Pharmacology1

22. Which FDA pregnancy category would appear to be the safest for a developing fetus? A. Category A B. Category B C. Category C D. Category D E. Category X

Category A

25. Explain the difference between peripheral skeletal muscle relaxants and centrally acting skeletal muscle relaxants.

Centrally acting skeletal muscle relaxants are drugs that inhibit skeletal muscle contraction by blocking conduction within the spinal cord. Peripheral skeletal muscle relaxants are drugs that inhibit muscle contraction of the neuromuscular junction or within the contractile process.

34. When are centrally acting skeletal muscle relaxants used?

Centrally acting skeletal muscle relaxants are used for relaxation of skeletal muscle. Centrally acting drugs are given to interrupt muscle spasms, tension, and pain arising from acute injury or trauma to muscles. Baclofen is primarily used to relieve the symptoms of spasticity (flexor spasms, clonus, muscle rigidity) in patients with multiple sclerosis but also may be of value in patients with spinal cord injury resulting in severe spasticity. Several drugs in this class influence the CNS and are used primarily as tranquilizers to relieve the anxiety.

33. What is the mechanism of action of centrally acting skeletal muscle relaxants?

Centrally acting skeletal muscle relaxants depress reflex impulse conduction within the spinal cord. This change in conduction reduces the number of impulses available to produce muscle contraction Centrally acting skeletal muscle relaxants do not alter the function of the nicotinic-muscle receptors or the skeletal muscle fibers. Some of these muscle relaxants interfere with select areas of the brain to interrupt the spasticity (reduce intraneuronal activity).

32. How does dantrolene differ from neuromuscular blockers?

Dantrolene is a direct-acting relaxant as it prevents elements of the muscle fiber, actin and myosin, from contracting even though it does not inhibit nerve conduction. This drug has no effect on the neuromuscular receptors or on metabolism of acetylcholine.

20. How do the direct-acting and the indirect-acting cholinergic drugs produce their parasympathetic effects?

Direct-acting cholinergic drugs bind to and stimulate cholinergic receptors. Indirect-acting cholinergic drugs inhibit acetylcholinesterase and allow the buildup of acetylcholine, which then binds to and stimulates cholinergic receptors. The result in both cases is an increase in parasympathetic activity.

8. By what method of cell transport are most drugs absorbed? What are the main requirements for drug absorption?

Drugs are primarily absorbed by passive diffusion. Drugs possessing lipid solubility are readily absorbed. If a drug is water soluble or ionizable, the un-ionized form is required for absorption to occur. The degree of ionization of the drug and the pH of the solution determine the proportion of ionized and un-ionized molecules.

5. What is the significance of "dual autonomic innervation" to most internal organs?

Dual autonomic innervation allows one division to increase the activity of a particular organ while the other division decreases the activity of the organ. Dual innervation is a way of controlling and regulating organ function during different bodily activities.

8. Which of the following are actions of nonselective beta-adrenergic blocking drugs? A. decreasing heart rate B. decreasing force of myocardial contraction C. vasoconstriction of skeletal muscle blood vessels D. lowering of blood pressure E. all of these

all of these

9. The actions of epinephrine (EPI) include which of the following? A. bronchodilation B. vasoconstriction C. relaxation of uterus D. increased heart rate E. all of these

all of these

9. Which of the following could be categorized as an adverse reaction? A. idiosyncrasy B. drug allergy C. teratogenicity D. carcinogenicity E. all of these

all of these

11. What is the major requirement for a drug if it is to gain access to the brain?

Lipid solubility is required for a drug to cross the blood-brain barrier.

16. Your grandmother has just been prescribed a very lipid-soluble drug. Would you expect her dosage to be larger or smaller than that for a younger adult? Explain.

Lipid-soluble drugs require drug metabolism before elimination. Drug metabolism and drug excretion decrease with age, so the dosage should be smaller than that for a younger adult.

7. What is the main disadvantage to the IV method of drug administration?

Once a drug is injected, it cannot be withdrawn. Miscalculation of dosage or mistakes in drug selection may cause serious consequences. Intravenous injection also requires the services of medical personnel to administer the drug. It has the risk of infection. Pain.

8. During what body activities is the parasympathetic division active?

Parasympathetic activity predominates when the body is at rest or engaged in activities that do not require large expenditures of energy, such as reading and watching television. It is also active during bodily activities that restore energy or are important to bodily homeostasis, such as food digestion and excretion of waste products.

