RefinedModule2Pharm Flashcards
What should be avoided with cephalosporins?
a) statins
b) alcohol
c) MAOIs
d) chelating agents
Answer: b) alcohol should be avoided
remember the “chef” who had too much to drink on the show
Which are side effects of cephalosporins?
a) bleeds
b) superinfections
c) Red man syndrome
d) long QT
Answer: a) bleeds
Remember the “chef” with his “ax”=ceftriaxone as well as cefazolin, cefotetan can cause bleeds
True or false, cephalosporin coverage becomes more broad with later generations?
True
What coverage type increases with generations of cephalosporins?
More gram negative coverage
What would 2nd generation cephalosporins be used for?
a) surgery prophylaxis
b) pseudomonas
c) pneumonia
d) meningitis
answer c) pneumonia and URI
Gives Gram + coverage and some gram - coverage
Which generation of cephalosprins penetrate the CSF?
3rd- can be used to treat gram - bacteria and meningitis
Which is not a use for 5th generation cephalosporins?
a) HAI
b) MRSA
c) enterobacteriaceae
d) pseudomonas
Answer: A)HAI (better treated with 4th gen)
What is a side effect of cephalosporins?
a) long QT
b) hepatotoxicity
c) photosensitivity
d) renal impairment
Answer d)renal impairment
(remember the “dead” kidney on the “cooking show)
Most common SE is allergic reaction
What drug can be used if a patient has a severe (anaphylactic) allergy to PCN?
a) cephalospoin
b) erythromycin
c) macrolide
d) none of these
Answer b&c
Erythromycin (a macrolide) can be used in patients with severe allergy to PCN. Avoid cephalosporin use as cross-allergy may exist (in severe allergies).
Which of these is a penicillinase-reistant PCN?
a) amoxicillin
b) piperacillin
c) naficillin
d) penicillin G
Answer c)naficillin
Others include oxicillin and dicloxicillin
They treat STAPHYLOCOCCI ONLY–> gram + narrow
Which penicillin is appropriate to treat staphylococci?
a) amoxicillin
b) piperacillin
c) oxicillin
d) penicillin V
Answer:
c) oxicillin
Others include naficillin and dicloxicillin
Which of the following are broad-spectrum PCN?
a) amoxicillin
b) piperacillin
c) naficillin
d) penicillin G
Answer: a)amoxicillin
Ampicillin is the other. They cover mostly gram + and some gram -
What does piperacillin cover?
a) gram -
b) gram +
c) both
Answer: a) gram -
Note: can be broad spectrum if combined with a Beta-lactamase inhibitor (sulbactam, tazobactam, clavulanic acid)
If I use vancomycin, what am I treating?
MRSA or C.diff
Which is a side effect of PCN?
a) QT prolongation
b) bleeds
c) renal toxicity
d) hemolytic anemia
Answer:
d)hemolytic anemia (remember the anemone that the “pencil villain” stole along with the hypersensitive hiker)
Which is not a beta-lactamase inhibitor?
a) sulbactam
b) sulfamethoxazole
c) clavulanic acid
d) none of the above
Answer b)sulfamethoxazole
It is used to treat UTIs
MALT in reference to mechanism of action refers to what 4 antibiotics?
Antibiotics that inhibit protein synthesis
Macrolides: (azithromycin/erythromycin)
Aminoglycosides (streptomycin and gentamicin)
Lincosamides (Clindamycin)
Tetracyclines (tetracycline, doxycycline)
What is the suffix for macrolides?
“____thromycin”
What is the suffix for tetracyclines?
“_____cycline”
What are the aminoglycoside names?
GNATS
gentamicin, neomycin, amikacin, tobramycin, streptomycin
What medication is a lincosamide? (think MALT)
Clindamycin
What are carbapenems used to treat?
a) skin
b) GI
c) STI
d) serious infections
Answer: d) serious infections
also used to treat urinary and GI infections
What are aminoglygosides used to treat?
a) bacteremia
b) Lyme disease
c) STIs
d) skin
Answer: a)bacteremia and abdominal infections
Acronym GLAM means what?
