Systemic Pharmacology Part II - Midterm II

1. This group of drugs' MOA is inhibition of bacterial protein synthesis by binding to the 30-S ribosomal subunit. It has bacteriostatic effects, with variable effects against some Gram-positive bacteria, reliable effects against systemic Listeria infections. O.D.s prescribing these drugs for oral use should be rare, and considered for very specific conditions such as chlamydial inclusion conjuncitivitis, tracoma. There are many potential adverse effects and drug interactions possible with use of tetracycline antibiotics. O.Ds should prescribe these medications sparingly and with caution. Adverse side effects include photosensitivity and various GI effects including N/V.Use in pregnant women and young children should be avoided.

Tetrayclines

Polymysin

Sulfonamides

Aminoglycosides

Antiviral agents

Tetracyclines are a group of drugs that inhibit bacterial protein synthesis by binding to the 30-S ribosomal subunit. They have bacteriostatic effects and can vary in their effectiveness against Gram-positive bacteria. They are reliable in treating systemic Listeria infections. However, these drugs should be prescribed orally only in rare cases and for specific conditions such as chlamydial inclusion conjunctivitis and trachoma. Tetracycline antibiotics have many potential adverse effects and drug interactions, so they should be prescribed sparingly and with caution. Adverse side effects include photosensitivity and various gastrointestinal effects. Pregnant women and young children should avoid using tetracyclines.

Explanation

Tetracyclines are a group of drugs that inhibit bacterial protein synthesis by binding to the 30-S ribosomal subunit. They have bacteriostatic effects and can vary in their effectiveness against Gram-positive bacteria. They are reliable in treating systemic Listeria infections. However, these drugs should be prescribed orally only in rare cases and for specific conditions such as chlamydial inclusion conjunctivitis and trachoma. Tetracycline antibiotics have many potential adverse effects and drug interactions, so they should be prescribed sparingly and with caution. Adverse side effects include photosensitivity and various gastrointestinal effects. Pregnant women and young children should avoid using tetracyclines.

2. You patient has been placed on a beta-adrenergic blocking agent for the treatment of angina pectoris. They have come into your office complaining about soreness of the eyes and dryness. He was told not too take several doses at a time because it exacerbate his asthma. What medication is he most likely on?

Nifedipine/ Procardia

Atenolol/Tenormin

Doxazosin/Cardura

Hydralazine/Apresoline

Remember that Drugs w/ "lol" endings fall in the class of beta-adrenergic blocking agents

Explanation

Remember that Drugs w/ "lol" endings fall in the class of beta-adrenergic blocking agents

3. Cephalosporins have the same mechanism of action as penicillins, they also share the same GI effects and possibilities of blood dyscrasias. Some cephalosporins may need to be dose adjusted in patients who have renal impairment, like penicillins. True or False: it is estimated that 2-10% of patients who are allergic to penicillin will also be allergic to cephalosporins. Allergies to cephalosporins may occur in up to 5% of patients. Reactions may range from rash to anaphylaxis.

True

False

Cephalosporins have a similar mechanism of action as penicillins and can cause similar gastrointestinal effects and blood dyscrasias. Some cephalosporins may require dose adjustment in patients with renal impairment, just like penicillins. Additionally, it is estimated that 2-10% of patients who are allergic to penicillin will also be allergic to cephalosporins. Allergies to cephalosporins can occur in up to 5% of patients and can range from a rash to a severe allergic reaction known as anaphylaxis. Therefore, the statement "True" is correct.

Explanation

Cephalosporins have a similar mechanism of action as penicillins and can cause similar gastrointestinal effects and blood dyscrasias. Some cephalosporins may require dose adjustment in patients with renal impairment, just like penicillins. Additionally, it is estimated that 2-10% of patients who are allergic to penicillin will also be allergic to cephalosporins. Allergies to cephalosporins can occur in up to 5% of patients and can range from a rash to a severe allergic reaction known as anaphylaxis. Therefore, the statement "True" is correct.

