Practice Questions Flashcards
A pt is dx with chronic mucocutaneous candidiasis and is treated with an oral antifungal agent. After several weeks he develops gynecomastia, decreased libido and azoospermia. The antifungal agent responsible for these SE is?
Ketoconazole
Which of the following statements of antifungal agents is incorrect?
A. Amphotercin B may cause nephrotoxicity and anemia
B. Nystatin binds to sterols in the fungal cell membrane
C. Ketoconazole may cause endocrinologic abnormalities
D. Itraconazole inhibits squalene monooxygenase
E. Griseofulvin disrupts the cells mitotic spindle
Itraconazole inhibits squalene monooxygenase
A pt being treated for disseminated cryptococcosis develops nephrotoxicity and hypochromic anemia. Which of the following antifungal agents would be the most probable cause of these SE?
Amphotercin B
A triazole antifungal agent with a long half life (35 hr) is
Itraconazole
Which of the following agents is used for treatment of superficial fungal agents disrupts the mitotic spindle structure and is deposited in keratin precursor cells?
Griseofulvin
Itraconazole produces its antifungal effects by inhibiting which enzyme?
Sterol 14-alpha-demethylase
Pharmacological actions of triazole antifungal agents include?
- Inhibition of sterol-14-alpha demethylase
- Reduced ergosterol biosynthesis
- Longer half life than imidazoles
- Binding to fungal cytochrome P450
All of the Above
Which of the following statements on antifungal agents is incorrect?
A. Amphotericin B inhibits sterol 14-alpha-demethylase
B. Nystatin binds to sterols in the fungal cell membrane
C. Ketoconazole may cause endocrinologic abnormalities
D. Terbinafine inhibits squalene monooxygenase
E. Griseofulvin disrupts the cells mitotic spindle
A. Amphotericin B inhibits sterol 14-alpha-demethylase
Which antifungal treats invasive aspergillosis and esophogeal candidiasis?
Caspofungin
Which Anti-fungal inhibits Beta 1,3-Glucansynthase?
Caspofungin
Which Anti-fungal blocks the metabolism from Squalene to ergosterol
Tolnaftate
Penicillin G is only given ________, while Penicillin V is administered _________.
Parenterally; Orally
Penicillin useful for prophylaxis of rheumatic fever by reinfection of group A strep
Penicllin G Benzathine
Treatment for Enterococcal Endocarditis?
Penicilin + Aminoglycosides
Augmentin
Amoxicillin + Clavulanic Acid
Timentin
Ticarcillin + Clavulanic Acid
Zosyn
Piperacillin + Tazobactam
In the US, the 6-month regimen for TB treatment consists of:
Isoniazid, rifampin, and pyrazinamide for 8 weeks, followed by isoniazid and rifampin for 16 weeks.
Which of the following statements regarding antituberculosis agents is incorrect?
A. Isoniazid may cause methemoglobinemia
B. Rifampin may cause GI disturbances and reddish urine, saliva, and tears
C. Ethambuton may cause ocular toxicity
D. Streptomycin sulfate may cause ototoxicitiy
E. Pyrazinamide may cause hyperuricemia
Isoniazid may cause methemoglobinemia
Pharmacological and toxic actions of isoniazid include:
- Interferences with mycolic acid biosynthesis
- Bactericidal effect on rapidly dividing bacteria
- Hepatitis, greater in slow acetylators
- Increases excretion of pyridoxine (Vit B6)
All of the Above
Actions of antituberculosis drugs depends upon the metabolic activity of the tubercle bacillus. Isoniazid is effective on bacilli:
A. In cavitary lesions where multiplication is active
B. In closed caseous lesions were replication is slow
C. Within macrophages were multiplication is relatively slow
All of the Above
In the US single drug therapy in tuberculosis is limited to preventive therapy. Which of the following drugs is the only approved for this use?
Isoniazid
Drug regimens for the chemotherapy of leprosy include:
Dapsone and rifampin
Which of the following statements regarding antituberculosis agents is incorrect?
