Midterm Exam

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Which therapeutic action listed below results from stimulation of β2-adrenergic receptors? A. Vasoconstriction in anaphylactic reactions B. Increase in cardiac output during acute heart failure C. Mydriasis for ophthalmic examinations D. Suppression of catecholamine-induced tachyarrhythmias E. Relief of acute bronchospastic episodes in asthma

..........B?

Select the optimal receptor action to increase salivary flow for treatment of radiation-induced xerostomia A. Alpha-1 adrenergic antagonist B. Beta-1 adrenergic antagonist C. Beta-2 adrenergic agonist D. Muscarinic agonist E. Muscarinic antagonist

.....D?

Data regarding comparison of the maximal efficacies of two drugs is best obtained from: A. Graded dose-response curves B. Quantal dose-response curves C. Population dose-response curves D. Plasma drug concentration versus time curves

Local anesthetics such as lidocaine or bupivacaine are metabolized in the liver by A. Amidases B. Esterases C. Hydrolysis D. Cytochrome 3a4 E. Glucuronyl transferase.

A and C.

Which of the following statements concerning neurotransmission in the peripheral nervous system is FALSE? A. Norepinephrine activation of alpha-2 adrenergic receptors on presynaptic adrenergic neurons in the heart will increase acetylcholine release. B. Adrenergic neurotransmission (NE) is terminated in the synapse by reuptake via the norepinephrine transporter (NET). C. Cholinergic neurotransmission (ACh) is terminated in the synapse by the hydrolysis of acetylcholine by acetylcholinesterase. D. Norepinephrine activation of alpha-2 adrenergic receptors on presynaptic adrenergic neurons in the heart will increase norepinephrine release.

A and D.

A drug-drug interaction that is of importance in dentistry is the possibility that hypersensitivity to epinephrine-induced hypertension can occur if epinephrine is given to a dental patient who is also taking a drug which blocks: A. α 1 -adrenergic receptors B. β 1 -adrenergic receptors C. β 1and β2-adrenergic receptors (non-selective) D. Muscarinic cholinergic receptors E. Nicotinic receptors at the neuromuscular junction

Epinephrine "reversal" (a paradoxical decrease in blood pressure when systemic epinephrine is given) occurs because epinephrine stimulates: A. Alpha-1 adrenergic receptors B. Beta-1 adrenergic receptors C. Beta-2 adrenergic receptors D. Muscarinic cholinergic receptors

The direct actions of epinephrine to increase total peripheral resistance and systolic blood pressure would be further increased if the patient was also given a drug that blocks which receptor: A. A1-adrenergic B. B1-adrenergic C. B2-adrenergic D. Muscarinic cholinergic

The half-life of a drug: A. Is independent of the volume of distribution B. Must be known to calculate the loading dose C. Decreases if the volume of distribution decreases D. Increases if the clearance increases

Which of the following autonomic nervous system drugs would be MOST likely to predispose a patient to cardiac arrhythmias due to an increase in cardiac conduction rate? A. Albuterol-B2 agonist (SM) B. Atenolol-b1 antagonist (would decrease conduction) C. Isoproterenol (b1-2 agonist) D. Pilocarpine- m agonist E. Propranolol-b1-2 antagonist

Which of the following is TRUE about the blood-brain barrier? A. Endothelial cells of the blood-brain barrier have slit junctions (fenestrations) B. Ionized or polar drugs can cross the blood-brain barrier easily--no they cannot C. Drugs can cross the blood-brain barrier through specific transporters (tight junctions) D. Water soluble drugs readily cross the blood-brain barrier--no they cannot

Which of the following organs or organ systems has muscarinic receptors present, but lacks cholinergic innervation? (PNS controls tone everywhere but the answer) A. Eye B. Heart C. BV (resistance) D. Urinary bladder muscle E. Lungs

Which of the following statements concerning drug metabolism is FALSE? A. Liver is primary organ involved in drug metabolism. B. Oxidation is the most common reaction. C. Inhibition of cytochrome P450 enzymes can decrease plasma levels of drug substrates. D. Drug metabolism can also occur in kidney and intestine.

Which of the following types of drugs will have the greatest oral bioavailability? A. Drugs with high first pass metabolism-would limit bioavailability. B. Highly hydrophilic drugs saboidnonbelow C. Largely lipophilic drugs, soluble in aqueous solutions D. Drugs that are P-glycoprotein substrates. P glycoproteins are carrier molecules for active transport pumps substances out of cells, decreasing bioavailability.

Which set of direct action / reflex compensatory response would you see following IV administration of a selective α1-adrenergic receptor agonist? Direct effect/ baroreceptors reflex action A. Vasodilation/ reflex bradycardia B. Vasodilation/ reflex tachycardia C. Vasoconstriction/ reflex bradycardia D. Vasoconstriction/ reflex tachycardia

Which set of direct action / reflex compensatory response would you see following IV administration of a selective α1-adrenergic receptor agonist? Direct effect / baroreceptors reflex action A. Vasodilation/ reflex bradycardia B. Vasodilation/ reflex tachycardia C. Vasoconstriction/ reflex bradycardia D. Vasoconstriction/ reflex tachycardia

Which of the following statements concerning the controlled substances act of 1970 is true? A. Marijuana is recognized by the DEA as an approved agent for the management of PTSD. B. Prescriptions for schedule II drugs may be refilled one time in 3 months. C. Prescriptions for schedule III and IV drugs may be telephoned to a pharmacist. D. Use of Schedule IV drugs has a greater potential for abuse than use of Schedule II drugs. E. Schedule V drugs can be obtained without a prescription in Colorado.

C. Because marijuana is not approved by DEA; Rx for schedule II drugs cannot be refilled. Doc must write a new script each time, I>II>III>IV>V; treated like III-IV in colorado-requires a rx.

First pass effect is most commonly described as: A. Destruction of orally administered drug by the low pH of the gastric contents B. Destruction of orally administered drug by digestive enzymes. C. Hepatic metabolism of a drug prior to entry into the Systemic circulation. D. Gastric metabolism of a drug prior to entry into the systemic circulation

C. Big factor in reducing bioavailability.

Bolus or slug effects are most likely to be seen when drugs are administered by which of the following routes? A. IM B. Subcutaneous C. Intravenous D. Inhalation

C. Bolus toxicity: slow distribution, travels at once then distributed.

In the presence of buprenorphine, a higher concentration of morphine is required to elicit full pain relief. Buprenorphine by itself has a smaller analgesic effect than does more-hike, even when given at the highest dose. Which of the following is correct regarding these meds? A. Buprenoorphine is a competitive antagonist B. Buprenorphine is a non competitive antagonist C. Morphine is more efficacious than buprenorphine D. Buprenorphine is less potent than morphine.

