Medicinal Chemistry 561P. 2 st hour Examination. May 6, 2013 NAME: KEY. Good Luck!

Transcription

1 Medicinal Chemistry 561P 2 st hour Examination May 6, 2013 NAME: KEY Good Luck!

2 2 MDCH 561P Exam 2 May 6, 2013 Name: KEY Grade: Fill in your scantron with the best choice for the questions below: 1. Which bacterium is notably associated with potentially severe antibiotic associated diarrhea and colitis. A) Haemophilus influenzae B) Neisseria meninigitidis C) Clostridium difficile D) Helicobacter pylori 2. Which drug is associated with increased risk of pseudomembranous colitis? A) Penicillin G B) Clindamycin C) Metronidazole D) Erithromycin 3. Which are the most common bacterial species involved in acute otitis media (ear) infections: A) A. baumanii, E. coli., K. penumoniae B) H. influenzae, M. catarrhalis, S. pneumoniae C) H. influenzae, S. aureus, S. pyogenes D) P. aeruginosa, S. pyogenes, P. jiroveci 4. The following bacteria are most commonly associated with CAP (community acquired pneumonia): A) S. pneumoniae, H. influenzae, S. aureus B) K. penumoniae, P. aeruginosa, S. aureus C) PRSP, MRSA, C. difficile D) S. pyogenes, S. pneumoniae, P. aeruginosa 5. Empiric antibiotic therapy refers to: A) Testing a new antibiotic drug against a panel of common pathogens B) Use of a broad spectrum antibiotic in an attempt to control an infection prior to pathogen identification C) Starting antibiotic therapy with a narrow spectrum drug so as to minimize collateral damage to commensal flora D) Synonymous with prophylactic use of an antibiotic 6. Nafcillin could be used against which of the following pathogens: A) MRSA B) MSSA C) C. difficile D) Pseudomonas aeruginosa

3 3 7. Which of the following is a common drug combination used against Pseudomonas A) Piperacillin + Tazobactam B) Amoxicillin + Clavulanic acid C) Ampicillin + Streptomycin D) Ertapenem + Sulbactam 8. Cilastatin is combined with which beta-lactam, and for what purpose? A) Ertapenem; to prevent renal excretion of the active drug B) Doripenem; to inhibit activity of metallo beta-lactamase C) Imipenem; to prevent hydrolysis by dihydropeptidase in the kidneys D) Meropenem; to increase pepentration through pseudomonas porins 9. Which of the following is stable against (resistant to) penicillinases produced by MSSA (A) Pen G (B) Amoxicillin (C) Dicloxacillin (D) Piperacillin 10. Select the penicillin allergen that is a trigger for serious, immediate hypersensitivity reactions such as anaphylaxis? A) Protein conjugate of major determinant B) Protein conjugate of minor determinant C) Unmodified Benzylpenicillin D) Aztreonam 11. The Pre-Pen penicillin allergy test includes which components? A) Penicillin G B) Penicillin VK C) Benzylpenicilloyl major determinant D) Penicillenyl minor determinant 12. Which enzyme class and biological function is targeted by beta-lactams A) MurA and intracellular peptidoglycan precursor synthesis B) Autolysins and cell wall hydrolysis C) Transpeptidase and peptidoglycan crosslink formation during cell wall synthesis D) Lipopolysaccharides and Gram- outer membrane integrity 13. Select the drug that is a common therapeutic used in treatment of C. difficile infections. A) Vancomycin B) Cefepime C) Azithromycin D) Clindamycin

4 4 14. Vancomycin is most frequently administered IV but can be used orally (PO) for the treatment of what type of infection A) Strep pyogenes, complicated skin structure B) E. coli, urinary tract infection C) Pseudomonas aeruginosa, complicated respiratory tract infection in cystic fibrosis patients D) C. difficile overgrowth 15. The spectrum of activity for Aztreonam is best described as: A) Broad spectrum Gram+ B) Broad spectrum Gram- C) Anaerobes D) Protozoa 16. One distinguishing difference between ampicillin and amoxicillin is: A) Level of oral bioavailability B) Degree of enterohepatic recycling C) Allergenicity 17. Which cephalosporin is distinguished by its long half-life and hence requires less frequent dosing? A) Cefotaxime B) Ceftriaxone C) Ceftazidime D) Cephalexin 18. Choose the beta-lactam that could be an effective drug against MRSA and PRSP? A) Cetriaxone B) Doripenem C) Ceftaroline D) Aztreonam 19. Drugs such as cefazolin, cefotetan that contain the N-methylthiotetrazole (N-MTT) or N-MTD moiety are associated with what combination of adverse reactions? A) Neurotoxicity and seizures B) Bleeding reactions and alcohol hypersensitivity C) Muscle weakness and breathing difficulty 20. Which of the following statements applies to carbapenems A) Broad spectrum of activity including for some multi-drug resistant bacteria B) Resistance to Extended Spectrum Beta-lactamases (ESBLs) [Ertapenem may be a bit more susceptible to ESBLs but generally the carbapenems are stable] C) Relatively low level of toxicities

