appleton pharmacology Flashcards

Question 1

Q

Zafirlukast (Accolate) is a drug that can best
be classified as a (an)
(A) leukocyte stimulant
(B) carbonic anhydrase inhibitor
(C) monoamine oxidase inhibitor
(D) angiotensin-converting enzyme inhibitor
(E) Leukotriene formation inhibitor

Answer

A

(E) Zafirlukast (Accolate), zileuton (Zyflo),
and montelukast sodium (Singulair) are examples of leukotriene receptor antagonists.
Leukotriene production in the body has been
associated with the development of asthma
symptoms such as airway edema. By interfering with leukotriene receptors, these drugs
can be used for prophylaxis and long-term
treatment of asthma. They are not useful for
the treatment of acute asthmatic attacks. (3)

Question 2

Q

Which of the following is (are) true of milrinone lactate (Primacor)?
I. may be administered orally or parenterally
II. produces a positive inotropic action
III. produces vasodilation
(A) I only
(B) III only
(C) I and II only
(D) II and III
(E) I, II, and III

Answer

A

(D) Milrinone lactate (Primacor) and amrinone
lactate (Inocor) are classified as
inotropic agents. They are used only parenterally
for the short-term treatment of congestive
heart failure (CHF). They produce a
positive inotropic effect (ie, they increase the
force of cardiac contraction) and they produce
vasodilation. (3)

Question 3

Q

Which of the following is (are) true of finas teride (Proscar, Propecia)?
I. pregnancy category X
II. employed in the treatment of BPH
III. used in alopecia treatment
(A) I only (D) II and III only
(B) III only (E) I, II, and III
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(E) Finasteride (Proscar, Propecia) is an agent
that is administered orally for the treatment
of benign prostatic hyperplasia (BPH). It is
also used in the treatment of alopecia (hair
loss) in men, particularly in male patients
who have male-pattern hair loss. Finasteride
acts to inhibit the formation of 5a-dihydrotestosterone, a potent androgen. It is
classified as a pregnancy category X drug.
Women who are or may become pregnant
should avoid contact with crushed finasteride tablets and with semen from patients
using the drug. (3)

Question 4

Q

Latanoprost (Xalatan) can best be described as an
(A) leukocyte stimulant
(B) carbonic anhydrase inhibitor
(D) prodrug
(C) monoamine oxidase inhibitor
(E) prostaglandin agonist

Answer

A

(E) Latanoprost (Xalatan) is a prostaglandin
F2a analog that is used as an ophthalmic solution
to reduce intraocular pressure by increasing
the outflow of aqueous humor from
the eye. Altered pigmentation of the iris may occur in 7 to 22% of patients using the drug
over a 3- to 12-month period. The drug may
be used in combination with other glaucoma
drugs. (5:1475)

Question 5

Q

Which of the following is (are) true of ticlopidine?

I. inhibit platelet aggregation
ii. dissolves blood clots
iii. only administered pareterally
(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(A) Ticlopidine (Ticlid) is an inhibitor of
platelet aggregation that is administered
orally, with food, in doses of 250 mg twice
daily. Patients using this drug should have a
complete blood count (CBC) with differential
performed every two weeks for three months
to detect neutropenia (decreased number of
white blood cells). The drug’s antiplatelet effects are not maximal until at least 8 to 11
days of therapy have been completed. (5:3

Question 6

Q

Nicardipine (Cardene) is indicated for the
only treatment of

I. angina pectoris
II. hypertension
III. ventricular tachycardia

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(C) Nicardipine (Cardene) is a calcium channel-
blocking agent employed in the treatment
of angina pectoris and hypertension. It is also
indicated for the treatment of congestive
heart failure. (3)

Question 7

Q

Alteplase (Activase) is an example of a tissue plasminogen activator. Which of the following describes the characteristics of this drug?

I. administered orally
II. stimulates erythrocyte production
III. produced by recombinant DNA technology

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(B) Alteplase (Activase) and reteplase (Retavase)
are tissue plasminogen activators prepared
by recombinant DNA technology. They
are administered intravenously in order to
lyse thrombi in patients with acute myocardial
infarction. (3)

Question 8

Q

Which of the following is a gold compound?

I. aurothioglucose (Solganal)
II. goserelin acetate (Zoladex)
III. ergonovine

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(A) Gold compounds such as aurothioglucose
(Solganal), auranofin (Ridaura), and gold
sodium thiomalate (Myochrysine) are used to
suppress or prevent, but not cure, arthritis
and synovitis. Aurothioglucose and gold
sodium thiomalate are administered intramuscularly
while auranofin is only administered
orally. All gold compounds may cause
serious adverse effects, including dermatitis,
renal damage, and blood dyscrasias. (5:1436)

Question 9

Q

As an antiarrhythmic drug, tocainide is most
similar in action to which one of the following agents?

(A) amiodarone
(B) propranolol
(C) digoxin
(D) verapamil
(E) mexiletine

Answer

A

(E) Tocainide (Tonocard) is most similar to
mexiletine (Mexitil). Both are classified as
Group IB antiarrhythmic drugs. These are
agents that slightly depress phase a and may
shorten the duration of the action potential.
(3)

Question 10

Q

Which of the following antiarrhythmic agents is (are) associated with an adverse effect
known as cinchonism?

(A) acebutolol
(B) moricizine
(C) quinidine
(D) lidocaine
(E) disopyramide

Answer

A

(C) Quinidine is an antiarrhythmic agent
that derived from the bark of the cinchona
tree. As does quinine, quinidine may cause
an array of adverse effects collectively referred
to as cinchonism. (3)

Question 11

Q

Which of the following are employed as intranasal steroids?

I. budesonide (Rhinocort)
I. administered orally II. fluticasone propionate (Flonase)
II. stimulates erythrocyte production III. nedocromil (Tilade)

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(C) Budesonide (Rhinocort) and fluticasone
propionate (Flonase) are corticosteroids that
are employed clinically for the treatment of
seasonal and perennial allergic rhinitis. Nedocromil
(Tilade) is an inhalational product
that is used for maintenance therapy in the
management of bronchial asthma. (3)

Question 12

Q

Which of the following agents is (are) used as
anorexiants?