C. Morphine> buprenorphine

Alkalinization of urine by giving bicarbonate is used to treat patients presenting with pentobarbital (weak acid) overdose. Which of the following best describes the rationale for alkalinization of urine in this setting? A. To decrease ionization of pentobarbital B. To increase glomerular filtration of pentobarbital C. To decrease proximal tubular secretion D. To reduce tubular reabsorption of pentobarbital.

An action common to activation of BOTH a1 adrenergic and M3-muscarinic cholinergic receptors is: A. Constriction of vascular smooth muscle B. Dilatation of vascular smooth muscle C. Constriction of bladder sphincter D. Increase in intracellular Ca++ mediated via Gq-proteins

An irreversible non competitive antagonist: A. Causes the potency of an agonist to increase B. Causes the ec50 of an agonist to increase C. Causes the EMAX of an agonist to increase D. Causes the EMAX of an agonist to decrease.

Azithromycin is an antibacterial agent with a half-life of 12 hours. The prescribed dosage regimen is 250 mg every day. How long will it take to reach steady state using this dosage regimen? A. 12 hrs B. 18 hrs C. 24 hrs D. 30 hrs E. 60 hrs F. 4-5 days

E. Steady state is assumed to be 4-5 half lives

A new drug is undergoing pharmacokinetic evaluation during phase 1 testing and it is determined that it has a volume of distribution of 3-5 liters in a 150 lb (70 kg) patient. Based on this finding alone, this value for Vd is most consistent with: A. The drug being highly bound to plasma proteins B. The drug being highly sequestered in fatty tissues C. The drug being distributed in total body water (TBW) 42L D. The drug being distributed in extracellular fluids (ECF) 12-15L

Activation of the sympathetic nervous system in a flight-or -fight response to an environmental stressor causes epinephrine release from the adrenal gland, resulting in which of the following actions? A. Increased blood glucose levels B. Bronchoconstriction C. Pupil constriction (miosis) D. Decrease in ab node conduction velocity E. Increased GI motility F. Increase in thermoregulatory sweating via m3 receptors

Epinephrine "reversal" (a paradoxical decrease in blood pressure when systemic epinephrine is given) occurs if epinephrine is given with a drug that blocks which receptor type: A. A1-adrenergic B. B1-adrenergic C. B2-adrenergic Bp D. Muscarinic cholinergic

Erythromycin is an antibacterial agent with a half-life of 6 hours. The prescribed dosage regimen is 500 mg every 6 hours. If the dosage regimen is changed to 1000 mg every 12 hours, how will the fluctuations in steady state plasma levels change? A. Increase B. Decrease C. No Change

How will acidification of the urine affect the rate of excretion of the weak base morphine? A. Rate will increase B. Rate will decrease C. Rate will be unchanged

Local anesthetics such as lidocaine or bupivacaine are metabolized in the liver by: A. Amidases B. Esterases C. Alcohol dehydrogenase D. Monoamine oxidase E. Cytochrome 3A4 F. Glucuronyl transferase

Select the optimal drug action for relief of nasal congestion: A. Alpha-1 adrenergic agonist B. Alpha-1 adrenergic antagonist C. Beta-2 adrenergic agonist D. Muscarinic agonist E. Muscarinic antagonist

The addition of glucuronic acid to a drug molecule: A. Decreases its lipid solubility B. Usually leads to activation of the drug C. Is an example of a phase I reaction D. Occurs at the same rate in adults and newborn E. Involves cytochrome P450

Which of the following drug dosage regimens would result in the GREATEST amount of fluctuation in the plasma drug level during the dosing interval? A. Drug E (t B. Drug A (t C. Drug B (t D. Drug C (t E. Drug D (t 1/2 1/2 1/2 1/2 1/2 = 1.5 hrs) dosed every 8 hours = 6 hrs) dosed every 6 hours = 4 hrs) dosed every 18 hrs = 24 hrs) dosed every 3 days = 12 hrs) dosed every 6 hours

Which of the following statements about drugs that are weak acids is CORRECT? A. An acid will most readily cross membranes when it is contained in acidic body fluids. B. An acid will have a pKa greater than 7.0. C. An acid becomes charged when it takes up a hydrogen ion. D. An acid will be trapped into more acidic body fluids.

Which of the following statements about weak acid drugs is andwilltrytoneutralize CORRECT? A. An acid will most readily cross membranes when it is contained in acidic body fluids. B. An acid will have a pKa greater than 7.0. C. An acid becomes charged when it takes up a hydrogen ion. --nope. When releasing a proton an acid becomes charged. D. An acid will be trapped into more acidic body fluids.

A. An acid will try to neutralize so this would be true if this were a base instead of acid/or a weak acid instead of weak base.

Vicodin has been moved from a schedule III medication to a schedule II medication. Which of the following is a consequence of this action? A. It now requires a written prescription in ink to be dispensed B. It now allows the prescription to be telephoned in to the pharmacy. C. It now limits refills to 3 times in 3 months D. It can no longer be used for treatment of dental pain

A. Schedule II drugs must be handwritten in ink. Schedule II will require a rx/cannot be phoned in. II: no refills, III, IV, V may be refilled 5-6x in 6 months. Schedule I drugs: cannot prescribe!

Which of the following activities are regulated by the FDA? A. Safety and efficacy of OTC meds B. Physicians use of medication off label C. Efficacy of herbal meds D. Therapeutic equivalence of generic drug formulations.

A. Because docs cannot prescribe meds for reasons other than what the FDA approved the drug for, the FDA does not regulate herbal meds, FDA only cares that it is safe.

A. If ph>pka-molecule is de protonated (negative charged acid, neutral base) If ph<pka-molecule is protonated (neutral acid, positively charged base).

A medical emergency arises in the dental office and it is necessary to provide rapid drug therapy to the patient. Which route of drug administration will result in the fastest onset of drug action and produce the most predictable plasma levels? A. Intravenous B. Inhalation C. Intramuscular D. Subcutaneous

A. Intravenous is fast and predictable Inhalation is fast but volatile Intramuscular are intermediate Subcutaneous is intermediate.

