NR566 Midterm Exam Review: 100 Advanced Pharmacology Newest
Questions with Answers & Rationales | Comprehensive FNP Study Guide |
Week 1-4 Coverage of Antibiotics, Antivirals, Antifungals, Gender Health &
Urinary Medications | pdf
Complete Week 1-4 Content Coverage
Domain Topics Covered Question
Numbers
Antibiotics & β-lactams (penicillins, cephalosporins, carbapenems), macrolides, tetracyclines, 1-20, 54-56,
Antimicrobial fluoroquinolones, aminoglycosides, sulfonamides, vancomycin, bactericidal vs. 77-81, 85-90,
Stewardship bacteriostatic, empiric therapy, C. difficile, antibiotic resistance mechanisms 96-99
(MRSA, VRE, CRE), drug interactions, G6PD deficiency, penicillin cross-reactivity
Antifungal Agents Azoles (fluconazole, itraconazole, clotrimazole), amphotericin B, echinocandins, 21-25, 70-72
nystatin, terbinafine, mechanism of action, drug interactions (CYP inhibition), heart
failure contraindication, onychomycosis
Antiviral Agents HIV antiretrovirals (NRTIs, NNRTIs, INSTIs, PIs), tenofovir nephrotoxicity, 26-30, 62-69,
abacavir hypersensitivity (HLA-B*5701), PrEP, hepatitis B (tenofovir), hepatitis C 92-93
(DAAs), influenza antivirals (oseltamivir, baloxavir), herpes antivirals (acyclovir,
valacyclovir), mechanism of action, black box warnings
Gender-Related Health BPH medications (tamsulosin, finasteride), alpha-1 blockers (orthostatic 31-40, 73-76
hypotension), 5-alpha-reductase inhibitors (sexual side effects), erectile
dysfunction (PDE5 inhibitors, nitrate contraindication), testosterone therapy
(hematocrit monitoring, polycythemia), GnRH agonists (leuprolide, flare
phenomenon), estrogen therapy (VTE risk, endometrial cancer), SERMs
(ospemifene), contraception (Depo-Provera bone density)
,Urinary Conditions Overactive bladder (solifenacin, oxybutynin, mirabegron, tolterodine), 41-53, 94-95
anticholinergic side effects (cognitive impairment, dry mouth), beta-3 agonists
(mirabegron, hypertension), bethanechol (cholinergic agonist, contraindication in
obstruction), phenazopyridine (urine discoloration), desmopressin (nocturnal
enuresis, hyponatremia), urinary tract infections (nitrofurantoin, TMP-SMX,
fosfomycin), pyelonephritis treatment, antibiotic duration
Pharmacokinetics & Bioavailability, first-pass effect, protein binding, half-life, renal dosing in older 82-84, 89-91
Pharmacodynamics adults, pregnancy and breastfeeding considerations
Sexually Transmitted Gonorrhea (ceftriaxone), chlamydia (doxycycline), trichomoniasis (metronidazole,
Infections alcohol avoidance), pelvic inflammatory disease (PID treatment regimens)
Domain: Antibiotics & Antimicrobial Stewardship
1. What is the primary mechanism of action (MOA) of β-lactam antibiotics
(penicillins, cephalosporins, carbapenems)?
A) Inhibition of protein synthesis at the 50S ribosomal subunit
B) Inhibition of folic acid synthesis
C) Disruption of the bacterial cell wall via inhibition of transpeptidases and
activation of autolysins
D) Inhibition of DNA gyrase
Correct Answer: C) Disruption of the bacterial cell wall via inhibition of
transpeptidases and activation of autolysins
Rationale: β-lactam antibiotics weaken the bacterial cell wall by two actions: (1)
inhibition of transpeptidases (enzymes that cross-link peptidoglycan) and (2)
disinhibition (activation) of autolysins (enzymes that degrade the cell wall). These drugs
must bind to penicillin-binding proteins (PBPs) to produce antibacterial effects.
,2. A patient is critically ill with suspected sepsis. Blood cultures have been drawn
but results are not yet available. What type of antibiotic therapy should be
initiated?
A) Narrow-spectrum antibiotic therapy
B) Empiric broad-spectrum antibiotic therapy
C) No antibiotics until culture results return
D) Prophylactic antibiotic therapy
Correct Answer: B) Empiric broad-spectrum antibiotic therapy
Rationale: Empiric antibiotic therapy is started before culture results are available,
based on clinical evaluation and knowledge of the most likely pathogens. This is
indicated for critically ill patients, those with severe infections, or when the pathogen is
unknown. Broad-spectrum antibiotics are used initially, then narrowed once culture
results are available (de-escalation).
3. Which of the following statements correctly distinguishes bactericidal from
bacteriostatic antibiotics?
