Pharmacology
1. A jaundiced 1 day old premature infant with an elevated free bilirubin is seen in the premature baby nursery. The mother had received an antibiotic combination for a urinary tract infection (UTI) 1 week before delivery. Which antibiotic drug or class was the most likely cause of the baby’s kernicterus?
a. An aminopenicillin (eg, amoxicillin)
b. Azithromycin
c. Erythromycin
d. Fourth-generation cephalosporin
e. Sulfamethoxazole plus trimethoprim
2. You are caring for a patient with HIV infection and will start drug therapy initially with the nucleoside analog zidovudine (formerly called azidothmidine, or AZT). Which statement most correctly describes zidovudine or the dideoxynucleoside class to which it belongs?
a. Levels of active metabolite in cerebrospinal fluid usually are not detectable (ie,zero) because it can not cross the blood–brain barrier
b. Resistance to these anti virals develops rapidly after mono therapy starts, involves decreased in corporation of active metabolite into viral DNA
c. The dideoxynucleoside stops viral nucleic acid synthesis
d. The active metabolite is an equally effective substrate for viral reverse transcriptase and mammalian
dnapolymerase, which explains the high incidence of host toxicity
e. Zidovudine is dephosphorylated to form the active metabolite, which is incorporated into viral nucleic acid via HIV reverse transcriptase
3. A patient on antimicrobial therapy develops the following signs and symptoms that ultimately are found to be drug-induced: cough, dyspnea, and pulmonary infiltrates; neutropenia and bleeding tendencies; and paresthesias.
What was the most likely cause of this patient’s symptoms?
a. Amoxicillin
b. Azithromycin
c. Ciprofloxacin
d. Isoniazid
e. Nitrofurantoin
4. A patient will be started on primaquine to treat active Plasmodium vivax malaria, specifically to target the hepaticforms of the parasite. Before you administer the drug, you should screen the patient to assess their relative risk of developing a relatively common and severe adverse response to the drug. What is that primaquine associated risk?
a. Cardiac conduction disturbances
b. Hemolytic disease
c. Nephrotoxicity
d. Retinopathy
e. Seizures, convulsions
5. On morning rounds in the hospital, you encounter a patient being treated with linezolid, the first approved member of the oxazolidine class of antimicrobials. Which statement accurately describes a characteristic of this drug?
a. Exerts strong bactericidal effects
b. Mainly used for relatively minor infections with gram-negative organisms
c. Preferred alternative to amoxicillin for children with otitis media
d. Preferred alternative to ciprofloxacin for B. Anthracis infections
e. Suitable for vancomycin-resistant enterococci
6. A 59-year-old woman is diagnosed with tuberculosis (TB). Before prescribing a multi drug regimen, you take a careful medication history because one of the drugs commonly used to treat TB induces some of the microsomal cytochrome P450 enzymes in the liver, and is a common cause of drug–drug interactions. What is the most likely drug?
a. Ethambutol
b. Isoniazid
c. Pyrazinamide
d. Rifampin
e. Vitaminb6
7. A patient with HIV infection is receiving a combination of protease inhibitors as 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
e. Pancreatitis
8. A27-year-old woman has just returned from a trip to Southeast Asia. Over the past 24 hours she has developed shaking, chills, and a temperature of 104°F. A blood smear reveals Plasmodium vivax. What drug would you prescribe to eradicate the extraerythrocytic phase of the organism?
a. Chloroguanide
b. Chloroquine
c. Primaquine
d. Pyrimethamine
e. Quinacrine
9. 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 classes of drugs. Given the history, what drug would be preferred for treating the infection, and also poses the least risk of cross –reactivity and anallergic response?
a. Clotrimazole
b. Gentamicin
c. Metronidazole
d. Tetracycline
e. Vancomycin
10. A 40-year-old man ishiv-positive and has a cluster-of-differentiation-4 (CD4) count of 200/mm3. Within 2 months after starting drug therapy for his HIV he develops a peripheral white blood cell count of 1000/mm3 and a hemoglobin of 9.0mg/dl. Which drug most likely caused the hematologic abnormalities?
