Clinical Pharmacology Exam
Questions
Course Introduction
Clinical Pharmacology is the study of drugs in humans, focusing on the safe, effective, and rational use of medications in clinical practice. This course explores the principles of pharmacokinetics and pharmacodynamics, mechanisms of drug action, therapeutic drug monitoring, adverse drug reactions, and drug interactions. Emphasizing current clinical guidelines and evidence-based practice, students will learn to apply pharmacological concepts to patient care, understand the ethical and legal considerations of prescribing, and stay informed about recent advances and challenges in drug therapy across a variety of medical conditions and patient populations.
Recommended Textbook
Brodys Human Pharmacology 5th Edition by Lynn Crespo
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55 Chapters
152 Verified Questions
152 Flashcards
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Page 2
Chapter 1: Pharmacodynamics: Receptors and
Concentration-Response Relationships
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Sample Questions
Q1) The majority of medications available today act on which superfamily of cellular membrane receptor?
A) Ligand-gated ion channel
B) G-protein-coupled receptor
C) Receptor tyrosine kinase
D) Nuclear hormone receptor
E) Cytokine receptor
Answer: B
Q2) Nalbuphine is an effective pain reliever because of its activity at mu-opioid receptors. However, if given to a patient who has recently received morphine (which also affects mu-opioid receptors) for postoperative pain, nalbuphine can worsen his or her pain. Thus nalbuphine is said to have what kind of activity at mu-opioid receptors?
A) Full agonist
B) Partial agonist
C) Competitive antagonist
D) Non-competitive antagonist
E) Allosteric modifier
Answer: B
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Chapter 2: Pharmacokinetics: Absorption, Distribution,
and Elimination
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Sample Questions
Q1) Which organ contains predominantly tight intercellular junctions, thereby restricting its uptake of drugs?
A) Kidney
B) Liver
C) Brain
D) Heart
E) Lungs
Answer: C
Q2) Drugs commonly undergo all of the following types of metabolism in the liver EXCEPT FOR:
A) Polymerization
B) Conjugation
C) Oxidation
D) Reduction
E) Hydrolysis
Answer: A
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Page 4
Chapter 3: Clinical Pharmacokinetics and Issues in Therapeutics
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3 Verified Questions
3 Flashcards
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Sample Questions
Q1) For a 40-year-old, 75-kg man, drug X has a volume of distribution of 40 L and a clearance of 25 ml/min. Calculate the predicted loading dose of drug X to achieve a plasma concentration of 2 g/ml.
A) 20 g
B) 80 g
C) 20 mg
D) 50 mg
E) 80 mg
Answer: E
Q2) Ketamine has a half-life of 2 ½ hours. If used as a continuous infusion at a dosage of 12.5 mg/hr for postoperative pain relief, how long will it take to achieve a practical steady-state concentration?
A) 5 hours
B) 7 ½ hours
C) 10 hours
D) 12 ½ hours
E) 15 hours
Answer: D
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Chapter 4: Drug Development, Regulation, and Prescription Writing
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Sample Questions
Q1) The following characterizes Phase 3 trials of drug development:
A) Conducted on several thousand patients with specific diseases to determine overall risk-benefit relationships
B) Conducted on a small number of normal volunteers to determine safe dosage range and pharmacokinetic parameters
C) Conducted on animals to determine what potential toxicities exist and at what serum levels those toxicities are manifest
D) Surveillance of a drug after release on the market to determine whether any previously undetected side effects develop after extended use of the drug on large populations
E) Conducted on several hundred patients with specific diseases to determine short-term safety and effectiveness of the drug
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Chapter 5: Gene Therapy and Emerging Molecular Therapies
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Sample Questions
Q1) Choose the true statement regarding gene transfer mechanisms.
A) Plasmid DNA transfer has the advantage of being highly efficient.
B) Retrovirus transfer is optimal when the target cell is undergoing division.
C) The high rate of protein uptake makes liposomal transfer mechanisms less desirable.
D) Adenovirus transfer typically has effects lasting 3 years or longer.
E) Herpes simplex viruses are clinically used to transfer DNA to reproductive organs.
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Chapter 6: Antibodies and Biological Products
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Sample Questions
Q1) ?Which of the following effectively treats relapsing forms of multiple sclerosis, thereby decreasing the frequency of clinical exacerbations and delaying physical disability?
A) INF-
B) INF-
C) INF-
D) IL-2
E) IL-11
Q2) Over the first 24 hours of glucocorticoid therapy, which group of leukocytes increases in number?
A) Neutrophils
B) Eosinophils
C) Macrophages
D) Basophils
E) Lymphocytes
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Chapter 7: Herbals and Natural Products
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Sample Questions
Q1) Which of the following agents is marketed to decrease nausea and vomiting?
