1. NAPLEX
ANTIMICROBIAL AGENTS

2. Selecting Appropriate Antimicrobial Agents
Empiric therapy
Identify the causative organism
Test the sensitivity of the organism to antimicrobial drugs
Identify important host factors:
Site of infection-CNS, bone, prostate, UTI
Susceptibility to toxicity
Patient allergies
PG 52

3. Mechanisms of Action of Antimicrobial Agents
Interference with cell wall synthesis
penicillins, cephalosporins
Inhibition of protein synthesis
macrolides, clindamycin, tetracyclines, quinolones
Interference with enzyme unique to bacterial cell
sulfonamides
Interference with the permeability of microbial cell membranes
amphotericin B
PG 52

4. Sulfonamides
PABA dihydrofolic acid (DHFA) tetrahydrolfolic acid (THFA)
Sulfa
PG 53

5. General considerations - Sulfonamides
Mechanism of action : competitive antagonism of PABA in enzyme system essential for bacteria growth.
For ophthalmic use, sulfa sodium salt solutions are very alkaline (i.e., pH 10+). The only sodium salt suitable for ophthalmic use is sulfacetamide sodium (solutions have pH of about 7.4).
Sulfas are eliminated renally unchanged. Makes them good for UTIs.
Sulfas are less soluble in acid urine. This is one cause of crystalluria.
Stevens-Johnson syndrome is associated with sulfa use.
PG 53

6. General considerations – Sulfonamides (cont’d)
Combinations of sulfamethoxazole and trimethoprim (Bactrim, Septra, etc.) are less likely to result in bacterial resistance.
Sulfasalazine (Azulfidine) is used in treating inflammatory bowel disease and RA. Watch for sulfa allergy, salicylate allergy, and urine discoloration. - GI side effects, dose is titrated upward slowly, monitor blood counts – dyscrasias
If a patient cannot use sulfasalazine because of sulfa sensitivity, use mesalamine products, i.e., Asacol, Pentasa, Rowasa. – various dosage forms
Remember that silver sulfadiazine (Silvadene) and mafenide (Sulfamylon) are used topically for treatment of serious burns.
PG 53

7. Penicillins
PG 54

8. General Considerations – Penicillins
Mechanism of action: interfere with bacterial cell-wall synthesis (bactericidal)
Note that all penicillins have a beta lactam ring and thiazolidine ring.
Possible cross-sensitivity with other beta lactam antimicrobials (e.g., cephalosporins).
- percent cross-sensitive ranges from 5-7%
PG 54

9. Structure Activity Relationships:
AMino penicillins – AMpicillin, AMoxicillin, bacAMpicillin
NOX penicillins – penicillinase (beta lactamase) resistant penicillins: Nafcillin, OXacillin, clOXacillin (PO), diclOXacillin(PO)----MSSA (vanco alternative)
MEZPCT penicillins – antipseudomonal penicillins: MEZlocillin, Piperacillin, Carbenicillin, Ticarcillin (combo with aminoglycosides, not in the same IV)
Therapy problems with penicillins:
Acid Resistance
Beta-lactamase (penicillinase) resistance (combo products; Zosyn, Timentin, Augmentin)
Hypersensitivity
PG 55

10. Which of the following is an adverse
effect associated with use of
aminopenicillins?
a. polydipsia
b. hemolytic anemia
c. cholelithiasis
d. tardive dyskinesia
e. angina

11. Which of the following is an adverse
effect associated with use of
aminopenicillins?
a. polydipsia
b. hemolytic anemia
c. cholelithiasis
d. tardive dyskinesia
e. angina

12. Cephalosporins
PG 56

13. General considerations
Contains beta-lactam ring. Therefore, may have cross-sensitivity with penicillins.
As you go from 1st generation to 4th generation, you get:
increased gram-negative activity
decreased gram-positive activity
increased resistance to beta-lactamase destruction
increased ability to enter cerebrospinal fluid
PG 56

14. Which of the following antimicrobial
agents has effective coverage of streptococcus pneumoniae?
I. amoxicillin
II. doxycycline
III. gentamicin
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III

