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GMPA 624: Pharmacology III University of Charlestion -Beckley Midterm Review Spring 2013

GMPA 624: Pharmacology III University of Charlestion -Beckley Midterm Review Spring 2013. Kevin W. Garlow Pharm.D kcgarlow@suddenlink.net. What is the clinical significance of cellular respiration (i.e. aerobic vs. anaerobic)?

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GMPA 624: Pharmacology III University of Charlestion -Beckley Midterm Review Spring 2013

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  1. GMPA 624: Pharmacology IIIUniversity of Charlestion-BeckleyMidterm ReviewSpring 2013 Kevin W. Garlow Pharm.D kcgarlow@suddenlink.net

  2. What is the clinical significance of cellular respiration (i.e. aerobic vs. anaerobic)? a.  It determines where in the body that a particular organism is most likely to thrive and with potential for infection. b.  It determines the potential for an organism to develop resistance to a particular antimicrobial. c.  It  influences the clinician’s decision with regards to proper antibiotic selection. d.  A & B only e.  A & C only

  3. What is the clinical significance of cellular respiration (i.e. aerobic vs. anaerobic)? a.  It determines where in the body that a particular organism is most likely to thrive and with potential for infection. b.  It determines the potential for an organism to develop resistance to a particular antimicrobial. c.  It  influences the clinician’s decision with regards to proper antibiotic selection. d.  A & B only e.  A & C only

  4. Mr. A. is admitted to your facility for treatment of Community-acquired pneumonia.  You order culture and susceptibility testing on the sputum. In the interim you place the patient on ZithromaxR and RocephinR pending the results of the C&S.  When the results are available you are surprised to see resistance to the penicillin UnasynR, the cephalosporin RocephinR, as well as the macrolide ZithromaxR.  This is an example of multidrug resistance and which is characterized by which of the following statements? a.  Resistance of a microorganism to >3 antibacterial medications from separate drug classes. b.  Resistance of a microorganism to >2 antibacterial medications from separate drug classes. c.  Resistance of a microorganism to >3 antibacterial medications regardless of drug class. d.  Resistance of a microorganism to >2 antibacterial medications regardless of drug class. e.  None of the above.

  5. Mr. A. is admitted to your facility for treatment of Community-acquired pneumonia.  You order culture and susceptibility testing on the sputum. In the interim you place the patient on ZithromaxR and RocephinR pending the results of the C&S.  When the results are available you are surprised to see resistance to the penicillin UnasynR, the cephalosporin RocephinR, as well as the macrolide ZithromaxR.  This is an example of multidrug resistance and which is characterized by which of the following statements? a.  Resistance of a microorganism to >3 antibacterial medications from separate drug classes. b.  Resistance of a microorganism to >2 antibacterial medications from separate drug classes. c.  Resistance of a microorganism to >3 antibacterial medications regardless of drug class. d.  Resistance of a microorganism to >2 antibacterial medications regardless of drug class. e.  None of the above.

  6. Which of the following statements with regards to assessment of the patient prior to prescribing an antibiotic is correct? a.  The majority of respiratory infections are viral. b.  Some patients may exhibit atypical symptoms (e.g., confusion, disorientation) to an infectious process. c.  The site of a particular infection may assist in identifying the most common pathogens. d.  Prior antibiotic use and drug allergies are major factors with regards to proper selection of an antimicrobial. e.  All of the above.

  7. Which of the following statements with regards to assessment of the patient prior to prescribing an antibiotic is correct? a.  The majority of respiratory infections are viral. b.  Some patients may exhibit atypical symptoms (e.g., confusion, disorientation) to an infectious process. c.  The site of a particular infection may assist in identifying the most common pathogens. d.  Prior antibiotic use and drug allergies are major factors with regards to proper selection of an antimicrobial. e.  All of the above.

