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Antimicrobial and Antiviral Pharmacology- Part 1
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1.You are a physician and epidemiologist employed by the US Centers for Disease Control and You get an urgent phone call stating that an envelope was opened in the mail room of a large corporation, and s imilar ones were delivered to various government offices. Some sort of white powder fell out and was blown around the room, exposing dozens of workers. The suspicion i s anthrax. Which drug would be best, most properly indicated, for prophylaxis i f the substance tests positive for Bacillus anthracis?
2. A jaundiced 1-day-old premature infant with an elevated free bili-rubin i s seen in the premature baby The mother had received an antibiotic combination for a urinary tract infection (UTI) 1 week before delivery. Which antibiotic drug or class was the most l ikely cause of the baby’s kernicterus?
- An aminopenicillin (eg, amoxicillin)
- Fourth-generation cephalosporin
- Sulfamethoxazole plus trimethoprim
3. You are caring for a patient with HIV infection and will start drug therapy initially with the nucleoside analog zidovudine (formerly called azidothymidine, or AZT). Which statement most correctly describes zidovudine or the dideoxynucleoside class to which i t belongs?
- Levels of active metabolite in cerebrospinal fluid usually are not detectable (ie, zero) because i t cannot cross the blood–brain barrier
- Resistance to these antivirals develops rapidly after monotherapy starts, involves decreased incorporation of active metabolite into vi ral DNA
- The dideoxynucleoside stops vi ral nucleic acid synthesis
- The active metabolite i s an equally effective substrate for vi ral reverse transcriptase and mammalian DNA polymerase, which explains the high incidence of host toxicity
- Zidovudine i s dephosphorylated to form the active metabolite, which i s incorporated into vi ral nucleic acid via HIV reverse transcriptase
4. A patient on antimicrobial therapy develops the following s igns and symptoms that ultimately are found to be drug-induced: cough, dyspnea, and pulmonary infiltrates; neutropenia and bleeding tendencies; and What was the most l ikely cause of this patient’s symptoms?
5. A patient presents with severe, unrelenting diarrhea, and the fluid and electrolyte imbalances one would expect from She had been started on an antibiotic recently, and the l ikely diagnosis i s antibiotic-associated pseudomembranous colitis (AAPMC). What drug was the most l ikely cause?
- Cl indamycin
- Trimethoprim plus sulfamethoxazole (TMP-SMZ)
6. A 35-year-old woman complains of itching in the vulval Hanging-drop examination of the urine reveals trichomonads. What i s the preferred treatment for the trichomoniasis?
7. A patient will be started on primaquine to treat active Plasmodium vivax malaria, specifically to target the hepatic forms of the Before you administer the drug you should screen the patient to assess their relative ri sk of developing a relatively common and severe adverse response to the drug. What i s that primaquine-associated ri sk?
- Cardiac conduction disturbances
- Hemolytic disease
- Seizures, convulsions
8. On morning rounds in the hospital you encounter a patient being treated with l inezolid, the first approved member of the oxazolidine class of Which statement accurately describes a characteristic of this drug?
- Exerts strong bactericidal effects
- Mainly used for relatively minor infections with gram-negative organisms
- Preferred alternative to amoxicillin for children with otitis media
- Preferred alternative to ciprofloxacin for B. anthracis infections
- Suitable for vancomycin-resistant enterococci
9. A 59-year-old woman i s diagnosed with tuberculosis (TB). Before prescribing a multidrug regimen, you take a careful medication history because one of the drugs commonly used to treat TB induces some of the microsomal cytochrome P450 enzymes in the l iver, and i s a common cause of drug–drug What i s the most likely drug?
- Vitamin B6
10. A patient with HIV infection i s receiving a combination of protease inhibitors as part of overall antiviral What i s , ordinarily, the most l ikely/most common s ide effect(s) of the protease inhibitors?
- Anemia and neutropenia
- Hyperglycemia and hyperlipidemia
- Lactic acidosis
11. A 27-year-old woman has just returned from a trip to Southeast Over the past 24 hours she has developed shaking, chills, and a temperature of 104°F. A blood smear reveals Plasmodium vivax. What drug would you prescribe to eradicate the extraerythrocytic phase of the organism?
12. A patient has a severe bacterial infection that normally would respond to an oral penicillin or However, his chart documents anaphylactoid reactions to both classes of drugs. Given the history, what drug would be preferred for treating the infection, and also poses the least ri sk of cross-reactivity and an allergic response?
