Dental Therapeutics Exam 3 Practice

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• Seizures occur in about 1.5% of patients treated with imipenem/cilastatin. Which option is correct?
• Aminopenicillins generally have an __ antibacterial spectrum compared to penicillin G/V.
• Which statement about the beta-lactam ring is accurate?
• Which type of beta-lactam antibiotic contains only a monocyclic beta-lactam ring?
• What is the total recommended adult dose of amoxicillin for prophylaxis?
• What is the recommended IM or IV dose of Ceftriaxone for the same scenario?
• Due to resistance, which therapy should be considered?
• What class of antibiotics contains a Beta-lactam ring in their molecular structure?
• Peptidoglycan is composed of cross-linked polymers of which two types?
• True or false: Piperacillin/tazobactam is effective when given orally.
• Which of the following is a macrolide that is notably associated with extensive drug interactions due to enzyme inhibition?
• In patients with compromised renal function, piperacillin/tazobactam requires which adjustment?
• Cephalosporins should not be prescribed for antibiotic prophylaxis in patients with penicillin allergies if they have a history of which reaction?
• Penicillins form covalent complexes with proteins that elicit an immune response. What are these small molecules called?
• Penicillinase-resistant penicillins have a __ spectrum of activity compared to Pen G/V, but are __ to hydrolysis by some staphylococcal penicillinases (β-lactamases).
• Which of the following is NOT listed as a risk factor for penicillin allergy?
• Which bacterium causes strep throat?
• Imipenem is often administered with what other drug?
• CNS accumulation of penicillins can cause seizures; the mechanism is related to antagonism of which receptor?
• Which penicillin combination provides the broadest spectrum of activity?
• Which macrolide is listed as an option for patients with severe penicillin allergy who can take oral medication?
• What is the only anti-pseudomonal penicillin available in the United States?
• Meropenem is used for what type of infections?
• Aztreonam is currently the only monobactam in clinical use in the US; its use is restricted to which route?
• What is the total recommended adult dose of azithromycin for prophylaxis?
• Penicillins can be used for people with which type of throat infection?
• Bacteriostatic antibiotics such as which agents antagonize penicillin?
• What is the recommended IM or IV dose of Cefazolin for penicillin-allergic patients who cannot take oral medications?
• Penicillin G is acid-labile in the stomach so only used parenterally, but Penicillin V is less labile and can be administered orally.
• Piperacillin is administered how?
• What is the prototypical agent for penicillinase-resistant penicillins that is no longer in clinical use?
• Most allergic penicillin manifestations present as which of the following?
• Which enzyme is responsible for removing the terminal alanine residue in order to form the required peptide cross link during transpeptidation?
• Penicillin allergy is rarely associated with which severe reaction?
• Aminopenicillins are susceptible to hydrolysis by β-lactamases, so co-administration with what improves efficacy?
• Why is amoxicillin + metronidazole effective against β-lactamase producing subgingival bacteria?
• True penicillin allergy ranges from 5% to 8% of the population, but only a ______ fraction have severe reactions.
• Which group is included among the conditions that warrant endocarditis prophylaxis after cardiac transplant?
• Which item is NOT among the seven conditions listed as NOT suggesting prophylaxis?
• More than 90% of which organism are resistant to Pen G/V?
• Antibiotics such as penicillins ____________________ colonic bacteria that normally aid absorption of ethinyl estradiol (EE).
• Which antibiotic is commonly used for prophylaxis and is known for being a potent CYP3A4 inhibitor?
• Bacteriostatic antibiotics have what effect on the bactericidal action of penicillin?
• The primary clinical use for penicillinase-resistant penicillins is infections caused by MSSA.
• The biggest risk for CNS toxicity from high-dose IV penicillins occurs in patients with impairment of which organ function?
• When should antibiotic prophylaxis be administered prior to dental procedures?
• Aminopenicillins are susceptible to hydrolysis by β-lactamases. True or False?
• Metronidazole, used with amoxicillin for β-lactamase producing subgingival bacteria, belongs to which class?
• How do penicillins interact with PBPs to inhibit cell wall synthesis?
• In what year did Fleming win the Nobel Prize for penicillin?
• Which two penicillins are most associated with pseudomembranous colitis?
• Which of the following is a carbapenem antibiotic?
• Which of the following is NOT among the conditions for which antibiotic prophylaxis for endocarditis is suggested?
• Which description best describes the purpose of endocarditis prophylaxis guidelines for dental patients?
• Which statement about penicillin is true?
• β-lactam antibiotics exert their antibacterial effect by interfering with which process?
• Which statement best describes the general tolerability of penicillins and the cause of most severe adverse reactions?
• For most penicillins, the unchanged drug is eliminated primarily via renal excretion by tubular secretion (90%) and somewhat by glomerular filtration (10%).
