Download 1-11-17 PPT

ANTIBIOTICS
By Alaina Darby
CEPHALOSPORINS,
VANC, ETC.
Which of the following would not be an
alternative for use in the presence of
cephalosporinases?
a. cefepime
b.aztreonam
c. fluoroquinolone
d.carbapenem
Which of the following is a first generation
cephalosporin?
a. Cefoxitin
b.Cefepime
c. Cefotaxine
d.Cefazolin
Which of the following has the least grampositive coverage?
a. Cefoxitin
b.Cefepime
c. Cefotaxine
d.Cefazolin
Which of the following has the least gramnegative coverage?
a. Cefoxitin
b.Cefepime
c. Cefotaxine
d.Cefazolin
Which of the following is a second generation
cephalosporin with B. fragilis coverage?
a. Cefaclor
b.Cefotetan
c. Cefotaxine
d.Cefazolin
Which of the following is a third generation
cephalosporin with coverage of Pseudomonas?
a. Cefataroline
b.Cefepime
c. Ceftazidime
d.Cefotaxime
Which of the following is FDA approved for
CABP and ABSSSI?
a. Cefaroline
b.Cefotaxime
c. Cefoxitin
d.Cefazolin
Which of the following is not true of first to
third generation progression?
a. Increased gram-negative bacterial
susceptibility
b.Increased gram-positive bacterial
susceptibility
c. Increased beta-latamase inactivation
d.Increased capability to enter CSF
Which of the following can be used for
meningitis?
a. First generation
b.Second generation
c. Third generation
d.Fourth generation
The dosage of which of the following would
not have to be adjusted when taking
probenecid?
a. Ceftazidime
b.Cefepime
c. Cefazolin
d.Cefoxitin
Which of the following exhibits significant
hemodialysis and is also partially hepatically
excreted?
a. Cefotaxime
b.Ceftriaxone
c. Ceftazidime
d.Cefpodoxime
Which of the following adverse reactions is not
common with cephalosporins?
a. Nephrotoxicity at high dosage
b.Phlebitis with IV administration
c. Superinfections
d.Diarrhea and GI disturbance
Which of the following adverse reactions is
most common with ceftriaxone?
a. Nephrotoxicity at high dosage
b.Phlebitis with IV administration
c. Superinfections
d.Diarrhea and GI disturbance
The N-methylthiotetrazole side chain in some
cephalosporins can cause what?
a. Neurotoxicity
b.Nephrotoxicity
c. Disulfiram-like effects
d.Anticholinergic effects
Which of the following gives the broadest
spectrum of any beta-lactam antibiotic?
a. Vancomycin
b.Methicillin
c. Imipenem
d.Cefuroxime
Which is true of Imipenem?
a. Well absorbed when given orally
b.Good distribution to body tissues and into
the CSF
c. Administered with cilastatin to inhibit betalactamases
d.Excreted by both glomerular filtration and
active secretion
The hospital has run out of cilastatin but needs
an effective treatment for P. aeruginosa. Which
of the following would be chosen?
a. Cephalexin
b.Meropenem
c. Ertapenem
d.Imipenem
Which of the following has the longest serum
half-life?
a. Doripenem
b.Meropenem
c. Ertapenem
d.Imipenem
Which of the following would be used for
intra-abdominal and pelvic infections?
a. Doripenem
b.Meropenem
c. Ertapenem
d.Imipenem
Which of the following describes the spectrum of
aztreonam?
a. Broad and useful for gram negative and positives
b.Narrow and useful for gram negative anaerobes
c. Narrow and useful for gram negative aerobes
d.Narrow and useful for gram positive anaerobes
Which of the following is not given primarily by
parenteral administration?
a. Bacitracin
b.Vancomycin
c. Aztreonam
d.Imipenem
Which of the following would be most targeted
to Staphylococcus endocarditis?
a. Bacitracin
b.Vancomycin
c. Aztreonam
d.Imipenem
Which of the following is useful for its CSF
distribution?
a. Bacitracin
b.Vancomycin
c. Aztreonam
d.Imipenem
Which of the following is used topically?
a. Bacitracin
b.Vancomycin
c. Aztreonam
d.Imipenem
For which of the following would renal
function be most important for excretion?
a. Bacitracin
b.Vancomycin
c. Aztreonam
d.Imipenem
Which of the following is most selective for P.
aeruginosa?