A. Isoniazid may cause methoglobinemia
B. Rifampin may cause GI disturbances and reddish urine, saliva, and tears
C. Ethambutol may cause ocular toxicity
D. Streptomycin sulfate may cause ototoxicity
E. Pyrazinamide may cause hyperuricemia
A. Isoniazid may cause methoglobinemia
Pharmacological and toxic actions of dapsone include:
- Inhibition of folic acid synthesis
- Hemolytic anemia
- Methomoglobinemia
- Exacerbation of lepromatous leprosy aka sulfone syndrome
All of the Above
Which of the following drugs are recommended for standard leprosy chemotherapy regimens?
Dapsone, rifampin, and clofazimine
Which of the following is paired incorrectly with its main adverse effect?
A. Clofazimine can discolor skin
B. Rifampin can cause GI disturbances and reddish urine, saliva, and tears
C. Ethambutol can cause methemoglobinemia
D. Streptomycin sulfate can cause ototoxicity
E. Pyrazinamide can cause hyperuricemia
C. Ethambutol can cause methemoglobinemia
Gray Baby syndrome
Chloramphenicol
An adult patient has meningitis, and gram stain analysis indicates the presence of gram negative cocci suggestive of Neisseria meningitidis. This patient has had a severe anaphylactic reaction with Amoxicillin. Which of the following drugs would be most useful for treating infection in this patient?
Chloramphenicol
A 20-Y.O female with meningitidis has previously experienced a severe anaphylactic reaction while taking ampicillin for a UTI. Empirical treatment of the causative microorganisms for meningitis in this patient would be best achieved with this drug:
Chloramphenicol
Drugs that inhibit the bacterial protein synthesis by binding to the 50S ribosomal subunit include:
- Erythromycin
- Chloramphenicol
- Clarithromycin
- Streptomycin
- Erythromycin
- Chloramphenicol
- Clarithromycin
Sunburn
Tetracycline
Divalent cations in antacids might decrease the oral absorption of which of the following drugs?
- Ciprofloxacin
- Penicillin V
- Tetracycline
- Clarithromycin
- Ciprofloxacin
3. Tetracycline
Calcium can interfere with the oral absorption of which of the following?
Tetracycline
Which of the following drugs inhibits protein synthesis by binding to the 30S ribosomal subunit?
- Doxycycline
- Tobramycin
- Gentamicin
- Clarithromycin
- Doxycycline
- Tobramycin
- Gentamicin
Johnny Fever its going on a trip to the jungles of Papua- New Guinea. He has a history of bipolar disorder and psychomotor epilepsy, both treated with Carbamazepine. Which of the following drugs would be most appropriate for protecting him against the chloroquine-resistant strains of P. Falciparum which are endemic to Papua New Guinea?
Doxycycline
A patient takes ergotamine tartrate as an abortive treatment for migraine headaches. He is also taking an antibiotic for community acquired pneumonia. While taking both medications, he develops severe pain in his legs caused by vasoconstriction. Which of the following antibiotics might cause this adverse SE with ergotamine tartrate?
Erythromycin
A patient has a positive pregnancy test and is co-infected with clamydia trachomatis. Treatment for the chlamydial infection in this patient could be achieved with this drug?
Erythromycin base
A pregnant woman requires therapy for pneumonia caused by Mycoplasma pneumoniae. The best therapy for this patient is
Erythromycin
Which of the following is not a feature of the drug azithromycin?
A. Interferes with the metabolism of drugs that are metabolized by hepatic p450 enzymes
B. Tissue concentrations exceed [plasma] by 10-100 fold
C. Inhibits bacterial protein synthesis by binding to the 50S bacterial ribosomal subunit
D. Has better activity against Haemophilus influenzae versus erythromycin
E. Can be administered during pregnancy
A. Interferes with the metabolism of drugs that are metabolized by hepatic p450 enzymes
A bacteriostatic MOA is exhibited by:
Erythromycin
A 19 year old college student living in a dormitory has developed a persistant non-productive hacking cough, suggestive of Mycoplasma pneumonia. This patient recently tested + for hCG in the urine. Antibiotic therapy in this patient would consist of:
Erythromycin
. A patient has previously had a severe allergic reaction to Penicillin G and requires an antibiotic to treat pneumonia caused by the gram + microorganism strep. pneumoniae. Which of the following drugs would work best for this situation?