21. List the potential adverse effects of the cholinergic drugs.

The adverse effects of cholinergic drugs include nausea, vomiting, diarrhea, blurred vision, excessive sweating, muscular tremors, bronchoconstriction, bradycardia, and hypotension.

19. When a drug increases the rate of drug metabolism of other drugs, the process is termed A. first-pass metabolism B. enzyme induction C. enzyme inhibition D. enterohepatic cycling E. microsomal inhibition

enzyme induction

7. The drug of choice to treat acute allergic reactions is A. norepinephrine B. phenylephrine C. pseudoephedrine D. epinephrine E. propranolol

epinephrine

20. Which of the following is correct about skeletal muscle relaxants? A. intubation for emergency airway management may be accomplished quickly B. the clinical indication for these drugs is to prolong surgical procedures C. centrally acting skeletal muscle relaxants must inhibit nicotinic receptors D. their use is limited by the amount of histamine released from mast cells E. the class does not include botulinumtoxinA and B

intubation for emergency airway management may be accomplished quickly

A 36-year-old male has been diagnosed with chronic myeloid leukemia. His oncologist discusses treatment options with him. The patient is glad to hear that novel anticancer drugs used to treat chronic myeloid leukemia have a much better risk-benefit ratio than older ones, due to their improved selectivity. A major determinant for the selectivity of a given drug is its target receptor ligand affinity. its target receptor cell-type distribution. its ionic interactions. its hydrogen bonding. its intrinsic activity.

its target receptor cell-type distribution.

18. What is the function of acetylcholinesterase? Where is it found?

Acetylcholinesterase is the enzyme that inactivates or destroys acetylcholine at each of the three sites where acetylcholine is released. It is found mainly around cholinergic nerve endings and receptor sites.

2. Differentiate between adrenergic receptors and cholinergic receptors.

Adrenergic receptors are located on internal organs and respond to norepinephrine. Cholinergic receptors are also located on internal organs but respond to acetylcholine. .

17. Differentiate between parasympatholytic and parasympathomimetic. Explain the terms cholinergic and anticholinergic.

Parasympatholytic refers to drugs (anticholinergic) that decrease activity of the parasympathetic nervous system. Parasympathomimetic refers to drugs (cholinergic) that mimic stimulation of the parasympathetic nervous system. Cholinergic refers to the neurons that release acetylcholine. Specifically, the term refers to the receptors and the drugs that affect the parasympathetic system. Anticholinergic refers to drugs or effects that reduce the activity of the parasympathetic nervous system.

1. Symptoms of cholinergic drug overdosage include A. slow pulse rate B. increased urination C. diarrhea D. sweating E. all of these

all of these

17. Select the effect(s) produced by anticholinergic drugs such as atropine. A. mydriasis B. bronchodilation C. cycloplegia D. sedation E. all of these

all of these

3. Epinephrine stimulates A. alpha-1 receptors B. alpha-2 receptors C. beta-1 receptors D. beta-2 receptors E. all of these

all of these

4. At therapeutic doses, albuterol stimulates A. alpha-1 receptors B. alpha-2 receptors C. beta-1 receptors D. beta-2 receptors E. all of these

beta-2 receptors

10. The time a drug continues to produce its effect is its A. ED50 B. maximal response C. ceiling effect D. onset of action E. duration of action

duration of action

6. The mechanism of action of methyldopa is A. increased release of NE from adrenergic nerve ending B. alpha-1 receptor blocker C. beta-1 receptor blocker D. formation of a false transmitter in adrenergic nerve ending E. none of these

formation of a false transmitter in adrenergic nerve

3. An unusual or unexpected drug reaction by an individual is known as A. toxic effect B. antagonism C. idiosyncrasy D. side effect E. drug allergy

idiosyncrasy

4. The proprietary drug name supplied by a pharmaceutical company is also referred to as the A. generic name B. over-the-counter name C. trade name D. chemical name E. none of these

trade name

The drug administration route demonstrating the slowest onset of action is A. inhalation B. transdermal C. intramuscular D. sublingual E. intravenous

transdermal

1. The main pharmacologic effect of norepinephrine on alpha-1 receptors is A. increased heart rate B. bronchodilation C. vasoconstriction D. contraction of urinary bladder E. increased force of myocardial contraction

vasoconstriction

Drug X has a half-life of 6 hours. How much drug is left in the body 18 hours after an IV injection of 1200 milligrams (mg)? A. 75 mg B. 150 mg C. 300 mg D. 600 mg E. 900 mg

