Ratio 3rd Shifting Even

Question 1

DOC for N. meningitidis meningitis but will not eliminate carrier state

Answer 1

Penicillin

Question 2

DOC for MRSA,

Answer 2

Vancomycin

Question 3

A 20 year old student was diagnosed with bacterial meningitis probably due to Streptococcus pneumonia. The most appropriate empiric antibiotic therapy considering its efficacy against this pathogen and good penetration into the BBB achieving therapeutic concentration in the CSF?

Answer 3

Ceftriaxone

Question 4

Drug that can be used to eliminate the carrier state of N. meningitidis meningitis

Answer 4

Rifampicin, Ciprofloxacin, Ceftriaxone

Question 5

the DOC for meningitis as a substitute for beta lactams if there is hypersensitivity to beta lactam

Answer 5

chloramphenicol

Question 6

Concentration dependent antibiotics

these are given as single large daily dose

Answer 6

SAD MFKr - sad muderfuker?

Streptogramins (dalfopristin quinupristin), aminoglycosides, daptomycin, metronidazole, fluoroquinolones, ketolides (telithromycin)

Question 7

time dependent antibiotics

requires continuous IV infusion

Answer 7

CLAM TV

Clindamycin, linezolid, All beta lactams, macrolides, tetracycline, vancomycin

Question 8

gene mutation in Rifampicin vs Streptomycin resistance

Answer 8

Rifampicin: rpoB

Streptomycin: rpsL, Rrs

Question 9

A 30 year old patient with latent TB was started in isoniazid. The antibacterial effect of this drug most likely is mediated by the inhibition of the synthesis of what molecule?

Answer 9

Mycolic acid

Question 10

Inhibition of DNA dependent RNA polymerase is the MOA of which anti-TB drug?

Answer 10

Rifampicin

Question 11

similarity of linezolid and ethambutol

Answer 11

both can cause optic neuritis

Question 12

A 13 y/o taking unrecalled antibiotic presents with respiratory paralysis. This patient may have been given very high doses of:

Answer 12

Gentamicin

Question 13

A 34 year old female with Rheumatic Heart Disease was admitted for treatment of infective enterococcal endocarditis/ In the past she had severe anaphylactic reaction to Penicillin G. The best drug to give is:

Answer 13

Enterococcal endocarditis: vancomycin plus gentamicin

Question 14

most associated antibiotic with colitis

Answer 14

Clindamycin

Question 15

Although PPIs have a very short half life, their acid suppression effect lasts for 24 hours because of this reason:

Answer 15

Inactivation of the HK atpase is irreversible

Question 16

Anti-emetic with the MOA of:

1. Centrally acting D2 antagonist
2. 5HT3 receptor antagonist
3. Muscarinic receptor antagonist

Answer 16

1. Metoclopramide
2. Ondansetron
3. Scopolammine

Question 17

only macrolide wherein bioavailability is not affected by food intake

Answer 17

Clarithromycin

Question 18

What laxatives have the ff side effects:

1. Bloating and flatus formation
2. Melanosis coli
3. Vitamin D and E deficiency

Answer 18

1. Lactulose
2. Senna
3. Mineral oil

Question 19

DOC for flukes

Answer 19

praziquantel - almost always

Question 20

drugs that can cause Mazzotti reaction

Answer 20

DEC
Ivermectin
Praziquantel

Question 21

Treatment in a PREGNANT patient with:

1. Uncomplicated chloroquine-sensitive
2. Uncomplicated chloroquine-resistant:
3. Uncomplicated falciparum (2nd and 3rd trim)
4. Uncomplicated P. vivax and ovale:
5. Severe malaria (1st trim)
6. Severe malaria (2nd & 3rd trim):

Answer 21

1. Chloroquine
2. Quinine (oral) + Clindamycin
3. ACT (Arthemter Based Combination Therapy)
4. Weekly Chloroquine prophylaxis until delivery and breastfeeding, then if G6PD levels are normal switch to Primaquine
5. IV Quinine + Clinda
6. IV/IM Artemether

Question 22

Prophylaxis in a PREGNANT patient with:

1. Chloroquine-sensitive
2. Chloroquine-resistant
3. Malaria-endemic areas

Answer 22

1. Chloroquine
2. Mefloquine
3. FDC Sulfadoxine-Pyrimethamine

Question 23

A traveler consulted you for drug prophylaxis prior to going to Thailand, known to be HIGHLY endemic for multi-drug resistant falciparum malaria. The most appropriate drug is:

Answer 23

Doxycycline

Question 24

acts by inhibiting neuraminidase leading to clumping of newly released influenza virus

Answer 24

Oseltamivir and Zanamivir

Question 25

drug that selectively inhibits viral DNA synthesis

Answer 25

Acyclovir

Question 26

Drug that is indicated for acyclovir resistant HSV and VZV in immunocompromised individuals

Answer 26

Foscarnet

Question 27

Drugs that prevent the vertical transmission of HIV

Answer 27

Zidovudine and Nevirapine

Question 28

Drug that prevents vertical transmission of HBV when given in that last 4 weeks of gestation

Answer 28

Lamivudine

Question 29

A 28 y/o HIV (+) patient who is being treated with multiple drugs, develops breast hypertrophy, central adiposity, and insulin resistance. If these changes are related to his drug treatment, this drug belongs to what group of antiretroviral drugs?

