Pharmacology Exam 2
Where is histamine located in the body?
What stimulates histamine release? Histamine is found throughout the body within mast cells and basophilic white blood cells. When antigens come into contact with the skin or lungs or enter the bloodstream of sensitized individuals (previously exposed to the antigen), the mast cells and basophils immediately release histamine into the blood
15. What is the rationale for the treatment of hypothyroidism?
When thyroid hormone secretion is suppressed, there is no way to inhibit the secretion of TSH from the pituitary gland. When little or no T3 and T4 circulate in the blood, TSH continues to stimulate the thyroid gland to release active hormones that are not there. This constant stimulation of the thyroid results in glandular enlargement (hypertrophy). As the thyroid increases in size, it protrudes from the front of the neck, causing a swollen appearance known as goiter. In severe cases, respiratory acidosis, electrolyte imbalance, and coma may develop (myxedema coma).
Define xerostomia.
Xerostomia is dryness of the oral cavity resulting from inhibition of the natural moistening action of salivary gland secretions or increased secretion of salivary mucus, rather than serous material.
12. What drugs commonly interact with antihistaminics? A
ntihistaminics have the potential to interact with anticholinergics, anticoagulants, antidepressants, corticosteroids, drugs that produce CNS depression (alcohol, barbiturates, hypnotics, narcotic analgesics, phenothiazines, tranquilizers), corticosteroids, and MAO inhibitors.
16. What are the two main effects of propranolol (a beta blocker) to lower blood pressure?
slows down the activity of your heart by stopping messages sent by some nerves to your heart. It does this by blocking tiny areas (called beta-adrenergic receptors) where the messages are received by your heart. changed from drug to beta-antagonist by liver
5. What role does glucagon play in diabetes?
As glucose is taken up by the cells, the blood glucose level falls, stimulating the secretion of glucagon by the alpha cells of the pancreas. Glucagon enables glucose to enter the circulation and enhances the conversion of amino acids to glucose. As the blood glucose level increases, insulin secretion is stimulated and the metabolic cycle begins again.
4. Compare the actions of azathioprine and cyclophosphamide with that of cyclosporine. Is there any advantage with cyclosporine?
Azathioprine and cyclophosphamide are cytotoxic drugs that kill cells. The immunosuppressive effect occurs as the number of lymphocytes are reduced and, therefore, are unable to carry out an effective immune response. Cyclosporine is not cytotoxic and produces immunosuppression by temporarily inhibiting the activity of T-cells, particularly helper T-cells.
11. What is the relationship between BP, CO, and PR?
Blood pressure (BP) is a result of all the factors that regulate cardiac output (CO) and peripheral resistance (PR). The formula for blood pressure is BP = CO × PR.
10. Define the following terms and explain their relationship: CO, HR, SV.
CO (cardiac output) is the amount of blood pumped by the heart per minute. HR is heart rate in beats per minute. SV (stroke volume) is the amount of blood pumped per beat. The formula for cardiac output is CO = HR × SV.
17. Where is the site of action of clonidine?
Clonidine reduces the activity of the vasomotor center in the medulla oblongata. It is an alpha-2 adrenergic receptor agonist.
22. How does acetylcysteine liquefy mucus?
Acetylcysteine contains sulfhydryl, which chemically breaks apart the large molecules contained in bronchial secretions. Therefore, acetylcysteine promotes mobilization and removal of respiratory secretions.
9. Compare the adverse effects of the nitrates and the calcium channel blocker drugs.
Adverse effects of nitrates and calcium antagonists may be similar: flushing, dizziness, and tachycardia if blood pressure is excessively reduced.
13. A patient presents with dehydration. Following ACTH administration, plasma cortisol levels cannot be detected. The most likely diagnosis for this patient is A. Addison's disease B. Cushing's disease C. thyroid disease D. rheumatoid arthritis E. excessive cortisol excretion
Answer: A, Addison's disease
9. All of the following are correct EXCEPT A. LDL pulls cholesterol out of plaque and returns it to the liver B. VLDL transports triglycerides C. apolipoproteins B and E contain a cholesterol core to form LDL and HDL, respectively D. foam cells are cholesterol-rich macrophages E. cholesterol is essential for production of myelin sheaths and bile salts
Answer: A, LDL pulls cholesterol out of plaque and returns it to the liver
18. Which of the following could be used for treatment in an infant diagnosed with cretinism? A. T3 and T4 B. calcitonin C. propylthiouracil D. bisphosphonates E. thyroglobulin
Answer: A, T3 and T4
15. Select the causes of type 1 diabetes. A. autoantibody destruction of beta cells B. malformed beta cells C. failure of target tissue to respond to insulin D. hyperinsulinemia E. increase in the secretion of incretins
Answer: A, autoantibody destruction of beta cells
10. Water-soluble hormones work by A. binding receptors on the cell membranes B. crossing the plasma membrane C. being second messengers D. stimulating gene transcription E. binding to receptors inside the cell nucleus
Answer: A, binding receptors on cell membranes
6. Which of the following hormone disorders causes mental retardation in infancy? A. cretinism: thyroid hormone B. gigantism: growth hormone C. dwarfism: adrenal medulla D. diabetes mellitus: insulin-like factor E. acromegaly: growth hormone
Answer: A, cretinism: thyroid hormone
9. Which of the following is correct about polyuria in types 1 and 2 DM? A. excess glucose spills into the urine and osmotically attracts water into the renal tubule B. antidiuretic hormone is no longer secreted in DM C. GLUT2 receptors move glucose from the blood into the renal tubule D. sulfonylurea drugs interact with their receptors in the kidney to increase urine flow E. glucose transport proteins in the renal tubules are blocked
Answer: A, excess glucose spills into the urine and osmotically attracts water into renal tubule
20. Bisphosphonates A. inhibit bone resorption B. increase T3 and T4 synthesis C. inhibit propylthiouracil D. stimulate PTH E. stimulate TRAb (thyrotropin receptor antibody) production
Answer: A, inhibit bone resorption
11. Beta cells secrete the following substances: A. insulin and amylin B. glucagon C. incretins D. acetate E. GLP1 and GIP
Answer: A, insulin and amylin
28. Which of the following is true? A. oxytocin and ADH are both polypeptides B. ADH is the only hormone secreted from the posterior pituitary C. the release of ADH and oxytocin is caused by another hormone D. ADH and oxytocin are secreted by the anterior pituitary gland E. vasopressin is the trade name for oxytocin
Answer: A, oxytocin and ADH are both polypeptides
14. All potassium-sparing diuretics A. produce a mild diuresis without acid/base disturbance B. inhibit aldosterone receptors C. produce hypokalemia D. produce similar adverse effects to thiazide diuretics E. increase the excretion of potassium ions
Answer: A, produce a mild diuresis without acid/base disturbance
11. Select the first-generation antihistaminic drug. A. promethazine B. cetirizine C. loratadine D. levocetirizine E. bepotastine
Answer: A, promethazine
8. Which of the following is NOT a correct statement? A. promethazine is the only antihistamine with a cautionary (black box) warning B. antihistamines reduce itching and pain at the sensory nerve endings C. histamine causes relaxation of bronchiolar smooth muscle D. hypersensitivity can develop to antihistamines E. antihistamines are found in multiple ingredient OTC products
Answer: A, promethazine is the only antihistamine with a cautionary (black box) warning
19. The antihypertensive action of hydrochlorothiazide (thiazide class) includes A. reduction of blood volume B. blockade of alpha adrenergic receptors C. relaxation of vascular smooth muscle D. only reduction of blood volume and relaxation of vascular smooth muscle E. all of these
Answer: A, reduction of blood volume
4. The most effective drug to relieve edema and congestion in acute heart failure would be A. hydralazine (Apresoline) B. furosemide (Lasix) C. metoprolol (Lopressor) D. hydrochlorothiazide (HyroDIURIL) E. digoxin (Lanoxin)
Answer: B, furosemide (Lasix)
4. Which of the following oral agents is categorized as a secretagogue? A. metformin B. glipizide C. sitagliptin D. miglitol E. dapagliflozin
Answer: B, glipizide
5. Which of the following hormones would be elevated during a fast? A. insulin B. glucagon C. humulin D. GnRH
Answer: B, glucagon
5. The monoclonal antibody that inhibits tumor necrosis factor-alpha in the treatment of Crohn's disease is A. sargramostim B. infliximab C. interleukin-2 D. daclizumab E. omalizumab
Answer: B, infliximab
20. Clomiphene produces its effects by A. inhibiting the release of LH B. inhibiting estrogen's negative feedback C. combining estrogen and progesterone D. increasing bone mineral density E. stimulating dysfunctional ovarian tissue directly
Answer: B, inhibiting estrogen's negative feedback
1. Histamine A. is classified as a mast cell release inhibitor B. is one of the substances released during an allergic response C. is found in white blood cells known as neutrophils D. does not cause skin reactions E. is clinically limited to interacting with H1-receptors
Answer: B, is one of the substances released during an allergic response
27. Choose the correct action of antidiuretic hormone on the body. A. it increases urine output B. it regulates water balance C. the adrenal glands are its target organ D. its secretion is controlled by ADH-releasing factor E. all of these
