Practice questions (Exam 1)
Which 3 antibacterial agents are associated with increased nephrotoxicity requiring monitoring?
Vanc aminoglycosides polymyxins
Which of the following general statements concerning the spectrum of activity of cephalosporins are true? Select all that apply. A. 1st generation agents (ie, cefazolin) generally have better coverage for MSSA and streptococci than 4th generation agents(ie, cefepime). B. To date, only 5th generation cephalosporin (ie, ceftaroline) covers MRSA. C. 4th generation agents (ie, cefepime) generally have better Gram negative coverage than 1st (ie, cefazolin) and 2nd generation (ie, cefuroxime) agents. D. None of the currently available cephalosporin generations cover Enterococci.
all the above
which cephalosporin does not need renal dosing?
ceftriaxone
daptomycin and polymyxins inhibit the bacterial ______ ____________
cell membrane
which drug inhibits stage 1 of cell wall synthesis (inhibition of MurA enzyme responsible for making the peptidoglycan chain)
fosfomycin
which two antibacterial agents commonly cover VRE (E. faecium)
linezolid daptomycin
A patient has confirmed MSSA, which IV agent would be most appropriate for definitive, de-escalation therapy?
nafcillin
Which 3 antibacterial agents are associated with require concentration monitoring to maximize efficacy and/or minimize toxicity?
vanc aminoglycosides chloremphenicol
vancomycin range
10-20 mcg/mL
Which of the following antimicrobial classes would you need to monitor for the possibility of developing mental health adverse effect such as attention difficulties, memory impairment, agitation and delirium? A. Fluoroquinolones B. Macrolides C. Glycopeptides D. 5th gneration Cephalosporins
A. Fluoroquinolones
Which statement is true concerning aminoglycosides? Select all that apply. A. They are bactericidal and efficacy correlates with the peak to MIC ratio B. They are associated with nephrotoxicity and ototoxicity C. Because of their poor penetration into most tissue sites, they are generally not used alone for most infections outside of the urinary tract D. They are primarily used for their Gram positive coverage E. They are associated with significant CYP3A4 drug-drug interactions
A, B, C
Which of the following general statements concerning the spectrum of activity of cephalosporins is/are true? Select all that apply. A. 1st generation agents generally have better coverage for MSSA and streptococci than 4th generation agents. B. To date, only Cefazolin covers MRSA. C. 4th generation agents generally have better Gram-negative coverage than 1st and 2nd generation agents. D. None of the cephalosporins cover Enterococci
A, C, D
Which antimicrobial drug classes require patient instructions about avoiding co-administration with antacids. Select all that apply. all students received full credit A. Fluoroquinolones B. Tetracyclines C. Macrolides D. Penicillins E. Sulfonamides
A. Fluoroquinolones B. Tetracyclines
To which side chain or area of the fluoroquinolone structure do metal cations bind resulting in an insoluble chelation complex? A. Between the carboxylic acid at position 3 and carbonyl group at position 4 B. Between the carbonyl group at position 4 and R5 side chain C. Between the side chain at position 8 and the R1 side chain D. Between the fluoro group at position 6 and the R7 substituent
A. Between the carboxylic acid at position 3 and carbonyl group at position 4
The two most common bacterial causes of meningitis are Streptococcus pneumoniae and Neisseria meningitidis. Which specific cephalosporin is generally considered the drug of choice for treating either this gram positive or gram negative pathogen due to its broad activity and excellent penetration into the CSF? A. Ceftriaxone B. Cefepime C. Cefazolin D. Ceftaroline
A. Ceftriaxone
Which of the following antimicrobial drug classes are associated with the possibility of QT prolongation? Select all that apply. A. Clarithromycin (a macrolide) B. Lefamulin (a pleuromultilin) C. Vancomycin (a glycopeptide) D. Levofloxacin (a fluoroquinolone) E. Cetriaxone (a cephalosporin)
A. Clarithromycin (a macrolide) B. Lefamulin (a pleuromultilin) D. Levofloxacin (a fluoroquinolone)
