PHARMACOLOGY TEST BANK

PHARMACOLOGY TEST BANK A 10-year old boy is sent to a pediatric neurologist for an evaluation due to poor performance and inability to pay attention in school. He has also been fighting with other children. He is given a diagnosis of ADHD with impulsivity and irratibility. Which is the most appropriate for management of the ADHD? - dextroamphetamine A 10-year-old boy with ADHD has symptoms that are controlled with an oral psychostimulant. However, he and his family wish to avoid having to give a second dose of medication at school. They prefer an alternative treatment that can be administered in the morning and last the entire day. Which treatment option is best? - methylphenidate in a transdermal delivery system A 12-year old girl has tonic-clonic seizures and is taking phenytoin. What is the mechanism of action of this drug? - inactivation of voltage-gated sodium channels A 20-year old man is admitted to the emergency room after an accidental overdose of alprazolam, a benzodiazepine. Which of the following treatment could reverse the effect of the alprazolam overdose? - flumazenil A 23-year old male college student is taking amphetamine on a regular basis to stay alert while studying. The mechanism of action of amphetamine that causes this effect is: - due to the release of norepinephrine from central adrenergic neurons A 23-year old man has deliberately ingested an organophosphate insecticide. His initial symptoms of salivation, lacrimation, and diarrhea are a consequence of - inhibition of acetylcholinesterase A 23-year old man is accosted by 3 men late at night. Immediately his heart rate increases due to an increase in epinephrine in his circulation. The release of epinephrine from the adrenal medulla is the result of the action of acetylcholine on - nicotine receptors A 28-year-old woman is brought to the emergency department after overdosing on oxycodone, an opiate analgesic. She is unconscious and barely breathing when she arrives at the hospital, but revives and is breathing normally within 2 minutes after receiving an injection of naloxone. After about an hour, she requires another dose of naloxone as the symptoms of opiate overdose begin to redevelop. Naloxone is likely acting as a - competitive antagonist of opioid receptors A 32-year old women is treated for schizophrenia with clozapine. Her physician insists on regular monitoring of - complete blood count (CBC) A 32-year old women with the diagnosis of pheochromocytoma is scheduled for surgery to remove her adrenal tumor. The best drug to control her episodes of high blood pressure prior to her surgery would be - a nonselective a adrenergic antagonist such as phenoxybenzamine A 33-year old man is taking valproic acid for tonic-clonic seizures. Lamotrigine is added to improve seizure control. The plasma concentration of lamotrigine may be increased because valproate inhibits - glucuronidation A 35-year old woman is anesthetized with desflurane for outpatient surgery. The induction with desflurane is rapid because desflurane is not very soluble in fat and because desflurane - has a low blood:gas partitiion coefficient A 35-year old women complains of not being able to sleep for the past week. She is prescribed zolpidem to be taken at bedtime. What is the mechanism of action of zolpidem? - a nonbenzodiazepine, GABA agonist A 40-year old man presents to his family physician with drooping eyelids, difficulty chewing and swallowing, and muscle fatigue even on mild exertion. Which agent could be used to diagnose myasthenia gravis in this patient? - edrophonium A 65-year old men with the diagnosis of Alzheimer's disease is being treated with donepezil. This drug acts by - inhibiting acetylcholinesterase A 72-year old patient is seeking treatment for chronic open-angle glaucoma, what drug would you recommend? - timolol A 75-year old man with OCD is treated with risperidone. After 3 weeks of therapy, he develops bradykinesia, loss of facial expressions, and reduced arm movements when walking. These symptoms are due to - D2 receptor antagonism A child is experiencing absence seizures that interrupt his ability to pay attention during school and activities. Which therapy is most appropriate for this patient? - ethosuximide A drug has a pKa of 7.8. Will the drug favor the protonated or deprotonated form in the stomach? - protonated A drug with a half-life of 2 hours is administered by continuous intravenous infusion. How long will it take for the drug to reach 50% of its steady state concentration? - 2 hours A drug, given as a 150 mg single dose, results in a peak plasma concentration of 10 