503 Final Previous Questions
Which statement below most accurately characterizes the principal pharmacologic activities that differentiate the actions of esomeprazole and famotidine on gastric acid secretion? A: esomeprazole reduces only stimulated acid secretion; famotidine reduces both basal and stimulated secretion B: esomeprazole is an irreversible inhibitor of H+/K+/ATPase; famotidine is an orthosteric antagonist of H2Rs C: esomeprazole acts at a target expressed on parietal cells; famotidine acts at a target expressed in enterochromaffin-like cells.
B
Zolpidem has less anti-anxiety and anti-seizure activity than benzodiazepines. Which of the following best explains this difference? A: zolpidem has less capacity to penetrate into the CNS than benzodiazepines B: zolpidem preferentially binds to the GABAAR 1 subunit while benzodiazepines also have strong binding to 4, 5, and 6 receptor subunits C: zolpidem selectively binds to ligand-gated ion channel GABAAR while benzodiazepines also strongly interact with voltage-gated Na+ channels D: zolpidem has a shorter half-life in the plasma than benzodiazepines
B
ZD is currently taking citalopram to treat major depressive disorder but has started to experience insomnia. A switch to mirtazapine is being considered. Consider the structures and pharmacologic activity data pictured in the attachment. Which of the following statements best supports the conclusion that mirtazapine would be more likely than sertraline to address ZDs insomnia symptoms? A: mirtazapine is a less potent SERT inhibitor than sertraline B: mirtazapine is a more potent H1 antagonist than sertraline C: mirtazapine is a more potent 5HT2C antagonist than sertraline
B
You are trying to help a patient who is suffering from both hypertension and LUTS associated with benign prostatic hyperplasia (BPH). Which one of the following agents could result in therapeutic effects for both indications? A: doxazosin B: solifenacin C: finasteride D: oxybutynin
A
Which of the following statements most accurately describes rivaroxaban? A: rivaroxaban is an orally available factor IIa (or thrombin) specific inhibitor B: rivaroxaban is an orally available factor Xa specific inhibitor C: rivaroxaban takes 5-6 hours for its full anticoagulation effect D: rivaroxaban should not be used with a vitamin-K rich diet
B
HF is a 55-year-old male with complaints of sexual dysfunction. HF's past medical history reveals that he has been on lovastatin for six years and low-dose aspirin for three years. Which of the following statements most reasonably explains HF's symptoms? A: statins inhibit HMG-CoA reductase to lower the levels of testosterone precursors B: statins inhibit 5-alpha reductase to directly inhibit testosterone synthesis. C: statins are androgen receptor antagonists and block testosterone activity
A
Which statement most accurately describes how sildenafil can effectively treat erectile dysfunction? A: sildenafil inhibits PDE5 leading to an increase in cGMP which causes a decrease in available Ca2+ leading to vasodilation B: sildenafil activate PDE5 leading to a decrease in cGMP which causes an increase in available Ca2+ leading to vasoconstriction. C: sildenafil inhibits PDE5 leading to an increase in cGMP which causes an increase in available Ca2+ leading to vasodilation. D: sildenafil inhibits PDE5 leading to an increase in cGMP which causes a decrease in available Ca2+ leading to vasoconstriction.
A
Consider the receptor and transporter activity data tabulated in the attachment to answer the following question. Which drug is most likely to be indicated for depression? A: A B: B C: C
A
Enalapril (see structure 1 in attachment) is a prodrug that is hydrolyzed to the active form enalaprilat. Based on the known mechanism and SAR for ACE inhibitors, which structure is consistent with enalaprilat? A: A B: B C: C
A
Fill in the blanks with the correct receptors: Based on the current understanding of antipsychotic drug action and the data tabulated in the attachment, risperidone has antipsychotic effects because it is an antagonist of ________ and it has reduced EPS side effects compared to first-generation antipsychotic drugs by because it is also an antagonist of _________. A: D2, 5HT2A B: H1, alpha-1B C: 5HT2A, D2 D: D2, H1
A
Compensatory effects of SSRIs leading to decreased changes in a targets activity have been hypothesized to be responsible for the delay in therapeutic effect of SSRIs. Which of the following targets is involved in this hypothesis? A: 5HT1A autoreceptor B: 5HT2A receptor C: monoamine oxidase D: D1 autoreceptor
A
Consider agents used to treat hypertension and agents used to treat LUTS associated with benign prostatic hyperplasia (BPH). Which one of the following pharmacologic activities could result in both types of therapeutic effect? A: alpha-1 AR antagonist B: alpha-2 AR agonist C: beta-1 AR antagonist D: mAChR antagonist
A
Consider the data and drug structures pictured in the attachment. Based on these data, which drug (A, B, or D; C is provided as reference) would be predicted to have the greatest risk for endometrial cancer or hyperplasia when used for long-term treatment? A: A B: B C: D
A
Consider the data tabulated in the attachment to answer the following question. Which antipsychotic drug would have the highest risk for EPS? A: thiothixene B: iloperidone C: asenapine
A
In the context of treating LUTS associated with BPH, consider the relative advantages of inhibiting steroid metabolism versus modulating the activation of adrenergic receptors. Which one of the following statements most accurately characterizes the relative advantages? A: Inhibition of steroid metabolism can only decrease levels of steroid products; however, the increased levels of substrates and products from alternative pathways can lead to side effects. B: Modulation of adrenergic receptors can lead to increased or decreased signaling activity depending on the ligand; however, the narrow distribution of ARs results in few side effects. C: Modulation of adrenergic receptors can reduce the amount of prostatic tissue to address a root cause of LUTS directly; however, the therapeutic outcomes can take months to become evident. D: Inhibition of steroid metabolism can only reduce the severity of LUTS without addressing prostatic tissue growth; however, therapeutic outcomes can be seen after a single dose.
