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MedChem561P Immunizing and Agents EXAM 2 (100 points) April 29, 2011

Select the one best answer. Enjoy your weekend!

1. Which drug should be used as first-line therapy against a C. difficile associated ? a) b) c) SMX/TMP d) Metronidazole

2. If the drug in #1 fails, which should be used as an alternative agent? a) Pipercillin b) c) (IV) d) Vancomycin (PO)

3. Which of the following is a known P-gp (P-glycoprotein) inhibitor? a) Erythromcyin b) Clarithromycin c) Azithromycin d) Telithromycin

4. Resistance to metronidazole can occur by all of the following EXCEPT: a) Reduced drug activation, by encoding for an alternate form of nitroreductase b) Efflux pumps c) Induction of nim genes, which cause result in drug inactivation d) Decreased target binding, due to production of a mutant form of DNA gyrase

5. Infants less than 2 months of age should not receive because: a) They have a higher risk of Stevens-Johnson Syndrome b) Risk of kernicterus c) Lack of drug efficacy d) They will more prone to megaloblastic anemia

6. Formation of reactive intermediates, which eventually results in damage of bacterial DNA, is a characteristic mechanism of action of which drug: a) Moxifloxacin b) Metronidazole c) d) Clindamycin

7. Sulfamethoxazole works by _____, while works by_____. a) Competitive inhibitor to PABA, dihydrofolate reductase inhibitor b) Competitive inhibitor to PABA, actively destroying folic acid c) Dihydrofolate reductase inhibitor, competitive inhibitor to PABA d) Actively destroying folic acid, dihydrofolate reductase inhibitor

8. Clindamycin, at ordinary doses, acts by: a) Binding to the 30S ribosomal subunit, and is bactericidal b) Binding to the 30S ribosomal subunit, and is bacteriostatic c) Binding to the 50S ribosomal subunit, and is bactericidal d) Binding to the 50S ribosomal subunit, and is bacteriostatic

9. The most common side-effect (occurs in >20% of patients) of clindamycin is: a) Rash b) Diarrhea c) Photosensitivity d) Hepatotoxicity

10. The spectrum of coverage of clindamycin includes all EXCEPT: a) Gram(+) aerobes b) Gram(+) anaerobes c) Gram(-) aerobes d) Gram(-) anaerobes

11. Azithromycin, when not given in extremely high doses, acts by: a) Binds to 2 sites on the 50S ribosomal subunit, and is bactericidal b) Binding to the 50S ribosomal subunit, and is bacteriostatic c) Binding to the 30S ribosomal subunit, and is bacteristatic d) Binding to the 50S ribosomal subunit, and is bactericidal

12. The mechanism of action of gentamicin inludes: a) Creating fissures on the outer membrane of gram(-) bacteria b) Binding to the 50S ribosomal subunit c) Inhibiting folic acid synthesis d) Inhibiting the activity of topoisomerase IV

13. is primarily used for treating: a) Legionella b) Leprosy by Mycobacterium leprae c) Malaria by Plasmodium falciparum d) Rocky Mountain Fever by Rickettsia species

14. Macrolides, as a class, are ALL expected to have VERY LITTLE activity against: a) Streptococcus pneumoniae b) Klebsiella pneumoniae c) Chlamydia pneumoniae d) Mycoplasma pneumoniae

15. Among macrolides, which is commonly used against H. pylori? a) Erythromycin b) Clarithromycin c) Telithromycin d) Azithromycin

16. Decreased clearance of , a CYP2C9 substrate, is expected to occur through concurrent use with: a) Metronidazole b) Sulfamethoxazole c) d) A and B

17. If a patient is diagnosed with an intra-abdominal involving Bacteriodes fragilis, a good agent to use in this infection would be: a) Clindamycin b) c) d) Metronidazole

18. All of the following are true regarding tigecycline EXCEPT: a) Effective against Pseudomonas b) Effective against both MRSA and VRE c) Not as susceptible to efflux pumps compared to other drugs in its class d) Available IV only