Most antibiotics cover gram + and gram - except GLAM:
Glycopeptide (vanco)=gram positive
Lincosamide (clindamycin)=gram positive
AmiNOglycoside= gram negative
Macrolides=gram positive
Which is not a side effect of carbapenem?
a) renal toxicity
b) GI
c) decreases valproate
d) superinfections
Answer: a) renal toxicity
Which is not a side effect of vancomycin?
a) Red man syndrome
b) ototoxic
c) renal failure
d) QT prolongation
e) thrombocytopenia
f) blood dyscrasia
Answer d)QT prolongation f)blood dyscrasias
Remember: we do monitor trough levels to protect from renal damage.
Telavancin (synthetic vancomycin) has what side effect?
a) Red man syndrome
b) ototoxic
c) renal failure
d) QT prolongation
Answer: d)QT prolongation
Why would telvancin be used?
a) to treat organism resistant to MRSA
b) to treat organism resistant to piperacillin
c) to treat C.diff
d) to treat organism resistant to vancomycin
Answer: d) to treat organism resistant to vancomycin
Aztreonam uses include:
a) H. flu and pneumonia
b) E. coli and pneumonia
c) Klebsiella and H. pylori
d) H. flu and pseudomonas
Answer: d) H. flu and pseudomonas
Which is not a use for aztreonam:
a) enterobacteriaceae
b) E. coli
c) shigella
d) mycoplasma pneumoniae
Answer d) mycoplasma pneumoniae
Treat that with tetracycline (doxycycline)
Which beta-lactam antibiotic is resistant to beta-lactamase?
a) PCN
b) cephalosporin
c) monobactam
d) carbapenem
Answer: d) carbapenem
remember beta-lactamase “fish” with the resistance band in the video with a “penny” lead character
What ABX can be given for a UTI during pregnancy?
a) trimethoprim/sulfamethoxazole
b) amoxicillin
c) nitrofurantoin
d) fosfomycin
e) one or more of the above
answer e) one or more of the above
Amoxicillin and Fosfomycin can both be given to pregnant patients. Fosfomycin is for uncomplicated UTIs and are a single dose. However, pregnancy itself is considered a complicated UTI which indicates use of amoxicillin?
First line treatment in a complicated UTI/uncomplicated pyelo would be?
a) fluoroquinolones
b) SMP/TMZ
c) cephalosporins
d) nitrofurantoin
e) one or more of the above
Answer: e) one or more of the above.
The first line treatment for COMPLICATED UTI/uncomplicated pyelo would be SMP/TMZ and fluoroquinolones.
2nd line tx: cephalosporins and amoxicilin/clavulante
Nitrofurantoin (lower UTI drug) carries what adverse reactions?
a) blood issues
b) renal toxic
c) hepatotoxic
d) pulmonary
e) one or more of the above
Answer: e) one or more of the above
Nitrofurantoin is associated with blood issues, hepatotoxicity, GI, pulmonary, and teratogen
How long should a patient be treated for recurrent UTIs?
a) 3 months
b) 6 months
c) 1 year
d) none of the above
Answer: b) 6 months
Which organism is not associated with UTIs?
a) klebsiella
b) proteus
c) staph saphrophyticus
d) E. coli
e) one or more of the above
f) none of the above
Answer: f)none of the above
Note: they all are associated with UTIs
What is the most significant side effect of HIV medications?
a) bone marrow suppression
b) G6PD
c) immunosuppression
d) CYP450 metabolism
Answer: d) CYP450 metabolism
Thus, they have LOTS of drug interactions/adverse effects as a result.
