Antimicrobial Pharmacology
Which statement about vancomycin is accurate? (A) Active against methicillin-resistant staphylococci (B) Bacteriostatic (C) Binds to PBPs (D) Inhibits transpeptidation (E) Oral bioavailability
(A) Active against methicillin-resistant staphylococci
If this patient had been 82 years old and the Gram stain of the smear of cerebrospinal fluid had revealed Gram-positive rods resembling diphtheroids, the antibiotic regimen for empiric treatment would include (A) Ampicillin (B) Cefoxitin (C) Ceftriaxone (D) Fosfomycin (E) Vancomycin
(A) Ampicillin
A 5-d course of treatment for community-acquired pneumonia would be effective in this patient with little risk of drug interactions if the drug prescribed were (A) Azithromycin (B) Clindamycin (C) Doxycycline (D) Erythromycin (E) Vancomycin
(A) Azithromycin
Your 23-year-old female patient is pregnant and has gonorrhea. The medical history includes anaphylaxis following exposure to amoxicillin. The most appropriate drug to use is (A) Azithromycin (B) Cefixime (C) Ceftriaxone (D) Ciprofloxacin (E) Doxycycline
(A) Azithromycin
A 36-year-old woman recently treated for leukemia is admitted to the hospital with malaise, chills, and high fever. A blood culture reveals the presence of Gram-negative bacilli. The initial diagnosis is bacteremia, and parenteral antibiotics are indicated. The records of the patient reveal that she had a severe urticarial rash, hypotension, and respiratory difficulty after oral penicillin V about 6 mo ago. The most appropriate drug regimen for empiric treatment is (A) Aztreonam (B) Ceftriaxone (C) Meropenem (D) Oxacillin (E) Ticarcillin plus clavulanic acid
(A) Aztreonam
Which statement about "once-daily" dosing with aminoglycosides is accurate? (A) Dose adjustment is important in renal dysfunction (B) It is inconvenient for outpatient treatment (C) Extra nursing time is required for drug administration (D) Often more side effects than multiple (conventional) dosing regimens (E) It results in underdosing
(A) Dose adjustment is important in renal dysfunction
Concerning quinupristin-dalfopristin, which statement is accurate? (A) Active in treatment of infections caused by E faecalis (B) An effective drug in treatment of multidrug-resistant streptococcal infections (C) Bacteriostatic (D) Hepatotoxicity has led to FDA drug alerts (E) Increase the activity of hepatic drug-metabolizing enzymes
(B) An effective drug in treatment of multidrug-resistant streptococcal infections
Which of the following statements about beta-lactam antibiotics is most correct? (A) Cephalexin and other first-generation cephalosporins cross the blood-brain barrier (B) Ceftriaxone and nafcillin are both eliminated mainly via biliary secretion (C) Instability of penicillins in gastric acid does not limit their oral absorption (D) Renal tubular reabsorption of amoxicillin is inhibited by probenecid (E) Ticarcillin has limited activity against several Gramnegative rods
(B) Ceftriaxone and nafcillin are both eliminated mainly via biliary secretion
A 55-year-old patient with a prosthetic heart valve is to undergo a periodontal procedure involving scaling and root planing. Several years ago, the patient had a severe allergic reaction to procaine penicillin G. Regarding prophylaxis against bacterial endocarditis, which one of the following drugs taken orally is most appropriate? (A) Amoxicillin 10 min before the procedure (B) Clindamycin 1 h before the procedure (C) Erythromycin 1 h before the procedure and 4 h after the procedure (D) Vancomycin 15 min before the procedure (E) No prophylaxis is needed because this patient is in the negligible risk category
(B) Clindamycin 1 h before the procedure
Which of the following statements about the clinical uses of the aminoglycosides is accurate? (A) Effective in the treatment of infections caused by anaerobes such as Bacteroides fragilis (B) Gentamycin is used with ampicillin for synergistic effects in the treatment of enterococcal endocarditis (C) In the treatment of a hospital-acquired infection caused by Serratia marcescens, netilmicin is less effective than streptomycin (D) Often used as monotherapy in the empiric treatment of life-threatening bacterial infections (E) Aminoglycosides are well absorbed after oral administration
(B) Gentamycin is used with ampicillin for synergistic effects in the treatment of enterococcal endocarditis
A 65-year-old woman has returned from a vacation abroad suffering from traveler's diarrhea, and her problem has not responded to antidiarrheal drugs. A pathogenic Gram-negative bacillus is suspected. Which drug is most likely to be effective in the treatment of this patient? (A) Ampicillin (B) Ofloxacin (C) Sulfadiazine (D) Trimethoprim (E) Vancomycin
(B) Ofloxacin
Regarding the toxicity of aminoglycosides which statement is accurate? (A) Gentamicin and tobramycin are the least likely to cause renal damage (B) Ototoxicity due to amikacin and gentamicin includes vestibular dysfunction, which is often irreversible (C) Ototoxicity is reduced if loop diuretics are used to facilitate the renal excretion of aminoglycoside antibiotics (D) Reduced blood creatinine is an early sign of aminoglycoside nephrotoxicity (E) Skin reactions are very rare following topical use of neomycin
(B) Ototoxicity due to amikacin and gentamicin includes vestibular dysfunction, which is often irreversible
A 34-year-old patient is febrile (39.5°C [103.1°F]), with a white blood cell count that has risen from 8500 to 20,000/mm3 . The ICU attending physician is concerned about a bloodstream infection and decides to treat with empiric combination therapy directed against Pseudomonas aeruginosa. The combination therapy includes tobramycin. Regarding the mechanism of action of aminoglycosides, the drugs (A) Are bacteriostatic (B) Bind to the 50S ribosomal subunit (C) Cause misreading of the code on the mRNA template (D) Inhibit peptidyl transferase (E) Stabilize polysomes
(C) Cause misreading of the code on the mRNA template
A 4-year-old child is brought to the hospital after ingesting pills that a parent had used for bacterial dysentery when traveling outside the United States. The child has been vomiting for more than 24 h and has had diarrhea with green stools. She is now lethargic with an ashen color. Other signs and symptoms include hypothermia, hypotension, and abdominal distention. The drug most likely to be the cause of this problem is (A) Ampicillin (B) Azithromycin (C) Chloramphenicol (D) Doxycycline (E) Erythromycin
