Pharm Exam #2 Book Questions
A 21-year-old woman is admitted to receive a kidney transplant from her father. Since she has a low-to- moderate risk of rejection, she will receive induction with the antibody basiliximab. Which statement indicates the uniqueness of the therapy she is receiving compared with other antibody agents? A. Basiliximab is generally well tolerated and does not require premedications prior to administration. B. Basiliximab binds to CD52 and targets B and T lymphocytes. C. Basiliximab is used only in combination with antithymocyte globulin. D. Basiliximab targets B cells, not T cells.
A. Basiliximab is generally well tolerated and does not require premedications prior to administration.
A 25-year-old male presents to the urgent care center with a painless sore on his genitals that started 1 to 2 weeks ago. He reports unprotected sex with a new partner about a month ago. A blood test confirms the patient has Treponema pallidum. Which of the following is the drug of choice for the treatment of this patient's infection as a single dose? A. Benzathine penicillin G. B. Ceftriaxone. C. Aztreonam. D. Vancomycin.
A. Benzathine penicillin G.
Which drug requires a loading dose? A. Caspofungin B. Micafungin C. Liposomal amphotericin B D. Tavaborole
A. Caspofungin
Which of the following cephalosporins has activity against gram-negative anaerobic pathogens like Bacteroides fragilis? A. Cefoxitin. B. Cefepime. C. Ceftriaxone. D. Cefazolin.
A. Cefoxitin.
Which drug is a pharmacokinetic enhancer used to boost levels of some HIV protease inhibitors and elvitagravir? A. Cobicistat B. Dolutegravir C. Entecavir D. Tenofovir
A. Cobicistat
A 63-year-old female patient with anemia secondary to chronic kidney disease and a hemoglobin level of 8.6 g/dL is treated with epoetin alfa. Eight days after the initial dose of epoetin alfa, the patient's hemoglobin is 10.5 g/dL. Which would be the next step in the management of this patient's anemia? A. Discontinue epoetin alfa B. Discontinue epoetin alfa and initiate darbepoetin C. Continue epoetin alfa D. Increase the dose of epoetin alfa
A. Discontinue epoetin alfa
Which is a common adverse effect of cotrimoxazole? A. Hyperkalemia B. Pulmonary fibrosis C. Tendon rupture D. Blood glucose disturbances
A. Hyperkalemia
Which antiretroviral drug chelates with polyvalent cations and, as such, their administration must be separated from antacids by several hours? A. Integrase inhibitors B. Nonnucleoside reverse transcriptase inhibitors C. Protease inhibitors D. Entry inhibitors
A. Integrase inhibitors
A 32-year old man has been on standard four-drug therapy for active pulmonary tuberculosis for the past 2 months. He has no other comorbid conditions. At his regular clinic visit, he complains of a "pins and needles" sensation in his feet. Which drug is most likely causing this? A. Isoniazid B. Rifampin C. Pyrazinamide D. Ethambutol
A. Isoniazid
Clotrimoxazole provides activity against which organism? A. MRSA B. Pseudomonas aeruginosa C. Anaerobes D. Mycoplasma
A. MRSA
Which HIV antiretroviral is an orally administered entry inhibitor? A. Maraviroc B. Enfuvirtide C. Rilpivirine D. Raltegravir
A. Maraviroc
A 22 year old woman reports a cottage cheese like vaginal discharge and slight dysuria for 1 week. The patient is diagnosed with vulvovaginal candidiasis. She requests as short a course of treatment as possible due to her busy schedule. Which anti fungal is the best choice? A. Oral fluconazole B. Topical miconazole C. Oral terbinafine D. Topical efinaconazole
A. Oral fluconazole
An 18-year-old woman who received a kidney transplant 6 months ago comes in to clinic complaining of facial hair growth and does not want to take an immunosuppressant anymore. Which treatment option would be the most appropriate to address her concerns? A. Switch cyclosporine to tacrolimus. B. Switch mycophenolate mofetil to sirolimus. C. Stop prednisone and add methylprednisolone. D. Switch mycophenolate mofetil to mycophenolic acid.
A. Switch cyclosporine to tacrolimus.
A 56 y/o female with diabetes presents for routine foot evaluation with her podiatrist. The patient complains of thickening of the nail of the right great toes and change in color from white to yellow. The podiatrist diagnoses the patient with onychomycosis of the toenail. Which is most appropriate to recommend for this patient? A. Terbinafine B. Micafungin C. Itraconazole D. Griseofulvin
A. Terbinafine
Which recommendation should be provided to avoid phototoxicity associated with fluoroquinolone therapy? A. Use sunscreen and avoid excessive exposure to UV light. B. Take the medication at night to avoid high drug concentrations during the day. C. Take with food. D. Drink with 1 L of water per day to minimize drug buildup in skin tissue.
A. Use sunscreen and avoid excessive exposure to UV light.
A 24-year-old female is diagnosed with genital herpes simplex virus infection. Which of the following agents is indicated for use in this diagnosis? A. Valacyclovir. B. Cidofovir. C. Ganciclovir. D. Zanamivir. E. Lamivudine.