Answer: B, it regulates water balance
f) The drug used in asthma to block IgE antibodies is A. cromolyn B. omalizumab C. ipratropium D. guaifenesin E. nedocromil
Answer: B, omalizumab
9. Select the mechanism of action for 5-HT 3 antagonists. A. prevent labyrinthine stimulation of emesis B. prevent serotonin from stimulating the CTZ C. block stimulation of dopamine receptors D. increase secretions from ECL cells E. coat the stomach lining
Answer: B, prevent serotonin from stimulating CTZ
5. A patient presents with severe nausea and vomiting after his cisplatin chemotherapy this morning. Which of the following drugs would you prescribe to reduce nausea and vomiting? A. a prokinetic drug like bismuth subsalicylate B. serotonin (5-HT3) antagonists C. proton pump inhibitors D. antisecretory drugs E. diphenhydramine
Answer: B, serotonin (5-HT3) antagonists
8. The primary therapeutic goal in treatment of GERD and peptic ulcer is to A. increase mucosal production B. suppress acid production and relieve symptoms C. prevent erosion of ileum D. maintain levels of magnesium and calcium with antacids E. get patient on prostaglandins
Answer: B, suppress acid production and relieve symptoms
26. Which of the following is NOT a symptom of hypothyroidism? A. cretinism B. tachycardia C. myxedema D. goiter E. agranulocytosis
Answer: B, tachycardia
12. Which of these medications is NOT used to treat hyperlipidemia? A. statins B. thiazides C. nicotinic acid D. fibric acid derivatives E. gemfibrozil (Lopid) and fenofibrate (Tricor)
Answer: B, thiazides
28. Select the ion movement that is associated with depolarization of ventricular muscle. A. Na ions move out of the cell B. K ions move out of the cell C. Na ions move into the cell D. Ca ions move into the cell E. K ions move into the cell 29. According to Vaughn-Williams, procainamide is classified as Class A. IA B. IB C. IC D. II E. IV Answer: A
Answer: C, Na ions move into the cell
25. Which of the following is a hormone secreted from the thyroid gland to help regulate tissue growth? A. TRH B. TSH C. T3, triiodothyronine D. calciothyroxin E. osteoprozin
Answer: C, T3, triiodothyronine
20. A decrease in the formation of angiotensin II and an increase in the concentration of bradykinin explains the vasodilator action of A. alpha-blockers B. beta-blockers C. angiotensin-converting enzyme inhibitors D. angiotensin receptor blockers E. renin inhibitors
Answer: C, angiotensin-converting enzyme inhibitors
7. The greatest reduction in circulating LDL is associated with which hypolipidemic drug? A. gemfibrozil (Lopid) B. nicotinic acid (Niacor) C. atorvastatin (Lipitor) D. colesevelam (Welchol) E. clopidogrel (Plavix)
Answer: C, atorvastatin (Lipitor)
1. A hormone A. rapidly responds to a stimulus B. is a neurotransmitter C. binds to specific receptors to produce its effects D. produces nerve impulses E. is secreted into a specialized duct system
Answer: C, binds to specific receptors to produce its effects
2. The mechanism of action of triamterene (Dyrenium) is to A. block aldosterone receptors B. increase sodium excretion at loop of Henle C. block sodium channels (ENaC) at nephron collecting ducts D. increase the release of aldosterone E. decrease the release of ADH
Answer: C, block sodium channels (ENaC) at nephron collecting ducts
9. Select the drug that is non cytotoxic. A. lefazathioprine B. cyclophosphamide C. cyclosporine D. mycophenolate mofetil E. leflunomide
Answer: C, cyclosporine
j) Corticosteroids are used in the treatment of asthma in which of the following ways? A. decrease activation of arachidonic acid B. increase the release of inflammatory mediators C. decrease the production of allergic antibodies D. only decrease activation of arachidonic acid and decrease the production of allergic antibodies E. all of these
Answer: C, decrease production of allergic antibodies
17. When a diuretic is refractory, it does which of the following? A. produces a decreased response to a decreased amount of drug B. produces an increased response to an increased amount of drug C. doesn't produce a greater response to an increased amount of drug D. doesn't produce any response to a decrease in the amount of drug E. inhibits the secretion of antidiuretic hormone
Answer: C, doesn't produce a greater response to an increased amount of drug
17. Choose the mechanism of action of adsorbents antidiarrheal drugs. A. kill bacteria B. decrease serotonin release C. form a complex with irritating substance D. absorbed into blood circulation to work on the system E. complex with glucose in the intestinal lumen
Answer: C, form a complex with irritating substance
1. Which of the three phases of gastric acid secretion is stimulated by the distention of the stomach? A. cephalic B. colonic C. gastric D. intestinal E. activation of the CTZ
Answer: C, gastric
1. The immune cell that when activated stimulates the activity of killer T-cells and B-cells is A. macrophage B. B-cell C. helper T-cell D. killer T-cell E. memory T-cell
Answer: C, helper T-cell
10. Metoclopramide (Reglan) is used to treat which ailments of the GI tract? A. GI hypermotility B. irritable bowel syndrome C. newly diagnosed peptic ulcers D. neurogenic colon E. GERD and chemotherapy induced vomiting
Answer: C, newly diagnosed peptic ulcers
18. In the treatment of variant angina, the drug that is an a rterial dilator without direct effects on the heart is A. nitroglycerin B. metoprolol C. nifedipine D. verapamil E. diltiazem
Answer: C, nifedipine
9. Which of the following is NOT a correct statement? A. antihistamines decrease nausea and heartburn through the H 2 -receptors B. mastocytosis is a condition of excess histamine release and stimulation C. only a few antihistamines can be administered orally D. levocetirizine is usually administered once a day E. antihistamines can reduce ocular hyperemia
Answer: C, only a few antihistamines can be administered orally
3. Chronically elevated blood lipid levels may cause A. pancreatitis when cholesterol is 80 to 100 mg/dL B. plaque when HMG-CoA reductase is 80 to 100 mg/dL C. plaque when LDL cholesterol exceeds 160 mg/dL D. arthritis and edema E. hematomas
Answer: C, plaque when LDL cholesterol exceeds 160 mg/dL
10. Mast cell stabilizers work by blocking A. histamine after it is released B. H 1 -receptors from binding histamine C. the release of histamine and other active substances from cells D. the effect of histamine after it binds E. only histamine in the treatment of eczematoid dermatitis
Answer: C, the release of histamine and other active substances from cells
16. A patient has just been diagnosed with hyperthyroidism. You review her labs and find that T3-T4 level is elevated; however, TSH level is low, along with TRH. You suspect the problem is occurring at the A. hypothalamus B. anterior pituitary C. thyroid gland D. parathyroid gland E. posterior pituitary
Answer: C, thyroid gland
15. The nitroglycerin dosage form providing the longest duration of action is A. sublingual nitroglycerin tablets B. nitroglycerin ointment C. transdermal nitroglycerin D. IV nitroglycerin (bolus injection) E. sublingual spray
Answer: C, transdermal nitroglycerin
15. Tubular reabsorption involves which of the following? A. movement of small molecules into the glomerulus B. nephron production of calcium carbonate C. transport of ions into the blood D. movement of sodium ions into circulation E. increased glucose concentration in the urine
Answer: C, transport of ions into the blood
11. Which drugs are NOT routinely used in the clinical management of hypertension? A. thiazide diuretics B. chlorthalidone C. isosorbide mononitrate D. triamterene E. metolazone
Answer: C?, isosorbide mononitrate
5. Which of the following mechanisms of action is correct? A. ezetimibe (Zetia) acts in the intestinal lumen to bind and trap cholesterol B. fibric acid derivatives act at the brush border of the intestine wall C. nicotinamide stimulates lipoprotein lipase to lower triglycerides D. lovastatin (Mevacor) inhibits an enzyme in the cholesterol synthetic pathway E. niacin interrupts the cholesterol synthetic pathway
Answer: D , lovastatin (Mevacor) inhibts an enzyme in the cholesterol synthetic pathway
18. In the menstrual cycle which of the following hormones is responsible for ovulation? A. progesterone B. FSH C. hCG D. LH E. oxymetholone
Answer: D, LH
13. Which of the following treatments for simple diarrhea works by forming a complex with the irritant? A. antibiotics B. opioid derivatives C. anticholinergics D. adsorbents E. lactulose
Answer: D, adsorbents
6. Cromolyn and pemirolast A. are effective oral antihistamines B. work best after the mast cells have degranulated C. are effective in reducing the symptoms of conjunctivitis D. are applied intranasally E. increase ocular hyperemia
Answer: D, are applied intranasally
16. Which of the following is not true of mineralocorticoids like fludrocortisone? A. cause an increase in reabsorption of sodium B. cause K+ ion transport to urine C. regulate fluid balance D. decrease inflammation E. are administered with a glucocorticoid in Addison's disease
Answer: D, decrease inflammation
34. Select the actions of beta-blockers. A. decrease heart rate B. increase AV conduction C. decrease automaticity of ventricular muscle D. decrease heart rate and decrease automaticity of ventricular muscle E. all of these
Answer: D, decreased heart rate and decrease automaticity of ventricular muscle
7. Which is NOT a mechanism of action of an oral antidiabetic drug? A. increased insulin sensitivity in target tissues B. inhibit or delay the breakdown of carbohydrates in the intestine C. direct action on the beta cell membrane-bound receptors D. direct stimulation of insulin receptors in skeletal muscle E. inhibit renal glucose transport proteins
Answer: D, direct stimulation of insulin receptors in skeletal muscle
