Examination 2

A young man comes to a community clinic with a urogenital infection due to Neisseria gonorrhoeae. questioning suggests that the patient acquired the infection while vacationing abroad. the physician is concerned about drug resistance of the gonococcus The physician is also concerned about the possibility of a nongonococcal urethritis in this patient. several antibiotics in the list below are active in nongonococcal urethritis, however, these infections, including those caused by C trachomatis can usually be eradicated by the administration of a single dose of A. azithromycin B. doxycycline C. erythromycin D. levofloxacin E. trimethoprim sulfa

A

A young man comes to a community clinic with a urogenital infection due to Neisseria gonorrhoeae. questioning suggests that the patient acquired the infection while vacationing abroad. the physician is concerned about drug resistance of the gonococcus which drug is least likely to be effective in the treatment of gonorrhea in this patient? A. amoxicillin B. azithromycin C. cefixime D. ceftriaxone E. ciprofloxacin

A

Although fentanyl or one of its congeners is usually administered in the early stages of a general anesthesia procedure, it is likely that the patient will receive an injection of morphine during the last phase. the re rationale for switching to morphine is that the drug has A. a longer duration of action B. greater analgesic efficacy C. more of a ceiling effect and less tendency to cause respiratory failure D. opioid receptor agonist activity whereas fentanyl is a selective kappa receptor agonist E. the advantage of being more completely reversed by naloxone.

A

An individual who ingested an antifreeze solution containing ethylene glycol was brought to a hospital emergency department. in an attempt to prevent severe acidosis and renal damage. the patient was given fomepizole. fomepizole is useful in ethylene glycol poisoning because it inhibits which of the following? A. alcohol dehydrogenase B. aldehyde dehydrogenase C. enzymes in the microsomal ethanol-oxidizing system (MEOS) D. enzymes that require thiamin as a cofactor E. glutathione transferase

A

This cell cycle non-specific agent is commonly used as a component of cancer chemotherapy regimens, including those for non-hodgkin's lymphoma and for breast cancers; administration of mercaptoethanesulfonate decreases the risk of hematuria A. cyclophosphamide B. azathioprine C. fluorouracil D. methotrexate E. vinblastine

A

A 65 year old man has chronic open angle glaucoma. the drug that is most likely to have therapetic value for this condition is A. ephedrine B. isoproterenol C. latanoprost D. mannitol E. propranolol

C

A new drug was administered to a group of normal volunteers in a phase 1 clinical trial. IV bolus doses produced a decrease in systolic and diastolic BP and a increase in heart rate. The most probably receptor affinities of the new drug are A. a1, a2 and B1 B. a1 and a2 only C b1 and b2 only D. muscarinic M3 only E. nicotinic Nn only

C

A patient with diffuse non-hodgkin's lymphoma is treated with a combination drug regimen that includes bleomycin, cyclophosphamide, vincristine, doxorubicin and prednisone. Dexrazoxane is thought to protect against the distinctive toxicity of which drug in this patient's regimen? a. bleomycin B. cyclophosphamide C. doxorubicin D. prenisone E. vincristine

C

A young patient with end-stage kidney disease receives a transplant from a living related donor who is HLA identical and red blood cell ABO matched. to prevent rejection the transplant recipient is treated with cyclosporine. Two years after initiating cyclosporine therapy the patient developed evidence of cyclosporine induced nephrotoxicity and hypertension. he was switched to an immunosuppressant that lacks renal toxicity and produces its immunosuppressant effect by inhibiting the de novo pathway of guanosine monophosphate (GTP) synthesis. the new immunosuppressant is which of the following drugs? A. azathioprine B. etanercept C. mycophenolate mofetil D. sulfasalazine E. prednisone

C

Adding a progestin to the estrogenic component of hormone replacement therapy for post menopausal women provides which of the following effects? A. prevents thromboembolic events B. provides better control of problematic hot flushes C. reduces the risk of endometrial cancer D. restores regular vaginal bleeding E. slows bone loss

C

An example of a phase I drug metabolizing reaction is A. acetylation B. glucuronidation C. hydroxylation D. methylation E. sulfation

C

In a laboratory study of a new agent, the activity of a membrane bound enzyme was found to be increased by the drug. analysis of this enzyme molecule revealed that it is an integral tyrosine kinase, the extracellular domain of which binds ligands while the intracellular domain phosphorylates tyrosine residues. which of the following receptors communicate their activation by turning on an integral intracellular tyrosine kinase domain? A. acetylcholine nicotinic receptors B. g protein coupled receptors C. insulin receptors D. steroid receptors E. vitamin D receptors

