NAPLEX

ANTIMICROBIAL AGENTS

PG 52 Selecting Appropriate Antimicrobial Agents



Empiric therapy



Identify the causative organism



Test the sensitivity of the organism to antimicrobial drugs



Identify important host factors:

 Site of infection-CNS, bone, prostate, UTI  Susceptibility to toxicity  Patient allergies

Mechanisms of Action of Antimicrobial Agents



Interference with cell wall synthesis

 penicillins, cephalosporins 

Inhibition of protein synthesis

 macrolides, clindamycin, tetracyclines, quinolones 

Interference with enzyme unique to bacterial cell

 sulfonamides 

Interference with the permeability of microbial cell membranes

 amphotericin B

PG 52

Sulfonamides

PABA dihydrofolic acid (DHFA) tetrahydrolfolic acid (THFA)

Sulfa

PG 53

PG 53

General considerations - Sulfonamides

Mechanism of action : competitive antagonism of PABA in enzyme system essential for bacteria growth.

For ophthalmic use, sulfa sodium salt solutions are very alkaline (i.e., pH 10 + ). The only sodium salt suitable for ophthalmic use is sulfacetamide sodium (solutions have pH of about 7.4).

Sulfas are eliminated renally unchanged. Makes them good for UTIs.

Sulfas are less soluble in acid urine. This is one cause of crystalluria.

Stevens-Johnson syndrome is associated with sulfa use.

General considerations – Sulfonamides (cont’d)

Combinations of sulfamethoxazole and trimethoprim (Bactrim, Septra, etc.) are less likely to result in bacterial resistance.

Sulfasalazine (Azulfidine) is used in treating inflammatory bowel disease and RA. Watch for sulfa allergy, salicylate allergy, and urine discoloration. GI side effects, dose is titrated upward slowly, monitor blood counts – dyscrasias If a patient cannot use sulfasalazine because of sulfa sensitivity, use mesalamine products, i.e., Asacol, Pentasa, Rowasa. – various dosage forms Remember that silver sulfadiazine (Silvadene) and mafenide (Sulfamylon) are used topically for treatment of serious burns. PG 53

Penicillins

PG 54

General Considerations – Penicillins

Mechanism of action: interfere with bacterial cell-wall synthesis (bactericidal) Note that all penicillins have a beta lactam ring and thiazolidine ring.

Possible cross-sensitivity with other beta lactam antimicrobials (e.g., cephalosporins). percent cross-sensitive ranges from 5-7% PG 54

Structure Activity Relationships:

 AMino penicillins – AMpicillin, AMoxicillin, bacAMpicillin  NOX penicillins – penicillinase (beta lactamase) resistant penicillins: N afcillin, OX acillin, cl OX acillin (PO), dicl OX acillin(PO)----MSSA (vanco alternative)  MEZPCT penicillins – antipseudomonal penicillins: MEZ locillin, P iperacillin, C arbenicillin, T icarcillin (combo with aminoglycosides, not in the same IV)

PG 55 Therapy problems with penicillins:

 Acid Resistance  Beta-lactamase (penicillinase) resistance (combo products; Zosyn, Timentin, Augmentin)  Hypersensitivity

Which of the following is an adverse effect associated with use of aminopenicillins?

a. polydipsia b. hemolytic anemia c. cholelithiasis d. tardive dyskinesia e. angina

Which of the following is an adverse effect associated with use of aminopenicillins?

a. polydipsia b. hemolytic anemia c. cholelithiasis d. tardive dyskinesia e. angina

PG 56

Cephalosporins

PG 56

General considerations

Contains beta-lactam ring. Therefore, may have cross-sensitivity with penicillins.

As you go from 1 st generation to 4 th generation, you get:

   increased gram-negative activity decreased gram-positive activity increased resistance to beta-lactamase destruction  increased ability to enter cerebrospinal fluid

Which of the following antimicrobial agents has effective coverage of streptococcus pneumoniae?

I. amoxicillin II. doxycycline III. gentamicin a. I only b. III only c. I and II only d. II and III only e. I, II, and III

Which of the following antimicrobial agents has effective coverage of streptococcus pneumoniae?