15. Which of the following antimicrobial
agents has effective coverage of streptococcus pneumoniae?
I. amoxicillin
II. doxycycline
III. gentamicin
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III
Gram +
Non-DRSP

16. General considerations (cont’d)
First generation (generally start with CEPH):
Good for surgical prophylaxis
Second generation (generally start with CEF):
Good for otitis, sinusitis and respiratory tract infections
Third generation (generally end with IME or ONE):
Good for meningitis, CAP, gram-negative bacilli, gonorrhea, Proteus, Salmonella, Klebsiella
Cefixime (suprax), cefotaxime (claforan), ceftriaxone (rocephin)
Fourth generation (cefepime) Maxipime:
Good antipseudomonal activity
PG 57

17. Tetracyclines
PG 58

18. General Considerations
Products:
Tetracycline HCI (Achromycin V, Sumycin, Robitet, Panmycin)
Minocycline (Minocin)
Doxycycline (Vibramycin, Doxy 100, Doxychel, Vibra-Tabs)
These are bacteriostatic antimicrobials. They interfere with protein synthesis.
Broad spectrum antimicrobials. Work against many gram-positive and gram-negative organisms.
- also effective against atypical organisms mycoplasma and chlamydia pneumoniae, useful for patients allergic to penicillin b/c gram + coverage
PG 58

19. General Considerations
Not for use in children under age 8. May cause discoloration of developing tooth enamel.
Not for pregnant women. May adversely affect fetal development.
Most have the potential for causing phototoxicity.
Drug interaction with divalent (Mg, Ca, Fe) or trivalent (Al) compounds and tetracyclines may result in complexation and impaired absorption. Do not use together.
Broad spectrum activity can lead to thrush or vaginal candidias
PG 58

20. Macrolides General Considerations:
Bacteriostatic – inhibit protein synthesis
May be good for patients who are
hypersensitive to beta-lactam
antimicrobials.
Good respiratory coverage.
CAP caused by S.pneumo, M.cat, H.flu or atypicals (mycoplasma, legionella, and chlamydia)
PG 59

21. Erythromycin Oral Products
Erythromycin base (E-Mycin, Ery-Tab, PCE, Eryc)
Coating used on most products
Administer on an empty stomach
Erythromycin stearate (Erythromycin Stearate, Wyamycin S)
Better absorbed than erythromycin base
PG 59

22. Erythromycin (cont’d)
Erythromycin esolate (Ilosone)
Associated with cholestatic hepatitis
Better absorbed than erythromycin base
Erythromycin ethylsuccinate (eryPed, E.E.S.)
Most well absrobed
Available in liquid form
400 mg of EES = 250 mg of erythromycin base
Parenteral Products
Erythromycin lactobionate
Erythromycin glucepate
Drug Interactions: Mainly due to enzyme inhibition of erythromycin – (3A4)
PG 59

23. Clarithromycin (Biaxin)
Usually used BID. XL form used once daily.
Prodrug: May be given with or without meals
Used in combination with a proton pump inhibitor for H. pylori treatment.
Metallic taste
PG 60

24. Azithromycin (Zithromax)
More gram-negative activity than erythromycin or clarithromycin
Once-daily dosing, usually for five days after otitis media (e.g., Z-Pack)
Available as suspension, tablets, IV
Suspension should not be taken with food or antacids.
Dirithromycin (Dynabac)
Prodrug
Once-daily dosing
PG 60

25. Lincosamides General considerations
Watch for pseudomembranous enterocolitis (Clostridium difficile).
Treat clostridium with metronidazole (Flagyl) or oral vancomycin.
Good in gram positive (staph) and gram-negative infections, particularly anaerobes
Lincomycin (Lincocin, Lincorex)
Morbilliform rash possible; DC drug if it happens
Clindamycin (Cleocin)
Available in topical form for acne
PG 61

26. Which of the following antibiotics has
bacteriostatic activity?
a. amoxicillin
b. ciprofloxacin
c. erythromycin
d. penicillin
e. cephalexin

