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Монографии, изданные в издательстве Российской Академии Естествознания

Chapter 5. CHEMOTHERAPEUTIC DRUGS

«BETA-LACTAM ANTIBIOTICS»

85. A female patient has pelvic inflammatory disease, and the decision is made to treat her with antibiotics as an outpatient. One of the drugs to be used is a cell-wall synthesis inhibitor with activity against anaerobic gram-negative rods including Bacteroides fragilis. She is warned that unpleasant reactions may occur if she consumes alcoholic beverages while taking this drug. If you also know that the antibiotic may cause hypoprothrombinemia, you can identify it as … (Cefotetan, Ceftriaxone, Doxycycline, Metronidazole, Ofloxacin).

86. A patient’s history notes a documented severe (anaphylactoid) reaction to a penicillin. What other antibiotic or class is likely to cross-react and so should be avoided in this patient?

87. A 39-year-old man with aortic insufficiency and a history of multiple antibiotic resistances is given a prophylactic intravenous dose of antibiotic before surgery to insert a prosthetic heart valve. As the antibiotic is being infused, the patient becomes flushed over most of his body. Which antibiotic is most likely responsible?

88. An 86-year-old man complains of cough and blood in his sputum for the past 2 days. On admission, his temperature is 103°F. Physical examination reveals rales in his right lung, and x-ray examination shows increased density in the right middle lobe. A sputum smear shows many gram-positive cocci, confirmed by sputum culture as penicillinase-producing Staphylococcus aureus. Which agent should be given?

89. A sputum culture of a 65-year-old man with pneumonia is positive for b-lactamase-positive staphylococci. Which drug is the best choice of penicillin therapy in this patient?

90. A 75-year-old man has a fever of 104°F. He develops a cough that produces blood-tinged sputum with gram-positive cocci in clusters. A chest x-ray shows increased density in the right upper lobe. Which penicillin is likely to fail to treat this infection adequately?

«ANTIBIOTICS – PROTEIN SYNTHESIS INHIBITORS»

91. Several antibiotics are effective in single doses for the treatment of uncomplicated gonorrhea. Which one of the following drugs necessitates a 7-day course of treatment to be effective? (Doxycycline, Azithromycin, Cefixime, Ofloxacin, Spectinomycin)

92. In community-acquired pneumonia, pathogens responsible for infection include pneumococci, gram-negative rods, and atypicals such as Mycoplasma pneumoniae and Chlamydia pneumoniae. Which one of the following drugs used as monotherapy is most likely to be both effective and safe, if your patient is pregnant? (Azithromycin, Amoxicillin, Erythromycin estolate, Clarithromycin, Ofloxacin)

93. An 82-year-old hospitalized patient with creatinine clearance of 25 mL/min has a microbial infection requiring treatment with antibiotics. Which one of the following drugs is least likely to require a dosage adjustment, either a smaller dose than usual or an increased interval between doses? (Erythromycin, Amphotericin B, Gentamycin, Imipinem-cilastatin, Vancomycin)

94. In a patient who has an established hypersensitivity to metronidazole, the most appropriate drug to use for the management of pseudomembranous colitis is … (Vancomycin, Ampicillin, Clindamycin, Doxycycline, Ofloxacin)

95. A 7-year-old child presents with pharyngitis and fever of 2 days duration, and microbiology reveals small, translucent beta-hemolytic colonies sensitive in vitro to bacitracin. Past history includes a severe allergic reaction to amoxicillin when used for an ear infection. You need to treat this infection, but you prefer not to use a drug that needs parenteral administration. Which one of the following agents is most likely to be appropriate in terms of both effectiveness and safety? (Azithromycin, Cefaclor, Doxycycline, Penicillin G, Vancomycin)

96. You are taking an initial health history from a 22-year-old woman who just moved to your town. She is remarkably fit and healthy, but is wearing two hearing aids for binaural (bilateral) high frequency hearing loss. You inquire about the possible reason(s) for this. She says she lost most of her hearing after receiving an antibiotic for a severe infection when she was 19, but cannot recall the specific drug. Which drug was most likely responsible for her hearing loss?

97. A patient with an infectious disease routinely takes their antimicrobial medication with milk or other dairy products in an attempt to reduce stomach upset from the drug. This is most likely to lead to therapeutic failure if the drug is what?

98. A patient is being treated with an antibiotic for a vancomycin-resistant enterococcal infection. They consume an over-the-counter medication containing ephedrine and develop a significant spike of blood pressure that leads to a pounding headache. They are transported to the hospital. As part of the work-up, blood tests indicate some bone marrow suppression. Which antibiotic is most likely associated with this clinical picture?

«SULFONAMIDES AND URINARY ANTISEPTICS»

99. A jaundiced 1-day-old premature infant with an elevated free bilirubin is seen in the premature baby nursery. The mother had received an antibiotic combination for a urinary tract infection (UTI) 1 week before delivery. Which drug is the most likely cause of the baby’s kernicterus?

