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Pharmacology/Medicinal Chemistry Test 3

1. Which of the following possible mechanisms of resistance to a penicillin is least likely to be

associated with a gram positive bacteria?

(j) Acquisition of a plasmid encoding an efflux pump.

B. Acquisition of a plasmid encoding a beta-lactamase gene. b
C. Acquisition of a plasmid encoding a mutated penicillin binding protein.
~ Acquisition of a plasmid encoding a mutated porm p~otein.
E. All of the mechanisms above are likely to be associated with a gram positive bacteria

2. Which of the following drug combinations would be expected to result in an indifferent effect?

)( Which of the following would be drugs that co-uld be safely administered to a pregnant woman
throughout the gestation period?

A. sulfamethoxazole$-
B. ketoconazole
c. ciprofloxacin
ci)) isoniazid
E. demeclocycline \ J::-~
- _f\ \
"
4. Which of the following might explain why a drug might be active i1'}Yi1ro but not ~o?
;r_":" ._"

-p£.'The drug is metabolized to an active form by host cells. 'f--

B7 The drug is concentrated at the site of the infection in the body.
® The drug is unable to penetrate into the brain.,

A 5. The administration of drug X to a 3 month-old baby results in greater than expected kidney toxicity.
What would be the most reasonable explanation for this result?

A. metabolite
Drug accumulated
is slowerinthan
this normal.
3 month-old baby because metabolism of the drug to an inactive /\
B. The toxicity seen in this baby occurred because a larger amount of drug than normally expected

!The toxicity results from greater than expected-excretion of the parent drug via the kidneys;
leading to accumulation of the drug in proximal tubule cells.
~•. \ was activated to a toxic metabolite which then accumulated in the kidneys.

)
 ,//, ,

YVrnchof the following would account for increased penetration of drug X in to the brain relative to
drugY?

~ Drug X is less lipid soluble than drug Y. , ":

"k Drug X has a larger molecular weight than drug Y. ~'

'e' Drug X is more highly bound to plasma proteins than drug Y.

@ Drug X is predominantly unionized at neutral pH while drug Y is largely ionized at neutral pH.
E. Any of the above could account for this difference in penetration.

"E ~ 7. For which of the following surgical procedures would it be acceptable for prophylactic antibiotic to
;£ ~ be given after the first incision?

A. Gastrointestinal surgery' to remove a ruptured appendix.

B. Orthopedic surgery to replace a knee joint '
C. Cardiac surgery to replace a heart valve.
@ -~ Delivery by cesarean section .
. .•

~ Lower leg surgery to reparr a compound fracture.

f\ 8.. What does the term cross resi$tance imply?

~ An organism, which is resistant to one penicillin, 'Will be resistant to other penicillins.

B. Cross resistance usually implies that the drugs involved are structurally very different.
_
/' -
C. An organism, which is resistant to one protein synthesis inhibitor, will be resistant to all protein
synthesis inhibitors.
D. Cross resistance wiil occur as a result of plasmid acquisition but not as a result of chromosomal
mutation.

~ g. Which of the following describes the process by which a plasmid can exchange genetic information
with another plaSmid, when both plasrnids reside in the same bacterial cell?

A. transduction
® transposition
C. conjugation

10. Which of the following is true?

,k A single point mutation of q. bacterial chromosome leading to resistance is not caused as a result
o(~g -exposure.
B. A single point mutation of a bacterial chromosome leading to resistance can not result from a
lethal mutation.
-CO A single point mutation of a bacterial chromosome leading to resistance can give rise to high
level resistance.

g. All of the above are true.

--
~

~ 1L As drug structure is modified to produce a series of drllgs with increased lipi"': s;:: :'_:::~::-:'c~~:?12.;,-ma
protein binding oftbis series .is most like to _

A. increase
giJ decrease
C. be unaltered

12.' Which of the following is consistent with the mechanism of action of penicillins?

1\. Inhibition of both transpeptidase and autolysins.

@ Inhibition oftranspeptidase and activation of autolysins.
~ Activation of both transpeptidase and autolysins.
'D., Activation oftranspeptidase and inhibition of autolysins.
E. None of the above accurately describe the mechanism of action of penicillins.

f713. A drug with which of the following structures would be most likely to cause a superinfection
1\ " following oral administration? '/'-
. ;'_. . ' ,=_u_ --.q
A. .' . c.
~
. ~i .. ~
\, ,-§j'
14. If aztreonam is administered as a combination with cilastatin, the metabolic inactivation of
aztreonam will _

A. increase

W
~'\ be unaltered
decrease

15. Which of the following interferes with transport of cell wall precursor;molecules across the
cytoplasmic membrane of bacteria ? .

A. bacitracin
B. vancomycin
C. streptomycin
D. neomycin
E. nitrofurantoin

16. Which of the following structures is associated with the ability of cephalosporins to inhibit vitamin
K-dependent clotting mechanisms?