A. Valacyclovir.
A 72-year-old male is admitted to the hospital from a nursing home with severe pneumonia. He was recently discharged from the hospital 1 week ago after open heart surgery. The patient has no known allergies. Which of the following regimens is most appropriate for empiric coverage of methicillin- resistant Staphylococcus aureus and Pseudomonas aeruginosa in this patient? A. Vancomycin + cefepime + ciprofloxacin. B. Vancomycin + cefazolin + ciprofloxacin. C. Telavancin + cefepime + ciprofloxacin. D. Daptomycin + cefepime + ciprofloxacin.
A. Vancomycin + cefepime + ciprofloxacin.
An 81-year-old woman presents to the emergency department with progressive weakness, fatigue, confusion, and reports of seeing people in her house who were trying to hurt her but who were not physically present. Her physical exam was positive for pallor but negative for koilonychias or cracking at the corners of the mouth. Which deficiency would be the highest priority in this patient's workup? A. Vitamin B12 B. Iron C. Folate D. Calcium
A. Vitamin B12
A 55 y/o female presents to the hospital with SOB, fever, and malaise. She has a history of breast cancer, which was diagnosed 3 months ago and she is being treated with chemotherapy. Her CXR shows possible pneumonia and sputum cultures are positive for aspergillus fumigatus. Which of the following antifungal agents is the most appropriate to recommend for therapy? A. Voriconazole B. Fluconazole C. Flucytosine D. Ketoconazole
A. Voriconazole
A 37-year-old woman with GERD and chronic hepatitis C genotype 1a infection is preparing to begin treatment with ledipasvir/sofosbuvir. Which is the most appropriate information for the patient regarding use of a proton pump inhibitor during treatment with ledipasvir/sofosbuvir? A. Absorption of ledipasvir is increased with increasing pH. B. A proton pump inhibitor can be safely administered with ledipasvir/sofosbuvir without regard to timing of the dose or food intake. C. The patient should either stop using the proton pump inhibitor or take it with ledipasvir/sofosbuvir under fasted conditions. D. Absorption of ledipasvir is not affected by gastric pH.
Answer = C. The patient should either stop using the proton pump inhibitor or take it with ledipasvir/sofosbuvir under fasted conditions. Absorption of ledipasvir is reduced when gastric pH is increased. Patients receiving proton pump inhibitors should stop these agents during HCV therapy with ledipasvir or take the proton pump inhibitor with ledipasvir/sofosbuvir under fasted conditions to ensure that gastric pH is at its lowest point of the day at the time of drug administration.
When evaluating drug therapy for meningitis, which of the following factors is expected to have the LEAST influence on the penetration and concentration of an antibacterial age in the cerebrospinal fluid? A. Lipid solubility of the drug B. Minimum inhibitory concentration of the drug C. Protein binding of the drug D. Molecular weight of the drug
B. . Minimum inhibitory concentration of the drug
Which patient with iron deficiency anemia would need the parenteral form of iron replacement? A. 22-year-old woman with heavy menstrual periods B. 58-year-old man with end stage renal disease on hemodialysis C. 32-year-old woman in the first trimester of pregnancy D. 40-year-old man with a diabetic foot infection
B. 58-year-old man with end stage renal disease on hemodialysis Clinical evidence supports the use of parenteral iron over oral iron in hemodialysis patients due to a significantly greater increase in hemoglobin levels and lower incidence of treatment-related adverse events. Parenteral iron is also preferred in patients who cannot tolerate oral iron or who have iron malabsorption. Patients with heavy menstrual periods, who are pregnant, or who have chronic disease states, such as diabetes, and infections, should be administered an initial trial of oral iron.
a 30 year old man with human immunodeficiency virus infection is being treated with an antiretroviral regimen. Four weeks after initiating therapy, he presents tot he emergency department complaining of fever, rash, and GI upset. His HLA-B5701 test is positive. Which drug is most likely to cause his symptoms? A. Zidovudine B. Abacavir C. Efavirenz D. Farunavir
B. Abacavir
Which of the following antifungal agents is most likely to cause renal insufficiency or failure? A. Fluconazole B. Amphotericin B C. Itraconazole D. Posaconazole
B. Amphotericin B
A 32 year old HIV positive woman is admitted to the hospital with severe confusion and dizziness. She has been non adherent with her HIV medications for several months. She is diagnosed with meningitis caused by crytococcus neoformans. Which is the most appropriate choice for treating the infection in this patient? A. Anidulafungin alone B. Amphotericin B plus flucyosine C. Flucytosine alone D. Isavuconazole plus anidulafungin
