Pharm: Antimicrobials

Question 0

Where is Nafcillin and Oxacillin excreted?

Answer 0

Bile

Question 1

What substance inhibits the tubular secretion of penicillins AND fluoroquinolones via the kidney?

Answer 1

Probenecid

Question 2

Which penicillin is known to cause interstitial nephritis?

Answer 2

Methicillin

Question 3

Which penicillin is known to cause neutropenia?

Answer 3

Nafcillin

Question 4

Which cephalosporins are excreted mainly in bile?

Answer 4

Ceforperazone and Ceftriaxone

Question 5

What is the main route for elimination of penicillins and cephalosporins?

Answer 5

Renal excretion

Question 6

Which penicillin undergoes enterohepatic recycling?

Answer 6

Ampicillin

Question 7

Which two 3rd generation Cephalosporin are unable to penetrate the BBB?

Answer 7

Cefoperazone and Cefixime

Question 8

Which penicillin causes interstitial nephritis?

Answer 8

Methicillin

Question 9

The methylthiotetrazole group in cefamandole cefoperazone and cefotetan cause which 2 adverse effects?

Answer 9

Disulfiram reactions with alcohol and hypoprothrombinemia

Question 10

Besides cefoxitin give another cephalosporin with activity agains B. frag.

Answer 10

Cefotetan

Question 11

Aztreonam only has activity against?

Answer 11

Gram negative bacteria

Question 12

Cilastin given with imipinem is an inhibitor of?

Answer 12

Renal dehydropeptidase 1

Question 13

Rapid infusion with vancomycin results in?

Answer 13

Red man syndrome

Question 14

Among protein synthesis inhibitors chloramphenicol and tetracyclines are known to have: 
A. Broad
B. Moderate
C. Narrow
Spectrum of activity?

Answer 14

Broad

Question 15

Chloramphenicol is usually bacteriostatic except for the following organisms in which it is cidal.

Answer 15

No Boyfriend (Since) HS
Neisseria meningitidis
Bacteroides spp
(Streptococcus pneumoniae)
Haemophilus influenzae

Note: S. pneumo not mentioned in Katzung but included in lecture

Question 16

Aplastic anemia and gray baby syndrome are adverse effects of which drug?

Answer 16

Chloramphenicol.

Gray baby syndrome: cyanosis decreased RBC and cardiovascular collapse

Question 17

Resistance to tetracyclines are thought what mechanism?

Answer 17

Efflux pumps

Question 18

Bacitracin is active against?

Answer 18

Gram positive organisms. Limited to topical use due to nephrotoxicity.

Question 19

Tooth enamel dysplasia with vestibular toxicity is probably due to which protein synthesis inhibitor?

Answer 19

Tetracyclines (doxycycline)

Question 20

Which macrolide attains highest tissue levels?

Answer 20

Azithromycin

Question 21

Which macrolide DOES NOT inhibit cyp p450?

Answer 21

Azithromycin

Question 22

Which tetracycline can be used against ADH secreting tumors?

Characteristic toxicity?

Answer 22

Demeclocycline

Photosensitivity

Question 23

What is a known adverse effect of streptogramins after it has been give via IV?

Answer 23

Pain and the arthralgia myalgia syndrome

Question 24

What is the main resistance mechanism to aminoglycosides? Which 2 aminoglycosides are NOT affected by these?

Answer 24

Inactivating enzymes in the form of: Group transferases Amikacin and streptomycin

Question 25

Which aminoglycoside is used as backup drug for N. gonorrhea?

Answer 25

Spectinomycin. Technically only an aminocyclitol related to aminoglycosides.

Question 26

What is the major AE in the use of streptomycin?

Answer 26

Ototoxicity

Question 27

Aminoglycosides depend on concentration OR time dependent killing of organisms?

Answer 27

Concentration dependent

Question 28

With normal renal function, the elimination half-life of aminoglycosides is:

Answer 28

2 - 3 hours

Question 29

Three reason why aminoglycosides are bacteriocidal

Answer 29

1. Block formation of initiation complex 2. Cause misreading of the code on the mRNA template 3. Inhibit translocation

Question 30

Which aminoglycosides are more likely associated with auditory dysfunction? Vestibular dysfunction?

Answer 30

Auditory: Kanamycin, Amikacin Vestibular: Gentamicin, Tobramycin

Question 31

Side effects of beta lactamase inhibitors

Answer 31

Hypersensitivity and cholestatic jaundice

Question 32

Clindamycin is NOT effective against?

