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72 Cards in this Set
- Front
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Choose the statement that best describes the activity of ceftriaxone: Answer A1st generation cephalosporin: Better gram positive than gram negative activity. B2nd generation cephalosporin: Better gram negative activity compared to 1st generation, with similar gram positive activity. C3rd generation cephalosporin: Better gram negative activity than 2nd generation, less staph (gram positive) activity compared to second generation but better strep (gram positive) activity. D4th generation cephalosporin: Best gram negative activity,and gram positive activity that is similar to 1st generation. E5th generation cephalosporin: best gram positive activity, covers MRSA, gram negative activity similar to ceftriaxone
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C3rd generation cephalosporin: Better gram negative activity than 2nd generation, less staph (gram positive) activity compared to second generation but better strep (gram positive) activity. |
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Nafcillin is considered the drug of first choice for which of the following pathogens? Answer AMethicillin susceptible Staphylococcus aureus (MSSA) BStreptococcus pneumoniae CEnterococcus faecalis DEscherichia coli EBacteroides fragilis |
AMethicillin susceptible Staphylococcus aureus (MSSA) |
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A physician calls the pharmacy and wants to know what to prescribe for his patient with primary Lyme disease. The patient is a 27 year-old female who is 29 weeks pregnant. Which of the following agents would you recommend? Answer AAmoxicillin 500 mg PO TID x 14 days BItraconazole 400 mg PO BID x 14 days CFluconazole 400 mg PO daily x 14 days DCiprofloxacin 500 mg PO BID x 14 days EDoxycycline 100 mg PO BID x 14 days |
AAmoxicillin 500 mg PO TID x 14 days |
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Mary comes to the pharmacy to pick up her prescription for levofloxacin 500 mg tabs once daily for 10 days. You notice her profile states that she is taking simvastatin, hydrochlorothiazide, amlodipine, rabeprazole, warfarin and aspirin. She is purchasing zinc tablets for her cold. Counseling should include the following: (Select ALL that apply.) Answer ATake the medication 2 hours before or 2 hours after the zinc. BTake the medication with a full glass of water and drink more water during the day. CTake the medication on an empty stomach for best absorption. DThis medication may interact with her warfarin. EThis medicine can make your skin more sensitive to the sun. |
ATake the medication 2 hours before or 2 hours after the zinc. BTake the medication with a full glass of water and drink more water during the day.
DThis medication may interact with her warfarin. EThis medicine can make your skin more sensitive to the sun. |
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Which of the following clinical scenarios would be considered appropriate use of vancomycin? (Select ALL that apply.) Answer A62 year-old male with no known allergies presenting with a life-threatening MRSA pneumonia. B18 year-old female presenting with Streptococcus pneumoniae meningitis who has a severe beta-lactam allergy (e.g., anaphylaxis). C24 year-old female with no known allergies presenting with a urinary tract infection (cultures pending). D42 year-old male presenting with a severe C. difficile colitis refractory to metronidazole E62 year-old female with cirrhosis presenting with primary peritonitis (spontaneous bacterial peritonitis). |
A62 year-old male with no known allergies presenting with a life-threatening MRSA pneumonia. B18 year-old female presenting with Streptococcus pneumoniae meningitis who has a severe beta-lactam allergy (e.g., anaphylaxis).
D42 year-old male presenting with a severe C. difficile colitis refractory to metronidazole |
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Which of the following agents are associated with ototoxicity? (Select ALL that apply.) Answer AEthambutol BVoriconazole CGentamicin DPenicillin EVancomycin |
CGentamicin
EVancomycin |
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What is the trade name for ceftaroline? Answer AKetek BTeflaro CVibativ DInvanz ERaniclor
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BTeflaro |
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A patient is purchasing miconazole 200 mg vaginal suppositories for a fungal infection. The instructions state to insert one vaginal suppository once daily for three days. Which of the following counseling statements are correct? (Select ALL that apply.) Answer AYou can use tampons or douches while using this medication; separate from the timing of the dose by 4 hours. BThis product is safe to use with condoms or diaphragms, but it is preferable to avoid sex until treatment is complete. CIt is best to use prior to bed; unwrap and insert medication right before lying down so that the medicine stays at the site of infection. DIf your yeast infection dose not clear up contact your doctor. EThis medication can be used to treat other viral infections. |