4. Antiviral agents are used by ODs for the treatment of Herpes simplex related keratitis, keratoconjunctivitis and Herpes zoster. Which of the following is not an example of an antiviral agent?

Acyclovir

Azithromycin

Trifluridine

Vidarabine

Azithromycin is not an example of an antiviral agent because it is an antibiotic, specifically a macrolide antibiotic, commonly used to treat bacterial infections. Antiviral agents, on the other hand, are medications that specifically target and inhibit the replication of viruses. Examples of antiviral agents include Acyclovir, Trifluridine, and Vidarabine, which are commonly used to treat viral infections such as herpes simplex related keratitis, keratoconjunctivitis, and herpes zoster.

Explanation

Azithromycin is not an example of an antiviral agent because it is an antibiotic, specifically a macrolide antibiotic, commonly used to treat bacterial infections. Antiviral agents, on the other hand, are medications that specifically target and inhibit the replication of viruses. Examples of antiviral agents include Acyclovir, Trifluridine, and Vidarabine, which are commonly used to treat viral infections such as herpes simplex related keratitis, keratoconjunctivitis, and herpes zoster.

5. Taking frequent or routine doses of aspirin or NSAIDs can blunt or lower the effect of antihypertensive medication therapy in individuals w/high blood pressure.

True

False

Frequent or routine use of aspirin or NSAIDs can reduce the effectiveness of antihypertensive medication in people with high blood pressure. This is because aspirin and NSAIDs can interfere with the mechanisms by which antihypertensive medications work, leading to a decrease in their ability to lower blood pressure. Therefore, it is important for individuals with high blood pressure to avoid regular use of these medications without consulting their healthcare provider.

Explanation

Frequent or routine use of aspirin or NSAIDs can reduce the effectiveness of antihypertensive medication in people with high blood pressure. This is because aspirin and NSAIDs can interfere with the mechanisms by which antihypertensive medications work, leading to a decrease in their ability to lower blood pressure. Therefore, it is important for individuals with high blood pressure to avoid regular use of these medications without consulting their healthcare provider.

6. This category of anti-infective medications inhibits bacterial DNA-gyrase. It's effects are often bacteriocidal, however, they are not good against MRSA and generally are not recommended against Enterococci. All drugs in this group have a category "C". Use may cause white precipitate of active drug at the site of epithelial defect that may be confused with a worsening infection. These medications can increase photosensitivity and cause photohobia and there are many more potential ophthalmic adverse effects. Caution should also be used when prescribing to patients taking blood-thinning medications.

Sulfonamides

Fluroroquinolones

Tetrayclines

Macrolides

Aminoglycosides

Fluoroquinolones are a category of anti-infective medications that inhibit bacterial DNA-gyrase. They are often bacteriocidal, meaning they kill bacteria, but they are not effective against MRSA and are generally not recommended for Enterococci infections. All drugs in this group have a category "C" rating, indicating that their safety during pregnancy has not been established. One potential adverse effect is the formation of a white precipitate of the active drug at the site of an epithelial defect, which can be mistaken for a worsening infection. Fluoroquinolones can also increase photosensitivity, causing sensitivity to light, and may have various ophthalmic adverse effects. Caution should be exercised when prescribing them to patients taking blood-thinning medications.

Explanation

Fluoroquinolones are a category of anti-infective medications that inhibit bacterial DNA-gyrase. They are often bacteriocidal, meaning they kill bacteria, but they are not effective against MRSA and are generally not recommended for Enterococci infections. All drugs in this group have a category "C" rating, indicating that their safety during pregnancy has not been established. One potential adverse effect is the formation of a white precipitate of the active drug at the site of an epithelial defect, which can be mistaken for a worsening infection. Fluoroquinolones can also increase photosensitivity, causing sensitivity to light, and may have various ophthalmic adverse effects. Caution should be exercised when prescribing them to patients taking blood-thinning medications.