I. sibutramine (Meridia)
II. mazindol (Sanorex, Mazanor)
III. benzphetamine (Didrex)

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(E) Sibutramine (Meridia), mazindol (Sanorex,
Mazanor), and benzphetamine (Didrex)
are central nervous system stimulants used
as anorexiants, ie, they are used to reduce appetite.
(3)

Question 13

Q

Colestipol HCl (Colestid) can best be classified as a (an) similar in action to which one of the following agents?
(B) vasopressor
(A) amiodarone (C) potassium-sparing diuretic
(B) propranolol (D) ACE inhibitor
(C) digoxin (E) bile acid sequestrant

Answer

A

(E) Colestipol (Colestid) is an anion exchange
resin that binds bile acids in the intestine,
causing them to be removed in the feces.
This causes further breakdown of cholesterol
to bile acids, as well as a decrease in lowdensity
lipoproteins (LDL) and serum cholesterollevels.
(5:361)

Question 14

Q

Which of the following is (are) true of simvastatin (Zocor)?

I. HMG-CoA reductase inhibitor
II. pregnancy category X
III. antiviral
(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(C) Simvastatin (Zocor) is an HMG-CoA reductase
inhibitor. It is employed as an adjunct
to diet in treating hypercholesterolemia.
It is classified in pregnancy category X. (3)

Question 15

Q

Benzodiazepines appear to act as anxiolytics
by altering the sodium ion influx into the
CNS

(A) Altering the sodium ion influx into the CNS
(B) potentiating the effects of GABA
(C) altering the calcium ion influx into the
drug-induced bronchospasm is
CNS (A) cromolyn
(D) interfering with the amine pump
(E) inhibiting the action of monoamine oxidase

Answer

A

(B) Benzodiazepines are believed to act by
potentiating the effects of gamma-aminobutyric
acid (GABA), an inhibitory amino acid.
(3)

Question 16

Q

Which of the following is a COMT inhibitor?

(A) selegiline
(B) carbidopa
(C) disulfiram
(D) tolcapone
(E) pramipexole

Answer

A

(D) Tolcapone (Tasmar) is a COMT inhibitor
used in the treatment of Parkinson’s disease.
Its use has been associated with the potential
for the development of hepatic failure. It
should, therefore, not be used in patients who have any evidence of liver disease. Baseline
liver enzyme studies should be performed
before therapy is begun and at twoweek
intervals during the first year of therapy.
Such studies should be continued every
four weeks during the 12 to 18 months of
therapy and every eight weeks thereafter. (3)

Question 17

Q

Trifluridine is useful in the treatment of epithelial keratitis caused by

(A) herpes simplex
(B) Pseudomonas aeruginosa
(C) Staphylococcus aureus
(D) Clostridium difficile
(E) Escherichia coli

Answer

A

(A) Epithelial keratitis is an ophthalmic disorder
caused by the action of herpes simplex
virus. Trifluridine (Viroptic) blocks herpes
simplex virus reproduction and thereby
helps to control this condition. (3)

Question 18

Q

Which of the following is (are) employed as
an antifungal agent?
I. cycloserine
II. mafenide (A) I only
III. terbinafine (B) III only
(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(B) Terbinafine (Lamisil) is an antifungal
agent used in treating onychomycosis of the
fingernail or toenail caused by dermatophytes.
Mafenide is for the treatment of
burns and cycloserine is an antitubercular
drug. (3)

Question 19

Q

Which of the following is (are) true of iso-
I. for the treatment of acute asthma attacks
tretinoin (Accutane)?

I. in pregnancy category X
II. indicated for the treatment of psoriasis
III. useful for treatment of alopecia
(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I,II and III

Answer

A

(A) Isotretinoin (Accutane) is a vitamin A
derivative that appears to be useful in the
treatment of acne because of its ability to
reduce the secretion of sebum. It is classified
in pregnancy category X. Female patients
should be advised to use an effective contraceptive
technique for at least one month prior
to starting isotretinoin and for at least one
month after discontinuing it. Such patients
must also have had a negative serum pregnancy
test within two weeks of starting the
drug. (5:1495)

Question 20

Q

An agent that would be most likely to cause
drug-induced bronchospasm is
(A) cromolyn
(B) benazepril
(C) isoproterenol
(D) fluvastatin
(E) sotalol

Answer

A

(E) Sotalol (Betapace) is a nonselective betaadrenergic
blocking agent. Such drugs
should be avoided in patients with bronchospastic
disorders because they may cause
bronchoconstriction. (3)

Question 21

Q

Which of the following is (are) true of dobutamine (Dobutrex)?
I. antidepressant
II. only administered parenterally
III. beta1 agonist

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(D) Dobutamine (Dobutrex) is a parenterally
administered agent that is chemically related
to dopamine. It acts by stimulating primarily
beta1-adrenergic receptors to produce an inotropic
effect. It is commonly employed in
the treatment of shock syndrome. Unlike
dopamine, dobutamine does not cause the
endogenous release of norepinephrine. (5:398)

Question 22

Q

Which of the following is (are) dopaminergic
antiparkinson agents?

I. ropinirole (Requip)
II. pergolide (Permax)
III. procyclidine (Kemadrin)

(A) I only
(C) I and II only
(D) II and III only
(B) III only
(E) I, II, and III

Answer

A

(C) Ropinirole (Requip) and pergolide (Permax)
are dopaminergic agents that enhance
dopamine activity and provide palliative
treatment of Parkinson’s disease. Procyclidine
is an anticholinergic drug used to treat
Parkinson’s disease. (3)

Question 23

Q

Which of the following is (are) true of salmeterol (Serevent)?

I. for the treatment of acute asthma attacks
II. available in an aerosol and inhalation
powder form
III. beta2 agonist

(A) I only
(B) III only
(C) I and II only
(D) II and III
(E) I, II and III

Answer

A

(D) Salmeterol (Serevent) is an agonist acting
primarily on beta2-adrenergic receptors to
produce bronchodilation. It is the longestacting
sympathomimetic bronchodilating
agent with a duration of approximately 12
hours. It is available as an aerosol (Serevent)
and as a powder for inhalation (Serevent
Diskus). Because of its rather slow onset of
action it is used only for maintenance and
prophylaxis. It is not used for treating acute
asthma attacks. (3)

Question 24

Q

Which of the following drugs is (are) H1-histamine receptor antagonists?
I. diphenhydramine
II. hydroxyzine
III. famotidine
(A) I only
(B) III only
(C) I and II only
(D) II and III
(E) I, II, and III

Answer

A

(C) Diphenhydramine and hydroxyzine are
HI-receptor antagonists. They antagonize actions
of histamine such as vasodilation.
Famotidine is an H2-receptor antagonist that
is used to reduce gastric acid secretion. (3)

Question 25

Q

Which of the following is (are) considered to
be prokinetic agents?