  8. With regards to identification of a bacterial pathogen via use of culture and susceptibility testing, which of the following statements is incorrect? a.  In general treat first and culture second. b.  If the patient is acutely ill treat empirically until the results of the culture are available. c.  If the site cannot be cultured treat empirically based upon the most likely pathogens. d.  Contamination of the sample with normal flora may result in misinterpretation of the results. e.  Culture and susceptibility testing not only assists in identification of the organism but also antimicrobial selection.

  9. With regards to identification of a bacterial pathogen via use of culture and susceptibility testing, which of the following statements is incorrect? a.  In general treat first and culture second. b.  If the patient is acutely ill treat empirically until the results of the culture are available. c.  If the site cannot be cultured treat empirically based upon the most likely pathogens. d.  Contamination of the sample with normal flora may result in misinterpretation of the results. e.  Culture and susceptibility testing not only assists in identification of the organism but also antimicrobial selection.

  10. Which of the following is not a commonly accepted antimicrobial mechanism of action? a.  Inhibition of cell wall synthesis. b.  Inhibition of protein synthesis. c.  Disruption of the cell membrane. d.  Inhibition of nucleic acid synthesis. e.  Inhibition of the synthesis of sugars (e.g., lactose, maltose, etc.)

  11. Which of the following is not a commonly accepted antimicrobial mechanism of action? a.  Inhibition of cell wall synthesis. b.  Inhibition of protein synthesis. c.  Disruption of the cell membrane. d.  Inhibition of nucleic acid synthesis. e.  Inhibition of the synthesis of sugars (e.g., lactose, maltose, etc.)

  12. Which of the following gram-positive organisms are commonly associated with Impetigo? a.  Staphylococcus aureus b.  Streptococusagalactiae c.  Streptococcus pyogenes d.  A & C only e.  B & C only

  13. Which of the following gram-positive organisms are commonly associated with Impetigo? a.  Staphylococcus aureus b.  Streptococusagalactiae c.  Streptococcus pyogenes d.  A & C only e.  B & C only

  14. 16.  Which of the following medications is the drug of choice (1st-line) per IDSA guidelines for the treatment of moderate-to-severe Impetigo in an adult? a.  Demeclocyline b.  Penicillin VK c.  Dicloxacillin d.  Clindamycin e.  Azithromycin

  15. 16.  Which of the following medications is the drug of choice (1st-line) per IDSA guidelines for the treatment of moderate-to-severe Impetigo in an adult? a.  Demeclocyline b.  Penicillin VK c.  Dicloxacillin d.  Clindamycin e.  Azithromycin

  16. Which of the following organisms is most commonly associated with cellulitis? a. Streptococcus pneumoniae b. Streptococcus agalactiae c. Streptococcus pyogenes d. Methicillin-resistant Staphylococcus aureus e. Staphylococcus epidermidis

  17. Which of the following organisms is most commonly associated with cellulitis? a. Streptococcus pneumoniae b. Streptococcus agalactiae c. Streptococcus pyogenes d. Methicillin-resistant Staphylococcus aureus e. Staphylococcus epidermidis

  18. The most common pathogens associated with otitis media include Streptococcus pneumoniae, Haemophilusinfluenzae and ___________. a. Pasturellamultocida b. Staphyloccousepidermidis c. Staphylococcus aureus d. Moraxella catarrhalis e. Streptococcus pyogenes

  19. The most common pathogens associated with otitis media include Streptococcus pneumoniae, Haemophilusinfluenzae and ___________. a. Pasturellamultocida b. Staphyloccousepidermidis c. Staphylococcus aureus d. Moraxella catarrhalis e. Streptococcus pyogenes

  20. With regards to treatment of otitis media in children (e.g., 6-24 months of age), which of the following statements is incorrect? a. Oral symptomatic management of ear pain may include use of ibuprofen or acetaminophen. b. Antibiotic therapy should be prescribed routinely in all patients and regardless of the severity of infection. c. Topical symptomatic management of ear pain may include use of antipyrine/benzocaine (AuralganR). d. Antibiotic therapy should not be prescribed routinely as spontaneous resolution may occur, and especially in children in whom the diagnosis is uncertain or with only mild otitis media. e. Delaying antibiotic therapy in selected patients reduces treatment-related costs, the potential for adverse effects, and minimizes the potential for emergence of resistant strains.