5 5 21. Carbapenemases such as NDM-1 have so far been found in which types of bacteria? A) S. pyogenes B) MRSA C) Enterobacteriaciae 22. Identify the drug that is least likely to be effective against C. difficile: A) Vancomycin B) Metronidazole C) Clindamycin D) Fidaxomicin 23. Metronidazole s mechanism of action involves: A) Membrane permeabilization B) Activation to a reactive radical species that leads to DNA damage C) Bacteriostatic inhibition of protein synthesis D) Inhibits the activity of an organic anion transporter 24. Clindamycin s spectrum of activity would be best characterized as: A) Anti-anaerobic with some Gram- coverage B) Broad spectrum Gram+ and Gram- anaerobic coverage C) Selective against C. Difficile D) Anti-anaerobic with some Gram+ coverage 25. Mark the selection that is false: A) Tetracyclines are not recommended for use in pregnant women and children due to deposition of the drug in bones and teeth B) Tetracyclines generally share the same spectrum of activity but different pharmacokinetics C) Tetracyclines should not be stored long term due to conversion to toxic compounds D) Resistance to tetracyclines is rare 26. Mark the selection that is true regarding tigecycline: A) Exhibits cross-resistance with minocyline B) Inactive against MRSA C) Active against NDM-1 producing Gram- bacteria D) Bactericidal 27. Infections involving anaerobic bacteria are frequently: A) Polymicrobial involving a mixture of aerobic, facultative anaerobes, and strict anaerobes B) Difficult to treat without initial tissue debridement and draining C) Involve commensal bacteria

6 6 28. Certain strains of Staph aureus are believed to have acquired resistance to vancomycin in the form of D-Ala-D-lactate peptide crossbridge usage from which other bacterial species: A) Klebsiella pneumonia B) Enterococcus faecium C) Haemophilus influenza D) Streptococcus pyogenes 29. Which of the following exhibits antagonistic interaction with Ampicillin, lowering its effectiveness: A) Streptomycin B) Vancomycin C) Tetracycline D) Probenecid 30. Which of the following is a reasonable drug choice for treatment of a Chlamydia infection: A) Azithromycin B) Vancomycin C) Gentamicin D) Metronidazole 31. Macrolides such as clarithromycin are frequently used in treatment of: A) Intraabdominal infections B) Respiratory tract infections C) Urinary tract infections D) Brain abcesses 32. Identify the macrolide that has antimicrobially active metabolic products: A) Erithromycin B) Azithromycin C) Clarithromycin D) Telithromycin 33. Which macrolide is less likely to exhibit drug-drug interactions: A) Telithromycin B) Azithromycin C) Erithromycin D) Clarithromycin 34. Choose the macrolide that has activity against penicillin-resistant Strep. pneumoniae (PRSP) A) Clarithromycin B) Azithromycin C) Telithromycin

7 7 D) All of them do 35. Select the most serious adverse effect associated with aminoglycosides that can have long-term consequences: A) Neurotoxicity B) Nephrotoxicity C) Ototoxicity D) Hepatotoxicity 36. Cross-resistance is likely among which set of antimicrobials: A) Beta-lactams and vancomycin B) Aminoglycosides and Beta-lactams C) Aminoglycisdes and tetracyclines D) Macrolides and Clindamycin 37. Indicated uses for aminoglycosides such as gentamicin include all but which one: A) C. difficile overgrowth B) Prophylactic cleansing of intestinal tract prior to surgery C) Septicemia D) Osteomyelitis 38. Which antibiotic would not be used as part of a multidrug regimen to treat bacterial infections responsible for stomach ulcers: A) Clarithromycin B) Metronidazole C) Benzylpenicillin D) Doxycycline 39. Mycoplasma pneumonia, often responsible for walking pneumonia, can be treated with a: A) Macrolide B) Clindamycin C) Cephalosporin D) Vancomycin 40. Which of the following is NOT an indicated use for metronidazole? A) Bacterial vaginosis B) Trichomonas vaginalis ( trich ) C) Gonorrhea D) Entamoeba histolytica infection