10. Which of the following when used together have complementary actions that increase insulin secretion? A. regular human insulin and insulin glargine B. DPP-4 inhibitor sitagliptin and metformin C. amylin and glucagon D. glyburide and incretin mimetics E. SGLT2 inhibitor canagliflozin and metformin
Answer: D, glyburide and incretin mimetrics
13. Which of the following is correct? A. lipodystropy is exacerbated by alpha glucosidase inhibitors miglitol and acarbose B. insulin is the preferred treatment in type 2 DM because there are no drug interactions C. oral antidiabetic drugs include pramlintide D. hypoglycemia is the most common adverse effect of many antidiabetic drugs E. metformin is the drug of choice in patients with metabolic acidosis
Answer: D, hypoglycemia is the most common adverse effect of many antidiabetic drugs
17. The pharmacologic actions of verapamil include A. decreased AV conduction B. increased myocardial contraction C. decreased heart rate D. only decreased AV conduction and decreased heart rate E. all of these
Answer: D, only decreased AV conduction and decreased HR
24. Thiazide diuretics help treat hypertension by A. decreasing peripheral resistance B. increasing cardiac output C. increasing excretion of sodium D. only decreasing peripheral resistance and increasing excretion of sodium E. all of these
Answer: D, only decreasing peripheral resistance and increasing excretion of sodium
i) Select the mechanisms of action for terbutaline (a beta-2 agonist). A. inhibit release of mediators from mast cells B. block beta-2 receptors C. relax smooth muscle D. only inhibit release of mediators from mast cells and relax smooth muscle E. all of these
Answer: D, only inhibit release of mediators from mast cells and relax smooth muscle
25. Which hormone is synthesized in the hypothalamus and released from the posterior pituitary? A. insulin B. thyroxine C. cortisol D. oxytocin E. mefipristone
Answer: D, oxytocin
8. Corticosteroids work by doing which of the following? A. reduce the number of T- and B-cells B. increase the number of lymphocytes in the blood C. inhibit synthesis of inflammatory mediators D. reduce the number of T- and B-cells and inhibit synthesis of inflammatory mediators E. all of these
Answer: D, reduce the number of T- and B-cells and inhibit synthesis of inflammatory mediators
20. The main mechanisms of action of nitrates include A. increasing the venous return to the heart B. reducing atherosclerosis in the arteries C. increasing cardiac work D. relaxation of systemic veins and arteries E. increasing oxygen consumption
Answer: D, relaxation of systemic veins and arteries
20. What is NOT an adverse effect of osmotic laxatives? A. depressed CNS B. decreased muscle function C. dehydration D. respiratory depression E. flatulence and cramps
Answer: D, respiratory depression
13. All of the following are true EXCEPT A. anuria is a state where no urine is formed B. the major tubular secretory function of the nephron involves hydrogen and potassium ions C. uremia is an accumulation of nitrogen waste products D. tubular reabsorption of water is diuresis E. diuretics are a significant drug therapy for hypertension
Answer: D, tubular reabsorption of water is diuresis
23. The release of renin causes which of the following? A. activation of RNA mechanism B. vasodilation C. water excretion D. decreased blood pressure E. activation of angiotensin I
Answer: E, activation of angiotensin I
12. Which of the following is correct about mineralocorticoids? A. they are secreted by the adrenal medulla B. the target organ is the pancreas C. they cause excess excretion of sodium ions D. their principle action is to reduce inflammation E. aldosterone is the primary hormone
Answer: E, aldosterone is primary hormone
1. The therapeutic actions of angiotensin-converting enzyme (ACE) inhibitors include A. arterial dilation B. elimination of sodium C. venous dilation D. increased bradykinin (a peptide cause blood vessel to dilate) E. all of these
Answer: E, all of these
10. Which of the following are uses for interferons? A. multiple sclerosis B. hairy cell leukemia C. lymphoma D. multiple sclerosis and lymphoma E. all of these
Answer: E, all of these
15. The regulation of cortisol secretions involves which of the following? A. diurnal rhythm B. negative feedback triggered by elevated circulating cortisol levels C. stress D. circadian rhythm E. all of these
Answer: E, all of these
16. The therapeutic actions of propranolol to prevent anginal attacks include A. decreased heart rate B. reduced force of myocardial contraction C. decreased oxygen consumption D. decreased cardiac work E. all of these
Answer: E, all of these
21. Propranolol works by doing which of the following? A. decreasing heart rate B. decreasing cardiac work C. decreasing force of contractions D. decreasing oxygen consumption E. all of these
Answer: E, all of these
3. The actions of digoxin (Lanoxin) include A. decreased heart rate (yes) B. inhibition of Na/K ATPase C. increased calcium inside heart muscle D. increase formation of actinomyosin E. all of these
Answer: E, all of these
31. The pharmacologic effects of verapamil may include A. decreased heart rate B. decreased force of myocardial contraction C. slowed AV conduction D. vasodilation E. all of these
Answer: E, all of these
5. The causes of heart failure include A. untreated hypertension B. weakening of contractile force C. myocardial infarction D. valvular defects E. all of these
Answer: E, all of these
7. Select the cells involved in the immune response. A. killer T-cells B. B-cells C. memory cells D. killer T-cells and memory cells E. all of these
Answer: E, all of these
e) The pharmacologic actions of theophylline (Elixophylline) in the treatment of COPD include A. bronchodilation B. increased contractility of respiratory muscles C. increased mucociliary activity D. only bronchodilation and increased mucociliary activity E. all of these
Answer: E, all of these
g) The chemical mediators involved in asthma include A. prostaglandins B. ECF-A C. leukotrienes D. only prostaglandins and leukotrienes E. all of these
Answer: E, all of these
24. Which of the following is NOT associated with thyroid hormone actions on the body? A. increase in blood glucose B. stimulation of protein synthesis C. decrease in serum cholesterol D. increase in circulating fatty acids E. calcitonin stimulation of osteoclasts
Answer: E, calcitonin stimulation of osteoclasts
6. What are the different routes of administration for nitroglycerin? When is each indicated?
For acute relief of angina, sublingual or intravenous administration may be used. For prophylactic prevention of angina, oral, transdermal, or ointment is indicated.
12. What factors antagonize the actions of insulin and the oral hypoglycemics?
Glucagon, epinephrine, diazoxide, chlorpromazine, and sympathomimetics counteract the action of insulin by inhibiting glucose utilization. Thus, they also antagonize the actions of the oral hypoglycemics.
What are the effects of histamine on various tissues?
Histamine produces vasodilation of capillaries, contraction of muscle in the intestine, constriction of smooth muscle of the bronchioles, increased heart rate, and secretion of gastric acid. Effects of histamine on the capillaries within the skin produce the characteristic allergic responses of redness, swelling (edema), and itching or pain.
10. Why are antihistaminics found in over-the-counter products? What are two examples?
Dimenhydrinate (Dramamine) can relieve vertigo, motion sickness, and nausea. Antihistaminics that relieve symptoms associated with the common cold include Tylenol Cold and Flu. Nonprescription sleeping aids include Nytol (diphenhydramine). Diphenhydramine is sometimes used as an antiemitic too.
13. What is the mechanism of action of diphenoxylate?
Diphenoxylate is a narcotic derivative that interacts with cholinergic and opiate receptors in the body to decrease intestinal motility. Diphenoxylate is rapidly metabolized in humans to difenoxen. Difenoxen is a mu receptor agonist that stimulates mu receptors in the myenteric plexus to decrease peristalsis and constrict sphincters.
5. How does the mechanism of action of proton pump inhibitors differ from that of antacids and sucralfate?
Drugs that decrease gastric acid secretion by inhibiting the enzyme (ATPase) exchange of hydrogen and potassium ions are proton pump inhibitors. These drugs are absorbed into the circulation before a clinical response can be achieved. In contrast, most antacids and sucralfate perform a local action (complex with the acid or mucopolysaccharides) at the ulcer site to minimize continued irritation.
11. A 14-year-old girl has ingested large amounts of pills in a suicide attempt. She is rushed to the emergency department in a soporific state. Acetaminophen is identified as the ingested compound. Immediate steps are taken to address the clinical problem of A) CNS hyperexcitability. B) nephrotoxicity. C) cardiotoxicity. D) neurotoxicity. E) hepatotoxicity.
E, hepatotoxicity
A 15-year-old female has severe inflammatory bowel disease. She has been treated with mesalamine. Recently, frequent flares of her disease have increased the need for oral prednisone and antibiotics. Her gastroenterologist considers treatment with an anti-tumor necrosis factor alpha (anti-TNF-) antibody. 15. Refer to the case above. This drug is most likely to be A) etanercept. B) OKT3. C) rituximab. D) efalizumab. E) infliximab.
E, infliximab
6. How do systemic antacids (sodium bicarbonate) differ from nonsystemic antacids?
Elements of systemic antacids (for example, sodium bicarbonate) are absorbed into the circulation and distributed to other tissues. Nonsystemic antacids remain within the gastrointestinal lumen, interact with the acid or mucosal lining on contact, and are then excreted in the feces.
