Pharmacology Module 2

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Which one of the following is the primary neurotransmitter agent normally released in the sinoatrial node of the heart in response to a blood pressure increase? (A) Acetylcholine (B) Dopamine (C) Epinephrine (D) Glutamate (E) Norepinephrine

(A) Acetylcholine

If ketamine is used as the sole anesthetic in the attempted reduction of a dislocated shoulder joint, its actions will include (A) Analgesia (B) Bradycardia (C) Hypotension (D) Muscle rigidity (E) Respiratory depression

(A) Analgesia

A group of volunteers are involved in a phase 1 clinical trial of a new autonomic drug. When administered by intravenous bolus, the blood pressure increases. When given orally for 1 week, the blood pressure decreases. Which of the following standard agents does the new drug most resemble? (A) Atropine (B) Clonidine (C) Phentolamine (an α blocker) (D) Phenylephrine (E) Propranolol (a β blocker)

(B) Clonidine

Which of the following receptors shares the same potassium channel as the 5-HT1A receptor? (A) Dopamine D2 receptor (B) GABAB receptor (C) Mu opioid receptor (D) Muscarinic M1 receptor (E) Substance P receptor

(B) GABAB receptor

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

Which drug is an antagonist at 5-HT2 receptors and widely used for the management of insomnia in depressed patients? (A) Estazolam (B) Flurazepam (C) Trazodone (D) Triazolam (E) Zolpidem

Parasympathetic nerve stimulation and a slow infusion of bethanechol will each (A) Cause ganglion cell depolarization (B) Cause skeletal muscle end plate depolarization (C) Cause vasodilation (D) Increase bronchial smooth muscle tone (E) Increase heart rate

(D) Increase bronchial smooth muscle tone

Which drug used in the maintenance treatment of patients with tonic-clonic or partial seizure states increases the hepatic metabolism of many drugs including both phenytoin and warfarin? (A) Buspirone (B) Clonazepam (C) Eszopiclone (D) Phenobarbital (E) Triazolam

(D) Phenobarbital

Which one of the following drugs has a very high affinity for the phosphorus atom in parathion and is often used to treat life-threatening insecticide toxicity? (A) Bethanechol (B) Botulinum (C) Cyclopentolate (D) Neostigmine (E) Pralidoxime

(E) Pralidoxime

Which drug used in management of seizure disorders is most likely to elevate the plasma concentration of other drugs administered concomitantly? (A) Carbamazepine (B) Clonazepam (C) Phenobarbital (D) Phenytoin (E) Valproic acid

(E) Valproic acid

Which statement concerning nitrous oxide is most accurate? (A) A useful component of anesthesia protocols because it lacks cardiovascular depression (B) Anemia is a common adverse effect in patients exposed to nitrous oxide for periods longer than 2h (C) It is the most potent of the inhaled anesthetics (D) There is a direct association between the use of nitrous oxide and malignant hyperthermia (E) Up to 50% of nitrous oxide is eliminated via hepatic metabolism

(A) A useful component of anesthesia protocols because it lacks cardiovascular depression

A vasoconstrictor added to a solution of lidocaine for a peripheral nerve block will (A) Decrease the risk of a seizure (B) Increase the duration of anesthetic action of the local anesthetic (C) Both A and B (D) Neither A nor B

The most important effect of inadvertent intravenous administration of a large dose of lidocaine is (A) Bronchoconstriction (B) Methemoglobinemia (C) Renal failure (D) Seizures (E) Tachycardia

(D) Seizures

With respect to pramipexole, which of the following is most 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

The net changes in heart rate induced by drug Y in these experiments are shown in the following graph. (page 73) Drug Y is probably a drug similar to (A) Acetylcholine (B) Edrophonium (C) Hexamethonium (D) Nicotine (E) Pralidoxime

(A) Acetylcholine

Total intravenous anesthesia with fentanyl has been selected for a frail elderly woman about to undergo cardiac surgery. Which statement about this anesthesia protocol is most accurate? (A) Fentanyl's effects can be reversed with naloxone after the procedure (B) Marked relaxation of skeletal muscles is anticipated (C) Opioids such as fentanyl provide useful hypotensive effects (D) Patient awareness is rare during surgery, with minimal recall after recovery (E) The patient is likely to experience pain during surgery

(A) Fentanyl's effects can be reversed with naloxone after the procedure

All of the listed neurotransmitters change membrane excitability by decreasing K+ conductance except (A) Acetylcholine (B) Dopamine (C) Glutamic acid (D) Norepinephrine (E) Serotonin

(B) Dopamine

Which of the following is an accepted therapeutic indication for the use of antimuscarinic drugs? (A) Atrial fibrillation (B) Botulinum poisoning (C) Chronic obstructive pulmonary disease (COPD) (D) Glaucoma (E) Postoperative urinary retention

For these questions, use the accompanying diagram. Assume that the diagram can represent either the sympathetic or the parasympathetic system. (page 57) Assuming the structure is part of the sympathetic system, norepinephrine acts at which of the following sites in the diagram? (A) Sites 2 and 4 (B) Site 4 only (C) Sites 5 and 6 (D) Site 7 only

You have a vial containing 10 mL of a 2% solution of lidocaine. How much lidocaine is present in 1 mL? (A) 2 mg (B) 5 mg (C) 10 mg (D) 20 mg (E) 50 mg

(D) 20 mg

Which drug is most likely to cause hyperkalemia leading to cardiac arrest in patients with spinal cord injuries? (A) Baclofen (B) Dantrolene (C) Pancuronium (D) Succinylcholine (E) Vecuronium

(D) Succinylcholine

Four new synthetic drugs (designated W, X, Y, and Z) are to be studied for their cardiovascular effects. They are given to 4 anesthetized animals while the heart rate is recorded. The first animal has received no pretreatment (control); the second has received an effective dose of hexamethonium; the third has received an effective dose of atropine; and the fourth has received an effective dose of phenoxybenzamine. The net changes induced by W, X, Y, and Z in the animals are described in the following questions. Drug Z is probably a drug similar to (page 90) (A) Acetylcholine (B) Edrophonium (C) Isoproterenol (D) Norepinephrine (E) Pralidoxime

(A) Acetylcholine

All of the following factors influence the action of local anesthetics except (A) Acetylcholinesterase activity in the region of the injection site (B) Blood flow through the tissue in which the injection is made (C) Dose of local anesthetic injected (D) The use of vasoconstrictors (E) Tissue pH

(A) Acetylcholinesterase activity in the region of the injection site

A 40-year-old woman has occasional acute attacks of intense anxiety with marked physical symptoms, including hyperventilation, tachycardia, and sweating. If she is diagnosed as suffering from a panic disorder, the most appropriate drug to use is (A) Alprazolam (B) Eszopiclone (C) Flurazepam (D) Propranolol (E) Ramelteon

(A) Alprazolam

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 akinesia. A drug used to "rescue" the patient that provides temporary relief is (A) Apomorphine (B) Benztropine (C) Carbidopa (D) Pramipexole (E) Selegiline

