ID II part II
A physician calls the pharmacy and wants to know what to prescribe for his patient with primary Lyme disease. The patient is a 27 year-old female who is 29 weeks pregnant. Which of the following agents would you recommend? Answer A Amoxicillin 500 mg PO TID x 14 days B Itraconazole 400 mg PO BID x 14 days C Fluconazole 400 mg PO daily x 14 days D Ciprofloxacin 500 mg PO BID x 14 days E Doxycycline 100 mg PO BID x 14 days
A Amoxicillin
A 71 year-old female patient status post renal transplant on tacrolimus and prednisone immunosuppressive therapy has been prescribed ciprofloxacin 500 mg daily for 10 days to treat her infection. Her other medical conditions include heart failure, COPD and GERD. She presents to the grocery-store pharmacy with an extremely painful heel. She cannot put weight on her foot and is being supported by her daughter. Which of the following risk factors does this patient have for fluoroquinolone-associated tendonitis? Answer A Age, transplant history, steroid use B Heart failure, gender, tacrolimus use C Age, gender, steroid use D Transplant history, heart failure, tacrolimus use E Tacrolimus use, age, gender
A Quinolones increase the risk of tendonitis and tendon rupture and this frequently involves the Achilles' tendon. The medication should be stopped immediately. Risk factors include age greater than 60 years, concurrent corticosteroid use, and organ transplant patients.
Joshua is going to the operating room for knee joint replacement. He has no known drug allergies. Which of the following medications should be used for antibiotic prophylaxis? Answer A Ertapenem B Cefotetan C Metronidazole D Cefazolin E Clindamycin
D
MR is a 27 year-old female patient who received emergency treatment for a ruptured appendix. She has received IV cefazolin since surgery. On day four, she complains of diffuse pain over the incision site. The patient's temperature is recorded at 103.5°F. A CT scan of her abdomen revealed a peritoneal abscess. The abscess was drained and fluid was sent to the laboratory. The physician wishes to use a single drug that provides both aerobic and anaerobic coverage. What are two single drug options that cover both aerobic and anaerobic Gram-negative pathogens implicated in intra-abdominal infections that could be recommended to the physician? Answer A Zosyn and Cipro B Maxipime and Avelox C Rocephin and Cipro D Zosyn and Cefoxitin E Cefoxitin and Nafcillin
D
QJ is a 72 year old male who slipped on his icy driveway and fractured his hip as he was going to the pharmacy to pick up a prescription for mupirocin nasal ointment. He will go to the OR for surgical repair. He was scheduled to have knee replacement surgery the next week and was about to begin an MRSA decolonization regimen prior to this scheduled procedure. He has no known allergies. Which antibiotic regimen should he receive for surgical prophylaxis? Answer A Clindamycin 600 mg IV x1 B Clindamycin 600 mg IV x1 plus cefazolin 1g IV x1 C Levofloxacin 500 mg IV x1 D Vancomycin 1 gram IV x1 E Cefotetan 1g IV x1
D
A 30 year-old female patient is 12 weeks pregnant and presents to the physician with symptoms of urinary urgency, burning and frequency. She is diagnosed with a urinary tract infection. Her only medications are a daily prenatal vitamin and a calcium supplement. She has no drug allergies. Which is the best medication to recommend for this patient? Answer A Ciprofloxacin B Doxycycline C Tobramycin D Cephalexin E Vancomycin
D Cephalexin
A healthy, 25 year-old male is traveling to the Baja Peninsula in Mexico to visit a friend. He has never traveled to Mexico before and is concerned that he may acquire traveler's diarrhea. He asked his doctor for a prescription to take with him in case he develops traveler's diarrhea during his trip. Recommend an appropriate medication: Answer A Amoxicillin 500 mg every 12 hours x 3 days B A Z-pak C Metronidazole 2 grams x1 D Ciprofloxacin 500 mg BID x 1 day E Erythromycin 500 mg every 6 hours for 3 days
D Cipro
LF is a 3 year old male who presents to the pediatrician's office with his mother. He has been complaining of ear pain and has had a fever up to 101 degrees F. He is 96 cm tall and weighs 36 lb. He had been in to the clinic 3 days prior with the same symptoms and at that time the pediatrician and parents agree to observation rather than antibiotics. With little improvement in his symptoms, and based on the otic exam, the pediatrician feels that antibiotics are warranted at this time for acute otitis media. He prescribes amoxicillin 80 mg/kg/day, divided in two doses. How many mL of the 400 mg/5 mL solution should he receive for each dose? (Answer must be numeric; no units or commas. Round to the nearest 0.1 mL.)