A
KA is a female patient being treated for edema caused by congestive heart failure and is complaining of unusual hair growth. Patients with generalized edema (due to heart failure, nephrotic syndrome, or renal disease, for example) are often treated with daily loop diuretics or spironolactone. Consider the case history to suggest a different drug to treat KAs edema but avoid the hair growth sider effect. A: furosemide B: triamterene C: chlorthalidone
A
Men being treated with dutasteride or finasteride can experience gynecomastia. Select the response that best explains this side effect based on the MOA of these drugs and the steroid metabolizing enzymes involved. A: inhibition of 5-alpha reductase by these drugs increases the levels of testosterone which is converted to estrogen and causes gynecornastia. B: inhibition of 5-alpha reductase by these drugs increases the levels of dihydrotestosterone which causes gynecomastia. C: inhibition of 3-beta hydroxysteroid dehydrogenase is an off-target effect of both drugs and this decreases progesterone levels which causes gynecomastia.
A
Pioglitazone, which is pictured in the attachment, can reduce fasting glucose and triglycerides levels in treated individuals. Which of the following statements best explains how the drug affects both pathways? A: pioglitazone is a PPAR-gamma agonist activated by PPAR-gamma directly increases expression of GLUT4 and lipoprotein lipase B: pioglitazone is a PPAR-gamma antagonist, blocking PPAR-gamma directly increases expression of GLUT4 and lipoprotein lipase C: pioglitazone is a DPP-4 inhibitor that increases GLP-1 activity and increases insulin sensitivity
A
Pioglitazone, which is pictured in the attachment, can reduce fasting glucose and triglycerides levels in treated individuals. Which of the following statements best explains how the drug affects both pathways? A: pioglitazone is a PPAR-gamma agonist; activated PPAR-gamma directly increases expression of GLUT4 and lipoprotein lipase. B: pioglitazone is a PPAR-gamma antagonist, blocking PPAR-gamma increases expression of GLUT4 and lipoprotein lipase C: pioglitazone is a DPP-4 inhibitor that increases GLP-1 activity and increases insulin sensitivity.
A
Proton pump inhibitors decrease gastric acid secretion. Correctly match each cell type (1, 2, or 3) in the gastric gland to its major function (A, B, or C) in acid secretion. Cell types Functions 1. G-cells A. secrete acid (proton- pump containing cell type) 2. enterochromaffin-like cells (ECLs) B. detect food and produce gastrin 3. parietal cells C. produce histamine A: B,C,A B: B,A,C C: A,B,C D: C,A,B
A
TJ is a new patient who has been diagnosed with schizophrenia and presents with severe psychosis. TJ has been prescribed haloperidol and the plan is to start with 3 mg twice daily. During consultation, the pharmacist tells the patient that if they miss a dose, they should just take the next dose as prescribed and dont add the missed dose. Which of the following statements best explains why dose of haloperidol is so important? A: doses that provide D2R occupancy from 60-80% can provide antipsychotic effects, but at higher doses, D2R can become saturated (>80% occupancy) and this greatly increases the risk of EPS symptoms B: doses that provide D2R occupancy from 60-80% can provide antipsychotic effects, but at higher doses, H1R can become occupied, and this greatly increases sedation C: doses that provide D2R occupancy from 60-80% can provide antipsychotic effects, but at higher doses, the antipsychotic effects are inhibited by 5HT2A receptor occupancy
A
There are several treatment strategies that will provide an anti-androgenic effect. Which one of the three drugs pictured in the attachment would result in the most complete anti-androgenic effect? A: bicalutamide B: dutasteride C: mifepristone
A
When a cells energy demands are low, the ratio of ATP to AMP concentrations change, leading to activation of a key protein. This activation results in decreased gluconeogenesis and increased glucose uptake, especially in the liver. Which antidiabetes drug also activates this key protein to influence blood glucose concentration? A: metformin B: liraglutide C: glipizide
A
Which of following pentasaccharides binds to antithrombin with the highest affinity and thus has the highest anticoagulant activity? A: A B: B C: C D: A, B, and C have equivalent anticoagulant activity
A
Which of following statements most accurately describes a property of low-molecular weight heparins (LMWH)? A: LMWH is a depolymerized product of unfractionated heparin B: the three approved LMWH drugs are interchangable C: LMWH must contain the thrombin-binding polysaccaride domain
A
Which of the anti-seizure drugs pictured in the attachment likely uses synaptic vesicular protein SV2A as one of its targets? A: levetiracetam B: phenytoin C: diazepam D: valproate E: clobazam
A
Which of the following drugs lowers LDL levels by inhibiting cholesterol absorption from the diet? A: ezetimibe B: gemfibrozil C: pravastatin
A
Which of the following drugs would be most likely to act pharmacologically like a combination of doxazosin plus propranolol? A: carvedilol B: clonidine C: nebivolol D: prasugrel
A
Which of the following is an agent to treat acid peptic disorders whose API must be modified by enzymatic or chemical reactions in the body before the drug is active? A: esomeprazole B: famotidine C: ondansteron
A
You are asked to recommend a drug for a patient who has been diagnosed with hypertension. Which of the following pharmacologic activities would be the best choice for helping this patient? A: alpha-1 adrenergic receptor antagonist B: alpha-2 adrenergic receptor antagonist C: beta-1 adrenergic receptor agonist D: beta-2 adrenergic receptor agonist
A
Which THREE of the following statements accurately characterize the drug class that includes promethazine? A: the drug class is first-generation H1R antagonists B: the drugs act as reversible, orthosteric antagonists of histamine H1 receptors C: the drugs target is a GPCR expressed on SMCs in lung, GI, and secretory tissue; on endothelial cells in the peripheral vasculature; and on post-synaptic neurons in the CNS D: the drugs target normally uses ATP and the conformation associated with the autophosphorylated state allows a hydronium to be transported out of the cell. E: the drugs suppress stimulated gastric acid secretion to treat upper GI disorders like PUD, GERD, and heartburn.