(C) Chloramphenicol
A 72-kg patient with creatinine clearance of 80 mL/min has a Gram-negative infection. Amikacin is administered intramuscularly at a dose of 5 mg/kg every 8 h, and the patient begins to respond. After 2 d, creatinine clearance declines to 40 mL/min. Assuming that no information is available about amikacin plasma levels, what would be the most reasonable approach to management of the patient at this point? (A) Administer 5 mg/kg every 12 h (B) Decrease the dosage to daily total of 200 mg (C) Decrease the dosage to 180 mg every 8 h (D) Discontinue amikacin and switch to gentamicin (E) Maintain the patient on the present dosage and test auditory function
(C) Decrease the dosage to 180 mg every 8 h
Clarithromycin and erythromycin have very similar spectra of antimicrobial activity. The major advantage of clarithromycin is that it (A) Does not inhibit hepatic drug-metabolizing enzymes (B) Eradicates mycoplasmal infections in a single dose (C) Has greater activity against H pylori (D) Is active against methicillin-resistant strains of staphylococci (E) Is active against strains of streptococci that are resistant to erythromycin
(C) Has greater activity against H pylori
A 26-year-old woman was treated for a suspected chlamydial infection at a neighborhood clinic. She was given a prescription for oral doxycycline to be taken for 14 d. Three weeks later, she returned to the clinic with a mucopurulent cervicitis. On questioning she admitted not having the prescription filled. The best course of action at this point would be to (A) Delay drug treatment until the infecting organism is identified (B) Rewrite the original prescription for oral doxycycline (C) Treat her in the clinic with a single oral dose of azithromycin (D) Treat her in the clinic with an intravenous dose of amoxicillin (E) Write a prescription for oral erythromycin for 10 d
(C) Treat her in the clinic with a single oral dose of azithromycin
An adult patient (weight 80 kg) has bacteremia suspected to be due to a Gram-negative rod. Tobramycin is to be administered using a once-daily dosing regimen, and the loading dose must be calculated to achieve a peak plasma level of 20 mg/L. Assume that the patient has normal renal function. Pharmacokinetic parameters of tobramycin in this patient are as follows: Vd = 30 L; t1/2 = 3 h; CL = 80 mL/min. What loading dose should be given? (A) 100 mg (B) 200 mg (C) 400 mg (D) 600 mg (E) 800 mg
(D) 600 mg
Which statement about the fluoroquinolones is accurate? (A) Antacids increase their oral bioavailability (B) Contraindicated in patients with hepatic dysfunction (C) Fluoroquinolones are drugs of choice in a 6-year-old child with a urinary tract infection (D) Gonococcal resistance to fluoroquinolones may involve changes in DNA gyrase (E) Modification of moxifloxacin dosage is required in patients when creatinine clearance is less than 50 mL/min
(D) Gonococcal resistance to fluoroquinolones may involve changes in DNA gyrase
Tetracyclines are the drugs of choice for Rocky Mountain spotted fever and Lyme disease. The mechanism of antibacterial action of tetracycline involves (A) Antagonism of bacterial translocase activity (B) Binding to a component of the 50S ribosomal subunit (C) Inhibition of DNA-dependent RNA polymerase (D) Interference with binding of aminoacyl-tRNA to bacterial ribosomes (E) Selective inhibition of ribosomal peptidyl transferases
(D) Interference with binding of aminoacyl-tRNA to bacterial ribosomes
JT is a 14-year-old patient who is diagnosed with otitis media, requiring amoxicillin. The primary mechanism of antibacterial action of amoxicillin involves inhibition of (A) Beta-lactamases (B) Cell membrane synthesis (C) N-acetylmuramic acid synthesis (D) Peptidoglycan cross-linking (E) Transglycosylation
(D) Peptidoglycan cross-linking
Which drug is effective in the treatment of nocardiosis and, in combination with pyrimethamine, is prophylactic against Pneumocystis jirovecii infections in AIDS patients? (A) Amoxicillin (B) Erythromycin (C) Levofloxacin (D) Sulfadiazine (E) Trimethoprim
(D) Sulfadiazine
A 40-year-old man complains of periodic bouts of diarrhea with lower abdominal cramping and intermittent rectal bleeding. Seen in the clinic, he appears well nourished, with blood pressure in the normal range. Examination reveals moderate abdominal pain and tenderness. His current medications are limited to loperamide for his diarrhea. Sigmoidoscopy reveals mucosal edema, friability, and some pus. Laboratory findings include mild anemia and decreased serum albumin. Microbiologic examination via stool cultures and mucosal biopsies do not reveal any evidence for bacterial, amebic, or cytomegalovirus involvement. The most appropriate drug to use in this patient is (A) Ampicillin (B) Doxycycline (C) Norfloxacin (D) Sulfasalazine (E) Trimethoprim-sulfamethoxazole
(D) Sulfasalazine
Trimethoprim-sulfamethoxazole is established to be effective against which of the following opportunistic infections in the AIDS patient? (A) Cryptococcal meningitis (B) Herpes simplex (C) Oral candidiasis (D) Toxoplasmosis (E) Tuberculosis
(D) Toxoplasmosis
The primary mechanism of resistance of Gram-positive organisms to macrolide antibiotics including erythromycin is (A) Changes in the 30S ribosomal subunit (B) Decreased drug permeability of the cytoplasmic membrane (C) Formation of drug-inactivating acetyltransferases (D) Formation of esterases that hydrolyze the lactone ring (E) Methylation of binding sites on the 50S ribosomal subunit
(E) Methylation of binding sites on the 50S ribosomal subunit
A 31-year-old man has gonorrhea. He has no drug allergies, but a few years ago acute hemolysis followed use of an antimalarial drug. The physician is concerned that the patient has an accompanying urethritis caused by C trachomatis, although no cultures or enzyme tests have been performed. Which of the following drugs will be reliably effective against both gonococci and C trachomatis and safe to use in this patient? (A) Cefixime (B) Ciprofloxacin (C) Spectinomycin (D) Sulfamethoxazole-trimethoprim (E) None of the above
(E) None of the above This patient could be treated by single oral doses of cefixime plus azithromycin (not listed).
