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Pharmacology II
Exam 1
| Question | Answer |
|---|---|
| B-lactam antibiotics, cycloserine, vancomycin, and bacitracin all function to...? | Inhibit bacterial cell-wall synthesis |
| Polymyxin, nystatin, amphotericin B-antifungals, and daptomycin all function to..? | Act directly on cell membrane of the microorganism and increase permeability |
| Chloramphenicol, clindamycin, tetracyclines, erythromycin, and linezolid all function to..? | Reversible inhibition of protein synthesis |
| Aminoglycosides function to..? | Alter protein synthesis |
| Rifampin and fluoroquinolones function to..? | Affect bacterial nucleic acid metabolism |
| Trimethoprim and sulfonamides are both in this antibiotic classification? | Antimetabolites |
| Acyclovir, efavirenz, nevirapine, protease inhibitors and enfuviritide are all classified as what type of antimicrobials? | Antiviral agents |
| These antibiotics inhibit peptidoglycan synthesis or "transpeptidation" of bacterial cell wall. | B-lactam antibiotics |
| Which Penicillins do not require dose adjustments in renal impairment? | Nafcillin, Oxacillin |
| Which penicillins are both IV drugs for Pseudomonas? | Ticarcillin, Piperacillin |
| What has no antimicrobial activity but helps a medication to live longer and "out-do" the organism? | B-Lactamase Inhibitors |
| Which cephalosporin does not require dose adjustments in renal impairment? | Ceftriaxone |
| Which cephalosporins have mostly gram positive coverage? | First generation |
| Which cephalosporins have pseudomonas coverage? | Ceftazidime, cefepime |
| Doripenem, Imipenem, Meropenem, Ertapenem all fall into which antibiotic class? | Carbapenems |
| Which Carbapenem is the only one that does not cover for Pseudomonas? | Ertapenem |
| What is the bleeding disorder that can be an adverse effect of B-lactams and may be prevented with vitamin K therapy? | Hypoprothrombinemia |
| What is the only drug of the monobactam class that has activity against gram negative bacteria including pseudomonas? | Aztreonam |
| Cephalosporins are not active against which 2 groups of microorganisms? | Enterococci and L. monocytogenes |
| This drug has gram positive coverage only, is good for VRE and has adverse effects of myopathy and increased CPK | Daptomycin |
| Which of the following is not an adverse effect of vancomycin? ototoxicity, red man's syndrome, ALT elevations, nephrotoxicity | ALT elevations |
| Which of the macrolides is the worst for causing the adverse effect of GI symptoms? | Erythromycin |
| Which antimicrobial is broad spectrum that can cause Gray baby syndrome? | Chloramphenicol |
| Which of the fluoroquinolones are respiratory, used for CAP? | Levofloxacin, Moxifloxacin |
| Which NNRTI is Pregnancy Category D and can worsen psychiatric illness? | Efavirenz |
| Which of the following fluoroquinolones are not PO? Levoflaxacin, Norfloxacin, Ciprofloxacin, Moxifloxacin | Norfloxacin |
| Which TB agent can cause retrobulbar neuritis? | Ethambutol |
| Which of the following non-retroviral agents are not used for CMV? Docosonal, Acyclovir, Foscarnet, Ganciclovir | Docosanol |
| Which antifungal is known to cause anemia, nephrotoxicity, and infusion-related toxicity? | Amphotericin B |
| Which of the following drugs is not used for Hepatitis B? Adefovir, Telbivudine, Sofosbuvir, Entecavir | Sofosbuvir |
| Which of the following ART drugs is a CCR5 receptor antagonist and has a BBW of hepatotoxicity? Indinavir, Maraviroc, Abacavir, Stavudine | Maraviroc |
| Which penicillin would be prescribed to treat a Pseudomonas infection? Oxacillin, Amoxicillin, Ticarcillin, Penicillin G | Ticarcillin |
| What is the BBW for fluoroquinolones? | Tendon rupture |
| Which of the following is not a side effect of Isoniazid (INH)? Hepatotoxicity, ototoxicity, peripheral neuropathy, drug-induced SLE? | Ototoxicity |
| What can you give along with elemental iron to improve its absorption? | Vitamin C/acidic environment |
| What adverse effects would you warn your patient about when started on oral iron therapy? | Dark stools, constipation |
| How do you treat iron toxicity? | Deferoxamine, Deferasirox |
| Which iron therapy would you perform a test dose first with the patient in order to avoid a hypersensitivity reaction? | Iron dextran |