a. Acyclovir
b. Dideoxycytidine
c. Foscarnet
d. Rimantadine
e. Zidovudine
11. An 86-year-old man complains of cough and blood in his sputum for the past 5 days.On admission, his temperature is 103°F. Physical examination reveals rales in his right lung, and x-ray examination shows increased density in the right middle lobe. A sputum smear shows many gram positive cocci, confirmed by sputum culture as penicillinase-producing Staphylococcus aureus. Which antibiotic would be best to administer first?
a. Ampicillin
b. Mezlocillin
c. Oxacillin
d. Penicillin(gorv)
e. Ticarcillin
12. When considering all the main antibacterial drugs that work by inhibiting protein synthesis in one way or another, virtually everyone exerts bacteriostatic actions. Which drug or drug class differs from the rest because the usual consequence of therapeutic plasma levels is bactericidal, rather than mere inhibition of bacterial growth and replication?
a. Aminoglycosides
b. Clindamycin
c. Erythromycins
d. Linezolid
e. Tetracyclines
13. A patient with HIV infection and clinical AIDS is treated with a combination of agents, one of which is zidovudine. Which enzyme or replicative process is the main target of this antiviral drug?
a. Non-nucleoside reverse transcriptase
b. Nucleoside reverse transcriptase
c. RNA synthesis
d. Viral particle assembly
e. Viral proteases
14. A patient with HIV/AIDS, being treated with multiple antiviral and immunosuppressive drugs, develops an opportunistic infection caused by P. Jiroveci. Which drug are you most likely to use to treat the pulmonary infection caused by this protozoan?
a. Carbenicillin
b. Metronidazole
c. Nifurtimox
d. Penicilling
e. Pentamidine
15. A 25-year-old woman with an upper respiratory tract infection causedby H. influenzae is treated with trimethoprim-sulfamethoxazole. She responds well in a matter of days after starting the TMP-SMZ. Which bacterial process is inhibited by this combination, and accounts for the antibacterial effects?
a. Cell –wall synthesis
b. Protein synthesis
c. Folic acid synthesis
d. Topoisomerase II (dnagyrase)
e. DNA polymerase
16. A man who has been at the local tavern, drinking alcohol heavily, is assaulted. He is transported to the hospital. Among various findings is an infection for which prompt antibiotic therapy is indicated. Given his high blood alcohol level, which antibiotic should be avoided because of a high potential of causing a serious disulfiram-like reaction that might provoke ventilator or cardiovascular failure? (Assume that were it not for the alcohol consumption, the antibiotic would be suitable for the infectious organisms that have been detected.)
a. Amoxicillin
b. Cefotetan
c. Erythromycin ethyl succinate
d. Linezolid
e. Penicillin G
17. A 43-year-old woman is recovering from major surgery, following discharge from the hospital, in an assisted-care facility. She develops fever, rales, dyspnea, cough, and purulent sputum. Results of a chest radiograph indicate bilateral pulmonary infiltrates. We send blood and sputum cultures to the clinical pathology lab for culturing, but now must turn our attention to what we believe is community-acquired pneumonia caused by antibiotic-resistant pneumococci. We want to start empiric antibiotic therapy until culture results are available. Which drug would be best for this initial therapy?
a. Amoxicillin
b. Cefazolin
c. Erythromycin
d. Levofloxacin
e. Penicillin G
f. Vancomycin
18. Blood and sputum cultures taken in a critically ill 26-year-old woman indicate the presence of MRSA— methicillin-resistant Staph.aureus. Which drug is most likely to be effective in treating this infection?
a. Amoxicillin plus clavulanic acid
b. Clindamycin
c. Erythromycin
d. Trimethoprim-sulfamethoxazole (TMP-SMZ)
e. Vancomycin
19. Compared with most other cephalosporins, the administration of cefmetazole, cefoperazone, or cefotetan is associated with a higher incidence of an adverse response that is particularly dangerous for some patients. What is that rather unique adverse response?
