CME/CE QUIZ CME/CE QUESTIONS. a) 20% b) 22% c) 34% d) 35% b) Susceptible and resistant strains of typical respiratory

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1 CME/CE QUIZ CME/CE QUESTIONS Continuing Medical Education Accreditation This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Postgraduate Institute for Medicine and Advanced Concepts Institute. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians. The Postgraduate Institute for Medicine designates this educational activity for a maximum of 1.75 Category 1 credits toward the AMA Physician s Recognition Award. Each physician should claim only those credits that he/she Continuing Education Accreditation The Philadelphia College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. The Philadelphia College of Pharmacy designates this educational activity (# H01) acceptable for 1.8 continuing education credits (0.18 CEUs). Each pharmacist should claim only those credits that he/she Method of Participation There are no fees for participating and receiving credit for this activity. During the period October 15, 2004, through October 31, 2006, participants must (1) read the educational objectives and faculty disclosures; (2) study the educational activity; (3) complete the post-test by recording the best answer to each question in the answer key on the evaluation form; (4) complete the evaluation form; and (5) mail or fax the evaluation form with answer key to Advanced Concepts Institute, 600 South 43rd Street, Philadelphia, PA 19104, Fax (215) A statement of credit will be issued only upon receipt of a completed activity evaluation form and a completed posttest with a score of 70% or better. Your statement of credit will be mailed to you within 3 weeks. Media Printed Journal Supplement Instructions After reading The Management of Respiratory Tract Infections: A Focus on Appropriate Antibiotic Utilization, complete the program evaluation and select the 1 best answer to each of the following questions. A statement of continuing education hours will be mailed to those who successfully complete (a minimum score of 70%) the examination at the conclusion of the program. 1. Which of the following community-acquired respiratory tract infections (CARTIs) can be described as an infection of the lung parenchyma? a) Acute exacerbations of chronic bronchitis b) Acute rhinosinusitis c) Community-acquired pneumonia (CAP) d) Acute otitis media 2. What percentage of Streptococcus pneumoniae is multidrug resistant? a) 20% b) 22% c) 34% d) 35% 3. Which of the following pathogens are responsible for up to 20% of CAP cases? a) S pneumoniae, Haemophilus influenzae, Moraxella catarrhalis b) Legionella spp, H influenzae, S pneumoniae c) S pneumoniae, Mycoplasma pneumoniae, Legionella spp d) Legionella spp, M pneumoniae, Chlamydia pneumoniae 4. An agent expected to successfully combat a CARTI should cover which of the following organisms? a) Susceptible and resistant strains of typical respiratory pathogens as well as atypical respiratory pathogens b) Susceptible and resistant strains of typical respiratory pathogens, atypical respiratory pathogens, as well as gram-negative pathogens c) Susceptible strains of typical respiratory pathogens, atypical respiratory pathogens, as well as gram-negative pathogens d) Resistant strains of typical respiratory pathogens, atypical respiratory pathogens, as well as gramnegative pathogens 5. Which of the following forms of bacterial resistance is relevant to antibiotic structure? a) Prolonged exposure of a pathogen to subtherapeutic levels of an antibiotic selecting for resistant strains b) Mutation of the antibiotic binding site preventing antibiotic action c) Exposure of pathogens to suboptimal bacterial kill leaving stronger/resistant pathogens to survive d) Exposure to bacteriostatic agents 6. What 2 antibiotic characteristics are key in the development of antibiotic resistance? a) Bactericidal activity and the potential to induce future antibiotic resistance b) Spectrum of activity and half-life c) Spectrum of activity and the potential to induce future antibiotic resistance d) Bactericidal activity and potency S408 THE AMERICAN JOURNAL OF MANAGED CARE OCTOBER 2004

2 CME/CE QUIZ 7. What chemical structure modification enables the ketolides to overcome the most common forms of bacterial resistance? a) Addition of an alkyl-aryl group at positions 11/12 b) Addition of a 6-methoxy group c) Removal of the D-cladinose moiety d) Replacement of the L-cladinose moiety with a 3-ketone 8. How do the ketolides exert their antimicrobial activity? a) Inhibition of deoxyribonucleic acid gyrase and topoisomerase I.V. b) Prevention of the translation of bacterial messenger ribonucleic acid c) Inhibition of the biosynthesis of cell wall mucopeptide d) Competitive antagonism of folic acid synthesis 9. What percentage of multidrug-resistant S pneumoniae isolates was susceptible to telithromycin at 1 mg/ml in the Prospective Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin study? a) >99% b) 95%-99% c) 90%-94% d) <90% 10. Which of the following medications are contraindicated with the coadministration of telithromycin? a) Pimozide and cisapride b) Itraconazole and ketoconazole c) Simvastatin and lovastatin d) Theophylline and paroxetine 11. Clinical trials of telithromycin have found that telithromycin 800 mg once daily for 5 days was. a) As effective as cefuroxime axetil 500 mg twice daily for 5 days b) More effective than trimethoprim/sulfamethoxazole 160 mg/800 mg 4 times daily for 10 days c) Less effective than clarithromycin 500 mg twice daily for 10 days d) As effective as amoxicillin/clavulanate 500 mg/125 mg 3 times daily for 10 days 12. Which of the following was the most common treatment-related adverse event in patients receiving telithromycin? a) Dizziness b) Vomiting c) Diarrhea d) Headache 13. In a rank order of the leading causes of death in the United States, CAP ranks. a) 4th b) 5th c) 6th d) 7th 14. In an examination of an administrative claims database of a national employer from the years , the hospitalization rate for patients younger than 65 years of age for CAP was. a) 11.8% b) 19.6% c) 28.4% d) 39.2% 15. The majority of the treatment costs (93.7%) for acute exacerbations of chronic bronchitis (AECB) are the result of. a) Outpatient costs b) Medication costs c) Hospital costs d) Physician visits 16. Current recommendations from the Infectious Diseases Society of America for empiric antibiotic selection in CAP are based on. a) Severity of illness, resistance patterns of S pneumoniae, comorbid conditions, and cost of therapy b) Severity of illness, pathogen probabilities, comorbid conditions, and cost of therapy c) Severity of illness, pathogen probabilities, resistance patterns of S pneumoniae, and cost of therapy d) Severity of illness, pathogen probabilities, resistance patterns of S pneumoniae, and comorbid conditions 17. In calculating the true economic cost of pharmaceuticals, which of the following indirect costs should be considered? a) Costs of medical care, adverse events, medication acquisition, clinical monitoring b) Costs of medical care, adverse events, medication acquisition, treatment failures c) Costs of medical care, adverse events, clinical monitoring, treatment failures d) Costs of medical care, medication acquisition, clinical monitoring, treatment failures 18. When examining health economic outcomes data for various antibiotics used to treat CAP and AECB, what factor drove significant cost differences? a) I.V. antibiotic use b) Length of hospital stay c) Emergency room visits d) Outpatient visits VOL. 10, NO. 12, SUP. THE AMERICAN JOURNAL OF MANAGED CARE S409

