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Topic
Snapshot
  • A 23-year-old woman presents to her gynecologist for a wellness exam. She reports that she has been having a “fishy” vaginal odor for the past 3 days. She endorses to recently being sexually active with a new partner and does not use barrier contraception. Physical examination is notable for gray vaginal discharge that has a fishy odor. Nucleic acid amplification testing for gonorrhea and chlamydia is negative. An amine whiff test enhances the fishy odor. Vaginal fluid pH is > 4.5. There are clue cells with a stippled appearance on the outer margins on microscopic testing of the vaginal fluid. She is started on metronidazole. (Bacterial vaginosis)
Introduction
  • Mechanism of action
    • free radical formation that damages bacterial DNA 
      • is bactericidal and has antiprotozoal activity
  • Clinical use
    • protozoal infections
      • Giardia
      • Entamoeba
      • Trichomonas
    • anaerobic bacteria (below the diaphragm)
      • Bacteroides
      • Clostridium difficile
      • Gardnerella vaginalis
    • Helicobacter pylori
      • as part of triple therapy in patients who are penicillin allergic
  • Adverse reaction
    • disulfiram-like reaction  
      • when consuming alcohol, patients can experience severe flushing, hypotension, and tachycardia
    • metallic taste
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Questions (3)
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(M1.MC.14.1) A 45-year-old female with a history of gastroesophageal reflux disease presents to her family physician with symptoms of epigastric pain right after a meal. The physician performs a urea breath test which is positive and the patient is started on appropriate medical therapy. Three days later at a restaurant, she experienced severe flushing, tachycardia, hypotension, and vomiting after her first glass of wine. Which of the following is the mechanism of action of the medication causing this side effect? Tested Concept

QID: 106335
1

Blocks the synthesis of the peptidoglycan layer

15%

(11/72)

2

Blocks protein synthesis by binding to the 50S ribosomal subunit inhibiting protein translocation

10%

(7/72)

3

Binds to the 30S ribosomal subunit preventing attachment of the aminoacyl-tRNA

7%

(5/72)

4

Forms toxic metabolites that damage bacterial DNA

46%

(33/72)

5

Inhibits the H+/K+ ATPase

22%

(16/72)

M 1 E

Select Answer to see Preferred Response

(M1.MC.13.63) A 22-year-old female college student is treated with metronidazole after presenting to student health services with itching, discharge, and pain in her vagina. At a party shortly afterward she experiences facial flushing, nausea, tachycardia, dyspnea, headache, and abdominal cramps after consuming alcohol. Serum levels of which of the following are likely elevated in this patient following alcohol consumption: Tested Concept

QID: 101281
1

Acetaldehyde

82%

(313/382)

2

Uric acid

1%

(5/382)

3

Cytochrome P-450 enzymes

13%

(49/382)

4

Triglycerides

1%

(4/382)

5

Amylase

2%

(7/382)

M 3 E

Select Answer to see Preferred Response

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