrease the risk of nephrotoxicity with dapsone d. To reduce the risk of myelosuppression with pyrimethamine e. To decrease the risk of hepatotoxicity with pyrimethamine

What is a preferred regimen for primary prophylaxis of Pneumocystis pneumonia? a. Azithromycin 1200 mg PO once weekly b. Bactrim DS 1 tab PO daily c. Clarithromycin 500 mg PO daily d. Moxifloxacin 400 mg PO daily e. Fluconazole 100 mg PO daily