3 CME/CE EVALUATION The Management of Respiratory Tract Infections: A Focus on Appropriate Antibiotic Utilization EVALUATION FORM ACPE Number: H01 Mail or fax this form by October 31, 2006: (Mail) Advanced Concepts Institute 600 South 43rd Street, Philadelphia, PA (Fax) NAME AND ADDRESS INFORMATION (please print clearly) Pharmacist Physician Other LAST NAME FIRST NAME INITIAL CREDENTIALS POSITION/TITLE MAILING ADDRESS CITY STATE ZIP ADDRESS TELEPHONE (WITH AREA CODE) FAX (WITH AREA CODE) EVALUATION Excellent Good Satisfactory Poor Accuracy and timeliness of content Relevance to your clinical practice Freedom from commercial bias Relationship of objectives to overall purpose of activity Relevance of the content to the learning objectives Extent to which the learning objectives were met Explain the various community-acquired respiratory tract infections and current treatment options Describe the emerging resistance patterns of respiratory tract pathogens to antibiotics in both hospital- and community-acquired infections Evaluate current and future pharmacologic options for the management of respiratory tract infections by comparing and contrasting antibiotic profile characteristics such as spectrum of coverage, risk of resistance, pharmacokinetics, and pharmacodynamics A103 S410 THE AMERICAN JOURNAL OF MANAGED CARE OCTOBER 2004

4 CME/CE EVALUATION EVALUATION (continued) Excellent Good Satisfactory Poor Discuss formulary decision-making strategies that may limit antimicrobial resistance and improve outcomes Discuss the pharmacoeconomic outcomes of various antibiotic regimens Effectiveness of the teaching methods Effectiveness of the learning materials Level of difficulty of this activity Did this activity add to your knowledge? Yes Somewhat No Will this information help in your practice? Yes Somewhat No Comments or topics for future activities The Management of Respiratory Tract Infections: A Focus on Appropriate Antibiotic Utilization ANSWERS (refer to the CME/CE Quiz on page S408) a b c d a b c d a b c d a b c d A103 VOL. 10, NO. 12, SUP. THE AMERICAN JOURNAL OF MANAGED CARE S411

5 The Management of Respiratory Tract Infections: A Focus on Appropriate Antibiotic Utilization GOAL The goal of the supplement will be to educate managed care professionals about the influence of inappropriate antibiotic utilization for the treatment of community-acquired respiratory tract infections and its impact on antimicrobial resistance. This supplement will also present new strategies for optimizing antibiotic utilization and improving clinical outcomes. TARGET AUDIENCE This continuing education activity has been designed for managed care physicians and pharmacists who practice in or are interested in the field of infectious disease. EDUCATIONAL OBJECTIVES Upon completion of the activity, participants should be better able to: Explain the various community-acquired respiratory tract infections and current treatment options. Describe the emerging resistance patterns of respiratory tract pathogens to antibiotics in both hospitaland community-acquired infections. Evaluate current and future pharmacologic options for the management of respiratory tract infections by comparing and contrasting antibiotic profile characteristics such as spectrum of coverage, risk of resistance, pharmacokinetics, and pharmacodynamics. Discuss formulary decision-making strategies that may limit antimicrobial resistance and improve outcomes. Discuss the pharmacoeconomic outcomes of various antibiotic regimens. CONTINUING MEDICAL EDUCATION CONTINUING EDUCATION Accreditation Statement This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Postgraduate Institute for Medicine and Advanced Concepts Institute. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians. The Postgraduate Institute for Medicine designates this educational activity for a maximum of 1.75 category 1 credits toward the AMA Physician s Recognition Award. Each physician should claim only those credits that he/she CONTINUING PHARMACY EDUCATION Accreditation Statement The Philadelphia College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. The Philadelphia College of Pharmacy designates this educational activity (# H01) acceptable for 1.8 continuing education credits (0.18 CEUs). Each pharmacist should claim only those credits that he/she Release date: October 15, Expiration date: October 31, Estimated time to complete activity: 1.75 hours. This program is supported by an educational grant from Sanofi-Aventis Pharmaceuticals. This activity is developed and managed by Advanced Concepts Institute. THE AMERICAN JOURNAL OF MANAGED CARE