A patient is prescribed Bactrim for a urinary tract infection. Which two drugs are in this combination?

A) Ciprofloxacin and levofloxacin

B) Trimethoprim and sulfamethoxazole

C) Sulfadiazine and pyrimethamine

D) Moxifloxacin and delafloxacin

B. Trimethoprim and sulfamethoxazole

TMP-SMX is also commonly known by which drug name?

A) Bactrim

B) Leucovorin

C) Pyrimethamine

D) Delafloxacin

A. Bactrim

Trimethoprim-sulfamethoxazole works by blocking which bacterial pathway?

A) DNA gyrase pathway

B) Folate pathway

C) Protein synthesis pathway

D) Cell wall pathway

B. Folate pathway

Why does blocking bacterial folate impair bacterial growth?

A) Bacteria cannot make DNA well

B) Bacteria cannot make capsules

C) Bacteria cannot make flagella

D) Bacteria cannot make ribosomes

A. Bacteria cannot make DNA well

Bacteria need folate mainly to synthesize which molecule?

A) RNA polymerase

B) Cell membrane

C) DNA

D) Peptidoglycan

C. DNA

TMP-SMX prevents bacterial survival mainly by disrupting which process?

A) Calcium entry

B) DNA production

C) Beta-lactamase release

D) Protein folding

B. DNA production

Which infection is a clinical use of TMP-SMX?

A) UTIs

B) Influenza

C) Malaria only

D) Syphilis

A. UTIs

A patient has a soft tissue infection treated with Bactrim. Which drug class is being used?

A) Fluoroquinolone

B) Folate antagonist

C) Macrolide

D) Aminoglycoside

B. Folate antagonist

TMP-SMX is used for Pneumocystis jirovecii pneumonia because it blocks which process?

A) DNA replication via gyrase

B) Folate-dependent DNA synthesis

C) Cell wall crosslinking

D) Viral genome release

B. Folate-dependent DNA synthesis

Which opportunistic pneumonia can be treated with TMP-SMX?

A) Pneumocystis jirovecii pneumonia

B) Streptococcus pneumoniae pneumonia

C) Mycoplasma pneumoniae pneumonia

D) Klebsiella pneumoniae pneumonia

A. Pneumocystis jirovecii pneumonia

Which parasitic infection is listed as a use for TMP-SMX?

A) Giardiasis

B) Toxoplasmosis

C) Malaria

D) Schistosomiasis

B. Toxoplasmosis

TMP-SMX is used for which branching filamentous bacterial infection?

A) Nocardiosis

B) Anthrax

C) Tetanus

D) Botulism

A. Nocardiosis

Which clinical use belongs to TMP-SMX?

A) Osteomyelitis only

B) Digitalis toxicity

C) Nocardiosis

D) Torsades

C. Nocardiosis

Which side effect is associated with TMP-SMX?

A) Tendon rupture

B) Rash

C) Ototoxicity

D) Lupus-like syndrome

B. Rash

Bacrtrim adverse effect?

A) Fever

B) Constipation

C) Cyanide toxicity

D) Visual brightness

A. Fever

TMP-SMX can suppress which body system?

A) Bone marrow

B) Adrenal cortex

C) Thyroid gland

D) Pancreatic islets

A. Bone marrow

A patient taking TMP-SMX develops low blood cell counts. Which adverse effect best explains this?

A) Neurotoxicity

B) Tendon rupture

C) Bone marrow suppression

D) Calcium binding

C. Bone marrow suppression

Which electrolyte abnormality is associated with TMP-SMX?

A) Hypocalcemia

B) Hyperkalemia

C) Hypernatremia

D) Hypokalemia

B. Hyperkalemia

A patient on TMP-SMX can have what adverse effect?

A) Nephrotoxicity

B) Tendonitis

C) Bronchoconstriction

D) Cyanosis

A. Nephrotoxicity

Which side effect set best matches TMP-SMX?

A) GI upset, tendon rupture, neurotoxicity

B) Rash, fever, bone marrow suppression

C) QT prolongation, constipation, dizziness

D) Cough, angioedema, hyperkalemia

B. Rash, fever, bone marrow suppression

Which adverse effect is shared by TMP-SMX and sulfadiazine plus pyrimethamine?

A) Bone marrow toxicity

B) Tendon rupture

C) Calcium chelation

D) Neurotoxicity

A. Bone marrow toxicity

A patient with sulfa allergy needs treatment for a lower UTI. Which drug from the notes may be used alone?

