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LEVEL II > PHARMA 3/4 > Flashcards

PHARMA 3/4 Flashcards

1
Q

Which of the following is a pharmacokinetic basis in choosing antimicrobial therapy?

A. Identification of the infecting organism
B. Determination of antimicrobial susceptibility of infecting organism
C. Confirm the presence of an infection
D. Penetration of the drug to the site of infection

A

D. Penetration of the drug to the site of infection

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2
Q

Which one of the following is a non-B lactam β-lactamase inhibitor that provides clinically useful inhibition against narrow-spectrum, ESBL-type, chromosomal AmpC, and KPC-type β-lactamases (although not metallo-β-lactamases)?

A. Sulbactam
B. Clavulanic acid
C. Tazobactam
D. Avibactam

A

D. Avibactam

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3
Q

Which of the following is a monobactam?

A. Avibactam
B. Meropenem
C. Tazobactam
D. Aztreonam

A

D. Aztreonam

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4
Q

Which of the following statements is correct regarding proper selection of antimicrobial agents?

A. All patients who present with fever should be started immediately with antibiotics
B. One should have an accurate differential diagnosis that includes likely bacterial etiology
C. The presence of a positive culture in the absence of signs or symptoms of infection should always be given with antibiotics
D. Always give antibiotics for 7 days

A

B. One should have an accurate differential diagnosis
that includes likely bacterial etiology

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5
Q

Which of the following is NOT an indication of combination therapy?

A. If the patient has pneumonia and meningitis it is necessary to give a combination therapy
B. Preventing resistance to monotherapy
C. Accelerating the rapidity of microbial killing
D. Enhancing therapeutic efficacy by use of synergistic interaction or enhancing kill by a drug based on mutation generated by resistance to another drug

A

A. If the patient has pneumonia and meningitis it is
necessary to give a combination therapy

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6
Q

Seizure is one of the common adverse reactions of which one of these antibiotics?

A. Ertapenem
B. Aztreonam
C. Imepenem
D. Meropenem

A

C. Imepenem

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7
Q

A 30-year-old male diagnosed with HIV infection with no subjective complaints but with CD4 count of less than 150 cell/mm3 was given cotrimoxazole by his attending physician. This type of antimicrobial therapy is called

A. prophylactic therapy
B. empirical therapy
C. post-treatment suppressive therapy
D. definitive therapy

A

A. prophylactic therapy

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8
Q

Which of the following refers to the lowest concentration of the drug that prevents visible bacterial growth after 24 hours of incubation in a specified growth medium?

A. Susceptibility testing
B. Minimum inhibitory concentration
C. Optimal concentrations
D. Area under the curve

A

B. Minimum inhibitory concentration

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9
Q

Which of the following carbapenem antibiotics has no activity against Pseudomonas aeruginosa?

A. Imepenem
B. Doripenem
C. Ertapenem
D. Meropenem

A

C. Ertapenem

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10
Q

Which of the following is an anti-MRSA cephalosporin?

A. Ceftaroline
B. Cefepime
C. Linezolid
D. Vancomycin

A

A. Ceftaroline

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11
Q

Which of the following is a structural analogue of ceftazidime that has enhanced activity against Pseudomonas, including activity against strains resistant to ceftazidime through β-lactamase overexpression?

A. Ceftolozane
B. Avibactam
C. Cefepime
D. Aztreonam

A

A. Ceftolozane

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12
Q

Which of the following is NOT a mechanism of resistance to antimicrobial killing?

A. Resistance due to reduced entry of drug into pathogen
B. Resistance due to drug influx
C. Resistance due to destruction of antibiotic
D. Resistance due to altered target structure

A

B. Resistance due to drug influx

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13
Q

Which one of the following is NOT a common property of penicillin?

A. Penicillins are not absorbed orally
B. Eliminated rapidly by glomerular filtration and renal tubular secretion
C. Inflammation increases the concentration of penicillin in the CSF
D. Therapeutic concentrations are achieved readily in tissue

A

A. Penicillins are not absorbed orally

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14
Q

Concurrent administration of a β-lactamase inhibitor such as clavulanate or sulbactam to this type of agents markedly expands their spectrum of activity, particularly against H. influenzae, E. coli, Klebsiella, Proteus, and B. fragilis

A. Aminopenicillins
B. Isoxazolyl penicillin
C. Carbapenems
D. Monobactam

A

A. Aminopenicillins

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15
Q

In choosing an antimicrobial agent, which of the following principles is correct?