Multidrug resistant TB (MDR TB) resists:
a) INH
b) rifampin
c) all fluoroquinolones
d) one or more 2nd line injectables
e) one or more of the above
Answer: e) one more more of the above
Multidrug resistant TB resists: INH & rifampin
Extensively drug resistant TB (XDR TB) resists:
a) INH
b) rifampin
c) all fluoroquinolones
d) one or more 2nd line injectables
e) one or more of the above
Answer e) one or more of the the above
XDR TB resists:
INH, rifampin, all fluoroquinolones, one or more 2nd line injectables
Patients with HIV and TB:
a) require longer treatment but less aggressive
b) require shorter, more aggressive treatment
c) cannot be treated for both simultaneously
d) will be denied treatment for one infection
e) one or more of the above
Answer: d) will be denied treatment for one infection
Patients with simultaneous HIV&TB will require longer, more aggressive treatment (6 months). Rifampin (TB drug) can increase the metabolism of HIV drugs rendering them less effective. Note: Rifabutin does not increase metabolism of HIV drugs as much.
Which option would be better for a patient with simultaneous HIV and TB?
a) Rifapentine
b) Rifampin
c) Rifabutin
d) none of the above
Answer: c) Rifabutin
Rifampin and Rifabutin can increase the metabolism of HIV drugs rendering them less effective. Note: Rifabutin does not increase metabolism of HIV drugs as much.
For drug sensitive TB, initial TB treatment lasts __ weeks and is designed to make sputum noninfectious. Whereas, continuation of TB treatment lasts ___ weeks and is designed to eliminate persistent organisms.
a) 3, 6+
b )6, 12+
c) 8, 18+
d) 10, 24+
Answer c) 8, 18+
Note: initial treatment requires the use of 4 drugs “RIPE” and continuation treatment requires the use of 2 “RI”
Which is harder to treat, INH resistant TB or rifampin resistant?
Answer: rifampin
Treatment is 18-24 months with “IPE” drugs
INH resistant TB requires ___ months of treatment with ____ drugs.
a) 3 months, 3 drugs
b) 6 months, 3 drugs
c) 8 months, 3 drugs
d) 10 months, 3 drugs
Answer: b) 6 months, 3 drugs “RPE”
Treatment of MDR-TB and XDR-TB involves:
a) 24 months minimum
b) 28 months minimum
c) 5-7 drugs at once
d) 7-9 drugs at once
e) one or more of the above
Answer: e) one or more of the above
Treatment is 24 months minimum with 5-7 second line drugs used at once.
TB drug acronym RIPE stands for what?
Rifampin, INH (isoniazid), Pyrazinamide, Ethambutol
What should be given if the patient is taking INH for TB?
a) B6
b) iron
c) calcium
d) pyridoxine
e) one or more of the above
Answer: e) one or more of the above
Answer: Give B6/pyridoxine to decrease neuropathy
What is a side effect of Rifampin?
a) neuropathy
b) vision changes
c) muscle weakness in those with M. gravis
d) discoloration of body fluids
Answer: d) discoloration of body fluids
Harmless discoloration may occur.
Note: this may also occur with Rifabutin
Latent TB treatment with rifampin is done daily for ___ months. Whereas latent TB treatment with INH is done daily/weekly for _____ months.
Answer :Latent TB treatment with rifampin is done daily for 4 months. Whereas latent TB treatment with INH is done daily/weekly for 6-9 months.
When INH and Rifampin are used to treat latent TB weekly, the treatment duration should be:
a) 6-8 weeks
b) 2 months
c) 3 months
d) 4 months
Answer: c) 3 months
Think of this combo as being the most “strong” and therefore less time is needed in the treatment of latent TB
Which drug is the most toxic of all TB medications?
a) Rifabutin
b) Rifapentine
c) Pyrazinamide
d) Ethambutol
Answer: c) pyrazinamide
Works on Mycobacterium TB
Vision changes can occur with which TB medication?
a) Rifabutin
b) Rifapentine
c) Pyrazinamide
d) Ethambutol
Answer: d) ethambutol
What severe reaction can occur with mebendazole (an anthelmintic)?
a) muscle weakness in M. gravis patients
b) tendon rupture
c) cancer in rats (so it should be used carefully)
d) bone marrow suppression
Answer:
d) bone marrow suppression
Also true of albendazole*
Metronidazole is useful in what infections?
a) aerobic organisms
b) anaerobic organisms
c) URI
d) GI
e) one or more of the above
Answer: e) one or more of the above
It is useful in ANaerobic bacteria found in the GI and vagina. (C. diff, H. pylori, trichomonas)
What is a BBW for metronidazole?
a) cancer in rats (so it should be used carefully)
b) bone marrow suppression
c) tendon rupture
d) muscle weakness in M. gravis patients
Answer: a) cancer in rats
Other SE: neurotoxicity and a reaction with alcohol
What labs should be monitored in a patient taking mebendazole or albendazole?
a) PT/INR
b) K+
c) CBC
d) LFT
e) one or more of the above
Answer: e) one or more of the above
As these medications can suppress bone marrow, the CBC and LFT should be monitored.