27. Which of the following antibiotics has
bacteriostatic activity?
a. amoxicillin (cell wall)
b. ciprofloxacin (inhibits DNA gyrase)
c. erythromycin (protein synthesis)
d. penicillin (cell wall)
e. cephalexin (cell wall)

28. Aminoglycosides General Considerations
Glycosides – poorly absorbed from the GI tract
Bactericidal
Good for serious gram-negative pathogens (pseudomonas, proteus, etc.)
Frequently administered with extended-action penicillin (IV incompatible) - dosed q8h or q24h (conc. dependant kill)
Eliminated by glomerular filtration; Watch for ototoxicity
Monitor peaks and troughs – peaks 30 min after infusion, trough 30 minutes before next dose. peak = 4-10ug/ml trough = 0.5-2, adjust dose if CrCl < 60ml/min. hearing test if prolonged therapy
PG 61

29. Which of the following antimicrobial
agents is available for parenteral use only?
I. cefaclor
II. tobramycin
III. ticarcillin
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III

30. Which of the following antimicrobial
agents is available for parenteral use only?
I. cefaclor
II. tobramycin
III. ticarcillin
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III

31. Parenteral use Streptomycin sulfate Kanamycin sulfate (Kantrex)
Gentamicin sulfate (Garamycin (4mcg-10mcg/ml)
Tobramycin sulfate (Nebcin) (4mcg-10mcg/ml)
Amikacin sulfate (Amikin) (15mcg-25mcg/ml)
Netilmicin sulfate (Netromycin)
Reference Peak Range
PG 61

32. Which of the following antibiotics
requires monitoring of serum levels?
a. penicillin
b. ceftazidime
c. azithromycin
d. gentamicin
e. cephalexin

33. Which of the following antibiotics
requires monitoring of serum levels?
a. penicillin
b. ceftazidime
c. azithromycin
d. gentamicin
e. cephalexin

34. Not for systemic action
Oral use
Not for systemic action
Neomycin sulfate (Mycifradin) - Used for bowel prep prior to surgery , treat diarrhea caused by e.coli, neomycin also binds ammonia, use in patients w/hepatic encephalopathy, watch for absorption interactions
Tobramycin (TOBI) – inhaled product for CF patients
PG 62

35. Fluoroquinolones General Considerations - Inhibits DNA-Gyrase
May cause phototoxicity
Not for patients under 18 – affects growth
Do not use within 2-4 hours of antacids; iron – also inhibits CYP1A2 (increased levels of theophylline and caffeine)
Generally useful for UTI, lower respiratory infections, gonorrhea, prostatitis – older agents have more gram -, less gram + coverage, newer agents have broader gram + [moxifloxacin, gatifloxacin]
All end in -oxacin
PG 62

36. Names Second generation Third generation Fourth generation
Norfloxacin (Noroxin) – high urine levels - UTIs
Ciprofloxacin (Cipro)- renal elimination: reduce dose
Ofloxacin (Floxin)
Third generation
Levofloxacin (Levaquin) – renal elimination: reduce dose
Sparfloxacin (Zagam) – reports of prolongation of QT interval (D/C)
Gemifloxacin (Factive) – renal elimination: reduce dose, skin rash
Fourth generation
Moxifloxacin (Avelox) – Multi-drug resistant Streptococcus pneumonia (MDRSP)
PG 62

37. MISCELLANEOUS ANTIMICROBIAL AGENTS
Antibacterials
Mupirocin (Bactroban) – topical use for impetigo, intranasal for staph
Vancomycin (Vancocin) – associated with red man syndrome (must be infused slowly, over min of 30 minutes); reserved for serious/resistant gram + infections (MRSA, enterococcus)
– rapid drop in BP accompanied by rash in neck or chest area
- Monitoring – 1 hour before and 1 hour after
- Peak – 25-40mcg/dl & Trough 5-12mcg/dl
Metronidazole (Flagyl) – active against gram-negative organisms and protozoa, (anaerobes) Avoid alcohol. May darken urine.
PG 63

