HISTAMINE PHARMACOLOGY - RX WRITING AND DRUG COSTS (DR. TERLECKY, DR. WAKADE, DR. TODI, DR. WU AND D

What is histamine?

Which of the following is required for histamine synthesis:

A. biotin
B. coenzyme A
C. glutathione
D. pyridoxal phosphate
E. none of the above

All of the following are true of histamine degradation except:

A. histamie is immediately stored or degraded quickly
B. very little histamine is excreted unchanged
C. histamine (or imidazole) N-methyltransferase catalyzes  histamine breakdown
D. N-methylimidazole acetic acid is the major excreted metabolote
E. histamine is mostly degraded in the liver
d. all of the above are true

All of the following are true of the causes of histamine release except:

A. sensitization of mast cells by IgE antibodies
B. asthma, hay fever, skin rashes and anaphylaxis are symptoms of histamine release
C. exposure to extreme hot or cold, scratches, crushes and/or sunlight
D. sodium and ATP are modulators
E. all of the above are true

All of the following are true of the modulation of histamine release except:

A. cromolyn sodium blocks the influx of calcium and inhibit the release of histamine
B. nedocramil is used in the prophylactic treatment of asthma
C. compound 48/80 and penicillin act as ionophores and result in clacium influx and release of histamine
D. morphine and turbocurarine stimulate histamine release
E. all of the above of true

All of the following are true of the effects of histamine as mediated by its receptors except:

A. bronchospasms via H1 receptors
B. gastric secretion via H2 receptors
C. increases heart rate and blood pressure via H2 receptors
D. sensory nerve ending stimulation via H1 receptor resulting in severe itching
E. smooth muscle contraction of the GI tract via H1 receptors
F. the lungs, uterus, ureters and urinary bladder all contract via H1 receptors

Which of the following are true of drugs that block histamine actions:

A. epinephrine is a physiological histamine blocker
B. Benadryl and Chlor-Trimethon are 2nd generation H1 blockers that help to reduce the symptoms of allergy, allergic rhinitis and urticaria
C. Allegra and Claritin  cause sedative effects due to their high central nervous system distribution
D. Dramamine is an H2 receptor blocker and aids in the treatment of motion sickness
E. Zantac is a H1 receptor blocker and is useful in the treatment of duodenal ulcers, gastritis and reflux esophagitis
F. none of the above are true
G. more than one of the above are true

Match the following.

1. first generation antihistamines
2. second generation antihistamines

a. Zyrtec
b. Clarinex
c. Dramamine
d. Allegra
e. Benadryl
f. Chlor-Trimethon
g. Claritin

All of the following are ways to treat ulcerative and inflammatory GI diseases except:

A. neutralize acid
B. administer a proton pump stimulator
C. reduce gastric acid secretion
D. enhance mucosal defenses through cytoprotective or antimicrobial intervention
E. all of the above are true

All of the following are true of antacids except:

A. they are weak bases that inactivate HCL production
B. they confer mucosal protection via prostagladin production
C. system alkalosis, constipation, hypercalcemia and diarrhea may be side effects of antacid use
D. Tums, Amphogel, Milk of Magnesia and Alk Seltzer are common antacids used
E. all of the above are true

Which of the following are true of gastric secretion reduction:

A. its under the control of 3 agonists: histamine, epinephrine, and gastrin
B. cholinergic receptor antagonist can be used to depress smooth muscle motility and parasympathetic mediated release of HCL
C. Prilosec reversibly inhibits the gastric parietal cell proton pump
D. it increases gastric acidity

All of the following are true of the enhancement of mucosal defenses except:

A. Carafate directly inhibits pepsin and bile action without changing the pH of the stomach
B. prostaglandins increase gastric acid secretion by stimulating histamine-stimulated cAMP production
C. mechanism of action is to form protective coating on ulcer crater that will remain for several hours
D. misoprostol is the drug of choice for treating ulcers caused by the use of NSAIDS

Reglan exhibits _____ activity and _____ the motility of the upper GI tract without increasing gastric, biliary, or pancreatic secretions.

What condition is associated with chronic use of too much Reglan (metoclopramide)?

What antibitoics are most commonly used to eradicate Helicobacter pylori colonization?

What are the 3 basic steps involved in emesis that are controlled by the emetic center in the medulla?