18. Compare the pharmacological effects of epinephrine and albuterol. What is the main indication for each?
Epinephrine stimulates all adrenergic receptors (alpha, beta-1, beta-2). In addition to producing bronchodilation, epinephrine increases heart rate and produces other sympathetic effects. Albuterol, a newer drug, is selective and stimulates only beta-2 receptors so that only bronchodilation occurs. Newer drugs such as albuterol generally are used to cause bronchodilation and avoid possible adverse sympathetic effects such as tachycardia and cardiac arrhythmias, but epinephrine is still preferred for treating acute asthma attacks.
Differentiate between erythema and dermatitis.
Erythema is redness of the skin that is often the result of capillary dilation. Dermatitis is an inflammatory condition of the skin associated with itching, burning, and edematous vesicular formations.
3. How does lovastatin produce its hypolipidemic effect?
Lovastatin produce its hypolipidemic effect (Mevacor) as it alters cholesterol synthesis in the liver by inhibiting the enzyme HMG-CoA reductase. All drugs in this class have the same site of action and effectively reduce total cholesterol and LDL plasma levels.
4. How does insulin control the symptoms of diabetes?
Insulin administration rapidly reduces hyperglycemia and its complications and suppresses ketosis.
5. What is the mechanism of action of the nitrates?
Nitrites and nitrates produce a general vasodilation of systemic veins and arteries which reduces venous return cardiac work, and oxygen consumption. Reduction of cardiac work and oxygen consumption provides relief of ischemia and pain.
14. What are the primary causes of constipation?
Poorly developed toilet habits, such as ignoring the intestinal stimulus to defecate (rectal distention) or voluntary retention of feces, may result in constipation. Diets low in fiber also contribute to the development of constipation.
7. Why are some insulins shorter acting than others?
The size of the insulin crystal or amount of additional protein combined with the insulin determines the duration of action. Short-acting insulins are usually smaller.
2. What is the difference between type 1 and type 2 diabetes?
Type I (insulin-dependent diabetes, juvenile diabetes, or growth-onset diabetes) is characterized by a total lack of insulin production and secretion. Onset occurs before the age of 20, when growth is still evident. Type 2 (maturity-onset diabetes, adult diabetes) usually occurs after the age of 40 and is characterized by a relative insulin deficiency.
11. What factors potentiate the hypoglycemic actions of insulin and the oral hypoglycemic
Salicylates, beta-blockers, adrenergic neuronal blockers, and MAO inhibitors reduce circulating blood glucose levels; therefore, these drugs potentiate the hypoglycemic actions of insulin. Drugs that inhibit liver enzymes, displace sulfonylureas from protein-binding sites, or inhibit glucose metabolism will potentiate the hypoglycemic actions of sulfonylureas.
16. Discuss the relationship of cyclic AMP to the autonomic nervous system.
Sympathetic stimulation increases cyclic adenosine monophosphate (AMP) levels, while parasympathetic stimulation increases cyclic guanosine monophosphate (GMP) levels.
13. What physiological effects are produced by the thyroid hormones T3 and T4?
T3 and T4 stimulate protein synthesis, increase blood glucose and circulating fatty acids, and decrease serum cholesterol. These substances are essential for cell building, repair, and energy. By stimulating cell metabolism, T3 and T4 also increase the basal metabolic rate (BMR) and heat production.
13. What role do the kidneys play in hypertension?
The kidneys play an important role in maintaining sodium and water balance in the body. When renal blood flow is reduced, the enzyme renin is released by the kidneys into the bloodstream.
10. What are the consequences of chronic and acute diarrhea?
Acute diarrhea is associated with the production of loose stools in otherwise healthy individuals that lasts less than 14 days. Diarrhea that lasts more than 30 days is defined as chronic and is accompanied by weight loss, muscle weakness, and electrolyte imbalance.
6. How do the insulin preparations differ?
All commercial insulin preparations produce the same metabolic effects, but preparations differ in the source of the polypeptide, their onset and duration of action, and the compatibility of products to extend the insulin action.
5. Fexofenadine and cetirizine A. are more selective for peripheral H 1 -receptors B. bind the H 1 -receptors in the brain to produce fewer side effects C. are more sedating and drying than diphenhydramine D. are mast cell stabilizers E. shorten the cardiac QTc interval
Answer A, are more selective than peripheral H1-receptors
8. Which of the following is correct? A. TC (total cholesterol) 5 HDL - LDL - TG B. periodic monitoring of liver enzymes (AST, ALT) appropriate to the clinical situation is not recommended with systemic hypolipidemic drugs C. grapefruit consumption may reduce the blood level of the statin drugs D. grapefruit inhibits the same enzyme in the cholesterol pathway as the statin drugs E. all statins are contraindicated for use with azole antifungal drugs
Answer: ?
33. A class IB antiarrhythmic drug, like lidocaine, does which of the following? A. mildly decrease in Phase 0 depolarization B. prolongation of ventricular repolarization C. decrease in AV conduction D. increase in PR interval E. decrease Phase 4 automaticity
Answer: A , mildly decrease in Phase 0 depolarization
25. Clonidine works to reduce blood pressure by which of the following actions? A. decreasing sympathetic nerve activity B. stimulating inhibitory alpha-2 receptors C. decreasing release of renin D. decreasing sympathetic nerve activity and decreasing release of renin E. all of these
Answer: A and B, decreasing sympathetic nerve activity and stimulating inhibitory alpha-2 receptors
6. Which of the following are roles of macrophages? A. release interleukins B. produce antibodies C. provide long-term immunity D. recognize foreign antigens E. inhibit immune activity
Answer: A and D, release interleukins and recognize foreign antigens
22. Variant angina is best treated with what types of medication? A. calcium channel blockers B. beta-blockers C. nitrates D. only calcium channel blockers and nitrates E. all of these
Answer: A, calcium channel blockers
4. All of the following are correct about cholesterol or these hypolipidemic drugs EXCEPT A. cholesterol is lowered by a diet rich in saturated fats B. cholesterol is elevated in people with primary hypercholesterolemia C. nicotinic acid is used to treat hyper cholesterolemia D. fenofibrate primarily affects VLDL and triglycerides E. macrophages consume LDL to form cholesterol-rich foam cells
Answer: A, cholesterol is lowered by a diet rich in saturated fats
6. Which of the following is NOT an antiemetic drug? A. cisplatin B. granisetron C. aprepitant (Emend) D. promethazine E. dolasetron (Anzemet)
Answer: A, cisplatin
7. Which is not a function of hormones? A. conduct electrical impulses B. regulate growth C. control metabolism D. help in reproduction E. milk letdown
Answer: A, conduct electrical impulses
30. The uses of oxytocics include A. control of postpartum bleeding B. decreasing contractions C. inducing therapeutic abortions D. uterine tetany E. lowering blood pressure
Answer: A, control of postpartum bleeding
21. The mechanism of drug action by which erectile dysfunction is treated A. inhibition of phosphodiesterases B. inhibition of GnRH C. vasoconstriction of the blood vessels in the penis D. stimulation of the release of testosterone E. stimulation of estrogen secretion
Answer: A, inhibition of phosphodiesterases
8. Which of the following is correct about type 2 DM? A. insulin is secreted by the beta cells and insulin resistance is present B. insulin cannot be used in type 2 DM C. patients are only prone to persistent infections in type 1 DM D. oral antidiabetic drugs cannot be combined to achieve glycemic control E. oral antidiabetic drugs are ineffective
Answer: A, insulin is secreted by beta cells and insulin resistance is present
1. Which of the following is correct: 75 to 80 percent of total cholesterol in the body A. is synthesized in the liver B. enters the body as dietary cholesterol C. is transported as chylomicrons in the blood D. is transported as HDL E. causes hyperlipidemia
Answer: A, is synthesized in the liver
8. Which of the following is true of the hypothalamus? A. it controls the master gland B. it is composed of two main lobes C. it is connected by a portal system to the posterior pituitary gland D. it releases luteinizing hormone E. it is the target organ for growth hormone
Answer: A, it controls the master gland
2. All of the following are correct about "bad" cholesterol EXCEPT A. it is a high-density lipoprotein B. high levels of LDL contribute to atherosclerosis C. it is a lipoprotein D. it contains more fat and less protein than "good cholesterol" E. the liver produces more LDL to transport cholesterol as the cholesterol level rises
Answer: A, it is a high-density lipoprotein
7. The causes of peptic ulcers include A. not enough mucosal lining in the stomach B. suppressed acid production C. regurgitation of bile acids into the esophagus D. being genetically predisposed E. hypersecretion of mucus in the stomach
Answer: A, not enough mucosal lining in stomach
14. The main therapeutic effects of the statins include A. reducing LDL and CRP levels B. reducing HDL levels C. reducing hepatic CYP3A4 levels D. reducing acetyl CoA levels E. reducing triglyceride secretion at the intestine's brush border
Answer: A, reducing LDL and CRP levels
12. A patient presents with severe diarrhea. Upon questioning, the patient mentions that he returned from Thailand a week ago. The patient is diagnosed with "traveler's diarrhea." The drug of choice for this patient would include A. rifaximin B. bulk laxatives C. lubiprostone (a ClC 2 chloride channel activator) D. methylnaltrexone E. polyethylene glycol-electrolyte solution (PEG-ES)