A, B, C
Which THREE of the following statements accurately characterize the drug class that includes tolterodine? A: the drug class is anticholinergic agent B: the drugs act as reversible, orthosteric antagonists of mAChR C: the drugs target is a GPCR expressed on SMCs in the bladder wall D: the drugs target normally uses ATP and the conformation associated with the autophosphorylated state allows a hydronium to be transported out of the cell E: the drugs suppress stimulated gastric acid secretion to treat upper GI disorders like PUD, GERD, and heartburn
A, B, C
SELECT ALL THAT APPLY: Consider the structures of duloxetine and citalopram pictured in the attachment. Which THREE of the following statements most accurately characterizes the pharmacological activities of the two drugs? A: duloxetine inhibits NET B: duloxetine inhibits SERT C: citalopram inhibits NET D: citalopram inhibits SERT
A, B, D
SELECT ALL THAT APPLY: Consider a patient who is suffering from memory loss and cognitive decline associated with dysfunction and degeneration of neurons in her hippocampus, prefrontal cortex, and nucleus basalis. Which TWO of the following drugs would be indicated for her treatment? A: memantine B: omeprazole C: rivastigmine D: ropinorole
A, C
Which THREE of the following statements accurately characterize the drug class that includes clonidine? A: the drug class is alpha-2 agonist B: the drugs act as allosteric antagonists of P2Y12 receptors C: the drugs target is a GPCR expressed on CNS neurons, especially those in the sympathetic nervous system D: the drugs target is normally bound by adrenaline to activate Gas and induce muscle contraction E: the drugs reduce sympathetic outflow from the CNS and decrease peripheral vascular resistance
A, C, E
Which THREE of the following statements accurately characterize the drug class that includes doxazosin? A: The drug class is alpha-1 blocker B: The drugs act as allosteric mAChR alpha inhibitors. C: The drugs target is a GPCR expressed on smooth muscle cells enervated by the sympathetic nervous system. D: The drugs target is normally bound by cholinylacetate to activate Gai and induce antispasms of the smooth muscle. E: The drugs reduce sympathetic tone-induced urethral structure that contribute to LUTS associated with BPH.
A, C, E
Which THREE of the following statements accurately characterize the drug class that includes insulin aspart? A: the drugs are indicated to treat type 1 and type 2 diabetes mellitus B: the drugs act as reversible, competitive inhibitors of the insulin receptor (IR) C: the drugs target is a recepto tyrosine kinase expressed on the surfaces of liver, skeletal muscle, and adipose cells D: activation of the drugs target normally enhance the secretion of a peptide incretin by pancreatic B cells E: the drugs mimic a peptide hormone to lower the blood glucose concentration and reduce hyperglycemia
A, C, E
MS is a 55-year-old male who reports to the Emergency Department with complications associated with otherwise stable, symptomatic heart failure of hypertensive origin. MS's medical history reveals that he also suffers from chronic asthma that is partially controlled with Symbicort. The emergency physician wants to start MS on a beta- blocker and asks for your advice. Based solely on their pharmacologic activities, which TWO of the following drugs would be the best choices to recommend to MS's physician? A: atenolol B: carvedilol C: methanol D: nebivolol E: propranolol
A, D
SELECT ALL THAT APPLY: Which TWO of the anticonvulsants pictured in the attachment are prodrugs? A: eslicarbazepine acetate B: valproate C: lamotrigine D: fosphenytoin
A, D
Which THREE of the following statements accurately characterize the physiologic outcomes of treating a patient with prasugrel? A: irreversible inactivation of an ADP receptor on the surface of platelets B: decreased production of TxA2 C: increased production of cysteinyl leukotrienes D: decreased activation of the fibrinogen receptor E: decreased platelet aggregation
A, D, E
Which THREE of the following drugs modulate acetylcholine receptor activity to treat urinary symptoms (e.g., overactive bladder or urinary retention)? A: bethanechol B: carvedilol C: ranitidine D: solifenacin E: tamsulosin F: tolterodine
A, D, F
BC is a 28-year-old female who presents with severe muscle spasms and restlessness. Several years ago, she was diagnosed with schizophrenia and treated with chlorpromazine. For most of the intervening years, BC experienced successful treatment with minimal side effects. Despite her stated adherence, however, BC relapsed. To treat her relapse, the dose of chlorpromazine was increased. After several days, BCs psychotic symptoms were well controlled, but then she began to experience severe muscle spasms and restlessness. Which statement best explains the appearance of new symptoms after the chlorpromazine dose was increased? A: the lower dose results in modest D2R occupancy (60-80%), which can alleviate symptoms of psychosis and the higher dose results in higher D2R occupancy (>80%) but also caused off target alpha-1 antagonist, which caused the EPS side effects B: the lower dose results in modest D2R occupancy (60-80%), which can alleviate symptoms of psychosis, and the higher dose results in higher D2R occupancy (>80%) which increases the chances of EPS side effects. C: the lower dose results in modest D2R occupancy (60-80%), which can alleviate symptoms of psychosis, and the higher dose results in higher D2R occupancy (>80%) but also caused off target H1 occupancy, which caused the EPS effects.
