Examl 2:l NSG124/l NSGl 124l (Latestl 2025/l
2026l Update)l Pharmacologyl Review|l
Questionsl &l Answers|l Gradel A|l 100%l
Correctl (Verifiedl Solutions)-l Herzing
Q:l Indicationsl forl Antibioticl Combinations
Answer:
-l initiall therapyl (empiric)l forl severel infection
-l mixedl infections
-l preventingl resistancel (TBl only)
-l decreasel toxicity
-l enhancedl action
Q:l Disadvantagesl ofl Antibioticl Combinations
Answer:
1)l increasedl riskl ofl toxicl andl allergicl reactions
2)l possiblel antagonisml ofl antimicrobiall effects
3)l increasedl riskl ofl superinfection
4)l selectionl ofl drug-resistantl bacteria
5)l increasedl cost
Q:l Prophylacticl usel ofl antibioticsl canl decreasel incidencel ofl infectionl inl certainl kindsl
ofl surgery.
Answer:
Ex:l cardiacl surgery,l peripherall vascularl surgery,l orthopedicl surgery,l andl surgeryl onl thel
GIl tractl (stomach,l duodenum,l colon,l rectum,l andl appendix).
-l hysterectomyl orl anl emergencyl cesareanl section.
Q:l Examplesl ofl Inappropriatel Antibioticl Prescriptions
,Answer:
-l Commonl cold
-l Bronchitisl
-l Sinusitisl
-l Sorel throat
Q:l Truel orl False:
Antimicrobiall therapyl isl assessedl byl monitoringl clinicall responsesl andl laboratoryl results.
Answer:
Truel
EX:l Seruml drugl levelsl mayl bel monitoredl forl twol reasons:l tol ensurel thatl levelsl arel
sufficientl forl antimicrobiall effectsl andl tol avoidl toxicityl froml excessivel levels.
Q:l Penicillin
Answer:
Mechanisml ofl Action-l Penicillinl weakenl thel celll wall,l causingl bacterial tol takel upl
excessivel amountsl ofl waterl andl rupture.l
Penicillinl weakensl thel celll walll byl twol actions:l (1)l inhibitionl ofl transpeptidasesl andl
(2)l disinhibitionl (activation)l ofl autolysins.
Use-l Penicillinl effectivelyl treatl al varietyl ofl bacterial withl lowl toxicityl andl arel widelyl
prescribed.
Q:l Classificationl ofl penicillin
Answer:
Narrow-spectruml penicillins:l penicillinasel sensitive-l Drugsl (Penicillinl G,l Penicillinl V)
Narrow-spectruml penicillins:l penicillinasel resistantl (Antil staphylococcall penicillins)l -l
Drugsl (Nafcillin,l Oxacillin,l Dicloxacillin)
Broad-spectruml penicillinsl (aminopenicillins)-l Drugsl (Ampicillin,l Amoxicillin)
Extended-spectruml penicillinl (antipseudomonall penicillin)l -l Drugsl (Piperacillin).
,Q:l Bacteriall resistancel tol penicillinsl isl determinedl primarilyl byl threel factors:
Answer:
(1)l inabilityl ofl penicillinsl tol reachl theirl targetsl (PBPs),
l (2)l inactivationl ofl penicillinsl byl bacteriall enzymes,l
(3)l productionl ofl PBPsl thatl havel al lowl affinityl forl penicillins.
Q:l Penicillinl allergy
Answer:
rash,l hives,l angioedema,l bronchospasm,l anaphylaxis
Penicillinl reactionsl arel classifiedl asl immediate,l accelerated,l andl delayed.
-Immediatel reactionsl occurl 2l tol 30l minutesl afterl drugl administration.l
-Acceleratedl reactionsl occurl withinl 1l tol 72l hours;l
-l Delayedl reactionsl occurl withinl daysl tol weeks.
Q:l Penicillinl Interactions
Answer:
NSAIDs,l orall contraceptives,l warfarin
Forl somel infections,l penicillinsl arel usedl inl combinationl withl anl aminoglycosidel (e.g.,l
gentamicin).
Unfortunately,l whenl penicillinsl arel presentl inl highl concentrations,l theyl interactl
chemicallyl withl aminoglycosidesl andl therebyl inactivatel thel aminoglycoside.
penicillinsl andl aminoglycosidesl shouldl neverl bel mixedl inl thel samel IVl solution.