150 mg

6. A drug that has the potential for abuse and is regulated by the Drug Enforcement Agency is classified as a A. poison B. OTC drug C. prescription drug D. controlled substance E. nonproprietary drug

controlled substance

5. The time from drug administration to the first observable drug effect is known as the A. duration of action B. onset of action C. ceiling effect D. maximal response E. ceiling effect

onset of action

19. Which of the following would be a preferred treatment for overactive bladder? A. neostigmine B. tolterodine C. physostigmine D. bethanechol E. donepezil

tolterodine

Prolonged receptor stimulation during chronic drug therapy may induce cells to endocytose and sequester drug receptors in endocytic vesicles. This molecular mechanism is called A) tachyphylaxis. B) inactivation. C) desensitization. D) downregulation. E) refractoriness.

downregulation.

14. Anticholinergic effects include all of the following except A. bronchodilation B. increased heart rate C. increased gastrointestinal activity D. decreased respiratory secretions E. dry mouth

increased gastrointestinal activity

11. Select the pharmacologic effect produced by cholinergic drugs. A. increased heart rate B. increased gastrointestinal motility C. decreased urination D. pupillary dilation E. bronchodilation

increased gastrointestinal motility

24. Centrally acting skeletal muscle relaxants A. include dantrolene and cisatracurium B. inhibit or reduce activity within the spinal cord (intraneuronal), interrupting the central stimulus to muscle contraction C. can only be given parenterally D. cause systemic release of histamine, leading to hypotension E. counteract the effect of botulinumtoxin B

inhibit/ reduce activity within the spinal cord (intraneuronal), interrupting the central stimulus to muscle contraction

20. The rate of drug absorption would be increased by which of the following? A. drug ionization B. water solubility C. positively charged drug D. negatively charged drug E. lipid solubility

lipid solubility

In order for drugs to cross the blood-brain barrier, they must be A. ionized B. positively charged C. water soluble D. lipid soluble E. negatively charged

lipid soluble

13. First-pass metabolism refers to the metabolism of drugs in the A. kidney B. blood vessels C. liver D. heart E. adipose tissue

liver

10. Parasympathetic receptors located on the membranes of the internal organs are classified as A. alpha-1 B. nicotinic-neural (Nn) C. nicotinic-muscle (Nm) D. muscarinic E. ganglionic

muscarinic

18. Pick the correct pharmacological effect(s) of direct-acting cholinergic drugs. A. respiratory paralysis B. urinary retention C. increased heart rate D. bronchodilation E. none of these Answer: E

none of these

8. A medication that does not require a physician's service to obtain is referred to as A. trade B. nonproprietary C. nonprescription D. brand E. generic

nonprescription

2. The medical situation when a particular drug should not be administered is referred to as A. side effect B. adverse effect C. drug allergy D. contraindication E. antagonism

. contraindication

15. List the factors that can contribute to individual variation in drug response.

Age, sex, and body weight are some of the physical factors that affect drug response. Genetic differences among individuals, particularly in their drug microsomal enzymes, can produce variations in drug response. Also, various psychological factors, such as emotional state and placebo effect, particularly affect the response to drugs such as narcotic analgesics and tranquilizers that act on the central nervous system.

6. Write a short paragraph describing the terms agonist, antagonist, competitive antagonism, noncompetitive antagonism, and uncompetitive antagonism

Agonists stimulate receptors, while antagonists suppress the activity of receptors. When an agonist drug and an antagonist drug bind specifically to the same site of the receptors, they are referred to as competitive antagonists. If they are both administered at the same time, they compete with each other for binding to the receptors; this is known as competitive antagonism. Noncompetitive does not bind the same site as the nature ligand and it allosteric affects the efficacy the natural ligand. Uncompetitive antagonist requires the prior activation of receptor and affects both the potency and efficacy of natural ligand.

13. A patient brought into the emergency room is experiencing severe hypotension. Blood pressure reads 90/50. What class of drugs is indicated for treatment? What precautions should be observed when these drugs are administered? What would be the first indication that too much drug has been administered?

Alpha-adrenergic drugs are indicated that will cause vasoconstriction and increase the blood pressure. When the drug is injected intravenously, the injection site must be checked frequently to ensure that the drug is not leaking into the tissues. Overdosage would cause the blood pressure to rise above normal and there would be reflex bradycardia.

