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Pharmacology/Med Chern II
Exam 1
November 2,2006

Version A

Name (printed): tl1XJttl'Jl 'NtnlLlino


At the end of the exam please write submittedJirith honor and sign:
~l1bmu+{lL wHit MYWY

Signature

I
Pharmacology/Med Chern II Exam 1 Page 2 of8

I. Although tetracycline binds to the 30S subunit of ribosomal RNA, its mechanism of
action is to inhibitthe -bInding of ~inoacyl t-RNA in the A site of the 50S
subunit. - 0 •

@ True b. False

2. A common resistance
modification of the sitemechanism for many
on the ribosome to w~otein
ich thesynthesis ipnihiti?rs is
drug binds.
@ True b. False

3. ""Second generation ~phalosporins have a more extended gram-negative spectrum


when compared to firs1.g~neration cephalosporins, included in the list of susceptible
bacteria are: --
a. H injluenzae b. N meningitidis
c. M catarrhalis d. a and b
G) all of the above
4. In choosing a drug to treat your patient's infection, what do you need to know about
your patient?
a. whether they have any drug allergies -/ b. the age of the patientv'
c. whether they have any other diseases./ d. if female, whether she is pregnant ./
@ all of the above

5. Irreversible adverse effects commonly associated with the use of g~p.tamicin include:
(i) ototoxicity b. nephrotoxicity --.-.-
c. neuromuscular blockage d. all of the above

6. In counseling a patient who is taking ~y~e what would you say about taking
the
a. drug
that itwith food?matter ifthe drug is •taken
doesn't U L'f T{;tl""M\.1t.\"\.lj\.t ..~ ~\
with food. ~ o.,,\U\ ~iV".~·'tU.cA.!
C;MtH ~.ll;l.:h.~"" cf (a,.1i
(9) that it shouldJlQ.tbe taken with food, especially dairy products o:iantacids
l that because t1i'edrug is excreted in the bile, eating ~r.omote~ the release of the
drug

(1) Marianne is having dental work this afternoon. She has mitral valve 12rillilPSeand her
dentist has recommended that she take c:l,mo~n 1 hour pri..?f.to surg~ry. This is an
A example of:
a. prophylaxis-/
b. treatment to reduce the normal flora in the mouth
c. treatment to reduce inflammation
(ID all of the above

I
Pharmacology/Med Chern II Exam 1 Page 3 of8

8. Your bum patient has an infection with Pseudomonas aeruginnsa.. You plan to treat
this infection with a cephalosporin, which generations can provide coverage?
e, l-:-1st. 2. 2nd/ 3. 3rd/ 4. 4th

Q 2&3 ):f. 3&4


c. 2,3&4 ;r: 3 only
". 4 only

'lS \~t.
9. Clavulamc t;
\\'\rl-\t..hvp.;r
aCId gIVen Jas ' ~\A.A.'- ~
a combmatIOn wIth pemcIllm o...~
':-1'\,h •.kJ,.l..Jo-'P'Y'l., ~ l.A. CJLLl~ '
6'1\ ~ C;..('~~.c...\.,
because:
a. cIavulanic acid increases the penetration of penicillin through the inner
cytoplasmic membrane of bacteria
..If.' cIavulanic acid decreasesjhe J.ikeli~£.<2d that an individual will suffer an ~!~ic
r~~sj;ill..llto a penicillin
G) cIavulanic acid i11hibi1Uh~~tabp1iSl1J_QLQ,£;.ui~iUiu.l2x.~tWllase
,,<it." cIavulanic acid is also a poteIlt.9~~L~<llLiu.hibit,Qrand can proliferate the effects of
penicillin
;( cIavulanic acid protects penicillin from breakdown in stomach acid when the
combination is given orally ~

10. A patient is admitted to the hospital in septic shock. It is obvious that the patient has
sepsis, but you d.Qn't know what..Q[£IDJ.ismis...£.ill!§ing the disease. The physician does
1.!QL~ant10 l,!§.~,;d~r.o...ad..s.pe.c.tnnn antibiotic because she wants to be able to rapidly
change treatment to a n~!.EUm agent to r~us.~..Qrug,r~,~i§tant isolate in the
hospital. How would you recommend treating the patient?
<i) Use two different drugs with different mechanisms of action .... S;I6'i"JtA~.\.j
)1. Use two drugs with different . §p,e~1rnm.s..Q(a~ism
I"el Wait for the lab results to come back and then pick an agent - s-e.9s U' v.. "tOO CA••.J:.'\. <: ."J(
d. Use two drugs with a!!.t!gQ,.ui~effects . -to v.l 0..•..,.'"
'(".;.;It'\,~/.l t.tU'.{~ u..e "r' &rl.iS ~
l
(,tf'\ ()..t; t";·