(A) Apomorphine

Myalgias are a common postoperative complaint of patients who receive large doses of succinylcholine, possibly the result of muscle fasciculations caused by depolarization. Which drug administered in the operating room can be used to pre-vent postoperative pain caused by succinylcholine? (A) Atracurium (B) Baclofen (C) Dantrolene (D) Diazepam (E) Lidocaine

(A) Atracurium

Regarding the spasmolytic drugs, which of the following statements is least accurate? (A) Baclofen acts on GABA receptors in the spinal cord to increase chloride ion conductance (B) Cyclobenzaprine decreases both oropharyngeal secretions and gut motility (C) Dantrolene has no significant effect on the release of calcium from sarcoplasmic reticulum in cardiac muscle (D) Diazepam causes slight sedation at doses commonly used to reduce muscle spasms (E) Intrathecal use of baclofen is effective in some refractory cases of muscle spasticity

(A) Baclofen acts on GABA receptors in the spinal cord to increase chloride ion conductance

A patient underwent a surgical procedure of 2 h. Anesthesia was provided by isoflurane, supplemented by intravenous midazolam and a nondepolarizing muscle relaxant. At the end of the procedure, a low dose of atropine was administered followed by pyridostigmine The main reason for administering atropine was to (A) Block cardiac muscarinic receptors (B) Enhance the action of pyridostigmine (C) Prevent spasm of gastrointestinal smooth muscle (D) Provide postoperative analgesia (E) Reverse the effects of the muscle relaxant

(A) Block cardiac muscarinic receptors

The mechanism of antiseizure activity of carbamazepine is (A) Block of sodium ion channels (B) Block of calcium ion channels (C) Facilitation of GABA actions on chloride ion channels (D) Glutamate receptor antagonism (E) Inhibition of GABA transaminase

(A) Block of sodium ion channels

When given to a patient, phentolamine blocks which one of the following? (A) Bradycardia induced by phenylephrine (B) Bronchodilation induced by epinephrine (C) Increased cardiac contractile force induced by norepinephrine (D) Miosis induced by acetylcholine (E) Vasodilation induced by isoproterenol

(A) Bradycardia induced by phenylephrine

Activation of metabotropic receptors located presynaptically causes inhibition by decreasing the inward flux of (A) Calcium (B) Chloride (C) Potassium (D) Sodium (E) None of the above

(A) Calcium

Which statement about hallucinogens is most accurate? (A) Dilated pupils and tachycardia are characteristic effects of scopolamine (B) LSD is unique among hallucinogens in that animals will self-administer it (C) Mescaline and psilocybin exert their CNS actions through dopaminergic systems in the brain (D) Phencyclidine is a known teratogen (E) Withdrawal signs characteristic of dependence occur with abrupt discontinuance of ketamine

(A) Dilated pupils and tachycardia are characteristic effects of scopolamine

Which of the following chemicals is most likely to function as a neurotransmitter in hierarchical systems? (A) Glutamate (B) Met-enkephalin (C) Nitric oxide (D) Norepinephrine (E) Substance P

(A) Glutamate

Mr Green is a 60-year-old man with atherosclerosis and poorly controlled hypertension of 170/110 mm Hg. He has been taking several antihypertensive drugs, including minoxidil. Minoxidil is a powerful arteriolar vasodilator that does not act on autonomic receptors. Which of the following effects will be observed if no other drugs are used? (A) Tachycardia and increased cardiac contractility (B) Tachycardia and decreased cardiac output (C) Decreased mean arterial pressure and decreased cardiac contractility (D) Decreased mean arterial pressure and increased salt and water excretion by the kidney (E) Bradycardia and decreased cardiac contractility

(A) Tachycardia and increased cardiac contractility

The pKa of lidocaine is 7.7. In infected tissue, which can be acidic, for example, at pH 6.7, the percentage of the drug in the nonionized form will be (A) 1% (B) 10% (C) 50% (D) 90% (E) 99%

(B) 10%

Clinical studies have shown that adrenoceptor blockers have many useful effects in patients. However, a number of drug toxicities have been documented. Adverse effects that limit the use of adrenoceptor blockers include which one of the following? (A) Bronchoconstriction (from α-blocking agents) (B) Acute heart failure exacerbation (from β blockers) (C) Impaired blood sugar response (with α blockers) (D) Increased intraocular pressure (with β blockers) (E) Sleep disturbances (from α-blocking drugs)

(B) Acute heart failure exacerbation (from β blockers)

Which statement concerning the barbiturates is most accurate? (A) Abstinence syndromes are more severe during withdrawal from phenobarbital than from secobarbital (B) Alkalinization of the urine accelerates the elimination of phenobarbital (C) Barbiturates may increase the half-lives of drugs metabolized by the liver (D) Compared with barbiturates, the benzodiazepines exhibit a steeper dose-response relationship (E) Respiratory depression caused by barbiturate overdosage can be reversed by flumazenil

(B) Alkalinization of the urine accelerates the elimination of phenobarbital

Haloperidol is not an appropriate drug for management of (A) Acute mania (B) Amenorrhea-galactorrhea syndrome (C) Phencyclidine intoxication (D) Schizoaffective disorders (E) Tourette syndrome

(B) Amenorrhea-galactorrhea syndrome

The clinical use of succinylcholine, especially in patients with diabetes, is associated with (A) Antagonism by pyridostigmine during the early phase of blockade (B) Aspiration of gastric contents (C) Decreased intragastric pressure (D) Histamine release in a genetically determined population (E) Metabolism at the neuromuscular junction by acetylcholinesterase

(B) Aspiration of gastric contents

Which one of the following drugs causes vasodilation that can be blocked by atropine? (A) Benztropine (B) Bethanechol (C) Botulinum toxin (D) Cyclopentolate (E) Edrophonium

(B) Bethanechol

A young man is brought to the emergency department suffering from an intravenous overdose of cocaine. His signs and symptoms are not likely to include (A) Agitation (B) Bradycardia (C) Hyperthermia (D) Myocardial infarct (E) Seizures

(B) Bradycardia

While playing in the garden, a 7-year-old boy is stung by 3 bees. Because he has a previous history of bee sting allergy, he is brought to the emergency department by his mother who is very concerned about a possible anaphylactic reaction. Which of the following are probable signs of an anaphylactic reaction to bee stings? (A) Bronchodilation, tachycardia, hypertension, vomiting, diarrhea (B) Bronchospasm, tachycardia, hypotension, laryngeal edema (C) Diarrhea, bradycardia, vomiting (D) Laryngeal edema, bradycardia, hypotension, diarrhea (E) Miosis, tachycardia, vomiting, diarrhea

(B) Bronchospasm, tachycardia, hypotension, laryngeal edema

A 34-year-old man who was prescribed citalopram for depres-sion has decided he wants to stop taking the drug. When questioned, he said that it was affecting his sexual perfor-mance. 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

Flumazenil will counteract the action of each of the following drugs except (A) Alprazolam (B) Buspirone (C) Diazepam (D) Eszopiclone (E) Zaleplon