A) Sulfamethoxazole

B) Trimethoprim

C) Pyrimethamine

D) Sulfadiazine

B. Trimethoprim

Trimethoprim alone treats lower UTIs by blocking which pathway?

A) DNA gyrase pathway

B) Bacterial folate pathway

C) Topoisomerase IV pathway

D) Cell membrane pathway

B. Bacterial folate pathway

Trimethoprim alone is especially useful when a patient has which issue?

A) Beta blocker allergy

B) Sulfa allergy

C) Calcium deficiency

D) Tendon injury

B. Sulfa allergy

Which infection is listed as a use for trimethoprim alone?

A) Lower UTIs

B) Anthrax

C) Osteomyelitis

D) Toxoplasmosis only

A. Lower UTIs

Which drug blocks bacterial folate without the sulfa component?

A) Ciprofloxacin

B) Trimethoprim

C) Sulfadiazine

D) Moxifloxacin

B. Trimethoprim

Sulfadiazine plus pyrimethamine produces what type of antimicrobial blockade?

A) Strong folate pathway blockade

B) Strong DNA gyrase blockade

C) Strong ribosomal blockade

D) Strong cell wall blockade

A. Strong folate pathway blockade

Sulfadiazine plus pyrimethamine is used clinically for which infection?

A) Anthrax

B) Nocardiosis

C) Toxoplasmosis

D) Gastroenteritis

C. Toxoplasmosis

A patient with toxoplasmosis receives sulfadiazine plus pyrimethamine. What pathway is targeted?

A) Topoisomerase pathway

B) Folate pathway

C) Calcium transport pathway

D) Beta receptor pathway

B. Folate pathway

Sulfadiazine plus pyrimethamine prevents organisms from making which molecule properly?

A) DNA

B) Capsule

C) Flagella

D) Toxin

A. DNA

Which adverse effect is especially associated with sulfadiazine plus pyrimethamine?

A) Bone marrow toxicity

B) Tendon rupture

C) GI upset only

D) Neurotoxicity

A. Bone marrow toxicity

Leucovorin is given with sulfadiazine plus pyrimethamine to protect which tissue?

A) Bone marrow

B) Tendon

C) Kidney tubules

D) Gastric mucosa

A. Bone marrow

Which drug combination requires leucovorin protection in the notes?

A) TMP-SMX

B) Sulfadiazine plus pyrimethamine

C) Ciprofloxacin plus calcium

D) Levofloxacin plus magnesium

B. Sulfadiazine plus pyrimethamine

Which drug is a fluoroquinolone?

A) Ciprofloxacin

B) Trimethoprim

C) Sulfadiazine

D) Pyrimethamine

A. Ciprofloxacin

Which drug is a fluoroquinolone?

A) Bactrim

B) Levofloxacin

C) Leucovorin

D) Sulfamethoxazole

B. Levofloxacin

Which drug is a fluoroquinolone?

A) Pyrimethamine

B) Trimethoprim

C) Moxifloxacin

D) Sulfadiazine

C. Moxifloxacin

Which drug is a fluoroquinolone?

A) Delafloxacin

B) Leucovorin

C) Pyrimethamine

D) Sulfamethoxazole

A. Delafloxacin

Fluoroquinolones inhibit which bacterial enzymes?

A) ACE and renin

B) DNA gyrase and topoisomerase IV

C) Na/K ATPase and PDE-3

D) Transpeptidase and beta-lactamase

B. DNA gyrase and topoisomerase IV

DNA gyrase and topoisomerase IV help bacteria do what?

A) Unwind and replicate DNA

B) Build fungal cell walls

C) Produce viral envelopes

D) Secrete histamine

A. Unwind and replicate DNA

Fluoroquinolones kill bacteria by preventing which process?

A) DNA copying

B) Folate absorption

C) Calcium binding

D) Capsule staining

A. DNA copying

A patient receives ciprofloxacin. Which mechanism explains bacterial death?

A) Blocks beta receptors

B) Inhibits DNA gyrase

C) Blocks folate only

D) Activates leucovorin

B. Inhibits DNA gyrase

A drug blocks topoisomerase IV and DNA gyrase. Which class is it?

A) Sulfonamide

B) Folate antagonist

C) Fluoroquinolone

D) Antimetabolite

C. Fluoroquinolone

Which clinical use belongs to fluoroquinolones?

A) UTIs

B) Torsades

C) Asthma

D) Angina

A. UTIs

Which gastrointestinal infection category is listed for fluoroquinolone use?

