Blood pharmacology
The iron stored in intestinal mucosal cells is complexed to which of the following? (A) Apoferritin (B) Intrinsic factor (C) Oprelvekin (D) Transcobalamin II (E) Transferrin
(A) Apoferritin
Which of the following is an analgesic and antipyretic drug that lacks an anti-inflammatory action? (A) Acetaminophen (B) Celecoxib (C) Colchicine (D) Indomethacin (E) Probenecid
(A) Acetaminophen
A 52-year-old woman presented with intense pain, warmth, and redness in the first toe on her left foot. Examination of fluid withdrawn from the inflamed joint revealed crystals of uric acid. Over the next 7 mo, the patient had 2 more attacks of acute gout. Her serum concentration of uric acid was elevated. The decision was made to put her on chronic drug therapy to try to prevent subsequent attacks. Which of the following drugs could be used to decrease this woman's rate of production of uric acid? (A) Allopurinol (B) Aspirin (C) Colchicine (D) Hydroxychloroquine (E) Probenecid
(A) Allopurinol
A 67-year-old woman presents with pain in her left thigh muscle. Duplex ultrasonography indicates the presence of deep vein thrombosis (DVT) in the affected limb. The decision was made to treat this woman with enoxaparin. Relative to unfractionated heparin, enoxaparin (A) Can be used without monitoring the patient's aPTT (B) Has a shorter duration of action (C) Is less likely to have a teratogenic effect (D) Is more likely to be given intravenously (E) Is more likely to cause thrombosis and thrombocytopenia
(A) Can be used without monitoring the patient's aPTT
Among NSAIDs, aspirin is unique because it (A) Irreversibly inhibits its target enzyme (B) Prevents episodes of gouty arthritis with long-term use (C) Reduces fever (D) Reduces the risk of colon cancer (E) Selectively inhibits the COX-2 enzyme
(A) Irreversibly inhibits its target enzyme
A 43-year-old man has heterozygous familial hypercholesterolemia. His serum concentrations of total choles- terol and LDL are markedly elevated. His serum concentration of HDL cholesterol, VLDL cholesterol, and triglycerides are nor- mal or slightly elevated. The patient's mother and older brother died of myocardial infarctions before the age of 50. This patient recently experienced mild chest pain when walking upstairs and has been diagnosed as having angina of effort. The patient is somewhat overweight. He drinks alcohol most evenings and smokes about 1 pack of cigarettes per week. After being counseled about lifestyle and dietary changes, the patient was started on atorvastatin. During his treatment with atorvastatin, it is important to routinely monitor serum concentrations of which of the following? (A) Blood urea nitrogen (B) Alanine and aspartate aminotransferase (C) Platelets (D) Red blood cells (E) Uric acid
(B) Alanine and aspartate aminotransferase
A 65-year-old man is brought to the emergency department 30 min after the onset of right-sided weakness and aphasia (difficulty speaking). Imaging studies ruled out cerebral hemorrhage as the cause of his acute symptoms of stroke. Prompt administration of which of the following drugs is most likely to improve this patient's clinical outcome? (A) Abciximab (B) Alteplase (C) Factor VIII (D) Streptokinase (E) Vitamin K
(B) Alteplase
A 65-year-old man is brought to the emergency department 30 min after the onset of right-sided weakness and aphasia (difficulty speaking). Imaging studies ruled out cerebral hemorrhage as the cause of his acute symptoms of stroke. Over the next 2 d, the patient's symptoms resolved completely. To prevent a recurrence of this disease, the patient is most likely to be treated indefinitely with which of the following? (A) Aminocaproic acid (B) Aspirin (C) Enoxaparin (D) Lepirudin (E) Warfarin
(B) Aspirin
A 35-year-old woman appears to have familial combined hyperlipidemia. Her serum concentrations of total cholesterol, LDL cholesterol, and triglyceride are elevated. Her serum concentration of HDL cholesterol is somewhat reduced. Which of the following is a major toxicity associated with gemfibrozil therapy? (A) Bloating and constipation (B) Cholelithiasis (C) Hyperuricemia (D) Liver damage (E) Severe cardiac arrhythmia