All of the following are emetic agents except:

A. Ipecac syrup
B. Zofran (ondansteron)
C. apomorphine
D. all of the above are true

All of the following are true of antiemetic agents except:

A. most are 5-HT3 antagonists or are neurokinin receptor antagonists at the CTZ
B. Granisol (granisetron) is a 5-HT3 antagonist
C. Compazine, Tigan and Reglan are all antiemetics
D. Zofran is a neurokinin receptor antagonist

All of the following are true of laxatives except:

A. stool softners, like mineral oil, promote laxation by coating and lubricating fecal matter, and preventing normal absorption of water
B.  daily repeated use can result in atonic hypomotility states of the colon
C. castor oil, senna, and Exlax are osmotic laxatives
D. Metamucil and Konsyl promote the "most natural physiological laxation"

What are the 6 most common therapeutic uses of laxatives?

All of the following are true of anti-diarrhea agents except:

A. opiates promote sustained contraction of the intestine and interrupt the normal organized sequence of peristalic contractions
B. Immodium is an anti-diarrhea agent that decreases the motility of the GI tract
C. Lomotril is an absorbent powder that absorbs water and toxins as well as provides a protective coating to the inflammed intestine
D. all of the above are true

What is the rate-limiting step in the entire biosynthetic pathway of catecholamines?

True or false. phenylethanolamine-N-methyl-transferase (PNMT) is present mainly in the adrenal gland.
True False

All of the following are true of voltage sensitive calcium channels except:

A. L-type calcium channels are located in smooth muscle and endo-, exocrine glands, and their pharmacological antagonist are DHP, nifedipine and verapamil
B. T-type calcium channels are located in cardiac SA and AV nodes and are activated at > -70 mV
C. N-type calcium channels are located in neurons and their pharmacological antagonists are omega-conatoxin GVIA and dilthiazam
D. P-type are located in cerebellar Purkinje neurons and are activated at -10 mV

All of the following are true of the locations of alpha-1-adrenergic receptors except:

A. internal sex organs
B. blood platelets
C. blood vessels
D. salivary glands
E. pancreas

All of the following are true of the locations of alpha-2-adrenergic receptors except:

A. CNS
B. blood platelets
C. blood vessels
D. sympathetic nerve terminals

All of the following are true of alpha agonists except:

A. methoxamine is more potent than phenylephrine
B. naphazoline, epinephrine and norepinephrine are all equally potent
C.  clonidine is more potent than oxymetazoline
D. alpha-methyl-NE binds to alpha-2-adrenergic receptors

Which of the following is true of beta-adrenergic receptors:

A. beta-1-receptors are located in vascular and bronchial smooth muscle cells
B. phenylephrine is less potent than isoproterenol
C.  beta-2-receptors are located in the heart, kidney and adipose cells
D. isoproterenol, epinephrine, norepinephrine and phenylephrine bind to both beta-1 and beta-2 receptors
E. more than one of the above

All of the following is true of adrenergic response on the heart except:

A. beta-1-receptors mediate all actions
B. cardiac force of contraction is increased by catecholamines
C. activation of beta-1-receptors leads to increase in heart rate due to action of catecholamines on pacemaker cells
D. activation of beta-1-receptors of SA node leads to more rapid diastolic depolarization and increase in action potential frequency
E. the rate of decrease of the "potassium leak" from the SA node pacemaker cells during diastolic interval is slowed down leading to shortened time for depolarization to threshold

Which of the following is true of adrenergic response on the heart:

A. decrease in calcium influx leads to greater force of contraction
B. activation of beta-1 receptors of myocardial cells decreases calcium influx
C. catecholamines induce arrhythmias by activation of beta-2 receptors
D. cardiac efficiency is decreased by catecholamines
E. velocity of impulse transfer from SA node and AV nodes is increased and refractory period of AV node is decreased

All of the following are true of adrenergic receptors and their affect on vascular beds except:

A.  skeletal muscle is mediated by alpha-1 and alpha-2 receptors and activation leads to vasoconstriction and vasodilation depending on the sympathomimetic amine and its concentration
B.  coronary arteries are mediated by beta-2 receptors and activation leads to vasodilation
C. EPI has higher affinity for beta receptors than for alpha receptors
D. kidney is predominately mediated by alpha-2 receptors and activation leads to vasoconstriction in response to epinephrine and norepinephrine and slight vasodilation with ISO
E.  the liver and splanchnic area are mostly mediated by alpha-1 receptors and activation leads to vasodilation at low [EPI] and vasoconstriction at high [EPI] and [NE]

Which of the following is true of adrenergic receptors and their affect on vascular beds:

