PHARMA Prelims2 Guidelines
ertapenem)
1. Which of the following penicillin have
improved activity against gram-
negative organism? Teracillin
2. The most common form of
resistance to penicillin is? A. Beta-
lactamase production
3. This type of resistance to penicillin is
only observed in gram negative
organisms D. There is impaired
penetration of the drug (outer cell
wall is impermeable)
4. Resistance to fosfomycin is due to?
D. inadequate transport of drug into
the cell. Mechanism of action is drug
is transported into the cell thru action
of g6p transport system. Once
inside, the drug will inhibit bacterial
cell wall synthesis by blocking the
formation of n-acetyl neuramic acid
which is found in the cell wall
5. The absorption of penicillin is
impaired by food except? B
6. Compared with the other agents,
which of the following cephalosporin
is susceptible to Beta lactamase
hydrolysis losing its clinical
usefulness? B. Cefaclor, among 2nd
gen cephalosporins, (Ceclor)
7. Which of the following cephalosporin
is excreted in the biliary tract hence
does not need adjustment in cases
with renal insufficiency? Ceftriaxone
8. This is a characteristic of Beta-
lactamase inhibitor? B. the beta-
lactamase inhibitor have weak anti-
bacterial action (sulbactam,
clavulanic acid)
9. Which of the following carbapenem
have the least activity against gram
negative organism like
pseudomonas and acinetobacter?
B. Ertapenem (doripenem =
meropenem > imipenem >
10. Primary mechanism of resistance in
aminoglycoside? A. production of
enzyme that inactivates the drug
(irreversible inhibitor of protein
synthesis)
11. Characteristic of aminoglycoside? A.
poor cell penetration (poor git
absorption hence given IV or IM, has
low concentration in most tissues
except in the renal cortex)
12. Which of the following sulfonamides
has the lowest oral absorption? A.
sulfamethoxazole
13. The least active of the
fluoroquinolone? B. Norfloxacin
14. The most active 2nd gen quinolone
against gram-negative organism
especially pseudomonas? A.
Ciprofloxacin
15. A 2nd gen quinolone has the most
superior activity against gram
positive organism, especially
streptococcus pneumonia? C.
Levofloxacin
16. Which among the quinolone has the
highest bioavailability? B. Ofloxacin
(95%) (cipro 70%. Gemi 70,
Norfloxacin 85%)
17. Which of the following quinolone has
the highest half-life D. Moxifloxacin
18. The most important mechanism of
resistance against tetracycline? D.
increased efflux pump by active
transport protein pump
19. Tetracycline with the highest
absorption rate? C. Doxycycline
20. The absorption of this drug is not
impaired by presence food? C.
Doxycycline
21. The best absorbed oral preparation
of Erythromycin is? A. Estolate
22. Most of the serious adverse effect of
penicillin is due to? A.
Hypersensitivity reaction
23. This adverse effect is demonstrated
with several cephalosporin and has
cause withdrawal of cefaloridin? B.
tubular necrosis
24. Which adverse effect is associated
with Imipenem in patient with renal
failure? B. Seizure
25. Adverse effect assoc with
tetracycline? B. Deposited in fetal
teeth
26. An idiosyncratic reaction associated
with chloramphenicol? A. aplastic
anemia
27. One of the most ototoxic
aminoglycoside? A.
28. One of the most nephrotoxic
aminoglycoside? A. gentamicin
29. One of the most vestibule-toxic
aminoglycoside D. streptomycin
30. A serous potential adverse effect of
sulfonamide A. Steven Johnson’s
Syndrome
31. Quinolone should be avoided in
patient taking anti-arrythmic drug
due to? B. QT prolongation
32. Fluoroquinolone is not
recommended for less than 18 year
old due to? Damage to growing
cartilage
33. The role of cilastatin in its
combination with imipenem is? A.