7. Oral acyclovir is listed in the California Optometry scope of practice for treatment of opthalmic Herpes zoster. Which of the following statements regarding Acyclovir is false?

Acyclovir works by inhibiting DNA replication

Acyclovir can cause renal failure and can complicate or worsen renal function in patients with renal impairment.

Possible regimen would be 800 PO 5x per day

Acyclovir works by inhibiting DNA replication and is used for the treatment of ophthalmic Herpes zoster. However, the statement that oral acyclovir can be taken by patients who are sensitive to valacyclovir as this does not cause any cross-sensitivity is false. Both acyclovir and valacyclovir are antiviral medications in the same class called nucleoside analogues, and cross-sensitivity between the two drugs has been reported. Therefore, patients who are sensitive to valacyclovir may also be sensitive to acyclovir.

Explanation

Acyclovir works by inhibiting DNA replication and is used for the treatment of ophthalmic Herpes zoster. However, the statement that oral acyclovir can be taken by patients who are sensitive to valacyclovir as this does not cause any cross-sensitivity is false. Both acyclovir and valacyclovir are antiviral medications in the same class called nucleoside analogues, and cross-sensitivity between the two drugs has been reported. Therefore, patients who are sensitive to valacyclovir may also be sensitive to acyclovir.

8. The class of anti-infective medications works by inhibiting protein synthesis by binding to the 50-S ribosomal subunit. Drugs in this class are generally very good for Mycoplasma, Chlamydia, Rickettsia and some Clostridia. Some drugs in this class do need to be dose adjusted for renally impaired individuals. Azithromycin is an important drug in this class and does not need to be dose-adjusted in renal impairment patients. Potentially serious side effects include hepatic complications such as hepatitis and jaundice, Ototoxicity may occur, cross-reactivity between agents in this class is possible with rxns ranging from mild rash to anaphylaxis.

Tetrayclines

Macrolides

Sulfonamides

Polymyxin

Fluoroquinolones

Macrolides are a class of anti-infective medications that work by inhibiting protein synthesis by binding to the 50-S ribosomal subunit. They are effective against Mycoplasma, Chlamydia, Rickettsia, and some Clostridia. Unlike some other drugs in this class, such as Azithromycin, macrolides do not need to be dose-adjusted in patients with renal impairment. However, they can have potentially serious side effects, including hepatic complications like hepatitis and jaundice, as well as ototoxicity. There is also a possibility of cross-reactivity between different agents in this class, which can range from mild rash to anaphylaxis.

Explanation

Macrolides are a class of anti-infective medications that work by inhibiting protein synthesis by binding to the 50-S ribosomal subunit. They are effective against Mycoplasma, Chlamydia, Rickettsia, and some Clostridia. Unlike some other drugs in this class, such as Azithromycin, macrolides do not need to be dose-adjusted in patients with renal impairment. However, they can have potentially serious side effects, including hepatic complications like hepatitis and jaundice, as well as ototoxicity. There is also a possibility of cross-reactivity between different agents in this class, which can range from mild rash to anaphylaxis.

9. Mr. Ace Pril has come into your office complaining of changes in his vision (like a good patient he doesn't have a specific complaint he says he thinks its blurry but he can't be sure), a nagging cough, and headaches. On his chart you note that he has recently been seen by his PCP and placed on Captopril/Capoten. What class of antihypertensive medication is is possibly on?

Potassium Sparing Diuretics

Ace-inhibitors

Angiotensin receptor blockers (ARBs)

Beta-adrenergic blocking agents

The nagging cough is due to the bradykinin accumulation from the ACE inhibitor

Explanation

The nagging cough is due to the bradykinin accumulation from the ACE inhibitor

10. This class of diuretic can be used to treat edema, acute mountain sickness and glaucoma. Adverse side effects include stomach upset, inducing metabolic acidosis, dehydration and rare cases of transient myopia. Drugs in this calss include Acetazolamide/Diamox and Brinzolamide/Azopt. Name this class of diuretics.