B. Amphotericin B plus flucyosine
Which iron supplement contains the highest percentage of elemental iron? A. Ferrous sulfate B. Carbonyl iron C. Ferrous gluconate D. Ferric ammonium citrate
B. Carbonyl iron
A 70 year old woman with acute cystitis presents to the family medicine clinic for assessment. She has a past medical history of hypertension and chronic kidney disease. The team recommends initiation of nitrofurantoin for cystitis. After reviewing her antimicrobial therapy, which actions should be taken prior to clinic discharge? A. Continue current therapy and counsel on gastrointestinal effects of nitrofurantoin B. Change nitrofurantoin to alternative agent due to chronic kidney disease C. Reduce nitrofurantoin dose due to impaired renal function D. Counsel patient regarding neuropathy associated with short-term therapy
B. Change nitrofurantoin to alternative agent due to chronic kidney disease
A 55-year-old man presents to primary care clinic with an erythematous and tender abscess on his left thigh. He has a history of MRSA skin infections. Which is an appropriate antibiotic for empiric treatment? A. Ciprofloxacin B. Cotrimoxazole C. Pyrimethamine D. Cephalexin
B. Cotrimoxazole
A 36 year old woman with multidrug resistant tuberculosis is being treated with the following agents: streptomycin, cycloserine, pyrazinamide, ethionamide, and p-aminosalicyclic acid. Her physician recently noticed that she appears confused and anxious, and has a slight tremor. Which drug is most likely contributing to her current state? A. Streptomycin B. Cycloserine C. Pyrazinamide D. Ethionamide
B. Cycloserine
A 46 year old male patient with active tuberculosis is to be initiated on the four-drug regimen of isoniazid, rifampin, pyrazinamide, and ethambutol. The patient reports no other conditions except gout. Which pair of antituberculosis drugs has the potential to worsen his gout? A. Rifampin and Isoniazid B. Ethambutol and pyrazinamide C. Rifampin and ethambutol D. Isoniazid and ethambutol
B. Ethambutol and pyrazinamide
Which statement is correct regarding the difference between induction immunosuppression (IS) and maintenance IS? A. Maintenance IS is less important than induction IS for long-term graft survival. B. Induction IS is more intense than maintenance IS. C. Maintenance IS includes lymphocyte-depleting antibodies, while induction IS does not. D. Induction IS increases the risk of infection, while maintenance IS does not.
B. Induction IS is more intense than maintenance IS.
A 44 year old man presents to the clinic with fevers and chills, headaches, and shortness of breath. He reports that he was exploring caves about 5 weeks ago. He is diagnosed with mild/moderate acute pulmonary histoplasmosis. Which is the most appropriate choice for treating this infection? A. Micafungin B. Itraconazole C. Terbinafine D. Griseofulvin
B. Itraconazole
Which of the following antifungal agents should be avoided in patients with evidence of ventricular dysfunction? A. Micafungin B. Itraconazole C. Terbinafine D. Posaconazole
B. Itraconazole
Which of the following drugs is correctly matched with the appropriate adverse effect? A. Levofloxacin—hyperkalemia. B. Nitrofurantoin—pulmonary fibrosis. C. Cotrimoxazole—hepatic encephalopathy. D. Methenamine—nystagmus.
B. Nitrofurantoin—pulmonary fibrosis.
A 75-year-old man with chronic obstructive pulmonary disease is diagnosed with suspected influenza based on his complaints of flu-like symptoms that began 24 hours ago. Which of the following agents is most appropriate to initiate for the treatment of influenza? A. Ribavirin. B. Oseltamivir. C. Zanamivir. D. Rimantadine. E. Amantadine.
B. Oseltamivir.
After completing his last cycle of chemotherapy, a 68-year-old man received a dose of pegfilgrastim prophylactically to reduce his risk of neutropenia. Twenty-four hours later, he returned to clinic to receive an additional dose of pegfilgrastim and was told he did not need another dose. Which would explain the rationale behind this recommendation? A. Absolute neutrophil count is above 1000/μL B. Pegfilgrastim is given as single dose C. Next dose of pegfilgrastim is due 72 hours after the first dose D. Next dose of pegfilgrastim is due 48 hours after the first dose
B. Pegfilgrastim is given as single dose Pegfilgrastim is a pegylated form of G-CSF and has a longer half-life; therefore, it is administered as a single dose with no additional doses needed. Monitoring of the ANC is not necessary with pegfilgrastim due to the pharmacokinetics of the drug.
A 23-year-old male presents with acute appendicitis that ruptures shortly after admission. He is taken to the operating room for surgery, and postsurgical cultures reveal Escherichia coli and Bacteroides fragilis, susceptibilities pending. Which of the following provides adequate empiric coverage of these two pathogens? A. Cefepime. B. Piperacillin/tazobactam. C. Aztreonam. D. Ceftaroline.