A. Distinguish new infection from failure of initial therapy
B. If therapy is not working, change the present antimicrobial therapy immediately
C. A higher threshold for empirical therapy should be used in critically ill patients
D. Host factors do not affect breadth of empirical therapy

A

A. Distinguish new infection from failure of initial
therapy

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16
Q

Which of the following is NOT a characteristic of isoxazolyl penicillin?

A. Can be given in patients with skin and soft tissue infection
B. Can be useful against Gram-negative bacteria
C. Excellent activity against MSSA
D. CSF penetration with inflammation

A

B. Can be useful against Gram-negative bacteria

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17
Q

Which of the following antibiotics will you give in a patient diagnosed with syphilis?

A. Cloxacillin
B. Vancomycin
C. Clarithromycin
D. Penicillin G

A

D. Penicillin G

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18
Q

A 45-year-old male was admitted in a certain hospital in Cagayan de Oro due to fever, headache, and neck rigidity. Chest x-ray, CT scan, lumbar tap and other lab tests were done. The presentation of the patient and the laboratory results are consistent of an Acute Bacterial Meningitis. His attending physician started him on ceftriaxone 2 grams IV every 12 hours. Which of the following is NOT a mechanism of resistance of ceftriaxone?

A. Low-affinity of the antibiotics to target PBPs
B. Efflux of drug across the outer membrane of gram negative bacteria
C. Hydrolysis by esterases produced by Enterobacteriacea
D. Destruction of antibiotics by β-lactamases

A

C. Hydrolysis by esterases produced by Enterobacteriacea

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19
Q

Which of the following antibiotics inhibits the last step in peptidoglycan synthesis?

A. Vancomycin
B. Erythromycin
C. Metronidazole
D. Penicillin

A

D. Penicillin

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20
Q

Which of the following is the mechanism of action of doxycycline?

A. Inhibition of and misreading of
B. Binding to 30S subunit and inhibiting the binding of aminoacyl-t-RNA to A site
C. Binding to 50S subunit
D. Inhibiting peptidyl transferase activity

A

B. Binding to 30S subunit and inhibiting the binding of aminoacyl-t-RNA to A site

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21
Q

Which of the following is the currently available glycylcycline?

A. Linezolid
B. Tigecycline
C. Minocycline
D. Vancomycin

A

B. Tigecycline

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22
Q

Which of the following is a protein synthesis inhibitor that targets the ribosome?

A. Polymixin
B. Amikacin
C. Azithromycin
D. Quinupristin

A

C. Azithromycin
D. Quinupristin

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23
Q

Which of the following aminoglycosides can be used topically only and not systemically?

A. Neomycin
B. Amikacin
C. Gentamycin
D. Paromomycin

A

A. Neomycin

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24
Q

Which of the following is NOT a characteristic of aminoglycosides?

A. They are susceptible to anaerobic bacteria
B. Act by interfering with protein synthesis
C. Very poorly absorbed from the GI tract
D. Exhibit ototoxicity and nephrotoxicity

A

A. They are susceptible to anaerobic bacteria

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25
Q

Which of the following is a characteristic of vancomycin?

A. It is a beta-lactam antibiotic, inhibits cell wall synthesis active only against Pseudomonas aeruginosa
B. It is a glycopeptide, inhibits cell wall synthesis and is active only against Gram-positive bacteria
C. It is a glycopeptide, inhibits cell wall synthesis active only against Gram-negative bacteria
D. It is a glycopeptide, that alters permeability of cell membrane and is active against anaerobic bacteria

A

B. It is a glycopeptide, inhibits cell wall synthesis and
is active only against Gram-positive bacteria

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26
Q

Which of the following is an adverse effect of chloramphenicol?