Answer: A, rifaximin
3. Which of the following oral antidiabetic agents increases the incretin's duration of action? A. sitagliptin B. acarbose C. nateglinide D. tolbutamide E. exenatide
Answer: A, sitagliptin
8. The main effects of beta blockers include A. slowing the heart rate B. increasing the release of renin C. increasing ADH D. increasing aldosterone E. increasing sodium retention
Answer: A, slowing the heart rate
26. During parturition, oxytocin A. stimulates uterine muscle contraction B. increases urine output C. inhibits preterm labor D. decreases urine output E. relaxes uterine muscle
Answer: A, stimulates uterine muscle contraction
3. All hormones released by the anterior pituitary are regulated by A. the hypothalamus B. the posterior pituitary C. the fat-soluble releasing hormones D. TSH E. a positive feedback response
Answer: A, the hypothalamus
16. Kidneys maintain acid balance in the body by which of the following actions? A. tubular secretion of hydrogen ions B. increasing the pH of the urine C. neutralizing cell waste products D. decreasing the production of bicarbonate ions E. excreting excess silenium ions
Answer: A, tubular secretion of hydrogen ions
21. The drug that is classified as an arterial vasodilator and that also has a direct effect to decrease heart rate and cardiac contractility is A. verapamil B. propranolol C. prazosin D. captopril E. nifedipine
Answer: A, verapamil
15. Which of the following laxatives would be ordered before a colonoscopy? A. docusate sodium (laxative to treat constipation in children) B. polyethylene glycol C. psyllium hydrophilic (dietary fiber to relieve symptoms of both constipation and mild diarrhea) D. mineral oil E. bismuth subsalicylate (adsorbents)
Answer: B (hyperosmotic cathartic), polyethlyene glycol
11. Which of the following is true of the negative feedback system? A. levels of circulating hormone always change suddenly and severely B. the target organ turns off pituitary secretion C. a baby suckling is an example of negative feedback D. hormones are NOT controlled by this process E. oxytocin causes the reduction in thyroid hormone secretion
Answer: B , target organ turns off pituitary secretion
32. Select the ion that enters the cardiac cell during phase 2 of the cardiac cycle. A. Cl B. Ca C. Na D. K E. Li
Answer: B, Ca
4. A patient is newly diagnosed with mild GERD. Which of the following medications might be prescribed first? A. barbiturates B. H2 -receptor antagonists C. metoclopramide D. dronabinol (Marinol) E. OTC Emetrol
Answer: B, H2-receptor antagonists
6. Which of the following is an indicator of glycemic control in type 2 DM patients? A. hourly blood glucose values B. HbA1c level C. RBC hematocrit D. blood insulin of 50 IU/dl E. miglitol secretion
Answer: B, HbA1c level
17. If calcium levels decrease below normal, which hormone would be released to compensate? A. calcitonin B. PTH C. TRH D. TSH E. FSH
Answer: B, PTH
30. The antiarrhythmic drug with the shortest duration of action that is administered IV in the emergency treatment of supraventricular tachycardia is A. lidocaine B. adenosine C. propranolol D. amiodarone E. verapamil
Answer: B, adensine
2. Releasing hormones A. travel along axons to the posterior pituitary B. affect the secretion of hormones in the anterior pituitary C. are released by the target organ to regulate hypothalamus D. produce nerve impulses E. stimulate the release of oxytocin
Answer: B, affect the secretion of hormones in anterior pituitary
2. Mast cells A. are only found in the bloodstream B. are coated with immunoglobulins that recognize antigens C. have no other role than antiallergy in the body D. degranulate when the H 1 -receptor is stimulated E. degranulation results in hypertension
Answer: B, are coated with immunoglobulins that recognize antigens
4. Antihistamines like chlorpheniramine A. are the newest, third-generation drugs B. are effective and can cause drowsiness C. are not found in OTC products D. do not have anticholinergic properties E. are less effective than diphenhydramine
Answer: B, are effective and can cause drowsiness
7. Vasodilators decrease afterload by affecting A. veins B. arteries C. the SA node D. myocardial contraction E. venous return
Answer: B, arteries
c) The only drug class that provides immediate relief of an acute asthmatic attack is A. anticholinergics B. beta adrenergics C. methylxanthines D. corticosteroids E. leukotriene inhibitors
Answer: B, beta adrenergics
22. The antihypertensive drug that decreases sympathetic activity by an action on the vasomotor center in the medulla oblongata is A. hydralazine B. clonidine C. diltiazem D. losartan E. captopril
Answer: B, clonidine
2. The immunosuppressive drug that inhibits the production of interleukin-2 is A. azathioprine B. cyclosporine C. cyclophosphamide D. infliximab E. thalidomide
Answer: B, cyclosporine
27. Select the medication administered IV that is primarily indicated for the treatment of malignant hypertension. A. guanabenz B. diazoxide C. carvedilol D. terazosin E. chlorothiazide
Answer: B, diazoxide
6. All of the following are correct about the statin drugs EXCEPT A. all drugs in this class have the same mechanism of action B. dosing is recommended for the evening because the patient won't experience adverse effects while sleeping C. these are systemic drugs meaning they have to be absorbed into the blood D. they are used as adjunct treatment to diet adjustment E. they may cause mental confusion and memory loss
Answer: B, dosing is recommended for the evening because the patient won't experience adverse effects while sleeping
22. Which of the following are true about oral contraceptives? A. the hormone is delivered via a vaginal ring B. they can be monophasic, biphasic, or triphasic C. they can be administered as a spray D. the doses of estrogen are at the highest effective coverage dose E. they are used for hormone replacement therapy (HRT)
Answer: B, they can be monophasic, biphasic, or triphasic
a) The bronchodilator drug that would provide the longest duration of action is A. epinephrine (Adrenaline) B. ipratropium (Atrovent) C. salmeterol (Serevent) D. theophylline (Elixophylline) E. terbutaline (Brethine)
Answer: C (that is long-acting), salmeterol (Servent)
4. The immunosuppressive drug that forms a toxic metabolite and that can cause hemorrhagic cystis is A. cyclosporine B. muromonab-CD3 C. cyclophosphamide D. mycophenolate E. azathioprine
Answer: C and E , cyclophosphamide and azathioprine
17. In both males and females the hypothalamus secretes this hormone to stimulate the release of LH and FSH. A. testosterone B. estrogen C. GnRH D. DHEA E. TRH
Answer: C, GnRH
9. Choose the hormones whose target organs are the gonads of males and females. A. TSH B. ACTH C. LH, FSH D. GH E. somatostatin
Answer: C, LH, FSH
4. Dwarfism is caused by A. elevated thyroid hormone production B. decreased adrenocorticotropic hormone (ACTH) C. decreased growth hormone D. high plasma glucose concentration E. an overactive negative feedback response
Answer: C, decreased growth hormone
21. Irradiation and antithyroid drug administration A. increases T3 and T4 secretion B. increases blood flow to the thyroid gland C. inactivates overactive thyroid tissue D. has no effect on thyroid tumors E. increases heat production in the body
Answer: C, inactivates overactive thyroid tissue
h) Parasympathetic activation of the respiratory tract causes which of the following? A. bronchodilation B. increased cyclic AMP C. increased mucus secretion D. stimulation of the beta-2 receptors E. increased mucociliary action
Answer: C, increased mucus secretion
22. Thyroid hormone replacement therapy A. is indicated in the management of euthyroid patients B. increases bone density with long-term use C. increases blood glucose levels D. is recommended in the management of patients with a history of myocardial infarction E. includes potassium iodide combination therapy
Answer: C, increases blood glucose levels
19. A mechanism by which oral contraceptives prevent ovulation includes A. inhibiting the corpus luteum's production of progesterone B. facilitating implantation to occur C. increasing the levels of estrogen and progesterone D. stimulating the release of LH and FSH E. stimulating the release of follitropin
Answer: C, increasing levels of estrogen and progesterone
d) The mechanism of action of cromolyn sodium (Intal) is to A. produce bronchodilation B. increase expectoration of mucus C. inhibit release of mast cell mediators D. liquefy bronchial secretions E. block leukotrienes
Answer: C, inhibit release of mast cell mediators
13. HMG-CoA reductase inhibitors (statins) work by doing which of the following? A. blocking the intestinal absorption of cholesterol B. inhibiting triglyceride lipase C. inhibiting the production of mevalonic acid D. decreasing hepatic VLDL-triglyceride synthesis E. blocking the reabsorption of cholesterol in the kidney
Answer: C, inhibiting production of mevalonic acid
2. Which of the following insulins would provide a patient diagnosed with type 1 diabetes mellitus a constant release of insulin over a 24-hour period? A. regular insulin B. insulin aspart C. insulin glargine D. insulin lispro E. aerosolized insulin powder
Answer: C, insulin glargine
3. An acute allergic response A. can be blocked only by histamine B. cannot be prophylactically treated C. is characterized by itching, sneezing, and edema D. is only characterized by wheals and urticaria E. is the same as a type IV delayed allergic response
Answer: C, is characterized by itching, sneezing, and edema
11. The defecation reflex A. is a voluntary process B. contracts the external anal sphincter C. is initiated by distension of the colon D. propels feces into the small intestine E. is controlled by the sympathetic nervous system
Answer: C, is initiated by distension of colon
1. Which of the following parameters would help to differentiate between type 1 and type 2 diabetes? A. blood glucose level B. hemoglobin A1c level C. ketoacidosis D. cholesterol level E. glucagon levels
Answer: C, ketoacidosis