C

Long term use of meperidine for analgesia is avoided because the accumulation of a metabolite, normeperidine is associated with risk of A. constipation B. dependence C. neutropenia D. renal impairment E. Seizures

E

Drug 1 was given as an IV bolus to a subject while blood pressure and heart rate were recorded (increased systolic and diastolic BP, decreased heart rate). after recovery from drug 1, drug 2 was given then drug 1 was given again. this time there was no increase in BP and the heart rate raised slightly Drug 1: A. albuterol B. angiotensin II C. endothelin D. epinephrine E. hexamethonium F. isoproterenol G. norepinephrine H. phenylephrine I. prazosin J. propranolol

G Drug 1 evokes a strong pressor effect and bradycardia as a reflex compensatory response, effect of drug 2 unmasks a tachycardia, making this norepinephrine because phenylephrine does not have beta agonist action

A 64 year old recipient of a kidney transplant was being treated with immunosuppressants. after several episodes of gout the decision was made to treat his gout with the xanthine oxidase inhibitor allopurinol. the dose of which of the following of his immunosuppressant drugs should be reduced to avoid excessive bone marrow suppression due to a drug drug interaction? A. azathioprine B. cyclosporine C. hydroxychloroquine D. methotrexate E. tacrolimus

A

Which statement about nitric oxide is most correct? A. nitric oxide is synthesized in vascular endothelium and the brain B. nitric oxide is released from storage vesicles by acetylcholine C. nitric oxide synthase is stimulated by nitroprusside D. nitric oxide synthase is inhibited by histamine E. nitric oxide causes pulmonary vasoconstriction

A

Which of the following is an oral antidiabetic drug that inhibits an enzyme in the GI tract that converts polysaccharides to monosaccharides and thereby reduces postprandial hyperglycemia? a. acarbose B. glipizide C. metformin D. rosiglitazone E. sitagliptin

A (Glipizide is a secretagogue, metformin acts int he liver, rosiglitazone is a ppar-gamma activator, and sitagliptin is a dpp-iv inhibitor)

Ms. B, a 40 year old woman, has been receiving a slow IV infusion of phenylephrine. she is currently showing an excessive heart rate effect from this drug. A drug that blocks the heartrate effect of a slow IV infusion of phenylephrine is A. atropine B. echothiopate C. neostigmine D. pilocarpine E. propranolol

A reflex tachycardia is mediated by vagus nerve acting muscarinic receptors in the SA node

A 2 year old girl was brought to the emergency department because of vomiting, bloody diarrhea and hypotension. an abdominal x-ray film showed multiple radiopaque pills and a relative a the child's home reported the discovery of an open bottle of iron pills behind a large piece of furniture. in addition to supportive care, treatment of the child is most likely to include which of the following actions? A. IV administration of acetylcysteine B. iv administration of deferoxamine C. iv administration of pralidoxime D. oral administration of activate charcoal E. oral administration of edetate (EDTA)

B

A 35 year old patient is brought to the ER in drug induced coma. Graph shows first order kinetics, which of the following drugs is the most likely cause of this patient's coma? A. aspirin B. diazepam C. ethanol D. phenytoin

B

A 40 year old woman was being treated for chronic moderate hypertension. when she went on vacation and forgot her pills, her bp rose markedly and she was admitted with blurred vision, severe headache and retinal hemorrhages. a drug that is most likely to be followed by rebound hypertension if stopped suddenly is A. atenolol B. clonidine C. labetalol D. lorsartan e. prazosin

B

A patient admitted to the emergency department is vomiting blood. her supine bp is 100/60, sitting up her BP is 50/0. which of the following most accurately describes the probable autonomic response to the bleeding? A. slow heart rate, dilated pupils, damp skin B. rapid heart rate, dilated pupils, damp skin C. slow heart rate, dry skin, increased bowel sounds D. rapid heart rate, dry skin, constricted pupils, increased bowel sounds E. rapid heart rate, constricted pupils, warm skin

B

A patient with a 30 year history of type 1 diabetes comes to you with a complaint of bloating and sour belching after meals. vomiting has occurred on several occasions. evaluation reveals delayed emptying of the stomach and you diagnose diabetic gastroparesis. which drug would be most useful in this patient a. famotidine B. metoclopramide C. misoprostol D. omeprazole E. ondansetron

B

Rameleton, a drug prescribed for insomnia, is thought to act in the CNS via A. activation of benzodiazepine receptors B. activation of melatonin receptors C. bloc of the GABA transporter D. inhibition of GABA metabolism E. stimulation of glutamate receptors

