Review questions on Antibiotics and Antiviraldrugs

True/ False
1.Bacterial static effect is destroying bacterial cells………………………..

2.Penicillin is the drug of choice for chlamydia………………………………

3.In cancer treatment cell cycle drugs work in any phase of the cell cycle…………

4.The antidote for heparin is protamine sulfate……………………………..

5.The drug of choice for pseudomembranous colitis or C. Difficile is

Vancomycin…….

6.Erythromycin can be used in the treatment of pneumonia for patients allergic

with penicillin ……….

7. Warfarin can cross the placenta , therefore not recommended during

pregnancy…………

8. Antibiotics can be used in the treatment of cancer………………………….

9. Pulmonary fibrosis may be associated with bleomycin…………………

10. Anticonvulsants are used for the treatment of fibromyalgia…………

11. Plavix is used to prevent deep vein thrombosis………………..

12. The antidote for Dabigatran ( Pradaxa ) is vitamin K or fresh frozen plasma……

13. Opioids withdrawal is associated with diarrhea………………………………

14. Amantadine is an antiviral drug used for influenza…………………….

15. Aspirin is associated with Reyes syndrome in children under the age of 12……

16. Opioids are generally used for acute pain………………………………….

17. The drug of choice for herpes acyclovir (Valtrex)………………………….

18.This above patient has a viral infection……………………………….
19.People that are allergic to penicillin are also allergic to cephalosporins…………….

20.Red man syndrome is associated with vancomycin……………………….

Part II
1.The drug of choice for Lyme disease is :
a)Amantadine
b)Valtrex
c)Penicillin
d)Doxycycline

2. The drug of choice for syphilis treatment is:

a) Gentamycin
b) Penicillin
c) Chloramphenicol
d) Doxycycline

3.The patient’s INR is 5.5 . The nurse will :

a)Recheck the lab value
b)Notify the doctor
c)Administer warfarin (Coumadin)
d)Hold the warfarin and notify the physician.

4.The patient with tuberculosis is now on isoniazid (INH) . Which laboratory test
should the nurse monitor ?
a)PT and PTT
b)CBC
c)BUN
d)Liver enzymes

5. Bactericidal effect is:

a) Inhibition of bacterial cell division
b) Inhibition of young bacterial cell growth
c) Destroying of bacterial cells
d) Formation of bacterial L-form

6. A patient is receiving an NSAID , so the nurse monitors the patient for :

a)GI upset and bleeding
b)Urinary retention
c)Blurred vision
d)Anorexia

7. Since a patient is allergic to aspirin , the nurse administers what drug as an

alternative for relief of mild pain ?
a)Acetaminophen
b)Morphine
c)Etodolac
d)Fentanyl

8. Which of the following groups of antibiotics demonstrates a bactericidal effect?

a) Tetracyclines
b) Macrolides
c) Penicillins
d) All of the above
9. Vancomicin has the following unwanted effects:
a) Pseudomembranous colitis
b) Hepatotoxicity
c) “Red neck” syndrome, phlebitis
d) All of the above

10. Which of the following drugs is used for systemic and deep mycotic infections
treatment:
a) Co-trimoxazol
b) Griseofulvin
c) Amphotericin B
d) Nitrofungin

11. Prior to administering pain medication, the nurse obtained which of the
following information about the patient’s pain ?
a)The patient’s diagnosis
b)The location of the pain
c)When the patient last has a meal
d)The severity of the pain

12. Aminoglycosides have the following unwanted effects:

a) Pancytopenia
b) Hepatotoxicity
c) Ototoxicity, nephrotoxicity
d) Irritation of gastrointestinal mucosa

13. The patient is receiving enoxaparin(lovenox) subcutaneously every 12 hours

following knee replacement surgery. The nurse monitors the patient for :
a)Gingival hyperplasia
b)Signs and symptoms of bruising and bleeding
c)Clotting at the incision site
d)Increased pain

14. The patient is receiving warfarin (Coumadin) .Which of the following

laboratory tests should the nurse check to ensure that clottingtime stays within the
therapeutic level ?
a)Prothrombin time (PT)
b)International normalized ratio (INR) and PT
c)Activated partial thromboplastin time (aPT)
d)INR

15. Tetracyclines have following unwanted effects:

a) Irritation of gastrointestinal mucosa, phototoxicity
b) Hepatotoxicity, anti-anabolic effect
c) Dental hypoplasia, bone deformities
d) All of the above

16.Which is not an indication for Acyclovir

(Zorivax)
A. HSV 1 / 2
B
CMV
.
C
Varicella
.
D. HPV
E. None of the above

17.
 These patients are suffering from
A. Varicella chickenpox
B. Kaposi sarcoma
C. Varicella zoster
D
None of the above
.

18.Which of these is a unique side effect for cyclophosphamide?

A. Alopecia
B. Bone marrow suppression
C. Gastroenterocolitis
D
Hemorrhagic cystitis
.

19.Excessive anticoagulant effect in bleeding due to warfarin can be

reversed by:

A) stopping the drug

B) large doses of vitamin K
C) factor IX concentrates
D) cholestyramine
E) diuretics

20.What does the term “antibiotics” mean:

A) Non-organic or synthetic substances that selectively kill or inhibit the growth of
other microorganisms
B) Substances produced by some microorganisms and their synthetic analogues
that selectively kill or inhibit
the growth of another microorganisms
C) Substances produced by some microorganisms and their synthetic analogues
that inhibit the growth of organism cells
D) Synthetic analogues of natural substances that kill protozoa and helminthes.

21.The indication for interferon alpha administration is:

a) Hepatitis C virus infection
b) Kaposi's sarcoma
c) Condyloma acuminatum
d) All of the above

22.Side effects of aspirin include following:

a) Gastric upset (intolerance)
b) Salicylism (vomiting, tinnitus, decreased hearing, and vertigo)
c) Gastric ulcers and upper gastrointestinal bleeding
d) All of the above

23. The patient is experiencing opioid dependency . The nurse would expect which
drug to be used to treat this condition ?
a)Oxycodone (Oxycontin)
b)Tramadol (Ultram)
c)Hydromorphone (Dilaudid)
d)Methadone (Dolophine)

24.Indication of glucocorticoids is:

a) Chronic (Addison’s disease) and acute adrenocortical insufficiency
b) Organ transplants (prevention and treatment of rejection – immunosuppression)
c) Inflammatory conditions of bones and joints (arthritis, bursitis, tenosynovitis).
d) All of the above

25. Which of the following drugs is fiibrinolytic?

a) Ticlopidine
b) Streptokinase
c) Aspirin
d) Warfarin

True/False
1.Alpha blockers can be both used to treat hypertension and benign prostate
hyperplasia in men………………..

2.Spironolactone (Aldactone) , a diuretic used as an antihypertensive drug for

reducing edema…………….

3.ARB’s are drug of choice for the treatment of hypertension in the African
American population………………….

4.African American men have the highest rate of HTN worldwide…………..

5.ACE inhibitors are drugs of choice in pregnanacy………………………..

6.Furosemide (Lasix) is the most potent diuretic drug………………………………..

7.Hypoplastic heart or Ebstein anomaly in a newborn , is one of the side effect
of ACE inhibitors when prescribed during pregnancy……………..