14. Select the long-acting insulin preparation. A. Apidra B. Novolog C. Lantus D. Symlin E. Afrezza
Answer: C, lantus
3. Which of the following drugs blocks the release of HCl from the parietal gland? A. antacids B. H2 -receptor antagonists C. proton pump inhibitors D. sucralfate E. misoprostil
Answer: C, proton pump inhibitors
10. The primary site of action of thiazide diuretics in the nephron is A. the proximal tubule B. the loop of Henle C. the distal tubule D. the capsule area of glomerular filtration E. the osmotic urea channel
Answer: C, the distal tubule
7. Which of the following is correct about drugs used to treat allergy? A. oral cromolyn cannot be taken with fruit juices or food B. first-generation antihistamines are selective for H2-receptor interaction C. meclizine is also effective in reducing anxiety D. antihistamines should not be used during pregnancy E. tolerance does not develop to the drowsiness
Answer: D, antihistamines should not be used during pregnancy
19. Therapy for a patient with hypercalcemia would include A. estrogen B. irradiation C. vitamin D D. calcitonin E. antibody replacement
Answer: D, calcitonin
9. Which of these is NOT true with regard to loop diuretics? A. can cause hyperuricemia B. can cause hyperglycemia C. can be used to reduce ascites due to malignancy D. can cause metabolic acidosis E. the diuresis is not refractory
Answer: D, can cause metabolic acidosis
18. Which of the following drugs are used to stimulate defecation? A. 5-HT 3 antagonists B. adsorbents C. antimotility drugs D. cathartics E. cholestyramine resin 19. Select the mechanisms by which swelling agents increase defecation. A. soak up water and distend the rectum B. irritate the mucosal lining of the intestine C. inhibit stool formation in the large intestine D. coat the fecal matter E. complex with bile salts to produce diarrhea Answer: A
Answer: D, cathartics
6. Which medication reduces edema by blocking the reabsorption of sodium in the distal tubules? A. eplerenone B. torsemide C. triamterene D. chlorothiazide E. lasix
Answer: D, chlorothiazide
3. Filgrastim is classified as a(n) A. interleukin B. interferon C. corticosteroid D. colony stimulating factor E. immunosuppressive drug
Answer: D, colony stimulating factor
26. Verapamil would be useful to treat hypertension in individuals who also suffer from A. coronary artery disease B. CHF C. supraventricular arrhythmias D. coronary artery disease and supraventricular arrhythmias E. all of these
Answer: D, coronary artery disease and supraventricular arrhythmias
23. Which is not correct about how clomiphene works? A. stimulates the release of FSH and LH B. can cause more than one egg to be released C. acts as a follicular development stimulant D. increases estrogen receptors E. binds to estrogen receptors as a receptor antagonist
Answer: D, increases estrogen receptors
19. The drug that is best described as a venodilator that decreases preload (venous return) in the treatment of angina is A. propranolol B. verapamil C. nifedipine D. isosorbide dinitrate E. amlodipine
Answer: D, isosorbide dinitrate
14. Which of the following drugs has been approved for treatment of patients with constipation caused by opioid analgesics? A. emollients B. lubiprostone C. stimulants D. methylnaltrexone E. magnesium citrate
Answer: D, methylaltrexone
b) The drug used in the treatment of asthma that blocks the leukotriene receptor is A. fluticasone (Flovent) B. cromolyn (Intal) C. albuterol (Proventil) D. montelukast (Singulair) E. tiotropium (Spiriva)
Answer: D, montelukast (singulair)
18. The desired antihypertensive effects of adrenergic beta-blocking drugs include A. decrease in heart rate B. decrease in release of renin C. decrease in cardiac output D. only decrease in heart rate and decrease in cardiac output E. all of these
Answer: D, only decrease in heart rate and decrease in cardiac output
5. A patient newly diagnosed with hyperthyroidism has blood drawn for labs. The physician tells the patient that his TRH function is normal as is the TSH level. Using negative feedback, which location is most likely secreting excess hormone? A. CNS B. anterior pituitary C. hypothalamus D. target organ (thyroid gland) E. adrenal cortex
Answer: D, target organ (thyroid gland)
24. Which is not an action of androgens? A. stimulation of protein synthesis B. increase in appetite C. erythropoiesis D. weight gain E. dyspareunia (painful sexual intercourse)
Answer: E, dyspareunia (painful sexual intercourse)
11. Which of the following are not risk factors for atherosclerosis? A. male over the age of 45 B. smoker C. hypothyroidism D. low HDL levels E. elevated HDL levels
Answer: E, elevated HDL levels
12. Loop diuretics increase the excretion of all of the following EXCEPT A. sodium B. uric acid C. water D. potassium E. glucose
Answer: E, glucose
16. Which of the following is NOT a primary cause of diarrhea? A. increased intestinal motility B. inflammation C. osmotic imbalance D. drug therapy E. hydration from daily water intake
Answer: E, hydration from daily water intake
10. All of the following make cholesterol so important for the body EXCEPT A. building block for glucocorticoids B. essential for building cell membranes C. needed to help form myelin sheath D. helps in digestion of dietary fats E. inhibits formation of nerve covering
Answer: E, inhibits formation of nerve covering
14. A patient taking prednisone long term (chronically) might develop which of the following adverse effects? A. dehydration B. hypotension C. bronchial asthma D. weight loss E. moon face or buffalo hump
Answer: E, moon face or buffalo hump
27. The adverse effects of thioamide drugs include A. psychotic behavior B. increased blood pressure C. weight loss D. insomnia E. rash and myalgia
Answer: E, rash and myalgia
29. Which of the following are causes of diabetes insipidus? A. increased ADH B. damage to the pancreas C. tumors of the thyroid gland D. positive feedback response on the posterior pituitary E. renal disease and head trauma
Answer: E, renal disease and head trauma
12. Choose the true statement about oral antidiabetic drugs. A. incretins increase glucagon secretion B. biguanides have receptors on skeletal muscle C. elderly patients are usually resistant so doses have to be increased D. insulin sensitizers (thiazolidionediones) do not stimulate insulin secretion E. they cannot be used with insulins
Answer: E, they cannot be used with insulins
23. Which of the following is true regarding bisphosphonates? A. they include ibandronate and calcitrol B. they can only be administered orally once or twice a year C. they reverse hypocalcemia D. they promote osteoporosis E. they should be combined with calcium supplements and vitamin D for optimal effect
Answer: E, they should be combined with calcium supplements and vitamin D for optimal effect
3. How does the mechanism of action of an antisecretory drug differ from that of an antacid?
Antacids neutralize the acid ions. Antacids are taken orally and usually remain within the gastrointestinal tract to exert their effects. Antisecretory drugs, although taken orally, are expected to be absorbed into the tissues, especially gastrointestinal tissue, where they interfere with metabolic pathways or specific receptors in order to inhibit acid secretion.
8. How do the antihistaminics prevent the action of histamine? What receptors are involved in allergic reactions?
Antihistaminic drugs have a structure that permits the molecules to interact with (occupy) histamine receptors and block histamine from producing its usual responses. Two types of known histamine receptors are H1- and H2-receptors. Allergic responses produced by histamine are mediated through the H1-receptors located in the smooth muscle of blood vessels, bronchioles, intestine, and skin capillaries.
7. Can antacids be used in conjunction with antisecretory drugs in the treatment of ulcers?
Because antacids are easily available as over-the-counter, nonprescription drugs, many patients take antacids concurrently with antisecretory drugs; however, these products may counteract each other if they are taken too close together. Antacids may decrease the absorption of many drugs, including antisecretory drugs, by changing the pH of the gastric environment so the other drug cannot be efficiently absorbed, or the antacids may complex with antisecretory drugs and impair systemic absorption.
8. Why do the insulins occasionally produce allergic reactions?
Because the hormone is a polypeptide and is frequently combined with a protein (antigen), diabetics sometimes develop allergic reactions. Insulin obtained from pigs (porcine) is less antigenic than is beef insulin. Regular or lente insulins are preferred because these preparations do not contain protein complexes (protamine or globin).
7. Explain the mechanism of action of propranolol in the treatment of angina.
Beta-adrenergic blockers, such as propranolol, decrease heart rate and force of cardiac contractions. This reduces cardiac work and oxygen requirements.
13. A 52-year-old male heart transplant recipient is on an immunosuppressant regimen with cyclosporine, prednisolone, and azathioprine. Cyclosporine binds to cyclophilin. The resulting complex A) inhibits dihydroorotate dehydrogenase, leading to inhibition of pyrimidine synthesis. B) inhibits inosine monophosphate dehydrogenase, the rate limiting enzyme in the formation of guanosine. C) inhibits the phosphatase activity of calcineurin, a cell-signaling protein that mediates T-cell activation. D) inhibits mTOR, a regulator of protein translation. E) inhibits B lymphocyte stimulator.
C, inhibits the phosphatase activity of calcineurin, a cell-signaling protein that mediates T-cell activation
21. When is calcitonin used?
Calcitonin, available as a synthetic polypeptide hormone, is administered to hypercalcemia patients whose thyroid and parathyroid glands function normally in order to inhibit accelerated bone resorption.
8. What is the effect of the calcium channel blockers on vascular smooth muscle?
Calcium antagonists relax vascular smooth muscle, decreasing venous return, blood pressure, and coronary artery spasm.