A) Bactericidal agents inhibit bacterial proliferation while the host immune system kills
the bacteria
B) Bactericidal agents directly kill bacteria and are preferred for
immunocompromised patients
C) Bacteriostatic agents directly kill bacteria and are preferred for immunocompromised
patients
D) There is no clinical difference between bactericidal and bacteriostatic agents
Correct Answer: B) Bactericidal agents directly kill bacteria and are preferred for
immunocompromised patients
Rationale: Bactericidal antibiotics (e.g., aminoglycosides, β-lactams, fluoroquinolones,
vancomycin) directly kill bacteria. Bacteriostatic agents (e.g., clindamycin, macrolides,
sulfonamides, tetracyclines) inhibit bacterial proliferation while the host's immune
system does the killing. Bactericidal agents are preferred for immunocompromised
patients (e.g., those with diabetes, HIV, or cancer) and for overwhelming infections.
, 4. A patient develops Clostridium difficile-associated diarrhea (CDAD) after a
course of antibiotics. What is the recommended treatment?
A) Continue the same antibiotic and add loperamide
B) Stop the offending antibiotic and start vancomycin or fidaxomicin
C) Prescribe metronidazole only
D) Start oral probiotics and discharge home
Correct Answer: B) Stop the offending antibiotic and start vancomycin or
fidaxomicin
Rationale: C. diff treatment involves discontinuing the causative antibiotic when
possible and initiating targeted therapy. Current IDSA/SHEA guidelines recommend
vancomycin or fidaxomicin as first-line agents for initial C. difficile infection.
Metronidazole is no longer preferred for initial treatment.
5. A patient with a severe penicillin allergy (anaphylaxis) requires antibiotic
treatment for a serious infection. Which drug classes have the highest risk for
cross-sensitivity reactions?
A) Macrolides and tetracyclines
B) Cephalosporins and carbapenems
C) Fluoroquinolones and aminoglycosides
D) Sulfonamides and nitrofurantoin
Correct Answer: B) Cephalosporins and carbapenems
Rationale: Patients with severe penicillin allergy (especially anaphylaxis) may have
cross-sensitivity reactions with cephalosporins and carbapenems due to similar β-lactam
ring structures. Cross-reactivity rates are approximately 1-10% for cephalosporins.
Alternative non-β-lactam agents (e.g., vancomycin, fluoroquinolones) are preferred in
patients with severe penicillin allergy.
6. Which drug class is known to promote the development of Clostridium difficile
infection (CDI) more than any other?
Questions with Answers & Rationales | Comprehensive FNP Study Guide |
Week 1-4 Coverage of Antibiotics, Antivirals, Antifungals, Gender Health &
Urinary Medications | pdf
Complete Week 1-4 Content Coverage
Domain Topics Covered Question
Numbers
Antibiotics & β-lactams (penicillins, cephalosporins, carbapenems), macrolides, tetracyclines, 1-20, 54-56,
Antimicrobial fluoroquinolones, aminoglycosides, sulfonamides, vancomycin, bactericidal vs. 77-81, 85-90,
Stewardship bacteriostatic, empiric therapy, C. difficile, antibiotic resistance mechanisms 96-99
(MRSA, VRE, CRE), drug interactions, G6PD deficiency, penicillin cross-reactivity
Antifungal Agents Azoles (fluconazole, itraconazole, clotrimazole), amphotericin B, echinocandins, 21-25, 70-72
nystatin, terbinafine, mechanism of action, drug interactions (CYP inhibition), heart
failure contraindication, onychomycosis
Antiviral Agents HIV antiretrovirals (NRTIs, NNRTIs, INSTIs, PIs), tenofovir nephrotoxicity, 26-30, 62-69,
abacavir hypersensitivity (HLA-B*5701), PrEP, hepatitis B (tenofovir), hepatitis C 92-93
(DAAs), influenza antivirals (oseltamivir, baloxavir), herpes antivirals (acyclovir,
valacyclovir), mechanism of action, black box warnings
Gender-Related Health BPH medications (tamsulosin, finasteride), alpha-1 blockers (orthostatic 31-40, 73-76
hypotension), 5-alpha-reductase inhibitors (sexual side effects), erectile
dysfunction (PDE5 inhibitors, nitrate contraindication), testosterone therapy
(hematocrit monitoring, polycythemia), GnRH agonists (leuprolide, flare
phenomenon), estrogen therapy (VTE risk, endometrial cancer), SERMs
(ospemifene), contraception (Depo-Provera bone density)
,Urinary Conditions Overactive bladder (solifenacin, oxybutynin, mirabegron, tolterodine), 41-53, 94-95
anticholinergic side effects (cognitive impairment, dry mouth), beta-3 agonists
(mirabegron, hypertension), bethanechol (cholinergic agonist, contraindication in
obstruction), phenazopyridine (urine discoloration), desmopressin (nocturnal
enuresis, hyponatremia), urinary tract infections (nitrofurantoin, TMP-SMX,
fosfomycin), pyelonephritis treatment, antibiotic duration
Pharmacokinetics & Bioavailability, first-pass effect, protein binding, half-life, renal dosing in older 82-84, 89-91
Pharmacodynamics adults, pregnancy and breastfeeding considerations
Sexually Transmitted Gonorrhea (ceftriaxone), chlamydia (doxycycline), trichomoniasis (metronidazole,
Infections alcohol avoidance), pelvic inflammatory disease (PID treatment regimens)
Domain: Antibiotics & Antimicrobial Stewardship
1. What is the primary mechanism of action (MOA) of β-lactam antibiotics
(penicillins, cephalosporins, carbapenems)?