Thiazide Diuretics

Loop Diuretics

Carbonic Anhydrase inhibitors

Osmotic Diuretics

pg. 88 of the manual

Explanation

pg. 88 of the manual

11. Penicillins are bacteriocidal and inhibit bacterial cell wall synthesis. Certain drugs in this category need to be dose-adjusted in patients with renal impairment. GI effects with oral use have included N/V/D. CNS effects are rare, but can include confusion, seizures, and encephalopathy. Blood dyscrasias can occur as well: eosinophilia, and thrombocytopenia. Which of the following is not a penicillin?

Amoxicillin with Clavulanate

Amoxicillin

Cephalexin

Diclocxacillin

Cephalexin is not a penicillin. Penicillins are a class of antibiotics that inhibit bacterial cell wall synthesis and are bacteriocidal. They are commonly used to treat various bacterial infections. Amoxicillin with Clavulanate, Amoxicillin, and Diclocxacillin are all penicillins. Cephalexin, on the other hand, is a cephalosporin antibiotic. While cephalosporins have a similar mechanism of action to penicillins, they are structurally different and not considered penicillins. Therefore, Cephalexin is not a penicillin.

Explanation

Cephalexin is not a penicillin. Penicillins are a class of antibiotics that inhibit bacterial cell wall synthesis and are bacteriocidal. They are commonly used to treat various bacterial infections. Amoxicillin with Clavulanate, Amoxicillin, and Diclocxacillin are all penicillins. Cephalexin, on the other hand, is a cephalosporin antibiotic. While cephalosporins have a similar mechanism of action to penicillins, they are structurally different and not considered penicillins. Therefore, Cephalexin is not a penicillin.

12. The mechanism of action for this group of anti-infective medications was through inhibition of folic acid formation resulting in bacteria not being able to synthesize amino acids and DNA. Several of the drugs in this group are used to treat bacterial conjunctivitis and trachoma/chlamydial infections, however they are not effective against MRSA. You must inform patients that allergic rxns are possible. Dematologic rxns can range from swelling to hives and rash. What category of anti-infective medications would this description belong to?

Tetracyclines

Sulfonamides

Polymyxin and Bacitracin

Penicillins

Macrolides

The correct answer is sulfonamides. Sulfonamides inhibit the formation of folic acid in bacteria, which prevents them from synthesizing amino acids and DNA. This mechanism of action makes them effective against bacterial infections such as conjunctivitis and chlamydial infections. However, they are not effective against MRSA. It is important to inform patients that allergic reactions are possible, and these can range from swelling to hives and rash.

Explanation

The correct answer is sulfonamides. Sulfonamides inhibit the formation of folic acid in bacteria, which prevents them from synthesizing amino acids and DNA. This mechanism of action makes them effective against bacterial infections such as conjunctivitis and chlamydial infections. However, they are not effective against MRSA. It is important to inform patients that allergic reactions are possible, and these can range from swelling to hives and rash.

13. Corticosteroids can accelerate the spread of viral infections and are usually contraindicated in superficial Herpes simplex virus keratitis. Steroids may be used concurrently with trifluridine in the treatment of Herpes simplex stromal infections.

True

False

pg. 77 of manual

Explanation

pg. 77 of manual

14. Which of the following is a reasonable/ possible regimen for Valacyclovir/Valtrex?

150mg-450 PO q6Hr

400mg PO q24hr

800mg PO 5x per day

1000mg PO TID

Option 1 - for clindamycin
Option 2 - dosage for moxifloxacin
Option 3 - for acyclovir

Explanation

Option 1 - for clindamycin
Option 2 - dosage for moxifloxacin
Option 3 - for acyclovir

15. Which of the following anti-infective medications requires renal dose adjustments?

Azithromycin

Moxifloxacin

Doxycycline

Ampicillin

Ampicillin is the correct answer because it is an antibiotic that is primarily eliminated through the kidneys. Renal dose adjustments are necessary in patients with impaired renal function to ensure that the medication is properly cleared from the body and to prevent potential toxicity. The other options, Azithromycin, Moxifloxacin, and Doxycycline, do not require renal dose adjustments as they are primarily eliminated through non-renal routes.