A) Ginger
B) Saw palmetto
C) St. John's wort
D) Ginkgo biloba
E) Kava
Q2) The following is NOT a common safety issue with herbal medication:
A) Adulteration
B) Side effects
C) Radioactivity
D) Contamination
E) Misidentification
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9
Chapter 8: Principles of Toxicology
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Sample Questions
Q1) Choose the correct statement of the following:
A) The deleterious effects of most toxic substances are confined to a single organ system.
B) The lungs do not have a significant role in the biotransformation of toxic chemicals.
C) By helping to clear the foreign substance, the immunologic system has a primarily beneficial role in response to nickel exposure.
D) Common targets of neurotoxins include axonal transport and neurotransmitter release.
E) Benzene toxicity is primarily autoimmune-mediated by immunologic overstimulation.
Q2) Which of the following is not recommended in the treatment of the patient suffering from cyanide toxicity?
A) Sodium nitrite
B) Sodium thiosulfate
C) Supplemental oxygen
D) Hydroxocobalamin
E) Methylene blue
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Chapter 9: Introduction to the Autonomic Nervous System
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Sample Questions
Q1) Influx of this ion into the terminal of the presynaptic nerve mediates neurotransmitter release:
A) Sodium
B) Potassium
C) Calcium
D) Magnesium
E) Chloride
Q2) Bronchodilation occurs in response to stimulation of this autonomic receptor:
A) -1
B) -2
C) -1
D) -2
E) M-1
Q3) Which of the following tissues is NOT directly innervated by the autonomic nervous system?
A) Skeletal muscle
B) Kidney
C) Liver
D) Blood vessels
E) Heart
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Chapter 10: Drugs Affecting the Parasympathetic Nervous
System and Autonomic Ganglia
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Sample Questions
Q1) A 58-year-old woman is given scopolamine to treat postoperative nausea. She then becomes extremely sedated and unresponsive. The following medication would be most effective in reversing the central nervous system side effects of scopolamine:
A) Physostigmine
B) Edrophonium
C) Neostigmine
D) Pyridostigmine
E) Pralidoxime (2-PAM)
Q2) ?Which of the following is a muscarinic antagonist selective for the urinary tract and therefore is used to treat urge incontinence?
A) Atropine
B) Bethanechol
C) Tolterodine
D) Ipratropium
E) Glycopyrrolate
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Chapter 11: Drugs Affecting the Sympathetic Nervous System
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Sample Questions
Q1) A 67-year-old man who suffers from hypertension and benign prostatic hyperplasia (BPH) has been receiving medications for both of those conditions. During his routine checkup, he tells his physician that he has experienced frequent episodes of light-headedness upon standing up. Which of the following medications is most likely responsible for these episodes?
A) Metoprolol
B) Propranolol
C) Ephedrine
D) Clonidine
E) Terazosin
Q2) A 63-year-old man is experiencing an acute exacerbation of his congestive heart failure in the intensive care unit. Among other treatments, the physicians have decided to start a drug infusion that will increase the contractility of his heart while having a minimal effect on his systemic vascular resistance. Which of the following would be the best option?
A) Epinephrine
B) Dobutamine
C) Isoproteronol
D) Norepinephrine
E) Phenylephrine
Page 13
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Chapter 12: Skeletal Muscle Relaxants
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Sample Questions
Q1) A 72-year-old woman in the intensive care unit has end-stage renal disease with a potassium level of 5.3 mEq/L and severely compromised hepatic function. She needs to undergo a debridement of a sacral decubitus ulcer. Which of the following would be the best skeletal muscle relaxant for use on this patient?
A) Pancuronium
B) Vecuronium
C) Cisatracurium
D) Succinylcholine
E) Rocuronium
Q2) A 54-year-old man with coronary artery disease is scheduled to undergo surgical excision of a tumor from his sigmoid colon. His cardiologist's recommendations included ensuring that his heart rate stay below 80 beats per minute during the procedure. The following muscle relaxant should be AVOIDED:
A) Pancuronium
B) Vecuronium
C) Cisatracurium
D) Succinylcholine
E) Rocuronium
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Chapter 13: Local Anesthetics
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Sample Questions
Q1) The following drug should NOT be administered to a patient with a plasma cholinesterase deficiency:
A) Lidocaine
B) Mepivacaine
C) Etidocaine
D) Bupivacaine
E) Procaine
Q2) For the above 34-year-old woman experiencing local anesthetic-induced cardiac arrest, therapy with which of the following is most likely to aid resuscitation efforts?
A) Saline infusion
B) Dextrose solution
C) Fat emulsion
D) Magnesium sulfate
E) Amino acids
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Chapter 14: Histamine and Antihistamines
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Sample Questions
Q1) A 10-year-old boy presents to the emergency department in severe shock. His mother states that he was bitten by a wasp before becoming progressively more unresponsive. What is the first medication that should be given to treat the boy's histamine-mediated anaphylaxis?
A) Diphenhydramine
B) Cromolyn sodium
C) Fexofenadine
D) Epinephrine
E) Ranitidine
Q2) Which of the following is a physiologic effect of histamine?
