Gvsu Pharm Exam 4

Front 1

During a follow-up visit, a patient being treated for HIV has routine blood tests. The tests reveal anemia & neutropenia, and elevated levels of lactic acid (lactic acidosis). Which of the following drugs is most likely the cause of these adverse effects?

Back 1

Zidovudine (AZT, Retrovir)

Front 2

Recently, there have been reports of delirium, hallucinations and unusual psychiatric behavior in children after taking a flu drug. This drug is a second generation viral neuraminidase inhibitor. Which of the following drugs is it?

Back 2

Oseltamivir (Tamiflu)

Front 3

Systemic fungal infections can be very dangerous. Which of the following is a broad spectrum fungal agent that causes the leakage of fungal cell membranes? This drug is highly toxic and is usually given as a 1 mg test dose IV. Adverse effects include infusion reactions, nephrotoxicity, & hypokalemia.

Back 3

Amphotericin B (Fungizone)

Front 4

Of the following, which is used for tuberculosis anti-microbial therapy as part of a multi-drug regimen? This drug is bacteriostatic and believed to inhibit the synthesis of the mycobacterial cell wall. This is one of the few antibiotics that usually require a vision exam prior to therapy to monitor the possibility of optic neuritis.

Back 4

Ethambutol (Myambutol)

Front 5

A patient is diagnosed with peptic ulcer disease (PUD) due to Helicobacter pylori. As part of a multi-drug therapy, this patient is prescribed a drug that is bactericidal to anaerobes through DNA strand breakage. This drug is also useful against protozoal infections. Which one is it?

Back 5

Metronidazole (Flagyl)

Front 6

This drug can be used to treat autoimmune disorders and as adjuvant therapy with transplant patients. It is considered to be one of the ‘cytotoxic’ immunosuppressants that suppress cell-mediated & humoral immune responses by inhibiting DNA synthesis. Adverse effects include neutropenia, thrombocytopenia and increased risk of cancer. Which is it?

Back 6

Azathioprine (Imuran)

Front 7

Of the second generation H1 antagonists currently available, this drug appears to offer the best combination of efficacy & safety. That is why it is at the top of the list in the slide set. It is approved for oral therapy of seasonal allergic rhinitis & in clinical trials side effects were nearly the same as with placebo. Which one?

Back 7

Fexofenadine (Allegra)

Front 8

Of the following, which is a first generation drug for influenza & also used to treat Parkinson’s disease? The precise MOA of how viral growth is inhibited is not completely understood.

Back 8

Amantadine (Symmetrel)

Front 9

Aspirin (Bayer, Excedrin, etc.) is a drug with a long history and many different characteristics. Which of the following is NOT a characteristic associated with aspirin?

Back 9

Selective inhibitor of cyclooxygenase-2

Front 10

A patient presents for a follow-up visit for his HIV therapy. Since taking his ‘cocktail’ (combination of drugs), he has noticed several side effects. In addition to elevated blood cholesterol and glucose levels, he has noticed fat redistribution (specifically a ‘buffalo hump’). Which of the following drugs is most likely the cause of these symptoms?

Back 10

Saquinavir (Invirase, Fortovase)

Front 11

This drug has been used for years in introductory biology labs to inhibit cell division. It is believed that this drug acts as an anti-inflammatory agent by inhibiting microtubules & therefore cell migration and division. This drug is used to treat acute gouty attacks, reduce incidences of an attack and to abort an attack. Adverse effects with oral administration are usually gastrointestinal. Which one is it?

Back 11

Colchicine

Front 12

There are numerous adverse effects associated with long-term pharmacological doses of glucocorticoids. Which of the following is NOT considered an adverse effect?

Back 12

ALL would be considered adverse effects

Front 13

The structure of HIV is relatively simple. The HIV virion (entire virus particle) consists of a limited number of components. Which is NOT a component of the HIV virion?

Back 13

DNA

Front 14

On BlackBoard, an article was posted describing the increasing occurrence of a resistant strain of a microbe outside of the clinical setting. This microbe is often described in regards to its resistance to a particular antibiotic. Which of the following antibiotics is most often linked to this resistant strain of Staphylococcus aureus?

Back 14

Methicillin

Front 15

In order to survive exposure to penicillins, certain bacteria can produce enzymes that inactivate penicillins. This type of enzyme is commonly referred to as a penicillinase. What else is it called?

Back 15

Beta-lactamase

Front 16

Clindamycin (Cleocin) is used only for certain anaerobic infections located outside the CNS. It can induce ‘antibiotic-associated pseudomembranous colitis’, blood dyscrasias, liver toxicity, and renal toxicity. How does this drug work? What is it’s mechanism of action?

Back 16

Non-lethal inhibitor of protein synthesis

Front 17

A soldier is on a training mission where she may have been exposed to cholera and anthrax. Further examinations reveal the possibility of Lyme disease and peptic ulcer disease due to Helicobacter pylori. Which of the following is a broad spectrum antibiotic that inhibits protein synthesis & could be used to treat all these disorders? Adverse effects include GI distress, effects on bone and teeth, risk of superinfection, hepatotoxicity, & renal toxicity.

