Quiz Pharmacology Part 2 of 2

Pharmacology – Part 2 14Mar2009
1 – General Principles of Antimicrobial Chemotherapy

1) Antibiotics are chemicals produced by which of the following?
a) Cancer cells
b) Viruses
c) Bacteria
d) Fungi
e) Microorganisms
2) When choosing antibiotics for chemotherapy, critically ill patients need immediate
administration of drugs covering infection by both gram-positive and gram-negative
classes of organisms. This is known as:
a) Site-specific therapy
b) Sensitivity
c) Cost-effective therapy
d) Empiric therapy
e) Selective toxicity
3) Imipenem/Cilastatin is an example of a:
a) Narrow spectrum antibiotic
b) Combination broad spectrum antibiotic
c) Single broad spectrum antibiotic
d) Gram-positive antibiotic
e) Gram-negative antibiotic
f) Anaerobic antibiotic
4) A patient presents with a rapid heart rate, fever, and diaphoresis. Infection is highly
suspected and a blood sample is sent to the lab. In the disk diffusion method for lab
testing cultured bacteria, what would a large zone of inhibition indicate?
a) Drug sensitivity
b) Drug resistance
c) Presence of anaerobic bacteria
d) Presence of gram-positive bacteria
e) Presence of gram-negative bacteria
5) Several families of drugs such as penicillins and cephalosporins act to ____ the
bacterial ____ and thereby promoting lysis. The mechanism is through prevention of
murein (peptidoglycan) synthesis.
a) Weaken; Cell membrane
b) Weaken; Cell wall
c) Strengthen; Cell membrane
d) Strengthen; Cell wall
6) Which of the following would be a quantitative method of measuring selective
toxicity?
a) Equilibrium dissociation constant
b) Toxic dosage
c) Effective dosage
d) Sensitivity
e) Therapeutic index
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7) The enzyme that sulfonamides inhibit (para-aminobenzoic acid, PABA) is needed for
bacterial production of which of the following, which is required for synthesis of DNA,
RNA, and protein?
a) Murein
b) Niacin
c) Folic acid
d) Arachidonic acid
e) Phosphodiesterase
8) Bactrim is an effective and cheap medication containing a sulphonamide and
trimethoprim. Which enzyme is targeted by trimethoprim?
a) Monohydropteroate synthase
b) Monohydrofolate reductase
c) Dihydropteroate synthase
d) Dihydrofolate reductase
9) When prescribing Bactrim, care must be taken for patients with glucose-6-phosphate
deficiencies. In which of the following cases is Bactrim contraindicated?
a) Gram-negative infected patients
b) Hemological deficiency patients
c) Congestive heart failure patients
d) Thyroid hormone deficiency patients
e) Alcoholics
10) Fluoroquinolones works by which of the following mechanisms?
a) Disruption of protein synthesis via ribosomes
b) Inhibition of DNA gyrase
c) Inhibition of reverse transcriptase
d) Inhibition of fungal membrane
11) Erythromycin works by which of the following mechanisms?
a) Disruption of protein synthesis via ribosomes
b) Inhibition of DNA gyrase
c) Inhibition of reverse transcriptase
d) Inhibition of fungal membrane
12) Which of the following mechanisms is NOT correctly matched with the drug?
a) Vancomycin; Inhibitor of cell wall synthesis
b) Amphotericin B; Disruption of cell wall membrane
c) Tetracyclines: Bacteriostatic inhibitor of protein synthesis
d) Ketokonazole; Disruption of cell wall membrane
e) Rifampin; Inhibitor of cell wall synthesis
13) Which of the following is NOT an antibiotic?
a) Flucytosine
b) Clindamycin
c) Fluroquinolone
d) Imipenem
e) Cephalosporin
14) Which of the following is a prodrug (must be activated by bacterial catalase) and
works by inhibiting mycolic acid synthesis?
a) Flucytosine

b) Acyclovir
c) Zidovudine
d) Isoniazid
e) Pyrazinamine
15) Which of the following drugs does NOT inhibit viral enzymes?
a) Acyclovir
b) Zidovudine
c) Ethambutol
d) Saquinavir
e) Indinavir
16) What is the mechanism of action for the drug amantadine, which is used against type
A influenza?
a) Antimetabolite
b) Interference with synthesis of bacterial DNA or RNA
c) Viral enzyme inhibitor
d) Mycolic acid synthesis inhibitor
e) Unknown
Match the drug with the inhibited ribosomal subunit:
17) Tetracycline a) 30s inhibitor
18) Clindamycin b) 50s inhibitor
19) Gentamicin
20) Erythromycin
21) Streptomycin
22) Chloramphenical
23) Spectinomycin
24) Which of the following types of drugs disrupts the DNA unwinding process?
a) Penicillins
b) Cephalosporins
c) Macrolides
d) Aminoglycosides
e) Fluoroquinolones
f) Sulfonamides
Match the type of targeting with the mechanism or example:
25) Bacterial cell wall synthesis inhibitors a) Common targeting
26) Drug targets protein isoform; DHFR inhibitor b) Unique targeting
27) Drug targets metabolic pathway; 5-Fluorouracil c) Selective targeting
28) Which of the following narrow spectrum antimicrobial drugs would affect gram-
negative aerobes (versus gram-positive cocci/bacilli)?
a) Nafcillin
b) Vancomycin
c) Gentamycin
d) Erythromycin
e) Clindamycin
29) Which of the following would NOT be a narrow spectrum antibiotic used for
Mycobacterium tuberculosis?
a) Isonizid

b) Rifampin
c) Ethambutol
d) Imipenem
e) Pyrazinamide
30) A(n) ____ drug will halt bacterial growth but not deplete it, while a(n) ____ drug will
start to decline the growth of bacteria.
a) Bactericidal; Antibiotic
b) Antibiotic; Bacteriostatic
c) Bactericidal; Bacteriostatic
d) Bacteriostatic; Bactericidal
e) Antibiotic; Bactericidal
31) Penicillin is a ____ drug and tetracycline is a ____ drug.
a) Bactericidal; Bacteriostatic
b) Bacteriostatic; Bactericidal
c) Bactericidal; Bactericidal
d) Bacteriostatic; Bacteriostatic
32) Which of the following drugs is bactericidal?
a) Sulfonamides
b) Trimethoprim
c) Macrolides
d) Lincosamides
e) Choramphenicol
f) Cephalosporins
33) What does an increase in minimum inhibitory concentration (MIC) response mean,
such as seen with Staphylococcus aureus, Enterococcus, and Mycobacterium
tuberculosis?
a) The drug was not originally effective
b) Intracellular uptake of the drug has increased
c) The bacteria has gained resistance to the drug
d) The bacteria has halted growth (bacteriostatic)
e) The bacterial growth is declining (bactericidal)
34) Spontaneous mutation usually results in resistance to ____ drug(s) and conjugation
(via plasmid) usually results in resistance to ____ drug(s).
a) One; One
b) One; Multiple
c) Multiple; One
d) Multiple; Multiple
e) No; One
35) Selective pressure can occur with plasma-mediated infections (hospital or
nosocomial). This occurs when:
a) Drug-resistant and drug-sensitive bacteria survive
b) Drug-resistant bacteria survive (drug-sensitive killed)
c) Drug-sensitive bacteria survive (drug-resistant killed)
d) Drug-resistant and drug-sensitive bacteria are killed (lack of nutrients)
36) Emergence of drug resistance during primary treatment (suprainfection) is facilitated
most likely by broad-spectrum antibiotics.

a) True
b) False
37) What type of drug would be needed to enter the brain and CNS?
a) Hydrophilic
b) Hydrophobic
c) Lipophilic
d) Lipophobic
e) Large molecular weight
38) Which of the following drugs is contraindicated in neonates as it causes kernicterus
(brain yellowing from bilirubin)?
a) Tetracyclines
b) Aminoglycosides
c) Cephalosporins
d) Fluoroquinolones
e) Sulfonamides
39) Which of the following drugs is considered FDA pregnancy category D
(contraindicated)?
a) Tetracyclines
b) Macrolides
c) Cephalosporins
d) Penicillins
e) Sulfonamides
40) Which of the following patients would have to rely on bactericidal antibiotics?
a) Liver disease patient
b) Acquired immune deficiency syndrome (AIDS) patient
c) Congestive heart failure (CHF) patient
d) Chronic obstructive pulmonary disease (COPD) patient
e) Abdominal trauma patient
41) Along with infected abscesses, which type of infection can impede drug access?
a) Pneumonia
b) Upper respiratory tract infections
c) Urinary tract infections
d) Gastroenteritis
e) Endocarditis
42) When treating meningitis, one of the steps to achieve the MIC is by injecting
antibiotic where?
a) Epidural space
b) Subdural space
c) Subarachnoid space
d) Subpial space
e) Corneal space
43) A patient undergoes a procedure to implant a cardiac pacemaker and prosthetic heart
valve. One month later, the patient returns with a high fever. Infection is found in the
pacemaker pocket, along the pathway of the electrical lead, and near the prosthetic valve.
Which of the following is the most likely cause?
a) Staphylococcus aureus

b) Staphylococcus epidermidis
c) Staphylococcus saprophyticus
d) Viridans Streptococci
e) Escherichia Coli
44) Accumulation of antibiotics to toxic levels can most likely occur in which of the
following patient populations?
a) AIDS patients
b) Elderly
c) Pregnant
d) Neonates
e) B & D
f) A & C
45) Which of the following types of drugs binds to teeth and can cause discoloration?
a) Tetracyclines
b) Macrolides
c) Cephalosporins
d) Penicillins
e) Sulfonamides
46) Which of the following clinical results is associated with gentamicin
(aminoglycoside), not tetracyclines?
a) Hepatic necrosis
b) Pancreatitis
c) Hearing loss
d) Renal damage
47) Which of the following types of drugs can enter breast milk?
a) Tetracyclines
b) Macrolides
c) Cephalosporins
d) Penicillins
e) Sulfonamides
48) Severe allergic reactions are more common with what family of drugs?
a) Tetracyclines
b) Macrolides
c) Cephalosporins
d) Penicillins
e) Sulfonamides
49) Which of the following types of drugs is NOT associated with an incidence of
allergic response?
a) Trimethoprim
b) Tetracyclines
c) Erythromycin
d) Penicillins
e) Sulfonamides
50) Sulfonamides and nalidixic acid can cause hemolysis in patients that are deficient in
what enzyme?
a) Phosphoenolpyruvate carboxykinase