B
BM, a 58-year-old woman with a 20-year history of poorly controlled type II diabetes mellitus, comes in for routine follow-up at her physicians office. She has had multiple complications from her diabetes, including retinopathy and peripheral neuropathy. She complains that for several months she's felt as if her stomach is full after eating very little. You suspect that her bowel smooth muscles, which are controlled by enteric neurons, are not active enough. Which of the following drugs would best improve the patients GI symptoms? A: meclizine B: metoclopramide C: metoprolol
B
Based on their mechanisms of action, which of the drugs listed below is expected to have the greatest triglyceride lowering effect? A: rosuvastatin B: fenofibrate C: ezetimibe
B
CJ is a male patient being treated for edema caused by congestive heart failure and is complaining of breast enlargement. Patients with generalized edema (due to heart failure, nephrotic syndrome, or renal disease, for example) are often treated with daily furosemide or spironolactone, and CJ cannot recall which of these drugs he is on. Consider the case history to predict which drug CJ is taking. A: furosemide B: spironolactone C: either drug (both are expected to cause breast enlargement)
B
Considering that that PCSK9 degrades the LDL-receptor, what statement most accurately predicts the different effects of statin therapy in a patient with normal level of active PCSK9 versus a patient with high level of active PCSK9. A: LDL is not predicted to be lowered in either patient B: the patient with high levels of PCSK9 activity is expected to have decreased LDL lowering effects from statin therapy C: the patient with a high level of PCSK9 activity is expected to have the greater LDL lowering effect from statin therapy
B
ER is a 52-year old male who was recently treated by radiation therapy for a head and neck cancer. He developed xerostomia (dry mouth) and pilocarpine was ordered for him. While you expect the drug to relieve ER's symptoms, which of the following physiologic effects should you look for as potential side effects? A: constipation B: frequent urination C: gastric ulcers
B
How does ramipril both decrease angiotensin II levels and increase bradykinin levels? A: ramipril inhibits ACE and the excess substrate activates bradykinin production B: ramipril inhibits ACE, which cleaves both angiotensin I and bradykinin C: ramipril inhibits two enzymes: ACE and bradykinin hydrolase
B
Insensitivity to heparins thromboprophylactic effects is observed in some cancer patients, especially those patients with aggressively metastasized cancers. Which of the following statements offers the best explanation for this observation? A: the patient has expressed vitamin K dependent decarboxylase mutants that do not react with heparin B: the patient expresses more heparanase, a hydrolase that can depolymerize heparin to produce short oligosaccharides C: the patient may show delayed anticoagulant effects, so the care team should wait at least 12 hours
B
Insulin release by cells in response to increased blood glucose concentration is a Ca2+-dependent process. Consequently, blocking voltage-gated calcium ion channels inhibits insulin release, even when the concentration of glucose is high. Consider diazoxide (pictured), a K+-channel opener. When cells are treated with diazoxide, which of the following statements is most likely to be correct? A: insulin release is enhanced even when the concentration of glucose is low B: insulin release is reduced even when the concentration of glucose is high C: insulin release is enhanced when the concentration of glucose is high and is reduced when the concentration of glucose is low D: insulin release is reduced when the concentration of glucose is high and is enhanced when the concentration of glucose is low
B
KA is a 71-year old patient being discharged today and you are reviewing her discharge medication list with the pharmacist. Your role is important to ensure that all disease states managed during the patients stay have appropriate plans for medication therapy at home. The physicians discharge notes indicate that KA was treated for the following disease states during her hospital stay: anxiety, hyperlipidemia, and incontinence. As you review the discharge medication list, you see that KA will be discharged on alprazolam (3 mg daily), rivastigmine (3 mg daily), and simvastatin (40 mg daily). Which drug cannot be correctly matched with an indicated disease state in KA's proposed treatment plan? A: alprazolam B: rivastigmine C: simvastatin
B
