Quiz Pharmacology Part 2 of 2

Pharmacology – Part 2

14Mar2009

1 – General Principles of Antimicrobial Chemotherapy 1) Antibiotics are chemicals produced by which of the following? a) Cancer cells b) Viruses c) Bacteria d) Fungi e) Microorganisms 2) When choosing antibiotics for chemotherapy, critically ill patients need immediate administration of drugs covering infection by both gram-positive and gram-negative classes of organisms. This is known as: a) Site-specific therapy b) Sensitivity c) Cost-effective therapy d) Empiric therapy e) Selective toxicity 3) Imipenem/Cilastatin is an example of a: a) Narrow spectrum antibiotic b) Combination broad spectrum antibiotic c) Single broad spectrum antibiotic d) Gram-positive antibiotic e) Gram-negative antibiotic f) Anaerobic antibiotic 4) A patient presents with a rapid heart rate, fever, and diaphoresis. Infection is highly suspected and a blood sample is sent to the lab. In the disk diffusion method for lab testing cultured bacteria, what would a large zone of inhibition indicate? a) Drug sensitivity b) Drug resistance c) Presence of anaerobic bacteria d) Presence of gram-positive bacteria e) Presence of gram-negative bacteria 5) Several families of drugs such as penicillins and cephalosporins act to ____ the bacterial ____ and thereby promoting lysis. The mechanism is through prevention of murein (peptidoglycan) synthesis. a) Weaken; Cell membrane b) Weaken; Cell wall c) Strengthen; Cell membrane d) Strengthen; Cell wall 6) Which of the following would be a quantitative method of measuring selective toxicity? a) Equilibrium dissociation constant b) Toxic dosage c) Effective dosage d) Sensitivity e) Therapeutic index

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Pharmacology – Part 2

14Mar2009

7) The enzyme that sulfonamides inhibit (para-aminobenzoic acid, PABA) is needed for bacterial production of which of the following, which is required for synthesis of DNA, RNA, and protein? a) Murein b) Niacin c) Folic acid d) Arachidonic acid e) Phosphodiesterase 8) Bactrim is an effective and cheap medication containing a sulphonamide and trimethoprim. Which enzyme is targeted by trimethoprim? a) Monohydropteroate synthase b) Monohydrofolate reductase c) Dihydropteroate synthase d) Dihydrofolate reductase 9) When prescribing Bactrim, care must be taken for patients with glucose-6-phosphate deficiencies. In which of the following cases is Bactrim contraindicated? a) Gram-negative infected patients b) Hemological deficiency patients c) Congestive heart failure patients d) Thyroid hormone deficiency patients e) Alcoholics 10) Fluoroquinolones works by which of the following mechanisms? a) Disruption of protein synthesis via ribosomes b) Inhibition of DNA gyrase c) Inhibition of reverse transcriptase d) Inhibition of fungal membrane 11) Erythromycin works by which of the following mechanisms? a) Disruption of protein synthesis via ribosomes b) Inhibition of DNA gyrase c) Inhibition of reverse transcriptase d) Inhibition of fungal membrane 12) Which of the following mechanisms is NOT correctly matched with the drug? a) Vancomycin; Inhibitor of cell wall synthesis b) Amphotericin B; Disruption of cell wall membrane c) Tetracyclines: Bacteriostatic inhibitor of protein synthesis d) Ketokonazole; Disruption of cell wall membrane e) Rifampin; Inhibitor of cell wall synthesis 13) Which of the following is NOT an antibiotic? a) Flucytosine b) Clindamycin c) Fluroquinolone d) Imipenem e) Cephalosporin 14) Which of the following is a prodrug (must be activated by bacterial catalase) and works by inhibiting mycolic acid synthesis? a) Flucytosine

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Pharmacology – Part 2

14Mar2009

b) Acyclovir c) Zidovudine d) Isoniazid e) Pyrazinamine 15) Which of the following drugs does NOT inhibit viral enzymes? a) Acyclovir b) Zidovudine c) Ethambutol d) Saquinavir e) Indinavir 16) What is the mechanism of action for the drug amantadine, which is used against type A influenza? a) Antimetabolite b) Interference with synthesis of bacterial DNA or RNA c) Viral enzyme inhibitor d) Mycolic acid synthesis inhibitor e) Unknown Match the drug with the inhibited ribosomal subunit: 17) Tetracycline a) 30s inhibitor 18) Clindamycin b) 50s inhibitor 19) Gentamicin 20) Erythromycin 21) Streptomycin 22) Chloramphenical 23) Spectinomycin 24) Which of the following types of drugs disrupts the DNA unwinding process? a) Penicillins b) Cephalosporins c) Macrolides d) Aminoglycosides e) Fluoroquinolones f) Sulfonamides Match the type of targeting with the mechanism or example: 25) Bacterial cell wall synthesis inhibitors a) Common targeting 26) Drug targets protein isoform; DHFR inhibitor b) Unique targeting 27) Drug targets metabolic pathway; 5-Fluorouracil c) Selective targeting 28) Which of the following narrow spectrum antimicrobial drugs would affect gramnegative aerobes (versus gram-positive cocci/bacilli)? a) Nafcillin b) Vancomycin c) Gentamycin d) Erythromycin e) Clindamycin 29) Which of the following would NOT be a narrow spectrum antibiotic used for Mycobacterium tuberculosis? a) Isonizid

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Pharmacology – Part 2

14Mar2009

b) Rifampin c) Ethambutol d) Imipenem e) Pyrazinamide 30) A(n) ____ drug will halt bacterial growth but not deplete it, while a(n) ____ drug will start to decline the growth of bacteria. a) Bactericidal; Antibiotic b) Antibiotic; Bacteriostatic c) Bactericidal; Bacteriostatic d) Bacteriostatic; Bactericidal e) Antibiotic; Bactericidal 31) Penicillin is a ____ drug and tetracycline is a ____ drug. a) Bactericidal; Bacteriostatic b) Bacteriostatic; Bactericidal c) Bactericidal; Bactericidal d) Bacteriostatic; Bacteriostatic 32) Which of the following drugs is bactericidal? a) Sulfonamides b) Trimethoprim c) Macrolides d) Lincosamides e) Choramphenicol f) Cephalosporins 33) What does an increase in minimum inhibitory concentration (MIC) response mean, such as seen with Staphylococcus aureus, Enterococcus, and Mycobacterium tuberculosis? a) The drug was not originally effective b) Intracellular uptake of the drug has increased c) The bacteria has gained resistance to the drug d) The bacteria has halted growth (bacteriostatic) e) The bacterial growth is declining (bactericidal) 34) Spontaneous mutation usually results in resistance to ____ drug(s) and conjugation (via plasmid) usually results in resistance to ____ drug(s). a) One; One b) One; Multiple c) Multiple; One d) Multiple; Multiple e) No; One 35) Selective pressure can occur with plasma-mediated infections (hospital or nosocomial). This occurs when: a) Drug-resistant and drug-sensitive bacteria survive b) Drug-resistant bacteria survive (drug-sensitive killed) c) Drug-sensitive bacteria survive (drug-resistant killed) d) Drug-resistant and drug-sensitive bacteria are killed (lack of nutrients) 36) Emergence of drug resistance during primary treatment (suprainfection) is facilitated most likely by broad-spectrum antibiotics.

