Pharm Exam Three
In which of the following patients is the use of barbiturates contraindicated?
Raphael, a 30-year-old man, who has acute intermittent porphyria
Which of the following statements is true of the basal ganglia?
The basal ganglia help regulate skeletal muscle activity.
Select the correct indication of use for zaleplon (Sonata).
Zaleplon is used in individuals who have difficulty falling asleep, but it does not increase total sleep time.
Select the group that contains hypnotic drugs listed in order of increasing duration of action.
Zaleplon, estazolam, flurazepam
Identify a difference between "typical" antipsychotic drugs and "atypical" antipsychotic drugs.
"Typical" antipsychotic drugs primarily block D2 receptors, whereas "atypical" antipsychotic drugs primarily block 5HT2A receptors.
Explain the pharmacologic actions of bupropion (Wellbutrin).
- Bupropion increases the release of norepinephrine and dopamine. - Bupropion inhibits the reuptake of norepinephrine and dopamine. - Bupropion has minimal effects to inhibit the reuptake of serotonin.
Which of the following is a difference between mania and depression?
- Depression is a mental state characterized by feelings of hopelessness, frustration, and depressed mood, whereas mania is characterized by excitement, hyperactivity, and elevated mood. - Depression is treated with SSRIs, whereas mania is treated with lithium. - Depression is associated with low levels of norepinephrine and/or serotonin, while high levels of norepinephrine and/or serotonin are involved in mania.
Describe the type of disorder that responds to lithium treatment.
- Disorders characterized by alternating cycles of depression and mania - Disorders characterized by hyperactivity and excessive elevation of mood - Disorders characterized by wide shifts in mood
Identify a difference between secondary amines and tertiary amines.
- Tertiary amines contain three amine substitutions on the nitrogen, whereas secondary amines contain two amine substitutions on the nitrogen. - Secondary amines mainly increase brain levels of norepinephrine more than serotonin, while the tertiary amines increase brain levels of serotonin more than epinephrine. - Tertiary amines produce more sedation than do the secondary amines.
Identify the possible cause of nausea, vomiting, and headache that an alcoholic patient is experiencing while taking disulfiram.
Acetaldehyde is accumulating in the blood, causing these symptoms to occur, The patient may be drinking alcoholic beverages while taking disulfiram, The patient may be using OTC products that contain alcohol while taking disulfiram.
Which of the following is not a method of treating parkinsonism which may develop from the continued use of a phenothiazine?
Administering a dopamine agonist
Which of the following is not one of the procedures used in the treatment of amphetamine intoxication?
Administering an anticholinergic
Alison is rushed to the hospital after suffering a serious head injury in a car accident. Dr. Jacob takes a few specialized scans of Alison's head to locate the site of injury in her brain. All the scans indicate damage to the temporal lobe of the brain. Alison's parents ask Dr. Jacob if Alison's functions will be impaired as a result of this brain injury. What is Dr. Jacob most likely to say?
Alison may lose her memory.
Which of the following is true of the use of psychomotor stimulants in the treatment of narcolepsy and hyperactivity?
Amphetamines have the disadvantage of producing drug tolerance and dependence.
_____ is an endogenous substance in the brain that is thought to bind to the cannabinoid receptors.
Anandamide
Flurazepam (Dalmane) is classified as a long-acting benzodiazepine. The antianxiety effects of flurazepam are usually evident the day after taking the flurazepam dose. Select the precaution that you will emphasize to a patient when you give him the prescription the doctor has written.
Avoid hazardous activities, Do not take other antianxiety agents at the same time, Do not drink alcohol while taking flurazepam.
Explain the effects of barbiturates on the sleep cycle when used as hypnotics.
Barbiturates increase stage 2 sleep, decrease stages 3 and 4 sleep, and suppress REM sleep.
Select the therapy of choice for patients suffering from insomnia that is complicated with anxiety or stressful situations.
Benzodiazepines
Which of the following atypical antipsychotic drugs cause significant anticholinergic, alpha-adrenergic blocking, or antihistaminic actions as side effects?
Clozapine
Select the adverse effect associated with the use of barbiturates.