CIt is best to use prior to bed; unwrap and insert medication right before lying down so that the medicine stays at the site of infection. DIf your yeast infection dose not clear up contact your doctor. |
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Gwen is a 72 year-old female with atrial fibrillation and degenerative joint disease. She has been well-controlled on warfarin, with an INR in the range of 2.2-2.7 for over a year. She has recently been started on rifampin therapy. What is likely to happen to the level of the INR? Answer ANo expected drug interaction. BThe INR will increase to a small extent. CThe INR will increase to a large extent. DThe INR will decrease to a small extent. EThe INR will decrease to a large extent. |
EThe INR will decrease to a large extent. |
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Choose the statement that best describes the activity of cefuroxime: Answer A1st generation cephalosporin: Better gram positive than gram negative activity. B2nd generation cephalosporin: Better gram negative activity compared to 1st generation, with similar gram positive activity. C3rd generation cephalosporin: Better gram negative activity than 2nd generation, less staph (gram positive) activity compared to second generation but better strep (gram positive) activity. D4th generation cephalosporin: Best gram negative activity,and gram positive activity that is similar to 1st generation. E5th generation cephalosporin: best gram positive activity, covers MRSA, gram negative activity similar to ceftriaxone. |
B2nd generation cephalosporin: Better gram negative activity compared to 1st generation, with similar gram positive activity. |
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A pharmacist is filling an order for Maxipime 2 grams IV Q8H. Which of the following is an appropriate generic substitution for Maxipime? Answer ACefuroxime BAztreonam CDoripenem DCefepime EImipenem/cilastatin |
DCefepime |
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MR is a 27 year-old female patient who received emergency treatment for a ruptured appendix. She has received IV cefazolin since surgery. On day four, she complains of diffuse pain over the incision site. The patient's temperature is recorded at 103.5°F. A CT scan of her abdomen revealed a peritoneal abscess. The abscess was drained and fluid was sent to the laboratory. The physician wishes to use an empiric agent that provides both aerobic and anaerobic coverage. Which of the following agents, as a single drug, cover both aerobic and anaerobic Gram-negative pathogens implicated in intra-abdominal infections? (Select ALL that apply.) Answer AAmpicillin/sulbactam BPiperacillin/tazobactam CCefepime DCefotetan ECiprofloxacin |
AAmpicillin/sulbactam BPiperacillin/tazobactam
DCefotetan |
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A pharmacist is traveling in Mexico with a group of health care professionals to perform medical work in the area. One of the nurses on the trip develops traveler's diarrhea. She is afebrile, slightly dehydrated, and states that there is no blood in her stool. She asks the pharmacist about taking loperamide. Which of the following statements regarding loperamide therapy for this patient is correct? Answer AShe is not a candidate for loperamide therapy if she is taking an antibiotic concurrently. BShe is a candidate for loperamide. Start with 2 mg and repeat every 2 hours for a maximum daily dose of 16 mg. CShe is a candidate for loperamide. Start with 4 mg and take 2 mg after each loose stool for a maximum daily dose of 16 mg. DShe is a candidate for loperamide. Start with 6 mg and take 2 mg after each loose stool for a maximum daily dose of 24 mg. EShe is not a candidate for loperamide therapy due to her symptoms. |
CShe is a candidate for loperamide. Start with 4 mg and take 2 mg after each loose stool for a maximum daily dose of 16 mg. |
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Which of the following organisms are considered to be anaerobes? (Select ALL that apply.) Answer AEnterobacter BBacteroides CPeptostreptococci DClostridium EStaphylococcus
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DClostridium |
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Of the following oral suspension antibiotics, which one should not be refrigerated? Answer AAugmentin BPen VK CCeftin DKeflex EBiaxin |
EBiaxin |
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Which of the following statements are accurate with regards to aminoglycosides? (Select ALL that apply.) Answer AActive against most aerobic Gram-negative pathogens when used alone. BActive against most Gram-positive pathogens when used alone. CSignificant toxicities include nephrotoxicity and ototoxicity. DBactericidal and concentration-dependent killing suitable for "high dose once daily" dosing. EPrimarily cleared by the kidney. |
AActive against most aerobic Gram-negative pathogens when used alone.