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Pharmacology – Part 2

14Mar2009

a) True b) False 37) What type of drug would be needed to enter the brain and CNS? a) Hydrophilic b) Hydrophobic c) Lipophilic d) Lipophobic e) Large molecular weight 38) Which of the following drugs is contraindicated in neonates as it causes kernicterus (brain yellowing from bilirubin)? a) Tetracyclines b) Aminoglycosides c) Cephalosporins d) Fluoroquinolones e) Sulfonamides 39) Which of the following drugs is considered FDA pregnancy category D (contraindicated)? a) Tetracyclines b) Macrolides c) Cephalosporins d) Penicillins e) Sulfonamides 40) Which of the following patients would have to rely on bactericidal antibiotics? a) Liver disease patient b) Acquired immune deficiency syndrome (AIDS) patient c) Congestive heart failure (CHF) patient d) Chronic obstructive pulmonary disease (COPD) patient e) Abdominal trauma patient 41) Along with infected abscesses, which type of infection can impede drug access? a) Pneumonia b) Upper respiratory tract infections c) Urinary tract infections d) Gastroenteritis e) Endocarditis 42) When treating meningitis, one of the steps to achieve the MIC is by injecting antibiotic where? a) Epidural space b) Subdural space c) Subarachnoid space d) Subpial space e) Corneal space 43) A patient undergoes a procedure to implant a cardiac pacemaker and prosthetic heart valve. One month later, the patient returns with a high fever. Infection is found in the pacemaker pocket, along the pathway of the electrical lead, and near the prosthetic valve. Which of the following is the most likely cause? a) Staphylococcus aureus

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Pharmacology – Part 2

14Mar2009

b) Staphylococcus epidermidis c) Staphylococcus saprophyticus d) Viridans Streptococci e) Escherichia Coli 44) Accumulation of antibiotics to toxic levels can most likely occur in which of the following patient populations? a) AIDS patients b) Elderly c) Pregnant d) Neonates e) B & D f) A & C 45) Which of the following types of drugs binds to teeth and can cause discoloration? a) Tetracyclines b) Macrolides c) Cephalosporins d) Penicillins e) Sulfonamides 46) Which of the following clinical results is associated with gentamicin (aminoglycoside), not tetracyclines? a) Hepatic necrosis b) Pancreatitis c) Hearing loss d) Renal damage 47) Which of the following types of drugs can enter breast milk? a) Tetracyclines b) Macrolides c) Cephalosporins d) Penicillins e) Sulfonamides 48) Severe allergic reactions are more common with what family of drugs? a) Tetracyclines b) Macrolides c) Cephalosporins d) Penicillins e) Sulfonamides 49) Which of the following types of drugs is NOT associated with an incidence of allergic response? a) Trimethoprim b) Tetracyclines c) Erythromycin d) Penicillins e) Sulfonamides 50) Sulfonamides and nalidixic acid can cause hemolysis in patients that are deficient in what enzyme? a) Phosphoenolpyruvate carboxykinase

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Pharmacology – Part 2

14Mar2009

b) Fructose 1,6-bisphosphatase c) Glucose 6-phosphate d) Glucokinase f) Fructokinase 51) If a bacteriostatic agent, such as tetracycline, is given in synergy with a bactericidal agent, such as penicillin, what is the likely result? a) Additive response b) Potentiative response c) Antagonistic response 52) If trimethoprim and sulfamethoxazole are given together, what decrease in MIC must be seen to be considered a synergistic (potentiative) interaction? a) 5-fold (1/5 MIC) b) 4-fold (1/4 MIC) c) 3-fold (1/3 MIC) d) 2-fold (1/2 MIC) e) 1-fold (MIC) 53) Although the use of multiple antibiotics can lead to drug resistance, what disease is treated with several drugs as it has a risk for CNS damage? a) Leprosy b) Syphilis c) Thrush d) Pneumonia e) Tuberculosis 54) When treating fungal meningitis with combined flucytosine and amphotericin B, reducing the dose of ____ can decrease the risk of damage to the ____. a) Flucytosine; Kidney b) Flucytosine; Liver c) Amphotericin; Kidney d) Amphotericin; Liver 55) Penicillin is used in combination with what drug to enhance antibacterial action in the treatment of enterococcal endocarditis? a) Sulfonamides b) Cephalosporins c) Macrolides d) Aminoglycosides e) Fluoroquinolones 56) Which of the following, along with beta-lactams and aminoglycosides, is excreted by the kidney? a) Erythromycin b) Clindamycin c) Vancomycin d) Rifampin e) Chloramphenicol 57) Which of the following tests would be used to monitor kidney function? a) D-dimer, Fibrin degradation products (FDP) b) Blood urea nitrogen (BUN), Creatinine

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Pharmacology – Part 2

14Mar2009

c) Aspartate aminotransferase (AST) d) Lactate dehydrogenase (LDH) e) Bilirubin 58) It is estimated that 30-50% of antibiotics used in the United States are administered for prophylaxis. The drug trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim) is often given in what situation? a) Before dental appointments for patients with endocarditis b) For young women with recurrent urinary tract infections c) For elderly patients with an increased risk of pneumonia d) For pregnant women showing signs of systemic infection e) For all neonates with mild neutropenia 59) Prophylactic penicillin is indicated following exposure to STDs as well as for patients with rheumatic carditis. If the patient is allergic to penicillin, which drug should be used? a) Sulfonamides b) Cephalosporins c) Macrolides d) Aminoglycosides e) Fluoroquinolones 60) Which of the following antibiotics should be used for the treatment of fever with unknown origin? a) Sulfonamides b) Cephalosporins c) Macrolides d) Aminoglycosides e) Penicillins f) Antibiotics should not be used 61) Saquinavir and ritonavir are what type of drugs? a) Fusion inhibitors b) Ion channel blockers c) Polymerase inhibitors d) Protease inhibitors e) Neuraminidase inhibitors 62) Amantadine and rimantadine are what type of drugs? a) Fusion inhibitors b) Ion channel blockers c) Polymerase inhibitors d) Protease inhibitors e) Neuraminidase inhibitors 63) Zanamivir and oseltamivir are what type of drugs? a) Fusion inhibitors b) Ion channel blockers c) Polymerase inhibitors d) Protease inhibitors e) Neuraminidase inhibitors 64) Efuvirtide (T-20) is what type of drug? a) Fusion inhibitors

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Pharmacology – Part 2

14Mar2009

b) Ion channel blockers c) Polymerase inhibitors d) Protease inhibitors e) Neuraminidase inhibitors 65) Acyclovir, zidovudine, and efavirenz are what types of drugs? a) Fusion inhibitors b) Ion channel blockers c) Polymerase inhibitors d) Protease inhibitors e) Neuraminidase inhibitors 66) Amphotericin and nystatin are what type of antifungal drugs? a) Polyenes b) Azoles c) Pyrimidines 67) What is the principal goal in antimicrobial chemotherapy? a) Site-specific therapy b) Sensitivity c) Cost-effective therapy d) Empiric therapy e) Selective toxicity 68) What type of antibiotic has bacteriostatic activity? a) Penicillins b) Chloramphenocol c) Macrolides d) Aminoglycosides e) Fluoroquinolones 69) Which of the following types of antibiotics should be used to treat the common cold? a) Sulfonamides b) Cephalosporins c) Macrolides d) Aminoglycosides e) Penicillins f) Antibiotics should not be used 2 – Antimicrobial Case Reviews For the next few questions, use the following case. A mother brings her 3-year-old girl to your office because the child has a fever and complains that her ear hurts. She has no significant medical history. The child is not pleased to be in the physician's office and has been crying. Her mother explains that she developed a “cold” about 3 days ago with sniffles. Her temperature is 37.8°C (100°F), and the rest of the physical examination is completed with some difficulty. The only abnormalities are slight redness of the throat, a nose full of thick green mucus, and red tympanic membranes. 1.1) What is the most likely cause of these symptoms? a) Common cold b) Gastroenteritis c) Otitis media