(B) Buspirone

Prilocaine is relatively contraindicated in patients with cardiovascular or pulmonary disease because the drug (A) Acts as an antagonist at β adrenoceptors in the heart and the lung (B) Causes decompensation through formation of methemoglobin (C) Inhibits cyclooxygenase in cardiac and pulmonary cells (D) Is a potent bronchoconstrictor (E) None of the above

(B) Causes decompensation through formation of methemoglobin

Which statement concerning the effects of anesthetic agents is most accurate? (A) Bronchiolar smooth muscle contraction occurs during halothane anesthesia (B) Chest muscle rigidity often follows the administration of fentanyl (C) Mild, generalized muscle twitching occurs at high doses of isoflurane (D) Severe nausea and vomiting has been reported after the use of propofol (E) The use of thiopental preceding inhalation anesthetics may prolong postanesthesia recovery

(B) Chest muscle rigidity often follows the administration of fentanyl

SSRIs are much less effective than tricyclic antidepressants in the management of (A) Bulimia (B) Chronic neuropathic pain (C) Generalized anxiety disorder (D) Obsessive-compulsive disorder (E) Premenstrual dysphoric disorder

(B) Chronic neuropathic pain

Concerning the proposed mechanisms of action of antidepressant drugs, which statement is most 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

A recently widowed 76-year-old woman was treated with a benzodiazepine for several weeks after the death of her hus-band, but she did not like the daytime sedation it caused even at low dosage. Living independently, she has no major medi-cal problems but appears rather infirm for her age and has poor eyesight. Because her depressive symptoms are not abat-ing, 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

A child requires multiple minor surgical procedures involv-ing the nasopharynx. Which drug has high surface local anesthetic activity and intrinsic vasoconstrictor actions that reduce bleeding in mucous membranes? (A) Bupivacaine (B) Cocaine (C) Lidocaine (D) Mepivacaine (E) Tetracaine

(B) Cocaine

Genetic polymorphisms in certain hepatic enzymes involved in drug metabolism are established to be responsible for variations in analgesic response to (A) Buprenorphine (B) Codeine (C) Fentanyl (D) Methadone (E) Tramadol

(B) Codeine

A patient with liver dysfunction is scheduled for a surgical procedure. Lorazepam or oxazepam can be used for preanesthetic sedation in this patient without special concern regarding excessive CNS depression because these drugs are (A) Actively secreted in the renal proximal tubule (B) Conjugated extrahepatically (C) Eliminated via the lungs (D) Reversible by administration of naloxone (E) Selective anxiolytics like buspirone

(B) Conjugated extrahepatically

Which sign or symptom is most likely to occur with marijuana? (A) Bradycardia (B) Conjunctival reddening (C) Hypertension (D) Increased psychomotor performance (E) Mydriasis

(B) Conjunctival reddening

Which of the following chemicals does not satisfy the criteria for a neurotransmitter role in the CNS? (A) Acetylcholine (B) Cyclic AMP (C) Dopamine (D) Glycine (E) Substance P

(B) Cyclic AMP

Several children at a summer camp were hospitalized with symptoms thought to be due to ingestion of food containing botulinum toxin. Which one of the following signs or symptoms is consistent with the diagnosis of botulinum poisoning? (A) Bronchospasm (B) Cycloplegia (C) Diarrhea (D) Skeletal muscle spasms (E) Hyperventilation

(B) Cycloplegia

Which of the following drugs is the most effective in the emergency management of malignant hyperthermia? (A) Atropine (B) Dantrolene (C) Haloperidol (D) Succinylcholine (E) Vecuronium

(B) Dantrolene

Which of the following is an expected effect of a therapeutic dose of an antimuscarinic drug? (A) Decreased cAMP (cyclic adenosine monophosphate) in cardiac muscle (B) Decreased DAG (diacylglycerol) in salivary gland tissue (C) Increased IP3 (inositol trisphosphate) in intestinal smooth muscle (D) Increased potassium efflux from smooth muscle (E) Increased sodium influx into the skeletal muscle end plate

(B) Decreased DAG (diacylglycerol) in salivary gland tissue

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 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 most 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 admin-istered 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

Ms Brown, a 28-year-old accountant, has been treated for myasthenia gravis for several years. She reports to the emer-gency department complaining of recent onset of weakness of her hands, diplopia, and difficulty swallowing. She may be suffering from a change in response to her myasthenia therapy, that is, a cholinergic or a myasthenic crisis. Which of the following is the best drug for distinguishing between myasthenic crisis (insufficient therapy) and cholinergic crisis (excessive therapy)? (A) Atropine (B) Edrophonium (C) Physostigmine (D) Pralidoxime (E) Pyridostigmine

(B) Edrophonium

A new drug was given by subcutaneous injection to 25 normal subjects in a phase 1 clinical trial. The cardiovascular effects are summarized in the table below. (page 82) Which of the following drugs does the new experimental agent most resemble? (A) Atropine (B) Epinephrine (C) Isoproterenol (D) Phenylephrine (E) Physostigmine

(B) Epinephrine

Which statement about the speed of onset of nerve blockade with local anesthetics is correct (A) Faster in hypercalcemia (B) Faster in myelinated fibers (C) Faster in tissues that are infected (D) Slower in hyperkalemia (E) Slower in the periphery of a nerve bundle than in the center of a bundle

(B) Faster in myelinated fibers

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

Which statement about the toxicity of local anesthetics is correct? (A) Bupivacaine is the safest local anesthetic to use in patients at risk for cardiac arrhythmias (B) In overdosage, hyperventilation (with oxygen) is helpful to correct acidosis and lower extracellular potassium (C) Intravenous injection of local anesthetics may stimulate ectopic cardiac pacemaker activity (D) Most local anesthetics cause vasoconstriction (E) Serious cardiovascular reactions are more likely to occur with tetracaine than with bupivacaine

(B) In overdosage, hyperventilation (with oxygen) is helpful to correct acidosis and lower extracellular potassium

A 27-year old compulsive drug user injected a drug he thought was methamphetamine, but he has not developed any signs of methamphetamine action. He has been admitted to the emergency department and antimuscarinic drug over-dose is suspected. Probable signs of atropine overdose include which one of the following? (A) Gastrointestinal smooth muscle cramping (B) Increased heart rate (C) Increased gastric secretion (D) Pupillary constriction (E) Urinary frequency

(B) Increased heart rate

Concerning the drugs used in parkinsonism, which statement is most 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 parkin-sonism 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

Actions and clinical uses of muscarinic cholinoceptor agonists include which one of the following? (A) Bronchodilation (treatment of asthma) (B) Miosis (treatment of narrow angle glaucoma) (C) Decreased gastrointestinal motility (treatment of diarrhea) (D) Decreased neuromuscular transmission and relaxation of skeletal muscle (during surgical anesthesia) (E) Increased sweating (treatment of fever)

(B) Miosis (treatment of narrow angle glaucoma)