Lidocaine is a local anesthetic that is a weak base with a pKa of 7.9 . Relative to normal tissue pH of 7.4, the percentage of lidocaine that is in the protonated form in inflamed tissue at pH 6.4 would be: A. Increased B. Decreased C. Unchanged because both pH's are below the pKa How will this change affect the ability of lidocaine to pass through neuronal membranes to its site of action? A. Increase B. Decrease

A. Increased Lidocaine is a weak base; inflammation is acidic. The protonated form is ineffective at numbing, so the protonated form must be increased in infection. B. Decrease The base is trying to go through the acid, but it will be neutralized in the process.

Drug metabolism usually results in a product that is: A. Less likely to distribute intracellularly B. More lipid soluble than the parent drug C. More likely to be reabsorbed by kidney tubules D. More likely to produce adverse effects.

A. Less likely to distribute intracellularly Lipid soluble drugs are converted to water soluble (polar) components for excretion. Metabolism commonly converts drugs to larger, more hydrophilic, more ionized compounds that can be excreted.

The following equation describes the hyperbolic relationship between the dose of a drug administered and the magnitude of the response obtained: E/Emax= D / (ED50+ D) The term ED50 in this equation is best described as a measure of the: A. The potency of the drug B. The concentration of the drug C. The size of the maximum response D. The power of the drug to bring about a response E. The dose of the drug necessary to bring about the maximum response The dose response equation in Question 26 above also shows that: A. E max will always be larger than EC 50 B. The size of EC 50 depends on the dose of the drug. C. The size of the E max depends on the dose of the drug D. There is a limit to the increases in response that can be achieved by increasing the dose. E. If the dose is very large compared to EC 50 the response will nearly double when the dose is doubled.

A; D

Hydrochlorothiazide is a weakly acidic drug with a pKa of 6.5. If administered orally, at which of the following sites of absorption will the drug be able to most readily pass through the membrane (based solely on % ionized considerations)? A. Oral mucosa (pH 7.0) B. Stomach (pH 2.5) C. Duodenum (pH 6.1) D. Jejunum (pH 8.0)

B. An acid will move most quickly out of the most acidic solution to move toward neutralization.

A side effect that can be seen with a cholinesterase inhibitor is: A. Blurred vision B. Diarrhea C. Drowsiness D. Tachycardia E. Urinary retention

B. (BB SLUDGE)

Which of the following categories of drugs would cross the blood brain barrier well and be expected to exert effects in the central nervous system? A. Highly protein bound drugs B. Highly lipid soluble drugs C. Very large molecules D. Permanently charged drugs

B. Drugs that cannot pass through membranes: large size, protein bound, positive charge, high water solubility.

Acetylcholine is the neurotransmitter released from neurons at all of the following synapses in the peripheral nervous system EXCEPT: A. The neuromuscular junction of voluntary skeletal muscle B. Postganglionic neurons of the sympathetic nervous system to the heart C. Preganglionic neurons of the parasympathetic nervous system D. Preganglionic neurons of the sympathetic nervous system E. Preganglionic neurons to the adrenal medulla

Which of the following poisoning interventions act primarily via increasing the elimination of the toxin? A. Adsorption of the toxin in the GI tract with activated charcoal B. Alkalinization of the urine with sodium bicarbonate C. Gastric lavage with saline solutions D. Induction of emesis with syrup of ipecac E. Producing a cathartic effect with 70% sorbitol

Which of the following drugs causes vasoconstriction that can be blocked by doxazosin? (A1 antagonist) A. Atropine -m antagonist B. Epinephrine- a1, b1/B2 agonist C. Isoproterenol-b1 and B2 agonist D. Lab eta lol- a1, b1, B2 antagonist E. Phenylephrine-a1 agonist

B and E

A patient with a history of episodic attacks of coughing, wheezing, and shortness of breath is being evaluated in the asthma clinic. Several treatments via different routes are under consideration. Which of the following statements about routes of administration is MOST correct? A. Blood levels rise more slowly after intramuscular injection than after oral dosing B. First pass effect results from hepatic metabolism of a drug after oral administration before it enters the systemic circulation C. Administration of anti-asthmatic drugs by inhaled aerosol is usually associated with more adverse effects than is administration of these drugs by mouth D. Bioavailability of most drugs is greater with rectal administration than with sublingual administration E. Administration of a drug by transdermal patch is often faster in onset than oral administration but is associated with more first pass metabolism

A phase I drug metabolism reaction: A. Will always be followed by a phase II reaction B. Is dependent on molecular oxygen (O2) and NADPH as cofactors C. Is more likely to reach saturation (VMAX) levels than phase II reactions D. Will be less likely to decline in activity with aging than phase II reactions

Activation of the flight-or-fight response to an environmental stressor (i.e., sympathetic nervous system activation) will result in decreases in: A. Pupil size B. GI motility C. Blood glucose levels D. Blood flow to skeletal muscle E. Bronchodilation

Blockade of α1-adrenergic receptors would result in the therapeutic action of: A. Relief of nasal congestion B. Lowering of BP in hypertensive individuals C. Prolongation of LA action D. Relief of overactive or unstable bladder

If 30 mg of ketorolac produces the same analgesic potencycalculated response as 200 mg of ibuprofen, which of the following statements is TRUE? a. Ketorolac is more efficacious than ibuprofen B. Ketorolac is more potent than ibuprofen C. Ketorolac is a full agonist and ibuprofen is a partialagonist D. Ketorolac is a better drug to take for pain relief than is ibuprofen

If the dosage regimen for azithromycin (in Question 15) is changed to 500 mg every 24 hours, one will observe that: A. Steady-state will be achieved more rapidly B. A higher steady state plasma level will be attained C. Fluctuations in plasma levels will be decreased D. B and C only E. All of the above

Select the optimal receptor action to increase in cardiac output following cardiogenic shock A. Alpha-1 adrenergic agonist B. Beta-1 adrenergic agonist C. Beta-1 adrenergic antagonist D. Beta-2 adrenergic agonist

The addition of glucuronic acid to a drug molecule: A. Decreases its water solubility B. Usually leads to inactivation of the drug C. Is an example of a phase I reaction D. Occurs at the same rate in adults and newborns E. Involves cytochrome p 450 enzymes.

