Pharm 43 Flashcards

Penicillin G kills susceptible bacteria by inhibiting which target?

A. DNA gyrase

B. Cell wall transpeptidases

C. Folate reductase

D. Ribosomal translocation

What antimicrobial effect does penicillin G produce?

A. Reversible bacteriostatic activity

B. Delayed bactericidal activity

C. Rapid bactericidal activity

D. Slow bacteriostatic activity

A patient has a susceptible streptococcal infection. Which penicillin is specifically indicated?

A. Penicillin G

B. Oxacillin

C. Piperacillin

D. Penicillin V

A patient develops meningococcal infection. Which penicillin is specifically indicated?

A. Amoxicillin

B. Nafcillin

C. Penicillin V

D. Penicillin G

A patient with neurosyphilis requires antibiotic therapy. Which agent is indicated?

A. Oxacillin

B. Penicillin G

C. Amoxicillin

D. Procaine penicillin

Which route is used for penicillin G?

________

Penicillin G requires frequent dosing primarily because of:

A. Rapid renal clearance

B. Slow hepatic metabolism

C. Extensive protein binding

D. Rapid biliary clearance

A patient rapidly develops an allergic reaction after penicillin G. Which toxicity occurred?

A. Immediate hypersensitivity

B. Delayed hepatotoxicity

C. Chronic nephrotoxicity

D. Dose-related anemia

Which toxicity can occur with penicillin G?

A. Alopecia

B. Petechiae

C. Rash

D. Hyperpigmentation

Which neurologic toxicity can occur with penicillin G?

A. Ataxia

B. Seizures

C. Neuropathy

D. Tremor

Which feature distinguishes penicillin V?

A. Biliary clearance

B. Intramuscular administration

C. β-lactamase stability

D. Oral administration

Why is widespread penicillin V use limited?

A. Low systemic levels

B. Severe hypersensitivity

C. Rapid biliary clearance

D. Poor β-lactamase stability

Penicillin V is given by mouth. Only part of the dose goes into the blood. It does not reach high levels in the body. Because of this, doctors use it only for ______ infections

Which pair contains long-acting penicillin formulations?

A. Nafcillin and oxacillin

B. Ampicillin and amoxicillin

C. Benzathine and procaine penicillin

D. Penicillin G and piperacillin

How are benzathine and procaine penicillin administered?

A. Intravenously

B. Intramuscularly

C. Orally

D. Subcutaneously

Which pair has increased staphylococcal β-lactamase stability?

A. Penicillin G and V

B. Ampicillin and amoxicillin

C. Benzathine and procaine

D. Nafcillin and oxacillin

Nafcillin and oxacillin are administered primarily by:

A. Intravenous route

B. Oral route

C. Intramuscular route

D. Subcutaneous route

Nafcillin and oxacillin primarily undergo which clearance?

A. Renal clearance

B. Pulmonary clearance

C. Biliary clearance

D. Intestinal clearance

Which group has greater gram-negative bacterial activity?

A. Penicillin G and V

B. Ampicillin, amoxicillin, piperacillin

C. Nafcillin, oxacillin, amoxicillin

D. Benzathine, procaine, piperacillin

A β-lactamase-producing bacterium resists a susceptible penicillin. What addition may restore activity?

A. Folate inhibitor

B. Transpeptidase inducer

C. Renal clearance inhibitor

D. β-lactamase inhibitor

Adding a β-lactamase inhibitor can restore activity against bacteria that:

A. Produce β-lactamase

B. Lack cell walls

C. Lack transpeptidases

D. Require intracellular growth

Against which organism are dicloxacillin, nafcillin, and oxacillin useful?

______ ______

Name the narrow-spectrum, penicillinase-resistant antibiotics.

_____

_____

_____

What is the mechanism of action of dicloxacillin, nafcillin, and oxacillin?

Inhibition of peptidoglycan _____-_____ in bacterial cell walls

Dicloxacillin, nafcillin, and oxacillin work by binding to penicillin-binding proteins (_______). This action blocks the final _______ step of peptidoglycan synthesis in the bacterial cell wall, leading to cell lysis and death.

Cefazolin kills susceptible bacteria by inhibiting which target?

A. DNA gyrase

B. Cell wall transpeptidases

C. Folate reductase

D. Ribosomal translocation

What antimicrobial effect does cefazolin produce?

A. Slow bacteriostatic activity

B. Reversible growth inhibition

C. Rapid bactericidal activity

D. Delayed bactericidal activity

A patient has a skin and soft tissue infection. Which drug is specifically listed for treatment?