A) Decreased bronchiolar smooth muscle tone
B) Decreased systemic vascular resistance
C) Decreased capillary permeability
D) Decreased myocardial contractility
E) Decreased gastric acid secretion
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16
Chapter 15: Prostaglandins and Other Eicosanoids
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Sample Questions
Q1) Prostaglandins act via which type of receptor?
A) Ligand-gated ion channel
B) G-protein-coupled receptor
C) Receptor tyrosine kinase
D) Nuclear hormone receptor
E) Cytokine receptor
Q2) Which of the following enzymes is NOT directly involved in the production of eicosanoids (prostaglandins, leukotrienes, and thromboxane) from the cell membrane lipid bilayer?
A) Lipoxygenase
B) Monoamine oxidase
C) Cyclooxygenase
D) Phospholipase A2
E) Cytochrome P450
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Chapter 16: Drugs to Treat Asthma and Chronic Obstructive Pulmonary Disease
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Sample Questions
Q1) Chronic obstructive pulmonary disease (COPD) is characterized by an increase in which of the following types of leukocytes?
A) Neutrophil
B) Basophil
C) Eosinophil
D) Lymphocyte
E) Monocyte
Q2) Which of the following asthma medications does not include tachycardia as a side effect?
A) Theophylline
B) Ipratropium
C) Albuterol
D) Salmeterol
E) Cromolyn
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18
Chapter 17: Drugs Affecting Uterine Motility
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Sample Questions
Q1) A 26-year-old woman undergoes a caesarean section. Following delivery of the baby, her uterus does not contract adequately and begins to bleed excessively. Which of the following would be an acceptable agent for the anesthesiologist to administer to improve uterine tone?
A) Methylergonovine
B) Magnesium sulfate
C) Nifedipine
D) Indomethacin
E) Terbutaline
Q2) The following is a common side effect of magnesium sulfate when used for tocolysis:
A) Hyperreflexia
B) Hypercalcemia
C) Drowsiness
D) Hypertension
E) Hypokalemia
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Chapter 18: Drugs Affecting the Gastrointestinal System
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Sample Questions
Q1) A 59-year-old schizophrenic man has a history of dystonic reactions to typical antipsychotic medications. He now takes olanzapine as treatment of his schizophrenia. He is scheduled to undergo an inguinal hernia repair under general anesthesia. He has a history of postoperative nausea. Which of the following would be the most suitable anti-emetic medication for this man?
A) Droperidol
B) Aprepitant
C) Metoclopramide
D) Promethazine
E) Dronabinol
Q2) The following medication is NOT commonly used to treat gastric Helicobacter pylori infection:
A) Amoxicillin
B) Linezolid
C) Tetracycline
D) Metronidazole
E) Clarithromycin
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Chapter 19: Introduction to the Regulation of Cardiovascular Function
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Sample Questions
Q1) The largest and most extensive network of norepinephrine fibers in the brain arises from a group of neurons called:
A) Locus ceruleus
B) Raphe nuclei
C) Nucleus accumbens
D) Ventral tegmentum area
E) Nucleus basilis
Q2) Which of the following mechanisms most directly affects the amount of neurotransmitter released by a nerve terminal vesicle?
A) Destruction via metabolic enzymes
B) Irreversible binding at the post-synaptic receptor
C) Re-uptake at the pre-synaptic terminal
D) Removal through diffusion within the terminal
E) Activation of prejunctional autoreceptors
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Chapter 20: Antihypertensive Drugs
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Q1) The reason to use an angiotensin receptor blocker and hydrochlorothiazide together would most likely be:
A) Intensify the effects of the angiotensin receptor blocker
B) The two together will maintain a normal potassium level
C) The HCT is potentiated by the angiotensin receptor blocker
D) Use the stepped care approach to HTN treatment
E) The HCT will have the effect of blocking the dry cough induced by the angiotensin receptor blocker
Q2) Alpha-1 receptor antagonist therapy can result in an increase in cardiac oxygen consumption due to increased sympathetic discharge from baroreceptors. This can be alleviated by the use of which class of drug?