A. pulmonary circulation is mediated by alpha- and beta-receptors and activation leads to vasodilation with EPI and NE
B. alpha cells of the pancreas contain beta-receptors that when stimulated, secrete glucagon
C. beta cells of the pancreas contain beta-receptors that when stimulated, inhibit insulin secretion
D. none of the above 
E. more than one of the above

All of the following are true of the cardiovascular system and adrenergic stimulation except:

A. low [EPI ] produces an increase in systolic pressure, a decrease in diastolic pressure, a small/no change in mean BP, increase in CO and decrease in TPR
B. NE and low[EPI] produces an increase in both systolic and diastolic pressure, an increase in BP, an increase in CO and an increase in TPR
C. ISO produces an increase in systolic pressure, a large decrease in diastolic pressure, a decrease in mean BP, a possible decrease of CO and a decrease in TPR
D. all of the above are true

All of the following are true of smooth muscles and adrenergic stimulation except:

A. bronchial smooth muscle contain beta-2-receptors that when stimulated cause bronchoconstriction
B. the iris radial muscle contain alpha-1-receptors that when stimulated result in contraction (dilation of pupil)
C. the GI tract contain both alpha- and beta-receptors that relax upon stimulation
D.  the bladder smooth muscle contain alpha-1 receptors that mediate contraction of the trigone region and beta-2-receptors that mediate relaxation of the detrussor muscle
E.  the uterus contain both alpha-1 and beta-2-receptors that mediate contraction upon stimulation by NE and biphasic effects by EPI

Which of the following is true of smooth muscles and adrenergic stimulation:

A. spleen smooth muscle contain alpha-1-receptors that result in contraction and blood expulsion when stimulated
B. the vas deferens smooth muscle is alpha-1-receptor dominant and dilate when stimulated
C. the seminal vesicles are alpha-2-receptor dominant and contract when stimulated
D. none of the above
E. more than one of the above

True or false. When EPI is given systemically, it may cause some respiratory stimulatin, restlessness and anxiety.
True False

Indirect-acting adrenergic drugs include _____, _____ and _____, all of which are _____.

Why are tyramine, amphetamine and ephedrine called indirect-acting adrenergic drugs?

What are the responses of tyramine injection and what are its possible drug-drug interaction?

All of the following are true of amphetamine and ephedrine except:

A. mechanism of action is similar to tyramine
B. can penetrate the blood-brain-barrier and produce CNS arousal by releasing NE and/or DA
C. CNS effects include restlessness, tremor, reduction of fatigue, and loss of appetite
D. tachyphylaxis refers to the chronic development of amphetamine tolerance to autonomic effects
E. all of the above are true

True or false. Ephedrine is used in the US therapeutically for the management of bronchial asthma.
True False

All of the following are true of the antihypertensive agent, Serpasil (reserpine), except:

A. the mechanism of action is the blocking of the NE carrier of synaptic vesicles (VMAT) and inhibition of NE transport and accumulation of NE in cytosol which allows for degradation by MAO
B. impairs the transport of DA by synaptic vesicles thereby impairing synthesis of NE in the ANS and depleting DA from the brain
C. depletion of serotonin from serotonergic neurons and histamine from mast cells
D. may cause miosis, excessive salivation, gastric hypersecretion, peptic ulceration, hyperperistalsis, diarrhea, bradycardia and hypotension
E. all of the above are true

All of the following are true of the antihypertensive agent, Ismalin (guanethidine), except:

A. mechanism of action is blockage of exocytosis via interference with calcium entry
B. chronic use can reduce NE storage and produce a faster and long-lasting reduction in NE release
C. lowers heart rate and renin secretion
D. all of the above are true

How does Catapress (clonidine) lower BP and what are some possible side effects?

True or false. Sudden withdrawal from clonidine after long-term  use can result in hypertensive crisis caused by over activity of sympathetic nervous system.
True False

What are the symptoms of hypertensive crisis?

The effect of alpha-Me-NE is to _____ sympathetic nerve impulse activity originating in the _____ of the medulla by activation of _____ receptors.

