Pharmacology Test 1 multiple choice

hepatic metabolism and renal excretion

Which of the following major routes remove etomidate and midazolam from the body? A. hepatic metabolism and renal excretion B. excretion through the lungs and sweating C. accumulation in fat tissue and redistribution D. increased salivation and bile production E. gastrointestinal reabsorption

tolterodine

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

methylphenidate- MAOI

Which of these represents the drug that is not correctly matched with its drug classification? A. paroxetine—SSRI B. amitriptyline—TCA C. methylphenidate—MAOI D. duloxetine—SNRI E. phenelzine—MAOI

producing complimentary effects using a few drugs avoids unnecessary intense (deep) CNS depression with one anesthetic to achieve the same effect

12. What is the best reason for using a balanced anesthesia strategy? A. producing complementary effects using a few drugs avoids unnecessary intense (deep) CNS depression with one anesthetic to achieve the same effect B. the concentration of volatile anesthetic in the alveoli is balanced against the amount of anesthetic in the blood C. less monitoring of anesthesia is required D. fewer patients experience emergence delirium E. there is less chance of aspirating saliva

there are two groups in this class, either depolarizing agents and nondepolarizing agents

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

peripheral neuromuscular receptor blockade after stimulating the Nm receptors

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

tolerance develops to the analgesic response

6. All opioid analgesics are associated with which of the following? A. reversal of respiratory depression from barbiturates B. use only for the relief of acute pain C. cough suppression alone or in combination with other analgesics over-the-counter D. tolerance develops to the analgesic response E. drug of choice in treating biliary obstruction

all of these

9. Opioid drugs are derived from which of the following? A. poppy B. opium C. chemical synthesis D. alkaloids E. all of these

increase nrem stage 2 sleep

Barbiturate and benzodiazepine hypnotics both A. increase NREM stage 2 sleep B. increase REM sleep C. increase NREM stage 4 sleep D. cause REM rebound E. all of these statements are true

induction of monitored anesthesia care and treatment of chronic severe pain

Opioid analgesics are used in which of the following settings? A. induction of Monitored Anesthesia Care and treatment of chronic severe pain B. routine treatment of migraine C. unmonitored treatment of chronic severe pain D. analgesia for patients with paralytic ileus E. chronic osteoarthritis

relaxation of the skeletal muscle controlling posture

Oxycodone in therapeutic doses can stimulate mu receptors to cause A. hyperventilation and deep breathing B. bronchospasms C. spasmogenic activity in the ureters and sphincter muscle D. relaxation of the skeletal muscles controlling posture (spasmolytic) E. suppression of coughing

muscarinic

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

reversible acetylcholinesterase inhibitor

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

none of these

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

downregulation

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

all of these

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

trade name

Th e proprietary drug name supplied by a pharmaceutical company is also referred to as the generic name over the counter name trade name chemical name none of these

tolcapone

The COMT inhibitor that has been associated with causing liver toxicity is A. ropinirole B. entacapone C. pramipexole D. tolcapone E. benztropine

all of these

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

blockage of serotonin receptors

The antianxiety effect of buspirone (BuSpar) is associated with A. stimulation of DA receptors B. stimulation of serotonin receptors C. blockage of serotonin receptors D. blockade of dopamine receptors E. blockage of GABA receptors

physostigmine

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

benzodiazapines increase chloride channel opening

The correct statement concerning the use of hypnotic drugs is A. zolpidem binds to the GABA receptor B. benzodiazepines increase chloride channel opening C. barbiturates block the GABA receptor D. ramelteon is a melatonin antagonist E. flumazenil is a benzodiazepine receptor agonist

it is a complete anesthetic witha quick onset of action and recovery period uncomplicated by nausea and vomiting

