Question 1

Macrolides—core mechanism of action?

Accepted Answer

Bind the 50S ribosomal subunit → inhibit translocation → ↓ bacterial protein synthesis (usually bacteriostatic).

Question 2

3 common macrolide agents?

Accepted Answer

Azithromycin, clarithromycin, erythromycin.

Question 3

Typical coverage/uses for macrolides?

Accepted Answer

Atypicals (Mycoplasma, Chlamydia, Legionella), respiratory infections, pertussis; clarithro with H. pylori regimens.

Question 4

3 high-yield adverse effects of macrolides to monitor?

Accepted Answer

QT prolongation, GI upset, hepatotoxicity (check for jaundice, LFTs).

Question 5

Big drug–drug interaction issue with (erythro/clarithro)?

Accepted Answer

CYP3A4 inhibition → ↑ levels of other meds (e.g., some statins, warfarin, carbamazepine)

Question 6

Key nursing considerations with macrolides?

Accepted Answer

Review med list for QT-prolongers, baseline LFTs if indicated, teach to report palpitations/syncope, severe diarrhea, jaundice.

Question 7

Clindamycin—go-to uses & top risk?

Accepted Answer

Skin/soft tissue, dental/anaerobes, toxin suppression; highest risk of C. difficile colitis—report ≥3 loose stools/day.

Question 8

Linezolid—coverage and 2 major cautions?

Accepted Answer

Strong for MRSA/VRE; watch thrombocytopenia (check CBC) and serotonin syndrome with SSRIs/MAOIs (has MAOI activity)

Question 9

Metronidazole—what it’s great for & one crucial teaching point?

Accepted Answer

Anaerobes, BV, trichomoniasis, some intra-abdominal infections; no alcohol during & 48–72 h after (disulfiram-like reaction).

Question 10

Vancomycin—oral vs IV uses?

Accepted Answer

Oral vanco for C. difficile (not systemic); IV for serious MRSA/systemic infections.

Question 11

Vancomycin infusion-related reaction & fix?

Accepted Answer

Red Man syndrome (flushing) if too fast → slow the rate, consider premedication per policy.

Question 12

Specimen collection with an indwelling cath—best practice?

Accepted Answer

Use the sampling port (needleless), not the drainage bag; maintain a closed system and dependent drainage.

Question 13

First-line vasopressor in septic/distributive shock after fluids?

Accepted Answer

Norepinephrine (α1 >>> β1): ↑ SVR/MAP; monitor for ischemia/arrhythmias.

Question 14

Epinephrine—when preferred and key side effects?

Accepted Answer

Anaphylaxis (IM first), refractory shock; can ↑ lactate/glucose, cause tachyarrhythmias.

Question 15

Phenylephrine role?

Accepted Answer

Pure α1; useful if tachyarrhythmias limit β-agonists or in neurogenic shock; may ↓ stroke volume—avoid as primary in cardiogenic shock.

Question 16

Dopamine—why not first-line in sepsis?

Accepted Answer

Low-output (cardiogenic) states to ↑ contractility; combine with NE if hypotensive.

Question 17

Milrinone pearls?

Accepted Answer

PDE-3 inodilator, helpful with β-blockers/RV failure; renally cleared—risk hypotension/arrhythmias.

Question 18

Vasopressin in septic shock—how used?

Accepted Answer

Fixed-dose add-on to NE to raise MAP and spare catecholamine dose; watch for ischemia at high doses.

Question 19

Angiotensin II role?

Accepted Answer

Rescue therapy for refractory vasodilatory shock; ensure VTE prophylaxis (↑ thrombosis risk).

Question 20

Pressor extravasation—first steps?

Accepted Answer

Leave catheter in, aspirate drug, infiltrate phentolamine per protocol, warm compress.

Question 21

Lines & monitoring for vasoactives?

Accepted Answer

: Prefer central line for pressors; arterial line for continuous BP when titrating.

Question 22

Fluid strategy in shock (general)?

Accepted Answer

Start with balanced crystalloids; assess responsiveness (clinical, PLR/echo); avoid over-resuscitation.

Pharm Exam 2