Exam 2- Discussion Questions
Which of the following is a unique property of SERMs? (A) Act as agonists in some tissues and antagonists in other tissues (B) Activate a unique plasma membrane-bound receptor (C) Have both estrogenic and progestational agonist activity (D) Inhibit the aromatase enzyme required for estrogen synthesis (E) Produce estrogenic effects without binding to estrogen receptors
(A) Act as agonists in some tissues and antagonists in other tissues
16.Which one of the following drugs is considered a first-line treatment for post-traumatic stress disorder? (A) Citalopram (B) Diazepam (C) Imipramine (D) Nefazodone (E) Selegiline
(A) Citalopram
As part of the discharge teaching for patients taking amitriptypline, the patients should be instructed that the most important thing to avoid is: (A) caffeine (B) Alcohol (C) Cheese products (D) Exercise
(B) Alcohol
Which of the following statements is correct for antidepressants? (A) Fluoxetine acts by inhibiting MAO (B) TCA's increase synaptic availability of norepinephrine and/or serotonin (C) 5-HTa Serotonin receptor Antagonists are the most widely used drugs (D) Most agents act by blocking dopamine
(B) TCA's increase synaptic availability of norepinephrine and/or serotonin
Monoamine oxidase inhibitors are: (A) used as first line drugs in treatment of depression (B) reserved for patients who have not responded to SSRI's and TCA's (C) Used in patients who have developred serotonergic syndrome (D) Indicated for patients who have difficulty sleeping
(B) reserved for patients who have not responded to SSRI's and TCA's
When the following a patient who has been on lithium therapy for bipolar disorder for three years, which drug added for treatment of his hypertension would cause the most concern? (A) An Ace inhibitor (B) A vasodilator (C) A Thiazide Diuretic (D) A calcium channel blocker
(C) A Thiazide Diuretic
9.Which of the following drugs is most likely to be of value in obsessive-compulsive disorders? (A) Amitriptyline (B) Bupropion (C) Clomipramine (D) Trazodone (E) Venlafaxine
(C) Clomipramine
Which one of the following drugs would usually be considered to be the best drug to use in treament of OCD? (A) amitriptyline (B) Bupropion (C) Fluoxetine (D) Carbamazepine (E) Haloperidol
(C) Fluoxetine
A 60-year-old man is found to have a prostate lump and an elevated prostate-specific antigen (PSA) blood test. Magnetic resonance imaging suggests several enlarged lymph nodes in the lower abdomen, and an x-ray reveals 2 radiolucent lesions in the bony pelvis. This patient is likely to be treated with which of the following drugs? (A) Anastrozole (B) Desogestrel (C) Leuprolide (D) Methyltestosterone (E) Oxandrolone
(C) Leuprolide
A 30-year-old male patient is on drug therapy for a psychiatric problem. He complains that he feels "flat" and that he gets confused at times. He has been gaining weight and has lost his sex drive. As he moves his hands, you notice a slight tremor. He tells you that since he has been on medication he is always thirsty and frequently has to urinate. The drug he is most likely to be taking is (A) Carbamazepine (B) Clozapine (C) Lithium (D) Risperidone (E) Valproic acid
(C) Lithium
6.Which drug is an antagonist at 5-HT2 receptors and widely used for the management of insomnia? (A) Estazolam (B) Flurazepam (C) Trazodone (D) Triazolam (E) Zolpidem
(C) Trazodone
Which of the following statements is true about the use of lamotrigine for bipolar disorder? (A) it is more likely to cause weight gain than is lithium or carbamazepine (B) it is more useful for the depressive episodes but may provoke or exacerbate mania (C) it is now FDA approved for maintenance of bipolar disorder (D) it is reserved for those bipolar patients that also have epilepsy
(C) it is now FDA approved for maintenance of bipolar disorder
Which of the following best describes a glucocorticoid response element? (A) A protein regulator that controls the interaction between an activated steroid receptor and DNA (B) A short DNA sequence that binds tightly to RNA polymerase (C) A small protein that binds to an unoccupied steroid receptor protein and prevents it from becoming denatured (D) A specific nucleotide sequence that is recognized by a steroid hormone receptor-hormone complex (E) The portion of the steroid receptor that binds to DNA
(D) A specific nucleotide sequence that is recognized by a steroid hormone receptor-hormone complex
A 46-year-old male patient has Cushing's syndrome due to an adrenal tumor. Which of the following drugs would be expected to reduce the signs and symptoms of this man's disease? (A) Betamethasone (B) Cortisol (C) Fludrocortisone (D) Ketoconazole (E) Triamcinolone
(D) Ketoconazole
Which of the following is the more serious side effect of the TCA's? (A) Headache (B) Dry Mouth (C) Nasal Stuffiness (D) Orthostatic Hypotension