Explanation

Ampicillin is the correct answer because it is an antibiotic that is primarily eliminated through the kidneys. Renal dose adjustments are necessary in patients with impaired renal function to ensure that the medication is properly cleared from the body and to prevent potential toxicity. The other options, Azithromycin, Moxifloxacin, and Doxycycline, do not require renal dose adjustments as they are primarily eliminated through non-renal routes.

16. Which of the following anti-infectives has a possible oral regimen for q24hr?

Clindamycin

Ampicillin

Doxycycline

Moxifloxacin

Acyclovir

Possible dosage for Moxifloxacin: 400mg PO q24hr

Clindamycin - 150mg-450mg PO q6hr
Doxycycline - 100mg PO q12hr
Ampicillin - 250-500mg PO q6hr
Acyclovir - 800mg PO 5x per day

Explanation

Possible dosage for Moxifloxacin: 400mg PO q24hr

Clindamycin - 150mg-450mg PO q6hr
Doxycycline - 100mg PO q12hr
Ampicillin - 250-500mg PO q6hr
Acyclovir - 800mg PO 5x per day

17. Staphylococcus aureus can cause all of the following except what condition?

Bacterial Keratitis

Dacryocystitis

Protozoan Keratitis

Blepharitis

Hordeolum

Bacterial conjunctivitis

Staphylococcus aureus is a bacterium that can cause various infections, including bacterial keratitis, dacryocystitis, blepharitis, hordeolum, and bacterial conjunctivitis. However, it does not cause protozoan keratitis, which is an infection caused by protozoa.

Explanation

Staphylococcus aureus is a bacterium that can cause various infections, including bacterial keratitis, dacryocystitis, blepharitis, hordeolum, and bacterial conjunctivitis. However, it does not cause protozoan keratitis, which is an infection caused by protozoa.

18. Which of the following statements regarding Aminoglycosides is false?

It's mechanism of action is inhibition of bacterial protein synthesis by binding principally to 30-S and 50-S ribosomal subunits.

Use in the opthalmic form may result in allergic rxns such as swelling of eyelids, face, appearance of rash, etc.

They are widely used for Gram negative bacteria

The statement that there has been no reports of bacterial resistances in Pseudomonas, and that all patients respond quickly to treatment with this class of drugs making culturing unnecessary is false. Bacterial resistance to aminoglycosides, including Pseudomonas, has been reported. Culturing is necessary to determine the susceptibility of the bacteria to the drug and to guide appropriate treatment.

Explanation

The statement that there has been no reports of bacterial resistances in Pseudomonas, and that all patients respond quickly to treatment with this class of drugs making culturing unnecessary is false. Bacterial resistance to aminoglycosides, including Pseudomonas, has been reported. Culturing is necessary to determine the susceptibility of the bacteria to the drug and to guide appropriate treatment.

19. Select the false statement

NSAIDs, aspirin, clopidogrel, several antibiotics, heparin, thrombolytics agents can increase bleeding risk when used with Warfarin/coumadin

Warfarin is administered subcutaneously

If a patient complaining of pain is taking warfarin/coumadin a safer alternative to an NSAID or aspirin would be Tylenol.

Warfarin is administered orally, it has a high degree of serum protein binding, long T1/2. ADEs include bleeding, necrosis and GI upset.

Explanation

Warfarin is administered orally, it has a high degree of serum protein binding, long T1/2. ADEs include bleeding, necrosis and GI upset.

20. Which of the following oral anti-infective medications does not need a renal dose adjustment?

Ampicillin

Doxycycline

Levofloxacin

Acyclovir

Valacyclovir

Doxycycline is a Tetraycline: MOA via inhibition of bacterial protein synthesis by binding to the 30-S ribosomal subunit, cross-sensitivity exists b/t agents in the same class, avoid use during pregnancy. Remember these stain teeth!!!