8. How can acetazolamide produce metabolic acidosis?
Carbonic anhydrase facilitates the availability of hydrogen and bicarbonate ions, which are essential for maintenance of acid-base balance. Acetazolamide inhibits carbonic anhydrase so that very little hydrogen and bicarbonate are produced (it does not totally eliminate these ions). When bicarbonate ions are not available to buffer acid molecules, a state of metabolic acidosis results. 9. What adverse effects are common to both the thiazide and the organic acid diuretics? Both of these classes of drugs are potent diuretics. Because these drugs rapidly remove water and sodium ions from the body, the plasma volume may decrease, causing hypotension. Because these drugs cause loss of potassium ions, patients may experience muscle cramping or changes in cardiovascular function (hypokalemia). Hyperuricemia and hyperglycemia are other possible adverse effects.
What is the main action of digoxin on heart rate and force of myocardial contraction?
Cardiac glycosides increase the contractile force of the heart without increasing oxygen consumption.
15. What chemical mediators are released from mast cells? What effects do they produce?
Chemical mediators released include histamine, prostaglandins such as slow-reacting substance of anaphylaxis (SRS-A), and eosinophilic chemotactic factor (ECF-A). Bronchoconstriction, increased vascular permeability that contributes to mucosal edema, and infiltration of leukocytes into the respiratory tract are the usual responses to mediator release.
2. What stimulates gastric secretion of digestive enzymes and acid?
Gastric acid secretion is stimulated when food enters the stomach. Distension of the stomach causes hormones (gastrin) or vagal nerves to stimulate acid release. Sensory (for example, sight, smell, or taste) or emotional (memory) stimuli can also trigger the gastrointestinal system to secrete digestive enzymes (pepsin) and acid.
15. What are the various types of laxatives? How do they differ?
Laxatives can be classified according to their mechanism of action, which includes stimulants, swelling agents, osmotic (saline) laxatives, emollients, chloride channel activators, and mu-opioid receptor antagonists. Stimulant laxatives directly irritate the mucosal lining of the intestine. In addition to the irritation, histamine is released, enhancing intestinal motility. Swelling agents are natural fibers or grains that remain in the intestine, soak up water, and expand (swell). The water, which is retained, softens the stool, whereas the swelling action distends the rectum and initiates defecation. Osmotic, or saline, laxatives attract water (osmosis) which causes a more liquid stool to be formed. Emollients are laxatives that act on the stool to permit water to penetrate the fecal mass.
5. What is the mechanism of action of muromonab-CD3?
Cluster of differentiation 3 (CD3) is a multimeric protein complex, known historically as the T3 complex. The CD3 complex serves as a T cell co-receptor that associates noncovalently with the T cell receptor (TCR) (Smith-Garvin et al. 2009). The CD3 protein complex is a defining feature of the T cell lineage, therefore anti-CD3 antibodies can be used effectively as T cell markers (Chetty and Gatter 1994). Following antigen stimulation, conformational changes within the cytoplasmic tails of the CD3 polypeptides occur. https://www.bio-rad-antibodies.com/minireview-cd3-antibody.html CD-3 is required for T cell activation. Muromonab-CD3 is a monoclonal antibody that binds specifically to T-cells and reduces their ability to participate in immune responses.
2. Briefly describe the function of macrophages, helper T-cells, B-cells, and killer T-cells.
Macrophages are responsible for phagocytizing infectious organisms and for initiating the immune response by stimulating helper T-cells. Helper T-cells stimulate B-cells and other T-cells to multiply and become active. B-cells produce antibodies, while killer T-cells attack and destroy infectious organisms.
20. Discuss the indications for the use of corticosteroids. What advantage is there to using beclomethasone by inhalation?
Corticosteroids are used to control the inflammatory reaction that occurs in the lining of the respiratory airways during an asthma attack. Aerosol inhalation of eclomethasone (a corticosteroid) allows delivery of lower doses of steroid directly into the respiratory tract. This reduces the incidence and severity of adverse effects.
21. Explain the mechanism of action of cromolyn. How is it administered?
Cromolyn prevents the release of chemical mediators from mast cells in the respiratory tract. Cromolyn is administered by inhalation.
7. How does cromolyn sodium produce its antiallergic response? When is cromolyn sodium used?
Cromolyn sodium prevents the release of histamine from the mast cells, so an allergic response is avoided. It has no effect on histamine receptors or smooth muscle tone to interrupt an allergic reaction; therefore, cromolyn must be given prophylactically, before histamine release has begun.
16. What methods are available for treating hyperthyroidism?
Hypersecretory conditions may be corrected with antithyroid drugs, irradiation, or surgical removal of the overactive tissue. Treatment of a hyperactive thyroid usually includes a combination of these methods.
1. What diseases are associated with hyperlipidemia?
Diseases associated with hyperlipidemia include acute pancreatitis, chronic renal failure, diabetes mellitus, hypothyroidism, gout, and liver disease which can elevate cholesterol and/or triglycerides. Secondary hyperlipidemias arising from diet or disease are risk factors that contribute to the development of atherosclerosis and heart disease.
14. What is the mechanism of action of each of the drug classes to lower blood pressure?
Diuretics increase excretion of sodium and water, reduce circulating blood volume. Sympathetic blockers..... Vasodilators act directly on vascular smooth muscle to cause vasodilation. Calcium channels blockers interfere with the influx of calcium to cardiac and vascular smooth muscle, causing vasodilation. ACE inhibitors decrease angiotensin formation, producing vasodilation.
12. Describe the antihypertensive action of the diuretics.
Diuretics increase excretion of sodium, relaxing vascular muscle and producing vasodilation, which leads to a decrease in blood pressure.
What is the difference between an antiallergic and an antihistaminic drug?
Drugs that prevent mast cells from releasing histamine (as well as other substances) are antiallergic drugs or mast cell stabilizers. Drugs that are administered to relieve signs and symptoms of acute reactions in which histamine has already been released are called antihistaminic drugs.
18. What is hypertensive crisis? What drugs are used to treat it?
Hypertensive crisis is the sudden development of severe hypertension. A vasodilator drug such as diazoxide or nitroprusside is administered intravenously to treat hypertensive crisis.
20. What are the side effects of hypoparathyroid therapy? Why?
Hypoparathyroidism is not usually treated by replacement of the parathyroid hormone because parathyroid hormone produces allergic reactions and drug resistance usually develops within 2 weeks. Therefore, hypocalcemia is usually managed with oral calcium salts and vitamin D derivatives.
14. What clinical symptoms reflect the metabolic changes associated with hypothyroidism?
Hypothyroidism (lack of T3 and T4) in infants and children produces mental and physical retardation (cretinism). Hyposecretion of T3 and T4 in adults results in myxedema and nontoxic goiter.
4. How does the mechanism of action of fenofibrate (Tricor) differ from that of cholestyramine (Questran)?
Fenofibrate (Tricor) is directed at triglyceride production. It inhibits triglyceride lipolysis in adipose tissue, decreases free fatty acid uptake by the liver, and decreases hepatic VLDL-triglyceride synthesis. Cholestyramine (Questran) is an ion-exchange resin that combines with the bile salts and cholesterol in the intestinal tract. This prevents the absorption of bile salts and cholesterol resulting in an increased elimination of bile salts, cholesterol, and other fats in the feces.
10. When are the oral hypoglycemics used?
Oral hypoglycemics are used primarily in the treatment of mild type 2 diabetes. They have no value in the treatment of type 1 diabetes or severe diabetes that occurs in the elderly, and they cannot substitute for insulin. The advantage of the sulfonylureas over insulin is that they avoid the trauma and complications, such as lipodystrophy.
16. Why are the osmotic laxatives potentially dangerous?
Osmotic laxatives usually contain sodium and magnesium ions that are absorbed and excreted through the kidneys. An increase in the sodium load may be harmful to patients who have impaired renal function, edema, or congestive heart failure. In sensitive patients, magnesium ions may depress CNS and muscle function.
14. List four physiological changes that can occur in the respiratory tract during an asthma attack.
Physiological changes occurring during an asthma attack include bronchoconstriction, mucosal edema, decreased ciliary action, and release of chemical mediators from mast cells.
4. What would predictably occur from the administration of prostaglandins to a pregnant woman?
Prostaglandins are contraindicated for use in pregnancy because they produce uterine contractions through normal prostaglandin mediated pathways and can precipitate miscarriage or abortion.
19. What hormones control calcium metabolism? How do these hormones differ?
Serum calcium levels are strictly regulated by the secretion of two hormones: calcitonin and parathyroid hormone (parahormone, PTH). Acting directly on bone cells that store calcium, PTH mobilizes calcium ions into the blood (bone resorption) and increases the intestinal absorption and renal reabsorption of calcium ions. These two physiological processes require vitamin D and increase the level of circulating calcium ions in response to hypocalcemia. Calcitonin directly inhibits bone resorption so that calcium ions are retained in the bone. It does not affect intestinal and renal calcium absorption, and its action does not require vitamin D.
1. What factors contribute to ulcer production?
Several factors contribute to ulcer production in people who are predisposed to develop ulcers. Emotional stress, alcohol consumption, smoking, and increased cholinergic activity stimulate the production of gastric acid, which may erode the protective lining of the gastrointestinal tract. Certain drugs are ulcerogenic because they interfere with cytoprotective mechanisms (for example, prostaglandins) in the stomach.