All of the following are true of tricyclic antidepressants except:

A. amitryptyline is the most potent inhibitor of NET
B. mechanism of action is the blockage of NET and enhancement of NE actions
C. side effects include tremor, insomnia, blurred vision and orthostatic hypotension
D. all of the above are true

All of the following are true of cocaine abuse and its affect on adrenergic response except:

A. enhancement of NE, EPI and DA response
B. irreversibly binds to NET and blocks uptake of NE and EPI in CNS
C. blocks conduction of nerve terminals (local anesthetic)
D. all of the above are true

All of the following are true of amphetamine and its affect on adrenergic response except:

A. used to control narcolepsy and ADHD in children
B. causes CNS arousal and suppresses appetite and sleep
C. chronic overdose can produce psychotic behavior
D. restlessness, tremor, reduction of fatigue and loss of appetite are typical side effects of chronic overdose
E. acute overdose can produce severe confusion, anxiety, increase BP, angina and cardiac arrhythmias
F. all of the above are true

What 3 drugs should be given in the event of an anaphylactic shock (cardiovascular emergency)?

What drug should be given in the event of a circulatory shock (cardiovascular emergency)?

Match the following.

Local anesthetics for:

1. urticaria
2. nasal decongestant
3. mydriatic agent
4. CNS stimulant

a. amphetamine (oral)
b. PE
c. naphazoline
d. methamphetamine
e. EPI (parenteral)
f. ephedrine (topical)

Dobutamine is an _____ _____ and comes as a racemic mixture of (L) and (D) isomers. The _____ isomer acts on both receptors as an alpha-agonist and weak beta-1-agonist. The _____ isomer acts as an alpha-1-antagonist and a potent beta-1-agonist. Dobutamine is commonly used in the acute management of _____ _____ to improve _____ _____.

All of the following are true of alpha adrenergic blocking agents except:

A. phenoxybenzamine is a noncomeptitive irreversible alpha-adrenergic antagonist and is used for the treatment of pheochromocytoma and severe hypertension
B. phentolamine is a competitive reversible antagonist and it is also used to treat pheochromocytoma, hypertension and hypertensive crisis
C. prazosin is a selective antagonist of alpha-1 and alpha-2 receptors and is used to treat hypertension, lowers preload and increases afterload, and treats congestive heart failure
D. all of the above are true

All of the following are true of propanolol except:

A. it is a selective noncompetitive beta-receptor antagonist
B. can exert profound effects when sympathetic control is elevated (exercise)
C. causes decrease in heart rate, cardiac output, sinus rate and conduction
D. causes decrease in peripheral resistance
E. more than one of the above

All of the following are true of beta-blockers except:

A. propanolol blocks the release of renin from juxtaglomerular apparatus which accounts for antihypertensive effect
B. increase peripheral manifestations of hyperthyroidism
C. increase intraocular pressure
D. can be used in the treatment of anxiety and migraine headaches
E. more than one of the above

What are some important situations to consider before prescribing a beta-blocker?

True or false. Selectivity of beta-blockers decreases with higher concentrations.
True False

What is Bystolic and what are its effects?

What drug is most commonly known for blocking both alpha AND beta receptors?

All of the following are true of glucocorticoids except:

A. steroid-receptor dimer binds to glucose response elements (GRE) in promoter or enhancer regions of response genes and modulates their transcription
B. net result is anti-growth, anti-inflammation and immunosuppression
C. used to treat rheumatoid arthritis, asthma, inflammatory bowel disease, allergic reactions, and graft vs. host disease
D. complications of chronic use are thinning of skin, cataracts, atherosclerosis, hypertension, gastritis, peptic ulcers, osteoporosis, psychosis, increased risk for infection, diabetes, weight gain and amenorrhea
E. all of the above are true

All of the following are true of glucocorticoid actions except:

A. stimulate production of IL-1, IL-2, IL-4, and TNF-alpha
B. inhibit T-lymphocyte proliferation response to antigen
C. inhibit monocyte and macrophage activation and chemotaxis
D. inhibit neutrophil chemotaxis and adhesion to endothelium
E. stimulate phospholipase A2 and COX-2
F. none of the above
G. more than one of the above

All of the following are true of immunophilins except:

A. they selectively block the production of IL-2 in helper T-cells
B. used in the treatment of rheumatoid arthritis, psoriasis, atopic dermatitis, eczema and chronic dry eye
C. cyclosporin A and tacrolimus are the most common agent used
D. primarily act on cytotoxic T-cells and inhibit cytokine release
E. more than one of the above

All of the following are true of calcineurin inhibitors except:

A. Ketoconazole and grapefruit juice increase cyclosporin and tacrolimus levels
B. NSAIDS and acyclovir decrease cyclosporin and tacrolimus levels
C. amphotericin B and aminoglycosides potentiate the nephrotoxic effects of cyclosporin and tacrolimus
D. none of the above
E. more than one of the above