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Pharmacology – Part 2

14Mar2009

d) Pneumonia e) Immune deficiency 1.2) Symptoms of this infectious disease are nonspecific. a) True b) False 1.3) Cloudiness and bulging of the tympanic membrane would help with this diagnosis. a) True b) False 1.4) Antibiotic therapy in this case has no important effect on hearing loss. a) True b) False 1.5) What is the most common pathogen in the presumed diagnosis for this case? a) Streptococcus pyogenes b) Streptococcus agalactiae c) Bacillus anthracis d) Listeria monocytogenes e) Streptococcus pneumoniae 1.6) What is the antibiotic of choice in this case? a) Gentamycin b) Vancomycin c) Amoxicillin d) Erythromycin e) Clindamycin 1.7) If the patient is allergic to the initial antibiotic of choice, what should be given instead? a) Sulfonamides b) Cephalosporins c) Macrolides d) Aminoglycosides e) Fluoroquinolones For the next few questions, use the following case. A 29 yr-old male from rural South Carolina presents with fever, chills, and headache for past 10 days. Also noted are worsening depression and anxiety. He developed dark urine, back pain, oliguria (scanty urine production), nausea and anorexia. On examination, bumpy rash, edema and petechial rash were noted on his hands and trunk. At the time of examination, the patient’s temperature was high (>102°F). 2.1) Which of the following intracellular pathogens is the most likely cause? a) Rickettsiae b) Mycobacterium tuberculosis c) Salmonella typhi d) Chlamydia e) Shigella dysenteriae 2.2) Which of the following is the antibiotic of choice in this case as it shows 30s inhibition and thus interferes with tRNA anticodon reading of mRNA? a) Erythromycin b) Clindamycin

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Pharmacology – Part 2

14Mar2009

c) Chloramphenical d) Doxycycline 2.3) Which of the following adverse effects of the antibiotic is the most life threatening? a) GI adverse effects b) CNS adverse effects c) Allergies d) Phototoxicity e) Steven-Johnson Syndrome (SJS) For the next few questions, use the following case. A 32-yr-old man with a history of skull trauma presents with headache, mental status changes, and fever. He reports two brief episodes seizures (3-5 seconds of duration). A CT scan of brain shows brain abscess with accompanying edema. CSF analysis revealed aerobic and anaerobic streptococci. 3.1) Which of the following antibiotics should be given? a) Gentamicin b) Streptomycin c) Chloramphenicol d) Erythromycin e) Tetracycline 3.2) Which of the following is the most commonly seen adverse effect when giving this antibiotic? a) UTI b) Brain swelling c) Allergies d) Migrane headaches e) Aplastic anemia 3 – Penicillins 1) Penicillin was first discovered when colonies of staphylococci lysed when contaminated with what? a) Penicillium bacteria b) Penicillium virus c) Penicillium fungi d) Penicillium parasite 2) Which of the following sites in an antibiotic molecule is the site of cleavage for bacterial enzymes? a) Thiazolidine ring, C–S bond b) Thiazolidine ring, C–C bond c) Thiazolidine ring, C–N bond d) Beta-lactam ring, C–C bond e) Beta-lactam ring, C–N bond Match the chemical R-group ring side-chain group with the antibiotic it signifies: 3) Penicillin G a) –CH–COOH 4) Penicillin V b) –OCH2 5) Ampicillin c) –CH–NH2 6) Carbeniccilin d) –CH2

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Pharmacology – Part 2

14Mar2009

7) Penicillin G is ____ to penicillinase and methicillin is ____ to penicillinase. Both are considered ____ spectrum antibiotics. Penicillin G cannot be taken orally due to stomach acids. a) Resistant; Sensitive; Narrow b) Resistant; Sensitive; Broad c) Sensitive; Resistant; Narrow d) Sensitive; Resistant; Broad 8) What is the order of bacterial wall biosynthesis? a) Murein synthesis, polymerization, cross-linking b) Murein polymerization, cross-linking, synthesis c) Murein cross-linking, polymerization, synthesis d) Murein synthesis, cross-linking, polymerization e) Murein polymerization, synthesis, cross-linking 9) Gram-negative bacteria have a thicker murein (peptidoglycan) layer than grampositive bacteria. a) True b) False 10) Which of the following enzymes is the main target for penicillin? a) Transglucosylases b) Transpeptidases c) D-alanine carboxykinases d) Penicillin binding proteins (PBPs) 11) Which of the following is NOT a common indication for penicillin? a) Meningitis b) Pneumonia or chronic bronchitis c) UTIs d) MRSA e) Gonorrhea or syphilis 12) Which of the following has the highest bacterial resistance pattern? a) Penicillin G b) Penicillin V c) Methicillin d) Ampicillin e) Carbencillin 13) Which of the following is considered extended-spectrum as it can fight pseudomonal aeroginosa, enterobacter species, proteus, bacteroids fragilis, and many klebsiella? a) Oxacillin b) Ampicillin c) Amoxicillin d) Penicillin G e) Carbencillin 14) Which of the following would be used to treat Neisseria gonorrhoeae if the patient was allergic to penicillins? a) Ticarcillin b) Carbencillin c) Ceftriaxone

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Pharmacology – Part 2

14Mar2009

d) Penicillin G e) Penicillin V 15) Penicillin V is given via orally (PO) versus IM or IV. a) True b) False 16) Ampicillin has a bioavilability of 40% with initial dose (F=0.40). What is the bioavailability of amoxicillin with one dose? a) 5% b) 25% c) 50% d) 75% e) 95% 17) Clavulanate is added to amoxicillin (Augmentin) to protect the drug molecule. This results in a ____ bioavailability and a change from dosage three times a day (tid) to ____ times a day. However, this produces a high incidence of diarrhea. a) Increase; Four (qid) b) Increase; Two (tid) c) Decrease; Four (qid) d) Decrease; Two (tid) 18) When adding a second antibiotic to a drug regimen, which of the following would have the least affect on improving health due to drug-drug interactions? a) Both drugs have mild protein binding b) Both drugs are highly protein bound c) The first drug is highly protein bound and the second is not d) The second drug is highly protein bound and the first is not 19) Which of the following is the least protein-bound? a) Oxacillin b) Cloxacillin c) Dicloxacillin d) Flucoxacillin e) Amoxicillin 20) Which of the following is considered the least toxic? a) Ticarcillin b) Oxacillin c) Ampicillin d) Penicillin G e) Penicillin V 21) Which of the following would NOT be an adverse effect seen with hypersensitivity to penicillin? a) Vomiting b) Pruritus (need to scratch) c) Bradycardia d) Vertigo e) Loss of consciousness 22) Which of the following adverse effects to penicillin is a sign of hematologic toxicity, not nephropathy?

