GMPA 624: Pharmacology IIIUniversity of Charlestion-Beckley

Midterm ReviewSpring 2013

Kevin W. Garlow Pharm.Dkcgarlow@suddenlink.net

What is the clinical significance of cellular respiration (i.e. aerobic vs. anaerobic)?a. It determines where in the body that a particular organism is most likely to thrive and with potential for infection.b. It determines the potential for an organism to develop resistance to a particular antimicrobial.c. It influences the clinician’s decision with regards to proper antibiotic selection.d. A & B onlye. A & C only

What is the clinical significance of cellular respiration (i.e. aerobic vs. anaerobic)?a. It determines where in the body that a particular organism is most likely to thrive and with potential for infection.b. It determines the potential for an organism to develop resistance to a particular antimicrobial.c. It influences the clinician’s decision with regards to proper antibiotic selection.d. A & B onlye. A & C only

Mr. A. is admitted to your facility for treatment of Community-acquired pneumonia. You order culture and susceptibility testing on the sputum. In the interim you place the patient on ZithromaxR and RocephinR pending the results of the C&S. When the results are available you are surprised to see resistance to the penicillin UnasynR, the cephalosporin RocephinR, as well as the macrolide ZithromaxR. This is an example of multidrug resistance and which is characterized by which of the following statements?a. Resistance of a microorganism to >3 antibacterial medications from separate drug classes.b. Resistance of a microorganism to >2 antibacterial medications from separate drug classes.c. Resistance of a microorganism to >3 antibacterial medications regardless of drug class.d. Resistance of a microorganism to >2 antibacterial medications regardless of drug class.e. None of the above.

Mr. A. is admitted to your facility for treatment of Community-acquired pneumonia. You order culture and susceptibility testing on the sputum. In the interim you place the patient on ZithromaxR and RocephinR pending the results of the C&S. When the results are available you are surprised to see resistance to the penicillin UnasynR, the cephalosporin RocephinR, as well as the macrolide ZithromaxR. This is an example of multidrug resistance and which is characterized by which of the following statements?a. Resistance of a microorganism to >3 antibacterial medications from separate drug classes.b. Resistance of a microorganism to >2 antibacterial medications from separate drug classes.c. Resistance of a microorganism to >3 antibacterial medications regardless of drug class.d. Resistance of a microorganism to >2 antibacterial medications regardless of drug class.e. None of the above.

Which of the following statements with regards to assessment of the patient prior to prescribing an antibiotic is correct?a. The majority of respiratory infections are viral.b. Some patients may exhibit atypical symptoms (e.g., confusion, disorientation) to an infectious process.c. The site of a particular infection may assist in identifying the most common pathogens.d. Prior antibiotic use and drug allergies are major factors with regards to proper selection of an antimicrobial.e. All of the above.

Which of the following statements with regards to assessment of the patient prior to prescribing an antibiotic is correct?a. The majority of respiratory infections are viral.b. Some patients may exhibit atypical symptoms (e.g., confusion, disorientation) to an infectious process.c. The site of a particular infection may assist in identifying the most common pathogens.d. Prior antibiotic use and drug allergies are major factors with regards to proper selection of an antimicrobial.e. All of the above.

With regards to identification of a bacterial pathogen via use of culture and susceptibility testing, which of the following statements is incorrect?a. In general treat first and culture second.b. If the patient is acutely ill treat empirically until the results of the culture are available.c. If the site cannot be cultured treat empirically based upon the most likely pathogens.d. Contamination of the sample with normal flora may result in misinterpretation of the results.e. Culture and susceptibility testing not only assists in identification of the organism but also antimicrobial selection.

With regards to identification of a bacterial pathogen via use of culture and susceptibility testing, which of the following statements is incorrect?a. In general treat first and culture second.b. If the patient is acutely ill treat empirically until the results of the culture are available.c. If the site cannot be cultured treat empirically based upon the most likely pathogens.d. Contamination of the sample with normal flora may result in misinterpretation of the results.e. Culture and susceptibility testing not only assists in identification of the organism but also antimicrobial selection.

Which of the following is not a commonly accepted antimicrobial mechanism of action?a. Inhibition of cell wall synthesis.b. Inhibition of protein synthesis.c. Disruption of the cell membrane.d. Inhibition of nucleic acid synthesis.e. Inhibition of the synthesis of sugars (e.g., lactose, maltose, etc.)

Which of the following is not a commonly accepted antimicrobial mechanism of action?a. Inhibition of cell wall synthesis.b. Inhibition of protein synthesis.c. Disruption of the cell membrane.d. Inhibition of nucleic acid synthesis.e. Inhibition of the synthesis of sugars (e.g., lactose, maltose, etc.)