• Fill in the blank in Gwyn Macfarlane's quote: 'The discovery of penicillin was a series of chance events of almost unbelievable ________'?
• How do penicillins cause seizures, hallucinations, and CNS excitation?
• Tooth discoloration attributed to amoxicillin-clavulanic acid was reduced or eliminated with which measure?
• Transpeptidation leads to the formation of what layer that surrounds the cytosolic membrane and maintains cell shape and integrity while protecting from osmotic pressure?
• Absorption of most penicillins (except amoxicillin) is impaired by what?
• Subgingival plaque specimens from deep periodontal pockets were removed from how many adults with severe chronic periodontitis before treatment?
• Which of the following is a listed clinical use of penicillins?
• Dicloxacillin should be administered apart from meals because its absorption is erratic when taken with food.
• In what year was penicillin accidentally discovered?
• Penicillin and the Nobel Prize: which statement is true?
• How did Alexander Fleming accidentally discover penicillin?
• Which penicillin is considered antipseudomonal?
• Which penicillin is associated with extrinsic tooth discoloration?
• In amoxicillin/clavulanic acid–related DILI, onset is after initiation; the average time is about how many weeks?
• Which regimen is recommended for periodontal patients with severe chronic periodontitis to cover β-lactamase producing subgingival bacteria?
• Industrial strains of Penicillium chrysogenum can produce approximately 40-50 grams of penicillin per liter of culture.
• What is the incidence range for anaphylactoid reactions to penicillins?
• Which of the following is a clinical use of penicillins?
• For amoxicillin 500 mg q8h, CrCl less than 10 mL/min: dosing is adjusted to what interval?
• Which statement best describes clavulanic acid?
• Piperacillin/tazobactam is an example of an anti-pseudomonal penicillin used for which infections?
• Which of the following is NOT among the four conditions where prophylaxis is suggested?
• Which statement about penicillins is true?
• If symptoms persist after the initial epinephrine dose, when can it be repeated?
• What mechanism allows imipenem to remain effective when co-administered with cilastatin?
• Which drug is the prototypical beta-lactam antibiotic accidentally discovered by Alexander Fleming in 1928?
• Which is an example of an antipseudominal penicillin?
• Which of the following constitutes a correct amoxicillin prescription for dental prophylaxis?
• Which statement is true regarding aminopenicillins and β-lactamases?
• Which aminopenicillin is better absorbed orally and can be taken without regard to meals?
• Aminopenicillins have more activity against which type of organisms compared to penicillin G/V?
• Clarithromycin, used in antibiotic prophylaxis, is known for causing drug-drug interactions because it inhibits which enzyme?
• Which of the following is NOT a listed clinical use of penicillins?
• Penicilloic acid is a metabolite formed from β-lactam ring breakdown and lacks antibacterial activity.
• Doxycycline is listed as an oral alternative for prophylaxis. What is its adult dose?
• Which antibiotic prophylaxis is a potent enzyme inhibitor and precipitates myriad drug-drug interactions?
• Which organisms are highly resistant to Penicillin G/V?
• Which macrolide is primarily associated with a higher risk of drug interactions due to potent enzyme inhibition?
• The addition of a beta-lactamase inhibitor to a penicillin primarily serves to what?
• The most active penicillinase-resistant penicillin is which drug?
• Most reports of tooth discoloration occurred in pediatric patients taking which formulation?
• What polysaccharides does peptidoglycan contain?
• On the plate Fleming observed Penicillium mold inhibited the growth of which bacterium?
• Which condition is explicitly associated with increased penicillin penetration into the CNS?
• Tooth discoloration can occur with amoxicillin/clavulanic acid use as well as amoxicillin alone.
• Probenecid inhibits which renal transporter to affect penicillin excretion?
• Which of the following antibiotics is commonly used for dental prophylaxis in penicillin-allergic patients and is known for drug interactions?
• Which antibiotic is best choice for a penicillin-allergic patient requiring dental prophylaxis?
• Transpeptidation is the cross-linking step; which antibiotic class targets this step?
• Which description best characterizes aztreonam's spectrum?
• What sized tablets is azithromycin available in for prophylaxis?
• Among penicillinase-resistant penicillins, which two are Oxacillin and Nafcillin?
• Carbapenems have a broader spectrum of activity compared with most penicillins. Which option best describes their spectrum?
• Which of the following statements about clarithromycin is true?
• Which of the following is NOT a carbapenem?
• Penicillin G and Penicillin VK are exemplars of which category?
• How do penicillins prolong bleeding times?
• Which penicillin formulation is among the most frequently reported causes of drug-induced liver injury in the US and Europe?
• Which sequence correctly describes how penicillin is produced today?
• ~1% of people who claim they are penicillin allergic are actually allergic.
• Co-administration of probenecid with penicillin is expected to do what to penicillin exposure (AUC)?
