Pharmacology 5334 Module 2 Exam With 100% Correct Answers 2023, Exams of Advanced Education

Download Pharmacology 5334 Module 2 Exam With 100% Correct Answers 2023 and more Exams Advanced Education in PDF only on Docsity! Pharmacology 5334 Module 2 Exam With 100% Correct Answers 2023 Treatment of choice for oral therapy of UTI's - Correct Answer-TMP/SMZ for 3 days; Nitrofurantoin for 5 days Second line drugs for UTI - Correct Answer-Ciprofloxacin and levofloxacin for 3 days Nitrofurantoin - Correct Answer-Urinary tract antiseptic Nitrofurantoin uses - Correct Answer-Lower UTI's; prophylaxis; recurrent lower UTI's. (not absorbed systemically: cannot be used for anything in the kidneys) Nitrofurantoin adverse effects - Correct Answer-GI effects; pulmonary reactions; hematologic effects; peripheral neuropathy (demyelination and nerve degeneration can occur and may be irreversible); hepatotoxicity; birth defects Methenamine - Correct Answer-Decomposes to formaldehyde and ammonia; used for chronic lower UTI's; contraindicated in renal and liver failure; drug interactions - urinary alkalinizers, which reduce effects, sulfonamides pose risk for crystalluria Acute cystitis treatment - Correct Answer-Single dose therapy: fosfomycin; short-course therapy: TMP/SMZ for 3 days; conventional therapy: nitrofurantoin for 7 days Acute uncomplicated pyelonephritis treatment - Correct Answer-First line: TMP/SMZ, ciprofloxacin, and levofloxacin for 10-14 days; second line: augmentin, cephalexin Complicated UTI treatment - Correct Answer-TMP/SMZ for 7-14 days, ciprofloxacin for 7-14 days, levofloxacin for 5-14 days, augmentin for 7-14 days, cephalexin for 7-14 days Recurrent UTI treatment - Correct Answer-Prophylaxis with TMP/SMZ 3 times weekly for 6 months; TMP at bedtime for 6 months; OR nitrofurantoin at bedtime for 6 months Acute bacterial prostatitis treatment - Correct Answer--floxacins for 2-4 weeks Evaluation of drug sensitivity - Correct Answer-Best done with sputum culture (takes up to 16 weeks for results); drugs are chosen by patterns of drug resistance in the community and immunocompetence of the patient; a new automated TB assay can identify sensitivity to rifampin in 2 hours and confirm the presence of M. tuberculosis Multi-drug resistant TB (MDR-TB) - Correct Answer-Resistant to both isoniazid and rifampin Extremely drug-resistant TB (XDR-TB) - Correct Answer-Resistant to isoniazid and rifampin, all fluoroquinolones, and at least one of the injectable second-line drugs First line treatment of TB - Correct Answer-Isoniazid, rifampin, pyrazinamide, and ethambutol. Rifapentine and rifabutin are also considered to be first line Two phases of TB treatment - Correct Answer-Induction phase: lasts about 8 weeks, eliminate actively dividing tubercle bacilli. Continuation phase: lasts from 18 weeks to 24 months, eliminate intracellular persisters Drug sensitive TB treatment - Correct Answer-8 weeks induction of isoniazid, rifampin, pyrazinamide, and ethambutol; continuation 18 weeks with isoniazid and rifampin Isoniazid-resistant TB treatment - Correct Answer-Rifampin, ethambutol, and pyrazinamide for 6 months Rifampin-resistant TB treatment - Correct Answer-Isoniazid, ethambutol, and pyrazinamide for 18-24 months MDR-TB and XDR-TB treatment - Correct Answer-24 months with 2nd and 3rd line drugs; poor prognosis Patients with TB plus HIV - Correct Answer-More aggressive therapy required; minimum 6 months of treatment; rifampin accelerates metabolism of antiretroviral therapy drugs and decreases their effects Promoting drug adherence in TB patients - Correct Answer-Directly Observed Therapy (DOT) - also allows for ongoing assessment of clinical signs; intermittent dosing: 2-3 times/week Latent TB tests - Correct Answer-TB skin test; interferon Gamma Release Assays Latent TB treatment - Correct Answer-Isoniazid alone for 9 months; isoniazid and rifampin weekly for 3 months; active TB must be ruled out TB vaccination - Correct Answer-Bacillus