(D) Orthostatic Hypotension
A 34-year-old woman with ulcerative colitis has required long-term treatment with pharmacologic doses of a glucocorticoid agonist. Which of the following is a toxic effect associated with long-term glucocorticoid treatment? (A) A lupus-like syndrome (B) Adrenal gland neoplasm (C) Hepatotoxicity (D) Osteoporosis (E) Precocious puberty in children
(D) Osteoporosis
Which one of the following pairs of drug and indication is accurate? (A) Amphetamine: Alzheimer's dementia (B) Bupropion: acute anxiety (C) Fluoxetine: insomnia (D) Pramipexole: Parkinson's disease (E) Ramelteon: attention deficit disorder
(D) Pramipexole: Parkinson's disease
Which of the following antidepressants is most selective for inhibition of neuronal reuptake of serotonin? (A) Mirtazapine (B) Venlafaxine (C) Bupropion (D) Sertraline (E) Imipramine
(D) Sertraline
Which of the following is decreased in stress associated depression? (A) Size of the hippocampus and complexity of neurons (B) Brain-derived neurotropic factor (BDNF) (C) Neurogenesis in hippocampus (D) all of the above are decreased
(D) all of the above are decreased
Blurred vision, dry mouth, and constipation are adverse effects of antidepressants such as amitriptyline. These adverse effects are classified as: (A) akathisia symptoms (B) cholinergic effects (C) tardive dyskinesia symptoms (D) anticholinergic effects
(D) anticholinergic effects
In patients treated with MAOI's, one should be particularly concerned about the risk of hypertensive crisis in response to: (A) an overdose of the drug (B) stress (C) vasodilation (D) foods containing tyramine
(D) foods containing tyramine
Drugs approved for maintenance of bipolar disorder instead of lithium include all of the following except: (A) carbamazepine (B) valproic acid (C) lamotrigine (D) haloperidol
(D) haloperidol
Which of the following does NOT cross BBB? (A) L-DOPA (B) Carbidopa (C) Dopamine (D) 1 & 2 don't cross (E) 2 & 3 don't cross
(E) 2 & 3 don't cross
1.A 36-year-old woman presents with symptoms of major depression that are unrelated to a general medical condition, bereavement, or substance abuse. She is not currently taking any prescription or over-the-counter medications. Drug treatment is to be initiated with sertraline. In your information to the patient, you would tell her that (A) Sertraline may take 2 wk or more to become effective (B) It is preferable that she take the drug in the morning (C) Muscle cramps and twitches can occur (D) She should notify you if she anticipates using other prescription drugs (E) All of the above
(E) All of the above
Drugs associated with serotonin syndrome include: (A) SSRI's (B) Demerol (C) St. John's Wort (D) MAOI's (E) All of the above
(E) All of the above
Finasteride has efficacy in the prevention of male-pattern baldness by virtue of its ability to do which of the following? (A) Competitively antagonize androgen receptors (B) Decrease the release of gonadotropins (C) Increase the serum concentration of sex hormone-binding globulin (D) Inhibit the synthesis of testosterone (E) Reduce the production of dihydrotestosterone
(E) Reduce the production of dihydrotestosterone
Glucocorticoids have proved useful in the treatment of which of the following medical conditions? (A) Chemotherapy-induced vomiting (B) Essential hypertension (C) Hyperprolactinemia (D) Parkinson's disease (E) Type II diabetes
(A) Chemotherapy-induced vomiting
Fluoxetine achieves its effects by: (A) Selectively inhibiting serotonin reuptake (B) Blocking the uptake of monoamines (C) Inhibiting MAO-A in nerve terminals (D) Direct stimulation of serotonin receptors
(A) Selectively inhibiting serotonin reuptake
You are counseling a patient who has recently been started on a mood stabilizer and an antipsychotic. The patient is questioning the rationale for the antipsychotic drug. Which of the following would be the best response? (A) The antipsychotic is used to prevent acute mania while waiting for the lithium to take effect (B) Antipsychotics are long-term components of therapy for bipolar disorder (C) Antipsychotics allow higher levels of lithium without signs of toxicity (D) Lithium is only an adjunct, the antipsychotic is actually the mainstay of bipolar disorder therapy
(A) The antipsychotic is used to prevent acute mania while waiting for the lithium to take effect
A 19-year old college student is being treated for depression. He reports that he took a 30-day supply of his antidepressant at one time. Which agent is most dangerous in overdose? (A) Venlafaxine (B) Fluoxetine (C) Paroxetine (D) Sertaline
(A) Venlafaxine
10.To be effective in breast cancer, tamoxifen must be converted to an active form by CYP2D6. Cases of inadequate treatment of breast cancer have occurred when tamoxifen was administered to patients who were being treated with (A) Amitriptyline (B) Bupropion (C) Fluoxetine (D) Mirtazapine (E) Phenelzine