Which statement about the clinical use of sulfonamides is correct? (A) Cannot be used topically for treatment of chlamydial infections of the eye (B) Effective as sole agents in the treatment of prostatitis (C) Effective in Rocky Mountain spotted fever (D) In some bacterial strains resistance occurs via reduced PABA formation (E) Reduced intracellular uptake is a mechanism of sulfonamide resistance in some bacterial strains
(E) Reduced intracellular uptake is a mechanism of sulfonamide resistance in some bacterial strains
Which adverse effect is most common with sulfonamides? (A) Fanconi's aminoaciduria syndrome (B) Hematuria (C) Kernicterus in the newborn (D) Neurologic dysfunction (E) Skin rash
(E) Skin rash
Which statement about ciprofloxacin is accurate? (A) Antagonism occurs if used with dihydrofolate reductase inhibitors (B) Ciprofloxacin is active against MRSA strains of staphylococci (C) Most "first-time" urinary tract infections are resistant to ciprofloxacin (D) Organisms that commonly cause ear infections are highly resistant (E) Tendinitis may occur during treatment
(E) Tendinitis may occur during treatment
Which statement is accurate regarding the antibacterial action of the aminoglycoside amikacin? (A) Antibacterial activity is often reduced by the presence of an inhibitor of cell wall synthesis (B) Antibacterial action is not concentration-dependent (C) Antibacterial action is time-dependent (D) Efficacy is directly proportional to the duration of time that the plasma level is greater than the minimal inhibitory concentration (E) The drug continues to exert antibacterial effects even after plasma levels decrease below detectable levels
(E) The drug continues to exert antibacterial effects even after plasma levels decrease below detectable levels
A 76-year-old man is seen in a hospital emergency department complaining of pain in and behind the right ear. Physical examination shows edema of the external otic canal with purulent exudate and weakness of the muscles on the right side of the face. The patient informs the physician that he is a diabetic. Gram stain of the exudate from the ear shows many polymorphonucleocytes and Gram-negative rods, and samples are sent to the microbiology laboratory for culture and drug susceptibility testing. A preliminary diagnosis is made of external otitis. At this point, which of the following is most appropriate? (A) Amikacin should be injected intramuscularly and the patient should be sent home (B) Analgesics should be prescribed, but antibiotics should be withheld pending microbiological results (C) Oral cefaclor should be prescribed together with analgesics, and the patient should be sent home (D) The patient should be hospitalized and treatment started with imipenem-cilastatin (E) The patient should be hospitalized and treatment started with gentamicin plus ticarcillin
(E) The patient should be hospitalized and treatment started with gentamicin plus ticarcillin Likely pathogens include E coli and Pseudomonas aeruginosa, and coverage must be provided for these and possibly other Gram-negative rods. The combination of an aminoglycoside plus a wider-spectrum penicillin is most suitable in this case and is synergistic against many pseudomonas strains
This drug has characteristics almost identical to those of gentamicin but has much weaker activity in combination with penicillin against enterococci. (A) Amikacin (B) Erythromycin (C) Netilmicin (D) Spectinomycin (E) Tobramycin
(E) Tobramycin
Supplementary folinic acid may prevent anemia in folate-deficient persons who use this drug; it is a weak base achieving tissue levels similar to those in plasma. (A) Ciprofloxacin (B) Levofloxacin (C) Linezolid (D) Sulfamethoxazole (E) Trimethoprim
(E) Trimethoprim
A patient needs antibiotic treatment for native valve, culture-positive infective enterococcal endocarditis. His medical history includes a severe anaphylactic reaction to penicillin G during the last year. The best approach would be treatment with (A) Amoxicillin-clavulanate (B) Aztreonam (C) Ceftriaxone (D) Piperacillin (E) Vancomycin
(E) Vancomycin
A 33-year-old man was seen in a clinic with a complaint of dysuria and urethral discharge of yellow pus. He had a painless clean-based ulcer on the penis and nontender enlargement of the regional lymph nodes. Gram stain of the urethral exudate showed Gram-negative diplococci within polymorphonucleocytes. The patient informed the clinic staff that he was unemployed and had not eaten a meal for 2 d. 2. The most appropriate treatment of gonorrhea in this patient is (A) A single intramuscular dose of ceftriaxone (B) Amoxicillin orally for 7 d (C) Procaine penicillin G intramuscularly as a single dose plus oral probenecid (D) Meropenem orally for 7 d (E) Vancomycin intramuscularly as a single dose 3. Immunofluorescent microscopic examination of fluid expressed from the penile chancre of this patient revealed treponemes. Because he appears to be infected with Treponema pallidum, the best course of action would be to (A) Administer a single oral dose of fosfomycin (B) Give no other antibiotics because drug treatment of gonorrhea provides coverage for incubating syphilis (C) Inject intramuscular benzathine penicillin G (D) Treat with oral tetracycline for 7 d (E) Treat with vancomycin
2 (A) A single intramuscular dose of ceftriaxone 3 (C) Inject intramuscular benzathine penicillin G
A 52-year-old man (weight 70 kg) is brought to the hospital emergency department in a confused and delirious state. He has had an elevated temperature for more than 24 h, during which time he had complained of a severe headache and had suffered from nausea and vomiting. Lumbar puncture reveals an elevated opening pressure, and cerebrospinal fluid findings include elevated protein, decreased glucose, and increased neutrophils. Gram stain of a smear of cerebrospinal fluid reveals Gram-positive diplococci, and a preliminary diagnosis is made of purulent meningitis. The microbiology report informs you that for approximately 15% of S pneumoniae isolates in the community, the minimal inhibitory concentration for penicillin G is 20 mcg/mL. 6. Treatment of this patient should be initiated immediately with intravenous administration of (A) Amoxicillin (B) Cephalexin (C) Ceftriaxone plus vancomycin (D) Nafcillin (E) Piperacillin 7. Resistance of pneumococci to penicillin G is due to (A) Alterations in porin structure (B) Beta-lactamase production (C) Changes in chemical structure of target penicillin-binding proteins (D) Changes in the d-Ala-d-Ala building block of peptidoglycan precursor (E) Decreased intracellular accumulation of penicillin G
6 (C) Ceftriaxone plus vancomycin 7 (C) Changes in chemical structure of target penicillin-binding proteins
A 24-year-old woman comes to a clinic with complaints of dry cough, headache, fever, and malaise, which have lasted 3 or 4 d. She appears to have some respiratory difficulty, and chest examination reveals rales but no other obvious signs of pulmonary involvement. However, extensive patchy infiltrates are seen on chest x-ray film. Gram stain of expectorated sputum fails to reveal any bacterial pathogens. The patient mentions that a colleague at work had similar symptoms to those she is experiencing. The patient has no history of serious medical problems. She takes loratadine for allergies and supplementary iron tablets, and she drinks at least 6 cups of caffeinated coffee per day. The physician makes an initial diagnosis of community-acquired pneumonia 7. Regarding the treatment of this patient, which of the following drugs is most suitable? (A) Ampicillin (B) Clindamycin (C) Doxycycline (D) Linezolid (E) Vancomycin If this patient were to be treated with erythromycin, she should (A) Avoid exposure to sunlight (B) Avoid taking supplementary iron tablets (C) Decrease her intake of caffeinated beverages (D) Have her plasma urea nitrogen or creatinine checked before treatment (E) Temporarily stop taking loratadine
7 (C) Doxycycline 8 (C) Decrease her intake of caffeinated beverages (Although erythromycin does not inhibit loratadine metabolism, it does inhibit the CYP1A2 form of cytochrome P450, which metabolizes methylxanthines.)