CSignificant toxicities include nephrotoxicity and ototoxicity. DBactericidal and concentration-dependent killing suitable for "high dose once daily" dosing. EPrimarily cleared by the kidney. |
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Which of the following agent(s) have excellent bioavailability suitable for a 1:1 intravenous:oral conversion? (Select ALL that apply.) Answer ALevaquin BBactrim CVancocin DZyvox EFlagyl |
ALevaquin BBactrim
DZyvox EFlagyl |
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Metronidazole is likely to be useful in each of the following infections? (Select ALL that apply.) Answer ACommunity-Acquired Pneumonia BPeritonitis, due to fecal contamination CTrichomoniasis DBacterial vaginosis EBacteroides infection |
BPeritonitis, due to fecal contamination CTrichomoniasis DBacterial vaginosis EBacteroides infection |
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Which of the following antibiotics require dose adjustment in patients with renal impairment? (Select ALL that apply.) Answer AMoxifloxacin BDoripenem CDaptomycin DClindamycin EOxacillin |
BDoripenem CDaptomycin |
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David is a 61 year-old male who experienced a painful, blistery rash on his neck and upper chest. He was diagnosed with shingles and prescribed valacyclovir 1 gram TID for 7 days. Which of the following counseling points on valacyclovir is correct? Answer AIt must be taken with food. BThis medicine often causes a rash; if the rash appears severe contact your doctor immediately. CIf you feel better, you do not need to continue the medication for the full 7 days. DSince you have had a shingles attack, you are not a candidate for the shingles vaccine. EYou may experience headache, and possible nausea, from using this medicine, but it is usually mild. |
EYou may experience headache, and possible nausea, from using this medicine, but it is usually mild. |
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George is admitted to the hospital for an acute gastrointestinal bleed. On the third day from admission, he develops a hospital-acquired pneumonia. MRSA is documented from respiratory cultures. Which of the following medications can be used to cover the pneumonia? (Select ALL that apply.) Answer ALinezolid BCefazolin CDaptomycin DNafcillin EVancomycin
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ALinezolid
EVancomycin |
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Which of the following cephalosporins are considered to be third generation cephalosporins? (Select ALL that apply.) Answer ACefprozil BCefpodoxime CCefotaxime DCefdinir ECephalexin
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BCefpodoxime CCefotaxime DCefdinir |
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Which of the following are potential treatment options for vancomycin-resistant enterococci (VRE) skin-soft tissue infection? (Select ALL that apply.) Answer ATygacil BCubicin CMerrem DZyvox ELevaquin
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ATygacil BCubicin
DZyvox |
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A 71 year-old female patient status post renal transplant on tacrolimus and prednisone immunosuppressive therapy has been prescribed ciprofloxacin 500 mg daily for 10 days to treat her infection. Her other medical conditions include heart failure, COPD and GERD. She presents to the grocery-store pharmacy with an extremely painful Achilles' tendon. She cannot put weight on her foot and is being supported by her daughter. Which of the following risk factors does this patient have for fluoroquinolone-associated tendonitis? (Select ALL that apply.) Answer AAge BTransplant history CPrednisone use DLong-term history of reflux EGender
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AAge BTransplant history CPrednisone use |
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Which of the following agents can be used to cover/treat atypical pathogens (e.g., Mycoplasma)? (Select ALL that apply.) Answer ADoxycycline BZithromax CCefdinir DFlagyl EAvelox |
ADoxycycline BZithromax
EAvelox |
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A patient comes into the clinic with classic signs and symptoms of an infection. The patient has an extensive history of alcohol abuse. Which of the following antibiotics would be the least safe option for this patient? Answer ACefuroxime BCefotaxime CCefotetan DCefprozil ECefaclor |
CCefotetan |
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Choose the correct statement concerning azithromycin: Answer AIt has drug interactions similar to clarithromycin. BIt leaves a metallic taste in the mouth. CIt binds to the 50S ribosomal subunit. DIt binds to penicillin-binding proteins. EIt can be used if an allergy is noted to erythromycin. |
CIt binds to the 50S ribosomal subunit. |
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Which of the following agents may caused additive QT prolongation when combined with amiodarone? (Select ALL that apply.) Answer AZithromax BPen VK CKetek DLevaquin EAvelox |
AZithromax
CKetek DLevaquin EAvelox |
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Which of the following antibacterials should a patient be counseled on the risk for photosensitivity? (Select ALL that apply.) Answer AAugmentin BNorfloxacin CSeptra DVfend EDoxycycline
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BNorfloxacin CSeptra DVfend EDoxycycline |
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Linda was initiated on gentamicin 200 mg IV Q8H for treatment of gram negative urosepsis. The peak level comes back at 3.8 mcg/mL and her trough level was undetectable. What is the best recommendation to make regarding the gentamicin regimen? Answer AIncrease the gentamicin dose BDecrease the gentamicin dose CIncrease the dosing interval to Q12H DDecrease the dosing interval to Q6H EIncrease the dose and the dosing interval |
AIncrease the gentamicin dose |
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Choose the statement that best describes the activity of ceftaroline: Answer A1st generation cephalosporin: Better gram positive than gram negative activity. B2nd generation cephalosporin: Better gram negative activity compared to 1st generation, with similar gram positive activity. C3rd generation cephalosporin: Better gram negative activity than 2nd generation, less staph (gram positive) activity compared to second generation but better strep (gram positive) activity. D4th generation cephalosporin: Best gram negative activity,and gram positive activity that is similar to 1st generation. E5th generation cephalosporin: best gram positive activity, covers MRSA, gram negative activity similar to ceftriaxone. |
E5th generation cephalosporin: best gram positive activity, covers MRSA, gram negative activity similar to ceftriaxone. |
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Which of the following are correct statements with regards to piperacillin/tazobactam? (Select ALL that apply.) Answer AThe brand name is Zosyn. BConsidered to be a broad-spectrum agent with coverage of Pseudomonas, streptococci, MSSA and anaerobes. CTazobactam is added to piperacillin to inhibit beta-lactamase activity. DThe dosing formulation is 0.375 grams / 3 grams of piperacillin/tazobactam respectively. EIs a concentration-dependent killer and bacteriostatic agent. |
AThe brand name is Zosyn. BConsidered to be a broad-spectrum agent with coverage of Pseudomonas, streptococci, MSSA and anaerobes. CTazobactam is added to piperacillin to inhibit beta-lactamase activity. |
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Which of the following statements are correct with regards to ceftriaxone? (Select ALL that apply.) Answer AIt is the drug of choice for primary peritonitis infections. BIt is cleared unchanged by the kidney and requires dose adjustments in renal impairment. CIt is considered a broad-spectrum antimicrobial agent with activity against Pseudomonas. DIt should be avoided via Y-site administration and with calcium containing solutions. EIt should be avoided in pregnancy. |
AIt is the drug of choice for primary peritonitis infections.