B

The antibacterial action of aminoglycosides is due to their ability to A. activate autolytic enzymes B. bind to the 30S ribosomal subunit and block initiation of bacterial protein synthesis C. inhibit bacterial topoisomerases II and IV D. inhibit the synthesis of precursors of the linear peptidoglycan chains of the bacterial cell wall E. interfere with the synthesis of tetrahydrofolate

B

Which statement is accurate? A. alprazolam is effective in OCD B. clonazepam is a useful ant seizure drug C. diazepam is a drug of choice for bipolar affective disorder D. ramelteon is used in status epilepticus E. symptoms of alcohol withdrawal may be alleviated by buspirone

B

A 15 year old girl is admitted complaining of palpitations and shortness of breath. an ECG reveals sinus tachycardia with a heart rate of 160 bpm. a drug suitable for producing a brief increase in cardiac vagal effects is A. digoxin B. edrophonium C. ergotamine D. pralidoxime E. pyridostigmine

B convert too much vagal tone with short acting cholinesterase

A 52 year old plumber comes to the office with a complaint of periodic onset of chest pain, described as a sensation of heavy pressure over the sternum that comes on when he exercises and disappears within 15 minutes when he stops. you dx angina of effort. In considering medical therapy for this patient, which of the following best describes the beneficial action of nitroglycerin in this condition? A. dilation of coronary arterioles reduces resistance and increases coronary flow through ischemic tissue B. dilation of peripheral arterioles increases cardiac work C. dilation of systemic veins results in decreased diastolic cardiac size D. increased sympathetic outflow increases coronary flow E. tachycardia increases diastolic coronary flow

C

A 55 year old man being treated with a monoamine oxidase inhibitor for resistant major depressive disorder is admitted to the ED with a stroke after consuming a large meal in a restaurant. his BP is 180/110 when mao inhibitors are used as antidepressant drugs, some patients may suffer hemodynamic effects caused by tyramine in their diet. which of the following is the primary site of action of tyramine? A. ganglionic receptors B. gut and liver catechol o methyltransferase C. postganglionic sympathetic nerve terminals D. preganglionic sympathetic nerve terminals E. vascular smooth muscle cell receptors

C

A 57 year old contractor with hypertension has been treated by 2 different physicians. he now comes to the ED with a severe reaction. questioning reveals that he has been taking captopril and spironolactone. this combination is usually ill advised because of the risk of A. bone loss and osteoporosis B. calcium containing kidney stones C. hyperkalemia D. metabolic acidosis E. postural hypotension

C

Several drugs used in patients with advanced Parkinson's disease allow patients to lower their dose of L-dopa/ carbidopa and thus reduce the incidence of L-dopa-induced dyskinesias. These drugs also decrease the amount of 'Off' time for the patient. Which drug is used in this way but does not, if used alone, ameliorate the symptoms of early parkinson's disease or enhance CNS dopaminergic activity A. amantadine B. bromocrptine C. entacapone D. pramipexole E. selegiline

C

A patient with a myocardial infarction, heart failure and arrhythmia is to receive lidocaine by constant IV infusion. the target plasma concentration is 3 mg/L, Vd 70L, CL 35 L/h and thalf 1.4 h. Plasma concentration of lidocaine is measured 2.8 hours later and found to be 2.4 mg/L. this indicates that the final steady state plasma concentration in this patient will be A. 1.5 mg/L B. 2.4 mg/L C. 3.2 mg/L D. 4.6 mg/L E. 6.9 mg/L

C 75% at 2 half lives, 2.4/.75 =3.2

A 26 year old woman with chronic bronchitis lives in a region of the country where winter conditions are harsh. her physician recommends prophylactic use of oral doxycycline, to be taken once daily during the winter season. which statement about the characteristics and use of doxy in this patient is accurate? A. absorption from the GI tract is enhanced by yogurt B. elimination of doxy is predominantly via cytochorome p450 mediated hepatic metabolism C. formation of drug metabolizing enzymes is a primary mechanism of resistance to tetracyclines D. the patient should discontinue the tetracycline if she becomes pregnant E. the tetracyclines have no value in prophylaxis against infections in patients with chronic bronchitis

D

A 70 year old woman with mild to moderate hypertension fell 2 years ago during a spell of dizziness and broke her hip. during the last 18 months her bp has increased, now she is to be treated for a bp of 170/100. when treating hypertension chronically, orthostatic hypotension is greatest with A. ace inhibitors B. arteriolar dilators C. centrally acting a2 agonist D. peripherally acting a1 antagonists E. betablockers

