Medications

Question 1

Glucocorticoid effects

Answer 1

Neutrophilic leukocytosis
Neutrophilia
Immune suppression
HPA axis suppression
Hyperglycemia
weight gain
skin thinning, striae, ecchymosis, acne, facial erythema,
mild hirsutism
Fluid retention, hypertension, arrhythmias, hyperlipidemia
gastritis, ulcers, GI bleeding
pancreatitis, hepatic steatosis
osteoporosis, myopathy
psychosis, mood disturbances
cataracts, exophthalmos
increased intraocular pressure
increased creatinine

Question 2

Beta-lactam antibiotics can lead to immunodeficiency through bone marrow suppression, while macrolides are known to impair proinflammatory cytokine production
True or False

Answer 2

True

Question 3

Bacteriocidal antibiotics can transiently exacerbate the inflammatory response due to release of bacterial components at the time of cell death.
True or False

Answer 3

True

Question 4

Ampicillin and amoxicillin are in the same group of penicillins. However, there is one clinically important difference. Which of the following phrases best states how amoxicillin differs from ampicillin?
A. Has better oral bioavailability, particularly when taken with meals
B. Is effective against penicillinase-producing organisms
C. Is a broad spectrum penicillin
D. Does not cause hypersensitivity reactions

Answer 4

A. Has better oral bioavailability, particularly when taken with meals

Question 5

You are on morning rounds in the hospital and encounter a patient being treated with linezolid. Which of the following most correctly describes a characteristic of this drug?
A. Exerts strong bacteriocidal effects
B. Mainly used for relatively minor infections with gram negative organisms
C. Preferred alternative to amoxicillin for children with otitis media
D. Suitable for vancomycin-resistant enterococci

Answer 5

D. Suitable for vancomycin-resistant enterococci

Question 6

A jaundiced 1 day old premature infant with elevated free bilirubin is seen in the premature baby nursery. The mother had received an antibiotic combination for a urinary tract infection one week before delivery. Which of the following antibiotic drugs or classes was the most likely cause of the baby’s kermicterus?
A. Aminopenicillin
B. Azithromycin
C. Sulfamethoxazole plus trimethoprim
D. Fourth generation cephalosporin

Answer 6

C. Sulfamethoxazole plus trimethoprim

Question 7

A patient has a severe bacterial infection that normally would respond to an oral penicillin or cephalosporin. However, his chart documents anaphylactoid reactions to both drugs. Given the history, what drug would be preferred for treating the infection, and also poses the least risk of cross-reactivity and an allergic response?
A. Vancomycin
B. Clotrimazole
C. Metronidazole
D. Tetracycline

Answer 7

A. Vancomycin

Question 8

A patient with HIV infection is receiving a combination of protease inhibitors a part of overall antiviral therapy. What is the most likely/most common side effect (s) of the protease inhibitors?
A. Anemia and neutropenia
B. Hyperglycemia and hyperlipidemia
C. Lactic acidosis
D. Neuropathy

Answer 8

B. Hyperglycemia and hyperlipidemia

Question 9

A patient’s history notes a documented severe anaphylactoid reaction to a penicillin. What other antibiotic or class is likely to cross-react and so should be avoided in this patient?
A. Aminoglycosides
B. Cephalosporins
C. Erythromycin
D. Tetracyclines

Answer 9

B. Cephalosporins

Question 10

Your teenage patient is being treated for leukemia, and develops a fever. You give several agents that will cover bacterial, viral and fungal infections. Two days later, he develops acute renal failures. Which of the following drugs is most likely responsible?
A. Acyclovir
B. Amphotericin B
C. Ceftazidime
D. Penicillin G

Answer 10

B. Amphotericin B

Question 11

Your 17 yo woman with AIDS develops cryptococcal meningitis. She refuses IV medication. Which antifungal agent is the best choice for oral therapy of the meningitis?
A. Amphotericin B
B. Fluconazole
C. Ketoconazole
D. Metronidazole.

Answer 11

B. Fluconazole

Question 12

Which antibiotic would be appropriate for the nurse practitioner to prescribe for the beta-lactamase production by strains of Haemophilus influenza and Moraxella catarrhalis in a child with acute otitis media?
A. Amoxicillin
B. Erythromycin-sulfixoxazole
C. Penicillin V Potassium
D. Amoxicillin with clavulanic acid

Answer 12

D. Amoxicillin with clavulanic acid

Question 13

Prophylactic antibiotics are indicated for which of the following clients who have a history of acute otitis media?
A. A 3 year old with 2 episodes of AOM in the previous winter.
B. A 2 year old with 3 episodes of AOM within the last 6 months
C. A 4 year old with history of prophylactic antibiotics in the last 2 years but
without evidence of AOM this year
D. A 2 year old with 3 episodes of AOM over the last 9 months