Which of the following gram-positive organisms are commonly associated with Impetigo?a. Staphylococcus aureusb. Streptococus agalactiaec. Streptococcus pyogenesd. A & C onlye. B & C only

Which of the following gram-positive organisms are commonly associated with Impetigo?a. Staphylococcus aureusb. Streptococus agalactiaec. Streptococcus pyogenesd. A & C onlye. B & C only

16. Which of the following medications is the drug of choice (1st-line) per IDSA guidelines for the treatment of moderate-to-severe Impetigo in an adult?a. Demeclocylineb. Penicillin VKc. Dicloxacillind. Clindamycine. Azithromycin

16. Which of the following medications is the drug of choice (1st-line) per IDSA guidelines for the treatment of moderate-to-severe Impetigo in an adult?a. Demeclocylineb. Penicillin VKc. Dicloxacillind. Clindamycine. Azithromycin

Which of the following organisms is most commonly associated with cellulitis?a. Streptococcus pneumoniaeb. Streptococcus agalactiaec. Streptococcus pyogenesd. Methicillin-resistant Staphylococcus aureuse. Staphylococcus epidermidis

Which of the following organisms is most commonly associated with cellulitis?a. Streptococcus pneumoniaeb. Streptococcus agalactiaec. Streptococcus pyogenesd. Methicillin-resistant Staphylococcus aureuse. Staphylococcus epidermidis

The most common pathogens associated with otitis media include Streptococcus pneumoniae, Haemophilus influenzae and ___________.a. Pasturella multocidab. Staphyloccous epidermidisc. Staphylococcus aureusd. Moraxella catarrhalise. Streptococcus pyogenes

The most common pathogens associated with otitis media include Streptococcus pneumoniae, Haemophilus influenzae and ___________.a. Pasturella multocidab. Staphyloccous epidermidisc. Staphylococcus aureusd. Moraxella catarrhalise. Streptococcus pyogenes

With regards to treatment of otitis media in children (e.g., 6-24 months of age), which of the following statements is incorrect?a. Oral symptomatic management of ear pain may include use of ibuprofen or acetaminophen.b. Antibiotic therapy should be prescribed routinely in all patients and regardless of the severity of infection.c. Topical symptomatic management of ear pain may include use of antipyrine/benzocaine (AuralganR).d. Antibiotic therapy should not be prescribed routinely as spontaneous resolution may occur, and especially in children in whom the diagnosis is uncertain or with only mild otitis media.e. Delaying antibiotic therapy in selected patients reduces treatment-related costs, the potential for adverse effects, and minimizes the potential for emergence of resistant strains.

With regards to treatment of otitis media in children (e.g., 6-24 months of age), which of the following statements is incorrect?a. Oral symptomatic management of ear pain may include use of ibuprofen or acetaminophen.b. Antibiotic therapy should be prescribed routinely in all patients and regardless of the severity of infection.c. Topical symptomatic management of ear pain may include use of antipyrine/benzocaine (AuralganR).d. Antibiotic therapy should not be prescribed routinely as spontaneous resolution may occur, and especially in children in whom the diagnosis is uncertain or with only mild otitis media.e. Delaying antibiotic therapy in selected patients reduces treatment-related costs, the potential for adverse effects, and minimizes the potential for emergence of resistant strains.

Which of the following medications is the drug of choice (1st line) for treatment of recurrent otitis media in children?a. Erythromycin 20mg/kg/day po qdb. Levofloxacin (LevaquinR) 10-20mg/kg/day po qdc. Clindamycin 10-20mg/kg/day divided po q8hd. Amoxicilllin/clavulanate (AugmentinR) 90mg/kg/day divided po bide. Dicloxacillin 12mg/kg/day divided po q6h

Which of the following medications is the drug of choice (1st line) for treatment of recurrent otitis media in children?a. Erythromycin 20mg/kg/day po qdb. Levofloxacin (LevaquinR) 10-20mg/kg/day po qdc. Clindamycin 10-20mg/kg/day divided po q8hd. Amoxicilllin/clavulanate (AugmentinR) 90mg/kg/day divided po bide. Dicloxacillin 12mg/kg/day divided po q6h

The most common pathogens associated with rhinosinusitis include Moraxella catarrhalis, Haemophilus influenzae and ___________.a. Pasturella multocidab. Staphyloccous epidermidisc. Staphylococcus aureusd. Streptococcus pneumoniaee. Streptococcus pyogenes

The most common pathogens associated with rhinosinusitis include Moraxella catarrhalis, Haemophilus influenzae and ___________.a. Pasturella multocidab. Staphyloccous epidermidisc. Staphylococcus aureusd. Streptococcus pneumoniaee. Streptococcus pyogenes

Which of the following statements regarding rhinosinusitis is incorrect?a. It is defined as inflammation of the mucosal lining of the nasal passages and paranasal sinuses lasting up to 4 weeks.b. Etiologies may include allergies, environmental irritants, and infection secondary to viruses, bacteria, or fungi.c. A bacterial etiology is the most frequent cause with an incidence of 90-98%.d. Symptoms may include facial pain/congestion/fullness, headache, nasal discharge, fever, dental pain, fatigue, etc.e. Acute bacterial rhinosinusitis is generally characterized by persistent (i.e., non-improving), severe (i.e., fever >102, purulent nasal discharge), or worsening (i.e., double-sickening) signs/symptoms.

Which of the following statements regarding rhinosinusitis is incorrect?a. It is defined as inflammation of the mucosal lining of the nasal passages and paranasal sinuses lasting up to 4 weeks.b. Etiologies may include allergies, environmental irritants, and infection secondary to viruses, bacteria, or fungi.c. A bacterial etiology is the most frequent cause with an incidence of 90-98%.d. Symptoms may include facial pain/congestion/fullness, headache, nasal discharge, fever, dental pain, fatigue, etc.e. Acute bacterial rhinosinusitis is generally characterized by persistent (i.e., non-improving), severe (i.e., fever >102, purulent nasal discharge), or worsening (i.e., double-sickening) signs/symptoms.

