A/D. Both Ciprofloxacin and Ofloxacin are second generation Fluoroquinolones. Recall “CO2” for second generation and “Three LEVO clover” for third generation. There are no first generation Fluoroquinolones. This information is important as second generation target Gram Negative bacteria while later generations could be used to target both Negative and Positive.

C. Pyrimethamine is NOT used in treatment of Tuberculosis. It is important to note that Isoniazid and Rifampin can be used in isolation for treatment of Latent TB. Active TB is treated with a combination of the RIPE medications.

B. Zidovudine, also known as Retrovir, inhibits the viral RNA-dependent, DNA polymerase responsible for reverse transcription. RIbavirin is used in treatment of Hepatitis C. Foscarnet is used in treatment of CMV that is not responding to other antivirals. Natamycin is an antifungal.

A. Trifluridine, also known as Viroptic, contains Thimerosal – a mercury-based preservative found in drops. The remaining options are oral medications used in treatment of herpes virus.

C. Oseltamivir, also known as Tamiflu, is used in the treatment of Influenza. The remaining options are antifungals. Of note, Natamycin is NOT a Macrolide as the name indicates.

D. Bacitracin prevents bacterial wall synthesis by inhibiting transfer of peptidoglycan into the growing wall. Oxacillin and Cephalexin inhibit transpeptidase. Gentamicin inhibits bacterial protein synthesis by binding 30s subunits of the bacterial ribosome.

D. If a patient is on Warfarin, it is best to prescribe a Penicillin. Cephalosporins may destroy normal intestinal flora thus altering Vitamin K absorption. This may lead to excessive thinning of the blood in conjunction with Warfarin.

B/C. Recall, “Buy AT 30, CEL at 50”. Aminoglycosides and Tetracyclines act by binding the 30s subunit of bacterial ribosomes and preventing protein synthesis. The other three classes work by binding the 50s subunit.

C. Azithromycin is classified as a Macrolide. Recall “Buy AT 30, CEL at 50”. CEL stands for Chloramphenicol, Erythromycin (Macrolides), and Lincomycin. These meds target the 50s subunit. Doxycycline and Gentamicin target the 30s subunit. Sulfacetamide is a sulfonamide that inhibits DHP synthase.

C. Natamycin is an antifungal that works by inhibiting ergosterol thereby forming pores in cell walls. This leads to cell death. Recall that Natamycin is NOT a macrolide – a drug class that inhibits the 50s subunit of bacterial ribosomes. Penicillins inhibit transpeptidase.

A. Weight GAIN is common in chronic steroid use. Chronic steroid use comes with many risks including the above as well as hypertension, diabetes mellitus, or peptic ulcers. Ocular effects include PSC cataracts, glaucoma, and risk of secondary infections.

C. Aspirin use in children leads to the development of Reye’s syndrome – a rapid degenerative brain disease that is marked with confusion, seizures, and multi-organ failure.

B. Loratidine is an example of a second generation antihistamine. To recall, “phen” in the drug name is a clue to determining first generation – exception of promethazine. First generation antihistamines penetrate the blood/barrier more easily than second generation antihistamines. This leads to less side effects such as sedation.

A. Loratidine is a second generation antihistamine. This question is here to demonstrate the mechanism of action of H2 blockers in treatment of stomach ulcers and acid reflux. We are also taught to remember H2 blockers from the “-tidine”. Here is one exception, do not forget on test day.

C. Nexium and its sister drug Prilosec are classified as Proton Pump Inhibitors. PPIs function by inhibiting H+/K+ ATPase proton pumps.These medications are used in treatment of peptic ulcer disease and GERD.

B. Albuterol is a short acting Beta-2 agonist used as a rescue inhaler for Asthma and COPD. Other short acting agonists include Levalbuterol, Terbutaline, Metaproterenol (no longer used due to excessive cardiovascular effects) and Isoproterenol (nonspecific Beta agonist used in treatment of arrhythmias). Salmeterol is a long acting Beta-2 agonist used in maintenance therapy of the above conditions.

B. Acetaminophen, also known as Tylenol, functions as an analgesic and antipyretic that does not have anticoagulant nor anti-inflammatory properties. Tylenol is safe to use in all ages and during pregnancy.