A) Thiazide diuretic
B) ACE inhibitor
C) Beta-1 receptor blocker
D) Centrally acting sympatholytic
E) Calcium channel blocker
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22
Chapter 21: Diuretic Drugs
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Q1) Diuretic resistance after chronic loop diuretic administration is due to:
A) Increase in the transport of organic cations from the blood to the urine
B) Increased Na /K -ATPase activity
C) A decrease in Na reabsorption by distal tubule cells
D) Decreased osmotic load at the distal tubule
E) Decreased Na /K -ATPase activity
Q2) The location of the mechanism that leads to hypokalemia with many diuretics is located in the:
A) Glomerulus
B) Proximal convoluted tubule
C) Descending loop
D) Ascending loop
E) Collecting tubule
Q3) Carbonic anhydrase inhibitors promote the excretion of Na and HCO , whereas thiazide diuretics promote:
A) Excretion of Na , Cl , and Ca
B) Excretion of Na and Cl while diminishing Ca excretion
C) Excretion of Na , Cl , Ca , and Mg
D) Excretion of Na and Cl while reabsorbing Mg
E) Excretion of Na while diminishing Cl excretion
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Chapter 22: Antiarrhythmic Drugs
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Sample Questions
Q1) The class III drug amiodarone:
A) Delays influx of sodium into the myocyte
B) Blocks several potassium channels, prolonging the action potential
C) Delays influx of calcium into the myocyte
D) Has beta adrenergic receptor blockade properties
E) All of the above are correct
Q2) The mechanism of action of class III antiarrhythmic drugs is:
A) Sodium channel blocker
B) Potassium channel blocker
C) Beta adrenergic blocker
D) Calcium channel blocker
E) Local anesthetic action
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24
Chapter 23: Drugs to Treat Heart Failure
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Q1) The use of sympathomimetics such as norepinephrine should be used with caution in patients on beta adrenergic blockers due to:
A) Creation of acute malignant hypertension
B) Adverse effect of pulmonary hypertension
C) Acute hypertension due to unopposed alpha-1 receptor blockade
D) Reduced renal blood flow
E) Ventilation-perfusion mismatch
Q2) The effects of digitalis glycosides are best described as:
A) Intracellular calcium increases leading to higher contractility
B) Increased myocardial automaticity
C) Increased parasympathetic discharge and decreased heart rate
D) Refractory period remains the same even though heart rate is decreased
E) Both A and C
Q3) Systolic failure secondary to ischemic cardiomyopathy leads to all of the following except:
A) Down regulation of the sympathetic nervous system
B) Peripheral vasoconstriction leading to an increased afterload
C) Activation of the renin-angiotensin system
D) Fluid retention
E) Remodeling of the functional proteins within the myocardium
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Chapter 24: Vasodilators and Nitric Oxide Synthase
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Sample Questions
Q1) Nitroglycerin is a mainstay for treatment of angina pectoris because:
A) Redistributes intracardiac blood flow to the subendocardium
B) It causes venodilation, reducing venous return to the heart
C) Causes an increase in LV end-diastolic pressure
D) Decreases afterload through precapillary vasodilation
E) A, B, and D
Q2) Clinical problems with vasodilators include
A) Renin release
B) A phenomenon where blood flow is shunted from ischemic tissues to healthier tissues
C) Activation of the sympathetic nervous system
D) B and C
E) All of the above
Q3) Phosphodiesterase type 5 inhibitors
A) Are primarily used in congestive heart failure
B) Cause increased levels of cGMP in certain tissues, which leads to increased NO concentrations and vasodilation
C) A and B
D) Are vasodilators used in the treatment of hypertension
E) A, B, and D
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Page 26
Chapter 25: Lipid-Lowering Drugs and Atherosclerosis
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Q1) When a patient is intolerant to statin class drugs, the most common second choice for treating LDL cholesterol levels greater than 135 mg/dl is:
A) Bile acid sequestrants
B) Fibric acid derivatives
C) Cholesterol absorption inhibitors
D) Niacin
E) Statins
Q2) Vytorin is a combination of ezetimibe and simvastatin. The pharmacologic effects include:
A) Platelet inhibition
B) Reduction in intestinal absorption of cholesterol
C) Cholesterol-lowering ability independent of plasma lipoprotein levels
D) Inhibition in cholesterol synthesis within hepatocytes
E) A, B, and D
Q3) Isolated hypertriglyceridemia is best treated with:
A) Statins
B) Fibric acid derivatives
C) Cholesterol absorption inhibitors
D) Niacin
E) Bile acid sequestrants
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Chapter 26: Antithrombotic Drugs
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Q1) Heparin differs from low molecular weight heparins (LMWH) in that:
A) LMWHs can be given PO
B) LMWHs' effectiveness is measured by PT and INR
C) LMWHs have a greater capacity to directly inhibit factor Xa
D) LMWHs cannot be reversed by protamine sulfate
E) B and C
Q2) Two vitamin K-dependent factors made in the liver are proteins C and S.
A) These are part of the thrombus-forming cascade.
B) These act primarily to regulate sodium excretion.
C) These proteins function to inactivate clotting factors V and VIII.
D) These proteins are clinically used to treat myocardial infarction and stroke.
E) These proteins are not affected by warfarin.
Q3) Warfarin administration:
A) Is used to lyse deep vein thromboses
B) Interferes with the production of clotting factor VII
C) Can be reversed with the use of vitamin K
D) Is monitored with PTT levels
E) Is ideal when rapid-acting, short-duration treatment is indicated
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28
Chapter 27: Introduction to the Central Nervous System
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Q1) After the neurotransmitter serotonin attaches to a post-synaptic receptor, it:
A) Releases and is then destroyed by proteases
B) Spontaneously degrades
C) It is taken back up into the pre-synaptic neuron
D) It is taken up by the post-synaptic neuron
E) Is metabolized by acetylcholinesterase
Q2) A GABA agonist will result in:
A) Hyperpolarization of post-synaptic neurons
B) The same effect as that of glutamine
C) Decreased seizure threshold
D) Decreased neurotransmitter destruction
E) Decreased chloride ion influx
Q3) Long-term use of a receptor agonist can lead to:
A) Adaptation of the post-synaptic neuron yielding creation of less receptor density (desensitization)
B) Adaptation of the post-synaptic neuron yielding increased cell messenger production
C) Down regulation yielding less synaptic neurotransmitter.