8.2
A patient presents with symptoms of a common cold: runny nose, sore throat, sneezing, and coughing. What is the most likely cause of the patient's cold? Answer A Rhinovirus B Staphylococcus aureus C Group B Streptococci D Adenovirus E Multiple organisms are likely
A
PD has contracted trichomoniasis. Which of the following options would be preferred treatments for trichomoniasis? Answer A Metronidazole 2 grams PO x 1 B Ciprofloxacin 1 gram PO x 1 C Azithromycin 2 grams PO x 1 D Penicillin G benzathine 2.4 million units IM x 1 E Penicillin G benzathine 2.4 million units IM x 3 weekly doses
A
SQ presents to the emergency department with fever, chills, nausea, cough, and fatigue. She reports feeling awful for the past week. Her previous doctor started her on amoxicillin 4 days ago. Her white blood cell count was found to be elevated today. Her past medical history is significant for COPD, hypertension, dyslipidemia, and atrial fibrillation. Home medications include: lisinopril, lovastatin, procainamide, amoxicillin and some inhalers. Her chest X-ray reveals a new infiltrate. The doctor would like admit her to the general medical floor and start broad empiric coverage for her infectious process. Which of the following broad spectrum medication/s would be most appropriate to treat Sarah? Answer A Ceftriaxone + doxycycline B Moxifloxacin C Tigecycline D Clarithromycin E Aztreonam
A
A patient with an active tuberculosis infection will receive ethambutol therapy as part of their combination drug therapy. The patient will require counseling regarding the possibility of the following adverse effect: Answer A Vision problems B Shortness of breath C Thyroid dysfunction D Appetite suppression E Hearing loss
A Vision Problems Ethambutol can cause optic neuritis, which can decrease visual acuity and may cause blindness. Patients should be counseled to report any changes in vision to their physician promptly.
Which of the following are appropriate patient counseling points for a patient picking up a prescription for oral rifampin? (Select ALL that apply.) Answer A Contact your doctor right away if you are passing brown or dark-colored urine, have pale stools, or if your skin or whites of your eyes become yellow. This may be a sign of liver damage. B This medicine can cause the tongue to become black. C This medication may cause your urine and other body secretions to turn orange-red in color. D This medicine can increase the levels of many other medicines. Please discuss with your pharmacist or physician if any new medications are started. E This medicine can affect your vision. Contact your doctor if you have any changes in your vision.
A and C
GS is admitted to the hospital for an acute gastrointestinal bleed. On the third day from admission, he develops a hospital-acquired pneumonia. MRSA is documented from respiratory cultures. Which of the following medications can be used to cover the pneumonia? (Select ALL that apply.) Answer A Linezolid B Cefazolin C Daptomycin D Nafcillin E Vancomycin
A and E
MB is a 51 year-old female who has been prescribed Biaxin for pneumonia. She had a heart attack two years ago. During the hospitalization she was found to have an arrhythmia (atrial fibrillation) and was placed on warfarin. Her other medications include simvastatin, atenolol and one fish oil, taken twice daily. Which of the following statements are correct? (Select ALL that apply.) Answer A Biaxin causes QT prolongation and is not a safe choice in a patient with an existing arrhythmia. B Biaxin can cause hepatotoxicity. C Biaxin will increase the levels of simvastatin and may cause muscle damage. D Biaxin can increase the levels of atenolol and may cause bradycardia. E Biaxin can increase the levels of fish oils and increase the bleeding risk.