A piperazine ring
B. methythiotetrazole ring
C. thiazolidine ring
D. dihydrothiazide ring
E. None of the above

3
 I
17..~ch of the following R groups would be present on' a drug which is likely to be resistant to the
r;I , action bfbeta-lactamase?

A.
~
COOH

, ~ ~,~,~~
'(""" ..•~"" '

A a decrease in antibacterial activity and a decreased chance for an allergic reaction to Penn G.
~:..Q 18. A
B. decrease in the
an increase in conversion
antibacterial ofPenn'G to E-emcilloic
activity and an increasedacid wouldforresult
chance in:
an allergic reaction to Penn G.

-?J~
.r1§J an increase inin antibacterial
a decrease antibacterial activity
activity and
and an
a decreased
increased chance for an allergic reaction to Penn G.

C 19.}
/ What is the normal function of the autolysin activities that are present in bacterial cells?

'A.. These activities are responsible for cross-link: formation during cell wall synthesis.'
B. These activities are responsible for inactivation ofbeta-lactamase produced by other bacterial
re~ .
C. These activities are responsible for cell wall remodeling during cell division.
~ These activities are responsible for transporting cell wall precursor molecules across the
cytoplasmic membrane ..

A 20. Patient X is thought to be suffering from an infection caused by Staph. aureus. Which of the
following antibiotics would be most likely to be effective in patient X?

A. First generation cephalosporin

B. Second generation cephalosporin
C. Third generation cephalosporin
D. Aztreonam
E. Clavulanic acid
:;~~;;~
f\ 21. Wbich of the following aCts bybindmg to the 50S ribosome subunit? ~.*\,
..
tJ
A. linez~~d:o It) ~
R ,gentmilicm 't' ...,~
C. doxycycline 3CD
~_ vancomycin
~. bacitracin

~ 22. Which of the following is most likely to interfere with bone and tooth development in a fetus?
.~~:- .•.

A. chloramphenicol \!/~' "

R tetracycline
C. vancomycin
D. kanamycin
E. azithromycin
 Il

~I '.

'-"- 23. Drug ~e1if~~lJ.,resulting in decreased antibacterial activity, is associated with which of
followmg~-gs'?

A quinupFistinldalfopristin _'f,,-:;iCln
B • .;...:......
..•.1...
U.!..Uie1JJ.opnm " .[ ~.,.~- c:-
-'> .,.r.....•..,.~._ ~.z.:""c...
,<,/ am.J.KaCm
';=--C' , . ~.
c..t.\\ '~'~'.1
',".
c..\'J-'
-'- \

D. rifampin -'> ~ . ntv \

E. pyrazinamide-"--r'D J

~. 24. R~sistance to the actions of sulfamethoxazole is most likely to occur as a result of:

tfE"

D.
.
an increa:>~~ the synthesis of p-amino-be~oic acid by bacterial cells ..
aandecrease
mutationinmthe
theacetylation of sulfamethoxazole
gene that encodes by gyrase.
bactenal DNA bacterial cells.
a decrease in oxygen-dependent transport of sulfamethoxazole into bacterial cells.
E. acquisition of a plasmid with a gene encoding an altered dihydrofolate reductase. ~~";\"1>\,,' r•• '

( 25. Some individuals are susceptible to red blood cell hemolysis as a result of a deficiency in:

A glucuronyl transferase
B. glycosyltransferase
@ glucose-6-phosphate dehydrogenase

b' 26. Leucovorin can be ailminstered to prevent bone marrow toxicity resulting from treatment with:
1_ rescue
A. sulfarnetboxazole
B. nomoxacin
C. ni1rofurantion
D. chloramphenicol
E. trimethoprim

i' '~. Nitroreductase is thought to be responsible for:

A. inactivation of gatifloxacin.
B. inactivation of nitrofurantion.

~
'i C.
the ability of quinolones to cause bone marrow toxicity.
the ability of chloramphenicol to cause pulmonary damage with chronic treatment.
activation of nitrofurantoin to metabolites which damage nucleic acids.

28. When taking sulfamethoxazole, patients should be advised:

A. to avoid taking the drug with milk.. ..-

C. that
(~~ their urine
to increase fluidmay become red or P(<€'V~J)t-
consumption.~ UL{~08i~
orange colored. ~ ~
D. that their urine may be brown colored.
E. that antacids will greatly decrease the effectiveness of this drug.

5
'-;,~ yihen +comp~ed
, ./ " gram orgamsms.to quinolones, fluoroquinolones have· activity agrrinst

'::l A. increased
B. decreased
C. similar

XAtQisoniazid?
mutation resulting in which ofth~
H,YL mycolic follo~Fwould
ctcAlA. '
be associated with re~istance of mycobacteria
--
~- r;;\fnme<;lS .
•...••A. catalase/peroxidase
pyrazinamidase
C. R...~Apolymerase
'fJ. tubulin (protein associated with microtubules)
E. the enzyme associated with acetylation of isoniazid

\M.
/....Initial
-~---- -----
proliferation -=== .
of mycobacteria following inhalational exposure is most likely to occur:

A. inredbloodcells mo.UO(jJ -to \Vmph

R1\in macrophages
in the spleen
D. Proliferation is likely to occur in any of the above

¥ Administration of pyridoxine will prevent peripheral neurotoxicity associated with:

~ .
A. flucytosine
isoniazid
ethambutol
D. amoxicillin
E. caspofungin

)( An increase in the form~tion of acetylhydrazine from isoniazid should the

. hePatic toxicity' that results from isoniazid treatment.