38. MISCELLANEOUS ANTIMICROBIAL AGENTS (cont’d)
Carbapenems
broad spectrum; used for resistant gram +/– organisms, pseudomonas, MRSA, enterococcus, anaerobes
similar to penicillins (cross-sensitivity) but b-lactamase resistant
Risk of seizures and renal adjustment
Imipenem/cilastatin (Primaxin) – cilastatin is a renal dipeptidase inhibitor
Meropenem (Merrem)---lacks good pseudomonas coverage
Doripenem (Doribax)
Ertapenem (Invanz)
----Aztreonam (Azactam)---monobactam, ok with PCN allergy
PG 63

39. Which of the following antibiotic is
classified as a macrolide?
a. telithromycin
b. tobramycin
c. azithromycin
d. doxycycline
e. kanamycin

40. Which of the following antibiotic is
classified as a macrolide?
a. telithromycin
b. tobramycin
c. azithromycin
d. doxycycline
e. kanamycin

41. MISCELLANEOUS ANTIMICROBIAL AGENTS (cont’d)
VRE and MRSA drugs
Quinupristin / dalfopristin (Synercid) –
Linezolid (Zyvox) –……oral dosing available
Tigecycline (Tygacil) –
Chloramphenicol (Chloromycetin) – for typhoid fever; may cause aplastic anemia and gray baby syndrome
PG 63-64

42. Pneumonia Organisms: Treatment:
--Comorbidities: Chronic obstructive pulmonary disease (COPD), diabetes, chronic renal failure, chronic liver failure, heart failure (HF), cancer, asplenia, immunosuppressed

43. Pneumonia
Treatment:
--Risk factors for MDR organisms: recent antibiotic therapy (in last 90 days), hospitalized ≥ 5 days,  resistance in environment, nursing home resident, chronic dialysis, home infusion therapy, immunosuppressed

44. Meningitis
Organisms:
Treatment:

45. Urinary Tract Infection
Organisms:
Treatment:

46. STDs
Organisms:
Treatment:

47. Antitubercular Drugs R rifampin I isoniazid P pyrazinamide
E ethambutol
S streptomycin
PG 64

48. Antitubercular Drugs PG 64 Isoniazid (Nydrazid, Laniazid)
May cause B6 deficiency – supplement malnourished, alcoholics, kids
Used for prophylaxis or in combo with other drugs for active disease
6 months of prophylaxis if +PPD; For treatment used in combo with
rifampin for at least 6 months
Metabolized by acetylation (slow versus rapid acetylators)
monitor for hepatoxicity
Rifampin (Rifadin, Rimactane)
Potent enzyme inducer (potential drug interactions with many drugs)
Potentially hepatotoxic;
Use may result in discoloration of virtually all body fluids (urine and tears----watch contact lenses)
PG 64

49. Antitubercular Drugs (cont.)
Ethambutol (Myambutal) – for treatment of MAC and drug-resistant Tb as part of combination therapy
- optic neuritis is a rare but serious side effect
- monitor with eye exams
Pyrazinamide – used in combination therapy; potentially hepatotoxic
- may increase uric acid levels
Steptomycin- can be used as fourth drug in regimen instead of pyrazinamide
PG 65

50. Antimalarials
Quinine sulfate (Quinamm) – also used for muscle cramps; no longer used due to hematologic adverse effects
Doxycycline – tetracycline; possible phototoxicity and binding interactions
Melfoquine HCl (Lariam) – may cause neuropsychiatric adverse effects; once- weekly dosing
Atovaquone/proguanil (Malarone) – newer product; once daily; do not use if renally impaired
PG 65

51. Antimalarials Chloroquine (Aralen) – may worsen psoriasis symptoms
Hydroxychloroquine sulfate (Plaquenil Sulfate) – may worsen psoriasis symptoms
- also used as a DMARD for RA; phototoxicity,
hematological side effects, ocular and ototoxicity
Primaquine phosphate – take with food to reduce GI upset; may be used for PCP
PG 66