B. Piperacillin/tazobactam.
A 32-year old man who takes standard four-drug therapy for active pulmonary tuberculosis complains about "pins and needles" sensation in his feet. He is diagnosed with peripheral neuropathy. Which vitamin should have been included in the regimen for this patient to reduce the risk of neuropathy? A. Niacin B. Pyridoxine C. Thiamine D. Ascorbic acid
B. Pyridoxine
A 26 year old female HIV patient was recently diagnosed with active tuberculosis. Currently, she is on a stable HIV regimen consisting of two protease inhibitors and two nucleoside reverse transcriptase inhibitors. Which is the most appropriate regimen for treatment of her TB? A. Rifampin + isoniazid + pyrazinamide + ethambutol B. Rifabutin + isoniazid + pyrazinamide + ethambutol C. Rifapentine + isoniazid + pyrazinamide + ethambutol D. Rifampin + moxifloxacin + pyrazinamide + ethambutol
B. Rifabutin + isoniazid + pyrazinamide + ethambutol
A 22 year old female intravenous drug user was admitted to the hospital with a 4-week history of cough and fever. A chest radiograph showed left upper lobe cavitary infiltrate. Cultures of sputum yielded M. tuberculosis susceptible to all antimycobacterial drugs. The patient received self-administered isoniazid, rifampin, pyrazinamide, and ethambutol. Two weeks following initiation of therapy, the patient is concerned that her urine is a "funny looking reddish color". Which drug is most likely the cause? A. Isoniazid B. Rifampin C. Pyrazinamide D. Ethambutol
B. Rifampin
A 23 year old man was started on standard four drug antimycobacterial therapy for treatment of active TB. He has epilepsy, which is controlled with carbamazepine. He has had no seizures in 5 years; however, upon return to clinic at 1 month, he reports having two seizures since his last visit. Which drug may be the reason his carbamazepine is less effective? A. Isoniazid B. Rifampin C. Pyrazinamide D. Ethambutol
B. Rifampin
Which drug specifically inhibits calcineurin in the activated T lymphocytes? A. Basiliximab B. Tacrolimus C. Sirolimus D. Mycophenolate mofetil
B. Tacrolimus
A 45-year-old man who received a renal transplant 3 months ago and is being maintained on tacrolimus, prednisone, and mycophenolate mofetil is found to have increased creatinine levels and a kidney biopsy indicates severe rejection. Which course of therapy would be appropriate? A. Increased dose of prednisone. B. Treatment with rabbit antithymocyte globulin. C. Treatment with sirolimus. D. Treatment with azathioprine.
B. Treatment with rabbit antithymocyte globulin.
In which of the following cases would it be appropriate to use telavancin? A. A 29-year-old pregnant female with ventilator- associated pneumonia. B. A 76-year-old male with hospital-acquired pneumonia also receiving amiodarone for atrial fibrillation. C. A 36-year-old male with cellulitis and abscess growing MRSA. D. A 72-year-old female with a diabetic foot infection growing MRSA who has moderate renal dysfunction.
C. A 36-year-old male with cellulitis and abscess growing MRSA
Which drug works by creating pores/channels in the fungal cell membrane? A. Fluconazole B. Anidulafungin C. Amphtericin B D. Flucytosine
C. Amphtericin B
A68-year-old male presents from a nursing home with fever, increased urinary frequency and urgency, and mental status changes. He has a penicillin allergy of anaphylaxis. Which of the following β-lactams is the most appropriate choice for gram-negative coverage of this patient's urinary tract infection? A. Cefepime. B. Ertapenem. C. Aztreonam. D. Ceftaroline.
C. Aztreonam.
A 20-year-old female presents to the emergency room with headache, stiff neck, and fever for 2 days and is diagnosed with meningitis. Which of the following agents is the best choice for the treatment of meningitis in this patient? A. Cefazolin. B. Cefdinir. C. Cefotaxime. D. Cefuroxime axetil.
C. Cefotaxime.
which of the following is correct regarding clofazimine in the treatment of leprosy? A. Clofazimine should not be used in patients with a deficiency in G6P dehydrogenase B. Perioheral neuropathy is one of the most common adverse effects seen with the drug C. Clofazimine may cause skin discoloration over time D. The risk of erythema nodosum leprosum is increased in patients given clofazimine
C. Clofazimine may cause skin discoloration over time
A 45-year-old male presented to the hospital 3 days ago with severe cellulitis and a large abscess on his left leg. Incision and drainage were performed on the abscess, and cultures revealed methicillin-resistant Staphylococcus aureus. Which of the following would be the most appropriate treatment option for once- daily outpatient intravenous therapy? A. Ertapenem. B. Ceftaroline. C. Daptomycin. D. Piperacillin/tazobactam.
C. Daptomycin.
Which drug would be beneficial to reduce the frequency of painful crises in a patient with sickle cell disease? A. Epoetin alfa B. Filgrastim C. Hydroxyurea D. Sargramostim
C. Hydroxyurea Clinical evidence supports the use of hydroxyurea for reducing the frequency and severity of painful sickle cell crises during the course of sickle cell disease. Epoetin alfa helps increase hemoglobin and red blood cell production in anemias secondary to chronic kidney disease, HIV, bone marrow disorders, and other disorders. Filgrastim and sargramostim stimulate granulocyte production in the marrow to increase the neutrophil counts and reduce the duration of severe neutropenia.
A female patient who is being treated for chronic hepatitis B develops nephrotoxicity while on treatment. Which is the most likely medication she is taking for HBV treatment? A. Entecavir. B. Telbivudine. C. Lamivudine. D. Adefovir.