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
A. Azithromycin
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.
A. Azithromycin has better activity against respiratory pathogens such as Haemophilus influenzae and Moraxella catarrhalis but less potent activity against staphylococci and streptococci.
A 25-year-old man presents to the urgent care center with a painless sore on his genitals that started 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 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 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.
A. Bind the 30S subunit of the bacterial ribosome, preventing binding of tRNA to the mRNA-ribosome complex.
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 of the following antibiotics exhibits a long postantibiotic effect that permits once-daily dosing? A. Gentamicin B. Penicillin G C. Vancomycin D. Aztreonam
A. Gentamicin
Which is a common adverse effect of cotrimoxazole? A. Hyperkalemia B. Pulmonary fibrosis C. Tendon rupture D. Blood glucose disturbances
A. Hyperkalemia
A 32-year-old man presents to an outpatient clinic with a 5-day history of productive cough, purulent sputum, and shortness of breath. He is diagnosed with community-acquired pneumonia (CAP). It is noted that this patient has a severe ampicillin allergy (anaphylaxis). Which would be an acceptable treatment for this patient? A. Levofloxacin B. Ciprofloxacin C. Penicillin VK D. Nitrofurantoin
A. Levofloxacin
Cotrimoxazole provides activity against which organism? A. MRSA B. Pseudomonas aeruginosa C. Anaerobes D. Mycoplasma
A. MRSA
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
A. Modification of target site
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 72-year-old man is admitted to the hospital from a nursing home with severe pneumonia. He was 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
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
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
B. Doxycycline
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
B. Gram-negative aerobes
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
B. Increased gastrointestinal motility
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 agent 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 drug 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 23-year-old man 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
Which of the following adverse drug reactions precludes a patient from being rechallenged with that drug in the future? A. Itching/rash from penicillin B. Stevens-Johnson syndrome from sulfamethoxazole-trimethoprim C. Gastrointestinal (GI) upset from clarithromycin D. Clostridium difficile superinfection from moxifloxacin
B. Stevens-Johnson syndrome from sulfamethoxazole-trimethoprim
In which of the following cases would it be appropriate to use telavancin? A. A 29-year-old pregnant woman with ventilator-associated pneumonia B. A 76-year-old man with hospital-acquired pneumonia also receiving amiodarone for atrial fibrillation C. A 36-year-old man with cellulitis and abscess growing MRSA D. A 72-year-old woman with a diabetic foot infection growing MRSA who has moderate renal dysfunction
C. A 36-year-old man with cellulitis and abscess growing MRSA
A 68-year-old man 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 woman presents to the emergency room with headache, stiff neck, and fever for 2 days and is diagnosed with meningitis. Which is the best agent for the treatment of meningitis in this patient? A. Cefazolin B. Cefdinir C. Cefotaxime D. Cefuroxime axetil
C. Cefotaxime
A 45-year-old man 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 is the most appropriate treatment option for once-daily outpatient intravenous therapy in this patient? A. Ertapenem B. Ceftaroline C. Daptomycin D. Piperacillin/tazobactam
C. Daptomycin
A 58-year-old man 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.
C. Erythromycin.
Which of the following agents is considered a narrow-spectrum antibiotic? A. Ceftriaxone B. Ciprofloxacin C. Isoniazid D. Imipenem
C. Isoniazid
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
A 22-year-old woman presents with a 2-day history of dysuria with increased urinary frequency and urgency. A urine culture and urinalysis are done. She is diagnosed with a urinary tract infection caused by E. coli. Which agent should be avoided in the treatment of her UTI? A. Levofloxacin B. Cotrimoxazole C. Moxifloxacin D. Nitrofurantoin
C. Moxifloxacin
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
C. Pneumonia caused by drug-resistant Streptococcus pneumoniae
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
C. Tobramycin
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
D. 4 g given as continuous infusion over 24 hours
An 18-year-old woman presents to the urgent care clinic with symptoms of 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
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
D. Chloramphenicol
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
D. Clostridium difficile
Which of the following antibiotics exhibits concentration-dependent killing? A. Clindamycin B. Linezolid C. Vancomycin D. Daptomycin
D. Daptomycin
A 24-year-old pregnant woman presents to the urgent care clinic with fever and urinary 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. Doxycycline
D. Doxycycline
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.