Which of the following poisoning interventions acts primarily via increasing the elimination of the toxin? A. Adsorption of the toxin in the GI tract with activated charcoal B. Alkalinization of the urine with sodium bicarbonate C. Gastric lavage with saline solutions D. Induction of emesis with syrup of ipecac E. Producing a cathartic effect with 70% sorbitol

A reversible competitive antagonist: A. Causes the potency of an agonist to increase B. Causes the EC50 of an agonist to increase C. Has no effect on the potency of an agonist D. Causes the Emax of an agonist to decrease

B. Equivalent to a decrease in potency.

You are providing dental care for a patient who became dependent on opioids following inappropriate prescribing of Oxycontin for chronic lower back pain. When he was no longer able to get prescription opioids from his physician, he began using intravenous heroin obtained from "the street". He tells you that a friend recently tested positive for Hep B from a contaminated needle. He asks if there is a way to get the drug to his brain as fast or faster than injecting into a vein. You tell him that you learned in dental school that he might try which route of administration? A. Oral B. Inhalation C. Intramuscular D. Rectal E. Subcutaneous

B. Inhalation> intravenous> intramuscular> subcutaneous> oral.

Which of the following organ systems is INCORRECTLY matched with the predominant adrenergic receptor subtype present in that tissue? A. Heart- b1 B. Uterine SM-b1 C. Urinary bladder sphincter-a1 D. Kidney-renin release-b1 E. Radial pupillary dilator muscle-a1

B. Uterine SM-is B2

Multiple mechanisms exist in or near the adrenergic nerve terminal that can diminish the action of norepinephrine. The major action that terminates the synaptic activity of norepinephrine is: A. Metabolism by catechol-O-methyl transferase (COMT) B. Metabolism by monoamine oxidase (MAO) C. Reuptake into neuron by norepinephrine transporter [NET] on nerve terminal) D. Uptake into non-neuronal cells by the Uptake 2 2 transporter E. Metabolism by acetylcholinesterase (AChE)

Select the one best answer: A. Drug A is more powerful and more potent than Drugs B and C B. Drug B is less powerful and less potent than Drugs A and C C. Drug C is more potent and less powerful than Drugs D and E D. Drug D is more powerful and more potent than Drugs B and C E. Drug E is the least powerful and most potent of the five drugs

Which of the following is correct regarding the autonomic nervous system (ANS)? A. Afferent neurons carry signals from the CNS to the effector organs B. The neurotransmitter at the parasympathetic ganglion is norepinephrine (NE) C. The neurotransmitter at the sympathetic ganglion is acetylcholine (ACh) D. Parasympathetic neurons release NE in the effector organs

Which of the following statements concerning the autonomic nervous system (ANS) is FALSE? A. Most organs are innervated by both branches. B. Norepinephrine and acetylcholine are the major neurotransmitters in the ANS. C. Vascular tone is under predominant control of the parasympathetic nervous system. D. Sympathetic responses are generally more diffuse than parasympathetic responses. E. The parasympathetic nervous system is essential for life.

Erythromycin is an antibacterial agent with a half-life of 6 hours . The prescribed dosage regimen is 500 mg every 6 hours. How long will it take to reach steady state using this dosage regimen? A. 12 hrs B. 18 hrs C. 24 hrs D. 30 hrs E. 60 hrs F. 6 days 7a. What is the fluctuation in Cp (plasma levels) between doses? tau = 1 half-life 21 = 2-fold fluctuation

C and D.

Prevention of the formation of toxic metabolites is utilized in the management of poisoning with: A. Drugs with small volumes of distribution B. Drugs that are weak acids or weak bases C. Methanol D. Acetaminophen E. Mercury F. Ethylene glycol G. Inducers of CYP450

C and F

53.Which of the following autonomic nervous system drugs would be MOST likely to predispose a dental patient to cardiac arrhythmias due to an increase in cardiac conduction rate? A. Albuterol B. Atenolol C. Isoproterenol D. Pilocarpine E. Propranolol

A 3-year-old child has swallowed the contents of 2 bottles of a nasal decongestant whose primary ingredient is a selective α-adrenergic agonist drug. Which of the following is a sign of α 1 receptor activation that may occur in this patient? A. Bronchodilation -B2 Sm relaxation B. Tachycardia- increased hr-b1 C. Pupillary dilation (mydriasis)-a1 constricts radiodialators/m3 -pupils get smaller D. Renin release-b1 E. Hypotension-a1 blocker

A 65 year old female (60kg) underwent an outpatient procedure under local anesthesia. You advised her that otc NSAIDs (ibuprofen) should be sufficient for post procedure pain management, but you would also give her a rx for 2-3 days of Tylenol #3 (acetaminophen-codeine) if pain control was inadequate. She informed you that codeine never really worked to control her pain. If true, which of the following cyp450 genetic polymorphism is the most likely reason she does not respond to codeine analgesia. ? A. Fast cyp2e1 metabolizer B. Fast cyp2d6 metabolizer C. Poor cyp2d6 metabolizer D. Poor cyp2c9 metabolizer

Activation of the sympathetic nervous system in response (flight-or-fight response) to an environmental stressor causes epinephrine release from the adrenal gland, resulting in which of the following actions? A. Decreased blood glucose levels B. Pupil constriction (miosis) C. Increase in AV node conduction velocity D. Increased GI motility 2 E. Loss of bladder sphincter tone

In the presence of buprenorphine, a higher concentration of morphine is required to elicit full pain relief. Buprenorphine by itself has a smaller analgesic effect than does morphine, even when given at the highest dose. Based on these observations, which of the following is correct regarding these medications? A. Buprenorphine is a competitive antagonist B. Morphine is a full agonist and buprenorphine is a partial agonist C. Morphine is more efficacious than buprenorphine D. Buprenorphine is less potent than morphine

Select the INCORRECT statement regarding the regulation of pharmacologically active chemicals in the United States. A. Manufacturers of saw palmetto can claim their product will maintain prostate health B. Some prescription-only drug formulations are available in lower strengths as OTC products. C. Herbal medications cannot be sold to the public until their safety has been evaluated by the FDA. D. It is possible for prescription-only drugs to be moved into OTC status after reevaluation by the FDA. E. Advertising claims of herbal medication manufacturers are monitored by the Federal Trade Commission (FTC).

