Pharmacology

  1. Area of pharmacology that refers to the use of specific drugs to prevent, treat, or diagnose a disease




    B) Pharmacotherapeutics
  2. Study of how the body deals with the drug in terms of the way it is absorbed, distributed, and eliminated




    C) Pharmacokinetics
  3. Analysis of what the drug does to the body, including the mechanism by which the drug exerts its effect




    B) Pharmacodynamics
  4. All of the following are forms of enteral administration of drugs, except:




    A) Injection

    In general, drugs can be administered via two primary routes: through the alimentary canal (enteral administration) or through non-alimentary routes (parenteral administration).
  5. Most common method of administering medications




    C) Oral
  6. All of the following are disadvantages of the oral route of administration, except:




    D) The drug enters the systemic circulation in a rapid manner, causing sudden increase in plasma drug levels.
  7. This route of drug administration is indicated for patients who are unconscious or are vomiting




    D) Rectal
  8. This type of injection is advantageous in emergency situations when it is necessary for the medication to exert an immediate effect




    A) Intravenous
  9. This type of injection are occasionally used in cancer chemotherapy to administer anticancer drug directly to the tumor site with minimal exposure of the drug to other health tissues




    D) Intra-arterial
  10. This type of injection provides a relatively rapid effect while avoiding the sudden, large increase in plasma levels of the drug




    A) Intramuscular
  11. Which intramuscular injection site has the fastest rate of drug absorption?




    A) Deltoid

    Deltoid has the fastest rate of drug absorption because it has the least amount of adipose tissue among the other muscles. However, it can only accommodate a limited amount of drug (~2 ml) due to its small area. On the other hand, the gluteus has the slowest rate of drug absorption due to its significant amount of adipose tissue in this area; but due to its large area, it can accommodate a large of amount of drug (~3 ml).
  12. When injecting medications through the gluteal region, the needle must be placed on which quadrant to avoid damaging nerves branching from the sacral plexus?




    D) Superior outer

    Placing the needle on the superior inner quadrant of the buttock may damage the superior gluteal nerve. Meanwhile, placing the needle on the inferior inner quadrant may damage the sciatic nerve.
  13. Intrathecal injections usually refer to injections within the




    A) Subarachnoid space
  14. This type of injection allows certain drugs to bypass the blood brain barrier and reach the central nervous system




    B) Intrathecal
  15. Topical administration involves applying the medication directly to the skin.
    False

    Topical administration involves applying the medication directly to the skin and mucous membranes.
  16. Parameter expressed as the percentage of the drug administered that reaches the bloodstream
    Bioavailability
  17. Most drugs and weak acids or weak bases. As a result, they have the potential to become positively or negatively charged, depending on the pH of certain body fluids.




    A) Both statements are true.

    For example, a weak acid such as aspirin will be non-ionized and will therefore be absorbed fairly easily from the stomach because of its lipid solubility. However, this same drug will be poorly absorbed if it reaches the duodenum and becomes ionized.
  18. Refers to chemical changes that take place in the drug following administration
    Drug metabolism (biotransformation)
  19. Altered version of the original compound which is usually inactive or has greatly reduced level of pharmacologic activity
    Metabolite
  20. If the metabolite has a higher level of activity than the original compound, a _____ is usually given.
    Prodrug (inactive form of the drug that becomes activated via biotransformation following its administration)
  21. Cellular mechanism of drug biotransformation which either involves addition of oxygen to or removal of hydrogen from the original compound




    C) Oxidation

    Oxidation reactions comprise the predominant method of drug biotransformation in the body. Ibuprofen, Acetaminophen, and Diazepam are some examples of drug that undergo oxidation.
  22. Cellular mechanism of biotransformation which involves removal of oxygen from or addition of hydrogen to the original compound




    C) Reduction

    Examples of drug that undergo reduction are Dantrolene and Methadone.
  23. Cellular mechanism of drug biotransformation in which the original compound is broken into separate parts




    D) Hydrolysis

    Examples of drug that undergo hydrolysis are Aspirin and Lidocaine.
  24. Cellular mechanism of drug biotransformation in which the intact drug or metabolite of oxidation, reduction, or hydrolysis is coupled to an endogenous substance




    D) Conjugation

    Examples of drug that undergo conjugation are Clonazepam and Benzoic acid.
  25. Primary site/s for drug metabolism




    D) Liver
  26. A frequent problem in drug metabolism resulting from prolonged use of certain drugs induces the body to be able to enzymatically destroy the drug more rapidly, usually because either more metabolizing enzymes are being manufactures or less are being degraded
    Enzyme induction
  27. Need for increased drug dosages to produce the same effect following long-term ingestion
    Tolerance
  28. Primary site/s for drug excretion




    A) Kidneys
  29. Nonpolar drugs or their metabolites are relatively impermeable to the epithelial lining, trapping them in the nephron following filtration. As a result, they are excreted in significant amounts by the kidneys.




    D) Both statements are false.

    Polar (water-soluble) drugs or their metabolites are relatively impermeable to the epithelial lining, trapping them in the nephron following filtration. As a result, they are excreted in significant amounts by the kidneys. On the other hand, nonpolar (lipid-soluble) drugs and their metabolites are easily reabsorbed back into the body passively by diffusing through the wall of the nephron.
  30. Certain drugs can be excreted by the liver into the bile and eventually by the gastrointestinal tract into the feces. However, most of the secreted bile, as well the drugs contained within it, are often reabsorbed.




    B) Both statements are true.

    Certain drugs can be excreted by the liver into the bile and subsequently reach the duodenum via the bile duct. If the drug remains in the gastrointestinal tract, it will eventually be excreted in the feces. However, most of the secreted bile is reabsorbed, and the drugs contained in it are often reabsorbed simultaneously.
  31. Careful consideration for the welfare of the nursing infant must always be a factor when administering medications to the lactating mother.
    True

    Although drugs excreted via lactation are considered a relatively minor route with regards to loss from the mother, the possibility the infant may imbibe substantial concentrations of the drug does exist.
  32. Drug elimination rates are significant in determining the amount and frequency of drug dosage.
    True

    If a drug is administered much faster than it is eliminated, the drug will accumulate excessively in the body and reach toxic levels. Conversely, if elimination greatly exceeds the rate of delivery, the concentration in the body may never reach therapeutic levels.
  33. Clearance is independent on the organ or tissue's ability to extract the drug from the plasma as well as the perfusion of the organ.
    False

    Clearance is dependent on the organ or tissue's ability to extract the drug from the plasma as well as the perfusion of the organ.
  34. Amount of time required for 50 percent of the drug remaining in the body to be eliminated
    Half-life
  35. Half-life is a function of both clearance and volume distribution.
    True

    Half-life depends not only on the ability of the organ/s to remove the drug from the plasma, but also on the distribution or presence of the drug in the plasma. For example, a drug that undergoes extensive inactivation in the liver may have a long half-life if it is sequestered intracellularly in skeletal muscle.
  36. Drugs are usually not metabolized as quickly in the elderly, primarily because of the decreases in liver and kidney functions that typically accompany the aging process. Newborns and infants also encounter similar problems as their liver and kidney functions are still immature, and they may be deficient in specific drug-metabolizing enzymes.




    C) Both statements are true.
  37. Grape juice inhibits the enzymes that metabolize certain drugs as they are absorbed from the gastrointestinal tract. As a result, taking these drugs orally with grape juice will result in increased bioavailability.






    A) Both statements are false.
    B) Both statements are false.
    C) Only the first statement is true.
    D) Only the second statement is true.
    B) Both statements are false.

    The correct answer is grapefruit juice, not grape juice. Increased bioavailability of the drug means that more of the drug's active form will reach the bloodstream, resulting to greater risk for side effects and adverse reactions.
  38. An antagonist drug has both affinity and efficacy; whereas an agonist drug only has affinity.
    False

    Affinity refers to the attraction or desire of the drug to bind to a given receptor. While, efficacy refers to the drug's ability to activate the receptor and subsequently lead to a change in the function of the cell.

    An agonist drug has both affinity and efficacy; whereas an antagonist drug only has affinity.
  39. Which of the following is not true about competitive antagonists?




    B) Raising the concentration of the agonists with a competitive antagonist present cannot overcome the original inhibition.
  40. Non-competitive antagonists often remain bound for the receptor's lifespan. Their effect is only terminated when there is sufficient concentration of agonist molecules.




    A) First statement is true, but second statement is false.

    Their effect is only terminated only after the receptor has been replaced as part of the normal protein turnover within the cell.
  41. Partial agonists do not evoke a maximal response. Their efficacy lies between that of a full agonist and a full noncompetitive antagonist.




    B) Both statements are true.
  42. Onset of withdrawal symptoms if drug administration is ceased
    Dependence
  43. The lack of safety of barbiturates and their strong potential for addiction and abuse necessitated the development of alternative drugs such as the
    Benzodiazepines
  44. Subunit of GABA receptor which mediates sedation




    A) Alpha 1
  45. Subunit of GABA receptor which mediates anxiety




    A) Alpha 2 and 3
  46. Benzodiazepine which has long half-life because of active metabolites




    D) Flurazepam (Dalmane)
  47. Antidepressant drug category which works by blocking the reuptake of amine neurotransmitters into the presynaptic terminal




    A) Tricyclics
  48. Enzyme located at amine synapses which helps destroy and remove released transmitters through, preventing these transmitters to remain in the synaptic cleft and continue to exert their effect
    Monoamine oxidase (MAO)
  49. Second-generation antidepressants which selectively block the reuptake of 5-hydroxytryptamine, producing fewer and less bothersome side effects that their nonselective counterparts
    Selective serotonin reuptake inhibitors (SSRIs)
  50. Initial drug of choice for treating depression




    D) SSRIs
  51. Antidepressants which can also block certain central and peripheral acetylcholine receptors, producing a variety of symptoms such as dry mouth, constipation, urinary retention, and tachycardia
    Tricyclics
  52. Among the antidepressants, MAO inhibitors have the highest potential for fatal overdose.
    False

    Among the antidepressants, tricyclics have the highest potential for fatal overdose. These drugs should be used cautiously in patients who have suicidal thoughts or a history of suicidal behaviors.
  53. Antidepressants which tend to produce CNS excitation, resulting in restlessness, irritability, agitation, and sleep loss




    C) MAO inhibitors
  54. MAO inhibitors should not be taken with certain foods such as fermented cheese and wines which contain tyramine. The additive effect of increase cathecolamine release due to ingested tyramine and decreased catecholamine breakdown due to MAO inhibition can lead to excessive cathecolamine levels and a hypotensive crisis.
    A) Only the first statement is true.

    The additive effect of increase cathecolamine release due to ingested tyramine and decreased catecholamine breakdown due to MAO inhibition can lead to excessive cathecolamine levels and a hypertensive crisis.
  55. Characterized by shivering, sweating, movement disorders, muscle fasciculations, and other neuromuscular symptoms
    Serotonin syndrome
  56. Traditional antipsychotics are associated with more side effects than newer counterparts, including an increased incidence of extrapyramidal symptoms.
    True

    Traditional antipsychotics have a strong affinity for CNS dopamine receptors and can exert beneficial effects when used in low dosages.
  57. Atypical antipsychotics do not block D1 receptors in the basal ganglia as strongly as conventional antipsychotics, hence producing less motor side effects.
    False

    Atypical antipsychotics do not block D2 receptors in the basal ganglia as strongly as conventional antipsychotics, hence producing less motor side effects. Clozapine and Resperidone are examples of atypical antipsychotics.
  58. Extrapyramidal side effect of traditional antipsychotics characterized by  involuntary and fragmented movements often seen in the tongue and orofacial musculature
    Tardive dyskinesia
  59. Traditional antipsychotics can cause pseudoparkinsonism, producing symptoms such as resting tremor, bradykinesia, and rigidity. Primary antiparkinsonsian drugs such levodopa and dopamine agonists are typically used to treat these side effects.




    B) Only the first statement is true.

    Drugs used as adjuncts in treating Parkinson's disease (e.g. amantadine and benztropine mesylate) may be administered to deal with parkinsonian-like side effects. However, primary antiparkinsonian drugs such as levodopa and dopamine agonists are not typically used to treat these side effects because they tend to exacerbate psychotic symptoms.
  60. Akathisia is a side effect of antipsychotics which is characterized by sensations of motor restlessness and complaints of inability to sit or lie still. It is usually dealt with by altering the dosage or type of medication, but if persists, metoprolol may help decrease symptoms.




    D) Only the first statement is true.

    Akathisia is usually dealt with by altering the dosage or type of medication. If this is unsuccessful, beta-2 adrenergic receptor blockers such as propanolol may help decrease symptoms by a mechanism involving the central adrenergic receptors.
  61. Neuroleptic malignant syndrome is characterized by hypertonia, stupor, rigidity, tremors, and fever. It is typically experienced by patients who are taking relatively high doses of more potent antiepileptic medications.




    A) Both statements are false.

    Neuroleptic malignant syndrome is characterized by catatonia, stupor, rigidity, tremors, and fever. It is typically experienced by patients who are taking relatively high doses of more potent antipsychotics.
  62. Limited (focal) motor or sensory signs; consciousness remains intact




    A) Simple partial seizure

    Manifestations may be convulsions confined to one limb or specific sensory hallucinations.
  63. Sudden, brief loss of consciousness




    D) Absence seizure

    Absence seizure is also known as petit mal seizure.
  64. Sudden, brief, shocklike contractions of muscles in the face and trunk, or in one or more extremities




    B) Myoclonic seizure
  65. Rhythmic, synchronized contractions throughout the body; loss of consciousness




    B) Clonic seizure
  66. Generalized sustained muscle contractions throughout the body; loss of consciousness




    B) Tonic seizure

    Meanwhile, atonic seizure is characterized by sudden loss of muscle tone in the head and neck, one limb, or throughout the entire body. Consciousness may be maintained or lost briefly.
  67. Sustained contraction of all muscles followed by powerful rhythmic contractions; loss of consciousness




    C) Tonic-clonic seizure

    Tonic-clonic seizure is also known as grand mal seizure.
  68. Anti-epileptic drug which stabilizes neuronal membranes and decreases neuronal excitability by decreasing sodium entry into rapidly firing neurons




    B) Both of these
  69. Side effects of this anti-epileptic drug includes gastric irritation, headache, cerebellar signs, gingival hyperplasia, hirsutism, and skin disorders




    D) Phenytoin

    Side effects of carbamazepine include blurred vision, anemia, water retention, cardiac arrhythmias, and congestive heart failure.

    Side effects of ethosuximide include gastrointestinal distress, lethargy, movement disorders, and skin rashes.