Which of the following adverse effects is associated with daptomycin? A. Ototoxicity B. Red man syndrome C. QTc prolongation D. Rhabdomyolysis
D. Rhabdomyolysis
44. Erythromycin work by which of the following mechanisms? o A. Disruption of protein synthesis via ribosomes o B. Inhibition of DNA gyrase o C. Inhibition of reverse transcriptase o D. Inhibition of fungal membrane
o A. Disruption of protein synthesis via ribosome
1. A patient presents with a rapid heart rate, fever, and diaphoresis. Infection is highly suspected and a blood sample is sent to the lab. In the disk diffusion method for lab testing cultured bacteria, what would a large zone of inhibition indicate? o A. Drug sensitivity o B. Drug resistance o C. Presence of anaerobic bacteria o D. Presence of gram-positive bacteria o E. Presence of gram-negative bacteria
o A. Drug sensitivity
29. Patients with diphtheria or whooping cough will not respond to penicillin. Which of the following drugs would be the best choice? o A. Erythromycin o B. Clarithromycin o C. Azithromycin o D. Dirithromycin o E. Telithromycin
o A. Erythromycin
9. The mechanism of bacterial resistance to penicilins can be described as: o A. Inactivation of drug by beta-lactamases o B. Overproduction of PBPs o C. Overproduction of peptidoglycans o D. Breakdown of penicillins by the immune system o E. Rapid biotransformation
o A. Inactivation of drug by beta-lactamases
5. Chloramphenicol has which mechanism of action during protein synthesis? o A. Interfere with the donor site growing peptide o B. Interfere with tRNA release o C. Interfere with acceptor site so next tRNA cannot bind
o A. Interfere with the donor site growing peptide
61. Chloramphenicol has which mechanism of action during protein synthesis? o A. Interfere with the donor site growing peptide o B. Interfere with tRNA release o C. Interfere with acceptor site so next tRNA cannot bind
o A. Interfere with the donor site growing peptide
34. Which of the following would be used for pelvic inflammatory disease (C. trichomatic, N. gonorrhoeae, Enterobacteriaceae, anaerobes)? o A. Ofloxacin o B. Gatifloxacin o C. Levofloxacin o D. Ciprofloxacin o E. B & C
o A. Ofloxacin
45. Which of the following types of drugs binds to teeth and can cause discoloration? o A. Tetracyclines o B. Macrolides o C. Cephalosporins o D. Penicillins o E. Sulfonamides
o A. Tetracyclines
8. Which of the following drugs is considered FDA pregnancy category D (contraindicated)? o A. Tetracyclines o B. Macrolides o C. Cephalosporins o D. Penicillins o E. Sulfonamides
o A. Tetracyclines
86. Which of the following patients would have to rely on bactericidal antibiotics? o Liver disease patients o AIDS patients o CHF patients o COPD patients o Abdomenal trauma patients
o AIDS patients
82. Which of the following adverse effects is the most common with the sulphonamides [sulfa drugs] o Allergic reactions o Acute hemolytic anemia o Crystalluria o Steven-Johnson syndrome
o Allergic reactions
73. Which of the following is least protein bound? o Oxacillin o Cloxacillin o Dicloxacillin o Flucoxacillin o Amoxicillin
o Amoxicillin
81. Which of the following penicillins is an aminopenicillin? o Methicillin o Ampicillin o Penicillin G o Penicillin V o Carbencillin
o Ampicillin
84. Which of the following antibiotics should be used for the treatment of fever of unknown origin? o Sulphonamides o Cefalosporines o Macrolides o Aminoglycosides o Penicillin o Antibiotic should not be used
o Antibiotic should not be used
24. Chloamphenicol has what mechanism of action? o A. Changes the shape of 30 rRNA to cause mRNA to be read incorrectly o B. Binds to 50s rRNA and inhibits formation of peptide bond o C. Binds to 50s rRNA and prevents movement along mRNA o D. Interferes with the tRNA anticodon reading of mRNA codon o E. Inhibits folic acid metabolism
o B. Binds to 50s rRNA and inhibits formation of peptide bond
14. What type of antibiotic has bacteriostatic activity? o A. Penicillins o B. Chloramphenicol o C. Aminoglycosides o D. Fluoroquinolones
o B. Chloramphenicol
38. What type of antibiotic has bacteriostatic activity? o A. Penicillins o B. Chloramphenocol o C. Aminoglycosides o D. Fluoroquinolones
o B. Chloramphenocol
54. Which of the following should be monitored (lab work) when administering penicillins or cephalosporins to older adults? o A. D-dimer o B. Creatinine o C. Aspartate aminotransferase (AST) o D. Lactate dehydrogenase (LDH) o E. Bilirubin
o B. Creatinine
4. A 27-year-old man complains of occasional heartburn. His physician makes a few suggestions of diet and lifestyle changes he could make as well as some medications he can take for symptom management. The patient decides to try a magnesium hydroxide (MgOH) preparation. Which of the following is a side effect of MgOH that the physician should warn him about? o A. Constipation o B. Diarrhea o C. Headache o D. Impotence o E. Seizures
o B. Diarrhea
30. What is the elimination mechanism of doxycycline? o A. Urine via renal route o B. Fecal via biliary route o C. Blood via bone marrow route o D. Blood via hepatic route o E. White cells via splenic route
o B. Fecal via biliary route
22. It is estimated that 30-50% of antibiotics used in the United States are administered for prophylaxis. The drug trimethoprim-sulfamethoxazole (TMPSMX, Bactrim) is often given in what situation? o A. Before dental appointments for patients with endocarditis o B. For young women with recurrent urinary tract infections o C. For elderly patients with an increased risk of pneumonia o D. For pregnant women showing signs of systemic infection o E. For all neonates with mild neutropenia
o B. For young women with recurrent urinary tract infections
17. The most common patient complaint with oral macrolides is which of the following? o A. Cardiac o B. GI tract o C. Neurologic o D. Urinary o E. Respiratory
o B. GI tract
40. Which of the following drugs would require doing a BUN and creatinine lab serum test before administering? o A. Kanamycin o B. Gentamicin o C. Amikacin o D. Neomycin
o B. Gentamicin
15. A 35-year-old woman with a history of type 2 diabetes presents to her primary care physician with fever and dysuria. She is started on a medication that has the potential to cause tendon rupture. What is the mechanism of action for the drug that was started? o A. Inhibition of bacterial cell wall synthesis o B. Inhibition of DNA gyrase o C. Inhibition of RNA synthesis o D. Inhibition of the 30s ribosome o E. Inhibition of the 50s ribosome
o B. Inhibition of DNA gyrase