Clarithromycin
Drugs that inhibit bacterial protein synthesis by binding to the 50 S ribosomal subunit include:
- erythromycin
- Chloramphenicol
- Clarithromycin
- Streptomycin
- erythromycin
- Chloramphenicol
- Clarithromycin
A 25 YO woman with a + pregnancy test has developed pain associated with urination. Urinalysis indicates pyuria with an absence of bacteria in the urine as indicated by Gram’s stain. Which of the following would be an appropriate therapy for this patient?
Azithromycin
Which of the following is mismatched?
A. Erythromycin/GI upset
B. Chloramphenicol/ Gray baby syndrome
C. Azithromycin/inhibits cytochrome P450 drug metabolism
D. Cefazolin/Type I hypersensitivity reactions
E. Doxycycline/inhibits bone growth
C. Azithromycin/inhibits cytochrome P450 drug metabolism
Treating otitis media in a patient who is allergic to penicillins, cephalosporins, and sulfonamides could be accomplished with a 5-day course of therapy with this drug:
Azithromycin
Which of the following combinations is most beneficial for a patient co-infected with Chlamydia trachomatis and Neisseria gonorrhoeae?
Ceftriaxone + Azithromycin
An adult patient with hx of severe allergic reactions to beta lactam antibiotics has meningitis caused by strep pneumoniae. Which antibiotic would be an apropriate therapy for this patient?
Chloramphenicol
The following drug could be useful for enterococcal endocarditis resistant to gentamicin?
Streptomycin
Which of the following statements regarding aminoglycoside antibiotics is true?
A. Dosages do not need to be adjusted with renal failure
B. Nephrotoxicity is characterized by a decrease in serum creatinine
C. Once a day dosing increases toxic trough concentrations
D. Usage is associated with ototoxicity
E. Exhibit good oral absorption
D. Usage is associated with ototoxicity
Administration of this drug while a patient is taking gentamicin increases the risk of ototoxicity:
Ethacrynic acid
A patient is receiving an antibiotic combination for the treatment of Enterococcal endocarditis. While receiving drug therapy the patient experiences vertigo, ataxia, and loss of balance. The drug responsible for these adverse effects is:
Gentamicin
A synergistic killing effect against Pseudomonas aeruginosa would be expected from which of the following bactericidal/bactericidal drug combinations?
Ticarcillin/tobramycin
An aminoglycoside antibiotic like tobramycin would exhibit poor activity against this microorganism
Bacteroides fragilis
Tobramycin inhibits protein synthesis by
by binding to the 30S subunit
A patient taking ethacryinc acid would be at increased risk of ototoxicity with which of the following drugs? A. Ciprofloxacin B. Tobramycin C. Nitrofurantoin D. Sulfamethaxazole E. Trimethoprim
?
Which of the following drugs in combination with ceftazidime would be useful for treating pneumonia caused by Pseudomonas aeruginosa (gram - bacilli)?
Tobramycin
A patient has endocarditis caused by enterococcus (gram +) which is resistant to gentamicin. Which of the following antibiotic combinations might be useful for this patient’s infection?
Penicillin G + Streptomycin
Streptomycin sulfate SE?
may cause ototoxicity
Which of the following is true about aminoglycosides?
A. Dosing adjustments are not necessary for patients with renal failure
B. Exhibit poor oral absorption and are usually administered parenterally
C. Typically used in combo with tetracyclines to obtain a synergistic effect
D. Once daily dosing results in higher toxic trough concentrations than multiple daily dosings
E. Have good activity against anaerobic bacteria
B. Exhibit poor oral absorption and are usually administered parenterally
Bacterial resistance to aminoglycosides is best described as:
A. Bacterial production of beta-lactamase
B. Mutation in the bacterial 50S ribosomal subunit
C. Bacterial enzymes phosphorylate, acetylate, or adenylate the drug
D. Bacterial enzyme methylase alters the 30S ribosomal subunit
E. Active efflux of drug out of the bacteria
C. Bacterial enzymes phosphorylate, acetylate, or adenylate the drug
- Which of the following statements regarding aminoglycosides is correct?