b) Fructose 1,6-bisphosphatase
c) Glucose 6-phosphate
d) Glucokinase
f) Fructokinase
51) If a bacteriostatic agent, such as tetracycline, is given in synergy with a bactericidal
agent, such as penicillin, what is the likely result?
a) Additive response
b) Potentiative response
c) Antagonistic response
52) If trimethoprim and sulfamethoxazole are given together, what decrease in MIC must
be seen to be considered a synergistic (potentiative) interaction?
a) 5-fold (1/5 MIC)
b) 4-fold (1/4 MIC)
c) 3-fold (1/3 MIC)
d) 2-fold (1/2 MIC)
e) 1-fold (MIC)
53) Although the use of multiple antibiotics can lead to drug resistance, what disease is
treated with several drugs as it has a risk for CNS damage?
a) Leprosy
b) Syphilis
c) Thrush
d) Pneumonia
e) Tuberculosis
54) When treating fungal meningitis with combined flucytosine and amphotericin B,
reducing the dose of ____ can decrease the risk of damage to the ____.
a) Flucytosine; Kidney
b) Flucytosine; Liver
c) Amphotericin; Kidney
d) Amphotericin; Liver
55) Penicillin is used in combination with what drug to enhance antibacterial action in the
treatment of enterococcal endocarditis?
a) Sulfonamides
b) Cephalosporins
c) Macrolides
d) Aminoglycosides
e) Fluoroquinolones
56) Which of the following, along with beta-lactams and aminoglycosides, is excreted by
the kidney?
a) Erythromycin
b) Clindamycin
c) Vancomycin
d) Rifampin
e) Chloramphenicol
57) Which of the following tests would be used to monitor kidney function?
a) D-dimer, Fibrin degradation products (FDP)
b) Blood urea nitrogen (BUN), Creatinine

c) Aspartate aminotransferase (AST)

d) Lactate dehydrogenase (LDH)
e) Bilirubin
58) It is estimated that 30-50% of antibiotics used in the United States are administered
for prophylaxis. The drug trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim) is often
given in what situation?
a) Before dental appointments for patients with endocarditis
b) For young women with recurrent urinary tract infections
c) For elderly patients with an increased risk of pneumonia
d) For pregnant women showing signs of systemic infection
e) For all neonates with mild neutropenia
59) Prophylactic penicillin is indicated following exposure to STDs as well as for patients
with rheumatic carditis. If the patient is allergic to penicillin, which drug should be used?
a) Sulfonamides
b) Cephalosporins
c) Macrolides
d) Aminoglycosides
e) Fluoroquinolones
60) Which of the following antibiotics should be used for the treatment of fever with
unknown origin?
a) Sulfonamides
b) Cephalosporins
c) Macrolides
d) Aminoglycosides
e) Penicillins
f) Antibiotics should not be used
61) Saquinavir and ritonavir are what type of drugs?
a) Fusion inhibitors
b) Ion channel blockers
c) Polymerase inhibitors
d) Protease inhibitors
e) Neuraminidase inhibitors
62) Amantadine and rimantadine are what type of drugs?
63) Zanamivir and oseltamivir are what type of drugs?
64) Efuvirtide (T-20) is what type of drug?


65) Acyclovir, zidovudine, and efavirenz are what types of drugs?
66) Amphotericin and nystatin are what type of antifungal drugs?
a) Polyenes
b) Azoles
c) Pyrimidines
67) What is the principal goal in antimicrobial chemotherapy?
a) Site-specific therapy
b) Sensitivity
c) Cost-effective therapy
d) Empiric therapy
e) Selective toxicity
68) What type of antibiotic has bacteriostatic activity?
a) Penicillins
b) Chloramphenocol
c) Macrolides
d) Aminoglycosides
e) Fluoroquinolones
69) Which of the following types of antibiotics should be used to treat the common cold?
a) Sulfonamides
b) Cephalosporins
c) Macrolides
d) Aminoglycosides
e) Penicillins
f) Antibiotics should not be used
2 – Antimicrobial Case Reviews

For the next few questions, use the following case. A mother brings her 3-year-old girl to
your office because the child has a fever and complains that her ear hurts. She has no
significant medical history. The child is not pleased to be in the physician's office and has
been crying. Her mother explains that she developed a “cold” about 3 days ago with
sniffles. Her temperature is 37.8°C (100°F), and the rest of the physical examination is
completed with some difficulty. The only abnormalities are slight redness of the throat, a
nose full of thick green mucus, and red tympanic membranes.
1.1) What is the most likely cause of these symptoms?
a) Common cold
b) Gastroenteritis
c) Otitis media

d) Pneumonia
e) Immune deficiency
1.2) Symptoms of this infectious disease are nonspecific.
a) True
b) False
1.3) Cloudiness and bulging of the tympanic membrane would help with this diagnosis.
a) True
b) False
1.4) Antibiotic therapy in this case has no important effect on hearing loss.
a) True
b) False
1.5) What is the most common pathogen in the presumed diagnosis for this case?
a) Streptococcus pyogenes
b) Streptococcus agalactiae
c) Bacillus anthracis
d) Listeria monocytogenes
e) Streptococcus pneumoniae
1.6) What is the antibiotic of choice in this case?
a) Gentamycin
b) Vancomycin
c) Amoxicillin
d) Erythromycin
e) Clindamycin
1.7) If the patient is allergic to the initial antibiotic of choice, what should be given
instead?
a) Sulfonamides
b) Cephalosporins
c) Macrolides
d) Aminoglycosides
e) Fluoroquinolones
For the next few questions, use the following case. A 29 yr-old male from rural South
Carolina presents with fever, chills, and headache for past 10 days. Also noted are
worsening depression and anxiety. He developed dark urine, back pain, oliguria (scanty
urine production), nausea and anorexia. On examination, bumpy rash, edema and
petechial rash were noted on his hands and trunk. At the time of examination, the
patient’s temperature was high (>102°F).
2.1) Which of the following intracellular pathogens is the most likely cause?
a) Rickettsiae
b) Mycobacterium tuberculosis
c) Salmonella typhi
d) Chlamydia
e) Shigella dysenteriae
2.2) Which of the following is the antibiotic of choice in this case as it shows 30s
inhibition and thus interferes with tRNA anticodon reading of mRNA?
a) Erythromycin
b) Clindamycin
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c) Chloramphenical
d) Doxycycline
2.3) Which of the following adverse effects of the antibiotic is the most life threatening?
a) GI adverse effects
b) CNS adverse effects
c) Allergies
d) Phototoxicity
e) Steven-Johnson Syndrome (SJS)
For the next few questions, use the following case. A 32-yr-old man with a history of
skull trauma presents with headache, mental status changes, and fever. He reports two
brief episodes seizures (3-5 seconds of duration). A CT scan of brain shows brain abscess
with accompanying edema. CSF analysis revealed aerobic and anaerobic streptococci.
3.1) Which of the following antibiotics should be given?
a) Gentamicin
b) Streptomycin
c) Chloramphenicol
d) Erythromycin
e) Tetracycline
3.2) Which of the following is the most commonly seen adverse effect when giving this
antibiotic?
a) UTI
b) Brain swelling
c) Allergies
d) Migrane headaches
e) Aplastic anemia
3 – Penicillins
1) Penicillin was first discovered when colonies of staphylococci lysed when
contaminated with what?
a) Penicillium bacteria
b) Penicillium virus
c) Penicillium fungi
d) Penicillium parasite
2) Which of the following sites in an antibiotic molecule is the site of cleavage for
bacterial enzymes?
a) Thiazolidine ring, C–S bond
b) Thiazolidine ring, C–C bond
c) Thiazolidine ring, C–N bond
d) Beta-lactam ring, C–C bond
e) Beta-lactam ring, C–N bond
Match the chemical R-group ring side-chain group with the antibiotic it signifies:
3) Penicillin G a) –CH–COOH
4) Penicillin V b) –OCH2
5) Ampicillin c) –CH–NH2
6) Carbeniccilin d) –CH2
7) Penicillin G is ____ to penicillinase and methicillin is ____ to penicillinase. Both are

considered ____ spectrum antibiotics. Penicillin G cannot be taken orally due to stomach
acids.
a) Resistant; Sensitive; Narrow
b) Resistant; Sensitive; Broad
c) Sensitive; Resistant; Narrow
d) Sensitive; Resistant; Broad
8) What is the order of bacterial wall biosynthesis?
a) Murein synthesis, polymerization, cross-linking
b) Murein polymerization, cross-linking, synthesis
c) Murein cross-linking, polymerization, synthesis
d) Murein synthesis, cross-linking, polymerization
e) Murein polymerization, synthesis, cross-linking
9) Gram-negative bacteria have a thicker murein (peptidoglycan) layer than gram-
positive bacteria.
a) True
b) False
10) Which of the following enzymes is the main target for penicillin?
a) Transglucosylases
b) Transpeptidases
c) D-alanine carboxykinases
d) Penicillin binding proteins (PBPs)
11) Which of the following is NOT a common indication for penicillin?
a) Meningitis
b) Pneumonia or chronic bronchitis
c) UTIs
d) MRSA
e) Gonorrhea or syphilis
12) Which of the following has the highest bacterial resistance pattern?
a) Penicillin G
b) Penicillin V
c) Methicillin
d) Ampicillin
e) Carbencillin
13) Which of the following is considered extended-spectrum as it can fight pseudomonal
aeroginosa, enterobacter species, proteus, bacteroids fragilis, and many klebsiella?
a) Oxacillin
b) Ampicillin
c) Amoxicillin
d) Penicillin G
e) Carbencillin
14) Which of the following would be used to treat Neisseria gonorrhoeae if the patient
was allergic to penicillins?
a) Ticarcillin
b) Carbencillin
c) Ceftriaxone
d) Penicillin G
e) Penicillin V
15) Penicillin V is given via orally (PO) versus IM or IV.
a) True
b) False
16) Ampicillin has a bioavilability of 40% with initial dose (F=0.40). What is the
bioavailability of amoxicillin with one dose?
a) 5%
b) 25%
c) 50%
d) 75%
e) 95%
17) Clavulanate is added to amoxicillin (Augmentin) to protect the drug molecule. This
results in a ____ bioavailability and a change from dosage three times a day (tid) to ____
times a day. However, this produces a high incidence of diarrhea.
a) Increase; Four (qid)
b) Increase; Two (tid)
c) Decrease; Four (qid)
d) Decrease; Two (tid)
18) When adding a second antibiotic to a drug regimen, which of the following would
have the least affect on improving health due to drug-drug interactions?
a) Both drugs have mild protein binding
b) Both drugs are highly protein bound
c) The first drug is highly protein bound and the second is not
d) The second drug is highly protein bound and the first is not
19) Which of the following is the least protein-bound?
a) Oxacillin
b) Cloxacillin
c) Dicloxacillin
d) Flucoxacillin
e) Amoxicillin
20) Which of the following is considered the least toxic?
a) Ticarcillin
b) Oxacillin
c) Ampicillin
d) Penicillin G
e) Penicillin V
21) Which of the following would NOT be an adverse effect seen with hypersensitivity to
penicillin?
a) Vomiting
b) Pruritus (need to scratch)
c) Bradycardia
d) Vertigo
e) Loss of consciousness
22) Which of the following adverse effects to penicillin is a sign of hematologic toxicity,
not nephropathy?
a) Fever
b) Macular rash
c) Eosinophilia
d) Neutropenia
e) Hematuria
23) Which of the following should be monitored (lab work) when administering
penicillins or cephalosporins to older adults?
a) D-dimer
b) Creatinine
e) Bilirubin
24) What is the drug of choice for an anaphylactic reaction?
a) Adenosine
b) Atropine
c) Epinephrine
d) Dobutamine
e) Midazolam
25) Which of the following drugs delays renal excretion of penicillin, therefore
prolonging antibacterial effects?
a) Gentamicin
b) Probenecid
c) Chloramphenicol
d) Erythromycin
e) Tetracycline
26) Genes that code for synthesis of beta-lactamases are located on bacterial plasmids,
thus they can be transferred from one bacterium to another.
a) True
b) False
27) Clavulanic acid and sulbactam ____ antibiotics, and are added to give better ____
properties and effects.
a) Are; Antibacterial
b) Are; Pharmacokinetic
c) Are not; Antibacterial
d) Are not; Pharmacokinetic
28) In which of the following cases would you use penicillin G procaine aqueous
(APPG), which serves as a long-term depot to slowly release peniciliin G?
a) Oritis media
b) Sinusitis
c) Lower respiratory tract infection
d) Urinary tract infection
e) Rheumatic fever
29) Which of the following drugs would be used to treat methicillin-resistant
Staphylococcus aureus (MRSA)?
a) Nafcillin
b) Vancomycin
c) Gentamycin
d) Erythromycin
e) Clindamycin
30) Which of the following is a broad spectrum antibiotic reserved chiefly for use against
Pseudomonas aeroginosa?
a) Penicillin G
b) Penicillin V
c) Methicillin
d) Ampicillin
e) Carbencillin
31) The mechanism of bacterial resistance to penicilins can be described as:
a) Inactivation of drug by beta-lactamases
b) Overproduction of PBPs
c) Overproduction of peptidoglycans
d) Breakdown of penicillins by the immune system
e) Rapid biotransformation
32) Which of the following penicillins is an aminopenicillin?
a) Methicillin
b) Ampicillin
c) Penicillin G
d) Penicillin V
e) Carbencillin
33) Which of the following penicillins produces a higher incidence of diarrhea?
a) Cloxacillin
b) Ampicillin
c) Amoxicillin
d) Augmentin
e) Penicilin G
34) Which of the following penicillins is effective against Bacteroides fragilis?
a) Oxacillin
b) Ampicillin
c) Penicillin G Procaine
d) Amoxicillin
e) Ticarcillin-clavulanate
4 – Cephalosporins
1) Cephalosporins are very similar chemically to penicillins. However, unlike penicillins,
cephalosporins have ____ members in their chemical ring?
a) 3
b) 4
c) 5
d) 6
e) 7
2) Cephalosporins have a ____ spectrum of antimicrobial activity and are considered
____.
a) Broad; Bactericidal
b) Broad; Bacteristatic
c) Narrow; Bactericidal
d) Narrow; Bacteristatic
3) Which of the following classes of drugs is used the most in hospitals (hospitals in the
United States spend the most on these)?
a) Penicillins
b) Cephalosporins
c) Macrolides
d) Aminoglycosides
e) Fluoroquinolones
f) Sulfonamides
4) Which of the following are in the correct order from most gram-positive activity to
most gram-negative activity?
a) First-generation, second-generation, third-generation
b) Third-generation, second-generation, first-generation
c) First-generation, third-generation, second-generation
d) Second-generation, third-generation, first-generation
e) Third-generation, first-generation, second-generation
Match the drug with the cephalosporin generation:
5) Cefamanidole a) First-generation
6) Cefotaxime b) Second-generation
7) Cephalothin c) Third-generation
8) A patient is given a first-generation and second-generation cephalosporin for a
bacterial infection. In which of the following cases would the drug be ineffective?
a) Blood infection
b) GI infection
c) UTI
d) CSF infection
e) Respiratory infection
9) Which of the following bacteria would not be affected by a second-generation
cephalosporin, but would be affected by ceftazidime?
a) Staphylococcus
b) Streptococcus
c) Listeria
d) Enterococcus
e) Pseudomonas
10) Which of the following should be given for gram-negative bacterial meningitis?
a) First-generation cephalosporin
b) Second-generation cephalosporin
c) Third-generation cephalosporin
11) Cefepime is considered a:
a) First-generation cephalosporin
b) Second-generation cephalosporin
c) Third-generation cephalosporin
d) Fourth-generation cephalosporin
12) Which of the following cephalosporins would be destroyed by beta-lactamases