a. Acute heart failure
b. Acute renal failure
c. Bleeding tendencies inpatients taking warfarin
d. Hypertension
e. Ototoxicity
20. A patient develops muscle aches and pains during the course of antibiotic therapy. A muscle biopsy would clearly show myopathy. Which drug most likely (and rather uniquely) caused this adverse effect on skeletal muscle?
a. Daptomycin
b. Erythromycin
c. Gentamicin
d. Linezolid
e. Vancomycin
21. A patient with an infectious disease routinely takes their antimicrobial medication with milk or other dairy products in an attempt to reduce stomach upset from the drug. The antibiotic fails to work adequately because calcium in the dairy products chelates the drug and reduces its oral bioavailability. Which antimicrobial drug or drug class was the patient most likely taking?
a. Aminoglycoside
b. Antimycobacterial drug, specifically isoniazid
c. Cephalosporin, first generation
d. Cephalosporin, third generation
e. Penicillin
f. Tetracycline
22. A patient develops profuse, watery diarrhea, fever, abdominal pain, and leukocytosis in response to antibiotic therapy. C.difficile infection in the gut is confirmed. What is the preferred agent for therapy of this antibioticassociated pseudomembranous colitis (AAPMC)?
a. Amphotericinb
b. Clindamycin
c. Gentamicin
d. Metronidazole
e. Trimethoprim plus sulfamethoxazole (TMP-SMZ)
23. A patient has been taking warfarin for several months and his INR (normalized prothrombin time) has been kept within the desired therapeutic range consistently. They develop an infection and are started on antibiotic therapy. Shortly thereafter their INR rises to eight (very high) and they develop epistaxis and other indicators of excessive bleeding. Which antibiotic most likely interacted with thewarfarin, increasing its blood levelsa nd effects, by inhibiting warfarin’s metabolism by the hepatic P-450 system?
a. Azithromycin
b. Erythromycin
c. Gentamicin
d. Penicilling
e. Rifampin
24. Ampicillin and amoxicillin are in the same group of penicillins (broad spectrum, or aminopenicillins). However, there is one clinically important difference. Which phrase 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 abroad-spectrum penicillin
d. Does not cause hypersensitivity reactions
e. Has great antipseudomonal activity
25. 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. Azithromycin
c. Cephalosporins
d. Erythromycin
e. Linezolid
f. Tetracyclines
26. A 30-year-old woman develops a severe P. aeruginosa infection. The physician chooses to treat it with amikacin, not with gentamicin. Which phrase best describes how amikacin differs from gentamicin?
a. Does not require monitoring of blood levels during therapy
b. Exerts significant bactericidal effects against anaerobes too
c. Has broaders pectrum against gram-negative bacilli
d. Lacks ototoxic potential
e. Protects against typical aminoglycoside nephrotoxicity
27. A 19-year-old being treated for leukemia develops a fever. You give several agents that will cover bacterial, viral, and fungal infections. Two days later, he develops acute renal failure. Which drug was most likely responsible?
a. Acyclovir
b. Amphotericin B
c. Ceftazidime
d. Penicilling
e. Vancomycin
28. Penicillins, cephalosporins, and amphotericin B are quite different structurally, and the antimicrobial spectrum of amphotericin B is decidedly different from those of the other agents. Nonetheless, they all share a common property or action. Which statement identifies what that is?
a. Act, though various mechanisms, on cell walls or membranes of susceptible organisms
b. Contraindicated in immunocompromised patients
c. Interact with many drugs by inducing their hepatic metabolism
d. Leukopenia (decreased white cell counts) is a common side effect
e. Nephrotoxicity is common
29. Given the periodic worldwide outbreaks of “swineflu” (particularly influenza A virus subtype H1N1) there has been a great need for prophylactic measures in certain at-risk populations who may be susceptible. Which drug is generally recommended by the US Centersfor Disease Control and Prevention for this purpose?