C. Lamivudine.
A 21-year-old marathon runner reports to the clinic with acute Achilles tendon rupture. The nurse noted that the patient recently took an antibiotic for community-acquired pneumonia. Which antibiotic may have contributed to tendon rupture? A. Amoxicillin/clavulanate B. Cefdinir C. Levofloxacin D. Minocycline
C. Levofloxacin
Which drug is relatively free of drug-drug interactions? A. Voriconazole B. Itraconazole C. Micafungin D. Terbinafine
C. Micafungin
A 22-year old woman presents with a 2-day history of dysuria with increased urinary frequency and urgency. A urine culture and UA are done. She is diagnosed with a UTI caused by E. coli. Which agent should be avoided in the treatment of her UTI? A. levofloxacin B. clotrimazole C. Moxifloxacin D. Nitrofurantoin
C. Moxifloxacin
Which immunosuppressant medication avoids the need for therapeutic drug monitoring? A. Cyclosporine B. Tacrolimus C. Mycophenolate mofetil D. Sirolimus
C. Mycophenolate mofetil
Which class of direct-acting antivirals for hepatitis C works by inhibiting formation of the membranous web that provides a platform for viral replication? A. NS3/NS4A protease inhibitors B. NS5B polymerase inhibitors C. NS5A replication complex inhibitors D. Interferons
C. NS5A replication complex inhibitors
Which combination of immunosuppressive drugs should be avoided? A. Basiliximab, belatacept, mycophenolate mofetil, and prednisone. B. Tacrolimus, mycophenolate mofetil, and prednisone. C. Tacrolimus, cyclosporine, and prednisone. D. Tacrolimus, sirolimus, and prednisone.
C. Tacrolimus, cyclosporine, and prednisone.
A 28 year old man with MDR-TB is receiving the following medications for treatment: pyrazinamide, ethionamide, moxifloxacin, streptomycin, and para-aminosalicyclic acid. Which drug in this regimen requires monitoring for QT prolongation? A. pyrazinamide B. ethionamide C. moxifloxacin D. streptomycin
C. moxifloxacin
A 24-year-old pregnant woman was diagnosed with community-acquired pneumonia and will be managed in the outpatient setting. Which antibiotic is a safe option for this patient to treat her pneumonia? A. Azithromycin B. Doxycycline C. Fidaxomicin D. Gentamicin
Correct answer = A. Azithromycin Azithromycin is available orally and considered safe in pregnancy. Doxycycline should not be used in pregnancy due to its ability to cross the placenta and affect bone and skeletal development in the fetus. Fidaxomicin does not reach therapeutic concentrations in serum or at this site of infection. It concentrates in the gut. Gentamicin crosses the placental barrier and may accumulate in fetal plasma and amniotic fluid. It would also not be used clinically in this outpatient scenario.
Which of the following statements accurately describes the difference in spectrum of activity between erythromycin and azithromycin? A. Azithromycin has better activity against respiratory pathogens such as Haemophilus influenzae and Moraxella catarrhalis but less potent activity against staphylococci and streptococci. B. Erythromycin has the same activity as azithromycin against gram-positives and gram-negatives. C. Azithromycin has better activity against staphylococci and streptococci compared to erythromycin. D. Erythromycin has better activity against gram-negatives such as H. influenza.
Correct answer = A. Azithromycin has better activity against respiratory pathogens such as Haemophilus influenzae and Moraxella catarrhalis but less potent activity against staphylococci and streptococci. Erythromycin has better activity against gram-positive organisms, so B and C are incorrect. D is incorrect as azithromycin has better activity against H. influenza
Which of the following describes the mechanism of action of tetracycline antibiotics? A. Bind the 30S subunit of the bacterial ribosome, preventing binding of tRNA to the mRNA-ribosome complex. B. Bind the 30S ribosomal subunit, interfering with assembly of the functional ribosomal apparatus. C. Bind irreversibly to a site on the 50S subunit of the bacterial ribosome, inhibiting translocation steps of protein synthesis. D. Bind the bacterial 23S ribosomal RNA of the 50S subunit, inhibiting the formation of the 70S initiation complex.
Correct answer = A. Bind the 30S subunit of the bacterial ribosome, preventing binding of tRNA to the mRNA-ribosome complex. Tetracyclines enter susceptible organisms via passive diffusion and also by an energy-dependent transport protein mechanism unique to the bacterial inner cytoplasmic membrane. The drugs bind reversibly to the 30S subunit of the bacterial ribosome. This action prevents binding of tRNA to the mRNA-ribosome complex, thereby inhibiting bacterial protein synthesis. B is the mechanism for aminoglycosides, C is the mechanism for macrolides, and D is the mechanism for oxazolidinones.
Which of the following antibiotics exhibits a long postantibiotic effect that permits once-daily dosing? A. Gentamicin. B. Penicillin G. C. Vancomycin. D. Aztreonam.
Correct answer = A. Gentamicin Aminoglycosides, including gentamicin, possess a long post-antibiotic effect, especially when given as a high dose every 24 hours. Penicillin G, clindamycin, and vancomycin have a relatively short postantibiotic effect and require frequent dosing to maintain activity
A 32-year-old male presents to an outpatient clinic with a 5-day history of productive cough, purulent sputum, and shortness of breath. He is diagnosed with communityacquired pneumonia (CAP). It is noted that this patient has a severe ampicillin allergy (anaphylaxis). Which of the following would be an acceptable treatment for this patient? A. Levofloxacin. B. Ciprofloxacin. C. Penicillin VK. D. Nitrofurantoin.