A. Once daily dosing increases toxic potential by increasing the amount of time above toxic trough concentrations
B. Inhibit protein synthesis by binding to the 50S subunit
C. Bactericidal
D. Pen G decreases the concentration of aminoglycosides in bacteria
E. Have good activity against anaerobic bacteria
C. Bactericidal
Sulfamethoxazole does NOT inhibit
DHFR
Displacement of bilirubin from albumin is a problem associated with the use of this drug in a pregnant patient near the time of parturition:
Sulfamethoxazole
Best therapy for a woman with a UTI caused by E. Coli would be?
Trimethoprim-sulfathoxazole
Best therapy for a pregnant woman near term with a UTI caused by E. Coli would be?
Trimethoprim-sulfathoxazole
A 40 Y.O male patient requires prophylactic treatment to prevent Pneumocystis carinii pneumonia but is intolerant of sulfonamides due to severe adverse effects. A potential alternative therapy for this patient is:
Pentamidine
Treating ulcerative colitis is an indicated use of this drug:
Sulfasalazine
A 35 year old male patient who is HIV+ has a low-grade fever, SOB, and a non-productive cough for 4 weeks duration. A chest xray shows diffuse bilateral infiltrates.
Trimethoprim-sulfamethaxozole
Kernicterus is an adverse effect associated with the use of this drug:
Sulfamethoxazole
The MOA of sulfasalazine in relation to treating ulcerative colitis is best described as: A. Binding to the 50S subunit B. Inhibiting DHFR C. Inhibiting dihydropteroate synthetase D. Formation of 5-Aminosalicylate E. Inhibiting cell wall synthesis
C. Inhibiting dihydropteroate synthetase
D. Formation of 5-Aminosalicylate
Which of the following is NOT an adverse drug effect associated with trimethoprim? A. Pruritis B. Tetrahydrofolate deficiency C. Teratogenesis D. Hyperkalemia E. Crystalluria
Crystalluria
Folinic acid would be useful for treating the adverse hematological effects of this drug
Trimethoprim
40 year old male patient requires prophylactic drug therapy to prevent pneumocystiscarinii pneumonia but is intolerant to sulfonamides. A potential alternative therapy for this patient is:
Pentamidine
Which of the following antibiotic/resistance mechanisms is correct?
A. Trimethoprim/mutations in the dihydropteroate synthetase
B. Gentamicin/modification of the 50S ribosomal subunit by methylase
C. Sulfamethoxazole/mutations in DHFR
D. Streptomycin/mutations in the 50S ribosomal subunit
E. Ciprofloxacin/mutations in DNA gyrase
E. Ciprofloxacin/mutations in DNA gyrase
The pharmacological actions of amantadine include:
- Inhibition of viral neuraminidase
- Inhibition of viral penetration and uncoating
- Effectie for respiratory syncytial virus infections
- Effective for influenza A
- Inhibition of viral penetration and uncoating
4. Effective for influenza A
Pharmacologic actions of zanamivir include:
- Inhibition of viral DNA synthesis
- Inhibition of influenza NA
- Effective for treatment of herpes infections
- Effective for treatment of influenza A and B infections
- Inhibition of influenza NA
4. Effective for treatment of influenza A and B infections
Infections with amantidine resistant influenza A can cause severe morbidity and mortality in the elderly particularly in enclosed settings such as nursing homes. Which of the following agents could be recommended for the treatment of influenza A infections in these patients?
Zanamivir
Respiratory syncytial virus infections in infants and young children are treated with:
Ribavirin
Which of the following agents is commonly used for the treatment of mucosal, cutaneous, and systemic herpes simplex infections?
Acyclovir
Which of the following is a synthetic purine nucleoside that is phosphorylated by a herpes virus specific thymidine kinase in herpes-infected host cells only?
Acyclovir
Which combination of agents is an effective therapeutic option for the treatment of recurrent cytomegalovirus retinitis in children with AIDS?
Ganciclovir and foscarnet
Which of the following agents is currently used to treat chronic viral hepatitis B and C?