11.Lysis of penicillins by p-Iactamases produces penicilloic acid, which is a hapten. '8. G~c,.t
~
Which of the following is true about this hapten?
a. The hapten binds to lysine and modifies self proteins.
b. An immune respon~et;this hapten can produce r.ashes, anaRh.YJ.?xisand..~,um
si.£ku.ess. "tl-i~ \ ""jfi,f)~'''~'f:f'
..~
t'~f'
i
p... c. ••.C\

c. The incidente of hypersensitivity reactions to penicillin may be as high as 10% ../


-d:--a-arrd-c~~
@ all of the above "\\.j~At{;A't'\J

@ lJlli;a£.~ and its derivatives can be used to treat meningitis even ifthe causative
organism is unkn.Q.wn,because:
a. these drugs are effective against both gram-positive and gram-negative organisms
CQ the drugs are effective against Pseudomonas
c/ the drugs cross the blood brain barrier
d. a and c
e. all of the above
Pharmacology/Med Chem II Exam 1 Page 4 of8

13. Advantages of azithromycin as compared to ery.thrgmygn or c1aritbromyJ,n include:


C cg) longer half-life 0/
c. both
b. concentration of the drug in phagocytes
d. l'icith:er

14. InhiJ2i1ioo of Cytochrome p. ~CTIL4J.Q. by drugs such as chloLall!1~.nic.aJ and


~J.Lhro.!l1Y.£i!1result in:
a. prolongation ofthe ~ life of affected drugs ../
"..b'7 of other drugs metabolized by CYP 450 ~ d.0~
i!!£reasingJ)1~d,&lS"'=!ge
c. decreasing the dosage of CYP 450 substrates "I
@) aandc
~1-ef1:he-m,-UVe
't" \~ l' rt..4l.)~~, ot:g
15. The drugs quinuprisinlq~tin and lilJ..9Q~in are us~~~ly because of ';""~lJ:.J..:h••~",~
their broad spectrum of actiYity and because of the lack of resistance to these drugs in
the bacterial population.
a. True lli? False

16. Following treatment with amoxicillin~ Mrs. Smith developed vaginal candidiasis. This
is an example of: .,,, ~,-
a. a superinfection b. a potential adverse reaction
d. neither
@ both
17. You are asked to design a penicillin with the following characteristics: it needs to
have a broad spectrum of activiry and be resistant to li-lactamas~. How do you do
this? l' C.,h~-e..A. ~ tj ruue'" . t:.. O(~() ~I.h+0 CClIJ ••-e lV\.-h.. •••b ",h.OV'
v .
I.......'l
(.)~ f\-+1-1 n.., I.l'\.t'o 8· Lttct
a. You design an R group that is charged
Af. You change the S in the 5-membered ring to a C
c. You make ortho- substitutions on the R group ./
@) aandc
e. all of the above

18. When drugs are synergistic the effect on bacterial Q'rowth of using them together
compared to the single agents is:
a. increased bacterial growth b. no effect on bacterial growth
(f) decreased bacterial growth

19. A potential adverse reaction with some cephalosporins is a disulfiram-like reaction.


These reactions are not associated with: -
~ an MTT (methylthiotetrazole) side group ® Cefaclor
~ Moxalactam .;1 1'1 f111rl p,

20. Lack ofpermeahility of the blood-brain barrier makes it more difficult to treat
infectiQns of the central nervous syste!ll.
® True b. False
Pharmacology/Med Chern II Exam 1 Page 5 of8

USE THE PICTURE BELOW TO ANSWER QUESTIONS 21-23:

PP-MG

Membrane

'\ I ~I-I \I'" t b l ~\OO X~,(!'I\

I ~,_." I J~" "~e \" e~(i)" t>\ V\llhV\\Ol\\\·

Cytoplasm = l-lYC-IG'Y)s l-~\'S l-Ils l-ila

UMP
\
~
~1 ,
D-iIU
c-AI.
,
D-~JU
o-AI.
) J~
0
-
Ala
I
\DP i I

I
t-Lys
~
~~
~
" c-AlaPPi VO_?la o-",Ia I o-Ala
o-Glu r

Y
UTP L-Ala o-Ala
UDP-G --- -I+- UDP-M~ { ~{ ~{. I
c-Glu
\ UDP-M:1 ' "'I"'f(D
CD l-AI. o-Glu l-Lys I n-Ala-D'Ala~0
~ l-Lys
NAcGle-I-P Glc-6-P