15. Alpha- and beta-blockers are both indicated for the treatment of hypertension. Explain the difference in the mechanism of action of these two drug classes to lower blood pressure.

Alpha-blockers block the alpha effects of NE and EPI to cause vasoconstriction; therefore, alpha-blockers cause vasodilation. Beta-blockers block beta-1 receptors in the heart to decrease the heart rate and force of contraction. This decreases the amount of blood pumped by the heart, and the blood pressure is reduced.

1. What is the difference between an afferent nerve and an efferent nerve?

An afferent nerve transmits sensory information to the brain and spinal cord. An efferent carries the appropriate motor response from the brain and spinal cord.

9. Think of an emergency situation requiring immediate and intense physical exertion. List as many body organs as you can and predict the desired level of activity (increased or decreased). Which neurotransmitter would produce this effect? Do your predictions correctly correspond to the fight or flight reaction? (Important)

An emergency situation would be running two blocks to get emergency help for an injured friend. Heart-increased activity: Norepinephrine and epinephrine stimulate beta-1 receptors. Arteries to GI and genitourinary tracts: Vasoconstriction to divert blood to skeletal muscle—norepinephrine stimulates alpha-1 receptors. Arteries to skeletal muscle: Vasodilation to increase blood flow—epinephrine stimulates beta-2 receptors. Respiratory bronchioles: Relaxation of smooth muscle (bronchodilation)—epinephrine stimulates beta-2 receptors. GI tract: Decrease in activity—norepinephrine and epinephrine stimulate alpha to decrease intestinal peristalsis. Note: Sympathetic division is activated and responsible for all of the above effects.

9. Explain why alkalinization of the urine increases the rate of excretion of drugs such as aspirin or phenobarbital (both are weak acids).

Aspirin, phenobarbital, and other acidic drugs are predominantly in their ionized form in alkaline urine and therefore are readily excreted. In acidic urine, they are more un-ionized and consequently more likely to be reabsorbed into the blood.

14. Following cardiac surgery, a patient suddenly experiences a drop in cardiac function and blood pressure. The patient may be developing heart failure. What drugs would most likely be indicated in this situation? What autonomic receptor, in particular, needs to be acted upon? Should it be stimulated or blocked?

Beta-adrenergic drugs that stimulate beta-1 receptors in the heart, like dopamine or dobutamine, would be indicated.

17. Rifampin is a drug that causes enzyme induction. Would you have to increase or decrease the dosage of another drug taken concurrently if it required drug metabolism for elimination? What change in dosage would a very water-soluble drug require?

Enzyme induction increases the rate of drug metabolism. The dosage would need to be increased. Since water-soluble drugs may not need metabolism for elimination, the dosage would not generally have to be changed.

30. What adverse effects are produced by the neuromuscular blockers as a result of histamine release?

Evidence suggests that the release of histamine may directly contribute to the production of bronchospasms and increased bronchial secretions in sensitive patients. Histamine may also contribute to hypotension because it acts like a vasodilator.

5. Explain the difference between idiosyncrasy and drug allergy.

Idiosyncrasy is an unusual or unexpected drug response. It is usually caused by genetic differences among individuals. Drug allergy is an adverse drug reaction that occurs when an individual becomes sensitized to a drug. Antibodies produced within the body react with the drug to cause an allergic reaction.

24. What are the physiological events that precede skeletal muscle contraction?

Motor neuron axons from the spinal cord enter the muscle fibers. The unmyelinated nerve fibers end in the NMJ Presynaptic ends contain vesicles of acetylcholine. When triggered, acetylcholine is released into the synapse to bind with the nicotinicmuscle (Nm) receptors on the other side of the junction/ synapse. This receptor binding with acetylcholine enables sodium ions to move into the cells and potassium ions to move out of the muscle cells (depolarization). As depolarization spreads across the surface of the muscle fiber, calcium ions are released and muscle contraction occurs.

29. Why are neuromuscular blockers administered IV?

Neuromuscular blockers are administered intravenously primarily because they're not absorbed following oral administration, neuromuscular blockers are administered parenterally.