52. HIV Antiretroviral Therapy
Therapy initiated based on CD4 count, viral load and presence of symptoms
Initial regimen in treatment naive patients:
NNRTI + 2 NRTIs
PI + 2 NRTIs
Learn drug class representatives and major toxicities
PG 69

53. Which HIV drug is correctly matched with its mechanism of action?
a. Lamivudine - nucleoside reverse transcriptase inhibitor
b. Enfuvirtide - protease inhibitor
c. Stavudine - binds to human CCR5 receptor
d. Didanosine – protease inhibitor
e. Indinavir – blocks virus entry into human cells and subsequent viral replication

54. Which HIV drug is correctly matched with its mechanism of action?
a. Lamivudine - nucleoside reverse transcriptase inhibitor
b. Enfuvirtide - protease inhibitor
c. Stavudine - binds to human CCR5 receptor
d. Didanosine – protease inhibitor
e. Indinavir – blocks virus entry into human cells and subsequent viral replication

55. NNRTIs non-nucleoside reverse transcriptase inhibitors (vir in the middle)
Delavirdine (rescriptor) (rash, LFTs)
Efavirenz (Sustiva)
Drug of choice
Category X, vivid dreams
Nevirapine (Viramune)
Rash (Steven Johnson Syndrom)
Liver metabolism

56. PIs Protease inhibitors (vir at the end)
Exception – darunavir, tenofovir, raltegravir, abacavir
Metabolized through the liver (commonly 3A4)
potential for significant drug interactions
Low dose of ritonavir frequently used to enhance the concentrations of coadministered PIs
Adverse effects: GI intolerance, hyperglycemia, dyslipidemia, lipodystrophy, LFT alterations
PG 72

57. NRTIs nucleoside reverse transcriptase inhibitors (all the others)
Exception – maraviroc
All NRTIs (except abacavir) are excreted renally; require dose adjustment but few drug interactions
Most common ADRs – GI intolerance, typically subsides in first couple of weeks
- High risk for perpheral neuropathy
Black Box warning: Risk of lactic acidosis with hepatic steatosis
PG 69

58. AIDS – Opportunistic Infections
PCP / PJP (pneumocystis carninii pneumonia)
trimethoprim-sulfamethoxazole
CMV retinitis
Ganciclovir
MAC / MAI (mycobacterium avium complex)
Macrolide + ethambutol
Cryptococcus neuformans meningitis
Amphotericin B +/- flucytosine
Fluconazole used for maintenance
PG 74

59. Drugs for influenza M2 inhibitors Amantadine, rimantidine
Effective for influenza A virus only
Begin within 48h of symptom onset; continue 2-5 days
Neuroaminidase inhibitors
Oseltamivir (Tamiflu)
Zanamivir (Relenza)
Effective for influenza A and B viruses
Begin with 48h of symptoms onset; continue 5 days
PG 74

60. Drugs for herpes simplex and herpes zoster (shingles)
Acyclovir (Zovirax) – for herpes simplex types 1 and 2
- dosed 5x/day for 10 days, 5 days if recurrence
Penciclovir (Denavir) – topical treatment for herpes labialis (cold sores)
Valacyclovir HCl (Valtrex) – for herpes simplex and herpes zoster; acyclovir prodrug
Famcyclovir (Famvir) for herpes simplex and herpes zoster (shingles); penciclovir prodrug
- begin therapy as soon as first sign of lesion
Docosanol (OTC-Abreva) topical cream
PG 75

61. Anthelmintic drugs of choice
Nematodes (roundworm)
Mebendazole (Vermox)—do not use in pregnancy – blocks glucose uptake
Albendazole (Albenza) – degeneration of cytoplasmic microtubules intestinal cells of helminths
Piperazine citrate Preg B – blocks affect of ACH
Pyrantel pamoate (Antiminth)
Trichuriasis (whipworm)
Mebendazole (do not use in pregnancy)
Hookworm – mebendazole (do not use in pregnancy)
PG 75