(C) Fluoxetine
Diethylstilbestrol (DES) should never be used in pregnant women because it is associated with which of the following? (A) Deep vein thrombosis (B) Feminization of the external genitalia of male offspring (C) Infertility and development of vaginal cancer in female offspring (D) Miscarriages (E) Virilization of the external genitalia of female offspring
(C) Infertility and development of vaginal cancer in female offspring
A 34-year-old man was diagnosed with Hodgkin's lymphoma, and chemotherapy with multiple anticancer drugs was initiated. Which of the following agents is an agonist of a hormone receptor and is used in the treatment of Hodgkin's lymphoma? (A) Dacarbazine (B) Doxorubicin (C) Prednisone (D) Procarbazine (E) Vinblastine
(C) Prednisone
With respect to pramipexole, which of the following is accurate? (A) Activates brain dopamine D3 receptors (B) Effective as monotherapy in mild parkinsonism (C) May cause postural hypotension (D) Not an ergot derivative (E) All of the above
(E) All of the above
In a patient with a seizure disorder, which antidepressant is contraindicated? (A) Nefazodone (B) Fluoxetine (C) Venlafaxine (D) Mirtazepine (E) Bupropion
(E) Bupropion
18.Naloxone will not antagonize or reverse (A) Analgesic effects of morphine in a cancer patient (B) Drug actions resulting from activation of μ opioid receptors (C) Opioid-analgesic overdose in a patient on methadone maintenance (D) Pupillary constriction caused by levorphanol (E) Respiratory depression caused by overdose of nefazodone
(E) Respiratory depression caused by overdose of nefazodone
A 50-year-old woman with a positive mammogram undergoes lumpectomy and a small carcinoma is removed. Biochemical analysis of the cancer reveals the presence of estrogen and progesterone receptors. After this procedure, she will probably receive which of the following drugs? (A) Danazol (B) Flutamide (C) Leuprolide (D) Mifepristone (E) Tamoxifen
(E) Tamoxifen
4.Regarding the clinical use of antidepressant drugs, which statement is accurate? (A) Chronic use of serotonin-norepinephrine reuptake inhibitors (SNRIs) increases the activity of hepatic drug-metabolizing enzymes (B) In the treatment of major depressive disorders, citalopram is usually more effective than paroxetine (C) Tricyclics are highly effective in depressions with attendant anxiety, phobic features, and hypochondriasis (D) Weight gain often occurs during the first few months in patients taking SSRIs (E) When selecting an appropriate drug for treatment of depression, the history of patient response to specific drugs is a valuable guide
(E) When selecting an appropriate drug for treatment of depression, the history of patient response to specific drugs is a valuable guide
14.A 43-year-old woman was brought to a hospital emergency department by her brother. Visiting the halfway house in which she lived, he had found her to be lethargic, with slurred speech. The patient had a long history of treatment for depression, and the brother feared that she might have overdosed on 1 or more of her prescription drugs. Physical examination revealed hypotension, tachycardia, decreased bowel sounds, dilated pupils, and hyperthermia. If this patient had taken a drug overdose, the most likely causative agent was (A) Amitriptyline (B) Celecoxib (C) Lithium (D) Ramelteon (E) Zaleplon
(A) Amitriptyline
A 54-year-old woman was found to have node-positive breast cancer. Following her surgery, she was treated with a drug that prevents the conversion of testosterone to estradiol. The drug used for her treatment most likely was which of the following? (A) Anastrozole (B) Ethinylestradiol (C) Finasteride (D) Spironolactone (E) Tamoxifen
(A) Anastrozole
A 51-year-old patient with parkinsonism is being maintained on levodopa-carbidopa with adjunctive use of low doses of tolcapone but continues to have off-periods of alkinesia. The most appropriate drug to "rescue" the patient but that will only provide temporary relief is (A) Apomorphine (B) Benztropine (C) Carbidopa (D) Pramipexole (E) Selegiline
(A) Apomorphine
A 34-year-old woman seeks advice because she has been trying to get pregnant for 2 yr. You diagnose anovulation. Which of the following can increase LH and FSH output to induce ovulation? (A) Clomiphene (B) Diethylstilbestrol plus raloxifene (C) Flutamide (D) Letrozole plus finasteride (E) Levonorgestrel
(A) Clomiphene
A 45-year-old woman was suspected of having Cushing's syndrome. To confirm the diagnosis, the patient was given an oral medication late in the evening and had blood drawn the following morning for laboratory testing. The oral medication was which of the following? (A) Dexamethasone (B) Fludrocortisone (C) Glucose (D) Ketoconazole (E) Propylthiouracil
(A) Dexamethasone