Which statement concerning the pharmacokinetics of anti-seizure drugs is most accurate? (A) Administration of phenytoin to patients in methadone maintenance programs has led to symptoms of opioid overdose, including respiratory depression (B) To reduce gastrointestinal toxicity, ethosuximide is usu-ally taken twice a day (C) At high doses, phenytoin elimination follows first-order kinetics (D) Gabapentin has a very long half-life and is usually given every other day (E) Treatment with vigabatrin reduces the effectiveness of oral contraceptives(F) Valproic acid may increase the activity of hepatic ALA synthase and the synthesis of porphyrins

(B) To reduce gastrointestinal toxicity, ethosuximide is usu-ally taken twice a day

A 30-year-old woman undergoes abdominal surgery. In spite of minimal tissue damage, complete ileus (absence of bowel motility) follows, and she complains of severe bloating. She also finds it difficult to urinate. Mild cholinomimetic stimulation with bethanechol or neostigmine is often effective in relieving these complications of surgery. Neostigmine and bethanechol in moderate doses have significantly differenteffects on which one of the following? (A) Gastric secretory cells (B) Vascular endothelium (C) Salivary glands (D) Sweat glands (E) Ureteral tone

(B) Vascular endothelium

Assume that the diagram below represents a sympathetic noradrenergic postganglionic nerve ending. (page 57) Which of the following blocks the carrier represented by "z" in the diagram? (A) Amphetamine (B) Botulinum toxin (C) Cocaine (D) Hemicholinium (E) Reserpine

Mr Green has just been diagnosed with dysautonomia (chronic idiopathic autonomic insufficiency). You are considering different therapies for his disease. Pyridostigmine and neostigmine may cause which one of the following in this patient? (A) Bronchodilation (B) Cycloplegia (C) Diarrhea (D) Irreversible inhibition of acetylcholinesterase (E) Reduced gastric acid secretion

Which drug has spasmolytic activity and could also be used in the management of seizures caused by overdose of a local anesthetic? (A) Baclofen (B) Cyclobenzaprine (C) Diazepam (D) Gabapentin (E) Tizanidine

Which statement about the pathophysiologic basis of schizo-phrenia is most accurate? (A) All clinically effective antipsychotic drugs have high affinity for dopamine D2 receptors (B) Dopamine receptor-blocking drugs are used to alleviate psychotic symptoms in parkinsonism (C) Drug-induced psychosis can occur without activation of brain dopamine receptors (D) Serotonin receptors are present at lower than normal levels in the brains of untreated schizophrenics (E) The clinical potency of olanzapine correlates well with its dopamine receptor-blocking activity

If this child has signs of anaphylaxis, what is the treatment of choice?(A) Diphenhydramine (an antihistamine) (B) Ephedrine (C) Epinephrine (D) Isoproterenol (E) Methylprednisolone (a corticosteroid)

This drug is used in the management of insomnia and facili-tates the inhibitory actions of GABA, but it lacks anticonvulsant or musclerelaxing properties and has minimal effect on REM sleep. Its actions are antagonized by flumazenil. (A) Buspirone (B) Chlordiazepoxide (C) Eszopiclone (D) Ramelteon (E) Phenobarbital

A 9-year-old child is having learning difficulties at school. He has brief lapses of awareness with eyelid fluttering that occur every 5-10 min. Electroencephalogram (EEG) studies reveal brief 3-Hz spike and wave discharges appearing synchronously in all leads. Which drug would be effective in this child without the disadvantages of excessive sedation or tolerance development? (A) Clonazepam (B) Diazepam (C) Ethosuximide (D) Gabapentin (E) Phenobarbital

Abrupt withdrawal of antiseizure drugs can result in increases in seizure frequency and severity. Withdrawal is most easily accomplished if the patient is treated with (A) Carbamazepine (B) Clonazepam (C) Ethosuximide (D) Phenobarbital (E) Phenytoin

Trifluoperazine was prescribed for a young male patient diagnosed as suffering from schizophrenia. He complains about the side effects of his medication. Which of the following is not likely to be one of his complaints? (A) Constipation (B) Decreased libido (C) Excessive salivation (D) Postural hypotension

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 adminis-tered to patients who were being treated with (A) Amitriptyline (B) Bupropion (C) Fluoxetine (D) Mirtazapine (E) Phenelzine

The most appropriate oral medication for his increasing pain is (A) Buprenorphine (B) Codeine plus aspirin (C) Hydromorphone (D) Pentazocine (E) Tramadol

A 20-year-old woman suffers from absence seizures. Which of the following statements about her proposed drug manage-ment is least accurate? (A) Ethosuximide and valproic acid are preferred drugs (B) Gastrointestinal side effects are common with ethosuximide (C) If given valproic acid, patient should be examined every 2 or 3 months for deep tendon reflex activity (D) The use of valproic acid in pregnancy may cause con-genital malformations (E) Weight gain is common in patients on valproic acid

Which of the following best describes the mechanism of action of benzodiazepines? (A) Activate GABAB receptors in the spinal cord (B) Block glutamate receptors in hierarchical neuronal pathways in the brain (C) Increase frequency of opening of chloride ion channels coupled to GABAA receptors (D) Inhibit GABA transaminase to increase brain levels of GABA (E) Stimulate release of GABA from nerve endings in the brain

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

A 23-year-old man has a pheochromocytoma, blood pressure of 190/120 mm Hg, and hematocrit of 50%. Pulmonary function and renal function are normal. His catecholamines are elevated, and he has a well-defined abdominal tumor on MRI. He has been scheduled for surgery. Which one of the following agents should be avoided in the anesthesia protocol? (A) Desflurane (B) Fentanyl (C) Isoflurane (D) Midazolam (E) Sevoflurane

Four new synthetic drugs (designated W, X, Y, and Z) are to be studied for their cardiovascular effects. They are given to 4 anesthetized animals while the heart rate is recorded. The first animal has received no pretreatment (control); the second has received an effective dose of hexamethonium; the third has received an effective dose of atropine; and the fourth has received an effective dose of phenoxybenzamine. The net changes induced by W, X, Y, and Z in the animals are described in the following questions. Drug Y is probably a drug similar to (page 90) (A) Acetylcholine (B) Edrophonium (C) Isoproterenol (D) Norepinephrine (E) Prazosin

Several new drugs with autonomic actions were studied in preclinical trials in animals. Autonomic drugs X and Y were given in moderate doses as intravenous boluses. The systolic and diastolic blood pressures changed as shown in the diagram below. (page 82) Which of the following drugs most resembles drug X? (A) Bethanechol (B) Epinephrine (C) Isoproterenol (D) Methacholine (E) Phenylephrine

A new drug was administered to an anesthetized animal with the results shown here. A large dose of epinephrine (epi) was administered before and after the new agent for comparison. (page 90) Which of the following agents does the new drug most closely resemble? (A) Atenolol (B) Atropine (C) Labetalol (D) Phenoxybenzamine (E) Propranolol

A 30-year-old male patient is on drug therapy for a psychi-atric 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

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 need 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

