SL is a 25-year-old male who presents with hypoxia at 78% of oxygen saturation, shortness of breath, muscle aches, fatigue with a fever of 102.6 F for the last three days, elevated inflammatory markers (CRP 300 mg/L, D-dimer 8 times ULM, ferritin 1200 mcg/L) and tested positive for COVID-19 at admission. High-flow oxygen support at 40 LPM is given, and hypoxia was corrected with a saturation of 91 %. AST/ALT and renal function is normal. ALC is 600 mm3, ANC is 2000 mm3. Platelet count is 200,000 and Hemoglobin (HgB) is 10.2. He has no drug allergies or past medical history and is unvaccinated. No antimicrobials have been started. No presence of VTE after both CTA chest and Doppler study were done. The attending physician diagnosed him with stage III COVID-19 infection and calls you as the internal medicine clinical pharmacist for the current treatment recommendations due to very frequent literature updates with the current pandemic. What would be the best recommendation(s) for SL?

The ER physician consults you as the ER clinical pharmacist and asks for a recommendation on treating AH, a 40-year-old female with confirmed acute bacterial rhinosinusitis before being discharged home. She has a severe penicillin allergy that caused anaphylaxis two years ago. AH has a history of Type II Diabetes. What would be the best recommendation to give to the ED physician?

When should Acetaminophen be preferred over Ibuprofen for patients with symptoms of fever, chills, and body aches?

TD is a 58-year-old male came into your pharmacy to see if he can get a third COVID-19 shot. He has a history of renal transplantation, and his current immunosuppressive medications are Tacrolimus 4 mg PO q12h and Mycophenolate mofetil 500 mg PO q12h. He also completed the Pfizer-Biotech vaccine two-dose series two months ago. As the pharmacist on duty, what would be your recommendation to TD?

Which of the following is false about Fluoroquinolones?

Which of the following antibiotic(s) for pyelonephritis in the outpatient setting cannot be used as a one-time dose?

PJ is a 45 y/o female who presents to the ED with dysuria, suprapubic pain, and fever of 101.4 F for the last three days. Her past medical history includes Asthma. The urinalysis/urine culture was then obtained.

Allergies: Trimethoprim/sulfamethoxazole (Bactrim) –Anaphylaxis

Urinalysis report: See attachment.

Urine culture report pending, and patient is admitted into the 3 South Observation unit until cultures come back.

After reviewing the case, what type of UTI as well as treatment option bests fits PJ?

A patient has just been prescribed Metronidazole (Flagyl). Which of the following statements would indicate a need for further teaching?

Which of the following clinical scenarios would be considered appropriate use of vancomycin? (Select ALL that apply.)

A 46-year-old woman presents to the emergency department with acute diarrhea (8 stools per day) for 2 days. Initial laboratory test results are as follows: white blood cells (WBCs) 16.1 cells/mm3, hemoglobin (Hgb) 11.8 g/dL, hematocrit (Hct) 34.5 g/dL, platelet count (Plt) 278 cells/mm3, sodium (Na) 140 mEq/L, potassium (K) 4.7 mEq/L, chloride (Cl) 108 mEq/L, serum bicarbonate (HCO3-) 18 mEq/L, serum creatinine (SCr) 1.7 mg/dL (baseline 1.0 mg/dL), and blood urea nitrogen (BUN) 33 g/dL. Vital signs include blood pressure 110/70 mm Hg, temperature 100°F (37.8°C), heart rate 88 beats/minute, respiratory rate 22 breaths/minute, and oxygen saturation (SaO2) 96% on room air. An abdominal examination reveals no distention with some rebound pain. A stool sample is sent for toxin testing. She states that she never had similar problem before. Given her presentation, which is/are the best empiric management strategy for this patient with suspected CDI?

HY has recently been admitted to hospital yesterday and placed on Vapotherm to assist with his dyspnea and O2 demands. A CRP was drawn on HY, it was 85. Following 48 hours of pharmacotherapeutic and supportive care HY has continued to progress from a respiratory aspect. What would be the most appropriate therapeutic option for HY at this point? Select all that apply

HY has recently been admitted to hospital yesterday and placed on Vapotherm to assist with his dyspnea and O2 demands. A CRP was drawn on HY, it was 85. What is not a appropriate therapeutic option for HY? Select all that apply

HY has recently been admitted to hospital yesterday and placed on Vapotherm to assist with his dyspnea and O2 demands. A CRP was drawn on HY, it was 85. What is a appropriate therapeutic option for HY?

GY is a 17 yo HM who has recently been diagnosed with bronchitis, his ED physician has suspicion of whooping cough being the causes due to breakout at his school. Which of the following antibiotic(s) is/are appropriate for GY? Select all the apply

SD is a 56 year old alcoholic that is inquiring about recommendations for the pneumonia vaccine. Which vaccine is recommended for this patient? Select all that apply

A patient calls your pharmacy in Houston, Texas and states that he just removed a tick from under his arm after hiking in Sam Houston National Forest (60 miles north of Houston) 4 days ago. He is very concerned about various tickborne-illness, especially Lyme disease, and ask you if there is any medication he can take to prevent from disease. Which of the following is the most appropriate response?