D

After delivery of a healthy infant, a young woman begins to bleed extensively because her uterus has failed to contract. which drug should be administered to this woman? A. prednisone B. desmopressin C. leuprolide D. oxytocin E. prolactin

D

An important difference between nonselective alpha receptor antagonists and alpha-1 selective antagonists is that alpha-1 selective antagonists A. are more likely to cause hypoglycemia B. are more likely to precipitate bronchoconstriction in patients with asthma C. have greater efficacy in relaxing smooth muscle in the urinary tract D. produce less reflex tachycardia e. reduce MAP to a greater extent

D

Persons who ingest three or more alcoholic drinks daily can develop severe hepatotoxicity after doses of acetaminophen that are not toxic to individuals with normal liver function. this increased sensitivity to acetaminophen's toxicity is due to which of the following mechanisms? A. decreased availability of acetaldehyde dehydrogenase B. decreased hepatocellular stores of NADPH C. increased extraction of acetaminophen by the cirrhotic liver D. increased activity of cytochrome P450 mixed function oxidase isozymes E. increased liver blood flow

D

The research division of a pharmaceutical corporation has characterized the receptor blocking actions of 5 new drugs, each of which may have therapeutic value. Each drug is lipophilic so can cross BBB and are expected to have CNS effects. Which drug is most likely to exacerbate the symptoms of parkinson's disease A. Drug A (Beta ++, M +++, D2 +++, GABA -) B. Drug B (Beta -, M -, D2 none, Gaba ++++) C. Drug C (Beta -, M ++++, D2 +, GABA -) D. Drug D (Beta +, M -, D2 +++, Gaba +) E. drug E (beta -, M +, D2+, GABA +)

D

Which antimalarial drug can cause a dose-dependent toxic state that includes blurred vision, dizziness, flushed and sweaty skin, nausea, diarrhea and tinnitus A. artesunate B. atovaquone-proguanil C. mefloquine D. quinidine E. primaquine

D

Which of the following toxic compounds is correctly paired with an antidote that is used in the tx of a patient poisoned with the toxic compound? A. acetaminophen: vitamin K B. betablocker: dobutamine C. ethanol: Methanol D. cyanide: hydroxocobalamin E. tricyclic antidepressants: neostigmine

D

Regarding drugs that relax skeletal muscle, which one of the following statements is accurate? A. baclofen blocks the release of calcium from skeletal muscle fibers B. dantrolene is an activator of specific GABA receptors in the spinal cord C. halothane decreases the action of skeletal muscle relaxants D. muscle relaxation caused by succinylcholine is not reversed by acetylcholinesterase inhibitors E. tubocurarine prevents histamine release via stabilizing action on mast cells

D (baclofen activates gaba, dantrolene blocks the release of calcium, halothane enhances relaxants, tubocuraine causes histamine release)

Ventricular muscle from a cardiac biopsy was prepared for transmembrane potential recording in an isolated muscle chamber. action potentials were recorded before and after application of drug X. (The action potential is prolonged without significant slowing of upstroke) Identify drug X A. adenosine B. amiodarone C. procainamide D. sotalol E. verapamil

D (the drug effect is mainly on potassium channels and not on both sodium and potassium channels)

A 52 year old plumber comes to the office with a complaint of periodic onset of chest pain, described as a sensation of heavy pressure over the sternum that comes on when he exercises and disappears within 15 minutes when he stops. you dx angina of effort. A drug that is useful in angina but causes constipation, edema and increased cardiac size is A. atenolol b. hydralazine C. isosorbide dinitrate D. nitroglycerin E. verapamil

E

A new drug for the prophylaxis of asthma is under development in a pharmaceutical company. before human trials are begun, FDA regulations require that A. all acute and chronic animal toxicity data be submitted to the FDA B. the drug be shown to be free of carcinogenic effects C. the drug be shown to be safe in animals with the target disease D. the drug be studied in 3 mammalian species E. the effect of the drug on reproduction be studied in at least 2 animal species

E

A patient is admitted to the emergency department with signs and symptoms that could be due to either a muscarinic stimulant or an opioid. Which of the following is a common effect of both muscarinic stimulant drugs and opioids? A. decreased peristalsis B. decreased secretion by salivary glands C. hypertension d. inhibition of thermoregulatory sweat glands E. miosis