All of the following are possible side effects of calcineurin-inhibiting agents except:

A. nephrotoxicity
B. hypotension
C. neurotoxicity
D. osteoporosis
E. non-Hodgkin's lyphoma
F.  all of the above are true

Which of the following is true of sirolimus:

A. mechanism is similar to that of cyclosporin and tacrolimus
B. limits growth factor-induced cell proliferation
C. compromised wound healing, dyslipidemia and thrombocytopenia are all major side effects
D. drug interactions include ketoconazole, grapefruit juice, phenytoin, rifampin, NSAIDs and ACE inhibitors
E. none of the above
F. more than one of the above

All of the following are true of azathioprine except:

A. adverse drug effects include bone marrow suppression, anemia and alopecia
B. mechanism of action is decreased RNA production caused by production of thioinosinic and thioguanylic acid via breakdown of 6-MP by hypoxanthine guanine phosphoribosyltransferase
C. used as an immunosuppressive agent for organ transplant and autoimmune disorders
D. it is an alkylating agent that decreases B and T lymphocyte numbers, and decreases immunoglobulin and IL-2 production
E. allopurinol is the major drug interaction

All of the following are true of methotrexate except:

A. it is an anti-metabolite designed for the treat of rheumatoid arthritis, psoriasis and graft vs. host disease
B. it is a structural analog of folic acid that can competitively and reversibly bind to DHFR that reduces dihydrofolic acidto its active form
C. it is excreted renally
D. TMP/SMX is a possible drug interaction
E. GI upset,  stomatitis, alopecia, fatigue and headaches are all possible side effects
F. all of the above are true

True or false. Methotrexate toxicity can be severe and even fatal.
True False

All of the following are true of mycophenolate mofetil except:

A. it is a lympthocyte specific agent used to treat refractory renal or organ transplant rejection
B. its mechanism of action is inhibition of inosine monophosphate dehydronase (IMPD) that leads to decreased production of guanosine nucleotides and excess adenosine nucleotides
C. depresses lymphocyte proliferation and response to antigen
D. decreased production of IL-1 and IL-2
E. more than one of the above

True or false. Leflunomide is a prodrug inhibitor of purine synthesis.
True False

Which of the following is true of cyclophosphamide:

A. it is an alkylating agent used in the treatment of severe, life threatening autoimmune and inflammatory diseases
B. it is metabolized by the kidney
C. corticosteroids, antimalarials, tricyclic antidepressants and allopurinol increase its toxicity
D. barbituates, alcohol, phenytoin and rifampin decrease its toxicity
E. possible side effects are weight gain, constipation, and hirsutism
F. all of the above

Antithymocyte globulin is used largely to _____ immunosuppression and its side effects are _____, _____, _____, and _____.

Muromonab-CD3 _____, _____, and _____ T-cells. Its side effects are _____, _____, and _____.

Humira (adalimumab), Remicade (infliximab) and Enbrel (entanercept) are all examples of what types of agents?

What are the 2 anti-cytokine monoclonal antibodies that we discussed in class?

All of the following are true of the COX enzymes except:

A. COX products are released by facilitated transport and act via GPCRs
B. COX-1 is inducible and is found mostly in the stomach and platelets
C. COX-1 and COX-2 catalyze an oxygenation and peroxidation two-step reaction to yield the prostaglandin, PGH2
D. Eicosanoids have a very short half-life and are first inactivated by specific enzymes followed by fatty acid oxidation
E. COX-2 is inducible in inflammatory tissues, but is constitutive in the kidney and vascular endothelium

All of the following are true of COX products and their affect on the kidney except:

A. PGE2 and PGI2 are syntehsized and act locally in the kidney
B. PGE2 and PGI2 directly increase release of renin from the JG apparatus
C. PGE2 and PGI2 are vasoconstrictors and decrease GFR
D. PGE2 and PGI2 reduce the effects of ADH resulting in increased sodium and water clearance
E. TXA2 causes vasoconstriction and decline in renal function
F. more than one of the above

All of the following are true of COX products and their affect on blood vessels except:

A. PGI2 is primarily synthesized in vascular endothelium
B. In microcirculation, PGE2 is produced by endothelial cells
C. PGI2 and PGE2 both cause vasodilation
D. IV injection of PGI2 can cause hypertension and reflex tachycardia
E. more than one of the above

All of the following are true of COX products and their affect on the GI tract except:

A. PGF2 and PGD2  are synthesized by COX1 in the stomach where they are cytoprotective by maintaining the secretion of mucins and limiting pepsin and acid secretion
B. Inhibition of COX1 can cause GI distress
C. COX2 plays a role in healing gastric ulcers
D. most prostaglandins and thromboxanes cause GI smooth muscle contraction
E. more than one of the above

All of the following are true of COX products and their affect on platelets except:

A. TXA2 synthesized by COX1 is the major eicosanoid produced in platelets
B. TXA2 is a vasodilator and potent platelet aggregator
C. TXA2 increases the effects of thrombin
D. TXA2 effects are countered by PGI2 and PGD2
E. more than one of the above

Which of the following is true of COX products and their affect on the lung:

A. TXA2 relaxes bronchiolar and tracheal muscle
B. PGI2 and PGE2 constrict bronchiolar and tracheal muscle
C. none of the above
D. all of the above

Which of the following is true of COX products and their affect on the nervous system:

A. IL-2 induces the synthesis of PGE2 which causes fever
B. PGE2 increases transmission in pain fibers in the spinal cord
C. In the periphery, PGE2 and PGI2 sensitize nerve endings of pain fibers
D. none of the above
E. more than one of the above

True or false. TXA2, PGF2-alpha, and low doses of PGE2 cause uterine contraction.
True False

Which of the following is true of COX products and their affect on inflammation:

A. PGE2 inhibit differentiation of B-lymphocytes into plasma cells
B. the stimulation of COX1 and COX2 produces paliative relief from inflammation
C. PGE2 stimulates mitogen induced proliferation and lymphokine release from T-lymphocytes
D. TXA2 inhibits clonal expansion of T-lymphocytes and inhibits interleukin and interleukin receptor synthesis
E. all of the above

What is the most likely explanation for the anti-inflammatory effect of COX-inhibitors?

All of the following are descriptive of prostaglandins that are used as pharmacological agents except:

A. prostacyclin (PGI2) is used to treat pulmonary and portopulmonary hypertension
B. PGE2 and PGF2-alpha are used with oxytocin to induce labor
C. misoprostol is a PGE1 derivative and is used in conjunction with mifepristone to terminate pregnancies and to protect against peptic ulcers
D. alprostadil is a PGF2 that is used for its vasodilating effect of impotence and maintenance of the patent ductus arteriosus prior to cardiac surgery

All of the following are true of LOX enzymes except:

A. LTA4 is either hydrated to LTB4 or conjugated by a thiol bond to form glutathione
B. arachidonate is oxygenated and dehydrated by 5-LOX to produce LTA4
C. can catalyze the oxygenation of arachadonic acid to hydroperoxides
D. PMNs, basophils, mast cells,eosinophils and macrophages contain the 12-LOX isoform

Which of the following is true of LOX enzymes:

A. Platelets contain 12-LOX which can convert arachidonic acid to 12S-HETE and 12R-HETE
B. LTA4 is converted to lipoxin by 12-LOX
C. Leukotrienes and HETEs interact with GPCRs
D. LTB4 and LTC4 are actively transported out of the cell and have short half-lives
E. LTB4 is inactivated by CYP enzymes in leukocytes
F. all of the above

Which of the following is true of LOX products and their affect on airways:

a. LTC4 and LTD4 are secreted in anaphylaxis asthma and are powerful broncoconstrictors
b. LTC4 and LTD4 increase permeability of microvessels leading to mucus secretion and plasma exudation
c. none of the above
e. all of the above

True or false. LTC4 is secreted by colonic epithelial cells and levels of this leukotriene are high in inflammatory bowel disease.
True False

_____ and _____ are leukotrienes that depress myocardium and coronary blood flow.

Inhibitors of _____ and _____ antagonists are effective in asthma but are not useful in generalized inflammation like rheumatoid arthritis.