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Pharmacology – Part 2

14Mar2009

a) Fever b) Macular rash c) Eosinophilia d) Neutropenia e) Hematuria 23) Which of the following should be monitored (lab work) when administering penicillins or cephalosporins to older adults? a) D-dimer b) Creatinine c) Aspartate aminotransferase (AST) d) Lactate dehydrogenase (LDH) e) Bilirubin 24) What is the drug of choice for an anaphylactic reaction? a) Adenosine b) Atropine c) Epinephrine d) Dobutamine e) Midazolam 25) Which of the following drugs delays renal excretion of penicillin, therefore prolonging antibacterial effects? a) Gentamicin b) Probenecid c) Chloramphenicol d) Erythromycin e) Tetracycline 26) Genes that code for synthesis of beta-lactamases are located on bacterial plasmids, thus they can be transferred from one bacterium to another. a) True b) False 27) Clavulanic acid and sulbactam ____ antibiotics, and are added to give better ____ properties and effects. a) Are; Antibacterial b) Are; Pharmacokinetic c) Are not; Antibacterial d) Are not; Pharmacokinetic 28) In which of the following cases would you use penicillin G procaine aqueous (APPG), which serves as a long-term depot to slowly release peniciliin G? a) Oritis media b) Sinusitis c) Lower respiratory tract infection d) Urinary tract infection e) Rheumatic fever 29) Which of the following drugs would be used to treat methicillin-resistant Staphylococcus aureus (MRSA)? a) Nafcillin b) Vancomycin

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Pharmacology – Part 2

14Mar2009

c) Gentamycin d) Erythromycin e) Clindamycin 30) Which of the following is a broad spectrum antibiotic reserved chiefly for use against Pseudomonas aeroginosa? a) Penicillin G b) Penicillin V c) Methicillin d) Ampicillin e) Carbencillin 31) The mechanism of bacterial resistance to penicilins can be described as: a) Inactivation of drug by beta-lactamases b) Overproduction of PBPs c) Overproduction of peptidoglycans d) Breakdown of penicillins by the immune system e) Rapid biotransformation 32) Which of the following penicillins is an aminopenicillin? a) Methicillin b) Ampicillin c) Penicillin G d) Penicillin V e) Carbencillin 33) Which of the following penicillins produces a higher incidence of diarrhea? a) Cloxacillin b) Ampicillin c) Amoxicillin d) Augmentin e) Penicilin G 34) Which of the following penicillins is effective against Bacteroides fragilis? a) Oxacillin b) Ampicillin c) Penicillin G Procaine d) Amoxicillin e) Ticarcillin-clavulanate 4 – Cephalosporins 1) Cephalosporins are very similar chemically to penicillins. However, unlike penicillins, cephalosporins have ____ members in their chemical ring? a) 3 b) 4 c) 5 d) 6 e) 7 2) Cephalosporins have a ____ spectrum of antimicrobial activity and are considered ____. a) Broad; Bactericidal

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Pharmacology – Part 2

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b) Broad; Bacteristatic c) Narrow; Bactericidal d) Narrow; Bacteristatic 3) Which of the following classes of drugs is used the most in hospitals (hospitals in the United States spend the most on these)? a) Penicillins b) Cephalosporins c) Macrolides d) Aminoglycosides e) Fluoroquinolones f) Sulfonamides 4) Which of the following are in the correct order from most gram-positive activity to most gram-negative activity? a) First-generation, second-generation, third-generation b) Third-generation, second-generation, first-generation c) First-generation, third-generation, second-generation d) Second-generation, third-generation, first-generation e) Third-generation, first-generation, second-generation Match the drug with the cephalosporin generation: 5) Cefamanidole a) First-generation 6) Cefotaxime b) Second-generation 7) Cephalothin c) Third-generation 8) A patient is given a first-generation and second-generation cephalosporin for a bacterial infection. In which of the following cases would the drug be ineffective? a) Blood infection b) GI infection c) UTI d) CSF infection e) Respiratory infection 9) Which of the following bacteria would not be affected by a second-generation cephalosporin, but would be affected by ceftazidime? a) Staphylococcus b) Streptococcus c) Listeria d) Enterococcus e) Pseudomonas 10) Which of the following should be given for gram-negative bacterial meningitis? a) First-generation cephalosporin b) Second-generation cephalosporin c) Third-generation cephalosporin 11) Cefepime is considered a: a) First-generation cephalosporin b) Second-generation cephalosporin c) Third-generation cephalosporin d) Fourth-generation cephalosporin

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Pharmacology – Part 2

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12) Which of the following cephalosporins would be destroyed by beta-lactamases (cephalosporinases)? a) Cephalothin b) Cefamandole c) Cefotaxime d) Cefepime 13) Which of the following best describes ceftazidime and cefepime? a) First-generation cephalosporins b) Second-generation with Haemophilus influenzae activity c) Second-generation with Bacteroids fragilis activity d) Third-generation cephalosporins e) Third-generaion with Pseudomonas aeruginosa activity f) Oral broad-spectrum cephalosporins 14) Which of the following describes cefazolin and cephalexin? a) First-generation cephalosporins b) Second-generation with Haemophilus influenzae activity c) Second-generation with Bacteroids fragilis activity d) Third-generation cephalosporins e) Third-generaion with Pseudomonas aeruginosa activity f) Oral broad-spectrum cephalosporins 15) Which of the following describes cefmetazole, cefotetan, and cefoxitin? a) First-generation cephalosporins b) Second-generation with Haemophilus influenzae activity c) Second-generation with Bacteroids fragilis activity d) Third-generation cephalosporins e) Third-generaion with Pseudomonas aeruginosa activity f) Oral broad-spectrum cephalosporins 16) Which of the following describes cefixime and cefpodoxime proxecil? a) First-generation cephalosporins b) Second-generation with Haemophilus influenzae activity c) Second-generation with Bacteroids fragilis activity d) Third-generation cephalosporins e) Third-generaion with Pseudomonas aeruginosa activity f) Oral broad-spectrum cephalosporins 17) Which of the following describes cefoperazone and ceftriaxone? a) First-generation cephalosporins b) Second-generation with Haemophilus influenzae activity c) Second-generation with Bacteroids fragilis activity d) Third-generation cephalosporins e) Third-generaion with Pseudomonas aeruginosa activity f) Oral broad-spectrum cephalosporins 18) Which of the following describes cefaclor and cefuroxime? a) First-generation cephalosporins b) Second-generation with Haemophilus influenzae activity c) Second-generation with Bacteroids fragilis activity d) Third-generation cephalosporins

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Pharmacology – Part 2

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e) Third-generaion with Pseudomonas aeruginosa activity f) Oral broad-spectrum cephalosporins 19) Which of the following are eliminated largely by non-renal routed? a) Ceftazidime and cefepime b) Cefazolin and cephalexin c) Cefmetazole, cefotetan, and cefoxitin d) Cefixime and cefpodoxime proxecil e) Cefoperazone and ceftriaxone 20) All of the following cause bleeding by reducing pro-thrombin levels, except for ____, which causes bleeding by impairing platelet aggregation and has been removed from use in the United States. a) Cefamandole b) Cefmetazole c) Cefoperazone d) Cefotetan e) Moxalactam 21) Which of the following drugs prolongs cephalosporin effects? a) Gentamicin b) Probenecid c) Chloramphenicol d) Erythromycin e) Tetracycline 22) Which of the following drugs is NOT associated with alcohol intolerance? a) Cefuroxime b) Cefmetazole c) Cefoperazone d) Cefotetan e) Cefamandole 23) Which of the following has the shortest half life? a) Cefotetan (Cefotan) b) Cefazolin (Ancef) c) Cefadroxil (Duricef) d) Cephalothin (Keflin) e) Cefaclor (Ceclor) 24) Which of the following has the longest half life? a) Cefotaxime (Claforan) b) Ceftriaxone (Rocephin) c) Cefpodoxime proxetil (Vantin) d) Cefepime (Maxipime) e) Cefrazidime (Fortaz) 25) Which of the following is used to treat otitis media and has a risk of significant serum-sickness type reaction, especially in children? a) Cefotetan (Cefotan) b) Cefazolin (Ancef) c) Cefadroxil (Duricef) d) Cephalothin (Keflin)