62. Which of the following medication(s) can cause nephrotoxicity?
Ganciclovir
Foscarnet
Gentamicin
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III

63. Which of the following medication(s) can cause nephrotoxicity?
Ganciclovir
Foscarnet
Gentamicin
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III

64. Which of the following agents inhibits the
HIV enzyme reverse transcriptase?
I. zanamivir
II. ritonivir
III. didanosine
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III

65. Which of the following agents inhibits the
HIV enzyme reverse transcriptase?
I. zanamivir (Neuroaminidase inhibitors)
II. ritonivir (protease inhibitor)
III. didanosine (nucleoside reverse transcriptase inhibitors)
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III

66. DERMATOLOGIC STUDY OUTLINE Acne
Pathophysiology— abnormal keratinization leads to obstruction of the follicle and accumulation of sebum to form a closed comedo or “white-head”
Goal of therapy is to unblock follicles
PG 146

68. Normal Pore Inflamed Pore

69. Dermatologic Study Outline
PG 146

70. Dermatologic Study Outline
Isotretinoin (Accutane)
Effective therapy option for the treatment of severe, inflammatory acne, or more moderate forms that have been refractory to other treatment options
pregnancy category X
two forms of contrception, iPLEDGE program
Oral Antimicrobials
• Tetracycline
• Erythromycin
• Clindamycin
PG 146

71. Psoriasis
Pathophysiology — exact mechanism unknown. May be due to defects in epidermal cell cycle, AA metabolism, immunologic mechanisms, environmental triggers
Treatment modalities
• Emollients (e.g., petrolatum)
• Ultraviolet light
• Coal tars (typically compounded)
• Topical corticosteroids
• Systemic corticosteroids (pulse dosing)
• Antineoplastic agents (methotrexate, hydroxyurea)
• Psoralens (pulse dosing)
• Immunosuppressant agents (Etanercept, Efalizumab)
• Retinoids (pulse dosing)
PG 146

72. Which of the following psoriasis medications is not pregnancy category X?
I. Dovonex
II. Methotrexate
III. Soriatane
I only
III only
I and II only
II and III only
I, II and III

73. Which of the following psoriasis medications is not pregnancy category X?
I. Dovonex
II. Methotrexate
III. Soriatane
I only
III only
I and II only
II and III only
I, II and III

74. A patient presents to the pharmacy with obvious mild acne, which of the following cannot be recommended without a prescription?
a. Benzoyl peroxide 2.5% cream
b. Sulfur soap
c. Benzamycin gel
d. Salicylic acid wash
e. Benzoyl peroxide 10% lotion

75. A patient presents to the pharmacy with obvious mild acne, which of the following cannot be recommended without a prescription?
a. Benzoyl peroxide 2.5% cream
b. Sulfur soap
c. Benzamycin gel
d. Salicylic acid wash
e. Benzoyl peroxide 10% lotion

76. Fungal Infections Tinea corporis – body surface Tinea capitis – scalp
Tinea cruris – groin (“jock itch”)
Tinea pedis – feet (“athlete’s foot”)
Onychomycosis – nails
PG and 147

77. Therapy
Prophylaxis. Keep skin dry; frequent changes and thorough cleaning of clothing; and avoid likely areas of contamination.
Active:
Dusting powders (medicated versus nonmedicated), wet compresses
Topical drug therapy
• Fatty acids (undecylenic acid) • Tolnaftate (Tinactin, Aftate)
• Haloprogin (Halotex) • Miconazole (Micatin,Monistat)
• Clotrimazole (Lotrimin) • Oxiconazole (Oxistat)
• Sulconazole (Exelderm) • Butenafine (Mentax)
Nystatin (Mycostatin, Nilstat) – good for superficial candida (thrush)
Systemic drug therapy for topical fungal disorders
• Griseofulvin (microsized versus ultramicrosized)
• Terbinafine (Lamisil)
• Avoid corticosteroids
PG 147