(B) Cholelithiasis
A 35-year-old woman appears to have familial combined hyperlipidemia. Her serum concentrations of total cholesterol, LDL cholesterol, and triglyceride are elevated. Her serum concentration of HDL cholesterol is somewhat reduced. Which of the following drugs is most likely to increase this patient's triglyceride and VLDL cholesterol concentrations when used as monotherapy? (A) Atorvastatin (B) Cholestyramine (C) Ezetimibe (D) Gemfibrozil (E) Niacin
(B) Cholestyramine
A 54-year-old woman presented with signs and symptoms consistent with an early stage of rheumatoid arthritis. The decision was made to initiate NSAID therapy. Although the patient's disease was adequately controlled with an NSAID and methotrexate for some time, her symptoms began to worsen and radiologic studies of her hands indicated progressive destruction in the joints of several fingers. Treatment with another second-line agent for rheumatoid arthritis was considered. Which of the following is a parenterally administered DMARD whose mechanism of anti- inflammatory action is antagonism of tumor necrosis factor? (A) Cyclosporine (B) Etanercept (C) Penicillamine (D) Phenylbutazone (E) Sulfasalazine
(B) Etanercept
After undergoing surgery for breast cancer, a 53-year-old woman is scheduled to receive 4 cycles of cancer chemotherapy. The cycles are to be administered every 3-5 wks. Her first cycle was complicated by severe chemotherapy-induced thrombocytopenia. Twenty months after finishing her chemotherapy, the woman had a relapse of breast cancer. The cancer was now unre- sponsive to standard doses of chemotherapy. The decision was made to treat the patient with high-dose chemotherapy followed by autologous stem cell transplantation. Which of the following drugs is most likely to be used to mobi- lize the peripheral blood stem cells needed for the patient's autologous stem cell transplantation? (A) Erythropoietin (B) Filgrastim (G-CSF) (C) Folic acid (D) Intrinsic factor (E) Oprelvekin (interleukin-11)
(B) Filgrastim (G-CSF)
A 65-year-old man is brought to the emergency department 30 min after the onset of right-sided weakness and aphasia (difficulty speaking). Imaging studies ruled out cerebral hemorrhage as the cause of his acute symptoms of stroke. f the patient is unable to tolerate the drug identified in Question 6, he may be treated with clopidogrel. Relative to ticlopidine, clopidogrel (A) Has a shorter duration of action (B) Is less likely to cause neutropenia (C) Is more likely to induce antiplatelet antibodies (D) Is more likely to precipitate serious bleeding (E) Will have a greater antiplatelet effect
(B) Is less likely to cause neutropenia
The megaloblastic anemia that results from vitamin B12 deficiency is due to inadequate supplies of which of the following? (A) Cobalamin (B) dTMP (C) Folic acid (D) Homocysteine (E) N5-methyltetrahydrofolate
(B) dTMP
A 43-year-old man has heterozygous familial hypercholesterolemia. His serum concentrations of total choles- terol and LDL are markedly elevated. His serum concentration of HDL cholesterol, VLDL cholesterol, and triglycerides are normal or slightly elevated. The patient's mother and older brother died of myocardial infarctions before the age of 50. This patient recently experienced mild chest pain when walking upstairs and has been diagnosed as having angina of effort. The patient is somewhat overweight. He drinks alcohol most evenings and smokes about 1 pack of cigarettes per week. Six months after beginning atorvastatin, the patient's total and LDL cholesterol concentrations remained above normal, and he continued to have anginal attacks despite good adherence to his antianginal medications. His physician decided to add ezetimibe. Which of the following is the most accurate description of ezetimibe's mechanism of an action? (A) Decreased lipid synthesis in adipose tissue (B) Decreased secretion of VLDL by the liver (C) Decreased gastrointestinal absorption of cholesterol (D) Increased endocytosis of HDL by the liver (E) Increased lipid hydrolysis by lipoprotein lipase
(C) Decreased gastrointestinal absorption of cholesterol