• Which class has a fused β-lactam ring with a five-membered ring and no sulfur in the ring?
• Why has penicillin G/V use dropped dramatically over the years?
• Which feature of penicillins is generally influenced by side chains?
• Which CHD scenario warrants antibiotic prophylaxis?
• Amoxicillin renal dosing is based on which renal function measurement?
• Penicillins act by inhibiting which enzymatic process, thereby disrupting peptidoglycan synthesis?
• Which penicillin is the exception whose absorption is not impaired by food?
• Which patients would typically receive azithromycin as prophylaxis?
• Penicillin G/V is active against which infections caused by Streptococcus pneumoniae?
• Penicillins are generally well tolerated; most severe adverse drug reactions are due to which type of reactions?
• Penicillins are primarily which type of antimicrobial in terms of action?
• Actinomyces israelii belongs to which genus?
• For an adult dose of 500 mg every 8 hours of amoxicillin, if CrCl is 10 to 30 mL/min, the regimen should be adjusted to every how many hours?
• Which antibiotic is no longer recommended for antibiotic prophylaxis prior to dental treatment?
• Ever emerging bacterial what to penicillins is shaping future management of dental infections?
• Updated guidelines have been published to assist the dentist in rational prescription of what for high-risk IE patients?
• How does probenecid interact with penicillins?
• In the dental office, penicillin allergy represents what kind of risk that can be potentially dangerous?
• Which class of penicillins is defined by resistance to penicillinase enzymes?
• Which antibiotic prophylaxis option has minimal known drug interactions and does not carry QT prolongation risk?
• Penicillins can be administered by IV, IM, and PO.
• Which of the following is a macrolide widely used in prophylaxis and known for significant drug interactions due to enzyme inhibition?
• Which of the following is a well-known adverse event associated with large intravenous doses of penicillins, causing CNS symptoms?
• Which medication class used for antibiotic prophylaxis is most associated with drug-drug interactions due to enzyme inhibition?
• Incidence of ________ reactions from penicillins ranges from 0.004% to 0.04%; approximately 0.001% die from these reactions.
• Among oral options for penicillin-allergic patients with no severe reaction, which is listed as an oral prophylaxis option?
• In the presence of probenecid, penicillin half-life is prolonged and exposure (AUC) is increased. Which pharmacokinetic changes occur?
• Which of the following is an aminopenicillin + β-lactamase inhibitor combination administered orally?
• Aminopenicillins are resistant to hydrolysis by β-lactamases. True or False?
• Which of the following is NOT one of the four classifications of penicillins?
• Actinomyces israelii is associated with which condition?
• Compared with Pen G/V, penicillinase-resistant penicillins have a spectrum that is:
• CNS distribution of penicillins is enhanced during which conditions, leading to increased BBB permeability?
• The beta-lactam ring is essentially a cyclic amide and is a highly ________ ring system.
• Which of the following is NOT a beta-lactam antibiotic?
• Which sequence best describes how endocarditis can arise from dental bacteria?
• What size tablet is amoxicillin available in according to prophylaxis guidelines?
• Meropenem is administered by which route?
• Which penicillin has a narrow spectrum against mostly gram-positive bacteria and a few gram-negative bacteria?
• Which penicillinase-resistant penicillin is commonly administered orally?
• Which adverse effect occurs in 1-20% of patients treated with imipenem/cilastatin?
• Which antibiotic prophylaxis agent would be least likely to interact with other drugs due to enzyme inhibition?
• The risk of CNS toxicity from large IV doses of penicillins is greatest in patients with impaired which function?
• Penicillins have what effect on the effectiveness of oral contraceptives (ethinyl estradiol)?
• Which agent is administered intramuscularly as an alternative for penicillin-allergic patients?
• Two other penicillinase-resistant penicillins besides dicloxacillin are:
• Penicillins should be used with caution in patients with which condition?
• Which statement best describes the effect of penicillins on cell wall synthesis?
• Which of the following is a condition where antibiotic prophylaxis for endocarditis is suggested?
• Which of the following is NOT listed as an IM/IV option for patients who cannot take oral medications and have a penicillin allergy?
• Amoxicillin/clavulanate–related DILI most commonly begins after which therapy event?
• Piperacillin/tazobactam is used by which route of administration?
• What is the initial treatment to anaphylaxis?
• Penicillin binding proteins are also called what?
• Which of the following is an example of a penicillinase-resistant penicillin?
• Aztreonam is generally well tolerated with infrequent hepatotoxicity reports in infants and young children.
• Penicillins interact with oral anticoagulants (warfarin) by which mechanism?
• Which group do dicloxacillin, oxacillin, and nafcillin belong to?
• In the dental setting, what is the purpose of antibiotic prophylaxis for infective endocarditis?