4. Explain the difference between a prescription drug, OTC drug, and a controlled substance.

Prescription drugs require a written or phone order by a licensed physician and must be dispensed by a licensed pharmacist. OTC drugs can be sold at a variety of stores and do not require a physician or pharmacist. Controlled substances are drugs that have the potential for abuse and are scheduled and regulated by the Drug Enforcement Administration (DEA).

16. What is the function of the parasympathetic nervous system?

The parasympathetic nervous system regulates the function of internal organs and glands during activities that restore energy (rest, digestion) and maintain homeostasis (waste elimination).

2. What is the difference between site of action and mechanism of action?

Site of action is the location within the body where a drug exerts its therapeutic effect. It may be a body organ, tissue, or specific drug receptor site. The mechanism of action refers to how the drug produces its effects. Mechanism of action may involve inhibition of a body enzyme or chemical process or may involve the drug acting as an antagonist on a receptor to block the action of a hormone or body substance.

27. What sites are involved in the production of skeletal muscle relaxation?

Skeletal muscle relaxation can be produced by interfering with a variety of pathways, including depression of the CNS, administration of tranquilizers that depress impulses within the spinal cord, and administration of local anesthetics directly to the motor nerves supplying a section of musculature. However, skeletal muscle relaxation can also be achieved by blocking receptors within the neuromuscular junctions. Finally, some drugs are capable of interfering with components of muscle fiber so that contraction cannot occur even when impulse conduction is not altered.

3. What is the main function of the two main divisions of the autonomic nervous system?

The activity of the parasympathetic division predominates when the body is engaged in activities that restore body energy and function: eating and digestion, excretory function, and rest. The sympathetic division predominates when the body is under stress and when physical exertion and energy expenditure are required.

22. List the potential adverse effects of the anticholinergic drugs.

The adverse effects of anticholinergic drugs include dry mouth, visual disturbances, urinary retention, constipation, flushing and dryness of the skin, fever, tachycardia, and symptoms of central nervous system stimulation and depression.

4. From what areas of the CNS does each division originate?

The cholinergic nerves of the parasympathetic division originate from the brain (cranial nerves) and sacral portion of the spinal cord. The adrenergic nerves of the sympathetic division originate from the thoracic and lumbar portions of the spinal cord

11. List the different types of adrenergic receptors and relate them to specific organ functions.

The different types of adrenergic receptors are: • Alpha-1 adrenergic receptors—found predominantly on smooth muscle membranes of arteries, veins, and sphincters of the urinary and gastrointestinal tract. When stimulated by NE or EPI, they produce contraction; for example, vasoconstriction of most blood vessels • Alpha-2 adrenergic receptors—located on adrenergic nerve endings; they are activated by NE and EPI to activate a negative feedback mechanism that reduces and regulates the release of additional NE • Beta-1 receptors—predominant receptors in the heart and when stimulated by NE or EPI, they increase heart rate and force of contraction • Beta-2 receptors—predominant beta receptor in the smooth muscle of coronary and skeletal muscle blood vessels and bronchiolar smooth muscle

12. What is the drug microsomal metabolizing system, and what is its main function?

The drug microsomal metabolizing system is a group of enzymes mainly in the liver that break down lipid-soluble drugs into water-soluble metabolites. The majority of oxidases are heme protein monooxygenases of the cytochrome P450 class. Cytochrome P450 enzymes (sometimes abbreviated CYP) are also known as microsomal mixed-function oxidases and are involved in the metabolism of approximately 75% of all drugs used today

3. What is the relationship between ED50, LD50, and therapeutic index?

The effective dose 50 (ED50) is the dose that will produce half the maximal response possible. The lethal dose 50 (LD50) is the dose that will kill half of the animals tested during a test of drug toxicity. The therapeutic index is the ratio of the ED 50 to the LD 50, which provides an estimate of the relative safety of a drug.

7. Describe what is meant by the fight or flight reaction. What conditions activate this reaction?

The fight or flight reaction is a response of the body to fearful, emergency, and stressful situations, when increased alertness and greater expenditures of energy are required. Activation of the sympathetic division initiates this response.

10. Briefly describe the main factors that determine drug distribution.

The main factors that determine drug distribution to any tissue or organ are the amount of blood normally flowing to that organ, the degree of plasma protein binding, and the lipid solubility of the drug. Generally, the more lipid soluble the drug, the greater the degree of distribution, especially into the brain, adipose tissue, and other tissues with high lipid content.

10. What is the main function of the sympathetic nervous system?

The main function of the sympathetic nervous system is to regulate the activity of the internal organs and glands during bodily stress and physical exertion.