(cephalosporinases)?
a) Cephalothin
b) Cefamandole
c) Cefotaxime
d) Cefepime
13) Which of the following best describes ceftazidime and cefepime?
a) First-generation cephalosporins
b) Second-generation with Haemophilus influenzae activity
c) Second-generation with Bacteroids fragilis activity
d) Third-generation cephalosporins
e) Third-generaion with Pseudomonas aeruginosa activity
f) Oral broad-spectrum cephalosporins
14) Which of the following describes cefazolin and cephalexin?
15) Which of the following describes cefmetazole, cefotetan, and cefoxitin?
16) Which of the following describes cefixime and cefpodoxime proxecil?
17) Which of the following describes cefoperazone and ceftriaxone?
18) Which of the following describes cefaclor and cefuroxime?

19) Which of the following are eliminated largely by non-renal routed?
a) Ceftazidime and cefepime
b) Cefazolin and cephalexin
c) Cefmetazole, cefotetan, and cefoxitin
d) Cefixime and cefpodoxime proxecil
e) Cefoperazone and ceftriaxone
20) All of the following cause bleeding by reducing pro-thrombin levels, except for ____,
which causes bleeding by impairing platelet aggregation and has been removed from use
in the United States.
a) Cefamandole
b) Cefmetazole
c) Cefoperazone
d) Cefotetan
e) Moxalactam
21) Which of the following drugs prolongs cephalosporin effects?
a) Gentamicin
b) Probenecid
c) Chloramphenicol
d) Erythromycin
e) Tetracycline
22) Which of the following drugs is NOT associated with alcohol intolerance?
a) Cefuroxime
b) Cefmetazole
c) Cefoperazone
d) Cefotetan
e) Cefamandole
23) Which of the following has the shortest half life?
a) Cefotetan (Cefotan)
b) Cefazolin (Ancef)
c) Cefadroxil (Duricef)
d) Cephalothin (Keflin)
e) Cefaclor (Ceclor)
24) Which of the following has the longest half life?
a) Cefotaxime (Claforan)
b) Ceftriaxone (Rocephin)
c) Cefpodoxime proxetil (Vantin)
d) Cefepime (Maxipime)
e) Cefrazidime (Fortaz)
25) Which of the following is used to treat otitis media and has a risk of significant
serum-sickness type reaction, especially in children?
a) Cefotetan (Cefotan)
b) Cefazolin (Ancef)
d) Cephalothin (Keflin)
e) Cefaclor (Ceclor)
26) Which of the following would be treated with a first-generation cephalosporin?
a) E. Coli
b) Klebsiella
c) Proteus
d) Staphylococcus
e) Enterobacter
f) Serratia
g) Providencia
27) A patient is prescribed a cephalosporin for their gonorrhea infection. After injection,
the patient complains of pain at the injection site. A rash appears later and the patient
develops difficulty breathing (dyspnea). Which of the following drugs was likely given?
a) Ceftriaxone (Rocephin)
b) Loracarbef (Lorabid)
d) Cephalexin (Keflex)
e) Cefazolin (Ancef)
28) Imipenem (Primaixin) is a beta-lactam antibiotic that is eliminated by glomerular
filtration, thus is combined with cilastin (renal dehydropeptidase inhibitor). Which of the
following is true of this drug?
a) Acid stable and cannot cross the blood brain barrier (BBB)
b) Acid instable and cannot cross the blood brain barrier (BBB)
c) Acid stable and is able to cross the blood brain barrier (BBB)
d) Acid instable and is able to cross the blood brain barrier (BBB)
29) Imipenem is NOT active against MRSA.
a) True
b) False
30) Which of the following is NOT true of Azetreonam (Azactam)?
a) It is not affected by beta-lactamases
b) It is active against gram-negative bacteria
c) It is active against Pseudomonas aeroginosa
d) It has a high potential to produce hypersensitivity reactions
31) A 2-mo-old male neonate presents with a thick eye discharge. The mother admits to
having sexual partners and complains of a vaginal discharge. Exams of both eyes of
infant reveals a thick purulent discharge and conjunctival congestion and edema. Corneal
ulcerations was also noted. Conjunctival swabs on gram staining revealed presence of
gram-negative diplococci and many polymorphonuclear cells. What organism, which can
be treated with penicillin G or a third-generation cephalosporin, is the most likely cause?
a) C. trachomatis
b) T. pallidum
c) N. gonorrhea
d) H. ducreyi
e) H. influenza
5 – Macrolide Antibiotics
1) Which of the following antibiotics can be taken safely and effectively as three tablets?
a) Erythromycin (Erythrocin)
b) Clarithromycin (Biaxin)
c) Azithromycin (Zithromax)
d) Dirithromycin (Dynabac)
e) Telithromycin (Ketek)
2) Which of the following is best suited to treat mycoplasma, chlamydiae, and legionella?
3) Macrolids are ____ ribosomal subunit inhibitors that are ____ at low concentrations
and ____ at high concentrations.
a) 30s; Bactericidal; Bacteriostatic
b) 30s; Bacteriostatic; Bactericidal
c) 50s; Bactericidal; Bacteriostatic
d) 50s; Bacteriostatic; Bactericidal
4) Macrolides and clindamycin have which mechanism of action during protein
synthesis?
a) Interfere with the donor site growing peptide
b) Interfere with tRNA release
c) Interfere with acceptor site so next tRNA cannot bind
5) Tetracyclines and aminoglycosides have which mechanism of action during protein
synthesis?
6) Chloramphenicol has which mechanism of action during protein synthesis?
7) Which of the following types of infection would erythromycin be the least effective
against?
a) Throat
b) Ears
c) Skin
d) Respiratory tract
e) GI tract
8) Patients with diphtheria or whooping cough will not respond to penicillin. Which of
the following drugs would be the best choice?
9) Resistant strains of which of the following have emerged with the use of
erythromycin?
c) Bacillus anthracis
10) Although erythromycin is not normally effective with gram-negative bacteria, cell
wall deficient forms of E. coli and Proteus mirabilis (L-forms) are exceptions. These are
seen in recurrent:
a) Pneumonia
d) Gastroenteritis
e) Endocarditis
11) Which of the following bactericidal antibiotics is the drug of choice for pneumonia
caused by H. influenzae?
12) A patient presents with mild symptoms of fever, chills, headache, and coughing.
However, they show little sign of bacterial infection. Lab blood results show infection is
present and the physician chooses to use a macrolide antibiotic. Which of the following
was most likely the cause of the patient’s symptoms?
c) Mycoplasma pneumoniae
13) Oral erythromycin is enterically coated because it is sensitive to ____ pH. This
allows the drug to be absorbed in the ____.
a) Acidic; Stomach
b) Acidic; Small intestine
c) Basic; Stomach
d) Basic; Small intestine
14) Estolate esters can be added to macrolide antibiotics (e.g. erythromycin estolate) to:
a) Decrease resistance to acidic pH
b) Increase resistance to basic pH
c) Decrease bioavailability
d) Increase bioavailability
e) Lyse bacterial cell walls
15) Eating while taking azithromycin will decrease the drug’s concentration.
a) True
b) False
16) In which of the following locations would erythromycin be the least concentrated, at
less than 20% or serum blood levels?
a) Liver
b) Spleen
c) Fetal blood
d) Breast milk
e) Tears
17) Which of the following antibiotics would persist for the shortest amount of time in
tissues?
a) Azithromycin
b) Clarithromycin
c) Dirithromycin
d) Erythromycin
18) Which of the following is the main organ for biotransformation of macrolides such as
erythromycin (90%) and clarithromycin?
a) Spleen
b) Kidneys
c) Brain
d) GI tract
e) Liver
19) Azithromycin has a volume of distribution of over 2000L. This indicated that the
drug is concentrated in which of the following locations?
a) Extracellular fluid
b) Plasma
c) Tissues
d) Liver
e) CNS
20) The most common patient complaint with oral macrolides is which of the following?
a) Cardiac
b) GI tract
c) Neurologic
d) Urinary
e) Respiratory
21) Severe pain and nausea with macrolides may be suggestive of inflammation to what
organ?
a) Pancreas
b) Spleen
c) Kidneys
d) Gall bladder
e) Heart
22) Which of the following drugs can occasionally cause thrombocytopenia with bruising
or bleeding?
a) Azithromycin
b) Clarithromycin
c) Dirithromycin
d) Erythromycin
23) Which of the following can damage the liver by direct drug toxicity or an immune
reaction, called cholestatic hepatitis or cholestatic jaundice, which can be seen in
newborns if the drug is taken by pregnant women?
a) Azithromycin
b) Clarithromycin
c) Erythromycin
d) Erythromycin estolate
e) Azithromycin estolate
24) If erythromycin is given with drugs that must be excreted by ____ mechanisms (e.g.
warfarin, acetaminophen), those drugs will show a gradual ____ in serum levels due to
P450-mediated drug metabolism.
a) Renal; Increase
b) Renal; Decrease
c) Hepatic; Increase
d) Hepatic; Decrease
25) A patient presents with Mycobacterium avium intracellulare and is given Rifampin.
This can significantly lower the serum concentrations of zidovudine and what other drug?
26) Which of the following drugs was designed to overcome erythromycin resistance
within gram-positive cocci, such as community-acquired pneumonia (CAP) from S.
pneumoniae?
a) Telithromycin (Ketek)
27) Ketolide (telithromycin) blocks which domain of 23S rRNA of the 50S ribosomal
subunit, preventing protein synthesis?
a) I
b) II
c) III
d) IV
28) Which of the following is NOT true regarding telithromycin?
a) Contraindicated in patients taking cisapride
b) Not recommended if patient has myasthenia gravis (MG)
c) Can cause visual disturbances and hepatic dysfunction
d) Can prolong cardiac QTc interval, increasing ventricular arrhythmias
e) Is not considered effective against mild to moderate respiratory tract infections
29) JJ is a 22-yr-old pregnant woman in her first prenatal visit. She is 14 weeks pregnant
and complains of lower abdominal pain, and symptoms of urinary tract infections. She is
allergic to penicillins and cephalosporins, which cause a rash. JJ is diagnosed with
Chlamydia infection (a leading cause of conjunctivitis, known as ophthalmia neonatorum,
and febrile pneumonia in neonates). She has scant vaginal discharge, and no odor.
Culture is negative for gonorrhea, and syphilis. Which drug should be given to this
patient if they do not want abdominal cramping, nausea, vomiting, or diarrhea?
30) An 8-yr-old child presents with pharyngitis and fever of 3 days duration.
Microbiology lab confirms translucent beta-hemolytic colonies. Past history includes a
severe allergic reaction to amoxicillin when used for ear infection. Which one of the
following agents as an oral drug is most likely appropriate in terms of both effectiveness
and safety?
a) Penicillin G
b) Cefaclor
c) Doxycycline
d) Vancomycin
e) Azithromycin
6 – Aminoglycosides
1) Aminoglycosides are effective only against which of the following and are a good
choice for septicemia (a serious toxicity)?
a) Gram-positive aerobic bacteria
b) Gram-positive anaerobic bacteria
c) Gram-negative aerobic bacteria
d) Gram-negative anaerobic bacteria
2) Which of the following antibiotics would be used topically and thus has the most
common adverse effect being dermatitis?
a) Gentamicin
b) Tobramycin
c) Neomycin
d) Amikacin
3) Aminoglycosides are ____, thus their main form of metabolism is through the ____.
a) Polar; Liver
b) Polar; Kidneys
c) Non-polar; Liver
d) Non-polar; Kidneys
4) Which of the following would be the preferred treatment for infections caused by
Pseudomonas aeroginosa?
a) Gentamicin
b) Tobramycin
c) Neomycin
d) Amikacin
e) Netilmicin
5) Aminoglycosides inhibit bacterial protein synthesis through binding to ____ bacterial
ribosome subunits. They cause leakage of intracellular contents and thus are ____.
a) 30s; Bactericidal
b) 30s; Bacteriostatic
c) 50s; Bactericidal
d) 50s; Bacteriostatic
6) At low dosages, which of the following describes the mechanism of aminoglycosides?
a) Misreading of mRNA during elongation leading to synthesis of proteins
containing incorrect amino acids.
b) Nonsense insertion in mRNA during elongation leading to a stop codon
c) Complete inhibition of protein causing ribosomes to become trapped at the
AUG strand condons of mRNA
d) Partial inhibition of protein causing ribosome to translate incorrectly
e) Amino acid deletions during protein synthesis leading to nonfunctional proteins
7) At high dosages, which of the following describes the mechanism of aminoglycosides?
a) Misreading of mRNA during elongation leading to synthesis of proteins
containing incorrect amino acids.
b) Nonsense insertion in mRNA during elongation leading to a stop codon
c) Complete inhibition of protein causing ribosomes to become trapped at the
AUG strand condons of mRNA
d) Partial inhibition of protein causing ribosome to translate incorrectly
e) Amino acid deletions during protein synthesis leading to nonfunctional proteins
8) Following administration of aminoglycosides, where would concentrations be the
lowest?
a) Prostate
b) Brain
c) Vitreous fluid
d) CSF
e) Intracellular
9) Accumulation of aminoglycosides is most common in what location?
a) Liver capsule
b) Renal medulla
c) Nephrons
d) Renal cortex
e) Spleen
10) Which of the following is NOT a dose-dependent toxicity location for
aminoglycosides?
a) Auditory canal
b) Vestibular canal
c) Kidney
d) Liver
e) Neuromuscular
11) Which of the following drugs would require doing a BUN and creatinine lab serum
test before administering?
a) Kanamycin
b) Gentamicin
c) Amikacin
d) Neomycin
12) If aminoglycosides are administered with neuromuscular blockers, respiratory