I. amoxicillin II. doxycycline III. gentamicin

Gram + Non-DRSP

a. I only b. III only c. I and II only d. II and III only e. I, II, and III

PG 57

General considerations (cont’d)

First generation (generally start with CEPH):

 Good for surgical prophylaxis

Second generation (generally start with CEF):

 Good for otitis, sinusitis and respiratory tract infections

Third generation (generally end with IME or ONE):

● Good for meningitis, CAP, gram-negative bacilli, gonorrhea,

Proteus, Salmonella, Klebsiella

●

Cefixime (suprax), cefotaxime (claforan), ceftriaxone (rocephin)

Fourth generation (cefepime) Maxipime:

● Good antipseudomonal activity

PG 58

Tetracyclines

PG 58

General Considerations

Products:



Tetracycline HCI (Achromycin V, Sumycin, Robitet, Panmycin)



Minocycline (Minocin)



Doxycycline (Vibramycin, Doxy 100, Doxychel, Vibra-Tabs) These are bacteriostatic antimicrobials. They interfere with protein synthesis.

Broad spectrum antimicrobials . Work against many gram-positive and gram-negative organisms.

also effective against atypical organisms mycoplasma and chlamydia pneumoniae, useful for patients allergic to penicillin b/c gram + coverage

PG 58

General Considerations

Not for use in children under age 8 . May cause discoloration of developing tooth enamel.

Not for pregnant women . May adversely affect fetal development. Most have the potential for causing phototoxicity .

Drug interaction with divalent (Mg, Ca, Fe) or trivalent (Al) compounds and tetracyclines may result in complexation and impaired absorption. Do not use together.

Broad spectrum activity can lead to thrush or vaginal candidias

PG 59

Macrolides

General Considerations:



Bacteriostatic – inhibit protein synthesis



May be good for patients who are hypersensitive to beta-lactam antimicrobials.



Good respiratory coverage

.

 CAP caused by S.pneumo, M.cat, H.flu or atypicals (mycoplasma, legionella, and chlamydia)

Erythromycin

Oral Products Erythromycin base (E-Mycin, Ery-Tab, PCE, Eryc)



Coating used on most products



Administer on an empty stomach Erythromycin stearate (Erythromycin Stearate, Wyamycin S)



Better absorbed than erythromycin base PG 59

Erythromycin (cont’d)

Erythromycin esolate (Ilosone)  Associated with cholestatic hepatitis  Better absorbed than erythromycin base Erythromycin ethylsuccinate (eryPed, E.E.S.)  Most well absrobed  Available in liquid form  400 mg of EES = 250 mg of erythromycin base

Parenteral Products

Erythromycin lactobionate Erythromycin glucepate

Drug Interactions:

Mainly due to enzyme inhibition of erythromycin – (3A4)

PG 59

PG 60

Clarithromycin (Biaxin)

Usually used BID. XL form used once daily.

Prodrug: May be given with or without meals

Used in combination with a proton pump inhibitor for H. pylori treatment.

Metallic taste

PG 60

Azithromycin (Zithromax)

More gram-negative activity than erythromycin or clarithromycin Once-daily dosing, usually for five days after otitis media (e.g., Z-Pack) Available as suspension, tablets, IV Suspension should not be taken with food or antacids.

Dirithromycin (Dynabac)

Prodrug Once-daily dosing

PG 61

Lincosamides

General considerations

Watch for pseudomembranous enterocolitis

(Clostridium difficile).

•Treat clostridium with metronidazole (Flagyl) or oral vancomycin.