A serious complication associated with the long-term use of extended-spectrum beta lactams and fluoroquinolones is the development of: A. Clostridium difficile colitis B. QT interval prolongation and Torsades de pointes C. Acute pancreatitis D. Peripheral neuropathy E. Hepatotoxicity
A. Clostridium difficile colitis
A patient is on day 5 of vancomycin therapy for a MRSA bacteremia, but without significant clinical improvement. Which of the following would be appropriate as a possible alternative agent? Select three that apply. A. Daptomycin B. Linezolid C. Gentamicin D. Ceftaroline E. Azithromycin
A. Daptomycin B. Linezolid D. Ceftaroline
Estrogen-containing oral contraceptives rely on the presence of gut bacteria (especially anaerobes) for enterohepatic reabsorption in order to have adequate estrogen levels for effective contraception. Which of the following antibiotics represents the greatest theoretical risk for decreasing the effectiveness of estrogen-containing contraceptives? A. Doxycycline B. Ciprofloxacin C. Vancomycin D. Gentamicin
A. Doxycycline
Estrogen-containing oral contraceptives rely on the presence of gut bacteria (especially anaerobes) for enterohepatic reabsorption in order to have adequate estrogen levels for effective contraception. Which of the following antibiotics represents the greatest theoretical risk for decreasing the effectiveness of estrogen-containing contraceptives? A. Doxycycline (tetracycline) B. Cephalexin (cephalosporin) C. Penicillin VK (penicillin) D. Azithromycin (macrolide)
A. Doxycycline (tetracycline)
Which of the following could be used to treat an infection caused by Pseudomonas aeruginosa? Select four that apply. A. Gentamicin (aminoglycoside) B. Cefepime (4th generation cephalosporin) C. Piperacillin/tazobactam (ureido penicillin) D. Amoxicillin/clavulanate (amino penicillin) E. Ceftaroline (5th generation cephalosporin) F. Meropenem (carbapenem)
A. Gentamicin (aminoglycoside) B. Cefepime (4th generation cephalosporin) C. Piperacillin/tazobactam (ureido penicillin) F. Meropenem (carbapenem)
A hospitalized patient with chronic renal insufficiency is diagnosed with an infection requiring an antibiotic. Which of the following antibiotics would you be most concerned with causing additional renal toxicity if required? Select three that apply. A. Gentamicin (aminoglycoside) B. Colistin (polymyxin E) C. Ceftriaxone (3rd generation cephalosporin) D. Vancomycin (glycopeptide) E. Nafcillin (semisynthetic acyl penicillin)
A. Gentamicin (aminoglycoside) B. Colistin (polymyxin E) D. Vancomycin (glycopeptide)
Which of the following antimicrobials exhibits concentration-dependent killing allowing larger dosages to be given less frequently to maximize pharmacodynamic goals? Select three that apply. A. Gentamicin (aminoglycoside) B. Daptomycin (lipopeptide) C. Ciprofloxacin (fluroquinolone) D. Azithromycin (macrolide) E. Ceftriaxone (cephalosporin)
A. Gentamicin (aminoglycoside) B. Daptomycin (lipopeptide) C. Ciprofloxacin (fluroquinolone)
A 19 year male develops a skin rash and some difficulty breathing 1 hour following the administration of IM ceftriaxone for urogenital gonorrhea. Which of the following statements is/are correct? A. He should be considered allergic to ceftriaxone, but not necesarily to other cephalosporins with different side chains B. He should be considered allergic to all third and fourth generation cephalosporins C. He should be considered allergic to all agents with a beta lactam ring D. He should not be considered allergic to any drug as this was likely a reaction related to having gonorrhea
A. He should be considered allergic to ceftriaxone, but not necesarily to other cephalosporins with different side chains
Which of the following "top 200" antimicrobials require patient instructions about avoiding co-administration with antacids. Select all three that apply. A. Levofloxacin (Levaquin) B. Doxycycline (Vibramycin) C. Azithromycin (Zithromax) D. Cefdinir (Omnicef) E. Trimethoprim/sulfamethoxazole (Bactrim)
A. Levofloxacin (Levaquin) B. Doxycycline (Vibramycin) D. Cefdinir (Omnicef)