Calmette and Guerin (BCG) vaccine Second line treatment of TB - Correct Answer-Levofloxacin, moxifloxacin, kanamycin, amikacin, capreomycin, stretpomycin, para-aminosalicylic acid, ethonamid cycloserine Isoniazid - Correct Answer-Standard treatment for latent TB; must be given for at least 6 months, preferably 9 months; poses a risk for liver damage Isoniazid adverse effects - Correct Answer-Peripheral neuropathy (give pyridoxine and vitamin B6); hepatotoxicity; optic neuritis; anemia Ganciclovir distribution - Correct Answer-Widely distributed to body fluids and tissues Ganciclovir excretion - Correct Answer-Renal: unchanged; half-life is 3 hours with normal renal function (reduce dose in renal impairment) Ganciclovir side effects - Correct Answer-Granulocytopenia, thrombocytopenia, reproductive toxicity, anemia, nausea, fever, rash, liver dysfunction, confusion, CNS symptoms Valganciclovir - Correct Answer-Prodrug of ganciclovir; used for CMV retinitis and prevention of CMV Valganciclovir adverse effects - Correct Answer-Blood dycrasias (bone marrow suppression, granulocytopenia, thrombocytopenia, anemia); N/V/D; potential for mutagenesis and carcinogenesis (no crushing tabs; handle like chemo) Cidofovir indication - Correct Answer-CMV retinitis in patients with AIDS who have failed on ganciclovir or foscarnet Cidofovir kinetcs - Correct Answer-IV infusion; excreted by the kidneys; probenecid competes for renal tubular secretion and delays elimination; prolonged intracellular half life (17-65 hours) and can have 2 weeks between doses Cidofovir adverse effects - Correct Answer-BBW: nephrotoxicity; neutropenia; ocular disorders Foscarnet uses - Correct Answer-Active against all known herpes viruses; less tolerated, more difficult to give Foscarnet adverse effects - Correct Answer-BBW: nephrotoxicity; electrolyte/mineral imbalances Foscarnet absorption - Correct Answer-Low oral bioavailability and must be given IV Foscarnet distribution - Correct Answer-Poorly soluble in water and does not penetrate cells easily; give in large doses with large volumes of fluid Foscarnet excretion - Correct Answer-10% to 20% of each dose is deposited in bone, the remainder is excreted in urine (reduce dose in renal impairment); half-life is 3-5 hours Four classes of antifungal drugs - Correct Answer-Polyene antibiotics, azoles, echinocandins, pyrimidine analogs Opportunistic fungal infections - Correct Answer--Candidiasis, aspergillosis, cryptococcosis, and mucormycosis -Usually occur in immunocompromised or debilitated population taking antibiotics, corticosteroids, chemotherapy, or other immunosuppressives Nonopportunistic fungal infections - Correct Answer-Sporotrichosis, blastomycosis, histoplasmosis, coccidioidomycosis Amphotericin B BBW - Correct Answer-Highly toxic. Only to be used in the setting of life threatening infections (infusion reaction and renal damage occur in many patients) Amphotericin B uses - Correct Answer-Drug of choice for most systemic mycoses. Before its use, systemic fungal infections were usually fatal. Must be given IV Amphotericin B MOA - Correct Answer-Binds ergosterol (unique to fungi); forms membrane pores that allow leakage of electrolytes. "Tears" holes in the fungal membrane by forming pores Amphotericin B adverse effects - Correct Answer-Infusion reactions, nephrotoxicity, hypokalemia Azoles - Correct Answer-Broad-spectrum anti fungal drugs; less toxic than ampho B, can be given orally Itraconazole uses/MOA - Correct Answer-Systemic mycoses; inhibits the synthesis of ergosterol and disrupts the fungal cell membrane Itraconazole metabolism - Correct Answer-Inhibits fungal cytochrome P450-dependent enzymes Itraconazole side effects - Correct Answer-Cardiosuppression (transient decrease in ventricular ejection fraction); BBW - should not be used in patients with heart failure or other indicators of ventricular dysfunction; liver damage (can inhibit drug-metabolizing enzymes); N/V/D Fluconazole - Correct