Good in gram positive (staph) and gram-negative infections, particularly anaerobes

Lincomycin (Lincocin, Lincorex)

Morbilliform rash possible; DC drug if it happens

Clindamycin (Cleocin)

Available in topical form for acne

Which of the following antibiotics has bacteriostatic activity?

a. amoxicillin b. ciprofloxacin c. erythromycin d. penicillin e. cephalexin

Which of the following antibiotics has bacteriostatic activity?

a. amoxicillin (cell wall) b. ciprofloxacin (inhibits DNA gyrase) c. erythromycin (protein synthesis) d. penicillin (cell wall) e. cephalexin (cell wall)

PG 61

Aminoglycosides General Considerations

Glycosides – poorly absorbed from the GI tract Bactericidal Good for serious gram-negative pathogens (pseudomonas, proteus, etc.) Frequently administered with extended-action penicillin (

IV incompatible

) dosed q8h or q24h (conc. dependant kill) Eliminated by glomerular filtration; Watch for ototoxicity Monitor peaks and troughs – peaks 30 min after infusion, trough 30 minutes before next dose.

peak = 4-10ug/ml trough = 0.5-2, adjust dose if CrCl < 60ml/min. hearing test if prolonged therapy

Which of the following antimicrobial agents is available for parenteral use only?

I. cefaclor II. tobramycin III. ticarcillin a. I only b. III only c. I and II only d. II and III only e. I, II, and III

Which of the following antimicrobial agents is available for parenteral use only?

I. cefaclor II. tobramycin III. ticarcillin a. I only b. III only c. I and II only d. II and III only e. I, II, and III

PG 61

Parenteral use

Reference Peak Range Streptomycin sulfate Kanamycin sulfate (Kantrex) Gentamicin sulfate (Garamycin Tobramycin sulfate (Nebcin) (4mcg-10mcg/ml) (4mcg-10mcg/ml) Amikacin sulfate (Amikin) (15mcg-25mcg/ml) Netilmicin sulfate (Netromycin)

Which of the following antibiotics requires monitoring of serum levels? a. penicillin b. ceftazidime c. azithromycin d. gentamicin e. cephalexin

Which of the following antibiotics requires monitoring of serum levels? a. penicillin b. ceftazidime c. azithromycin d. gentamicin e. cephalexin

PG 62

Oral use

Not for systemic action Neomycin sulfate (Mycifradin) Used for bowel prep prior to surgery , treat diarrhea caused by e.coli, neomycin also binds ammonia, use in patients w/hepatic encephalopathy, watch for absorption interactions Tobramycin (TOBI) – inhaled product for CF patients

PG 62

Fluoroquinolones General Considerations - Inhibits DNA-Gyrase

May cause phototoxicity Not for patients under 18 – affects growth Do not use within 2-4 hours of antacids

;

iron – also inhibits CYP1A2 (increased levels of theophylline and caffeine) Generally useful for UTI, lower respiratory infections, gonorrhea, prostatitis – older agents have more gram -, less gram + coverage, newer agents have broader gram + [moxifloxacin, gatifloxacin] All end in

-oxacin

PG 62

Names

Second generation Norfloxacin (Noroxin) – high urine levels - UTIs Ciprofloxacin (Cipro) renal elimination: reduce dose Ofloxacin (Floxin) Third generation Levofloxacin (Levaquin) – renal elimination: reduce dose Sparfloxacin (Zagam) – reports of prolongation of QT interval (D/C) Gemifloxacin (Factive) – renal elimination: reduce dose, skin rash Fourth generation Moxifloxacin (Avelox) – (MDRSP) Multi-drug resistant Streptococcus pneumonia

MISCELLANEOUS ANTIMICROBIAL AGENTS

Antibacterials

Mupirocin (Bactroban) – topical use for impetigo, intranasal for staph Vancomycin (Vancocin) – associated with red man syndrome (must be infused slowly, over min of 30 minutes); reserved for serious/resistant gram + infections (MRSA, enterococcus) – rapid drop in BP accompanied by rash in neck or chest area - Monitoring – 1 hour before and 1 hour after - Peak – 25-40mcg/dl & Trough 5-12mcg/dl

PG 63

Metronidazole (Flagyl) – active against gram-negative organisms and protozoa, (anaerobes) Avoid alcohol. May darken urine.