ug/mL. The apparent volume of distribution is (rapid distribution and negligible elimination prior to measuring the peak plasma level): - 15 L A majority of treatments for MS target - the immune system A patent with mild depression was being treated with an MAOI, but his physician is now switching the antidepressant therapy to fluoxetine. How should these medications be switched out? - The patient should wait 2 weeks after he stops taking the MAOI before beginning the SSRI A patient being treated for schizophrenia develops tardive dyskinesia. Which of the following agents is most likely to improve this adverse effect? - valbenzine A patient enters the emergency room with bradycardia and hypotension. He reports eating Amanita muscaria mushrooms, a species known to contain muscarine. What is the best drug to use as an antidote? - atropine A patient is experiencing seizures that result in a loss of consciousness followed by continuous contraction and rapid contraction/relaxation phases - tonic-clonic A patient need short-term relief for acute asthma symptoms, which drug should be prescribed? - albuterol A patient on a diagnostic test for myasthenia gravis would be expected to have improved neuromuscular function after being treated with with - edrophonium A patient visits her doctor with symptoms typical of a bladder infection. She is immediately prescribed a 400 mg dose of antibiotic (t1/2 = 12 hrs). The corresponding plasma concentration of the drug is found to be 96ug/mL. What is the volume of distribution of this drug? - 4.2 L A patient with Alzheimer disease needs treatment for overactive bladder. Which drug is the best choice for this patient? - trospium A patient with an acute attack of glaucoma is treated with pilocarpine. The primary reason for its effectiveness in this condition is its: - ability to lower intraocular pressure A semisynthetic opioid - Has a structure derived from a naturally occurring opioid agonist A soldiers' unit has come under attack with a nerve agent. The symptoms exhibited are skeletal muscle paralysis, profuse brachial secretions, miosis, bradycardia, and convulsions. The alarm indicates exposure to an organophosphate. What is the correct treatment? - administer atropine and 2-PAM (pralidoxime) a study examining how a drug is distributed throughout the body and how the drug is changed before eliminated is an example of - pharmacokinetics absence seizures medication - ethosuximimde ADHD treatment - lisdexamfetamine Amphetamines may be used in patients with which of the following conditions? - obesity An antipsychotic fluphenazine is order for a patient with psychosis. This agent can lead to symptoms of EPS, what are those symptoms? - hallucinations An indirect agonist will - enhance the release of norepinephrine from vesicles An unpleasant state of tension, apprehension, or uneasiness is characteristic of - anxiety appetite suppressant, treatment for obesity - phentermine Atropine has been used to decrease gastrointestinal motility and to counteract anticholinesterase poisoning. What function does this molecule have? - muscarinic anatgonist Based on the process that occurs when a somatic signal innervates at the neuromuscular junction, place the following steps in the correct order: - 1. acetylcholine bind to nicotine receptors on the sarcolemma 2. voltage-gated ion channels open in the T-tubule 3. calcium ions from he sarcoplasmic reticulum are released 4. myosin binds to actin, shortening the muscle fiber blocks calcium release from sarcoplasmic reticulum, treatmetn for malignant hyperthermia - dantrolene blocks reuptake of monoamine neurotransmitters, no approved treatment for addiction - cocaine blocks T-type calcium channels - ethosuximide blocks voltage-gated sodium ion channels - phenytoin buprenorphine - partial mu opioid agonist Caffeine is eliminated primarily by metabolism and with first order kinetics. The half-life of caffeine varies significantly with individuals, but is on average 5.0 hours. The volume of distribution is 0.60 L/kg. Joe has a mass of 70 kg and is an average subject with regard to caffeine pharmacokinetics. He has a regular habit of consuming a cup of coffee (85 mg of caffeine) at 8 am. What is the clearance value (CL) of caffeine in a normal individual? - 0.083 L/hr/kg classify the following drug - Secondary TCA Consider this pathway: epinephrine -- G protein-coupled receptor -- G protein adenylyl cyclase -- cAMP. Identify the second messenger. - cAMP Current treatments for which of the following diseases is able to stop and reverse disease progression? - none of the above Drug X produces maximal contraction of