Inhibit renal dehydropeptidase
34. Which of the following would not
require adjustment o dose in
patients with renal insufficiency? D.
cefoperazone (All of the drugs are
eliminated in the kidney except
cefoperazone which is eliminated in
the liver)
35. In patients with normal renal
function, a single daily dose of
aminoglycoside is preferred over
multiple dosing due to? D. post-
antibiotic effect
36. High concentration of
aminoglycoside is seen in? D. Renal
cortex
37. The aminoglycoside produces
synergistic effect when combined
with? A. Beta-lactam
38. What is the effect of fluorination
quinolone? B. it has increased the
antibacterial activity. (Nalidixic acid
is non-fluorinated)
39. Which of the following drug will
increase the liver function test? C.
fluoroquinoloneinc lft, headache,
insomnia, qtc prolongation, tendinitis
(penicillin hypersensi, cholitis, gi
upset
40. Which of the following is associated
with renal toxicity? B. Caphalosporin
41. Which of the following prevention is
proven to be effective in improving
appropriate antibiotic use among
prescriber (WHO Data)? A. Regular
audit and sin tax
42. Which of the following message
should be contained in the program
for physicians to promote rational
antibiotic use? B. Consider cost
effectiveness data
43. Based on the internationguidelines,
what is the recommended treatment
for acute uncomplicated cystitis? D.
nitrofurantoin
44. What is the primary indication for the
use of co-trimoxazole in acute
uncomplicated cystitis? B. resistant
uropathogens causing infection in
<20%
45. According to the IDSA guidelines,
what is the primary disadvantage of
using fluoroquinolones in patients
 with acute uncomplicated cystitis? B.
propensity for collateral damage
46. What is the primary disadvantage of
using cephalosporin in patients with
acute uncomplicated cystitis? B.
Inferior efficacy (and adverse effect
compared to others, Included under
β-lactam)
47. Discard (incomplete stem question)
B. ciprofloxacin
48. Discard (incomplete stem question)
D.
49. In acute pyelonephritis not requiring
hospitalization, what should be given
initially before cotrimoxazole if the
community susceptibility is
unknown? C. Ceftriaxone
50. Based on the Philippine Clinical
Practice Guidelines of 2004, which
antibiotic has the highest level of
resistance as of 2003? A. Ampicillin,
80% (other choices: Cotrimoxazole
70%, Cipro 44, nitrofurantoin 26%)
51. Based on Philippine Clinical Practice
Guidelines of 2004, which antibiotic
has the lowest level of resistance as
of 2003? B. Cefuroxime, 18% (nitro
26% coamox, 29)
52. Based on Philippine Clinical Practice
Guidelines on UTI of 2004, which
antibiotic has the lowest cost for one
course of treatment? B.
Cotrimoxazole
53. Based on Philippine Clinical Practice
Guidelines on UTI, what is the
effective duration of treatment for
acute uncomplicated cystitis with a
grade A recommendation, except for
nitrofurantoin which is 7 days? B. 3
days
54. Based on Philippine Clinical Practice
Guidelines on UTI, what is the
effective duration of treatment for
acute uncomplicated cystitis I
healthy patient who are more than
65 years old, except for
nitrofurantoin which is 7 days? B. 3
days
55. Based on Philippine Clinical Practice
Guidelines on UTI of 2004, what is
the recommended intervention if the
patient did not improve or worsened
after the recommended treatment?
B. request for culture and sensitivity
56. Based on Philippine Clinical Practice
Guidelines on UTI, what is the
recommended Empiric oral
treatment for acute uncomplicated
pyelonephritis not requiring
hospitalization? B. Fluoroquinolones
57. Discard C.
58. Based on Philippine Clinical Practice
Guidelines on UTI, cranberry juice
and cranberry product are not
recommended for the treatment of
UTI with a grade D recommendation.
What is a Grade D
recommendation? C. moderate
evidence to support a
recommendation against it.
59. Based on Philippine Clinical Practice
Guidelines on UTI, lactobacilli, both
in oral form and vaginal suppository,
are not recommended in the
prevention of UTI. What is the
meaning of Grade C. poor evidence
to support a recommendation for or
against it
60. A 25-year old female developed
flank pain and dysuria; this is her
first episode of infection. She denies
pregnancy, co-morbid conditions or
chronic use of antibiotics. The
resident prescribed her with
antibiotics however, the patient
requested for oral water hydration
instead. What is the evidence on this
 issue based on the Philippine CPG?
D. Insufficient evidence
61. In a lecture on UTI, one student
asked if she can take cranberry juice
to prevent the occurrence of UTI in
her current age group? Based on the
evidence, the results showed the
following data: Absolute risk
reduction (ARR) 14%, 95% CI (-4,
32%) what is the meaning of this
data? D. There is no evidence of
efficacy.
62. A 35 year old female with frequency,
dysuria, flank pain, and hematuria
sought consult at the OPD. What is
the recommended management
based on the Philippine CPG? B.