PG 63

MISCELLANEOUS ANTIMICROBIAL AGENTS (cont’d)

Carbapenems

•broad spectrum; used for resistant gram +/– organisms, pseudomonas, MRSA, enterococcus, anaerobes •similar to penicillins (cross-sensitivity) but b-lactamase resistant •Risk of seizures and renal adjustment Imipenem/cilastatin (Primaxin) – cilastatin is a renal dipeptidase inhibitor Meropenem (Merrem)---lacks good pseudomonas coverage Doripenem (Doribax) Ertapenem (Invanz) ----Aztreonam (Azactam)---monobactam, ok with PCN allergy

Which of the following antibiotic is classified as a macrolide?

a. telithromycin b. tobramycin c. azithromycin d. doxycycline e. kanamycin

Which of the following antibiotic is classified as a macrolide?

a. telithromycin b. tobramycin c. azithromycin d. doxycycline e. kanamycin

MISCELLANEOUS ANTIMICROBIAL AGENTS (cont’d)

VRE and MRSA drugs

Quinupristin / dalfopristin (Synercid) – Linezolid (Zyvox) –……oral dosing available Tigecycline (Tygacil) – Chloramphenicol (Chloromycetin) – for typhoid fever; may cause aplastic anemia and gray baby syndrome

PG 63-64

 Organisms:

Pneumonia

 Treatment: --Comorbidities: Chronic obstructive pulmonary disease (COPD), diabetes, chronic renal failure, chronic liver failure, heart failure (HF), cancer, asplenia, immunosuppressed

 Treatment:

Pneumonia

--Risk factors for MDR organisms: recent antibiotic therapy (in last 90 days), hospitalized ≥ 5 days,  resistance in environment, nursing home resident, chronic dialysis, home infusion therapy, immunosuppressed

 Organisms:

Meningitis

 Treatment:

Urinary Tract Infection

 Organisms:  Treatment:

 Organisms:

STDs

 Treatment:

PG 64

Antitubercular Drugs

I R P E S

rifampin isoniazid pyrazinamide ethambutol streptomycin

Antitubercular Drugs

Isoniazid (Nydrazid, Laniazid)  May cause B 6 deficiency – supplement malnourished, alcoholics, kids  Used for prophylaxis or in combo with other drugs for active disease  6 months of prophylaxis if +PPD; For treatment used in combo with rifampin for at least 6 months  Metabolized by acetylation (slow versus rapid acetylators)  monitor for hepatoxicity Rifampin (Rifadin, Rimactane)  Potent enzyme inducer (potential drug interactions with many drugs)  Potentially hepatotoxic;  Use may result in discoloration of virtually all body fluids (urine and tears----watch contact lenses)

PG 64

Antitubercular Drugs (cont.)

Ethambutol (Myambutal) – for treatment of MAC and drug-resistant Tb as part of combination therapy - optic neuritis is a rare but serious side effect - monitor with eye exams Pyrazinamide – used in combination therapy; potentially hepatotoxic - may increase uric acid levels Steptomycin- can be used as fourth drug in regimen instead of pyrazinamide PG 65

Antimalarials

Quinine sulfate (Quinamm) – also used for muscle cramps; no longer used due to hematologic adverse effects Doxycycline – tetracycline; possible phototoxicity and binding interactions Melfoquine HCl (Lariam) – may cause neuropsychiatric adverse effects; once- weekly dosing Atovaquone/proguanil (Malarone) – newer product; once daily; do not use if renally impaired

PG 65

Antimalarials

Chloroquine (Aralen) – may worsen psoriasis symptoms Hydroxychloroquine sulfate (Plaquenil Sulfate) – may worsen psoriasis symptoms also used as a DMARD for RA; phototoxicity, hematological side effects, ocular and ototoxicity Primaquine phosphate – take with food to reduce GI upset; may be used for PCP

PG 66

PG 69

HIV Antiretroviral Therapy



Therapy initiated based on CD4 count, viral load and presence of symptoms

 Initial regimen in treatment naive patients: • •

NNRTI + 2 NRTIs PI + 2 NRTIs



Learn drug class representatives and major toxicities

Which HIV drug is correctly matched with its mechanism of action?

a. Lamivudine - nucleoside reverse transcriptase inhibitor b. Enfuvirtide - protease inhibitor c. Stavudine - binds to human CCR5 receptor d. Didanosine – protease inhibitor e. Indinavir – blocks virus entry into human cells and subsequent viral replication