A 70-year-old man has severe urinary hesitancy associated with benign prostatic hyperplasia. He has tried α blockers with little relief. His physician recommends a drug that blocks 5α-reductase in the prostate. Which of the following drugs did the physician most likely prescribe? (A) Finasteride (B) Flutamide (C) Ketoconazole (D) Leuprolide (E) Oxandrolone
(A) Finasteride
You are assessing a patient for possible Li toxicity. Which of the following signs/symptoms is consistent with excessive levels of lithium? (A) Weight again (B) Decreased urine output (C) Constipation (D) EKG changes
(A) Weight again
3.A 34-year-old male patient who was prescribed citalopram for depression has decided he wants to stop taking the drug. When questioned, he said that it was affecting his sexual performance. You ascertain that he is also trying to overcome his dependency on tobacco products. If you decide to reinstitute drug therapy in this patient, the best choice would be (A) Amitriptyline (B) Bupropion (C) Fluoxetine (D) Imipramine (E) Venlafaxine
(B) Bupropion
Men who use large doses of anabolic steroids are at increased risk of which of the following? (A) Anemia (B) Cholestatic jaundice and elevation of aspartate transaminase levels in the blood (C) Hirsutism (D) Hyperprolactinemia (E) Testicular enlargement
(B) Cholestatic jaundice and elevation of aspartate transaminase levels in the blood
8.SSRIs are much less effective than tricyclic antidepressants in the management of (A) Bulimia (B) Chronic pain of neuropathic origin (C) Generalized anxiety disorder (D) Obsessive-compulsive disorder (E) Premenstrual dysphoric disorder
(B) Chronic pain of neuropathic origin
2.Concerning the proposed mechanisms of action of antidepressant drugs, which statement is accurate? (A) Bupropion inhibits NE reuptake into nerve endings in the CNS (B) Chronic treatment with tricyclic antidepressants leads to downregulation of adrenoceptors in the CNS (C) Decreased levels of NE and 5-HT in cerebrospinal fluid is a characteristic of depressed patients before drug therapy (D) Nefazodone activates 5-HT receptors in the CNS (E) Selegiline selectively decreases the metabolism of serotonin
(B) Chronic treatment with tricyclic antidepressants leads to downregulation of adrenoceptors in the CNS
7.A recently widowed 76-year-old female patient was treated with a benzodiazepine for several weeks after the death of her husband, but she did not like the daytime sedation it caused even at low dosage. Living independently, she has no major medical problems but appears rather infirm for her age and has poor eyesight. Because her depressive symptoms are not abating, you decide on a trial of an antidepressant medication. Which of the following drugs would be the most appropriate choice for this patient? (A) Amitriptyline (B) Citalopram (C) Mirtazapine (D) Phenelzine (E) Trazodone
(B) Citalopram
13.The selective serotonin reuptake inhibitors fluoxetine and paroxetine are potent inhibitors of hepatic CYP2D6 drug-metabolizing enzymes. This action may lead to changes in the intensity of the effects of (A) Benztropine (B) Codeine (C) Gentamicin (D) Lithium (E) Methotrexate
(B) Codeine
A 54-year-old man with advanced tuberculosis has developed signs of severe acute adrenal insufficiency. The patient should be treated immediately. Which of the following combinations is most rational? (A) Aldosterone and fludrocortisone (B) Cortisol and fludrocortisone (C) Dexamethasone and metyrapone (D) Fludrocortisone and metyrapone (E) Triamcinolone and dexamethasone
(B) Cortisol and fludrocortisone
Which of the following is correct for neurochemical alterations in PD? (A)↑GABA but decreased DA & ACh (B) DA decreased with relative increase of ACh activity (C) DA hyperactivity decreased GABA & decreased ACh (D) Loss of DA in substantia nigra results in low level of DA, GABA & ACh in striatum
(B) DA decreased with relative increase of ACh activity
AT, a 23-year-old woman with asthma, was excited when you told her about budesonide, an inhaled steroid. The topical administration and short half-life greatly reduce risk of systemic side effects compared with oral prednisone. The long-term daily oral administration of therapeutic doses of prednisone results in which of the following? (A) Anemia (B) Decreased bone density (C) Elevated serum calcium concentration (D) Hyperplasia of cells in the zona fasciculata and zona reticularis of the adrenal cortex (E) Increased male-pattern hair growth in women
(B) Decreased bone density
Tolcapone may be of value in patients being treated with levodopa-carbidopa because it (A) Activates COMT (B) Decreases the formation of 3-O-methyldopa (C) Inhibits monoamine oxidase type A (D) Inhibits neuronal reuptake of dopamine (E) Releases dopamine from nerve endings
(B) Decreases the formation of 3-O-methyldopa