DIt should be avoided via Y-site administration and with calcium containing solutions. |
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A 72 year-old patient has been hospitalized for ten days. She was having difficulty breathing and was just diagnosed with pneumonia. The patient had been on Unasyn for the past 5 days for a UTI infection. The Unasyn was discontinued this morning. The infectious disease specialist suspects MRSA as there is evidence of Gram-positive cocci from the blood cultures. Choose an appropriate option for empiric therapy of the pneumonia: Answer AAmpicillin + tigecycline BCefoxitin + vancomycin CPiperacillin-tazobactam + metronidazole DPiperacillin-tazobactam + vancomycin EPiperacillin-tazobactam + tigecycline |
DPiperacillin-tazobactam + vancomycin |
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Which of the following oral antibiotic suspensions require refrigeration? (Select ALL that apply.) Answer ASeptra BKeflex CCeftin DCubicin ELevaquin
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BKeflex CCeftin |
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A pharmacy intern is giving a presentation on antibiotic therapy for gram-positive infections. She is preparing a slide on an overview of penicillins. She should include the following points. (Select ALL that apply.) Answer APenicillins can lower the seizure threshold. BA possible side effect of penicillins is rash. CAll penicillins need dose reductions in patients with renal insufficiency. DPenicillins are safe to use in pregnancy EPenicillins have atypical coverage. |
APenicillins can lower the seizure threshold. BA possible side effect of penicillins is rash.
DPenicillins are safe to use in pregnancy |
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The pharmacist is on rounds with the internal medicine team. They are discussing a patient who has oral candidiasis due to a recent chemotherapy treatment. The infection is very painful for the patient and is considered moderate to severe. Which of the following is the best regimen to recommend for this patient? Answer AClotrimazole troches 10 mg PO 5 times per day x 7-14 days BFluconazole 200 mg IV daily x 7-14 days CPosaconazole 400 mg PO BID x 14-21 days DAmphotericin B 15 mg/kg IV BID x 14-21 days EItraconazole 200 mg PO daily for 14-21 days |
BFluconazole 200 mg IV daily x 7-14 days |
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Each of the following drugs can be used to treat nosocomial-acquired MRSA skin-soft tissue infections except? Answer ADaptomycin BTigecycline CTelithromycin DVancomycin EQuinupristin-dalfopristin |
CTelithromycin |
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Choose the statement that best describes the activity of cefazolin: Answer A1st generation cephalosporin: Better gram positive than gram negative activity. B2nd generation cephalosporin: Better gram negative activity compared to 1st generation, with similar gram positive activity. C3rd generation cephalosporin: Better gram negative activity than 2nd generation, less staph (gram positive) activity compared to second generation but better strep (gram positive) activity. D4th generation cephalosporin: Best gram negative activity,and gram positive activity that is similar to 1st generation. E5th generation cephalosporin: Best gram positive activity, covers MRSA, gram negative activity similar to ceftriaxone. |
A1st generation cephalosporin: Better gram positive than gram negative activity. |
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Cedric has been getting gentamicin for the last 10 days. Which of the following are side effects associated with gentamicin? (Select ALL that apply.) Answer ANephrotoxicity BPulmonary toxicity CCardiotoxicity DNeurotoxicity EOtotoxicity |
ANephrotoxicity
DNeurotoxicity EOtotoxicity |
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Which of the following pathogens are covered by ceftaroline? (Select ALL that apply.) Answer APseudomonas BE. coli CBacteroides fragilis DStreptococci species EMethicillin resistant Staphylococcus aureus (MRSA) |
BE. coli
DStreptococci species EMethicillin resistant Staphylococcus aureus (MRSA) |
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A patient is receiving itraconazole for treatment of an aspergillosis infection. Which of the following statements regarding itraconazole therapy is correct? Answer AThe oral capsule and oral solution can be used interchangeably. BThe oral capsule is best if administered on an empty stomach. CThe oral solution should be administered on an empty stomach DSt. John's wort will have no effect on itraconazole levels. EThis medication is safe to use in heart failure patients.