8.Clonidine is associated with rebounding hypertension when the patient stops

taking it…………
9.Myocardial Infarction can lead to congestive heart failure…………………………

10.Propanolol can be used to treat HTN in diabetic patients………………………

Part II
1.Mr Novi has eventually been placed in Digoxin and Furosemide. Which of the
following adverse effects of furosemide should nurse tell the patient about
because it could lead to dysrhythmias and other cardiac disease while taking
digoxin ?
A) Hypotension
B) Bradycardia
C) Hypokalemia
D) Hyperkalemia

2.The nurse takes a patient’s blood pressure at 142/92 mm Hg . In an adult

patient , this level is considered :
A) Normal
B) Prehypertension
C) Hypertension stage I
D) Hypertension stage II
3.When taking diuretics , the patient is instructed to decrease or avoid the intake
of:
A) Dark green, leafy vegetables
B) Nuts
C) Fruits
D) Caffeine

4.The patient is receiving IV normal saline because of hyponatremia . On

assessment the nurse determines that the hyponatremia may have been caused
by :
A) Constipation
B) Severe diarrhea and vomiting
C) Hemorrhage
D) Diabetes

5.The drug of choice for the treatment of hypertension in African Americans is :

A) Acetazolamide (Diamox)
B) Furosemide (Lasix)
C) Hydrochorothiazide (Hydrodiuril)
D) Amiloride (Midamor)

6.The drug can cause ototoxicity:

A) Acetazolamide (Diamox)
B) Furosemide (Lasix)
C) Hydrochlorothiazide (Hydrodiuril)
D) Amiloride (Midamor)
7.Hydralazine (a vasodilator) can produce:
A) Seizures, extrapyramidal disturbances
B) Tachycardia, lupus erhythromatosis
C) Acute hepatitis
D) Aplastic anemia

8.This drug is contraindicated in patients with bronchial asthma:

A) Propranolol
B) Clonidine
C) Enalapril
D) Nifedipine

9.The patient has developed a cough and shortness of breath when he or she lies
down . After thoroughly collecting data on the patient, the nurse suspects :
A) Right Heart Failure
B) Left Heart Failure
C) Liver engorgement
D) Peripheral edema

10.This drug inhibits the angiotensin-converting enzyme:

a) Captopril
b) Enalapril
c) Ramipril
d) All of the above

11.This drug reduces blood pressure by acting on vasomotor centers in the CNS:
A) Labetalol
B) Clonidine
C) Enalapril
D) Nifedipine
12.The patient has been started on antihypertensives. The nurse monitors the
A) Nausea and vomiting
B) Diarrhea
C) Dizziness
D) Tetany

13.The patient is on ACE inhibitor . As the result of this therapy , the nurse checks
for which of the following :
A) Hypokalemia
B) Hyperkalemia
C) Hypernatremia
D) Hyperglycemia

14.Drugs most commonly used in chronic heart failure are:

A) Cardiac glycosides
B) Diuretics
C) Angiotensin-converting enzyme inhibitors
D) All the above

15.The drug is one of the most potent diuretics:

A) Acetazolamide (Diamox)
B) Furosemide (Lasix)
C) Hydrochlorothiazide (Hydrodiuril)
D) Amiloride (Midamor

Drugs for bacterial infections

1.General principles of anti-infective therapy are:

a) Clinical judgment of microbiological factors
b) Definitive identification of a bacterial infection and the microorganism’s
susceptibility
c) Optimal route of administration, dose, dosing frequency and duration of
treatment
d) All of the above

2.Minimal duration of antibacterial treatment usually is:

a) Not less than 1 day
b) Not less than 5 days
c) Not less than 10-14 days
d) Not less than 3 weeks

3.Rational anti-microbial combination is used to:

a) Provide synergism when microorganisms are not effectively eradicated with a
single agent alone
b) Provide broad coverage
c) Prevent the emergence of resistance
d) All of the above

4.Bactericidal effect is:

a) Inhibition of bacterial cell division
b) Inhibition of young bacterial cell growth
c) Destroying of bacterial cells
d) Formation of bacterial L-form

5.Which of the following groups of antibiotics demonstrates a bactericidal effect?

a) Tetracyclines
b) Macrolides
c) Penicillins
d) All of the above

6.Tick the drug belonging to antibiotics-macrolides:

a) Neomycin
b) Doxycycline
c) Erythromycin
d) Cefotaxime

7.Tick the drug belonging to antibiotics-tetracyclines:

a) Doxycycline
b) Streptomycin
c) Clarithromycin
d) Amoxacillin
8.Antibiotics inhibiting the bacterial cell wall synthesis are:
a) Beta-lactam antibiotics
b) Tetracyclines
c) Aminoglycosides
d) Macrolides

9.Which of the following drugs is the drug of choice for the treatment of syphilis :
a) Penicillin G
b) Penicillin V
c) Carbenicillin
d) Procain penicillin

10.Cephalosporines are drugs of choice for treatment of:

a) Gram-positive microorganism infections
b) Gram-negative microorganism infections
c) Gram-negative and gram-positive microorganism infections, if penicillins have
no effect
d) Only bacteroide infections

11.Tetracyclins have following unwanted effects:

a) Irritation of gastrointestinal mucosa, phototoxicity
b) Hepatotoxicity, anti-anabolic effect
c) Dental hypoplasia, bone deformities
d) All of the above

12.Tick the drug belonging to antibiotics-aminoglycosides:

a) Erythromycin
b) Gentamycin
c) Vancomycin
d) Polymyxin

13.Aminoglycosides have the following unwanted effects:

a) Pancytopenia
b) Hepatotoxicity
c) Ototoxicity, nephrotoxicity
d) Irritation of gastrointestinal mucosa

14.Ampicillin and Clindamycin have the following unwanted effect:

a) Nephrotoxicity
b) Cancerogenity
c) Pseudomembranous colitis
d) Irritation of respiratory organs

15.Vancomicin has the following unwanted effects:

a) Pseudomembranous colitis
b) Hepatotoxicity
c) “Red man” syndrome, phlebitis
d) All of the above

16.True or False
- Nosocomial infections are one of the top 10 causes of death.

17.True or False
- As a general rule, community acquired infections are not as
severe and usually easier to treat.

18.True or False

Opportunistic Pathogens Likely to occur with severe burns

Antifungal drugs

1.Which of the following drugs is used for systemic and deep mycotic infections
treatment:
a) Co-trimoxazol
b) Griseofulvin
c) Amphotericin B
d) Nitrofungin

2.Which of the following drugs is used for dermatomycosis treatment:

a) Nystatin
b) Griseofulvin
c) Amphotericin B
d) Vancomycin

3.Which of the following drugs alters permeability of Candida cell membranes:

a) Amphotericin B
b) Ketoconazole
c) Nystatin
d) Terbinafine

4.Amphotericin B has the following unwanted effects:

a) Psychosis
b) Renal impairment, anemia
c) Hypertension, cardiac arrhythmia
d) Bone marrow toxicity

More on antibacterial drugs

1.Sulfonamides are effective against:

a) Bacteria and Chlamidia
b) Actinomyces
c) Protozoa
d) All of the above

2.Resorptive sulfonamides have the following unwanted effects on blood system:

a) Hemolytic anemia
b) Thrombocytopenia
c) Granulocytopenia
d) All of the above

3.Tick the drug, which is effective against mycobacteria only:

a) Isoniazid
b) Streptomycin
c) Rifampin
130
d) Kanamycin

4.Tick the antimycobacterial drug belonging to first-line agents:

a) PAS
b) Isoniazid
c) Kanamycin
d) Pyrazinamide
5.Rifampin has the following unwanted effect:
a) Dizziness, headache
b) Loss of hair
c) Flu-like syndrome, tubular necrosis
d) Hepatotoxicity

6.Isoniazid has following unwanted effect:

a) Cardiotoxicity
b) Hepatotoxicity, peripheral neuropathy
c) Loss of hair
d) Immunotoxicity

7.Ethambutol has the following unwanted effect:

a) Cardiotoxicity
b) Immunetoxicity
c) Retrobulbar neuritis with red-green color blindness
d) Hepatotoxicity

8.Tick the antibacterial drug – a nitrofurane derivative:

a) Nitrofurantoin
b) Trimethoprim
c) Ciprofloxacin
d) Nystatin

9.Tick the indications for Metronidazole:

a) Intra-abdominal infections, vaginitis, enterocolitis
b) Pneumonia
c) As a disinfectant
d) Influenza

10.Tick the unwanted effects of Metronidazole:

a) Nausea, vomiting, diarrhea, stomatitis
b) Hypertension
c) Disturbances of peripheral blood circulation
d) All of the above