Select the optimal receptor action to increase in cardiac output following cardiogenic shock: A. Alpha-1 adrenergic agonist B. Alpha-1 adrenergic antagonist C. Beta-1 adrenergic agonist D. Beta-1 adrenergic antagonist E. Beta-2 adrenergic agonist F. Muscarinic agonist G. Muscarinic antagonist

THIS EXACT QUESTION WILL BE ON THE EXAM. Which of the following poisoning interventions acts via inhibiting toxic action? A. Alteration of urinary ph (enhances elimination) B. N acetylcysteine (enhancing detoxification) C. Fomepizonle (prevents methanols from going to Formica acid) D. Syrup of ipecac (decreases absorption) E. Activated charcoal (decreases absorption)

The best-documented and quantitatively the most clinically important mechanism by which drug-drug interactions occur is via: A. Antibiotic alteration of intestinal flora B. Physiochemical inactivation of the drug in the stomach C. Inhibition or induction of the metabolism of the drug D. Interference with renal tubular secretion of the drug E. Alterations in gastric motility.

Select the TRUE statement regarding drug equivalency and generic drugs: A. Therapeutic equivalence is less costly costly for a generic manufacturer to satisfy than pharmaceutical equivalence. B. A pharmacist, not the prescribing dentist, has final authority to decide which product is dispensed. C. Extreme caution should be exercised when switching between brands of narrow therapeutic index drugs. D. Generic equivalents should not be substituted for brand drugs when treating acute pain.

C. -Most generics are bioequivalent to brand counterpart...caveat for narrow therapeutic index drugs so do not switch these products. -Pharmaceutical equivalence given in some dose age regimen provide some efficacy with some safety. Therapeutic equivalence is not required for generic drugs (expensive/time consuming). -Prescribing Docs make the final call! -generics have same active ingredient/same pharmacological effects/do not substitute for narrow therapeutic drug index. Avoid switching for: narrow therapeutic index (anti seizure meds), zero order (phenytoin), poor bioavailability drugs.

The half life of a drug: A. Is an independent pharmacokinetic parameter B. Must be known to calculate loading dose (half life is independent) C. Increases when the volume of distribution increases D. Increases when the clearance increases.

C. Half life is directly proportional to Vd

The most common mechanism for drug passage across biologic membranes is: A. Active transport B. Facilitated carrier-mediated diffusion C. Lipid diffusion through membrane itself. D. Aqueous diffusion through membrane pores

C. Majority of drugs 500-800 mg good for drugs with increase in lipid to water partition coefficient. Ph dependent. Unionized moiety crosses the membrane down concentration gradient.

Direct acting parasympathetic agonists are used in the treatment of? A. Asthma B. Peptic ulcers C. Xerostomia D. Diarrhea E. Bradycardia

C. Muscarinic agonist constricts bronchiole SM (A) Secretions in the GI tract increase (B) (Muscarinic antagonists are used to treat diarrhea)-D Use anti Muscarinic to manage (E) Parasympathetic agonist of dentistry-pylocarpine

Identify the enzyme responsible for producing the hepatotoxic metabolite of acetaminophen? A. Alcohol dehydrogenase-methanol toxicity) B. Aldehyde dehydrogenase-Formic acid_) C. Cyp2e1 D. Glutathione s transferase (safe for acetaminophen) E. Glucuronyl transferase (safe for acetaminophen) What about the enzyme responsible for producing the renal toxic metabolite of Ethel Une glycol?

C. Phase I enzymes-10% hepatotoxic metabolite Alcohol dehydrogenase

All of the following side effects are associated with drugs that block muscarinic receptors except: A. Tachycardia B. Blurred vision C. Diarrhea D. Sedation E. Urinary retention

C. Should be constipation

Which of the following are phase II metabolic reactions that make phase I metabolites more readily excretable in urine? A. Oxidation B. Hydrolysis C. Glucuronidation D. Alcohol dehydrogenation

C. The others are phase 1

Erythromycin is an antibacterial agent with a half-life of 6 hours. The prescribed dosage regimen is 500 mg every 6 hours. If the dosage regimen is changed to 1000 mg every 12 hours, how will the time to achieve the new steady state change? A. Increase B. Decrease C. No change

C. You're keeping up with the half life.

Which of the following organ systems is INCORRECTLY matched with the predominant adrenergic receptor subtype present in that tissue? A. Heart - β 1 B. Lungs - β 2 C. Uterine smooth muscle - β 2 D. Urinary bladder sphincter - β 2 E. Kidney-renin release - β 1 F. Radial pupillary dilator muscle - α1

A 3-year-old child is brought to the ED having just ingested a large overdose of promethazine, an antihistamine. Promethazine is a weak base with a pKa of 9.1. It is capable of entering most tissues, including the brain. On physical examination, the heart rate is 100/min, blood pressure 110/60, and respiratory rate 20/min. In this case of promethazine overdose: A. Urinary excretion would be unaffected by administration of NaHCO3, an alkalinizing agent B. More of the drug would be ionized at blood pH than at stomach pH C. Absorption of the drug would be faster from the stomach than from the small intestine D. Urinary excretion would be accelerated by administration of NH4Cl, an acidifying agent

A city clinic is considering the substitution of generic drugs in order to save money. The clinical pharmacologist is asked to advise them on the bioavailability of generic products. She informs the head of the clinic that the bioavailability of drugs is: A. Established by FDA regulation at 100% for preparations for intramuscular injection B. 100% for oral agents that are not metabolized in the liver C. Calculated from the peak concentration of drug divided by the dose administered D. Important because bioavailability determines the fraction of the administered dose that reaches the systemic circulation E. Equal to 1 (100%) only for drugs administered by a parenteral route

A concern when examining patients is the possibility that they may be taking medications that interfere with the function of the baroreceptor reflex and can increase the potential for orthostatic hypotension. This would be most likely to occur with which class of autonomic nervous system drugs? A. Muscarinic antagonists B. Muscarinic agonists C. Cholinesterase inhibitors D. A1 antagonists E. B2 antagonists

A homeless middle-aged male patient presents in the emergency department in a state of intoxication. You note that he is behaviorally disinhibited and rowdy. He tells you that he recently consumed about a pint of a red-colored liquid that his friends were using to "get high". He complains that his vision is blurred and that it is like being in a snow storm. His breath smells like formaldehyde and he is acidotic. Which of the following is the most likely cause of this patient's intoxicated state? A. Ethanol B. Ethylene glycol C. Isopropanol D. Methanol

A phase II drug metabolism reaction: A. Must always be preceded by a phase I rxn (may rarely actually) B. Is dependent on molecular o2 and NADPH as cofactors C. Is less likely to reach saturation levels than phase I reactions. (Phase ii is high likelihood of saturation/phase I: minimal) D. Will be less likely to decline in activity with aging than phase I reactions.