Which HIV drug is correctly matched with its mechanism of action?

a. Lamivudine - nucleoside reverse transcriptase inhibitor b. Enfuvirtide - protease inhibitor c. Stavudine - binds to human CCR5 receptor d. Didanosine – protease inhibitor e. Indinavir – blocks virus entry into human cells and subsequent viral replication

NNRTIs

non-nucleoside reverse transcriptase inhibitors

(vir in the middle)

   Delavirdine (rescriptor) (rash, LFTs) Efavirenz (Sustiva) 

Drug of choice



Category X, vivid dreams

Nevirapine (Viramune) 

Rash (Steven Johnson Syndrom)



Liver metabolism

PIs Protease inhibitors (vir at the end)

Exception – darunavir, tenofovir, raltegravir, abacavir Metabolized through the liver (commonly 3A4) • potential for significant drug interactions Low dose of ritonavir frequently used to enhance the concentrations of coadministered PIs Adverse effects: GI intolerance, hyperglycemia, dyslipidemia, lipodystrophy, LFT alterations

PG 72

NRTIs

nucleoside reverse transcriptase

inhibitors (all the others)

Exception – maraviroc All NRTIs (except abacavir) are excreted renally; require dose adjustment but few drug interactions Most common ADRs – GI intolerance, typically subsides in first couple of weeks - High risk for perpheral neuropathy Black Box warning: Risk of lactic acidosis with hepatic steatosis

PG 69

PG 74

AIDS – Opportunistic Infections

 PCP / PJP (pneumocystis carninii pneumonia)  trimethoprim-sulfamethoxazole  CMV retinitis  Ganciclovir  MAC / MAI (mycobacterium avium complex)  Macrolide + ethambutol  Cryptococcus neuformans meningitis  Amphotericin B +/- flucytosine  Fluconazole used for maintenance

Drugs for influenza

M2 inhibitors Amantadine, rimantidine Effective for influenza A virus only Begin within 48h of symptom onset; continue 2-5 days Neuroaminidase inhibitors Oseltamivir (Tamiflu) Zanamivir (Relenza) Effective for influenza A and B viruses Begin with 48h of symptoms onset; continue 5 days

PG 74

Drugs for herpes simplex and herpes zoster (shingles)

Acyclovir (Zovirax) – for herpes simplex types 1 and 2 - dosed 5x/day for 10 days, 5 days if recurrence Penciclovir (Denavir) – topical treatment for herpes labialis (cold sores) Valacyclovir HCl (Valtrex) – for herpes simplex and herpes zoster; acyclovir prodrug Famcyclovir (Famvir) for herpes simplex and herpes zoster (shingles); penciclovir prodrug - begin therapy as soon as first sign of lesion Docosanol (OTC-Abreva) topical cream

PG 75

Anthelmintic drugs of choice

Nematodes (roundworm)  Mebendazole (Vermox) — do not use in pregnancy – blocks glucose uptake  Albendazole (Albenza) – of helminths degeneration of cytoplasmic microtubules intestinal cells  Piperazine citrate Preg B – blocks affect of ACH  Pyrantel pamoate (Antiminth) Trichuriasis (whipworm)  Mebendazole (do not use in pregnancy) Hookworm – mebendazole (do not use in pregnancy)

PG 75

Which of the following medication(s) can cause nephrotoxicity

?

I.

II.

Ganciclovir Foscarnet III.

Gentamicin

a. I only b. III only c. I and II only d. II and III only e. I, II, and III

Which of the following medication(s) can cause nephrotoxicity

?

I.

II.

Ganciclovir Foscarnet III.

Gentamicin

a. I only b. III only c. I and II only d. II and III only e. I, II, and III

Which of the following agents inhibits the HIV enzyme reverse transcriptase?

I. zanamivir II. ritonivir III. didanosine a. I only b. III only c. I and II only d. II and III only e. I, II, and III

Which of the following agents inhibits the HIV enzyme reverse transcriptase?