a. Acyclovir
b. Amantadine
c. Lopinavir
d. Oseltamivir
e. Ritonavir
30. A patient with a P. Aeruginosa infection is receiving intravenous gentamicin. The aminoglycoside blood levels are well above the minimum inhibitory concentration (MIC), but the clinical response is not satisfactory. A new medication order calls for adding a penicillin, administered in a separate IV line to avoid a physical incompatibility. If this order is carried out, what is most likely to occur?
a. The aminoglycoside will inactivate the penicillin
b. The aminoglycoside will chemically neutralize and abolish the effects of the penicillin
c. The patient is likely to develop Clostridium difficile colitis(superinfection)
d. The penicillin will act synergistically with the aminoglycoside
e. The penicillin will increase the risk of aminoglycoside nephrotoxicity
f. The risk of inducing resistance to both drugs increases dramatically
31. We have a patient with an intraabdominal infection, and Bacteroides fragilis is the main organism found upon culture. Which cephalosporin has the greatest activity against anaerobes such B. fragilis?
a. Cefaclor
b. Cefoxitin
c. Cefuroxime
d. Cephalexin
e. Cephalothin
32. A patient with a serious infection received intensive antibiotic therapy that leads to hearing loss. Which antibiotic most likely caused the ototoxicity?
a. Aminoglycoside (eg, gentamicin)
b. Cephalosporin, first-generation
c. Cephalosporin, third-generation
d. Fluoroquinolone (eg, ciprofloxacin)
e. Penicillin
33. A 26-year-old woman with acquired immunodeficiency syndrome (AIDS) develops cryptococcal meningitis. She refuses intravenous medication. Which antifungal agent is the best choice for oral therapy of the meningitis?
a. Amphotericinb
b. Fluconazole
c. Ketoconazole
d. Metronidazole
e. Nystatin
34. An adult patientis being treated with a parenteral aminoglycoside for a serious Pseudomonas aeruginosa infection. He requires immediate surgery. He is premedicated with midazolam, followed by administration of propofol for induction. A dose of succinylcholine is often given for intubation (due to its rapid onset), with skeletal muscle paralysis maintained during surgery with vecuronium or another neuromuscular blocker in the same class (nondepolarizing, or competitive nicotinic receptor blocker). Other components of balanced anesthesia include nitrous oxide, isoflurane, and oxygen. What is the most likely outcome of having the aminoglycoside “onboard” in the perioperative setting along with all these other drugs?
a. Acute hepatotoxicity from an aminoglycoside-isoflurane interaction
b. Antagonism of midazolam’s amnestic and sedative effects
c. Enhanced aminoglycoside toxicity to host cells
d. Increased or prolonged response to neuromuscular blockers
e. Reduced risk of catecholamine-induced cardiac arrhythmias
35. A patient with tuberculosisis started on isoniazid (INH) as part of a multidrug regimen. The physician also starts therapy with vitamin B6 at the same time. What is the main reason for giving the vitamin B6 prophylactically?
a. Facilitates INH renal excretion, thereby protecting against nephrotoxicity
b. Inhibits metabolism of INH, thereby increasing INH blood levels
c. Is a cofactor required for activation of the INH to its antimycobacterial metabolite
d. Potentiates the antitubercular activity of the INH
e. Prevents some adverse effects of INH therapy
36. One antibiotic is considered very effective in treatment of Rickettsia, Mycoplasma, and Chlamydia infections? It is also used to mange some patients with acne vulgaris lesions. To which drug does this description apply?
a. Bacitracin
b. Gentamicin
c. Penicilling
d. Tetracycline
e. Vancomycin
37. You are starting therapy for an established HIV infection in a28-year-old man. The drugs are ritonavir, lopinavir, zidovudine, and didanosine. This involves, ofcourse, using two protease inhibitors and two nucleoside reverse transcriptase inhibitors (nrtis). What is the main purpose of using the ritonavir?