Amphotericin B side effects:
a) nephrotoxic
b) hepatotoxic
c) bone marrow suppression
d) muscle weakness in M. gravis
e) one or more of the above
Answer e) one or more of above
nephrotoxic, hepatotoxic, bone marrow suppression, phlebitis
Amphotericin B will terrorize your body.
Used only for LIFE THREATENING FUNGAL INFECTIONS
What can cause blood issues in those with G6PD?
A)TMP/SMZ
B) fluoroquinolones
C) doxycycline
D)valacylovir
Answer: a)TMP/SMZ
Match the letters to the generation for cephalosporins:
first gen= \_\_\_\_\_ second gen=\_\_\_\_\_\_ third gen=\_\_\_\_\_\_ fourth gen=\_\_\_\_\_\_\_ fifth gen=\_\_\_\_\_\_\_
Answer:
1st: FA/PHA (ceFAzolin, cePHalexin)
2nd: all others
3rd: ONE/TEN/IME (ceftriaxONE, cefibuTEN, cefixIME)
4th: Pi (CefePime)
5th: ROL (CeftaROLine)
Which of the following is not a beta-lactam antibiotic?
a) penicillin
b) cefepime
c) carbapenem
d) ciprofloxacin
e) one or more of the above
Answer: d) ciprofloxacin
Beta-lactam antibiotics are: PCN, cephalosporins, carbapenems, aztreonam
Which medication can cause muscle breakdown when combined with a statin?
a) fluoroquinolone
b) SMZ/TMP
c) Tetracycline
d) Macrolide
Answer: d)macrolide
Other SE: QT, (erythromycin can increase warfarin, and clindamycin has a BBW for C. Diff)
Which antibiotic has a BBW for C. Diff?
a) carbapenem
b) vancomycin
c) aztreonam
d) clindamycin
Answer: d) clindamycin
This can occur even after medication cessation.
Amphotericin B should be used:
a) to treat MRSA
b) to treat HCAI
c) to treat pseudomonas
d) to treat serious fungal infections
Answer: d) to treat serious fungal infections
It is a broad spectrum antifungal with SERIOUS SE.
What is the MOA for amphotericin B?
a) disrupts cell wall
b) disrupts protein synthesis
c) increases cell membrane permeability
d) inhibits ergosterol
Answer: c) increases cell membrane permeability so “stuff” leaks out via a “sterol” which is not found in human cells
What is a BBW found on amphotericin B?
a) blood dyscracia
b) bone marrow suppression
c) muscle weakness in M. gravis
d) cancer in lab rats
e) one or more of the above
Answer: b) bone marrow suppression
Other BBW: use only in life threatening FUNGAL infections
Which of the following is not a SE of amphotericin B?
a) renal toxicity
b) hepatotoxicity
c) IV infusion reactions
d) cardiac suppression
Answer: d) cardiac suppression
This can occur with fungal azoles such as Itraconazole.
What medications should be avoided with amphotericin B?
a) statins
b) aminoglycosides
c) warfarin
d) NSAIDs
e) one or more of the above
Answer: e) one or more of the above
Avoid nephrotoxic drugs concurrently with amphotericin B such as NSAIDs and aminoglycosides (ototoxic and nephrotoxic).
Which of the following is an appropriate match:
a) azoles- ringworm and onychomycosis
b) griseofulvin-candida and tinea capitis
c) griseofulvin- tinea capitis only
d) azoles-all
Answer: d) azoles-all
Azoles cover all; allylamine covers ringworm and onychomycosis (nails); Griseofulvin won’t cover candida but it is the drug of choice for tinea capitis
What is fidaxomicin used for?
a) GI/GU infections
b) serious infections
c) M. pneumoniae
d) CDAD
Answer: d) CDAD
Fidaxomicin covers C. Diff associated diarrhea.