31. Describe the major toxicity associated with neuromuscular blockers and the antidote used.

The major toxicity associated with all neuromuscular blockers is paralysis of the respiratory muscles. Skeletal muscle paralysis caused by the nondepolarizing blockers may be reversed by the use of neostigmine or edrophonium. Succinylcholine overdose presents a special problem because this drug alters the ability of nicotinicmuscle receptors to become stimulated. There is no known that reverses the neuromuscular blockade produced by succinylcholine. For succinylcholine, respiration must supported artificially until the drug is metabolized and the receptors responsiveness returns to normal.

26. What is a neuromuscular junction (NMJ)?

The neuromuscular junction (NMJ) is the area where the motor neuron axon terminal meets the muscle tissue.

14. Why is the plasma drug concentration important? What are the main factors that determine plasma concentration?

The plasma drug concentration is important because it is the most reliable measurement of the intensity of drug action. Drug dosage, route of administration, and bioavailability are important for determining how much drug gets into the body. The extent to which the drug is distributed to the tissues and the rate of drug metabolism and drug excretion are the main factors that determine plasma drug concentration.

23. What is the preferred drug treatment for myasthenia gravis?

The preferred drug for treatment of myasthenia gravis is pyridostigmine (Mestinon).

6. What property of smooth and cardiac muscle allows them to initiate their own contractions?

The property of autorhythmicity allows smooth muscle and cardiac muscle to initiate their own contractions. Voluntary or skeletal muscle requires nerve impulses from the brain in order to contract and do work.

13. List the major pathways of drug excretion.

The two most common pathways of drug excretion are renal and gastrointestinal.

12. What two neurotransmitter substances are associated with the sympathetic nervous system? Describe the effects of each.

The two neurotransmitter substances that are associated with the sympathetic nervous system are norepinephrine and epinephrine. Norepinephrine primarily stimulates alpha receptors, resulting in vasoconstriction of most blood vessels and smooth muscle in internal organs. It also stimulates beta-1 receptors in the heart. Epinephrine is more potent than norepinephrine and stimulates all adrenergic receptors (alpha, beta-1, and beta-2). Epinephrine additionally causes bronchodilation and vasodilation of skeletal muscle blood vessels.

28. What are the two types of neuromuscular blockers? How do they differ in their mechanism of action?

The two types of neuromuscular blockers are: • Depolarizing blockers o The depolarizing blockers inhibit muscle contraction by a two-step process: Succinylcholine attaches to the nicotinic-muscle receptors and induces depolarization, observed as muscle fasciculations Succinylcholine alters the nicotinic-muscle receptors so that they cannot respond to endogenous ACH stimulation • Nondepolarizing blockers o The nondepolarizing blockers combine with the nicotinic-muscle receptors but do not stimulate the receptors. o These agents occupy the nicotinic-muscle sites so that ACH cannot combine with the receptors and depolarization cannot occur (nondepolarizing, no depolarization).

1. Differentiate between therapeutic effect, side effect, and toxic effect.

Therapeutic effect is the reason for administering a drug, to alleviate some symptom or disease process. A side effect is an additional fact, unwanted but usually not harmful. Drowsiness after some cold remedies is an example of a side effect. A toxic effect is a harmful effect that requires a reduction in dosage or elimination of the drug.

19. Where are the three different cholinergic receptors located? What class of drug is needed to block each receptor?

There are three types of cholinergic receptors in the peripheral nervous system. The muscarinic receptors are located at the parasympathetic postganglionic nerve endings and are blocked by anticholinergic drugs. Nicotinic-neural receptors are located at the ganglionic sites of both sympathetic and parasympathetic nerves and are blocked by ganglionic blocking drugs. Nicotinic-muscle receptors are located at the skeletal neuromuscular junctions and are blocked by the neuromuscular blocking drugs.

18. Drugs that have demonstrated teratogenic effects in women are classified as Pregnancy Category A. B B. C C. D D. X E. NR

X

Use the following to answer question 29: A 16-year-old female with a history of goiter is admitted with fever, profuse sweating, tachyarrhythmia, hypertension, abdominal pain, and anxiety. Based on a working diagnosis of thyrotoxicosis, she is started on a beta-adrenoceptor antagonist that has a very short half-life. 29. Refer to the case above. Regarding the mechanism by which the drug ameliorates the toxic effects of excessive thyroxine levels, the drug acts as A) a physiologic antagonist. B) a competitive receptor antagonist. C) a noncompetitive receptor antagonist. D) a partial agonist. E) an inverse agonist.

a physiologic antagonist.