E

A patient is brought to the emergency department suffering from an overdose of an illicit drug. she is agitated, has disordered thought processes, suffers from paranoia and hears voices. her physical symptoms include tachycardia, hyperreflexia and hyperthermia. the drug most likely to be responsible for her condition is A. gamma hydroxybutyrate (GHB) B. hashish C. heroin D. marijuana E. methamphetamine

E

A woman taking haloperidol developed a spectrum of adverse effects that included the amenorrhea-galactorrhea syndrome and extrapyramidal dysfunction. another newer antipsychotic drug was prescribed which however caused weight gain and hyperglycemia due to a diabetogenic action. the drug prescribed was A. bupropion B. chlorpromazine C. fluoxetine D. lithium E. olanzapine

E

Naloxone will not antagonize or reverse A. analgesic effects of morphine in a cancer patient B. drug actions resulting from activation of u opioid receptors C. opioid analgesic overdose in a patient on methadone maintenance D. pupillary constriction caused by levorphanol E. respiratory depression caused by overdose of nefazodone.

E

The mechanism of high level isoniazid (INH) resistance of M. tuberculosis is A. changed pathway of mycolic acid synthesis B. decreased intracellular accumulation of isoniazid C. formation of drug inactivating N-methyltransferase D. mutation in the inhA gene E. reduced expression of the KatG gene

E

The mechanism of local anesthetic action of cocaine is A. activation of G protein linked membrane receptors B. block of the reuptake of norepinephrine at sympathetic nerve endings C. competitive pharmacologic antagonism of nicotinic receptors D. inhibition of blood and tissue enzymes that hydrolyze acetylcholine E. use dependent blockade of voltage gated sodium channels

E

Relative to Lugol's solution, propylthiouracil has A. a faster onset of antithyroid action B. a greater inhibitory effect on the proteolytic release of hormones from the thyroid gland C. increased likelihood of causing exophthalmos during the first week of treatment D. increased risk of fetal toxicity E. more sustained antithyroid activity when used continuously for several months

E (iodine salt inhibit iodoniation of tyrosine and thyroid hormone release and decrease vascularity and size of the hyperplastic thyroid gland)

Drug 1 was given as an IV bolus to a subject while blood pressure and heart rate were recorded (increased systolic and diastolic BP, decreased heart rate). after recovery from drug 1, drug 2 was given then drug 1 was given again. this time there was no increase in BP and the heart rate raised slightly Drug 2 is: A. albuterol B. angiotensin II C. endothelin D. epinephrine E. hexamethonium F. isoproterenol G. norepinephrine H. phenylephrine I. prazosin J. propranolol

I Drug 2 is an alpha blocker without beta blocking action

A 16 year old student has had asthma for 8 years, the number of episodes of severe bronchospasm has increased recently and you have been asked to review the therapeutic plan. Which of the following agents is most likely to be of immediate therapeutic value in relieving an acute bronchospastic attack A. albuterol B. atenolol C. formoterol D. metoprolol E. theophylline

a

A 29year old accountant has recurrent episodes of tachycardia that sometimes convert to sinus rhythm spontaneously but more often require medical treatment. A drug that is commonly given as an IV bolus for the purpose of converting AV nodal tachycardias to normal sinus rhythm is A. adenosine B. amiodarone C. lidocaine D. quinidine E. sotalol

a

Chronic heart failure is commonly treated with a combination of drugs that both improve symptoms and provide long term benefits. Three drugs or drug groups that have been shown in clinical trials to provide benefits in patients with chronic heart failure are A. ace inhibitors, carvedilol, spironolactone B. alpha1 selective antagonists, digoxin and hydrochlorothiazide C. digoxin, beta agonists and nitroglycerin D. dobutamine, propranolol and furosemide E. verapamil, isosorbide dinitrate and furosemide

a

In a patient with familial combined hyperlipidemia that is associated with increased VLDL and LDL which of the following is most likely to increase plasma triglycerides while also decreasing plasma LDL? A. cholestyramine B. ezetimibe C. gemfibrozil D. niacin E. lovastatin

a

A 54 year old woman was found to have node-positive breast cancer. following her surgery, she was treated with a drug that prevents the conversion of testosterone to estradiol. the drug used for her treatment was most likely A. anastrozole B. ethinyl estradiol C. finasteride D. spironolactone E. tamoxifen

a (prevents conversion of testosterone to estradiolol)