11.Tick the indications for fluoroquinolones:

a) Infections of the urinary tract
b) Bacterial diarrhea
c) Infections of the urinary and respiratory tract, bacterial diarrhea
d) Respiratory tract infections
Anti parasitic drugs

1.Tick the drug used for trichomoniasis treatment:

a) Metronidazole
b) Suramin
c) Pyrimethamine
d) Tetracycline

2.Tick the drug used for toxoplasmosis treatment:

a) Chloroquine
b) Tetracyclin
c) Suramin
d) Pyrimethamine

3.Tick the group of antibiotics having an antimalarial effect:

a) Aminoglycosides
b) Tetracyclins
c) Carbapenems
d) Penicillins

4.Tick the drug for neurocysticercosis treatment:

a) Praziquantel
b) Pyrantel
c) Piperazine
d) Bithionol

Antiviral drugs

Tick the drug of choice for herpes and cytomegalovirus infection treatment:
a) Saquinavir
b) Interferon alfa
c) Didanozine
d) Acyclovir

Tick the drug used for influenza A prevention:

a) Acyclovir
b) Rimantadine
c) Saquinavir
d) Foscarnet

Tick the unwanted effects of intravenous acyclovir infusion:

a) Renal insufficiency, tremors, delerium
b) Rash, diarrhea, nausea
c) Neuropathy, abdominal pain
d) Anemia, neutropenia, nausea, insomnia

Just remember to review drugs for hypertension , cholesterol, Diabetes ,

anticoagulant and CHF .

Cancer drugs
All of the following antiviral drugs are the analogs of nucleosides, EXCEPT:
a) Acyclovir
b) Zidovudine
c) Saquinavir
d) Didanozine

002. Tick the drug, a derivative of adamantane:

a) Didanozine
b) Rimantadine
c) Gancyclovir
d) Foscarnet

003. Tick the drug, a derivative of pyrophosphate:

a) Foscarnet
b) Zidovudine
c) Vidarabine
d) Acyclovir

004. Tick the drug, inhibiting viral DNA synthesis:

a) Interferon
b) Saquinavir
c) Amantadine
d) Acyclovir
005. Tick the drug, inhibiting uncoating of the viral RNA:
a) Vidarabine
b) Rimantadine
c) Acyclovir
d) Didanozine

006. Tick the drug, inhibiting viral reverse transcriptase:

a) Zidovudine
b) Vidarabine
c) Rimantadine
d) Gancyclovir

007. Tick the drug, inhibiting viral proteases:

a) Rimantadine
b) Acyclovir
c) Saquinavir
d) Zalcitabine

008. Tick the drug of choice for herpes and cytomegalovirus infection treatment:
a) Saquinavir
b) Interferon alfa
c) Didanozine
d) Acyclovir
136

009. Tick the drug which belongs to nonnucleoside reverse transcriptase inhibitors:
a) Zidovudine
b) Vidarabine
c) Nevirapine
d) Gancyclovir

010. All of the following antiviral drugs are antiretroviral agents, EXCEPT:
a) Acyclovir
b) Zidovudine
c) Zalcitabine
d) Didanozine

011. Tick the drug used for influenza A prevention:

a) Acyclovir
b) Rimantadine
c) Saquinavir
d) Foscarnet

012. Tick the drug used for HIV infection treatment, a derivative of nucleosides:
a) Acyclovir
b) Zidovudine
c) Gancyclovir
d) Trifluridine

013. Tick the antiviral drug which belongs to endogenous proteins:

a) Amantadine
b) Saquinavir
c) Interferon alfa
d) Pencyclovir

014. Tick the drug which belongs to nucleoside reverse transcriptase inhibitors:
a) Didanosine
b) Gancyclovir
c) Nevirapine
d) Vidarabine

015. All of the following antiviral drugs are anti-influenza agents, EXCEPT:
a) Acyclovir
b) Amantadine
c) Interferons
d) Rimantadine

016. Tick the unwanted effects of zidovudine:

a) Hallucinations, dizziness
b) Anemia, neutropenia, nausea, insomnia
c) Hypertension, vomiting
d) Peripheral neuropathy

017. Tick the unwanted effects of intravenous acyclovir infusion:

a) Renal insufficiency, tremors, delerium
b) Rash, diarrhea, nausea
c) Neuropathy, abdominal pain
d) Anemia, neutropenia, nausea, insomnia

018. Tick the drug that can induce peripheral neuropathy and oral ulceration:
a) Acyclovire
b) Zalcitabine
c) Zidovudine
d) Saquinavir

019. Tick the unwanted effects of didanozine:

a) Hallucinations, dizziness, insomnia
b) Anemia, neutropenia, nausea
c) Hypertension, vomiting, diarrhea
d) Peripheral neuropathy, pancreatitis, diarrhea, hyperuricemia

020. Tick the unwanted effects of indinavir:

a) Hypotension, vomiting, dizziness
b) Nephrolithiasis, nausea, hepatotoxicity
c) Peripheral neuropathy, pancreatitis, hyperuricemia
d) Anemia, neutropenia, nausea

021. Tick the drug that can induce nausea, diarrhea, abdominal pain and rhinitis:
137
a) Acyclovire
b) Zalcitabine
c) Zidovudine
d) Saquinavir

022. All of the following effects are disadvantages of anticancer drugs, EXCEPT:
a) Low selectivity to cancer cells
b) Depression of bone marrow
c) Depression of angiogenesis
d) Depression of immune system

023. Rational combination of anticancer drugs is used to:

a) Provide synergism resulting from the use of anticancer drugs with different
mechanisms combination
b) Provide synergism resulting from the use of anticancer drugs with the same
mechanisms combination
c) Provide stimulation of immune system
d) Provide stimulation of cell proliferation

024. Tick the anticancer alkylating drug, a derivative of chloroethylamine:

a) Methotrexate
b) Cisplatin
c) Cyclophosphamide
d) Carmustine

025. Tick the anticancer alkylating drug, a derivative of ethylenimine:

a) Mercaptopurine
b) Thiotepa
c) Chlorambucil
d) Procarbazine

026. Tick the group of hormonal drugs used for cancer treatment:
a) Mineralocorticoids and glucocorticoids
b) Glucocorticoids and gonadal hormones
c) Gonadal hormones and somatotropin
d) Insulin

027. Tick the anticancer alkylating drug, a derivative of alkylsulfonate:

a) Fluorouracil
b) Carboplatin
c) Vinblastine
d) Busulfan
028. Tick the anticancer drug of plant origin:
a) Dactinomycin
b) Vincristine
c) Methotrexate
d) Procarbazine

029. Action mechanism of alkylating agents is:

a) Producing carbonium ions altering protein structure
b) Producing carbonium ions altering DNA structure
c) Structural antagonism against purine and pyrimidine
d) Inhibition of DNA-dependent RNA synthesis

030. Tick the anticancer drug, a pyrimidine antagonist:

a) Fluorouracil
b) Mercaptopurine
c) Thioguanine
d) Methotrexate
031. Methotrexate is:
a) A purine antagonist
b) A folic acid antagonist
c) An antibiotic
d) An alkylating agent

032. Tick the antibiotic for cancer chemotherapy:

a) Cytarabine
b) Doxorubicin
c) Gentamycin
d) Etoposide

033. Fluorouracil belongs to:

a) Antibiotics
b) Antimetabolites
c) Plant alkaloids
d) Bone marrow growth factor

034. Tick the action mechanism of anticancer drugs belonging to plant alkaloids:
a) Inhibition of DNA-dependent RNA synthesis
b) Cross-linking of DNA
c) Mitotic arrest at a metaphase
d) Nonselective inhibition of aromatases

035. General contraindications for anticancer drugs are:

a) Depression of bone marrow
b) Acute infections
c) Severe hepatic and/or renal insufficiency
d) All of the above