A young man is brought to the emergency department in an anxious and agitated state. He informs the attending physician that he uses "street drugs" and that he gave himself an intravenous "fix" approximately 12 h ago. After an initial period of contentment and relaxation, he now has chills and muscle aches and has also been vomiting. His symptoms include hyperventilation and hyperthermia. The attending physician notes that his pupil size is larger than normal. Which drug will be most effective in alleviating the symptoms experienced by this patient? (A) Buprenorphine (B) Codeine (C) Methadone (D) Naltrexone (E) Tramadol

Which drug is a full agonist at opioid receptors with analgesic activity equivalent to morphine, a longer duration of action, and fewer withdrawal signs on abrupt discontinuance than morphine? (A) Fentanyl (B) Hydromorphone (C) Methadone (D) Nalbuphine (E) Oxycodone

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

A patient presents at the emergency department with threatened anaphylaxis. Respiratory obstruction appears likely if she is not treated immediately. Her past medical history includes hypertension, for which she is receiving an adre-noceptor blocker. The emergency physician plans to use epinephrine to treat her anaphylactic reaction. Which of the following effects of epinephrine would be blocked by prazosin but not by metoprolol? (A) Cardiac stimulation (B) Increase of cAMP (cyclic adenosine monophosphate) in fat cells (C) Mydriasis (D) Relaxation of bronchial smooth muscle (E) Relaxation of the uterus

A 3-year-old child is admitted to the emergency department after taking a drug from her parents' medicine cabinet and swallowing multiple tablets. The signs suggest that the drug is a cholinomimetic with little or no vascular effect, little or no CNS effect, and a duration of action of about 2-4 h. Which of the following is the most likely cause of these effects? (A) Acetylcholine (B) Bethanechol (C) Neostigmine (D) Physostigmine (E) Pilocarpine

A patient underwent a surgical procedure of 2 h. Anesthesia was provided by isoflurane, supplemented by intravenous midazolam and a nondepolarizing muscle relaxant. At the end of the procedure, a low dose of atropine was administered followed by pyridostigmine A muscarinic receptor antagonist would probably not be needed when a cholinesterase inhibitor was given for reversal of the skeletal muscle relaxant actions of a nondepolarizing drug if the NM blocking agent used was (A) Cisatracurium (B) Mivacurium (C) Pancuronium (D) Tubocurarine (E) Vecuronium

A 65-year-old woman with impaired renal function and a necrotic ulcer in the sole of her right foot is admitted to the ward from the emergency department. She has long-standing type 2 diabetes mellitus and you wish to examine her retinas for possible vascular changes. Which of the fol-lowing drugs is a good choice when pupillary dilation—but not cycloplegia—is desired? (A) Isoproterenol (B) Norepinephrine (C) Phenylephrine (D) Pilocarpine (E) Tropicamide

With chronic use in seizure states, the adverse effects of this drug include coarsening of facial features, hirsutism, and gingival hyperplasia. (A) Carbamazepine (B) Ethosuximide (C) Phenytoin (D) Tiagabine (E) Zonisamide

It is possible that this patient will have to increase the dose of the analgesic as his condition progresses as a result of developing tolerance. However, tolerance will not develop to a significant extent with respect to (A) Biliary smooth muscle (B) Emesis (C) Pupillary constriction (D) Sedation (E) Urinary retention

A 3-year-old child has been admitted to the emergency department having swallowed the contents of 2 bottles of a nasal decongestant. The active ingredient of the medication is phenylephrine, a potent, selective α-adrenoceptor agonist drug. Which of the following is a sign of α-receptor activa-tion that may occur in this child? (A) Bronchodilation (B) Cardiac acceleration (tachycardia) (C) Pupillary dilation (mydriasis) (D) Renin release from the kidneys (E) Vasodilation of blood vessels

A 20-year-old male patient scheduled for hernia surgery was anesthetized with halothane and nitrous oxide; tubocurarine was provided for skeletal muscle relaxation. The patient rapidly developed tachycardia and became hypertensive. Generalized skeletal muscle rigidity was accompanied by marked hyperthermia. Laboratory values revealed hyperkalemia and acidosis. This unusual complication of anesthesia is most likely to be caused by (A) Acetylcholine release from somatic nerve endings at skeletal muscle (B) Activation of brain dopamine receptors by halothane (C) Antagonism of autonomic ganglia by tubocurarine (D) Calcium released within skeletal muscle (E) Toxic metabolites of nitrous oxide

(D) Calcium released within skeletal muscle

An increase of chloride conductance is the most important result of activation of (A) Acetylcholine M1 receptors (B) Beta1 adrenoceptors (C) 5-HT3 receptors (D) GABAA receptors (E) Glutamate NMDA receptors

(D) GABAA receptors

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 but sev-eral relatives have had similar symptoms. 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

Which of the following is the most dangerous effect of belladonna alkaloids in infants and toddlers? (A) Dehydration (B) Hallucinations (C) Hypertension (D) Hyperthermia (E) Intraventricular heart block

(D) Hyperthermia

Which of the following is the primary second-messenger process in the contraction of the ciliary muscle when focusing on near objects (A) cAMP (cyclic adenosine monophosphate) (B) DAG (diacylglycerol) (C) Depolarizing influx of sodium ions via a channel (D) IP3 (inositol 1,4,5-trisphosphate) (E) NO (nitric oxide)

(D) IP3 (inositol 1,4,5-trisphosphate)

Full activation of the parasympathetic nerves is likely to pro-duce which of the following effects? (A) Bronchodilation (B) Decreased intestinal motility (C) Increased thermoregulatory sweating (D) Increased pupillary constrictor tone (miosis) (E) Increased heart rate (tachycardia)

(D) Increased pupillary constrictor tone (miosis)

A young woman recently diagnosed as schizophrenic develops severe muscle cramps with torticollis a short time after drug therapy is initiated with haloperidol. The best course of action would be to (A) Add risperidone to the drug regimen (B) Discontinue haloperidol and observe the patient (C) Give oral diphenhydramine (D) Inject benztropine (E) Switch the patient to fluphenazine

(D) Inject benztropine

You are on your way to take an examination and you sud-denly get an attack of diarrhea. If you stop at a nearby drugstore for an over-the-counter opioid with antidiarrheal action, you will be asking for (A) Codeine (B) Dextromethorphan (C) Diphenoxylate (D) Loperamide (E) Nalbuphine

(D) Loperamide

For these questions, use the accompanying diagram. Assume that the diagram can represent either the sympathetic or the parasympathetic system. (page 57) If the effector cell in the diagram is a pupillary constrictor smooth muscle cell, which of the following receptor types is denoted by structure 6? (A) Alpha1 adrenoceptor (B) Beta1 adrenoceptor (C) Beta2 adrenoceptor (D) M3 cholinoceptor (E) Ng cholinoceptor

(D) M3 cholinoceptor

Which statement concerning anesthetic MAC (minimum anesthetic concentration) value is most accurate? (A) Anesthetics with low MAC value have low potency (B) MAC values increase in elderly patients (C) MAC values give information about the slope of the dose-response curve (D) Methoxyflurane has an extremely low MAC value (E) Simultaneous use of opioid analgesics increases the MAC for inhaled anesthetics