Interferon-alpha
Ganciclovir is an inhibitor of:
Herpes viral DNA polymerase
Pharmacologic actions of zanamivir include:
- Inhibition of viral DNA synthesis
- Inhibition of DHFR
- Effective for treatment of herpes infections
- Effective for treatment of influenza A and B infections
- Effective for treatment of influenza A and B infections
Pharmacologic and toxic actions of ganciclovir include:
- rapid phosphorylation in herpes infected cells by herpes virus specific thymidine kinase
- Inhibition of viral DNA synthesis
- Granulocytopenia and thrombocytopenia
- Inhibition of thymidylate synthase
- rapid phosphorylation in herpes infected cells by herpes virus specific thymidine kinase
- Inhibition of viral DNA synthesis
- Granulocytopenia and thrombocytopenia
Which of the following drug/MOA or toxicity is incorrect?
A. Terbinafine/interferes with ergosterol biosynthesis
B. Nystatin/binds to sterols in the fungal cell wall
C. Caspofungin/blocks synthesis of a cell wall polysacharide
D. Itraconazole/binds to sialic acid residues on cell membranes
E. Gamma globulin/prevent attachment of viral particles to cells
D. Itraconazole/binds to sialic acid residues on cell membranes
Inhibits bone growth
Ciprofloxacin
A 30 Y.o woman has a burning sensation when she urinates. A gram stain analysis of the urine indicates presence of gram - bacilli. In the past, she has severe allergic reactions to beta lactam antibiotics and hydrochlorothiazide. Which of the following would be most useful for treating this infection?
Ciprofloxacin
While traveling to Mexico, a woman develops the symptoms of fever, nausea, vomiting and a watery diarrhea with pus in the stools. The culprit is the gram - bacilli salmonella from an undercooked chicken burrito. Which of the following drugs to treat?
Ciprofloxacin
A woman who developed an allergic rxn when treated with hydrochlorothiazide for HTN requires therapy to treat a UTI caused by E. coli (gram -). An appropriate therapy would include
Ciprofloxacin
Mutations in DNA gyrase (M. Of resistance)
Ciprofloxacin
Which of the following MOA/drug is not correct?
A. Ciprofloxacin/inhibits bacterial cell wall synthesis by binding to bacterial topoisomerase II
B. Polymyxin B/interacts with bacterial membrane phospholipids to cause a leakage of intracellular components
C. Sulfamethoxazole/inhibits the enzyme dihydropteroate synthetase
D. Vancomycin/inhibits cell wall synthesis by binding to D-alanyl-D-alanine portion of the cell wall glycopeptide precursor
E. Trimethoprim/inhibits DHFR
A. Ciprofloxacin/inhibits bacterial cell wall synthesis by binding to bacterial topoisomerase II → Incorrect because it is not the CELL WALL!! It inhibits transcription and translation.
Treatment of a Comm acquired resp tract infection caused by strep pneumoniae could be a use for this drug: A. polymixin B B. Levofloxacin C. Metronidazole D. Nitrofurantoin E. Ciprofloxacin
B. Levofloxacin (could also be moxifloxacin)
Treatment of a lower UTI caused by E. Coli is an indicated use for this drug:
- Ciprofloxacin
- Trimethoprim-sulfamethoxazole
- Nitrofurantoin
- Vancomycin
- Ciprofloxacin
- Trimethoprim-sulfamethoxazole
- Nitrofurantoin
Recently married couple going to Mexico for their honeymoon. They want to enjoy their trip without getting bacteria diarrhea. The prophylactic use of this drug would help protect them
Ciprofloxacin
A 68 year old male who is allergic to sulfonamides is experiencing dysuria. After visiting his physician this patient is found to have an enlarged prostate and a UTI caused by E. Coli. Treatment would include the use of this drug
Ciprofloxacin
This drug is contraindicated during pregnancy because it has the potential to damage growing cartilage:
- Bacitracin
- Ciprofloxacin
- Polymyxin B
- Levofloxacin
- Ciprofloxacin
4. Levofloxacin
Which of the following drugs would be most useful for treating a respiratory tract infection caused by Strep pneumoniae (gram + cocci) A. Metronidazole B. Levofloxacin C. Gentamicin D. Nitrofurantoin E. Streptomycin
B. Levofloxacin
A hospitalized patient has acquired pneumonia caused by MRSA. Which of the following drugs might be useful for treating this infection? A. Nafcillin B. Vancomycin C. Pen G D. Ampicillin E. Oxacillin
B. Vancomycin
Vancomycin/inhibits cell wall synthesis by
binding to the D-alanyl-D-alanine portion of the cell wall glycopeptide precursor
This drug might be useful for treating cellulitis caused by MRSA
- Vancomycin
- Quinupristine + dalfopristin
- Linezolid
- Nafcillin
- Vancomycin
- Quinupristine + dalfopristin
- Linezolid
A patient who has previously had rheumatic fever is going to the dentist. This drug would be useful for preventing endocarditis caused by viridans group streptococci in this patient.