I. lansoprazole
II. diphenoxylate cillin disodium
III. metoclopramide
(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and II

Answer

A

(B) Metoclopramide (Reglan) is a prokinetic
agent that increases the motility of the upper
GI tract without increasing the production of
secretions. It appears to act by increasing the
sensitivity of GI tissues to the action of
acetylcholine. (5:593)

Question 26

Q

Effects expected as a result of inhaling the smoke of cannabis

I. decreased pulse rate
II. perceptual changes
III. vascular congestion of the eye

(A) I only
(B) III only
(C) I and II
(D) II and III only
(E) I, II, and III

Answer

A

(D) Inhalation of the smoke of cannabis generally
results in increased pulse rate, perceptual
changes, and vascular congestion of the
eye. (3)

Question 27

Q

Of the following glucocorticoids, which one
has the greatest anti-inflammatory potency
when administered systemically?

(A) hydrocortisone (Corte£)
(B) prednisone (Meticorten)
(C) triamcinolone (Aristocort)
D) betamethasone (Celestone)
(E) cortisone (Cortone)

Answer

A

(D) Betamethasone is about 25 times as potent
as hydrocortisone, 5 to 6 times as potent
as prednisone, 4 to 6 times as potent as triamcinolone,
and about 30 times as potent as cortisone.
(3)

Question 28

Q

Benzoyl peroxide is commonly employed in
the treatment of
(A) psoriasis
(B) pinworms
(C) seborrheic dermatitis
(D) trichomonal infections
(E) acne

Answer

A

(E) Benzoyl peroxide is an oxidizing agent
found in many aTe products that are used in
the treatment of acne. It is believed to exert
an antibacterial effect, thereby reducing the
level of Propionibacterium acnes on the skin
surface. (3)

Question 29

Q

Timentin is a product that contains ticarcillin
disodium and clavulanate potassium. Clavulanate potassium

(A) inhibits beta-Iactamase enzymes
(B) prevents the urinary excretion of ticarcillin
disodium
C) prevents first-pass metabolism of ticarcillin disodium
(D) is a buffer
(E) is an antifungal agent

Answer

A

(A) Clavulanate potassium is an agent capable
of inactivating beta-lactamase enzymes
that are often found in microorganisms resistant
to penicillins. The addition of clavulanate
potassium to ticarcillin disodium extends
the spectrum of antimicrobial coverage
of this penicillin to include beta-lactamaseproducing
organisms. (3)

Question 30

Q

Which of the following hormones is released
from the posterior pituitary gland?

I. growth hormone
II. follicle-stimulating hormone (FSH)
III. oxytocin

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(B) Oxytocin is an endogenous hormone
produced by the posterior pituitary gland. It
is a uterine stimulant that promotes uterine
contractions, particularly during labor. The
other hormones listed are released by the anterior
pituitary gland. (3)

Question 31

Q

During ovulation, peak plasma concentration(s) of which of the following hormone(s)
will be reached?

I. luteinizing hormone (LH)
II. follicle-stimulating hormone (FSH)
III. progesterone
when administered systemically?
(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(C) During the menstrual cycle, levels of follicle-
stimulating hormone (FSH) and luteinizing
hormone (LH) vary widely. At the time of
ovulation, the concentration of each of these
hormones reaches a peak, coinciding with the
release of the ovum and the complete development
of a mature endometrial wall. (3)

Question 32

Q

Liotrix is a thyroid preparation that contains
I. desiccated thyroid
II. levothyroxine sodium
III. liothyronine sodium
(A) I only
(B) III only
(C) I and II
(D) II and III only
(E) I, II, and III

Answer

A

(D) Liotrix consists of a uniform mixture of
synthetic levothyroxine sodium (T4) and liothyronine
sodium (T3) in a ratio of 4:1 by
weight. It is used in products such as Euthroid
and Thyrolar as a thyroid hormone
supplement. (5:1258)

Question 33

Q

Propylthiouracil is used for the same therapeutic indication as
(A) methoxsalen
(B) danazol
(C) azathioprine aminopenicillins?
(D) omeprazole
(E) methimazole

Answer

A

(E) Propylthiouracil and methimazole (Tapazole)
are antithyroid agents that inhibit synthesis
of thyroid hormone and thus are useful
in the treatment of hyperthyroidism. (3)

Question 34

Q

Most antipsychotic drugs can be said to have
which of the following actions?
(A) cholinergic
(B) dopaminergic
(C) COMT inhibition
(D) dopamine inhibition
(E) alpha1-adrenergic agonist

Answer

A

(D) Most antipsychotic agents are believed to
act by antagonizing dopamine receptors.
They may also cause some blockade of
cholinergic, alphaI-adrenergic, and histamine
receptors. (3)

Question 35

Q

Which of the following agents is (are) indicated for the treatment of convulsive disorders

I. clonidine
II. tiagabine
III. topiramate

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(D) Tiagabine (Gabitril) and topiramate
(Topamax) are anticonvulsants utilized for
the treatment of partial seizures. (3)

Question 36

Q

Which of the following antianxiety agents
causes the least sedation?
(A) diazepam (Valium)
(B) buspirone (BuSpar)
(C) chlordiazepoxide (Librium)
(D) meprobamate
(E) oxazepam (Serax)

Answer

A

(B) Buspirone (BuSpar) is an antianxiety
agent that, unlike the benzodiazepines, barbiturates,
and carbamates, does not produce
significant sedative, muscle relaxant, or anticonvulsant
effects. (3)

Question 37

Q

Which of the following drugs is (are) classified as protease inhibitors?
I. cidofovir
II. acyclovir
III. nelfinavir

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(B) Nelfinavir (Viracept) is the only protease
inhibitor. Cidofovir is an inhibitor of DNA
polymerase that is used for the treatment of
CMV retinitis. Acyclovir (Zovirax) also acts
by interfering with DNA polymerase and is
used for the treatment of herpes simplex and
herpes zoster infections. (3)

Question 38

Q

Which of the following is (are) classified as
aminopenicillins?