A patient presents with pain and stiffness in his wrists and knees. The stiffness is worse first thing in the morning. A blood test confirms rheumatoid arthritis. You advise a short course of steroids. Which one of the following is the most potent anti-inflammatory steroid? (A) Cortisol (B) Dexamethasone (C) Fludrocortisone (D) Prednisone (E) Triamcinolone
(B) Dexamethasone
19.Drugs classified as selective serotonin reuptake inhibitors have minimal clinical efficacy in the treatment of patients who suffer from (A) Bulimia (B) Diminished sexual function and interest (C) Obsessive-compulsive disorder (OCD) (D) Panic attacks (E) Premenstrual dysphoric disorder (PMDD)
(B) Diminished sexual function and interest
A patient with parkinsonism is being treated with levodopa. He suffers from irregular, involuntary muscle jerks that affect the proximal muscles of the limbs. Which of the following statements about these symptoms is accurate? (A) Coadministration of muscarinic blockers prevents the occurrence of dyskinesias during treatment with levodopa (B) Drugs that activate dopamine receptors can exacerbate dyskinesias in a patient taking levodopa (C) Dyskinesias are less likely to occur if levodopa is administered with carbidopa (D) Symptoms are likely to be alleviated by continued treatment with levodopa (E) The symptoms are usually reduced if the dose of levodopa is increased
(B) Drugs that activate dopamine receptors can exacerbate dyskinesias in a patient taking levodopa
Bradykinesia has made drug treatment necessary in a 60-year-old male patient with Parkinson's disease, and therapy is to be initiated with levodopa. The prescribing physician will (or should) know that levodopa (A) Causes fewer CNS side effects if given together with a drug that inhibits hepatic dopa decarboxylase (B) Fluctuates in its effectiveness with increasing frequency as treatment continues (C) Prevents extrapyramidal adverse effects of antipsychotic drugs (D) Protects against cancer in patients with melanoma (E) Has toxic effects, which include pulmonary infiltrates
(B) Fluctuates in its effectiveness with increasing frequency as treatment continues
Concerning the drugs used in parkinsonism, which statement is accurate? (A) Dopamine receptor agonists should never be used in Parkinson's disease before a trial of levodopa (B) Levodopa causes mydriasis and may precipitate an acute attack of glaucoma (C) Selegiline is a selective inhibitor of COMT (D) The primary benefit of antimuscarinic drugs in parkinsonism is their ability to relieve bradykinesia (E) Therapeutic effects of amantadine continue for several years
(B) Levodopa causes mydriasis and may precipitate an acute attack of glaucoma
A young woman complains of abdominal pain at the time of menstruation. Careful evaluation indicates the presence of significant endometrial deposits on the pelvic peritoneum. Which of the following is the most appropriate medical therapy for this patient? (A) Flutamide, orally (B) Medroxyprogesterone acetate by intramuscular injection (C) Norgestrel as an IUD (D) Oxandrolone by intramuscular injection (E) Raloxifene orally
(B) Medroxyprogesterone acetate by intramuscular injection
Which antidepressant would be most useful for a depressed patient with insomnia? (A) Venlafaxine (B) Mirtazepine (C) Bupropion (D) Phenelzine
(B) Mirtazepine
Which of the following statements regarding antidepressant agents is correct? (A) Fluoxetine and SSRI's are significantly more effective than TCA's such as imipramine in alleviation of symptoms of depression (B) Amoxapine stimulates dopamine receptors and may therefore be useful in treating depression in psychotic patients (C) Bupropion has been used for smoking cessation and ADHD as well as in treatment of depression (D) Heterocyclics unlike TCA's lower seizure threshold and have a much greater convulsant action (D) Tranylcypromine and MAOI are thought to produce antidepressant actions by decreasing synaptic norepinephrine and serotonin
(C) Bupropion has been used for smoking cessation and ADHD as well as in treatment of depression
Differences between bupropion and SSRI's include which of the following? (A) Bupropion is more likely to cause weight gain (B) SSRI's can be taken safely with TCA's and Lithium, whereas bupropion can't (C) Bupropion is less likely to cause sexual dysfunction (D) SSRI's are an effective aid to smoking cessation
(C) Bupropion is less likely to cause sexual dysfunction
Which of the following laboratory values requires the most diligent surveillance in a patient who has been treated on carbamazepine for 2 years? (A) Serum urea nitrogen (B) Direct bilirubin (C) Complete Blood Count (D) Thyroid Function studies
(C) Complete Blood Count
Which of the following is correct for neurochemical alterations in Huntington's Disease? (A)↑GABA but decreased DA & ACh (B) DA decreased with relative increase of ACh activity (C) DA hyperactivity decreased GABA & decreased ACh (D) Loss of DA in substantia nigra results in low level of DA, GABA & ACh in striatum