A 42 year old woman developed a syndrome of polyuria, thirst and hypernatremia after surgical removal of part of her pituitary gland. these signs and symptoms will be treated with which of the following? A. bromocriptine B. desmopressin C. octreotide D. prednisone E. somatropin

b

A 5 year old boy was diagnosed as having an intestinal infection with Enterobius vermicularis (pinworm). he should be treated with A. Ivermectin B. mebendazole C. mefloquine D. praziquantel E. quinine

b

A 55 year old executive has cardiomyopathy and congestive heart failure. he is being treated with diuretics. the MOA of furosemide is best described as A. interference with H/HCO3 exchange B. blockade of a Na/K/2Cl transporter c. blockade of a Na/Cl cotransporter D. blockade of a carbonic anhydrase E. inhibition of genetic expression of dna in the kidney

b

A 73 year old patient has chronic pulmonary dysfunction requiring daily hospital visits for respiratory therapy. she is hospitalized with pneumonia, and it is not clear whether the infection is community or hospital acquired. If she has a community acquired pneumonia, coverage must be provided for pneumococci and atypical pathogens. in such a case, the most appropriate drug treatment in this patient is a. ampicillin plus gentamycin B. ceftriaxone plus erythromycin C. penicillin G plus gentamicin D. ticarcillin clavulanic acid E. trimethoprim sulfamethoxazole

b

A young patient has a seizure disorder with recurrent contractions starting in muscles of the right hand that spread through the arm and the right side of the face. the attacks last for only a minute or two with no loss of consciousness. which of the following drugs is least likely to be useful in the treatment of this patient? A. carbamazepine B. ethosuximide C. lamotrigine D. phenobarbital E. phenytoin

b

Anticoagulation is needed immediately in a patient with deep vein thrombosis. the patient has a history of heparin induced thrombocytopenia. which of the following is the most appropriate drug for parenteral administration in this patient? A. eptifibatide B. lepirudin C. clopidogrel D. unfractionated heparin E. warfarin

b

Drugs classified as SSRI's have minimal clinical efficacy in the treatment of patients who suffer from a. bulimia B. diminished sexual function and interest C. OCD D. panic attacks E. premenstrual dysphoric disorder

b

Early in an anesthetic procedure which includes the use of succinylcholine and halothane, a surgical patient develops severe muscle rigidity, hypertension and hyperthermia. Management of this patient will almost certainly include the administration of A. baclofen B. dantrolene C. fentanyl D. naloxone E. tubocurarine

b

Resistance to acyclovir is most commonly due to mutations in a viral gene that encodes a protein that A. converts viral single stranded RNA into double stranded DNA B. phosphorylates acyclovir C. synthesizes glutathione D. transports acyclovir into the cell E. transports acyclovir out of the cell

b

The long term daily oral administration of therapeutic doses of prednisone results in which of the following? a. anemia B. decreased bone density C. elevated serum calcium concentration D. hyperplasia of cells in the zona fasiculata and zona reticularis of the adrenal cortex E. increased male pattern hair growth in women

b

Which of the following drugs is most likely to cause hypoglycemia when used as monotherapy in the treatment of a patient with type 2 diabetes? a. acarbose B. glipizide C. metformin D. militol E. roiglitazone

b

a 67 year old man with osteoporosis was being treated with once weekly alendronate. this medication has the potential to cause which of the following unusual adverse effects? A. a bluish hue to skin color B. esophageal irritation C. impairment of blue green color vision D. priapism E. tendinitis

b

A 57 year old man presented with signs and symptoms of acute gout that included intense pain in the first metatarsophalangeal joint of his right big toe of `1 day's duration and a joint that was swollen, tender and red. examination of synovial fluid removed from the joint revealed crystals of uric acid. the patient had a serum uric acid concentration of 10 mg/dL. this was the patient's first episode of gout. he did not have any other medical illnesses and was not taking any medications. which of the following is the most appropriate drug for immediate treatment of this acute attack of gout? a. allopurinol B. indomethacin C. methotrexate D. morphine E. probenecid

b (NSAID)

A 16 year old student has had asthma for 8 years, the number of episodes of severe bronchospasm has increased recently and you have been asked to review the therapeutic plan. A long acting B2 selective agonist that is used as an inhaled therapy for moderate or severe asthma is A. ipratropium B. montelukast C. salmeterol D. theophylline E. Zafirlukast

c

A 34 year old woman in her second trimester of pregnancy presented with a tender red swollen calf that was diagnosed as a deep vein thrombosis and was treated successfully. however, because of the high risk of recurrence of the DVT she was treated with an anticoagulant for the remainder of her pregnancy. the drug most likely was which of the following? A. aspirin B. clopidogrel C. enoxaparin D. lepirudin E. warfarin