I. bacampicillin
II. amoxicillin
III. ampicillin

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(E) All of these are aminopenicillins. They
are easily recognized by the “ … am …” in
their name. (3)

Question 39

Q

Which of the following antimicrobial products is (are) prodrugs?
I. cefpodoxime proxetil
II. dirithromycin
III. clindamycin

(A) I only
III. topiramate
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(C) Cefpodoxime proxetil (Vantin) and
dirithromycin (Dynabac) are prodrugs, ie,
they are pharmacologically inactive until
they are enzymatically converted to their active
forms in the body. (3)

Question 40

Q

Which one of the following agents can be administered
with ampicillin and other penicillins to achieve higher blood levels of the
causes the least sedation? penicillin?
(A) clavulanic acid
(B) penicillamine (Cuprimine)
(C) probenecid (Benemid)
(D) colchicine
(E) sulbactam

Answer

A

(C) Probenecid is a uricosuric and renal
tubular blocking agent. It is capable of inhibiting
the tubular secretion of penicillins
and cephalosporins, thereby increasing the
plasma levels of these drugs and prolonging
their action in the body. (3)

Question 41

Q

Three hundred milligrams of phenoxymethyl
penicillin is equivalent to approximately how
many units of penicillin activity?
(A) 480,000
(B) 300,000
(C) 1600
(D) 270,000
(E) 960,000

Answer

A

(A) The strength of phenoxymethyl penicillin
is usually measured in milligrams or units.
Each milligram of the pure drug is equivalent
to 1600 units of activity. Thus, 300 mg of
phenoxymethyl penicillin is approximately
equivalent to 480,000 units of activity. (3)

Question 42

Q

Which one of the following agents is most
similar in action to cloxacillin?

(A) amoxicillin (Amoxil)
(B) bacampicillin (Spectrobid)
(C) penicillin V potassium (Pen Vee K)
(D) nafcillin (Unipen,

Answer

A

(D) Nafcillin and cloxacillin are both betalactamase-
resistant penicillins. They are
employed primarily in treating infections
caused by beta-lactamase-producing staphylococci.
(3)

Question 43

Q

Which of the following agents is (are) classi-
fied as antiseptics or germicides?

I. chlorhexidine gluconate (Hibiclens)
II. glutaraldehyde (Cidex) by competitively inhibiting the action of
III. benzalkonium chloride (Zephiran)
(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(E) Chlorhexidine gluconate (Hibiclens, Betasept),
glutaraldehyde (Cidex), and benzalkonium
chloride (Zephiran) are antiseptic
agents used either as surgical scrubs or for
the disinfection of surgical and dental equipment.
(3)

Question 44

Q

Diflunisal (Dolobid) is most likely to be used commonly in the treatment of

(A) Wilson’s disease
(B) rheumatoid arthritis
(C) cysteinuria
(D) psoriasis
(E) Hansen’s disease

Answer

A

(B) Diflunisal (Dolobid) is a salicylate that is
employed in the treatment of mild to moderate
pain, rheumatoid arthritis, and osteoarthritis.
(5:1452)

Question 45

Q

Which of the products listed below are vaccines?
I. Sandimmune
II. Prograf (D) alpha-adrenergic agonist
III. LYMErix

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(B) LYMErix is a vaccine that is used to prevent
Lyme disease, a tick-borne infection.
Cyclosporine (Sandimmune) and tacrolimus
(Prograf) are immunosuppressive agents
employed in preventing rejection of transplanted
organs. (3)

Question 46

Q

Sumatriptan (Imitrex) is most commonly employed in the treatment of
(A) partial seizures
(B) arthritic pain
(C) arrhythmias
(D) psoriasis
(E) migraine headaches

Answer

A

(E) Sumatriptan (Imitrex) and other “triptans”
such as naratriptan (Amerge), rizatriptan
(Maxalt), and zolmitriptan (Zomig) are
primarily used for the treatment of migraine
headaches. (3)

Question 47

Q

Which of the following morphine derivatives
is most likely to cause dependence?
(A) diacetylmorphine
(B) ethylmorphine
(C) methylmorphine
(D) hydrocodone
(E) oxycodone

Answer

A

(A) Diacetylmorphine is another name for
heroin. Because of its great ability to cause
dependence, diacetylmorphine may not be
legally prescribed in the United States. (3)

Question 48

Q

Sulfonamides exert their antimicrobial effect
by competitively inhibiting the action of
(A) monoamine oxidase
(B) p-aminobenzoic acid
(C) pyrimidine
(D) beta lactamase
(E) DNA polymerase

Answer

A

(B) Sulfonamides exert their antimicrobial
action by competitively antagonizing paminobenzoic
acid (PABA). Sulfonamide resistance
may occur if an organism produces
excessive amounts of PABA or if PABAcontaining
products are used concurrently
with a sulfonamide drug. (3)

Question 49

Q

Sulfones such as dapsone are employed commonly in the treatment of

(A) Wilson’s disease
(B) psoriasis
(C) urinary incontinence
(D) atrial flutter
(E) leprosy

Answer

A

(E) Dapsone is a sulfone that is bactericidal
and bacteriostatic against Mycobacterium leprae,
the organism believed to be the cause of
leprosy (Hansen’s disease). (3)

Question 50

Q

Clonidine may best be described as a (an)
(A) alpha-adrenergic blocker
(B) beta-adrenergic blocker
(C) MAO inhibitor
(D) alpha-adrenergic agonist
(E) beta-adrenergic agonist

Answer

A

(0) Clonidine is a central alpha-adrenergic
stimulant. Its primary action is to stimulate
alpha-adrenergic receptors to reduce sympathetic
outflow from the CNS, thereby reducing
peripheral vascular resistance and reducing
heart rate and blood pressure. (3)

Question 51

Q

Minoxidil is an antihypertensive agent that
works by
(A) potentiating GABA activity
(B) directly dilating peripheral blood vessels
(C) blocking alpha-adrenergic receptors
(D) inhibiting COMT
(E) blocking beta-adrenergic receptors

Answer

A

(B) Minoxidil is a direct-acting peripheral
vasodilator. Because of its potential for producing
a number of serious adverse effects,
minoxidil is not a first-choice antihypertensive
agent. Its ability to produce excess hair
growth (hirsutism, hypertrichosis) has led to
its topical use for the treatment of alopecia as
the product Rogaine. (5:142-3)

Question 52

Q

Agent(s) indicated for the treatment of de
pression include(s)
I. bupropion (Wellbutrin)
II. venlafaxine (Effexor)
III. citalopram (Celexa)

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(E) Bupropion (Wellbutrin), venlafaxine (Effexor),
and citalopram (Celexa) are each antidepressants.
(3)

Question 53

Q

A common adverse effect associated with the
chronic use of magnesium antacids is

(A) nausea and vomiting
(B) gastrointestinal bleeding
(C) flatulence
(D) diarrhea
(E) constipation