paralysis can take place due to competition of ____ at the presynaptic site, leading to
acetylcholine (Ach) release reduction.
a) Na+
b) Cl-
c) K+
d) Mg++
e) Ca++
13) Which of the following drugs can be mixed with aminoglycosides, such as for use
against Staphylococcus aureus?
a) Diuretics
b) NSAIDs
c) Cisplatin (Platinol)
d) Amphotericin B
e) Penicillin G
14) Aminoglycoside resistance is becoming common for enterococci infections causing
which of the following?
a) Pneumonia
c) Endocarditis
d) Gastroenteritis
e) Urinary tract infections
15) Which of the following is NOT a membrane enzyme involved in aminoglycoside
resistance?
a) Acetylases
b) Adenlyl transferases
c) Phosphorylases
d) Phosphatases
16) What is meant by gentamicin having a trough serum level of 2mcg/mL?
a) No drug effect is seen at <2mcg/mL
b) Drug effect is seen at <2mcg/mL
c) No drug toxicity is seen at <2mcg/mL
d) Drug toxicity is seen at <2mcg/mL
e) The drug should be administered IV at 2mcg/mL
17) Which of the following drugs is combined with isoniazid to treat tuberculosis?
a) Neomycin
b) Streptomycin
c) Amikacin
d) Kanamycin
e) Gentamicin
18) AE is a 75-yr-old man admitted to ICU with sepsis resulting from a urinary tract
infection. He has had an indwelling urinary catheter for 2 weeks while rehabilitating
from hip fracture. AE has a history of type 2 diabetes and is on glucotrol XL. He has
allergies to beta-lactam antibiotics and erythromycim. The result of blood cultures are
positive for P. aeroginosa; the urine culture is positive for P. aeroginosa and E. coli.
From aminoglycoside class, which one would you choose?
a) Neomycin
b) Streptomycin
c) Netilmicin
d) Kanamycin
e) Gentamicin
19) The most active aminoglycoside against Mycobacterium tuberculosis is:
a) Kanamycin
b) Tobramycin
c) Streptomycin
d) Amikacin
e) Neomycin
7 – Fluoroquinolones
1) Which of the following fluoroquinolones is the most potent?
a) Ciproflocaxin (Cipro)
b) Levofloxacin (Levaquin)
c) Lomefloxicin (Maxaquin)
d) Moxifloxacin (Avelox)
e) Norfloxacin (Noroxin)
2) Which of the following features were combined to create fluoroquinolones (e.g
norfloxin) from quinilone (e.g. nalidixic acid) antibiotics?
a) Broader gram-negative activity, less protein binding, longer half-life
b) Broader gram-negative activity, more protein binding, longer half-life
c) Broader gram-positive activity, less protein binding, shorter half-life
d) Broader gram-positive activity, more protein binding, shorter half-life
3) The addition of a cyclopropyl group to norfloxacin, making ciprofloxacin (first-
generation), accomplished which of the following?
a) Decreased potency (toxicity)
b) Increased potency (effectiveness)
c) Decreased protein binding (less drug-drug interaction)
d) Added activity against anaerobes
e) Improved gram-positive antibiotic activity
4) Which of the following was accomplished with second-generation fluoroquinolones?
5) Which of the following was accomplished with third-generation fluoroquinolones,
such as moxifloxacin?
6) Which of the following second-generation fluoroquinolones has anti-anaerobic