A. Ototoxicity
B. Hepatotoxicity
C. Nephrotoxicity
D. Pancytopenia

A

D. Pancytopenia

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27
Q

Which of the following can be given for eradication of nasal carriage caused by Staphylococcus aureus?

A. Bacitracin
B. Daptomycin
C. Polymixin B
D. Mupirocin

A

D. Mupirocin

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28
Q

Which of the following is a bacteriostatic antibiotic?

A. Streptomycin
B. Azithromycin
C. Vancomycin
D. Amikacin

A

B. Azithromycin

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29
Q

Which of the following antibiotics can be inactivated by pulmonary surfactant?

A. Dalbavancin
B. Daptomycin
C. Tedizolid
D. Vancomycin

A

B. Daptomycin

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30
Q

Bacteria may be resistant to amikacin through which of the following mechanisms?

A. Mutations that decrease the affinity of PBPs for amikacin
B. Low affinity of the drug for bacterial ribosome
C. Decreased accumulation of amikacin as a result of decreased antibiotic influx
D. Production of ribosomal protection protein that displaces amikacin from its target

A

B. Low affinity of the drug for bacterial ribosome

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31
Q

Which of the following aminoglycosides can be given to patients with leishmaniasis?

A. Amikacin
B. Streptomycin
C. Paromomycin
D. Gentamicin

A

C. Paromomycin

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32
Q

Aminoglycosides inhibit protein synthesis by which of the following mechanisms?

A. By preventing access of aminoacyl tRNA to the acceptor site on the mRNA-ribosome complex
B. By binding irreversibly to the 50s ribosomal subunit
C. By reversible binding and inhibition of isoleucyl tRNA synthase
D. By causing misreading and premature termination
of mRNA translation

A

D. By causing misreading and premature termination of mRNA translation

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33
Q

Antibiotic associated colitis is a common side effect of which of the following antibiotics?

A. Azithromycin
B. Quinupristin
C. Clindamycin
D. Tigecyclin

A

C. Clindamycin

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34
Q

Which of the following antibiotics can be used to treat Helicobacter pylori infection in combination with omeprazole?

A. Minocycline
B. Clindamycin
C. Doxycycline
D. Clarithromycin

A

D. Clarithromycin

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35
Q

A 50-year-old male diabetic sought consult with his attending physician due to cough for 3-week duration not relieved by intake of azithromycin. About 2 years ago patient was treated for 3 months for tuberculosis, but lost to follow up. Gene
expert done showed resistance to INH. Which of the following can be given to this patient?

A. Neomycin
B. Streptomycin
C. Gentamycin
D. Paromomycin

A

B. Streptomycin

36
Q

A 40-year-old male with severe mitral regurgitation was admitted due to one-week fever. Blood culture done showed Enterococcus species resistant to vancomycin. What will you give to this patient?

A. Ceftriaxone
B. Linezolid
C. Ceftaroline
D. Vancomycin

A

B. Linezolid

37
Q

Aminoglycosides frequently are used in combination with which of the following cell wall-active agent for the therapy of serious proven or suspected bacterial infections?

A. Tetracyclines
B. Meropenem
C. Lipopeptides
D. Polymyxins

A

B. Meropenem

38
Q

Which of the following is NOT a therapeutic use of aminoglycosides?

A. Urinary tract infection
B. Meningitis caused by Pseudomonas aeruginosa
C. Pneumonia caused by methicillin-resistant Staphylococcus aureus
D. Peritonitis caused by Gram-negative organism

A

C. Pneumonia caused by methicillin-resistant Staphylococcus aureus

39
Q

Which of the following is NOT an adverse reaction of tetracyclines?

A. Vestibular toxicity
B. Peripheral neuropathy
C. GI irritation
D. Hepatotoxicity

A

B. Peripheral neuropathy

40
Q

Which of the following is the aminoglycoside of first choice because of its lower cost and reliable activity?

A. Tobramycin
B. Gentamycin
C. Streptomycin
D. Kanamycin

A

B. Gentamycin

41
Q

A 25-year-old male was admitted at a certain Hospital in Cagayan de Oro City due to fever associated with chills, headache, muscle aches, abdominal pain and conjunctival suffusion. Patient had history of wading to flooded water one week prior to admission. Patient was diagnosed to have Leptospirosis. Which of the following antibiotics will you give to this patient?