True or false. Aspirin inhibits COX1 and COX2, but has a higher affinity for COX2.
True False

All of the following are true of aspirin and its pharmacological effects except:

A. acts peripherally and centrally to relieve mild to moderate pain
B. blocks pyrogen induced prostaglandin synthesis in the hypothalamus to lower febrile body temperature as well as basal body temperature
C. reduces heat, pain and swelling
D. low doses can reversibly inhibit platelet COX1 without affecting endothelial COX2
E. more than one of the above

All of the following are true of aspirin and its possible side effects except:

A. can precipitate gouty attacks
B. gastric irritation, bleeding and peptic ulcers are due to inhibition of gastric COX2
C. linked to Reye's Syndrome in children
D. can exacerbate existing renal disease
E. bronchospasms caused by hypersensitivities

All of the following are true of acetaminophen except:

A. has analgesic and antipyretic effects
B. causes gastric irritation
C. it is a non-specific COX inhibitor
D. hepatotoxicity and nephrotoxicity are major concerns
E. lacks antiinflammatory and anticoagulant effects

All of the following are true of ibuprofen and naproxen except:

A. they are non-selective reversible inhibitors of COX
B. have antiinflammatory, analgesic and antipyretic effects
C. are less useful as anticoagulants
D. have milder GI effects
E. may cause agranulocytosis, aplastic anemia, and renal failure
F. all of the above are true

Which of the following is true of indomethacin:

A. it is a selective COX inhibitor
B. has severe gastric, headache, thrombocytopenia, aplastic anemia, coronary artery constriction and hyperkalemia effects
C. can be used long-term
D. should not be used in children
E. more than one of the above

Which of the following is true of Celebrax (celecoxib):

A. it is a non-selective reversible COX inhibitor
B. higher incidence of gastric irritation than aspirin
C. has anticoagulant effects
D. linked to high incidence of myocardial infarction and sudden cardiac death
E. more than one of the above

All of the following are true of misoprostol except:

A. it is a synthetic prostaglandin
B. can prevent gastric ulcers when used concurrently with a selective COX inhibitor
C. can cause diarrhea and should not be used during pregnancy
D. all of the above are true

All of the following are true of methotrexate except:

A. reduce inflammation and joint destruction
B. can cause thymidine deficiency
C. is teratogenic
D. has GI, hematological and hepatic effects
E. it stimulates dihydrofolate reductase (DHFR)

All of the following are true of hydroxychloroquine except:

A. reduces inflammation and joint destruction
B. used in the treatment of malaria and ameba infestation
C. it is a basic drug that partition into the acidic vacuoles of microbes
D. should be avoided in pregnancy
E. side effects are rare, but vision should be monitored regularly for retinal damage

Which of the following is true of sulfasalazine:

A. used to treat pain and fever
B. lacks antirheumatic effect
C. prefered over methotrexate in treatment of mild rheumatoid arthritis
D. common side effects are rash, GI upset and photosensitivity
E. more than one of the above

All of the following are true of leflunomide except:

A. inhibits dihydroorotate dehydrogenase
B. possible side effects are diarrhea, hairloss and hepatic damage 
C. stimulates p450 enzyme in liver
D. drug interaction with NSAIDS
E. all of the above are true

Azathioprine is an inhibitor of several steps in _____ _____ that inhibit _____ synthesis.

True or false. Azathioprine and methotrexate have similar effects.
True False

Match the following.

1. Enbrel (etanercept)
2. Remicade (imfliximab)
3. Humira (adalimumab)

a. human antibody
b. administered subQ
c. human TNF receptor and Fc fragment of IgG
d. produces effects similar to that of methotrexate
e. chimeric human-mouse monoclonal anti-TNF
f. administered IV

All of the following are true of Orencia (abatacept) except:

A. fusion protein composed of T-lymphocyte-associated-antigen-4 and a modified human Fc fragment
B. inhibits T-lymphocyte activation by binding to CD80 and CD86 on APCs to prevent binding of T-cells CD28
C. may be used to treat RA
D. principle untoward effect is renal failure
E. all of the above are true

All of the following are true of Rituxan (rituximab) except:

A. it is a chimeric monoclonal antibody that targets T-cell antigen CD28
B. recently used for treatment of autoimmune diseases that are resistent to anti-TNF agents
C. adminstered IV
D. some possible side effects include infusion reactions and activation of hepatitis B
E. all of the above are true

All of the following are true of colchicine except:

A. binds to tubulin in leukocytes and reduces their mobility and ability to undergo phagocytosis
B. can be used for acute and chronic gout attacks
C. administered orally
D. causes GI disturbances, mainly diarrhea
E. side effects include hair loss, bone marrow suppresion, peripheral neuropathy and myopathy
F. none of the above

All of the following are true of allopurinol except:

A. it is an inhibitor of xanthine oxidase
B. inhibitor the synthesis of urate
C. used to treat chronic gout
D. rare side effects include skin reactions, GI disturbances, bone marrow suppression and peripheral neuritis
E. none of the above

All of the following are true of probenicid except:

