Post 4 Infect

Serious adverse reactions to the aminoglycoside antibiotics such as gentamicin are:

A. ringing in the ears and metallic taste in the mouth
B. kidney failure and loss of hearing
C. localized pain over the upper cheeks and eyes
D. liver failure



Infections caused by beta-lactamase producing bacteria may be treated with:

A. Use of a broad spectrum antibiotic such as amoxicillin.
B. An antibiotic with minimal oral absorbtion such as neomycin.
C. An antibiotic with a beta-lactam ring, such as penicillin.
D. An antibiotic prepared with an enzyme inhibitor such as clavulonate.



Drugs effective against tuberculosis include:

A. amphotericin B, fluconazole, nystatin
B. lamivudine, indinavir, zidovudine
C. vancomycin, amikacin, cefotaxime
D. rifabutin, ethambutol, isoniazid



Sue is a 19 year old sexually active female being seen in a family planning clinic for birth control. Her routine annual screening for chlamydia was positive despite being asymptomatic. She has no drug allergies. Should she be treated? With what drug(s), dose and for how long?

A. Yes, she should be treated with Zidovudine (x 7days) and Indinavir (x 7days) by mouth.
B. Yes, she should be treated with Mycostatin vaginal cream for 7 days.
C. Yes, she should be treated with Azithromycin (x 1 dose)
D. No, she does not need to be treated.



Robert is a 42-year-old prison guard whose annual TB skin test converted this year, with a 20-mm induration. He does not feel sick. Several of the inmates are receiving treatment for TB. What treatment if any should he receive?

A. 2 weeks of metronidazole
B. A single dose of streptomycin
C. 6-9 months of isoniazid
D. No treatment is needed.



With therapeutic doses of ticarcillin, brain (CSF) concentrations of 15 mcg/ml are acheivable. You get a report from the laboratory that there is a bacteria in the patient's CSF that has an ticarcillin "MIC" of 128 mcg/ml. This means:

A. You could treat the infection with ticarcillin.
B. You could treat the infection with ticarcillin, but it would have to be high dose.
C. The bacteria is resistant to ticarcillin.
D. The patient is allergic to ticarcillin.



Match the drug to its main mechanism of action.

Penicillin
Sulfonamides
Aminoglycosides
Flouroquinolones

a. inhibit protein synthesis
b. inhibit cell wall synthesis
c. inhibit nucleic acid syntheisis
d. antimetabolite, competition for folate



The main use of metronidazole is in the treatment of:

A. Superficial skin infections.
B. Intestinal amebias and anaerobic infections
C. Viral infections of the throat.
D. Malaria.



A patient insured by Aetna has an infection and is being considered for therapy with Zyvox (Linezolid). You know that:

A. Aetna will not permit their customers to have Zyvox.
B. Prior approval is required to have insurance pay for the Zyvox (Linezolid).
C. Aetna prefers this inexpensive, effective drug treatment for vancomycin and methicillin susceptible infections.
D. Aetna will only pay for this drug if the patient has been insured by Aetna for over 3 years.



While making a home visit to a patient, you want to verify that the patient understands his medications. The patient tells you he took his cefuroxime once a day for the first 3 days, then twice a day for 3 days and now he is up to three times a day. Which would be your best response?

A. And were you able to tolerate the side effects alright building up to a therapeutic dose like that?
B. May I see the directions on the bottle? That's a very unusual way to take an antibiotic.
C. You must have had a previous allergy to that medicine. Are you having any rashes or difficulty breathing now?
D. Will you increase the dose again or stay at 3 tablets each day?



Ototoxicity (ear) and nephrotoxicity (kidney) are serious side effects of which of the following drug classes?

A. aminoglycosides
B. rifampins
C. penicillins
D. sulfonamides



Which of the following drug(s) is/are used in the treatment of tuberculosis?

A. azithromycin and ciprofloxacin
B. rifampin and isoniazid
C. phenazopyridine
D. echinacea



Michael is a 10-month-old seen in a primary care office with a 4-day history of runny nose. Yesterday he was rubbing his ear and was described by his mother as being "cranky". He looks sick and has a high fever 39.5). Tympanic membranes in his ears are red and swollen. He has not been treated for ear infections in the past and has no known allergies. Should he be treated? What medicine might be appropriate?

A. Yes, he should be hospitalized and treated with intravenous vancomycin for 14 days.
B. No, he does not require treatment. He probably has a viral irritation of the ear which will resolve on its own without treatment. Over-prescribing antibiotics lead to resistance.
C. Yes, he should be treated as an outpatient with ampicillin for 10 days.
D. Yes, he should be treated as an outpatient with oral vancomycin for 7 days.



You go to employee health after being stuck deep into your muscle with a needle containing blood from a patient with end-stage AIDS. Which of the following should happen?

A. You will be placed on broad spectrum antibiotics such as imipenem and taken to the operating room to have the wound thoroughly cleaned out.
B. It will be recommended that you take zidovudine, lamivudine and perhaps indinavir, starting within hours of the needlestick.
C. You will be offered zidovudine as single drug therapy.
D. Nystatin (MYCOSTATIN) will be applied topically to the wound after it has been thoroughly cleaned.



Match the drug to its mechanism of action or target organism.

Rifampin
Trimethoprim
Cephalosporins

a. interferes with folic acid metabolism
b. inhibit nucleic acid synthesis
c. inhibits cell wall synthesis



The main use of tetracyclines is in the treatment of:

A. Skin, lung and urinary tract infections.
B. Infections in pregnant women and infants.
C. Viral infections of the throat.
D. Malaria.



A patient insured by Medical has a fungal infection and is being considered for therapy with Sporanox (Itraconazole). You know that:

A. Patients on Medical cannot get Sporanox.
B. Prior approval is required to have Medical pay for the Sporanox.
C. Medical prefers this inexpensive, effective drug treatment for all fungal infections.
D. Sporanox is not effective against fungal infections.



Azithromycin can be useful for treating:

A. Some community-acquired pneumonias and sexually transmitted infections
B. Inflammatory pain in the joints not responsive to NSAIDS
C. Seizures in patients allergic to macrolides
D. Drug resistant strains of HIV



Additional Questions

You are splashed on your intact skin with normal looking, yellow urine from an HIV positive patient. Center for Disease Control Guidelines would advise you to:

A. Take a 4 week course of zidovudine, lamivudine, and indinavir.
B. Take a single dose of fluconazole (DIFLUCAN), and have an HIV test done.
C. Take a 6 month course of metronidazole (FLAGYL).
D. No prophylaxis will be offered.



Martha is a 70-year-old female who is brought from home to the emergency department by her daughter with a three-day history of "flu" and a one-day history of coughing purulent sputum. She has no co-morbidities except mild congestive heart failure. Her vital signs are: temp 38.1, pulse 100, respirations 26, BP130/80, 92% oxygen saturation on room air. Chemistries labs are normal. The WBC is 16,000 with left shift indicating new infection. Her chest X-ray shows an abnormal consolidation but no effusion. She is allergic to penicillin, which caused a rash.Should she receive drug treatment for an infection?

A. Yes, she should receive a single dose of oral vancomycin and followed up as an outpatient.
B. No treatment is needed. This pneumonia is probably caused by a virus, so she just needs some tike to get better.
C. Yes, she should be treated in the hospital with intravenous ampicillin for 2 weeks.
D. Yes, a fluroquinolone such as levofloxacin would be effective outpatient treatment.