036. Action mechanism of methotrexate is:

a) Inhibition of dihydrofolate reductase
b) Activation of cell differentiation
c) Catabolic depletion of serum asparagine
d) All of the above

037. Tick the anticancer drug belonging to inorganic metal complexes:

a) Dacarbazine
b) Cisplatin
c) Methotrexate
d) Vincristine

038. Tick the indication for estrogens in oncological practice:

a) Leukemia
b) Cancer of prostate
c) Endometrial cancer
d) Brain tumors

039. Enzyme drug used for acute leukemia treatment:

a) Dihydrofolate reductase
b) Asparaginase
c) Aromatase
d) DNA gyrase

040. All of the following drugs are derivatives of nitrosoureas, EXCEPT:

a) Carmustine
b) Vincristine
c) Lomustine
d) Semustine

041. Tick the group of drugs used as subsidiary medicines in cancer treatment:
a) Cytoprotectors
b) Bone marrow growth factors
c) Antimetastatic agents
d) All of the above

042. Tick the estrogen inhibitor:

a) Leuprolide
b) Tamoxifen
c) Flutamide
d) Anastrozole

043. Tick the antiandrogen drug:

a) Flutamide
b) Aminoglutethimide
c) Tamoxifen
d) Testosterone

044. Tick the drug belonging to aromatase inhibitors:

a) Octreotide
b) Anastrozole
c) Flutamide
d) Tamoxifen

045. Tick the drug belonging to gonadotropin-releasing hormone agonists:

a) Leuprolide
b) Tamoxifen
c) Flutamide
d) Anastrozole

More on cancer drugs

SET 1

1. While it is always important to know a drugs mechanism of action, what

other characteristics of cancer chemotherapeutic drugs is likely to be
emphasized the MOST on standardized exams such as the Nursing
board ?

A.   ?    Clinical indications

B.   ?    Pharmacokinetics

C. *  Side effects / toxicity

2. Slowly growing tumors with a small growth fraction are often

unresponsive to chemotherapeutic drugs.

A. *  true

B.   ?    false

3. One of the most common forms of leukemia is Chronic Myelogenous

Leukemia (CML). In most cases these leukemic cells contain a
chromosomal abnormality that is a "target" for drug therapy that is not
 seen in non-leukemic white blood cells. A current treatment of choice for
this form of cancer is:

A.   ?    bleomycin

B.   ?    imatinib

C.   ?    mechlorethamine

D.   ?    tamoxifen

E.   ?    trastuzumab

4. The two most common side effects produced by the majority of

anticancer drugs are:

A.   ?    CNS depression & gingival hyperplasia

B.   ?    Hemorrhagic cystitis & peripheral neuropathy

C.   ?    Nausea & vomiting

D.   ?    Pulmonary & cardiac toxicity

5. A 43 year old man with Hodgkin's disease was treated with the MOPP
drug regimen (merchlorethamine + vincristine + procarbazine +
prednisone) followed by ABVD (adriamycin + bleomycin + vinblastine +
dacarbazine). Four years later he develops a cardiomyopathy, followed
by CHF. The drug in his treatment regimen that was most likely
responsible for causing this is:

A.   ?    Adriamycin (doxorubicin)

B.   ?    Bleomycin

C.   ?    Dacarbazine
 D.   ?    Merchlorethamine

E.   ?    Prednisone

F.   ?    Procarbazine

G.   ?    Vinblastine

H.   ?    Vincristine

6. A patient being treated with the ABVD drug regimen for Hodgkin's
disease presents to the Emergency Department with the chief complaint
of shortness of breath upon exertion & a nagging dry cough. A chest
Xray indicates the presence of pulmonary infiltration. Which of the drugs
in this patient's regimen is the most likely cause & should be
discontinued?

A.   ?    Bleomycin

B.   ?    Dacarbazine

C.   ?    Doxorubicin

D.   ?    Vinblastine

7. An alkylating agent that is one of the most versatile nitrogen mustards in

clinical use. It is a prodrug that must be first activated by hepatic P-450
to produce its active metabolites.

A.   ?    5-fluorouracil

B.   ?    Cyclophosphamide

C.   ?    Doxorubicin

D.   ?    Mercaptopurine

E.   ?    Methotrexate
8. An antimetabolite that becomes polyglutamated and selectively retained
within cancer cells, resulting in the inhibition of dihydrofolate reductase.
It is frequently used in high doses in conjuction with Leucovorin to
"rescue" normal cells from otherwise potentially lethal toxicity.

A.   ?    Bleomycin

B.   ?    Cisplatin

C.   ?    Mercaptopurine

D.   ?    Methotrexate

E.   ?    Paclitaxel

9. A type of therapy for cancer patients that is given after surgery to try
and kill microscopic forms of cancer that are invisible to the naked eye.

A.   ?    Adjuvant therapy

B.   ?    Chemoprophylaxis

C.   ?    Combo chemotherapy

D.   ?    Neoadjuvant therapy

E.   ?    Targeted therapy

10. When combined with leucovorin, the efficacy of this drug against
cancer is increased.

A.   ?    Busulfan

B.   ?    Bleomycin

C.   ?    Doxorubicin
 D.   ?    5-Fluorouracil

E.   ?    Methotrexate

F.   ?    Topotecan

Set II

1. The development of drug resistance to multiple cancer

chemotherapeutic drugs is most likely caused by:

A.   ?    Amplification of metabolizing enzymes

B.   ?    Amplification of target enzymes

C.   ?    Increased cellular efflux of drugs

D.   ?    Increased repair of DNA damage

2. A 33 year old woman who is 4 months post partum presents with tender
swelling of the breast. A biopsy reveals cells with an S phase fraction of
11% (for normal cells it should be ~1%). The cells are estrogen &
progesterone receptor negative, but there is over expression of the
Her2/neu oncogene. There is no evidence for metastasis. The patient is
initially treated with 4 courses of doxorubicin & cyclophosphamide. G-
CSF was also given when the granulocyte count dipped below 500.
Chemotherapy was followed by a modified radical mastectomy.
Following surgery the patient was treated with adjuvant therapy
consisting of 4 cycles of paclitaxel. Other than allopecia and nausea &
vomiting, which additional side effect should you warn your patient to
look for since it is frequently associated with this type of adjuvant
therapy?

A.   ?    Heart failure
 B.   ?    Hemorrhagic cystitis

C.   ?    Nephrotoxicity

D.   ?    Peripheral neuropathy

E.   ?    Pulmonary fibrosis

F.   ?    Thromboembolism

3. An anthracycline antibiotic that acts by multiple mechanisms including:

a) intercalating between DNA base pairs; b) resulting in blocking of DNA
synthesis & DNA strand scission; c) inhibition of DNA topoisomerase II;
d) changes in membrane permeability; and e) generation of toxic
semiquinone free radicals.

A.   ?    Doxorubicin (adriamycin)

B.   ?    5-Fluorouracil

C.   ?    Imatinib

D.   ?    Irinotecan

E.   ?    Vinblastine

4. An anticancer drug that intercalates with DNA and causes single &
double strand breaks following interaction with iron to form free radicals.

A.   ?    Bleomycin

B.   ?    Cisplatin

C.   ?    Lomustine

D.   ?    Mechlorethamine

E.   ?    Methotrexate
5. Which of the following bases is most susceptible to alkylating agents?

A.   ?    Adenine

B.   ?    Guanine

C.   ?    Cytosine

D.   ?    Thymine

E.   ?    Uracil

6. A plant product useful in treating a variety of cancers that has significant

side effects including peripheral neuropathy, significant allopecia, but
relatively little nausea, vomiting or bone marrow suppression.