A. inhibits the active excretion and reaccumulation of urate
B. used to treat acute gout
C. side effects are rare and may include allergic dermatitis and aplastic anemia
D. inhibits proximal tubular secretion of penicillins
E. none of the above

All of the following are true of glucocorticoids except:

A. cause metabolic, anti-inflammatory and sodium retentive effects
B. usually administered orally
C. prednisone and dexamethasone are 5-30 times more potent than cortisol
D. the untoward effects of cortisol include cataracts, hyperglycemia, thinning of the skin, edema and peptic ulcers
E. can be used to treat inflammation due to an insect bite, bronchial asthma, rheumatoid arthritis, acute leukemia and some breast cancers
F. once bound to its receptor a signaling cascade is initiated and tyrosine kinases are activated

All of the following are drugs that are currently used to treat bronchial asthma and COPD except:

A. albuterol
B. ipratropium
C. ephedrine
D. fluticasone
E. prednisone
F. Singulair (montelukast)
G. none of the above

Match the following.

1. bronchodilators
2. non-selective beta-2-agonists
3. selective beta-2-agonists
4. anticholinergic agents
5. anti-inflammatory agents
6. prostaglandins
7. leukotriene synthesis inhibitors
8. leukotriene receptor blocker
9. IgE antibody
10. corticosteroid
11. xanthine

a. cromolyn sodium
b. PGE1 and PGE2
c. epinephrine
d. prednisone
e. Genentech (omalizumab)
f. fluticasone
g. theophylline
h. Albuterol
i. ephedrine
j. Spiriva (tiotropium)
k. Atrovent (ipratropium bromide)
l. Advair
m. zileuton
n. Accolate (zafirleukast)

_____ and _____ are two new therapeutic treatments for asthma and COPD that are still under development.

All of the following are true of selective beta-2-agonists used to treat asthma and COPD except:

A. superior to non-selective beta-2-agonists because they produce bronchodilation and fewer cardiac effects
B. long-acting salmeterol and formoterol can be used as monotherapy
C. most of them are short-acting
D. drug contraindications include non-selective beta-blockerslike propanolol or timolol because they decrease the bronchodilating effects of beta-2-agonists

All of the following are true of anticholinergic agents used to treat asthma and COPD except:

A. Atrovent (ipratropium bromide) is used as a long-acting broncodilator for patients with chronic bronchitis and COPD
B. Spiriva (tiotropium bromide) is an inhalation powder that is used for the treatment of bronchospasms associated with COPD
C. Atrovent and Spiriva are not FDA-approved for the treatment of asthma, but they may be used off-label for treatment of acute asthma
D. theophylline can be administered orally or IV and its mechanism of action is inhibition of phosphodiesterase which leads to bronchial muscle relaxation and decreased mucosal secretion and edema
E. none of the above

All of the following are true of anticholinergic agents used to treat asthma and COPD except:

A. possible side effects include seizures, arrhythmia, hypertension and cardiac arrest
B. theophylline has modest anti-inflammatory effects
C. barbituates and caffeine cause drug interactions
D. may cause N/V
E. plasma levels should be monitored during treatment
F. anticholinergic agents and beta-2-agonists can be used synergistically in treatments for prolonged asthma and COPD

All of the following are true of corticosteroids except:

A. they are used as anti-inflammatory agents
B. inhaled corticosteroids have a direct and immediate effect on airflow obstruction, similar to that of inhaled bronchodilators
C. prednisone is given orally or IV for systemic treatment of severe acute asthma
D. adverse reactions include Cushing's syndrome and growth retardation
E. Advair should not be used for the treatment of children less than 12 year-old

All of the following are true of corticosteroids except:

A. cromolyn sodium stabilizes mast cell membranes and prevent the release of mediators, but does not inhibit binding of IgE to mast cells
B. possible side effects are sore throat, dry mouth, skin rashes, headache and dizziness
C. does not relax smooth muscle directly and should not be used to treat acute bronchospasms
D. must be given via inhalation because oral absorption is poor
E.  acts as a sodium channel blocker and is used exclusively for the prophylatic treatment of mild to moderate asthma

Singulair (montelukast) is most commonly used in the treatment of _____ _____ _____.

_____ is a humanized monoclonal antibody given subQ that binds to IgE and is used in the treatment of moderate to severe asthma.

True or false. Oral administration is superior to IV administration if a patient has a functioning gut.
True False

What are the 4 basic prescription laws?

What should always be included on a Rx?