You are seeing Mr. G. for the first time in the urgent care clinic. He complains of fatigue, fever, a purulent discharge, and severe facial pain which has persisted for nearly two weeks and which is getting worse. He reports infrequent antibiotic use in the past and denies any drug allergies. Per IDSA guidelines, which of the following medications represents an appropriate choice for this patient?a. Ciprofloxacin (CiproR) 500mg po bid x 5-7 daysb. Doxycycline (VibramycinR) 100mg po bid x 7-10 daysc. Amoxicillin/clavulanate (AugmentinR) 875/125mg po bid x 5-7 daysd. Erythromycin 500mg po q6h x 10 dayse. Clindamycin 300mg po q8h x 14 days

You are seeing Mr. G. for the first time in the urgent care clinic. He complains of fatigue, fever, a purulent discharge, and severe facial pain which has persisted for nearly two weeks and which is getting worse. He reports infrequent antibiotic use in the past and denies any drug allergies. Per IDSA guidelines, which of the following medications represents an appropriate choice for this patient?a. Ciprofloxacin (CiproR) 500mg po bid x 5-7 daysb. Doxycycline (VibramycinR) 100mg po bid x 7-10 daysc. Amoxicillin/clavulanate (AugmentinR) 875/125mg po bid x 5-7 daysd. Erythromycin 500mg po q6h x 10 dayse. Clindamycin 300mg po q8h x 14 days

Which of the following organisms is most commonly associated with uncomplicated urinary tract infections?a. Proteus mirabilisb. Escherichia colic. Staphylococcus aureusd. Streptococcus pyogenese. Neisseria gonorrhoeae

Which of the following organisms is most commonly associated with uncomplicated urinary tract infections?a. Proteus mirabilisb. Escherichia colic. Staphylococcus aureusd. Streptococcus pyogenese. Neisseria gonorrhoeae

Which of the following is not a 1st-generation “natural” penicillin?a. Penicillin G sodiumb. Penicillin G potassiumc. Penicillin G procained. Bacampacilline. Penicillin G benzathine

Which of the following is not a 1st-generation “natural” penicillin?a. Penicillin G sodiumb. Penicillin G potassiumc. Penicillin G procained. Bacampacilline. Penicillin G benzathine

Which of the following statements regarding 1st-generation penicillins is incorrect?a. The sodium and potassium salts of Penicillin G can be administered both IM and IV only.b. The benzathine and procaine salts of penicillin G are long-acting.c. The potassium salt of penicillin V enhances antimicrobial activity.d. Penicillin G is also referred to as benzylpenicillin and can be administered IM and/or IV depending on the particular salt.e. Penicillin V also referred to as phenoxymethylpenicillin and is administered orally only.

Which of the following statements regarding 1st-generation penicillins is incorrect?a. The sodium and potassium salts of Penicillin G can be administered both IM and IV only.b. The benzathine and procaine salts of penicillin G are long-acting.c. The potassium salt of penicillin V enhances antimicrobial activity.d. Penicillin G is also referred to as benzylpenicillin and can be administered IM and/or IV depending on the particular salt.e. Penicillin V also referred to as phenoxymethylpenicillin and is administered orally only.

Which of the following statements regarding the spectrum of activity of 1st-generation penicillins is incorrect?a. They exhibit activity against non-penicillinase-producing streptococci and staphylococci.b. They exhibit activity against other gram-positive organisms in addition to streptococci and staphylococci.c. Given coverage of both gram-positive and gram-negative organisms they are considered “broad spectrum”.d. They exhibit activity against “some” gram-negative organisms.e. They exhibit activity against many anaerobes as well.

Which of the following statements regarding the spectrum of activity of 1st-generation penicillins is incorrect?a. They exhibit activity against non-penicillinase-producing streptococci and staphylococci.b. They exhibit activity against other gram-positive organisms in addition to streptococci and staphylococci.c. Given coverage of both gram-positive and gram-negative organisms they are considered “broad spectrum”.d. They exhibit activity against “some” gram-negative organisms.e. They exhibit activity against many anaerobes as well.

Which of the following penicillins are 2nd-generation penicillins?a. Ampicillinb. Dicloxacillinc. Amoxicillind. A & C onlye. B & C only

Which of the following penicillins are 2nd-generation penicillins?a. Ampicillinb. Dicloxacillinc. Amoxicillind. A & C onlye. B & C only

Which of the following penicillins is not a 3rd-generation penicillin?a. Dicloxacillinb. Nafcillinc. Methicillind. Ticarcilline. Oxacillin

Which of the following penicillins is not a 3rd-generation penicillin?a. Dicloxacillinb. Nafcillinc. Methicillind. Ticarcilline. Oxacillin

Which of the following penicillins are 4th-generation penicillins?a. Ticarcillinb. Methicillinc. Piperacillind. A & B onlye. A & C only

Which of the following penicillins are 4th-generation penicillins?a. Ticarcillinb. Methicillinc. Piperacillind. A & B onlye. A & C only