    Side effects of valproic acid include gastrointestinal distress, temporary hair loss, weight gain or loss, and impaired platelet function.
  70. Primary anti-epileptic agent used for treating partial and tonic-clonic seizures




    C) Carbamazepine

    However, carbamazepine has not been shown to be effective in treating absence seizures.
  71. Anti-epileptic agent used to treat absence (petit mal) seizures




    A) Ethosuximide (Zarontin)

    All three drugs are primary agents in the treatment of absence (petit mal) seizures, but ethosuxumide is the most commonly prescribed.
  72. All of the following are true about indications of valproic acid, except:




    D) May be used to treat bipolar disorder, especially the acute depressive phase
  73. Second-generation anti-epileptic agent used to treat generalized absence seizures associated with Lennox-Gastaut syndrome in children




    D) Felbamate (Felbatol)

    Both Felbamate and Lamotrigine are used as adjunct treatment for generalized seizures associated with Lennox-Gastaut syndrome, but their mechanisms of action differ. Felbamate binds with N-methyl-D-aspartate receptor to block the excitatory effects of glutamate; whereas Lamotrigine works in the similar manner as Phenytoin and Gabapentin by stabilizing sodium channels and inhibiting sodium entry into the presynaptic terminals of the neurons firing too rapidly.
  74. Most women with epilepsy may continue to take their anti-seizure medications when they become pregnant, and eventually give birth to normal, healthy babies. However, there is increased incidence of birth defects in their children compared to the children of mothers who are not epileptic.




    C) Both statements are true.

    There is a considerable debate as to whether these birth defects are side effects of antiepileptic drug therapy or sequela of the epilepsy itself.
  75. Which of the following is incorrect about status epilepticus?




    B) If left untreated, it may result to permanent damage or death, especially if the seizures are generalized tonic in nature

    If left untreated, it may result to permanent damage or death, especially if the seizures are generalized tonic-clonic in nature.

    • Order of medication administration:
    • 1. Benzodiazepines, such as lorazepam (Ativan) or diazepam (Valium), administered intravenously
    • 2. Phenytoin administered intravenously concurrently with or immediately after the benzodiazepine 
    • 3. Phenobarbital administered intravenously if seizures continue
    • 4. General anesthesia such as halothane as last resort
  76. This drug resolves dopamine deficiency in Parkinson's disease by being converted to dopamine after crossing the blood-brain barrier




    B) Levodopa

    Levodopa is still the best drug for resolving parkinsonian symptoms; however, its long term-use is limited by side effects and decreased efficacy.
  77. Dopamine agonists directly stimulate dopamine receptors in the basal ganglia. All of the following drugs are dopamine agonists, except:




    D) Amantadine

    Pramipexole and Pergolide are also examples of dopamine agonists. Dopamine agonists may produce fewer side effects than levodopa and preliminary evidence suggests that their early use may also delay the progression of Parkinson's disease.
  78. This drug may inhibit the effects of excitatory amino acids in the basal ganglia and may be used alone during early/mild stages or added to drug regimen when levodopa loses effectiveness




    C) Amantadine
  79. This drug prevents monoamine oxidase from breaking down dopamine in the basal ganglia, enabling dopamine to remain active for longer periods of time




    B) Selegiline

    MAO inhibitors may improve symptoms, especially in the early stages of Parkinson's disease, but their ability to produce long-term benefits remain unclear.
  80. This drug helps prevent breakdown of dopamine in peripheral tissues, allowing more levodopa to reach the brain




    D) Entacapone

    Entacapone and Tolcapone are examples of catechol-O-methyltransferase (COMT) inhibitors. COMT converts levodopa to an inactive metabolite known as 3-O-methyldopa. COMT inhibitors can be used as adjuncts to levodopa/carbidopa administration.
  81. Upon entering the brain, levodopa is then transformed into dopamine by decarboxylation from the enzyme
    Dopa decarboxylase

    Dopa decarboxylase is extensively distributed throughout the body and can be found in the liver, intestinal mucosa, kidneys, and skeletal muscle.
  82. Dosages of levodopa are minimized by administering it with a companion drug that inhibits premature levodopa breakdown in the peripheral tissues
    Carbidopa
  83. If levodopa is not administered with a peripheral decarboxylase inhibitor, less than 1% of administered levodopa reaches the brain in that form.
    True

    Only levodopa that will be able to cross the blood-brain barrier is subsequently transformed into dopamine. Any levodopa that is converted prematurely to dopamine in the periphery must remain there, becoming essentially useless in alleviating parkinsonism symptoms.
  84. When prepared as Sinemet, levodopa and carbidopa are combined in specific proportions, usually a fixed carbidopa-to-levodopa ratio of either 1:4 or 1:10.
    True

    The Sinemet preparation that is typically used to initiate therapy consists of tablets containing 25 mg of carbidopa and 100 mg of levodopa. A 10:100 or 25:250 mg preparation of carbidopa to levodopa is usually instituted as the parkinsonism become more pronounced and there is need for larger relative amounts of levodopa.
  85. Gastrointestinal problems such as nausea and vomiting, and cardiovascular problems such as arryhthmias and postural hypotension are adverse effects of levodopa therapy brought about by excessive levels of peripherally circulating dopamine.
    True

    Administration of levodopa in conjunction with a peripheral decarboxylase inhibitor such as carbidopa reduces these adverse effects.
  86. Dyskinesias are adverse side effects of levodopa therapy which may be due to




    D) Both of these

    Strategies for minimizing dyskinesias include adjusting the dose of levodopa, using a controlled-release form of this drug, and incorporating other anti-Parkinson medications into the patient's drug regimen.
  87. Patients with Parkinson's disease show diminished response to levodopa over time due to




    C) Both of these
  88. Phenomenon where the effectiveness of the anti-Parkinsonian drug simple seems to wear off prior to the next dose
    End-of-dose akinesia (wearing off)

    End-of-dose akinesia is usually resolved by adjusting the quantity and timing of levodopa administration, or by using a sustained release form of the drug.
  89. A fluctuation in response to levodopa where the drug's effectiveness may suddenly and spontaneously decrease, resulting in abrupt worsening of parkinsonism symptoms, but remission of symptoms may then occur spontaneously or after taking a dose of levodopa
    On-off phenomenon

    On-off phenomenon may repeat itself several times during the day. The off periods may result from poor absorption of orally administered levodopa, which may be due to poor gastrointestinal motility or if the presence of large amino acids competing with levodopa for transport across the intestinal mucosa.
  90. When patients become refractory to the beneficial effects of levodopa or have had sudden increase in adverse side effects, they are gradually removed from all anti-Parkinson medication for 3 days to 3 weeks while under close medical supervision
    Drug holiday

    Drug holidays are done so that levodopa can eventually be resumed at a lower dosage and with better results. Despite these potential benefits, drug holidays are no longer used routinely because these patients are in the advanced stages of Parkinson's disease and discontinuing anti-Parkinson medications even temporarily results in severe immobility, which can lead to venous thrombosis and pneumonia.
  91. Which of the following is not true about dopamine agonists?




    C) They have shorter half-life than levodopa, producing erratic and fluctuating effect on dopamine receptors.

    Dopamine agonists have longer half-life than levodopa, producing a steadier and more prolonged effect on dopamine receptors. Dopamine agonists may help normalize endogenous dopamine activity, thus having a neuroprotective effect on substantia nigra neurons.
  92. Anti-cholinergic agents may help alleviate the symptoms of Parkinson's disease, especially bradykinesia and rigidity. They selectively bloc acetylcholine receptors in the basal ganglia.




    D) Both statements are false.

    Anti-cholinergic agents may help alleviate the symptoms of Parkinson's disease, especially tremors and rigidity. However, these drugs are fairly nonselective and tend to produce a wide variety of side effects because they block acetylcholine receptors in various tissues throughout the body. Associated side effects include mood change, confusion, hallucination, drowsiness, cardiac irregularity, blurred vision, dryness of mouth, nausea, vomiting, constipation, and urinary retention.
  93. This drug was originally developed as an antiviral drug which is particularly used to treat influenza drug and its ability to reduce parkinsonian symptoms was discovered by chance
    Amantadine (Symmetrel)
  94. Selegiline, a MAO inhibitor, can be used alone in the early stages of Parkinson's disease to prolong the effect of endogenous dopamine produced within the basal ganglia. However, selegiline may lead to hypertensive crisis, especially if it is taken with tyramine-containing foods.




    C) Only the first statement is true.

    Selegiline may also be combined with levodopa because it prolongs the action of dopamine, allowing reduction of parkinsonism symptoms using a relatively low dose of levodopa. Hypertensive crisis usually results if MAO inhibitors are taken with tyramine-containing foods; however, this is not the case for Selegiline.
  95. A skeletal muscle relaxant which works by increasing the central inhibitory effects of GABA
    Diazepam (Valium)

    The primary side effect of Diazepan is that dosages successful in relaxing skeletal muscle also produce sedation and general reduction in psychomotor ability.
  96. This anti-spasticity agent is more effective in treating spasticity resulting from spinal cord lesions compared to cerebral lesions




    D) Baclofen (Lioresal)

    Baclofen is a derivative of GABA which preferentially binds to GABAb receptors. It is administered orally, making it less effective in treating spasticity associated with supraspinal lesions (e.g. stroke and cerebral palsy), because the drug does not readily penetrate the blood-brain barrier. However, it can also be administered intrathecally in patients with severe, intractable spasticity.
  97. Only anti-spasticity agent available that exerts its effect directly on the skeletal muscle




    A) Dantrolene sodium (Dantrium)

    Dantrolene sodium relaxes skeletal muscles by impairing the release of calcium from the sarcoplasmic reticulum within the muscle cell during excitation. This drug is also invaluable in treating malignant hyperthermia, a life-threatening reaction which may occur following exposure to general anesthesia, muscle paralytics, and antipsychotics.
  98. Dantrolene sodium selectively impairs sarcoplasmic calcium release in hyperexcitable muscles. This drug may cause severe hepatotoxicity, which may even lead to fatal hepatitis.




    A) Only the second statement is true.

    The most common side effects of dantrolene sodium is generalized muscle weakness because it impairs sarcoplasmic calcium release in skeletal muscles throughout the body.
  99. This drug reduces muscle spasticity  by increasing the inhibitory effects of GABA in the CNS; however, it use if limited by its sedative effects




    A) Diazepam (Valium)

    Extended use of diazepam can cause tolerance and physical dependence.
  100. This anti-spasticity agent is an alpha-2-adrenergic agonist which inhibits the firing of interneurons that relay information to the alpha motor neuron
    Tizanidine (Zanaflex)

    Tizanidine binds to the receptors on the spinal interneurons to decrease the release of excitatory neurotransmitters from their presynaptic terminals and to decrease the excitability of postsynaptic neuron.
  101. This muscle relaxant inhibits the release of acetylcholine from presynaptic terminals at the skeletal neuromuscular junction
    Botulinum toxin

    Once attached to the membrane, the toxin enters the presynaptic terminal where it cleaves and destroys proteins which help fuse presynaptic vesicles with the inner surface of the presynaptic terminal, thereby inhibiting the vesicles to release acetylcholine via exocytosis.
  102. The most commonly used therapeutic type of botulinum toxin is type B. Botulinum toxin can be used to control localized muscle dystonias, but relief may only be temporary.




    B) Only the second statement is true.

    The most commonly used therapeutic type of botulinum toxin is type A and this is marketed commercially under trade names Botox and Dysport. Meanwhile, botulinum toxin type B can be useful for patients who developed immunity to type A.
  103. For patients with generalized spasticity, the first line of management includes botulinum toxin injections.
    False

    Botulinum toxin does not cure spasticity and only a limited amount of it can be administered during each set of injections. For example, the total amount of botulinum toxin type A injected during each treatment session is 200-300 units in adults, with proportionally smaller amounts used in children depending on their age and size. Exceeding this recommended dose will cause an immune response whereby antibodies are synthesized against the toxin, making subsequent treatments ineffective.
  104. Poppy seeds are the sources of naturally occurring and semisynthetic narcotic analgesics. Opium contains about 20 biologically active compounds, including morphine and codeine.




    B) Both statements are true.
  105. The following are families of endogenous opioids, except:




    A) Susbtance P

    These peptides are manufactured and released within the body to control pain under specific conditions.
  106. All of the following are classes of opioid receptors, except:




    D) Gamma

    Opioids that are used clinically to reduce pain typically have a fairly high affinity for the mu class of opioid receptors. Unfortunately, some of the problematic side effects of opioids (e.g. respiratory depression and constipation) may also be mediated. in addition, repeated stimulation of these receptors has been associated with cellular changes that might lead to opioid abuse and addiction.
  107. Stimulation of mu opioid receptors inhibits neurotransmitter (e.g. dopamine and acetylcholine) release, but increases hormonal (e.g. prolactin and growth hormone) release.
    True

    Stimulation of mu opioid receptors may also cause sedation, respiratory depression, and constipation.
  108. Opioid drugs which are used to treat severe pain because they have high affinity for mu opioid receptors in the CNS




    C) Strong agonists

    Some examples of strong agonists are morphine, fentanyl, hydromorphone, oxymorphone, meperidine, levorphanol, and methadone.
  109. All of the following opioid drugs are classified as mild-to-moderate agonists, except:




    A) Methadone

    Methodone is a strong opioid agonist. Another example of mild-to-moderate opioid agonist is propoxyphene.
  110. Opioid drugs which can produce adequate analgesia with less risk of side effects associated with mu receptors




    A) Mixed agonist-antagonists

    Some examples of mixed agonist-antagonists are butorphanol, buprenorphine, nalbuphine, and pentazocine. Because of these drugs' ability to stimulate certain receptors while blocking or partially activating other receptors, they have fewer addictive qualities and less risk for fatal overdose. However, they may produce more psychotrophic effects (e.g. hallucination and vivid dreams), and their maximal analgesic effect may not be as great as that of strong agonists.
  111. Which mixed opioid agonist-antagonist partially activates mu receptors but inhibits kappa receptors, making it a suitable treatment for opioid dependence and withdrawal




    A) Buprenorphine
  112. Opioid antagonists block all opioid receptors, with a particular affinity for the mu variety. These drugs can be used to rapidly and dramatically reverse the respiratory depression associated with excessive opioid ingestion.




    B) Both statements are true.

    Nalmefene and naloxone can be used to rapidly and dramatically reverse respiratory depression associated with excessive opioid ingestion. Meanwhile, naltrexone is used in conjunction with behavioral therapy to maintain an opioid-free state in individuals recovering from opioid addiction.
  113. Opioids exert their analgesic effects through their ability to decrease ascending (efferent) pain transmission, combined with their ability to activate descending (afferent) anti-nociceptive pathways.
    True

    • Ascending = Afferent
    • Descending = Efferent
  114. Orally administered opioids are more effective when given at regularly scheduled intervals rather than when the patient feels the need for the drug.
    True

    With regularly schedules dosages, plasma concentrations may be contained within therapeutic range, rather than allowing large plasma fluctuations that may occur if the drugs are given at sporadic intervals.
  115. Which of the following is not a symptom of narcotic withdrawal?