I. zanamivir (

Neuroaminidase inhibitors)

II. ritonivir

(protease inhibitor)

III. didanosine (

nucleoside reverse transcriptase inhibitors)

a. I only b. III only c. I and II only d. II and III only e. I, II, and III

PG 146 DERMATOLOGIC STUDY OUTLINE Acne Pathophysiology — abnormal keratinization leads to obstruction of the follicle and accumulation of sebum to form a closed comedo or “white-head” Goal of therapy is to unblock follicles

Normal Pore Inflamed Pore

Dermatologic Study Outline

PG 146

Dermatologic Study Outline

Isotretinoin (Accutane)

 Effective therapy option for the treatment of severe, inflammatory acne, or more moderate forms that have been refractory to other treatment options   pregnancy category X two forms of contrception, iPLEDGE program

Oral Antimicrobials

• Tetracycline • Erythromycin • Clindamycin

PG 146

Psoriasis

Pathophysiology — exact mechanism unknown. May be due to defects in epidermal cell cycle, AA metabolism, immunologic mechanisms, environmental triggers

PG 146 Treatment modalities

• Emollients (e.g., petrolatum) • Ultraviolet light • Coal tars (typically compounded) • Topical corticosteroids • Systemic corticosteroids (pulse dosing) • Antineoplastic agents (methotrexate, hydroxyurea) • Psoralens (pulse dosing) • Immunosuppressant agents (Etanercept, Efalizumab) • Retinoids (pulse dosing)

Which of the following psoriasis medications is not pregnancy category X?

I. Dovonex II. Methotrexate III. Soriatane A.

B.

C.

D.

E.

I only III only I and II only II and III only I, II and III

Which of the following psoriasis medications is not pregnancy category X?

I. Dovonex II. Methotrexate III. Soriatane A.

B.

C.

D.

E.

I only III only I and II only II and III only I, II and III

A patient presents to the pharmacy with obvious mild acne, which of the following cannot be recommended without a prescription?

a. Benzoyl peroxide 2.5% cream b. Sulfur soap c. Benzamycin gel d. Salicylic acid wash e. Benzoyl peroxide 10% lotion

A patient presents to the pharmacy with obvious mild acne, which of the following cannot be recommended without a prescription?

a. Benzoyl peroxide 2.5% cream b. Sulfur soap c. Benzamycin gel d. Salicylic acid wash e. Benzoyl peroxide 10% lotion

Fungal Infections

     Tinea corporis – body surface Tinea capitis – scalp Tinea cruris – groin (“jock itch”) Tinea pedis – feet (“athlete’s foot”) Onychomycosis – nails

PG 67-68 and 147

Therapy

Prophylaxis.

Keep skin dry; frequent changes and thorough cleaning of clothing; and avoid likely areas of contamination.

Active: Dusting powders (medicated versus nonmedicated), wet compresses Topical drug therapy

•

Fatty acids (undecylenic acid) • Haloprogin (Halotex) • Clotrimazole (Lotrimin) • Sulconazole (Exelderm) • Tolnaftate (Tinactin, Aftate) • Miconazole (Micatin,Monistat) • Oxiconazole (Oxistat) • Butenafine (Mentax)

Nystatin (Mycostatin, Nilstat) – good for superficial candida (thrush)

PG 147 Systemic drug therapy for topical fungal disorders

•

Griseofulvin (microsized versus ultramicrosized) • Terbinafine (Lamisil)

• Avoid corticosteroids

PG 67

Antifungal Drugs (cont’d)

Miconazole (Monistat, Micatin) – broad-spectrum antifungal agent available as powder, aerosol, cream, and suppository; may be used topically or vaginally Clotrimazole (Lotrimin, Mycelex) – broad-spectrum antifungal available as cream, lotion, suppositories, and troches (OTC use for 2 weeks after infection clears) Ketoconazole (Nizoral) – for superficial and systemic fungal infections; also available as OTC shampoo for dandruff; enzyme inhibitor Itraconazole (Sporanox) – for oral or topical treatment of superficial or systemic fungal disorders; enzyme inhibitor.