Drowsiness, Lethargy, Lack of coordination
Use your critical-thinking skills to determine a pharmacokinetic effect of barbiturates as a result of enzyme induction.
Enzyme induction leads to faster metabolism of the barbiturate in the liver and decreased duration of action.
Which of the following pairs of drugs is approved for the treatment of premenstrual dysphoric disorder, where mood disturbances occur in relation to the menstrual cycle?
Fluoxetine and sertraline
Use critical thinking skills to determine a major difference between flurazepam and temazepam.
Flurazepam is a long-acting hypnotic that forms several active metabolites, while temazepam is an intermediate-acting hypnotic that does not form any important active metabolites.
Martina is prescribed isocarboxazid to treat mental depression. Which of the following foods can be included in Martina's diet?
Fresh meat
Select the contributing factor that leads to physical dependency while taking barbiturates.
Greater therapeutic dosages taken on a regular basis for more than 1 to 2 months
John is addicted to amphetamines. What will he experience when he discontinues using the drugs?
He will enter a phase of deep sleep and will awaken with a strong desire to continue taking the drug.
Identify the statement that best explains bipolar mood disorder.
It is a disorder consisting of alternating periods of depression and mania.
Identify a function of the pons.
It serves as a relay station for nerve fibers traveling to other brain areas.
How does anxiety affect the human body?
It triggers the hyperarousal of the cerebral cortex.
Identify an accurate statement about the drug lysergic acid diethylamide (LSD).
LSD has a high therapeutic index.
Identify the mechanism through which lithium decreases nerve conduction.
Lithium interferes with nerve conduction, resulting in a decrease in the excitability of nerve tissue.
A drug abuser experiences a psychotomimetic flashback experience after using marijuana. What other drug was probably abused by the user in the past?
Lysergic acid diethylamide
Identify the most potent hallucinogenic drug from the following.
Lysergic acid diethylamide
Within which group of commonly abused drugs does cross-tolerance exist?
Lysergic acid diethylamide (LSD)
Identify the type of depression that originates from within an individual and may not be linked to easily identifiable causes.
Major depressive disorder
Which of the following statements is true of marijuana?
Marijuana increases the activity of the mesolimbic dopamine system.
Which part of a person's brain is activated when he or she is choking on a piece of steak?
Medulla oblongata
Which of the following is among the least potent of the hallucinogenic drugs?
Mescaline
Phencyclidine produces its psychotomimetic effects by blocking the _____ receptor.
N-methyl-D-aspartate
Select the statement that is not consistent with the mechanism of action or adverse effect profiles of the atypical SSRIs nefazodone (generic) and trazodone (Desyrel).
Nefazodone and trazodone are prescribed for patients who are trying to quit smoking.
Which type of atypical antipsychotic is available in special formulations for difficult patients needing immediate treatment from a psychotic episode?
Olanzapine
Jamie, a 50-year-old man, is prescribed fluvoxamine to treat his obsessive-compulsive disorder (OCD). Fluvoxamine is available as a 100-mg scored tablets. Jamie takes half a tablet each day. After two days, Jamie begins experiencing symptoms of sedation such as drowsiness. What is the most likely explanation for this occurrence?
One of the effects of fluvoxamine on the central nervous system is sedation.
Select the drug class that has a decreased pharmacological effect as a result of the concurrent use of barbiturates.
Oral anticoagulants
Degeneration of the neurons in the basal ganglia leads to _____.
Parkinson's disease
Identify the main characteristic of the REM stage of the sleep cycle.
Periods of rapid eye movement, Dreaming, Increased autonomic system activity
Which of the following statements is true of phencyclidine?
Phencyclidine dependency appears to be predominantly psychological rather than physical.
Select an accurate statement about phencyclidine.
Phencyclidine produces its effects through the antagonism of glutamate receptors that normally regulate certain ion channels.
Kendall is on a week's course of a medication for a sleep disorder. After completing the course, she immediately discontinues its use. For the next few days, Kendall keeps having nightmares and is unable to sleep. She also feels very restless and anxious. Identify the medication that Kendall was most probably taking.
Phenobarbital
Which of the following symptoms will a person who is under the influence of lysergic acid diethylamide (LSD) most likely experience?