Answer

A

(D) Magnesium-containing antacids (eg,
magnesium hydroxide) may cause diarrhea
because of their saline cathartic action on the
GI tract. They may also cause hypermagnesemia
in renal failure patients. (3)

Question 54

Q

Reduced clotting ability of the blood is asso
ciated with the administration of

I. clopidogrel (Plavix) (E) Crohn’s disease
II. abciximab (ReoPro)
III. filgrastim (Neupogen)

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(C) Clopidogrel (Plavix) and abciximab (ReoPro)
are platelet aggregation inhibitors. Filgrastim
(Neupogen) is a human granulocyte
colony-stimulating factor. (3)

Question 55

Q

Carbidopa can best be classified as a drug

(A) reverses symptoms of Parkinson’s disease
(B) exerts an anticholinergic action
(C) is a dopaminergic agent
(D) is a neuromuscular blocking agent
(E) is a dopa-decarboxylase inhibitor

Answer

A

(E) Carbidopa is a dopa-decarboxylase inhibitor
that prevents peripheral decarboxylation
of levodopa in the body. This reduces the
adverse effects associated with peripheral
dopa decarboxylation and reduces the dose
of levodopa required to control a patient with
Parkinson’s disease. Carbidopa is available
alone (Lodosyn) or in combination with levodopa
(Sinemet). (3)

Question 56

Q

Selegeline (Eldepryl) can best be described as (A) MAO inhibitor
(B) anticholinergic
C) COMT inhibitor
(D) anticonvulsant
E) alpha! agonist

Answer

A

(A) Selegeline (Eldepryl) is an MAO-B inhibitor
that is used in the adjunctive treatment
of Parkinson’s disease. (5:1006)

Question 57

Q

Which of the following is (are) true of fentanyl?
(A) I only
I. available as a transdermal system
II. used as a local anesthetic
III. may be used as a cough suppressant

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(A) Fentanyl is a potent narcotic agonist
analgesic used 1M or IV to promote analgesia
during anesthesia. It is also available in a
transmucosal (Fentanyl Oralet, Actiq) and
transdermal (Duragesic) dosage form. (3)

Question 58

Q

Lactase enzyme is available for the treatment
of
(A) lactose intolerance
(B) galactokinase deficiency
(C) cystic fibrosis
(D) phenylketonuria
(E) Crohn’s disease

Answer

A

(A) Lactase enzyme is effective in treating
symptoms of lactose intolerance. These
symptoms are most evident shortly after consuming
a lactose-containing food and may
include bloating and diarrhea. Lactase enzyme
is available as a liquid (Lactaid), caplets
(Lactaid), capsules (Lactrase), or as chewable
tablets (Dairy Ease). It is also added to some
commercial dairy products. (3)

Question 59

Q

Isotretinoin (Accutane) is a drug employed in
the treatment of severe recalcitrant cystic
(A) I only acne. Which one of the following is NOT an adverse effect associated with its use?
(A) hypertriglyceridemia
(B) hyperglycemia
(C) pseudotumor cerebri
(D) conjunctivitis
(E) fetal abnormalities

Answer

A

(B) Hyperglycemia is not a problem commonly
associated with the use of isotretinoin
(Accutane). Cheilitis (cracked margins of the
lips), conjunctivitis, and dry mouth occur in a
large proportion of patients receiving this
drug. Hypertriglyceridemia, pseudotumor
cerebri have also been reported. Isotretinoin
is classified in pregnancy category X and
will, therefore, potentially cause fetal abnormalities.
(3)

Question 60

Q

Which of the following is (are) true of isoease
tretinoin (Accutane)?

(A) may be used safely in pregnant patients
after the first trimester
(B) a derivative of vitamin D
(C) is applied topically to severe acne lesions
(D) contraindicated in patients with diabetes
(E) commonly causes cheilitis

Answer

A

(E) The use of isotretinoin (Accutane), a vitamin
A derivative, is associated with an incidence
of cheilitis (cracking around the margin
of the lips) greater than 90%. The drug is
administered orally and must not be used in
pregnant women because it carries a high
risk of causing fetal deformities. (3)

Question 61

Q

Endorphins are
(A) endogenous neurotransmitters
(B) a new class of topical anti-inflammatory
agents
(C) neuromuscular blocking agents
(D) biogenic amines believed to cause schizophrenia
(E) endogenous opioid peptides

Answer

A

(E) Endorphins are endogenous (naturally
found in the body) opioid peptides that are
released in response to stress. (3)

Question 62

Q

Which of the following statements is (are)
true of “crack”?
I. It is a free-base form of cocaine.
II. Its use results in CNS depression.
III. It is generally injected intravenously.
(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer

A

(A) Crack is a free-base form of cocaine. It is
generally smoked and rapidly absorbed
through the respiratory membranes. Within
seconds, it reaches the brain and produces
central nervous system stimulation and euphoria.
Dependence may occur with only a
single dose of the drug. (3)

Question 63

Q

A uricosuric drug is one that
(A) decreases urine flow
(B) promotes excretion of uric acid in the
urine
(C) blocks excretion of uric acid in the urine
(D) aids in the tubular reabsorption of uric
acid
(E) increases urine flow

Answer

A

(B) A uricosuric drug is one that promotes
the excretion of uric acid in the urine. Uricosuric
agents such as probenecid (Benemid)
and sulfinpyrazone (Anturane) inhibit tubular
reabsorption of urate and promote urate
excretion. They are used to treat hyperuricemia
associated with gout or gouty
arthritis. (3)

Question 64

Q

Alteplase (Activase) is employed clinically as
a (an)
(A) xanthine oxidase inhibitor
(B) proteolytic enzyme
(C) monoamine oxidase inhibitor
(D) ulcer adherent complex
(E) tissue plasminogen activator

Answer

A

(E) Alteplase (Activase) is a tissue plasminogen
activator produced by recombinant DNA
technology. It is used in the management of
acute myocardial infarction, acute ischemic
stroke, and pulmonary embolism. Once injected
into the circulation, alteplase binds to
fibrin in a thrombus and converts the entrapped
plasminogen to plasmin. This produces
local fibrinolysis and assists in reopening
a blocked blood vessel. (5:219)

Answer 65

A

(C) Cimetidine (Tagamet) is an Hz-histamine
receptor antagonist used to decrease gastric
acid secretion in patients with peptic ulcer
disease. It has been shown to inhibit the hepatic
metabolism of drugs metabolized via
the cytochrome P-450 pathway, thereby delaying
metabolism and increasing serum levels.
Cimetidine may affect the metabolism of
drugs such as theophylline, some benzodiazepines,
phenytoin, and warfarin. (3)