(D) Methoxyflurane has an extremely low MAC value

In comparing the characteristics of thioridazine with other first generation antipsychotic drugs, which of the following statements is most accurate (A) Most likely to cause extrapyramidal dysfunction (B) Least likely to cause urinary retention (C) Most likely to be safe in patients with history of cardiac arrhythmias (D) Most likely to cause ocular dysfunction (E) The safest antipsychotic drug in overdose

(D) Most likely to cause ocular dysfunction

Which statement about abuse of the opioid analgesics is false? (A) Lacrimation, rhinorrhea, yawning, and sweating are early signs of withdrawal from opioid analgesics (B) In withdrawal from opioids, clonidine may be useful in reducing symptoms caused by sympathetic overactivity (C) Methadone alleviates most of the symptoms of heroin withdrawal (D) Most patients experiencing withdrawal from heroin are free of the symptoms of abstinence in 6-8 d (E) Naloxone may precipitate a severe withdrawal state in abusers of opioid analgesics with symptoms starting in less than 15-30 min

(D) Most patients experiencing withdrawal from heroin are free of the symptoms of abstinence in 6-8 d

Which drug does not activate opioid receptors, has been proposed as a maintenance drug in treatment programs for opioid addicts, and with a single oral dose, will block the effects of injected heroin for up to 48 h? (A) Fentanyl (B) Nalbuphine (C) Naloxone (D) Naltrexone (E) Propoxyphene

(D) Naltrexone

Four new synthetic drugs (designated W, X, Y, and Z) are to be studied for their cardiovascular effects. They are given to 4 anesthetized animals while the heart rate is recorded. The first animal has received no pretreatment (control); the second has received an effective dose of hexamethonium; the third has received an effective dose of atropine; and the fourth has received an effective dose of phenoxybenzamine. The net changes induced by W, X, Y, and Z in the animals are described in the following questions. Drug W increased heart rate in the control animal, the atropine-pretreated animal, and the phenoxybenzamine-pretreated animal. However, drug W had no effect on heart rate in the hexamethonium-pretreated animal. Drug W is probably a drug similar to (A) Acetylcholine (B) Edrophonium (C) Isoproterenol (D) Nicotine (E) Norepinephrine

(D) Nicotine

One of the first neurotransmitter receptors to be identified in the CNS is located on the Renshaw cell in the spinal cord. Activation of this receptor results in excitation via an increase in cation (Na+, K+) conductance independently of G-protein-coupled mechanisms. Which of the following compounds is most likely to activate this receptor? (A) Dopamine (B) Glycine (C) GABA (D) Nicotine (E) Serotonin

(D) Nicotine

A 60-year-old woman was told she had hypertension and should be taking antihypertensive medication. She decides to take an herbal medication from an online "holistic pharmacy." One week after starting the medication, she is found uncon-scious in her apartment. In the emergency department, her blood pressure is 50/0 mm Hg and heart rate is 40 bpm. Respirations are 20/min; pupils are slightly constricted. Bowel sounds are present. Which of the following would be the most effective cardiovascular stimulant? (A) Amphetamine (B) Clonidine (C) Isoproterenol (D) Norepinephrine (E) Tyramine

(D) Norepinephrine

Which of the following drugs is established to be both effective and safe to use in a pregnant patient suffering from bipolar disorder? (A) Carbamazepine (B) Fluphenazine (C) Lithium (D) Olanzapine (E) Valproic acid

(D) Olanzapine

An emergency department patient with severe pain thought to be of gastrointestinal origin received 80 mg of meperi-dine. She subsequently developed a severe reaction char-acterized by tachycardia, hypertension, hyperpyrexia, and seizures. Questioning revealed that the patient had been taking a drug for a psychiatric condition. Which drug is most likely to be responsible for this untoward interaction with meperidine? (A) Alprazolam (B) Bupropion (C) Lithium (D) Phenelzine (E) Mirtazapine

(D) Phenelzine

A young man suffers from a seizure disorder characterized by tonic rigidity of the extremities followed in 15-30 s of tremor progressing to massive jerking of the body. This clonic phase lasts for 1 or 2 min, leaving the patient in a stuporous state. Of the following drugs, which is most suitable for long-term management of this patient? (A) Clonazepam (B) Ethosuximide (C) Felbamate (D) Phenytoin (E) Pregabalin

(D) Phenytoin

Which statement concerning the proposed mechanisms of action of anticonvulsant drugs is most accurate? (A) Benzodiazepines facilitate glutamate-mediated inhibi-tory actions (B) Ethosuximide selectively blocks potassium ion (K+) channels in thalamic neurons (C) Phenobarbital produces a selective blockade of calcium ion (Ca2+) channels (D) Phenytoin prolongs the inactivated state of the Na+channel (E) Zonisamide blocks voltage-gated K+ channels

(D) Phenytoin prolongs the inactivated state of the Na+channel

A 30-year-old man has been treated with several autonomic drugs for 4 weeks. He is now admitted to the emergency department showing signs of drug toxicity. Which of the following signs would distinguish between an overdose of a ganglion blocker versus a muscarinic blocker? (A) Cycloplegia (B) Dry skin in a warm environment (C) Miosis (D) Postural hypotension (E) Tachycardia

(D) Postural hypotension

A 56-year-old man has hypertension and an enlarged prostate, which biopsy shows to be benign prostatic hyperplasia. He complains of urinary retention. Which of the following drugs would be the most appropriate initial therapy? (A) Albuterol (B) Atenolol (C) Metoprolol (D) Prazosin (E) Timolol

(D) Prazosin

Characteristic properties of local anesthetics include all of the following except (A) An increase in membrane refractory period (B) Blockade of voltage-dependent sodium channels (C) Effects on vascular tone (D) Preferential binding to resting channels (E) Slowing of axonal impulse conduction

(D) Preferential binding to resting channels

Postoperative vomiting is uncommon with this intravenous agent, and patients are often able to ambulate sooner than those who receive other anesthetics. (A) Enflurane (B) Etomidate (C) Midazolam (D) Propofol (E) Thiopental

(D) Propofol

Assume that the diagram below represents a sympathetic noradrenergic postganglionic nerve ending. (page 57) Which of the following inhibits the carrier denoted "y" in the diagram? (A) Cocaine (B) Dopamine (C) Hemicholinium (D) Reserpine (E) Vesamicol

(D) Reserpine

Which statement concerning the adverse effects of antipsy-chotic drugs is most accurate? (A) Acute dystonic reactions occur commonly with olanzapine (B) Akathisias due to antipsychotic drugs are managed by increasing the drug dose (C) Blurring of vision and urinary retention are common adverse effects of haloperidol (D) Retinal pigmentation is a dose-dependent toxic effect of thioridazine (E) The late-occurring choreoathetoid movements caused by conventional antipsychotic drugs may be alleviated by atropine