42. Fluoroquinolones works by which of the following mechanisms? o A. Disruption of protein synthesis via ribosomes o B. Inhibition of DNA gyrase o C. Inhibition of reverse transcriptase o D. Inhibition of fungal membrane
o B. Inhibition of DNA gyrase
26. Macrolides and clindamycin have which mechanism of action during protein synthesis? o A. Interfere with the donor site growing peptide o B. Interfere with tRNA release o C. Interfere with acceptor site so next tRNA cannot bind
o B. Interfere with tRNA release
52. Which of the following describes cefaclor and cefuroxime? o A. First-generation cephalosporins o B. Second-generation with Haemophilus influenzae activity o C. Second-generation with Bacteroids fragilis activity o D. Third-generation cephalosporinse) o E. Third-generaion with Pseudomonas aeruginosa activity o F. Oral broad-spectrum cephalosporins
o B. Second-generation with Haemophilus influenzae activity
31. Which of the following drugs is a monotherapy used prophylactically to treat urinary tract infections, such as with AIDS patients? o A. Sulfacetamide o B. Trimethoprim o C. Co-trimazole (TMP-SMX) o D. Sulfamethoxazole o E. Sulfasalazine
o B. Trimethoprim
63. Which of the following drugs would be used to treat methicillin-resistant Staphylococcus aureus (MRSA)? o A. Nafcillin o B. Vancomycin o C. Gentamycin o D. Erythromycin o E. Clindamycin
o B. Vancomycin
90. Silver sulfadiazine, which is useful for P. aeruginosa, is a common treatment for which of the following? o Facial trauma o Clotting disorders o Urinary tract infections o Burns o Hepatitis
o Burns
41. If a bacteriostatic agent, such as tetracycline, is given in synergy with a bactericidal agent, such as penicillin, what is the likely result? o A. Additive response o B. Potentiative response o C. Antagonistic response
o C. Antagonistic response
65. Which of the following bactericidal antibiotics is the drug of choice for pneumonia caused by H. influenzae? o A. Erythromycin o B. Clarithromycin o C. Azithromycin o D. Dirithromycin o E. Telithromycin
o C. Azithromycin
55. Which of the following would be used to treat Neisseria gonorrhoeae if the patient was allergic to penicillins? o A. Ticarcillin o B. Carbencillin o C. Ceftriaxone o D. Penicillin G o E. Penicillin V
o C. Ceftriaxone
37. Which of the following can cause irreversible bone marrow depression, leading to aplastic anemia? o A. Demeclocycline o B. Tetracycline o C. Chloamphenicol o D. Minocycline o E. Oxytetracycline
o C. Chloamphenicol
39. Which of the following drugs would be given to a patient with rickettsia who is allergic to doxycycline? o A. Demeclocycline o B. Tetracycline o C. Chloramphenicol o D. Minocycline o E. Oxytetracycline
o C. Chloramphenicol
71. Which of the following drugs is a sequential inhibitor of folate metabolism? o A. Sulfacetamide o B. Trimethoprim o C. Co-trimazole (TMP-SMX) o D. Sulfamethoxazole o E. Sulfasalazine
o C. Co-trimazole (TMP-SMX)
47. Which enzyme is targeted by sulfonamide? o A. Monohydropteroate synthase o B. Monohydrofolate reductase o C. Dihydropteroate synthase o D. Dihydrofolate reductase
o C. Dihydropteroate synthase
6. Which of the following is extensively biotransformed in the liver? o A. Demeclocycline o B. Oxytetracycline o C. Doxycycline o D. Tetracycline
o C. Doxycycline
58. Aminoglycoside resistance is becoming common for enterococci infections causing which of the following? o A. Pneumonia o B. Upper respiratory tract infections o C. Endocarditis o D. Gastroenteritis o E. Urinary tract infections
o C. Endocarditis
64. The enzyme that sulfonamides inhibit (para-aminobenzoic acid, PABA) is needed for bacterial production of which of the following, which is required for synthesis of DNA, RNA, and protein? o A. Murein o B. Niacin o C. Folic acid o D. Arachidonic acid o E. Phosphodiesterase
o C. Folic acid
28. Sulfonamides and nalidixic acid can cause hemolysis in patients that are deficient in what enzyme? o A. Phosphoenolpyruvate carboxykinase o B. Fructose 1,6-bisphosphatase o C. Glucose 6-phosphate o D. Glucokinase o E. Fructokinase
o C. Glucose 6-phosphate
66. Aminoglycosides are effective only against which of the following and are a good choice for septicemia (a serious toxicity)? o A. Gram-positive aerobic bacteria o B. Gram-positive anaerobic bacteria o C. Gram-negative aerobic bacteria o D. Gram-negative anaerobic bacteria
o C. Gram-negative aerobic bacteria
46. Which of the following clinical results is associated with gentamicin (aminoglycoside), not tetracyclines? o A. Hepatic necrosis o B. Pancreatitis o C. Hearing loss o D. Renal damage
o C. Hearing loss
35. A 55-year-old man complains of poor urinary flow and nocturia. He is found to suffer from benign prostatic hyperplasia. The physician prescribes finasteride to help his symptoms. What is the mechanism of action of this agent? o A. Antagonizes alfa-1-adrenergic receptors o B. Blocks DHT receptors o C. Inhibits 5-alfa-reductase o D. Inhibits testosterone synthesis o E. Relaxes prostatic smooth muscle
o C. Inhibits 5-alfa-reductase
53. Tetracyclines and aminoglycosides have which mechanism of action during protein synthesis? o A. Interfere with the donor site growing peptide o B. Interfere with tRNA release o C. Interfere with acceptor site so next tRNA cannot bind
o C. Interfere with acceptor site so next tRNA cannot bind
68. What type of drug would be needed to enter the brain and CNS? o A. Hydrophilic o B. Hydrophobic o C. Lipophilic o D. Lipophobic o E. Large molecular weight
o C. Lipophilic
10. Prophylactic penicillin is indicated following exposure to STDs as well as for patients with rheumatic carditis. If the patient is allergic to penicillin, which drug should be used? o A. Sulfonamides o B. Cephalosporins o C. Macrolides o D. Aminoglycosides o E. Fluoroquinolones
o C. Macrolides
49. A patient who is taking verapamil for hypertension and angina has become constipated. Which of the following drugs is an osmotic laxative that could be used to treat the patientâs constipation? o A. Aluminum hydroxide o B. Diphenoxylate o C. Magnesium hydroxide o D. Metoclopramide o E. Ranitidin
o C. Magnesium hydroxide
50. Which of the following has the highest bacterial resistance pattern? o A. Penicillin G o B. Penicillin V o C. Methicillin o D. Ampicillin o E. Carbencillin
o C. Methicillin
70. Which of the following describes cefmetazole, cefotetan, and cefoxitin? o A. First-generation cephalosporins o B. Second-generation with Haemophilus influenzae activity o C. Second-generation with Bacteroids fragilis activity o D. Third-generation cephalosporins o E. Third-generaion with Pseudomonas aeruginosa activity o F. Oral broad-spectrum cephalosporins