Answer 66

A

(B) Allopurinol (Zyloprim) is a xanthine oxidase
inhibitor that does not exert a uricosuric
effect but does prevent the conversion of hypoxanthine
to uric acid. It is employed in the
treatment of gout as well as in the management
of patients receiving therapy for
leukemia and other malignancies that increase
uric acid formation. (5:1463)

Answer 67

A

(E) Dihydrotachysterol is a synthetic product
of tachysterol, a substance similar to vitamin
D. It is used in combination with calcium and
parathyroid hormone in the treatment of hypoparathyroidism.
(3)

Answer 68

A

(C) Gemfibrozil (Lopid) is a fibric acid derivative
that reduces serum triglycerides and
very low-density lipoprotein (VLDL) and increases
HDL cholesterol by inhibiting peripheral
lipolysis and descreasing the hepatic
extraction of free fatty acids. Cerivastatin
(Baycol) is an HMG-CoA reductase inhibitor
that is employed as a cholesterol-lowering
agent used to reduce elevated total and LDL
cholesterol levels in patients with primary
hypercholesterolemia when response to diet
and other nondrug approaches have not been
successful. Its use is associated with hepatic
dysfunction and danger to the developing fetus.
(3)

Answer 69

A

(E) Acarbose (Precose) and miglitol (Glyset)
are both alpha-glucosidase inhibitors. Since
they act to reduce the GI absorption of carbohydrates,
they are best taken three times a
day with the first bite of each main meal. (3)

Answer 70

A

(B) The autonomic nervous system consists
of two major branches: the sympathetic
(adrenergic) branch and the parasympathetic
(cholinergic) branch. Each branch utilizes different
neurotransmitters. For example, the
sympathetic branch utilizes norepinephrine,
whereas the parasympathetic branch utilizes
acetylcholine. (3)

Answer 71

A

(A) Amiodarone (Cordarone) is an antiarrhythmic
agent used in treating ventricular
arrhythmias. It may cause a number of serious
adverse effects, the most serious being pulmonary toxicity. Baseline chest x-rays and
pulmonary function studies should be performed
before therapy begins. Studies should
be repeated at 3- to 6-month intervals. (5:250)

Answer 72

A

(C) Methadone (Dolophine) is a narcotic agonist
analgesic with actions similar to those
of morphine. It is twice as potent when used
parenterally than when used orally. It is employed
in the treatment of severe pain and in
maintenance treatment of narcotic addiction.
(5:1098)

Answer 73

A

(D) A pure narcotic antagonist is one that reverses
the effects of opioids without producing
agonist action of its own. Naltrexone
(ReVia) is an example of a pure narcotic
antagonist. Other drugs listed have agonist
and some antagonist activity. (3)

Answer 74

A

(C) Rizatriptan benzoate (Maxalt), a serotonin
5HT1-receptor agonist and methysergide
(Sansert), a semisynthetic ergot derivative,
are used in treating migraine
headaches. (3)

Answer 75

A

(D) Constipation is a common effect because
morphine decreases peristaltic activity in the
GI tract. Constriction of the pupils, CNS and
respiratory depression, and nausea and vomiting
are all effects also associated with morphine
use. (3)

Answer 76

A

(D) Primidone (Mysoline) is an anticonvulsant
drug used in a variety of convulsive disorders.
Primidone and its two active metabolites,
phenobarbital and phenylethylmalonamide
(PEMA), have anticonvulsant activity.
(5:967)

Answer 77

A

(C) Pamidronate (Aredia) is an agent used in
treating Paget’s disease of the bone, a condition
characterized by abnormal bone resorption
and the development of fractures. The
use of the drug seems to decrease the dissolution
of hydroxyapatite crystals, the building
blocks of bone tissue. (3)

Answer 78

A

(C) Repaglinide (Prandin) acts by stimulating
the release of insulin from the pancreas. (3)

Answer 79

A

(D) The naturally occurring adrenal cortical
steroids exert both salt-retaining (mineralocorticoid)
and anti-inflammatory (glucocorticoid)
activity. The synthetic steroids prednisone
and prednisolone exert similar actions
on the body. The use of these agents is often
associated with fluid and sodium retention.
(3)

Answer 80

A

(C) Dronabinol (Marinol) is a marijuana derivative
and granisetron (Kytril) is a selective
serotonin receptor antagonist used for the
prevention of nausea and vomiting associated
with cancer chemotherapy. (5:593)

Answer 81

A

(E) Amrinone (Inocor), like digoxin, is a
drug that produces a positive inotropic effect.
In addition, amrinone also produces vasodilation.
The drug is used for the short-term
management of congestive heart failure in
patients who have not responded adequately
to digoxin, diuretics, or vasodilators. Use of
the drug has been associated with the development
of thrombocytopenia, arrhythmias,
and GI upset. It is administered by IV bolus
or infusion. (3)

Answer 82

A

(A) The International Normalization Ratio
(INR) is a measure of the degree of anticoagulation
of the patient. Ideally, for a patient
who has experienced a myocardial infarction,
the INR should be maintained at about 2 to 3.
Higher levels do not seem to improve the
therapeutic outcome and are likely to increase
the chance of bleeding. (3)

Answer 83

A

(C) Lactulose (Cephulac, Chronulac), a synthetic
disaccharide, is an analog of lactose.
Unlike lactose, which is hydrolyzed enzymatically
to its monosaccharide components,
oral doses of lactulose pass to the colon virtually
unchanged. In the colon, bacteria chemically
convert the lactulose to low-molecularweight
acids and carbon dioxide. The acids
produce an osmotic effect that draws water
into the colon and makes the stools more watery.
They also permit ammonia in the body
to be converted to ammonium ion in the
acidic colon and allow it to be eliminated in
the stool. (5:611, 624)

Answer 84

A

(A) Milk of magnesia contains magnesium
hydroxide as its active ingredient. This acts
osmotically to produce a laxative effect. (3)

Answer 85

A

(D) Liothyronine sodium (Cytomel) is a synthetic
form of the natural thyroid hormone
T3. Approximately 25 )..lg of liothyronine
sodium is equivalent to 100 )..lg of levothyroxine
sodium (T4). (3)