KA is a 71-year old patient being discharged today and you are reviewing her discharge medication list with the pharmacist. Your role is important to ensure that all disease states managed during the patients stay have appropriate plans for medication therapy at home. The physicians discharge notes indicate that KA was treatedfor the following disease states during her hospital stay: alopecia, gout, and hyperlipidemia. As you review thedischarge medication list, you see that KF will be discharged on allopurinol (100 mg daily), rivastigmine (3 mg daily), and simvastatin (40 mg daily). Which drug cannot be correctly matched with an indicated disease state in KA's proposed treatment plan? A: allopurinol B: rivastigmine C: simvastatin
B
MB is a 49-year old male who presents at your community pharmacy with a grocery bag full of prescription medications. He feels that he's taking more medications than is necessary and asks you to review his medications and their corresponding indications with him. MB's health record indicates that he currently suffers from gastroesophageal reflux disease, hypertension, and erectile dysfunction. Among the medications that he has brought in are gemfibrozil, meclizine, ramipril, and sildenafil. You note that one of the drugs is not indicated for treatment of any of MB's current disease states and that one his disease states has no pharmacotherapeutic agent. Which of the following would be the best recommednation to correct both errors? A: replace gemfibrozil with gravastatin B: replace meclizine with ranitidine C: replace ramipril with metoclopramide D: replace sildenafil with solifenacin
B
NA has been taking furosemide to treat hypertension. NA complains of fatigue, numbness, and tingling. NA has been moved to a triamterene/furosemide combination. What is the target of triamterene, and why would this combination be considered in NAs case? A: triamterene inhibits the Na+ channel in the collecting duct and decreases Na+ excretion B: triamterene inhibits the Na+ channel in the collecting duct and decreases K+ excretion C: triamterene inhibits the Na+/K+/2Cl-symport in the ascending loop and decreases Na+ excretion D: triamterene inhibits the Na+/K+/2Cl-symport in the ascending loop and decreases K+ excretion
B
Tamoxifen and estradiol are both agonists of the estrogen receptors in liver cells; but tamoxifen is an antagonist in estrogen receptor positive (ER+) breast cancer cells. Which statement provides the best molecular explanation for this difference? A: tamoxifene is a progesterone receptor agonist, but estradiol is not B: tamoxifene and estradiol stabilize different conformations of the estrogen receptor C: estradiol is metabolized more rapidly than tamoxifen
B
The diagram below presents major pathways in human steroidogenesis. Anastrozole (Arimidex) inhibits an activity that is covered by the black rectangle. Pick the statement below that most accurately describes this activity, the MOA of anastrazole and the effect it has on steroid levels. A: Anastrozole inhibits C19 lyase by binding in the cofactor binding site, being reduced by the NADPH cofactor and forming a covalent bond with the enzyme to yield an irreversible covalent inhibitor. This leads to an increase in testosterone and androstenedione levels and a decrease in estradiol and estrone. B: Anastrozole inhibits aromatase by binding competitively to the heme cofactor, preventing substrate binding. This leads to an increase in testosterone and androstenedione levels and a decrease in estrone and estradiol. C: Anastrozole competitively inhibits type 1 and 2 aromatase by binding in the steroid binding site. This leads to an increase in testosterone levels and a decrease in dihydrotestosterone.
B
The diagram pictured in the attachment presents major pathways in human steroidogenesis. Dutasteride specifically inhibits an activity that is covered by the red rectangle and is used to treat benign prostatic hyperplasia. Pick the statement below that most accurately describes this activity, the MOA of dutasteride and the effect it has on steroid levels. A: Dutasteride inhibits type 1 and 2 5-alpha reductase by binding in the cofactor binding site, being reduced by the NADPH cofactor and forming a covalent bond with the enzyme to yield an irreversible covalent inhibitor. This leads to an increase in testosterone levels and a decrease in dihydrotestosterone. B: Dutasteride inhibits type 1 and 2 5-alpha reductase by binding in the steroid binding site, being reduced by the NADPH cofactor and forming a covalent bond with the oxidized cofactor to yield an irreversible inhibitor because it binds in both the steroid and cofactor binding site with very high affinity. This leads to an increase in testosterone levels and a decrease in dihydrotestosterone. C: Dutasteride inhibits 3-beta hydroxysteroid dehydrogenase by binding in the steroid binding site, being reduced by the NADPH cofactor and forming a covalent bond with the cofactor to yield an irreversible inhibitor because it binds in both the steroid and cofactor binding site to give very high affinity. This leads to a decrease in testosterone levels and an increase in dihydrotestosterone.