A) Gastroenteritis

B) Toxoplasmosis

C) Pneumocystis pneumonia

D) Nocardiosis

A. Gastroenteritis

Which bone infection is listed as a fluoroquinolone clinical use?

A) Osteomyelitis

B) Cellulitis only

C) Septic arthritis only

D) Endocarditis

A. Osteomyelitis

Which bioterrorism-associated infection is listed as a fluoroquinolone use?

A) Anthrax

B) Botulism

C) Tetanus

D) Diphtheria

A. Anthrax

A patient with anthrax is treated with an antibiotic ending in “floxacin.” Which class is this?

A) Fluoroquinolone

B) Folate antagonist

C) Sulfonamide

D) Pyrimidine analog

A. Fluoroquinolone

A patient with osteomyelitis receives ciprofloxacin. Which bacterial process is inhibited?

A) DNA replication

B) Folate rescue

C) Peptidoglycan crosslinking

D) Ribosomal translocation

A. DNA replication

Which side effect set best matches fluoroquinolones?

A) GI upset, neurotoxicity, tendon rupture

B) Rash, fever, hyperkalemia

C) Bone marrow toxicity only

D) Cough, angioedema, nephrotoxicity

A. GI upset, neurotoxicity, tendon rupture

Why should fluoroquinolones not be taken with calcium, magnesium, iron, or aluminum?

A) They bind drug and decrease absorption

B) They increase folate synthesis

C) They worsen bacterial DNA copying

D) They activate topoisomerase IV

A. They bind drug and decrease absorption

A patient takes ciprofloxacin with calcium supplements. What is the likely result?

A) Decreased drug absorption

B) Increased drug absorption

C) Increased folate blockade

D) Increased leucovorin activity

A. Decreased drug absorption

Which medication should be separated from iron supplements because absorption can decrease?

A) Ciprofloxacin

B) Trimethoprim

C) Pyrimethamine

D) Leucovorin

A. Ciprofloxacin

Which pairing is correct?

A) TMP-SMX—folate pathway blockade

B) Ciprofloxacin—cell wall blockade

C) Trimethoprim—DNA gyrase inhibitor

D) Leucovorin—fluoroquinolone

A. TMP-SMX—folate pathway blockade

Which pairing is correct?

A) Sulfadiazine/pyrimethamine—toxoplasmosis

B) Levofloxacin—bone marrow rescue

C) TMP-SMX—tendon rupture

D) Leucovorin—DNA gyrase inhibition

A. Sulfadiazine/pyrimethamine—toxoplasmosis

Which pairing is correct?

A) Fluoroquinolones—DNA gyrase inhibition

B) TMP-SMX—topoisomerase IV inhibition

C) Trimethoprim—calcium chelation

D) Leucovorin—bacterial DNA unwinding

A. Fluoroquinolones—DNA gyrase inhibition

Which pairing is correct?

A) Trimethoprim alone—lower UTIs

B) Moxifloxacin—sulfa allergy alternative

C) Bactrim—anthrax first only

D) Delafloxacin—leucovorin rescue

A. Trimethoprim alone—lower UTIs

Which pairing is correct?

A) Fluoroquinolones—avoid calcium coadministration

B) TMP-SMX—avoid all folate rescue

C) Leucovorin—causes tendon rupture

D) Sulfadiazine—blocks DNA gyrase

A. Fluoroquinolones—avoid calcium coadministration

A patient with sulfa allergy has a lower UTI. Which option best avoids the sulfa component?

A) Trimethoprim alone

B) TMP-SMX

C) Sulfadiazine/pyrimethamine

D) Sulfamethoxazole alone

A. Trimethoprim alone

A patient with toxoplasmosis receives sulfadiazine and pyrimethamine. Which add-on reduces bone marrow toxicity

A) Leucovorin

B) Aluminum

C) Ciprofloxacin

D) Dapagliflozin

A. Leucovorin

A patient with UTI and soft tissue infection is prescribed Bactrim. Which side effect should be monitored?

A) Hyperkalemia

B) Tendon rupture only

C) Constipation

D) Bradycardia

A. Hyperkalemia

A patient taking TMP-SMX develops rash, fever, and cytopenias. Which drug caused this?

A) Bactrim

B) Ciprofloxacin

C) Leucovorin

D) Moxifloxacin

A. Bactrim

A patient taking moxifloxacin develops GI upset and tendon pain. Which class toxicity is this?