    B) Bradycardia

    Other symptoms include body aches, fever, insomnia, irritability, loss of appetite, nausea/vomiting, runny nose, shivering, sneezing, stomach cramps, sweating, and weakness/fatigue.
  116. Methadone, a strong opioid agonist, is the primary pharmacological intervention used to treat opioid addiction. Although this drug is similar to morphine in terms of efficacy and potency, it has milder withdrawal symptoms.




    B) Both statements are true.

    Methadone is substituted for the abused opioid and is then slowly withdrawn as various methods of counselling are employed.
  117. Opioids tend to make the medullary chemoreceptors less responsive to oxygen, thus slowing down the respiratory rate and inducing relative hypoxia and hypercapnia.
    False

    Opioids tend to make the medullary chemoreceptors less responsive to carbon dioxide, not oxygen.
  118. The following are properties of NSAIDs, except:




    B) None of these

    NSAIDs have the ability to relieve mild-to-moderate pain, to decrease elevated body temperature associated with fever, and to decrease blood clotting by inhibiting platelet aggregation.
  119. Acetaminophen is an NSAID.
    False

    Acetaminophen is similar to NSAIDs in its ability to decrease pain and fever; however, it is not considered an NSAID because it lacks anti-inflammatory and anticoagulant properties.
  120. Which enzyme should be inhibited to decrease prostaglandin and thromboxane production?
    Cyclooxygenase
  121. Key site of NSAID action within the cell




    D) Cyclooxygenase

    There are at least two primary subtypes of the COX enzyme: COX-1 enzyme is responsible for mediating normal cell activity and maintaining homeostasis; while COX-2 enzyme is responsible for mediating pain and other aspects of inflammation in response to cell injury.
  122. Oldest and most widely used NSAID




    B) Aspirin
  123. NSAID which is considered as a reasonable alternative for non-opioid management of post-operative pain and may be especially valuable when opioid side effects are harmful or undesirable




    B) Ketorolac
  124. Aspirin is the primary NSAID used in treating fever in children and adults.
    False

    Aspirin is the primary NSAID used in treating fever in adults, but it is contraindicated in children and teenagers because of its association with Reye syndrome. Non-aspirin antipyretics such as ibuprofen and acetaminophen are preferred for treating fever in children and teenagers.
  125. Primary adverse effect of aspirin and other non-selective NSAIDs
    Gastrointestinal damage

    Certain prostaglandins such as PGI2 and PGE2 are produced locally in the stomach and they help protect the gastric mucosa by inhibiting gastric acid secretion, increasing mucus production, and maintaining blood flow. By inhibiting the formation of these protective prostaglandins, aspirin and other non-selective NSAIDs render the stomach more susceptible to damage from acidic gastric juice, ranging from minor stomach discomfort to upper gastrointestinal hemorrhage and ulceration.
  126. The following increases a person's susceptibility to gastrointestinal injury from aspirin-like drug:




    A) All of these

    Other factors include history of ulcers, use of high doses of NSAID, and use of other agents (e.g. anti-inflammatory steroids and anticoagulants).
  127. The following are strategies which can be employed to manage gastrointestinal problems associated with aspirin-like drugs:




    D) All of these

    All of these strategies can be used to decrease gastrointestinal damage associated with aspirin-like drugs. However, enteric-coated aspirin may delay the onset of analgesic effects and may cause duodenal ulcerations instead. It is also questionable whether sufficient buffer is added to the commercial aspirin to lessen stomach irritation. Lastly, the presence of food can also delay drug absorption, decreasing peak levels of drug that reach the bloodstream.
  128. Misoprostol, proton pump inhibitors, and H2 receptor blockers can be used to prevent or treat gastrointestinal damage in patients taking aspirin and other NSAIDs. However, these protective agents are typically reserved for people who exhibit symptoms of gastrointestinal irritation or who are at risk for developing ulceration while undergoing NSAID therapy.




    D) Both statements are true.
  129. Symptoms of aspirin intoxication include the following:



    C) All of these

    More severe cases also result in metabolic acidosis and dehydration.
  130. Reye syndrome is a rare condition which occurs in children and teenagers, usually following a bout of influenza or chicken pox. It is characterized by the following symptoms, except:




    A) Kidney dysfunction

    Liver dysfunction is a symptom of Reye syndrome. Increasing responsiveness is often rapidly progressing and may lead to delirium, convulsion, coma, and possibly death.
  131. People with asthma or other hypersensitivity reactions are more likely to exhibit aspirin intolerance. Aspirin intolerance often indicates a concomitant sensitivity to other NSAIDs, including COX-2 selective drugs.




    B) Both statements are true.

    People with aspirin intolerance will display allergic-like reactions such as acute bronchospasm, urticaria, and severe rhinitis within a few hours after taking aspirin and aspirin-like NSAIDs. Aspirin intolerance often indicates concomitant sensitivity to other NSAIDs, including COX-2 selective drugs; hence, the use of all NSAIDs is contraindicated in these individuals.
  132. Non-aspirin NSAIDs are significantly better than aspirin in terms of therapeutic and adverse effects.
    False

    There is no clear evidence that non-aspirin NSAIDs are better than aspirin as anti-inflammatory analgesics. However, non-aspirin NSAIDSs tend to be associated with less gastrointestinal discomfort and organ toxicity (e.g. liver and kidneys) than aspirin.
  133. Use of COX-2 selective NSAIDs decreases the risk for gastrointestinal damage, but increases the risk for heart attack and stroke.
    True

    By inhibiting the COX-2 form of the enzyme, these drugs inadvertently impair the production of prostacyclin, a prostaglandin that promotes vasodilation and prevents platelet-induced occlusion in the coronary and carotid arteries. Simultaneously, these drugs do not inhibit the production of thromboxane, a prostaglandin which facilitates platelet aggregation and clot formation, from the COX-1 enzyme.
  134. People with pre-existing liver disease or those who are chronic alcohol abusers may be particularly susceptible to hepatic necrosis caused by high doses of acetaminophen.
    True

    Accumulation of NAPQI induces hepatic necrosis by binding to and inactivating certain liver proteins. Likewise, previous damage to the liver may impair the ability of this organ to convert NAPQI to mercapturic acid, resulting in accumulation and damage even at relatively low doses.
  135. Plasma protein binding with acetaminophen is higher than with aspirin.
    False

    Plasma protein binding with acetaminophen is highly variable (20-50%), but is considerably less than with aspirin (80-90%). Note that only unbound or free drug exerts the therapeutic effects.
  136. The following drugs can be used to treat rheumatoid arthritis:




    B) All of these

    NSAIDs and glucocorticoids are used primarily to decrease joint inflammation. Meanwhile, DMARDs are used to slow or halt the progression of the disease by interfering with the immune response.
  137. These drugs are usually considered as the first line of defense in treating rheumatoid arthritis




    C) NSAIDs

    Although NSAIDs are not as powerful in reducing inflammation as glucocorticoids, they are associated with fewer side effects and they offer the added advantage of analgesia.
  138. As the rheumatoid arthritis progresses, it is recommended to use two different NSAIDs simultaneously to effectively manage worsening symptoms.
    False

    For a progressing rheumatoid arthritis, it is recommended to combine NSAID with DMARDs. Usually, it is not advisable to use two different NSAIDs simultaneously because there is an increased risk of side effects without any appreciable increase in therapeutic benefits.
  139. These drugs are commonly used to treat acute exacerbations of rheumatoid arthritis




    D) Glucocorticoids

    Glucocorticoids can often be given systematically at high doses for short periods (a week or two) to provide anti-inflammatory effects. This so-called pulse treatment may be helpful in managing acute exacerbations of rheumatoid arthritis without producing the severe side effects associated with long-term use.
  140. Antimalarial drugs such as chloroquine and hydroxychloroquine can be used to treat rheumatoid arthritis, but they are only marginally effective when compared to other DMARDs.
    True

    Antimalarial drugs are usually used in combination with other DMARDs for more comprehensive treatment.
  141. High doses of antimalarial drugs can produce irreversible kidney damage. Renal toxicity is rare, however, when daily dosages are maintained below the levels typically used to treat rheumatoid arthritis.




    D) Both statements are false.

    High doses of antimalarial drugs can produce irreversible retinal damage. Retinal toxicity is rare, however, when daily dosages are maintained below the levels typically used to treat rheumatoid arthritis. Nonetheless, ocular exams should be scheduled periodically to ensure safe and effective use of these drugs during prolonged administration.
  142. Auranofin (Ridaura) is an active gold compound which can be administered orally. It is safer than parenteral gold compounds because it produces fewer cutaneous and hematologic side effects; however, it may produce more gastrointestinal irritation.




    A) Both statements are true.

    Traditional gold compounds such as aurothioglucose (Solganal) and gold soidum thiomalate (Myochrysine) are usually administered by intramuscular injection. Adverse side effects of gold therapy include gastrointestinal distress (diarrhea, indigestion), irritation of oral mucosa, and rashes and itching of the skin. Other side effects include proteinuria, conjunctivitis, and blood dyscrasias (thrombocytopenia, leukopenia)
  143. Often the first DMARD used to treat rheumatoid arthritis in both adults and children




    D) Methotrexate

    Methotrexate is an anticancer drug which inhibits folic acid metabolism, thereby limiting the proliferation of lymphocytes and other cells that cause the autoimmune responses in rheumatoid arthritis.
  144. First biologic DMARD




    A) Etanercept

    Etanercept was created by fusing human IgG with an amino acid sequence that mimics the binding portion of TNF receptor. TNF-α recognizes the binding portion of the drug, attaches to this portion, and therefore cannot bind to the real TNF receptor. Meanwhile, the two newer agents (infliximab and adalimumab) were created using monoclonal antibody techniques which enable them to bind tightly to antigenic components on TNF-α, forming a drug-cytokine molecule that is too large to bind to the real TNF receptor. In addition, they can also destroy cells that express TNF-α, further reducing the destructive effects of this cytokine.
  145. DMARD which blocks the effects of interleukin-1, a cytokine that promotes joint inflammation and destruction in rheumatoid arthritis




    B) Anakinra

    Etanercept and adalimumab block TNF-α. Sulfasalazine is an immunosuppressant used to treat inflammatory bowel disease.
  146. Often the first drug used to treat mild-to-moderate osteoarthritis




    B) Acetaminophen

    Acetaminophen is as effective as NSAIDs in controlling pain, but it does not have anti-inflammatory properties. However, the lack of anti-inflammatory properties is of less concern when acetaminophen is used in osteoarthritis because the inflammatory symptoms are milder.
  147. Viscosupplementation is a clinical procedure that is being increasingly used in the treatment of osteoarthritis and it involves the injection of ______ into an arthritic joint to help restore the normal viscosity of the synovial fluid.
    Hyaluronan

    Hyaluronan is a polysaccharide used to restore the lubricating properties of synovial fluid in osteoarthritic joints.
  148. Dietary supplements such as glucosamine and chondroitin sulfate may help protect articular cartilage and halt or reverse joint degeneration is osteoarthritis. However, patients with high rate of cartilage turnover may be more likely to experience positive effects from these supplements.




    C) Both statements are true.

    Glucosamine and chondroitin sulfate are key ingredients needed for the production of several components of articular cartilage and synovial fluid. These supplements will provide the necessary substrates to sustain joint turnover and maintain joint integrity.
  149. Range-of-motion and strengthening programs must be used judiciously in patients with rheumatoid arthritis taking glucocorticoids because of the anabolic effects of these drugs.
    False

    Glucocorticoids have catabolic affects on supporting tissues such as muscle, tendon, skin, and bone. Consequently, range-of-motion and strengthening programs must be used judiciously to avoid fractures and soft tissue injuries.
  150. Demand dose is a single large dose initially given to establish analgesia.
    False

    Loading dose is a single large dose initially given to establish analgesia.
  151. Demand dose is the amount of drug that is self-administered by the patient each time he or she activates the PCA delivery mechanism.
    True
  152. The PCA delivery system will deliver a drug every time the patient activates it.
    False

    After the patient self-administers a dose, the PCA delivery system will not deliver the next dose until the lockout interval has expired. Lockout interval is the minimum amount of time allowed between each demand dose.
  153. Background infusion refers to the small amount of analgesic infused continuously to maintain a low, background level of analgesia. It can maintain adequate analgesia even when patients are asleep or otherwise unable to activate the pump manually.




    C) Both statements are true.

    In background infusion, the patient will receive a larger amount of the drug (background infusion plus demand doses). Consequently, the use of background infusion has been discouraged, especially with opioids, because it can lead to respiratory depression.
  154. To determine if the PCA parameters are effective in providing adequate analgesia, we can compare the number of successful and total demands.
    True

    Successful demands occur when the patient activates the PCA delivery system and actually receives a demand dose of the drug. Demands made during the lockout interval are not considered successful, but are added to the number of successful demands to indicate the total demands. A large number of unsuccessful demands may indicate that PCA parameters are not effective in providing adequate analgesia.
  155. Although epidural administration can be used in certain situations, the intrathecal route seems to be the preferred method during PCS because it is safer and there is less risk of damaging the meninges.
    False

    Although intrathecal administration can be used in certain situations, the epidural route seems to be the preferred method during PCS because it is safer and there is less risk of damaging the meninges.
  156. Administration of drugs into the epidural space is more difficult to perform than into a peripheral vein. However, epidural delivery can provide more effective analgesia with a smaller amount of drug.




    D) Both statements are true.

    PCEA administers the drug closer and more directly to the spinal cord.
  157. PCTA is similar to phonophoresis techniques that use a small amount of ultrasound waves to facilitate transdermal delivery. PCTA, however, offers the additional benefit of allowing patients to activate drug delivery according to their specific needs.




    B) Only the second statement is true.

    PCTA is similar to iontophoresis techniques that use a small amount of electric current to facilitate transdermal delivery.
  158. Patient self-administers the medication directly into a specific anatomical site, providing adequate pain control with minimal effects on other tissues and organs




    A) Regional PCA
  159. Direct-acting cholinergic stimulants exert their effects by binding with the cholinergic receptor. Meanwhile, indirect-acting cholinergic stimulants exert their effects by inhibiting acetylcholinesterase enzyme.




    A) Both statements are true.
  160. True or False: The primary indirect-acting cholinergic stimulants currently in use an neostigmine and donepezil.
    False

    The primary indirect-acting cholinergic stimulants currently in use an neostigmine and pyridostigmine.
  161. All of the following are cholinergic stimulants used to treat glaucoma, except:




    D) Rivastigmine

    Rivastigmine is indicated for Alzheimer's type dementia. Meanwhile, physostigmine is also indicated for reversal of CNS toxicity caused by anticholinergic drugs. Other drugs used to treat glaucoma are Demecarium, Echothiophate, and Isoflurophate.
  162. All of the following cholinergic stimulants are used to treat myasthenia gravis, except:




    B) Physostigmine

    Physostigmine is used to treat glaucoma and to reverse CNS toxicity caused by anticholinergic drugs.
  163. All of the following cholinergic stimulants are used to manage Alzheimer's type dementia, except:




    B) Isoflurophate

    Isoflurophate is used to treat glaucoma.
  164. Which of the following is not an indirect-acting cholinergic stimulant?