Answer 86

A

(A) Aluminum hydroxide reacts with phosphate
ion in the intestine to form insoluble
aluminum phosphate which is eliminated in
the feces. This may be of value in treating hyperphosphatemia
in chronic renal failure. (3)

Answer 87

A

(C) Mesalamine (Asacol) or 5-aminosalicylic
acid (5-ASA) is a breakdown product of sulfasalazine
that is believed to be useful in
treating chronic ulcerative colitis. (3)

Answer 88

A

(D) Ibuprofen (Motrin) and oxaprozin
(Daypro) are nonsteroidal anti-inflammatory
drugs (NSAIDs) and should be avoided in
patients who are sensitive to aspirin because
of possible cross-sensitivity reactions. (3)

Answer 89

A

(D) Single aspirin doses are known to inhibit
platelet aggregation. This is believed to occur
by the acetylation of platelet cyclooxygenase
by aspirin. This in turn prevents the synthesis
of thromboxane A2, a prostaglandin that is a
potent vasoconstrictor and an inducer of
platelet aggregation. (3)

Answer 90

A

(E) Both triamterene (Dyrenium) and spironolactone
(Aldactone) inhibit sodium reabsorption
in the distal tubule. Spironolactone
is an aldosterone antagonist that prevents the
formation of a protein important for sodium
transport in the distal tubule. Triamterene inhibits
sodium reabsorption induced by aldosterone
and inhibits basal sodium reabsorption.
Triamterene is not an aldosterone
antagonist. (3)

Answer 91

A

(B) Labetalol (Normodyne, Trandate) is a
nonselective beta-adrenergic blocking agent
primarily used for the management of hypertension.
In addition to its beta-blocking action, labetalol is also able to block alpha1adrenergic
receptors. This lowers standing
blood pressure and may result in hypotension
and syncope. (5:139)

Answer 92

A

(A) Colchicine is a substance that may be
employed orally or parenterally to relieve the
pain of acute gout. It appears to act by reducing
the inflammatory response to deposited
urate crystals and by diminishing phagocytosis.
Although it relieves pain in cases of acute
gout, colchicine is not an analgesic or a uricosuric
agent. Vomiting, diarrhea, abdominal
pain, and nausea have all been reported with
the use of colchicine. Bone marrow suppression
and thrombocytopenia have also been
associated with colchicine use. (3)

Answer 93

A

(D) Oxymetazoline (Afrin, Duration) and xylometazoline
(Otrivin), when used as topical
nasal decongestants, produce an effect that
may persist for 8 to 12 hours. This is in sharp
contrast to other topical nasal decongestant
drugs such as phenylephrine, naphazoline,
and tetrahydrozoline, which require dosing
at 3- to 4-hour intervals. (3)

Answer 94

A

(A) The use of gold compounds such as auranofin
(Ridaura), gold sodium thiomalate
(Myochrysine), and aurothioglucose (Solganal)
has been associated with a wide variety
of adverse effects, including blood
dyscrasias, dermatitis, and renal disorders.
Patients using such compounds must be
monitored constantly for adverse effects. (3)

Answer 95

A

(A) Glucagon is a polypeptide secreted by
the pancreas. It acts to enhance gluconeogenesis
and glycogenolysis, thereby causing
higher levels of glucose in the blood.
Glucagon is used to treat severe hypoglycemia.
It is generally administered intramuscularly
or intravenously. Pioglitazone
(Actos) and repaglinide (Prandin) are oral antidiabetic
agents. (3)

Answer 96

A

(C) Iron is primarily absorbed in the duodenum
and the jejunum by an active transport
mechanism. The ferrous salt form is absorbed
approximately three times more readily than the ferric form. The presence of food, particularly
dairy products, eggs, coffee, and tea, in
the GI tract may decrease the absorption of
iron significantly, although the concurrent
administration of vitamin C maintains iron in
the ferrous state, thereby enhancing its absorption
from the GI tract. (5:1532)

Answer 97

A

(E) Iron is an essential component of hemoglobin,
myoglobin, and several enzymes. Approximately
two-thirds of total body iron is
in the circulating red blood cells as part of hemoglobin,
the most important carrier of oxygen
in the body. (3)

Answer 98

A

(B) The development of tolerance to the action
of nitroglycerin and other nitrates may
occur with repeated use. Sensitivity to the action
of nitroglycerin is generally restored after
several hours of withdrawal from the
drug. (3)

Answer 99

A

(D) Regular insulin is secreted by the beta
cells of the pancreas. In its unmodified form,
regular insulin is clear, has a short (0.5 to 1
hr) onset of action, and a relatively short (6 to
8 hr) duration of action. Lispro insulin solution
has a more rapid onset and shorter duration
of action than regular insulin. Because
regular insulin is a clear product, it can be
administered either SC or IV. (3)

Answer 100

A

(A) Fluvastatin (Lescol) is a cholesterollowering
agent contraindicated for use during
pregnancy because of its great potential
for causing fetal harm. The drug is in FDA
pregnancy category X. (3)

Answer 101

A

(E) Scopolamine is available in a transdermal
patch dosage form (Transderm Scop) for prevention
of nausea and vomiting associated
with motion sickness in adults. It is applied
to the skin behind the ear at least 4 hours before
the antiemetic effect is required. The
drug is then released from the transdermal
product for 3 days. (5:595)

Answer 102

A

(C) Desmopressin acetate (DDAVP) is the
synthetic analog of naturally occurring human
antidiuretic hormone (ADH) produced by the posterior pituitary gland. It is administered
intranasally for the treatment of primary
nocturnal enuresis. A single dose of the
drug will produce an antidiuretic effect lasting
from 8 to 20 hours. (3)

Answer 103

A

(C) Citalopram (Celexa) and sertraline
(Zoloft) are classified as SSRIs. Venlafaxine
(Effexor) is not an SSRI or a tricyclic antidepressant.
It acts to inhibit neuronal uptake of
serotonin and norepinephrine. (3)

Answer 104

A

(A) Dicloxacillin (Dynapen, Pathocil) is
a beta-Iactamase-resistant penicillin and
would be suitable for treating an infection
caused by beta-Iactamase-producing staphylococci.
Other penicillins that would also be
suitable include oxacillin (Prostaphlin, Bactocill),
cloxacillin (Cloxapen, Tegopen), and
nafcillin (Nafcil, Unipen). All of these products
are available for oral use. (3)