True or false, polymyxin B has been recently used for treating multi-drug resistant organisms?
True.
Which is not a side effect of fungal azoles (Itraconazole)?
a) increase CPY450
b) liver failure
c) cardiac suppression (negative inotrope)
d) GI
e) one or more of the above
Answer: a) increase CYP450
Fungal azoles can inhibit (DECREASE) the activity of CYP450. The other options are true side effects of azoles.
What is the MOA for echinocandins?
a) inhibit ergosterol
b) disrupt DNA/RNA synthesis
c) increase cell membrane permeability
d) disrupt cell wall
Answer: d) disrupt cell wall
This is unique, as many antifungals affect the cell membrane.
What is the MOA for flucytosine?
a) inhibit ergosterol
b) disrupt DNA/RNA synthesis
c) increase cell membrane permeability
d) disrupt cell wall
Answer: b) disrupt DNA/RNA synthesis in fungi
What is a side effect of echinocandins?
a) hyperkalemia
b) cardiac suppression
c) histamine release
d) inhibit CYP450
Answer: c) histamine release
Other SE: hypokalemia, headache, N/V
True or false, caspofungin (an echinocandin) is just as effective as highly toxic amphotericin B?
True, and caspofungin is better tolerated.
What drug is often combined with amphotericin B?
a) flucytosine
b) echinocandin (caspofungin)
c) itraconazole (azole)
d) triclabendazole
Answer: a) flucytosine
The combo is used to treat serious infections of candida and cryptococcus neoformans.
What is the use of flucytosine?
a) onychomycosis
b) candida and dermatophytes
c) candida
d) C. Diff associated diarrhea (CDAD)
Answer: c) candida
Also treats cyrptococcus neoformans.
Used often with amphotericin B
True or false, ciclopirox works on candida only?
False, it also works on dermatophytes
What is a side effect of flucytosine?
a) increased half life in renal impaired
b) renal toxicity
c) bone marrow suppression
d) teratogen
e) two of the above
f) three of the above
Answer: e) two of the above
Flucytosine: increased half life in renal-impaired patients, liver toxicity, inhibit liver metabolizing enzymes
BBW: bone marrow suppression
Side effect of mebendazole and albendazole?
a) none- anthelmintics are generally well tolerated
b) muscle weakness in M. gravis
c) bone marrow suppression
d) QT prolongation
Answer: c) bone marrow suppression
Also side effect of liver toxicity. We need to monitor LFT and CBC.
Chlamydia treatment is:
a) 100 mg azithromycin once
b) 100 mg doxycycline once
c) 1 g azithromycin once
d) 1 g doxycycine B.I.D. for 7 days
e) 100 mg azithromycin B.I.D for 7 days
Answer: c) 1 g azithromycin PO once
OR… 100 mg doxycycline PO BID Q7D
Gonorrhea treatment is:
a) 100 mg azithromycin PO BID Q7D
b) 1 gram azithromycin PO once
c) 250 mg azithromycin IM once
d) 1 gram ceftriaxone IM once
Answer: b) 1 gram azithromycin PO once
The combo is: 250 mg ceftriaxone IM once plus 1 g azithromycin PO once
Syphilis is treated with how much Pen G?
a) 1.4 million units PO once
b) 2.4 million units PO once
c) 2.4 million units IM once
d) 1.4 million units IM once
Answer: c) 2.4 million units IM once
What drugs are used for treating genital herpes?
Remember: No cure but we can use acycylovir, famciclovir, and valacyclovir.