c

A 48 year old surgical patient was anesthetized with an IV bolus dose of propofol, then maintained on isoflurane with vecuronium as the skeletal muscle relaxant. at the end of the surgical procedure, she was given pyridostimine and glycopyrrolate. the rationale for use of glycopyrrolate was to A. antagonize the skeletal muscle relaxation caused by vecuronium B. counter emetic effects of the inhaled anesthetic C. counter the potential cardiac effects of the acetylcholinesterase inhibitor D. prevent muscle fasciculations E. provide postoperative analgesia

c

A 56 year old woman has arthritis of the knees that limits her activity and post herpetic neuralgia on her torso after an episode of herpes zoster. which of the following drugs is used topically to control arthritic pain and post herpetic neuralgia A. aliskiren B. bosentan C. capsaicin D. losartan E. nesiritide

c

A male patient with AIDS has a super low CD4 t lymphocyte count. he is being maintained on a multidrug regimen consisting of acyclovir, clarithromycin, dronabinol, fluconazole, lamivudine, indinavir, trimethoprim, sulfamethoxazole and zidovudine. the drug that provides prophylaxis against cryptococcal infection of the meninges is A. acyclovir B. clarithromycin C. fluconazole D. lamivudine E. trimethoprim sulfamethoxazole

c

After ingestion of a meal that included sardines, cheese and red wine, a patient taking phenelzine experienced a hypertensive crisis. The most likely explanation for this untoward effect is that phenelzine A. acts to release tyramine from these foods B. inhibits MAO type B C. inhibits the metabolism of catecholamines D. is an activator of tyrosine hydroxylase E. promotes the release of norepinephrine from sympathetic nerve endings

c

Mental retardation, microcephaly and underdevelopment of the midface region in an infant is associated with chronic heavy maternal use during pregnancy of which of the following? A. cocaine B. diazepam C. ethanol D. heroin E. MDMA

c

Propranolol and hydralazine have which of the following effects in common? A. decreased cardiac force B. decreased cardiac output C. decreased mean arterial blood pressure D. increased systemic vascular resistance E. tachycardia

c

Which of the following drugs is approved for primary prophylaxis in aids patients with low cd4 counts against infections due to mycobacterium avium intracellulare A. amoxicillin B. ceftriaxone C. clarithromycin D. doxycycline E. nafcillin

c

Which of the following statements about acyclovir is accurate? A pro-drug converted to valacyclovir by hepatic enzymes B. active versus cytomegalovirus C. bioactivated by viral thymidine kinase D. highly active against HPV E. toxic to bone marrow

c

A 60 year old man with a history of a mild myocardial infarction was discovered to have low serum HDL cholesterol and moderately high serum triglyceride level. his serum total and LDL cholesterol concentrations were well below the upper limit of normal. which of the following drugs is likely to result in the greatest lowering of this patients serum triglyceride concentration and elevation of his serum HDL cholesterol concentration? A. cholestyramine B. ezetimibe C. gemfibrozil D. lovastatin E. rosiglitazone

c (fibrates are the main triglyceride lowering drugs. cholestyramine and ezetimibe and lovastatin mainly lower LDL cholesterol)

A 31 year old premenopausal woman has been using a combined oral contraceptive for 10 years. as a result of this contraceptive use, she has a reduced risk of which of the following? A. deep vein thrombosis B. episodes of migraine headache C. ischemic stroke D. ovarian cancer E. pituitary adenoma

d

A 45 year old woman suffers from abdominal pain and bloody diarrhea that has been diagnosed as Chron's disease? Which of the following is a first line drug for treatment of Chron's disease that acts locally in the GI tract to provide an antiinflammatory effect? A. aluminum hydroxide B. metocloparmide C. misoprostol D. mesalamine E. ranitidine

d

Protamine can be used to reverse the anticoagulant effect of which of the following? A. abciximab B. clopidogrel C. lepirudin D. unfractionated heparin E. warfarin

d

Which of the following is a drug that inhibits the synthesis of thyroid hormone by preventing coupling of iodotyrosine molecules? A. dexamethasone B. levothyroxine C. lithium D. methimazole e. propranolol

d

Which one of the following is characteristic of succinylcholine? A. actions in phase I block are reversed by neostigmine B. is an antagonist at muscarinic receptors C. blocks the release of histamine D. may cause hyperkalemia E. is primarily metabolized by acetylcholinesterase

d

Which one of the following pairs of drug and indication is accurate? A. amphetamine: Alzheimer's dementia B. bupropion: acute anxiety C. fluoxetine: insominia D. pramipexole: parkinson's disease E. rameleton: ADD