A. Naloxone, also known as Narcan, is administered to those experiencing an opioid overdose. Narcan acts as an opioid antagonist to reverse effects.

B/C. Sumatriptan, a drug commonly used as a therapy for Migraines, functions as an anti-inflammatory and vasoconstrictor. Sumatriptan is an agonist of 5-HT1B and 1D receptors.

C. Bromocriptine, a dopamine agonist, is commonly used in treatment of Parkinsons. Amantadine is also considered a dopamine agonist used to treat Parkinsons.

B/D. TCAs function by increasing levels of serotonin, norepinephrine/epinephrine, and anticholinergic activity. These three functions lead to increased sympathetic output.

D. Nardil, also known as Phenylzine, is a Monoamine oxidase inhibitor. MAO is an enzyme found in the synaptic cleft that breaks down norepinephrine and serotonin to be taken back up. By inhibiting MAO, norepinephrine and serotonin may remain active in the cleft for longer. When used in combination with Phenylephrine, there is too much sympathetic activity.

A. Metformin is the only known DM drug that does not cause hypoglycemia. For this reason, Metformin is considered first line therapy for T2DM.

D. Ciprofloxacin is safe to use in patients with Sulfa allergies. Sulfa drug classes include: Penicillins, CAIs, Sulfonylureas, and Sulfonamides.

C. Sildenafil, also known as Viagra, functions by inhibiting phosphodiesterase-5 (PDE-5). PDE-5 breaks down cGMP which will lead to weakening of smooth muscle.

B. Levothyroxine, also known as Synthroid, is a synthetic T4 agent that is used for the treatment of Hypothyroidism. Many patients take this medication chronically post-thyroidectomy. Side effects include Hyperthyroidism and IIH.

A. Losartan, an Angiotensin II receptor antagonist (ARB) is used to treat hypertension. It does not have any effect on bradykinin activity, thus leaving lungs unaffected for cough. The remaining options are ACE inhibitors which act by preventing formation of angiotensin II through ACE inhibition as well as blocking metabolism of bradykinins causing vasodilation.

D. Furosemide is the only diuretic to affect the ascending loop of Henle. Furosemide functions by inhibiting Na+/2Cl-/K+ co-transporter while also increasing Ca²⁺ secretion. Use of Furosemide may lead to development of hypokalemia and/or nephrotoxicity.

B. It is not a HYPEROPIC shift but rather a MYOPIC shift. The remaining options are correct. Of note, the dry eye is from decreased secretion from the lacrimal gland.

C. Mannitol, also known as Osmitrol, is a diuretic that affects the entire nephron. It works by increasing plasma osmolarity to draw water out.

B. Clopidogrel, also known as Plavix, is an anticoagulant that functions by inhibiting ADP receptors on platelet cell membranes. This receptor is critical for platelet aggregation and clot formation.

E. Vitamin K reverses the effects of Warfarin. Warfarin, also known as Coumadin, is a Vitamin K antagonist. It prevents clots by interfering with formation of clotting factors that are dependent on Vitamin K.

A. Simvastatin, also known as Zocor, is one of three cholesterol medications that function by inhibiting HMG-CoA reductase. This enzyme is responsible for production of cholesterol. These medications are first line therapies. Gemfibrozil binds to PPAR-alpha leading to breakdown of VLDL. Cholestyramine binds bile acids in intestines to prevent reabsorption. Isotretinoin is a distractor as it is used in treatment of acne.

A. Digoxin, a medication used in treatment of congestive heart failure, functions by inhibiting Na+/K+ ATPase resulting in increased intracellular Ca2+. Side effects include Retrobulbar Optic Neuritis and/or B/Y color defects.

B. Doxycycline must be digested after eating/with food. To recall, “PAT your stomach” for drug classes that must be taken with an empty stomach and include: Penicillins, Azithromycin (Macrolides), and Tetracycline. This is a trick question as Doxycycline, a Tetracycline, is the one exception that must be taken with food.

C. Cephalosporins are safe to use during pregnancy. To recall, “She is not FATS, she is PACking a baby”. FATS are not safe to use during pregnancy and includes: Fluoroquinolones, Aminoglycosides, Tetracyclines, and Sulfonamides. PAC is safe to use and includes: Penicillins, Azithromycin (Macrolides), and Cephalosporins.