(D) Retinal pigmentation is a dose-dependent toxic effect of thioridazine

A 42-year-old homemaker suffers from anxiety with phobic symptoms and occasional panic attacks. She uses over-the-counter antihistamines for allergic rhinitis and claims that ethanol use is "just 1 or 2 glasses of wine with dinner." Alprazolam, a benzodiazepine, is prescribed, and the patient is maintained on the drug for 3 years, with several dose increments over that time period. Her family notices that she does not seem to be improving and that her speech is often slurred in the evenings. She is finally hospitalized with severe withdrawal signs on one weekend while attempting to end her dependence on drugs. he main reason for hospitalization of this patient was to be able to effectively control (A) Cardiac arrhythmias (B) Delirium (C) Hepatic dysfunction (D) Seizures (E) None of the above

(D) Seizures

Which statement concerning the use of lithium in the treatment of bipolar affective disorder is most 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

(D) Since lithium does not cross the placental barrier, it is safe in pregnancy

Your 30-year-old patient has moderately severe new onset asthma, and you prescribe a highly selective β2 agonist inhaler to be used when needed. In considering the possible drug effects in this patient, you would note that β2 stimulants frequently cause (A) Direct stimulation of renin release (B) Hypoglycemia (C) Itching due to increased cGMP (cyclic guanine mono-phosphate) in mast cells (D) Skeletal muscle tremor (E) Vasodilation in the skin

(D) Skeletal muscle tremor

A new halogenated gas anesthetic has a blood:gas partition coefficient of 0.5 and a MAC value of 1%. Which prediction about this agent is most accurate? (Refer to Table 25-1 for comparison of agents.) (A) Equilibrium between arterial and venous gas tension will be achieved very slowly (B) It will be metabolized by the liver to release fluoride ions (C) It will be more soluble in the blood than isoflurane (D) Speed of onset will be similar to that of nitrous oxide (E) The new agent will be more potent than halothane

(D) Speed of onset will be similar to that of nitrous oxide

A 24-year-old stockbroker has developed a "nervous disposition." He is easily startled, worries about inconsequential matters, and sometimes complains of stomach cramps. At night he grinds his teeth in his sleep. There is no history of drug abuse. Diagnosed as suffering from generalized anxiety disorder, he is prescribed buspirone. The patient should be informed to anticipate (A) A need to continually increase drug dosage because of tolerance (B) A significant effect of the drug on memory (C) Additive CNS depression with alcoholic beverages (D) That the drug is likely to take a week or more to begin working (E) That if he stops taking the drug abruptly, he will experience withdrawal signs

(D) That the drug is likely to take a week or more to begin working

Which statement about pramipexole is most accurate? (A) Effectiveness in Parkinson's disease requires its metabolic conversion to an active metabolite (B) It should not be administered to patients taking anti-muscarinic 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

An 82-year-old woman, otherwise healthy for her age, has difficulty sleeping. Triazolam is prescribed for her at one half of the conventional adult dose. Which statement about the use of triazolam in this elderly patient is most accurate? (A) Ambulatory dysfunction is unlikely to occur in elderly patients taking one half of the conventional adult dose (B) Hypertension is a common adverse effect of benzodiaz-epines in elderly patients (C) Over-the-counter cold medications may antagonize the hypnotic effects of the drug (D) The patient may experience amnesia, especially if she also consumes alcoholic beverages (E) Triazolam does not cause rebound insomnia on abrupt discontinuance

(D) The patient may experience amnesia, especially if she also consumes alcoholic beverages

A young man is brought to the emergency department in an anxious and agitated state. He informs the attending physician that he uses "street drugs" and that he gave himself an intravenous "fix" approximately 12 h ago. After an initial period of contentment and relaxation, he now has chills and muscle aches and has also been vomiting. His symptoms include hyperventilation and hyperthermia. The attending physician notes that his pupil size is larger than normal. What is the most likely cause of these signs and symptoms? (A) The patient had injected dextroamphetamine (B) The patient has hepatitis B (C) The patient has overdosed with an opioid (D) The signs and symptoms are those of the opioid abstinence syndrome (E) These are early signs of toxicity due to contaminants in "street heroin"

(D) The signs and symptoms are those of the opioid abstinence syndrome

Which drug is most often associated with hypotension and is related to clonidine? (A) Baclofen (B) Pancuronium (C) Succinylcholine (D) Tizanidine (E) Vecuronium

(D) Tizanidine

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 weeks 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

A 42-year-old homemaker suffers from anxiety with phobic symptoms and occasional panic attacks. She uses over-the-counter antihistamines for allergic rhinitis and claims that ethanol use is "just 1 or 2 glasses of wine with dinner." Alprazolam, a benzodiazepine, is prescribed, and the patient is maintained on the drug for 3 years, with several dose increments over that time period. Her family notices that she does not seem to be improving and that her speech is often slurred in the evenings. She is finally hospitalized with severe withdrawal signs on one weekend while attempting to end her dependence on drugs. Which statement about the use of alprazolam is most accurate? (A) Abrupt discontinuance of alprazolam after 4 weeks of treatment may elicit withdrawal signs (B) Additive CNS depression occurs with ethanol (C) Most benzodiazepines are Schedule IV-controlled drugs (D) Tolerance can occur with chronic use of any benzodiazepine (E) All of the above statements are accurate

(E) All of the above statements are accurate

Neurotransmitters may (A) Increase chloride conductance to cause hyperpolarization (B) Increase potassium conductance to cause inhibition (C) Increase sodium conductance to cause excitation (D) Inhibit calcium conductance to reduce transmitter release (E) Exert all of the above actions

(E) Exert all of the above actions

Your 75-year-old patient with multiple comorbidities is to receive a β-blocking drug. For which of the following conditions are β-blocking drugs NOT indicated? (A) Acute arrhythmias during surgery (B) Atherosclerotic angina pectoris (angina of effort) (C) Chronic heart failure (D) Hypertension (E) Hypoglycemia in diabetes

(E) Hypoglycemia in diabetes

JR, a 35-year-old farm worker, is admitted to the emergency department suffering from insecticide poisoning. Parathion has which one of the following characteristics? (A) It is inactivated by conversion to paraoxon (B) It is less toxic to humans than malathion (C) It is more persistent in the environment than DDT (D) It is poorly absorbed through skin and lungs (E) If treated early, its toxicity may be partly reversed by pralidoxime

(E) If treated early, its toxicity may be partly reversed by pralidoxime

Drug X caused a 50 mm Hg rise in mean blood pressure in the control animal, no blood pressure change in the ganglion-blocked animal, and a 75 mm mean blood pressure rise in the atropine-pretreated animal. Drug X is probably a drug similar to (A) Acetylcholine (B) Atropine (C) Epinephrine (D) Hexamethonium (E) Nicotine