Which of the statements regarding the mechanism of action of penicillins are correct?a. In general, penicillins exhibit bacteriostatic vs. bactericidal activity.b. Penicillins act by binding the penicillin binding proteins in the cell wall thereby inhibiting cell wall synthesis.c. Interference with cell wall synthesis ultimately results in self-destruction (i.e., autolysis) of the bacterium.d. A & B onlye. B & C only

Which of the statements regarding the mechanism of action of penicillins are correct?a. In general, penicillins exhibit bacteriostatic vs. bactericidal activity.b. Penicillins act by binding the penicillin binding proteins in the cell wall thereby inhibiting cell wall synthesis.c. Interference with cell wall synthesis ultimately results in self-destruction (i.e., autolysis) of the bacterium.d. A & B onlye. B & C only

Mr. J. comes in today with a severe sore throat, fever, and malaise. You examine him and determine that he has Strep throat. He has no known drug allergies and states that he has taken penicillins in the past without any adverse effect. Which of the following dosages of amoxicillin would be appropriate for use in this patient?a. 875mg po bid x 10 daysb. 500mg po tid x 10 daysc. 1000mg po bid x 10 daysd. A & B onlye. B & C only

Mr. J. comes in today with a severe sore throat, fever, and malaise. You examine him and determine that he has Strep throat. He has no known drug allergies and states that he has taken penicillins in the past without any adverse effect. Which of the following dosages of amoxicillin would be appropriate for use in this patient?a. 875mg po bid x 10 daysb. 500mg po tid x 10 daysc. 1000mg po bid x 10 daysd. A & B onlye. B & C only

Mrs. K. is a newlywed that is seeing you today for what appears to be sinusitis. She has a temperature, facial pain, fatigue and a purulent nasal discharge. You decide to prescribe AugmentinR. What other information should you obtain from this patient?a. You should check to see if she has insurance, and if not you should consider a less expensive antibiotic.b. You should inquire as to past antibiotic use and previous allergies.c. You should inquire as to use of contraception and if oral contraception is used instruct the patient to use a back-up method while on the antibiotic.d. A & C onlye. B & C only

Mrs. K. is a newlywed that is seeing you today for what appears to be sinusitis. She has a temperature, facial pain, fatigue and a purulent nasal discharge. You decide to prescribe AugmentinR. What other information should you obtain from this patient?a. You should check to see if she has insurance, and if not you should consider a less expensive antibiotic.b. You should inquire as to past antibiotic use and previous allergies.c. You should inquire as to use of contraception and if oral contraception is used instruct the patient to use a back-up method while on the antibiotic.d. A & C onlye. B & C only

Which of the following drug-drug interactions with penicillins is potentially beneficial?a. Concurrent use of a tetracycline antibiotic.b. Concurrent use of allopurinol.c. Concurrent use of an oral contraceptive.d. Concurrent use of probenecid.e. None of the above.

Which of the following drug-drug interactions with penicillins is potentially beneficial?a. Concurrent use of a tetracycline antibiotic.b. Concurrent use of allopurinol.c. Concurrent use of an oral contraceptive.d. Concurrent use of probenecid.e. None of the above.

Which of the following are treatment considerations with penicillins are correct?a. When administered parenterally (i.e., IM or IV) the patient should be observed for approximately 30 minutes to rule out the potential for an allergic reaction.b. All oral penicillins with the exception of amoxicillin should be administered 1 hour before or 2 hours after a meal as penicillins are acid labile (ie.., unstable in an acidic environment with potential for degradation).c. When prescribing an oral penicillin, the patient should be instructed to use either an over-the-counter probiotic or to consume cultured yogurt in an effort to prevent C. difficile-associated diarrhea.d. A & B onlye. A & C only

Which of the following are treatment considerations with penicillins are correct?a. When administered parenterally (i.e., IM or IV) the patient should be observed for approximately 30 minutes to rule out the potential for an allergic reaction.b. All oral penicillins with the exception of amoxicillin should be administered 1 hour before or 2 hours after a meal as penicillins are acid labile (ie.., unstable in an acidic environment with potential for degradation).c. When prescribing an oral penicillin, the patient should be instructed to use either an over-the-counter probiotic or to consume cultured yogurt in an effort to prevent C. difficile-associated diarrhea.d. A & B onlye. A & C only

Which of the following statements regarding the general spectrum of coverage of cephalosporins are correct?a. 1st-generation cephalosporins (e.g., cephalexin) exhibit primarily gram-positive coverage against B-lactamase-producing strains of Staphylococci and Streptococci and with some gram-negative activity.b. 2nd-generation cephalosporins (e.g., cefuroxime) have activity against gram-positive organisms, and extended coverage against gram-negative organisms including beta-lactamase-producing M. catarrhalis and H. influenza.c. 3rd-generation cephalosporins (e.g., ceftriaxone) are broad spectrum antimicrobials with activity against some gram-positive organisms and anaerobes, but primarily with beneficial activity against the gram-negative organism Escherichia coli.d. A & C onlye. A & B only

Which of the following statements regarding the general spectrum of coverage of cephalosporins are correct?a. 1st-generation cephalosporins (e.g., cephalexin) exhibit primarily gram-positive coverage against B-lactamase-producing strains of Staphylococci and Streptococci and with some gram-negative activity.b. 2nd-generation cephalosporins (e.g., cefuroxime) have activity against gram-positive organisms, and extended coverage against gram-negative organisms including beta-lactamase-producing M. catarrhalis and H. influenza.c. 3rd-generation cephalosporins (e.g., ceftriaxone) are broad spectrum antimicrobials with activity against some gram-positive organisms and anaerobes, but primarily with beneficial activity against the gram-negative organism Escherichia coli.d. A & C onlye. A & B only