  21. With regards to treatment of otitis media in children (e.g., 6-24 months of age), which of the following statements is incorrect? a. Oral symptomatic management of ear pain may include use of ibuprofen or acetaminophen. b. Antibiotic therapy should be prescribed routinely in all patients and regardless of the severity of infection. c. Topical symptomatic management of ear pain may include use of antipyrine/benzocaine (AuralganR). d. Antibiotic therapy should not be prescribed routinely as spontaneous resolution may occur, and especially in children in whom the diagnosis is uncertain or with only mild otitis media. e. Delaying antibiotic therapy in selected patients reduces treatment-related costs, the potential for adverse effects, and minimizes the potential for emergence of resistant strains.

  22. Which of the following medications is the drug of choice (1st line) for treatment of recurrent otitis media in children? a. Erythromycin 20mg/kg/day poqd b. Levofloxacin (LevaquinR) 10-20mg/kg/day poqd c. Clindamycin 10-20mg/kg/day divided po q8h d. Amoxicilllin/clavulanate (AugmentinR) 90mg/kg/day divided po bid e. Dicloxacillin 12mg/kg/day divided po q6h

  23. Which of the following medications is the drug of choice (1st line) for treatment of recurrent otitis media in children? a. Erythromycin 20mg/kg/day poqd b. Levofloxacin (LevaquinR) 10-20mg/kg/day poqd c. Clindamycin 10-20mg/kg/day divided po q8h d. Amoxicilllin/clavulanate (AugmentinR) 90mg/kg/day divided po bid e. Dicloxacillin 12mg/kg/day divided po q6h

  24. The most common pathogens associated with rhinosinusitisinclude Moraxella catarrhalis, Haemophilusinfluenzae and ___________. a. Pasturellamultocida b. Staphyloccousepidermidis c. Staphylococcus aureus d. Streptococcus pneumoniae e. Streptococcus pyogenes

  25. The most common pathogens associated with rhinosinusitisinclude Moraxella catarrhalis, Haemophilusinfluenzae and ___________. a. Pasturellamultocida b. Staphyloccousepidermidis c. Staphylococcus aureus d. Streptococcus pneumoniae e. Streptococcus pyogenes

  26. Which of the following statements regarding rhinosinusitis is incorrect? a. It is defined as inflammation of the mucosal lining of the nasal passages and paranasal sinuses lasting up to 4 weeks. b. Etiologies may include allergies, environmental irritants, and infection secondary to viruses, bacteria, or fungi. c. A bacterial etiology is the most frequent cause with an incidence of 90-98%. d. Symptoms may include facial pain/congestion/fullness, headache, nasal discharge, fever, dental pain, fatigue, etc. e. Acute bacterial rhinosinusitis is generally characterized by persistent (i.e., non-improving), severe (i.e., fever >102, purulent nasal discharge), or worsening (i.e., double-sickening) signs/symptoms.

  27. Which of the following statements regarding rhinosinusitis is incorrect? a. It is defined as inflammation of the mucosal lining of the nasal passages and paranasal sinuses lasting up to 4 weeks. b. Etiologies may include allergies, environmental irritants, and infection secondary to viruses, bacteria, or fungi. c. A bacterial etiology is the most frequent cause with an incidence of 90-98%. d. Symptoms may include facial pain/congestion/fullness, headache, nasal discharge, fever, dental pain, fatigue, etc. e. Acute bacterial rhinosinusitis is generally characterized by persistent (i.e., non-improving), severe (i.e., fever >102, purulent nasal discharge), or worsening (i.e., double-sickening) signs/symptoms.