Clindamycin
Clindamycin MOA
inhibits 50S
A drug that is only used as a urinary tract antiseptic is:
Nitrofurantoin
MA is a 23 year old college student taking metronidazole for the treatment of trichomoniasis. After consuming 3 glasses of wine at a party, she begins to experience flushing, nausea, and a pounding headache. These effects most likely resulted from the ability of metronidazole to inhibit:
Aldehyde dehydrogenase
Which of the following has antibacterial acivity against the anaerobe b. fragilis?
- Cefoxitin
- Metronidazole
- Ticarcillin
- Gentamicin
- Cefoxitin
- Metronidazole
- Ticarcillin
During treatment with ceftazidime a pt develops abdominal pain and diarrhea with blood and shreds of material that look like mucous in the stools. This condition would best be treated with
Metronidazole
A 35 yo woman was admitted to Cook County Hospital with a dx of bacterial meningitis. She was treated with ceftriaxone for 2 weeks and on the 12th of therapy developed abdominal cramping and pain, fever, and loose stools containing blood. Appropriate treatment would be:
Metronidazole
A drug of choice for treating infections caused by B. Fragilis (gram - anaerobe) is:
Metronidazole
Bacitracin MOA
inhibits bacterial cell wall synthesis
Treatment of vancomycin-resistant enterococcus faecium
Quinupristin
Staph aureus (Gram +) isolate from a pt with a skin infection is methicillin-resistant and vancomycin-intermediate. Potential therapy for this pt is:
Quinupristin/Dalfopristin
Which of the following would be useful for the treatment of bacteremia caused by vancomycin-resistant Enterococcus faecium:
- Quinupristin/dalfopristin
- Clindamycin
- Linezolid
- Vancomycin
- Quinupristin/dalfopristin
3. Linezolid
Quinupristin/dalfopristin MOA
inhibits the 50S
Linezolid MOA
Reversible inhibitor of MAO
Gynecomastia, decreased libido SE
Ketoconazole
Pharmacological and toxic actions of zidovudine include:
- Inhibition of viral reverse transcriptase
- Inhibition of sterol 14-alpha-demethylase
- Anemia, granulocytopenia, and thrombocytopenia
- Peripheral neuropathy
- Inhibition of viral reverse transcriptase
3. Anemia, granulocytopenia, and thrombocytopenia
Which of the following anti-HIV drugs is paired incorrectly with its major toxicity:
A. zidovudine may cause bone marrow toxicity
B. Saquinavir may cause GI disturbance
C. Indinavir may cause nephrolithiasis
D. Didanosine may cause peripheral neuropathy
None of them
Pharmacological and toxic actions of didanosine include
- Inhibition of viral NA
- Inhibition of viral reverse transcriptase
- Effective for respiratory syncytial virus infections
- Peripheral neuropathy
- Inhibition of viral reverse transcriptase
4. Peripheral neuropathy
Efavirenz SE
dizziness, insomnia, and rash
HIV postexposure prophylaxis, a well-established part of the management of health care workers after occupational exposures to HIV includes 2 reverse transcriptase inhibitors and one protease inhibitor
Zidovudine, lamivudine, ritonavir
Indinavir SE
Nephrolithiasis
Progress in the field of antiretroviral therapy for human immunodeficiency virus type I has brought the end of the zidovudine-monotherapy era. Much of this progress is linked to the introudction of HIV protease inhibitors. Which of the following agents is this referring to?
Indinavir