Answer-Fungistatic; inhibits the synthesis of ergosterol and disrupts the fungal cell membrane; inhibits fungal cytochrome P450 dependent enzymes; good PO absorption; half-life of 30 hours - given once daily Fluconazole adverse effects - Correct Answer-Nausea, headache, vomiting, abdominal pain, diarrhea; can cause birth defects when given in high doses in the first trimester Fluconazole drug interactions - Correct Answer-CYP3A4 inhibitor: increases the effects of many drugs Voriconazole uses/MOA - Correct Answer-Candidemia, invasive aspergillosis (drug of choice), esophageal candidiasis, scedosporium apiospenum-resistant infections, suppresses synthesis of ergosterol Voriconazole adverse effects - Correct Answer-Hepatotoxicity, visual disturbances, hallucinations, teratogenicity, hypersensitivity reactions, nausea, vomiting, abdominal pain, headache Voriconazole drug interactions - Correct Answer-Metabolized by the P450 isoenzymes and inhibits P450 enzymes and can raise levels of other drugs Ketoconazole MOA/uses - Correct Answer-Inhibits ergosterol; alternative to ampho B for systemic mycoses (slower effects); more useful in suppressing chronic infections than in treating severe acute infections Ketoconazole adverse effects - Correct Answer-GI (can be reduced if given with food); hepatotoxicity (rare, but potentially fatal hepatic necrosis); BBW: should only be given for systemic infections because of fatal hepatic necrosis AND for use with drugs prolonging QT; can inhibit steroid synthesis in humans; rash, itching, dizziness, fever, chills, constipation, diarrhea, photophobia, and headache Prosaconazole adverse effects - Correct Answer-Nausea, vomiting, liver damage, prolonged QT Prosaconazole drug interactions - Correct Answer-Strong CYP3A4 inhibitor Echinocandins - Correct Answer-Newest class of antifungals; disrupts the fungal cell wall; given IV; used for aspergillus and candida infections Echinocandins adverse effects - Correct Answer-Fever and phlebitis at injection site Echinocandins drug interactions - Correct Answer-Drugs that induce CYP450 will decrease levels of this drug Flucytosine uses - Correct Answer-Serious infection with susceptible strains of candida and cryptococcus neoformans (resistance common); often used with ampho B Flucytosine adverse effects - Correct Answer-Bone marrow suppression, inhibits hepatic drug-metabolizing enzymes Flucytosine BBW - Correct Answer-Should not be used in patients with renal impairment Superficial mycoses organisms - Correct Answer-Candida species; dermatophytes (species of Epidermophyton, Tricophyton, and Microsporum) Nematodes (roundworm) treatment - Correct Answer-Albendazole or mebendazole; ivermectin Cestodes (tapeworm) treatment - Correct Answer-Praziquantel Trematodes (fluke) treatment - Correct Answer-Praziquantel, triclabendazole, albendazole Ascariasis (giant roundworm) treatment - Correct Answer-Albendazole, Mebendazole, ivermectin Pinworm treatment - Correct Answer-Albendazole, mebendazole Ancylostomiasis and necatoriasis (hookworm) treatment - Correct Answer-Albendazole, mebendazole, pyrantel pamoate Trichuriasis (whipworm) treatment - Correct Answer-Albendazole Strongyloidasis (tapeworm) treatment - Correct Answer-Ivermectin Nematode infestation (extra-intestinal) treatment - Correct Answer-Trichinosis (pork roundworm) - albendazole; wucheresis and brugiasis - diethylcarbamazine; onchocercias (river blindness) - praziquantel Cestode infestation treatment - Correct Answer-Taenisis (beef and pork tapeworm) - praziquantel; diphyllobothriasis (fish tapeworm) - praziquantel Trematode infestation treatment - Correct Answer-Schistosomiasis (blood flukes) - praziquantel; fascioliasis (liver fluke) - praziquantel or albendazole; fasciolopsiasis (intestinal fluke) - praziquantel Drugs of choice for helminthiasis - Correct Answer-Mebendazole, albendazole, praziquantel, pyrantel pamoate, diethylcarbamazine, ivermectin Cephalosporins that interact with alcohol - Correct