a. Bacitracin
b.Vancomycin
c. Aztreonam
d.Imipenem
Which of the following has been found to be
resistant to vancomycin?
a. Staphylococci
b.Enterococci
c. Streptococci
d.Clostridium
Which of the following would be given for a
Chlostridium difficile infection?
a. IV vancomycin
b.Oral vancomycin
c. IV imipenem
d.Oral imipenem
Which of the following is not an adverse effect
of vancomycin?
a. Ototoxicity
b.Hepatotoxicity
c. Nephrotoxicity
d.Red man syndrome
Which of the following drugs would not
precipitate adverse effects when given in
conjunction with vancomycin?
a. Rifampin
b.Furosemide
c. Aminoglycoside
d.Cyclosporine
When would vancomycin be considered a first
line therapy?
a. Antibiotic associated colitis
b.Empiric prophylaxis when MSSA is suspected
c. Pseudomembranous colitis caused by C.
difficile
d.Oxacillin resistant Staphylococcus aureus
PROTEIN SYNTHESIS
INHIBITORS
Which of the following is not true of
aminoglycosides?
a. They are basic compounds
b.An aminocyclitol is part of their structure
c. They can be combined with acids
d.They can be used with beta-lactams
Which of the following is true of the aminoglycoside
mechanism of action?
a. Their movement through the inner membrane is passive
b.Their movement through the cytoplasmic membrane is
passive
c. Their movement through the inner membrane is energy
dependent
d.Their movement through the outer membrane is energy
dependent
Which of the following is the rate limiting step to
aminoglycoside action?
a. Diffusion through porin channel of outer membrane
b.Diffusion through porin channel of cytoplasmic
membrane
c. Energy dependent transportation across outer membrane
d.Energy dependent transportation across cytoplasmic
membrane
Which of the following is true of
aminoglycoside movement in the electron
transport system?
a. They displace Mg++ on the membrane
b.They displace Ca++ on the membrane
c. Transport is blocked by increased pH
d.Transport is blocked by hypoosmolarity
Which of the following binds reversibly to the
30S ribosomal subunit?
a. Tetracyclines
b.Aminoglycosides
c. Microlides
d.Chloramphenicol
Which of the following is considered
bactericidal as a sole agent in growing cells?
a. Aminoglycosides
b.Tetracyclines
c. Streptogramins
d.Erythromycin
How can aminoglycoside activity be increased?
a. Increased membrane permeability due to
inhibition of aerobic pathways
b.Increased membrane permeability due to
aberrant protein production
c. Decreased efflux due to inhibition of
bacterial mRNA translation
d.Decreased efflux due to adenylase and
acetylase activity
Which of the following is not a mechanism of
aminoglycoside resistance?
a. Inactivation by microbial enzymes
b.Reduced transport of drug into the cell
c. Increased drug efflux from the cell
d.Alteration of target site
Which of the following aminoglycosides is
most resistant to inactivation?
a. Gentamicin
b.Netilmicin
c. Tobramycin
d.Amikacin
Which of the following does not describe the
distribution of aminoglycosides?
a. Hair cells of the ear and tubular cells of the
renal cortex exhibit higher concentrations
b.Plasma concentration decreases with fever
c. It rapidly distributes and crosses into the
CNS
d.Apparent Vd is decreased in obese patients
Which of the following is a type of toxicity
resulting from aminoglycoside treatment that
is not reversible?
a. Ototoxicity
b.Hepatotoxicity
c. Nephrotoxicity
d.Neurotoxicity
Which of the following is a type of toxicity
resulting from aminoglycoside treatment that
is reversible with calcium administration?
a. Ototoxicity
b.Hepatotoxicity
c. Nephrotoxicity
d.Neurotoxicity
Which of the following would be least likely to
be treated with gentamicin in combination
with a cell wall inhibitor?
a. Enterococcus endocarditis
b.Pseudomonas aeruginosa
c. Staphylococcus epidermidis
d.Methicillin resistant Staphylococcus aureus
Which of the following has the best activity
against P. aeruginosa?
a. Gentamycin
b.Tobramycin
c. Amikacin
d.Streptomycin
Which of the following would not be treated
with an aminoglycoside?
a. Pseudomonas
b.Eneterobacter
c. Clostridium
d.Serratia
For which of the following would
aminoglycosides not be a first line agent?
a. Plague
b.Tularemia
c. MRSA
d.MDR tuberculosis
For which of the following would a tetracycline
not be considered as the drug of choice?