a. Helps maintain adequate saquinavir levels by inhibiting its metabolism
b. Induces the metabolic activation of the nrtis, which are prodrugs
c. Prevents the likely development of hypoglycemia
d. Reduces, or hopefully eliminates, lopinavir-mediated host toxicity
e. Serves as the main, most active, inhibitor of viral protease in this combination
38. As part of a multidrug attack on a patient’s infection with Mycobacterium tuberculosis, a physician plans to use an aminoglycoside antibiotic. Which drug is most active against the tubercle bacillus and seems to be associated with the fewest problems with resistance or typical aminoglycoside-induced adverse effects?
a. Amikacin
b. Kanamycin
c. Neomycin
d. Streptomycin
e. Tobramycin
39. Such agents as clavulanic acid, sulbactam, or tazobactam are often added to some proprietary (manufactured) penicillin combination products. What is the main reason for including them, or describes their action best?
a. Add antibiotic activity against Pseudomon as and many Enterobacter species
b. Facilitate antibiotic penetration into the central nervous system and cerebro-spinal fluid
c. Inhibit cell wall transpeptidases
d. Inhibit in activation of penicillin by ß-lactamase-producingbacteria
e. Inhibit the normally significant hepatic metabolism of the penicillin
f. Reducethe risk and/or severity of allergic reactions in susceptible patients
40. A patient has a severe infection caused by anaerobic bacteria. The first-year house officer writes an order for gentamicin. This approach is doomed to fail because aminoglycosides have no activity against anaerobes. Which best explains why anaerobes will be resistant?
a. Can not metabolize the aminoglycosides, which are all prodrugs, to their bactericidal freer adical forms
b. Can not oxidatively metabolize aminoglycosides to moieties that are nontoxic to host cells
c. Lack molecular oxygen that is a prerequisite for drug binding to the 50S subunit of bacterial ribosomes
d. Lack the ability to transport aminoglycosides from the extracellular milieu in the absence of oxygen
e. Synthesize more, and more active, resistance factors than do aerobic bacteria
41. Inpatients with hepatic coma or portal –systemic encephalopathy decreasing the production and absorption of ammonia from the gastrointestinal (GI) tract will be beneficial. What antibiotic would be most useful in this situation?
a. Cephalothin
b. Chloramphenicol
c. Neomycin
d. Penicilling
e. Tetracycline
42. A 19-year-old girl who previously was healthy develops bacterial meningitis. What would you consider to be the drug of choice for this situation?
a. Ceftriaxone
b. Erythromycin
c. Penicillin G
d. Penicillin V
e. Procaine penicillin
43. A patient is being treated with an antibiotic for a vancomycin-resistant enterococcal (VRE) infection. They consume an over-the-counter medication containing ephedrine and develop a significant spike of blood pressure that leads to a pounding headache. They are transported to the hospital. As part of the work-up, blood tests indicate some bone marrow suppression. Which antibiotic is most likely associated with this clinical picture?
a. Azithromycin
b. Ciprofloxacin
c. Erythromycin estolate
d. Gentamicin
e. Linezolid
44. A patient has an inoperable pancreatic islet cell carcinoma and is chronically hypoglycemic. Which drug would be most likely chosen for relatively long-term oral therapy that attempts to raise blood glucose levels into a more acceptable range?
a. Atenolol (ormetoprolol)
b. Diazoxide
c. Glucagon
d. Octreotide (somatostatinanalog)
e. Oxytocin
45. A 70-year-old man complains of progressive difficulty starting his urine stream, and having to get up several times during each night to urinate. Rectal examination reveals a generally enlarged, smooth-surfaced prostate. Prostate-specific antigen (PSA) titers are significantly elevated. You decide to start finasteride treatment. Eventually urine flow increases, nocturesis episodes decrease, and verall prostate size decreases. Which phrase best summarizes the most likely mechanism by which finasteride caused symptom relief?