cardiac muscle in a manner similar to epinephrine. Drug X is considered to be a(n) - agonist Due to its shorter duration of action, this drug is used as ophthalmic solutions for mydriasis and cycloplegia - tropicamide fentanyl - synthetic opioid agonist First generation antipsychotic drugs are competitive inhibitors of a variety of receptors. They are most likely associated with - extrapyramidal symptoms focal seizure medication - tiagabine For a cholinesterase modified by an organophosphate compound (e.g. soman), what is the time-dependent dealkylation process called yielding an enzyme refractory toward reactivation? - aging For a patient with reduced cardiac output (CO), the body compensates by diverting more CO to the cerebral circulation. For this reason, the dose of an IV anesthetic should be - reduced GABA reuptake inhibitor - tiagabine Given the following blood:gas partition coefficients, which drug would be the most soluble in the blood? - isoflurane (blood:gas coefficient = 1.4 which was highest in chart) Given the following blood:gas partition coefficients, which drug would you predict will reach equilibrium the fastest (have the fastest induction time)? - desflurane (the lowest value on the chart) glucocorticoid helpful for minimizing PONV - dexamethasone hallucinogen - lysergic acid diethylamide Higher affinity to B adrenergic receptors is found with compounds that have - larger substituents on the amine nitrogen If 1 ng of drug A produces the same responses as 10 ng of drug B, which is correct? - Drug A is more potent than Drug B In addition to their use as an antipsychotic, haloperidol and promethazine can also be used as a treatment for - emesis (nausea) In the presence of pentazocine, a higher concentration of morphine is required to elicit full pain relief. Pentazocine by itself has a smaller analgesic effect than does morphine, even at the highest dose. Which of the following is correct regarding these medications? - morphine is a full agonist and pentazocine is a partial agonist In the presence of propranolol, a higher concentration of epinephrine is required to elict full anti asthmatic activity. Propranolol has no effect on asthma symptoms. Which is correct regarding these medications? - epinephrine is agonist and propranolol is a competitive antagonist Indirect cholinergic agonists cause - inhibition of acetylcholinesterase and a corresponding increase in the synaptic acetylcholine levels inhaled anesthetic with a very high MAC - nitrous oxide irreversible inhibitor of GABA transaminase - vigabatrin IV sedative and hypnotic with a low risk for PONV - propofol knowing that all three drugs interact with the same receptor, which drug is a competitive antagonist? - C on graph Knowing that all three drugs interact with the same receptor, which drug is a noncompetitive antagonist? - B on the graph Lennox-gastaut syndrome medication - lamotrigine local anesthetic - lidocaine Local anesthetics are often dosed with _____ in order to ______ - epinephrine; minimize toxicity and keep anesthetic at site of interest Modest improvements in the memory of patients with Alzheimer's disease may occur with drugs that increase transmission at which fo the following receptors? - cholinergic morphine - natural opioid agonist Most antidepressant drugs act through what mechanism? - selective serotonin reuptake inhibition MS is a(n) - autoimmune inflammatory disease characterized by a demyelination within the CNS Muscarinic receptors bind - acetylcholine muscles become stiff and flexed - tonic naltrexone - long-acting opioid antagonist Neuromuscular blocking drugs, such as ciastricurium and tubocurarine, function by - competitively blocking acetylcholine by binding to nicotine receptors in the neuromuscular junction One of the functions of the a2 receptors on sympathetic presynaptic neurons is to - inhibit the release of norephinephrine one portion of the hemisphere is affected - focal Orally administered drugs encounter the liver prior to systemic circulation and are susceptible toward extensive hepatic metabolism before being distributed in the body. What is this called? - first-pass effect oxycodone - semisynthetic opioid agonist partial agonist at nicotinic receptors, useful for smoking cessation - Varenicline Peripheral adverse effect of levodopa, including nausea, hypotension, and cardiac arrhythmias can be diminished by including which dug in therapy? - carbidopa person looks like they have spaced out, may involve rapid blinking - absence Phase II conjugates typically have the following property/properties - rapidly excreted in the urine Phenoxybenzamine is a