Which of the following statements regarding ceftriaxone (RocephinR) are correct?a. It is a 2nd-generation cephalosporin with activity against some gram-positive organisms (including some beta-lactamase-producing strains), many gram-negative organisms (including some beta-lactamase-producing strains), and some anaerobes.b. Some of the advantages to use of ceftriaxone include treatment of Gonorrhea (secondary to Nesseria gonorrhoeae), Menningitis (secondary to H. influenzae, N. meningitides, or S. pneumonia), and skin and skin structure infections (secondary to P. aeruginosa).c. Ceftriaxone is stable in the presence of beta-lactamase-producing organisms.d. A & B onlye. B & C only

Which of the following statements regarding ceftriaxone (RocephinR) are correct?a. It is a 2nd-generation cephalosporin with activity against some gram-positive organisms (including some beta-lactamase-producing strains), many gram-negative organisms (including some beta-lactamase-producing strains), and some anaerobes.b. Some of the advantages to use of ceftriaxone include treatment of Gonorrhea (secondary to Nesseria gonorrhoeae), Menningitis (secondary to H. influenzae, N. meningitides, or S. pneumonia), and skin and skin structure infections (secondary to P. aeruginosa).c. Ceftriaxone is stable in the presence of beta-lactamase-producing organisms.d. A & B onlye. B & C only

Mr. M. is a 19-year old who reports to the local urgent care with complaints of dysuria and a penile discharge. You suspect gonorrhea and possibly chlamydia. He has no known drug allergies. Which of the following combination regimens will you prescribe in an effort to cover both pathogens?a. Cephalexin 500mg po q12h + tetracycline 500mg po bid x 7 daysb. Ceftriaxone 125mg IM x 1 dose + tetracycline 500mg po bid x 7 daysc. Ceftriaxone 250mg IM x 1 dose + doxycycline 100mg po bid x 7 daysd. Cephalexin 250mg po q6h + doxycycline 100mg po bid x 7 dayse. Cefuroxime 250mg po bid + minocycline 100mg po qd x 7 days

Mr. M. is a 19-year old who reports to the local urgent care with complaints of dysuria and a penile discharge. You suspect gonorrhea and possibly chlamydia. He has no known drug allergies. Which of the following combination regimens will you prescribe in an effort to cover both pathogens?a. Cephalexin 500mg po q12h + tetracycline 500mg po bid x 7 daysb. Ceftriaxone 125mg IM x 1 dose + tetracycline 500mg po bid x 7 daysc. Ceftriaxone 250mg IM x 1 dose + doxycycline 100mg po bid x 7 daysd. Cephalexin 250mg po q6h + doxycycline 100mg po bid x 7 dayse. Cefuroxime 250mg po bid + minocycline 100mg po qd x 7 days

Which of the following statements regarding macrolide antibiotics are correct?a. They exhibit bactericidal action by binding the 30S ribosomal subunit to inhibit protein synthesis.b. As a class they are primarily active against gram-positive organisms, however, the newer macrolides (i.e., clarithromycin, azithromycin) have expanded activity against atypical gram-positive and gram-negative organisms.c. The primary mechanism of bacterial resistance is decreased permeability of the cell wall to the macrolide.d. A & C onlye. B & C only

Which of the following statements regarding macrolide antibiotics are correct?a. They exhibit bactericidal action by binding the 30S ribosomal subunit to inhibit protein synthesis.b. As a class they are primarily active against gram-positive organisms, however, the newer macrolides (i.e., clarithromycin, azithromycin) have expanded activity against atypical gram-positive and gram-negative organisms.c. The primary mechanism of bacterial resistance is decreased permeability of the cell wall to the macrolide.d. A & C onlye. B & C only

Which of the following statements regarding azithromycin (ZithromaxR) are correct?a. It is a newer macrolide and considered a drug of choice for the treatment of many atypical organisms such as Staphylococcus aureus.b. The drug is unique as it is initially widely distributed into tissues, then gradually released over a period of several days after completion of therapy.c. Macrolides such as azithromycin have the potential for QT interval prolongation which may result in cardiac arrhythmias such as Torsades de Pointe and especially in patients with a history of QT interval prolongation, uncorrected hypomagnesmia or hypokalemia, or receiving concurrent Class Ia or III antiarrhymics.d. A & C onlye. B & C only

Which of the following statements regarding azithromycin (ZithromaxR) are correct?a. It is a newer macrolide and considered a drug of choice for the treatment of many atypical organisms such as Staphylococcus aureus.b. The drug is unique as it is initially widely distributed into tissues, then gradually released over a period of several days after completion of therapy.c. Macrolides such as azithromycin have the potential for QT interval prolongation which may result in cardiac arrhythmias such as Torsades de Pointe and especially in patients with a history of QT interval prolongation, uncorrected hypomagnesmia or hypokalemia, or receiving concurrent Class Ia or III antiarrhymics.d. A & C onlye. B & C only

The risk of tendonitis and tendon rupture is a black box warning for fluoroquinolones. Which of the following is not a risk factor for this adverse effect?a. Age >60.b. Hispanic ethnicity.c. Heart, lung, and kidney transplant patients.d. Corticosteroid use.

