Science Quiz / Clinical Pharm, Midterm 2 part 3

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Can you name the Clinical Pharm, Midterm 2 part 3

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What does MRSS stand for in terms of veterinary dermatology?
 
What does MRSP stand for in terms of veterinary dermatology?
 
Between ____ and ____ was the North American Explosion, in which incidence of MRSI increased from 5 to 30% in the USA.
Hint: in 2005 they renamed MRSI into MRSP. This was towards the end of the explosion. 
Which of the following Staph species would NOT test coagulase positive?
a)pseudintermedius b)aureus c)epidermidis d)schleiferi e)none of the above 
What has replaced methicillin in laboratories, as a more stable alternative in testing resistance?
 
True or false: MRSP/MRSS species are currently resistant to all Beta lactam antibiotics including cephalosporins, cefovecin and clavamox combos.
 
PBP2a is the binding protein that has low affinity for all beta lactams, produced by the ___ gene in methicillin resistant staphs.
 
True or false: S. pseudintermedius can acquire genetic material from other bacteria, through a process in which plasmids are critical?
 
True or false: The risk of transmission of MRSP/MRSS infections is extremely high for healthy individuals.
 
True or false: MRSP, MRSS and MRSA are all commonly multi-drug resistant?
 
What property of community acquired MRSA of humans has not yet become common in MRSP/MRSS?
 
What should not form a part of your battle to curb MRSP and MRSS infections?
a)Avoiding inappropriate use b)Using fluoroquinolones frequently for the greater power c)culture and sensitivity testing d)all of the above are smart things 
True or false: isolation is typically necessary in a case of MRSP or MRSS in a companion animal?
 
True or false: topical therapy is contra-indicated in MRSP or MRSS infections?
 
What is the most effective topical biocide in vitro against multi-drug resistant bacteria?
 
Which of the following is NOT a factor in antibiotic selection?
a)route and frequency of administration b)cost c)patient species d)duration of treatment e)availability f)all of the above are good answers 
Which of the following is not a true statement regarding antibiotic selection?
a)Empirical therapy is contraindicated with recurrent skin infections with previous exposure to antibiotics b)non-recurrent infections indicate empirical therapy c)Culture and sensitivity testing is contraindicated in non-recurrent infections d)if previous treatment has been limited to topical antibacterials, empirical therapy is indicated 
Which of the following makes culture and sensitivity testing essential?
a)emergence of new lesions 2 weeks or more after initiation of empirical therapy b)no effect of empirical systemic AMD therapy after 1 week c)recurrent skin infections with prior exposure to multiple classes of AMDs d)all of the above e)A and C f)A and B 
The presence of intracellular ___ shaped bacteria is immediate grounds for culture and sensitivity testing on skin cytology.
 
Which of the following is not a factor linked to a nosocomial infection, which would indicate C and S testing?
a)long hospitalization stays b)recent surgery c)induced immunosuppression due to chemotherapy d)the use of injectable and oral antibiotics e)all of the above are factors linked to nosocomial infections 
Five of the top 7 reasons for treatment failure and recurrence of pyoderma are listed in the hint. Which two are missing?
1) Failure to recognize, eliminate or control underlying causes 2)Antibiotic curses too short, or wrong dose. 3) Wrong antibiotic choice 4)Wrong diagnosis (esp. pemphigus foliaceus) 5) concurrent steroid use 
 
This class of antibiotics targets the cell wall of bacteria?
 
Which of the following AMD classes does not target ribosomes?
a)potentiated sulfonamides b)clindamycin c)chloramphenicol d)tetracycline e)aminoglycosides 
Polymixin B is a topical which targets what part of the bacteria?
 
This class of AMD targets DNA?
 
Rifampin's target within the bacterial cell is?
 
This route of administration carries the greatest risk of significantly altering the normal GI microflora, for AMDs?
 
True or false: first line antibiotics have minimal impact on normal GI microflora, targetting S. pseudintermedius?
 
Which of the following is not a first line antibiotic choice?
a)clindamycin b)TMS c)chloramphenicol d)doxycycline e)minocycline 
Rifampin is what-line choice of antibiotic?
 
These third line antibiotics should be reserved for infections associated with gram negative bacteria.
Use is contraindicated with MRS pyoderma as they can select for methicillin resistance. 
The nephrotoxic potential of this class of antibiotics makes it a last resort, suitable only when all others would fail according to C and S?
 
Name a drug developed for use in human medicine which may be banned or at least extemely controversial for use in vet medicine?
 