78. Antifungal Drugs (cont’d)
Miconazole (Monistat, Micatin) – broad-spectrum antifungal agent available as powder, aerosol, cream, and suppository; may be used topically or vaginally
Clotrimazole (Lotrimin, Mycelex) – broad-spectrum antifungal available as cream, lotion, suppositories, and troches (OTC use for 2 weeks after infection clears)
Ketoconazole (Nizoral) – for superficial and systemic fungal infections; also available as OTC shampoo for dandruff; enzyme inhibitor
Itraconazole (Sporanox) – for oral or topical treatment of superficial or systemic fungal disorders; enzyme inhibitor.
- hepatotoxicity; take w/ food and avoid antacids
PG 67

79. Antifungal Drugs (cont’d)
Terbinafine (Lamisil) – used orally for onychomycosis of fingernail or toenail. Used topically for superficial tinea infections (OTC use for 1 week). Monitor for hepatoxicity with oral use.
Ciclopriox (Penlac) – applied topically once daily for treatment of onychomycosis. – requires long-term therapy
PG 67

80. Antifungal Drugs (cont’d)
Griseofulvin (Grisactin, Grifulvin V, Fulvicin)
For tinea only
Duration of therapy
depends on type: corporis: 2-4 wks.; capitis: 4-6 wks., pedis: 4-8 wk
Regular versus microsized versus ultramicrosized
ultra is better absorbed; take w/ fatty meal
causes induction interactions
PG 67

81. Antifungal Drugs (cont’d)
Other Azoles
Posaconazole (Noxafil)
Voriconazole (Vfend)
Reserved for severe invasive fungal infections (asperigillosis)
Echinocandins (less DI, but monitor LFTs)
Anidulafungin (Eraxis)
Caspofungin (Cancidas)
Micafungin (Mycamine)
Ampho B and related Lipid products
nephrotoxicity
PG 68

82. NAPLEX
Sample Questions

83. Which of the following antibiotics does not have a significant drug interaction with warfarin?
ciprofloxacin
azithromycin
TMP-SMZ
Metronidazole
Nafcillin

84. Which of the following antibiotics does not have a significant drug interaction with warfarin?
ciprofloxacin
azithromycin
TMP-SMZ
Metronidazole
Nafcillin

85. Which of the following medications is the best treatment option for an uncomplicated urinary tract infection?
penicillin
cefuroxime
levofloxacin
gentamicin
clarithromycin

86. Which of the following medications is the best treatment option for an uncomplicated urinary tract infection?
penicillin
cefuroxime
levofloxacin
gentamicin
clarithromycin

87. Which of the following antimicrobial agents is available for parenteral use only?
piperacillin
aztreonam
rifampin
I only
III only
I and II only
II and III only
I, II and III

88. Which of the following antimicrobial agents is available for parenteral use only?
piperacillin
aztreonam
rifampin
I only
III only
I and II only
II and III only
I, II and III

89. Which of the following agents is a non-nucleoside reverse transcriptase inhibitor?
didanosine
delavirdine
stavudine
zidovudine
lamivudine

90. Which of the following agents is a non-nucleoside reverse transcriptase inhibitor?
didanosine
delavirdine
stavudine
zidovudine
lamivudine

91. Which of the following agents may be utilized in combination with other medications for H. pylori eradication?
tetracycline
azithromycin
penicillin
fluconazole
cefuroxime

92. Which of the following agents may be utilized in combination with other medications for H. pylori eradication?
tetracycline
azithromycin
penicillin
fluconazole
cefuroxime

93. Peripheral neuropathy is associated with which one of the following agents:
nevirapine
delavirdine
Saquinavir
Stavudine
tenofovir

94. Peripheral neuropathy is associated with which one of the following agents:
Nevirapine (NNRTI)
Delavirdine (NNRTI)
Saquinavir (PI)
Stavudine (NRTI) do not use with AZT (zidovudine)
Tenofovir (NRTI)

95. Administration of calcium or iron must be separated by at least 2 hours if antibiotics in this category are prescribed:
Macrolides
Tetracyclines
Fluroquinolones
I only
III only
I and II only
II and III only
I, II and III

