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More Antibiotics
Tutoring for
Pharmacology
By Alaina Darby
Tuberculosis
Which of the following combinations is first line therapy
for M. tuberculosis?
a. Isoniazid, rifampin, pyrazinamide, and kanamycin
b. Isoniazid, rifampin, paraaminosalicylic acid, and
streptomycin
c. Isoniazid, rifampin, paraaminosalicylic acid, and
ethionamide
d. Isoniazid, rifampin, pyrazinamide, and ethambutol
Which of the following combinations is first line therapy
for M. avium complex?
a. Clarithromycin and ciprofloxacin
b. Clarithromycin and rifampin
c. Clindamycin and ethambutol
d. Clindamycin and azithromycin
Which drugs are included in Rifater?
a. Rifampin and isoniazid
b. Rifampin and pyrazinamide
c. Rifampin, isoniazid, and pyrazinamide
d. Rifampin, isoniazid, pyrazinamide, and ethambutol
When should the fourth drug be omitted in TB
treatment?
a. For the initial 8 week daily treatment of option 1
when drug resistance is <4%
b. For the initial 8 week daily treatment of option 1
when drug resistance is <2%
c. For the 24 day three times a week treatment of
option 3 when drug resistance is <4%
d. For the 24 day three times a week treatment of
option 3 when drug resistance is <2%
Which of the following is not a reason that TB is difficult
to treat and therapy may last up to two years?
a. Organisms multiply slowly
b. Organisms develop resistance
c. Organisms utilize host machinery
d. Organisms live intracellularly
Which of the following does not describe isoniazid?
a. It is effective for intracellular bacteria
b. It is cidal for bacteria living in macrophages
c. It interferes with mycolic acid synthesis
d. It is static for slow growing bacilli
Which of the following does not describe resistance to
isoniazid?
a. Decreased ability to take up the drug
b. Alternate pathway for cell wall synthesis
c. Overproduction of target enzyme
d. Emerges rapidly when used as a single agent
Which of the following is not true of isoniazid
pharmacokinetics?
a. Well absorbed when given orally or can be given IV
or IM
b. Reaches therapeutic levels in CSF with inflamed
meninges
c. Acetylated in the liver by N-acetyl transferase
d. Parental and metabolized compounds excreted
renally
Which of the following adverse reaction can be
corrected by supplementing with pyrodoxime?
a. Hepatotoxicity
b. Allergic reactions
c. Peripheral neuropathy
d. Nausea and vomiting
Which of the following adverse reactions is not dose
related?
a. Hepatotoxicity
b. Allergic reactions
c. Peripheral neuropathy
d. Nausea and vomiting
Peripheral neuropathy is more common for all but
which of the following conditions?
a. Malnourishment
b. Diabetes
c. Cushing’s syndrome
d. Alcoholism
Which of the following decreases the efficacy of
isoniazid?
a. Phenytoin
b. Diazepam
c. Fluoxetine
d. Hydrocortisone
Which of the following does not describe rifampin?
a. Resistance due to decreased binding to DNAdependent RNA polymerase
b. Inhibition of RNA synthesis mediated by binding to
alpha subunit of RNA polymerase
c. Spectrum includes both intra- and extracellular
mycobacterium
d. Produces bactericidal effects and is never given alone
due to emergence of resistance
Which of the following does not describe the
pharmacokinetics of rifampin?
a. Absorption impaired by para-aminosalicylic acid
b. Is well distributed throughout the body and CSF
c. Undergoes little to no hepatic metabolism
d. Does not need to be adjusted for renal dysfunction
Which of the following is not true of the adverse effects
of rifampin?
a. Discolors bodily fluids an orange-red color
b. Causes fever, chills and aches
c. May cause nervous system effects
d. Hepatotoxicity frequent in rapid acetylators
Which of the following describes drug interactions with
rifampin?
a. Inhibits cytochrome P450
b. Increases bioavailability of anticoagulants
c. Increased risk of pregnancy when taking oral
contraceptives
d. Probenecid decreases rifampin serum levels
Which of the following is not a therapeutic use of
rifampin as a sole agent?
a. Methicillin-resistant Staphylococcus aureus
b. Prophylaxis for H. influenza meningitis
c. Eradication of staphylococcus in nasal carriers
d. Treatment of leprosy
Which of the following does describes ethambutol?
a. Produces a bactericidal effect in dividing bacteria
b. Cross resistant with rifampin
c. Disrupts the cell membrane
d. Possible inhibition of RNA synthesis
Which of the following does not describe the
pharmacokinetics of ethambutol?
a. Concentrates in kidneys, lungs, saliva
b. Good distribution to all tissues including CSF
c. Requires dose adjustment with renal dysfunction
d. Partially metabolized in the liver
Which of the following is not an adverse reaction from
taking ethambutol?
a. Optic neuritis
b. Allergic reactions
c. Hepatotoxicity
d. Hyperuricemia
Which of the following describes pyrazinamide?
a. Increases pH within the acidic environment of the
macrophage
b. Converted to pyrazinamide from pyrazinoic acid
c. Resistant strains may lack pyrazinamidase
d. Only active against extracellular bacilli
Which of the following is not true of pyrazinamide?
a. May cause mild non gouty arthralgias
b. Should be discontinued if hyperuricemia develops
c. Exhibits dose related hepatotoxicity
d. Metabolized in the liver and excreted via glomerular
filtration
Which of the following is true of cycloserine?
a. Can be used for tuberculosis or mycobacterium
avium complex as a first line agent
b. Works by destabilizing the cell membrane in
mycobacterium
c. Is an antimicrobial that is effective against resistant
organisms
d. Can block D-alanine racemase and L-alanine
synthetase
Which is not true of the pharmacokinetics of
cycloserine?
a. Good absorption when administered orally
b. Good distribution in uninflamed meninges
c. Undergoes extensive hepatic metabolism
d. Dose adjustment required for renal dysfunction
Which of the following does not describe the adverse
events associated with cycloserine?
a. Central nervous system disorders are not reversible
b. Cause contraindication in persons with a history of
epilepsy
c. May include headache, tremor, and vertigo
d. Induces psychotic states and seizures
Which of the following is true of capreomycin?
a. Bacteriocidal
b. Administered orally
c. Causes nephrotoxicity
d. High cross resistance
Which of the following is not a toxicity caused by
ethionamide?
a. Gastrointestinal toxicity
b. Hepatotoxicity
c. Ototoxicity
d. Thyroid toxicity
Which of the following is not true of ethionamide?
a. Structural analog of isoniazid
b. Similar mechanism to isoniazid
c. Administered by IM injection
d. Distributes to CSF
Which of the following is a drug interaction seen in
isoniazid that is also seen in ethambutol?
a. Aluminum antacids reduce absorption
b. Inhibits cytochrome P450
c. Induces cytochrome P450
d. Corticosteroids decrease efficacy