  28. You are seeing Mr. G. for the first time in the urgent care clinic. He complains of fatigue, fever, a purulent discharge, and severe facial pain which has persisted for nearly two weeks and which is getting worse. He reports infrequent antibiotic use in the past and denies any drug allergies. Per IDSA guidelines, which of the following medications represents an appropriate choice for this patient? a. Ciprofloxacin (CiproR) 500mg po bid x 5-7 days b. Doxycycline (VibramycinR) 100mg po bid x 7-10 days c. Amoxicillin/clavulanate (AugmentinR) 875/125mg po bid x 5-7 days d. Erythromycin 500mg po q6h x 10 days e. Clindamycin 300mg po q8h x 14 days

  29. You are seeing Mr. G. for the first time in the urgent care clinic. He complains of fatigue, fever, a purulent discharge, and severe facial pain which has persisted for nearly two weeks and which is getting worse. He reports infrequent antibiotic use in the past and denies any drug allergies. Per IDSA guidelines, which of the following medications represents an appropriate choice for this patient? a. Ciprofloxacin (CiproR) 500mg po bid x 5-7 days b. Doxycycline (VibramycinR) 100mg po bid x 7-10 days c. Amoxicillin/clavulanate (AugmentinR) 875/125mg po bid x 5-7 days d. Erythromycin 500mg po q6h x 10 days e. Clindamycin 300mg po q8h x 14 days

  30. Which of the following organisms is most commonly associated with uncomplicated urinary tract infections? a. Proteus mirabilis b. Escherichia coli c. Staphylococcus aureus d. Streptococcus pyogenes e. Neisseria gonorrhoeae

  31. Which of the following organisms is most commonly associated with uncomplicated urinary tract infections? a. Proteus mirabilis b. Escherichia coli c. Staphylococcus aureus d. Streptococcus pyogenes e. Neisseria gonorrhoeae

  32. Which of the following is not a 1st-generation “natural” penicillin? a. Penicillin G sodium b. Penicillin G potassium c. Penicillin G procaine d. Bacampacillin e. Penicillin G benzathine

  33. Which of the following is not a 1st-generation “natural” penicillin? a. Penicillin G sodium b. Penicillin G potassium c. Penicillin G procaine d. Bacampacillin e. Penicillin G benzathine

  34. Which of the following statements regarding 1st-generation penicillins is incorrect? a. The sodium and potassium salts of Penicillin G can be administered both IM and IV only. b. The benzathine and procaine salts of penicillin G are long-acting. c. The potassium salt of penicillin V enhances antimicrobial activity. d. Penicillin G is also referred to as benzylpenicillin and can be administered IM and/or IV depending on the particular salt. e. Penicillin V also referred to as phenoxymethylpenicillin and is administered orally only.

  35. Which of the following statements regarding 1st-generation penicillins is incorrect? a. The sodium and potassium salts of Penicillin G can be administered both IM and IV only. b. The benzathine and procaine salts of penicillin G are long-acting. c. The potassium salt of penicillin V enhances antimicrobial activity. d. Penicillin G is also referred to as benzylpenicillin and can be administered IM and/or IV depending on the particular salt. e. Penicillin V also referred to as phenoxymethylpenicillin and is administered orally only.

  36. Which of the following statements regarding the spectrum of activity of 1st-generation penicillins is incorrect? a. They exhibit activity against non-penicillinase-producing streptococci and staphylococci. b. They exhibit activity against other gram-positive organisms in addition to streptococci and staphylococci. c. Given coverage of both gram-positive and gram-negative organisms they are considered “broad spectrum”. d. They exhibit activity against “some” gram-negative organisms. e. They exhibit activity against many anaerobes as well.

  37. Which of the following statements regarding the spectrum of activity of 1st-generation penicillins is incorrect? a. They exhibit activity against non-penicillinase-producing streptococci and staphylococci. b. They exhibit activity against other gram-positive organisms in addition to streptococci and staphylococci. c. Given coverage of both gram-positive and gram-negative organisms they are considered “broad spectrum”. d. They exhibit activity against “some” gram-negative organisms. e. They exhibit activity against many anaerobes as well.