96. Administration of calcium or iron must be separated by at least 2 hours if antibiotics in this category are prescribed:
Macrolides
Tetracyclines
Fluroquinolones
I only
III only
I and II only
II and III only
I, II and III

97. Which of the following antimicrobial agents has effective coverage for M. pneumoniae?
amoxicillin
erythromycin
metronidazole
cefotriaxone
clindamycin

98. Which of the following antimicrobial agents has effective coverage for M. pneumoniae?
amoxicillin
erythromycin
metronidazole
cefotriaxone
clindamycin

99. Which of the following regimens is most appropriate for C
Which of the following regimens is most appropriate for C. difficile eradication?
Clarithromycin 500 mg PO q 12 hours
Clindamycin 300 mg IV q 6 hours
Vancomycin 125 mg PO q 6 hours
Doxycycline 100 mg PO q 12 hours
Vancomycin 1000 mg IV q 12 hours

100. Which of the following regimens is most appropriate for C
Which of the following regimens is most appropriate for C. difficile eradication?
Clarithromycin 500 mg PO q 12 hours
Clindamycin 300 mg IV q 6 hours
Vancomycin 125 mg PO q 6 hours
Doxycycline 100 mg PO q 12 hours
Vancomycin 1000 mg IV q 12 hours

101. Which agent is available in both a topical and an oral product for the treatment of acne?
clindamycin
erythromycin
doxycycline
I only
III only
I and II only
II and III only
I, II and III

102. Which agent is available in both a topical and an oral product for the treatment of acne?
clindamycin
erythromycin
doxycycline
I only
III only
I and II only
II and III only
I, II and III

103. Which of the following drugs represents first (primary) agents in the treatment of TB?
Ethambutol + PASA
Ciprofloxacin + PASA
Isoniazid + rifampin
Cycloserine + streptomycin
Penicillin + Benemid

104. Which of the following drugs represents first (primary) agents in the treatment of TB?
Ethambutol + PASA
Ciprofloxacin + PASA
Isoniazid + rifampin
Cycloserine + streptomycin
Penicillin + Benemid

105. Which of the following antibiotics is considered first line treatment for a gonorrhea infection?
Ampicillin
Ciprofloxacin
Doxycycline
Penicillin
Tetracycline

106. Which of the following antibiotics is considered first line treatment for a gonorrhea infection?
Ampicillin
Ciprofloxacin (also..ceftriaxone, cefixime)
Doxycycline (chlamydia)
Penicillin
Tetracycline

107. Which of the following groups of antibiotics may be prescribed for a gravid patient with gonorrhea?
cephalosporins
fluoroquinolones
tetracyclines
I only
III only
I and II only
II and III only
I, II and III

108. Which of the following groups of antibiotics may be prescribed for a gravid patient with gonorrhea?
cephalosporins
fluoroquinolones
tetracyclines
I only
III only
I and II only
II and III only
I, II and III

109. A gravid patient with a Chlamydia infection is likely to be prescribed which of the following antibiotics?
Ampicillin
Levofloxacin
Doxycycline
Erythromycin
Penicillin

110. A gravid patient with a Chlamydia infection is likely to be prescribed which of the following antibiotics?
Ampicillin
Levofloxacin
Doxycycline
Erythromycin
Penicillin

111. Which of the following is the BEST treatment for a patient with herpes zoster?
Cidofovir
Famciclovir
Ganciclovir
Penciclovir
Tenofovir

112. Which of the following is the BEST treatment for a patient with herpes zoster?
Cidofovir
Famciclovir
Ganciclovir
Penciclovir
Tenofovir

113. Which of the following medications would be appropriate for the treatment of Pseudomonas aeruginosa?
Ampicillin
Cefepime
Ceftriaxone
Erythromycin
Clindamycin

114. Which of the following medications would be appropriate for the treatment of Pseudomonas aeruginosa?
Ampicillin
Cefepime
Ceftriaxone
Erythromycin
Clindamycin