hepatotoxicity; take w/ food and avoid antacids

Antifungal Drugs (cont’d)

 Terbinafine (Lamisil) – used orally for onychomycosis of fingernail or toenail. Used topically for superficial tinea infections (OTC use for 1 week). Monitor for hepatoxicity with oral use.  Ciclopriox (Penlac) – applied topically once daily for treatment of onychomycosis. – requires long-term therapy

PG 67

Antifungal Drugs (cont’d)

 Griseofulvin (Grisactin, Grifulvin V, Fulvicin)  For tinea only  Duration of therapy • depends on type: corporis: 2-4 wks.; capitis: 4-6 wks., pedis: 4-8 wk  Regular versus microsized versus ultramicrosized • ultra is better absorbed; take w/ fatty meal • causes induction interactions

PG 67

PG 68

Antifungal Drugs (cont’d)

   Other Azoles  

Posaconazole (Noxafil) Voriconazole (Vfend)

• Reserved for severe invasive fungal infections (asperigillosis)

Echinocandins

(less DI, but monitor LFTs) 

Anidulafungin (Eraxis)

 

Caspofungin (Cancidas) Micafungin (Mycamine) Ampho B and related Lipid products

 nephrotoxicity

NAPLEX

Sample Questions

Which of the following antibiotics does not have a significant drug interaction with warfarin?

A.

B.

C.

D.

E.

ciprofloxacin azithromycin TMP-SMZ Metronidazole Nafcillin

Which of the following antibiotics does not have a significant drug interaction with warfarin?

A.

B.

C.

D.

E.

ciprofloxacin azithromycin TMP-SMZ Metronidazole Nafcillin

Which of the following medications is the best treatment option for an uncomplicated urinary tract infection?

A.

B.

C.

D.

E.

penicillin cefuroxime levofloxacin gentamicin clarithromycin

Which of the following medications is the best treatment option for an uncomplicated urinary tract infection?

A.

B.

C.

D.

E.

penicillin cefuroxime levofloxacin gentamicin clarithromycin

Which of the following antimicrobial agents is available for parenteral use only?

I.

II.

III.

A.

B.

C.

D.

E.

piperacillin aztreonam rifampin I only III only I and II only II and III only I, II and III

Which of the following antimicrobial agents is available for parenteral use only?

I.

II.

III.

A.

B.

C.

D.

E.

piperacillin aztreonam rifampin I only III only I and II only II and III only I, II and III

Which of the following agents is a non-nucleoside reverse transcriptase inhibitor?

A.

B.

C.

D.

E.

didanosine delavirdine stavudine zidovudine lamivudine

Which of the following agents is a non-nucleoside reverse transcriptase inhibitor?

A.

B.

C.

D.

E.

didanosine delavirdine stavudine zidovudine lamivudine

Which of the following agents may be utilized in combination with other medications for H. pylori eradication?

A.

B.

C.

D.

E.

tetracycline azithromycin penicillin fluconazole cefuroxime

Which of the following agents may be utilized in combination with other medications for H. pylori eradication?

A.

B.

C.

D.

E.

tetracycline azithromycin penicillin fluconazole cefuroxime

Peripheral neuropathy is associated with which one of the following agents:

A.

B.

C.

D.

E.

nevirapine delavirdine Saquinavir Stavudine tenofovir

Peripheral neuropathy is associated with which one of the following agents:

A.

B.

C.

D.

E.

Nevirapine (NNRTI) Delavirdine (NNRTI) Saquinavir (PI) Stavudine (NRTI) do not use with AZT (zidovudine) Tenofovir (NRTI)

Administration of calcium or iron must be separated by at least 2 hours if antibiotics in this category are prescribed:

I.

II.

III.

A.

B.

C.

D.

E.

Macrolides Tetracyclines Fluroquinolones I only III only I and II only II and III only I, II and III

Administration of calcium or iron must be separated by at least 2 hours if antibiotics in this category are prescribed:

I.

II.

III.

A.

B.

C.

D.

E.

Macrolides Tetracyclines Fluroquinolones I only III only I and II only II and III only I, II and III

Which of the following antimicrobial agents has effective coverage for M. pneumoniae?