19. The best to treat Borellia burgdoferi (Lyme disease) would be: a) Clindamycin b) Erythromycin c) d) SMX/TMP

20. For a pen-allergic patient experiencing sinusitis infection by H. flu, what would be considered a reasonable alternative? a) Moxifloxacin b) Metronidazole c) d) Azithromycin

21. Renal toxicity as a result of using expired antibiotics is a concern with: a) b) Macrolides c) Penicillins d) Fluoroquinolones

22. The most serious and irreversible toxicity associated with use is: a) Ototoxicity b) Nephrotoxicity c) Stevens-Johnson Syndrome d) Bone marrow depression

23. The main reason gentamicin is ineffective against fragilis is because: a) It is unable to diffuse through porin channels b) It produces aminoglycoside inactivating enzymes c) utilize oxygen-dependent active transport to get into bacteria d) None of the above

24. Loss of balance after gentamicin use is most likely a manifestation of: a) Renal toxicity b) Vestibular toxicity c) Neuromuscular blockade d) B and C

25. Moxifloxacin would be preferred over ciprofloxacin in which of the following infections: a) Nosocomial by PRSP b) UTI by Escherichia coli c) Amebiasis by histolytica d) Bladder infection

26. An infection for which ciproifloxacin would be preferred over moxifloxacin would be: a) Nosocomial pneumonia by PRSP b) UTI by Escherichia coli c) Amebiasis by d) Skin infection by Strep. pyogenes

27. The concept of extended-interval (once-daily) dosing of aminoglycosides is based on: a) Absence of a post-antibiotic effect b) Time-dependent, bactericidal action c) Strong post-antibiotic effect of the drug d) Bacteriostatic nature of the drugs

28. Which of the following is true about nitrofurantoin? a) Can be used to treat systemic pseudomonas infections b) Has activity against VRE c) Is primarily cleared by the d) The microcrystalline form was developed to lower GI distress

29. Rare, but serious, adverse effect(s) associated with nitrofurantoin use is/are a) b) Hepatotoxicity c) Hemolytic anemia d) All of the above

30. Use of fluoroquinolones is avoided in patients <18 years old because of a) Nephrotoxicity b) Ototoxicity c) Risk of cartilage damage d) Teeth staining

31. All of the following drugs have activity against CA-MRSA EXCEPT: a) SMX/TMP b) Vancomycin c) Doxycycline d) Azithromycin

32. In treating penicillin-resistant S. pneumoniae (PRSP), all of the following could be used EXCEPT a) Moxifloxacin b) Telithromycin c) Amikacin d) All of the above have good activity against PRSP

33. Which of the following can be taken alongside dairy products and antacids without concern for decreased activity or uptake of the drug: a) Nitrofurantoin b) Tetracycline c) Ciprofloxacin d) All may be affected by the calcium in dairy and antacids

34. Which of the following may show activity against Pseudomonas aeruginosa? a) Daptomycin b) Tigecycline c) Ciprofloxacin d)

35. Gram+ membrane disruption is the PRIMARY mode of action for which one of the following drugs? a) Linezolid b) Amikacin c) Polymixin d) Daptomycin

36. If a pathogen is resistant to Clindamycin, it is likely to also exhibit cross- resistance with which one of the following: a) Tigecycline b) Gentamicin c) Doxycyline d) Azithromycin

37. A pregnant woman presents with a Chlamydia infection, which drug is a reasonable choice of therapeutic: a) Doxycycline b) Azithromycin c) d) Nitrofurantoin

38. The best first-line agent for treatment of caused by Garderella vaginalis is: a) Clindamycin b) Metronidazole c) Levofloxacin d) Erythromycin

39. All of the following drugs have activity against HA-MRSA except: a) Tigecycline b) Polymixin c) Vancomycin d) Daptomycin

40. Metallic taste is an undesired side effect of which two drugs? a) Metronidazole and clarithromycin b) Metronidaozle and Doxycycline c) Clarithromycin and Doxycycline d) Doxycycline and ciprofloxacin