Katzung Pharmacology Review questions and answers
2023 with complete solution
Question 1:
A 30-year-old hospitalized patient with AIDS has a CD4 cell count of 50/μL. He is being
treated with a highly active antiretroviral therapy (HAART) regimen consisting of
zidovudine (ZDV), lamivudine (3TC), and indinavir. Other drugs being administered to
this patient include ganciclovir, clarithromycin, rifabutin, and trimethoprim-
sulfamethoxazole.
The drug in this patient's regimen that inhibits posttranslational modification of viral
proteins is
A
Acyclovir
B
Indinavir
C
Lamivudine
D
Rifabutin
E
Zidovudine
• indinavir
The correct answer is (B).
Explanation:
Protease inhibitors such as indinavir act at the posttranslational step of HIV at which the
viral enzyme cleaves precursor molecules to form the final structural proteins of the
mature virion core.
Young woman brought to ER with intense abdominal pain 2 d duration. Pain spread to
RLQ w/ N/V and fever. BP 85/45, pulse 120/min, temp 40C. Given antimicrobial therapy
stating w/ IV ampicillin & gentamicin.
If antibiotic regimen in this pt is modified to include metronidazole:
monitor fo candidiasis
The primary mechanism of antibacterial action of the penicillins involves inhibition of
(A) Beta-lactamases
(B) N-acetylmuramic acid synthesis
(C) Peptidoglycan cross-linking
(D) Synthesis of cell membranes
(E) Transglycosylation
C (Penicillins (and cephalosporins) bind to PBPs acting at the transpeptidation stage of
cell wall synthesis (the final step) to inhibit peptidoglycan cross-linking. The beta-lactam
antibiotics also activate autolysins, which break down the bacterial cell wall. Synthesis
of N-acetylmuramic acid is inhibited by
fosfomycin. Vancomycin inhibits transglycolase preventing elongation of peptidoglycan
chains. The answer is C.)
,Question 2:
A 46-year-old man has hypertension of 155/95. His cardiac and kidney function is
normal. Losartan has been suggested as therapy. This drug provides an
antihypertensive effect by which of the following effects?
A
Accelerating the rate of enzymatic inactivation of amine neurotransmitters in the CNS
B
Activating α2-adrenoceptors located in the presynaptic membranes of CNS neurons that
regulate peripheral SANS activity
C
Blocking the transport of amine neurotransmitters from the cytoplasm to the inside of
synaptic transmitter storage vesicles
D
Inhibiting the uptake of amine neurotransmitters from the extracellular fluid into the
cytoplasm in the presynaptic nerve terminus
E
Interfering with the combination of angiotensin II with its receptor
• losartan
The correct answer is (E).
Explanation:
Losartan is a member of the angiotensin receptor-blocking group. It is a competitive
antagonist of angiotensin II at its receptor.
Methenamine salts are used as urinary antiseptics. Reason they lack systemic
antibacterial action is that they are
converted to formaldehyde only at low pH
Questions 2 and 3. A 33-year-old man was seen in a clinic with a complaint of dysuria
and urethral discharge of yellow pus. He had a painless clean-based ulcer on the penis
and nontender enlargement of the regional lymph nodes. Gram stain of the urethral
exudate showed gram-negative diplococci within polymorphonucleocytes. The patient
informed the clinic staff that he was unemployed and had not eaten a meal for 2 days.
2. The most appropriate treatment of gonorrhea in this patient is
(A) Ampicillin orally for 7 d
(B) Ceftriaxone intramuscularly as a single dose
(C) Procaine penicillin G intramuscularly as a single dose plus oral probenecid
(D) Tetracycline orally for 5 d
(E) Vancomycin intramuscularly as a single dose
B (The treatments of choice for gonorrhea include a single dose of ceftriaxone
(intramuscularly). Because of the high
incidence of beta-lactamase-producing gonococci, the use of penicillin G or amoxicillin
is no longer appropriate for
gonorrhea. Similarly, many strains of gonococci are resistant to tetracyclines.
Alternative drugs (not listed) for gonorrhea include cefixime, azithromycin (see Chapter
44) or spectinomycin (see Chapter 45). The answer is B.)