A.   ?    cytarabine

B.   ?    etoposide

C.   ?    vinblastine

D.   ?    vincristine

7. A 19 year old boy presents to his pediatrician with a chief complaint of a

pain in his right thigh. On evaluation his right thigh is found to have a
swollen area that extends a length of 15 cm. X-ray of the thigh reveals
extensive bony destruction and the presence of a bony tumor that is
diagosed as an osteogenic sarcoma. He is offered a limb salvage
treatment that includes neoadjuvant chemotherapy (doxorubicin +
cisplatin + high dose methotrexate) as well as radiotherapy prior to
tumor resection & bone grafting. He is also given leucovorin to rescue
normal cells from the toxicity of

A.   ?    Cisplatin

B.   ?    Doxorubicin
 C.   ?    Methotrexate

D.   ?    Radiotherapy

8. A plant product that "enhances" tubulin polymerization, which thereby

inhibits the depolymeration of tubulin, resulting in mitotic phase arrest.

A.   ?    Etoposide

B.   ?    Paclitaxel

C.   ?    Topotecan

D.   ?    Vincristine

9. Tumors require a blood supply and the ability to promote angiogenesis

in order to grow and proliferate. A targeted drug therapy that inhibits this
process is:

A.   ?    Anastrozole

B.   ?    Bevacizumab

C.   ?    Exemestane

D.   ?    Imatinib

E.   ?    Tamoxifen

10. Normal human cells undergo a finite number of cell divisions

before they enter into a nondividing state called replicative senescence.
An enzyme that can be modified by cancer cells, allowing them to
continuously divide without limits and avoid entering this form of growth
arrest is:
 A.   ?    aromatase

B.   ?    CD20

C.   ?    telomerase

D.   ?    topoisomerase

11. A 45 year old woman with metastatic breast cancer that

overexpresses the HER2/neu protein is treated with targeted therapy. A
year later she develops symptoms of congestive heart failure. The most
likely "targeted agent" involved in producing this toxicity was:

A.   ?    Bevacizumab

B.   ?    Erlotinib

C.   ?    Imatinib

D.   ?    Rituximab

E.   ?    Trastuzumab

12. A 51 year old woman with multiple risk factors is placed on the
Selective Estrogen Receptor Modulator (SERM) raloxifene for
prophylaxis against breast cancer and post-menopausal osteoporosis.
Before writing her prescription you warn her about the risks associated
with many SERMs, which includes an increased risk of:

A.   ?    Infections

B.   ?    Severe nausea and vomiting

C.   ?    Secondary leukemia

D.   ?    Thrombembolic events
 More on Antibiotics SETI

1. While beta-lactam antibiotics remain one of the most commonly

prescribed types of antibiotics, they have side effects that can range
from mild to life-threatening in nature. What type of side effect is most
commonly observed?

A.   ?    allergic reaction

B.   ?    anaphylactoid reaction

C.   ?    aplastic anemia

D.   ?    cartilage toxicity

E.   ?    disulfiram reaction

F.   ?    hearing loss

G.   ?    hemolytic anemia

H.   ?    Stevens-Johnson syndrome

I.   ?    red/orange colored urine or tears

J.   ?    yellowing of teeth

2. Susan H arrives at the emergency department with complaints of high

fever, malaise, painful urination and severe flank pain. Lab tests indicate
the presence of white blood cells and E.coli in her urine. A diagnosis of
kidney infection (pyelonephritis) is made, and the decision is made to
use a beta-lactam antibiotic that has both an appropriate antibacterial
spectrum of activity, and good tissue penetration, yet is more resistant
to beta-lactamases than narrow spectrum penicillins. The drug that best
fits these characteristics is:

A.   ?    ceftriaxone
 B.   ?    daptomycin

C.   ?    fosfomycin

D.   ?    nitrofurantoin

E.   ?    vancomycin

3. Will, a 14 year-old boy develops a bad case of otitis media a few days
after swimming in Hideaway Lake, MS. Will's previous medical history is
unremarkable except for having had a minor skin rash two years ago
after being treated with amoxicillin for a sore throat. Which of the
following shares a common mechanism, but would be very unlikely to
produce a similar allergic reaction (e.g. ~1-2% or lower chance)?

A.   ?    ampicillin

B.   ?    cefaclor

C.   ?    clarithromycin

D.   ?    clindamicin

E.   ?    gentamicin

4. Roxanne, a 23-year-old medical student arrives in the student health

clinic complaining of difficulty in swallowing, sore throat, and chills.
Upon examination, she is found to be running a fever, and has white
patches on her tonsils. A throat swab is positive for Streptococcus
pyogenes (group A). A diagnosis of acute pharyngitis is made. Her past
medical history is unremarkable except for an anaphylactic reaction to
cefaclor two years ago. Which of the following would be a safe
alternative for treating Roxanne's condition?

A.   ?    amoxicillin, oral

B.   ?    cephalexin, oral
 C.   ?    clindamycin

D.   ?    meropenem

E.   ?    nafcillin

5. One of the most challenging types of infections to treat are those

produced by gram-negative enteric bacteria that produce Extended-
Spectrum Beta-Lactamases (ESBLs). Which type of beta-lactam drug
(circa 2015) is structurally different enough to other beta-lactams to
remain effective in treating most infections caused by this type of
bacteria?

A.   ?    carbapenems

B.   ?    extended-spectrum pencillins

C.   ?    fourth generation cephalosporins

D.   ?    monobactams

E.   ?    narrow spectrum penicillins

6. A 47 year old patient with a severe bacterial infection is given a drug by

i.v. infusion. Because the drug is administered too rapidly, the patient
develops hypotension, as well as marked flushing & itching over the
upper portion of his chest, neck and face. The antibiotic most likely
responsible for producing this reaction is:

A.   ?    amoxicillin

B.   ?    aztreonam

C.   ?    daptomycin

D.   ?    linezolid

E.   ?    vancomycin
7. Bacterial sensitivity to antibiotics can be evaluated by the disc-diffusion
(Kirby-Bauer) test where thin filter-paper wafers impregnated with
antibiotics are placed on the surface of an agar plate swabbed uniformly
with bacteria. The figure below illustrates the result for this test when
equal concentrations of five different antibiotics (A-E) were used. Each
drug had the same diffusion characteristics. To which antibiotic is this
bacterial culture most sensitive?

A.   ?    Antibiotic A

B.   ?    Antibiotic B

C.   ?    Antibiotic C

D.   ?    Antibiotic D

E.   ?    Antibiotic E

8. Three different types of antibiotics inhibit bacterial protein synthesis by

targeting the peptidyl transferase center within the 50S ribosomal
subunit. Bacterial expression of a methyltransferase that modifies a
specific adenine residue in the 23S rRNA renders all of these drugs
ineffective. Hence resistance to one of these antibiotics frequently
 means that the bacteria will be resistant to all three drug types. These
three drug types include:

A.   ?    aminoglycosides, tetracyclines & tigecycline

B.   ?    chloamphenicol, rifamycins, fluorquinolones

C.   ?    clindamycin, macrolides, streptogramins

D.   ?    daptomycin, polymyxins, sulfonamides

E.   ?    metronidazole, mupirocin, isonaizid

9. Resistance to antibiotics among S. aureus is becoming an increasing

clinical problem. When S. aureus is found to be resistant to a macrolide
(such as erythromycin), a "Double diffusion test " (D test) is also
commonly performed to determine if the patient's bacteria is resistant to
other types of antibiotics as well. Shown below are the results from a D
test in which a strain of S. aureus obtained from a patient has been
cultured in the presence of different discs containing either erythromycin
(E) or clindamycin (C). The results shown from this test indicate:

A.   ?    This strain of S. aureus most likely expresses a macrolide-

indicible plasmid that confers resistance to clindamycin. Therefore
use of clindamycin should be avoided.
 B.   ?    This strain of S. aureus does not express an inducible
resistance to clindamycin.

C.   ?    Clindamycin is effective, and would be a good drug choice

for treating an infection caused by this bacteria.

D.   ?    Clindamycin should be used alone to treat infections by this

bacteria, and should not be coadministered with a macrolide.