Explanation

Doxycycline is a Tetraycline: MOA via inhibition of bacterial protein synthesis by binding to the 30-S ribosomal subunit, cross-sensitivity exists b/t agents in the same class, avoid use during pregnancy. Remember these stain teeth!!!

21. Your patient has bacterial conjunctivitis. Which of the following is LEAST likely to cause this condition?

Staphylococcus aureus

Fusarium

N. gonorrheae

C. trachomatis

Streptococcus pneumoniae

Hemophilus influenzae

All of the options except for option II are bacteria. Option II is a fungus

Explanation

All of the options except for option II are bacteria. Option II is a fungus

22. Which of the following antihypertensive medications is not known to cause any ocular side effects?

Metoprolol

Doxazosin

Spironolactone

Losartan

Spironolactone is not known to cause any ocular side effects. Ocular side effects are adverse effects that affect the eyes. While medications like Metoprolol, Doxazosin, and Losartan may cause ocular side effects such as blurred vision, dry eyes, or eye pain, Spironolactone does not have any reported ocular side effects.

Explanation

Spironolactone is not known to cause any ocular side effects. Ocular side effects are adverse effects that affect the eyes. While medications like Metoprolol, Doxazosin, and Losartan may cause ocular side effects such as blurred vision, dry eyes, or eye pain, Spironolactone does not have any reported ocular side effects.

23. The mechanism of action for both polymyxin and bacitracin work by binding to the cytoplasmic membranes, disrupting the structure and altering membrane permeability thereby working best against Gram negative bacteria.

True

False

pg. 74

Bacitracin works by binding to bacterial cell membranes and interfering with cell wall synthesis, most effects are against sensitive gram positive bacteria

Explanation

pg. 74

Bacitracin works by binding to bacterial cell membranes and interfering with cell wall synthesis, most effects are against sensitive gram positive bacteria

24. Regarding Drug metabolism: which of the following is considered an inhibitor?

Dexamethasone

Dicloxacillin

Trimethoprim

Prednisone

Option 1, 2 and 4 are all inducers

Explanation

Option 1, 2 and 4 are all inducers

25. This antiviral agent is typically indicated for use in herpes simplex -related keratitis and keratoconjunctivitis. It works by inhibiting viral DNA polymerase and prevents lengthening or building of DNA vial chains. it is not indicated for use in the treatment of adenoviruses. It can cause local hypersensitivityrxns including itching redness, foreign body feeling in the eye, swelling, pain, burning or other irritation on application. It can also cause increase flow of tears, and increased sensitivity of eyes to light. Excessive use can also cause small punctate defects in the cornea with too frequent use. What is this drug most likely to be?

Acyclovir

Azithromycin

Trifluridine

Vidarabine

Azithromycin is out immediately b/c it's not an anti-viral.
Acyclovir is out b/c it is used for the treatment of opthalmic herpes zoster - it can cuse encephalopathy, neurotoxicity, blood dyscrasias, coagulation problems, hepatic complications, severe skin reactions, visual changes, GI disturbances, agitation, dizziness, myalgia, paresthesias and other side effects.

Trifluridine is also for herpes simplex related keratitis and keratoconjunctivitis it can cause hyperemia, epithelial keratopathy, increased IOP, dry eye and irritation. Patients should also be warned that is can cause burning or stinging on instillation

Explanation

Azithromycin is out immediately b/c it's not an anti-viral.
Acyclovir is out b/c it is used for the treatment of opthalmic herpes zoster - it can cuse encephalopathy, neurotoxicity, blood dyscrasias, coagulation problems, hepatic complications, severe skin reactions, visual changes, GI disturbances, agitation, dizziness, myalgia, paresthesias and other side effects.

Trifluridine is also for herpes simplex related keratitis and keratoconjunctivitis it can cause hyperemia, epithelial keratopathy, increased IOP, dry eye and irritation. Patients should also be warned that is can cause burning or stinging on instillation