Start empiric antibiotic
63. When will the patient come back for
follow up? A. after 3 days
64. A 25 year old female, diagnosed to
have acute uncomplicated cystitis,
has completed a full course of
antibiotic treatment. On follow-up,
patient is still symptomatic with
positive pyuria on urinalysis. What is
the recommended management
based on the Philippine CPG? A.
change the antibiotic empirically
65. A 30 year old female with fever and
flank pain sought consult at the
OPD. The patient is conscious
coherent and not in distress. BP
110/70, HR 85, RR 18, T 38. There
is costovertebral angle tenderness
and the laboratory shows urinalysis
of WBC 20/hpf. Pregnancy test is
negative. You are waiting for urine
culture and sensitivity. What is the
recommended management for this
patient based on the Philippine
CPG? D. Ofloxacin 400 mg, TID, for
14 days (Acute pyelonephritis,
uncomplicated) no sepsis so not
admitted, no severe pain or disability
and patient is likely to come back for
follow up so treated as out-patient.
66. Non-pharmacologic intervention
proven to delay onset of type 2
Diabetes in patient with A1c of 5.7%-
6.4%? D. Moderate intensity
physical activity
67. Pharmacologic intervention proven
to delay onset of type 2 Diabetes in
patient with A1c of 5.7%-6.4%?
D.Biguanides (Metformin)
68. What is the recommended
monitoring schedule for pre-diabetic
patients? D. 1 year
69. What is the A1c glycemic goal in
patients with short duration of
diabetes, long life expectancy and
no significant cardiovascular
disease? D. 6.5%
70. What is the A1c glycemic goal in
patients with history of severe
hypoglycemia, limited life
expectancy, advanced
micro/macrovascular complication?
B. 8%
71. What is the recommended treatment
for patient with type 2 Diabetes who
can tolerate the drug? C. Metformin
72. What is the recommended treatment
for patient with severe
hypoglycemia? A. Glucagon
73. Which of the following vaccine is
recommended in patient with
Diabetes? A. Influenza vaccine
74. When is the right time to monitor
patient with type 2 Diabetes who
recently started pharmacologic
treatment? C. 3-6 months
75. What is the recommended dose of
Insulin in type 2 Diabetes not
responding to oral hypoglycemic
age? A. 0.1-0.2 U/kg/day
76. Ariel Medina, a 7 year old child who
was rushed to the ER because of
high grade fever. What is your initial
assessment? C. pCAP C
77. What is the action plan for Ariel
Medina? B. admit to ward
78. What is the bacterial pneumonia
score for the patient?B 7
79. Must empirically administered
antibiotic for bacterial etiology B.
ampicillin 100 mg/kg/day
80. Which of the following should be
given to Ariel Medina? B. Elemental
___vape____ for ages 2 to 59
months
81. The primary mechanism of
antibacterial action of penicillin
involves inhibition of B.
peptidoglycan from cleaving
82. Resistance to penicillin of
pneumococci is due to? B. changes
in the chemical structure of the
target binding protein
83. Which of the following statement
about vancomycin is correct? C.
active against MRSA
84. Which of the following drug is a
protein synthesis inhibitor? B.
Clindamycin
85. Which of the following statement
about azithromycin is correct? B.
less active than clarithromycin
against H. influenza
86. An uncommon but potentially fatal
adverse effect of sulfonamides? D.
steven Johnsons syndrome
87. Effective treatment for
pneumocystits jirovecii infection, B.
Cotrimoxazole
88. Inhibit DNA replication by binding to
DNA gyrase and topoisomerase? B.
ciprofloxacin
89. Which of the following drugs is used
for community acquired pneumonia
with a very minimal drug-drug
interaction? B. Azithromycin
90. 10 year old child, complain of dry,
welling tongue, headache and fever
what is your assessment? PCAP D
91. What is your actual plan? C. treat on
outpatient basis
92. What is the bacterial pneumonia
score? B. 3
93. After intake of antibiotic for
staphylococcal infection. What
empiric treatment should be
administered, in a bacterial etiology
should be considered? B.
azithromycin 15 mg/kg/day.
94. Krizia, one year old girl, came in with
productive cough accompanied by
high grade fever. Diagnosed to have
pneumonia. Which of the following is
the best antibiotic for use against
pneumonia. A. Amoxicillin
95. A 50 year old male developed
interstitial nephritis after intake of
antibiotic for staphylococcal
infection. What is the probable
antibiotic responsible for this
adverse effect? D. Methicillin