BCACP Infectious Disease and Immunization Management 5 — Questions and Answers
Question 1: A pharmacist reviews a patient's chart and notes MRSA bacteremia. Which antibiotic is the drug of choice?
- Vancomycin (Correct answer)
- Linezolid
- Ceftriaxone
- Clindamycin
Correct answer: Vancomycin
Vancomycin remains the standard of care for MRSA bacteremia in ambulatory and inpatient settings.
Question 2: Which dosing strategy for vancomycin is currently recommended by updated ASHP/IDSA/SIDP consensus guidelines?
- AUC/MIC-guided monitoring targeting AUC 400–600 mg·h/L (Correct answer)
- Trough-only monitoring targeting 15–20 mg/L
- Fixed weight-based dosing without monitoring
- Peak/trough monitoring with peak target of 30–40 mg/L
Correct answer: AUC/MIC-guided monitoring targeting AUC 400–600 mg·h/L
The 2020 ASHP/IDSA/SIDP consensus guideline recommends AUC/MIC-guided vancomycin monitoring to optimize efficacy and minimize nephrotoxicity.
Question 3: A patient with a penicillin allergy documented as 'rash' needs treatment for community-acquired pneumonia. What is the most appropriate approach?
- Perform allergy risk stratification; a low-risk history may allow use of cephalosporins (Correct answer)
- Avoid all beta-lactams and use a fluoroquinolone only
- Administer amoxicillin with monitoring due to cross-reactivity being minimal
- Refer to allergist before initiating any antibiotic
Correct answer: Perform allergy risk stratification; a low-risk history may allow use of cephalosporins
A non-severe penicillin allergy history (e.g., rash) warrants risk stratification; cross-reactivity with cephalosporins is low and cephalosporins can often be used safely.
Question 4: Which immunization is specifically recommended for adults asplenic or with functional asplenia to prevent encapsulated organism infections?
- PCV15 or PCV20 followed by PPSV23, plus meningococcal vaccines (MenACWY and MenB) (Correct answer)
- Annual influenza vaccine only
- Hepatitis A and B series only
- Tdap and varicella vaccines
Correct answer: PCV15 or PCV20 followed by PPSV23, plus meningococcal vaccines (MenACWY and MenB)
Asplenic patients are at high risk for infections with encapsulated organisms and require pneumococcal, meningococcal (MenACWY and MenB), and Hib vaccines.
Question 5: A clinic patient tests positive for HCV RNA. What is the preferred treatment regimen for treatment-naïve, non-cirrhotic genotype 1a HCV?
- Glecaprevir/pibrentasvir for 8 weeks (Correct answer)
- Peginterferon alfa plus ribavirin for 48 weeks
- Sofosbuvir monotherapy for 12 weeks
- Daclatasvir plus asunaprevir for 24 weeks
Correct answer: Glecaprevir/pibrentasvir for 8 weeks
Glecaprevir/pibrentasvir (Mavyret) for 8 weeks is a pangenotypic, guideline-recommended option for treatment-naïve non-cirrhotic HCV patients.
Question 6: When counseling a patient starting isoniazid (INH) for latent TB, which supplement should be co-prescribed to prevent peripheral neuropathy?
- Pyridoxine (vitamin B6) 25–50 mg daily (Correct answer)
- Thiamine (vitamin B1) 100 mg daily
- Folate 1 mg daily
- Cyanocobalamin (vitamin B12) 1000 mcg daily
Correct answer: Pyridoxine (vitamin B6) 25–50 mg daily
Isoniazid inhibits pyridoxine metabolism, increasing neuropathy risk; pyridoxine supplementation is recommended especially in at-risk patients.
Question 7: A pharmacist is managing HIV PrEP in a patient who is unable to adhere to daily oral therapy. Which alternative is FDA-approved for HIV pre-exposure prophylaxis?
- Cabotegravir extended-release injectable (Apretude) given every 2 months (Correct answer)
- Rilpivirine monthly injection
- Dolutegravir oral weekly dosing
- Maraviroc daily oral dosing
Correct answer: Cabotegravir extended-release injectable (Apretude) given every 2 months
Cabotegravir long-acting injectable (Apretude) is FDA-approved for PrEP administered as an injection every 2 months after initial loading doses.
BCACP Infectious Disease and Immunization Management 5
A pharmacist reviews a patient's chart and notes MRSA bacteremia.
Which antibiotic is the drug of choice?