| Which of the following is not an etiology of iron deficiency anemia? Menstruating women, blood donations, strict vegetarians, corticosteroids | Strict vegetarians |
| Which of the following is a parenteral preparation for Vitamin B12 deficiency? Hydroxocobalamin, pyridoxine, nicotinic acid, iron dextran | Hydroxocobalamin |
| What deficiency is caused by inadequate dietary intake, pregnancy, or medications such as methotrexate? | Folic acid deficiency |
| What is the difference between folic acid deficiency and vitamin B12 deficiency? | No neurologic symptoms in folic acid deficiency |
| What is the recommended dose and formulation for someone with folic acid deficiency and what could the dose be if they have a malabsorption syndrome? | 1 mg PO daily and up to 5 mg daily |
| What is the dose given to pregnant women at low risk for folic acid deficiency and women who have some sort of history of neural tube defect issues? | 0.4 mg daily low risk and 4 mg daily high risk |
| A patient is on Epoetin alfa because he is an HIV infected patient being treated with what drug most likely? | Zidovudine |
| What are the black box warnings for patients on erythropoeitin stimulating agents? | Chronic kidney disease, cancer, perisurgery |
| Which of the following is not an adverse effect of erythropoeitin stimulating agents? Bone pain, bone marrow suppression, pure red cell aplasia, thrombotic events | Bone marrow suppression |
| Meg presents with ataxia, weakness, and other neurological symptoms. What would the best treatment option be for her? IV cyanocobalamin, oral folic acid, ferrous fumarate, epoetin alfa | IV cyanocobalamin |
| Which of the following is not an indirect thrombin inhibitor? Enoxaparin (Lovenox), Warfarin (Coumadin), Fondaparinux (Arixtra), Dalteparin (Fragmin) | Warfarin (Coumadin) |
| What is the sister drug to Rivaroxaban (Xarelto)? | Apixaban (Eliquis) |
| Which of the following is not an indication of Dabigatran (Pradaxa)? DVT/PE treatment, DVT prophylaxis in patients undergoing hip/knee athroplasty, prevention of stroke and systemic embolism in nonvalvular afib | DVT prophylaxis in patients undergoing knee/hip surgery |
| How are the emerging oral anticoagulants dosed and excreted (Pradaxa, Xarelto, Eliquis)? | Renally |
| What would you counsel your patient to do if they miss a dose of their warfarin? | Skip that dose entirely and then continue on their normal time schedule |
| Which of the following is an acceptable intervention for someone on too much warfarin? Protamine sulfate, phytonadione, factor IIa, pyridoxine | Phytonadione |
| What is aspirin available in combination with as Aggrenox? | dipyridamole |
| Which of the following drugs is a glycoprotein IIB/IIIA receptor antagonist? Enoxaparin (Lovenox), Abciximab (Reopro), Clopidogrel (Plavix), Ticagrelor (Brilinta) | Abiciximab (Reopro) |
| What is the recommended therapy for a CHA2DS2 VASc score of 2 or more? | Anticoagulant or Aspirin + clopidogrel |
| What is a non-immune mediated response to heparin and what is the management? | HIT Type I; no intervention required |
| What is an immune-mediated response to heparin and is intervention required? | HIT Type II; intervention required |
| Which of the following medications cannot be used as an alternate medication for a patient with HIT? Fondaparinux, Lepirudin, Protamine sulfate, Argatroban | Protamine sulfate |
| What is the blackbox warning for Dabigatran (Pradaxa) and Rivaroxaban (Xarelto)? | Spinal/epidural hematoma |
| What are the adverse effects of warfarin? | Bleeding, bruising, purple toe syndrome |
| What is the initial dose and administration of warfarin? | 5-10 mg PO |
| What is the therapeutic INR range you would want for someone at risk for a VTE? | 2-3 |
| Medications that increase INR, increase _______, while medications that decrease INR increase ________. | bleed risk, clot risk |
| What are the goals of therapy for a diabetic patient? | A1c<7; pre-prandial plasma glucose 70-130, post-prandial plasma glucose <180 |
| What are the goals for hypertension of a diabetic patient? | SBP <130-140 and DBP <80 |
| The medications tolbutamide, chlorpropramide, and glimepiride all fall into what drug class. Which of them is preferred? | Sulfonylureas; Glimepiride |
| What are some adverse effects of sulfonylureas? | Weight gain, hypoglycemia, not tolerated well in the elderly |
| What are the CIs of sulfonylureas? | Hypersensitivity to sulfonamides; poor renal function |