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Pharmacology – Part 2

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e) Cefaclor (Ceclor) 26) Which of the following would be treated with a first-generation cephalosporin? a) E. Coli b) Klebsiella c) Proteus d) Staphylococcus e) Enterobacter f) Serratia g) Providencia 27) A patient is prescribed a cephalosporin for their gonorrhea infection. After injection, the patient complains of pain at the injection site. A rash appears later and the patient develops difficulty breathing (dyspnea). Which of the following drugs was likely given? a) Ceftriaxone (Rocephin) b) Loracarbef (Lorabid) c) Cefadroxil (Duricef) d) Cephalexin (Keflex) e) Cefazolin (Ancef) 28) Imipenem (Primaixin) is a beta-lactam antibiotic that is eliminated by glomerular filtration, thus is combined with cilastin (renal dehydropeptidase inhibitor). Which of the following is true of this drug? a) Acid stable and cannot cross the blood brain barrier (BBB) b) Acid instable and cannot cross the blood brain barrier (BBB) c) Acid stable and is able to cross the blood brain barrier (BBB) d) Acid instable and is able to cross the blood brain barrier (BBB) 29) Imipenem is NOT active against MRSA. a) True b) False 30) Which of the following is NOT true of Azetreonam (Azactam)? a) It is not affected by beta-lactamases b) It is active against gram-negative bacteria c) It is active against Pseudomonas aeroginosa d) It has a high potential to produce hypersensitivity reactions 31) A 2-mo-old male neonate presents with a thick eye discharge. The mother admits to having sexual partners and complains of a vaginal discharge. Exams of both eyes of infant reveals a thick purulent discharge and conjunctival congestion and edema. Corneal ulcerations was also noted. Conjunctival swabs on gram staining revealed presence of gram-negative diplococci and many polymorphonuclear cells. What organism, which can be treated with penicillin G or a third-generation cephalosporin, is the most likely cause? a) C. trachomatis b) T. pallidum c) N. gonorrhea d) H. ducreyi e) H. influenza 5 – Macrolide Antibiotics 1) Which of the following antibiotics can be taken safely and effectively as three tablets?

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Pharmacology – Part 2

14Mar2009

a) Erythromycin (Erythrocin) b) Clarithromycin (Biaxin) c) Azithromycin (Zithromax) d) Dirithromycin (Dynabac) e) Telithromycin (Ketek) 2) Which of the following is best suited to treat mycoplasma, chlamydiae, and legionella? a) Erythromycin (Erythrocin) b) Clarithromycin (Biaxin) c) Azithromycin (Zithromax) d) Dirithromycin (Dynabac) e) Telithromycin (Ketek) 3) Macrolids are ____ ribosomal subunit inhibitors that are ____ at low concentrations and ____ at high concentrations. a) 30s; Bactericidal; Bacteriostatic b) 30s; Bacteriostatic; Bactericidal c) 50s; Bactericidal; Bacteriostatic d) 50s; Bacteriostatic; Bactericidal 4) Macrolides and clindamycin have which mechanism of action during protein synthesis? a) Interfere with the donor site growing peptide b) Interfere with tRNA release c) Interfere with acceptor site so next tRNA cannot bind 5) Tetracyclines and aminoglycosides have which mechanism of action during protein synthesis? a) Interfere with the donor site growing peptide b) Interfere with tRNA release c) Interfere with acceptor site so next tRNA cannot bind 6) Chloramphenicol has which mechanism of action during protein synthesis? a) Interfere with the donor site growing peptide b) Interfere with tRNA release c) Interfere with acceptor site so next tRNA cannot bind 7) Which of the following types of infection would erythromycin be the least effective against? a) Throat b) Ears c) Skin d) Respiratory tract e) GI tract 8) Patients with diphtheria or whooping cough will not respond to penicillin. Which of the following drugs would be the best choice? a) Erythromycin (Erythrocin) b) Clarithromycin (Biaxin) c) Azithromycin (Zithromax) d) Dirithromycin (Dynabac) e) Telithromycin (Ketek)

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Pharmacology – Part 2

14Mar2009

9) Resistant strains of which of the following have emerged with the use of erythromycin? a) Streptococcus pyogenes b) Streptococcus agalactiae c) Bacillus anthracis d) Listeria monocytogenes e) Streptococcus pneumoniae 10) Although erythromycin is not normally effective with gram-negative bacteria, cell wall deficient forms of E. coli and Proteus mirabilis (L-forms) are exceptions. These are seen in recurrent: a) Pneumonia b) Upper respiratory tract infections c) Urinary tract infections d) Gastroenteritis e) Endocarditis 11) Which of the following bactericidal antibiotics is the drug of choice for pneumonia caused by H. influenzae? a) Erythromycin (Erythrocin) b) Clarithromycin (Biaxin) c) Azithromycin (Zithromax) d) Dirithromycin (Dynabac) e) Telithromycin (Ketek) 12) A patient presents with mild symptoms of fever, chills, headache, and coughing. However, they show little sign of bacterial infection. Lab blood results show infection is present and the physician chooses to use a macrolide antibiotic. Which of the following was most likely the cause of the patient’s symptoms? a) Streptococcus pyogenes b) Streptococcus agalactiae c) Mycoplasma pneumoniae d) Listeria monocytogenes e) Streptococcus pneumoniae 13) Oral erythromycin is enterically coated because it is sensitive to ____ pH. This allows the drug to be absorbed in the ____. a) Acidic; Stomach b) Acidic; Small intestine c) Basic; Stomach d) Basic; Small intestine 14) Estolate esters can be added to macrolide antibiotics (e.g. erythromycin estolate) to: a) Decrease resistance to acidic pH b) Increase resistance to basic pH c) Decrease bioavailability d) Increase bioavailability e) Lyse bacterial cell walls 15) Eating while taking azithromycin will decrease the drug’s concentration. a) True b) False

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Pharmacology – Part 2

14Mar2009

16) In which of the following locations would erythromycin be the least concentrated, at less than 20% or serum blood levels? a) Liver b) Spleen c) Fetal blood d) Breast milk e) Tears 17) Which of the following antibiotics would persist for the shortest amount of time in tissues? a) Azithromycin b) Clarithromycin c) Dirithromycin d) Erythromycin 18) Which of the following is the main organ for biotransformation of macrolides such as erythromycin (90%) and clarithromycin? a) Spleen b) Kidneys c) Brain d) GI tract e) Liver 19) Azithromycin has a volume of distribution of over 2000L. This indicated that the drug is concentrated in which of the following locations? a) Extracellular fluid b) Plasma c) Tissues d) Liver e) CNS 20) The most common patient complaint with oral macrolides is which of the following? a) Cardiac b) GI tract c) Neurologic d) Urinary e) Respiratory 21) Severe pain and nausea with macrolides may be suggestive of inflammation to what organ? a) Pancreas b) Spleen c) Kidneys d) Gall bladder e) Heart 22) Which of the following drugs can occasionally cause thrombocytopenia with bruising or bleeding? a) Azithromycin b) Clarithromycin c) Dirithromycin d) Erythromycin