Bacterial vaginosis can be treated with what dosage?
a) ciprofloxacin 500 mg PO BID Q7D
b) metronidazole 500 mg PO BID Q7D
c) clindamycin 5g vaginally at bedtime Q7D
d) metronidazole 5g vaginally at bedtime Q7D
Answer: b) metronidazole 500 mg PO BID Q7D
Other choices are metronidazole 5g vaginally Q5D or clindamycin 5g vaginally Q7D
Trichimoniasis treatment is:
a) ciprofloxacin 500 mg PO BID Q7D
b) metronidazole 500 mg PO BID Q7D
c) metronidazole 2 g PO once
d) metronidazle 5 g PO once
Answer: c) metronidazole 2 grams once PO
Which antivirals are safest and used for most:
a) famciclovir, cidofovir, acyclovir
b) acyclovir, vangancicovir, famciclovir
c) acyclovir, ganciclovir, valacyclovir
d) acyclovir, valacyclovir, famciclovir
Answer: D) acyclovir, valacyclovir, famciclovir
Which non-HIV antiviral carries the side effect of TTP/HUS?
a) acyclovir
b) famciclovir
c) ganciclovir
d) valacyclovir
Answer: d) valacyclovir
TTP/HUS can occur in immune compromised patients.
Which is a prodrug of acyclovir?
a) vanganciclovir
b) cidofovir
c) valacyclovir
d) famacyclovir
Answer: c) valacyclovir
It has greater bioavailability than acyclovir.
Which is not a side effect of ganciclovir (used to treat herpes and CMV in immunocompromised only)?
a) Bone marrow suppression
b) TTP/HUS
c) decreased sperm
d) cancer
Answer: b)TTP/HUS
TTP/HUS is seen with valacyclovir in immune compromised patients.
SE of ganciclovir and vanganciclovir are: bone marrow suppression, decreased sperm, cancer, and teratogen
Cidofovir uses include:
a) CMV retinitis in AIDS
b) resistant HSV and VSV in immunocompromised
c) CMV prevention
d) resistant VZV in AIDS
Answer: a) CMV retinitis in AIDS patients who have not responded to other drugs
What drug would be used to treat CMV retinitis in AIDS patients, and/or resistant HSV and VZV in immunocompromised patients?
a) vanganciclovir
b) foscarnet
c) cidofovir
d) ganciclovir
Answer: b) foscarnet
Which drug for Hep B can lead to resistant HIV?
a) lamivudine
b) tenofovir
c) entecavir
d) adefovir
Answer: b) tenofovir
Which drug for Hepatitis B will exacerbate hepatitis when discontinued?
a) sofobuvir
b) dasabuvir
c) tenofovir
d) entecavir
Answer: d) entecavir
Treatment for an 18 year old non pregnant female with uncomplicated cervix infection with gonorrhea and chlamydial infection has not been excluded is:
a) Ceftriaxone 500 mg IM once
b) Ceftriaxone 500 mg IM plus Doxycycline 100 mg po twice daily for 7 days
c) Ceftriaxone 250 mg IM plus Azithromycin 1 gm PO orally
d) Azithromycin 1 gram by mouth once
Answer: b) Ceftriaxone 500 mg IM plus Doxycycline 100 mg po twice daily for 7 days
Jade comes in with vaginal Candidiasis. What is the NP going to prescribe?
a) Metronidazole 150 mg by mouth for 7 days
b) Metronidazole 150 mg by mouth once
c) Fluconazole 150 mg by month once
d) Fluconazole 150 mg by mouth daily for 5 days
Answer: Fluconazole 150 mg by month once
Lauren a 22 year old female comes into the clinic and is diagnosed with Trichomoniasis. The NP can prescribe: Check all that apply.
a) Tinidazole 2 gram by mouth in a single dose for men and women
b) Metronidazole 2 gram by mouth in a single dose for men
c) Metronidazole 500 by mouth twice daily for 7 days
A,B,C all correct.
Which of the following statements regarding antiretroviral treatment are true? Check all that apply
a) Antiretroviral treatment is started immediately upon diagnosis
b) All regimens must include 2 NRTIs and another drug class
c) Protease inhibitors cause fat redistribution
A,B,C all correct.
Vancomycin works:
a) inhibiting cell wall synthesis
b) weakening the cell wall
c) interfering with protein synthesis
d) interfering with DNA/RNA
Answer: a) inhibiting cell wall synthesis