a. Blocks a-adrenergic receptors
b. Blocks testosterone receptors
c. Inhibits dihydrotestosterone synthesis
d. Inhibits testosterone synthesis
e. Lowers plasma testosterone levels by increasing its renal clearance
46. A 54-year-old woman who has not seen a physician for several years presents with a previously undiagnosed thyroid cancer and thyrotoxicosis. One drug that is administered as part of early management, and may be life saving, ispropranolol. Which of the following best summarizes the objective for administering this drug?
a. Block parenchymal cell receptors for thyroid hormones
b. Block thyroid hormone release by a direct effect on the gland
c. Inhibit thyroid hormone synthesis
d. Lessen dangerous cardiovascular signs and symptoms of thyroid hormone excess
e. Lower TSH levels
47. A woman deemed at high risk of post menopausal osteoporosisis started on alendronate. What is this representative bisphosphonate’s main mechanism of action?
a. Activates vitamin D and so facilitates absorption of dietary calcium
b. Contains lots of calcium, which supplements dietary calcium intake
c. Directly forms hydroxyapatite crystals in bone
d. Provides supplemental phosphate, which indirectly elevates plasma Ca 2+
e. Reduces the number and activity of osteoclasts in bone
48. A 60-year-old man on long-term therapy with a drug develops hypertension, hyperglycemia, and decreased bone density. Blood tests indicate anemia. Some of his stool samples initially were positive for occult blood, and then the stool developed a “coffee-grounds” appearance. Which drug is most likely responsible for the patient’s symptoms?
a. Beclomethasone
b. Hydrochlorothiazide
c. Metformin
d. Pamidronate
e. Prednisone
49. A 22-year-old woman has been sexually assaulted and she wishes to have the pregnancy terminated by pharmacologic means. What is generally the most appropriate drug, assuming no contraindications?
a. Ergonovine (ormethylergonovine)
b. Mifepristone
c. Raloxifene
d. Ritodrine
e. Tamoxifen
50. A 20-year-old woman, otherwise healthy, presents with irregular and occasionally missed menstrual periods, oily facial skin and acne, and slight hirsutism. She was a competitive runner during high school and now is in training for a triathlon. She is not taking any medications other than an estrogen-progesterone oral contraceptive. A pelvic ultrasound evaluation reveals numerous immature ovarian follicles (generally but incorrectly referred to as cysts). The diagnosis is polycystic ovarian syndrome (PCOS). Which drug would be the most rational initial therapy to prescribe to help provide symptom relief without compromising the woman’s ability to conceive?
a. Estrogen (dose higher than in her oral contraceptive)
b. Ketoconazole
c. Metformin
d. Prednisone (or a similar oral glucocorticoid)
e. Testosterone
51. A 50-year-old woman with a high risk of breast cancer is started o ntamoxifen for prophylaxis. What is the main mechanism of action of this drug?
a. Blocks estrogen receptors in breast tissue
b. Blocks estrogen receptors in the endometrium
c. Increases the risk of osteoporosis
d. Raises plasma LDL cholesterol and total cholesterol, lowers HDL
e. Reduces the risk of thromboembolic disorders
52. You have prescribed an oral agent to help control a patient’s blood glucose levels. He has type 2 diabetes. In explaining how the drug works, you describe it as a “starchblocker” that inhibits the intestinal uptake of complex carbohydrate sin the diet. You advise also that flatus or some cramping or “grumbling sounds” in the belly may develop. Which drug fits this description?
a. Acarbose
b. Any thiazolidinedione (“glitazone”)
c. Glipizide
d. Metformin
e. Tolbutamide
53. A patient presents in the emergency department (ED) with a massive overdose of a drug. The most worrisome signs and symptoms include excessive cardiac stimulation (severe tachycardia, palpitations, angina, etc). The ED physician orders IV administration a ß-adrenergic blocker, saying (correctly) it is the only drug likely to normalize cardiac function quickly and save the patient’s life. What was the most likely drug the patient overdosed on?