B
Which of the following pairs correctly matches an antidepressant drug target to the targets role in normal physiology? A: SERT-release serotonin to initiate signaling B: MAO-degradation of serotonin C: postsynaptic 5HT2A- inhibit serotonin release
B
There are a number of drug classes that have antiemetic activity. Which TWO of the following statements accurately predict the likely key side effects of antiemetic drugs? A: 5HT3R agonists would have a genitourinary side effect of overactive bladder B: 5HT3R antagonists would have a GI side effect of constipation C: 5HT4R agonists would have a GI side effect of diarrhea D: 5HT4R antagonists would have a genitourinary side effect of urinary retention E: H1R agonists would have a GI side effect of constipation F: H1R antagonists would have a genitourinary side effect of overactive bladder
B, C
Which TWO of the following characteristics do aspirin and clopidogrel have in common? A: both drugs are converted into active metabolites that bind GPCRs B: both drugs result in irreversible inactivation of their respective targets C: both drugs reduce platelet aggregation and thrombus formation D: both drugs attenuate the activation of platelets by TxA2
B, C
Which TWO of the following characteristics do aspirin and clopidogrel have in common? [ A: both drugs prevent platelets from secreting cAMP B: both drugs result in irreversible inactivation of their respective targets C: both drugs reduce platelet aggregation and thrombus formation D: both drugs reduce the amount of TxA2 produced by platelets
B, C
Which TWO of the following statements accurately characterize the drug class that includes oxybutynin? A: the drugs act as irreversible agonists of mAChRs B: the drugs target is normally bound by ACh to activate Gaq and cause SMC contraction in the bladder wall C: the drugs reduce the spasmodic smooth muscle contractions associated with overactive bladder
B, C
Which THREE of the following statements accurately characterize the physiologic outcomes of treating a patient with metoclopramide? A: increased dopaminergic signaling in the CNS chemoreceptor trigger zone. B: decreased serotongergic signaling in the CNS chemoreceptor trigger zone. C: increased cholinergic excitation of SMCs in GI. D: increased gastric emptying E: increased gastric secretions
B, C, D
Which THREE of the following statements accurately characterize the drug class that includes Protonix? A: the drug class is histamine H2 receptor antagonist B: the drugs act as irreversible inhibitors C: the drugs target is the H+, K+, ATPase expressed on the luminal membrane of parietal cells in the gastric fundus D: the drugs cross the blood-brain barrier and have significant side effects, including sedation E: the drugs suppress both basal and stimulated gastric acid secretion to treat acid peptic disorders like GERD and PUD
B, C, E
Which TWO of the following APIs must be modified by enzymatic or chemical reactions in the body before the drug is active (i.e., so that the reaction product is ready to carry out the pharmacologic activity associated with the drug)? A: atenolol B: benazepril C: clonidine D: prasugrel E: salicylic acid
B, D
Which THREE of the following drugs are antihypertensive agents that bind to target GPCRs without activating them? A: clopidogrel B: carvedilol C: clonidine D: doxazosin E: losartan F: lisinopril
B, D, E
Which THREE of the following statements accurately characterize the drug class that includes Zantac? A: the drug class includes the generic drug lansoprazole B: the drugs act as reversible orthosteric antagonists of their targets C: the drugs target is an ATP-dependent ion pump expressed on the lumenal membrane of parietal cells in the gastric fundus D: the drugs target is normally bound by histamine to activate Gas and induce H+, K+, ATPase tubulovesicles to be transported to and fuse with the plasma membrane E: the drugs are used to suppress gastric acid secretion in the treatment of GERD
B, D, E
Which THREE of the following statements accurately characterize the drug class that includes canagliflozin? A: the drug class is chymotrypsin activator B: the drugs act as reversible, competitive inhibitors of SGLT2 C: the drugs target is a protease secreted into the bloodstream to activate pro-peptides D: the drugs target normally uses the Na+ ion gradient to transport glucose from glomerular filtrate back into blood E: the drugs increase the amount of glucose that is excreted in urine and reduce the amount of glucose that is reabsorbed into the blood thereby reducing hyperglycemia
B, D, E
Which of the following statements best explains why initiation of lamotrigine (LTG) begins at a lower does when a patient is already on valproate (VPA) then dosing in the absence of VPA? A: both LTG and VPA inhibit voltage-gated Ca2+ channels B: both LTG and VPA allosterically modulate GABAA receptors C: VPA inhibits enzymes that metabolize LTG in the liver D: VPA and LTG bind at different sites of GABAA receptors and the binding of VPA increases affinity of LTG for the receptors
C
Time dependent enzyme inhibition is a frequent finding for clinically effective drugs. This property can lead to lack of correlation between the pharmacokinetics (PK) of a drug and its pharmacodynamics (PD). Pick the statement below that best explains and rationalizes this disconnect. A: A drug with an extended PK exposure but a very short PD effect demonstrates in vivo activity consistent with time dependent inhibition because the drug doesn't reach the site of action in the body. B: A drug whose PK correlates directly with its PD demonstrates in vivo activity consistent with time dependent inhibition because the drug has time to reach its site of action and exert a PD effect proportional to exposure. C: A drug with an extended PD effect but a very short PK exposure demonstrates in vivo activity consistent with time dependent inhibition because the drug reaches a concentration at its site of action sufficient for activity and has a slow off-rate from its target that prolongs its PD effect.