Question 3:
A child with strabismus ("wandering eye") is to be treated pharmacologically for a
,prolonged period. Which of the following drugs is used by the topical route in
ophthalmology and causes mydriasis and cycloplegia lasting more than 24 h?
A
Atropine
B
Echothiophate
C
Edrophonium
D
Pilocarpine
E
Timolol
• atropine
The correct answer is (A).
Explanation:
Atropine has a very long duration of action in the eye (>72 hr). By interfering with
accommodation in the dominant eye, atropine can sometimes prevent
amblyopia.Timolol has no significant effect on accommodation, whereas the other drugs
listed cause miosis and cyclospasm.
which statement about the axns of antimicrobial agents is false?
Resistance to nitrofurans emerges rapidly, and there is cross-resistance with
sulfonamides
Questions 2 and 3. A 33-year-old man was seen in a clinic with a complaint of dysuria
and urethral discharge of yellow pus. He had a painless clean-based ulcer on the penis
and nontender enlargement of the regional lymph nodes. Gram stain of the urethral
exudate showed gram-negative diplococci within polymorphonucleocytes. The patient
informed the clinic staff that he was unemployed and had not eaten a meal for 2 days.
3. Immunofluorescent microscopic examination of fluid expressed from the penile
chancre of this patient revealed treponemes. Because he appears to be infected with
Treponema pallidum, the best course of action would be to
(A) Administer a single oral dose of fosfomycin
(B) Give no other antibiotics because drug treatment of gonorrhea provides coverage
for incubating syphilis
(C) Inject intramuscular benzathine penicillin G
(D) Treat with oral tetracycline for 7 d
(E) Treat with vancomycin
C (This patient with gonorrhea also has primary syphilis. The penile chancre, the
enlarged nontender lymph nodes, and the
microscopic identification of treponemes in fluid expressed from the lesion are
essentials of diagnosis. Although a single dose of ceftriaxone may cure incubating
syphilis, it cannot be relied on for treating primary syphilis. The most appropriate course
of action in this patient is to administer a single
intramuscular injection of 2.4 million units of benzathine penicillin G. For penicillin-
allergic patients, oral doxycycline or tetracycline for 15 d (not 7 d) is effective in most
cases (see
, Chapter 44). However, lack of compliance may be a problem with oral therapy.
Fosfomycin and vancomycin have no significant activity against spirochetes. The
answer is C.)
Question 4:
A 46-year-old man consults you regarding his sexual performance issues. A drug that is
used in the treatment of male erectile dysfunction and inhibits a phosphodiesterase is
A
Finasteride
B
Fluoxetine
C
Mifepristone
D
Sildenafil
E
Timolol
• sildenafil
The correct answer is (D)
Explanation:
Inhibitors of phosphodiesterase, isoform 5, are useful in enhancing erection. Note:
Because the mechanism involves increased cGMP in vascular smooth muscle, these
drugs also potentiate the hypotensive action of nitrates.
A 22yo man w/ gonorrhea is to be treated with cefixime and will req another drug to
provide possible urethritis caused by C trachomatis. Which drug is least likely to be
effective in nongonoccoal urethritis?
nitrofurantoin
Which statement about imipenem is accurate?
(A) Active against methicillin-resistant staphylococci
(B) Has a narrow spectrum of antibacterial action
(C) In renal dysfunction, dosage reduction is necessary to avoid seizures
(D) Is highly susceptible to beta-lactamases produced by Enterobacter species
(E) Is used in fixed combination with sulbactam
C (Like other carbapenems, imipenem has a wide spectrum of activity that includes
anaerobes and many beta-lactamase-
producing gram-negative rods, including Enterobacter. However, the carbapenems are
not active against MRSA
strains. Imipenem is rapidly hydrolyzed by renal dehydropeptidases and is given in
combination with cilastatin, an inhibitor of this enzyme. Severe CNS toxicity, including
seizures,
will occur if the dose of imipenem is not reduced in patients with renal impairment. The
answer is C.)