10. Amongst those antibiotics that act by inhibiting protein synthesis,

several members this drug class are known to produce side effects
related to both drug interactions caused by inhibition of P-450 and
cardiac effects (QT prolongation/Torsade de pointes). Which drug class
is this?

A.   ?    Aminoglycosides

B.   ?    Fluoroquinolones

C.   ?    Macrolides

D.   ?    Rifamycins

E.   ?    Tetracyclines

Set II

1. A 47 year old man who presents in the ED with symptoms of fever,

nausea, neck stiffness and severe headache is diagnosed with bacterial
meningitis caused by Haemophilus influenzae. Which of the following is
a beta-lactam antibiotic that could adequately cross the blood brain
barrier and be used to treat this type of infection?

A.   ?    Chloramphenicol

B.   ?    Ceftriaxone (3rd Gen cephalosporin)

 C.   ?    Cephalexin (1st Gen cephalosporin)

D.   ?    Clofazimine

E.   ?    Tazobactam

2. A 34 year old HIV-positive man with a persistent cough and chest pain
has a positive response to a Mantoux tuberculin skin test. Blood tests
confirm the presense of TB infection, and the patient is started on
combination drug therapy. A few months later the patient develops a
bilateral numbness and tingling of his upper and lower extremities,
attributed to drug-induced peripheral neuropathy. Which agent is most
likely responsible?

A.   ?    Clindamycin

B.   ?    Ethambutol

C.   ?    Isoniazid

D.   ?    Pyrazinamide

E.   ?    Rifampin

3. A 24 year old African American woman with a history of anaphylaxis to

amoxicillin is treated with an oral antibiotic for cystitis (urinary tract
infection). A few days later she develops a fever, weakness, dark-
colered urine, and a yellow discoloration of her eyes. Lab tests confirm
that she is suffering from hemolytic anemia, and that she also has a
mild deficiency in glucose-6-phosphate dehydrogenase (a genetic
condition that was previously undiagnosed). The most likely cause for
her anemia is:

A.   ?    Ceftriaxone (3rd Gen cephalosporin)

B.   ?    Imipenem (a carbapenem)
 C.   ?    Nitrofurantoin

D.   ?    Piperacillin + Tazobactam

4. A 52 year old man with a 3 month history of stomach pain is diagnosed

with a stomach ulcer after undergoing an upper gastric biopsy, followed
by a positive urea breath test. After a week of combination drug therapy,
he arrives in the local emergency room suffering from a severe
disulfiram-like reaction (tachycardia, sweating, nausea, flushed skin)
after consuming two beers while watching a football game. Which drug
most likely is responsible for causing this reaction?

A.   ?    Ampicillin

B.   ?    Azithromycin

C.   ?    Bismuth subsalicylate

D.   ?    Clarithromycin

E.   ?    Levofloxacin

F.   ?    Metronidazole

5. A neonate suffering from a severe methicillin & vancomycin-resistant

infection is given a "rarely used antibiotic" in a last-ditch effort to save its
life. After 5 days of antibiotic therapy, the child develops hypothermia,
hypotension, irregular respiration, and develops an ashen gray skin
color. What drug was the baby most likely given?

A.   ?    Ampicillin (a Penicillin)

B.   ?    Cefatoxin (a Cephalosporin)

C.   ?    Chloramphenicol

D.   ?    Doripenem (a Carbapenem)
6. A 5 year old boy develops a serious infection that requires antibiotic
therapy. Assuming the bacteria causing the infection were sensitive to
any of the drugs listed below, which would be contraindicated due to the
age of the patient?

A.   ?    Aminoglycosides (e.g. gentamicin)

B.   ?    Carbapenems (e.g. doripenem)

C.   ?    Cephalosporins (e.g. cephalexin)

D.   ?    Macrolides (e.g. clarithromycin)

E.   ?    Tetracyclines (e.g. doxycycline)

7. Amy, a 35 year old woman develops a gram-negative soft tissue

infection below the waist. Which of the following antibiotic classes,
based upon basic antibiotic principles alone, would be "most likely"
ineffective, and therefore contraindicated for empiric treatment of this
type of infection?

A.   ?    Aminoglycosides

B.   ?    Antipseudonomal Carbapenems

C.   ?    Beta lactam + beta-lactamase inhibitors

D.   ?    Fluoroquinolones

E.   ?    Glycopeptides (e.g. vancomycin)

F.   ?    Third Generation Cephalosporins (e.g. moxifloxacin)

8. After successful treatment for her skin infection with a broad spectrum
cephalosporin (cefotaxime), Amy's condition improves for several days,
and then suddenly declines. A second set of cell cultures confirmed the
presence of a superinfection by a new organism Bacteroides fragilis, a
beta-lactamase producing obligate anaerobic gram-negative rod-shaped
 bacteria. Based upon basic principles of antibiotic action, which of the
following would be contraindicated for treating this infection?

A.   ?    a carbapenem (e.g. meropenem)

B.   ?    a macrolide (e.g. clarithromycin)

C.   ?    a tetracycline derivative (tigecycline)

D.   ?    an aminoglycoside (e.g. gentamicin)

E.   ?    metronidazole

9. A 30 year old male soldier who was seriously injured by an IED while on
patrol in Afghanistan develops a life-threatening infection by
Acinetobacter baumannii a gram-negative bacterium that is an
opportunistic pathogen that commonly lives in the soil. The infection
proves to be resistant to a wide spectrum of available antibiotics, and a
decision is made to treat the infection with i.v. infusion of a drug that
exerts its on the bacterial cell membrane, and can also produce serious
nephrotoxicity and neurotoxicity. Which drug was given?

A.   ?    Daptomycin

B.   ?    Fosfomycin

C.   ?    Mupirocin

D.   ?    Nitrofurantoin

E.   ?    Polymyxin

10. Johnny is a 5 year old boy hospitalized for a severe infection who
has been treated with a parenteral antibiotic having bactericidal
properties. Two days after the onset of therapy he complains of "ringing
in the ears", and appears to have difficulty walking normally. Which of
the following antibiotics was Johnny most likely given?
 A.   ?    a macrolide (e.g. azithromycin)

B.   ?    a tetracycline (e.g. minocycline)

C.   ?    an aminoglycoside (e.g. tobramycin)

D.   ?    an oxazolidinone (linezolid)

E.   ?    clindamycin

Antiviral Drugs

1. JCis a 72 year-old nursing home resident that arrives in your clinic

complaining that many of his fellow residents have come down with the
flu. This has occured even though all residents where he lives were
vaccinated several months ago. To provide additional & appropriate
antiviral protection for JC, the best choice would be to write a
prescription for:

A.   ?    acyclovir

B.   ?    foscarnet

C.   ?    ganciclovir

D.   ?    oseltamivir

E.   ?    valganciclovir

2. John Doe, a 38 year-old man arrives at your free clinic with the chief
complaint of irritating small blisters on his genitals. A swab from his
sores is taken and sent to the lab for analysis. Based upon the
appearance of his sores, a tentative diagnosis of genital herpes is
made. Which of the following should you prescribe for treatment, at
least until the lab results come back in 3-4 days?
 A.   ?    amantadine

B.   ?    lamivudine

C.   ?    ribavarin

D.   ?    valacyclovir

E.   ?    zanamivir

3. John Doe returns to your clinic two weeks later complaining that the
drug you prescribed for him is "not working". Upon examination his
genital sores have not healed. When questioned, he insists that he has
adhered to a 2 times per day dose regimen, as prescribed. You take
another swab for lab analysis. In the mean time, suspecting the
presence of a resistant strain of herpes simplex, the best choice would
be to switch his prescription to:

A.   ?    acyclovir

B.   ?    foscarnet

C.   ?    idoxuridine

D.   ?    rimantadine

4. A 40 year-old woman presents to your clinic with complaints of chronic

anorexia, nausea, fatigue, a low grade fever, and difficulty sleeping.
When taking her history, she admits to having had unprotected
intercourse with several men over the past few years. Her lab results
indicate high levels of aminotransferase (ALT & AST) of 1000-2000
IU/ml. A liver biopsy is taken and hepatocytes stain positive for hepatitis
B antigen. The best choice for treating her condition would be:

A.   ?    acyclovir

B.   ?    amantadine
 C.   ?    interferon alfa

D.   ?    stavudine

E.   ?    telaprevir

5. Drug X is a commonly used drug that can be taken orally to treat the flu.
It is an inhibitor of viral neuramidase, an enzyme that is unique to the
influenza virus, and plays a vital role in the release of viral particles from
host cells. It should be taken within two days after the onset of
symptoms in order to be effective. Drug X is:

A.   ?    acyclovir

B.   ?    oseltamivir

C.   ?    tenofovir

D.   ?    tipranavir

E.   ?    vidarabine

6. A 36 year-old man with HIV who has been on a HAART drug regimen
for several years arrives at your Covenant House clinic complaining of
feeling unusually fatigued and drained of energy for the past two weeks.
Upon examination his lymph nodes are found to be enlarged, and he is
running a low-grade fever. Lab tests are positive for CMV antibody and
DNA. A drug of choice for treating this newly diagnosed infection is:

A.   ?    acyclovir

B.   ?    foscarnet

C.   ?    rimantadine

D.   ?    valganciclovir

E.   ?    zanamivir
7. A young man who has been experiencing a severe episode of cough,
runny nose and conjunctivitis for the past week arrives at your clinic
seeking medical attention. A 30 minute rapid antigen-capture assay is
positive for RSV. You prescribe an inhaled nucleoside analog that is
considered a drug of choice for this type of infection. Which drug best
fits this description?

A.   ?    entecavir

B.   ?    lamivudine

C.   ?    palivizumab

D.   ?    ribavirin

E.   ?    vidarabine

8. A 36 year-old woman with a history of iv drug abuse seeks medical

attention complaining of low-grade fever, nausea and vomiting. Lab
tests indicate the presence of elevated liver enzymes, and both Hep C
antibody & viral RNA. A diagnosis of active HCV infection is made.
Which drug combination would be the best choice for treatment?

A.   ?    amantadine + acyclovir

B.   ?    foscarnet + vidarabine

C.   ?    PEG-interferon alfa + ribavirin

D.   ?    lopinavir + ritonavir

9. Purdue, a 22 year-old medical student arrives at the Student Health

Clinic with a breakout of shingles following a week of second year block
exams. His medical records confirm that he has a medical history of
infection by Varicella zoster. To best alleviate his symptoms you write a
prescription for oral tablets (bid) containing the active ingredient:
 A.   ?    amantadine

B.   ?    foscarnet

C.   ?    interferon alfa

D.   ?    oseltamivir

E.   ?    valacyclovir

10. An immunocompromised patient diagnosed with CMV retinitis

requires systemic therapy. The choice is made to try therapy with an
antiviral prodrug that is effectively orally, and is converted to a
triphosphorylated form that inhibits CMV viral DNA polymerase. This
drug is:

A.   ?    acyclovir

B.   ?    adefovir

C.   ?    ganciclovir

D.   ?    valacyclovir

E.   ?    valganciclovir

Set II

1. Several drugs used to treat the flu work by blocking the viral surface
protein neuraminidase. Blocking this viral enzyme prevents the release
of viral particles, halting the spread of infection within the respiratory
tract. Which drug works by this mechanism?

A.   ?    acyclovir

B.   ?    amantadine
 C.   ?    oseltamivir

D.   ?    ribavirin

E.   ?    rimantadine

2. Michael is an 8 year-old boy who is brought to the emergency

department by his mother after he returns home from school
complaining of flu-like symptoms. Because he has difficulty swallowing
tablets (like many children under the age of 10), you decide to prescribe
a flu medication that can be inhaled, instead of swallowed. What is the
active ingredient for the medication you will prescribe?

A.   ?    albuterol

B.   ?    amantadine

C.   ?    oseltamivir

D.   ?    trifluridine

E.   ?    zanamivir

3. An HIV immunocompromised patient develops a severe case of CMV

retinitis that requires treatment. Before prescribing the drug of choice,
you explain to your patient that it needs to be taken orally twice daily,
and that a follow-up visit for blood tests is needed to monitor for
possible decreased levels of red cells, white cells, and platelets. The
drug having this pharmacologic profile is:

A.   ?    amantadine

B.   ?    foscarnet

C.   ?    trifluridine

D.   ?    valacyclovir
 E.   ?    valganciclovir

4. Foscarnet is sometimes used to treat CMV retinitis in HIV patients who

have become immunocompromised. A primary dose-limiting side effect
of this drug includes:

A.   ?    acute exacerbation of hepatitis

B.   ?    bone marrow toxicity

C.   ?    deterioration of respiratory function

D.   ?    flu-like symptoms

E.   ?    nephrotoxicity

5. An "anti-influenza" medication no longer recommended by the CDC as

a treatment for the flu due to the development of high levels of drug
resistance.

A.   ?    adefovir

B.   ?    amantadine

C.   ?    entecavir

D.   ?    idoxuridine

E.   ?    oseltamivir

CHF

1. A 64 yo man with a history of systolic HF develops pulmonary edema

with difficulty breathing. Which drug is the best choice to acutely
increase cardiac output in this patient within the next 30 mins?
 A.   ?    captopril

B.   ?    digoxin

C.   ?    dobutamine

D.   ?    epinephrine

E.   ?    norepinephrine

2. A 62 yo man with diastolic dysfunction develops pulmonary edema

caused by the sudden onset of atrial fibrillation with a rapid ventricular
response. To prevent the deterioration of the heart's ability to maintain
circulation, which of the following should be given?

A.   ?    lidocaine

B.   ?    digoxin

C.   ?    dobutamine

D.   ?    nifedipine

E.   ?    verapamil

3. PJ, a 64 yo man with a history of diastolic dysfunction comes to your

clinic for an annual checkup. In reviewing his current list of daily
medications (he brought his pill containers with him in a paper bag),
which of the following would be considered contraindicated, and warrent
further discussion with PJ?

A.   ?    atenolol

B.   ?    diltiazem

C.   ?    hydrochlorothiazide

D.   ?    ibuprofen
 E.   ?    spironolactone

4. What combination of medications & patient conditions are

contraindicated?

A.   ?    losartan & a patient with a BP of 140/90

B.   ?    metoprolol & a patient with HR=70/min

C.   ?    diltiazem & a patient with Prinzmetal's angina

D.   ?    furosemide & a patient with leg cramps

E.   ?    verapamil & a patient with diastolic HF

5. A 76 yo man being treated with digoxin, captopril & furosemide for

systolic HF & hypertension presents to the ED with complaints of
dizziness & fatigue. His lab values indicate a plasma K level of 2.5 mM.
While waiting for his X-ray results the patient faints and his current ECG
indicates the presence of sinus bradycardia & 3rd degree AV
conduction block. The most likely explanation for this patient's rhythm
disturbance is:

A.   ?    a direct effect of hypokalemia on SA node automaticity & AV

conduction

B.   ?    captopril overdose

C.   ?    furosemide interacting with captopril

D.   ?    increased vagal tone caused by digoxin

6. Weight gain & edema occur in patients with CHF in response to:

A.   ?    decreased renin levels

 B.   ?    decreased vascular resistance

C.   ?    decreased angiotensin levels

D.   ?    increased aldosterone levels

E.   ?    increased diuresis

7. A 64 yo woman who is experiencing progressive dyspnea of effort

comes to your office for a physical exam. Her pulse is regular at 95
beats/min, and her blood pressure is 126/84 mm Hg. Auscultation of her
lungs reveals inspiratory crackles at both bases. There is no peripheral
edema, and the cardiac apical pulse is not displaced. An
echocardiogram reveals a left ventricular chamber that is not dilated,
with an estimated EF of 55%. Based upon your observations, which of
the following would be most likely to reduce this patient's symptoms?