The risk of tendonitis and tendon rupture is a black box warning for fluoroquinolones. Which of the following is not a risk factor for this adverse effect?a. Age >60.b. Hispanic ethnicity.c. Heart, lung, and kidney transplant patients.d. Corticosteroid use.

Which of the following is not an intravenously administered aminoglycoside antimicrobial?a. Tobramycinb. Gentamicinc. Neomycind. Amikacin

Which of the following is not an intravenously administered aminoglycoside antimicrobial?a. Tobramycinb. Gentamicinc. Neomycind. Amikacin

Which of the following statements regarding once-daily administration of aminoglycosides are correct?a. A nomogram is used to determine the appropriateness of dose and frequency.b. A peak and trough should be drawn 6-14 hours after the start of the infusion.c. The dosage for once-daily dosing is generally higher than that required for traditional dosing.d. A & B onlye. A & C only

Which of the following statements regarding once-daily administration of aminoglycosides are correct?a. A nomogram is used to determine the appropriateness of dose and frequency.b. A peak and trough should be drawn 6-14 hours after the start of the infusion.c. The dosage for once-daily dosing is generally higher than that required for traditional dosing.d. A & B onlye. A & C only

Which of the following is not a indication for use of BactrimR?a. Treatment and/or prophylaxis of pneumocystis carinii pneumonia.b. Urinary tract infections secondary to Pseudomonas aeruginosa.c. Acute otitis media in pediatric patients due to S. pneumoniae or H. influenzae.d. Traveler’s diarrhea secondary to enterotoxigenic strains of E. coli.e. Acute exacerbations of chronic bronchitis secondary to S. pneumoniae or H. influenzae.

Which of the following is not a indication for use of BactrimR?a. Treatment and/or prophylaxis of pneumocystis carinii pneumonia.b. Urinary tract infections secondary to Pseudomonas aeruginosa.c. Acute otitis media in pediatric patients due to S. pneumoniae or H. influenzae.d. Traveler’s diarrhea secondary to enterotoxigenic strains of E. coli.e. Acute exacerbations of chronic bronchitis secondary to S. pneumoniae or H. influenzae.

Which of the following is not a commonly occurring adverse effect associated with use of BactrimR?a. Nauseab. Agranulocytosisc. Vomitingd. Anorexiae. Allergic skin reactions (i.e., rash, urticaria)

Which of the following is not a commonly occurring adverse effect associated with use of BactrimR?a. Nauseab. Agranulocytosisc. Vomitingd. Anorexiae. Allergic skin reactions (i.e., rash, urticaria)

Myocaberium such as M. tuberculosis are referred to as “acid-fast bacilli” for which of the following reasons?a. Eradication of the organism requires a basic pH which is not conducive for survival of the organism.b. They resist use of acids and stains used in traditional gram staining procedures.c. The outer membrane of the organism contains a waxy, acidic coating which resists penetration via antimicrobials.d. The organism grows best in a culture medium which is acidic.e. None of the above.

Myocaberium such as M. tuberculosis are referred to as “acid-fast bacilli” for which of the following reasons?a. Eradication of the organism requires a basic pH which is not conducive for survival of the organism.b. They resist use of acids and stains used in traditional gram staining procedures.c. The outer membrane of the organism contains a waxy, acidic coating which resists penetration via antimicrobials.d. The organism grows best in a culture medium which is acidic.e. None of the above.

Which of the following is the number one risk factor for development of tuberculosis?a. Residence in a state (e.g., California) where there is a high percentage of immigrants.b. Overcrowded living environments in large urban areas.c. HIV/AIDSd. Age range of 25-44yo.e. Ethnicity (e..g, Asians, Hispanics, etc.)

Which of the following is the number one risk factor for development of tuberculosis?a. Residence in a state (e.g., California) where there is a high percentage of immigrants.b. Overcrowded living environments in large urban areas.c. HIV/AIDSd. Age range of 25-44yo.e. Ethnicity (e..g, Asians, Hispanics, etc.)

Which of the following initial treatment regimens for active TB would be preferred in most patients?a. Isoniazid + pyridoxine daily x 9 monthsb. Isoniazid + rifapentine once weekly x 12 weeksc. Isoniazid + rifampin + ethambutol + pyrazinamide daily x 8 weeksd. Isoniazid + rifampin + ethambutol + pyrazinamide 3-x-weekly x 8 weeks.e. Rifampin daily x 4 months

Which of the following initial treatment regimens for active TB would be preferred in most patients?a. Isoniazid + pyridoxine daily x 9 monthsb. Isoniazid + rifapentine once weekly x 12 weeksc. Isoniazid + rifampin + ethambutol + pyrazinamide daily x 8 weeksd. Isoniazid + rifampin + ethambutol + pyrazinamide 3-x-weekly x 8 weeks.e. Rifampin daily x 4 months

Multidrug resistant TB generally involves which of the following drugs?a. Rifampinb. Ethambutolc. Isoniazidd. A & C onlye. B & C only

Multidrug resistant TB generally involves which of the following drugs?a. Rifampinb. Ethambutolc. Isoniazidd. A & C onlye. B & C only