Back 17

Tetracycline (Sumycin)

Front 18

Which of the following is a cephalosporin?

Back 18

Cephalexin (Keflex, others)

Front 19

Of the different aminoglycosides, one compound is considered to have two outstanding features. The first feature is the broadest spectrum of activity against gram-negative bacteria, & the second is the highest resistance to inactivation by bacterial enzymes. Which drug is it?

Back 19

Amikacin (Amikin)

Front 20

The sulfonamides are broad spectrum antibiotics that were among the first available for systemic bacterial infections. Although they are still used for urinary tract infections, their use has declined due to the development of less toxic alternatives. Which of the following is a toxicity NOT associated with the sulfonamides?

Back 20

ALL are toxicities associated with sulfonamides

Front 21

Which of the following is used for ‘lower urinary tract infections’ & prophylaxis for recurrent urinary tract infections? Therapeutic levels are reached in the urine and the drug becomes activated once it crosses inside the bacteria. Adverse effects include: gastrointestinal disturbances (brown urine), pulmonary reactions, hematologic effects, & peripheral neuropathy.

Back 21

Nitrofurantoin (Furadantin)

Front 22

Which of the following is FALSE regarding urinary tract infections?

Back 22

Complicated urinary tract infection usually refers to a resistant infection

Front 23

A transplant patient is prescribed a calcineurin inhibitor to suppress the production of interleukin-2 and other cytokines. The patient is advised that while a relatively small increase in blood pressure is common (~ 50% of patients); nephrotoxicity (~75%) and infection (~74%) are even more common. Which drug is this patient most likely been prescribed?

Back 23

Cyclosporine (Sandimmune)

Front 24

Clarithromycin (Biaxin) and Azithromycin (Zithromax) are members of the macrolide family of antimicrobials. These drugs are considered the preferred drugs for the initial treatment (together with one other drug) and prophylaxis (together) of which of the following?

Back 24

Mycobacterium avium complex

Front 25

Vioxx (Rofecoxib) was pulled from the market in September 2004. This was due in large part because of the results of the ‘Vioxx GI Outcomes Research’ study. In that study, Vioxx was compared to another NSAID that is very well tolerated with multiple indications. Compared to that drug, Vioxx had significantly higher CV events with high doses. What was that drug that is still widely used?

Back 25

Naproxen (Naprosyn, Alleve, etc.)

Front 26

A patient presents for a follow-up visit for his treatment of a Haemophilus influenzae infection. You inform him that the medication he is taking is a broad-spectrum antibiotic that is also used for tuberculosis and Legionnaire’s disease. Although his liver function is normal, he has noticed a discoloration of his contact lenses and ‘sweat-spots’ of his underwear. Which medication is this patient taking?

Back 26

Rifampin (Rifadin)

Front 27

Ciprofloxacin (Cipro) is the prototype (most common example) of which class of antibiotics?

Back 27

Fluoroquinolones

Front 28

This drug is unusual in that it is administered orally to treat superficial mycoses. It is ineffective against systemic mycoses. This drug inhibits fungal mitosis and adverse effects include transient headache, rash, GI disturbances, insomnia and tiredness. Which is it?

Back 28

Griseofulvin (Fulvicin, others)

Front 29

In taking a patients history, you discover she is taking medication for rheumatoid arthritis. She cannot remember which one, but she is certain it is “one of those DMARDs”. She knows she had blood tests done to confirm proper liver and bone marrow function. Also, the full therapeutic effect took over a month to develop. Which of the following is she most likely taking?

Back 29

Methotrexate (Rheumatrex)

Front 30

A vaccine exists for this disorder which is usually transmitted by blood and semen. Drugs used for an active infection include Interferon alfa-2b, Lamivudine (Epivir-HBV) & Adefovir (Hepsera). Which is it?

Back 30

Hepatitis B viral infection

Front 31

Which of the following classes of anti-microbials have been grouped into four ‘generations’ based on the order of their introduction to clinical use? With each ‘new’ generation these anti-microbials have increased activity against gram-negative bacteria, increased resistance to beta-lactamase & increased distribution to the cerebrospinal fluid.

Back 31

Cephalosporins

Front 32

Which of the following is a DNA polymerase inhibitor used to suppress the synthesis of viral DNA? Specifically, its mechanism of action is activity as a purine nucleoside analog. This drug is used for herpes simplex and varicella-zoster viral infections. Oral therapy is devoid of serious adverse effects.

Back 32

Acyclovir (Zovirax)

Front 33

Which of the following is the first member of the oxazolidinone antibiotics? This drug is important because it has activity against ‘drug-resistant’ strains of certain microbes.

Back 33

Linezolid (Zyvox)

Front 34

Which of the following general statements about HIV is FALSE?

Back 34

CD8 cells (Cytolytic T lymphocytes) are targets

Front 35

Which of the following is the only second generation COX inhibitor still available in the USA? Theoretically, it should have fewer adverse effects than older NSAIDs. However, the manufacturer is currently running extended TV commercials (over 2 minutes) explaining the risks and benefits of the drug. Therapeutic uses include osteoarthritis, rheumatoid arthritis, acute pain, dysmenorrhea, and familial adenomatous polyposis.