A patient comes to your pharmacy stating that they are about to go on a hunting and fishing trip in Missouri and are looking for appropriate mosquito and tick repellent. Which of the following do you recommend?

What is the most appropriate treatment option for the above patient? He has no known drug allergies.

A 45 yo male presents to your clinic with a new rash under his arm. He said he recently returned from a camping trip in Vermont where he was sleeping outside and hiking in the woods for several days. He recalls finding several ticks on his clothes during his trip but doesn’t recall being bitten. He states the rash has expanded over the last several days and now has a bull’s eye appearance. He has no other symptoms. What is the likely cause of the rash based on the above presentation?

AB is a 75 year old female with a history of pacemaker placement 1 year ago who presents with fever of 101F for the past 2 weeks. Three sets of blood cultures reveal Staphylococcus aureus. Physical exam findings include Osler’s nodes, but no vascular phenomena. Using the Modified Duke’s Criteria, you think the patient has:

TS is a 76 year old male with acute renal dysfunction (creatinine 4.2 mg/dL) who has been diagnosed with endocarditis. The patient reports no known allergies. Culture and sensitivities show Streptococcus anginosus (Viridans Group Streptococci) that is susceptible to penicillin (MIC < 0.12). What is the most appropriate treatment recommendation?

RM is a 45 year old male with endocarditis. He was empirically started on cefazolin 6g IV divided into 3 doses per day and vancomycin 15mg/kg IV q12h. His blood cultures now show Staphylococcus aureus, oxacillin susceptible. What is your recommendation for this patient’s therapy?

TJ has been diagnosed with Enterococcus faecalis endocarditis. The blood culture shows susceptibility to both penicillin and aminoglycosides. The most appropriate treatment recommendation is:

SB is receiving vancomycin for MRSA endocarditis. He has home health to facilitate his infusions and medical care. As the pharmacist in charge of your facility’s outpatient antimicrobial therapy program, you recognize that appropriate monitoring of this patient includes:

GD who was recently diagnosed with active TB 5 years ago. She was started exhibit pulmonary symptoms and resistance is suspected. Her physician wants to change her from RIPE to a regimen designed to treated MDR-TB

What organism is the most common cause of cellulitis?

Which of the following is false regarding drug side/adverse effects?

Which of the following treatment option(s) can be used to treat influenza?

Which of the following medications is recommended as treatment for a patient presenting with a bite wound?

FG has recently been diagnosed with Latent TB, his infectious disease team is inquiring about antimicrobial regimens appropriate for FG’s clinical situation. Which of the following regimens is appropriate for FG? Select all that apply

A 7 year old boy is admitted to the local children’s hospital with macular rash on his hands, wrists, and ankles about 1 week after camping with his family in Arkansas. The differential diagnosis is tickborne disease, specifically Rickettsia rickettsii given the exposure history and presentation. The team asks you, the team pharmacist, if it is OK to give doxycycline given the patient’s age. Which of the following statements is TRUE?

FG is 28 y/o pregnant female at 39 weeks gestation and presents to your Walgreens pharmacy a prescription for Nitrofurantoin (Macrobid) 100 mg PO BID x 5 days for her uncomplicated cystitis. She is extremely offensive to you and wants the antibiotic to be filled now. As the pharmacist on duty, what is the best course of action?

KU is 70 y/o male presents to the ED with muscle aches and dizziness for the last 2 days. KU is diagnosed with rhabdomyolysis due to taking his home medication Simvastatin. However, ED physician also decides to do a urinalysis due to “wanting to cover his bases” with his assessment. Urinalysis reveals 2+ urine leukocyte esterase and pyuria (WBC 20) while the urine culture reveals Escherichia coli (E. coli) >100,000 CFU. In response, ED physician wants to start KU on Ceftriaxone (Rocephin) 1 gm IVPB q24h. Other than the symptoms regarding his current diagnosis, KU complains of no UTI specific symptoms for the past week. What would be the best course of action for KU?

For a patient presenting with a diabetic foot infection, in what situation would you empirically treat for MRSA?

What is the main purpose of clindamycin use in necrotizing fasciitis infections?

In a patient diagnosed with necrotizing fasciitis, what empiric antibiotic therapy would you start initially?

Which of the following predisposing factors can lead to skin and soft tissue infection? Select all that apply

A patient is telling you that once took an antibiotic that caused them to have C-diff. They can’t remember which antibiotic though. In their medication history, you see these antibiotics below. Which of these antibiotics is most likely to cause C-diff?

A 48-year-old male with ESRD on peritoneal dialysis presents with signs and symptoms suggestive of primary bacterial peritonitis. Patient has no known drug allergies. Fluid from abdomen grew MRSA. Which of the following would be a reasonable antimicrobial regimens and duration for the patient?

Which of the following statements is true in reference to the COVID vaccines? Select all that apply

GB (64 kg, 163 cm) has been placed on treatment for active TB. What is the calculated dose of INH this patient should be receiving RIPE therapy? Select all that apply

RL is a 82 year old male being evaluated for infective endocarditis. He has a past medical history of hypertension, diabetes, heart failure, COPD, and mitral valve replacement. What risk factors for infective endocarditis does this patient have?