Drug X (EC50 = 2.5 mg/kg) and Drug Y (EC50 = 10 mg/kg) both act on the mu opioid receptor to produce a strong analgesic effect but the maximum response produced by Drug X is greater than that produced by Drug Y. Based on these data it is most correct to say: A. Drug X is more powerful and less potent than Drug Y B. Drug X is equally powerful but more potent than Drug Y C. Drug Y is more powerful and less potent than Drug X D. Drug Y is less powerful and less potent than Drug X

Drug metabolism usually results in a product that is: A. More likely to distribute intracellularly B. More lipid soluble than the parent drug C. More likely to be reabsorbed by kidney tubules D. More water soluble than the parent drug E. More likely to produce adverse effects

If the plasma concentration of a drug declines with "first-order kinetics", this means that: A. The drug is not distributed outside the vascular system B. The half life is dependent on the plasma concentration C. The drug is largely metabolized in the liver after oral administration and has low bioavailability D. The rate of elimination is constantly changing as the plasma concentration declines.

Regarding the termination of drug action: A. Drugs must be excreted from the body to terminate their action. (Usually inactivated prior to excretion) B. Metabolism of drugs will always increase their degree of ionization. (Not always) C. Metabolism of drugs always abolishes their pharmacologic activity. asaturationofhepaticmembolieproasesCpuseaconjugations Samatarison.wiretoourcoloredexcretoryprocesses D. Hepatic metabolism and renal excretion are the two most important mechanisms involved.

Regarding the termination of drug action: A. Drugs must be excreted from the body to terminate their action. B. Metabolism of drugs will always increase their degree of ionization. C. Metabolism of drugs always abolishes their pharmacologic activity. D. Hepatic metabolism and renal excretion are the two most important mechanisms involved.

Symptoms of allergic rhinitis include nasal congestion (vasodilation) and runny nose (edema) caused by histamine's interaction with H1receptors on blood vessels. Loratadine is a treatment of choice, working via a competitive blockade of histamine H 1receptors on blood vessels. The role of loratadine in the treatment of allergic rhinitis is best described as: A. Chemical antagonism B. Noncompetitive antagonism C. Partial agonism D. Pharmacologic antagonism E. Physiologic antagonism

Symptoms of allergic rhinitis include nasal congestion (vasodilation) and runny nose (edema) caused by histamine's interaction with H1 receptors on vascular smooth muscle. Loratadine is a treatment of choice, working via a competitive blockade of histamine H1 receptors on blood vessels. The role of loratadine in the treatment of allergic rhinitis is best described as: A. Chemical antagonism B. Noncompetitive antagonism C. Pharmacologic antagonism D. Physiologic antagonism

The most common mechanism of action for indirect acting cholinergic agonists is: A. Inhibition of acetylcholine metabolism in the presynaptic agonistsdothisosed neuron lesstendirectadamerg agonists B. Inhibition of acetylcholine reuptake from the synapse into the presynaptic neuron C. Enhancement of acetylcholine release from presynaptic neurons D. Inhibition of acetylcholine metabolism in the synapse

Which of the following drug dosage regimens would result in the LEAST amount of fluctuation in the plasma drug level during the dosing interval? A. Drug E (t 1/2 = 1.5 hrs) dosed every 8 hours B. Drug A (t1/2 = 6 hrs) dosed every 6 hours C. Drug C (t 1/2 = 24 hrs) dosed every 3 days D. Drug D (t1/2 = 12 hrs) dosed every 6 hours

Which of the following statements concerning the ANS is true? A. Most organs are innervated only by the PNS. B. Ne and E are the major NT in the ANS (its actually NE and AcH) C. Vascular tone is under predominant control of the PNS (if there is any tone at all, its SNS) D. Sympathetic responses are generally more diffuse/widespread than parasympathetic responses.

Which of the following statements concerning the consequences of increasing the binding of a drug to plasma proteins is TRUE? A. Increases the plasma concentration of therapeutically active drug. B. Increases elimination of drug by metabolism in the liver and/or excretion in the kidney. C. Decreases the dose that must be administered to achieve therapeutic effectiveness. D. Increases the possibility of adverse interactions with other drugs that bind plasma proteins.

Which of the following statements concerning routes of drug administration is TRUE? A. An increase in gastric motility generally results in a decrease in the rate of oral absorption. B. The onset of action from the sublingual route of administration is slower than that from the IM route. C. Transdermal route of administration is designed to maximize local drug effects and avoid systemic effects. D. A permanently charged drug administered by IM injection will not be able to cross the blood brain barrier and enter the CNS

D. -ionized drugs cannot cross tight junctions or bbb. An increase in gastric motility results in an increase of rate of absorption -sublingual has onset within minutes: high bioavailability IM: rapid onset of 5-10 mins for aqueous solutions/absorption can be erratic/incomplete if drug solubility in solution is limited/depot form. -transdermal is for systemic effects, not local. Inhalation is systemic and local. Topical is local. Subcutaneous is local and not systemic.

3. A noncompetitive irreversible antagonist: A. Causes the potency of an agonist to increase B. Causes the EC 50 of an agonist to increase C. Causes the E max of an agonist to increase D. Causes the Emax of an agonist to decrease

D. Also has no effect on the potency of an agonist.

Side effects that can be seen with a cholinesterase inhibitor include: Think of BB sludge: Bronchoconstriciton Bradycardia Salivation LAcrimation, urination, defecation, gastric upset, emesis A. Blurred vision B. Drowsiness C. Tachycardia D. Excessive salivation E. Constipation

D. Blurred vision has anti cholinergic side effects Drowsiness: sedation=muscarinic antagonists Bradycardia would be seen here, not tachycardia Diarrhea not constipation.