100. A patient on antimicrobial therapy develops the following signs and symptoms that ultimately are found to be drug-induced: cough, dyspnea, and pulmonary infiltrates; neutropenia and bleeding tendencies; and paresthesias. Which drug is the most likely cause of this patient’s symptoms?

«ANTIFUNGAL DRUGS»

101. A patient suffering from invasive aspergillosis is first administered NSAIDs, antihistamines, and adrenal glucocorticoids, followed by … (Amphotericin B, Ketoconazole, Flucytosine, Itraconazole, Terfenadine).

102. Which one of the following drugs (Fluconazole, Amphotericin B, Ampicillin, Nystatin, Flucytosine) is most suitable in an immunocompromised patient for prophylaxis against infection due to Cryptococcus neoformans?

103. A 19-year-old man being treated for leukemia develops a fever. You give several agents that will cover bacterial, viral, and fungal infections. Two days later, he develops acute renal failure. Which drug was most likely responsible?

104. A 26-year-old woman with acquired immunodeficiency syndrome (AIDS) develops cryptococcal meningitis. She refuses intravenous medication. Which antifungal drug is the best choice for oral therapy of the meningitis?

«ANTIVIRAL DRUGS»

105. In AIDS patient who is being treated with multiple drugs, including AZT, lamivudine, indinavir, ketoconazole and TMP-SMP (co-trimoxazole), develops breast hypertrophy, central adiposity, hyperlipidemia, insulin resistance, and nephrolithiasis. If these changes are related to his drug treatment, the most likely cause is …. (Indinavir, Azidothymidine, Ketoconazole, Sulfamethoxazole, Trimetoprim).

106. A 40-year-old man is HIV-positive with a cluster-of-differentiation-4(CD4) count of 200/mm3. Within 2 months he develops a peripheral white blood cell count of 1000/mm3 and a hemoglobin of 9,0 mg/dL. Which drug is most likely caused the hematologic abnormalities?

«DRUGS USED TO TREAT TUBERCULOSIS»

107. A 59-year-old woman is diagnosed with tuberculosis (TB). Before prescribing a drug regimen, you take a careful medication history because one of the drugs commonly used to treat TB induces microsomal cytochrome P450 enzymes in the liver. Which drug is it?

108. As part of a multidrug attack on a patient’s infection with Mycobacterium tuberculosis, a physician plans to use an aminoglycoside antibiotic. Which drug is most active against the tubercle bacillus and seems to be associated with the fewest problems with resistance or typical aminoglycoside-induced adverse effects?

109. A patient with tuberculosis is started on isoniazid (INH). The physician starts therapy with vitamin B6 at the same time. What is the main reason for giving the vitamin B6?

«ANTIPROTOZOAL DRUGS»

110. A 27-year-old woman has just returned from a trip to Southeast Asia. Over the past 24 h she has developed shaking, chills, and a temperature of 104°F. A blood smear reveals Plasmodium vivax. Which agent should be used to eradicate the extraerythrocytic phase of the organism?

111. A 35-year-old woman complains of itching in the vulval area. Hanging-drop examination of the urine reveals trichomonads. Which drug is the preferred treatment for the trichomoniasis?

112. The patient develops profuse, watery diarrhea, fever, abdominal pain, and leukocytosis. C.difficile infection in the gut is confirmed. Preferred antimicrobial therapy for this antibiotic-associated pseudomembranous colitis is which drug?

«ANTICANCER DRUGS»

113. A 47-year-old woman with choriocarcinoma is treated with very high doses of methotrexate (MTX). You anticipate significant host cell toxicity in response to the high MTX dose, and so immediately after giving the anticancer drug you administer which drug?

114. A 41-year-old woman is admitted to the outpatient area of the hematology-oncology center for her first course of adjuvant chemotherapy for metastatic breast cancer following a left modified radical mastectomy and axillary lymph node dissection for infiltrating ductal carcinoma of the breast. Two biopsies were positive for cancer. Following premedication with IV dexamethasone and ondansetron, she will receive combination chemotherapy with doxorubicin, cyclophosphamide, and fluorouracil. Twenty-four hours after the first course of chemotherapy she will start a 10-day regimen with filgrastim. Which is the purpose of giving that drug?

115. A 30-year-old woman being treated for ovarian cancer develops high frequency hearing loss and declining renal function in response to anticancer drug therapy. Which drug is the most likely cause?

116. The oncology team has treated many patients with acute lymphocytic leukemia using a combination of drugs. One drug tends to cause a high incidence of lumbar and abdominal pain, significant increases of serum amylase and transaminase activity, and other symptoms of hepatic and/or pancreatic dysfunction. Some patients developed serious hypersensitivity reactions upon drug administration, and there have been occasional sudden deaths. Which drug best fits this description?

117. A man has prostate cancer that will be treated with leuprolide. Which drug must be used adjunctively when we start chemotherapy?

118. A 75-year-old man had surgery for prostate carcinoma, and local metastases were found intraoperatively. Which is the most appropriate drug aimed at treating the metastases?


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