Answer 32

Gram negative organisms

Question 33

Narrow spectrum macrolide selective for gram positive aerobes and anaerobes; used in C. difficile colitis

Answer 33

Fidaxomicin

Question 34

Antibiotic also used in diabetic gastric argh she to its stimulation of motilin receptors

Answer 34

Erythromycin

Question 35

Which among the adverse effects of aminoglycosides are IRREVERSIBLE? Nephrotoxicity, ototoxicity or neuromuscular blockade.

Answer 35

Nephrotoxicity

Question 36

How does one decrease the solubility of sulfonamide a in urine?

Answer 36

Acidify the urine

Question 37

Which sulfonamide is the longest acting? Sulfadoxine Sulfamethoxazole Sulfiaoxazole

Answer 37

Sulfadoxine

Question 38

Sulfonamides compete with what substance for the enzyme dihydropteroate synthase?

Answer 38

P-aminobenzoic acid

Question 39

What is the drug of choice for BOTH nocardiosis and pneumocystis pneumonia?

Answer 39

TMP-SMX

Question 40

What form of nephrotoxicity is seen in aminoglycosides?

Answer 40

Acute tubular necrosis? Remember: Methicillin interstitial nephritis!

Question 41

Ketolide structurally related to macrolides with a similar MOA/activity as erythromycin; used in macrolide-resistant strains. Adverse effects include prolongation of QT interval

Answer 41

Telithromycin

Question 42

Antibiotic implicated in serotonin syndrome when used in px taking SSRI

Answer 42

Linezolid

Question 43

Sulfonamide inhibits which enzyme? Trimethoprim?

Answer 43

Sulfonamide: dihydropteroate synthase Trimethoprim: dihydrofolate reductase

Question 44

Most common mechanism of resistance to trimethoprim

Answer 44

Production of dihydrofolate reductase that has a reduced affinity for the drug.

Question 45

Most common adverse effect of quinolones

Answer 45

Gastrointestinal distress. Other ADEs include rashes, headache, dizziness, insomnia, abnormal LFTs, phototoxicity, tendinitis and tendon rupture.

Question 46

Bacteriostatic protein synthesis inhibitor given for Vancomycin resistant E. faecium. Characteristic toxicity?

Answer 46

Quinupristin-dalfopristin (Streptogramins) Arthralgia-myalgia syndrome CYP450 inhibition

Question 47

What is the treatment for aminoglycoside induced respiratory paralysis?

Answer 47

Calcium, neostigmine and ventilators support.

Question 48

Which generation of fluroquinolones has the greatest activity against gram negative bacteria?

Answer 48

2nd gen, cipro and ofloxacin

Question 49

What kind of anemia can be caused by trimethoprim? Ameliorated by what drug?

Answer 49

Megaloblastic anemia; folinic acid

Question 50

What is the fluoroquinolone that does not need dose adjustment for patients with renal insufficiency?

Answer 50

Moxifloxacin. Eliminated partly by hepatic and biliary mechanisms

Question 51

What adverse effect is caused by Fluoroquinolones on children?

Answer 51

Arthropathy. It can also cause tendinitis and tendon rupture.

Question 52

Ototoxicity of aminoglycosides is increase by use of:

Answer 52

Loop diuretics

Question 53

Aminoglycoside MOST likely to cause allergic skin reaction

Answer 53

Neomycin

Question 54

The use of sulfonamides in the third trimester of pregnancy can result in?

Answer 54

Kernicterus due to displacement of bilirubin from plasma proteins. Also displaces warfarin and methotrexate!

Question 55

This quinolone is associated with development of diabetes

Answer 55

Gatifloxacin, currently discontinued

Question 56

What is the MOA of metronidazole?

Answer 56

Form reactive cytotoxic products to interfere with nucleic acid synthesis. Ferredoxin bioactivates nitro group of metronidazole.

Question 57

What drug has both disulfiram like reaction with alcohol and potential ion of coumarin anticoagulant effects?

Answer 57

Metronidazole

Question 58

What is the MOA of mupirocin?

Answer 58

Inhibits protein synthesis by binding to isoleucyl-tRNA synthetase

Question 59

What do nitrofurantoin, nalidixic acid and merge amine have in common?

Answer 59

Oral drugs RAPIDLY EXCRETED into the urine and act there to suppress bacteria.