Piloerection
Analyze the different FDA pregnancy categories and determine the appropriate category for lithium.
Pregnancy Category D
Which of the following symptoms is a person under the influence of amphetamines most likely to experience?
Profuse sweating
Select the stage of the sleep cycle that corresponds with the ability to dream.
REM
An elderly patient requests that the physician prescribe her chloral hydrate in place of zaleplon or zolpidem. You research the drug and find that chloral hydrate is an old drug related to alcohol that is still being used today, primarily in the elderly. The usual dosage range is 500-1000 mg. The patient states that she has difficulty in swallowing tablets because they stick to her tongue. Select the dosage form of chloral hydrate that is commercially available and could be prescribed for this patient.
Rectal suppositories, Syrup, Capsules
What physical characteristics would you expect to see in a person who habitually smokes marijuana?
Red eyes and increased heart rate
Which of the following is true of SSRIs?
SSRIs increase the concentration of serotonin in the synaptic cleft, resulting in increased stimulation of serotonin receptors.
Which of the following products is indicated for patients who have difficulty falling asleep but not staying asleep?
Secobarbital
Alex has been diagnosed with schizophrenia. Her doctor, Dr. Paris, prescribes her with a phenothiazine antipsychotic. After several weeks, Alex begins to experience the antipsychotic effects of the drug. How else is Alex going to be affected by the drug?
She will demonstrate less behavioral activation
David, a patient with schizophrenia, has been undergoing antipsychotic treatment for many years now. He stops taking his regular dose of phenothiazine when he discovers that he no longer has the funds to cover the expenses for his treatment. As soon as he stops his medication, he starts experiencing a new range of symptoms such as involuntary movements of his lips, jaw, tongue, and extremities. Worried about the onset of these new symptoms, David's mother consults David's doctor, Dr. Richards, about David's mental health. Dr. Richards examines David and informs David's mother that these new symptoms can be suppressed by reinstituting phenothiazine. From which condition is David most likely suffering?
Tardive dyskinesia
A patient informs you that she has been taking more phenobarbital than the doctor prescribed because the amount that he prescribed was not helping her sleep. She also says that when she does not take the drug, she becomes very anxious, has tremors, and feels like she is being watched. Using your knowledge of sedative-hypnotic drugs, explain to this patient that she has developed a physical dependency on phenobarbital.
The anxiety, tremors, and paranoid behavior are signs of withdrawal which occurs when a patient has taken larger than therapeutic dosages for more than 1 to 2 months.
Which of the following statements is true of butyrophenones?
The butyrophenones differ chemically from phenothiazines but produce the same type of antipsychotic effects.
Which area of the cerebral cortex has most likely been affected in a person who has developed speech problems as a result of a head injury?
The frontal lobe of the cerebral cortex
Identify a true statement about marijuana.
The most common route of administration of marijuana is smoking.
Identify the common symptoms associated with a patient suffering from mania.
The patient shows signs of hyperactivity, The patient is very talkative, The patient exhibits unrealistic thoughts.
Which of the following statements is true of the central nervous system (CNS)?
The primary functions of the CNS are to coordinate and control the activity of other body systems.
Alex hears a loud explosion outside his window. He immediately stands up and becomes more alert and attentive to his surroundings. Which part of Alex's brain has most likely been activated by the sudden explosion?
The reticular activating system
Esma suffered a serious head injury in a car crash about three months ago. Since the accident, Esma has had trouble learning and remembering new things and problems with hearing. Which of the following parts of her cerebrum has most likely suffered damage?
The temporal lobe
Which of the following structures does the diencephalon include?
The thalamus
Which of the following statements is true of the thalamus?
The thalamus receives and evaluates almost all of the sensory nerve impulses from peripheral sensory receptors.
What effect do amphetamines have on the human body?
They increase the amounts of norepinephrine (NE) and dopamine (DA) within the brain.
Identify a difference between the drugs thiothixene and chlorpromazine.
Thiothixene generally causes less sedation than chlorpromazine does.
Identify an accurate statement about thiothixene.
Thiothixene generally causes less sedation than chlorpromazine.