A) Fluoroquinolone toxicity

B) Folate antagonist toxicity

C) Sulfonamide rescue effect

D) Leucovorin toxicity

A. Fluoroquinolone toxicity

Trimethoprim-sulfamethoxazole is established to be effective
against which of the following opportunistic infections in the
AIDS patient?
(A) Cryptococcal meningitis
(B) Herpes simplex
(C) Oral candidiasis
(D) Toxoplasmosis
(E) Tuberculosis

(D) Toxoplasmosis

A 65-year-old woman has returned from a vacation abroad
suffering from traveler’s diarrhea, and her problem has not
responded to antidiarrheal drugs. A pathogenic Gram-negative bacillus is suspected. Which drug is most likely to be effective in the treatment of this patient?
(A) Ampicillin
(B) Ofloxacin
(C) Sulfadiazine
(D) Trimethoprim
(E) Vancomycin

(B) Ofloxacin

Which statement about the clinical use of sulfonamides is
correct?
(A) Cannot be used topically for treatment of chlamydial
infections of the eye
(B) Effective as sole agents in the treatment of prostatitis
(C) Effective in Rocky Mountain spotted fever
(D) In some bacterial strains resistance occurs via reduced
PABA formation
(E) Reduced intracellular uptake is a mechanism of sulfonamide
resistance in some bacterial strains

(E) Reduced intracellular uptake is a mechanism of sulfonamide
resistance in some bacterial strains

A 31-year-old man has gonorrhea. He has no drug allergies,
but a few years ago acute hemolysis followed use of an anti-malarial drug. The physician is concerned that the patient
has an accompanying urethritis caused by C trachomatis,
although no cultures or enzyme tests have been performed.
Which of the following drugs will be reliably effective against
both gonococci and C trachomatis and safe to use in this
patient?
(A) Cefixime
(B) Ciprofloxacin
(C) Spectinomycin
(D) Sulfamethoxazole-trimethoprim
(E) None of the above

(E) None of the above

Which statement about the fluoroquinolones is accurate?
(A) Antacids increase their oral bioavailability
(B) Contraindicated in patients with hepatic dysfunction
(C) Fluoroquinolones are drugs of choice in a 6-year-old
child with a urinary tract infection
(D) Gonococcal resistance to fluoroquinolones may involve
changes in DNA gyrase
(E) Modification of moxifloxacin dosage is required in
patients when creatinine clearance is less than 50 mL/min

(D) Gonococcal resistance to fluoroquinolones may involve
changes in DNA gyrase

A 40-year-old man complains of periodic bouts of diarrhea
with lower abdominal cramping and intermittent rectal
bleeding. Seen in the clinic, he appears well nourished,
with blood pressure in the normal range. Examination
reveals moderate abdominal pain and tenderness. His cur￾rent medications are limited to loperamide for his diarrhea.
Sigmoidoscopy reveals mucosal edema, friability, and some
pus. Laboratory findings include mild anemia and decreased
serum albumin. Microbiologic examination via stool cultures
and mucosal biopsies do not reveal any evidence for bacterial, amebic, or cytomegalovirus involvement. The most appropriate drug to use in this patient is
(A) Ampicillin
(B) Doxycycline
(C) Norfloxacin
(D) Sulfasalazine
(E) Trimethoprim-sulfamethoxazole

(D) Sulfasalazine

Which adverse effect is most common with sulfonamides?
(A) Fanconi’s aminoaciduria syndrome
(B) Hematuria
(C) Kernicterus in the newborn
(D) Neurologic dysfunction
(E) Skin rash

(E) Skin rash

Which drug is effective in the treatment of nocardiosis and,
in combination with pyrimethamine, is prophylactic against
Pneumocystis jirovecii infections in AIDS patients?
(A) Amoxicillin
(B) Erythromycin
(C) Levofloxacin
(D) Sulfadiazine
(E) Trimethoprim

(D) Sulfadiazine

Which statement about ciprofloxacin is accurate?
(A) Antagonism occurs if used with dihydrofolate reductase
inhibitors
(B) Ciprofloxacin is active against MRSA strains of
staphylococci
(C) Most “first-time” urinary tract infections are resistant to
ciprofloxacin
(D) Organisms that commonly cause ear infections are
highly resistant
(E) Tendinitis may occur during treatment

(E) Tendinitis may occur during treatment

Supplementary folinic acid may prevent anemia in folate-deficient persons who use this drug; it is a weak base achieving tissue levels similar to those in plasma.
(A) Ciprofloxacin
(B) Levofloxacin
(C) Linezolid
(D) Sulfamethoxazole
(E) Trimethoprim

(E) Trimethoprim