Which of the following organ systems is INCORRECTLY matched with the predominant adrenergic receptor subtype present in that tissue? A. Heart - β1 B. Bronchiolar smooth muscle - β2 C. Bladder sphincter - α1 D. Uterine smooth muscle - α1 E. Urinary bladder sphincter - α1 F. Radial pupillary dilator muscle - β1

D. Uterine SM should be B2 ; F. Radial pupilllary dilator should be a1

Alcohol is a small hydrophilic molecule that is most likely to pass across biologic membranes via: A. Active transport B. Facilitated carrier-mediated diffusion C. Lipid diffusion through membrane itself. D. Aqueous diffusion through membrane pores

D. -water soluble drugs go through aqueous channels. -facilitated diffusion via carrier molecules (p glycoproteins) -specialized transporters in cell membrane, regulate entry/exit of important physiologic molecules (sugars, AA, NT, Xeon biotechs) -lipid diffusion is good for high lipid, water partition coed/ ph important mechanism for drugs over 500-800 MW, unionized moiety crosses down Concentration gradient.

In the presence of naloxone, a higher concentration of morphine is required to elicit full pain relief. Naloxone by itself has no effect. Which of the following is correct regarding these agents? A. Morphine is a full agonist and naloxone is a partial agonist B. Morphine is less efficacious than naloxone C. Morphine is less potent than naloxone D. Naloxone is a competitive antagonist.

D. Naloxone reduces apparent affinity of morphine. Patient dependent on full agonist will experience withdrawal when given partial agonist or antagonist.

Nicotinic receptor sites include all of the following except: A. Adrenal medullary cells B. Parasympathetic ganglia C. Skeletal muscle end plates D. Bronchial smooth muscle E. Sympathetic ganglia.

D. Parasympathetic receptor here is muscarinic M3 and Beta 2 agonist--albuteral works this way

A 30-year-old patient with status epilepticus is placed on phenytoin in the emergency room. In order to achieve therapeutic concentrations rapidly, a loading dose is used. The loading dose should be equal to which of the following? A. 4.5 times the half-life of the drug B. The amount of drug in the body divided by the plasma concentration C. The drug's clearance times the desired plasma concentration D. The volume of distribution times the desired plasma concentration

D. Phenytoin is an anti seizure medication; LD: initial higher dose of a drug given at the beginning of a course of treatment before dropping to a lower maintenance dose.

Select the TRUE statement regarding regulation of pharmacologically active chemicals in the U.S. A. Herbal medicines are required to undergo the same testing for safety and efficacy as prescription drugs. B. The drug must be tested in ≥ 10,000 patients prior to FDA approval, allowing detection of low incidence Adverse Drug reaction (ADR). C. Children and women of childbearing age are routinely included from phase I-III clinical trials. D. Manufacturers of saw palmetto are allowed to claim their product will maintain healthy prostate function.

D. Saw palmetto is herbal so no proof of efficacy is required. Herbal meds are similar to OTC so no FDA approval is needed. RX: safety must be studied, found acceptable and have detailed evidence of efficacy required via clinical trials. Phase I: 20-100 ppl/ phase II:100-300 ppl/ phase III:1000-3000 ppl. Women and children are excluded.

Which route of drug administration has the most rapid onset of action? A. Intravenous B. Transdermal C. Intramuscular D. Subcutaneous E. Inhalational

E. Rate of absorption speed: inhalation/>intravenous>ingramuscular>subcutaneous>oral

An action common to both indirect-acting adrenergic and indirect-acting cholinergic agonists is: A. Inhibition of acetylcholinesterase B. Inhibition of monoamine oxidase C. Inhibition of choline uptake into the neuron D. Inhibition of the norepinephrine transporter (NET) E. Increase of endogenous neurotransmitter levels in the synapse

The standard safety margin is superior to the therapeutic index in evaluating the safety of a drug because: A. Standard safety margins are more easily determined than therapeutic indices. B. Data on standard safety margins are more widely available than data on therapeutic indices. C. The therapeutic index often exaggerates the danger in the use of a particular drug. D. The therapeutic index only provides information on the range of plasma concentrations over which the drug is clinically effective. E. The standard safety margin takes into account the response of individuals at the extremes of the population dose-response curves for therapeutic and toxic effects.

32.The therapeutic indices of Drugs A, B, C, D, and E from Question 31 above are given below: Drug A: 3.5 Drug B: 25 Drug C: 12 Drug D: 10 Drug E: 15 Assuming that the therapeutic indices give a reliable indication of the safety of the drugs, which drug would be the safest and most effective drug to use clinically? A. Drug A B. Drug B C. Drug C D. Drug D E. Drug E

AcH drugs used to treat overactive bladder can cause A. Dry mouth B. Dry eyes C. Confusion in the elderly D. Constipation E. All of the above

All of the following drugs or foods are inhibitors of various cytochrome P450 enzymes EXCEPT: A. Antifungal agents (e.g., ketoconazole) B. Cimetidine C. Grapefruit juice D. Macrolide antibiotics (e.g., erythromycin) E. Phenobarbital

Common, expected signs of epinephrine toxicity following administration of an Epi-Pen would most likely include: A. Miosis B. Fatigue C. Sweating D. Drowsiness and sedation E. Increased blood pressure F. Urinary incontinence (loss of bladder control)

Drug X (EC50 = 2.5 mg/kg) and Drug Y (EC 50= 10 mg/kg) both act on the mu opioid receptor to produce a strong analgesic effect. The maximum response produced by Drug X is equal to that produced by Drug Y. Based on these data it is most correct to say: A. Drug X is more powerful and less potent than Drug Y B. Drug X is equally powerful but less potent than Drug Y C. Drug X and Drug Y are partial agonists D. Drug Y is more powerful and less potent than Drug X E. Drug Y is equally powerful but less potent than Drug X

For drugs that are metabolized by the cytochrome P450 (CYP450) enzyme system they: A. Require molecular oxygen B. Are generally highly lipid soluble C. Usually become more highly oxidized D. Are unlikely to undergo zero-order metabolism at highdoses E. All of the above

For drugs that are metabolized by the phase 1 CYP450 (cytochrome P450) enzyme system they: A. Require molecular oxygen B. Are generally highly lipid soluble C. Usually become more highly oxidized D. Are metabolized in the smooth endoplasmic reticulum E. All of the above

If the plasma concentration of a drug declines with "first-order kinetics", this means that: A. There is only one metabolic path for drug elimination B. The drug is not distributed outside the vascular system C. The half-life is proportional to the Cp D. The drug is largely metabolized in the liver after oral administration and has low bioavailability E. The rate of elimination changes as the plasma concentration changes