The night before an exam, Mary feels a surge of panic. Her heart rate increases and she begins to sweat. The stress of writing the paper the next day makes her feel nauseous. These physiological changes that Mary is experiencing are caused by the:
activation of the sympathetic system
People who develop neurological conditions such as akathisia and parkinsonism as adverse reactions to phenothiazine drugs can be treated by:
administering centrally acting anticholinergic drugs.
A patient has been taking amitriptyline for 5 to 6 days, but she is still experiencing the feelings of depression. She wants the doctor to change her medication because she feels that the drug is not working. After doing research on amitriptyline, you tell the patient that:
amitriptyline is working, but the full antidepressant effect can take as long as 2 to 4 weeks to develop.
The two types of medications that are most often used for people who have emotional or behavioral problems are:
antianxiety drugs and antidepressants
One of your patients is undergoing MAO inhibitor therapy. You have been asked to explain to the patient the dietary restrictions concerning tyramine. The patient does not know what foods should be avoided. You list the foods to avoid as:
beer, wine, herring, and certain cheeses.
One of the main characteristics of phenothiazine antipsychotics is their ability to:
block dopamine D2 receptors to a greater degree than serotonin 5HT2A receptors
The adverse effects of phenothiazine antipsychotics arise due to the:
blocking of cholinergic and histamine receptors
Coordinating body movements and posture and helping maintain body equilibrium are the major functions of the _____.
cerebellum
The _____ is the only part of the brain that is under conscious control.
cerebral cortex
Steve has a sleep disorder and is prescribed pentobarbital for two weeks. After the first week, Steve notices that the medication has a diluted effect, and he is unable to feel the same hypnotic effects of the drug as he did during the first week. This effect is termed _____.
drug tolerance
Tricyclics interfere with antihistamine and anticholinergic drug agents resulting in _____.
dry mouth, constipation, urinary retention, and blurred vision
Kevin, a 12-year-old boy, grew up with his pet dog, Sparky, who was almost the same age as Kevin. Age-related health complications caused Sparky?s death, following which Kevin was distraught. He was depressed for more than a week and refused to go to school. The type of depression affecting Kevin is termed _____.
exogenous depression
Due to their alpha-blocking, anticholinergic, and antihistaminic effects, tricyclic antidepressants are contraindicated in patients suffering from:
glaucoma and prostatic hypertrophy.
The pituitary gland is attached to the _____.
hypothalamus
A drug abuser can experience the effects of cocaine for the longest period of time if he or she takes the drug _____.
intranasally
The _____ is involved with emotional and behavioral responses associated with reward, punishment, anger, fear, and anxiety.
limbic system
The beneficial side effects of phenothiazine antipsychotics allow them to be used for the treatment of _____.
nausea and vomiting
All of the following types of nerve impulses are carried by the axons of afferent neurons except:
nerve impulse for directing organ activity.
The axons of efferent neurons transmit nerve impulses carrying information associated with all of the following except:
pain
The _____ is referred to as the master gland of the body.
pituitary gland
Alex takes a large dose of LSD. In an hour's time, his sensory perceptions become distorted, and he begins to experience true hallucinations. Alex begins to believe that everything he sees and feels is real. Alex is experiencing the dose-related effects of the _____ phase.
psychic
Atypical antipsychotics differ from the other classes of antipsychotics because they:
reduce the activity of serotonin more than they reduce the activity of dopamine.
Henry, a college student, tends to drink a lot of coffee the night before an exam. The coffee helps him stay more alert and attentive late into the night. The presence of caffeine in the coffee stimulates the _____ of his brain.
reticular formation
One of the main causes of psychosis is _____.
schizophrenia
Long-term use of phenothiazine antipsychotics is most likely to result in _____.
tardive dyskinesia
The two main components of the central nervous system are:
the brain and the spinal cord.
Eszopiclone (Lunesta) is a hypnotic agent with a rapid onset of action, intermediate duration of action, and a half-life of 6 hours. Using half-life, at approximately what time would a dose administered to a patient at 8 a.m. be reduced to 50 percent?
2pm
Identify a difference between butyrophenones and phenothiazines.
Butyrophenones produce a higher incidence of extrapyramidal symptoms than phenothiazines.
Marijuana resin is extracted from the plant _____.
Cannabis sativa