Which of the following antimicrobials is associated with an increased risk of causing a serotonin syndrome in patients receiving concomitant SSRI antidepressants? A. Linezolid (Zyvox) B. Lefamulin (Xenleta) C. Levofloxacin (Levaquin) D. Cefiderocol (Fetroja)
A. Linezolid (Zyvox)
Which of the following organisms are not covered by any of the currently available penicillins? Select two that apply. A. MRSA B. MSSA C. Pseudomonas aeruginosa D. Anaerobes E. Atypicals
A. MRSA E. Atypicals
Which of the following antimicrobials would you need to monitor for QTc prolongation and the potential for arrhythmias? Select all three that apply. A. Moxifloxacin (Avelox) B. Clarithromycin (Biaxin) C. Vancomycin (Vancocin) D. Ceftriaxone (Rocephin) E. Lefamulin (Xenleta)
A. Moxifloxacin (Avelox) B. Clarithromycin (Biaxin) E. Lefamulin (Xenleta)
Which of the following prescriptions would require an auxilary label and patient consultation warning about avoiding excessive sun exposure? Select all that apply. A. Moxifloxacin (Avelox) B. Azithromycin (Zithromax) C. Trimethoprim/sulfamethoxazole (Bactrim) D. Doxycycline (Vibramycin)
A. Moxifloxacin (Avelox) C. Trimethoprim/sulfamethoxazole (Bactrim) D. Doxycycline (Vibramycin)
A 26 year old pregnant female, 1 week before anticipated delivery, is found to have bacteria in the urine. She has no symptoms, but her physician wants to treat her for a presumed bladder infection (cystitis). From a safety and bacterial coverage standpoint, which of the following oral antimicrobials would you recommend in this situation? She has no known drug allergies. Select two that apply. A. Nitrofurantoin (Macrodantin) B. Trimethoprim/sufamethoxazole (Bactrim) C. Cefdinir (Omnicef) D. Moxifloxacin (Avelox) E. Vancomycin (Vancocin)
A. Nitrofurantoin (Macrodantin) C. Cefdinir (Omnicef)
Which two of the following oral antibiotics would be safe and effective to treat a bacterial cystitis in a pregnant woman two weeks prior to anticipated delivery? She has no known drug allergies. Select two that apply. A. Nitrofurantoin (Macrodantin) B. Trimethoprim/sufamethoxazole (Bactrim) C. Cefdinir (Omnicef) D. Moxifloxacin (Avelox) E. Azithromycin (Zithromax)
A. Nitrofurantoin (Macrodantin) C. Cefdinir (Omnicef)
A 4 year old girl develops a rapid onset of difficulty breathing 20 minutes following her first dose of Augmentin suspension for otitis media (middle ear infection). EMT personnel administer epinephrine, diphenhydramine, IV fluids and oxygen en route to the hospital. Which of the following should occur? Select all that apply. A. She should be considered allergic to all penicillins B. She should be desensitized before receiving a cephalosporin C. She can safely receive either azithromycin or clarithromycin for her infection D. She should be considered allergic to all beta lactams and beta lactamase inhibitors E. She can safely receive either levofloxacin or doxycycline for her infection
A. She should be considered allergic to all penicillins C. She can safely receive either azithromycin or clarithromycin for her infection
Which Gram positive organism would be the most important to cover with your antimicrobial regimen for suspected outpatient-acquired bacterial pneumonia? A. Streptococcus pneumoniae B. Methicillin-resistant Staphylococcus aureus C. Group A Streptococcus D. Klebsiella pneumoniae
A. Streptococcus pneumoniae
Which Gram positive organism would be the most important to cover with your antimicrobial regimen for suspected outpatient-acquired bacterial pneumonia? A. Streptococcus pneumoniae B. Staphylococcus aureus C. Streptococcus pyogenes D. Enterococcus faecalis
A. Streptococcus pneumoniae
Which statement is true concerning aminoglycosides? Select all that apply. A. They are bactericidal and efficacy correlates with the peak to MIC ratio B. They are associated with nephrotoxicity and ototoxicity C. Because of their poor penetration into most tissue sites, they are generally not used alone for most infections outside of the urinary tract D. Trough levels must be kept in the 10-20 mcg/ml range E. They are associated with significant CYP3A4 drug-drug interactions
A. They are bactericidal and efficacy correlates with the peak to MIC ratio B. They are associated with nephrotoxicity and ototoxicity C. Because of their poor penetration into most tissue sites, they are generally not used alone for most infections outside of the urinary tract