a. Mycoplasma
b.Protozoa
c. Chlamydia
d.Spirochetes
Which of the following is not a mechanism of
resistance to tetracycline?
a. Reduced transport into the cell
b.Increased efflux from the cell
c. Production of ribosomal protection protein
d.Alteration of ribosomal drug target site
When counseling, which of the following
would not cause an interaction with
tetracycline that you would want to warn your
patient about?
a. Milk
b.Pepto-Bismol
c. Grapefruit juice
d.Rolaids
Into which of the following does tetracycline
not cross or enter in significant amounts?
a. Placenta
b.CSF
c. Liver
d.Tumors
Which of the following is most likely to cause
vestibular toxicity?
a. Minocycline
b.Chlortetracycline
c. Demeclocycline
d.Tetracycline
Which of the following is most likely to cause
photosensitivity?
a. Minocycline
b.Chlortetracycline
c. Demeclocycline
d.Tetracycline
Which of the following is useful for
meningococcal prophylaxis but may cause
vomiting and vertigo?
a. Minocycline
b.Chlortetracycline
c. Demeclocycline
d.Tetracycline
Which of the following mechanisms of
resistance to tetracyclines does tigecycline
overcome with high affinity binding?
a. Reduced transport into the cell
b.Increased efflux from the cell
c. Production of ribosomal protection protein
d.Enzymatic inactivation
Which of the following would not be treated
with tigecycline?
a. Staphylococcus aureus
b.Streptococcus epidermidis
c. Pseudomonas aeruginosa
d.Streptococcus pyrogenes
Which of the following mechanisms of resistance is the most
frequently displayed in chloramphenicol due to acquisition
of a plasmid resistance gene in gram negative bacteria?
a. Alteration in cell wall permeability
b.Alteration in ribosomal protein
c. Increased drug efflux
d.Inactivation by enzymatic acetylation
Which of the following is a form of toxicity that
is common in chloramphenicol?
a. Ototoxicity
b.Hepatotoxicity
c. Bone marrow toxicity
d.Neurotoxicity
Which of the following drugs has good
distribution into the CSF?
a. Gentamicin
b.Doxycycline
c. Chloramphenicol
d.Tigecycline
Which of the following groups of
antimicrobials is only given parenterally?
a. Tetracyclines
b.Chloramphenicol
c. Macrolides
d.Aminoglycosides
Jordan experiences a neuromuscular blockade
after administration of an antimicrobial into a
serosal cavity. Which of the following
antimicrobials most likely caused this reaction?
a. Gentamicin
b.Doxycycline
c. Chloramphenicol
d.Daptomycin
Which of the following would be used to treat
serious VRE infections?
a. Minocycline
b.Doxycycline
c. Chloramphenicol
d.Tigecycline
Which of the following drugs requires dosage
modification with renal failure?
a. Tobramycin
b.Minocycline
c. Tigecycline
d.Linezolid
Which of the following drugs is associated with
gray baby syndrome?
a. Minocycline
b.Doxycycline
c. Chloramphenicol
d.Tigecycline
Which of the following drugs exhibits biliary
excretion?
a. Gentamicin
b.Tigecycline
c. Chloramphenicol
d.Daptomycin
Which of the following is least likely to cause
superinfections due to broad spectrum
effects?
a. Minocycline
b.Doxycycline
c. Chloramphenicol
d.Tigecycline
Which of the following is not included in the
cross-resistance conferred by erm gene?
a. Erythromycin
b.Clindamycin
c. Linezolid
d.Streptogramin B
Which of the following is not a mechanism of
resistance to erythromycin?
a. Decreased transport
b.Modification of ribosomal target by
methylases
c. Chromosomal alteration of 30S ribosomal
protein
d.Hydrolysis of drug by esterases
Which of the following is true of
erythromycin?
a. Broad spectrum of activity
b.Gastric acidity increases absorption
c. Metabolized in the liver
d.Excreted primarily in bile and feces
Which of the following is not true of
erythromycin?
a. Used in patients allergic to penicillins
b.The estolate formulation causes fewer
adverse effects
c. Drug interactions due to CYP3A are common
d.Very safe with few adverse effects
Which of the following is not true of
clarithromycin?
a. Should not be taken with food
b.Better tissue penetration than erythromycin
c. Undergoes first pass metabolism
d.Dosage adjusted for creatinine clearance
For which of the following is would
clarithromycin be considered the drug of
choice?