D) A, B, and C
E) A and B
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Page 29
Chapter 28: Treatment of Parkinsons and Alzheimers Diseases
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Q1) Primary treatment goals of Alzheimer's disease include:
A) Increasing cholinergic activity
B) Increasing central dopaminergic activity
C) Increasing sympathetic activity
D) Increasing GABA-ergic activity
E) Increasing NMDA-receptor activity
Q2) L-DOPA is combined with carbidopa because:??
A) Carbidopa potentiates the action of L-DOPA
B) L-DOPA cannot cross the blood-brain barrier
C) Carbidopa prevents peripheral conversion of L-DOPA to dopamine
D) Carbidopa has additional anti-Parkinson effects
E) Carbidopa prolongs the half-life of L-DOPA
Q3) The pharmacologic treatment goals for Parkinson's disease include:
A) Increase the production of dopamine in the brain
B) Decrease the breakdown of dopamine in the brain
C) Increase the receptor density for dopamine in the brain
D) Provide additional agonist activity for existing dopamine receptors
E) All of the above
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Chapter 29: Treatment of Psychotic Disorders
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Q1) Extrapyramidal symptoms occur with antipsychotics due to:
A) Inhibition of receptors in the mesolimbic region of the brain
B) A compensatory response in the mesolimbic region due to receptor blockade
C) Blockade of muscarinic cholinergic receptors
D) Blocking of dopamine receptors in the basal ganglia
E) Up regulation of dopamine receptors
Q2) Atypical antipsychotics differ from typical antipsychotics in that:
A) Atypical antipsychotics have a smaller therapeutic window
B) Atypical antipsychotics block more D receptors than typical antipsychotics
C) Atypical antipsychotics block 5-HT A as well as D receptors
D) Atypical antipsychotics have a higher incidence of adverse effects
E) Atypical antipsychotics have no known side effects
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Chapter 30: Treatment of Affective Disorders
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Q1) Tricyclic antidepressants can produce delirium. Which of the following is true about this effect?
A) The delirium is considered beneficial in treating depression
B) Increasing the TCA dosage usually alleviates the problem
C) The delirium is due to increased 5-HT receptor stimulation
D) The antimuscarinic activity of this class is thought to be at the cause
E) Is usually a prelude to the onset of seizures
Q2) The physiologic effect of antidepressant medications is relatively quick. However, the clinical response is much slower; this is thought to be primarily due to:
A) An increase in serotonin hydrolysis within the synapse
B) Stimulation of serotonergic and noradrenergic autoreceptors that results in a decrease in 5-HT release
C) Immediate down regulation of serotonergic receptors
D) A transient up regulation of noradrenergic receptors
E) Induction of hepatic metabolism
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Chapter 31: Treatment of Anxiety and Insomnia
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Q1) The receptors of the GABA complex are variously stimulated by multiple classes of medications including benzodiazapines. The result of such stimulation is:
A) A down regulation of the GABA receptor complex
B) Hyperpolarization of the postsynaptic cell
C) Decreased chloride influx
D) Increased activity of the postsynaptic neuron
E) Decreased seizure threshold
Q2) The physiologic difference between temazepam and zolpidem is:
A) Temazepam is a sedative, whereas zolpidem is a hypnotic
B) Temazepam binds to all the GABA-receptor subunits, whereas zolpidem attaches to specific ones only
C) Zolpidem is a benzodiazepine
D) Zolpidem is a also a melatonin agonist
E) Temazepam is a barbiturate
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Chapter 32: Ethanol, Other Alcohols, and Drugs for Alcohol Dependence
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Q1) The pharmacologic basis for using acamprosate in an alcoholic is:
A) It blocks the disinhibition of alcohol
B) It has GABA agonist activity
C) It is a glutamate NMDA receptor antagonist
D) It enhances the rapid breakdown of ethanol.
E) It blocks opiate receptors
Q2) The blood alcohol concentration (BAC) for a given intake of alcohol (assuming a starting level of zero):
A) Tends to be higher in chronic alcoholics
B) Can be initially higher in women due to a lower first pass clearance
C) Is relatively consistent whether it was determined on whole blood, plasma, or serum.