Q:l Cephalosporinsl (classl ofl Beta-lactams)
, Answer:
Action:l Thesel agentsl bindl tol penicillin-bindingl proteinsl (PBPs)l andl therebyl (1)l disruptl
celll walll synthesisl andl (2)l activatel autolysinsl (enzymesl thatl cleavel bondsl inl thel celll
wall).
Therapeuticl use:l Theyl havel beenl employedl widelyl andl successfullyl againstl al varietyl ofl
infections.l
Adversel Reactions:l
Hypersensitivity,l painl atl sitesl ofl IMl injection,l pseudomembranousl colitis,l immune-
mediatedl hemolyticl anemia,l Thrombophlebitis
Q:l Carbapenemsl (Imipenem)
Answer:
Action:l Imipeneml bindsl tol twol PBPsl (PBP1l andl PBP2),l causingl weakeningl ofl thel
bacteriall celll walll withl subsequentl celll lysisl andl death.
Therapeuticl use:l Thisl drugl isl effectivel forl seriousl infectionsl causedl byl gram-positivel
cocci,l gram-negativel cocci,l gram-negativel bacilli,l andl anaerobicl bacteria.l Usedl widely.l
Adversel reaction:l nausea,l vomiting,l diarrhea,l Hypersensitivityl reactionsl (rashes,l pruritus,l
drugl fever),l rare-l seizuresl havel occurred.
Q:l Vancomycin
Answer:
Action:l Inhibitsl celll walll synthesisl andl therebyl promotesl bacteriall lysisl andl death.l
However,l inl contrastl tol thel beta-lactams,l doesl notl interactl withl PBPs.
Therapeuticl use:l shouldl bel reservedl forl seriousl infections.l Treatmentl ofl MRSAl orl
Staph.l epidermidis;l mostl strainsl ofl thesel bacterial arel stilll sensitivel tol vancomycin.l
Vancomycinl isl alsol thel drugl ofl choicel forl severel CDI,l butl notl forl mildl CDI.
Adversel reactions:l renall failure,l Hypersensitivityl reactionsl (especiallyl rashes)l occurl
frequently.l Hepatotoxicityl andl bloodl dyscrasiasl (agranulocytosis,l leukopenia,l
thrombocytopenia)l developl rarely.l Rapidl intravenousl administrationl canl causel
electrocardiographicl changes,l hypotension,l andl cardiacl arrest.
2026l Update)l Pharmacologyl Review|l
Questionsl &l Answers|l Gradel A|l 100%l
Correctl (Verifiedl Solutions)-l Herzing
Q:l Indicationsl forl Antibioticl Combinations
Answer:
-l initiall therapyl (empiric)l forl severel infection
-l mixedl infections
-l preventingl resistancel (TBl only)
-l decreasel toxicity
-l enhancedl action
Q:l Disadvantagesl ofl Antibioticl Combinations
Answer:
1)l increasedl riskl ofl toxicl andl allergicl reactions
2)l possiblel antagonisml ofl antimicrobiall effects
3)l increasedl riskl ofl superinfection
4)l selectionl ofl drug-resistantl bacteria
5)l increasedl cost
Q:l Prophylacticl usel ofl antibioticsl canl decreasel incidencel ofl infectionl inl certainl kindsl
ofl surgery.
Answer:
Ex:l cardiacl surgery,l peripherall vascularl surgery,l orthopedicl surgery,l andl surgeryl onl thel
GIl tractl (stomach,l duodenum,l colon,l rectum,l andl appendix).
-l hysterectomyl orl anl emergencyl cesareanl section.
Q:l Examplesl ofl Inappropriatel Antibioticl Prescriptions
,Answer:
-l Commonl cold
-l Bronchitisl
-l Sinusitisl
-l Sorel throat
Q:l Truel orl False:
Antimicrobiall therapyl isl assessedl byl monitoringl clinicall responsesl andl laboratoryl results.
Answer:
Truel
EX:l Seruml drugl levelsl mayl bel monitoredl forl twol reasons:l tol ensurel thatl levelsl arel
sufficientl forl antimicrobiall effectsl andl tol avoidl toxicityl froml excessivel levels.
Q:l Penicillin
Answer:
Mechanisml ofl Action-l Penicillinl weakenl thel celll wall,l causingl bacterial tol takel upl
excessivel amountsl ofl waterl andl rupture.l
Penicillinl weakensl thel celll walll byl twol actions:l (1)l inhibitionl ofl transpeptidasesl andl
(2)l disinhibitionl (activation)l ofl autolysins.