nonselective, noncompetitive blocker of a1 and a2 adrenergic receptors. This means that phenoxybenzamine - blocks the activation of a adrenergic receptors and prevents the function of endogenous and exogenous ligands e.g. norepinephrine promotes chloride ion influx via GABA receptors - phenobarbital Protein phosphorylation is commonly involved with all of the following EXCEPT - activation of G coupled receptors proton pump inhibitor to increase pH of the stomach - omeprazole Put the following steps in the correct order for neurotransmission at the cholinergic neuron - 1. acetylcholine is synthesized from choline and acetyl-CoA 2. acetylcholine is released from storage vesicles into the synaptic cleft 3. acetylcholine is synthesized from choline and acetyl-CoA 4. acetylcholine is degraded by acetylcholinesterase rapid contraction and relaxation phases - tonic-clonic rapid reversal of neuromuscular blockers - sugammadex rate the following drugs labeled 1-4 based on increasing efficacy - 2413 Regarding levels of sedation, which one applies to a reduction in anxiety and no effect on airway competency or the cardiovascular system - anxiolysis Riluzole is indicated for the management of ALS. This drug is a(n) - NMDA receptor antagonist Schizophrenia is characterized by -hallucinations -disturbances in thought -delusions - all of the above seizure lasting longer than 5 minutes, medical emergency - status epilepticus Select the answer that best describes the mechanism of action of barbiturates - barbiturates bind to the GABA receptor at a site distinct from benzodiazepine, potentiating GABA action and they block excitatory glutamate receptors Select the statement that best describes the relationship between GABA and benzodiazepine - the binding of benzodiazepine to the GABA receptor enhances the binding of GABA, increasing Cl- entry into the cell Serotonine syndrome can cause hypothermia, muscle rigidity, and sweating. Which of the following drugs will increase risk for serotonin syndrome when dosed with an SSRI? - MAOI short muscle twitches - myoclonic status epilepticus medication - phenobarbital sudden loss of muscle tone - atonic Termination of anesthesia after a single bolus dose of a parenteral anesthetic primarily reflects - redistribution out of the CNS The abrupt withdrawal of treatment with an SSRI can result in - discontinuation syndrome The activation of receptor tyrosine kinases is characterized by - dimerization and phosphorylation The autonomic nervous system innervates all of these except - skeletal muscle The benefits of antimuscarinic agents includes - -they have little to no action at the adrenal medulla -they have little to no action at skeletal neuromuscular junctions The characterization of the B adrenergic receptors is based on the strong response to - isoproterenol the equilibrium dissociation constant (Kd) is a measure of a drugs - affinity for its receptor The multi drug resistance proteins (or p-glycoproteins) can protect liver and kidney cells by exporting harmful chemicals against a concentration gradient in an energy-dependent manner. What is this called? - active transport The neurochemical abnormality most closely associated with schizophrenia is - dopamine abnormality The neurotransmitter at the neuromuscular junction is - acetylcholine The number of half-lives required to achieve steady state concentration - 5 The pKa (for the COOH group) of each of the three drugs is as follows: thyroxine = 3.0, mesothyroxine = 4.0, neothyroxine = 5.0. Of these, which will be absorbed to the greatest extent from the stomach (pH = 1.0)? - neothyroxine The primary agent used in chronic management of mania in bipolar disorder - lithium The primary use of fluoxetine is - treating depression the safest and most convenient route for drug administration is - oral The symptoms of Parkinson's disease are more correlated with the destruction of ______ neurons in the substantia nigra - dopaminergic The therapeutic window is an indictor of - range of concentrations over which a drug is safe and efficacious for most patients tonic-clonic seizure medication - topiramate treats glaucoma and anorexia in HIV patients - tetrahydrocannabinol treats narcolepsy - modafinil Tricyclic antidepressants are BEST assigned to which group? - SNRIs True or False. Drugs must always complete Phase 1 metabolism before entering Phase 2 metabolism - false Two chemicals were found to counterbalance each other by producing opposite effects on the same physiological system. What type of antagonism is this? - functional Two of the main mechanisms of action for current Alzheimer's disease drugs are - acetylcholinesterase inhibitors and NMDA receptor antagonists Variation in the sensitivity of a population of individuals to increasing doses of a drug is best determined by which of the following? - quantal dose-response curve violent muscle contraction or convulsions - clonic What are the two main adrenergic receptors? - alpha and beta What factor(s) may reduce drug bioavailability? -gastric acid instability -first-pass affect -exposure to digestive enzymes - all of the above What is a potential benefit for investigating natural compounds for the treatment of PD? - possibility of targeting both COMT and MAOI What is the benefit of salmeterol over other B2-adrenoceptor agonists such as terbutaline? - longer lasting duration of action, fewer doses throughout the day What is the effect of activation of the opioid receptor? - Efflux of potassium ions and reduced calcium influx What is the main clinic use for mirabegron, an agonist at the B3-adrenoceptor? - treatment of overactive bladder What is the main clinical use for agonists at the B2-adrenoceptor? - treatment of asthma What is the mechanism faction of suvorexant, a hypnotic drug? - orexin receptor antagonist What is the mechanism of action of atropine? - binds to muscarinic receptors and competitively prevents acetylcholine from binding What is the mechanism of action of Doxepin, an anxiolytic drug? - SNRI What is the name of the enzyme responsible for the synthesis of acetylcholine? - acetylcholinesterase What is the predominant adrenoceptor in heart muscles? - B1-adrenoceptor What is the primary goal of most Parkinson's disease treatments? - increase available dopamine What is the primary goal of most Parkinson's disease treatments? - increase available dopamine What is the target of entacapone and tolcapone? - catechol-o-methyltransferase What type of receptor is the muscarinic receptor? - G-protein coupled receptor When comparing two drugs acting the same receptor with the same maximum effect, a higher EC50 value indicates which of the following? - the drug is less potent Which classification of seizures is NOT typically associated with a loss of consciousness? - focal Which division of the peripheral nervous system is responsible for sending signals from the sensory receptors to the CNS? - afferent division Which dug is more likely to have the best chance to improve a patient's negative symptoms (e.g. apathy and blunted affect) - risperidone Which enzyme is responsible for the deactivation of norepinephrine through the oxidation of the amine? - monoamine oxidase (MAO) Which fo the following is responsible for the peripheral nervous system innervation at the skeletal muscle? - somatic system Which is the most effective drug for motion sickness for a person planning to go on a cruise? - scopolamine Which IV anesthetic targets alpha 2 receptors and is effective at blunting delirium in elderly patients as well as preventing respiratory depression? - dexmedetomidine Which of the following accurately describes the mechanism of action of varenicline - Partial agonist at nicotinic acetylcholine receptors Which of the following agents is best suited to treat pregnancy-induced hypertension? - labetalol Which of the following agents is considered a first-line treatment for narcolepsy? - modafanil Which of the following anti-epileptic drugs should be avoided in when due to a high risk for birth defects and impaired cognitive function in the fetus - valproate Which of the following antipsychotic agents is considered to be the most potent and thus have the highest risk of extrapyramidal symptoms? - haloperidol Which of the following are associated with the inhibitory pathways of the neuron? - associated with an influx of chloride ions and efflux of potassium ions Which of the following are concerns for the treatment of epilepsy in women of reproductive age? - All of the above Which of the following are direct-acting adrenergic agonists? - epinephrine and norepinephrine Which of the following are possible symptoms of opioid withdrawal (select all that apply) - -sweating and runny nose -vomiting and diarrhea -insomnia -seizures Which of the following are routes of drug clearance? -renal -sweat -intestines - all of the above Which of the following are symptoms of opioid-induced androgen deficiency? (select ALL that apply) - sexual dysfunction depression hot flashes fatigue Which of the following can be used for status epilepticus, even though long-term use has a high risk for tolerance and adverse effects? - phenobarbital Which of the following describes neuropathic pain? (select all that apply) - pain caused by nerve damage