D) Is not affected by end-stage renal disease
E) Is not clinically significant at 0.15%
Q3) The pharmacologic action(s) of disulfiram is/are:
A) Increased acetate concentration
B) Catabolism of acetaldehyde is increased
C) Acetaldehyde dehydrogenase is inhibited
D) Decreases central nervous system effects of alcohol
E) Alcohol is rapidly converted to glucose
Page 34
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Chapter 33: Treatment of Obesity and Eating Disorders
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Q1) The sympathomimetic anti-obesity agents:
A) Are chemically related to norepinephrine and dopamine
B) Include phentermine and orlistat
C) Inhibit GI lipase
D) Have their effect primarily through speeding up metabolism
E) Are Schedule II medications
Q2) Sibutramine has which of the following actions?
A) Decreases appetite
B) Decreases thermogenic physiologic pathways
C) Decreases high-density lipoprotein levels
D) Decreases heart rate
E) Decreases blood pressure
Q3) Which of the following can be used to stimulate appetite in patients with cachexia?
A) Dronabinol
B) Corticosteroids
C) Progestational agents
D) A and B
E) A, B, and C
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Chapter 34: Treatment of Seizure Disorders
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Q1) A patient with partial seizures was on phenytoin and having frequent breakthrough seizures. You switch her to valproic acid and she becomes lethargic with ataxia. The most likely cause:
A) The phenytoin and valproic acid had a synergistic effect
B) Valproic acid adverse effects were taking effect
C) The phenytoin was displaced from plasma proteins and reached toxic levels
D) Valproic acid catalyzed conversion of phenytoin to fosphenytoin
E) None of the above
Q2) The pharmacologic agent of choice for absence seizures is:
A) Diazepam
B) Phenytoin
C) Gabapentin
D) Ethosuximide
E) Phenobarbitol
Q3) The pharmacologic action of phenytoin is:
A) Activation of GABA receptors
B) Blockade of calcium channels
C) Activation of ligand-gated Cl-channels
D) Inhibition of glutamate receptors
E) Blockade of sodium channels
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Chapter 35: General Anesthetics
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Q1) The administration of halothane and morphine can lead to:
A) An increase in hepatic toxicity over that of halothane alone.
B) Increased amnestic response.
C) Cerebral vasodilation leading to increased ICP
D) Malignant hypertension
E) Improved organ perfusion over that of halothane alone.
Q2) A benzodiazepine is often administered along with the use of ketamine because:
A) Of the short duration of ketamine
B) Of the high incidence of dysphoric episodes and disturbing dreams with ketamine
C) Benzodiazepines increase the effectiveness of NMDA antagonism
D) Benzodiazepines have analgesic properties
Q3) The use of N O with halogenated anesthetics is common. The addition of N O can:
A) Trigger megaloblastic anemia
B) Reduce the amount of halogenated anesthetic used
C) Lead to air emboli in the bloodstream
D) A and C
E) All of the above
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Chapter 36: Drugs to Control Pain
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Q1) The use of naloxone in a somnolent, unresponsive ER patient with barbiturate overdose will lead to:
A) In improvement in neurologic status
B) An increase in respiratory rate
C) No response
D) Cardiovascular status improvement
E) Immediate withdrawal
Q2) Opioid class medications effects do NOT include:
A) Antidiarrheal
B) Antitussive
C) Analgesic
D) Antiemetic
Q3) A large IV push of naloxone to an unresponsive heroin addict can most commonly lead to:
A) Respiratory depression
B) Triggering of immediate withdrawal symptoms
C) Decreased level of consciousness
D) Pupillary constriction
E) Hypotension and bradycardia
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Page 38
Chapter 37: Drugs and Substance Abuse, Addiction, and Treatment
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Q1) The pharmacologic basis for varenicline is:
A) Decreased activity in the mesolimbic dopamine pathways
B) Increased norepinephrine synaptic density
C) Partial agonist of nicotinic receptors
D) Reverses carcinogenic effects of smoking history
Q2) Methadone maintenance therapy:
A) Also assists with benzodiazapine addictions
B) Blocks the ability to screen for other opiates
C) Does not directly stimulate mu-opioid receptors
D) Does not have any analgesic effect
E) Is a therapeutic regimen that cannot be abused
Q3) Of the following drugs, the most severe and life-threatening withdrawal is from:
A) Benzodiazapines
B) Opiates
C) Barbiturates
D) Ethanol
E) Hallucinogens
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Page 39
Chapter 38: Introduction to Endocrine Pharmacology and Hormones
of the Hypothalamus and Pituitary Gland
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Q1) Gonadotropin releasing hormone (GnRH):
A) Release is decreased by norepinephrine
B) Initiates the secretion of LH and FSH
C) Is released in a continuous concentration from the hypothalamus
D) Is a steroid hormone
E) Acts upon the posterior pituitary
Q2) The difference between the receptors of peptide hormones and steroid hormones is:
A) There is no difference between the two types of receptors.
B) The receptors for peptide hormones are on the cell surface, whereas receptors for steroids are within the cell.
C) The receptors for peptide hormones can also receive steroid hormones, whereas the receptors for steroid hormones cannot.