Which of the following is true about the pharmacodynamic properties of the aminoglycoside antibiotics such as gentamicin and tobramycin? Select all that apply. A. They exhibit concentration-dependent killing B. They exhibit time-dependent killing C. The goal is to maximize time spent above the MIC D. They exhibit a long post antibiotic effect (PAE) E. The goal is maximize the peak to MIC ratio
A. They exhibit concentration-dependent killing D. They exhibit a long post antibiotic effect (PAE) E. The goal is maximize the peak to MIC ratio
Which of the following agents would be reasonably appropriate to treat a 24 yof with a diagnosis of acute pyelonephritis? Assume a susceptible isolate. Select all three that apply. A. Trimethoprim/sulfamethoxazole (Bactrim) B. Levofloxacin (Levaquin) C. Fosfomycin (Monurol) D. Nitrofurantoin (Macrobid) E. Ceftriaxone (Rocephin)
A. Trimethoprim/sulfamethoxazole (Bactrim) B. Levofloxacin (Levaquin) E. Ceftriaxone (Rocephin)
Which of the following agents would be reasonably appropriate to treat a 24 yof with a diagnosis of acute pyelonephritis (ie, kidney involvement)? Assume a susceptible isolate, that the patient is not pregnant and she has NKDA. Select all that apply. This one is tricky! A. Trimethoprim/sulfamethoxazole (Bactrim) B. Moxifloxacin (Levaquin) C. Fosfomycin (Monurol) D. Nitrofurantoin (Macrobid) E. Ceftriaxone (Rocephin)
A. Trimethoprim/sulfamethoxazole (Bactrim) E. Ceftriaxone (Rocephin)
Formation of metal complexes with antibiotics contribute to which of the following side effects/drug interactions? Select all that apply. A. Reduced activity in the presence of antacids B. Higher incidence of tendonitis C. Enamel hypoplasia resulting in tooth discoloration D. Decreased oral absorption with iron supplements
All of the above
Bite wounds involving cats, dogs and humans involve mouth aerobes and anaerobes. Based on this spectrum of coverage which of the following agents would be anticipated to be useful for treating an infected bite wound? A. Ciprofloxacin B. Amoxicillin-clavulanate C. trimethoprim-sulfamethoxazole D. azithromycin
B. Amoxicillin-clavulanate
Bite wounds involving cats, dogs and humans involve mouth aerobes and anaerobes. Based on this spectrum of coverage, which two of the following would be anticipated to be useful for treating an infected bite wound? A. Moxifloxacin (Avelox) B. Amoxicillin-clavulanate (Augmentin) C. trimethoprim-sulfamethoxazole (Bactrim) D. azithromycin (Z-pak)
B. Amoxicillin-clavulanate (Augmentin) A. Moxifloxacin (Avelox)??
A 24 year old pharmacy student is planning a trip to Florida over a long weekend that includes a Reading Day! She has already received both Covid19 vaccine doses and plans to double mask and socially distance even on the beach. She was just seen for a chronic sinusitis infection and is being prescribed an antibiotic for a 10 day course. Which of the following oral antimicrobials would she not need to be concerned about the possibility of photosensitivity and the need to minimize excessive sun exposure while on her trip? A. Moxifloxacin (Avelox) B. Azithromycin (Zithromax) C. Trimethoprim/sulfamethoxazole (Bactrim) D. Doxycycline (Vibramycin)
B. Azithromycin (Zithromax)
_____________is a bactericidal broad spectrum cephalosporin that has a catechol moiety to bind free iron and thereby gain access to gram negative organisms, including Pseudomonas aeruginosa, through outer membrane porin channels. A. Ceftaroline B. Cefiderocol C. Cefepime D. Ceftriaxone E. Cefazolin
B. Cefiderocol
Which of the following agents is most likely to have activity against a Carbapenem-resistant Enterobacterales (CRE) isolate? A. Daptomycin (Cubicin) B. Cefiderocol (Fetroja) C. Meropenem (Merrem) D. Ceftaroline (Teflaro)
B. Cefiderocol (Fetroja)
A 16 year old female high soccer player is found to have numerous small, painful lesions on her legs thought to be characteristic of a community-acquired MRSA (CA-MRSA) skin infection. Which agent is considered the drug of choice for this patient? A. Doxycycline (Vibramycin) B. Trimethoprim/sulfamethoxazole (Bactrim) C. Amoxicillin clavulanate (Augmentin) D. Azithromycin (Zithromax)