Answer 13

B. A 2 year old with 3 episodes of AOM within the last 6 months

Question 14

Which of the following is false regarding epinephrine and anaphylaxis?
A. Epinephrine is indicated when symptoms from more than one organ system are presenti
B. Epinephrine should be administered sooner rather than later to avoid the likelihood of a fatal reaction due to delayed administration
C. Epinephrine should be administered subcutaneously as a 1:1000 solution at a dose of 0.01 mg/kg
D. If the initial dose of epi is ineffective, then a 1:10,000 solution at 0.01 mg/kg should be administered IV or IQ

Answer 14

C. Epinephrine should be administered subcutaneously as a 1:1000 solution at a dose of 0.01 mg/kg

Question 15

Lovenox

Answer 15

Monitoring; anti-factor Xa levels

Question 16

1st Generation Cephalosporin
(beta-lactams).

Answer 16

Cefazolin
Cephalexin
Cefadroxil
Cephradine

Question 17

1st Generation Cephalosporin Coverage

Answer 17

Gram + cocci
Strep, Staph, Entero
UTI’s, Group A strep
Gram neg: E. coli, P.Mirabilis, K.pneumoniae

Question 18

2nd Generation Cephalosporin

Answer 18

Cefaclor
Cefuroxime
Cefprozil
Loracarbef
Cephamycins

Question 19

2nd Generation Cephalosporin Coverage

Answer 19

Gram + cocci
Strep.
No MRSA
Some gram neg: M.catarrhalis, P.mirabilis, H.influenza, Klebsiela, N.gonorrheae
AOM, Acute sinusitis, URI,UTI

Question 20

3rd Generation Cephalosporin

Answer 20

Cefdinir
Cefixime
Cefotaxime
Ceftriaxone
Cefpiramide

Question 21

3rd Generation Cephalosporin Coverage

Answer 21

MSSA, Group A & B strep
Gram neg: h.influenza, M.catarrhalis, N.meningitidis, Klebsiella, serratia, Citrobacter, E. Coli
Meningitis (crosses BBB), URI, AOM, pyelonephritis, Lyme, gonorrhea, skin infections

Question 22

4th Generation Cephalosporin

Answer 22

Cefepime
Cefluprenam
Cefozopen
Cefpirome

Question 23

4th Generation Cephalosporin Coverage

Answer 23

Broad Spectrum
Group A & B, Strep pneumonia, MSSA, pseudomonas, Entero
Nosocomial pathogens & meningitis

Question 24

Beta-Lactams: Penicillin Abx

Answer 24

Bactericidal
* Gram positive organisms, gram negative cocci
* Non-beta-lactamase-producing anaerobes
* Uses: bacterial prophylaxis, UTIs, sinusitis, otitis media, lower
respiratory tract infections

Question 25

Beta-Lactams: Monobactams Abx

Answer 25

Gram negative coverage * No gram positive or anaerobic coverage

Question 26

Beta-Lactams: Carbapenems Abx

Answer 26

Gram positive, gram negative (including pseudomonas), and anaerobic coverage * Used for mixed aerobic/anaerobic infections, ESBL-producing gram negative infections, febrile neutropenia

Question 27

Glycopeptides Abx

Answer 27

Gram positive organisms (MRSA, MRSE) * No gram negative activity * Redman syndrome * Diffuse red rash * Histamine mediated hypersensitivity reaction

Question 28

Lipopeptides Abx

Answer 28

Gram positive organisms (including VRE) No gram negative or anaerobic activity

Question 29

Tetracyclines Abx

Answer 29

Gram positive, gram negative, some anaerobic coverage

Question 30

Macrolides Abx

Answer 30

Gram positive (pneumococci, staph, strep, corynebacteria), gram negative, atypical (mycoplasma, legionella, etc) coverage

Question 31

Lincomycins Abx

Answer 31

Gram positive, anaerobic coverage

Question 32

Aminoglycosides Abx

Answer 32

Gram negative coverage * Used for sepsis, endocarditis, UTIs * Nephrotoxicity

Question 33

Sulfonamides Abx

Answer 33

Gram positive, gram negative organism coverage Poor anaerobic activity

Question 34

Fluoroquinolones Abx

Answer 34

Gram positive, gram negative, atypical organism coverage Limited anaerobic coverage (moxifloxacin only) Used in UTIs, bacterial diarrhea, soft tissue/bone infections

Question 35

Amiodarone

Answer 35

antiarrhythmic. Used for JET. Do mix with dextrose. Monitor thyroid function.

Question 36

succinylcholine

Answer 36

causes malignant hypothermia-give dantroline.

Question 37

peppermint oil

Answer 37

causes GERD sx's

Question 38

Propofol

Answer 38

see propofol-related infusion syndrome: hypotension, hyperlipidemia, rhabdomyolysis & AKI.