C
Treatment with sildenafil will lead to an increase in which intracellular second messenger? A: Ca2+ B: GMP C: cGMP
C
Which drug pictured in the attachment would be more likely to have greater anabolic activity than androgenic activity? A: A B: B C: C
C
Which of the following drugs is a PDE5 inhibitor? A: rosuvastatin B: triamterene C: tadalafil
C
Which of the following events directly induce neurotransmitter release during neurotransmission? A: Na+ influx B: K+ efflux C: Ca2+ entry D: Cl- influx
C
Which of the following is the primary target of ethosuximide? A: voltage-gated Na+ channel B: voltage-gated K+ channel C: T-type Ca2+ channel D: ligand-gated Cl- channel
C
A 45-year-old male patient comes to the pharmacy for a diabetes education class. Over the past year while taking metformin, he has gained weight and is having trouble with his glycemic control. Your preceptor asks you to rationalize a drug to be recommended as an add-on to metformin to help the patient with his health goals. Which of the following represents the best drug choices for this patient? A: canagliflozin B: glipizide C: liraglutide D: sitagliptin
C
A common modification found in compounds used as sex hormone analogs is esterification of the C17beta hydroxyl group, exemplified by the drug testosterone 17beta-cypionate (pictured in the attachment). Which of the following most accurately describes the general property provided by such esterification? A: the esters are more hydrophobic and thus more potent B: the esters are antagonists C: the esters are longer lasting D: the esters are selective receptor modulators
C
A drug-specific side effect of erectile dysfunction pharmacotherapy is myalgia (muscle pain). Drug-induced myalgia is thought to be caused by inhibition of PDE11. Use the table below to select the drug predicted to have the greatest risk of myalgia. A: vardenafil B: sildenafil C: tadalafil
C
A new drug "trombolin" has just been introduced. The drug company's sales rep claims that it works like aspirin for secondary prevention of CV events associated with ASCVD, "But it's even more potent!" Assuming the sales rep's claims are accurate, which row in the attached data table most likely contains the IC50 values for trombolin's inhibition of cyclooxygenase enzymes? A: A B: B C: C
C
A patient with deep vein thrombosis (DVT) is receiving warfarin. After 5 hours of receiving the drug, the prothrombin time (PT), a measurement for the anticoagulant effect from warfarin, remains unchanged. Based on warfarins mechanism of action, which of the following represents the best recommendation for this patients care? A: administer vitamin K to improve the absorption of warfarin B: increase the patients dose of warfarin C: repeat the PT measurement 12-24 hours later and reassess D: stop administering warfarin and administer a different drug
C
Consider the dose-response curves pictured in the attachment. They illustrate the activity of the dopamine D2 receptor (D2R) with different concentrations of dopamine or aripiprazole. Which of the following statements most accurately characterizes the effect of aripiprazole on signaling through D2R? A: aripiprazole functions as a D2R antagonist that reduces signaling through D2R under all conditions B: aripiprazole functions as a D2R partial agonist that increases signaling through D2R under all conditions C: aripiprazole functions as a D2R partial agonist that decreases signaling through D2R when dopamine levels are high D: aripiprazole functions as a D2R agonist that selectively decreases signaling through D2R when dopamine levels are low
C
Lack of adherence, including missed doses leading to relapse, is a serious problem with schizophrenia pharmacotherapy. According to internal data from Janssen Pharmaceuticals, Inc., On average, adult patients are treated on 4 different oral antipsychotic regimens before starting on their first long-acting injectable antipsychotic. Which structure pictured in the attachment shows an antipsychotic drug with a modification commonly used to generate long-acting injectable forms of drugs? A: A B: B C: C
C
The anticoagulant activity of apixaban can be reversed by: A: protamine B: vitamin K C: andexanet alpha
C
The following clinical data has been reported: A combination of a 5HT1A receptor antagonist and fluoxetine has been reported to enhance extracellular levels of serotonin over what is obtained with fluoxetine alone. Which of the following statements best explains this observation? A: fluoxetine is a 5HT2A antagonist. Combined with a 5HT1A antagonist, the presynaptic 5HT1A and 5HT2A receptor mediated negative feedback of serotonin release is completely inhibited B: fluoxetine is a 5HT1A agonist which decreases serotonin levels released by the presynaptic neuron by negative feedback, the 5HT1A receptor antatgonist blocks 5HT1A-controlled negative feedback of serotonin levels release from the presynaptic neuron C: fluoxetine inhibits SERTM which increases serotonin levels, the 5HT1A receptor antagonist blows 5HT1A-autoreceptor controlled negative feedback of serotonin levels released from the presynaptic neuron
C
The toxin PMT from the bacterium P. multocida deamidates a conserved glutamate in the active site of Gq, thereby inactivating this subunit's GTPase activity. What direct effect would you predict PMT has on second messenger levels? A: increase cAMP concentration B: decrease cAMP concentration C: increase Ca2+ concentration D: decrease Ca2+ concentration
C
Which of the following statements best explains why lorazepam is better tolerated than diazepam in patients with hepatic dysfunctions? A: lorazepam is a non-benzodiazepine drug while diazepam is a traditional benzodiazepine. B: lorazepam can be taken once daily while diazepam is taken twice daily because lorazepam has a longer half-life in plasma than diazepam C: one major metabolic transformation of diazepam is N-demethylation by cytochrome enzymes while lorazepam is primarily metabolized thorugh glucuronidation D: lorazepam, but not diazepam, inhibits voltage-gated Ca2+ channels in the liver other than allosterically activated GABAA receptors
C