    A) Pilocarpine

    Pilocarpine, Carbachol, and Berhanechol are classified as direct-acting cholinergic stimulants.
  165. Neostigmine and Bethanechol are both indicated for post-operative gastrointestinal and urinary atony. However, Neostigmine acts directly while Bethanechol acts indirectly to increase cholinergic transmission.




    C) Only the first statement is true.

    Neostigmine acts indirectly while Bethanechol acts directly to increase cholinergic transmission.
  166. True or False: Cholinergic stimulants are only effective in decreasing symptoms during the early stages of Alzheimer's disease.
    True

    Cholinergic stimulants may help decrease symptoms during the early stages of Alzheimer's disease by inhibiting acetylcholine breakdown, thus prolonging the effects of any acetylcholine released from neurons that are still functioning in the cerebral cortex. However, these drugs tend to lose their effectiveness as the disease progresses into the advanced stages because acetylcholine is not longer synthesized and released within the brain.
  167. True or False: Direct-acting and indirect-acting cholinergic stimulants used to treat glaucoma are usually applied topically to the eye because they will produce too many side effects if administered systematically.
    True
  168. True or False: Direct-acting cholinergic stimulants can be used to reverse neuromuscular blockade during general anesthesia.
    False

    Indirect-acting cholinergic stimulants can be used to reverse neuromuscular blockage during general anesthesia. They inhibit acetylcholinesterase enzyme at the neuromuscular junction, thus allowing endogenously released acetylcholine to remain active at the synaptic site and effectively overcome neuromuscular blockade until the curare-like agents have been metabolized.
  169. The following are indications of cholinergic stimulants, except:




    B) None of these

    Other indications are myasthenia gravis, reversal of neuromuscular blockade, and reversal of anticholinergic-induced CNS toxicity.
  170. All of the following are adverse effects of cholinergic stimulants, except:




    A) Decreased sweating

    It should be increased sweating. Other adverse effects are flushing, nausea, vomiting, diarrhea, increased salivation, and difficulty in visual accommodation.
  171. Prototypical antimuscarinic anticholinergic drug




    C) Atropine

    Atropine blocks the effect of vagus nerve on the myocardium. Therefore, this drug can be used to treat symptomatic bradycardia, atrioventricular nodal block, and ventricular asystole.
  172. True or False: Cholinergic stimulants can be used as adjuncts in treating peptic ulcers.
    False

    Anticholinergic drugs can be used as adjuncts in treating peptic ulcers because they can limit gastric acid secretion, reducing irritation of the stomach mucosa.
  173. True or False: Anticholinergic drugs can be used to treat irritable bowel syndrome.
    True

    Irritable bowel syndrome is characterized by hyperactivity of gastrointestinal smooth muscle. Therefore, anticholinergic drugs can be used in treating this condition, acting as antispasmodics.
  174. All of the following anticholinergic drugs can be used to manage Parkinson's disease, except:




    A) Homatropine

    Hopamotropine is indicated for peptic ulcer and irritable bowel syndrome.
  175. Scopolamine is an anticholinergic drug used to treat motion sickness. It is often administered orally.




    C) Only the first statement is true.

    Scopolamine is often administered transdermally via small patches that adhere to the skin.
  176. All of the following are clinical uses of anticholinergic drugs, except:




    C) None of these

    • Other clinical uses of anticholinergic drugs are:
    •  1. peptic ulcer
    •  2. irritable bowel syndrome
    •  3. cardiac arrhythmias
    •  4. antidote to cholinesterase inhibitor poisoning
    •  5. nocturnal enuresis
    •  6. motion sickness
    •  7. bronchodilator
    •  8. overactive/neurogenic bladder
  177. All of the following are adverse side effects of anticholinergic drugs, except:




    D) Urinary frequency

    It should be urinary retention. If anticholinergic drugs readily cross the blood-brain barrier, it may also cause confusion, dizziness, nervousness, and drowsiness, presumably because their interaction with CNS cholinergic receptors.
  178. All of the following are indications of alpha-1 agonists, except:




    B) None of these

    • Alpha-1 receptors are primarily found in vascular smooth muscles. Therefore, alpha-1 agonists can help treat the conditions above through the following mechanisms:
    •    1. Vasoconstriction increases peripheral vascular resistance and blood pressure.
    •    2. Vasoconstriction of vessels in nasal and upper respiratory mucosa decreases congestion and mucosal discharge. 
    •    3. Vasoconstriction increases peripheral vascular resistance, causing a reflex decrease in heart rate through cardiac baroreceptor reflex.
  179. Orally administered alpha-1 agonist which is used to treat resistance cases of orthostatic hypotension




    A) Midodrine (ProAmatine)

    Midorine and Methoxamine are administered by intramuscular or intravenous injection. Phenylephrine is also indicated for supraventricular tachycardia and nasal congestion.
  180. Orally administered alpha-1 agonist commonly used to help relieve cold symptoms




    A) Pseudoephedrine

    Oxymetazoline, Xylometazoline, Phenylephrine are used as nasal sprays.
  181. True or False: Alpha-2 agonists can be used to treat hypertension and spasticity.
    True
  182. Clonidine (Catapres) is an alpha-2 agonist. Which of the following is not true about this drug?




    D) It is effective in long-term management of hypertension.

    Clonidine (Catapres) has antihypertensive properties as it stimulates alpha-2 receptors in the vasomotor center of the brainstem and decreases sympathetic discharge to the heart and vasculature. However, it is usually not successful when used alone in long-term treatment of hypertension.
  183. All of the following are indications of beta-1 antagonists, except?




    A) Cardiac decompensation

    Cardiac decompensation is an indication for beta-1 agonists. Other indications for beta-1 antagonists are heart failure and prevention of reinfarction.
  184. True or False: Beta-2 antagonists can be used to prevent bronchospasm and premature labor.
    False

    Beta-2 agonists can be used to prevent bronchospasm and premature labor.
  185. Which of the following is incorrect about the use of dopamine (Intropin) as a cardiac medication?




    D) At moderate to high doses, dopamine can stimulate alpha-1 and beta-2 receptors.

    Dopamine can be used to treat cardiac decompensation. At moderate to high doses, this can stimulate alpha-1 (increased peripheral vascular resistance) and beta-1 receptors (increased cardiac output).
  186. Which of the following is incorrect about the use of Ritodrine (Yutopar) in preventing premature labor?




    D) Ritodrine is safe for the mother to take.

    Ritodrine is associated with increases in maternal heart rate and systolic blood pressure, as well as pulmonary edema. These changes in maternal cardiopulmonary function can be quite severe and may be fatal to the mother.
  187. Amphetamines increase activity at synapses with norepinephrine-sensitive receptors, namely alpha-1, alpha-2, and beta-2. This drug can be used to increase mental alertness in adults with narcolepsy.




    C) Only the second statement is true.

    It should be beta-1 receptors, not beta-2. This drug can be used to combat narcolepsy, but not normal sleepiness because it has high potential for abuse.
  188. Which of the following is correct about the clinical use of epinephrine (Adrenalin)?




    A) All of these

    • Epinephrine can directly stimulate all adrenergic receptor subtypes and is administered for a variety of reasons:
    •   1. Acts as an anti-asthmatic agent by stimulating the beta-2 receptors on the bronchi
    •   2. Controls bleeding and prolongs anesthetic effects by stimulating the vascular alpha-1 receptors
    •   3. Treats anaphylactic shock by stimulating the cardiac beta-1 receptors (increased cardiac output), vascular alpha-1 receptors (increased peripheral vascular resistance), and bronchial beta-2 receptors (bronchodilation)
  189. Norepinephrine can stimulate all adrenergic receptor subtypes. Meanwhile, epinephrine can only stimulate both types of alpha receptors.




    B) Both statements are false.

    Epinephrine can stimulate all adrenergic subtypes. Norepinephrine can stimulate both types of alpha receptors as well as beta-1 receptors, but displays little agonistic activity toward beta-2 receptors.
  190. Which of the following is incorrect about the clinical use of alpha-1 antagonists?




    A) They can be used during a hypertensive crisis.

    Alpha-1 antagonists are used when peripheral vasodilation would be beneficial. Therefore, these drugs should be used to prevent or treat autonomic/hypertensive crisis, not hypotensive crisis.

    Pheochromocytoma is a tumor that produces large quantities of epinephrine and norepinephrine. Hypertensive crisis may occur from excessive stimulation from catecholamines released from the tumor as it is being removed.

    Alpha-1 receptors located on smooth muscle in the prostate capsule, bladder neck, and urethra cause muscle constriction that restricts urine flow and ability to empty bladder.
  191. This drug is useful in treating high blood pressure in people with metabolic problems including various hyperlipidemias and glucose intolerance
    Doxazosin (Cardura)

    Doxazosin (Cardura) is alpha-1 selective, and promotes relaxation of smooth muscle in the vasculature and other tissues. In addition to hypertension, hyperlipidemia, and insulin resistance, this drug can also be used to treat benign prostatic hyperplasia.
  192. True or False: Phenoxybenzamine is a competitive alpha-1 blocker that binds irreversibly to the alpha-1 receptor.
    False

    Phenoxybenzamine is a competitive alpha-1 blocker that binds irreversibly to the alpha-1 receptor. This drug is used primarily to control blood pressure prior to and during the removal of pheochromocytoma; however, it is not used for the long-term management of hypertension as it produces reflex tachycardia. Other indications of this drug include treatment of BPH and vasospastic disease.
  193. Prazosin (Minipress) is a non-competitive alpha-1 antagonist primarily used in the long-term management of essential hypertension. This drug is administered orally.




    C) Only the second statement is true.

    Prazosin (Minipress) is a competitive alpha-1 antagonist which reversibly binds with the alpha-1 receptor.
  194. True or False: Alpha-1 antagonists can cause reflex bradycardia.
    False

    Alpha-1 antagonists tend to decrease blood pressure by decreasing the peripheral vascular resistance. As blood pressure falls, a compensatory increase in cardiac output is initiated via reflex tachycardia.
  195. Beta-1 selective drugs are also referred to as cardioselective because of their preferential effect on the myocardium. However, these drugs tend to be less beta-specific at higher doses.




    A) Both statements are true.
  196. Which of the following beta blockers is not cardioselective?




    A) Propanolol

    Other examples of cardioselective (beta-1 specific) beta blockers are Betaxolol and Bisoprolol.
  197. Which of the following beta-blockers are not non-selective?




    C) Bisoprolol

    Other examples of non-selective beta blockers are Carteolol, Penbutolol, Pindolol, Propanolol, and Sotalol.
  198. Non-selective beta blocker that exhibits the highest level of intrinsic sympathomimetic activity




    D) Pindolol
  199. Beta-blocker which has been used in prevention of vascular headache and as an adjunct to alpha blockers in treating pheochromocytoma




    B) Propanolol
  200. True or False: Atenolol and Metoprolol are both cardioselective beta blockers which are indicated for angina pectoris, hypertension, and prevention of reinfarction.
    True
  201. True or False: Non-selective beta blockers can adversely affect the pulmonary function of healthy individuals.
    False

    Beta-2 blockers can cause bronchoconstriction and increased airway resistance. Although these are not usually problematic in individuals with normal pulmonary function, patients with asthma, bronchitis, or emphysema may be adversely affected.
  202. Both guanedrel and guanethidine slowly replace norepinephrine stored in the presynaptic vesicles. Unlike guanethidine, guanedrel selectively affects post-ganglionic sympathetic adrenergic nerve terminals and does not affect release of norepinephrine from the adrenal medulla.




    A) Only the first statement is true.

    Unlike guanedrel, guanethidine selectively affects post-ganglionic sympathetic adrenergic nerve terminals and does not affect release of norepinephrine from the adrenal medulla.
  203. Diuretics can be used as antihypertensive agents because of their ability to increase renal excretion of water and sodium, thus decreasing the volume of fluid within the vascular system. Diuretics are often the first type of drugs used to treat hypertension.




    D) Both statements are true.
  204. Segment of the nephron where thiazide diuretics exert their action?




    C) Early portion of DCT

    Thiazide diuretics inhibit sodium reabsorption, so more sodium is retained within the nephron, creating an osmotic force that also retains more water in the nephron. Thiazides are the most frequently used type of diuretics for hypertension.
  205. Which specific segment of the loop of Henle do loop diuretics act on?




    D) Thick ascending limb

    Loop diuretics inhibit reabsorption of sodium and chloride from the nephron by interfering the Na+/K+/2Cl– co-transporter.
  206. Potassium-sparing diuretics reduce potassium loss, preventing hypokalemia. Therefore, these drugs are considered superior to loop and thiazide diuretics.




    A) Only the first statement is true.

    Potassium-sparing diuretics prevents sodium reabsorption and potassium secretion by inhibiting the Na+/K+ exchange found in the distal tubule. Although these diuretics have the advantage of preventing hypokalemia, they do not produce a diuretic effect to the same extent as the loop and thiazide diuretics.
  207. All of the following are mechanism by which beta blockers decrease blood pressure, except:




    D) Decreased peripheral vascular resistance

    Decreased peripheral vascular resistance is more likely caused by alpha-1 blockers.
  208. Which of the following is not true about beta blockers?




    C) None of these
  209. True or False: Among the alpha-1 blockers, Clonidine appears to have less cardiovascular side effects (e.g. reflex tachycardia) because it acts longer and do not cause a sudden fall in blood pressure.
    False

    It should be doxazosin, not clonidine. Clonidine is also an anti-hypertensive agent, but it is an alpha-2 agonist.
  210. Alpha blockers can be used as stand-alone medications in treating hypertension. They are also the first choice for managing mild to moderate hypertension.




    C) Both statements are false.

    Alpha blockers can predispose certain patients to heart failure and other cardiac events (e.g. stroke, infarction). Hence, they are not typically prescribed alone in treating hypertension, but are used in advanced cases along with diuretics, beta blockers, or ACE inhibitors.
  211. All of the following drugs are presynaptic adrenergic inhibitors, except?