B. Trimethoprim/sulfamethoxazole (Bactrim)
A 20 year old male notices a purulent discharge from his urethra and is experiencing dysuria. He is found to be positive for both gonorrhea and chlamydia. Based on antimicrobial coverage, which of the following regimens would you think is most appropriate? A. Moxifloxacin plus Azithromycin B. Ceftriaxone plus Doxycycline C. Cephalexin plus Metronidazole D. Cefepime plus Vancomycin
B. Ceftriaxone plus Doxycycline
A 42 year old male is schedule to have all of his remaining teeth removed due to poor oral hygeine and severe inflammation with repeated infectious problems. He has a previously documented type 1 allergy to penicillin VK (difficulty breathing, hives) when he was 15 years old. Which of the following oral agents with good coverage for mouth bacteria (Gram positive aerobes and anaerobes) would you recommend for this patient as antimicrobial prophlaxis? A. Azithromycin B. Clindamycin C. Amoxicillin-clavulanate D. Cephalexin E. Trimethoprim/sulfamethoxazole
B. Clindamycin
I'm a bacteriostatic, 50S protein synthesis inhibitor with good coverage for gram positive aerobes and anaerobes, but I have a bad reputation for possibly causing C. difficile diarrhea. Who am I? A. Azithromycin B. Clindamycin C. Amoxicillin-clavulanate D. Lefamulin E. Trimethoprim/sulfamethoxazole
B. Clindamycin
A 16 year old female high soccer player is found to have numerous small, painful lesions on her legs thought to be characteristic of a community-acquired MRSA (CA-MRSA) skin infection. Which oral agent is considered the drug of choice for this patient? A. Clindamycin (Cleocin) B. Trimethoprim/sulfamethoxazole (Bactrim) C. Amoxicillin clavulanate (Augmentin) D. Azithromycin (Zithromax) E. Vancomycin (Vancocin)
B. Trimethoprim/sulfamethoxazole (Bactrim)
A 60 yof patient with an apparent pulmonary infection is admitted through the ED. Her nares test positive for the presence of the mecA gene. Which agent would you specifically recommend based on this finding. A. Nafcillin B. Vancomycin C. Cefepime D. Gentamicin E. Piperacillin/tazobactam
B. Vancomycin
The presence of the mecA gene indicates: A. inducible resistance to macrolides and clindamycin B. an altered penicillin binding protein C. ESBL-producing gram negatives D. an altered gyrA protein resulting in resistance to fluoroquinolones E. Two or more of the above
B. an altered penicillin binding protein
Which of the following tests should be performed at baseline and weekly during Daptomycin therapy to monitor for its major adverse effect? A. Serum creatinine B. Creatine phosphokinase C. Visual acuity testing D. QTc interval
B. Creatine phosphokinase
A patient is begun on a 6 week course of daptomycin for MRSA endocarditis. Which of the following tests should be performed at baseline and weekly during daptomycin therapy to monitor for its major adverse effect? A. Serum creatinine (Scr) B. Creatine phosphokinase (CPK) C. Hemoglobin &Hemotocrit (H&H) D. Aspartate and alanine aminotransferases (AST&ALT)
B. Creatine phosphokinase (CPK)
Which of the following antibiotics would be appropriate to treat a urinary traction infection caused by vancomycin-resistant Enterococcus faecium (VRE)? Select all that apply. A. Cefazolin B. Daptomycin C. Linezolid D. Ciprofloxacin
B. Daptomycin C. Linezolid
Which of the following antibiotics would be appropriate to treat a urinary traction infection caused by vancomycin-resistant Enterococcus faecium (VRE)? Select all that apply. A. Ceftaroline B. Daptomycin C. Linezolid D. Azithromycin E. Ciprofloxacin
B. Daptomycin C. Linezolid
The nurse practitioner calls and wants a recommendation for a 26 yof with suspected Lyme's disease acquired from a tick bite while hiking. Which agent do you recommend as the drug of choice? A. Azithromycin (Z-pak) B. Doxycycline (Vibramycin) C. Amoxicillin/clavulanate (Augmentin) D. Cephalexin (Keflex) E. Trimethoprim/sulfamethoxazole (Bactrim)
B. Doxycycline (Vibramycin)
Which antimicrobial class is generally considered the first-line for ESBL-producing organisms? A. macrolides B. carbapenems C. glycopeptides D. 4th generation cephalosporins