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Pharmacology – Part 2

14Mar2009

23) Which of the following can damage the liver by direct drug toxicity or an immune reaction, called cholestatic hepatitis or cholestatic jaundice, which can be seen in newborns if the drug is taken by pregnant women? a) Azithromycin b) Clarithromycin c) Erythromycin d) Erythromycin estolate e) Azithromycin estolate 24) If erythromycin is given with drugs that must be excreted by ____ mechanisms (e.g. warfarin, acetaminophen), those drugs will show a gradual ____ in serum levels due to P450-mediated drug metabolism. a) Renal; Increase b) Renal; Decrease c) Hepatic; Increase d) Hepatic; Decrease 25) A patient presents with Mycobacterium avium intracellulare and is given Rifampin. This can significantly lower the serum concentrations of zidovudine and what other drug? a) Erythromycin (Erythrocin) b) Clarithromycin (Biaxin) c) Azithromycin (Zithromax) d) Dirithromycin (Dynabac) e) Telithromycin (Ketek) 26) Which of the following drugs was designed to overcome erythromycin resistance within gram-positive cocci, such as community-acquired pneumonia (CAP) from S. pneumoniae? a) Telithromycin (Ketek) b) Clarithromycin (Biaxin) c) Azithromycin (Zithromax) d) Dirithromycin (Dynabac) 27) Ketolide (telithromycin) blocks which domain of 23S rRNA of the 50S ribosomal subunit, preventing protein synthesis? a) I b) II c) III d) IV 28) Which of the following is NOT true regarding telithromycin? a) Contraindicated in patients taking cisapride b) Not recommended if patient has myasthenia gravis (MG) c) Can cause visual disturbances and hepatic dysfunction d) Can prolong cardiac QTc interval, increasing ventricular arrhythmias e) Is not considered effective against mild to moderate respiratory tract infections 29) JJ is a 22-yr-old pregnant woman in her first prenatal visit. She is 14 weeks pregnant and complains of lower abdominal pain, and symptoms of urinary tract infections. She is allergic to penicillins and cephalosporins, which cause a rash. JJ is diagnosed with Chlamydia infection (a leading cause of conjunctivitis, known as ophthalmia neonatorum, and febrile pneumonia in neonates). She has scant vaginal discharge, and no odor.

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Pharmacology – Part 2

14Mar2009

Culture is negative for gonorrhea, and syphilis. Which drug should be given to this patient if they do not want abdominal cramping, nausea, vomiting, or diarrhea? a) Erythromycin (Erythrocin) b) Clarithromycin (Biaxin) c) Azithromycin (Zithromax) d) Dirithromycin (Dynabac) e) Telithromycin (Ketek) 30) An 8-yr-old child presents with pharyngitis and fever of 3 days duration. Microbiology lab confirms translucent beta-hemolytic colonies. Past history includes a severe allergic reaction to amoxicillin when used for ear infection. Which one of the following agents as an oral drug is most likely appropriate in terms of both effectiveness and safety? a) Penicillin G b) Cefaclor c) Doxycycline d) Vancomycin e) Azithromycin 6 – Aminoglycosides 1) Aminoglycosides are effective only against which of the following and are a good choice for septicemia (a serious toxicity)? a) Gram-positive aerobic bacteria b) Gram-positive anaerobic bacteria c) Gram-negative aerobic bacteria d) Gram-negative anaerobic bacteria 2) Which of the following antibiotics would be used topically and thus has the most common adverse effect being dermatitis? a) Gentamicin b) Tobramycin c) Neomycin d) Amikacin 3) Aminoglycosides are ____, thus their main form of metabolism is through the ____. a) Polar; Liver b) Polar; Kidneys c) Non-polar; Liver d) Non-polar; Kidneys 4) Which of the following would be the preferred treatment for infections caused by Pseudomonas aeroginosa? a) Gentamicin b) Tobramycin c) Neomycin d) Amikacin e) Netilmicin 5) Aminoglycosides inhibit bacterial protein synthesis through binding to ____ bacterial ribosome subunits. They cause leakage of intracellular contents and thus are ____. a) 30s; Bactericidal

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Pharmacology – Part 2

14Mar2009

b) 30s; Bacteriostatic c) 50s; Bactericidal d) 50s; Bacteriostatic 6) At low dosages, which of the following describes the mechanism of aminoglycosides? a) Misreading of mRNA during elongation leading to synthesis of proteins containing incorrect amino acids. b) Nonsense insertion in mRNA during elongation leading to a stop codon c) Complete inhibition of protein causing ribosomes to become trapped at the AUG strand condons of mRNA d) Partial inhibition of protein causing ribosome to translate incorrectly e) Amino acid deletions during protein synthesis leading to nonfunctional proteins 7) At high dosages, which of the following describes the mechanism of aminoglycosides? a) Misreading of mRNA during elongation leading to synthesis of proteins containing incorrect amino acids. b) Nonsense insertion in mRNA during elongation leading to a stop codon c) Complete inhibition of protein causing ribosomes to become trapped at the AUG strand condons of mRNA d) Partial inhibition of protein causing ribosome to translate incorrectly e) Amino acid deletions during protein synthesis leading to nonfunctional proteins 8) Following administration of aminoglycosides, where would concentrations be the lowest? a) Prostate b) Brain c) Vitreous fluid d) CSF e) Intracellular 9) Accumulation of aminoglycosides is most common in what location? a) Liver capsule b) Renal medulla c) Nephrons d) Renal cortex e) Spleen 10) Which of the following is NOT a dose-dependent toxicity location for aminoglycosides? a) Auditory canal b) Vestibular canal c) Kidney d) Liver e) Neuromuscular 11) Which of the following drugs would require doing a BUN and creatinine lab serum test before administering? a) Kanamycin b) Gentamicin c) Amikacin d) Neomycin

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Pharmacology – Part 2

14Mar2009

12) If aminoglycosides are administered with neuromuscular blockers, respiratory paralysis can take place due to competition of ____ at the presynaptic site, leading to acetylcholine (Ach) release reduction. a) Na+ b) Clc) K+ d) Mg++ e) Ca++ 13) Which of the following drugs can be mixed with aminoglycosides, such as for use against Staphylococcus aureus? a) Diuretics b) NSAIDs c) Cisplatin (Platinol) d) Amphotericin B e) Penicillin G 14) Aminoglycoside resistance is becoming common for enterococci infections causing which of the following? a) Pneumonia b) Upper respiratory tract infections c) Endocarditis d) Gastroenteritis e) Urinary tract infections 15) Which of the following is NOT a membrane enzyme involved in aminoglycoside resistance? a) Acetylases b) Adenlyl transferases c) Phosphorylases d) Phosphatases 16) What is meant by gentamicin having a trough serum level of 2mcg/mL? a) No drug effect is seen at Delavirdine c) Delavirdine > Efavirenz > Nevirapine d) Delavirdine > Nevirapine > Efavirenz e) Nevirapine > Efavirenz > Delavirdine 19) Proease inhibitors (PI) block HIV aspartyl protease (AP). What is the function of AP? a) Cleaves gag and gag-pol polyproteins into functional proteins b) Assembles gag and gag-pol polyproteins into a function segment c) Synthesis of the phenylalanine-proline peptide bond only d) Cleaves at phenylalanine-tyrosine peptide bond only e) Cleaves at phenylalanine-proline peptide bond only 20) Protease inhibitors are associated with accumulation of fat and hyperglycemia. Which of the following has the highest toxicity toward nausea, vomiting, and diarrhea? a) Indinavir

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Pharmacology – Part 2

14Mar2009

b) Nelfinavir c) Ritonavir d) Saquinavir 21) Which of the following is the most powerful inhibitor of the hepatic cytochrome P450 enzyme system? a) Indinavir b) Nelfinavir c) Ritonavir d) Saquinavir 22) Which of the following is the weakest inhibitor of the hepatic cytochrome P450 enzyme system? a) Indinavir b) Nelfinavir c) Ritonavir d) Saquinavir 23) Ethinyl estradiol and AZT levels are lowered by which of the following? a) Indinavir b) Nelfinavir c) Ritonavir d) Saquinavir 24) Ritonavir and saquinavir are contraindicated with use of which of the following? a) Penicillin b) Caffeine c) Theophylline d) Didanosine e) Sildenafil 25) The goal of HAART therapy is to increase CD4+ T-cell counts above what level, signifying the patient no longer has AIDS? a) 25 cells/mm3 b) 50 cells/mm3 c) 100 cells/mm3 d) 200 cells/mm3 e) 1000 cells/mm3 26) Which of the following is a fusion inhibitor that consists of a 36 amino acid synthetit peptide which binds to gp41? a) Efuvirtide b) Raltegravir c) Elvitegravir d) Nelfinavir e) Delavirdine 12 – Antitubercular & Antileprosy Drugs 1) Mycobacterium tuberculosis becomes a primary infection (TB) through which route of transmission? a) Ingestion b) Injection