D) Receptors for peptide hormones can receive more than one peptide, whereas the receptors for steroid hormones are hormone specific
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Chapter 39: Adrenocorticosteroids
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Q1) The chronic use of exogenous selective glucocorticoids leads to all of the following adverse effects except:
A) Increased gastric acid output
B) Increase in insulin resistance
C) Inhibition of osteoblastic activity
D) Metabolic alkalosis and mild hypernatremia
E) HPA axis suppression
Q2) The drug of choice for primary mineralocorticoid insufficiency is:
A) Fludrocortisone
B) Betamethasone
C) Fluticasone
D) Vasopressin
E) Lixivaptan
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Chapter 40: Estrogens and Progestins
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Q1) The pharmacologic action of mifepristone (RU 486) is:
A) Blocks the production of progesterone
B) Changes the ratio between estrogen and progesterone
C) Blocks the receptors for progesterone
D) Blocks the receptors for estrogen
E) Blocks the receptors for testosterone
Q2) Prolonged unopposed estrogen usage can lead to:
A) Gallbladder disease
B) Endometrial cancer
C) Thromboembolic disease
D) A, B, and C
E) B and C
Q3) The use of estrogen plus progestin replacement therapy in postmenopausal women with an intact uterus:
A) Does not show an increase in thromboembolic disease
B) Should be limited to treatment for acute symptoms and for the shortest time possible
C) Is advisable as long as there is no family history of breast cancer
D) Decreases the incidence of ovarian cancer
E) Decreases mortality
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Page 42
Chapter 41: Androgens and Antiandrogens
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Q1) Benign prostatic hypertrophy is treated with finasteride. Finasteride acts to:
A) Block the conversion of testosterone to 5-alpha-dihydrotestosterone
B) Antagonize alpha-1 adrenergic receptors
C) Up regulate 5-alpha-reductase type II
D) Treat prostate cancer
E) Decrease free testosterone and estrogen levels
Q2) Androgen treatment can be used to increase hematopoiesis. This is due to:
A) Increased growth hormone production
B) Increased erythropoietin receptor sensitivity in bone marrow
C) GnRH receptor up regulation
D) Increased renal erythropoietin production
E) Increased muscle mass effect
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43
Chapter 42: Thyroid and Antithyroid Drugs
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Q1) Which of the following drugs interacts with thyroperoxidase and NADPH oxidases to inhibit the organification of iodide?
A) Perchlorate
B) Propylthiouracil
C) L-thyroxine
D) Lithium
E) Iopanoate
Q2) Why are corticosteroids often included in the treatment of hyperthyroidism?
A) To stabilize the erratic blood sugars of hyperthyroidism
B) To increase the catabolism of T to T
C) As an antiinflammatory agent for the thyroid
D) To counteract the increased delta-4 steroid reductase activity
E) To displace thyroxine-binding globulin from plasma proteins
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Chapter
Diabetes Mellitus
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Q1) The incretins are a group of hormones that:
A) Increase the concentration of gastric inhibitory peptide
B) Stimulate the release of growth hormone
C) Stimulate pancreatic beta cells and inhibit pancreatic alpha cells
D) Are synthesized in the pituitary gland
E) Increase blood glucose levels
Q2) The sulfonylurea class of medications:
A) Stimulates exocytosis of insulin-containing vesicles
B) Slows the hydrolysis of glucose in the plasma
C) Speeds potassium transport into insulin-containing cells
D) Are analogs of incretin hormones
E) Increases insulin sensitivity
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Chapter 44: Calcium-Regulating Hormones and Other Agents Affecting Bone
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Q1) Regarding the pharmacologic class of bisphosphonates:
A) An example is teriparatide
B) At high doses inhibit osteoclasts
C) One example is calcitonin
D) Have less gastrointestinal side effects than other anti-osteoporosis drugs
E) Are usually prescribed for once-daily administration
Q2) Selective estrogen receptor modulators (SERMs) are known to inhibit bone resorption and prevent fractures. Their mechanism of action is:
A) Decrease production of interleukins that up regulate osteoclasts
B) Promote follicular production of progesterone, prostaglandin F , and proteolytic enzymes
C) Suppress the hypothalamic-pituitary axis
D) Decrease plasma calcium levels
E) Increase activity of the hypothalamic GnRH pulse generator
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Chapter 45: Principles of Antimicrobial Use
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Q1) For the treatment of meningitis, all of the following could be effective except:
A) Rifampin
B) Chloramphenicol
C) Ampicillin
D) Gentamicin
E) Ciprofloxacin
Q2) Methicillin-resistant Staphylococcus aureus (MRSA) has developed resistance to all ? -lactams by what mechanism?
A) Nonreactive receptor on the bacterial cell surface that binds the antibiotic
B) Destruction of the -lactam ring upon attachment to the mutated receptor
C) Mutated protein that acts to hydrolyze -lactams?
D) Acquisition onto the penicillin-binding site of a novel protein called PBP2a.