o C. Second-generation with Bacteroids fragilis activity
18. Which of the following should be given for gram-negative bacterial meningitis? o A. First-generation cephalosporin o B. Second-generation cephalosporin o C. Third-generation cephalosporin
o C. Third-generation cephalosporin
60. Fluoroquinolones are well distributed to the lung (pneumonia) and soft tissues (skin infections). Which of the following, along with moxifloxacin, has the most activity against anaerobic bacteria? o A. Ofloxacin o B. Gatifloxacin o C. Trovafloxacin o D. Ciprofloxacin o E. Levofloxacin
o C. Trovafloxacin
33. Which of the following, along with beta-lactams and aminoglycosides, is excreted by the kidney? o Select one: o A. Erythromycin o B. Clindamycin o C. Vancomycin o D. Rifampin o E. Chloramphenicol
o C. Vancomycin
102. Which of the following is a broad spectrum antibiotic reserved chiefly for use against Pseudomonas aeruginosa? o Penicillin G o Penicillin V o Methicillin o Ampicillin o Carbencillin
o Carbencillin
92. Which of the following is considered extended-spectrum as it can fight pseudomonal aeruginosa, Enterobacter species p... fragilis, and many klebsiella? o Oxacillin o Ampicillin o Amoxicillin o Penicillin G o Carbencillin
o Carbencillin
96. Which of the following drugs can occasionally cause thrombocytopenia with bruising or bleeding? o Azithromycin o Clarithromycin o Dirithromycin o Erythromycin
o Clarithromycin
21. Penicillin is used in combination with what drug to enhance antibacterial action in the treatment of enterococcal endocarditis? o A. Sulfonamides o B. Cephalosporins o C. Macrolides o D. Aminoglycosides o E. Fluoroquinolones
o D. Aminoglycosides
23. Silver sulfadiazine, which is useful for P. aeroginosa, is a common treatment for which of the following? o A. Facial trauma o B. Clotting disorders o C. Urinary tract infections o D. Burns o E. Hepatitis
o D. Burns
12. Cefepime is considered a: o A. First-generation cephalosporin o B. Second-generation cephalosporin o C. Third-generation cephalosporin o D. Fourth-generation cephalosporin
o D. Fourth-generation cephalosporin
43. Tetracyclines are bacteriostatic and have which of the following mechanisms of action? o A. Changes the shape of 30 rRNA to cause mRNA to be read incorrectly o B. Binds to 50s rRNA and inhibits formation of peptide bond o C. Binds to 50s rRNA and prevents movement along mRNA o D. Interferes with the tRNA anticodon reading of mRNA codon o E. Inhibits folic acid metabolism
o D. Interferes with the tRNA anticodon reading of mRNA codon
32. Which of the following is NOT true of Azetreonam (Azactam)? o A. It is not affected by beta-lactamases o B. It is active against gram-negative bacteria o C. It is active against Pseudomonas aeroginosa o D. It has a high potential to produce hypersensitivity reactions
o D. It has a high potential to produce hypersensitivity reactions
72. Which of the following is NOT a dose-dependent toxicity location for aminoglycosides? o A. Auditory canal o B. Vestibular canal o C. Kidney o D. Liver o E. Neuromuscular
o D. Liver
57. Which of the following is NOT a common indication for penicillin? o A. Meningitis o B. Pneumonia or chronic bronchitis o C. UTIs o D. MRSA o E. Gonorrhea or syphilis
o D. MRSA
3. A 27-year-old man presents to his primary care physician with complaints of a painless ulcer on his penis. The patient admits to having unprotected intercourse 2 weeks prior. Visualization of the lesion by dark field microscopy demonstrates spirochetes, and he is diagnosed with syphilis. The patient has no known drug allergies. Which of the following medications would be most appropriate for the treatment of this patient? o A. Bacittacin o B. Doxycycline o C. Erythromycln o D. Penicillin G
o D. Penicillin G
25. Severe allergic reactions are more common with what family of drugs? o A. Tetracyclines o B. Macrolides o C. Cephalosporins o D. Penicillins o E. Sulfonamides
o D. Penicillins
27. Which of the following describes cefoperazone and ceftriaxone? o A. First-generation cephalosporins o B. Second-generation with Haemophilus influenzae activity o C. Second-generation with Bacteroids fragilis activity o D. Third-generation cephalosporins o E. Third-generation with Pseudomonas aeruginosa activity o F. Oral broad-spectrum cephalosporins
o D. Third-generation cephalosporins
75. Which of the following would absorb well even in the presence of food in the stomach? o Demeclocycline o Doxycycline o Tetracycline o Oxytetracycline
o Doxycycline
59. Which of the following is considered extended-spectrum as it can fight pseudomonal aeroginosa, enterobacter species, proteus, bacteroids fragilis, and many klebsiella? o A. Oxacillin o B. Ampicillin o C. Amoxicillin o D. Penicillin G o E. Carbencillin
o E. Carbencillin
13. Which of the following are eliminated largely by non-renal routed? o A. Ceftazidime and cefepime o B. Cefazolin and cephalexin o C. Cefmetazole, cefotetan, and cefoxitin o D. Cefixime and cefpodoxime proxecil o E. Cefoperazone and ceftriaxone
o E. Cefoperazone and ceftriaxone
19. Which of the following drugs is associated with gray baby syndrome? o A. Demeclocycline o B. Doxycycline o C. Tetracycline o D. Oxytetracycline o E. Chloramphenicol
o E. Chloramphenicol
2. Sulfonamides, which are primarily used to treat UTIs and cystitis, have what mechanism of action against microbes? o A. Changes the shape of 30 rRNA to cause mRNA to be read incorrectly o B. Binds to 50s rRNA and inhibits formation of peptide bond o C. Binds to 50s rRNA and prevents movement along mRNA o D. Interferes with the tRNA anticodon reading of mRNA codon o E. Inhibits folic acid metabolism
o E. Inhibits folic acid metabolism
7. Following administration of aminoglycosides, where would concentrations be the lowest? o A. Prostate o B. Brain o C. Vitreous fluid o D. CSF o E. Intracellular
o E. Intracellular
11. Which of the following would NOT be a situation where fluoroquinolones are recommended? o A. Urinary tract infections o B. Gonorrhea o C. Urethritis o D. Cervicitis o E. Listeriosis
o E. Listeriosis
20. Antibiotics are chemicals produced by which of the following? o A. Cancer cells o B. Viruses o C. Bacteria o D. Fungi o E. Microorganisms
o E. Microorganisms
62. A 37-year-old man with gastroesophageal reflux takes over-the-counter cimetidine. He has no health care insurance and thus does not go to see a physician. This patient must be aware of which of the following side effects of this medication? o A. Confusion o B. Constipation o C. Hallucinations o D. Headache o E. Muscular pain