activity?
a) Temafloxacin
b) Sparfloxacin
c) Grepafloxacin
d) Gatifloxacin
7) Which of the following is NOT a third-generation fluoroquinolone?
a) Cliaflnoxacin
b) Trivafloxacin
c) Ciprofloxacin
d) Moxifloxacin
e) Gemifloxacin
8) Fluoroquinolones inhibit which topoisomerase (DNA gyrase) in gram-negative
bacteria?
a) I
b) II
c) III
d) IV
9) Fluoroquinolones inhibit which topoisomerase in gram-positive bacteria?
a) I
b) II
c) III
d) IV
10) Plasmids and increasing transport mechanisms to move antibiotics out of bacterial
cells are two common mechanisms for fluoroquinolone resistance.
a) True
b) False
11) Which of the following would NOT be a situation where fluoroquinolones are
recommended?
a) Urinary tract infections
b) Gonorrhea
c) Urethritis
d) Cervicitis
e) Listeriosis
12) Which of the following would be used for pelvic inflammatory disease (C.
trichomatic, N. gonorrhoeae, Enterobacteriaceae, anaerobes)?
a) Ofloxacin
b) Gatifloxacin
c) Levofloxacin
d) Ciprofloxacin
e) B & C
13) Which of the following is the most effective against Pseudomonas aeroginosa,
although resistance is becoming more common?
a) Ofloxacin
b) Gatifloxacin
c) Levofloxacin
d) Ciprofloxacin
e) B & C
14) Which of the following is indicated for pyelonephritis, an ascending UTI that has
reached the kidney pelvis (pyelum)? These are also the most effective against gram-
positive bacteria.
a) Ofloxacin
b) Gatifloxacin
c) Levofloxacin
d) Ciprofloxacin
e) B & C
15) Fluoroquinolones are well distributed to the lung (pneumonia) and soft tissues (skin
infections). Which of the following, along with moxifloxacin, has the most activity
against anaerobic bacteria?
a) Ofloxacin
b) Gatifloxacin
c) Trovafloxacin
d) Ciprofloxacin
e) Levofloxacin
16) Which of the following is the drug of choice for cutaneous and pulmonary anthrax?
a) Ofloxacin
b) Gatifloxacin
c) Trovafloxacin
d) Ciprofloxacin
e) Levofloxacin
17) Which of the following is indicated, along with alatrofloxin, for life-threatening
infections of the urinary or respiratory tract, but can cause acute liver failure?
a) Ofloxacin
b) Gatifloxacin
c) Trovafloxacin
d) Ciprofloxacin
e) Levofloxacin
18) Which of the following is active against anaerobic pathogens including B. fragilis?
a) Ofloxacin
b) Gatifloxacin
c) Moxifloxacin
d) Ciprofloxacin
e) Levofloxacin
19) What is the oral bioavailability of fluoroquinolones?
a) 0-10%
b) 10-40%
c) 40-70%
d) 70-100%
e) 100%
20) Which of the following can cause CNS symptoms and have a tendancy to damage
cartiledge, thus should never be given to children under the age of 18?
a) Penicillins
b) Cephalosporins
c) Macrolides
d) Aminoglycosides
e) Fluoroquinolones
f) Sulfonamides
21) Which of the following may cause hypoglycemia?
a) Ofloxacin
b) Gatifloxacin
c) Moxifloxacin
d) Ciprofloxacin
e) Levofloxacin
22) Which of the following can cause macrulopapular rash with evolving bullae on the
lower extremities of patients with toxic epidural necrolysis (TEN) in the elderly?
a) Ofloxacin
b) Gatifloxacin
c) Moxifloxacin
d) Ciprofloxacin
e) Levofloxacin
23) What affect do moxafloxacin and gatifloxacin have on the cardiac conduction
system?
a) Increased atrial rate, leading to atrial arrhythmias
b) Increased PR interval, leading to possible heart block
c) Decreased conduction speed through the AV node
d) Increased QTc interval, leading to possible fainting
e) Decreased QTc interval, leading to less risk of ventricular arrhythmias
24) Patients on what kind of diet can get alkaline and crystal urine when taking high
doses of ciprofloxacin or norfloxacin?
a) Very high protein
b) Very low fat
c) Very low carbohydrates
d) Increased dairy intake
e) No meat or dairy
25) Which of the following should NOT be consumed while taking ciprofloxacin as it
decrease absorption of the drug?
a) Meat
b) Dairy
c) Excess sugar
d) Excess salt
e) Excess fat
26) Lower plasma and urinary concentrations of fluoroquinolones and loss of
antibacterial effectiveness may result if the drug is taken within two hours of which of the
following?
a) Antacid
b) Aspirin
c) Tylenol
d) Daily vitamin
e) Throat lozenges
27) Crystalluria can occur if fluoroquinolones are taken with which of the following?
a) Penicillin
b) Caffeine
c) Enzyte
d) Theophylline
e) Didanosine
f) St. John’s Wort
28) Which of the following drugs, used for asthma, can cause seizures if mixed with
fluoroquinolones?
a) Penicillin
b) Caffeine
c) Theophylline
d) Didanosine
e) Viagra
29) Which of the following should be monitor for patients who are taking warfarin and
going to receive fluoroquinolones?
a) Pro-thrombin
b) Blood urea nitrogen (BUN)
e) Bilirubin
f) Creatinine
30) Which of the following drugs would NOT increase QT interval (potential for
ventricular arrythmias, torsade de pointes) when given with grepfloxacin or sparfloxacin?
a) Disopyramide
b) Erythromycin
c) Magnesium
d) Phenothiazines
e) Tricyclic antidepressants
31) TT is a 74-yr-old woman who complains of a headache, fever, and sudden onset of
chills; pleuritic chest pain; a cough with dark, thick, bloody sputum; increasing shortness
of breath; and anorexia. TT’s routine medications include multiple vitamins, warfarin,
furosemide, and enalapril. TT’s posterioanterior (PA) and lateral chest x-ray studies
show multifocal peribronchial consolidation consistent with CAP (community-acquired
pneumonia). Sputum culture is positive for Strep. Pneumoniae. What antibiotic from the
fluoroquinolones class would you choose?
a) Ofloxacin
b) Gatifloxacin
c) Trovafloxacin
d) Ciprofloxacin
e) Moxifloxacin
32) A patient presents with the symptoms of fever, chest pain, rales on chest auscultation,
and a purulent sputum. A chest x-ray confirms the presence of infiltrates.
Geographically, this patient lives in a county where there are drug-resistant pneumococci.
Empiric therapy of this patient therefore should include:
a) Penicillin G
b) Ceftriaxone
c) Levofloxacin
d) Amoxicillin
e) Vancomycin
8 – Chloramphenicol & Tetracyclines

1) A histological slide shows intracellular inclusions. Monoclonal antibodies (mAbs) are
used to confirm C. trachomatis. Which of the following is the drug of choice for
Chlamydia?
a) Doxycycline (Vibramycin)
b) Minocycline (Arestin)
c) Oxytetracycline (Terramycin)
d) Tetracycline (Achromycin)
e) Tetracycline phosphate complex (Tetrex)
2) Which of the following is considered very toxic and thus is only used topically for
acne treatment?
a) Doxycycline (Vibramycin)
b) Minocycline (Arestin)
c) Oxytetracycline (Terramycin)
d) Tetracycline (Achromycin)
e) Tetracycline phosphate complex (Tetrex)
3) Tetracyclines are bacteriostatic and have which of the following mechanisms of
action?
a) Changes the shape of 30 rRNA to cause mRNA to be read incorrectly
b) Binds to 50s rRNA and inhibits formation of peptide bond
c) Binds to 50s rRNA and prevents movement along mRNA
d) Interferes with the tRNA anticodon reading of mRNA codon
e) Inhibits folic acid metabolism
4) Chloamphenicol has what mechanism of action?
5) Tetracyclines, such as doxycycline, are effective against rare infections. Which of the
following infections that can be treated with doxycycline is associated with voluminous
rice-water diarrhea and may be seen as an epidemic in third world countries?
a) Chancroid (Haemophilus ducreyi)
b) Rabid fever (Francisella tularensis)
c) Black plague (Yersinia pestis)
d) Brucellosis (Brucella species)
e) Cholera (Vibrio cholera)
6) Tetracyclines are highly affective at treating all of the following. Which one is also
known as parrot fever?
a) Chlamydophila psittaci
b) Mycoplasma pneumoniae
c) Borrelia burgdorferi
d) Treponema pallidum
e) Rickettsia rickettsii
7) What is the elimination mechanism of doxycycline?
a) Urine via renal route
b) Fecal via biliary route
c) Blood via bone marrow route
d) Blood via hepatic route
e) White cells via splenic route
8) Which of the following is extensively biotransformed in the liver?
a) Demeclocycline
b) Oxytetracycline
c) Doxycycline
d) Tetracycline
9) What is the most common adverse reaction for tetracyclines?
a) Prolonged bleeding
b) Hepatomegaly
c) Bloody diarrhea
d) Seizures
e) GI irritation
10) What type of bacteria is associated with life-threatening enterocolitis producing
bloody diarrhea after the use of tetracyclines?
a) Staphylococcus
b) Streptococcus
c) Enterococcus
d) Gram-negative
e) Spirochetes
11) Patients on tetracycline should due which of the following to prevent toxicity?
a) Brush their teeth
b) Exercise regularly
c) Limit exposure to sunlight
d) Rest at least six hours each night
e) Eat a complete diet including meat and dairy
12) A patient presents with weakness, thirst, and increased urination. They are diagnosed
with nephrogenic diabetes insipidus (NDI). Which of the following tetracyclines likely
caused this problem?
a) Demeclocycline
b) Oxytetracycline
c) Doxycycline
d) Tetracycline
e) Minocycline
13) A patient presents with pain in their right side. After physical exam and testing, a
fatty liver is found. History is negative for excessive alcohol use. Which of the following
classes of antibiotics could have caused this?
a) Tetracyclines
b) Aminoglycosides
c) Cephalosporins
d) Fluoroquinolones
e) Sulfonamides
14) Which of the following would absorb well even in the presence of food in the
stomach?
a) Demeclocycline
b) Doxycycline
c) Tetracycline
d) Oxytetracycline
15) A female patient presents for a pregnancy consultation. She is angry that the birth
control method she was using did not work. This patient had been given tetracyclines for
an infection a little over a month ago. Which of the following birth control methods was
she likely using?
a) Condoms
b) Spermicidal cream
c) Progestogen only pill (POP)
d) Estrogen combined pill
e) Depo Provera (DMPA)
16) What affect do barbiturates have when taken in combination with doxycycline?
a) Increased duration of action of doxycycline
b) Decreased duration of action of doxycycline
c) Increased effectiveness of barbiturate
d) Decreased effectiveness of barbiturate
17) Which of the following drugs is associated with gray baby syndrome?
a) Demeclocycline
b) Doxycycline
c) Tetracycline
d) Oxytetracycline
e) Chloamphenicol
18) Which of the following drugs would be given to a patient with rickettsia who is
allergic to doxycycline?
a) Demeclocycline
b) Tetracycline
c) Chloamphenicol
d) Minocycline
e) Oxytetracycline
19) Which of the following can cause irreversible bone marrow depression, leading to
aplastic anemia?
a) Demeclocycline
b) Tetracycline
c) Chloamphenicol
d) Minocycline
e) Oxytetracycline
20) Along with alfentanil and warfarin, what anti-seizure drug does chloamphenicol react
adversely with?
a) Amiodarone
b) Phenytoin
c) Theophylline
d) Didanosine
e) Viagra
21) JJ is an 18-yr-old grill who complains of an expanding rash, fever, headache, and
muscle and joint pains for the last three weeks. She was in a spring camp expedition in
the wood of Minnesota. JJ is allergic to penicillins and cephalosporins, which causes
rash. ELISA test results show elevated IgM and IgG levels and the punch biopsy culture
is positive for spirochete Borellia burgdorferi. What drug should be used?
a) Demeclocycline
b) Doxycycline
c) Tetracycline
d) Oxytetracycline
e) Minocycline
22) A bacteremic patient is being treated with an antibiotic. Following one week of
therapy, this patients develops severe bone marrow depression resulting in pancytopenia.
Which one of the following antibiotics is the most likely cause of this patient’s toxic
reaction?
a) Doxycycline
b) Chloramphenicol
c) Azithromycin
d) Gentamycin
e) Ciprofloxacin
23) A one-yr-old baby who has been diagnosed with brain abscess is undergoing an
antibiotic treatment. The baby develops abdominal distention, emesis, and irregular
respiration. Which one of the following antibiotics is the most likely cause of this baby’s
toxic reaction?
a) Oxytetracycline
b) Amikacin
c) Clarithromycin
d) Sparfloxacin
e) Chloamphenicol
9 – Sulfonamides, Trimethoprim, & Nitrofurantoin