phantom limb paincheck Which of the following describes Shisa7? - It is a transmembrane protein that enhances the action of diazepam (a benzodiazepine) Which of the following describes the difference in naloxone treatment in an opioid naive patient vs a patient addicted to opioids? - an opioid naive patient will not experience anything; an addicted patient will experience withdrawal symptoms Which of the following describes the use of dopamine agonists in the treatment of PD? - dopamine agonists delay motor complications and can be used to delay levodopa therapy Which of the following drugs is a last-line agent for patients unresponsive to to other antidepressants? - selegiline Which of the following drugs is the LEAST potent? - nitrous oxide Which of the following drugs would be a TCA useful for bed-wetting in children? - imipramine Which of the following enzymes catalyzes the rate-limiting step in the synthesis of norepinephrine, responsible for the conversion of tyramine to L-DOPA - tyrosine hydroxylase Which of the following explains why a patient might experience muscle soreness after the use of succinylcholine for surgery - succinylcholine causes a brief muscle twitch and initial depolarization Which of the following explains why physostigmine is useful in treating the symptoms of myasthenia gravis? - physostigmine inhibits acetylcholinesterase and increases acetylcholine levels at the synaptic cleft Which of the following inhaled anestethics would be preferred for moderate sedation for a dentistry procedure? General anesthesia is not possible with this drug - nitrous oxide Which of the following inhaled anesthetics would be preferred for the induction of anesthesia for pediatric patients who do not tolerate IV placement? - sevoflurane Which of the following is a clinical use for a muscarinic agonist? - "switching on" the urinary tract after surgery Which of the following is a long-lasting opioid antagonist? - naltrexone Which of the following is a mixed-action adrenergic agonist? - pseudoephedrine Which of the following is a natural chemical messenger for the adrenergic receptor? - norepinephrine Which of the following is a partial agonist at the mu opioid receptor? - buprenorphine Which of the following is a useful adjunct to increase the pH of the stomach in case of aspiration? - ranitidine Which of the following is characteristic of parasympathetic stimulation? - contraction of sphincter muscles in the iris of the eye (miosis) Which of the following is characteristic of the sympathetic nervous system? - responded predominate during physical activity or when experiencing fright Which of the following is most likely to cause malignant hyperthermia, a rare, life-threatening condition - desflurance Which of the following is NOT a class of hypnotic drugs - dopamine antagonists Which of the following is NOT an example of a methylxanthine? - dextroamphetamine Which of the following is representative of Phase 1 metabolism? - oxidation Which of the following is the rate-limiting step for norepinephrine synthesis? - conversion of tyrosine to L-DOPA by tyrosine hydroxylase Which of the following is useful in treating hypertension and minimizing withdrawal symptoms from opiates? - clonidine Which of the following pertain to ketamine? (select ALL that apply) - -causes hallucinations-NMDA receptor antagonist-increases cardiac output Which of the following receptors involves the conversion of GDP to GTP? - GPCR Which of the following receptors requires a small, hydrophobic ligand? - intracellular receptor Which of the following represents the mechanism of action of SSRIs? - blocks the reputake of serotonin leading to increased concentrations of he neurotransmitter in the synaptic cleft Which of the following results in a doubling of the steady-state concentration - doubling the rate of infusion Which of the following routes is most likely to be affected by the first-pass effect? - oral Which of the following will decrease the minimum alveolar concentration (MAC)? - pregnancy Which of the following would be useful in treating status epilepticus? - lorazepam Which seizure subtype involves the muscles suddenly going limp, lasting less than 15 seconds? - atonic Which stage of anesthesia are inhalation anesthetics most likely used for? - maintenance Which, of the following, is the most potent mu agonist? - fentanyl Why is propranolol contradicted in patients with COPD or asthma? - it causes significant bronchoconstriction due to its blockade of the B2 receptor Why is the use of pseudoephedrine tightly regulated? - it can be used to make methamphetamine, a highly addictive stimulant