3. What is the function of regulatory (suppressor) T-cells and memory cells?
Suppressor T-cells are responsible for inactivating the immune response when it is no longer required. Memory cells retain the necessary information about the previous immune reactions so that if reinfection occurs, the immune response will occur more rapidly.
3. What are the common symptoms of diabetes?
The most outstanding feature of diabetes is the persistently high level of blood glucose, which leads to an increase in urine glucose (glycosuria) and glucose in circulation (hyperglycemia). Glucose in the renal tubules pulls water out of the cells, and the water is excreted into the urine with the glucose, resulting in polyuria. Patients drink large quantities of fluids (polydipsia) and may increase food consumption (polyphagia) in order to avoid fatigue and hunger. As cells use protein and fat as sources of fuel, ketone bodies increase in the blood (ketoacidosis). Ketoacidosis may enhance the loss of electrolytes (sodium, potassium, and chloride) and produce CNS depression, resulting in diabetic coma and death.
9. How do the oral hypoglycemic drugs differ from the insulins?
The oral hypoglycemics are occasionally useful in the treatment of type 2 diabetes. These drugs enter the beta cells and cause the release of insulin, which alters the blood glucose level, but these drugs do not have any insulin-like activity.
How does the mechanism of action of the osmotic diuretics differ from that of other diuretic drugs?
Unlike other diuretics, osmotic diuretics are not reabsorbed by the renal tubules. Instead, filtered by the glomerulus, they create an osmotic gradient that attracts water molecules, pulling them into the urine to be excreted with the diuretic. In addition, osmotic diuretics do not alter sodium reabsorption, so they do not alter electrolyte or acid-base balance.
Explain two important effects of verapamil on the cardiovascular system.
Verapamil decreases sinoatrial (SA) node activity, resulting in a slight decrease in heart rate. More importantly, verapamil decreases AV node conduction, so it is used to treat various types of AV nodal arrhythmias and other supraventricular tachycardias. Verapamil is also a vessel dilator.
Define prophylaxis.
Prophylaxis is any process or drug that prevents the onset of symptoms (or disease) as a result of exposure before the reactive process can take place.
14. The mechanism by which tacrolimus inhibits interleukin-2 (IL-2) production in activated T cells most closely resembles the pharmacodynamic action of A) cyclosporine. B) sirolimus. C) mycophenolate mofetil. D) leflunomide. E) thalidomide.
A, cyclosporine
12. The major distinction between the effects of aspirin and ibuprofen on platelet function involves the fact that ibuprofen A) does not irreversibly inactivate platelet cyclooxygenase. B) does not inhibit cyclooxygenase in the periphery. C) does not inhibit cyclooxygenase 1 (COX1). D) does not inhibit the lipoxygenase pathway. E) does not inhibit phospholipase A2.
A, does not irreversibly inactivate platelet cyclooxygenase
17. How does the action of the antithyroid drugs differ from the action of radioactive iodide?
Administration of radioactive iodide (irradiation) in hyperthyroidism is directed toward destroying the overactive tissue. When I is administered to severely hyperthyroid individuals, it reduces the thyroid mass (tumors and nodules) and destroys hormone synthesis. Occasionally, patients exposed to I become permanently hypothyroid. In these cases, hormone replacement therapy must be administered for life. Because of its destructive potential, I should never be used during pregnancy or lactation. Antithyroid drugs decrease the production and secretion of T3 and T4.
8. How do voluntary control and the autonomic nervous system affect the process of defecation?
Defecation is under voluntary control to some extent. Individuals may force defecation by increasing abdominal pressure (straining) to force contraction and evacuation (removal of waste matter) of the bowel. Emotional stress or changes in the nervous system. Defecation can be enhanced or inhibited by stimulating the divisions of the autonomic nervous system. Stimulation of parasympathetic fibers (cholinergic) that innervate the intestines increases intestinal motility, whereas stimulation of the sympathetic fibers (adrenergic) decreases motility.
9. What is diarrhea? What are the primary causes of diarrhea?
Diarrhea is a symptom of increased intestinal activity, resulting in loose, watery, unformed stools. Acute diarrhea is usually self-limiting when individuals are in good health but have encountered some irritant, infection, or emotional stress that has increased intestinal motility. Chronic diarrhea is usually accompanied by weight loss, muscle weakness, and electrolyte imbalance because continued intestinal stimulation does not permit proper reabsorption of water and essential ions before defecation occurs.
Explain the clinical importance of digitalization and tell how digitalization differs from maintenance.
Digitalization refers to the administration of glycosides in doses and at intervals that rapidly produce effective blood levels. Maintenance doses are lower dosages that maintain effective drug levels in the blood.
18. What side effects are associated with the use of antithyroid drugs?
The usual side effects of thioamide drugs include rash, fever, myalgia, jaundice, and nausea. Agranulocytosis also has been reported. Cross-sensitivity occurs for all thioamide drugs in sensitive individuals.
1. In what diseases or conditions is it useful to suppress immune function?
Immunosuppression is useful to prevent organ rejection after transplantation, to control severe allergic conditions, and to control diseases such as multiple sclerosis and rheumatoid arthritis, which involve disorders of the immune system.
9. What other pharmacological actions do antihistaminics produce?
In addition to inhibiting the actions of histamine, antihistaminics possess local anesthetic and anticholinergic activity. They can relieve vertigo, motion sickness, and nausea; are commonly found in over-the-counter products for relief of symptoms associated with common colds; and produce sedation.
1. What is the primary deficiency in diabetes?
In diabetes mellitus, the beta cells of the pancreas do not produce or secrete an adequate amount of insulin, which is essential for carbohydrate metabolism.
12. How do the adsorbent antidiarrheals differ from the opiates?
In the lumen of the intestine, adsorbent antidiarrheals form a complex (bind up, attach to) with irritating substances such as bacteria, digestive enzymes, or toxins, and carry them into the feces. Adsorbents also form a complex with vitamins, minerals, and other drugs, thereby impairing systemic absorption of these substances. Difenoxen (an opiod) is a mu receptor agonist that stimulates mu receptors in the myenteric plexus to decrease peristalsis and constrict sphincters. It also has a direct effect on circular smooth muscle of the bowel that prolongs gastrointestinal transit time. Diphenoxylate and difenoxen are chemically related to meperidine (Demerol).
17. What effects does increasing the level of cyclic AMP have on the respiratory tract during asthma?
Increasing cyclic AMP promotes bronchodilation and inhibits the formation and release of chemical mediators from the mast cells. Decreasing cyclic GMP also reduces the symptoms of asthma.
19. Explain the mechanism of action of theophylline.
Theophylline inhibits phosphodiesterase, an enzyme that inactivates cyclic AMP.
15. Briefly describe the function of the renin-angiotensin-aldosterone (RAA) mechanism. What drugs decrease the actions of this system?
Release of renin activates the renin-angiotensin-aldosterone (RAA) mechanism. Activation of the RAA mechanism causes vasoconstriction, and sodium and water retention, which increases blood pressure and is an important factor in hypertension. There are several drug classes that interfere with the activation of the renin-angiotensin-aldosterone (RAA) mechanism. Angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and renin inhibitors decrease the actions of the RAA mechanism.
13. What are some of the factors that can precipitate an asthma attack?
Respiratory irritants, exercise, cold, infection, drugs (aspirin and related drugs), and allergens (for example, pollen and animal dander) are factors that can precipitate an asthma attack.
11. What agents are used for the treatment of simple diarrhea?
Simple diarrhea is most frequently associated with poor dietary habits and emotional stress. Drugs useful in the treatment of nonspecific diarrhea include adsorbents, anticholinergics, and opioid derivative. These antidiarrheal drugs either decrease intestinal motility (anticholinergics and opioids) or remove the intestinal irritant (adsorbents, antibiotics).
Explain the use of aldosterone antagonists in treatment of CHF.
The aldosterone antagonists are weak diuretics that act on the collecting ducts of the nephron. Aldosterone is a steroid from the adrenal cortex that normally causes the retention of sodium ions and excretion of potassium ions. The main effects of the aldosterone antagonists are to decrease the expression of epithelial sodium channel that is responsible for sodium absorption, and cause retention of potassium. In CHF there can be excessive activity of aldosterone, and studies have shown that treatment with these drugs reduces mortality.
Compare the pharmacologic effects of the arterial dilators and venodilators.
The arterial dilators decrease blood pressure and reduce afterload because they dilate the arteries, causing the heart not to have to work as hard to pump blood out into the arteries. Venodilators decrease venous return of blood back to the heart. This decreases preload, which reduces cardiac work.
19. What two preferred antihypertensive drug classes have been shown to reduce mortality?
The drugs with the longest record of proven effectiveness to reduce high blood pressure and prevent mortality are the diuretics and beta-blockers.
11. What adverse effects are associated with antihistaminic use?
The most common adverse effects include drowsiness or sedation (because antihistaminics depress the CNS), dry mouth, hypotension, rapid heartbeat, anorexia, epigastric distress, and urinary retention.
What are the main functions of the kidneys?
The primary function of the kidneys is to maintain water, electrolytes, and acid-base balance for the entire body. In doing so, the blood is filtered, urine is formed, and blood pressure through the major organs is maintained.
2. What is the major approach to the treatment of hyperlipidemia?
The primary treatment of hyperlipidemia involves dietary restriction of saturated fats, cholesterol, and carbohydrates.