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CThe oral solution should be administered on an empty stomach |
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Adrian is in the intensive care unit for a severe intra-abdominal infection. It was stated he had symptoms for a couple of days, but initially refused to see a doctor. Looking at his chart, the pharmacist notices that he has an allergy to penicillin (hives). The team wants to start broad spectrum antibiotics on this patient immediately. Which drug regimen would be best to recommend? Answer ACefepime and metronidazole BImipenem/cilastatin CZosyn and metronidazole DDoribax ELevaquin and metronidazole |
ELevaquin and metronidazole |
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JR is a 47 year old obese male with end stage renal disease on hemodialysis presenting with a ruptured appendix and sepsis requiring surgical intervention, antimicrobial therapy and admission to the surgical intensive care unit. JR is allergic to penicillin (rash). Which of the following factor(s) should be considered when selecting empiric antimicrobial therapy and dosing for JR? (Select ALL that apply.) Answer AThe site of the infection BThe severity of the infection COrgan function (renal and hepatic) DPatient size EAllergy profile |
AThe site of the infection BThe severity of the infection COrgan function (renal and hepatic) DPatient size EAllergy profile |
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Which of the following antibacterials are associated with seizures and/or decreasing the seizure threshold? (Select ALL that apply.) Answer AImipenem/Cilastatin BCiprofloxacin CCefuroxime DPenicillin G EGanciclovir |
AImipenem/Cilastatin BCiprofloxacin CCefuroxime DPenicillin G EGanciclovir |
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Which of the following agents cover Pseudomonas aeruginosa? (Select ALL that apply.) Answer ATygacil BColistimethate CZyvox DTimentin EMeropenem |
BColistimethate
DTimentin EMeropenem |
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An infectious disease pharmacist is designing an empiric antibiotic regimen for a patient. The pharmacist suspectsLegionella may be a causative organism. Select the following antibiotics that would provide coverage for Legionella. (SelectALL that apply.) Answer AAugmentin BBiaxin CLevofloxacin DClindamycin ECefdinir |
BBiaxin CLevofloxacin |
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A physician is examining a patient in a clinic who is found to have tularemia. Which medication is the best treatment option to treat tularemia? Answer AAzithromycin BMetronidazole CDoxycycline DMeropenem EGentamicin |
EGentamicin |
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Each of the following drugs can be used to treat Pseudomonas aeruginosa except: Answer AAztreonam BDoripenem CLevofloxacin DCefuroxime EAmikacin |
DCefuroxime |
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Megan is a 51 year-old female who has been prescribed Ketek for pneumonia. She had a heart attack two years ago. During the hospitalization she was found to have an arrhythmia (atrial fibrillation) and was placed on warfarin. Her other medications include simvastatin, atenolol and one fish oil, taken twice daily. Which of the following statements are correct? (Select ALL that apply.) Answer ATelithromycin causes QT prolongation and is not a safe choice in a patient with an existing arrhythmia. BTelithromycin can cause hepatotoxicity. CTelithromycin will increase the levels of simvastatin and may cause muscle damage. DTelithromycin can increase the levels of atenolol and may cause bradycardia. ETelithromycin can increase the levels of fish oils and increase the bleeding risk
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ATelithromycin causes QT prolongation and is not a safe choice in a patient with an existing arrhythmia. BTelithromycin can cause hepatotoxicity. CTelithromycin will increase the levels of simvastatin and may cause muscle damage |
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Choose the statement that best describes the activity of cefepime: Answer A1st generation cephalosporin: Better gram positive than gram negative activity. B2nd generation cephalosporin: Better gram negative activity compared to 1st generation, with similar gram positive activity. C3rd generation cephalosporin: Better gram negative activity than 2nd generation, less staph (gram positive) activity compared to second generation but better strep (gram positive) activity. D4th generation cephalosporin: Best gram negative activity,and gram positive activity that is similar to 1st generation. E5th generation cephalosporin: best gram positive activity, covers MRSA, gram negative activity similar to ceftriaxone. |