  38. Which of the following penicillins are 2nd-generation penicillins? a. Ampicillin b. Dicloxacillin c. Amoxicillin d. A & C only e. B & C only

  39. Which of the following penicillins are 2nd-generation penicillins? a. Ampicillin b. Dicloxacillin c. Amoxicillin d. A & C only e. B & C only

  40. Which of the following penicillins is not a 3rd-generation penicillin? a. Dicloxacillin b. Nafcillin c. Methicillin d. Ticarcillin e. Oxacillin

  41. Which of the following penicillins is not a 3rd-generation penicillin? a. Dicloxacillin b. Nafcillin c. Methicillin d. Ticarcillin e. Oxacillin

  42. Which of the following penicillins are 4th-generation penicillins? a.  Ticarcillin b.  Methicillin c.  Piperacillin d.  A & B only e.  A & C only

  43. Which of the following penicillins are 4th-generation penicillins? a.  Ticarcillin b.  Methicillin c.  Piperacillin d.  A & B only e.  A & C only

  44. Which of the statements regarding the mechanism of action of penicillins are correct? a.  In general, penicillins exhibit bacteriostatic vs. bactericidal activity. b.  Penicillins act by binding the penicillin binding proteins in the cell wall thereby inhibiting cell wall synthesis. c.  Interference with cell wall synthesis ultimately results in self-destruction (i.e., autolysis) of the bacterium. d.  A & B only e.  B & C only

  45. Which of the statements regarding the mechanism of action of penicillins are correct? a.  In general, penicillins exhibit bacteriostatic vs. bactericidal activity. b.  Penicillins act by binding the penicillin binding proteins in the cell wall thereby inhibiting cell wall synthesis. c.  Interference with cell wall synthesis ultimately results in self-destruction (i.e., autolysis) of the bacterium. d.  A & B only e.  B & C only

  46.  Mr. J. comes in today with a severe sore throat, fever, and malaise.  You examine him and determine that he has Strep throat.  He has no known drug allergies and states that he has taken penicillins in the past without any adverse effect.  Which of the following dosages of amoxicillin would be appropriate for use in this patient? a.  875mg po bid x  10 days b.  500mg potid x 10 days c.  1000mg po bid x 10 days d.  A & B only e.  B & C only

  47.  Mr. J. comes in today with a severe sore throat, fever, and malaise.  You examine him and determine that he has Strep throat.  He has no known drug allergies and states that he has taken penicillins in the past without any adverse effect.  Which of the following dosages of amoxicillin would be appropriate for use in this patient? a.  875mg po bid x  10 days b.  500mg potid x 10 days c.  1000mg po bid x 10 days d.  A & B only e.  B & C only

  48. Mrs. K. is a newlywed that is seeing you today for what appears to be sinusitis.  She has a temperature, facial pain, fatigue and a purulent nasal discharge. You decide to prescribe AugmentinR.  What other information should you obtain from this patient? a.  You should check to see if she has insurance, and if not you should consider a less expensive antibiotic. b.  You should inquire as to past antibiotic use and previous allergies. c.  You should inquire as to use of contraception and if oral contraception is used instruct the patient to use a back-up method while on the antibiotic. d.  A & C only e.  B & C only

  49. Mrs. K. is a newlywed that is seeing you today for what appears to be sinusitis.  She has a temperature, facial pain, fatigue and a purulent nasal discharge. You decide to prescribe AugmentinR.  What other information should you obtain from this patient? a.  You should check to see if she has insurance, and if not you should consider a less expensive antibiotic. b.  You should inquire as to past antibiotic use and previous allergies. c.  You should inquire as to use of contraception and if oral contraception is used instruct the patient to use a back-up method while on the antibiotic. d.  A & C only e.  B & C only

  50. Which of the following drug-drug interactions with penicillins is potentially beneficial? a.  Concurrent use of a tetracycline antibiotic. b.  Concurrent use of allopurinol. c.  Concurrent use of an oral contraceptive. d.  Concurrent use of probenecid. e.  None of the above.

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