    B) Prazosin

    Prazosin is an alpha-1 antagonist. Reserpine decreases blood pressure by inhibiting presynaptic synthesis and storage of norepinephrine in peripheral and CNS adrenergic neurons. Meanwhile, guanadrel and guanethidine replace norepinephrine in peripheral sympathetic neurons, creating a false neurotransmitter.
  212. True or False: Centrally acting agents limit sympathetic activity at the brainstem vasomotor center rather than at the cardiovascular neuroeffector junction.
    True

    Examples of centrally acting agents are clonidine,guanfacine, guanabenz, monoxidine, and rilmenidine. Clonidine, guanfacine, and guanabenz stimulate alpha-2 receptors; whereas, monoxidine and rilmenidine stimulate imidazoline receptors in the brainstem.
  213. Sympatholytic agents which can be used to decrease blood pressure rapidly in certain emergencies such as acute aortic dissection or autonomic crisis in people with spinal cord injury




    D) Ganglionic blockers

    Ganglionic blockers are essentially nicotinic cholinergic antagonists, which block transmission at the junction between presynaptic and postsynaptic neurons in sympathetic and parasympathetic pathways. Because of their effect on both division of the autonomic nervous system, these drugs are used sparingly in treating hypertension.
  214. Minoxidil is one of the primary vasodilators used in treating hypertension. However, most women discontinue the use of this drug due to its associated increase in hair growth.




    C) Both statements are true.
  215. ACE inhibitors and angiotensin II blockers have lower incidence of cardiovascular side effects such as reflex tachycardia and orthostatic hypotension compared to other anti-hypertensives. However, these drugs do not have an effect on vascular hypertrophy and remodeling.




    D) Only the first statement is true.

    ACE inhibitors and angiotensin II blockers have the ability to inhibit angiotensin II-induced vascular hypertrophy and remodeling, which is an important benefit in treating hypertension.
  216. Which of the following is not true about ACE inhibitors?




    B) Some patients may develop anemia and agranulocytosis.

    Some patients may develop neutropenia, not anemia. Although the incidence is rare, ACE inhibitors may cause hematologic and renal problems. Therefore, these drugs should be used cautiously in patients with pre-existing blood or kidney diseases.
  217. Which of the following is not an adverse side effect of calcium channel blockers?




    A) None of these

    Other adverse side effects of calcium channel blockers are orthostatic hypotension, dizziness, and nausea.
  218. Which of the following drug classes is not included in step 1 of stepped-care approach to hypertension?




    B) Alpha-1 blockers

    Alpha-1 blockers is included in step 2. Step 1 of the stepped-care approach to hypertension states that: "In patients with mild hypertension, drug therapy is usually initiated with a single agent (monotherapy) from one of the following classes: a diuretic, a beta blocker, an ACE inhibitor, or a calcium channel blocker."
  219. Which of the following is incorrect about the Step 2 of the stepped-care approach to hypertension?




    B) The second drug can be from a second group that includes: centrally acting agents, presynaptic adrenergic inhibitors, alpha-2 blockers, and vasodilators.

    It should be alpha-1 blockers, not alpha-2 blockers. Drug classes included in step 1 are diuretics, beta blockers, calcium channel blockers, and ACE inhibitors.
  220. True or False: In step 3 of stepped-care approach to hypertension, three different agents from three different classes are administered concurrently.
    True
  221. A stepped care approach is an effective way to use different types of antihypertensive drugs. It involves how many steps?




    D) 4

    There are 4 steps, with each step having a corresponding number of drugs. For example, step 1 involves one drug; step 2 involves two drugs, and so forth.
  222. Nitrates are drug precursors (prodrugs) that become activated when they are converted to nitric oxide within the vascular smooth muscle. These drugs decrease myocardial oxygen demand by decreasing both the cardiac preload and afterload.




    A) Both statements are true.

    Nitrates produces general vasodilation in the vasculature throughout the body. By dilating the systemic venous system, nitrates decrease the amount of blood returning to the heart (cardiac preload). By dilating the systemic peripheral arterioles, nitrates decrease the pressure against which the heart must pump (cardiac afterload).
  223. All of the following organic nitrates can be administered orally, except:




    B) Amyl nitrite

    Amyl nitrite is administered through inhalation.
  224. Which of the following routes of administration is suitable for nitroglycerin?




    D) All of these

    Nitroglycerin can also be administered orally or using an ointment.
  225. Among the possible routes for nitroglycerin administration, which has the fastest onset of action?




    D) Sublingual/lingual

    Route Onset of Action
    Oral 20-45 minutes
    Buccal 2-3 minutes
    Sublingual/lingual 1-3 minutes
    Ointment 30 minutes
    Transdermal patches within 30 minutes
  226. Among the possible routes for nitroglycerin administration, which has the longest duration of action?




    A) Transdermal

    Route Duration of Action
    Oral 4-6 hours
    Buccal 3-5 hours
    Sublingual/lingual 30-60 minutes
    Ointment 4-8 hours
    Transdermal patches 8-24 hours
  227. Which of the following organic nitrates has the fastest onset of action, but the shortest duration of action?




    C) Amyl nitrite

    Amyl nitrite's onset of action is 30 seconds and its duration of action is 3-5 minutes.
  228. Isosorbide mononitrate can be administered orally and sublingually. On the other hand, isosorbide dinitrate can only be administered orally.




    B) Both statements are false.

    • Isosorbide dinitrate
    • Route Onset of Action Duration of Action
      Oral 15-40 minutes 4-6 hours
      Oral (extended release) 30 minutes 12 hours
      Chewable 2-5 minutes 1-2 hours
      Sublingual 2-5 minutes 1-2 hours

    • Isosorbide mononitrate
    • Route Onset of Action Duration of Action
      Oral 30-60 minutes 6-8 hours
  229. True or False: Nitrates relieve angina by decreasing myocardial oxygen demand instead of increasing myocardial oxygen supply.
    True
  230. Best route of nitroglycerin administration  when treating an acute attack of angina




    B) Sublingual

    With sublingual administration, the drug is rapidly absorbed through the oral mucosa into the systemic circulation. In addition, the drug is spared from the first-pass effect of the liver.
  231. Nitroglycerin patches help prevent the onset of anginal episodes by providing fairly continuous and sustained drug administration. However, these patches can cause drug tolerance, reducing the drug's effectiveness.




    B) Both statements are true.

    Drug tolerance associated with nitroglycerin patches can be prevented by wearing the patch for 12 to 14 hours followed by a 10- to 12-hour nitrate free interval.
  232. For acute attacks, isosorbide dinitrate is administered orally. For prevention of angina, it is administered sublingually, bucally, or by chewable tablets.




    B) Both statements are false.

    For acute attacks, isosorbide dinitrate is administered sublingually, buccally, or by chewable tablets. For prevention of angina, it is administered orally.
  233. Beta blocker suitable for patients with angina who also have hypertension




    C) Carvedilol

    Carvedilol produces peripheral vasodilation, making it an anti-anginal agent as well.
  234. Which of the following calcium channel blockers does not have negative chronotropic effect?




    D) Nifedipine

    Nifedipine and other dihydropyridines are associated with reflex tachycardia (compensatory response to decreased peripheral vascular resistance) because these drugs do not have negative chronotropic effect (inhibitory effect on heart rate).
  235. True or False: Diltiazem and verapamil can be used in conjunction with beta blockers.
    False

    Diltiazem and verapamil are calcium channel blockers which have negative chronotropic effect (decreased heart rate) and negative inotropic effect (decreased myocardial contractility). Therefore, bradycardia can be worsened by beta blockers.
  236. Nifedipine and other dihydropyridines may be associated with increased risk of myocardial infarction in certain patients. However, this is only applicable when using short-acting or immediate-release form of these drugs.




    A) Both statements are true.

    Short-acting or immediate-release form of nifedipine and other dihydropyridines causes a fairly rapid decrease in peripheral vascular resistance and blood pressure. These can precipitate reflex hemodynamic changes such as increased heart rate and decreased myocardial perfusion, leading to ischemia or even infarction in susceptible patients/ Therefore, longer-acting or sustained-release form is safer to use.
  237. Which of the following is incorrect about stable angina?




    B) Calcium-channel blocker or long-acting nitrate is often used to prevent attacks.

    Beta blocker or long-acting nitrate is often used to prevent attacks.
  238. Which of the following is not a characteristic of variant (prinzmetal) angina?




    C) This type of angina occurs when myocardial oxygen demand exceeds oxygen supply.

    Stable angina occurs when myocardial oxygen demand exceeds oxygen supply. It is the most common form of ischemic heart disease.
  239. Which of the following does not describe unstable angina?




    C) Thrombolytics may be helpful in preventing thrombogenesis and coronary occlusion.

    Anticoagulant and antiplatelet therapy may be helpful in preventing thrombogenesis and coronary occlusion. Anticoagulants are often administered in the early stages of unstable angina, with antiplatelet drugs being continued indefinitely.  

    Unstable angina is often a precursor to acute myocardial infarction; therefore, it is regarded as the most serious and potentially dangerous form of angina.
  240. True or False: If patients do not respond to a single calcium channel blocker, nitroglycerin may be added for management of severe variant angina.
    False

    If patients do not respond to a single calcium channel blocker, long-acting nitrates (e.g. isosorbide dinitrate, isosorbide mononitrate) may be added for management of severe variant angina.
  241. Class IA sodium channel blockers produce moderate slowing of phase 0 depolarization and a moderate slowing of action potential propagation throughout the myocardium. However, these drugs shorten cardiac repolarization by decreasing the effective refractory period. 




    A) Only the first statement is true.

    Class IB sodium channel blockers shorten cardiac repolarization by decreasing the effective refractory period. Class IA sodium channel blocker prolong cardiac repolarization by increasing the effective refractory period.
  242. Class IC sodium channel blockers produce a marked decrease in the rate of phase 0 depolarization and a marked slowing of cardiac conduction. However, they have little effect on repolarization.




    A) Both statements are true.

    Class IC sodium channel blockers are best suited to treat ventricular arrhythmias such as ventricular tachycardia and PVCs. However, class IB is used for more severe cases.
  243. Which of the following drugs is not included in class IB sodium channel blockers?




    B) Quinidine

    Quinidine, procainamide, and disopyramide are class IA sodium channel blockers.
  244. True or False: While attempting to control one type of arrhythmia, sodium channel blockers can aggravate or initiate other cardiac rhythm abnormalities
    True

    Patients with heart failure, myocardial ischemia, and structural heart disease (including previous infarction) seem to be especially prone to class I–induced arrhythmias, and these drugs should be avoided in these patients.
  245. Anti-arrhythmic drugs most effective in treating atrial tachycardia




    A) Beta blockers
  246. Class III anti-arrhythmic drugs prolong repolarization by inhibiting potassium efflux during phase 1 and 2 of cardiac action potential. These drugs are used to treat both atrial and ventricular arrhythmias and are relatively safer compared to class I drugs.




    B) Only the second statement is true.

    Class III anti-arrhythmic drugs prolong repolarization by inhibiting potassium efflux during phase 2 (plateau) and 3 (rapid repolarization) of cardiac action potential.
  247. Class III anti- arrhythmic drug associated with pulmonary and hepatic toxicity




    D) Amiodarone
  248. Form of fatal ventricular tachycardia associated with class III anti-arrhythmic drugs
    Torsades de pointes
  249. Diltiazem and verapamil are calcium channel blockers currently approved for treating arrhythmias. Nifedipine and other dihydropyridines do not have any substantial effects on cardiac rhythm.




    B) Both statements are true.

    Nifedipine and other dihydropyridines are more effective in dilating vascular smooth muscles and are used more frequently to treat hypertension and angina pectoris.
  250. Digitalis helps in decreasing symptoms of congestive heart failure by inducing a negative inotropic effect. This effect is due to elevated intracellular calcium levels, which facilitates actin-myosin interaction in cardiac cells.




    D) Only the second statement is true.

    Digitalis helps in decreasing symptoms of congestive heart failure by inducing a positive inotropic effect.
  251. All of the following are signs and symptoms of digitalis toxicity, except:




    D) None of these

    • The following are signs and symptoms of digitalis toxicity:
    •   1. Gastrointestinal distress (e.g. anorexia, nausea, vomiting, abdominal pain)
    •   2. Visual disturbances (e.g. halos, photophobia, problems with color perception, scotomata)
    •   3. CNS effects (e.g. headache, confusion, delirium, psychosis, fatigue, weakness)
    •   4. Cardiac effects (e.g. ventricular arrhythmias, premature ventricular contractions, AV blocks, sinus bradycardia)
  252. The following are positive inotropes used in treatment of congestive heart failure, except:




    A) None of these

    All of these are positive inotropes. Inamrinone enhances myocardial contractility via cAMP-mediated increase in intracellular calcium; whereas dopamine enhances myocardial contractility by stimulating cardiac beta-1 receptors.
  253. This is the first drug to be shown to prolong the life span of people with congestive heart failure




    D) ACE inhibitors

    ACE inhibitors inhibit the formation of angiotensin II. Angiotensin II promotes vasoconstriction, hypertrophy of vascular tissues, aldosterone secretion, and bradykinin breakdown; so inhibiting its formation would result in decreased cardiac workload, particularly the afterload.
  254. ARBs are as effective as ACE inhibitors in treating heart failure and preventing mortality. However, combining an ARB with an ACE inhibitor might provide more benefits than using either drug alone.




    C) Both statements are true.
  255. True or False: Beta blockers should not be used in treating heart failure because they decrease myocardial contractility.
    False

    Although beta blockers decrease myocardial contractility, these drugs attenuate the excessive sympathetic activity associated with heart failure. Increased sympathetic activity and other neurohumoral changes often contribute to the vicious cycle associated with heart failure, and excessive sympathetic activity stimulation can accelerate the pathologic changes in the failing heart.
  256. Anti-thrombotic drugs are administered for the acute treatment of venous thrombosis and thromboembolism. These drugs may also be given prophylactically to individuals who are at high risk to develop venous thrombosis.




    A) Both statements are false.

    It should be anticoagulants, not anti-thrombotic drugs. Anticoagulants are used to primarily prevent clot formation in the venous system; whereas anti-thrombotic drugs are used to primarily prevent thrombus formation in arteries.
  257. Warfarin accelerates the anti-thrombin III-induced inactivation of clotting factors, reducing the tendency for clotting and thrombogenesis. This drug is a large, sugar-like molecule that is poorly absorbed from the gastrointestinal tract, so it must be administered parenterally.




    B) Both statements are false.

    It should be heparin, not warfarin.
  258. Low molecular weight heparins (LMWHs) can be administered by subcutaneous injection, decreasing the need for repeated intravenous administration. In addition, the anticoagulant effects of these drugs are more predictable, reducing or even eliminating the need for laboratory monitoring of clotting time indicators.




    C) Both statements are true.

    For the above reasons, the use of traditional (unfractionated) heparin has been replaced by LMWHs to a large extent.
  259. Coumadin drugs block the conversion of vitamin K epoxide to vitamin K, thus impairing the synthesis of clotting factors III, VII, IX, and X. However, these drugs often have a lag time of several days before the decreased production of clotting factors is sufficient to interrupt the clotting cascade.