In the presence of naloxone, a higher concentration of morphine is required to elicit full pain relief. Naloxone by itself has no effect. Which of the following is correct regarding these agents? A. Naloxone is a noncompetitive antagonist B. Morphine is a full agonist and naloxone is a partial agonist C. Morphine is less efficacious than naloxone D. Morphine is less potent than naloxone E. Naloxone is a competitive antagonist

Select the optimal receptor action to decrease GI motility in patients with diarrhea A. Alpha-2 adrenergic agonist B. Alpha-1 adrenergic antagonist C. Beta-2 adrenergic agonist D. Muscarinic agonist E. Muscarinic antagonist

Symptoms of viral colds include nasal congestion (vasodilation) and runny nose (edema) caused by the interaction of histamine with H1 receptors on blood vessels. Phenylephrine (Neosynephrine® nasal spray) is a treatment of choice for cold symptoms, working via an agonist action on a1-adrenergic receptors on blood vessels to cause vasoconstriction. The role of phenylephrine in the treatment of allergic rhinitis is best described as: A. Chemical antagonism B. Noncompetitive antagonism C. Partial agonism D. Surmountable antagonism E. Physiologic antagonism

The oral bioavailability of a drug will be reduced by: A. Destruction of orally administered drug by the low pH of the gastric contents B. Destruction of orally administered drug by digestive enzymes C. Hepatic metabolism of a drug prior to entry into the systemic circulation D. Gastric metabolism of a drug prior to entry into the systemic circulation E. All of the above

Which of the following types of drug studies involve testing drug efficacy? A. Phase 1 B. Phase 2 C. Phase 3 D. Phases 1 and 2 E. Phases 2 and 3 F. Phases 1, 2, and 3

E. In phase I, patients do not yet have a condition. Pre clinical testing--animal study, pharmacology, metabolism, acute chronic toxicity in rodent/non rodent species. "What is a safe dosage for humans?"

All of the following drugs or foods are inhibitors of various cytochrome p450 enzymes except.? A. Antifungal agents B. Cimetidine C. Grapefruit juice D. Macro life antibiotics/erythromycin) E. Phenytoin

E. Phenytoin is an inducer.

Which of the following statements concerning the Controlled Substances Act of 1970 is INCORRECT? A. Schedule I drugs can only be used for research purposes and may not be prescribed. B. Prescriptions for schedule II drugs may not be refilled. C. Prescriptions for schedule III and IV drugs may be telephoned to a pharmacist. D. Prescriptions for schedule III and IV drugs can be refilled 5 times within 6 months. E. Dentists are required to register with the DEA (Drug Enforcement Administration) in order to prescribe controlled substances. F. Use of Schedule IV drugs has a greater potential for abuse than use of Schedule II drugs. G. Schedule V drugs can be obtained without a prescription in certain states.

Common, expected signs of epinephrine toxicity would most likely include: A. Miosis B. Fatigue C. Nausea and sweating D. Drowsiness and sedation E. Decreased blood pressure F. Hyperglycemia

For the majority of poisoning cases, the mainstay of treatment will be: A. Administration of activated charcoal B. Administration of osmotic cathartics C. Alteration of urinary pH D. Emptying of stomach contents with gastric lavage E. Induction of vomiting with syrup of ipecac F. Support of vital functions.

Select the optimal receptor action to increase salivary flow for treatment of radiation-induced xerostomia A. Alpha-1 adrenergic agonist B. Alpha-1 adrenergic antagonist C. Beta-1 adrenergic agonist D. Beta-1 adrenergic antagonist E. Beta-2 adrenergic agonist F. Muscarinic agonist G. Muscarinic antagonist

The results shown in the graph below were obtained in a comparison of 3 positive inotropic agents: Drugs A, B, and C. Which of the following statements is MOST correct? A. Drug A is most effective. B. Drug A is least potent. C. Drug C is most potent. D. Drug A is a noncompetitive irreversible antagonist of drug B E. Drug B is more potent and more effective than drug A. F. Drug A is more potent than drug B but less effective than drug C.

Which of the following types of drug studies involve testing drug safety? A. Phase 1 B. Phase 2 C. Phase 3 D. Phases 1 and 2 E. Phases 2 and 3 F. Phases 1, 2, and 3

An 18 year old female patient is brought unconscious to the ED due to heroin overdose. Which of the most following routes of administration is the most desirable for administering the antagonist naloxone? A. Intramuscular B. Subcutaneous C. Intranasally D. Inhalation E. Transdermal F. Intravenous

F. IM, subcutaneous and intranasally also work but not as fast. Inhalation is good for local topical effect/reduces systemic affect. Transdermal is like smoking/nicotine patients.

For the majority of poisoning cases, the mainstay of treatment will be: A. Administration of activated charcoal B. Administration of osmotic cathartics C. Alteration of urinary pH D. Emptying of stomach contents with gastric lavage E. Hemodialysis F. Induction of vomiting with syrup of ipecac G. Support of vital functions

Select the optimal receptor action to decrease GI motility in patients with diarrhea A. Alpha-1 adrenergic agonist B. Alpha-1 adrenergic antagonist C. Beta-1 adrenergic agonist D. Beta-1 adrenergic antagonist E. Beta-2 adrenergic agonist F. Muscarinic agonist G. Muscarinic antagonist

A patient is given a single 200 mg dose of Drug Y and the plasma concentration is obtained at 6 time points afterward as follows. Assume instantaneous distribution of drug. 0 hr -------------- 8 mg/L 2 hr -------------- 7 mg/L 4 hr -------------- 6 mg/L 8 hr -------------- 4 mg/L 10 hr ------------- 3 mg/L 12 hr ------------- 2 mg/L 16 hr ------------- 0 mg/L Based on these data, the volume of distribution of Drug Y is:

Vd=dose/cp--25L

A patient is given a single 500 mg dose of Drug Y and the plasma concentration is obtained at 6 time points afterward as follows: 0 hr -------------- 8000 mcg/L 2 hr -------------- 7500 mcg/L 4 hr -------------- 7000 mcg/L 8 hr -------------- 6000 mcg/L 10 hr ------------- 5500 mcg/L 12 hr ------------- 5000 mcg/L 16 hr ------------- 4000 mcg/L 24 hr-------------- 2000 mcg/L Are these data are consistent with first order or zero order elimination kinetics?

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