B. carbapenems
Which antimicrobial class is generally considered the first-line for ESBL-producing organisms? A. macrolides B. carbapenems C. glycopeptides D. 5th generation cephalosporins
B. carbapenems
Coverage of so-called "atypical" pathogens such as Mycoplasma pneumoniae is sometimes warranted for pneumonia not responding to initial coverage. Which of the following antimicrobial classes generally have recognized coverage for these pathogens? Select three that possess atypical coverage. A. 3rd generation cephalosporins (cefdinir) B. Fluoroquinolones (levofloxacin) C. Macrolides (clarithromycin) D. Tetracyclines (doxycycline) E. Beta lactam-beta lactamase inhibitor combinations (amoxicillin-clavulanate)
B. Fluoroquinolones (levofloxacin) C. Macrolides (clarithromycin) D. Tetracyclines (doxycycline)
A 21 year male develops a skin rash, difficulty breathing and hypotension 1-hour following the administration of IM ceftriaxone for anorectal gonorrhea. He has received various penicillin (Augmentin) and cephalosporin products (Keflex) in the past without incident. Which of the following statements is correct? Hint: you will need to use the attachment showing side chain similarities among cephalosporins. A. He should be considered allergic to ceftriaxone and cefotaxime, but not necessarily to cefepime or cefpodoxime B. He should be considered allergic to ceftriaxone and cefepime, but not necessarily ceftazidime or cefdinir C. He should be considered allergic to all agents with a beta lactam ring D. He should not be considered allergic to any drug as this was likely a reaction related to having concomitant gonorrhea
B. He should be considered allergic to ceftriaxone and cefepime, but not necessarily ceftazidime or cefdinir
A patient with several recent hospitalizations and IV antibiotic exposure is again admitted with signs, symptoms and a chest radiograph consistent with bacterial pneumonia. The patient is immediately started on Cefepime and Vancomycin while awaiting cultures and susceptibilties. What is the rational for using combination antimicrobial therapy in this particular situation. A. to prevent the emergence of microbial resistance B. to broaden the spectrum of empiric coverage C. to achieve microbial synergy D. to decrease the dose of one of the drugs thereby lessening the risk of toxicity
B. to broaden the spectrum of empiric coverage
The _____________ class of antibiotics works by inhibiting cell wall synthesis. A. Macrolide B. β-Lactam C. Fluoroquinolone D. Sulfonamide
B. β-Lactam
Why is gentamicin typically used as a topical antibiotic cream and not for bacterial infections outside the GI tract? A. It has a high log P. B. It is highly soluble in water. C. It undergoes hydrolysis in the stomach. D. It causes crystalluria when taken in high doses.
B. It is highly soluble in water.
A diabetic patient on metformin comes into the pharmacy to pick up a new prescription for an apparent infection. Which of the following antimicrobials would you need to be concerned about the increased risk of hypoglycemia while taking this medication? A. Bactrim B. Levaquin C. Vibramycin D. Zithromax E. Augmentin
B. Levaquin
A 22 year old male patient with a diagnosis of community-acquired pneumonia is placed on oral amoxicillin, but fails to respond after 4 days of outpatient therapy. The physician wants to change coverage to include Mycoplasma pneumonia, a so-called "atypical" pathogen. Which of the following antimicrobials would be an appropriate recommendation based on the request? Select three that apply. A. Cephalexin B. Levofloxacin C. Azithromycin D. Doxycycline E. Amoxicillin clavulanate
B. Levofloxacin C. Azithromycin D. Doxycycline
A patient is on day 5 of vancomycin therapy for a MRSA pneumonia, but without significant clinical improvement. Which of the following would be appropriate as a possible alternative agent? Select all that apply. A. Daptomycin B. Linezolid C. Cefepime D. Ceftaroline E. Azithromycin
B. Linezolid D. Ceftaroline