Which of the following statements most accurately characterizes a difference between H1 and H2 receptors? A: H1 receptors are ligand-gated Na+ channels, H2 receptors are ligand-gated Ca+ channels B: H1 receptors are expressed on enterochromaffin cells, H2 receptors are expressed in the chemoreceptor trigger zone C: H1 receptor activation is coupled to Gaq proteins, H2 receptor activation is coupled to Gas proteins
C
Which of the following statements most accurately characterizes metformins use or outcomes? A: metformin induces the excretion of insulin to exert its antidiabetic effect B: metformin is a peptide-based drug and must be used with a protease inhibitor C: metformin does not induce hypoglycemic effects in patients
C
Which of the following statements most accurately characterizes the mechanism of action of glyburide as an oral antidiabetic drug? A: increases the sensitivity of insulin receptors B: opens Kir channels to reduce insulin-dependent activity C: closes KATP channels to stimulate insulin release D: blocks insulin binding to insulin receptors
C
Which of the following statements most accurately describes the mechanism by which insulin acts to reduce blood sugar levels? A: insulin accelerates the conversion of pyruvate to glucose B: insulin stimulates the DNA synthesis and cell proliferation C: insulin accelerates the conversion of glucose to glycogen
C
Which statement best describes the mechanism of estradiol as a hormone replacement therapy? A: estradiol activates the estrogen receptor, a GPCR that increases the intracellular Ca2+ concentration after activation B: estradiol activates the androgen receptor, a GPCR that increases the intracellular Ca2+ concentration after activation C: estradiol activates the estrogen receptor, a nuclear receptor that increases the expression of estrogen receptor response genes D: testosterone activates the androgen receptor, a nuclear receptor that increases the expression of androgen receptor response genes
C
Which statement most accurately describes the differences between the physiologic effects of losartan and lisinopril on receptor activity after their administration to patients? A: Losartan treatment leads to decreased angiotensin II receptor activity but lisinopril treatment has no effect on angiotensin II receptor activity B: Losartan treatment leads to increased angiotensin II receptor activity but lisinopril treatment has decreased angiotensin II receptor activity C: Both losartan and lisinopril treatment leads to decreased angiotensin II receptor activity but only lisinopril treatment leads to increased bradykinin receptor activity. D: Both losartan and lisinopril treatment leads to decreased angiotensin II receptor activity but only ramipril treatment leads to decreased bradykinin receptor activity.
C
You are participating regular morning rounds on your patients in the medical-surgical unit when the physician mentions he thinks there is something wrong with the patients medication list. As the physician starts to read off the patients disease states you begin to look over the medication profile to make sure the patient has a treatment for every indication. You soon realize that the patient is lacking an agent that will help prevent the patient from developing blood clots after recent placement of a stent. Which one of the following agents would you want to recommend? A: carvedilol B: clonidine C: clopidogrel D: chlorthalidone
C
Consider a patient with type 2 diabetes who does not respond to glimepiride treatment, but still responds to insulin treatment. Which TWO of the following statements provide a reasonable explanation for this observation? A: the patient has a mutation in the insulin receptor that decreases its activity B: the patient has a mutation that increases the expression of the insulin receptor C: the patients pancreatic b-cells have decreased expression of the KATP channel D: the patients pancreatic b-cells do not produce a sufficient amount of insulin
C, D
There is an endogenous peptide that activates a GPCR to stimulate the secretion of insulin. Which TWO of the following drugs mimic that physiologic outcome? A: canagliflozin B: glipizide C: liraglutide D: sitagliptin
C, D
Which TWO of the following characteristics do ramipril and olmesartan have in common? A: both drugs must be activated by chemical modification B: both drugs produce irreversible inactivation of their respective targets C: both drugs block stimulation of RAAS by a peptide hormone D: both drugs reduce vasoconstriction to treat hypertension
C, D
Which THREE of the following statements accurately describes aspects of the mechanism of action of nebivolol? A: nebivolol is metabolically activated to achieve its therapeutic effects B: nebivolol is an irreversible inhibitor of noradrenergic neurons of the SNS. C: nebivolol is a reversible, orthosteric antagonist of beta-1 receptors D: nebivolol is selective in binding to its specific target sub-type E: nebivolol acts at a target found on the surface of cardiomyocytes F: nebivolol acts to reduce platelet aggregation
C, D, E
JM is a 72-year-old African American male who is being treated for hypertension and congestive heart failure with drugs that includes an ACE inhibitor. Today, JM complains that he has been coughing frequently in the past few months. JM's past medical history and examination reveal no clear cause of the patients chronic cough, so the physician concludes that this is a medication-related problem and expresses concern about the possibility of angioedema developing. Which of the following drugs would you recommend for the physicians consideration as an alternative treatment for JM's hypertension by targeting the same physiologic system as the ACE inhibitor but with the potential for reduced risk of angioedema? A: clonidine B: enalapril C: prasugrel D: valsartan
D
You are working in a community pharmacy when a customer approaches complaining of acid indigestion and persistent stomach pain. The customer is a 43-year-old male long-distance truck driver and reports that a recent endoscopy revealed that he has a duodenal injury. His physician believes that this is most likely a duodenal ulcer resulting from the patients ongoing secondary prevention (antithrombotic) therapy. Which of the following would you recommend to counteract this medication-related problem? A: fluoxetine B: metaclopramide C: promethazine D: ranitidine
D