Back 35

Celecoxib (Celebrex)

Front 36

A patient presents for a follow-up visit for her HIV therapy. Since taking her ‘cocktail’ (combination of drugs), she has noticed a rash. She thinks it may be due to the high-fat diet she has been instructed to take with the drug. Which of the following drugs is the most likely cause of her rash?

Back 36

Efavirenz (Sustiva)

Front 37

Which of the following drugs can be used as an immunosuppressant that has multiple mechanisms of action? This drug can block antigen-presenting and interleukin-1 production at the ‘beginning’ of the immune response. And, this drug can block T-cell and B-cell proliferation further ‘down-stream’ in the immune response.

Back 37

Prednisone

Front 38

Which of the following is a second generation H1 antagonist that is unique for two reasons? First, it is administered by nasal spray while the others are oral. Second, in addition to blocking receptors for histamine, it also blocks the release of histamine & other mediators from mast cells.

Back 38

Azelastine (Astelin)

Front 39

Figure 17.1 in the text illustrates the various stimulatory & feedback mechanisms in regulating glucocorticoid levels in the blood. Which of the following is NOT normally considered a stimulatory or inhibitory (feedback) mechanism?

Back 39

Glucocorticoids feedback onto the adrenal cortex

Front 40

Which of the following class or classes of antibiotics (antimicrobials) works by bactericidal inhibition of protein synthesis? In other words, their mechanism of action is the lethal inhibition of bacterial protein synthesis.

Back 40

Aminoglycosides

Front 41

‘Ringworm’ is the popular terms for infections of the foot (Tinea pedis), body (Tinea corporis), groin (Tinea cruris) and scalp (Tinea capitis). What is the actual clinical term for these infections?

Back 41

Dermatophytic infections

Front 42

Which of the following belongs to a large group of drugs that weaken the cell wall, causing bacteria to take up excessive water and rupture? This group is considered to be bactericidal but bacterial resistance has emerged through the inability of these drugs to reach their target and/or inactivation by bacterial enzymes. These drugs are usually classified as: narrow spectrum enzyme sensitive, narrow spectrum enzyme resistant, broad spectrum, or extended spectrum.

Back 42

Amoxicillin (Amoxil)

Front 43

Which of the following is used only for life-threatening infections for which safer drugs are ineffective or contraindicated? Adverse effects of this drug include reversible bone marrow depression, aplastic anemia and Gray syndrome. Use of this broad-spectrum antibiotic dropped sharply once its ability to cause fatal aplastic anemia became evident.

Back 43

Chloramphenicol (Chloromycetin)

Front 44

A patient is presenting for a follow-up for his rheumatoid arthritis therapy. He can’t recall the name of the drug, but knows its one of the new DMARDS used for moderate to severe RA. He has to inject the drug and has experienced some injection site reactions & was told to watch for increased incidence of infection. He knows the drug 'inactivates' tumor necrosis factor (TNF); which of the following is it?

Back 44

Etanercept (Enbrel)

Front 45

Which of the following is a combination anti-microbial that is available generic outside the USA? This drug combination inhibits sequential steps in bacterial folate synthesis. This is used to treat urinary tract infections, Pneumocystis carinii, & GI infections. Adverse effects from routine use/dosage of this combination are rare, but there are a wide variety of toxicities associated with each individual drug.

Back 45

Trimethoprim & Sulfonamide

Front 46

A patient presents at a clinic for a follow-up exam to drug therapy for a chronic lower urinary tract infection. While the patient can’t think of any real adverse effects associated with taking this medication, she has had problems swallowing the pills because of the thick coating. The attending explains that this is to prevent the acid of the stomach from decomposing the medication into ammonia and formaldehyde. Which drug is it?

Back 46

Methenamine (Mandelamine)

Front 47

Which of the following diseases has been associated with the emergence of ‘multi-drug resistant’ (MDR) and ‘extensively-drug resistant' (XDR) strains? A new investigational drug that targets ATP synthase may provide faster therapy than current drugs.

Back 47

Tuberculosis

Front 48

Of the following drugs, which belongs to a class of drugs closely related to nalidixic acid? This drug is a general broad spectrum anti-microbial used to treat a wide variety of infections and works by inhibiting bacterial DNA gyrase. This particular drug is a ‘drug of choice’ for anthrax & was recently 'stockpiled' by the government.

Back 48

Ciprofloxacin (Cipro)

Front 49

This synthetic antiviral agent can be used to treat Herpes simplex viruses or Epstein-Barr virus. When used to treat cytomegalovirus (CMV) in an immuno-compromised host it can be injected directly into the eye (intraocular injection). Side effects of this drug include granulocytopenia & thrombocytopenia. Which is it?

Back 49

Ganciclovir (Cytovene, Vitrasert)

Front 50

This compound is one of the more recently approved drugs for HIV. The chemical synthesis of this drug is complex and is the main reason for its high cost. This drug works by blocking the fusion of the HIV virus to target cells in the host. Which one is it?

Back 50

Enfuvirtide (Fuzeon, T-20)