Systemic Pharmacology Part II - Midterm II
Questions beginning with material from pg. 70
- 1.Your patient has bacterial conjunctivitis. Which of the following is LEAST likely to cause this condition?
- A.
Staphylococcus aureus
- B.
Fusarium
- C.
N. gonorrheae
- D.
C. trachomatis
- E.
Streptococcus pneumoniae
- F.
Hemophilus influenzae
- 2.Staphylococcus aureus can cause all of the following except what condition?
- A.
Bacterial Keratitis
- B.
Dacryocystitis
- C.
Protozoan Keratitis
- D.
Blepharitis
- E.
Hordeolum
- F.
Bacterial conjunctivitis
- 3.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?
- A.
Amoxicillin with Clavulanate
- B.
Amoxicillin
- C.
Cephalexin
- D.
Diclocxacillin
- 4.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.
- A.
True
- B.
False
- 5.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.
- A.
Sulfonamides
- B.
Fluroroquinolones
- C.
Tetrayclines
- D.
Macrolides
- E.
Aminoglycosides
- 6.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?
- A.
Tetracyclines
- B.
Sulfonamides
- C.
Polymyxin and Bacitracin
- D.
Penicillins
- E.
Macrolides
- 7.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.
- A.
True
- B.
False
- 8.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.
- A.
Tetrayclines
- B.
Polymysin
- C.
Sulfonamides
- D.
Aminoglycosides
- E.
Antiviral agents
- 9.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.
- A.
Tetrayclines
- B.
Macrolides
- C.
Sulfonamides
- D.
Polymyxin
- E.
Fluoroquinolones
- 10.Which of the following statements regarding Aminoglycosides is false?
- A.
It's mechanism of action is inhibition of bacterial protein synthesis by binding principally to 30-S and 50-S ribosomal subunits.
- B.
Use in the opthalmic form may result in allergic rxns such as swelling of eyelids, face, appearance of rash, etc.
- C.
They are widely used for Gram negative bacteria
- D.
There has been no reports of bacterial resistances in Pseudomonas, all patients respond quickly to treatment with this class of drugs making culturing unecessary
- 11.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?
- A.
Acyclovir works by inhibiting DNA replication
- B.
Oral acyclovir can be taken by patitents who are sensitive to valacyclovir as this does not cause any cross - sensitivity.
- C.
Acyclovir can cause renal failure and can complicate or worsen renal function in patients with renal impairment.
- D.
Possible regimen would be 800 PO 5x per day
- 12.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?
- A.
Acyclovir
- B.
Azithromycin
- C.
Trifluridine
- D.
Vidarabine
- 13.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?
- A.
Acyclovir
- B.
Azithromycin
- C.
Trifluridine
- D.
Vidarabine
- 14.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.
- A.
True
- B.
False
- 15.Which of the following is a reasonable/ possible regimen for Valacyclovir/Valtrex?
- A.
150mg-450 PO q6Hr
- B.
400mg PO q24hr
- C.
800mg PO 5x per day
- D.
1000mg PO TID
- 16.Which of the following oral anti-infective medications does not need a renal dose adjustment?
- A.
Ampicillin
- B.
Doxycycline
- C.
Levofloxacin
- D.
Acyclovir
- E.
Valacyclovir
- 17.Which of the following anti-infective medications requires renal dose adjustments?
- A.
Azithromycin
- B.
Moxifloxacin
- C.
Doxycycline
- D.
Ampicillin
- 18.Regarding Drug metabolism: which of the following is considered an inhibitor?
- A.
Dexamethasone
- B.
Dicloxacillin
- C.
Trimethoprim
- D.
Prednisone
- 19.Which of the following anti-infectives has a possible oral regimen for q24hr?
- A.
Clindamycin
- B.
Ampicillin
- C.
Doxycycline
- D.
Moxifloxacin
- E.
Acyclovir
- 20.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?
- A.
Potassium Sparing Diuretics
- B.
Ace-inhibitors
- C.
Angiotensin receptor blockers (ARBs)
- D.
Beta-adrenergic blocking agents
- 21.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?
- A.
Nifedipine/ Procardia
- B.
Atenolol/Tenormin
- C.
Doxazosin/Cardura
- D.
Hydralazine/Apresoline
- 22.Which of the following antihypertensive medications is not known to cause any ocular side effects?
- A.
Metoprolol
- B.
Doxazosin
- C.
Spironolactone
- D.
Losartan
- 23.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.
- A.
True
- B.
False
- 24.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.
- A.
Thiazide Diuretics
- B.
Loop Diuretics
- C.
Carbonic Anhydrase inhibitors
- D.
Osmotic Diuretics
- 25.Select the false statement
- A.
Heparin and Warfarin are both anticoagulants however warfarin/coumadin is more likely to be prescribed on an outpatient basis while Heparin will be used commonly in the hospital
- B.
NSAIDs, aspirin, clopidogrel, several antibiotics, heparin, thrombolytics agents can increase bleeding risk when used with Warfarin/coumadin
- C.
Warfarin is administered subcutaneously
- D.
If a patient complaining of pain is taking warfarin/coumadin a safer alternative to an NSAID or aspirin would be Tylenol.
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