Which of the following statements regarding food interactions with isoniazid are correct?a. Isoniazid should be avoided with tyramine-containing foods (e.g., some cheeses and wines) due to the potential for QT interval prolongation.b. Isoniazid should be avoided with histamine-containing foods (e.g., skipjack, tuna, etc.) due to the potential for headache, sweating, palpitations, flushing, and hypotension.c. Isoniazid should be taken either 1 hour before or 2 hours after a meal as food decreases the bioavailability of the drug.d. A & C onlye. B & C only

Which of the following statements regarding food interactions with isoniazid are correct?a. Isoniazid should be avoided with tyramine-containing foods (e.g., some cheeses and wines) due to the potential for QT interval prolongation.b. Isoniazid should be avoided with histamine-containing foods (e.g., skipjack, tuna, etc.) due to the potential for headache, sweating, palpitations, flushing, and hypotension.c. Isoniazid should be taken either 1 hour before or 2 hours after a meal as food decreases the bioavailability of the drug.d. A & C onlye. B & C only

Which of the following are possible superficial infections secondary to fungal overgrowth?a. Candidemiab. Oropharyngeal candidiasis (i.e., thrush)c. Vaginal candidiasisd. A & B onlye. B & C only

Which of the following are possible superficial infections secondary to fungal overgrowth?a. Candidemiab. Oropharyngeal candidiasis (i.e., thrush)c. Vaginal candidiasisd. A & B onlye. B & C only

Which of the following are potential consequences of inhalation pathogenic Aspergillus molds in non-immunocompromised pateints?a. Allergic Bronchopulmonary Aspergillosisb. Aspergilloma (i.e., “fungus ball”)c. Invasive Aspergillosisd. A & B onlye. A & C only

Which of the following are potential consequences of inhalation pathogenic Aspergillus molds in non-immunocompromised pateints?a. Allergic Bronchopulmonary Aspergillosisb. Aspergilloma (i.e., “fungus ball”)c. Invasive Aspergillosisd. A & B onlye. A & C only

Which of the following antifungals are polyene antifungals?a. Amphotericin Bb. Terbinafinec. Nystatind. A & C onlye. B & C only

Which of the following antifungals are polyene antifungals?a. Amphotericin Bb. Terbinafinec. Nystatind. A & C onlye. B & C only

Which of the following is not a commonly occurring adverse effect associated with fluconazole?a. Headacheb. Dysgeusiac. Drowsinessd. Abdominal paine. Nausea

Which of the following is not a commonly occurring adverse effect associated with fluconazole?a. Headacheb. Dysgeusiac. Drowsinessd. Abdominal paine. Nausea

Mr. W. is an elderly 88yo gentleman with carcinoma of the head and neck for which he receives chemotherapy and radiation. He has developed a nasty case of oropharyngeal candidiasis. You view his medication list and do not note any significant drug-drug interactions with fluconazole. His calculated creatinine clearance is 45ml/min. Which of the following represent an appropriate treatment regimen for this patient?a. 200mg po qd x 14 daysb. 200mg po once then 100mg po qd for a total of 14 daysc. 100mg po once then 50mg po qd for a total of 14 daysd. 150mg po oncee. 100mg po qd x 14 days

Mr. W. is an elderly 88yo gentleman with carcinoma of the head and neck for which he receives chemotherapy and radiation. He has developed a nasty case of oropharyngeal candidiasis. You view his medication list and do not note any significant drug-drug interactions with fluconazole. His calculated creatinine clearance is 45ml/min. Which of the following represent an appropriate treatment regimen for this patient?a. 200mg po qd x 14 daysb. 200mg po once then 100mg po qd for a total of 14 daysc. 100mg po once then 50mg po qd for a total of 14 daysd. 150mg po oncee. 100mg po qd x 14 days

Oral terbinafine (LamisilR) is indicated for which of the following conditions?a. Onychomycosisb. Candida urinary tract infectionsc. Vaginal candidiasisd. Oropharyngeal candidiasise. Cryptococcal meningitis

Oral terbinafine (LamisilR) is indicated for which of the following conditions?a. Onychomycosisb. Candida urinary tract infectionsc. Vaginal candidiasisd. Oropharyngeal candidiasise. Cryptococcal meningitis

Which of the following is not a warning or precaution with regards to use of terbinafine (LamisilR)?a. Heart failureb. Taste and smell disturbancesc. Depressiond. Neutropeniae. Precipitation/exacerbation of Systemic Lupus Erythematosus

Which of the following is not a warning or precaution with regards to use of terbinafine (LamisilR)?a. Heart failureb. Taste and smell disturbancesc. Depressiond. Neutropeniae. Precipitation/exacerbation of Systemic Lupus Erythematosus

Which of the following is not a potential adverse effect associated with oral terbinafine (LamisilR) therapy?a. Headacheb. Dysgeusiac. Renal function test abnormalitiesd. Abdominal paine. Nausea

Which of the following is not a potential adverse effect associated with oral terbinafine (LamisilR) therapy?a. Headacheb. Dysgeusiac. Renal function test abnormalitiesd. Abdominal paine. Nausea

Which of the following represents an appropriate treatment duration using terbinafine (LamisilR) for the treatment of a fungal infection of the fingernails?a. 2 weeksb. 4 weeksc. 6 weeksd. 8 weekse. 12 weeks