Use-l Penicillinl effectivelyl treatl al varietyl ofl bacterial withl lowl toxicityl andl arel widelyl
prescribed.
Q:l Classificationl ofl penicillin
Answer:
Narrow-spectruml penicillins:l penicillinasel sensitive-l Drugsl (Penicillinl G,l Penicillinl V)
Narrow-spectruml penicillins:l penicillinasel resistantl (Antil staphylococcall penicillins)l -l
Drugsl (Nafcillin,l Oxacillin,l Dicloxacillin)
Broad-spectruml penicillinsl (aminopenicillins)-l Drugsl (Ampicillin,l Amoxicillin)
Extended-spectruml penicillinl (antipseudomonall penicillin)l -l Drugsl (Piperacillin).
,Q:l Bacteriall resistancel tol penicillinsl isl determinedl primarilyl byl threel factors:
Answer:
(1)l inabilityl ofl penicillinsl tol reachl theirl targetsl (PBPs),
l (2)l inactivationl ofl penicillinsl byl bacteriall enzymes,l
(3)l productionl ofl PBPsl thatl havel al lowl affinityl forl penicillins.
Q:l Penicillinl allergy
Answer:
rash,l hives,l angioedema,l bronchospasm,l anaphylaxis
Penicillinl reactionsl arel classifiedl asl immediate,l accelerated,l andl delayed.
-Immediatel reactionsl occurl 2l tol 30l minutesl afterl drugl administration.l
-Acceleratedl reactionsl occurl withinl 1l tol 72l hours;l
-l Delayedl reactionsl occurl withinl daysl tol weeks.
Q:l Penicillinl Interactions
Answer:
NSAIDs,l orall contraceptives,l warfarin
Forl somel infections,l penicillinsl arel usedl inl combinationl withl anl aminoglycosidel (e.g.,l
gentamicin).
Unfortunately,l whenl penicillinsl arel presentl inl highl concentrations,l theyl interactl
chemicallyl withl aminoglycosidesl andl therebyl inactivatel thel aminoglycoside.
penicillinsl andl aminoglycosidesl shouldl neverl bel mixedl inl thel samel IVl solution.
Q:l Cephalosporinsl (classl ofl Beta-lactams)
, Answer:
Action:l Thesel agentsl bindl tol penicillin-bindingl proteinsl (PBPs)l andl therebyl (1)l disruptl
celll walll synthesisl andl (2)l activatel autolysinsl (enzymesl thatl cleavel bondsl inl thel celll
wall).
Therapeuticl use:l Theyl havel beenl employedl widelyl andl successfullyl againstl al varietyl ofl
infections.l
Adversel Reactions:l
Hypersensitivity,l painl atl sitesl ofl IMl injection,l pseudomembranousl colitis,l immune-
mediatedl hemolyticl anemia,l Thrombophlebitis
Q:l Carbapenemsl (Imipenem)
Answer:
Action:l Imipeneml bindsl tol twol PBPsl (PBP1l andl PBP2),l causingl weakeningl ofl thel
bacteriall celll walll withl subsequentl celll lysisl andl death.
Therapeuticl use:l Thisl drugl isl effectivel forl seriousl infectionsl causedl byl gram-positivel
cocci,l gram-negativel cocci,l gram-negativel bacilli,l andl anaerobicl bacteria.l Usedl widely.l
Adversel reaction:l nausea,l vomiting,l diarrhea,l Hypersensitivityl reactionsl (rashes,l pruritus,l
drugl fever),l rare-l seizuresl havel occurred.
Q:l Vancomycin
Answer:
Action:l Inhibitsl celll walll synthesisl andl therebyl promotesl bacteriall lysisl andl death.l
However,l inl contrastl tol thel beta-lactams,l doesl notl interactl withl PBPs.
Therapeuticl use:l shouldl bel reservedl forl seriousl infections.l Treatmentl ofl MRSAl orl
Staph.l epidermidis;l mostl strainsl ofl thesel bacterial arel stilll sensitivel tol vancomycin.l
Vancomycinl isl alsol thel drugl ofl choicel forl severel CDI,l butl notl forl mildl CDI.
Adversel reactions:l renall failure,l Hypersensitivityl reactionsl (especiallyl rashes)l occurl
frequently.l Hepatotoxicityl andl bloodl dyscrasiasl (agranulocytosis,l leukopenia,l
thrombocytopenia)l developl rarely.l Rapidl intravenousl administrationl canl causel
electrocardiographicl changes,l hypotension,l andl cardiacl arrest.