Which of the following is most likely to be required by a 5-year-old boy with chronic renal insufficiency? (A) Cyanocobalamin (B) Deferoxamine (C) Erythropoietin (D) Filgrastim (G-CSF) (E) Oprelvekin (IL-11)
(C) Erythropoietin
A 23-year-old pregnant woman is referred by her obstetrician for evaluation of anemia. She is in her fourth month of pregnancy and has no history of anemia; her grand- father had pernicious anemia. Her hemoglobin is 10 g/dL (normal, 12-16 g/dL). The laboratory data for your pregnant patient indicate that she does not have macrocytic anemia but rather microcytic anemia. Optimal treatment of normocytic or mild micro- cytic anemia associated with pregnancy uses which of the following? (A) A high-fiber diet (B) Erythropoietin injections (C) Ferrous sulfate tablets (D) Folic acid supplements (E) Hydroxocobalamin injections
(C) Ferrous sulfate tablets
A 23-year-old pregnant woman is referred by her obstetrician for evaluation of anemia. She is in her fourth month of pregnancy and has no history of anemia; her grand- father had pernicious anemia. Her hemoglobin is 10 g/dL (normal, 12-16 g/dL). If this woman has macrocytic anemia, an increased serum concentration of transferrin, and a normal serum concentra- tion of vitamin B12, the most likely cause of her anemia is deficiency of which of the following? (A) Cobalamin (B) Erythropoietin (C) Folic acid (D) Intrinsic factor (E) Iron
(C) Folic acid
Increased serum levels of which of the following is associated with a decreased risk of atherosclerosis? (A) Cholesterol (B) LDL (C) HDL (D) Triglyceride (E) VLDL
(C) HDL
A 54-year-old woman presented with signs and symptoms consistent with an early stage of rheumatoid arthritis. The decision was made to initiate NSAID therapy. Which of the following patient characteristics is the most compelling reason for avoiding celecoxib in the treatment of her arthritis? (A) History of alcohol abuse (B) History of gout (C) History of myocardial infarction (D) History of osteoporosis (E) History of peptic ulcer disease
(C) History of myocardial infarction
A 16-year-old girl comes to the emergency department suffering from the effects of an aspirin overdose. Which of the following syndromes is this patient most likely to exhibit as a result of this drug overdose? (A) Bone marrow suppression and possibly aplastic anemia (B) Fever, hepatic dysfunction, and encephalopathy (C) Hyperthermia, metabolic acidosis, and coma (D) Rapid, fulminant hepatic failure (E) Rash, interstitial nephritis, and acute renal failure
(C) Hyperthermia, metabolic acidosis, and coma
A patient develops severe thrombocytopenia in response to treatment with unfractionated heparin and still requires parenteral anticoagulation. The patient is most likely to be treated with which of the following? (A) Abciximab (B) Cilostazol (C) Lepirudin (D) Plasminogen (E) Vitamin K1
(C) Lepirudin
An 18-month-old boy dies from an accidental overdose of acetaminophen. Which of the following is the most likely cause of this patient's death? (A) Arrhythmia (B) Hemorrhagic stroke (C) Liver failure (D) Noncardiogenic pulmonary edema (E) Ventilatory failure
(C) Liver failure
A 58-year-old business executive is brought to the emergency department 2 h after the onset of severe chest pain during a vigorous tennis game. She has a history of poorly controlled mild hypertension and elevated blood cholesterol but does not smoke. ECG changes confirm the diagnosis of myocardial infarction. The decision is made to attempt to open her occluded artery. If a fibrinolytic drug is used for treatment of this woman's acute myocardial infarction, which of the following adverse drug effects is most likely to occur? (A) Acute renal failure (A) Acute renal failure (B) Development of antiplatelet antibodies (C) Encephalitis secondary to liver dysfunction (D) Hemorrhagic stroke (E) Neutropenia
(D) Hemorrhagic stroke