Why is propofol a drug of choice for induction and maintenance of anesthesia? A. it is a potent analgesic at all doses B. it slowly brings the patient to the stage of surgical anesthesia C. it is a complete anesthetic with a quick onset of action and recovery period uncomplicated by nausea and vomiting D. it is administered by special vaporizer to avoid mask delivery E. its preparation does not require special handling technique

binds to the alpha 1 subunit of the GABA A receptor

Zolpidem A. binds to the alpha-1 subunit of the GABA A receptor B. is useful as a muscle relaxant C. has a slow onset of action D. is useful as an anticonvulsant E. is chemically classified as a benzodiazepine

controlled substance

a drug that has the potential for abuse and is regulated by the Drug Enforcement agency is classified as a poison OTC drug prescription drug controlled substance non proprietary drug

nonprescription

a medication that does not require a physicians service to obtain is referred to as trade nonproprietary nonprescription brand generic

noncompetitive antagonist

lowers efficacy -competitive antagonist -partial agonist - inverse agonist -share receptor -noncompetitive antagonist

Vasoconstriction

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

all of these

The pharmacologic effects of TCAs include A. alpha-adrenergic blockade B. antihistaminic C. anticholinergic D. sedation E. all of these

selective serotonin reuptake inhibitors

The serotonin syndrome is mainly associated with overdosage of A. tricyclic antidepressants B. monoamine oxidase inhibitors C. selective serotonin reuptake inhibitors D. psychomotor stimulants E. lithium

Limbic System

The site of action of diazepam (Valium) to relieve anxiety is the A. spinal cord B. limbic system C. reticular formation D. basal ganglia E. cerebellum

C) Pharmacokinetics

The study of drug absorption, distribution, metabolism, and excretion is known as: A Pharmacotheraputics B Pharmacodynamics C Pharmacokinetics D Pharmacy E Posology

Onset of action

The time from drug administration to the first observable drug effect is known as the duration of action ceiling effect maximal response ceiling effect onset of action

liver

first pass metabolism refers to the metabolism of drugs in the kidney blood vessels liver heart adipose tissue

lipid soluble

in order for drugs to cross the blood brain barrier they must be ionized positively charged water soluble lipid soluble negatively charged

Physiologic antagonist

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

acetylcholine

A 17-year-old girl with suspected intrinsic asthma but nearly normal results on spirometry and flow volume testing takes a methacholine provocative test. The mechanism of action of methacholine most closely resembles that of hemicholinium. acetylcholine. edrophonium. succinylcholine. neostigmine.

blocks acetylcholinesterase

A 25-year old female presents with delirium, hyperthermia, and symptoms of central anticholinergic intoxication. She has attended a ìwitches' conventî and ingested some herbal extracts including fruits of the species ìAtropa belladonna.î As one component of her treatment, she receives a dose of physostigmine. How does physostigmine work

its target receptor cell type distribution

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

suicide substrates

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

tachyphylaxis

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

all of these

Adverse effects of TCAs include A. liver toxicity B. cardiac arrhythmias C. convulsions D. postural hypotension E. all of these

all of these

Alcohol has pharmacological effects on which body systems? A. central nervous system B. gastrointestinal system C. renal system D. vascular system E. all of these

idiosyncrasy

An unusual or unexpected drug reaction by an individual is known as toxic effect antagonism idiosyncrasy side effect drug allergy

increased gastrointestinal effects

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

dopamine receptor agonist

Apomorphine is classified as A. MAO-B inhibitor B. dopamine receptor agonist C. COMT inhibitor D. anticholinergic drug E. DOPA decarboxylase inhibitor

beta 2 receptors

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

intravenous

Choose the correct class of general anesthetics. A. intravenous B. dissociative anesthesia C. oral D. topical E. epidural

all of these

Disadvantages to the use of barbiturate hypnotics include A. development of drug tolerance B. risk of drug dependency C. disruption of normal stages of sleep D. suppression of REM sleep E. all of these statements are true

X

Drugs that have demonstrated teratogenic effects in women are classified as Pregnancy Category B c d x nr

fewer receptors are available to produce a response

During tolerance to opioid analgesics, the following is happening. A. fewer receptors are available to produce a response B. increased pain by the patient requires greater doses of medication C. the body reacts to removal of the opioid analgesic D. histamine release causes hypotension E. signals from nocieocptors are reduced

all of these

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

increases total sleep time

Eszopiclone A. is classified as a benzodiazepine B. has a half-life of 1-2 hours C. increases total sleep time D. is used as an antianxiety agent E. is also used as an anticonvulsant