A. Cefazolin

B. Ceftriaxone

C. Ceftazidime

D. Cefepime

Which infection is an indication for cefazolin?

A. Gonorrhea

B. Meningitis

C. Pneumonia

D. Urinary tract infection

A patient receives an antibiotic before surgery. Which cephalosporin is used for prophylaxis?

A. Cefuroxime

B. Cefazolin

C. Cefotaxime

D. Ceftaroline

Cefazolin primarily undergoes which clearance?

A. Renal clearance

B. Mixed clearance

C. Biliary clearance

D. Pulmonary clearance

Which pharmacologic limitation characterizes cefazolin?

A. Poor renal clearance

B. Poor gram-positive activity

C. Poor CNS penetration

D. Poor oral absorption

Which adverse effect can occur with cefazolin?

A. Rash

B. Seizures

C. Nephrotoxicity

D. Ototoxicity

A patient develops fever after cefazolin therapy. Which toxicity best explains this?

A. Serum sickness

B. Neurotoxicity

C. Hemolysis

D. Drug fever

Which oral first-generation cephalosporin treats skin infections?

A. Cefuroxime

B. Cephalexin

C. Ceftriaxone

D. Cefepime

Cephalexin is also used to treat:

A. Meningitis

B. Gonorrhea

C. Urinary tract infections

D. Pelvic infections

Cephalexin belongs to which cephalosporin generation?

A. Fourth

B. Third

C. Second

D. First

Which second-generation cephalosporin can be given orally or intravenously?

A. Cefotetan

B. Cefuroxime

C. Ceftriaxone

D. Ceftazidime

Cefuroxime has improved activity against which organism?

A. Pseudomonas aeruginosa

B. Bacteroides fragilis

C. Pneumococcus

D. Methicillin-resistant staphylococci

Cefuroxime also has improved activity against:

A. Haemophilus influenzae

B. Pseudomonas aeruginosa

C. Bacteroides fragilis

D. Methicillin-resistant staphylococci

Which pair consists of second-generation intravenous drugs?

A. Ceftriaxone and cefotaxime

B. Cefepime and ceftaroline

C. Cefuroxime and cephalexin

D. Cefotetan and cefoxitin

Cefotetan and cefoxitin have activity against:

A. Pneumococcus

B. Bacteroides fragilis

C. Pseudomonas aeruginosa

D. Methicillin-resistant staphylococci

Activity against Bacteroides fragilis makes cefotetan useful for:

A. Meningitis

B. Gonorrhea

C. Abdominal infections

D. Pneumonia

Cefotetan and cefoxitin are also useful for:

A. Pelvic infections

B. Skin infections

C. Meningitis

D. Pyelonephritis

Which third-generation cephalosporin has good CNS penetration?

A. Ceftazidime

B. Cefotaxime

C. Cefuroxime

D. Ceftriaxone

Ceftriaxone primarily has which clearance pattern?

A. Renal clearance

B. Biliary clearance

C. Mixed clearance

D. Pulmonary clearance

Good CNS penetration makes ceftriaxone useful for:

A. Skin infection

B. Pelvic infection

C. Surgical prophylaxis

D. Meningitis

Which infection is treated with ceftriaxone?

A. Skin infection

B. Pneumonia

C. Pelvic infection

D. Soft tissue infection

Which urinary infection is treated with ceftriaxone?

________

Which sexually transmitted infection can ceftriaxone treat?

A. Gonorrhea

B. Syphilis

C. Chlamydia

D. Herpes

Which third-generation drug is similar to ceftriaxone?

A. Cefepime

B. Cefuroxime

C. Ceftaroline

D. Cefotaxime

Unlike ceftriaxone, cefotaxime primarily undergoes:

A. Mixed clearance

B. Renal clearance

C. Biliary clearance

D. Pulmonary clearance

Which third-generation cephalosporin has poor gram-positive activity?

A. Ceftriaxone

B. Cefotaxime

C. Cefuroxime

D. Ceftazidime

Ceftazidime has good activity against which organism?

_____ _____

Which fourth-generation cephalosporin has broad activity?

A. Cefepime

B. Ceftriaxone

C. Cefuroxime

D. Ceftazidime

Cefepime has improved stability against which enzymes?

A. Extended-spectrum β-lactamases

B. Staphylococcal β-lactamases

C. Penicillin-binding proteins

D. Chromosomal β-lactamases

Which intravenous cephalosporin covers methicillin-resistant staphylococci?