A. Penicillin G
B. Amoxicillin-clavulanic acid
C. Cloxacillin
D. Ampicillin

A

A. Penicillin G

42
Q

Which of the following types of antimicrobial therapy is used as a substitute for universal prophylaxis and as early targeted therapy in high -risk patients who already have a laboratory or other test indicating that an asymptomatic patient is infected?

A. Preemptive therapy
B. Definitive therapy
C. Postexposure prophylaxis
D. Empirical therapy

A

A. Preemptive therapy

43
Q

Which of the following antibiotics inhibit folate metabolism?

A. Macrolides
B. Trimethoprim
C. Quinolones
D. Penicillin

A

B. Trimethoprim

44
Q

Which of the following is an anti-MRSA cephalosporins?

A. Vancomycin
B. Ceftriaxone
C. Cefepime
D. Ceftaroline

A

D. Ceftaroline

45
Q

What is the most prevalent mechanism of resistance to cephalosporins?

A. Efflux of drug across the outer membrane of Gram-negative bacteria
B. Low-affinity binding of antibiotic to target PBPs
C. Failure of antibiotics to penetrate outer membrane of gram-negative bacteria to reach PBP targets
D. Destruction of the cephalosporins by hydrolysis of the B-lactam ring

A

D. Destruction of the cephalosporins by hydrolysis of the B-lactam ring

46
Q

Diarrhea is more frequent among which of the following cephalosporins?

A. Cefoperazone
B. Cefoxitin
C. Cefotaxime
D. Cefixime

A

A. Cefoperazone

47
Q

A 60-year-old male was admitted due to cough, fever and shortness of breath. Chest x-ray showed Pneumonia. Sputum culture showed Pseudomonas aeruginosa. Which of the following antibiotics is the best agent for this patient?

A. Cefazolin
B. Ceftazidime
C. Cefuroxime
D. Ceftriaxone

A

B. Ceftazidime

48
Q

Which group of cephalosporins is highly resistant to beta-lactamases?

A. Second generation
B. Third generation
C. First generation
D. Fourth generation

A

D. Fourth generation

49
Q

Concurrent administration of a β-lactamase inhibitor such as clavulanate or sulbactam to this type of agents markedly expands their spectrum of activity, particularly against H. influenzae, E. coli, Klebsiella, Proteus, and B. fragilis:

A. Aminopenicillin
B. Carbapenems
C. Isoxazolyl penicillin
D. Monobactam

A

A. Aminopenicillin

50
Q

Which of the following antibiotics inhibits the last step in peptidoglycan synthesis?

A. Penicillin
B. Metronidazole
C. Vancomycin
D. Erythromycin

A

A. Penicillin

51
Q

Classification of antibiotics is based on:

A. Class and spectrum of microorganisms it kills
B. Host factors
C. Goals of antimicrobial therapy
D. Mechanism of resistance to antimicrobial

A

A. Class and spectrum of microorganisms it kills

52
Q

Nucleoside reverse transcriptase inhibitors such as zidovudine are 2’deoxyribonucleoside analogues that are converted to their 5’-triphosphate form and compete with natural nucleotides. This mechanism of resistance is an example of resistance due to

A. Enhanced excision of incorporated drug
B. Drug efflux
C. Reduced entry of drug into pathogen
D. Altered target structure

A

A. Enhanced excision of incorporated drug

53
Q

Resistance of Staphylococcus aureus to B-lactams antibiotics is caused by

A. The action of acetyltransferase
B. Decreased permeability of the bacterial cell wall to the drug
C. Staphylococcus aureus being an intracellular pathogen
D. Destruction of antibiotics by B-lactamase

A

D. Destruction of antibiotics by B-lactamase

54
Q

Which of the following is the therapeutic use of Aztreonam?