D4th generation cephalosporin: Best gram negative activity,and gram positive activity that is similar to 1st generation. |
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Metronidazole is likely to be useful in which group of infections? Answer AUrinary tract infection, community-acquired pneumonia, trichomoniasis BCommunity-acquired pneumonia, bacterial vaginosis, urinary tract infection CTrichomoniasis, bacterial vaginosis, peritonitis due to fecal contamination DPeritonitis due to fecal contamination, community-acquired pneumonia, urinary tract infection EBacterial vaginosis, trichomoniasis, community-acquired pneumonia |
CTrichomoniasis, bacterial vaginosis, peritonitis due to fecal contamination |
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Which of the following cephalosporins are considered to be third generation cephalosporins? Answer ACefprozil, Cephalexin, Fortaz BKefzol, Zinacef, Suprax CCefdinir, Cefditoren, Cefepime DCefpodoxime, Claforan, Cefdinir ECefadroxil, Rocephin, Cedax |
DCefpodoxime, Claforan, Cefdinir |
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Which of the following pathogens are covered by Teflaro? Answer ABacteroides fragilis, E. Coli BMethicillin resistant Staphylococcus aureus (MRSA), Pseudomonas CPseudomonas, E. Coli DMethicillin resistant Staphylococcus aureus (MRSA), E. Coli EBacteroides fragilis, Streptococci species |
DMethicillin resistant Staphylococcus aureus (MRSA), E. Coli |
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Which of the following agents are associated with ototoxicity? Answer AEthambutol and rifampin BVoriconazole and vancomycin CGentamicin and vancomycin DPenicillin and ciprofloxacin EDaptomycin and gentamicin |
CGentamicin and vancomycin |
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MR is a 27 year-old female patient who received emergency treatment for a ruptured appendix. She has received IV cefazolin since surgery. On day four, she complains of diffuse pain over the incision site. The patient's temperature is recorded at 103.5°F. A CT scan of her abdomen revealed a peritoneal abscess. The abscess was drained and fluid was sent to the laboratory. The physician wishes to use a single drug that provides both aerobic and anaerobic coverage. What are two single drug options that cover both aerobic and anaerobic Gram-negative pathogens implicated in intra-abdominal infections that could be recommended to the physician? Answer AZosyn and Cipro BMaxipime and Avelox CRocephin and Cipro DUnasyn and Cefotetan ECefoxitin and Nafcillin |
DUnasyn and Cefotetan |
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Chief Complaint: “I need antibiotics for my foot"
History of Present Illness: DR is a 58 y/o male with type 2 diabetes. He is concerned about an infection on his left foot that has not healed over 3-4 months. It started when he picked a scab on the bottom of his foot. The infection covers about 6 inches with mostly open areas on the lateral side of the left foot and there is superficial cellulitis on the dorsal surface of the foot. Due to his obesity, DR has avoided coming to the hospital or to his doctor to have this addressed.
Allergies: NKDA
Past Medical History: Type 2 diabetes x 10 years (poorly controlled) and hypertension
Medications: Glucophage XR 1,000 mg daily, lisinopril 20 mg daily
Physical Exam / Vitals: Height: 5’8” Weight: 265 pounds BP: 165/98 mmHg HR: 98 BPM RR: 16 BPM Temp: 100.2°F Pain: 5/10 General: Obese male, unable to walk in current state Lungs: clear CV: RRR GI: Normal bowel sounds, some tenderness to palpation in RUQ Ext: As noted in HPI. Very faint/absent peripheral pulses.
Labs: Na (mEq/L) = 142 (135 – 145) WBC (cells/mm3) = 12.6 (4 – 11 x 10^3) K (mEq/L) = 4.3 (3.5 – 5) Hgb (g/dL) = 14.1 (13.5 – 18 male, 12 – 16 female) Cl (mEq/L) = 102 (95 – 103) Hct (%) = 41.2 (38 – 50 male, 36 – 46 female) HCO3 (mEq/L) = 28 (24 – 30) Plt (cells/mm3) = 341 (150 – 450 x 10^3) BUN (mg/dL) = 17 (7 – 20) PMNs (%) = 87 (45 – 73) SCr (mg/dL) = 1.2 (0.6 – 1.3) Bands (%) = 5 (3 – 5) Glucose (mg/dL) = 258 (100 – 125) Eosinophils (%) = 1 (0 – 5) Ca (mg/dL) = 10.1 (8.5 – 10.5) Basophils (%) = 0 (0 – 1) Mg (mEq/L) = 2.0 (1.3 – 2.1) Lymphocytes (%) = 22% (20 – 40) PO4 (mg/dL) = 4.1 (2.3 – 4.7) Monocytes (%) = 1 (2 – 8) AST (IU/L) = 29 (10 – 40) ALT (IU/L) = 32 (10 – 40) Albumin (g/dL) = 4.1 (3.5 – 5) A1C (%) = 9.8
Tests: Xray left foot: soft tissue swelling, unable to rule out osteomyelitis. Recommend bone scan.