A.   ?    digoxin

B.   ?    dobutamine

C.   ?    dopamine

D.   ?    hydralazine

E.   ?    verapamil

8. A 59 yo man with a history of systolic HF arrives in the ED with

complaints of chest palpitations, nausea and visual (color) disturbances.
His chart indicates that he is currently taking digoxin, captopril,
metoprolol & furosemide. An ECG reveals the presence of frequent runs
of ventricular bigeminy. His echocardiogram indicates an ejection
fraction of 40%. His lab results show cardiac enzymes to be within
normal limits, a serum potassium of 4.0 mM, and an elevated digoxin
level of 2.2 ng/ml. The most appropriate drug for treating this patient's
arrhythmia would be:
 A.   ?    amiodarone

B.   ?    atropine

C.   ?    lidocaine

D.   ?    propranolol

E.   ?    verapamil

9. A 69 yo woman presents to the Tulane ED with signs of ankle edema,

shortness of breath & other symptoms consistent with CHF. Her
echocardiogram indicates that she has a relatively normal EF of 54%. A
drug that would be contraindicated in treating this patient is:

A.   ?    digoxin

B.   ?    hydrochlorothiazide

C.   ?    metoprolol

D.   ?    quniapril

E.   ?    spironolactone

F.   ?    verapamil

10. As a 3rd yr medical student in Baton Rouge you are helping with
the longitudinal care of a EJ, a 68 yo woman suffering from coronary
artery disease. One day you are called to the ED where you find EJ
complaining of chest pain that radiates down her left arm which began
less than an hour ago. She has been given a chewable aspirin,
sublingual nitroglycerin, oxygen by nasal canula, and i.v. morphine. Her
ECG indicates ST segment elevation, and her cardiac enzymes (CPK-
MB & troponin I) are elevated. She is given clopidegrel & is scheduled
for an immediate coronary angioplasty. While talking to EJ, she
complains to you of shortness of breath. Auscultation of her lungs
reveals inspiratory crackles at both bases. You make a tentative
 diagnosis of pulmonary edema secondary to an MI that requires drug
management. Your resident agrees with you & asks you what effect
would amrinone (a phosphodiesterase inhibitor), digoxin or a high dose
of dopamine have in common if you administered any of them for her
pulmonary edema. Having ace'd the Med Pharm course, you answer
that they would produce a(n):

A.   ?    decrease in cytoplasmic cAMP

B.   ?    decrease in heart rate

C.   ?    decrease in venous return

D.   ?    decrease in total peripheral resistance

E.   ?    increase in ventricular contractility

Thrombosis and Anemia

1. A 65 year old man suffering from chest pain and difficulty breathing for
the past 20 minutes is brought to the Emergency Department of a small
rural community hospital. He is given a chewable aspirin while his
history is taken. His ECG indicates ST segment elevation (STEMI), and
his pO2 is 85%. He is given supplemental oxygen while an intravenous
line is inserted. Which of the following would be the best choice to
improve blood flow to the ischemic region of the heart if angioplasty
(PCI) is not immediately available?

A.   ?    clopidogrel

B.   ?    dabigatran

C.   ?    enoxaparin

D.   ?    abciximab

E.   ?    reteplase
2. A 54 year old patient is diagnosed with a deep vein thrombosis, which
puts him at an increased risk for developing pulmonary embolism. A
decision is made to initiate treatment with an anticoagulant that has an
immediate onset of effect, and is not dependent on depletion of vitamin
K-dependent coagulation factors. The best choice for achieving this
treatment goal is:

A.   ?    abciximab

B.   ?    aspirin

C.   ?    LMW heparin

D.   ?    tenecteplase

E.   ?    warfarin

3. A 59 year old man on anticoagulant therapy develops an antibody-

mediated reaction resulting in irreversible aggregation of platelets, and
resulting thrombocytopenia. The drug most likely responsible for this
side effect is:

A.   ?    apixaban

B.   ?    argatroban

C.   ?    aspirin

D.   ?    heparin

E.   ?    warfarin

4. A patient who arrives in the emergency department suffering from chest

pain associated with apparent unstable angina is given a drug that
reduces the risk of thrombosis by inhibiting the formation of
thromboxane A2. The drug given was:
 A.   ?    apixaban

B.   ?    aspirin

C.   ?    cangrelor

D.   ?    clopidogrel

E.   ?    heparin

5. A patient is brought into the emergency room suffering from shock like
symptoms resulting from internal hemorrhage. The patients history
indicates they have been taking an orally effective anticoagulant for
prevention of DVT. The ER physician administers an antidote in two
doses 15 minutes apart, causing the patients clotting time to improve to
near normal values within 30 minutes, and consequent improvement of
the patient's hemodynamic status over the next 24 hours. What
anticoagulant had this patient most likely been taking?

A.   ?    Clopidogrel

B.   ?    Dabigatran

C.   ?    Enoxaparin

D.   ?    Heparin

6. Alvin Boudreaux, a 64 year old man with a history of angina of effort is

scheduled for elective coronary angioplasty (PCI) and placement of a
coronary stent. Associated with the procedure he is given eptifibatide.
What is the mechanism of action of this agent?

A.   ?    ADP receptor inhibitor

B.   ?    Blockade of GP IIB/IIIA receptors

C.   ?    Cox inhibitor
 D.   ?    Phosphodiesterase inhibitor

E.   ?    Protease-activated receptor-1 antagonist

7. A 67 year old man with a history of chronic atrial fibrillation arrives in the
emergency department with complaints consistent with internal
bleeding. He has been taking warfarin for the past few 5 years, but
recently began self medicating with cimetidine to treat an ulcer. His INR
is 5. To prevent hemorrhage, he is told to switch to either a newer
generation H2 antagonist, or a proton pump inhibitor instead of
cimetidine. Warfarin therapy is temporarily discontinued. What
additional treatment would also help reduce his risk of bleeding?

A.   ?    andexanet alfa

B.   ?    idarucizumab

C.   ?    protamine sulfate

D.   ?    vitamin K

8. A 30 year old pregnant woman with a high risk of thromboembolism

requires anticoagulation. Which agent that is orally effective, has the
strongest level of contraindication (Pregnancy Category X in the older
FDA risk category) because it can cross the placenta, is a known
teratogen, and increases the risk of fetal bleeding, including intracranial
hemorrhage?

A.   ?    dabigatran

B.   ?    LMW heparin

C.   ?    Unfractionated heparin

D.   ?    warfarin
9. A 59 year old man who recently survived a myocardial infarction is on
drug therapy designed to reduce his cardiovascular risk for a second MI.
During the cours of his therapy he is accidently given an overdose of
unfractionated heparin. What treatment would be most effective in
counteracting the effects of this overdose?

A.   ?    deferoxamine

B.   ?    dipyridamole

C.   ?    idarucizumab

D.   ?    protamine sulfate

E.   ?    vitamin K

10. A 23 year old pregnant woman is referred by her obstetrician for

evaluation of anemia. She is in her 4th month of pregnancy. Her
grandfather had pernicious anemia. Her hemoglobin is 10 g/dL (normal
for women is 12-14 g/dL). She is diagnosed with having a macrocytic
(megaloblastic) anemia. Her serum ferritin and vitamin B12 plasma
levels are in the normal range. What is the most likely deficiency
causing for her anemia?

A.   ?    cobalamin

B.   ?    erythropoietin

C.   ?    folic acid

D.   ?    iron

11. If the previous patient's lab values had indicated a microcytic

anemia, which treatment would be most appropriate for correcting this
condition?

A.   ?    deferoxamine injections
 B.   ?    erythropoietin injections

C.   ?    ferrous sulfate tablets

D.   ?    folic acid supplements

12. A 70 year old man is diagnosed with chronic kidney disease.

Which of the following would most likely be required in the treatment of
this condition?

A.   ?    deferoxamine

B.   ?    erythropoietin

C.   ?    iron

D.   ?    Vitamin B12