Correct answer = A. Levofloxacin Streptococcus pneumoniae is a common cause of CAP, and the respiratory fluoroquinolones levofloxacin and moxifloxacin provide good coverage. Ciprofloxacin does not cover S. pneumoniae well and is a poor choice for treatment of CAP. Penicillin would be a poorchoice due to allergy. Nitrofurantoin has no clinical utility for respiratory tract infections.
Which of the following is the primary method of β-lactam resistance with Streptococcus pneumoniae? A. Modification of target site. B. Decreased drug levels due to changes in permeability. C. Decreased drug levels due to an efflux pump. D. Enzymatic inactivation.
Correct answer = A. Modification of target site S. pneumoniae resistance to β-lactam antibiotics involves alteration in one or more of the major penicillin-binding proteins.
Which of the following antibiotic agents should not be given to children less than 8 years of age due to its deposition in bone and teeth? A. Azithromycin B. Doxycycline C. Linezolid D. Quinupristin/dalfopristin
Correct answer = B. Doxycycline Tetracyclines are contraindicated in this age group because they are deposited in tissues undergoing calcification, such as teeth and bone, and can stunt growth.
Aminoglycosides are commonly used for their concentration-dependent bactericidal activity against which group of organisms? A. Gram-positive aerobes B. Gram-negative aerobes C. Gram-positive anaerobes D. Gram-negative anaerobes
Correct answer = B. Gram-negative aerobes Although aminoglycosides (such as gentamicin) are sometimes used synergistically against gram-positive aerobes, this is not their most common use. They are typically used for their activity against gram-negative aerobes. Aminoglycosides do not have good anaerobic activity.
Which of the following adverse effects is often employed as a therapeutic use for erythromycin? A. QTc prolongation B. Increased gastrointestinal motility C. Photosensitivity D. Deposition in bone
Correct answer = B. Increased gastrointestinal motility Macrolides, but especially erythromycin, cause GI distress and increase motility of the GI tract, which is often used to treat gastroparesis and/or postoperative ileus. QTc prolongation is an adverse effect of erythromycin but not one employed therapeutically. Photosensitivity and deposition in bone are adverse effects of tetracyclines.
Which of the following adverse drug reactions precludes a patient from being re-challenged with that drug in the future? A. Itching/rash from penicillin. B. Stevens-Johnson syndrome fromsulfamethoxazole-trimethoprim. C. Gastrointestinal (GI) upset from clarithromycin. D. Clostridium difficile superinfection frommoxifloxacin.
Correct answer = B. Stevens-Johnson syndrome fromsulfamethoxazole-trimethoprim. Stevens-Johnson syndrome is a severe idiosyncratic reaction that can be life threatening, and these patients should never be rechallenged with the offending agent. Itching/rash is a commonly reported reactionin patients receiving penicillins but is not life threatening. A patient may be rechallenged if the benefits outweigh the risk (for example, pregnant patient with syphilis) or the patient could be exposed through a desensitization procedure.GI upset is a common side effect of clarithromycin but is not due to an allergic reaction. Moxifloxacin is a broadspectrum antibiotic that can inhibit the normal flora of the GI tract, increasing the risk for the development of superinfections like C. difficile. This is not an allergic reaction, and the patient can be rechallenged; however, the patient might beat risk for developing C. difficile infection again.
A 58-year-old male with a history of hepatitis C, cirrhosis, and ascites presents with spontaneous bacterial peritonitis. Which of the following antibiotics requires close monitoring and dosing adjustment in this patient given his liver disease? A. Penicillin G. B. Tobramycin. C. Erythromycin. D. Vancomycin.
Correct answer = C. Erythromycin Erythromycin is metabolized by the liver and should be used with caution in patients with hepatic impairment. Penicillin G, tobramycin, and vancomycin are primarily eliminated by the kidneys.
Which of the following agents is considered a narrowspectrum antibiotic? A. Ceftriaxone. B. Ciprofloxacin. C. Isoniazid. D. Imipenem.
Correct answer = C. Isoniazid Isoniazid is only active against Mycobacterium tuberculosis, while ceftriaxone, ciprofloxacin, and imipenem are considered broad spectrum due to their activity against multiple types of bacteria and risk for developing a superinfection.
Linezolid would be a good choice for antibiotic treatment in which of the following patient scenarios? A. Bacteremia caused by Staphylococcus aureus B. Urinary tract infection caused by Escherichia coli C. Pneumonia caused by drug-resistant Streptococcus pneumoniae D. Diabetic foot infection caused by Pseudomonas aeruginosa
Correct answer = C. Pneumonia caused by drug-resistant Streptococcus pneumoniae Linezolid does have coverage against resistant S. pneumoniae. It is not an optimal choice for treatment of bacteremia. Linezolid also does not have gram-negative coverage against E. coli and P. aeruginosa.
A 77-year-old woman was started on antibiotics for pneumonia treatment. After 3 days of antibiotic therapy, the serum creatinine doubled. Which of the following antibiotics is most likely responsible for this increase in serum creatinine? A. Doxycycline B. Clarithromycin C. Tobramycin D. Linezolid
Correct answer = C. Tobramycin Aminoglycosides such as tobramycin accumulate in the proximal tubular cells of the kidney and disrupt calcium-mediated transport processes. This results in kidney damage ranging from mild, reversible renal impairment to severe, potentially irreversible acute tubular necrosis. Nephrotoxicity is not commonly associated with tetracyclines, macrolides or oxazolidinones.