~ Agents which have toxicity because of their effects on cell membranes, include drugs
? -ui will
ccl1ntbltOK 7-

which inhibit steps:


a. 3 b. 4
~ 5 - V; \flUM\ ii~s ~~ a and b
if. a and c

22. Drugs such as fosfomycin and cycloserine are analogs of cell wall precursors. Use of
these drugs results in:
@ failure to form the NAM precursor
b. failure of the precursor to be transported across the membrane
c. failure to bind NAM to NAG
d. failure to cross-link the peptidoglycan chains

23. Drugs containing 13-lactam rings inhibit which of the processes?


a. 4 ~ 5
c. both d. neither
r
Pharmacology/Med Chem II Exam I Page 6 of8

-~~~~~ 24. Jennifer is an active 8 year old. Recently she was diagnosed with Lyme disease. Her
physician prescribed amoxicillin. Since doxycyclipe is the drug of choice for Lyme
-tCtwtll,ly k •.t,.,1"h..
sttuM~ Cll\..d disease, w~y wasn't it 1?re~cribed? (Jennifer has NO know drug allergies)
cJ.>MI vM.t ,a: because the dosing of amoxicillin is easier for a child to take
~.t ot..w-V.1\inu;t!. b. because in children bac.1eriucidaLagel1ts are better than bacteriostatic agents
since their immune systems are not developed ':
X because the physician was not up to date on current antimicrobial therapy
@) because of the adverse effects of tetracyclines on ~ones'and teeth of children
@ Modification ofthe1!£1one ring found in..ma~r.9lid.eshas the effect of:
a. increasing acid stability b. increasing tissue penetration/
c. increasing the spectrum of activity d. decreasing side effects v'
® all of the above

26. Drugs which inhibit peptidytransferase include:


a. chloramphenicol./ b. erythromycin
c. clindamycin d. quinupristin and dalfopristin ,/
@ all of the above
27. When using a bacteriocidal drug, curing the infection requires that the host.makes an
ad~t!v.~!.l1llUl}~ r~sp_~~e. C;,P..o...O..
dA.~.~ uU
a. True CD False \)O~U.'l\.

28. Plasmid mediated resistance to antibiotics: tJ>'.Tr"G\.,cJ\,f"'I.S'(\l\.mSt':;ln~ 6 CJ;~.

a. is easily transferred horizontally¥'" rt:.& \.,~~ •••.• 1 ~;


b. may contain information for resistance to manycaif'ferent ag~ts .,/
c. is extrachromosomal v ~f"'~\
\)\.-GL'i,vv.v..cII'
R,f'
~ ~'''1
~\
~r~~

d. a and c J..,.t. ve. s


@ all of the above

29. The lab results said that the organism was sensitivuo the dl].lgwhen it was teste<U!z
.vitro, unfortunately after administering the drug, your patient with meningitis is not
getting better. What are possible explanations for this?
a. the drug did not cross the blood brain barrier (dMl (\.Jlj" l\~~~ ~t).r
b. the drug was metabolized to an inactive compound./
c. lab error-/
d. a and c
@ all of the above .
s because it
30. Cloram~henicol is not dosed Witt€icilI~r ~!:lO
1\ a.
antagonIzes
True these drugs. a,
\.!v False
Pharmacology/Med Chem II Exam 1 Page 7 of8

31. In vitro amino.glycosides demonstrate a post-antihiotic effect. This means that the
drug is active:
~ only when the area under the curve ex*eds the MIC
b. when the drug is administered4fter alJol~K ~tJFiOtic sEc! as p:en~s~_
@ when the concentration of the drug in the body falls below the MI~
1h.. when it is administered at decreased @ S\tlbu.M"\..j--~or
~ .'i. ().d..1"/\.1..~ 0...1 h,..,. "•., <'"L"V'-
'-l ""-I:..'-" " .
32. Vancomycin is effective against both gram-J.2Q.?~ and gram-~a.tj.~e organisms
a. True ® -PaX;

@ ~minoglycoside
An example of a broad spectrum, aminoglvcoside
inactivating enzymes is:
which is resistaot to