Answer-Cefotetan and cefazolin Cephalosporins that decrease interference with vitamin K metabolism - Correct Answer- Cefotetan and ceftriaxone Medication which can cause break through seizures if given with valproate - Correct Answer-Imipenem Otitis media causative organisms - Correct Answer-Strep pneumoniae, H. Influenzae, m. Catarrhalis, viral Sinusitis causative organisms - Correct Answer-Strep pneumoniae, m. Catarrhalis, H. Influenzae, viral Pneumonia causative organisms - Correct Answer-Strep pneumoniae, S. Aureus, H. Influenzae, klebsiella, mycoplasma, chlamydia, legionella Diarrhea causative organisms - Correct Answer-Salmonella, shigella, campylobacter, E. Coli, c-diff, bacteroides fragilis UTI causative organisms - Correct Answer-E. Coli, proteus morabilis, klebsiella, staph saphrophyticus Skin infection causative organisms - Correct Answer-Strep, staph Intra-abdominal infection causative organisms - Correct Answer-E. Coli, klebsiella, enterobacter, proteus Antibiotics contraindicated in pregnancy - Correct Answer-Chloramphenicol (Gray baby syndrome); erythromycin estolate (cholestatic hepatitis in mother); tetracycline (limb abnormalities, dental staining, decrease in bone growth); fluoroquinolines (abnormalities in cartilage); TMP/SMZ (hemolysis, increased risk of kernicterus) Antibiotics excreted renally - Correct Answer-Aminoglycosides, cephalosporins, Imipenem, fluoroquinolones, PCN, trimethoprim, tetracycline, vancomycin Antibiotics excreted hepatic - Correct Answer-Cefoperazone, chloramphenicol, doxycycline, erythromycin, metronidazole, nafcillin, rifampin, sulfamethoxazole Oral drugs effective against MRSA - Correct Answer-TMP/SMZ, clindamycin, doxycycline, linezolid, tedizolid Bacteriostatic drugs Pneumonic (ECSTTC) - Correct Answer-ECSTATIC Erythromycin (macrolides) Clindamycin Sulfonamides Tetracyclines Trimethoprim Chloramphenicol Bacteriocidal drugs pneumonic (Very Finely Proficient At Cell Murder) - Correct Answer- Very Finely Proficient At Cell Murder: Vancomycin Fluoroquinolones Penicillin Aminoglycosides Cephalosporins Metronidazole Why do many medications lack pediatric dosing information in their drug labeling? - Correct Answer-There is a lack of evidence-based literature on the safe and effective use of medications in children. Why are neonates at greater risk for toxicity with highly protein-bound drugs? - Correct Answer-Protein binding is decreased in neonates increasing the amount of free drug available At what age are adult levels of renal function achieved? - Correct Answer-12 months In determining the intensity of response of a drug in a pediatric patient, organ immaturity puts patients at risk for _______________ and ____________ - Correct Answer- elevated drug levels and delayed elimination When does gastric acidity reach adult values? - Correct Answer-2 years In the pediatric population, adverse reactions to fluoroquinolones may cause - Correct Answer-Tendon rupture Nalidixic acid may cause __________ in children - Correct Answer-Cartilage erosion The principles underlying complication to drug therapy in the elderly include: - Correct Answer-Altered pharmacokinetics, multiple and severe illnesses, multiple drug-therapy, and poor adherence Altered absorption of drugs in the elderly may result in: - Correct Answer-Delayed drug response The most important cause of adverse drug reactions in the elderly is - Correct Answer- Drug accumulation secondary to reduced renal excretion In the elderly, the proper index of renal function is: - Correct Answer-Creatinine clearance or GFR What is the list that identifies drugs with a high likelihood of causing adverse effects in the elderly? - Correct Answer-Beers list The primary mechanism of antibacterial action of the penicillins involves inhibition of: - Correct Answer-cell wall synthesis by binding and inactivating penicillin binding proteins (PBPs) The mechanism of action of the tetracyclines involves: - Correct Answer-Inhibiting protein synthesis