A. Cefuroxime

B. Cefotetan

C. Ceftaroline

D. Cefazolin

Ceftaroline has broad activity against which group?

A. Gram-negative bacteria

B. Gram-positive bacteria only

C. Anaerobic bacteria

D. Atypical bacteria

Which organism is notably excluded from ceftaroline coverage?

A. Bacteroides fragilis

B. Haemophilus influenzae

C. Pneumococcus

D. Pseudomonas aeruginosa

Which pair contains cephalosporin-β-lactamase inhibitor combinations?

A. Cefotetan-avibactam and cefoxitin-tazobactam

B. Ceftazidime-avibactam and ceftolozane-tazobactam

C. Ceftriaxone-tazobactam and cefotaxime-avibactam

D. Cefepime-tazobactam and ceftaroline-avibactam

Ceftazidime-avibactam and ceftolozane-tazobactam have what spectrum?

A. Broad activity

B. Narrow gram-positive activity

C. Anaerobic activity

D. Limited urinary activity

These combination drugs have improved stability against:

A. Ribosomal enzymes

B. Transpeptidases

C. DNA gyrases

D. Chromosomal β-lactamases

Their improved stability also includes some:

A. Penicillin-binding proteins

B. Extended-spectrum β-lactamases

C. Bacterial ribosomes

D. Folate reductases

What generation?

Good for simple skin infections and UTIs. Covers Proteus, E. coli, and Klebsiella plus gram-positive cocci.

What generation?

Adds Haemophilus, Enterobacter, and Neisseria.

What generation?

Great for severe infections and meningitis because it crosses the blood-brain barrier.

What generation?

Broad spectrum with Pseudomonas coverage.

What generation?

The only generation that covers MRSA

Imipenem-cilastatin kills susceptible bacteria by inhibiting which target?

A. DNA gyrase

B. Cell wall transpeptidases

C. Folate reductase

D. Ribosomal translocation

What antimicrobial effect does imipenem produce?

A. Delayed bactericidal activity

B. Reversible growth inhibition

C. Rapid bactericidal activity

D. Slow bacteriostatic activity

A critically ill patient develops severe bacterial pneumonia. Which carbapenem is appropriate?

A. Imipenem-cilastatin

B. Ertapenem

C. Meropenem-vaborbactam

D. Meropenem

A patient with severe bacterial sepsis requires carbapenem therapy. Which drug is specifically indicated?

A. Ertapenem

B. Meropenem

C. Meropenem-vaborbactam

D. Imipenem-cilastatin

Imipenem primarily undergoes which clearance?

A. Biliary clearance

B. Mixed clearance

C. Renal clearance

D. Pulmonary clearance

Why is cilastatin combined with imipenem?

A. Improves CNS penetration

B. Prevents renal hydrolysis

C. Extends bacterial binding

D. Reduces biliary clearance

Which enzyme would hydrolyze imipenem without cilastatin?

A. Bacterial transpeptidase

B. Hepatic oxidase

C. Renal dehydropeptidase

D. Plasma cholinesterase

A patient receiving high-dose imipenem develops neurologic toxicity. Which manifestation is most likely?

A. Seizures

B. Neuropathy

C. Tremor

D. Ataxia

Which condition especially increases imipenem-associated seizure risk?

A. Hepatic failure

B. Heart failure

C. Respiratory failure

D. Renal failure

Which carbapenem has activity similar to imipenem?

A. Ertapenem

B. Cilastatin

C. Meropenem

D. Cefepime

Meropenem differs from imipenem because it is:

A. Stable to renal dehydropeptidase

B. Cleared primarily through bile

C. Given only once daily

D. Inactive against serious infections

Compared with imipenem, meropenem causes:

A. More renal hydrolysis

B. More frequent seizures

C. Greater biliary clearance

D. Fewer seizures

Which organism is not covered by ertapenem?

A. Pneumococcus

B. Haemophilus influenzae

C. Pseudomonas aeruginosa

D. Bacteroides fragilis

Ertapenem also lacks activity against which organism?

A. Acinetobacter

B. Pneumococcus

C. Meningococcus

D. Staphylococcus

Aztreonam kills susceptible bacteria by inhibiting which target?

A. DNA gyrase

B. Cell wall transpeptidases

C. Folate reductase

D. Ribosomal translocation

What antimicrobial effect does aztreonam produce?

A. Slow bacteriostatic activity

B. Delayed bactericidal activity

C. Rapid bactericidal activity

D. Reversible growth inhibition

Aztreonam primarily treats infections caused by which organisms?