Question 5:
An antifungal drug that binds to ergosterol forming "pores" that disrupt fungal membrane
integrity is
A
Amphotericin B
2023 with complete solution
Question 1:
A 30-year-old hospitalized patient with AIDS has a CD4 cell count of 50/μL. He is being
treated with a highly active antiretroviral therapy (HAART) regimen consisting of
zidovudine (ZDV), lamivudine (3TC), and indinavir. Other drugs being administered to
this patient include ganciclovir, clarithromycin, rifabutin, and trimethoprim-
sulfamethoxazole.
The drug in this patient's regimen that inhibits posttranslational modification of viral
proteins is
A
Acyclovir
B
Indinavir
C
Lamivudine
D
Rifabutin
E
Zidovudine
• indinavir
The correct answer is (B).
Explanation:
Protease inhibitors such as indinavir act at the posttranslational step of HIV at which the
viral enzyme cleaves precursor molecules to form the final structural proteins of the
mature virion core.
Young woman brought to ER with intense abdominal pain 2 d duration. Pain spread to
RLQ w/ N/V and fever. BP 85/45, pulse 120/min, temp 40C. Given antimicrobial therapy
stating w/ IV ampicillin & gentamicin.
If antibiotic regimen in this pt is modified to include metronidazole:
monitor fo candidiasis
The primary mechanism of antibacterial action of the penicillins involves inhibition of
(A) Beta-lactamases
(B) N-acetylmuramic acid synthesis
(C) Peptidoglycan cross-linking
(D) Synthesis of cell membranes
(E) Transglycosylation
C (Penicillins (and cephalosporins) bind to PBPs acting at the transpeptidation stage of
cell wall synthesis (the final step) to inhibit peptidoglycan cross-linking. The beta-lactam
antibiotics also activate autolysins, which break down the bacterial cell wall. Synthesis
of N-acetylmuramic acid is inhibited by
fosfomycin. Vancomycin inhibits transglycolase preventing elongation of peptidoglycan
chains. The answer is C.)
,Question 2:
A 46-year-old man has hypertension of 155/95. His cardiac and kidney function is
normal. Losartan has been suggested as therapy. This drug provides an
antihypertensive effect by which of the following effects?
A
Accelerating the rate of enzymatic inactivation of amine neurotransmitters in the CNS
B
Activating α2-adrenoceptors located in the presynaptic membranes of CNS neurons that
regulate peripheral SANS activity
C
Blocking the transport of amine neurotransmitters from the cytoplasm to the inside of
synaptic transmitter storage vesicles
D
Inhibiting the uptake of amine neurotransmitters from the extracellular fluid into the
cytoplasm in the presynaptic nerve terminus
E
Interfering with the combination of angiotensin II with its receptor
• losartan
The correct answer is (E).
Explanation:
Losartan is a member of the angiotensin receptor-blocking group. It is a competitive
antagonist of angiotensin II at its receptor.
Methenamine salts are used as urinary antiseptics. Reason they lack systemic
antibacterial action is that they are
converted to formaldehyde only at low pH
Questions 2 and 3. A 33-year-old man was seen in a clinic with a complaint of dysuria
and urethral discharge of yellow pus. He had a painless clean-based ulcer on the penis
and nontender enlargement of the regional lymph nodes. Gram stain of the urethral
exudate showed gram-negative diplococci within polymorphonucleocytes. The patient
informed the clinic staff that he was unemployed and had not eaten a meal for 2 days.
2. The most appropriate treatment of gonorrhea in this patient is
(A) Ampicillin orally for 7 d
(B) Ceftriaxone intramuscularly as a single dose
(C) Procaine penicillin G intramuscularly as a single dose plus oral probenecid
(D) Tetracycline orally for 5 d
(E) Vancomycin intramuscularly as a single dose
B (The treatments of choice for gonorrhea include a single dose of ceftriaxone
(intramuscularly). Because of the high
incidence of beta-lactamase-producing gonococci, the use of penicillin G or amoxicillin
is no longer appropriate for
gonorrhea. Similarly, many strains of gonococci are resistant to tetracyclines.
Alternative drugs (not listed) for gonorrhea include cefixime, azithromycin (see Chapter
44) or spectinomycin (see Chapter 45). The answer is B.)