A 35-year-old woman appears to have familial combined hyperlipidemia. Her serum concentrations of total cho- lesterol, LDL cholesterol, and triglyceride are elevated. Her serum concentration of HDL cholesterol is somewhat reduced. The patient is started on gemfibrozil. Which of the following is a major mechanism of gemfibrozil's action? (A) Increased excretion of bile acid salts (B) Increased expression of high-affinity LDL receptors (C) Increased secretion of VLDL by the liver (D) Increased triglyceride hydrolysis by lipoprotein lipase (E) Reduced uptake of dietary cholesterol
(D) Increased triglyceride hydrolysis by lipoprotein lipase
The main advantage of ketorolac over aspirin is that ketorolac (A) Can be combined more safely with an opioid such as codeine (B) Can be obtained as an over-the-counter agent (C) Does not prolong the bleeding time (D) Is available in a parenteral formulation that can be injected intramuscularly or intravenously (E) Is less likely to cause acute renal failure in patients with some preexisting degree of renal impairment
(D) Is available in a parenteral formulation that can be injected intramuscularly or intravenously
A 23-year-old pregnant woman is referred by her obstetrician for evaluation of anemia. She is in her fourth month of pregnancy and has no history of anemia; her grand- father had pernicious anemia. Her hemoglobin is 10 g/dL (normal, 12-16 g/dL). If this patient has a young child at home and is taking iron- containing prenatal supplements, she should be warned that they are a common source of accidental poisoning in young children and advised to make a special effort to keep these pills out of her child's reach. Toxicity associated with acute iron poisoning usually includes which of the following? (A) Dizziness, hypertension, and cerebral hemorrhage (B) Hyperthermia, delirium, and coma (C) Hypotension, cardiac arrhythmias, and seizures (D) Necrotizing gastroenteritis, shock, and metabolic acidosis (E) Severe hepatic injury, encephalitis, and coma
(D) Necrotizing gastroenteritis, shock, and metabolic acidosis
A 43-year-old man has heterozygous familial hypercholesterolemia. His serum concentrations of total choles- terol and LDL are markedly elevated. His serum concentration of HDL cholesterol, VLDL cholesterol, and triglycerides are nor- mal or slightly elevated. The patient's mother and older brother died of myocardial infarctions before the age of 50. This patient recently experienced mild chest pain when walking upstairs and has been diagnosed as having angina of effort. The patient is somewhat overweight. He drinks alcohol most evenings and smokes about 1 pack of cigarettes per week. If the patient has a history of gout, which of the following drugs is most likely to exacerbate this condition? (A) Colestipol (B) Ezetimibe (C) Gemfibrozil (D) Niacin (E) Simvastatin
(D) Niacin
After undergoing surgery for breast cancer, a 53-year-old woman is scheduled to receive 4 cycles of cancer chemotherapy. The cycles are to be administered every 3-5 wks. Her first cycle was complicated by severe chemotherapy-induced thrombocytopenia. During the second cycle of chemotherapy, it would be appropriate to consider treating this patient with which of the following? (A) Darbepoetin alpha (B) Filgrastim (G-CSF) (C) Iron dextran (D) Oprelvekin (IL-11) (E) Vitamin B12
(D) Oprelvekin (IL-11)
A 58-year-old business executive is brought to the emergency department 2 h after the onset of severe chest pain dur- ing a vigorous tennis game. She has a history of poorly controlled mild hypertension and elevated blood cholesterol but does not smoke. ECG changes confirm the diagnosis of myocardial infarc- tion. The decision is made to attempt to open her occluded artery. Which of the following drugs accelerates the conversion of plasminogen to plasmin? (A) Aminocaproic acid (B) Heparin (C) Lepirudin (D) Reteplase (E) Warfarin
(D) Reteplase
A 52-year-old woman presented with intense pain, warmth, and redness in the first toe on her left foot. Examination of fluid withdrawn from the inflamed joint revealed crystals of uric acid. In the treatment of this woman's acute attack of gout, a high dose of colchicine will reduce the pain and inflammation. However, many physicians prefer to treat acute gout with a corticosteroid or indomethacin because high doses of colchicine are likely to cause (A) Behavioral changes that include psychosis (B) High blood pressure (C) Rash (D) Severe diarrhea (E) Sudden gastrointestinal bleeding