(E) Nicotine

A college student is brought to the emergency department by friends. The physician is informed that the student had taken a drug and then "went crazy." The patient is agitated and delirious. Several persons are required to hold him down. His skin is warm and sweaty, and his pupils are dilated. Bowel sounds are normal. Signs and symptoms include tachycardia, marked hypertension, hyperthermia, increased muscle tone, and both horizontal and vertical nystagmus. The management of this patient is likely to include (A) Administration of epinephrine (B) Alkalinization of the urine to increase drug elimination (C) Amitriptyline if psychosis ensues (D) Atropine to control hyperthermia (E) None of the above

(E) None of the above

Four new synthetic drugs (designated W, X, Y, and Z) are to be studied for their cardiovascular effects. They are given to 4 anesthetized animals while the heart rate is recorded. The first animal has received no pretreatment (control); the second has received an effective dose of hexamethonium; the third has received an effective dose of atropine; and the fourth has received an effective dose of phenoxybenzamine. The net changes induced by W, X, Y, and Z in the animals are described in the following questions. Drug X is probably a drug similar to (page 89) (A) Acetylcholine (B) Albuterol (C) Edrophonium (D) Isoproterenol (E) Norepinephrine

(E) Norepinephrine

This neurotransmitter, found in diffuse systems, can exert both excitatory and inhibitory actions. Multiple receptor sub-types and a transporter have been identified, some of which are targets for drugs that are used in major depressive disorder and attention deficit hyperactivity disorder. (A) Acetylcholine (B) Beta-endorphin (C) Glycine (D) Glutamate (E) Norepinephrine

(E) Norepinephrine

A college student is brought to the emergency department by friends. The physician is informed that the student had taken a drug and then "went crazy." The patient is agitated and delirious. Several persons are required to hold him down. His skin is warm and sweaty, and his pupils are dilated. Bowel sounds are normal. Signs and symptoms include tachycardia, marked hypertension, hyperthermia, increased muscle tone, and both horizontal and vertical nystagmus. The most likely cause of these signs and symptoms is intoxication from (A) Hashish (B) LSD (C) Mescaline (D) Methamphetamine (E) Phencyclidine

(E) Phencyclidine

Mr Green, a 54-year-old banker, had a cardiac transplant 6 months ago. His current blood pressure is 120/70 mm Hg and heart rate is 100 bpm. Which of the following drugs would have the least effect on Mr Green's heart rate? (A) Albuterol (B) Epinephrine (C) Isoproterenol (D) Norepinephrine (E) Phenylephrine

(E) Phenylephrine

Several new drugs with autonomic actions were studied in preclinical trials in animals. Autonomic drugs X and Y were given in moderate doses as intravenous boluses. The systolic and diastolic blood pressures changed as shown in the diagram below. (page 82) Which of the following most resembles drug Y? (A) Bethanechol (B) Epinephrine (C) Isoproterenol (D) Methacholine (E) Phenylephrine

(E) Phenylephrine

A crop duster pilot has been accidentally exposed to a high concentration of a highly toxic agricultural organophosphate insecticide. If untreated, the cause of death from such exposure would probably be (A) Cardiac arrhythmia (B) Gastrointestinal bleeding (C) Heart failure (D) Hypotension (E) Respiratory failure

(E) Respiratory failure

Which statement about nalbuphine is most accurate? (A) Activates μ receptors (B) Does not cause respiratory depression (C) Is a nonsedating opioid (D) Pain-relieving action is not superior to that of codeine (E) Response to naloxone in overdose may be unreliable

(E) Response to naloxone in overdose may be unreliable

This transmitter is mostly located in diffuse neuronal systems in the CNS, with cell bodies particularly in the raphe nuclei. It appears to play a major role in the expression of mood states, and many antidepressant drugs are thought to increase its functional activity. (A) Acetylcholine (B) Dopamine (C) GABA (D) Glutamate (E) Serotonin

(E) Serotonin

Which one of the following can be blocked by atropine? (A) Decreased blood pressure caused by hexamethonium (B) Increased blood pressure caused by nicotine (C) Increased skeletal muscle strength caused by neostigmine (D) Tachycardia caused by exercise (E) Sweating caused by exercise

(E) Sweating caused by exercise

A 40-year-old man with a history of major depression is admitted to the emergency department following a suicide attempt with a drug overdose. Which of the following signs or symptoms would be consistent with an overdose of a ganglion-blocking drug? (A) Increased blood pressure (B) Increased bowel sounds (C) Increased sweating (D) Miosis (E) Tachycardia

(E) Tachycardia

Which statement about inhalants is most accurate (A) Euphoria, numbness, and tingling sensations with visual and auditory disturbances occur in most persons who inhale organic nitrites (B) Methemoglobinemia is a common toxicologic problem after repetitive inhalation of industrial solvents (C) Nitrous oxide is the most commonly abused drug by medical personnel working in hospitals (D) Solvent inhalation is mainly a drug abuse problem in petroleum industry workers (E) The inhalation of isobutyl nitrite is likely to cause head-ache, hypotension, and flushing

(E) The inhalation of isobutyl nitrite is likely to cause head-ache, hypotension, and flushing

Which statement about phenytoin is most accurate? (A) Displaces sulfonamides from plasma proteins (B) Drug of choice in myoclonic seizures (C) Half-life is increased if used with phenobarbital (D) Isoniazid (INH) decreases steady-state blood levels of phenytoin (E) Toxic effects may occur with only small increments in dose

(E) Toxic effects may occur with only small increments in dose

Which drug, a partial agonist at nicotinic acetylcholine receptors, is used in smoking cessation programs but may cause seizures in overdose? (A) Acamprosate (B) Buprenorphine (C) Nalbuphine (D) Rimonabant (E) Varenicline

(E) Varenicline

Which of the following is a direct-acting cholinomimetic that is lipid-soluble and is used to facilitate smoking cessation? (A) Acetylcholine (B) Bethanechol (C) Neostigmine (D) Physostigmine (E) Varenicline

(E) Varenicline

A 43-year-old very overweight man complains of not sleeping well and feeling tired during the day. He says that his wife is the cause of the problem because she wakes him up several times during the night because of his loud snores. This appears to be a breathing related sleep disorder, so you should probably write a prescription for (A) Clorazepate (B) Diazepam (C) Flurazepam (D) Pentobarbital (E) Weight loss

(E) Weight loss

Regarding the clinical use of antidepressant drugs, which statement is most 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, citalo-pram is usually more effective than paroxetine (C) Tricyclics are highly effective in depressions with atten-dant 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

Which of the following drugs has a high affinity for 5-HT2receptors in the brain, does not cause extrapyramidal dysfunction or hematotoxicity, but is reported to increase the risk of significant QT prolongation? (A) Clozapine (B) Haloperidol (C) Olanzapine (D) Valproic acid (E) Ziprasidone

(E) Ziprasidone

Characteristics of phase I depolarizing neuromuscular blockade due to succinylcholine include (A) Easy reversibility with nicotinic receptor antagonists (B) Marked muscarinic blockade (C) Muscle fasciculations only in the later stages of block (D) Reversibility by acetylcholinesterase (AChE) inhibitors (E)Sustained tension during a period of tetanic stimulation

Pharmacology Module 2

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