A.

B.

C.

D.

E.

amoxicillin erythromycin metronidazole cefotriaxone clindamycin

Which of the following antimicrobial agents has effective coverage for M. pneumoniae?

A.

B.

C.

D.

E.

amoxicillin erythromycin metronidazole cefotriaxone clindamycin

Which of the following regimens is most appropriate for C. difficile eradication?

A.

B.

C.

D.

E.

Clarithromycin 500 mg PO q 12 hours Clindamycin 300 mg IV q 6 hours Vancomycin 125 mg PO q 6 hours Doxycycline 100 mg PO q 12 hours Vancomycin 1000 mg IV q 12 hours

Which of the following regimens is most appropriate for C. difficile eradication?

A.

B.

C.

D.

E.

Clarithromycin 500 mg PO q 12 hours Clindamycin 300 mg IV q 6 hours Vancomycin 125 mg PO q 6 hours Doxycycline 100 mg PO q 12 hours Vancomycin 1000 mg IV q 12 hours

Which agent is available in both a topical and an oral product for the treatment of acne?

I.

II.

III.

A.

B.

C.

D.

E.

clindamycin erythromycin doxycycline I only III only I and II only II and III only I, II and III

Which agent is available in both a topical and an oral product for the treatment of acne?

I.

II.

III.

A.

B.

C.

D.

E.

clindamycin erythromycin doxycycline I only III only I and II only II and III only I, II and III

Which of the following drugs represents first (primary) agents in the treatment of TB?

A.

B.

C.

D.

E.

Ethambutol + PASA Ciprofloxacin + PASA Isoniazid + rifampin Cycloserine + streptomycin Penicillin + Benemid

Which of the following drugs represents first (primary) agents in the treatment of TB?

A.

B.

C.

D.

E.

Ethambutol + PASA Ciprofloxacin + PASA Isoniazid + rifampin Cycloserine + streptomycin Penicillin + Benemid

Which of the following antibiotics is considered first line treatment for a gonorrhea infection?

A.

B.

C.

D.

E.

Ampicillin Ciprofloxacin Doxycycline Penicillin Tetracycline

Which of the following antibiotics is considered first line treatment for a gonorrhea infection?

A.

B.

C.

D.

E.

Ampicillin Ciprofloxacin (also..ceftriaxone, cefixime) Doxycycline (chlamydia) Penicillin Tetracycline

Which of the following groups of antibiotics may be prescribed for a gravid patient with gonorrhea?

I.

II.

III.

A.

B.

C.

D.

E.

cephalosporins fluoroquinolones tetracyclines I only III only I and II only II and III only I, II and III

Which of the following groups of antibiotics may be prescribed for a gravid patient with gonorrhea?

I.

II.

III.

A.

B.

C.

D.

E.

cephalosporins fluoroquinolones tetracyclines I only III only I and II only II and III only I, II and III

A gravid patient with a Chlamydia infection is likely to be prescribed which of the following antibiotics?

A.

B.

C.

D.

E.

Ampicillin Levofloxacin Doxycycline Erythromycin Penicillin

A gravid patient with a Chlamydia infection is likely to be prescribed which of the following antibiotics?

A.

B.

C.

D.

E.

Ampicillin Levofloxacin Doxycycline Erythromycin Penicillin

Which of the following is the BEST treatment for a patient with herpes zoster?

A.

B.

C.

D.

E.

Cidofovir Famciclovir Ganciclovir Penciclovir Tenofovir

Which of the following is the BEST treatment for a patient with herpes zoster?

A.

B.

C.

D.

E.

Cidofovir Famciclovir Ganciclovir Penciclovir Tenofovir

Which of the following medications would be appropriate for the treatment of Pseudomonas aeruginosa?

c.

d.

e.

a.

b.

Ampicillin Cefepime Ceftriaxone Erythromycin Clindamycin

Which of the following medications would be appropriate for the treatment of Pseudomonas aeruginosa?

c.

d.

e.

a.

b.

Ampicillin Cefepime Ceftriaxone Erythromycin Clindamycin