A 72-year-old male presents with fever, cough, malaise, and shortness of breath. His chest x-ray shows bilateral infiltrates consistent with pneumonia. Bronchial wash cultures reveal Pseudomonas aeruginosa sensitive to cefepime. Which of the following is the best dosing scheme for cefepime based on the drug's time dependent bactericidal activity? A. 1 g every 6 hours given over 30 minutes. B. 2 g every 12 hours given over 3 hours. C. 4 g every 24 hours given over 30 minutes. D. 4 g given as continuous infusion over 24 hours.
Correct answer = D. 4 g given as continuous infusion over 24 hours. The clinical efficacy of cefepime is based on the percentage of time that the drug concentration remains above the MIC. A continuous infusion would allow for the greatest amount of time above the MIC compared to intermittent (30 minutes) and prolonged infusions(3 to 4 hours).
Parents of a 1-month-old baby are told their child has developed "gray baby syndrome." Which of the following antibiotics did the baby likely receive? A. Tobramycin B. Linezolid C. Erythromycin D. Chloramphenicol
Correct answer = D. Chloramphenicol Gray baby syndrome is an adverse effect caused by chloramphenicol in neonates due to their underdeveloped renal function and low capacity to glucuronidate the antibiotic. The other agents do not undergo this glucuronidation.
After 5 days of clindamycin treatment for a skin infection, a patient develops diarrhea (10 watery stools/day), severe abdominal pain, and fever. Which of the following organisms would you be concerned about as the causative pathogen of diarrhea? A. Escherichia coli B. Bacteroides fragilis C. Staphylococcus aureus D. Clostridium difficile
Correct answer = D. Clostridium difficile Clindamycin use has been associated with Clostridium difficile-associated diarrhea. This infection should be considered in a patient who presents with diarrhea while on clindamycin.
Which of the following antibiotics exhibits concentration dependent killing? A. Clindamycin. B. Linezolid. C. Vancomycin. D. Daptomycin.
Correct answer = D. Daptomycin daptomycin works best in a concentration-dependent fashion.Clindamycin, linezolid, and vancomycin exhibit time-dependent killing, while daptomycin works best when administered in a fashion that optimizes concentration-dependent killing
A 62-year-old man with human immunodeficiency virus infection is being treated with an antiretroviral regimen containing elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate and has achieved a sustained undetectable level of HIV RNA. His prescriber would like to change his therapy to elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide. Which information should the prescriber provide to the patient that best summarizes the advantage of tenofovir alafenamide over tenofovir disoproxil fumarate? A. Removal of food restrictions B. Fewer drug interactions C. Twice daily dosing D. Improved renal and bone safety profile
Correct answer = D. Improved renal and bone safety profile Tenofovir alafenamide delivers the same active drug as tenofovir disoproxil fumarate, but with a lower incidence of renal and bone adverse effects. Both tenofovir-containing combinations are dosed once daily and should be taken with food. No change in drug interactions is expected, since tenofovir alafenamide is a prodrug which, like TDF, is metabolized to tenofovir.
A 24-year-old pregnant female presents to the urgent care clinic with fever, frequency, and urgency. She is diagnosed with a urinary tract infection (UTI). Based on potential harm to the fetus, which of the following medications should be avoided in treating her UTI? A. Nitrofurantoin. B. Amoxicillin. C. Cephalexin. D. Tobramycin.
Correct answer = D. Tobramycin Tobramycin (an minoglycoside) is considered a pregnancy risk category D drug which means there is chance for potential harm to the fetus. Nitrofurantoin,amoxicillin (a penicillin), and cephalexin (a cephalosporin) are considered category B.
Which clinical situation is least appropriate for immunosuppression with sirolimus? A. A patient with primary renal failure. B. A patient who has failed calcineurin inhibitors due to neurotoxicity. C. A patient who is 6 months postliver transplant and the incision site is fully healed. D. A patient with an abnormal lipid profile.
D. A patient with an abnormal lipid profile.
An 18-year-old female presents to the urgent care clinic with urinary frequency, urgency, and fever for the past 3 days. Based on symptoms and a urinalysis, she is diagnosed with a urinary tract infection. Cultures reveal Enterococcus faecalis that is pan sensitive. Which of the following is an appropriate oral option to treat the urinary tract infection in this patient? A. Cephalexin. B. Vancomycin. C. Cefdinir. D. Amoxicillin.
D. Amoxicillin.
JS is a 3-day-old neonate, born at 37 weeks' gestation, who presents with new onset fever, lethargy, and decreased desire to feed. Based on JS's age, which of the following antibiotics is considered safe to use in neonates? A. Chloramphenicol B. Sulfamethoxazole/trimethoprim C. Tetracycline D. Ampicillin
D. Ampicillin
A 39-year-old man is admitted 3 months after liver transplant with increased liver function tests. A liver biopsy is performed and the results show acute rejection, severe. The team decides to start treatment with antithymocyte globulin, rabbit. What additional drug therapy is required for appropriate administration of this medication? A. No additional medications are required. B. Diphenhydramine, acetaminophen. C. Diphenhydramine, ketorolac, corticosteroids. D. Diphenhydramine, acetaminophen, corticosteroids.