A. Nosocomial pneumonia
B. Community Acquired pneumonia caused by Streptococcus pneumoniae
C. Skin and soft tissue infection causes by MSSA
D. Enterococcus faecalis infections

A

A. Nosocomial pneumonia

55
Q

Aminoglycoside is dose dependent. This means that the ratio of ___ of the antibiotic to the bacteria’s minimum inhibitory concentration is the most important measure of the antibiotic efficacy.

A. Half-life of the antibiotic
B. Peak concentration
C. Time of onset
D. Minimum effective concentration

A

B. Peak concentration

56
Q

The preferred way of administering aminoglycosides is through high dose extended interval for most indications and patient populations. This is not recommended in pregnancy, neonates, = pediatrics, severe renal insufficiency and combination = antibiotic therapy for

A. tuberculosis
B. meningitis
C. peritonitis
D. endocarditis

A

D. endocarditis

57
Q

What is the initial sign of cochlear toxicity of patients undergoing antibiotic treatment with Gentamicin?

A. Headache
B. Vertigo
C. High pitched tinnitus
D. High pitched hearing

A

C. High pitched tinnitus

58
Q

Which of the following adverse effects/toxicities of Aminoglycoside therapy is considered to be irreversible especially with prolonged antibiotic treatment

A. Labyrinthine dysfunction
B. Renal impairment
C. Neuromuscular weakness M
D. Nausea and vomiting

A

A. Labyrinthine dysfunction

59
Q

What is the most common significant finding of aminoglycoside nephrotoxicity?

A. Hyaline and granular casts
B. Mild proteinuria
C. Mild rise in creatinine

A

C. Mild rise in creatinine

60
Q

The preferred aminoglycoside treatment for serious infection of Pseudomonas aeruginosa

A. Amikacin
B. Gentamicin
C. Streptomycin
D. Tobramycin

A

D. Tobramycin

61
Q

Which of the following aminoglycosides has the widest & broadest spectrum
A. Tobramycin
B. Amikacin
C. Streptomycin
D. Gentamicin

A

B. Amikacin

62
Q

Which of the ff aminoglycosides present these toxicity profiles: irreversible vestibular toxicity, optic neural dysfunction presenting as scotomata and peripheral neuritis:

A. Amikacin
B. Netilmicin
C. Streptomycin
D. Tobramycin

A

C. Streptomycin

63
Q

Which of the following is a bacteriostatic drug that inhibits protein synthesis in ribosomes?

A. Vancomycin
B. Gentamicin
C. Bactracin
D. Linezolid

A

D. Linezolid

64
Q

What is the antimicrobial that binds to the 30s subunit of the ribosome?

A. Chloramphenicol
B. Linezolid
C. Clindamycin
D. Doxycyclin

A

D. Doxycyclin

65
Q

Which of the following is the mode of action exhibited by Metronidazole

A. Bind to 30s subunit
B. Bind to 50s subunit
C. DNA replication

A

C. DNA replication

66
Q

Drug is cleared during hemodialysis, thus, should be given after hemodialysis session.

A. Chloramphenicol
B. Vancomycin
C. Erythromycin
D. Quinupristin/dalfopristin

A

B. Vancomycin

67
Q

Which of these drugs cannot be cleared or excreted by hemodialysis?

A. Erythromycin
B. Amakicin
C. Azithromycin.
D. Linezolid

A

A. Erythromycin

68
Q

Vancomycin has the LEAST effective treatment against what pathogen:

A. Strep pneumoniae
B. Strep pyogenes
C. Enterococcus faecalis
D. Enterococcus faecium

A

D. Enterococcus faecium

69
Q

Tetracycline has the least antimicrobial activity against what pathogen?

A. Penicillin resistant streptococcus pneumonae
B. Penicillin susceptible streptococcus pneumonae
C. Methicilin resistant staphylococcus areus
D. Methicilin susceptible staphylococcus areus

A

A. Penicillin resistant streptococcus pneumonae

70
Q

A 21 year old woman waded in the flood waters last night and was asking you for post-prophylactic for leptospirosis. You gave a 5-day course of Doxycycline. What is true of the oral intake of doxycycline?