a. A second-generation sulfonylurea (eg, glipizide, glyburide)
b. Insulin
c. Levothyroxine
d. Prednisone (oral glucocorticoid)
e. Propylthiouracil
54. A patient with hypothyroidism following thyroidectomy will require lifelong hormone replacement therapy. What drug or formulation generally would be most suitable?
a. Levothyroxine (T4)
b. Liothyronine
c. Liotrix
d. Protirelin
e. Thyroid, desiccated
55. A patient develops marked skeletal muscle tetany soon after a recent thyroidectomy. The attending confirms the diagnosis, inpart, by lightly tapping the patient’s cheek in front of the ear. Stimulating the facial nerves in this manner leads to spasms of the local (oris) muscle (Chvostek sign). Which drug is most likely to be chosen to manage this adverse response to surgery?
a. Calcitonin
b. Calcium gluconate
c. Plicamycin (mithramycin)
d. PTH (parathyroid hormone)
e. Vitamin D
56. A 40-year-old man with a symmetrically enlarged thyroid gland associated with elevated levels of T3 and T4 is treated with propylthiouracil (PTU). Which phrase best summarizes the principal mechanism of action of PTU?
a. Blocks iodide transport into the thyroid
b. Increases hepatic metabolic inactivation of circulating T4 and T3
c. Inhibits proteolysis of thyroglobulin
d. Inhibits thyroidal peroxidase
e. Releases T3 and T4 into the blood
57. Your patient, who is taking an oral contraceptive, has heard about and asks about the risk of thromboembolism as a result of taking these drugs. To reduce the risk of this potentially severe adverse hematologic response, but still provide reasonably effective contraception, what would you prescribe?
a. A combination product with a higher estrogen dose
b. A combination product with a higher progestin dose
c. A combination product with a lower estrogen dose
d. A combination product with a lower progestin dose
e. A product that contains only estrogen
58. A patient with Cushing syndrome is being treated by X-irradiation of the pituitary. It may take several months of this therapy for adequate symptomatic and metabolic improvement. Until that time, which drug would be administered to suppress glucocorticoid synthesis?
a. Cimetidine
b. Cortisol (massive doses)
c. Fludrocortisone
d. Ketoconazole
e. Spironolactone
59. A 75-year-old man had surgery for prostate carcinoma, and local metastases were found intraoperatively. What is the most appropriate follow-up drug aimed at treating the metastases?
a. Aminoglutethimide
b. Fludrocortisone
c. Leuprolide
d. Mifepristone
e. Spironolactone
60. A 55-year-old post menopausal woman develops weakness, polyuria, polydipsia, and significant increases of plasma creatinine concentration. A computed tomogram (CT scan) indicates nephrocalcinosis. A drug is considered to be the cause. Which drug was most likely responsible?