Q3) Antimicrobial agents that disrupt or inhibit nucleic acid synthesis are:
A) Clindamycin and lincomycin
B) -Lactams, cephalosporins, and vancomycin
C) Quinolones and rifampin
D) Amikacin and gentamicin
E) Chloramphenicol
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Chapter 46: Bacterial Cell Wall Synthesis Inhibitors
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Q1) Which of the following antibiotics can cause what is known as "red-man syndrome"?
A) Cefoxitin
B) Ampicillin
C) Vancomycin
D) Gentamicin
E) Bacitracin
Q2) The antimicrobial class carbapenems includes:
A) Vancomycin
B) Cefepime
C) Meropenem
D) Aztreonam
E) Ceftriaxone
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Page 48
Chapter 47: Inhibitors of Bacterial Ribosomal Actions
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Q1) Which of the following antimicrobial agents are bacteriostatic?
A) Streptomycin
B) Tetracycline
C) Penicillin
D) Mupirocin
E) Ciprofloxacin
Q2) Telithromycin is of the class:
A) Ketolides
B) Tetracyclines
C) Penicillins
D) Macrolides
E) Fluoroquinolones
Q3) The aminoglycoside class of antibiotics:
A) Are bacteriostatic
B) Includes ciprofloxacin
C) Are ineffective against anaerobic bacteria
D) Have a wide therapeutic window
E) Are most often used as oral preparations
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Chapter 48: Bacterial Folate Antagonists,
Antibacterial Agents
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Q1) The combination of trimethoprim and sulfamethoxazole (TMP-SMZ) is frequently used because:
A) The TMP covers aerobic bacteria that the SMZ does not
B) The combination has no potential side effects
C) The SMZ potentiates the action of TMP
D) The SMZ covers anaerobic bacteria that TMP does not
E) The TMP covers fungi that SMZ does not
Q2) When the resistance of urinary tract Enterobacteriaceae to TMP-SMZ is higher than 20%, which of the following is the most commonly used drug class as alternative therapy?
A) Macrolide
B) Penicillin
C) Vancomycin
D) Fluoroquinolones
E) Tetracycline
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Chapter 49: Antimycobacterial Agents
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Q1) First-line drugs for the treatment of tuberculosis include the following except:
A) Isoniazid
B) Rifampin
C) Flouroquinolones
D) Ethambutol
E) Rifapentine
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Chapter 50: Antifungal Agents
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Q1) One class of antifungal drugs inhibits glucan synthesis, thereby blocking production of the major structural component of the fungal cell wall. Which of the following drugs has this mechanism of action?
A) Polyenes
B) Azoles
C) Triazoles
D) Echinocandins
E) Griseofulvin
Q2) Ketoconazole is of the azole class of antifungal medications. What is its mechanism of action?
A) Inhibits mitosis
B) Inhibit DNA synthesis
C) Bind to sterols in the cell membrane
D) Inhibit synthesis of membrane sterols
E) Inhibits ribosomal protein translation
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Chapter 51: Antiviral Agents
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Q1) The pharmacologic mechanism of action of didanosine is:
A) Nucleoside analog
B) Neuraminidase inhibitor
C) Nucleoside reverse transcriptase inhibitor
D) Non-nucleoside reverse transcriptase inhibitor
E) Protease inhibitor
Q2) The pharmacologic mechanism of action of acyclovir includes:
A) Inhibits DNA polymerases
B) Inhibits reverse transcriptase
C) Prevents viral entry into the cell
D) Spontaneous lysis of virus
E) Inhibits viral proteases
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Chapter 52: Drugs to Treat Parasitic Infections
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Q1) Quinine has been used for centuries. Which of the following is true about quinine?
A) It inhibits ribosomal protein translation.
B) It inhibits cell membrane synthesis.
C) It inhibits the activity of heme polymerase.
D) It inhibits DNA polymerase.
E) It inhibits DNA gyrase.
Q2) Which of the following can serve as an antiprotozoal?
A) Chloroquine
B) Clindamycin
C) Doxycycline
D) Overmectin
E) Penicillin
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Chapter 53: Principles of Antineoplastic Drug Use
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Q1) Which serves as the dose-limiting factor for most chemotherapeutic regimens?
A) Acute side effects such as nausea/vomiting, alopecia, bone marrow depression
B) Delayed side effects such as pulmonary fibrosis, sterility, neuropathy
C) Toxicity to surrounding normal tissues
D) Financial cost
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Chapter 54: Mechanisms of Action of Antineoplastic Drugs
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Q1) Vinblastine falls within which class of antineoplastic drugs?
A) Plant alkyloids
B) Antimetabolites
C) Antibiotics
D) Alkylating agents
E) Hydroxyureas
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Chapter 55: Adjuvant Antineoplastic Drugs
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Q1) Which of the following is a targeted antibody directed against the epidermal growth factor receptor (EGFR)?
A) Cetuximab
B) Gefitinib
C) Bortezomib
D) Goserelin
E) Tamoxifen
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