_____ gram-_____ bacteria

A patient has immediate penicillin hypersensitivity and a gram-negative infection. Which drug best fits what you wanna use?

A. Vancomycin

B. Daptomycin

C. Penicillin G

D. Aztreonam

Vancomycin inhibits cell wall synthesis by binding:

A. Cell wall transpeptidases

B. D-Ala-D-Ala terminus

C. Bacterial cell membrane

D. Folate synthesis enzymes

Vancomycin binds which bacterial structure directly?

A. Nascent peptidoglycan terminus

B. Bacterial ribosomal subunit

C. Cytoplasmic membrane channel

D. DNA replication complex

What antimicrobial effect does vancomycin produce?

A. Reversible bacteriostatic activity

B. Delayed growth inhibition

C. Rapid membrane depolarization

D. Bactericidal activity

Compared with β-lactams, vancomycin generally kills bacteria:

A. More rapidly

B. At identical speed

C. More slowly

D. Only during stationary phase

Vancomycin primarily treats infections caused by:

Gram-_______ bacteria

A patient with gram-positive sepsis requires therapy. Which drug is listed for this indication?

A. Vancomycin

B. Aztreonam

C. Penicillin V

D. Ertapenem

Which serious gram-positive infection can vancomycin treat?

A. Pyelonephritis

B. Gonorrhea

C. Cellulitis

D. Endocarditis

Which CNS infection is an indication for vancomycin?

A. Encephalitis

B. Meningitis

C. Brain abscess

D. Myelitis

Which formulation of vancomycin treats C difficile colitis?

A. Intravenous

B. Intramuscular

C. Oral

D. Subcutaneous

Daptomycin kills bacteria by binding which structure?

A. Cell membrane

B. Peptidoglycan terminus

C. DNA gyrase

D. Ribosomal subunit

Daptomycin binding causes which immediate cellular effect?

A. Folate depletion

B. Ribosomal blockade

C. Cell wall crosslinking

D. Membrane depolarization

Membrane depolarization by daptomycin ultimately causes:

A. Slow growth arrest

B. Rapid cell death

C. Delayed protein inhibition

D. Reversible metabolic suppression

What antimicrobial effect does daptomycin produce?

A. Primarily bacteriostatic activity

B. Delayed growth inhibition

C. Bactericidal activity

D. Reversible enzyme inhibition

Compared with vancomycin, daptomycin is bactericidal:

A. More rapidly

B. More slowly

C. At identical speed

D. Only at high doses

Daptomycin primarily treats infections caused by:

A. Gram-negative bacteria

B. Anaerobic bacteria

C. Atypical bacteria

D. Gram-positive bacteria

A patient has gram-positive sepsis. Which lipopeptide is listed for treatment?

______

Which serious infection is treated with daptomycin?

A. Meningitis

B. Pneumonia

C. Endocarditis

D. Gonorrhea

An 85-year-old female is brought to the emergency department with a fever, swollen leg, and deep pressure sore on her heel. She resides in an assisted living facility. She is admitted to the hospital for intravenous treatment. Contents of the heel wound are sent for culture and sensitivity, which reveal methicillin-resistant Staphylococcus aureus. The most likely adverse effect associated with the appropriate antibiotic therapy for this patient's infection is

A. a disulfiram-like reaction

B. infusion-related flushing

C. pseudomembranous colitis

D. Steven-Johnson syndrome

E. teeth discoloration

A 72-year-old man presents to the emergency department with a 3-day history of worsening fever and shortness of breath. Vital signs reveal a temperature of 39.1°C (102.3°F). Cardiac auscultation reveals a holosystolic murmur that is best heard at the cardiac apex. Transthoracic echocardiogram reveals vegetation on the mitral valve. Blood cultures are obtained, and the patient is started on intravenous vancomycin and admitted to the hospital. On day 2 of his hospitalization, the patient continues to have fevers. Blood cultures grow vancomycin-resistant enterococci. Antibiotic resistance was most likely acquired via

A. amino acid modification

B. enzymatic degradation of the drug

C. mutation in DNA gyrase

D. mutation in DNA polymerase

Intravenous vancomycin is the drug of choice for most methicillin-resistant Staphylococcus aureus infections in hospitalized patients.

Intravenous vancomycin can cause vancomycin infusion reactions, which are a type of anaphylactoid reaction. These reactions typically present as diffuse ______ of the skin and can be prevented by using a slow infusion rate and co-administering an ______.

Match:

monobactams

glycopeptide

lipopeptide

Daptomycin

Aztreonam

Vancomycin