(C) DA hyperactivity decreased GABA & decreased ACh
Several drugs used in patients with advanced Parkinson's disease allow patients to lower their dose of l-dopa/carbidopa, and thus reduce the incidence of l-dopa-induced dyskinesias. These drugs also decrease the amount of "off" time for the patient. Which drug is used in this way but does not, if used alone, ameliorate the symptoms of early Parkinson's disease or enhance CNS dopaminergic activity? (A) Amantadine (B) Bromocriptine (C) Entacapone (D) Pramipexole (E) Selegiline
(C) Entacapone
15.A 35-year-old woman who has never been pregnant suffers each month from pain, discomfort, and mood depression at the time of menses. She may benefit from the use of this selective inhibitor of the reuptake of serotonin in a form that can be taken once weekly. (A) Amoxapine (B) Bupropion (C) Fluoxetine (D) Mirtazapine (E) Tranylcypromine
(C) Fluoxetine
12.Of the following drugs, which has established clinical uses that include attention deficit hyperkinetic disorder, enuresis, and the management of chronic pain? (A) Bupropion (B) Citalopram (C) Imipramine (D) Risperidone (E) Sertraline
(C) Imipramine
A 50-year-old woman, a known asthmatic for the past 30 years, presented to the emergency department with a 2-d history of worsening breathlessness and cough. Chest auscultation revealed bilateral polyphonic inspiratory and expiratory wheeze. Supplemental oxygen, nebulized albuterol (salbutamol) (5 mg) and ipratropium (250 μg), as well as intravenous methyl prednisolone (40 mg) were administered. Which of the following is a pharmacologic effect of exogenous glucocorticoids? (A) Increased muscle mass (B) Hypoglycemia (C) Inhibition of leukotriene synthesis (D) Improved wound healing (E) Increased excretion of salt and water
(C) Inhibition of leukotriene synthesis
17.After ingestion of a meal that included sardines, cheese, and red wine, a patient taking phenelzine experienced a hypertensive crisis. The most likely explanation for this untoward effect is that phenelzine (A) Acts to release tyramine from these foods (B) Inhibits storage of catecholamines in vesicles (C) Inhibits the metabolism of catecholamines (D) Is an activator of tyrosine hydroxylase (E) Promotes the release of norepinephrine from sympathetic nerve endings
(C) Inhibits the metabolism of catecholamines
5.A patient under treatment for a major depressive disorder is brought to the emergency department after ingesting 30 times the normal daily therapeutic dose of imipramine. Which of the following would be least useful? (A) Administer bicarbonate and potassium chloride (to correct acidosis and hypokalemia) (B) Administer lidocaine (to control cardiac arrhythmias) (C) Initiate hemodialysis (to hasten drug elimination) (D) Maintain heart rhythm by electrical pacing (E) Use intravenous diazepam to control seizures
(C) Initiate hemodialysis (to hasten drug elimination)
11.The primary clinical application of the 5-HT2 receptor antagonist trazodone is the treatment of (A) Bipolar disorder (B) Chronic pain (C) Insomnia (D) Major depressive disorder (E) Premenstrual dysphoric disorder
(C) Insomnia
A 31-year-old premenopausal woman has been using a combined oral contraceptive for 10 yr. As a result of this contraceptive use, she has a reduced risk of which of the following? (A) Deep vein thrombosis (B) Episodes of migraine headache (C) Ischemic Stroke (D) Ovarian cancer (E) Pituitary adenoma
(C) Ischemic Stroke
Which statement concerning the use of lithium in the treatment of bipolar affective disorder is accurate? (A) Ingestion of foods with high salt content enhances the toxicity of lithium (B) Lithium usually alleviates the manic phase of bipolar disorder within 12 h (C) Lithium dosage may need to be decreased in patients taking thiazides (D) Since lithium does not cross the placental barrier, it is safe in pregnancy (E) The elimination rate of lithium is equivalent to that of creatinine
(C) Lithium dosage may need to be decreased in patients taking thiazides
Bradykinesia has made drug treatment necessary in a 60-year-old male patient with Parkinson's disease, and therapy is to be initiated with levodopa. Regarding the anticipated actions of levodopa, the patient would not be informed that (A) Dizziness may occur, especially when standing (B) He should take the drug in divided doses to avoid nausea (C) Livedo reticularis is a possible side effect (D) The drug will probably improve his symptoms for a period of time but not indefinitely (E) Uncontrollable muscle jerks may occur
(C) Livedo reticularis is a possible side effect
Which of the following drugs is most suitable for management of essential tremor in a patient who has pulmonary disease? (A) Diazepam (B) Levodopa (C) Metoprolol (D) Propranolol (E) Terbutaline