• Piperacillin is commonly administered in combination with which β-lactamase inhibitor?
• In renal insufficiency, penicillin dosing may require which adjustments?
• Penicillinase-resistant penicillins are mainly used for managing infections caused by which organism?
• Tooth discoloration associated with penicillin derivatives presents as which colors?
• Penicillins affect EE absorption by eradicating GI flora that hydrolyze EE conjugates, leading to what outcome?
• Approximately what percent die from penicillin-related reactions?
• Which antibiotic prophylaxis option has potential to cause dangerous QT prolongation in susceptible patients?
• Since most penicillins are impaired by food, what should you tell a patient prescribed penicillin V regarding meals?
• Penicillin G/V is active against Treponema pallidum, the agent of which disease?
• Compared with imipenem, meropenem has what difference in risk of seizures?
• Which option correctly lists the three risk factors for penicillin allergy?
• Penicillin G/V spectrum includes infections caused by which organism?
• Which carbapenem is not degraded by renal dipeptidases and thus does not need to be co-administered with cilastatin?
• What is the prescribed azithromycin regimen for dental prophylaxis as described?
• A notable feature of aztreonam is its lack of allergic cross-sensitivity to most other beta-lactam antibiotics.
• Which antibiotic is preferred in meningitis when carbapenem therapy is indicated, and why?
• Approximately what fraction of adults with a sore throat actually have strep throat?
• Probenecid inhibits which renal transport pathway to reduce tubular secretion of penicillin and other β-lactam antibiotics?
• Which antibiotic was removed from prophylaxis guidelines due to risk of adverse events including C. difficile infection?
• What is the dose of epinephrine to treat anaphylaxis in adults and children over 30 kg?
• Which set lists three examples of penicillinase-resistant penicillins?
• Which antibiotic used to be recommended for prophylaxis but is no longer recommended due to concerns about Clostridioides difficile infection?
• Penicillin inhibits bacterial cell wall synthesis by targeting which enzyme?
• Dosing adjustments of penicillinase-resistant penicillins are required for patients with renal failure.
• In industrial penicillin production, which organism is used to produce penicillin?
• Which statement best describes the clinical use of carbapenems with ESBL-producing infections?
• Which antibiotic is NOT an aminopenicillin?
• Which penicillin formulation is frequently reported as a cause of drug-induced liver injury in the US and Europe?
• Carbapenems have been used for what type of treatment?
• Penicillins contain what ring system?
• The breakdown of the β-lactam ring yields penicilloic acid, a metabolite that lacks antibacterial activity.
• Beta-lactams share a common mechanism of action. What is it?
• What are two examples of aminopenicillins?
• Which of the following is a listed clinical use of penicillins?
• Meropenem not degraded by renal dipeptidases and does not require Cilastatin co-administration is true because:
• Which aminopenicillin is best administered on an empty stomach?
• Anti-pseudomonal penicillins are primarily used for which type of infections?
• When should prophylactic antibiotics be taken relative to the dental appointment?
• Penicillin G/V is not reliably effective against which organism due to beta-lactamase production?
• Which compound is a beta-lactamase inhibitor used to extend penicillin activity?
• What is the antibiotic and adult dose used 30-60 minutes before a dental procedure for a patient who can take oral medication and has no penicillin or ampicillin allergy?
• Which medication used for antibiotic prophylaxis should be used with caution in patients who are known to have a prolonged QTc interval and ventricular arrhythmia?
• Penicillin is extracted from which organism?
• Aztreonam does not cover which type of bacteria?
• Most reports of penicillin-associated tooth discoloration occurred in which group taking which formulation?
• Aztreonam is active against which type of bacteria?
• Among antibiotic prophylaxis options, which one is known for causing numerous drug interactions due to potent enzyme inhibition?
• The two clinically used aminopenicillins are:
• Prolonged penicillin use may lead to Candida infections in which sites?
• Treponema pallidum is the agent for which disease?
• Imipenem/Cilastatin are highly active against bacteria expressing what?
• Which of the following is a cephalosporin option for dental prophylaxis in penicillin-allergic patients?
• Which of the following is a beta-lactam antibiotic?
• Probenecid is associated with which treatment outcome and toxicity profile in penicillin therapy?
• What is the role of tazobactam in piperacillin/tazobactam?
• What is the dose of epinephrine to treat anaphylaxis in children under 30 kg?
• Penicillins & Oral Contraceptives (Ethinyl Estradiol): The interaction is proposed with all antibiotics.
• A true statement about penicillin allergy prevalence and severity is:
• Which is an aminopenicillin?
• Which scenario qualifies for endocarditis prophylaxis?
• Which regimen is recommended as an option for periodontal patients with severe chronic periodontitis to cover β-lactamase producing bacteria?
• Macrolides used for prophylaxis are associated with which cardiac electrical abnormality that warrants caution?