    C) Only the second statement is true.

    In the liver, vitamin K acts a catalyst in the final step of the synthesis of clotting factors II, VII, IX, and X.
  260. True or False: Anticoagulant therapy often begins with parenteral administration of heparin, followed by oral administration of warfarin.
    True

    Heparin is administered for the first few days to achieve an immediate anticoagulant effect. Warfarin is then initiated, and heparin is discontinued after warfarin has had time to exert its anticoagulant effect.
  261. Heparin-induced thrombocytopenia can be asymptomatic and resolve spontaneously (type I HIT), or it can be severe (type II HIT). Type II HIT is mediated by an immune reaction which leads to increased thrombosis in vascular tissues throughout the body.




    C) Both statements are true.

    HIT is less common with LMWHs than unfractionated heparin.
  262. This drug suppresses platelet aggregation by inhibiting the synthesis of prostaglandins and thromboxanes




    C) Aspirin
  263. True or False: Antithrombotic effects can be achieved at remarkably low doses of aspirin because this drug inhibits platelet function irreversibly.
    True

    When aspirin reaches a given platelet, that platelet is inhibited for the remainder of its lifespan, which is about 7-8 days.
  264. True or False: Aspirin may help prevent types of stroke caused by cerebral ischemia and infarction, but it may also increase the risk of hemorrhagic stroke.
    True

    Aspirin is an anti-thrombotic which inhibits platelet-induced thrombus formation.
  265. Anti-thrombotic drugs which are considered as the most powerful inhibitors of platelet activity and are used primarily to maintain blood flow during balloon angioplasty and other percutaneous coronary interventions




    C) GP IIb-IIIa inhibitors

    Examples of GP IIb-IIIa inhibitors are abciximad, eptifibatide, and tirofiban.
  266. Thrombolytics facilitate the breakdown and dissolution of clots that have already formed, thus reopening the occluded blood vessels. These drugs work by converting profibrinolysin to fibrinolysin.




    A) Both statements are true.

    Profibrinolysin and fibrinolysin are other terms for plasminogen and plasmin respectively.
  267. When thrombolytics are administered within 12 hours after infarction onset, these drugs can re-establish blood flow through occluded coronary vessels, often preventing or reversing myocardial damage. The intracoronary route is a much more practical method of thrombolytic administration because it is easier, faster and safer than intravenous route.




    A) Only the first statement is true.

    The intravenous route is a much more practical method of thrombolytic administration because it is easier, faster and safer than intracoronary route.
  268. True or False: Thrombolytics can also be used to treat ischemic stroke; however, the window of opportunity for administration is smaller compared to myocardial infarction.
    True

    Thrombolytics must be typically administered within 3 hours after cerebral infarction and within 12 hours after myocardial infarction.
  269. The following are indications of thrombolytics, except:




    B) None of these
  270. Urokinase is a thrombolytic which directly converts plasminogen to plasmin by enzymatically cleaving a peptide bond within the plasminogen molecule. This drug is the most commonly used type of thrombolytic because it is relatively inexpensive and has lower incidence of intracranial hemorrhage.




    C) Only the first statement is true.

    Streptokinase, not urokinase, is the most commonly used type of thrombolytic because it is relatively inexpensive and has lower incidence of intracranial hemorrhage.
  271. Tissue plasminogen activator (t-PA) is more effective than other thrombolytics in its ability to initially reopen cerebral vessels. Therefore, this drug is often used preferentially during ischemic stroke.




    B) Both statements are true.
  272. Treatment of hemophilia involves administration of the missing clotting factor on a regular basis or during an acute hemorrhagic episode. The primary source of clotting factors is the human blood extract, so patients receiving exogenous factors are at risk of acquiring hepatitis A or HIV infection.




    C) Only the first statement is true.

    It should be hepatitis B, not hepatitis A.
  273. Which of the following is incorrect about vitamin K?




    B) Vitamin K is administered to newborns for the first 8-10 days following their birth because they lack intestinal bacteria necessary to synthesize vitamin K.

    It should be 5-8 days following birth, not 8-10 days.
  274. Aminocaproic acid and tranexamic acid are administered to treat hyperfibrinolysis or to prevent clot breakdown in patients with hemophilia who are undergoing surgery. These drugs inhibit the activation of fibrinogen into fibrin, an enzyme responsible for breaking down fibrin clots.




    A) Only the first statement is true.

    These drugs inhibit the activation of plasminogen (profibrinolysin) into plasmin (fibrinolysin), an enzyme responsible for breaking down fibrin clots. Fibrin is a clotting factor derived from activation of fibrinogen by thrombin.
  275. True or False: Certain lipoproteins are considered beneficial because they decrease the formation of atherosclerotic plaques  by removing cholesterol from the arterial wall.
    True

    These beneficial lipoproteins are known as high-density lipoproteins (HDLs) because of their relatively large amount of protein in the complex.
  276. Statin drugs treat hyperlipidemia by inhibiting HMG-CoA reductase, an enzyme that catalyzes cholesterol synthesis, especially in the liver cells. Decreased hepatic cholesterol synthesis creates more surface receptors for HDL cholesterol to be synthesized, thereby increasing their breakdown.




    D) Both statements are true.

    It should be LDL cholesterol, not HDL. HMG-CoA stands for 3-hydroxy-3-methylglutaryl coenzyme A.
  277. True or False: Fibrates are helpful in treating mixed hyperlipidemias which include increased triglycerides and HDL levels along with decreased LDL levels.
    False

    Fibrates are helpful in treating mixed hyperlipidemias which include increased triglycerides and LDL levels along with decreased HDL levels.
  278. True or False: Cholestyramine (Questran), a drug which attaches to bile acids within the gastrointestinal lumen and increases the fecal excretion of these acids, can be used to treat hyperlipidemia.
    True

    Increased fecal excretion of bile acids leads to decreased plasma cholesterol concentration because cholesterol breakdown is accelerated to replace the bile acids that are lost in the feces. Cholestryamine is also useful in treating diarrhea caused by excess bile acid secretion.
  279. True or False: Niacin (vitamin B2) may be used in treating hyperlipidemia as it binds to nicotinic acid receptors in fat cells to decrease lipid synthesis and increase lipolysis.
    False

    Niacin is vitamin B3. Riboflavin is vitamin B2.
  280. The following are risk factors for statin-induced myopathy, except:




    D) None of these
  281. True or False: Antitussives are helpful in treating an active and productive cough.
    False

    Antitussives inhibit the cough reflex, a defense mechanism that can help expel mucus and foreign material from the upper respiratory tract.
  282. True or False: Codeine and similar opiate derivatives can be used as an antitussive as they inhibit the cough reflex by a direct effect on brainstem cough center.
    True

    Dextromethorphan is a non-opioid antitussive which also inhibits cough reflex by directly acting on the brainstem cough center.
  283. True or False: Non-opioid antitussives work by inhibiting the irritant effects of histamine on the respiratory mucosa or by a local anesthetic action on the respiratory epithelium.
    True

    An example of a local anesthetic which can also be used as an antitussive is benzonatate. Meanwhile, diphenhydramine is an antihistamine which also acts as an antitussive.
  284. Decongestants work by binding to alpha-1 receptors located on the blood vessels of the nasal mucosa and stimulating vasoconstriction. Excessive use or abuse of decongestants should be avoided as they can cause serious cardiovascular and central nervous system excitation.




    D) Both statements are true.

    Adverse effects associated with decongestants are headache, dizziness, nervousness, nausea, increased blood pressure, and palpitations.
  285. Ephedrine and pseudoephedrine are decongestants that are administered orally. Oxymetazoline and phenylephrine are decongestants administered as nasal sprays.




    B) Both statements are true.
  286. Antihistamine drugs used to treat hypersensitivity (allergic) reactions specifically block which receptor subtype?




    B) H1
  287. Newer "second-generation" antihistamines are more selective for the H1 receptor subtype, thus producing fewer side effects related to other histamine receptors. However, older "first-generation" antihistamines are associated with less CNS-related side effects as they do not easily cross the blood-brain barrier.




    B) Only the first statement is true.

    Older "first-generation" antihistamines are associated with more CNS-related side effects as they easily cross the blood-brain barrier.
  288. True or False: Newer "second-generation" nonsedating antihistamines are associated with cardiotoxicity and severe ventricular arrhythmias (torsades de pointes).
    True

    Examples of these drugs are astemizole and terfenadine.
  289. Which of the following is incorrect about acetylcysteine?




    C) It can be administered directly to the respiratory mucosa by inhalation or intratracheal instillation (through a cricothyrotomy).

    It should be tracheostomy, not cricothyrotomy.
  290. Which of the following is not true about guaifenesin?




    B) None of these
  291. True or False: When administered via inhalation, the issue of adrenergic receptor selectivity of beta agonists becomes less important because the drug is applied directly to the respiratory tissues that primarily contain the beta-2 subtype.
    True

    Inhalation of beta agonists is often the preferred method of administration in treating respiratory disorders because there is rapid onset of action and fewer associated systemic side effects.
  292. Oral or subcutaneous administration of beta agonists is usually associated with more systemic side effects. However, when administered orally or subcutaneously, beta agonists may reach the more distal branches of the airway to a greater extent.




    A) Both statements are true.

    The bronchioles are usually constricted during an asthma attack, and beta agonist may not reach the distal respiratory passages when administered by inhalation.
  293. True or False: Nebulizers are more effective than metered-dose inhalers in treating asthma because they provide a fine mist and a longer time for administration, enabling better delivery of the drug to the more distal bronchioles.
    False

    Therapeutic benefits from nebulizers and metered-dose inhalers seem to be equivalent if the patient uses either device appropriately.
  294. All of the following are true regarding the adverse effects of beta agonists, except:




    B) The use of nonselective beta agonists may cause sedation.

    The use of nonselective beta agonists may stimulate CNS adrenergic receptors, producing symptoms of nervousness, restlessness, and tremor.
  295. This xanthine bronchodilator works by inhibiting phosphodiesterase, an enzyme which breaks down cAMP and produces inflammatory mediators




    B) Theophylline

    cAMP is the second messenger which brings about respiratory smooth-muscle relaxation and subsequent bronchodilation.
  296. True or False: Signs of theophylline toxicity may occur in some patients even when blood levels are in the therapeutic range.
    True

    Theophylline toxicity may appear when plasma levels are between 15 and 20 µg/mL. Because the recommended levels are between 10 and 20 µg/mL, signs of toxicity may occur in some patients even when blood levels are in the therapeutic range. When blood levels exceed 20µg/mL, serious toxic effects such as cardiac arrhythmias and seizures may occur.
  297. The following factors predispose a patient to theophylline toxicity, except:




    D) None of these

    Other factors for theophylline toxicity are patient age (older than 55), liver disease, and alcohol consumption.
  298. The primary factors that mediate bronchoconstriction in emphysema and chronic bronchitis appear to be decreased sympathetic tone and acetylcholine release. Therefore, cholinergic agonists are often the drug of choice in treating COP.




    C) Both statements are false.

    Bronchoconstriction results from increased vagal tone and acetylcholine release. Therefore, cholinergic antagonists are the drug of choice in treating COPD.
  299. True or False: Anticholinergics are typically the first-line treatment for asthma.
    False

    Anticholinergics are not typically the first-line treatment of asthma because the primary pathophysiological feature of asthma is airway inflammation rather than increased vagal tone. Examples of anticholinergic bronchodilators are ipratropium and tiotropium. Ipratropium is poorly absorbed in the systemic circulation and can be administered by an aerosol inhaler. Tiotropium is similar to ipratropium, but with longer lasting effects.
  300. Most effective agents in controlling asthma




    B) Glucocorticoids

    Glucocorticoids (corticosteroids)directly affect the genes and transcription factors that produce inflammatory components (e.g. cytokines, prostaglandins, and leukotrienes). In addition, these  drugs reverse the increased vascular permeability and inhibit the migration of neutrophils and monocytes that occur during an inflammatory response.
  301. During status asthmaticus, glucocorticoids are usually administered intravenously. However, these drugs are administered orally or by inhalation for more prolonged use.




    B) Both statements are true.

    As with beta agonists, the inhaled route is preferable because of the decrease chance of systemic side effects. Glucocorticoids that are currently available via inhalation include beclomethasone, budesonide, flunisolide, and triamcinolone.
  302. Cromones such as cromolyn sodium and nedocromil sodium can be used during an asthma attack. These drugs work by inhibiting the release of inflammatory mediators such as histamine and leukotrienes from pulmonary mast cells.




    B) Only the second statement is true.

    Cromones are not bronchodilators and will not reverse bronchoconstriction during an asthma attack. Instead, these drugs prevent bronchoconstriction by inhibiting the release of inflammatory mediators from pulmonary mast cells. Hence, they must only be administered prophylactically to prevent asthma attacks that are initiated by specific, well-defined activities.
  303. True or False: Leukotriene inhibitors work either by inhibiting the cyclooxygenase enzyme or blocking the receptors for leukotrienes on respiratory tissues.
    False

    Leukotrienes are derived from the same precursor as prostaglandins (arachidonic acid), but leukotrienes are synthesized by the lipooxygenase enzyme rather than the cyclooxygenase enzyme. Therefore, leukotrience inhibitors work by inhibiting the lipooxygenase enzyme, not the cyclooxygenasr enzyme. 

    Montelukast and zafirlukast work by blocking the leukotriene receptors, whereas zileuton works by inbiting the lipooxygenase enzyme.
  304. Glucocorticoids are associated with catabolic effects, especially if they are taken at high doses or for prolonged time. However, these adverse effects may be reduced by combining a glucocorticoid and an anti-leukotriene.




    C) Both statements are true.

    An anti-leukotriene, when combined with a glucocorticoid, may enhance the latter's anti-inflammatory properties. This results to glucocorticoid sparing effect, wherein lower doses of glucocorticoids are needed to achieve therapeutic benefits.
  305. The following drugs can be used in managing cystic fibrosis, except:




    D) None of these

    Cystic fibrosis is an autosomal recessive condition characterized by thick, viscous secretions which often form mucous plugs. These mucous plugs may obstruct bronchioles. Therefore, pharmacologic management of respiratory problems in cystic fibrosis is focused on maintaining airway patency.
  306. True or False: Aerosol preparations that contain deoxyribonucleases may help decrease the viscosity of respiratory secretions in patients with cystic fibrosis.
    True

    Respiratory secretions in patients with cystic fibrosis often contain large amounts of DNA because the genetic material contained in airway inflammatory cells is deposited into the airway lumen when these cells are destroyed. DNA increases the viscosity of the respiratory secretions, and preparations that contain recombinant human deoxyribonuclease can lyse this DNA.
  307. Antacids contain a base such as carbonate or hydroxide combined with aluminum, magnesium, or calcium. The base combines with excess hydrogen ions in the stomach to decrease intragastric pH.