Which statement is untrue concerning cephalexin?
a)it is a first line drug b)it may cause GI adverse effects c)it must be taken with food for ideal absorption d)bioavailability is high e)it inhibits cell wall synthesis 
Which statement is accurate regarding Cefpodoxime?
a)It is a last resort drug b)It may cause dose dependent hypersensitivity reactions c)it works by inhibiting protein synthesis d)it is a prodrug e)it has high plasma protein binding properties 
What is false regarding clavamox?
a)It is a second line drug b)it has good oral bioavailability c)it inhibits cell wall synthesis d)clavulanic acid is a competitive inhibitor of most Beta-lactamase enzymes e)it may cause GI adverse effects in rare cases. 
True or false: cefovecin inhibits bacterial cell wall synthesis?
 
***Which of the following statements is false regarding clindamycin?
a)It inhibits bacterial ribosomal 50s subunits b)it has high oral bioavailability c)it is distributed within neutrophils and macrophages due to its affinity for lipids d)just under 10% of the parent drug is excreted in the urine, the rest being metabolites e)the primary toxicity concern is GI adverse effects  
***Which of the following statements is false regarding doxycycline?
a)it is formulated as a hydrochloride salt b)it may cause esophageal stricture in cats if not administered with food c)it may discolour teeth of young animals as with all other tetracyclines d)it binds readily to plasma proteins e)the highest concentration of drug occurs in vascular organs 
***Which of the following statements is true regarding TMS?
a)it may cause esophageal stricture in cats b)it may cause hyperthyroidism c)it inhibits protein synthesis d)it can cause non-dose dependent KCS e)none of the above 
***The use of this second line drug risks bone marrow suppression, and the owner must wear gloves due to the risk of irreversibel aplastic anemia?
 
***Hepatotoxicity is the most common adverse reaction to this second line drug, which is unpalatable in flavour to dogs.
Also associated with rare death inducing hepatic necrosis, orange-red reversibel discolouration of bodily secretions and fluids, and a mechanism of action involving inhibition of bacterial RNA polymerase. 
Ocular toxicity in cats, musculoskeletal toxicity in young dogs and inhibition of bacterial DNA gyrase are associated with?
 
***Use of these last resort drugs risks tubular nephrotoxicity, along with ototoxicity.
They are also expensive, injectible only, and work by inhibiting the 30s subunit of bacterial ribosomes. They are not biotransformed before elimination in urine. 
***Who are the two primary bacterial suspects in veterinary pyoderma or otitis externa cases?
 
 
This coccus is part of the cutaneous microflora of normal dogs and cats, and usually infects secondary to a predisposing factor.
Such factors may include allergic skin disease, cutaneous damage, immunocompromise.  
True or false: Pseudomonas aeruginosa is a rod that is found on the skin of normal dogs and cats?
 
Name a medicated shampoo you might prescribe for bacterial pyoderma. (Lots of cocci and/or rods on skin cytology)
 
Suppose your patient has Malassezia otitis. What medicated ear drops do you recommend?
The best choice contains miconazole as it's antinfungal component. (Recall that ear drops have 3 active ingredients, antifungals, antibacterials and anti-inflammatories) 
What is it that makes the other three choices inferior to Surolan when treating bacterial otitis?
Hint: Which of the three components is the problem in the other three? 
Surolan has excellent activity against _______ _______, but it's touted efficacy against this human patogen is irrelevant in most cases of otitis externa.
Due to the miconazole component. 
Polymyxin B is the antibiotic in surofan, and is mainly used for gram negatives like Pseudomonas spp. Despite the reported efficacy against the answer, a gram positive, it is useless against S. pseudintermedius 
True or false: in treating mixed otitis, bacteria trumps the presence of Malassezia yeast?
 
True or false: Malassezia yeasts are also developing problematic antifungal drug resistances?
 
Seeing rods on cytology for otitis externa would likely indicate this species is present.
 
What two drugs might you use to treat a predominently cocci-dominated case of bacterial otitis externa?
 
This ear drop contains gentamycin, which is commonly resisted by P. aeruginosa. Its use is recommended most for neomycin-resistant Staph otitis.
Otomax would be another option in this case, but it may be phased out completely in the future. 
What drop is the best choice for rod-dominated otitis extenra?
 
True or false: the use of heavy duty fluoroquinolones in Baytril Otic nearly guarantees a cure form P. aeruginosa otitis?
 
Match (yeast, Cocci, rods) to their appropriate first line drug choice?
neomycin 
gentamycin or polymixin B 
miconazole or clotrimazole 
This AMD affects bacterial membrane permeability and is NEVER a good choice for Staph otitis.
 
True or false: clinical benefit is more expedient with oral cyclosporine than oral glucocorticoisteroids for pruritis?
 
True or false: long acting injectible glucocorticosteroids should be avoided unless oral treatment is absolutely impossible?
 