(D) Severe diarrhea
A 43-year-old man has heterozygous familial hypercholesterolemia. His serum concentrations of total cholesterol and LDL are markedly elevated. His serum concentration of HDL cholesterol, VLDL cholesterol, and triglycerides are normal or slightly elevated. The patient's mother and older brother died of myocardial infarctions before the age of 50. This patient recently experienced mild chest pain when walking upstairs and has been diagnosed as having angina of effort. The patient is somewhat overweight. He drinks alcohol most evenings and smokes about 1 pack of cigarettes per week. Consumption of alcohol is associated with which of the following changes in serum lipid concentrations? (A) Decreased chylomicrons (B) Decreased HDL cholesterol (C) Decreased VLDL cholesterol (D) Increased LDL cholesterol (E) Increased triglyceride
(E) Increased triglyceride
A 23-year-old pregnant woman is referred by her obstetrician for evaluation of anemia. She is in her fourth month of pregnancy and has no history of anemia; her grand- father had pernicious anemia. Her hemoglobin is 10 g/dL (normal, 12-16 g/dL). If the patient in Question 1 had the deficiency identified, her infant would have a higher than normal risk of which of the following? (A) Cardiac abnormality (B) Congenital neutropenia (C) Kidney damage (D) Limb deformity (E) Neural tube defect
(E) Neural tube defect
A 35-year-old woman appears to have familial combined hyperlipidemia. Her serum concentrations of total cholesterol, LDL cholesterol, and triglyceride are elevated. Her serum concentration of HDL cholesterol is somewhat reduced. If this patient is pregnant, which of the following drugs should be avoided because of a risk of harming the fetus? (A) Cholestyramine (B) Ezetimibe (C) Fenofibrate (D) Niacin (E) Pravastatin
(E) Pravastatin
Which of the following drugs is most likely to increase serum concentrations of conventional doses of methotrexate, a weak acid that is primarily cleared in the urine? (A) Acetaminophen (B) Allopurinol (C) Colchicine (D) Hydroxychloroquine (E) Probenecid
(E) Probenecid
A 58-year-old business executive is brought to the emergency department 2 h after the onset of severe chest pain during a vigorous tennis game. She has a history of poorly controlled mild hypertension and elevated blood cholesterol but does not smoke. ECG changes confirm the diagnosis of myocardial infarction. The decision is made to attempt to open her occluded artery. If this patient undergoes a percutaneous coronary angiography procedure and placement of a stent in a coronary blood vessel, she may be given eptifibatide. Which of the following most accurately describes the mechanism of eptifibatide anticlotting action? (A) Activation of antithrombin III (B) Blockade of post-translational modification of clotting factors (C) Inhibition of thromboxane production (D) Irreversible inhibition of platelet ADP receptors (E) Reversible inhibition of glycoprotein IIb/IIIa receptors
(E) Reversible inhibition of glycoprotein IIb/IIIa receptors
In a patient who requires filgrastim (G-CSF) after being treated with anticancer drugs, the therapeutic objective is to prevent which of the following? (A) Allergic reactions (B) Cancer recurrence (C) Excessive bleeding (D) Hypoxia (E) Systemic infection
(E) Systemic infection
A 67-year-old woman presents with pain in her left thigh muscle. Duplex ultrasonography indicates the presence of deep vein thrombosis (DVT) in the affected limb. During the next week, the patient was started on warfarin and her heparin was discontinued. Two months later, she returned after a severe nosebleed. Laboratory analysis revealed an INR (international normalized ratio) of 7.0 (INR value in such a warfarin-treated patient should be 2.0-3.0). To prevent severe hemorrhage, the warfarin should be discontinued and this patient should be treated immediately with which of the following? (A) Aminocaproic acid (B) Desmopressin (C) Factor VIII (D) Protamine (E) Vitamin K1
(E) Vitamin K1