Question 3:
A child with strabismus ("wandering eye") is to be treated pharmacologically for a
,prolonged period. Which of the following drugs is used by the topical route in
ophthalmology and causes mydriasis and cycloplegia lasting more than 24 h?
A
Atropine
B
Echothiophate
C
Edrophonium
D
Pilocarpine
E
Timolol
• atropine
The correct answer is (A).
Explanation:
Atropine has a very long duration of action in the eye (>72 hr). By interfering with
accommodation in the dominant eye, atropine can sometimes prevent
amblyopia.Timolol has no significant effect on accommodation, whereas the other drugs
listed cause miosis and cyclospasm.
which statement about the axns of antimicrobial agents is false?
Resistance to nitrofurans emerges rapidly, and there is cross-resistance with
sulfonamides
Questions 2 and 3. A 33-year-old man was seen in a clinic with a complaint of dysuria
and urethral discharge of yellow pus. He had a painless clean-based ulcer on the penis
and nontender enlargement of the regional lymph nodes. Gram stain of the urethral
exudate showed gram-negative diplococci within polymorphonucleocytes. The patient
informed the clinic staff that he was unemployed and had not eaten a meal for 2 days.
3. Immunofluorescent microscopic examination of fluid expressed from the penile
chancre of this patient revealed treponemes. Because he appears to be infected with
Treponema pallidum, the best course of action would be to
(A) Administer a single oral dose of fosfomycin
(B) Give no other antibiotics because drug treatment of gonorrhea provides coverage
for incubating syphilis
(C) Inject intramuscular benzathine penicillin G
(D) Treat with oral tetracycline for 7 d
(E) Treat with vancomycin
C (This patient with gonorrhea also has primary syphilis. The penile chancre, the
enlarged nontender lymph nodes, and the
microscopic identification of treponemes in fluid expressed from the lesion are
essentials of diagnosis. Although a single dose of ceftriaxone may cure incubating
syphilis, it cannot be relied on for treating primary syphilis. The most appropriate course
of action in this patient is to administer a single
intramuscular injection of 2.4 million units of benzathine penicillin G. For penicillin-
allergic patients, oral doxycycline or tetracycline for 15 d (not 7 d) is effective in most
cases (see
, Chapter 44). However, lack of compliance may be a problem with oral therapy.
Fosfomycin and vancomycin have no significant activity against spirochetes. The
answer is C.)
Question 4:
A 46-year-old man consults you regarding his sexual performance issues. A drug that is
used in the treatment of male erectile dysfunction and inhibits a phosphodiesterase is
A
Finasteride
B
Fluoxetine
C
Mifepristone
D
Sildenafil
E
Timolol
• sildenafil
The correct answer is (D)
Explanation:
Inhibitors of phosphodiesterase, isoform 5, are useful in enhancing erection. Note:
Because the mechanism involves increased cGMP in vascular smooth muscle, these
drugs also potentiate the hypotensive action of nitrates.
A 22yo man w/ gonorrhea is to be treated with cefixime and will req another drug to
provide possible urethritis caused by C trachomatis. Which drug is least likely to be
effective in nongonoccoal urethritis?
nitrofurantoin
Which statement about imipenem is accurate?
(A) Active against methicillin-resistant staphylococci
(B) Has a narrow spectrum of antibacterial action
(C) In renal dysfunction, dosage reduction is necessary to avoid seizures
(D) Is highly susceptible to beta-lactamases produced by Enterobacter species
(E) Is used in fixed combination with sulbactam
C (Like other carbapenems, imipenem has a wide spectrum of activity that includes
anaerobes and many beta-lactamase-
producing gram-negative rods, including Enterobacter. However, the carbapenems are
not active against MRSA
strains. Imipenem is rapidly hydrolyzed by renal dehydropeptidases and is given in
combination with cilastatin, an inhibitor of this enzyme. Severe CNS toxicity, including
seizures,
will occur if the dose of imipenem is not reduced in patients with renal impairment. The
answer is C.)
Question 5:
An antifungal drug that binds to ergosterol forming "pores" that disrupt fungal membrane
integrity is
A
Amphotericin B