Plan: Wound management for I&D. Surgery consult for viability of lateral toes and schedule for amputation as needed.
Question: An I&D is performed and osteomyelitis is ruled out. The culture reveals mixed E. coli, Klebsiella, and Streptococci. The order for antibiotic sensitivities was overlooked and the sensitivities were not performed. DR has received 4 days of IVZosyn monotherapy and the foot looks much better. DR is afebrile and lab indicators of infection have normalized. What is the best recommendation?
Answer AChange to Keflex PO BChange to Clindamycin PO CChange to Augmentin/ PO DChange to Avelox PO EChange to Rocephin IV |
CChange to Augmentin/ PO |
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Which of the following statements is correct regarding piperacillin/tazobactam? Answer ATazobactam is added to inhibit beta-lactamase activity. BThe brand name is Zofran. CIt exhibits concentration-dependent kill. DThe dosing is 0.375 grams/3 grams of piperacillin/tazobactam respectively. EIt is available as an oral suspension and intravenous formulation. |
ATazobactam is added to inhibit beta-lactamase activity. |
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Megan is a 51 year-old female who has been prescribed Ketek for pneumonia. She had a heart attack two years ago. During the hospitalization she was found to have an arrhythmia (atrial fibrillation) and was placed on warfarin. Her other medications include simvastatin, atenolol and one fish oil, taken twice daily. Which of the following statements are correct? (Select ALL that apply.) Answer AKetek causes QT prolongation and is not a safe choice in a patient with an existing arrhythmia. BKetek can cause hepatotoxicity. CKetek will increase the levels of simvastatin and may cause muscle damage. DKetek can increase the levels of atenolol and may cause bradycardia. EKetek can increase the levels of fish oils and increase the bleeding risk. |
AKetek causes QT prolongation and is not a safe choice in a patient with an existing arrhythmia. BKetek can cause hepatotoxicity. CKetek will increase the levels of simvastatin and may cause muscle damage. |
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Which of the following agents have excellent bioavailability suitable for a 1:1 intravenous:oral conversion? Answer AZosyn, Zyvox BCubicin, Flagyl CFlagyl, Zyvox DSulfatrim, Vancocin ESivextro, Zithromax |
CFlagyl, Zyvox |
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A pharmacy intern is giving a presentation on antibiotic therapy for Gram-positive infections. She is preparing a slide on penicillins. Which of the following points would be incorrect information to include? Answer APenicillins can raise the seizure threshold. BA possible side effect of penicillins is rash. CMost penicillins require dose reductions in patients with renal insufficiency. DPenicillins are safe to use in pregnancy. EPenicillins do not have atypical coverage. |
APenicillins can raise the seizure threshold. |
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Which one of the following agents does not cover Pseudomonas aeruginosa? Answer APrimaxin BColy-Mycin M CZyvox DTimentin EMeropenem |
CZyvox |
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Which group of agents cover atypical pathogens? Answer ALevaquin, Doryx, Augmentin BFlagyl, Erythromycin, Ceftin CBactrim, Keflex, Amoxil DCefdinir, Cipro, Biaxin EDoxycycline, Zithromax, Avelox |
EDoxycycline, Zithromax, Avelox |
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A 71 year-old female patient status post renal transplant on tacrolimus and prednisone immunosuppressive therapy has been prescribed ciprofloxacin 500 mg daily for 10 days to treat her infection. Her other medical conditions include heart failure, COPD and GERD. She presents to the grocery-store pharmacy with an extremely painful Achilles' tendon. She cannot put weight on her foot and is being supported by her daughter. Which of the following risk factors does this patient have for fluoroquinolone-associated tendonitis? Answer AAge, transplant history, steroid use BHeart failure, gender, tacrolimus use CAge, gender, steroid use DTransplant history, heart failure, tacrolimus use ETacrolimus use, age, gender |
AAge, transplant history, steroid use |
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Which of the following antimicrobials is not associated with additive QT prolongation when combined with amiodarone? Answer AZithromax BPen VK CKetek DLevaquin EAvelox |
BPen VK |
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Which of the following organisms are considered to be anaerobes? Answer AEnterobacter, Clostridium, Peptostreptococcus BEnterococcus, Bacteroides, Staphylococcus CBacteroides, Peptostreptococcus, Clostridium DStaphylococcus, Bacteroides, Clostridium EStaphylococcus, Enterobacter, Enterococcus |
CBacteroides, Peptostreptococcus, Clostridium |
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A patient is purchasing miconazole 200 mg vaginal suppositories for a fungal infection. The instructions state to insert one vaginal suppository once daily for three days. Which of the following counseling statements are correct? Answer AYou can use tampons or douches while using this medication; separate from the timing of the dose by 4 hours. BThis product is safe to use with condoms or diaphragms, but it is preferable to avoid sex until treatment is complete. CIt is best to use prior to bed; unwrap and insert medication right before lying down so that the medicine stays at the site of infection. DThis medication can be used to treat other viral infections. EYou can use 4 courses of over the counter therapy before consulting a physician. |
CIt is best to use prior to bed; unwrap and insert medication right before lying down so that the medicine stays at the site of infection. |
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Cedric has been getting gentamicin for the last 10 days. Which of the following are side effects associated with gentamicin? Answer ACardiotoxicity, pulmonary toxicity, nephrotoxicity BNeurotoxicity, cardiotoxicity, ototoxicity CPulmonary toxicity, ototoxicity, cardiotoxicity DPulmonary toxicity, nephrotoxicity, cardiotoxicity ENeurotoxicity, nephrotoxicity, ototoxicity |
ENeurotoxicity, nephrotoxicity, ototoxicity |
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Chief Complaint: “I need antibiotics for my foot"
History of Present Illness: DR is a 58 y/o male with type 2 diabetes. He is concerned about an infection on his left foot that has not healed over 3-4 months. It started when he picked a scab on the bottom of his foot. The infection covers about 6 inches with mostly open areas on the lateral side of the left foot and there is superficial cellulitis on the dorsal surface of the foot. Due to his obesity, DR has avoided coming to the hospital or to his doctor to have this addressed.