1) Sulfonamides, which are primarily used to treat UTIs and cystitis, have what
mechanism of action against microbes?
2) Which enzyme is targeted by sulfonamide?
a) Monohydropteroate synthase
b) Monohydrofolate reductase
c) Dihydropteroate synthase
d) Dihydrofolate reductase
3) Which of the following drugs is a monotherapy used prophylactically to treat urinary
tract infections, such as with AIDS patients?
a) Sulfacetamide
b) Trimethoprim
c) Co-trimazole (TMP-SMX)
d) Sulfamethoxazole
e) Sulfasalazine
4) Which of the following drugs is used topically for ocular infections?
a) Sulfacetamide
b) Trimethoprim
d) Sulfamethoxazole
e) Sulfasalazine
5) Which of the following drugs is a sequential inhibitor of folate metabolism?
a) Sulfacetamide
b) Trimethoprim
d) Sulfamethoxazole
e) Sulfasalazine
6) Which of the following adverse effects is the most common with sulfonamides (sulfa
drugs)?
a) Allergic reaction
b) Acute hemolytic anemia
c) Crystalluria
d) Stevens-Johnson syndrome
7) Sulfonamides are ____ and can be resisted if para-aminobenzoic acid (PABA)
production is greatly ____.
a) Bactericidal; Decreased
b) Bacteriostatic; Decreased
c) Bactericidal; Increased
d) Bacteriostatic; Increased
8) Sulfonamides bind to plasma proteins and can displace warfarin and what other drug?
a) Amiodarone
b) Phenytoin
c) Theophylline
d) Didanosine
e) Isoproterenol
9) Which of the following is the most commonly found in urinary tract infections?
a) E. Coli
b) Klebsiella
c) Proteus
d) Staphylococcus
e) Enterobacter
f) Shigella
10) Which of the following would NOT typically be treated with sulfonamides?
a) Nocardia infection
b) Chlamydia trachomatis infection
c) Toxoplasmosis
d) E. coli infection
e) Legionella infection
11) Silver sulfadiazine, which is useful for P. aeroginosa, is a common treatment for
a) Facial trauma
b) Clotting disorders
d) Burns
e) Hepatitis
12) Which of the following would be used to treat ulcerative colitis?
a) Sulfacetamide
b) Trimethoprim
d) Sulfamethoxazole
e) Sulfasalazine
13) Which of the following would NOT be a major therapeutic drug for urinary tract
infections, as it can cause crystalluria?
a) Sulfadiazine
b) Sulfixazole
c) Sulfamethoxazole
14) Co-trimazole (TMP-SMX) is used in patient who develop P. carinii pneumonia. This
type of pneumonia is seen in what type of patient?
a) Neonates
b) Elderly
c) Immune compromised
d) Patients taking warfarin
e) Patients with glucose-6-phosphate deficiency
15) Which of the following is taken in tablet form and exerts its antimicrobial effect in
the urine, working well against E. coli?
a) Sulfadiazine
b) Sulfixazole
c) Sulfamethoxazole
d) Nitrofurantoin
e) Trimethoprim
16) A patient is being treated with nitrofurantoin for long-term prophylaxis of lower
urinary tract infections. Which of the following can be done to help acidify urine and thus
improve antibacterial efficacy?
a) Take sodium bicarbonate
b) Drink cranberry juice
c) Eat potatoes
d) Eat dandelion greens
17) Pulmonary hypersensitivity with fibrosis can occur with long-term use of which of
the following?
a) Sulfadiazine
b) Sulfixazole
c) Sulfamethoxazole
d) Nitrofurantoin
e) Trimethoprim
18) A 28-yr-old AIDS patient requires prophylaxis against PCP (Pneumocystis
pneumonia) and cerebraltoxoplasmosis. Patient past medical history indicates no drug
allergies. Which one of the following agents is appropriate?
a) Nitrofurantoin
b) Gentamicin
c) Ciprofloxacin
d) Sulfadiazine
e) Trimethoprim-sulfamethoxazole
19) A 3-yr-old baby is given a presumptive diagnosis of sulfomanide-induced
kernicterus. Which one of the following mechanisms is involved ?
a) Competition for bilirubin-binding sites on plasma proteins
b) Defective bilirubin metabolism
c) Drug-induced RBC lysis
d) Hepatitis during pregnancy
e) Liver cirrhosis
10 – Antiviral Agents
1) Which of the following viral infections alternates between active replication and latent
periods where the virus remains dormant?
a) Human Immunodeficiency Virus (HIV)
b) Herpes Simplex Virus (HSV)
c) Hepatitis B
d) Hepatitis C
2) Therapy for viral infections is aimed at which of the following?
a) Enhancing CD4 counts
b) Enveloping viral infected cells
c) Lysing viral infected cells
d) Destroying viruses directly
e) Preventing or delaying viral replication
3) Highly Active Anti-Retroviral Therapy (HAART) is used instead of monotherapy for
a) Human Immunodeficiency Virus (HIV)
b) Herpes Simplex Virus (HSV)
c) Hepatitis B
d) Hepatitis C
e) Cytomegalovirus (CMV)
4) Which of the following drugs is used for CMV, not HSV?
a) Acyclovir (Zovirax)
b) Vidarabine (Vira-A)
c) Fomivirsen (Vitravene)
d) Foscarnet (Foscovir)
e) Cidofovir (Vistide)
5) Acyclovir is phosphorylated by viral kinsases at which step?
a) First (mono-phosphate)
b) Second (di-phosphate)
c) Third (tri-phosphate)
6) AZT (Zidovudine) has what mechanism of action?
a) Blocks viral absorption
b) Blocks uncoating stage
c) Blocks early protein synthesis
d) Blocks reverse transcriptase
e) Blocks packaging and assembly
7) Which of the following is NOT initially phosphorylated by host cell kinases?
a) Idoxuridine
b) Cytarabine
c) Ganciclovir
d) Vidarabine
e) Zidovudine
8) Acyclovir is phosphorylated by ____, idoxuridine is phosphorylated by ____, and
Ganciclovir is phosphorylated by ____.
a) Thymidine kinase (TK); CMV protein kinase (UL97); host cell kinases
b) CMV protein kinase (UL97); host cell kinases; Thymidine kinase (TK)
c) Host cell kinases; Thymidine kinase (TK); CMV protein kinase (UL97)
d) CMV protein kinase (UL97); Thymidine kinase (TK); host cell kinases
e) Thymidine kinase (TK); host cell kinases; CMV protein kinase (UL97)
9) Acyclovir is considered “fraudulent” because it is missing a sugar moiety and thus
terminates the viral DNA chain. Resistance to this drug can develop in which of the
following, via alteration in viral thymidine kinases (TK-) or viral polymerase?
a) Herpes simples virus
b) Varicella-zoster
c) Epstein-Barr virus
d) A & B
e) A, B, & C
10) Which of the following is NOT a side-effect of Acyclovir (Zovirax)?
a) Delirium
b) Tremors/Seizures
c) Hypotoxicity
d) Hypotension
e) Significant bone marrow toxicity
11) Valacyclovir (Valtrex) is the ester form of acyclovir and is used for recurrent genital
herpes or zoster infections. Which of the following is NOT true of the valacyclovir when
compared to acyclovir?
a) Longer acting
b) Improved bioavailability
c) Increased serum drug levels
d) Should not be taken orally
12) Which of the following is NOT true of famciclovir (Famvir)?
a) Improved bioavailability
b) Resistant to first-pass metabolism
c) Used for acute herpes zoster infections
d) Used for recurrent genital herpes
13) Ganciclovir (Cytovene) is a drug that works by acting as what type of analog?
a) Adenine
b) Thymine
c) Cytosine
d) Guanine
e) Uracil
14) Which of the following is standard therapy for CMV infections?
a) Idoxuridine
b) Cytarabine
c) Ganciclovir
d) Vidarabine
e) Zidovudine
15) What type of patient would most likely be symptomatic for CMV infection?
a) Kidney transplant
b) Endocarditis
c) Trauma
d) Congestive heart failure
e) Chronic obstructive pulmonary disease
16) Which of the following drugs is given prophylactically to prevent CMV disease in
AIDS patients and has adverse effects including leucopenia and thrombocytopenia?
a) Idoxuridine
b) Cytarabine
c) Ganciclovir
d) Vidarabine
e) Zidovudine
17) Cidofovir (Vistide) is a broad-spectrum treatment for mucocutaneous herpes
infections and CMV retinitis in AIDS patients. The drug works by acting as what type of
analog?
a) Adenine
b) Thymine
c) Cytosine
d) Guanine
e) Uracil
18) Cidofovir should be co-administered with probenecide to minimize damage (toxicity)
to which of the following?
a) Brain
b) Heart
c) Liver
d) Spleen
e) Kidneys
19) Cidofovir is 1000-fold more effective against herpesvirus DNA polymerases than
host cell polymerases. Which of the following activates cidofovir?
a) Thymidine kinase (TK)