ABC
JC comes to the emergency department with a large wound that is oozing pus on her lower right leg. She has diabetes and did not want to see a doctor earlier because she does not have medical insurance. It is presumed that the infection is due to community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Which of the following oral medications can be used to treat CA-MRSA? (Select ALL that apply.) Answer A Clindamycin B Sulfamethoxazole/trimethoprim C Ciprofloxacin D Linezolid E Quinupristin/dalfopristin
ABD
A patient with a urinary tract infection has asked for advice on a product for painful urination. Her doctor wrote the name phenazopyridine down on a sheet of paper. Which of the following patient counseling points are correct regarding phenazopyridine? (Select ALL that apply.) Answer A Take this medication with food and 8 oz of water to minimize stomach upset. B She can purchase the over the counter product Azo. C She should use the product as long as she has symptoms. D This medication is effective in treating a bacterial urinary tract infection. E This product will cause red-orange coloring of the urine and can stain clothing.
ABE
JR is a 47 year old obese male with end stage renal disease on hemodialysis presenting with a ruptured appendix and sepsis requiring surgical intervention, antimicrobial therapy and admission to the surgical intensive care unit. JR is allergic to penicillin (rash). Which of the following factor(s) should be considered when selecting empiric antimicrobial therapy and dosing for JR? (Select ALL that apply.) Answer A The site and severity of the infection B The size of the hospital C Organ function (renal and hepatic) D Patient size E Allergy profile
ACDE
SD is a 44 year old female who is going to start Humira injections for ulcerative colitis. A tuberculin skin test (TST) was performed prior to beginning therapy to rule out latent tuberculosis. She was not receiving any immunosuppressive therapies at the time of the test. At her follow-up appointment 48 hours later, the results are read as positive with an area of induration of 17 mm. Her chest x-ray is negative and she reports no signs and symptoms. Which of the following statements regarding SD's situation is incorrect? Answer A A tuberculin skin test is also called a purified protein derivative (PPD) test B A positive TST is diagnostic of active TB. She should begin RIPE therapy. C A TST will often be positive in patients who have received the BCG vaccine. D In patients who are immunosuppressed or are at high exposure risk, the threshold for a positive TST is lower. E Sally has latent TB and should begin isoniazid 300 mg PO daily x 9 months before starting Humira.
B
The mother of a 2 year-old daughter has been given a prescription for an acute otitis media infection. The child has no known drug allergies. This is the first time the child has received treatment for this condition. What is the drug of choice for this condition? Answer A Azithromycin suspension 30 mg/kg/day given daily B Amoxicillin 80-90 mg/kg/day, divided Q 12 hours C Clarithromycin suspension, divided Q 12 hours D Amoxicillin 40 mg/kg/day, divided Q 12 hours E Cephalexin suspension, divided Q 12 hours
B Amoxicillin (80-90 mg/kg/day) is a drug of choice for acute otitis media, which is most commonly caused by Streptococcus pneumoniae.
Which of the following statements are true regarding pyrazinamide? (Select ALL that apply.) Answer A This medication is used to reduce the risk of peripheral neuropathies in patients taking isoniazid. B This medication is contraindicated in patients with acute gout. C This medication can cause significant ototoxicity. D This medication should not be used if the patient has a sulfa allergy. E This medication can cause hepatotoxicity.
B and E
A patient is prescribed isoniazid for treatment of tuberculosis. Which of the following statements regarding isoniazid are correct? (Select ALL that apply.) Answer A It is an hepatic enzyme inducer. B It should be taken on an empty stomach. C Store the oral solution in the refrigerator. D It can turn the urine a reddish color. E It is associated with hepatitis and liver function tests may need to be monitored.
B and E Isoniazid is an hepatic inhibitor and needs to be taken on an empty stomach. The oral solution is stored at room temperature. Monitor liver function.
An infectious diseases pharmacist is designing an empiric antibiotic regimen for a patient. The pharmacist suspects Legionella may be a causative organism. Select the following antibiotics that would provide coverage for Legionella. (Select ALL that apply.) Answer A Augmentin B Biaxin C Levofloxacin D Clindamycin E Cefdinir
BC Legionella is a Gram-negative bacterium (sometimes grouped with atypical organisms) that can cause CAP or HAP. Levofloxacin and Biaxin are the only options listed above with Legionella coverage.