    C) Only the first statement is true.

    It should be to increase intragastric pH, not decrease.
  308. Which of the following is not true regarding the adverse side effects of antacids?




    A) Sodium bicarbonate-containing antacids are associated with acid-rebound phenomenon.

    Calcium-containing antacids, not sodium bicarbonate-containing antacids, are associated with acid-rebound phenomenon. That is, acid production may increase because antacids increase the pH of the gastric fluids, which serves as the normal stimulus for increased acid secretion. This does not present a problem while the antacid is in the stomach, because most of the excess acid will be neutralized. Gastric secretion may remain elevated, however, even after the antacid effects diminish and stomach pH returns to normal levels.
  309. First H2 blocker to be widely used as an antiulcer agent




    C) Cimetidine
  310. The following are indications for H2 blockers, except:




    B) None of these

    H2 blockers prevent the histamine-activated release of gastric acid under basal conditions and during stimulation by food and other factors.
  311. Drug of choice for long-term treatment of patients with gastric and duodenal ulcers and GERD




    A) Proton pump inhibitors
  312. Helicobacter pylori is a gram-positive bacterium often present in the upper GI tract in people with gastric ulcer disease. Treatment of H. pylori infection may involve "triple therapy" which consists of two antibacterials (amoxicillin and clarithromycin) and one PPI.




    B) Only the second statement is true.

    Helicobacter pylori is a gram-negative bacteria, not gram-positive. Alternatively, treatment of this infection may involve "quadruple therapy" which consists of bismuth compound, two antibacterials, and PPI.
  313. Anticholinergics can also be used in treating peptic ulcers because they decrease the release of gastric acid by the stomach parietal cells. However, these agents are rarely used because they are associated with multiple systemic side effects such as dry mouth, diarrhea, urinary incontinence, and confusion.




    B) Only the first statement is true.

    Anticholinergics are associated with constipation and urinary retention, not diarrhea and urinary incontinence.
  314. Which of the following is incorrect about metoclopramide?




    A) It is associated with psychotic symptoms.

    Metoclopramide is associated with extrapyramidal symptoms, not psychotic symptoms, because of its central antidopamine effects.

    This drug stimulates motility in the upper GI tract, which may be useful in moving the stomach contents toward the small intestine, thus decreasing the risk of gastric acid moving backward into the esophagus.
  315. Misoprostol is a prostaglandin analog which works as an anti-ulcer agent by stimulating gastric mucus secretion. This drug is typically reserved for the treatment of gastric damage caused by aspirin and similar NSAIDs.




    B) Both statements are true.
  316. True or False: Sucralfate exerts a cytoprotective effect on the stomach mucosa by forming a protective gel within the stomach that adheres to ulcers and shields them from stomach contents.
    True

    The protective barrier formed by sucralfate prevents further erosion and permits healing of duodenal and gastric ulcers.
  317. Opioids work as antidiarrheal agents by exerting antiperistaltic effects either by binding to neuronal receptors on the enteric nerve plexus within the gut wall or by directly affecting the GI epithelial and smooth muscle cells. In particular, the delta subtype of the opioid receptor mediates the GI effects of opioids.




    D) Only the first statement is true.

    The mu subtype, not the delta subtype, of the opioid receptor mediates the GI effects of opioids.

    Opium tincture and camphorated opium tincture are naturally occurring opiates that are very potent inhibitors of peristalsis. However, these agents have been essentially replaced by newer opioids such as diphenoxylate and loperamide which are less potent but produce fewer side effects.
  318. True or False: Adsorbents can be used to treat diarrhea because they sequester harmful products (e.g. toxins and bacteria) in the intestinal lumen that cause the diarrhea.
    True

    Adsorbents are essentially free from side effects, but constipation may follow prolonged or excessive use.
  319. Which of the following is not true about bismuth salicylates?




    B) The bismuth component of this drug inhibits prostaglandin production, while the salicylate component have antibacterial effects.

    The bismuth component of this drug have antibacterial effects, while the salicylate component may inhibits prostaglandin production.
  320. Which of the following is not an indication of laxatives?




    C) Daily bowel movement

    The long-term, chronic use of laxatives is usually unnecessary and often unhealthy. These agents are self-administered by individuals who are obsessed with maintaining daily bowel movements due to their misconception that daily bowel evacuation is needed to maintain normal GI function.
  321. Laxatives which contain natural and semisynthetic dietary fibers that absorb water and swell within the lower GI tract




    A) Bulk-forming laxatives

    Bulk laxatives commonly contain natural and semisynthetic dietary fibers such as bran, psyllium, and methylcellulose.
  322. Laxatives which activate peristalsis by a direct irritant effect on the intestinal mucosa or by stimulating the nerve plexus within the gut wall




    C) Stimulant laxatives
  323. Laxatives which produce gradient that draws water into the bowel, increasing its fluid content and stimulating peristalsis




    D) Hyperosmotic laxatives

    Hyperosmotic substances include magnesium salts, sodium salts, potassium salts, lactulose, polyethylene glycol, and glycerin.
  324. The following are adverse effects of laxatives, except:




    B) None of these

    Chronic administration of laxative may result in dependence when bowel evacuation has become so subservient to laxative use that the normal mechanisms governing evacuation and defecation are impaired.
  325. Digestant preparations contain pancreatic enzymes or bile salts. Administration of these agents may be helpful for patients with bronchiectasis.




    C) Only the first statement is true.

    The thick, viscous secretions in cystic fibrosis can obstruct pancreatic and bile ducts, leading to chronic deficiency of pancreatic enzymes and bile salts; as a result, patients cannot digest and absorb nutrients from the GI tract. Preparations containing these digestants may be administered orally to replace the missing compounds, thus improving digestion and nutrient absorption.
  326. Antiemetics are helpful in emptying the stomach of ingested poisons or toxins. Examples of these agents are apomorphine which work on the stomach and ipecac which work on the medulla.




    B) Both statements are false.

    Emetics, not antiemetics, are used to induce vomiting and are frequently administered to help empty the stomach of ingested poisons or toxins. The two primary emetics are apomorphine which work on the medulla and ipecac which work on the stomach.
  327. Which of the following is not an indication of antiemetics?




    D) None of these

    Antiemetics are used to decrease nausea and vomiting.
  328. True or False: Cholelitholytic agents are effective in treating calcified gallstones.
    False

    Cholelitholytic agents, such as chenodeoxycholic acid and ursodeoxycholic acid, decrease the cholesterol content of bile and may help dissolve gallstone that are supersaturated with cholesterol. However, these drugs are not effective in treating calcified gallstones.
  329. In hormone replacement therapy, physiologic dose refers to the amount of drug equivalent to the normal endogenous production. Meanwhile, pharmacologic dose refers to the amount of drug needed to induce a beneficial effect.




    A) Both statements are true.
  330. All steroid hormones share the same basic chemical configuration as their parent compound. Consequently, even relatively minor changes in the side chains of the parent compound create steroids with dramatically similar physiologic effects.




    A) Only the first statement is true.

    Even relatively minor changes in the side chains of the parent compound create steroids with dramatically different, not similar, physiologic effects. In addition, structural similarity between different types of steroids helps explain why there is some crossover in the physiologic effects of each major category.
  331. The following are mechanisms through which glucocorticoids inhibit inflammation?




    A) Stabilize nuclear membrane

    Glucocorticoids stabilize lysosomal, not nuclear, membrane. When lysosomes are ruptured, their degradative enzymes digest cellular components, thus contributing to the local damage present at the site of inflammation.

    Adhesion molecules are responsible for attracting leukocytes in the bloodstream to endothelial cells at the site of inflammation.
  332. All of the following are indication of glucocorticoid replacement therapy, except:




    B) None of these
  333. Adrenocortical suppression occurs because of the negative feedback effect of the administered glucocorticoids on the hypothalamic-anterior pituitary system and the adrenal glands. As a result, patients who developed adrenocortical suppression must immediately terminate their glucocorticoid therapy.




    D) Only the first statement is true.

    Adrenocortical suppression can be a serious problem when glucocorticoid therapy is terminated. Patients who have experienced complete suppression will not be able to immediately resume production of glucocorticoids. Because abrupt withdrawal can be life-threatening, glucocorticoids must be withdrawn slowly by tapering the dose.
  334. The following are adverse effects of glucocorticoids, except:




    D) None of these

    Glucocorticoids break down supporting proteins in the stomach wall, causing peptic ulcers. These drugs also cause growth retardation in children due to their inhibitory effect on growth hormone. Lastly, these drugs impair the normal drainage of aqueous fluid from the eye, leading to glaucoma.
  335. Fludrocortisone is the primary agent used in aldosterone replacement therapy. This compound is chemically classified as a glucocorticoid, but it has high levels of mineralocorticoid activity and is used exclusively as a mineralocorticoid.




    A) Both statements are true.
  336. Which of the following is not an adverse effect of mineralocorticoid agonists?




    D) Hyperkalemia

    Mineralocorticoid agonists cause hypokalemia because they promote secretion of potassium ions into renal tubules.
  337. Spironolactone and eplerenone are classified as non-competitive mineralocorticoid antagonists. These agents are primarily used as diuretics in treating hypertension and heart failure.




    B) Only the second statement is true.

    Spironolactone and eplerenone are classified as competitive mineralocorticoid antagonists.
  338. Spironolactone is useful for treating hypertension in patients with hyperkalemia. This drug can also be used to help diagnose Addison's disease.




    C) Both statements are false.

    Spironolactone is a potassium-sparing diuretics, so it is indicated for treating hypertension in patients with hypokalemia.

    Spironolactone can also be used to help diagnose Conn's syndrome (hyperaldosteronism). This drug is given for several days to antagonize the effects of excessive aldosterone production. When the drug is discontinued, serum potassium levels will decrease sharply if Conn's syndrome is present.
  339. All of the following are indications of androgen replacement therapy, except:




    C) Prostate cancer

    Androgens increase the risk of prostate cancer is susceptible older men.
  340. Androgens can be administered in the following conditions for their anabolic properties, except:




    D) None of these

    Men with HIV infection may have muscle wasting because of low testosterone production combined with the catabolic effects of this infection and subsequent anti-HIV therapies.
  341. estosterone is a potent stimulator of erythropoietin synthesis from the kidneys and other tissues. Therefore, androgens may be used as an adjunct in treating severe or recalcitrant anemia.




    A) Both statements are true.
  342. Certain androgens act on the liver to restore the production of several clotting factors and to increase production of a glycoprotein inhibiting the initial stages of the clotting sequence that leads to decreased vascular permeability. Hence, androgens are typically given prophylactically to decrease the frequency and severity of angioedema attacks.




    A) Only the second statement is true.

    Hereditary angioedema is a disorder characterized by a defect in the control of clotting factors that ultimately leads to increased, not decreased vascular permeability. Loss of vascular fluid from capillary beds causes localized edema.
  343. True or False: In males, high levels of androgens act as positive feedback and lead to testicular atrophy and impaired sperm production.
    False

    High levels of androgens act as negative, not positive feedback.
  344. Women undergoing androgen therapy may experience the following side effects, except:




    D) Enlarged labia

    Androgen therapy causes enlarge clitoris, not enlarged labia.
  345. True or False: Androgens should be used with caution in children because these agents cause accelerated sexual maturation and premature closure of epiphyseal plates.
    True
  346. True or False: Antiandrogens are used to treat benign prostate hypertrophy.
    True

    Antiandrogens such as finasteride and dutasteride inhibit the conversion of testosterone to dihydrotestosterone. Dihydrotestosterone accelerates the growth and development of the prostate gland. Therefore, antiandrogens may be helpful in attenuating this effect in conditions such as benign prostate hypertrophy.
  347. Higher dose or prolonged exposure to estrogen has been associated with serious cardiovascular problems, including myocardial infarction, stroke, and thromboembolism. These problems are significant when estrogen is administered to women for treatment of breast cancer.




    C) Only the first statement is true.

    These problems are significant when estrogen is administered to men for treatment of breast and prostate cancer.
  348. True or False: Selective estrogen receptor modulators activate estrogen receptors on bone and vascular tissues, while acting as estrogen antagonists on uterine and breast tissues.
    True

    Examples of SERMs are tamoxifen and raloxifene. Raloxifene is similar to tamoxifen except that it blocks estrogen receptors on breast and uterine tissues and may therefore inhibit breast cancer and improve bone and cardiovascular function, without increasing risk of endometrial cancers.
  349. True or False: Antiestrogens such as clomiphene can be used to treat infertility in females.
    True

    Relatively high levels of estrogen normally produce an inhibitory or negative feedback effect on the release of pituitary gonadotropins (LH and FSH). As an antiestrogen, clomiphene blocks this inhibitory effect, thus facilitating gonadotropin release.
  350. The following are mechanisms of contraceptive action, except:




    A) Decreases thickness and viscosity of mucous secretions in the uterine cervix

    Contraceptives increase the thickness and viscosity of mucous secretions in the uterine cervix, thus impeding the passage of sperm
  351. Thyroid hormones are synthesized first by adding iodine to residues of the amino acid tyrosine. Addition of one iodine atom creates monoiodotyrosine, and the addition of a second iodine creates diiodotyrosine.




    D) Both statements are true.

    The combination of a monoiodotyrosine and a diiodotyrosine yields triiodothyronine (T3), and the combination of two diiodotyrosine yields thyroxine (T4).
  352. Which of the following is incorrect about the mechanisms through which propylthiouracil acts as an antithyroid agent?




    D) It inhibits the thyroid hydroxylase enzyme necessary for preparing iodide for addition to tyrosine residues enzyme 

    It should be peroxidase, not hydroxylase enzyme.
  353. Although iodide is effective in treating hyperthyroidism for short periods, the effects of this drug begin to diminish after about two weeks of administration. Consequently, this drug is only used in limited situations, such as temporary control of hyperthyroidism prior to thyroidectomy.




    C) Both statements are true.
  354. Radioactive iodine is administered orally and is rapidly sequestered within the thyroid gland, where it emits gamma radiation to selectively destroy the follicle cells. Patients who undergo radioactive destruction of thyroid gland must be given thyroid hormones as replacement therapy.




    A) Only the second statement is true.

    It should be beta, not gamma radiation.
  355. Beta blockers are usually not the only drugs used in the long-term control of hyperthyroidism but serve as adjuncts to antithyroid drugs. Beta blockers may be especially helpful in severe, acute exacerbations of thyrotoxicosis (thyroid storm).




    C) Both statements are true.

