TOPIC: BETA-LACTAMS

EASY (True or False)

Question Answer and Rationale
1. Beta-lactams inhibit peptidoglycan synthesis TRUE
by inhibiting the transpeptidase enzyme. The mode of action of penicillins is to inhibit bacterial growth
by interfering with the transpeptidation reaction of bacterial
cell wall synthesis.
2. Beta-lactam drugs act on the peptidoglycan FALSE
lattice by preventing linkages between the The peptidoglycan layer has an aminosugar component of
aminosugars N-acetylgalactosamine and N- alternating residues of β-(1,4) linked N-acetylglucosamine
acetylmuramic acid from occurring. (NAG) and N-acetylmuramic acid (NAM).
3. Among the penicillins, benzathine penicillin G TRUE
has the longest duration of action. Benzathine penicillin G has a duration of action that is ≥ 3
weeks
4. First generation cepahlosporins have FALSE
enhanced aerobic gram-negative and This is descriptive of second generation cephalosporins, first
anaerobic bacterial coverage. generation cephalosporins are only very active against gram-
positive cocci.
5. Sulbactam is a monobactam. FALSE
Aztreonam is a monobactam.
Clavulanic acid, Sulbactam, and Tazobactam are beta-
lactamase inhibitors.

MODERATE
Question Answer and Rationale
1. This is a test used to predict the in vivo C
success or failure of antibiotic therapy. The goal of antimicrobial sensitivity testing (AST) is to predict
A. Synergy study the in vivo success or failure of antibiotic therapy. Tests are
B. Gram-stain performed in vitro, and measure the growth response of an
C. Sensitivity test isolated organism to a particular drug/s.
D. Beta-lactamase assay
2. The primary mechanism of antibacterial D
action of the penicillins involves inhibition of:
Penicillins (and cephalosporins) bind to PBPs acting at the
A. Beta-lactamases transpeptidation stage of cell wall synthesis (the final step) to
B. Cell membrane synthesis inhibit peptidoglycan cross-linking. The beta-lactam
C. N-acetylmuramic acid synthesis antibiotics also activate autolysins, which break down the
D. Peptidoglycan cross-linking bacterial cell wall. Synthesis of N-acetylmuramic acid is
E. Transglycosylation inhibited by fosfomycin. Vancomycin inhibits transglycolase,
preventing elongation of peptidoglycan chains.
3. Which of these penicillins is/are not impaired C
by food intake? Dicloxacillin, ampicillin, and amoxicillin are acid-stable and
A. Dicloxacillin relatively well absorbed, producing serum concentrations in
B. Ampicillin the range of 4–8 mcg/mL after a 500-mg oral dose.
C. Amoxicillin Absorption of most oral penicillins (amoxicillin being an
D. A and C exception) is impaired by food, and the drugs should be
E. All of the above administered at least 1–2 hours before or after a meal.
4. Most of the serious adverse effects of C
penicillin intake are due to: Most of the serious adverse effects are due to
A. Neurotoxicity hypersensitivity. The antigenic determinants are degradation
B. GIT distress products of penicillins, particularly penicilloic acid and
C. Hypersensitivity products of alkaline hydrolysis bound to host protein.
 D. Interstitial nephritis Because of the potential for anaphylaxis, penicillin should be
administered with caution or a substitute drug given if the
person has a history of serious penicillin allergy.
5. Which of the following drug and adverse A
reaction pairs is/are correct? Ampicillin:Pseudomembranous colitis
A. Ampicillin:Pseudomembranous colitis Methicillin: Interstitial nephritis
B. Methicillin:Neutropenia Nafcillin:Neutropenia
C. Nafcillin:Hepatitis Oxacillin:Hepatitis
D. Oxacillin:Interstitial nephritis
E. All of the above
6. Of the following drugs, which would have D
“red man” or “red neck” syndrome as one of Among the more common reactions is the so-called “red
the common adverse reactions? man” or “red neck” syndrome. This infusion-related flushing
A. Clavulanic acid is caused by release of histamine. It can be largely prevented
B. Benzathine penicillin G by prolonging the infusion period to 1–2 hours or
C. Ceftriaoxime pretreatment with an antihistamine such as
D. Vancomycin diphenhydramine.
7. Which of the following is/are methods of E
beta-lactam resistance? All three items are methods by which bacteria develop beta-
A. Modification of target site lactam resistance.
B. Decreased drug levels due to an efflux
pump
C. Enzymatic inactivation due to beta-
lactamase enzyme formation
D. A and C only
E. All of the above
8. Which of the following drug group/s would B
result in a disulfiram-like reaction? There are cephalosporins that contain a methylthiotetrazole
A. Penicillins group. Drugs with the methylthiotetrazole ring can also cause
B. Cephalosporins severe disulfiram-like reactions; consequently, alcohol and
C. Carbapenems alcohol-containing medications must be avoided.
D. A and B
E. All of the above
9. Which of the following is an anti- C
pseudomonal penicillin? Antipseudomonal penicillin: Piperacillin,
A. Cloxacillin Piperacillin/tazobactam, Ticarcillin/clavulanic acid
B. Amoxicillin
C. Piperacillin
D. Methicillin
10. Which cephalosporin would be most effective A
for Pseudomonas aeruginosa infection? Third generation cephalosporins with anti-pseudomonal
A. Ceftazidime activity: Ceftazidime, and Cefoperazone
B. Cephalexin
C. Cefuroxime
D. Ceftriaoxime