Answer 29

NRTIs

Question 30

anti HBV drug that can cause flu-like syndrome (fever, chills, and muscle aches)

Answer 30

interferon alfa

Question 31

A patient with Hepatitis B and co-infected with HIV is best treated with:

Answer 31

Lamivudine

Question 32

antifungal drug that can cause 1. menstrual irregularities 2. shake and bake syndrome (chills and fever)

Answer 32

1. Ketoconazole | 2. Amphotericin B

Question 33

the most common cause of Clostridium difficile toxin-mediated diarrhea (Pseudomembranous colitis or toxic megacolon)

Answer 33

Clindamycin

Question 34

DOC for: 1. atypical pneumonia 2. Diphteria 3. Pertussis 4. Ricketssia infection 5. Cholera

Answer 34

1. Erythromycin 2. Erythromycin 3. Erythromycin 4. Doxycycline 5. Doxycline

Question 35

T.L., 20 y/o with leukemia and on her 3rd cycle of chemotherapy is suspected of having febrile neutropenia. The most appropriate monotherapy for her is:

Answer 35

Meropenem

Question 36

anti-MRSA antibiotic that functions by disrupting the cell membrane function by binding to the D-ala-D-ala terminus

Answer 36

Daptomycin

Question 37

mnemonic for antibiotic that are protein synthesis inhibitors

Answer 37

AT (30s) CELLS (50s) - protein synthesis inhibitors Aminoglycosides Tetracyclines ``` Chloramphenicol Erythromycin (Macrolides) Lincosamides Linezolid Streptogramins ```

Question 38

The primary mechanism of resistance of Strep. Pneumoniae to beta lactam antibiotics is:

Answer 38

Beta-lactams act at PBP (penicillin binding protein) to inhibit transpeptidation/cross linking of peptidoglycan units. Resistance occurs when PBP of the bacteria evolve/transform to PBP2a wherein B-lactams can no longer bind

Question 39

Hypersensitivity, jaundice, GI intolerance and thrombocytopenia are side effects of which first line anti-TB agent?

Answer 39

Rifampicin

Question 40

A 30 y/o woman of childbearing potential, currently on contraceptive pills was discovered to have sputum (+) PTB. You are about to start anti-TB treatment but wary of possible drug interaction. Which of the anti-TB drugs is most likely to interact with the oral medication and pose a risk of decreased protective efficacy against pregnancy VERSUS drug that will prolong the effect of drug she is currently taking and cause toxicity

Answer 40

Rifampicin is an enzyme inducer hence it catalyzes the metabolism of other drugs which are metabolized by the CYP450 system. Here, contraceptive pills might be metabolized much more rapidly leading to decreased protective efficacy In contrast, Isoniazid is an enzyme inhibitor, with opposite effects as to Rifampicin which might predispose an individual to prolonged therapeutic effect of drugs or toxicity

Question 41

standard triple vs quadruple therapy for PPI

Answer 41

Standard “triple therapy” (BID for 14 days): Proton Pump Inhibitors Clarithromycin Amoxicillin or Metronidazole Quadruple therapy: Proton Pump Inhibitors Bismuth subsalicylate Tetracycline Metronidazole

Question 42

Small amounts of atropine is added to one of these antidiarrheal agents to discourage overdosage thus preventing opioid dependence:

Answer 42

Diphenoxylate - crosses the BBB ---> CNS effects and opioid dependence

Question 43

Role of somatostatin vs beta blocker in variceal bleeding

Answer 43

Somatostatin -> ACTIVE BLEEDING Beta Blocker -> PROPHYLAXIS

Question 44

The half-life of this anti-malarial drug is longer in patients with severe malaria than in healthy individual:

Answer 44

Plasma level, protein binding, half-life of quinine depend on severity of malaria (severe = higher: due to increased alpha-1-acid glycoprotein)

Question 45

1. Causes paralysis of the parasite by depolarizing neuromuscular synapse causing the release of acetylcholine and inhibiting acetylcholinesterase 2. Inhibit microtubule polymerization by binding to the parasite‟s beta-tubulin 3. Increase permeability of trematode and cestode cell membranes to calcium causing spastic paralysis 4. Paralysis of parasite by intensifying GABA-mediated transmission of signals in the parasite‟s peripheral nerves

Answer 45

1. Pyrantel pamoate 2. Mebendazole 3. Praziquantel 4. Ivermectin

Question 46

Anti TB meds with the ff ADR: 1. peripheral neuropathy, hepatitis 2. hyperuricemia, hepatitis 3. discoloration of body fluids 4. retrobulbar neuritis

Answer 46

1. Isoniazid 2. Pyrazinamide 3. Rifampicin 4. Ethambutol

Question 47

laxative that causes direct stimulation of the ENS leading to colonic fluid and electrolyte secretion VERSUS Hydrolyzed in the upper small intestine to a colonic irritant that stimulates intestinal motility

Answer 47

1. Senna | 2. Castor oil

Question 48

Antibiotics that cause QTc prolongation

Answer 48

Levofloxacin Erythromycin 3rd gen FQs (Levo, Moxi, Gati, Gemi)

Question 49

apart from Gray Baby syndrome, what is another ADR of chlorampencol

Answer 49

Aplastic anemia