13. A 40-year-old man i s HIV-positive and has a cluster-of-differentiation-4 (CD4) count of 200/mm3. Within 2 months after starting drug therapy for his HIV he develops a peripheral white blood cell count of 1000/mm3 and a hemoglobin of 0 mg/dL. Which drug most l ikely caused the hematologic abnormalities?
14. An 86-year-old man complains of cough and blood in his sputum for the past 5 On admission, his temperature i s 103°F. Physical examination reveals rales in his right lung, and x-ray examination shows increased density in the right middle lobe. A sputum smear shows many grampositive cocci, confirmed by sputum culture as penicillinase-producing Staphylococcus aureus. Which antibiotic would be best to administer fi rst?
- Penicillin (G or V)
15. When considering all the main antibacterial drugs that work by inhibiting protein synthesis in one way or another, vi rtually every one exerts bacteriostatic Which drug or drug class differs from the rest because the usual consequence of therapeutic plasma levels i s bactericidal, rather than mere inhibition of bacterial growth and replication?
- Cl indamycin
16..A patient with HIV infection and cl inical AIDS i s treated with a combination of agents, one of which i s Which enzyme or replicative process i s the main target of this antiviral drug?
- Nonnucleoside reverse transcriptase
- Nucleoside reverse transcriptase
- RNA synthesis
- Viral particle assembly
- Viral proteases
17. A patient with HIV/AIDS, being treated with multiple antiviral and immunosuppressive drugs, develops an opportunistic infection caused by jiroveci. Which drug are you most l ikely to use to treat the pulmonary infection caused by this protozoan?
- Penicillin G.
18. A 25-year-old woman with an upper respiratory tract infection caused by influenzae i s treated with trimethoprim-sulfamethoxazole. She responds well in a matter of days after starting the TMP-SMZ. Which bacterial process i s inhibited by this combination, and accounts for the antibacterial effects?
- Cell-wall synthesis
- Protein synthesis
- Folic acid synthesis
- Topoisomerase II (DNA gyrase)
- DNA polymerase
19. A man who has been at the local tavern, drinking alcohol heavily, i s He i s transported to the hospital. Among various findings i s an infection for which prompt antibiotic therapy i s indicated. Given his high blood alcohol level, which antibiotic should be avoided because of a high potential of causing a serious disulfiram-like reaction that might provoke ventilatory or cardiovascular failure? (Assume that were i t not for the alcohol consumption, the antibiotic would be suitable for the infectious organisms that have been detected.)
- Erythromycin ethylsuccinate
- Penicillin G
20. A 43-year-old woman i s recovering from major surgery, following discharge from the hospital, in an assisted-care She develops fever, rales, dyspnea, cough, and purulent sputum. Results of a chest radiograph indicate bilateral pulmonary infiltrates. We send blood and sputum cultures to the cl inical pathology lab for culturing, but now must turn our attention to what we believe i s community-acquired pneumonia caused by antibiotic-resistant pneumococci. We want to start empiric antibiotic therapy until culture results are available. Which drug would be best for this initial therapy?
- Levofloxacin Penicillin G
- . Vancomycin
21. Blood and sputum cultures taken in a cri ti cally i l l 26-year-old woman indicate the presence of MRSA—methicillin-resistant aureus. Which drug i s most l ikely to be effective in treating this infection?
- Amoxicillin plus clavulanic acid
- Cl indamycin
- Trimethoprim-sulfamethoxazole (TMP-SMZ)
22. Compared with most other cephalosporins, the administration of cefmetazole, cefoperazone, or cefotetan i s associated with a higher incidence of an adverse response that i s particularly dangerous for some What i s that rather unique adverse response?
- Acute heart failure
- Acute renal failure
- Bleeding tendencies in patients taking warfarin
23. A patient develops muscle aches and pains during the course of antibiotic A muscle biopsy would clearly show myopathy. Which drug most l ikely (and rather uniquely) caused this adverse effect on skeletal muscle?
24. A patient with an infectious disease routinely takes their antimicrobial medication with milk or other dairy products in an attempt to reduce stomach upset from the The antibiotic fails to work adequately because calcium in the dairy products chelates the drug and reduces i ts oral bioavailability. Which antimicrobial drug or drug class was the patient most l ikely taking?
- Antimycobacterial drug, specifically i soniazid
- Cephalosporin, fi rst generation
- Cephalosporin, third generation Penicillin