,it:
c. Streptomycin
Amikacin (bJ Tobramycin
'c( Neomycin
34. Bacterial resistance to antimicrobials is due to which of the following mechanisms:
a. develop enzymes which inactivate the drug V"
b. develop efflux pumps to increase elimination of the drug - ?U-X't\...f GM.~ ou...t of u-~\ ./
c:, modify the target ofthe drug - o..'\.M..~ v...f\AJo\.L \;u bl.~'/
@) all of the above
C .-- J"

l:> ~ Which of the following drugs does nnl contain a B-Iactam ring?"/ 1c - L

~e.rutl.lluLi<;a. amoxicillin./
(c. ticarcillin./ - @ imipenem4-5~c1
d. bacitracin Jl..LJl9

e. all of the above CONTAIN ~-lactam rings

36. Drugs such as sublactam and clauvulonic acid are able to ~bit bot

a. True - (t
<m..st~lactamases. ~ I!'i\..V.C..u:M. ~ ~.o..."''\"C'A.m~JA.~·'IJ.'•• \'\~Q I,.\;.,'\}.f"\ .
False

37 Th .. l'nhib' . f d . ~lC' ~vY\ c...CV\u..l\"Ii.,..~&l.,~n


. e mInIma I ItOry concentratIOn 0 a rug IS: ~ '0 ac:lC..Uo'b"\.""O-Oc::. o~ct\~S
c.., ~ the lowest concentration of the drug needed to kill a bacteria - CA.d...a...Q.
b. the concentration of the drug needed to maintain an inhibitoDL£~_~tratio.n in the
body.
c. the lowest concentration of the drug needed to inhibit bacterial growth- 5~tl'-
@bandc

38. After graduating from ACP, you decide to go to work for a pharmaceutical company.
Your group is assigned the task of developing a new antibiotic. What targets within
the bacteria should you look at for developing an antibiotic?
a. ribosomes b. nucleic acid synthesis
c. cell walls @) all of the above
Pharmacology/Med Chern II Exam 1 Page 8 of8

39. Inhibition of protein synthesis affects the:


a. formation of a peptide bond./
b. binding of an aminoacyl-tRNA into the a site ofthe ribosome ./
c. reading of the codon--/
d. binding of the mRNA, 30S ribosomal subunit, and the f-Met t-RNA

vo all of the above I'\U,'\'l.t '. t '0i\',1ill \1>I.l:t1. t


40. Cefazolin has ~ram positive activity than Ce~xone. ,/ \S1' ~ 2nd. ~ 3rd..
a. True C0 False
@XPenicillin binding proteins:
are located in the cytoplasm of gram- and gram+ bacteria ,/
3(Y\<£l loco.J-ea eM CI~ \.!J.JL of c..LLl

~ b. are responsible forcarrying out cross-Ii . 0 e :d9glycanlayers in gram-


Ilegative. but l!9tin gram-l2.9sitiv~£~lls
(S) exhibit significaniB.:la.ctamase_acti41ity
d. may have an altered structure in bacteria which are resistant to penicillin
X are a target for penicillins but.I!Ql,cephalosporins
42. Uptake of is mediated by an energy-dependent transport system.
p. erythromycin \Q) linezolid
;t: gentamicin d. chloramphenicol
~ c1indamycin

43. George is scheduled for surgery to remove an intestinal polyp. Prior to the surgery it
is advisable to remove as many bacteria from the GI tract as possible in order to

~. ~ ~
\}J~~ f\.; lessen the
Which chance
of the for bacterial
following would contamination
you recommendof for
the this
peritoneal
purpose?cavity during surgery.

~~
~ ~.. a.
~. gentamicin
streptomycin b. linezolid
;y. c1indamycin
Ie:; neomycin
\Y 6\ ~UJU:.tt'\.lJl
(-o'fo.l U),{ (lYl~ be.it.:ll'e
()'rl1.Ulw!J.t., onl.l.J \\Pl(c"~
44. Your patient has meningitis caused by Streptococcus pneul11oniae, this organism is
sensitive to a number of drugs. Which of the fonowing characteristics of the drug do
you want to consider when selecting an antibiotic? LD SO l' lD ~
a. You want a drug that has a 194 therapeutic index. ~ VLT'T ..•. ~ .t \::1::>)1.) }, IM.A..t ,
b. You want a drug that has a 1JlQder&tetherapeutic index.
(§) You want a drug that has a high therapeutic index.
d. Who cares about therapeutic-index?

45. Cloramphenciol is rarely used because:


a. it has a narrow spectrum of activity »C it does not penetrate the CNS
C9 it has serious hematological toxicities d. all of the:above