    Although beta blockers do not directly lower plasma levels of thyroid hormones, they may help suppress symptoms such as tachycardia, palpitations, fever, and restlessness.
  356. True or False: Goiter is associated with both hyperthyroidism and hypothyroidism.
    True

    Although goiter is usually associated with hyperthyroidism, it may also be present in hypothyroidism secondary to lack of dietary iodine. Under the influence of TSH, the thyroid manufactures large quantities of thyroglobulin. Thyroid hormone synthesis is incomplete, however, because no iodine is available to add to the tyrosine residues. If no thyroid hormones are produced, there is no negative feedback to limit the secretion of TSH. Consequently, the thyroid gland increases in size because of the unabated production of thyroglobulin.
  357. The following are indications of thyroid replacement therapy, except:




    D) None of these

    Thyroid hormones may be used to prevent and treat cancer of the thyroid gland and to prevent goiter caused by lithium therapy.
  358. True or False: Preparations containing T4 (liothyronine), T3 (levothyroxine), or both hormones can be administered to mimic normal thyroid production whenever the endogenous production of these hormones is impaired.
    False

    T3 = liothyronine; T4 = levothyroxine
  359. Vitamin D is a fat-soluble vitamin, and excessive doses can accumulate in the body, leading to toxicity. Early signs of vitamin D toxicity include headache, increased thirst, decreased appetite, metallic taste, fatigue, and gastrointestinal disturbances.




    D) Both statements are true.

    In addition, vitamin D toxicity is a serious problem that can cause death because of cardiac and renal failure.
  360. Which of the following is not an indication of biphosphonates?




    C) None of these

    Biphosphonates are absorbed directly into calcium crystals in the bone to inhibit osteoclastic activity.
  361. Biphosphonates are preferred in treating post-menopausal osteoporosis because they improve bone health in women without the risks associated with progesterone replacement. However, patients should remain upright after taking a biphosphonate so that the drug does not reflux into the esophagus and cause irritation.




    C) Only the second statement is true.

    It should be estrogen, not progesterone replacement.
  362. True or False: Biphosponates, particulary etidronate, can lead to fractures if excessive doses are taken for prolonged periods.
    True

    Etidronate (Didronel) can cause tenderness and pain over bony lesion sites in Paget disease, leading to fractures if excessive doses are taken for prolonged periods.
  363. Calcitonin may be a suitable alternative for people with painful vertebral fractures who cannot tolerate biphosphonates. This drug is usually administered orally.




    D) Only the first statement is true.

    Calcitonin can reduce the risk of vertebral fractures, but does not seem to be as effective as biphosphonates; however, calcitonin may have an analgesic effect, making it suitable for painful vertebral fractures.

    In the past, calcitonin was administered by intramuscular or subcutaneous injection, but aerosolized versions of calcitonin are now available that allow delivery in the form of nasal sprays. Oral delivery of calcitonin is difficult because this hormone is poorly absorbed from the GI tract and is degraded by proteolytic enzymes in the stomach.
  364. True or False: A prolonged, continuous increase in PTH secretion favors bone breakdown, whereas intermittent PTH release encourages bone synthesis and remodeling.
    True

    Teriparatide is a synthetic form of human PTH that was developed to treat severe cases of osteoporosis. Prolonged or continuous release of PTH increases bone resorption and breakdown, whereas intermittent doses of PTH may increase BMD. Hence, small dosages of this drug can be administered daily by subcutaneous injection to provide a burst of PTH activity.
  365. True or False: Calcimimetics can be used to treat disorders involving decreased bone mineral content.
    True

    Plasma calcium ions regulate the release of PTH by affecting calcium receptors on the parathyroid gland. An increase in plasma calcium inhibits the release of PTH, and a decrease in plasma calcium stimulates PTH release. Therefore, drugs mimicking the effects of endogenous calcium (e.g. calcimimetics) can be used to reduce PTH release in people with parathyroid tumors or other conditions that cause prolonged, continuous release of PTH.
  366. True or False: The beta cells of pancreas act as the primary glucose sensors, and adequate control of insulin release seems to be a higher priority than the control of glucagon function.
    True
  367. Exogenous insulin is administered in type 1 diabetes mellitus to replace normal pancreatic hormone production. However, exogenous insulin can also be administered in type 2 diabetes mellitus to supplement endogenous insulin release.




    C) Both statements are true.

    In type 2 diabetes, exogenous insulin makes up the difference between the patient's endogenous hormone production and his or her specific insulin requirement.
  368. True or False: Biosynthetically produced insulin, which is identical to regular human insulin, takes effects more quickly than endogenous insulin released from pancreatic beta cells.
    False

    Absorption of regular insulin from subcutaneous injection sites does not mimic the normal release of endogenous insulin occurring after a meal.
  369. Insulin is not suitable for oral administration. Even if the insulin molecule survived digestion by proteases in the stomach and small intestine, this compound is too large to be absorbed through the GI wall.




    B) Both statements are true.
  370. The following are possible sites of administration of insulin injection, except:




    B) Lower arm

    It should be upper, not lower arm. Upper thigh is also a possible injection site. Patients injecting insulin should rotate the sites of administration to avoid local damage from repeated injection.
  371. Insulin pumps are much more convenient than using an intravenous syringe to make multiple injections each day. However, these pumps can malfunction because the catheter delivering the insulin becomes occluded or obstructed.




    D) Only the second statement is true.

    It should be hypodermic, not intravenous syringe.
  372. True or False: To maintain blood glucose in the appropriate range much better, it is recommended to use a combination of short- and immediate-acting insulin.
    True

    Short-acting doses can be administered at mealtimes or whenever immediate control of glucose levels is needed, and the intermediate-acting form can be administered once or twice a day to provide lower, background levels of insulin throughout the day or night.
  373. The primary problem associated with exogenous insulin administration is hypoglycemia. All of the following may lead to hypoglycemia, except:




    B) None of these

    Exercise generally produces an insulin-like effect by accelerating the movement of glucose out of the bloodstream and into the skeletal muscles where it is needed.
  374. To avoid exercise-induced hypoglycemia, the insulin dose should be decreased by _____%




    C) 30-35
  375. Typically, administration of the equivalent of _____ g of D-glucose is recommended to restore blood glucose in the early stages of hypoglycemia.




    B) 10-15
  376. The oldest and largest group of oral antidiabetic agents is classified chemically as sulfonylureas. These drugs act directly on pancreatic beta cells and stimulate the release of insulin, which inhibits hepatic glucose production and promotes peripheral tissue glucose uptake.




    C) Both statements are true.
  377. True or False: Metformin is a sulfonylurea which directly acts on the liver to decrease hepatic glucose production.
    False

    Metformin is a biguanide agent, not a sulfonylurea. In addition to decreasing hepatic glucose production, this drug also increases the sensitivity of peripheral tissues to insulin.
  378. Acarbose and miglitol are beta-glucoside inhibitors that inhibit enzymes that break down sugars in the GI tract. This effect helps delay glucose absorption from the intestines, thereby slowing the entry of glucose into the bloodstream.




    A) Only the second statement is true.

    Acarbose and miglitol are alpha-, not beta-glucoside inhibitors. These drugs delay glucose absorption from the GI tract and entry into the bloodstream to allow time for the beta cells to respond to hyperglycemia after a meal.
  379. Thiazolidones work like metformin. Meanwhile, benzoic acid derivatives work like sulfonylureas.




    C) Both statements are true.

    Thiazolidones work like metformin because they decrease hepatic glucose production and increase tissue sensitivity to insulin. Examples of thiazolidones are rosiglitazone and pioglitazone.

    Meanwhile, benzoic acid derivative work like sulfonylureas because they directly increase insulin release from pancreatic beta cells. Examples of benzoic acid derivatives are repaglinide and nateglinide.
  380. Glucagon can be used to treat acute hypoglycemia induced by insulin or oral antidiabetic agents. Glucagon should reverse symptoms of hypoglycemia (including coma) within approximately 5 minutes after administration.




    A) Only the first statement is true.

    It should be 10, not 5 minutes after administration.
  381. Glucagon-like peptide 1 is a hormone which works similarly to thiazolidones and biguanides. Exenatide is the first form of this hormone approved for clinical use.




    D) Only the first statement is true.

    Glucagon-like peptide 1 is a hormone normally released from the GI tract after eating a meal. This hormone increases the ability of blood glucose to stimulate insulin release from pancreatic beta cell. Therefore, this hormone exert effects similar to sulfonylureas and benzoic acids, not thiazolidones and biguanides.
  382. True or False: Immunosuppressant drugs can be used to prevent the onset of type 2 diabetes mellitus.
    False

    It should be type 1, not type 2 diabetes mellitus. Most cases of type 1 diabetes mellitus are caused by an autoimmune response that selectively attacks and destroys pancreatic beta cells. Therefore, immunosuppressant drugs or immune system modulators can be used to prevent the onset of type 1 diabetes mellitus in genetically susceptible individuals.
  383. Aldose reductase inhibitors (ARIs) inhibit enzymes responsible for diabetic neuropathy. These drugs are effective in reversing pre-existing nerve damage.




    C) Only the first statement is true.

    • Aldose reductase is an enzyme located within neurons which is responsible for converting glucose into sorbitol. The excessive accumulation of sorbitol within neurons may lead to structural and functional changes that are responsible for diabetic neuropathy.                                       
    • Although treatment with ARIs may slow the progression of diabetic neuropathy, these drugs do not reverse any pre-existing nerve damage.
  384. Antibacterial drugs are usually classified as either bactericidal or bacteriostatic, depending on their mechanism of action. Bactericidal refers to drugs that kill or destroy bacteria, whereas bacteriostatic refers to drugs that limit growth and proliferation of bacteria.




    A) Both statements are true.
  385. All of the following are gram-negative bacilli, except:




    A) Clostridium tetani

    Clostridium tetani and Bacillus anthracis are gram-positive bacilli. Gram-positive bacilli are rod-shaped bacteria which retain color when treated by Gram's method of staining.
  386. Mycobacterium tuberculosis




    A) Acid-fast bacilli

    Mycobacterium tuberculosis and mycobacterium leprae are acid-fast bacilli which are rod-shaped and retain color of certain stains even when treat with acid.
  387. True or False: Staphylococcus aureus and Streptococcus pneumonia are gram-positive cocci.
    True

    Neisseria gonorrhoeae and Neisseria meningitidis are gram-negative cocci.
  388. The following are mechanisms through which antibacterials work, except:




    D) None of these

    Example of drug that inhibit cell wall synthesis and function is polymyxin antibiotics. Example of drugs that inhibit protein synthesis are aminoglycosides, erythromycin, and tetracyclines. Examples of drugs that inhibit DNA/RNA synthesis and function are fluoroquinolones and sulfonamides.
  389. Which of the following is incorrect about penicillin?




    D) It exerts its effects by binding to specific enzymatic proteins within the nuclear membrane.

    It exerts its effects by binding to specific enzymatic proteins within the bacterial cell wall. These enzymatic proteins, known as penicillin-binding proteins, help manufacture peptidoglycans which are essential for normal membrane structure and function.
  390. The naturally occurring penicillins (penicillin G and V) can be administered orally but have a narrow antibacterial spectrum. Meanwhile, semisynthetic penicillins (amoxicillin and ampicillin) have broader antibacterial spectrum and may be administered orally or parenterally depending on the specific agent.




    A) Both statements are true.
  391. True or False: Penicillin is ineffective in killing strains of bacteria that contain beta-lactamase.
    False

    Penicillinase-resistant forms of penicillin (beta-lactamase inhibitors + penicillin) were developed to overcome strains of bacteria that contain penicillinase or beta-lactamase. This enzyme destroys natural and some semisynthetic penicillins, rendering these drugs ineffective in bacteria containing this enzyme. Examples of beta-lactamase inhibitors are clavulanate, sulbactam, and tazobactam.
  392. Hypersensitivity to penicillin is exhibited by skin rashes, hives, itching, and difficult breathing. Severe penicillin hypersensitivity can lead to anaphylactic reaction characterized by severe bronchoconstriction and cardiovascular collapse.




    B) Both statements are true.
  393. Which generation of cephalosporin has the broadest antibacterial spectrum and are effective against gram-positive and gram-negative organisms?




    B) Fourth

    First-generation cephalosporins are generally effective against gram-positive cocci, but may also be used against some gram-negative bacteria. Second-generation cephalosporins are effective against gram-positive cocci, but are more effective than first-generation agents against gram-negative bacteria. Third-generation cephalosporins have the broadest spectrum of effectiveness against gram-negative bacteria, but have limited effect on gram-positive cocci.
  394. True or False: A patient who is allergic to penicillin drugs will also display hypersensitivity to cephalosporin agents.
    True
  395. Which of the following is incorrect about polymyxin B antibiotics?




    B) They are effective against gram-positive bacteria.

    They are effective against gram-negative bacteria, including E. coli, Klebsiella, and Salmonella. Systemic administration of this drug is often associated with extreme nephrotoxicity; hence, it is only used for treatment of local, superficial infections.
  396. Which of the following is not true about aminoglycosides?




    A) They have a narrow spectrum of antibacterial activity.

    They have a very broad spectrum of antibacterial activity and are effective against many aerobic gram-positive and gram-negative bacteria, as well as many anaerobic bacteria.

    They are commonly associated with nephrotoxicity and ototoxicity, especially in elderly patients or those who have liver or kidney failure.
  397. Which of the following is not a side effect of tetracyclines?




    A) Discoloration of bones

    It should be discoloration of teeth, not bones.
  398. Which of the following is incorrect about dapsone?




    D) It is effective against Mycobacterium tuberculosis.

    It is effective against Mycobacterium leprae, not tuberculosis.
  399. The following are mechanisms of antibacterial drug resistance, except:




    D) Development of drug influx pumps

    It should be drug efflux, not influx pumps. Drug efflux pumps expel the drug from the bacterial cell, rendering the drug ineffective.
  400. The following are clinical uses of acyclovir, except?




    B) Hepatitis B virus

    Acyclovir is the principal drug used to treat genital herpes and herpes simplex-related infections in other mucosal and cutaneous areas. It it also effective against other members of the herpes virus family, including varicella-zoster (chicken pox and herpes zoster) and Eipstein-Barr virus. Lastly, this drug can decrease risk of cytomegalovirus infection in people receiving solid organ transplants.
  401. Amantadine is used in prevention and treatment of infections caused by influenza B virus. This drug is also effective in alleviating some of the motor abnormalities of Parkinson's disease.




    B) Only the second statement is true.

    It should be influenza A, not B.
  402. Docosanol is applied topically to treat blisters and cold sores caused by herpes zoster virus. This drug does not inactivate the herpes virus, but acts on the host cells so that the virus cannot adsorb to the surface of the cell.




    B) Only the second statement is true.

    It should be herpes simplex, not zoster virus.
  403. True or False: It is advantageous to administer the prodrug because it will be absorbed more completely and will ultimately result in higher plasma levels of the drug's active form.
    True

    Drug Prodrug
    Acyclovir Valacyclovir
    Penciclovir Famciclovir
    Ganciclovir Valganciclovir
Author
carminaorlino
ID
355381
Card Set
Pharmacology
Description
Updated