A) Inhibition of protein synthesis at the 50S ribosomal subunit
B) Inhibition of folic acid synthesis
C) Disruption of the bacterial cell wall via inhibition of transpeptidases and
activation of autolysins
D) Inhibition of DNA gyrase
Correct Answer: C) Disruption of the bacterial cell wall via inhibition of
transpeptidases and activation of autolysins
Rationale: β-lactam antibiotics weaken the bacterial cell wall by two actions: (1)
inhibition of transpeptidases (enzymes that cross-link peptidoglycan) and (2)
disinhibition (activation) of autolysins (enzymes that degrade the cell wall). These drugs
must bind to penicillin-binding proteins (PBPs) to produce antibacterial effects.
,2. A patient is critically ill with suspected sepsis. Blood cultures have been drawn
but results are not yet available. What type of antibiotic therapy should be
initiated?
A) Narrow-spectrum antibiotic therapy
B) Empiric broad-spectrum antibiotic therapy
C) No antibiotics until culture results return
D) Prophylactic antibiotic therapy
Correct Answer: B) Empiric broad-spectrum antibiotic therapy
Rationale: Empiric antibiotic therapy is started before culture results are available,
based on clinical evaluation and knowledge of the most likely pathogens. This is
indicated for critically ill patients, those with severe infections, or when the pathogen is
unknown. Broad-spectrum antibiotics are used initially, then narrowed once culture
results are available (de-escalation).
3. Which of the following statements correctly distinguishes bactericidal from
bacteriostatic antibiotics?
A) Bactericidal agents inhibit bacterial proliferation while the host immune system kills
the bacteria
B) Bactericidal agents directly kill bacteria and are preferred for
immunocompromised patients
C) Bacteriostatic agents directly kill bacteria and are preferred for immunocompromised
patients
D) There is no clinical difference between bactericidal and bacteriostatic agents
Correct Answer: B) Bactericidal agents directly kill bacteria and are preferred for
immunocompromised patients
Rationale: Bactericidal antibiotics (e.g., aminoglycosides, β-lactams, fluoroquinolones,
vancomycin) directly kill bacteria. Bacteriostatic agents (e.g., clindamycin, macrolides,
sulfonamides, tetracyclines) inhibit bacterial proliferation while the host's immune
system does the killing. Bactericidal agents are preferred for immunocompromised
patients (e.g., those with diabetes, HIV, or cancer) and for overwhelming infections.
, 4. A patient develops Clostridium difficile-associated diarrhea (CDAD) after a
course of antibiotics. What is the recommended treatment?
A) Continue the same antibiotic and add loperamide
B) Stop the offending antibiotic and start vancomycin or fidaxomicin
C) Prescribe metronidazole only
D) Start oral probiotics and discharge home
Correct Answer: B) Stop the offending antibiotic and start vancomycin or
fidaxomicin
Rationale: C. diff treatment involves discontinuing the causative antibiotic when
possible and initiating targeted therapy. Current IDSA/SHEA guidelines recommend
vancomycin or fidaxomicin as first-line agents for initial C. difficile infection.
Metronidazole is no longer preferred for initial treatment.
5. A patient with a severe penicillin allergy (anaphylaxis) requires antibiotic
treatment for a serious infection. Which drug classes have the highest risk for
cross-sensitivity reactions?
A) Macrolides and tetracyclines
B) Cephalosporins and carbapenems
C) Fluoroquinolones and aminoglycosides
D) Sulfonamides and nitrofurantoin
Correct Answer: B) Cephalosporins and carbapenems
Rationale: Patients with severe penicillin allergy (especially anaphylaxis) may have
cross-sensitivity reactions with cephalosporins and carbapenems due to similar β-lactam
ring structures. Cross-reactivity rates are approximately 1-10% for cephalosporins.
Alternative non-β-lactam agents (e.g., vancomycin, fluoroquinolones) are preferred in
patients with severe penicillin allergy.
6. Which drug class is known to promote the development of Clostridium difficile
infection (CDI) more than any other?