(C) Metoprolol
Which of the following antidepressants requires therapeuti blood monitoring for safe use? (A) Paroxetine (B) Phenelzine (C) Nortiptyline (D) Venlafaxine (E) Bupropion
(C) Nortiptyline
Which of the following statements about antidepressant medications is most appropriate? (A) they all have a delay of approximately 48 hours for onset of benefit (B) there are large differences in efficacy among individual agents (C) Some benefit is expected in 65 to 80% of patients treated with an antidepressant for major depression (D) the major contribution of the newer antidepressants lies in the marked improvement in duration of action
(C) Some benefit is expected in 65 to 80% of patients treated with an antidepressant for major depression
Ned is treated for depression with desipramine. Three weeks later he starts having seizures and is given a presription for carbamazepine. Which of the following is most correct? (A) Tegretol, like desipramine is a tricyclic structure and will worsen seizures (B) Tegretol often worsens depression (C) Tegretol may increase certain adverse effects of desipraine (D) Desipramine has additive antiseizure effects to thsoe produced by tegretol
(C) Tegretol may increase certain adverse effects of desipraine
A Patient taking fluoxetine informs you that she has started taking St. John's wort. Your best course of action would be to: (A) add the herbal preparation to the medications listed in the patient's chart (B) assess the patinet for signs of hypotensive crisis (C) explain the risk of serotonin syndrome and discourage use of the herbal perparation (D) recommend that the patient stop both medications
(C) explain the risk of serotonin syndrome and discourage use of the herbal perparation
Patients should generally continue antidepressant medications: (A) until their symptoms have resolved (B) until side effects develop (C) for 6-12 months after symptoms have resolved (D) for one month after symptoms have improved
(C) for 6-12 months after symptoms have resolved
At a patient care conference, a patient's long term medication regime is discussed and a lithium level of 0.9mEq/L is noted. Your accurate understanding of lithium toxicity is best refelcted in which of the following statements? (A) The patients plasma level is below the toxic level of 3.0 mEq/L and is considered therapeutic (B) The patients plasma level exceeds 0.5 mEq/L and therefore is toxic (C) the patients plasma level is between 0.6 and 1.4 mEq/L and is considered therapeutic (D) the patients plasma level is below the 2.5 mEq/L level that would indicate toxicity
(C) the patients plasma level is between 0.6 and 1.4 mEq/L and is considered therapeutic
In a patient taking an MAOI, which of the following breakfast choices would indicate the need for additional teaching? (A) Orange Juice (B) Sausage (C) Fried eggs (D) Cheese Omelet
(D) Cheese Omelet
Why do you monitor linear growth when on corticosteroids? (A) Chronic glucocorticoid use diverts calcium to soft tissue rather than to bone (B) Chronic glucocorticoid use prevents glucose uptake by bone (C) Chronic glucocorticoid use prevents bone mineralization resulting in soft bones (D) Chronic glucocorticoid use slows linear bone growth, resulting in short stature (E) Chronic glucocorticoid use promotes bone resorption and pathologic fractures
(D) Chronic glucocorticoid use slows linear bone growth, resulting in short stature
A previously healthy 40-year-old woman begins to suffer from slowed mentation, lack of coordination, and brief writhing movements of her hands that are not rhythmic. In addition, she has delusions of being persecuted. The woman has no history of psychiatric or neurologic disorders. Although further diagnostic assessment should be made, it is very likely that the most appropriate drug for treatment will be (A) Amantadine (B) Bromocriptine (C) Diazepam (D) Haloperidol (E) Levodopa
(D) Haloperidol
A 23-year-old woman desires a combined oral contraceptive for pregnancy protection. Which of the following patient factors would lead a health professional to recommend an alternative form of contraception? (A) Evidence of hirsutism (B) History of gastroesophageal reflux disease and is currently taking omeprazole (C) History of pelvic inflammatory disease (D) History of migraine headache that is well controlled by sumatriptan (E) She plans to use this contraceptive for about 1 yr and will then attempt to become pregnant
(D) History of migraine headache that is well controlled by sumatriptan
A Patient is taking 300mg of Lithium carbonate QID. Her serum Li level yesterday was 1.8 mEq/L. Which of the following actions is correct? (A) Continue administering the drug as ordered (B) Increase the dosage to 450mg (C) Decrease the dose to 150mg (D) Hold the next dose and notify the prescriber