D. Diphenhydramine, acetaminophen, corticosteroids.
A 24 year old male has return to the clinic for his 1 month check up after starting treatment for tuberculosis. He is receiving isoniazid, rifampin, pyrazinamide, and ethambutol. He states he feels fine, but now is having difficulty reading his morning newspaper and feels he may need to get glasses which of the following drugs may be causing delcine in vison? A. Isoniazid B. Rifampin C. Pyrazinamide D. Ethambutol
D. Ethambutol
A 60-year-old woman presents to her primary care physician complaining of dizziness and fatigue. Following laboratory testing, the patient is diagnosed with iron deficiency anemia, and oral iron supplementation is needed. Which would be the most appropriate dosing regimen for the patient? A. Ferrous fumarate 325 mg once daily B. Ferrous gluconate 256 mg once daily C. Polysaccharide-iron complex 150 mg two to three times daily D. Ferrous sulfate 325 mg two to three times daily
D. Ferrous sulfate 325 mg two to three times daily The recommended dose of iron supplementation in iron deficiency anemia is typically about 150 mg of elemental iron in two to three divided doses. Extended-release formulations (such as polysaccharide- iron complex) may be dosed once daily. Ferrous sulfate 325 mg contains approximately 65 mg of elemental iron, ferrous fumarate 325 mg contains about 107 mg elemental iron, ferrous gluconate 256 mg contains approximately 30 mg elemental iron, and polysaccharide-iron complex 150 mg contains 150 mg elemental iron.
Which is an appropriate treatment for a nutritional anemia that presents as a hunger for ice and/or upward curvature of the fingernails? A. Vitamin B12 (cyanocobalamin) B. Folic acid C. Vitamin D D. Iron
D. Iron Vitamin B12, folic acid, and iron deficiencies all contribute to anemia, but iron deficiency isassociated with pica (hunger for ice or dirt) and koilonychias (upward curvature of toenails/fingernails). Vitamin D deficiency does exist but does not cause anemia.
What is the main benefit for prescribing methenamine for treatment of a urinary tract infection? A. Safe to use in patients with hepatic failure. B. Available in intravenous and oral formulations. C. Broad spectrum of activity. D. Minimal development of resistance.
D. Minimal development of resistance. Methenamine does not select for resistance. Due to its conversion to formaldehyde, this compound is the least likely compound to select for resistant isolates. Methenamine should be avoided in patients with hepatic failure. This agent is only available as an oral formulation, and it has a narrow spectrum of activity.
56-year-old woman is discovered to have megaloblastic anemia. Her past medical history is significant for alcoholism. Which would be the best treatment option for this patient? A. Oral vitamin B12 B. Parenteral vitamin B12 C. Oral folic acid D. Oral vitamin B12 with oral folic acid
D. Oral vitamin B12 with oral folic acid The patient has a history of alcoholism, which would suggest folic acid deficiency anemia. However, folic acid administration alone reverses the hematologic abnormality and masks possible vitamin B12 deficiency, which can then proceed to severe neurologic dysfunction and disease. The cause of megaloblastic anemia needs to be determined in order to be specific in terms of treatment. Therefore, megaloblastic anemia should not be treated with folic acid alone but, rather, with a combination of folic acid and vitamin B12.
A patient has been taking ferrous sulfate 325 mg twice daily for two weeks and is complaining of a bad taste after each dose. Which once-daily, oral iron formulations would improve tolerability and provide a similar total daily dose of elemental iron as twice-daily ferrous sulfate? A. Ferric ammonium citrate 25 mg B. Ferrous gluconate 100 mg C. Ferrous sulfate, anhydrous 142 mg D. Polysaccharide-iron complex 150 mg
D. Polysaccharide-iron complex 150 mg Once-daily polysaccharide-iron complex (150 mg = 150 mg elemental iron) is tasteless and odorless, with a similar total daily dose of elemental iron as ferrous sulfate 325 mg twice daily (130 mg elemental iron/day). Once-daily ferric ammonium citrate 25 mg (4.5 mg elemental iron) is less bioavailable than twice-daily ferrous sulfate. Ferrous sulfate and ferrous gluconate have similar tolerability, but once-daily ferrous gluconate has less elemental iron (12 mg elemental iron). Ferrous sulfate, anhydrous has better tolerability with the extended-release formulation, but has less elemental iron (43 mg elemental iron) administered once daily compared to twice daily ferrous sulfate.
Which of the following adverse effects is associated with daptomycin? A. Ototoxicity. B. Red man syndrome. C. QTc prolongation. D. Rhabdomyolysis.
D. Rhabdomyolysis.
Which drug used to prevent allograft rejection can cause hyperlipidemia? A. Basiliximab B. Belatacept C. Mycophenolate mofetil D. Sirolimus
D. Sirolimus