Category A

FDA pregnancy category that is the safest A B C D X

can be used for relief of cancer pain

Fentanyl is an opioid analgesic that A. can be used for relief of cancer pain B. has many formulations (lozenge, film) because it is used routinely in dental surgery C. induces neuropathic pain D. primarily works on peripheral nerve endings rather than higher centers E. does not have a black box warning because of its low addiction potential

alprazolam (benzodiazepine)

Flumazenil (Romazicon) is used to reverse the depressant effects of A. clozapine B. alprazolam (benzodiazepine) C. haloperidol D. chlorpromazine E. thiothixene

all of these

Flurazepam A. is classified as long-acting B. forms active metabolites C. may cause next-day residual effects D. increases chloride ion influx E. all of these statements are true

bradykinesia

In Parkinson's disease, slowed movements are defined as A. rigidity B. bradykinesia C. tremor D. dystonia E. postural instability

a rise in cytosolic Calcium

In the presynaptic terminal of neuronal cells, the immediate trigger to release a neurotransmitter from synaptic vesicles into the synaptic cleft is A) a drop in cytosolic Ca2+. B) a drop in cytosolic K+. C) a rise in cytosolic Ca2+. D) a drop in cytosolic Mg2+. E) a rise in cytosolic K+. F) a rise in cytosolic Mg2+.

selective beta 1 blocker

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

it is a nonpolar compound that penetrates the CNS more easily than neostigmine

Refer to the case above. Physostigmine is preferred over neostigmine because -it is a nonpolar compound that penetrates the CNS more easily than neostigmine. -it has a shorter half-life than neostigmine, making it more useful for emergency treatment. -it has a longer half-life than neostigmine, better matching the half-life of atropine. -it is eliminated via the kidneys, and dosage is not critical with compromised liver function. -it is eliminated via the liver, and dosage is not critical with compromised renal function.

constipation

Select the adverse effects of opioid analgesics. A. constipation B. polyuria C. convulsions D. mydriasis E. excessive tearing

all of these

Select the drugs that increase the duration of action of DA and/or the amount of levodopa that enters the brain. A. carbidopa B. tolcapone C. selegiline D. rasagiline E. all of these

all of these

Select the mechanisms by which levodopa works. A. crosses blood-brain barrier by an amino acid transporter B. converted to dopamine in the substantia nigra neurons C. increases level of dopamine in the brain D. peripheral metabolism to DA inhibited by carbidopa E. all of these

increased gastrointestinal motility

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

all of these

Select the symptoms of Parkinson's disease A. muscular rigidity B. increased sweating C. salivary drooling D. movement disturbances E. all of these

local anesthesia

Select the types of anesthesia in which there is no loss of consciousness. A. local anesthesia B. Monitored Anesthesia Care C. general anesthesia D. balanced anesthesia E. maintenance anesthesia

Myelinated A delta fibers

Sharp pain is transmitted through which type of nerve fibers? A. unmyelinated B. myelinated A-delta C. CTZ D. C fibers E. mu fibers in the intestine

carbidopa

Sinemet is the trade name of a drug combination that contains levodopa and A. carbidopa and entacapone B. entacapone C. carbidopa D. selegiline E. amantadine

all of these

Symptoms of Parkinson's disease would be increased by A. excess levels of acetylcholine B. treatment with some antipsychotic drugs C. decreased levels of dopamine D. drug administration after a high-protein meal E. all of these

ropinirole

The drug classified as a dopamine receptor agonist is A. amantadine B. benztropine C. ropinirole D. entacapone (COMT) E. carbidopa

epinephrine

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

increase levels of serotonin

The main pharmacologic effect of the SSRIs is A. increase levels of norepinephrine B. increase levels of serotonin C. decrease levels of norepinephrine D. decrease levels of serotonin E. decrease levels of dopamine

increase norepinephrine and serotonin only

The main pharmacologic effects of TCAs on neurotransmitter activity is A. increase norepinephrine B. increase acetylcholine C. increase serotonin D. increase norepinephrine and serotonin only E. increase norepinephrine, acetylcholine, and serotonin