An 80-year-old man with MSSA bacteremia is going to require two weeks of high-dose, parenteral, bactericidal antibiotic therapy. He has a PMH of CRI (Scr= 2.0 mg/dl). Which of the following agents, if selected, would not need to be dose-adjusted for his renal insufficiency? Select two that apply. A. Penicillin G B. Nafcillin C. Ceftriaxone D. Vancomycin
B. Nafcillin C. Ceftriaxone
Which of the following agents would you not need to dose-adjust in renal impairment (creatinine clearance of 30 ml/min). A. Gentamicin (aminoglycoside) B. Nafcillin (antistaphylococcal penicillin) C. Levofloxacin (fluoroquinolone) D. Vancomycin (glycopeptide)
B. Nafcillin (antistaphylococcal penicillin)
A 20 year old male notices a prurulent discharge from his urethra and is experiencing dysuria. He is found to be positive for both gonorrhea and chlamydia. Based on antimicrobial coverage, which of the following regimens would you think is most appropriate? A. Bactrim plus Macrodantin B. Rocephin plus Zithromax C. Cipro plus Flagyl D. Augmentin plus Vancocin
B. Rocephin plus Zithromax
The doctor's office calls in a prescription for a 10-day course of linezolid (Zyvox) to treat a serious skin infection. Which medication in the patient's profile would concern you the most about a potential adverse effect with coadministration of linezolid? A. Warfarin blood thinner B. SSRI antidepressant C. PPI acid inhibitor D. Statin for hyper-cholesterolemia
B. SSRI antidepressant
Lyme's disease and Rocky Mountain spotted fever (RMSF) are infections associated with tick bites. Which of the following antimicrobial drug classes is generally considered the drug of choice for these infections? A. Macrolides (eg, azithromycin) B. Tetracyclines (eg, doxycycline) C. Beta lactam/beta lactamase inhibitors (eg, amoxicillin/clavulanate) D. Cephalsopsorins (eg, cephalexin) E. Sulfonamides (eg, trimethoprim/sulfamethoxazole)
B. Tetracyclines (eg, doxycycline)
Which of the following is true about the pharmacodynamic properties of the beta lactam antibiotics such as the penicillins and cephalosporins? Select all that apply. A. They exhibit concentration-dependent killing B. They exhibit time-dependent killing C. The goal is to maximize time spent above the MIC D. They exhibit a long post antibiotic effect (PAE) E. The goal is maximize the peak to MIC ratio
B. They exhibit time-dependent killing C. The goal is to maximize time spent above the MIC
A 42-year-old man with a MRSA cellulitis of the left forearm is admitted for medical management. After three days of IV vancomycin therapy (planned course of 10 days), he elects to leave the hospital against medical advice. Which of the following agents might be useful to administer as a single dose before he leaves to extend his therapy out another week and hopefully cure his skin infection? A. Ceftaroline (Teflaro) B. Daptomycin (Cubicin) C. Dalbavancin (Dalvance) D. Delafloxacin (Baxdela)
C. Dalbavancin (Dalvance)
A 4 year old boy is diagnosed with "strep throat" develops a rapid onset of difficulty breathing 30 minutes following his first dose of Amoxicillin suspension. He is taken to the ED where he receives epinephrine, diphenhydramine, fluids and oxygen and rapidly recovers. Which oral antibiotic would be the most appropriate to treat this patient? A. Vancomycin B. Cephalexin C. Azithromycin D. Doxycycline E. Ciprofloxacin
C. Azithromycin
Which of the following antimicrobials exhibits time-dependent killing with time spent above the MIC being the important pharmacodynamic target parameter? Select all that apply. A. Gentamicin (aminoglycoside) B. Ciprofloxacin (fluroquinolone) C. Azithromycin (macrolide) D. Ceftriaxone (cephalosporin)
C. Azithromycin (macrolide) D. Ceftriaxone (cephalosporin)
Which of the following agents has a very long half life permitting single dose treatment for certain skin infections including those caused by MRSA? A. Ceftaroline B. Vancomycin C. Dalbavancin D. Azithromycin
C. Dalbavancin
A 22 year old female college student presents to the Student Health clinic with signs and symptoms consistent with acute cystitis. Which organism should be covered with your antimicrobial regimen in this patient? A. S. aureus B. S. pneumoniae C. E. coli D. P. aeruginosa
C. E. coli