(D) Hold the next dose and notify the prescriber
A 46 year old male has Cushings syndrome that is due to the presence of an adrenal tumor. Which of the following drugs would be expected to reduce the sign and symptoms of the disease? (A) betamethasone (B) cortisol (C)fludrocortisone (D) Ketoconazole (E) triamcinolone
(D) Ketoconazole
A patient taking medications for a psychiatric disorder develops a tremor, thyroid enlargement, edema, and acneiform eruptions on the face. The drug he is taking is most likely to be (A) Carbamazepine (B) Haloperidol (C) Lamotrigine (D) Lithium (E) Sertraline
(D) Lithium
A teenager seeks postcoital contraception. Which of the following preparations will be effective for this purpose? (A) Clomiphene (B) Ethinyl estradiol (C) Diethylstilbestrol (DES) (D) Mifepristone (E) Norgestrel
(D) Mifepristone
Which of the following is a drug that, in high doses, blocks the glucocorticoid receptor? (A) Aminoglutethimide (B) Beclomethasone (C) Ketoconazole (D) Mifepristone (E) Spironolactone
(D) Mifepristone
A newborn girl exhibited ambiguous genitalia, hyponatremia, hyperkalemia, and hypotension as a result of genetic deficiency of 21α-hydroxylase activity. Treatment consisted of fluid and salt replacement and hydrocortisone administration. In this type of adrenal hyperplasia in which there is excess production of cortisol precursors, which of the following describes the primary therapeutic effect of glucocorticoid administration? (A) Increased adrenal estrogen synthesis (B) Inhibition of adrenal aldosterone synthesis (C) Prevention of hypoglycemia (D) Recovery of normal immune function (E) Suppression of ACTH secretion
(D) Recovery of normal immune function
Adding a progestin to the estrogenic component of hormone replacement therapy for postmenopausal women provides which of the following effects? (A) Prevents thromboembolic events (B) Provides better control of problematic hot flushes (C) Reduces the risk of endometrial cancer (D) Restores regular vaginal bleeding (E) Slows bone loss
(D) Restores regular vaginal bleeding
A 52-year-old postmenopausal patient has evidence of low bone mineral density. She and her physician are considering therapy with raloxifene or a combination of conjugated estrogens and medroxyprogesterone acetate. Which of the following patient characteristics is most likely to lead them to select raloxifene? (A) Previous hysterectomy (B) Recurrent vaginitis (C) Rheumatoid arthritis (D) Strong family history of breast cancer (E) Troublesome hot flushes
(D) Strong family history of breast cancer
Which statement about pramipexole is accurate? (A) Effectiveness in Parkinson's disease requires its metabolic conversion to an active metabolite (B) It should not be administered to patients taking antimuscarinic drugs (C) Pramipexole causes less mental disturbances than levodopa (D) The drug selectively activates the dopamine D3 receptor subtype (E) Warfarin may enhance the actions of pramipexole
(D) The drug selectively activates the dopamine D3 receptor subtype
When comparing the effects and efficacy of valproic acid with those of lithium in treating bipolar disorder, one should understand that: (A) valproic acid does not have gastrointestinal side effects (B) valproic acid can't be used as monotherapy (C) valproic acid use is associated with unintentional weight loss (D) valproic acid has a greater therapeutic index
(D) valproic acid has a greater therapeutic index
Why are cortisol analogues such as prednisone used for treating asthma? (A)Cortisol Analogues reduce lung compliance (B) Cortisol Analogues enhance oxygen utilization (C) Coritsol Analogues enhance rib growth (D) Cortisol Analogues promote lung maturation (E) Cortisol analogues reduce airway inflammation
(E) Cortisol analogues reduce airway inflammation
Drugs activate or block a wide range of receptor types and their downstream receptor signaling pathways. Which of the following drugs mediates its effects by binding to and activating an intracellular receptor that, when activated, acts as a transcription factor, ultimately leading to the desired therapeutic effect? (A) Albuterol (B) Captopril (C) Erythropoietin (D) Morphine (E) Prednisone
(E) Prednisone
A 56-year-old woman with systemic lupus erythematosus had been maintained on a moderate daily dose of prednisone for 9 months. Her disease has finally gone into remission and she now wishes to gradually taper and then discontinue the prednisone. Gradual tapering of a glucocorticoid is required for recovery of which of the following? (A) Depressed release of insulin from pancreatic B cells (B) Hematopoiesis in the bone marrow (C) Normal osteoblast function (D) The control by vasopressin of water excretion (E) The hypothalamic-pituitary-adrenal system
(E) The hypothalamic-pituitary-adrenal system