b) Host cell kinases
c) CMV protein kinase (UL97)
d) Phosphorylation is not required
20) Foscarnet (Foscavir) is used for CMV and is activated by which of the following?
a) Thymidine kinase (TK)
b) Host cell kinases
c) CMV protein kinase (UL97)
d) Phosphorylation is not required
21) Resistance to foscarnet in HSV and CMV is due to which of the following occurring
in the DNA polymerase gene?
a) Point mutations
b) Missense mutations
c) Nonsense mutations
d) Insertion mutation
e) Deletion mutations
22) Which of the following should be monitored when giving foscarnet?
a) D-dimer, Fibrin degradation products (FDP)
b) Aspartate aminotransferase (AST)
c) Lactate dehydrogenase (LDH)
d) Electrolytes
e) Bilirubin
23) Which of the following drugs would be used for HSV encephalitis and HSV keratitis?
a) Idoxuridine
b) Cytarabine
c) Ganciclovir
d) Vidarabine
e) Zidovudine
24) Which of the following drugs is associated with GI irritation, along with paresthesia,
tremor, convulsions, and hepatic dysfunction?
a) Vidarabine
b) Zidovudine
c) Idoxuridine
d) Ganciclovir
e) Cytarabine
25) A 26-yr-old nursing mother is diagnosed as suffering from genital herpes. Apart
from her current problem, she is in good health. Which one of the following drugs is most
likely to be prescribed?
a) Acyclovir
b) Amantadine
c) Foscarnet
d) Ritonavir
e) Ganciclovir
26) Which one of the following antiviral agents is primarily phosphorylated by viral-
encoded enzymes?
a) Cytarabine
b) Amantadine
c) Foscarnet
d) Idoxuridine
e) Ganciclovir
11 – Antiretroviral Agents
1) What is the genus of the HIV retrovirus, acting slowly and replicating itself by
generating a DNA copy by reverse transcriptase?
a) Spumavirus
b) Lentivirus
c) Gammaretrovirus
d) Epsilonretrovirus
e) Deltaretrovirus
2) Which of the following is the primary target for HIV?
a) TH cells
b) TC cells
c) B cells
d) NK cells
e) Granulocytes
f) Macrophages
3) Antisense antiviral drugs block which of the following steps in the viral life cycle?
a) Binding
b) Reverse transcription
c) Integration
d) Transcription
e) Translation
f) Assembly
4) Protease inhibitors (PIs) block which of the following steps in the viral life cycle?
a) Binding
c) Integration
d) Transcription
e) Translation
f) Assembly
5) AZT (Retrovir), also called zidovudine, is used in the treatment of HIV by inhibiting
which step in the viral life cycle?
a) Binding
c) Integration
d) Transcription
e) Translation
f) Assembly
6) AZT can cause viral resistance, mitochondrial toxicity, and which of the following?
a) Anemia
b) Somnolence
c) Neutropenia
d) Leukocytopenia
e) Bone marrow over-production
7) HAART therapy usually includes which of the following?
a) Nucleoside reverse transcriptase inhibitor (NRTI), non-nucleoside reverse
transcriptase inhibitor (NNRTI), and transcription inhibitor (TI)
b) Nucleoside reverse transcriptase inhibitor (NRTI), transcription inhibitor (TI),
and protease inhibitor (PI)
c) Nucleoside reverse transcriptase inhibitor (NRTI), non-nucleoside reverse
transcriptase inhibitor (NNRTI), and protease inhibitor (PI)
d) Non-nucleoside reverse transcriptase inhibitor (NNRTI), transcription inhibitor
(TI), and protease inhibitor (PI)
8) Which of the following drugs, when given with AZT, does NOT inhibit the
glucoronidation pathway and leads to decreased serum levels of AZT?
a) Naproxin
b) Beta-lactam antibiotics
c) Phenytoin
d) Phenobarbital
e) Clarithromycin
9) Rifampin causes serum levels of what drug to increase when given together?
a) AZT
b) Intraconazole
c) Fluconazole
d) Ketoconazole
10) Didanosine, ddI (Videx) can show cross resistence with zalcitabine (Hivid).
Resistance can also occur with a mutation to what codon?
a) Codon 45
b) Codon 47
c) Codon 54
d) Codon 74
e) Codon 184
11) Which of the following drugs is associated with dose-dependent pancreatitis as well
as peripheral neuropathy?
a) AZT, Zidovudine (Retrovir)
b) 3TC, Lamivudine (Epivir)
c) ddC, Zalcitabine (Havid)
d) ddI, Didanosine (Videx)
e) d4T, Stavudine (Zerit)
12) Co-administration of diadenosine with which of the following would result in an
increased area under the curve (AUC) plasma concentration as a function of time and
thus is contraindicated?
a) Cytarabine
b) Amantadine
c) Foscarnet
d) Idoxuridine
e) Ganciclovir
13) Lamivudine (Epivir) is a reverse transcriptase inhibitor that works in synergism with
AZT against HIV-1. Concomitant administration with which of the following drugs is
contraindicated?
a) Nitrofurantoin
b) Gentamicin
c) Ciprofloxacin
d) Sulfadiazine
e) Trimethoprim-sulfamethoxazole
14) Stavudine (Zerit), a reverse transcriptase inhibitor, works as what type of analog?
a) Adenine
b) Thymidine
c) Cytosine
d) Adenosine
e) Tyrosine
15) What is the major toxicity for stavudine?
a) Peripheral sensory neuropathy
b) Arthralgia
c) Pancreatitis
d) Elevated serum transaminases
16) Which of the following is NOT a non-nucleoside reverse transcriptase inhibitor?
a) Zalcitabine (Hivid)
b) Nevirapine (Viramune)
c) Efavirenz (Sustiva)
d) Delaverdine (Rescriptase)
17) Which of the following is the most common adverse reaction with nevirapine?
a) Rash
b) Jaundice
c) Facial swelling
d) Conjunctivitis
e) Dark urine
18) Which of the following is the correct order from most drug contraindications (drug-
drug interations) to least contraindications?
a) Nevirapine > Delavirdine > Efavirenz
b) Nevirapine > Efavirenz > Delavirdine
c) Delavirdine > Efavirenz > Nevirapine
d) Delavirdine > Nevirapine > Efavirenz
e) Nevirapine > Efavirenz > Delavirdine
19) Proease inhibitors (PI) block HIV aspartyl protease (AP). What is the function of AP?
a) Cleaves gag and gag-pol polyproteins into functional proteins
b) Assembles gag and gag-pol polyproteins into a function segment
c) Synthesis of the phenylalanine-proline peptide bond only
d) Cleaves at phenylalanine-tyrosine peptide bond only
e) Cleaves at phenylalanine-proline peptide bond only
20) Protease inhibitors are associated with accumulation of fat and hyperglycemia. Which
of the following has the highest toxicity toward nausea, vomiting, and diarrhea?
a) Indinavir
b) Nelfinavir
c) Ritonavir
d) Saquinavir
21) Which of the following is the most powerful inhibitor of the hepatic cytochrome
P450 enzyme system?
a) Indinavir
b) Nelfinavir
c) Ritonavir
d) Saquinavir
22) Which of the following is the weakest inhibitor of the hepatic cytochrome P450
enzyme system?
a) Indinavir
b) Nelfinavir
c) Ritonavir
d) Saquinavir
23) Ethinyl estradiol and AZT levels are lowered by which of the following?
a) Indinavir
b) Nelfinavir
c) Ritonavir
d) Saquinavir
24) Ritonavir and saquinavir are contraindicated with use of which of the following?
a) Penicillin
b) Caffeine
c) Theophylline
d) Didanosine
e) Sildenafil
25) The goal of HAART therapy is to increase CD4+ T-cell counts above what level,
signifying the patient no longer has AIDS?
a) 25 cells/mm3
b) 50 cells/mm3
c) 100 cells/mm3
d) 200 cells/mm3
e) 1000 cells/mm3
26) Which of the following is a fusion inhibitor that consists of a 36 amino acid synthetit
peptide which binds to gp41?
a) Efuvirtide
b) Raltegravir
c) Elvitegravir
d) Nelfinavir
e) Delavirdine
12 – Antitubercular & Antileprosy Drugs

1) Mycobacterium tuberculosis becomes a primary infection (TB) through which route of
transmission?
a) Ingestion
b) Injection
c) Inhalation
d) Absorption
e) Mutation
2) M. tuberculosis reproduces within what type of cells, leading to necrosis and the
presence of Ghon complexes on chest x-ray?
a) TH cells
b) TC cells
c) Neutrophils
d) NK cells
e) Granulocytes
f) Macrophages
3) Which of the following is NOT true regarding treatment of tuberculosis?
a) Isoniazid (IHN) is considered a first-line agent
b) Multidrug therapy (MDT) may be needed
c) Resistance can become an issue
d) Patient compliance is an issie
e) Treatment is short-term
4) If three drugs are given to a patient and each drug has a 50% chance of failure due to
bacterial resistance, what is the overall probability that chemotherapy resistance will
develop?
a) 1 in 2
b) 1 in 4
c) 1 in 6
d) 1 in 8
e) 1 in 12
5) Which of the following drugs has the highest pattern of resistance?
a) Ethambutol
b) Isoniazid
c) Rifampin
d) Pyrazinamide
e) Streptomycin
6) Which of the following is considered a second-line antitubercular agent?
a) Para-aminosalicyclic acid
b) Isoniazid
c) Rifampin
d) Pyrazinamide
e) Streptomycin
7) Which of the following is an aminoglycoside only used for tuberculosis?
a) Ethambutol
b) Isoniazid
c) Rifampin
d) Pyrazinamide
e) Streptomycin
8) Isoniazid has a genetic polymorphism profile. Which of the following is NOT true
regarding the use of isoniazid?
a) 50% of African American are fast acetylators
b) 50% of Caucasians are slow acetylators

c) Most Native American are fast acetylators
d) Most Asians are fast acetlators
e) Slow acetylators should be given an increased dose of isoniazid
9) Isoniazid inhibits mycolid acid synthesis, disrupting bacterial walls and is associated
with hepatotoxicity, peripheral and central neuropathy, and optic neuritis. What vitamin
should be given as a supplement with isoniazid to help prevents these effects?
a) Vitamin A
b) Vitamin K
c) Vitamin B6
d) Vitamin B12
e) Vitamin E
10) Use of isoniazid is contraindicated in what patient population?
a) Elderly
b) Epileptics
c) Diabetics
d) Transplant
e) Pregnant
11) A patient is started on ethambutol after lab results show an infection of
Mycobacterium avium-intracellulare. What disease should the patient be tested for?
a) Tuberculosis
b) Diabetes
c) Epilepsy
d) Dementia
e) HIV
12) Which of the following drugs can cause joint pain and reversible optic neuritis?
a) Ethambutol
b) Isoniazid
c) Rifampin
d) Pyrazinamide
e) Streptomycin
13) Which of the following drugs would be used to treat Chlamydia if doxycycline is not
available for use?
a) Ethambutol
b) Isoniazid
c) Rifampin
d) Pyrazinamide
e) Streptomycin
14) A patient returns complaining of a reddish-orange color in their urine, saliva, sweat,
and tears. Which of the following drugs was the patient likely taking?
a) Dapsone
b) Isoniazid
c) Rifampin
d) Pyrazinamide
e) Streptomycin
15) Which of the following is a pro-drug that is activated by tuberculosis and can cause
hyperuricemia?
a) Ethambutol
b) Isoniazid
c) Rifampin
d) Pyrazinamide
e) Streptomycin
16) Which of the following TB drugs is the least toxic?
a) Para-aminosalicyclic acid
b) Ethionamide
c) Ethambutol
d) Cycloserine
Match the drug with the adverse effect:
17) Intense gastric pain a) Para-aminosalicyclic acid (PAS)
18) CNS toxicity b) Ethionamide (Trecator-SC)
19) Hypersensitivity c) Cycloserine (Seromycin)
20) A patient from Southeast Asia presents with discoloration of the skin. Neurological
testing of the skin shows sensory loss over the areas of discoloration. Which of the
following is the most likely?
a) AIDS
b) Huntington disease
c) Parkinson disease
d) Creutzfeldt-Jakob disease
e) Hansen disease
21) Which of the following drugs is combined with trimethoprim for prophylaxis of
Pneumocystis carinii pneumonia in AIDS patients?
a) Dapsone
b) Isoniazid
c) Rifampin
d) Pyrazinamide
e) Streptomycin
22) Which of the following drugs is used for Mycobacterium leprae?
a) Dapsone
b) Isoniazid
c) Didanosine
d) Pyrazinamide
e) Streptomycin
23) Dapsone is contraindicated in which of the following cases?
a) AIDS
b) Folate deficiency
c) Splenomegaly
d) Glucose 6-phosphate deficiency
f) Marfan syndrome
24) Which of the following drugs may block Dapson’s absorption?
a) Penicillin
b) Furosamine
c) St. John’s Wort