a. Legionella pneumophila
b.Helicobacter pylori
c. Chlamydia trachomatis
d.Mycobacterium avium complex
Which of the following is a benefit of
clarithromycin over erythromycin?
a. Fewer drug interactions
b.Wider range of therapeutic uses
c. Greater acid-stability
d.No adjustment for renal impairment
What is not a reason that a doctor might
choose to treat with azithromycin over
erythromycin?
a. Less GI toxicity
b.Fewer drug interactions
c. Longer half life
d.Decreased oral absorption with food
For which of the following is azithromycin not
the drug of choice?
a. Campylobacter
b.Legionella
c. Lyme disease
d.Mycobacterium avium complex
Which of the following is not a characteristic of
telithromycin that is also a characteristic of an
ideal antimicrobial drug?
a. Higher affinity binding
b.Less susceptible to resistance
c. Metabolized in the liver
d.Absorption not affected by food
Which of the following is not an adverse effect
associated with telithromycin?
a. Tachycardia
b.GI intolerance
c. Hepatic toxicity
d.QT prolongation
Which of the following patients would not
have a contraindication to taking
telithromycin?
a. Bradycardia
b.Myastenia gravis
c. Currently taking procainamide
d.Hyperkalemia
Based on telithromycin’s spectrum, what is a
therapeutic use of the antimicrobial?
a. Community acquired pneumonia
b.Hospital acquired pneumonia
c. Community acquired skin infections
d.Hospital acquired skin infections
Which of the following is especially effective
for anaerobes?
a. Erythromycin
b.Clarithromycin
c. Clindamycin
d.Streptogramins
Which of the following is a difference in
clindamycin from erythromycin?
a. Does not penetrate to CSF
b.Biliary excretion
c. Acid stability
d.Can be administered orally
In which of the following situations would
clindamycin not be used?
a. Clostridium difficile
b.Bacteroides fragilis
c. Pneumocystis jiroveci
d.Staphylococcus aureus
Which of the following is the composition of
streptogramins?
a. 30% dalfopristin, 70% quinupristin
b.70% dalfopristin, 30% quinupristin
c. 70% daptomycin, 30% quinolone
d.30% daptomycin, 70% quinolone
Where do streptogramins bind on the
ribosome?
a. Peptidyltransferase domain
b.23S RNA on ribosomal subunit
c. tRNA binding domain
d.30S ribosomal subunit
Streptogramins are not used to treat which of
the following?
a. Vancomycin-resistant Enterococcus faecium
b.Vancomycin-resistant Enterococcus faecalis
c. Methicillin-resistant Staphylococcus aureus
d.Streptococcus pyrogenes
Which of the following is not a common side
effect of streptogramins?
a. Thrombophlebitis
b.Gastrointestinal upset
c. Increased conjugated bilirubin
d.Arthralgias and myalgias
For which of the following is linezolid
bacteriocidal?
a. Enterococcus faecium
b.Enterococcus faecalis
c. Staphylococcus aureus
d.Streptococcus pyrogenes
For which of the following resistant infections
is linezolic reserved?
a. Methicillin-resistant Staphylococcus aureus
b.Methicillin-resistant Staphylococcus
epidermidis
c. Vancomycin-resistant Enterococcus faecium
d.Penicillin resistant Staphylococcus aureus
Which of the following is not true of linezolid?
a. Good oral absorption
b.No food effect on absorption
c. Does not induce CYP450 enzymes
d.Undergoes non-enzymatic oxidation
Which of the following have a possible drug
interaction with linezolid due to drug
metabolism?
a. Erythromycin
b.Cabenzapine
c. Phenylpropanolamine
d.Rifampin
Someone with which of the following
conditions would be least likely to take
linezolid as an oral suspension?
a. Phenylketonuria
b.Diabetes mellitus
c. Congestive heart failure
d.Renal failure
Which of the following is not a characteristic of
an ideal drug that is also a characteristic of
daptomycin?
a. Bactericidal
b.No resistance
c. No CYP450 interactions
d.Orally administered
For which of the following is daptomycin not a
therapeutic use?
a. Methicillin-resistant Staphylococcus aureus
b.Vancomycin-susceptible Enterococcus
faecalis
c. Vancomycin-resistant Enterococcus faecium
d.Streptococcus pyrogenes