A 25 year-old female has been to see her primary care physician. She is planning to become pregnant and wanted a "clean bill of health". She was found to be infected with gonorrhea. Which of the following statements is the best recommendation for this patient? Answer A She should be treated with cefixime 400 mg PO x 1. B She should be treated with ceftriaxone 250 mg IM x 1. C She should be treated with ceftriaxone 250 mg IM x 1 and azithromycin 1 gram PO x 1. D She should be treated with penicillin G 2.4 million units IM x 3. E Therapy should be withheld until a pregnancy test can be obtained.
C
A patient has a prosthetic mitral valve and needs to have some extensive dental work done. The patient is noted to have allergies to Keflex and Unasyn. Which of the following statements is the best recommendation to give this patient? Answer A Take amoxicillin 2 grams 1 hour prior to dental appointment. B Take cefadroxil 2 grams 30 minutes prior to dental appointment. C Take clindamycin 600 mg 1 hour prior to dental appointment. D Take azithromycin 500 mg 30 minutes after dental appointment. E This patient does not need antibiotics for his dental work.
C
BT is a 34 year old female who was recently diagnosed with an uncomplicated urinary tract infection (UTI). She has a history of VRE in the past. She has an allergy history of hives to several antibiotic drug classes including penicillin, sulfa, nitrofurantoin and quinolone antibiotics. Which of the following medications would be the best choice to treat BT's UTI? Answer A Norfloxacin B Ampicillin-sulbactam C Fosfomycin D Septra DS E Fidaxomicin
C
JM is a 36 year-old female who is diagnosed with community acquired pneumonia as an outpatient. She has no medical problems and is not on any prescription medications. JM has no known drug allergies. Which of the following medications would be most appropriate to recommend for treatment? Answer A Moxifloxacin B Tetracycline C Azithromycin D Amoxicillin E Vancomycin
C
Chief Complaint: "I'm out of my inhaler and I can't breathe". History of Present Illness: KS is a 30 year-old female who came to the ER for worsening shortness of breath and cough. She is out of her albuterol inhaler. She occasionally lives on the street, but has been staying in the local homeless shelter for 3 nights. She reports fatigue, but denies night sweats and hemoptysis. Her cough is nonproductive. Mild right lower extremity cellulitis extending from right ankle to right calf is noted. Patient states she scraped her leg on a fence and it has not healed. She has not been treated with antibiotics. Allergies: NKDA Past Medical History: HIV x 5 years, PCP pneumonia 5 years ago when she was diagnosed with HIV, asthma, and dyslipidemia Medications: Truvada 1 tablet daily, Tivicay 50 mg once daily, albuterol inhaler 1 puff 3-4 times daily as needed, Flovent Diskus 100 mcg BID, simvastatin 20 mg HS Physical Exam / Vitals: Height: 5'2" Weight: 105 pounds BP: 122/72 mmHg HR: 71 BPM RR: 18 BPM Temp: 103.2°F Pain: 3/10 General: Pleasant ill appearing female Lungs: decreased breath sounds bilaterally - right worse than left. Mild wheezing. CV: RRR - no murmurs GI: Normal bowel sounds Ext: Mild right lower extremity cellulitis with some