G increase
B. decrease
. C. not alter

)(. Patient Q has been diagnosed with liver disease. Which of the following drugs should be avoided by
patient Q?

A.
B. pyrazinamide
ethambutol 7 fle;\ftfLl

/~ streptomycin
ciprofloxacin
'-'-D. -../~
E. amphotericin B.-te~~

LO
 .)( :Whichof the following drugs is least efficacio~ agallist mtracellular mycobacteria?
.. - --=., l/"\/V\/\.
ethambutol
';;:;,I'

B. pyrazinamide

C. ?£ar:rP~
rn-~ ISOIDazId ~7L. \t ~t- lv IV
tif\P

'C 36. Unintended pregnancy while taking oral birth control pills could be a possible side effect ofwmch
C) of the following drugs?'
• A chloramphenicol
lK isoniazid
'-
~
(a erythromycin 1-\~0',.-,(~.'••U":(
\
':>

--K isoniazid ~ nOr P4ro

'i. rifampin -pOtent- d'\LlU~
)( The antimycobacterial effect of eth~butQl is associated with inhibition of which of the following?

A. enoyl-ACP reductase
B. fatty acid synthase I
<0arabinosyl transferases
D. DNA-dependent RNA polymerase
E. topoisomerase N

3?1:A decrease in bacterial cytosine deaminase activity would be associated with _

efficacy of flucytosine.

increased
V decreased
C. no change in the

(
"-- 39. Anemia is a potential side effect ofwmch of the following drugs:
'

-) A. nitrofurantoin
B. amphotericin B
~ ~ sulfamethoxazole
All of the above
. None of the above

~. Which of the following agents is most likely to decrease steroid Woduction by hosLcells?
.., --smv \
B.
A. caspofungm
fluconazol.e sucr-(\
itraconazole
(nh. of n1r110<6'\eJU\"
\::;l-J

ketoconazole'-l ()rl(d.{ttolD
griseofulvin 4 rni""'nc.- ':.?'!\1<t-
 is associated with a decreased'production of DNA by fungal cells?

L 42. Which of the following is ~ot effectively adsorbed from the gastrointestinal tract following
administration?

A. caspofungin
B. amphotericin B
- C. vancomycin
D. gentamicin
E. None of the above are absorbed from the gastrointestinal tract

)4. Administration ofterbinafine results in a direct decrease in

\OS\re tthdb kQXa.tin, h -:.j...,p~V7"'\"'~~------

,0-\;\.~ c.--- A.
B. glucan synthesis
arabinosyl _
transferase activity Stt ual.Q.nQ
't{CCt InI ()G,. 0:(108\ u '~J1
u.m L ~ to>(((J J1
)r'
~ squalene epoxidase activity
14-alpha-demethylase activity~5
E. mycolic acid synthesis

-'4/A
f
//'. emosterol formation would be associated with resis,tance to:

griseofulvin .

flucytosme - B.I(l \/\

B. ~hot~ricin IJ ~
J \ \ c"\ 9 t LACOvVY \ en
vv v•...
1vA\ c..eiU
D. itraconazole
~ E. none of the above

1'i
I Which of the following drugs will show significant Renetration across the blo£c1hmin barrier?

@.Quconazole
~ ketoconazole
~ itraconazole
D. All of the above
E. None of the above

Iii
p 46. Wmch of the following is the correct match?
'K chloramphenicol-ototoxicity
B. erythromycin-GI cramping and nausea
~ clindamycin-significant proximal tubular cell damage
El. linezolid-significant cytochrome P450 inhibitio,1
fr..: quinupristinldalfopristin-significant cytochrome P450 induction
 ioxycycline
~. linezolid
1>:- chloramphenicol
D. tlindamycin
~. All of the above would be safe

~ 48. Ototoxicity resulting from treatment with aminoglycosides:

A. is due to direct interference with neurotransmitter release from nerve cells.
E. is due to accumulation of aminoglycosides within hair cells with subsequent damage to these
ceils.
C. is due to accumulation of aminoglycosides within specific regions of the brain that are associated
with auditory signal processing.

~ 49. Which of the following drugs has the potential to decrease the number of circulating platelets.

A. clindamycin
B. a.mikacin
C. doxycycline
D. c1arithromycin
E. linezolid

50. Which of the following effectively blocks peptidyltransferase activity?

( • ~A... ampicillin
~" B. aztreonam
"c: chloramphenicol
D. oxytetracycline
E. clindamycin