22. Vercuronium and rocuronium are used to A. relax muscle spasms from "week-end warrior" back strain B. block acetylcholine at the nicotinic-muscle (Nm) receptor C. stimulate the nicotinic-muscle (Nm) receptors D. produce muscle fasciculations in surgery E. rejuvenate facial appearance by relaxing muscles

block acetylcholine at the nicotinic-muscle (Nm) receptor

23. Succinylcholine is associated with which of the following actions? A. stimulation of the actin and myosin muscle fibrils directly B. liver damage because the drug is metabolized only by the liver C. peripheral neuromuscular receptor blockade after stimulating the Nm receptors D. longer duration of action than vecuronium E. stimulation of presynaptic ACH release

peripheral neuromuscular receptor blockade after stimulating the Nm receptors

1. The study of drug absorption, distribution, metabolism, and excretion is known as A. pharmacotherapeutics B. pharmacodynamics C. pharmacokinetics D. pharmacy E. posology

pharmacokinetics

15. The antidote for atropine poisoning is A. scopolamine B. bethanechol C. neostigmine D. physostigmine E. dicyclomine

physostigmine

21. Which factor of individual variation is dependent upon the patient's attitude toward treatment? A. weight B. age C. genetic variation D. placebo effect E. gender

placebo effect

7. Select the term below that relates to the amount of drug administered to produce a therapeutic effect. A. posology B. toxicology C. pharmacodynamics D. pharmacotherapeutics E. pharmacy

posology

16. Tolterodine ( Detrol ) is indicated for the treatment of A. motion sickness B. relief of urinary incontinence C. ophthalmic examinations D. glaucoma E. Alzheimer's disease

relief of urinary incontinence

12. Physostigmine (Eserine ) is classified as a(n) A. direct-acting cholinergic drug B. reversible acetylcholinesterase inhibitor C. irreversible acetylcholinesterase inhibitor D. anticholinergic drug E. ganglionic blocker

reversible acetycholinesterase inhibitor

5. Metoprolol is classified as a(n) A. alpha-blocker B. nonselective beta-blocker C. selective beta-1 blocker D. adrenergic neuronal blocker E. selective beta-2 blocker

selective beta-1 blocker

25. Which of the drugs is correctly paired with its effect? A. succinylcholine: life-threatening cardiac arrest in children B. tizanidine: hypertension and increased salivation C. cyclobenzaprine/metaxolol: antagonized by alcohol and sedatives D. vecuronium: increased blood pressure and heart rate E. botulinumtoxin: increased respiration

succinylcholine: life-threatening cardiac arrest in children

A 45-year-old female shop assistant is treated for heartburn with omeprazole. She notes that the effect of a dose of omeprazole lasts much longer than that of a dose of the antacid drug calcium carbonate she had previously taken. The active metabolite of omeprazole binds covalently and irreversibly to a molecular structure involved in releasing protons into the gastric juice. Drugs that modify their target structures through this mechanism are called A) suicide substrates. B) orphan drugs. C) protein drugs. D) competitive antagonists. E) enantiomers.

suicide substrates.

A 56-year-old man with chest pain is diagnosed with stable angina and treated with several drugs including nitroglycerin. Every day he has to discontinue nitroglycerin for some hours to re-establish reactivity of his body to the drug. The clinical observation of a rapidly decreasing response to nitroglycerin after administration of just a few doses is called idiosyncrasy. tachyphylaxis. heterologous desensitization. refractoriness. receptor downregulation.

tachyphylaxis.

21. Which of the following is correct about the nicotinic-muscle (Nm) receptor blocking drugs? A. the mechanism of action is the same as represented by dantrolene B. all of these drugs depolarize the muscle fiber before blockade occurs C. calcium ions are released from the storage sites D. there are two groups in this class: either depolarizing agents or nondepolarizing agents E. botulinumtoxinA rapidly attaches to these receptors

there are two groups in this class: either depolarizing agents or nondepolarizing agents

2. The pharmacologic effect of IV metaraminol (an alpha-1 drug) is A. vasodilation B. vasoconstriction C. cardiac stimulation D. cardiac depression E. bronchodilation

vasoconstriction