formation of a false transmitter in adrenergic nerve ending

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

Contraindication

The medical situation when a particular drug should not be administered is referred to as side effect adverse effect drug allergy contraindication antagonism

muscarinic m2 receptor

The muscarinic receptor that couples to G proteins responsible for adenylyl cyclase inhibition and plays a key role in cholinergic input to the heart is classified as A) muscarinic-M1 receptor. B) muscarinic-M2 receptor. C) muscarinic-M3 receptor. D) muscarinic-M4 receptor. E) muscarinic-M5 receptor.

SNRI

Venlafaxine (Effexor) is classified as A. MAOI B. TCA C. SSRI D. SNRI E. psychomotor stimulant

all of these

What are the main areas at which benzodiazepines exert their effects? A. limbic system B. cerebral cortex C. reticular formation D. spinal cord E. all of these

tranylcypromine (MAOI)

Which drug requires a dietary restriction for foods containing tyramine? A. nortriptyline (TCA) B. tranylcypromine (MAOI) C. venlafaxine (SNRI) D. fluoxetine (SSRI) E. methamphetamine

all of these

Which drugs would be used as adjunct therapy to anesthesia? A. analgesics B. antiarrhythmics C. antianxiety, short-acting CNS depressants like midazolam D. anticholinergics E. all of these

all of these

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

acetaminophen

Which of the following drugs has a recognized medical therapy and does not interact with opioid receptors? A. heroin B. codeine C. methadone D. acetaminophen

procyclidine

Which of the following drugs would be used to decrease the actions of ACH? A. amantadine B. levodopa C. bromocriptine D. procyclidine E. carbidopa

ketamine causes chloride ions to flow out of the nerve cell by binding to GABA

Which of the following is NOT correct? A. ketamine causes chloride ions to flow out of the nerve cell by binding to GABA B. propofol binds to the GABA A receptor and enhances hyperpolarization of the neuron C. barbiturates and propofol act on the receptor and directly on the chloride channel D. potent anesthetics enhance GABA A receptor function E. general anesthetics interact with neurotransmitter-gated ion channels

agonism means the drug occupies the receptor and causes a response

Which of the following is a correct statement? A. endorphin is an abbreviation from the terms meaning inside the organ B. endogenous opioid receptors include mu, alpha-2 adrenergic, and delta receptors C. agonism means the drug occupies the receptor and causes a response D. opioid agonism means the drug occupies the receptor and stimulates the release of endorphins E. tolerance is a characteristic of chronic opioid antagonism

in low doses opioids produce nausea and vomiting

Which of the following is a correct statement? A. opioid analgesics produce little or no respiration depression with long-term use of analgesic doses B. opioid antagonists include endorphins C. all drugs in the opioid analgesic group are controlled substances, Schedule III D. in low doses, opioids produce nausea and vomiting E. fentanyl is a partial opioid antagonist

placebo effect

factor of individual variation is dependent upon patients attitude toward treatment weight age genetic variation placebo effect gender

transdermal

drug administration route demonstrating slowest onset of action inhalation transdermal intramuscular sublingual intravenous

lipid solubility

rate of drug absorption increased by drug ionization water solubility positively charged drug negatively charged drug lipid solubility

vasoconstriction

the main pharmacologic effect of norepinephrine on alpha 1 receptors is increased heart rate broncodilation vasoconstriction contraction of urinary bladder increased force of myocardial contraction

Posology

the study of the amount of drug administered to produce a therapeutic effect posology toxicology pharmacodynamics pharmacotherapeutics pharmacy

duration of action

the time a drug continues to produce effects is its ed50 maximal response ceiling effect onset of action duration of action

enzyme induction

when a drug increases the rate of drug metabolism of other drugs, it is called first pass metabolism enzyme induction enzyme inhibition enterohepatic cycling microsomal inhibition

all of these

which of the following could be categorized as an adverse reaction? idiosyncrasy drug allergy teratogenicity carcinogenicity all of these