A. Taken after meals to avoid gastric irritation
B. Taken on an empty stomach because food and dairy products can interfere with gastric absorption
C. Taken with vitamin C to enhance GI absorption
D. Taken with antacids to prevent gastric irritation

A

A. Taken after meals to avoid gastric irritation

71
Q

Which of the following drugs causes Gray Baby Syndrome?

A. Tetracycline
B. Gentamicin
C. Metronidazole
D. Chloramphenicol

A

D. Chloramphenicol

72
Q

Which of the ff drugs causes permanent yellow discoloration of the teeth?

A. Chloramphenicol
B. Tetracycline
C. Daptomycin
D. Gentamycin

A

B. Tetracycline

73
Q

Which of the ff causes the adverse reaction called red man syndrome?

A. metronidazole
B. chloramphenicol
C. doxycycline
D. Vancomycin

A

D. Vancomycin

74
Q

Which of the following antibiotic inhibits protein synthesis as its mechanism of action?

A. Penicillin
B. Quinolone
C. Macrolide

A

C. Macrolide

75
Q

Which of the following is a concentration dependent killing agent?

A. Penicillin
B. Aminoglycosides
C. Carbapenems
D. Cephalosporins

A

B. Aminoglycosides

76
Q

Which of the following factors is NOT generally considered in initial antimicrobial therapy?

A. Age of the patient
B. Anatomic site of the infection
C. Whether the patient is immunocompromised
D. Waiting for the susceptibility and culture

A

D. Waiting for the susceptibility and culture

77
Q

Bacteria producing B-lactamase, develop resistance to antibiotic:

A. Drug efflux
B. Reduced entry of pathogen
C. Altered protein structure
D. Destruction of antibiotic

A

D. Destruction of antibiotic

78
Q

What is the most common adverse effect with the penicillins?

A. Diarrhea
B. Hypersensitivity reactions
C. Nephrotoxicity
D. Bleeding

A

B. Hypersensitivity reactions

79
Q

MOA of Cephalosporin:

A. Inhibit folate metabolism
B. Alter nucleic acid metabolism
C. Inhibit cell wall synthesis

A

C. Inhibit cell wall synthesis

80
Q

Which of the following has no activity against gram positive bacteria and anaerobes

A. Cefixime
B. Ceftriaxone
C. Meropenem
D. Aztreonam

A

D. Aztreonam

81
Q

Antimicrobial drugs act in one of many ways:

  1. By inhibition of cell wall synthesis and function
  2. By alteration of protein synthesis
  3. By inhibition of nucleic acid synthesis
  4. By alteration of target protein structure
A
  1. By inhibition of cell wall synthesis and function
  2. By alteration of protein synthesis
  3. By inhibition of nucleic acid synthesis
82
Q

Which of the following conditions is penicillin used for prophylaxis?

  1. Streptococcal infections
  2. MRSA
  3. Syphilis
  4. Meningitis
A
  1. Streptococcal infections
  2. Syphilis
83
Q

Which of the following agents has excellent effects on MSSA.

  1. Oxacillin
  2. Penicillin V
  3. Cloxacillin
  4. Piperacillin
A
  1. Oxacillin
  2. Cloxacillin
84
Q

Which of the following is anti-pseudomonal?

  1. Amoxicillin + clavulanate
  2. Ampicillin + sulbactam
  3. Amoxicillin + sulbactam
  4. Piperacillin + Tazobactam
A
  1. Piperacillin + Tazobactam
85
Q

Which of the following are anti MRSA cephalosporin?

  1. Ceftaroline
  2. Ceftriaxone
  3. Ceftobiprole
  4. Vancomycin
A
  1. Ceftaroline
  2. Ceftobiprole
86
Q

Which of the following are beta-lactam inhibitors?

  1. Ticarcillin
  2. Clavulanate
  3. Piperacillin
  4. Sulbactam
A
  1. Clavulanate
  2. Sulbactam
87
Q

Which of the ff are the therapeutic uses of first generation cephalosporins

  1. Skin and soft tissue infections
  2. Serious infections due to MSSA
  3. Perioperative surgical prophylaxis
  4. otitis media
A
  1. Skin and soft tissue infections
  2. Serious infections due to MSSA
  3. Perioperative surgical prophylaxis

LEVEL II (16 decks)

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