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Pharmacology – Part 2

14Mar2009

c) Inhalation d) Absorption e) Mutation 2) M. tuberculosis reproduces within what type of cells, leading to necrosis and the presence of Ghon complexes on chest x-ray? a) TH cells b) TC cells c) Neutrophils d) NK cells e) Granulocytes f) Macrophages 3) Which of the following is NOT true regarding treatment of tuberculosis? a) Isoniazid (IHN) is considered a first-line agent b) Multidrug therapy (MDT) may be needed c) Resistance can become an issue d) Patient compliance is an issie e) Treatment is short-term 4) If three drugs are given to a patient and each drug has a 50% chance of failure due to bacterial resistance, what is the overall probability that chemotherapy resistance will develop? a) 1 in 2 b) 1 in 4 c) 1 in 6 d) 1 in 8 e) 1 in 12 5) Which of the following drugs has the highest pattern of resistance? a) Ethambutol b) Isoniazid c) Rifampin d) Pyrazinamide e) Streptomycin 6) Which of the following is considered a second-line antitubercular agent? a) Para-aminosalicyclic acid b) Isoniazid c) Rifampin d) Pyrazinamide e) Streptomycin 7) Which of the following is an aminoglycoside only used for tuberculosis? a) Ethambutol b) Isoniazid c) Rifampin d) Pyrazinamide e) Streptomycin 8) Isoniazid has a genetic polymorphism profile. Which of the following is NOT true regarding the use of isoniazid? a) 50% of African American are fast acetylators

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Pharmacology – Part 2

14Mar2009

b) 50% of Caucasians are slow acetylators c) Most Native American are fast acetylators d) Most Asians are fast acetlators e) Slow acetylators should be given an increased dose of isoniazid 9) Isoniazid inhibits mycolid acid synthesis, disrupting bacterial walls and is associated with hepatotoxicity, peripheral and central neuropathy, and optic neuritis. What vitamin should be given as a supplement with isoniazid to help prevents these effects? a) Vitamin A b) Vitamin K c) Vitamin B6 d) Vitamin B12 e) Vitamin E 10) Use of isoniazid is contraindicated in what patient population? a) Elderly b) Epileptics c) Diabetics d) Transplant e) Pregnant 11) A patient is started on ethambutol after lab results show an infection of Mycobacterium avium-intracellulare. What disease should the patient be tested for? a) Tuberculosis b) Diabetes c) Epilepsy d) Dementia e) HIV 12) Which of the following drugs can cause joint pain and reversible optic neuritis? a) Ethambutol b) Isoniazid c) Rifampin d) Pyrazinamide e) Streptomycin 13) Which of the following drugs would be used to treat Chlamydia if doxycycline is not available for use? a) Ethambutol b) Isoniazid c) Rifampin d) Pyrazinamide e) Streptomycin 14) A patient returns complaining of a reddish-orange color in their urine, saliva, sweat, and tears. Which of the following drugs was the patient likely taking? a) Dapsone b) Isoniazid c) Rifampin d) Pyrazinamide e) Streptomycin

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Pharmacology – Part 2

14Mar2009

15) Which of the following is a pro-drug that is activated by tuberculosis and can cause hyperuricemia? a) Ethambutol b) Isoniazid c) Rifampin d) Pyrazinamide e) Streptomycin 16) Which of the following TB drugs is the least toxic? a) Para-aminosalicyclic acid b) Ethionamide c) Ethambutol d) Cycloserine Match the drug with the adverse effect: 17) Intense gastric pain a) Para-aminosalicyclic acid (PAS) 18) CNS toxicity b) Ethionamide (Trecator-SC) 19) Hypersensitivity c) Cycloserine (Seromycin) 20) A patient from Southeast Asia presents with discoloration of the skin. Neurological testing of the skin shows sensory loss over the areas of discoloration. Which of the following is the most likely? a) AIDS b) Huntington disease c) Parkinson disease d) Creutzfeldt-Jakob disease e) Hansen disease 21) Which of the following drugs is combined with trimethoprim for prophylaxis of Pneumocystis carinii pneumonia in AIDS patients? a) Dapsone b) Isoniazid c) Rifampin d) Pyrazinamide e) Streptomycin 22) Which of the following drugs is used for Mycobacterium leprae? a) Dapsone b) Isoniazid c) Didanosine d) Pyrazinamide e) Streptomycin 23) Dapsone is contraindicated in which of the following cases? a) AIDS b) Folate deficiency c) Splenomegaly d) Glucose 6-phosphate deficiency f) Marfan syndrome 24) Which of the following drugs may block Dapson’s absorption? a) Penicillin b) Furosamine

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Pharmacology – Part 2

14Mar2009

c) St. John’s Wort d) Warfarin e) Didanosine 25) What drug is the single most effective bactericidal drug against M. leprae? a) Dapsone b) Isoniazid c) Rifampin d) Pyrazinamide e) Streptomycin 26) RL is a 46-yr-old African American man who has had intermittent, dull chest pain for 3 months; other symptoms include fatigue, night sweats, and bloody sputum. He has no known allergies. He has been on a 6-mo regimen of MTX for seropositive rheumatoid arthritis. RL is currently on active military duty and just returned from a 4-yr assignment in Southeast Asia. He admits to a daily consumption of alcohol (12-14 ounces). RL’s chest X ray reveals interstitial infiltrates and cavitation in left upper lobe. His sputum culture is positive for acid-fast bacilli. Which of the following is the most likely cause? a) Streptococcus pneumoniae b) Pneumocystis carinii c) Mycobacterium leprae d) Mycobacterium tuberculosis e) Mycobacterium avium-intracellulare 27) A 34-year-old man under treatment for pulmonary TB has acute-onset right big toe pains, swelling, and low-grade fever. His physical exam is consistent with gouty arthritis, and he is found to have high serum uric acid levels. Which one of the following anti-TB drugs is the most likely cause of this patient’s UA levels? a) Isoniazid b) Pyrazinamide c) Cycloserine d) Rifampin e) Ethionamide 28) A 30-year-old Haitian man has acute-onset confusion and suicidal tendency. Three weeks ago he began combination therapy for multidrug-resistant pulmonary TB. Which of the following anti-TB drugs is the most likely cause of the patient’s neurological symptoms? a) Rifampin b) Isoniazid c) Pyrazinamide d) Streptomycin e) Cycloserine 13 – Antifungal Agents 1) Which of the following is NOT considered opportunistic, and thus may be seen in nonimmunocompromised patients? a) Aspergillosis b) Histoplasmosis c) Cryptoccosis

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Pharmacology – Part 2

14Mar2009

d) Candidiasis 2) Which of the following types of patients would be the least susceptible to fungal infections? a) Surgical patients b) Patients in the ICU c) Patients with prostheses d) Patients with diabetes e) Immunocompromised patients 3) Which of the following is used to treat dermatophytosis (skin mycosis)? a) Amphotericin B (Fungizone) b) Miconazole (Monistat) c) Griseofulvin (Fulvicin) d) Terbinafine (Lamisil) e) Caspofungin (Cancidas) Match the antifungal mechanism with the drug: 4) Disruption of membrane structure a) Amphotericin B 5) Inhibition of cell membrane ergosterol synthesis b) Flucytosine 6) Inhibition of fungal DNA synthesis c) Miconazole 7) Which of the following shows synergistic characteristics for fungal infections when combined with amphotericin B? a) Flucytosine b) Clindamycin c) Fluroquinolone d) Imipenem e) Cephalosporin 8) Antifungal azole drugs are very nephrotoxic and should not be taken orally. a) True b) False 9) Which of the following locations shows the least penetrance of amphotericin B? a) Parotid bland b) Urine c) CNS d) Blood 10) What is the major adverse risk for amphotericin B, which is enhanced with drugs such as cyclosporine and aminoglycosides? a) Nephrotoxicity b) Nausea and vomiting c) Electrolyte imbalances d) Fever and chills e) Anemia 11) Due to “cytokine storm” effects, how should amphotericin B be administered? a) Orally b) Rapid push IV c) Slow push IV d) IV slow infusion e) IM