purulent discharge Labs 8/22: Na (mEq/L) = 129 (135 - 145) K (mEq/L) = 3.5 (3.5 - 5) Cl (mEq/L) = 103 (95 - 103) HCO3 (mEq/L) = 24 (24 - 30) BUN (mg/dL) = 12 (7 - 20) SCr (mg/dL) = 0.9 (0.6 - 1.3) Glucose (mg/dL) = 118 (100 - 125) Ca (mg/dL) = 8.8 (8.5 - 10.5) Mg (mEq/L) = 1.8 (1.3 - 2.1) PO4 (mg/dL) = 3.6 (2.3 - 4.7) WBC (cells/mm^3) = 10.4 (4 - 11 x 10^3) Hgb (g/dL) = 13.4 (13.5 - 18 male, 12 - 16 female) Hct (%) = 40.1 (38 - 50 male, 36 - 46 female) Plt (cells/mm^3) = 202 (150 - 450 x 10^3) PMNs (%) = 92 (45 - 73) Bands (%) = 7 (3 - 5) Eosinophils (%) = 3 (0 - 5) Basophils (%) = 0 (0 - 1). Lymphocytes (%) = 29% (20 - 40) Monocytes (%) = 2 (2 - 8) AST (IU/L) = 62 (10 - 40) ALT (IU/L) = 58 (10 - 40) Albumin (g/dL) = 3.1 (3.5 - 5) 8/24 WBC (cells/mm^3) = 8 (4 - 11 x 10^3) Hgb (g/dL) = 7.2 (13.5 - 18 male, 12 - 16 female) Hct (%) = 24.6 (38 - 50 male, 36 - 46 female) MCV (fL) = 120 (80-100) MCH (pg/cell) = 30 (26-34) Plt (cells/mm^3) = 202 (150 - 450 x 10^3) PMNs (%) = 85 (45 - 73) Bands (%) = 4 (3 - 5) Eosinophils (%) = 6 (0 - 5) Basophils (%) = 0 (0 - 1). Lymphocytes (%) = 31% (20 - 40) Monocytes (%) = 5 (2 - 8) Coombs test, direct = positive Bilirubin, total (mg/dL) = 1.8 (0.1-1.2) AST (IU/L) = 52 (10 - 40) ALT (IU/L) = 40 (10 - 40) Albumin (g/dL) = 2.9 (3.5 - 5) Tests: 8/22: Chest X-ray: Bilateral infiltrates with ground glass appearance. Recommend chest CT for further evaluation. Plan: Obtain CD4+ count and viral load. Admitted for IV antibiotics and additional diagnostic work-up. Question: KS is diagnosed with PCP and weight-based Bactrim therapy was initiated, along with prednisone, and home medications were restarted. Late on 8/23, the patient became more lethargic and stated that she felt dizzy. Her appearance was pale, with a slightly jaundiced appearance noted. On 8/24, additional labs were drawn. Which lab abnormality likely explains KS's symptoms? Answer A Microcytic anemia due to Truvada B Rhabdomylysis due to Tivicay C Hemolytic anemia secondary to Bactrim D Crystalluria secondary to Bactrim E Drug-induced kidney disease due to Truvada
C Hemolytic anemia can occur with sulfamethoxazole/trimethoprim. A positive Coombs test indicates the patient is experiencing hemolytic anemia. The drug should be stopped and alternative therapy started.
A patient has an MRSA wound infection. She has heart failure and impaired renal function with an estimated creatinine clearance of 40 mL/min. Her current medications include Toprol XL, Zestril and Lasix. She is going to receive intravenous vancomycin while in the hospital. Choose the correct statement: Answer A Vancomycin should not be used in patients with heart failure. B She should receive the vancomycin orally due to the risk of further renal insufficiency. C She is at an elevated risk of ototoxicity. D The trough is not important; only vancomycin peaks should be monitored. E She should receive ceftazidime instead of vancomycin.
C Oral vancomycin is not absorbed and could not treat a systemic infection. Nephrotoxicity and ototoxicity are the primary toxicities that can occur with vancomycin therapy, and the risk is increased with concomitant medications that have these same side effects such as loop diuretics and aminoglycosides.