o E. Muscular pain
36. A 37-year-old man complains of chest pain after meals. He says this pain has gone on for a few months and gets only minimal relief from antacid tablets. The physician prescribes a drug that will decrease the amount of acid secreted by binding to and inhibiting an ATPase on the lumenal surface of parietal cells. Which of the following drugs works by this mechanism? o A. Atropine o B. Cimetidine o C. Misoprostol o D. Octreotide o E. Omeprazole
o E. Omeprazole
48. Which of the following types of drugs can enter breast milk? o A. Tetracyclines o B. Macrolides o C. Cephalosporins o D. Penicillins o E. Sulfonamides
o E. Sulfonamides
69. Which of the following drugs is contraindicated in neonates as it causes kernicterus (brain yellowing from bilirubin)? o A. Tetracyclines o B. Aminoglycosides o C. Cephalosporins o D. Fluoroquinolones o E. Sulfonamides
o E. Sulfonamides
16. Which of the following would be a quantitative method of measuring selective toxicity? o A. Equilibrium dissociation constant o B. Toxic dosage o C. Effective dosage o D. Sensitivity o E. Therapeutic index
o E. Therapeutic index
78. When choosing antibiotic for chemotherapy, critically ill patients need immediate administration of drugs covering infection by both gram positive and gram- negative classes of organisms, this is known as: o Site-specific therapy o Sensitivity o Cost-effective therapy o Empiric therapy o Selective toxicity
o Empiric therapy
51. Which of the following types of antibiotics should be used to treat the common cold? o A. Sulfonamides o B. Cephalosporins o C. Macrolides o D. Aminoglycosides o E. Penicillins o F. Antibiotics should not be used
o F. Antibiotics should not be used
56. Which of the following antibiotics should be used for the treatment of fever with unknown origin? o A. Sulfonamides o B. Cephalosporins o C. Macrolides o D. Aminoglycosides o E. Penicillins o F. Antibiotics should not be used
o F. Antibiotics should not be used
93. Which of the following are in correct order from most gram positive activity to most gram negative activity? o Firs generation, second generation, third generation o Third generation, second generation, first generation o First generation, third generation, second generation o Second generation, third generation, first generation o Third generation, first generation, second generation
o Firs generation, second generation, third generation
95. Which of the following is not an antibiotic? o Flucytosine o Clindamycin o Fluroquinolone o Imipenem o Cephalosporine
o Flucytosine
97. Which is the most common adverse reactions to tetracyclines? o Prolonged bleeding o Hepatomegaly o Bloody diarrhea o Seizures o GI irritation
o GI irritation
85. Which of the following types of infection would erythromycin be the least effective against? o Throat o Ears o Skin o Respiratory tract o GI tract
o GI tract
79. Estolate esters can be added to macrolide antibiotics (e.g erythromycin estolate) to: o Decrease resistance to acidic pH o Increase resistance to basic pH o Decrease bioavailability o Increase bioavailability o Lyse bacterial cell wall
o Increase bioavailability
100. Which of the following fluroquinolones is the most potent? o Ciproflocaxin o Levofloxacin o Lomefloxacin o Moxifloxacin o Norfloxacin
o Moxifloxacin
94. Which of the following adverse effects to penicillin is a sign of hematologic toxicity, not nephropathy? o Fever o Macular rash o Eosinophilia o Neutropenia o Hematuria
o Neutropenia
91. Severe pain and nausea with macrolides maybe suggestive of inflammation to what organ? o Pancreas o Spleen o Kidneys o Gall bladder o Heart
o Pancreas
101. Which of the following drugs can be mixed with aminoglycosides, such as for use against Staphylococcus aureus? o Diuretics o NSAIDs o Cisplatin (platinol) o Amphotericin B o Penicillin G
o Penicillin G
77. Which of the following is considered the least toxic? o Ticarcillin o Oxacillin o Ampicillin o Penicillin G o Penicillin V
o Penicillin G
76. Accumulation of aminoglycosides is most common in which location? o Liver capsule o Renal medulla o Nephrons o Renal cortex o Spleen
o Renal cortex
89. Which of the following mechanisms is NOT correctly matched with the drug o Vancomycin; inhibitor of cell wall synthesis o Amphotericin B; Disruption of cell wall membrane o Tetracyclines; Bacteriostatic inhibitor of protein synthesis o Ketoconazole; disruption of cell wall membrane o Rifampin; inhibitor of cell wall synthesis
o Rifampin; inhibitor of cell wall synthesis
103. Imipenem/Cilastatin is an example of a o Narrow spectrum antibiotic o Combination broad spectrum antibiotic o Single broad spectrum antibiotic o Gram-positive antibiotic o Gram-negative antibiotic o Anaerobic antibiotic
o Single broad spectrum antibiotic
80. A patient undergoes a procedure to implant a cardiac pacemaker and prosthetic heart valve. One month later, the patient returns with a high fever, infection is found in pacemaker pocket, along the pathway of the electrical lead, and near the prosthetic valve. Which of the following is the most likely cause? o Staphylococcus aureus o Staphylococcus epidermidis o Staphylococcus saprophyticus o Viridian streptococci o Escherichia Coli
o Staphylococcus epidermidis
67. The most active aminoglycosides against mycobacterium tuberculosis is: o Kanamycin o Tobramycin o Streptomycin o Amikacin o Neomycin
o Streptomycin
74. When treating meningitis, one of the steps to achieve the MIC is by injecting antibiotic where? o Epidural space o Subdural space o Subarachnoid space o Subpial space o Corneal space
o Subarachnoid space
99. Which of the following drugs is used topically for ocular infections? o Sulfacetamide o Trimethoprim o Co-trimazole (TMP-SMX) o Sulfamethoxazole o Sulfasalazine
o Sulfacetamide
98. Which of the following would be used to treat ulcerative colitis? o Sulfacetamide o Trimethoprim o Co-trimazole (TMP-SMX) o Sulfamethoxazole o Sulfasalazine
o Sulfasalazine
87. Which of the following types of drugs is not assotiated with an incidence of allergic response? o Trimethoprim o Tetracyclines o Erythromycin o Penicillins o Sulphonamides
o Tetracyclines
83. Which of the following drugs, used for asthma, can cause seizure if mixed with fluroquinolones? o Penicillin o Caffeine o Theophylline o Didanosine o Viagra
o Theophylline
88. Which of the following enzymes is the main target for penicillin? o Transglucosylases o Transpeptidases o D-alanine carboxykinaze o Penicillin binding protein (PBPs)
o Transpeptidases