Which of the following signs would you not associate with feline iatrogenic hyperadrenocorticism?
a)medially curled pinnae b)bruising c)alopecia d)hypopigmentation e)thin or inelastic, fragile skin 
In which breed is canine calcinosis cutis most common?
 
True or false: oral glucocorticosteroids should be started at 2x daily, then tapered to lowest possible dose, possibly once every three days?
 
Name a potential side effect of oral glucocorticosteroids proportional to dosage and duration?
 
True or false: one may try to reduce the dose of oral glucocorticosteroids by combination with antihistamine trimeprazine?
 
Which of the following glucocorticosteroids has the highest potency?
a)prednisolone b)prednisone c)dexamethasone d)methylprednisone 
If given the option between prednisone and prednisolone for cats, should one choose the prodrug or the drug?
 
Which of the following is NOT a necessary test before starting oral GC therapy?
a)complete blood count b)serum biochemistry c)urinalysis and urine culture d)FIV/FeLV testing for cats e)all of the above are necessary 
Zentonil, zentonil plus, and zentonil advanced, along with milk thistle, are all ______ _______ drugs for dogs?
What is their function? What organ do they work with? 
Name a potential side effect of topical glucocorticosteroid use in canine atopic dermatitis?
 
This class of drug is made by soil fungi, inhibits T cell activation, and works by forming intracytoplasmic complexes with immunophilins (prodrugs).
Used on label in Canada only for canine atopic dermatitis and feline allergic skin diseases. 
This NSAID is an expensive but highly specific choice for T cells, with high client satisfaction for allergies in dogs and cats.
 
Which of the following calcineurin inhibitor drugs is classed for veterinary use?
a)tacrolimus b)pimecrolimus c)modified cyclosporine d)sirolimus e)none of the above 
True or false: it is necessary to give modified cyclosporin (Atopica) with food?
 
True or false: blood levels of Atopica are irrelevant for monitoring of allergic patients?
 
What is the only predictive factor for treatment with atopica?
 
True or false: ME CsA should be used once daily until halving of clinical signs, at which point you should decrease dose by half or go to once in two days?
 
In what time frame should you expect satisfactory clinical benefit after starting cyclosporine administration?
 
The induction phase of ME CsA involves 4 weeks at _ or _ mg/kg q24h
 
At how many weeks after the start of therapy does the maintenance phase for atopica start?
 
True or false: Atopica can also help with feline eosinophilic skin disease lip ulceration?
 
Dogs usually start at 5 mg/kg of atopica q24h, cats at _ mg/kg q24h.
 
Which of the following diseases may be treated with ME CsA?
a)erythema multiforme b) DLE c)perianal furunculosis d)facial dermatitis in persian cats e)all of the above and way more 
Which of the following conditions is not treatable with topical tacrolimus?
a)canine atopic dermatitis b)erythema multiforme c) DLE d)anal furunculosis e)all of the above are treatable. 
Cyclosporine binds cyclophilin, tarcolimus and pimecrolimus bind ______-12
 
Name an advantage of tacrolimus over CsA?
 
Name an advantage of tacrolimus over pimecrolimus?
 
True or false: atopica will achieve higher concentrations in canine skin than blood, and is eliminated slower from the skin?
 
What are the major pathways that metabolize ME CsA in the dog?
_____ and _______ (both accomplished by cytochrome P450 enzymes) 
Which of the following is untrue regarding ME CsA pharmacology between dogs and cats?
a)bioavailability is higher in dogs following oral administration b)clearance is lower in cats c)cats have a slightly longer elimination halflife d)all of the above are true 
True or false: concurrent administration of ketoconazole with atopica leads to increased ME CsA in the blood and increased risk of toxicity?
 
What is the main risk of long term concurrent administration of atopica and glucocorticosteroids?
 
What is the only (very rare) GI adverse effect which justifies discontinuing atopica therapy?
 
What side effect of atopicia is prevented with administration of maropitant citrate?
 
Which of the following would you not treat diarrhea as a result of atopicia with?
a)canned pumpkin b)dexmedetomidine c)metronidazole d)probiotics e)all of the above woudl work 
True or false: long term atopicia therapy is associated with increased risk of UTI?
 
What parasite may potentially be fatally 'reactivated' by atopicia therapy in cats?
This necessitates prior testing of scavenging outdoor cats or cats on raw meat diets... 
West highland white terriers are most prone to this dose dependent and reversible reaction in the mouth to atopicia?
 
What condition may proceed neoplasia as a result of atopicia therapy in rare cases?
 
True or false: there are reported cases of tacrolimus-induced neoplasia in dogs?
 
Is withdrawal time necessary after atopicia therapy for specific allergen testing?
 

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