a. Estrogens
b. Etidronate
c. Glipizide
d. Prednisone
e. Vitamin D
61. Drug of choice for primary, secondary, or latent < one-year syphilis:
a. Azithromycin (Zythromax)
b. Famciclovir (Famvir)
c. Penicillin G benzathine
d. Doxycycline (Vibramycin, Doryx)
e. Penicillin G procaine
62. Drug of choice for both pubic lice and scabies:
a. Acyclovir (Zovirax)
b. Valacyclovir (Valtrex)
c. 5% permethrin (Elimite)
d. Clindamycin (Cleocin) cream
e. Metronidazole (Flagyl) gel (0.75%)
63. Drug of choice-- trichomoniasis
a. Acyclovir (Zovirax)
b. Penicillin G
c. Penicillin G procaine
d. Metronidazole (Flagyl)
e. Permethrin (Elimite)
64. Drug of choice for neurosyphilis:
a. Clindamycin (Cleocin)
b. Metronidazole (Flagyl)
c. Penicillin G
d. Penicillin G procaine plus probenecid (Benemid)
e. Doxycycline (Vibramycin, Doryx)
65. Poor choice for treating sepsis caused anaerobes:
a. Imipenem
b. Meropenem (Merrem IV)
c. Aztreonam (Azactan)
d. All of the above
66. Treatment of sepsis due to Pseudomonas aeruginosa:
a. Cefotaxime (Claforan)
b. Ceftriaxone (Rocephin)
c. Ceftazidime (Fortax, Taxidime, Tazicef)
d. Ceftizoxime (Cefizox)
67. Intra-abdominal anaerobic infections:
a. Ticarcillin (Ticar)/clavulanic acid
b. Ampicillin (Principen, Omnipen)/sulbactam
c. Imipenem
d. All of the above
68. Bacteremia in neutropenic patients:
a. Ceftazidime (Fortax, Taxidime, Tazicef)
b. Imipenem
c. Meropenem (Merrem IV)
d. All of the above
69. Azole most likely to get into the cerebral spinal fluid (CSF):
a. Ketoconazole
b. Itraconazole
c. Fluconazole
d. Nystatin
70. Given by i.v. Administration, the drug of choice for nearly all life-threatening mycotic infections--usually used as the initial induction regimen
a. Ketoconazole
b. Itraconazole
c. Flucytosine
d. Amphotericin B
e. Nystatin
71. Microhemorrhages in the brain and other organs associated with Falciparum parasites mainly due to:
a. Increased platelet count
b. Reduced blood flow
c. Stickiness of falciparum parasites to the vascular epithelium
d. Falciparum parasite-induced thrombocytopenic purpura
e. Falciparum parasite induced polycythemia vera
72. An example of a 4-aminoquinoline antimalarial drug:
a. Pyrimethamine (Daraprim)
b. Sulfadiazine
c. Doxycycline (Vibramycin, Doryx)
d. Mefloquine (Lariam)
73. Pyrimethamine-sulfadoxine (Fansidar)-antimalarial characteristics:
a. Effective against falciparum malaria (some strains)
b. For serious cases quinine (Quinamm) is given concurrently since pyrimethamine-sulfadoxine (Fansidar) activity develops slowly
c. Effective against P vivax malaria
d. A & B
74. HIV protease inhibitor
a. Rimantadine (Flumadine)
b. Ribavirin (Virazole, Rebetron)
c. Saquinavir (Invirase)
d. Stavudine (Zerit, d4t)
75. Most likely to cause additive myelosuppresion in an HIV patient also receiving ganciclovir for CMV retinitis:
a. Didanosine (Videx, ddi)
b. Zidovudine (Retrovir, AZT, azidothymidine)
c. Zalcitabine (Hivid, ddc)
d. Saquinavir (Invirase)
76. Used to treat HSV:
a. Zidovudine (Retrovir, AZT, azidothymidine)
b. Acyclovir (Zovirax)
c. Interferon
d. Ribavirin (Virazole, Rebetron)
77. HIV reverse transcriptase inhibitor
a. Ritonavir (Norvir)
b. Didanosine (Videx, ddi)
c. Indinavir (Crixivan)
d. Saquinavir (Invirase)
78. Once daily anti-HIV/AIDS non-nucleoside reverse transcriptase inhibitor
a. Stavudine (Zerit, d4t)
b. Efavirenz (EFV; Sustiva)
c. Zalcitabine (Hivid, ddc)
d. Indinavir (Crixivan)
79. Mycobacterium avium prophylaxis in HIV patients:
a. Rifabutin (Mycobutin)
b. Dapsone/pyrimethamine (Daraprim)
c. Azithromycin (Zythromax)
d. A & C
80. Reasonable initial HIV treatment protocols
a. Indinavir (Crixivan) + AZT (zidovudine) + ddi
b. AZT (zidovudine) + ddi
c. Zidovudine (Retrovir, AZT, azidothymidine)
d. Ddc + 3TC

Pharmacology 1. A jaundiced 1 day old premature infant with an ele...