Which of the following medications can be given to reduce the risk of peripheral neuropathy in a diabetic patient taking isoniazid? Answer A Vitamin B1 B Vitamin B2 C Vitamin B6 D Vitamin E E Vitamin B12
C Vit B6
An I&D is performed and osteomyelitis is ruled out. The culture reveals mixed E. coli, Klebsiella, and Streptococci. The order for antibiotic sensitivities was overlooked and the sensitivities were not performed. DR has received 4 days of IV Zosyn monotherapy and the foot looks much better. DR is afebrile and lab indicators of infection have normalized. What is the best recommendation? Answer A Change to Keflex PO B Change to Clindamycin PO C Change to Augmentin PO D Change to Zyvox PO E Change to Rocephin IV
C Augmentin PO
SL is a renal transplant patient who is adherent with her medications and diet and physical activity regimens. She is doing well. The only current complications are anemia and elevated cholesterol levels, which are both being treated. A tuberculin skin test was ordered. The induration was 8 mm, which is positive for SL degree of immune suppression. The chest x-ray and signs and symptoms are all negative. Select the correct treatment option that should be added to her medications at this time: Answer A Atovaquone B Rifampin, Isoniazid, Pyrazinamide and Ethambutol C Isoniazid D Sulfamethoxazole and Trimethoprim E Valganciclovir
C Isoniazid Isoniazid (INH) x 9 months is a preferred regimen for latent TB. Pyridoxine (vitamin B6) is used with the isoniazid to prevent peripheral neuropathy
A 72 year-old patient has been hospitalized for ten days. She was having difficulty breathing and was just diagnosed with pneumonia. The patient had been on Unasyn for the past 5 days for a urinary tract infection. The Unasyn was discontinued this morning. The infectious disease specialist is concerned about MRSA as there is evidence of Gram-positive cocci from the blood cultures. Choose an appropriate option for empiric therapy of the pneumonia: Answer A Ampicillin + tigecycline B Cefoxitin + vancomycin C Piperacillin/tazobactam + metronidazole D Piperacillin/tazobactam + vancomycin E Piperacillin/tazobactam + tigecycline
D
A patient comes to the clinic with fever, chills, muscle aches and a severe headache. She was recently on a week-long camping trip in South Carolina with her extended family. The patient appears to have a tick bite and is suspected to have Rocky Mountain spotted fever. Rickettsia ricketsii serology is ordered. Which of the following medications is the best treatment option for this patient? Answer A Rifampin 300 mg x 5 days B Metronidazole 1 gram x 7 days C Tobramycin 5 mg/kg/d divided Q8H x 7 days D Doxycycline 100 mg BID x 7 days E Acyclovir 400 mg TID x 10 days
D
Chief Complaint: "I need antibiotics for my foot" History of Present Illness: DR is a 58 y/o male with type 2 diabetes who presented to the hospital with concerns about an infection on his left foot that has not healed over 3-4 months. It started when he picked a scab on the bottom of his foot. The infection covers about 6 inches with mostly open areas on the lateral side of the left foot and there is superficial cellulitis on the dorsal surface of the foot. Two months prior, he took 10 days of cefuroxime for the same infection and it showed improvement until the day before he presented. Allergies: NKDA Past Medical History: Type 2 diabetes x 10 years (poorly controlled) and hypertension Medications: Glucophage XR 1,000 mg daily, lisinopril 20 mg daily Physical Exam / Vitals: Height: 5'8" Weight: 265 pounds BP: 165/98 mmHg HR: 98 BPM RR: 16 BPM Temp: 100.2°F Pain: 5/10 General: Obese male, unable to walk in current state Lungs: clear CV: RRR GI: Normal bowel sounds, some tenderness to palpation in RUQ Ext: As noted in HPI. Very faint/absent peripheral pulses. Labs: Na (mEq/L) = 142 (135 - 145) K (mEq/L) = 4.3 (3.5 - 5) Cl (mEq/L) = 102 (95 - 103) HCO3 (mEq/L) = 28 (24 - 30) BUN (mg/dL) = 17 (7 - 20) SCr (mg/dL) = 1.2 (0.6 - 1.3) Glucose (mg/dL) = 258 (100 - 125) Ca (mg/dL) = 10.1 (8.5 - 10.5) Mg (mEq/L) = 2.0 (1.3 - 2.1) PO4 (mg/dL) = 4.1 (2.3 - 4.7) WBC (cells/mm3) = 12.6 (4 - 11 x 10^3) Hgb (g/dL) = 14.1 (13.5 - 18 male) Hct (%) = 41.2 (38 - 50 male) Plt (cells/mm3) = 341 (150 - 450 x 10^3) PMNs (%) = 87 (45 - 73) Bands (%) = 5 (3 - 5) Eosinophils (%) = 1 (0 - 5) Basophils (%) = 0 (0 - 1) Lymphocytes (%) = 22% (20 - 40) Monocytes (%) = 1 (2 - 8) AST (IU/L) = 29 (10 - 40) ALT (IU/L) = 32 (10 - 40) Albumin (g/dL) = 4.1 (3.5 - 5) A1C (%) = 9.8 Tests: Xray left foot: soft tissue swelling, unable to rule out osteomyelitis. Recommend MRI. Plan: Wound management for I&D. Surgery consult for viability of lateral toes and schedule for amputation as needed. Question While awaiting further testing, DR will require empiric antibiotics. Which of the following regimens provides coverage for the common pathogens? Answer A Linezolid B Clindamycin C Ceftriaxone D Ertapenem E Ciprofloxacin