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Pharmacology – Part 2

14Mar2009

12) Which of the following is used for cryptococcal infections in non-AIDS patients? a) Amphotericin B b) Amphotericin B and flucytosine c) Flucytosine d) Ketoconazole e) Voriconazle 13) Which of the following interferes with nucleic acid synthesis by inhibiting thymidylate synthase? a) Amphotericin B b) Miconazole c) Flucytosine d) Ketoconazole e) Voriconazle 14) Which of the following antifungal agents is removed by dialysis? a) Voriconazle b) Miconazole c) Amphotericin B d) Ketoconazole e) Flucytosine 15) Which of the following is NOT an adverse effect seen with flucytosine? a) Hepatotoxicity b) Hair loss (alopecia) c) GI distress d) Rash e) Bone marrow suppression 16) Which of the following is available over the counter (OTC) for acute vaginal infections? a) Ketoconazole b) Fluconazole c) Itraconazole d) Miconazole e) Clotrimazole 17) Which of the following should be used in gastric surgery? a) Ketoconazole b) Fluconazole c) Itraconazole d) Miconazole e) Clotrimazole 18) Which of the following should NOT be taken with azole antifungals? a) Antacids b) Cranberry juice c) Alcohol d) Aspirin 19) Which of the following drugs can cause hormonal imbalances as well as GI distress and rash? a) Ketoconazole

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Pharmacology – Part 2

14Mar2009

b) Fluconazole c) Itraconazole d) Miconazole e) Clotrimazole 20) Administration of which of the following drugs with ketoconazole could lead to lifethreatening cardiac arrhythmias? a) Cyclosporine b) Digoxin c) Phenytoin d) Isoniazid e) Rifampin f) Coumadin 21) Which of the following decreases serum concentrations of fluconazole? a) Cyclosporine b) Digoxin c) Phenytoin d) Coumadin e) Rifampin 22) Which of the following drugs is used for histoplasmosis and blastomycosis, and can possibly lead to minearalcorticoid excess? a) Ketoconazole b) Fluconazole c) Itraconazole d) Miconazole e) Clotrimazole 23) Which of the following is used for refractory invasive aspergillosis? a) Amphotericin B (Fungizone) b) Miconazole (Monistat) c) Griseofulvin (Fulvicin) d) Terbinafine (Lamisil) e) Caspofungin (Cancidas) 24) Which of the following inhibits fungal cytochrome P-450 mediated 14-alphalanosterol demethylation and has excellent activity against Aspergillus and Candida? a) Amphotericin B b) Caspofungin c) Flucytosine d) Ketoconazole e) Voriconazle 25) The oral azoles itraconazole and terbinafine are used because they have a ____ spectrum of activity and a ____ duration of treatment. a) Narrow; Short b) Narrow; Long c) Broad; Short d) Broad; Long James Lamberg

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Pharmacology – Part 2 AnswerKey Pharm #1 1) E 2) D 3) C 4) A 5) B 6) E 7) C 8) D 9) B 10) B 11) A 12) E 13) A 14) D 15) C 16) E 17) A 18) B 19) A 20) B 21) A 22) B 23) A 24) E 25) B 26) C 27) A 28) C 29) D 30) D 31) A 32) F 33) C 34) B 35) C 36) A 37) C 38) E 39) A 40) B 41) E 42) C 43) B 44) E

45) A 46) C 47) E 48) D 49) B 50) C 51) C 52) B 53) E 54) C 55) D 56) C 57) B 58) B 59) B 60) F 61) D 62) B 63) E 64) A 65) C 66) A 67) E 68) B 69) F Pharm #2 1.1) C 1.2) A 1.3) A 1.4) B 1.5) E 1.6) C 1.7) B 2.1) A 2.2) D 2.3) E 3.1) C 3.2) E Pharm #3 1) C 2) E 3) D 4) B 5) C

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14Mar2009 6) A 7) C 8) A 9) A 10) B 11) D 12) C 13) E 14) C 15) A 16) D 17) B 18) B 19) E 20) D 21) C 22) D 23) B 24) C 25) B 26) A 27) D 28) E 29) B 30) E 31) A 32) B 33) D 34) E Pharm #4 1) D 2) A 3) B 4) A 5) B 6) C 7) A 8) D 9) E 10) C 11) D 12) A 13) E 14) A 15) C

16) F 17) D 18) B 19) E 20) E 21) B 22) A 23) D 24) B 25) E 26) D 27) A 28) D 29) A 30) D 31) C Pharm #5 1) C 2) A 3) D 4) B 5) C 6) A 7) E 8) A 9) A 10) C 11) C 12) C 13) B 14) D 15) B 16) C 17) D 18) E 19) C 20) B 21) A 22) B 23) D 24) C 25) B 26) A 27) B 28) E

29) C 30) E Pharm #6 1) C 2) C 3) B 4) B 5) A 6) A 7) C 8) E 9) D 10) D 11) B 12) E 13) E 14) C 15) D 16) A 17) B 18) E 19) C Pharm #7 1) D 2) A 3) B 4) E 5) D 6) D 7) C 8) B 9) D 10) A 11) E 12) A 13) D 14) E 15) C 16) D 17) C 18) C 19) D 20) E 21) B

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Pharmacology – Part 2 22) E 23) D 24) E 25) B 26) A 27) E 28) C 29) A 30) C 31) B 32) C

9) A 10) E 11) D 12) E 13) A 14) C 15) D 16) B 17) D 18) E 19) A

Pharm #8 1) A 2) B 3) D 4) B 5) E 6) A 7) B 8) C 9) E 10) A 11) C 12) A 13) A 14) B 15) D 16) B 17) E 18) C 19) C 20) B 21) B 22) B 23) E

Pharm #10 1) B 2) E 3) A 4) C 5) A 6) D 7) C 8) E 9) D 10) E 11) D 12) B 13) D 14) C 15) A 16) C 17) C 18) E 19) B 20) D 21) A 22) D 23) D 24) A 25) A 26) E

Pharm #9 1) E 2) C 3) B 4) A 5) C 6) A 7) D 8) B

Pharm #11 1) B 2) A 3) D 4) F 5) B

DO NOT DISTRIBUTE

14Mar2009 6) A 7) C 8) E 9) D 10) D 11) D 12) E 13) B 14) C 15) A 16) A 17) A 18) C 19) A 20) C 21) C 22) D 23) B 24) E 25) D 26) A Pharm #12 1) C 2) F 3) E 4) D 5) B 6) A 7) E 8) E 9) C 10) B 11) E 12) A 13) C 14) C 15) D 16) C 17) B 18) C 19) A 20) E 21) A 22) A 23) D

24) E 25) C 26) D 27) B 28) E Pharm #13 1) B 2) D 3) C 4) A 5) C 6) B 7) A 8) B 9) C 10) A 11) D 12) B 13) C 14) E 15) C 16) E 17) B 18) A 19) A 20) B 21) E 22) C 23) E 24) E

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