| What is not an adverse effect of metformin? Lactic acidosis, metallic taste, weight gain, vitamin B12 deficiency | Weight gain |
| What are the renal levels that are needed to be maintained while the patient is on metformin? | Males SCr >1.5, Females SCr > 1.4; CrCl<60 |
| What are the CIs of metformin? | Iodinated contrast studies, renal impairment, increased lactic acidosis risk |
| Which drugs are indicated for postprandial glucose elevations? | Meglitinides |
| CIs of this drug class include heart failure, hepatic impairment, increased MI risk, increased bladder cancer risk, PCOS ovulation resumption | Thiazolidinediones |
| Which drug class causes GI symptoms but has a minimal risk of hypoglycemia? | alpha-glucosidase inhibitors |
| What is the SQ injection drug that is contraindicated with gastroparesis? | Amylin analog: Pramlintide (Symlin) |
| Which drug class increases insulin secretion, decreases glucagon secretion, and increases satiety as well as slows gastric emptying? Give examples and its formulations. | GLP-1 analog; Exenatide, Liraglutide; SQ injection |
| Personal or family history of thyroid C-cell hyperplasia carcinoma, MEN2, and CrCl <30 are all contraindications of which drug class? | GLP-1 analog |
| What is the adverse effect of exenatide? | Acute pancreatitis |
| Which two DPP-4 inhibitors are renally dose adjusted? | Sitagliptin, Saxagliptin |
| Which of the following drugs have a CI of decreased GFR and a precaution of drug interactions with UGT inducers/inhibitors? Sitagliptin (Januvia), Dapagliflozin (Forxiga), Pramlintide (Symlin), Acarbose (Precose) | Dapagliflozin (Forxiga) |
| What is the definition of hypoglycemia? | <70 mg/dl |
| What is the management for hypoglycemia? | Conscious and able to tolerate PO: 15-20 g glucose (fruit juice, sugar packets) |
| What is Telavancin used to treat? | Hospital acquired pneumonia |
| Which drug has renal dose adjustment and has adverse reactions of red man's syndrome and ALT elevations? | Dalbavancin |
| Which drug has adverse effects of myopathy and increased CPK? | Daptomycin |
| What is the CI of daptomycin? | Pneumonia |
| Which two NRTIs have the adverse effects of peripheral neuropathy? | Didanosine and Stavudine |
| What is the adverse effect of zidovudine? | Bone marrow suppression |
| What of the following is not an adverse effect of NRTIs? GI symptoms, Kernicterus, Lactic acidosis, severe hepatomegaly | Kernicterus |
| What is an adverse effect of Indinavir? | Nephrolithiasis |
| What are adverse effects of Protease Inhibitors as a class? | Metabolic issues: hyperglycemia, lipodystrophy syndrome, hyperlipidemia, increased LFTs |
| T/F: 3 NRTIs is an acceptable ART regimen. | False |
| Which ART drug is administered SQ BID and can cause injection site reactions? | Enfuvirtide (Fuzeon) |
| A patient on Raltegravir needs to be instructed to report any myalgias because of this adverse effect. | Increased CPK |
| What are the adverse effects of acyclovir/valacyclovir? | Nephrotoxicity, neurologic toxicity |
| This drug has adverse effects of myelosuppression and CNS toxicity and is available IV, PO, intravitreal injection, and intraocular implants. | Ganciclovir/Valganciclovir |
| Which of the following is not an adverse effect of Foscarnet: CNS toxicity, ototoxicity, electrolyte disturbances, renal impairment | ototoxicity |
| Which of the following drugs has these adverse effects: nephrotoxicity, ocular toxicity, neutropenia. Abacavir, Cidofovir, Famciclovir, Interferon alfa | Cidofovir |
| What are the contraindications of interferon alfa? | Autoimmune disease, arrhythmias, hepatic deompensation |
| Which of the following drugs can be used to treat both hepatitis C and influenza? | Ribaviran |
| Which of the following drugs is used to treat Hepatitis B only? Telbivudine, Ribaviran, Ganciclovir, Abacavir | Telbivudine |
| Which protease inhibitor has adverse effects of photosensitivity and can also be used to treat Hepatitis C? | Simepravir |
| Which of the following drugs inhibits the viral replication of influenza? Oseltamivir, Amantadine, Zanamivir, Ribaviran | Amantadine |
| Which drug has an infusion-related toxicity similar to vancomycin as well as anemia and nephrotoxicity? | Amphotericin B |
| Which of the following is not an antifungal: Nystatin, Metronidazole, Terbinafine, Griseofulvin | Metronidazole |
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