PHARM 180 MIDTERM EXAM 2025/2026 QUESTIONS WITH
ANSWERS GRADED A+
✔✔What toxic metabolite accumulation from cephalosporins can cause severe
flushing? - ✔✔Acetaldehyde
✔✔What symptoms may accompany severe flushing due to acetaldehyde
accumulation? - ✔✔Tachycardia and hypotension
✔✔cephalosporins and alcohol - ✔✔if cefotetan or ceftriaxone are concurrent with
alcohol can cause disulfiram effect.
✔✔disulfiram effect - ✔✔inhibition of acetaldehyde dehydrogenase will make you SICK
(inhibition of alcohol dehydro. will just make you drunk longer)
✔✔Macrolides - ✔✔bacteriostatic inhibitor of protein synthesis.
do everything penicillins do and more.
cover atypical bacteria.
✔✔macrolide medications - ✔✔erythromycin, pro motility.
clarithromycin.
azithromycin (Z pack).
✔✔macrolide uses - ✔✔whooping cough.
chlamydial infections.
✔✔which medication can be used in place of penicillin G if allergies occur? -
✔✔macrolides.
✔✔macrolides side effects - ✔✔GI distress, most common symptom.
rare risk for cardiac prolongation and sudden cardiac death syndrome. *torsades de
pointes*
✔✔which medications should not be taken with macrolides and why? -
✔✔antiarrhythmic drugs:
amiodarone, defetilide, quinidine, sotalol.
these prolong QT interval.
✔✔What type of infections should vancomycin be limited to? - ✔✔Serious infections
only
✔✔What infections does vancomycin treat? - ✔✔C. diff and MRSA
, ✔✔What is a common alternative use for vancomycin? - ✔✔As an alternative for
penicillin (PCN) in serious infections
✔✔What is a common adverse effect of vancomycin? - ✔✔Red man syndrome
✔✔What are the symptoms of red man syndrome caused by vancomycin? -
✔✔Flushing, rash, severe itching, tachycardia, hypotension
✔✔How should vancomycin be infused to minimize adverse effects? - ✔✔Infuse slowly
and consider premedicating with acetaminophen and diphenhydramine
✔✔What is the most serious side effect of vancomycin? - ✔✔Renal toxicity
✔✔Which types of drugs should be limited when using vancomycin due to renal
toxicity? - ✔✔Nephrotoxic drugs like NSAIDs, aminoglycosides, or cyclosporine
✔✔aminoglycosides - ✔✔bactericidal: used to treat serious infections with aerobic gram
- bacilli.
✔✔aminoglycoside medications - ✔✔not well absorbed from the GI tract so must be
given IM or IV.
gentamicin, tobramycin, amikacin.
✔✔what should be monitored with aminoglycosides? - ✔✔serum drug levels.
trough levels qday, one hour before BID just prior to next dose.
✔✔aminoglycoside adverse effects - ✔✔extremely ototoxic and nephrotoxic.
✔✔aminoglycoside peak - ✔✔after 30 minutes IM or IV.
✔✔What type of organisms is clindamycin active against? - ✔✔Most anaerobic
organisms, gram - and +, and most gram + aerobes.
✔✔What is a common use for clindamycin? - ✔✔It is widely used as an alternative to
penicillin.
✔✔What types of infections is clindamycin used for? - ✔✔Serious anaerobic infections
outside the CNS and severe group A streptococcus.
✔✔clindamycin adverse effects - ✔✔C diff, erosive esophagitis.
✔✔What are some examples of tetracycline medications? - ✔✔Tetracycline,
demeclocycline, doxycycline, minocycline.
ANSWERS GRADED A+
✔✔What toxic metabolite accumulation from cephalosporins can cause severe
flushing? - ✔✔Acetaldehyde
✔✔What symptoms may accompany severe flushing due to acetaldehyde
accumulation? - ✔✔Tachycardia and hypotension
✔✔cephalosporins and alcohol - ✔✔if cefotetan or ceftriaxone are concurrent with
alcohol can cause disulfiram effect.
✔✔disulfiram effect - ✔✔inhibition of acetaldehyde dehydrogenase will make you SICK
(inhibition of alcohol dehydro. will just make you drunk longer)
✔✔Macrolides - ✔✔bacteriostatic inhibitor of protein synthesis.
do everything penicillins do and more.
cover atypical bacteria.
✔✔macrolide medications - ✔✔erythromycin, pro motility.
clarithromycin.
azithromycin (Z pack).
✔✔macrolide uses - ✔✔whooping cough.
chlamydial infections.
✔✔which medication can be used in place of penicillin G if allergies occur? -
✔✔macrolides.
✔✔macrolides side effects - ✔✔GI distress, most common symptom.
rare risk for cardiac prolongation and sudden cardiac death syndrome. *torsades de
pointes*
✔✔which medications should not be taken with macrolides and why? -
✔✔antiarrhythmic drugs:
amiodarone, defetilide, quinidine, sotalol.
these prolong QT interval.
✔✔What type of infections should vancomycin be limited to? - ✔✔Serious infections
only
✔✔What infections does vancomycin treat? - ✔✔C. diff and MRSA
, ✔✔What is a common alternative use for vancomycin? - ✔✔As an alternative for
penicillin (PCN) in serious infections
✔✔What is a common adverse effect of vancomycin? - ✔✔Red man syndrome
✔✔What are the symptoms of red man syndrome caused by vancomycin? -
✔✔Flushing, rash, severe itching, tachycardia, hypotension
✔✔How should vancomycin be infused to minimize adverse effects? - ✔✔Infuse slowly
and consider premedicating with acetaminophen and diphenhydramine
✔✔What is the most serious side effect of vancomycin? - ✔✔Renal toxicity
✔✔Which types of drugs should be limited when using vancomycin due to renal
toxicity? - ✔✔Nephrotoxic drugs like NSAIDs, aminoglycosides, or cyclosporine
✔✔aminoglycosides - ✔✔bactericidal: used to treat serious infections with aerobic gram
- bacilli.
✔✔aminoglycoside medications - ✔✔not well absorbed from the GI tract so must be
given IM or IV.
gentamicin, tobramycin, amikacin.
✔✔what should be monitored with aminoglycosides? - ✔✔serum drug levels.
trough levels qday, one hour before BID just prior to next dose.
✔✔aminoglycoside adverse effects - ✔✔extremely ototoxic and nephrotoxic.
✔✔aminoglycoside peak - ✔✔after 30 minutes IM or IV.
✔✔What type of organisms is clindamycin active against? - ✔✔Most anaerobic
organisms, gram - and +, and most gram + aerobes.
✔✔What is a common use for clindamycin? - ✔✔It is widely used as an alternative to
penicillin.
✔✔What types of infections is clindamycin used for? - ✔✔Serious anaerobic infections
outside the CNS and severe group A streptococcus.
✔✔clindamycin adverse effects - ✔✔C diff, erosive esophagitis.
✔✔What are some examples of tetracycline medications? - ✔✔Tetracycline,
demeclocycline, doxycycline, minocycline.