d) Warfarin
e) Didanosine
25) What drug is the single most effective bactericidal drug against M. leprae?
a) Dapsone
b) Isoniazid
c) Rifampin
d) Pyrazinamide
e) Streptomycin
26) RL is a 46-yr-old African American man who has had intermittent, dull chest pain for
3 months; other symptoms include fatigue, night sweats, and bloody sputum. He has no
known allergies. He has been on a 6-mo regimen of MTX for seropositive rheumatoid
arthritis. RL is currently on active military duty and just returned from a 4-yr assignment
in Southeast Asia. He admits to a daily consumption of alcohol (12-14 ounces). RL’s
chest X ray reveals interstitial infiltrates and cavitation in left upper lobe. His sputum
culture is positive for acid-fast bacilli. Which of the following is the most likely cause?
a) Streptococcus pneumoniae
b) Pneumocystis carinii
c) Mycobacterium leprae
d) Mycobacterium tuberculosis
e) Mycobacterium avium-intracellulare
27) A 34-year-old man under treatment for pulmonary TB has acute-onset right big toe
pains, swelling, and low-grade fever. His physical exam is consistent with gouty arthritis,
and he is found to have high serum uric acid levels. Which one of the following anti-TB
drugs is the most likely cause of this patient’s UA levels?
a) Isoniazid
b) Pyrazinamide
c) Cycloserine
d) Rifampin
e) Ethionamide
28) A 30-year-old Haitian man has acute-onset confusion and suicidal tendency. Three
weeks ago he began combination therapy for multidrug-resistant pulmonary TB. Which
of the following anti-TB drugs is the most likely cause of the patient’s neurological
symptoms?
a) Rifampin
b) Isoniazid
c) Pyrazinamide
d) Streptomycin
e) Cycloserine
13 – Antifungal Agents
1) Which of the following is NOT considered opportunistic, and thus may be seen in non-
immunocompromised patients?
a) Aspergillosis
b) Histoplasmosis
c) Cryptoccosis
d) Candidiasis
2) Which of the following types of patients would be the least susceptible to fungal
infections?
a) Surgical patients
b) Patients in the ICU
c) Patients with prostheses
d) Patients with diabetes
e) Immunocompromised patients
3) Which of the following is used to treat dermatophytosis (skin mycosis)?
a) Amphotericin B (Fungizone)
b) Miconazole (Monistat)
c) Griseofulvin (Fulvicin)
d) Terbinafine (Lamisil)
e) Caspofungin (Cancidas)
Match the antifungal mechanism with the drug:
4) Disruption of membrane structure a) Amphotericin B
5) Inhibition of cell membrane ergosterol synthesis b) Flucytosine
6) Inhibition of fungal DNA synthesis c) Miconazole
7) Which of the following shows synergistic characteristics for fungal infections when
combined with amphotericin B?
a) Flucytosine
b) Clindamycin
c) Fluroquinolone
d) Imipenem
e) Cephalosporin
8) Antifungal azole drugs are very nephrotoxic and should not be taken orally.
a) True
b) False
9) Which of the following locations shows the least penetrance of amphotericin B?
a) Parotid bland
b) Urine
c) CNS
d) Blood
10) What is the major adverse risk for amphotericin B, which is enhanced with drugs
such as cyclosporine and aminoglycosides?
a) Nephrotoxicity
b) Nausea and vomiting
c) Electrolyte imbalances
d) Fever and chills
e) Anemia
11) Due to “cytokine storm” effects, how should amphotericin B be administered?
a) Orally
b) Rapid push IV
c) Slow push IV
d) IV slow infusion
e) IM
12) Which of the following is used for cryptococcal infections in non-AIDS patients?
a) Amphotericin B
b) Amphotericin B and flucytosine
c) Flucytosine
d) Ketoconazole
e) Voriconazle
13) Which of the following interferes with nucleic acid synthesis by inhibiting
thymidylate synthase?
a) Amphotericin B
b) Miconazole
c) Flucytosine
d) Ketoconazole
e) Voriconazle
14) Which of the following antifungal agents is removed by dialysis?
a) Voriconazle
b) Miconazole
c) Amphotericin B
d) Ketoconazole
e) Flucytosine
15) Which of the following is NOT an adverse effect seen with flucytosine?
a) Hepatotoxicity
b) Hair loss (alopecia)
c) GI distress
d) Rash
e) Bone marrow suppression
16) Which of the following is available over the counter (OTC) for acute vaginal
infections?
a) Ketoconazole
b) Fluconazole
c) Itraconazole
d) Miconazole
e) Clotrimazole
17) Which of the following should be used in gastric surgery?
a) Ketoconazole
b) Fluconazole
c) Itraconazole
d) Miconazole
e) Clotrimazole
18) Which of the following should NOT be taken with azole antifungals?
a) Antacids
b) Cranberry juice
c) Alcohol
d) Aspirin
19) Which of the following drugs can cause hormonal imbalances as well as GI distress
and rash?
a) Ketoconazole
b) Fluconazole
c) Itraconazole
d) Miconazole
e) Clotrimazole
20) Administration of which of the following drugs with ketoconazole could lead to life-
threatening cardiac arrhythmias?
a) Cyclosporine
b) Digoxin
c) Phenytoin
d) Isoniazid
e) Rifampin
f) Coumadin
21) Which of the following decreases serum concentrations of fluconazole?
a) Cyclosporine
b) Digoxin
c) Phenytoin
d) Coumadin
e) Rifampin
22) Which of the following drugs is used for histoplasmosis and blastomycosis, and can
possibly lead to minearalcorticoid excess?
a) Ketoconazole
b) Fluconazole
c) Itraconazole
d) Miconazole
e) Clotrimazole
23) Which of the following is used for refractory invasive aspergillosis?
a) Amphotericin B (Fungizone)
b) Miconazole (Monistat)
c) Griseofulvin (Fulvicin)
d) Terbinafine (Lamisil)
e) Caspofungin (Cancidas)
24) Which of the following inhibits fungal cytochrome P-450 mediated 14-alpha-
lanosterol demethylation and has excellent activity against Aspergillus and Candida?
a) Amphotericin B
b) Caspofungin
c) Flucytosine
d) Ketoconazole
e) Voriconazle
25) The oral azoles itraconazole and terbinafine are used because they have a ____
spectrum of activity and a ____ duration of treatment.
a) Narrow; Short
b) Narrow; Long
c) Broad; Short
d) Broad; Long
James Lamberg
AnswerKey 45) A 6) A 16) F 29) C

Pharm #1 46) C 7) C 17) D 30) E
1) E 47) E 8) A 18) B
2) D 48) D 9) A 19) E Pharm #6
3) C 49) B 10) B 20) E 1) C
4) A 50) C 11) D 21) B 2) C
5) B 51) C 12) C 22) A 3) B
6) E 52) B 13) E 23) D 4) B
7) C 53) E 14) C 24) B 5) A
8) D 54) C 15) A 25) E 6) A
9) B 55) D 16) D 26) D 7) C
10) B 56) C 17) B 27) A 8) E
11) A 57) B 18) B 28) D 9) D
12) E 58) B 19) E 29) A 10) D
13) A 59) B 20) D 30) D 11) B
14) D 60) F 21) C 31) C 12) E
15) C 61) D 22) D 13) E
16) E 62) B 23) B Pharm #5 14) C
17) A 63) E 24) C 1) C 15) D
18) B 64) A 25) B 2) A 16) A
19) A 65) C 26) A 3) D 17) B
20) B 66) A 27) D 4) B 18) E
21) A 67) E 28) E 5) C 19) C
22) B 68) B 29) B 6) A
23) A 69) F 30) E 7) E Pharm #7
24) E 31) A 8) A 1) D
25) B Pharm #2 32) B 9) A 2) A
26) C 1.1) C 33) D 10) C 3) B
27) A 1.2) A 34) E 11) C 4) E
28) C 1.3) A 12) C 5) D
29) D 1.4) B Pharm #4 13) B 6) D
30) D 1.5) E 1) D 14) D 7) C
31) A 1.6) C 2) A 15) B 8) B
32) F 1.7) B 3) B 16) C 9) D
33) C 2.1) A 4) A 17) D 10) A
34) B 2.2) D 5) B 18) E 11) E
35) C 2.3) E 6) C 19) C 12) A
36) A 3.1) C 7) A 20) B 13) D
37) C 3.2) E 8) D 21) A 14) E
38) E 9) E 22) B 15) C
39) A Pharm #3 10) C 23) D 16) D
40) B 1) C 11) D 24) C 17) C
41) E 2) E 12) A 25) B 18) C
42) C 3) D 13) E 26) A 19) D
43) B 4) B 14) A 27) B 20) E
44) E 5) C 15) C 28) E 21) B
22) E 9) A 6) A 24) E
23) D 10) E 7) C 25) C
24) E 11) D 8) E 26) D
25) B 12) E 9) D 27) B
26) A 13) A 10) D 28) E
27) E 14) C 11) D
28) C 15) D 12) E Pharm #13
29) A 16) B 13) B 1) B
30) C 17) D 14) C 2) D
31) B 18) E 15) A 3) C
32) C 19) A 16) A 4) A
17) A 5) C
Pharm #8 Pharm #10 18) C 6) B
1) A 1) B 19) A 7) A
2) B 2) E 20) C 8) B
3) D 3) A 21) C 9) C
4) B 4) C 22) D 10) A
5) E 5) A 23) B 11) D
6) A 6) D 24) E 12) B
7) B 7) C 25) D 13) C
8) C 8) E 26) A 14) E
9) E 9) D 15) C
10) A 10) E Pharm #12 16) E
11) C 11) D 1) C 17) B
12) A 12) B 2) F 18) A
13) A 13) D 3) E 19) A
14) B 14) C 4) D 20) B
15) D 15) A 5) B 21) E
16) B 16) C 6) A 22) C
17) E 17) C 7) E 23) E
18) C 18) E 8) E 24) E
19) C 19) B 9) C
20) B 20) D 10) B
21) B 21) A 11) E
22) B 22) D 12) A
23) E 23) D 13) C
24) A 14) C
Pharm #9 25) A 15) D
1) E 26) E 16) C
2) C 17) B
3) B Pharm #11 18) C
4) A 1) B 19) A
5) C 2) A 20) E
6) A 3) D 21) A
7) D 4) F 22) A
8) B 5) B 23) D

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What are the general principles of antimicrobial chemotherapy?

What are the general principles of antimicrobial chemotherapy?

What are some examples of broad spectrum antibiotics mentioned?

What are some examples of broad spectrum antibiotics mentioned?

Pharmacology – Part 2 14Mar2009

1 – General Principles of Antimicrobial Chemotherapy

DO NOT DISTRIBUTE -1-

DO NOT DISTRIBUTE -2-

DO NOT DISTRIBUTE -3-

DO NOT DISTRIBUTE -4-

DO NOT DISTRIBUTE -5-

DO NOT DISTRIBUTE -6-

DO NOT DISTRIBUTE -7-

c) Aspartate aminotransferase (AST)

DO NOT DISTRIBUTE -8-

b) Ion channel blockers

2 – Antimicrobial Case Reviews

DO NOT DISTRIBUTE -9-

7) Penicillin G is ____ to penicillinase and methicillin is ____ to penicillinase. Both are

12) Which of the following cephalosporins would be destroyed by beta-lactamases

e) Third-generaion with Pseudomonas aeruginosa activity

12) If aminoglycosides are administered with neuromuscular blockers, respiratory

6) Which of the following second-generation fluoroquinolones has anti-anaerobic

8 – Chloramphenicol & Tetracyclines

9 – Sulfonamides, Trimethoprim, & Nitrofurantoin

a) Thymidine kinase (TK)

12 – Antitubercular & Antileprosy Drugs

b) 50% of Caucasians are slow acetylators

c) St. John’s Wort

AnswerKey 45) A 6) A 16) F 29) C

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7) Penicillin G is to penicillinase and methicillin is to penicillinase. Both are