In the ICU, the fourth generation cephalosporin, cefepime, is often given by _____________ to optimize its pharmacodynamic properties? A. Bolus administration B. 30 minute infusion C. Extended infusion over 4 hours D. High-dose once-daily administration
C. Extended infusion over 4 hours
A 21 year old female college student presents to the Student Health clinic with signs and symptoms consistent with acute cystitis. Which primary group of organisms should be covered with your antimicrobial regimen in this patient? A. Gram positive aerobic cocci B. Gram positive anaerobic cocci C. Gram negative aerobic bacilli D. Gram negative anaerobic bacilli
C. Gram negative aerobic bacilli
A 67 yom is admitted with apparent pneumonia and he has risk factors for both MRSA and Pseudomonas aeruginosa. The medical student on the team is supposed to suggest appropriate coverage for this patient. He suggests vancomycin for the MRSA, but is unsure of which agents cover Pseudomonas aeruginosa? You step in to assist. Which three do you recommend? A. Amoxicillin/clavulanate B. Azithromycin C. Piperacillin/tazobactam D. Cefepime E. Ciprofloxacin
C. Piperacillin/tazobactam D. Cefepime E. Ciprofloxacin
Which four of the following antimicrobials would be appropriate as monotherapy to treat a pneumonia caused by Pseudomonas aeruginosa? A. Amoxicillin/clavulanate B. Azithromycin C. Piperacillin/tazobactam D. Cefepime E. Ciprofloxacin F. Meropenem G. Gentamicin
C. Piperacillin/tazobactam D. Cefepime E. Ciprofloxacin F. Meropenem
Which of the following is often considered a last resort drug for multi-drug resistant gram negative organisms? A. Daptomycin (Cubicin) B. Telavancin (Vibativ) C. Polymyxin E (Colistin) D. Ceftaroline (Teflaro)
C. Polymyxin E (Colistin)
A patient in the ICU is ordered meropenem for improved coverage for gram negative pathogens. The dosing is left up to you, the pharmacist. Which of the following regimens would you recommend to optimize its pharmacynamic properties? The patient has normal renal function and the normal daily dose is 6 grams. A. 2 grams by 30 min IV infusion every 8 hours B. 6 grams by 30 min IV infusion every 24 hours C. 3 grams by 30 min IV infusion every 12 hours D. 2 grams by 4 hour infusion every 8 hours E. 3 grams by 4 hour infusion every 12 hours F. 6 grams by 4 hour infusion every 24 hours
D. 2 grams by 4 hour infusion every 8 hours
Which of the following would be NOT be appropriate to treat an infection caused by Pseudomonas aeruginosa? A. Ciprofloxacin B. Cefepime C. Piperacillin/tazobactam D. Ampicillin/sulbactam E. Ceftazidime/avibactam F. Meropenem
D. Ampicillin/sulbactam
All antibacterials can cause some degree of gastrointestinal upset. Which of the following orally administered antibacterials is associated with the highest incidence of GI side effects especially diarrhea? A. Azithromycin B. Nitrofurantoin macrocrystals C. Cefdinir D. Clindamycin
D. Clindamycin
Which of the following antimicrobial drug classes is associated with the possibibility of QT prolongation, aortic aneurysm, and mental health adverse effects? A. Macrolides (Clarithromycin) B. Pleuromultilins (Lefamulin) C. Glycopeptides (Televancin) D. Fluoroquinolones (Moxifloxacin) E. Cephalosporins
D. Fluoroquinolones (Moxifloxacin)
All antibacterials can cause some degree of gastrointestinal upset. Which of the following orally administered antibacterials is associated with the highest incidence of GI side effects especially diarrhea? A. azithromycin B. nitrofurantoin macrocrystals C. cefdinir D. amoxicillin clavulanate
D. amoxicillin clavulanate
The two most common bacterial causes of meningitis are Streptococcus pneumoniae and Neisseria meningitidis. Which specific cephalosporins would you recommend for treating such as infection in a 4 month old baby? Select the single best option for this patient. A. Ceftriaxone B. Cefepime C. Cefazolin D. Ceftaroline E. Cefuroxime
E. Cefuroxime
Which of the following parenteral penicillin products would be appropriate to treat a patient with a MRSA bloodstream infection? A. Penicillin G B. Nafcillin C. Ampicillin-sulbactam D. Piperacillin-tazobactam E. None of the penicillins cover MRSA
E. None of the penicillins cover MRSA
which penicillins do not require renal dosing?
Nafcillin Oxacillin Dicloxacillin