d

You are on the hospital pharmacy committee and revising the formulary. Relative to loratadine, diphenydramine is more likely to A. be used for treatment of asthma B. be used for treatment of gastroesophageal reflux disease C. cause cardiac arrhythmias in overdose D. have efficacy in the prevention of motion sickness E. increase the serum concentration of warfarin

d

A 24 year old man with a history of partial seizures has been treated with standard anticonvulsants for several years. he is currently taking valproic acid which is not fully effective and his neurologist prescribes another drug approved for adjunctive use in partial seizures. unfortunately, the patient develops a toxic epidermal necrolysis. The second drug prescribed was A. diazepam B. ethosuximide C. felbamate D. lamotrigine E. phenobarbital

d (toxic epidermal necrolysis is the same as stevens-johnson syndrome)

A 30 year old male patient who is HIV positive has a low CD4 t lymphocyte count and high viral RNA load. He takes zidovudine, didanosine and efavirenz. efavirenz limits HIV infection by A .binding to the active site of HIV reverse transcriptase B. blocking the binding of HIV virions to the CD4 receptor on T cells C. inhibiting the HIV enzyme that cleaves sialic acid residues from the surface of HIV virions D. inhibiting the HIV protease E. serving as an allosteric inhibitor of HIV reverse transcriptase

e

A 54 year old farmer has a 5 year history of frequent recurrent and very painful calcium containing kidney stones. the patient has hypercalciuria caused by a primary defect in proximal tubule calcium reabsorption. which of the following is the most appropriate chronic therapy for this man? A. aldosterone antagonist B. loop diuretic C. nsaid D. stron gopioid E. thiazide diuretic

e

A 57 year old woman with moderately severe rheumatoid arthritis was treated with etanercept. which of the following proteins is the direct target of etanercept? A. cyclophilin B. granulocyte colony stimulating factor (G-CSF) C. interferon alpha D. interleukin 11 (IL11) E. tumor necrosis factor alpha (TNF alpha)

e

A 73 year old patient has chronic pulmonary dysfunction requiring daily hospital visits for respiratory therapy. she is hospitalized with pneumonia, and it is not clear whether the infection is community or hospital acquired. If she has a hospital acquired pneumonia, coverage must be provided for gram negative bacteria (especially pseudomonas aerguinosa) and for staph aureus, many of which can be multiple drug resistant organisms. in such a case, empiric treatment is likely to involve A. amoxicillin clavulanic acid B. cefazolin plus metronidazole C. doxycycline D. imipenem E. vancomycin plus piperacillin/tazobactam

e

A patient with diffuse non-hodgkin's lymphoma is treated with a combination drug regimen that includes bleomycin, cyclophosphamide, vincristine, doxorubicin and prednisone. The patient's cumulative dose of bleomycin will be carefully monitored because high cumulative doses are associated with which of the following? A. cardiotoxicity B. hemorrhagic cystitis C. hypoglycemia D. peripheral neuropathy E. pulmonary fibrosis

e

A young woman suffering from myoclonic seizures was receiving effective single drug therapy. because she was planning a pregnancy, her physician switched her to an alternative medication with much less potential for teratogenicity. the original ant seizure drug prescribed for this patient was most likely to have been A. baclofen B. diazepam C. ethosuximide D. olanzapine E. valproic acid

e

Hypercoagulability and dermal vascular necrosis resulting from protein C deficiency is known to be an early appearing adverse effect of treatment with which of the following drugs? A. alteplase B. aspirin C. clopidogrel D. heparin e. warfarin

e

In your pursuit of a nobel prize, you have been studying several intracellular enzymes. you recall that cyclooxygenase 1 and 2 are responsible for the A. conversion of GTP to cyclic GMP B. conversion of ATP to cyclic AMP C. metabolic degradation of cAMP D. synthesis of leukotrienes from arachidonate E. synthesis of prostaglandins from arachidonate

e

Lidocaine is commonly used as a local anesthetic. if a patient mistakenly receives a toxic dose of lidocaine intravenously, the patient is likely to exhibit A. cardiovascular stimulation B. excessive salivation, mydriasis and diarrhea C. hyperthermia and hypertension D. no effects immediately but then delayed massive hepatocellular damage E. seizures and coma

e

Which of the following, an inhibitor of fungal cell membrane synthesis, is effective IV in the management of disseminated infections due to aspergillus or candida species? A. amphotericin B B. caspofungin C. flucytosine D. nystatin E. voriconazole

e