Allergies: NKDA
Past Medical History: Type 2 diabetes x 10 years (poorly controlled) and hypertension
Medications: Glucophage XR 1,000 mg daily, lisinopril 20 mg daily
Physical Exam / Vitals: Height: 5’8” Weight: 265 pounds BP: 165/98 mmHg HR: 98 BPM RR: 16 BPM Temp: 100.2°F Pain: 5/10 General: Obese male, unable to walk in current state Lungs: clear CV: RRR GI: Normal bowel sounds, some tenderness to palpation in RUQ Ext: As noted in HPI. Very faint/absent peripheral pulses.
Labs: Na (mEq/L) = 142 (135 – 145) WBC (cells/mm3) = 12.6 (4 – 11 x 10^3) K (mEq/L) = 4.3 (3.5 – 5) Hgb (g/dL) = 14.1 (13.5 – 18 male, 12 – 16 female) Cl (mEq/L) = 102 (95 – 103) Hct (%) = 41.2 (38 – 50 male, 36 – 46 female) HCO3 (mEq/L) = 28 (24 – 30) Plt (cells/mm3) = 341 (150 – 450 x 10^3) BUN (mg/dL) = 17 (7 – 20) PMNs (%) = 87 (45 – 73) SCr (mg/dL) = 1.2 (0.6 – 1.3) Bands (%) = 5 (3 – 5) Glucose (mg/dL) = 258 (100 – 125) Eosinophils (%) = 1 (0 – 5) Ca (mg/dL) = 10.1 (8.5 – 10.5) Basophils (%) = 0 (0 – 1) Mg (mEq/L) = 2.0 (1.3 – 2.1) Lymphocytes (%) = 22% (20 – 40) PO4 (mg/dL) = 4.1 (2.3 – 4.7) Monocytes (%) = 1 (2 – 8) AST (IU/L) = 29 (10 – 40) ALT (IU/L) = 32 (10 – 40) Albumin (g/dL) = 4.1 (3.5 – 5) A1C (%) = 9.8
Tests: Xray left foot: soft tissue swelling, unable to rule out osteomyelitis. Recommend bone scan.
Plan: Wound management for I&D. Surgery consult for viability of lateral toes and schedule for amputation as needed.
Question: While awaiting further testing, DR will require empiric antibiotics. Which of the following regimens provides coverage for the common pathogens?
Answer ALinezolid BClindamycin CCeftriaxone DAmpicillin/sulbactam ECiprofloxacin |
DAmpicillin/sulbactam |
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Which of the following medications require patient counseling for risk of photosensitivity? Answer AVfend BVigamox CKeflex DAugmentin XR EUnasyn |
AVfend |
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Which of the following statements is correct with regards to Rocephin? Answer AIt is considered a broad-spectrum antimicrobial agent with activity against Pseudomonas. BIt is cleared unchanged by the kidney and requires dose adjustments in renal impairment. CIt is the drug of choice for primary peritonitis infections. DIt should be avoided in patients who are pregnant. EIt can be used with calcium containing IV products in neonates. |
CIt is the drug of choice for primary peritonitis infections. |
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Which of the following antimicrobials require dose adjustment in patients with renal impairment? Answer AAvelox and Rocephin BCubicin and Doribax CZyvox and Cleocin DFlagyl and Zithromax ESynercid and Dificid |
BCubicin and Doribax |