D Ertapenem
HW is a 68 year-old female who comes to the clinic for an urgent appointment. She has been feeling awful due to her "flu-like" symptoms and she cannot get any rest because of her coughing. Her past medical history is significant for heart failure, status-post breast cancer, peptic ulcer disease and gout. HW is diagnosed with pneumonia. Which is the best treatment regimen for her community-acquired pneumonia? Answer A Clarithromycin 500 mg PO Q12H B Cefpodoxime 500 mg PO Q12H C Doxycycline 100 mg PO Q12H D Moxifloxacin 400 mg PO daily E Patient should be admitted to the hospital for intravenous therapy
D Moxifloxicin A respiratory fluoroquinolone is one treatment option for patients at risk for drug resistant S. pneumoniae community acquired pneumonia. This patient is at risk due to her age and co-morbidities. A beta-lactam plus a macrolide is another option.
A physician is examining a patient in a clinic who is found to have tularemia. Which medication is the best treatment option to treat tularemia? Answer A Azithromycin B Metronidazole C Doxycycline D Meropenem E Gentamicin
E
GR is a 72 year-old female with atrial fibrillation and degenerative joint disease. She has been well-controlled on warfarin, with an INR in the range of 2.2-2.7 for over a year. She has recently been started on rifampin therapy. What is likely to happen to the level of the INR? Answer A No expected drug interaction. B The INR will increase to a small extent. C The INR will increase to a large extent. D The INR will decrease to a small extent. E The INR will decrease to a large extent.
E
T is in the intensive care unit for a severe intra-abdominal infection. It was stated he had symptoms for a couple of days, but initially refused to see a doctor. Looking at his chart, the pharmacist notices that he has an allergy to penicillin (hives). The team wants to start broad spectrum antibiotics immediately. Which drug regimen would be best to recommend? Answer A Cefepime and metronidazole B Imipenem/cilastatin C Zosyn and metronidazole D Doribax E Levaquin and metronidazole
E Levaquin and metronidazole
A pharmacist is working in the emergency department. A medical intern asks how to treat a patient who has tested positive for syphilis. The intern explains that the patient does not know how long he has had the disease and has stated that he has had multiple sexual partners over the last few years. Which regimen would be best to treat this patient's syphilis? Answer A Ceftriaxone 250 mg IM x 1 B Azithromycin 1 gram PO x 1 C Aqueous penicillin G 3-4 million units IV Q4H x 10 days D Penicillin G benzathine 2.4 million units IM x 1 E Penicillin G benzathine 2.4 million units IM weekly x 3 weeks
E Since the patient has had syphilis for an unknown duration, it is best to treat with penicillin G benzathine weekly for 3 weeks
AP is a 2 1/2 year old female who presents to the pediatrician's office with her mother. She has been complaining of ear pain, has had a decreased appetite and a fever up to 102.4 degrees F. She is 34 inches tall and weighs 25 lb. Based on the severity of symptoms, the pediatrician tells the mother that she will need antibiotics at this time for acute otitis media. He notices an allergy to amoxicillin listed on her profile with the reaction listed as rash on her trunk and arms. Which of the following antibiotics would be recommended? Answer A Clindamycin B Azithromycin C Levofloxacin D Doxycycline E Cefuroxime
E Cefuroxime The American Academy of Pediatrics recommendation is to use a 2nd or 3rd generation cephalosporin, since the reaction to amoxicillin was not severe and risk of cross-reactivity is low. The therapeutic alternatives that are appropriate for use in children do not have reliable activity against the primary pathogens in otitis media. This is one occasion on the exam where another beta-lactam is the appropriate choice in a patient with a reported penicillin allergy.