Which of the following represents an appropriate treatment duration using terbinafine (LamisilR) for the treatment of a fungal infection of the fingernails?a. 2 weeksb. 4 weeksc. 6 weeksd. 8 weekse. 12 weeks

Which of the following are indications for use of oral acyclovir?a. Herpes Zoster (i.e., shingles)b. Influenza virus Type Ac. Varicella Zoster (i.e., chickenpox)d. A & B onlye. A & C only

Which of the following are indications for use of oral acyclovir?a. Herpes Zoster (i.e., shingles)b. Influenza virus Type Ac. Varicella Zoster (i.e., chickenpox)d. A & B onlye. A & C only

For maximum therapeutic effect, for the treatment of chickenpox secondary to varicella zoster, treatment should be initiated within _____ after onset of the rash.a. 12 hoursb. 24 hoursc. 48 hoursd. 72 hourse. 96 hours

Which of the following is not a commonly occurring adverse effect associated with therapy with acyclovir?a. Nauseab. Vomitingc. Diarrhead. Headachee. Dysgeusia

Which of the following is not a commonly occurring adverse effect associated with therapy with acyclovir?a. Nauseab. Vomitingc. Diarrhead. Headachee. Dysgeusia

Mr. P. is a salesman who travels quite extensively. You are seeing him again regarding recurrent genital herpes. You counsel again regarding the need to wear a condom and to be honest with his sexual partners. You decide to prescribe prophylactic acyclovir for chronic suppressive therapy. Mr. P’s calculated creatinine clearance is 80ml/min. Which of the following represents an appropriate dosage regimen?a. 200mg po q12hb. 200mg po q8hc. 400mg po q12hd. 400mg po q8he. 800mg po qd

Mr. P. is a salesman who travels quite extensively. You are seeing him again regarding recurrent genital herpes. You counsel again regarding the need to wear a condom and to be honest with his sexual partners. You decide to prescribe prophylactic acyclovir for chronic suppressive therapy. Mr. P’s calculated creatinine clearance is 80ml/min. Which of the following represents an appropriate dosage regimen?a. 200mg po q12hb. 200mg po q8hc. 400mg po q12hd. 400mg po q8he. 800mg po qd

Inhibition of the the action of neuraminidase via this prodrug best describes the mechanism of action of which of the following drugs?a. Acyclovir (ZoviraxR)b. Oseltamivir (TamifluR)c. FlumistRd. Valacyclovir (ValtrexR)e. None of the above.

Inhibition of the the action of neuraminidase via this prodrug best describes the mechanism of action of which of the following drugs?a. Acyclovir (ZoviraxR)b. Oseltamivir (TamifluR)c. FlumistRd. Valacyclovir (ValtrexR)e. None of the above.

Which of the following adverse effects is not commonly associated with oseltamivir (TamifluR)?a. Nauseab. Vomitingc. Neuropsychiatric events (e.g., delirium, abnormal behavior, hallucinations)d. Diarrheae. None of the above.

Which of the following adverse effects is not commonly associated with oseltamivir (TamifluR)?a. Nauseab. Vomitingc. Neuropsychiatric events (e.g., delirium, abnormal behavior, hallucinations)d. Diarrheae. None of the above.

Which of the following statements is incorrect with regards to influenza?a. Types A, B, and C are strains that commonly infect humans, and Type A is commonly associated with pandemics.b. The influenza virus contains surface glycoproteins—neuraminidase which is responsible for binding and hemagglutinin which is responsible for enzymatic degradation of the receptor site to assist with exit of newly formed viral particles from the infected cell.c. The trivalent injectable influenza vaccine consist of inactivated, killed virus.d. The intranasal influenza virus vaccine FlumistR consists of live, attenuated virus.e. The current influenza vaccine contains two Type A strains and one Type B strain.

Which of the following statements is incorrect with regards to influenza?a. Types A, B, and C are strains that commonly infect humans, and Type A is commonly associated with pandemics.b. The influenza virus contains surface glycoproteins—neuraminidase which is responsible for binding and hemagglutinin which is responsible for enzymatic degradation of the receptor site to assist with exit of newly formed viral particles from the infected cell.c. The trivalent injectable influenza vaccine consist of inactivated, killed virus.d. The intranasal influenza virus vaccine FlumistR consists of live, attenuated virus.e. The current influenza vaccine contains two Type A strains and one Type B strain.

The live, attenuated influenza nasal vaccine FlumistR should not be administered within 2 weeks before or 48 hours after administration of oseltamivir (TamifluR) as antiviral drugs inhibit replication of the virus in live virus vaccines.a. Trueb. False

The live, attenuated influenza nasal vaccine FlumistR should not be administered within 2 weeks before or 48 hours after administration of oseltamivir (TamifluR) as antiviral drugs inhibit replication of the virus in live virus vaccines.a. Trueb. False

Mr. Z. is seeing you today for what he believes is the flu. He is correct as the nasal swab is positive for influenza Type A. He states that his symptoms started approximately two days ago. Would he still be a candidate for use of TamifluR?a. Yesb. No

Mr. Z. is seeing you today for what he believes is the flu. He is correct as the nasal swab is positive for influenza Type A. He states that his symptoms started approximately two days ago. Would he still be a candidate for use of TamifluR?a. Yesb. No