Answer 105

A

(D) Cyanocobalamin, or vitamin B12, is essential
for proper growth, cell reproduction,
formation of blood components, and many
other functions. In order for cyanocobalamin
to be absorbed properly from the GI tract, it
must combine with a glycoprotein called intrinsic
factor. In the absence of proper levels
of intrinsic factor, cyanocobalamin is administered
parenterally or intranasally. (3)

Answer 106

A

(B) Phenytoin (Dilantin) is an anticonvulsant
used in controlling grand mal and psychomotor
seizures as well as other convulsive
disorders. Adverse effects commonly
associated with phenytoin use include
nystagmus, gingival hyperplasia, ataxia, and
many other neurologic, dermatologic, and
hematologic disorders. Because of the high
frequency of adverse effects associated with
the use of this drug, patients must be monitored
closely during therapy. (5:967)

Answer 107

A

(D) Latanoprost (Xalatan) is a prostaglandin
F2a analog that reduces intraocular pressure
by increasing the outflow of aqueous humor.
(3)

Answer 108

A

(A) Betaxolol (Betoptic) is a beta-adrenergic
blocking agent used ophthalmically to reduce
intraocular pressure, particularly in patients
with chronic open-angle glaucoma. Unlike
other ophthalmic beta-blockers, the action of
betaxolol is more specific for beta1-adrenergic
receptors than for beta2-receptors, making it
less likely to affect respiratory function. (3)

Answer 109

A

(B) Pilocarpine (Isopto Carpine, Pilostat) is a
direct-acting miotic agent used to decrease elevated
intraocular pressure. By causing miosis
(constriction of the pupil), greater outflow
of aqueous humor is promoted and intraocular
pressure falls. Carbachol (Isopto Carbachol)
is another direct-acting miotic used in
situations in which pilocarpine is ineffective
or causes adverse effects. Dorzolamide (Trusopt)
acts by inhibiting the action of carbonic
anhydrase. (5:1472)

Answer 110

A

(B) Atropine is a belladonna alkaloid capable
of causing a wide range of effects in the human
body. Increased heart rate, diminished
sweating, reduction of gastric secretion and
tone, and mydriasis (dilation of the pupil of
the eye) are commonly associated with its administration.
(3)

Answer 111

A

(D) Ranitidine (Zantac) and other histamine
H2-receptor antagonists competitively block
H2-receptor sites, particularly those found in
gastric parietal cells. These agents do not
block histamine release, antibody production,
or antigen-antibody reactions and they do
not bind histamine. (3)

Answer 112

A

(E) Haloperidol (Haldol) is an antipsychotic
agent available in oral and parenteral forms.
It has pharmacologic actions similar to the
phenothiazines (sedation, extrapyramidal effects,
etc.). Chemically, haloperidol is a butyrophenone.
(5:1051)

Answer 113

A

(C) Tamoxifen (Nolvadex) is an agent that
has potent antiestrogenic effects because of
its ability to compete with estrogen for binding
sites in target tissues such as the breast. It
is used in the treatment of metastatic breast
cancer in women, particularly in patients
with tumors that are estrogen-receptor-positive. It is also used to reduce the incidence of
breast cancer in high-risk women. (3)

Answer 114

A

(A) Permethrin (Nix, Elimite) is a topical
scabicide and pediculocide. It acts by disrupting
the nerve cell membranes of parasites,
resulting in their paralysis. (3)

Answer 115

A

(A) Acetaminophen (Tylenol, APAP) is an
agent with analgesic and antipyretic actions
similar to aspirin. Unlike aspirin, acetaminophen
does not significantly inhibit peripheral
prostaglandin synthesis, which may
account for its relative lack of anti-inflammatory
activity. Acetaminophen does not inhibit
platelet function, affect prothrombin time, or
produce GI distress. (3)

Answer 116

A

(D) Clozapine (Clozaril) is an antipsychotic
agent indicated for use in patients who do
not respond to standard antipsychotic therapy
(phenothiazines, etc.). Use of clozapine
has been associated with the development of
agranulocytosis, a potentially life-threatening
blood disorder. Patients being treated with
clozapine must have a baseline white blood
cell (WBC) and differential count performed
before initiation of treatment, as well as a
WBC count every week during treatment and
for 4 weeks after discontinuing therapy.
(5:1129)

Answer 117

A

(B) Didanosine (Videx) is a reverse transcriptase
inhibitor that is active against the human
immunodeficiency virus (HIV). Its use has
been associated with the development of peripheral
neuropathy and pancreatitis. (3)

Answer 118

A

(D) Dactinomycin (Cosmegen) and plicamycin
(Mithracin) are antineoplastic agents
classified as antibiotics because they are derived
from a microbial source. These agents
appear to act in a cytotoxic fashion by interfering
with DNA and/or RNA synthesis.
Their use is associated with the development
of nausea and vomiting as well as with bone
marrow depression. (3)

Answer 119

A

(A) The anti-inflammatory and analgesic action
of NSAIDs is believed to result from inhibition
of prostaglandin synthesis. (3)

Answer 120

A

(A) Doxazosin (Cardura) is an alpha1-adrenergic
blocking agent used in the treatment of
hypertension. By causing dilation of arterioles
and veins, the drug causes the lowering
of both supine and standing blood pressures.
The “first-dose” effect is the development of
marked hypotension and syncope (fainting)
on administration of the first few doses of the
drug. Administering low initial doses of the
drug at bedtime can minimize this effect.
Dosage may be increased gradually until the
drug is better tolerated. (3)

Answer 121

A

(B) Carbon monoxide is a colorless and
odorless product of the incomplete combustion
of hydrocarbons. When it is inhaled and
carried to the blood, it reacts with hemoglobin
to form carboxyhemoglobin. This
reaction dramatically reduces the oxygencarrying
capacity of the blood and, unless
corrected quickly, results in the death of the
individual. (

Answer 122

A

(E) Aspiration of a liquid hydrocarbon such
as gasoline or kerosene may result in severe
inflammation of pulmonary tissues, interference
with gas exchange, pneumonitis, and
possible death. Emesis or gastric lavage is
avoided in such patients to avoid aspiration.
Catharsis using magnesium or sodium sulfate
may be attempted. Supportive therapy is
recommended for such patients unless antimicrobial
agents are required to treat respiratory
infection. (3)

Answer 123

A

(D) Deferoxamine mesylate (Desferal) is a
chelating agent that has a high affinity for
ferric iron and a relatively low affinity for calcium.
It is usually administered parenterally
in the treatment of acute iron poisoning. (5:83)

Answer 124

A

(B) Acetazolamide (Diamox) is a carbonic
anhydrase inhibitor used clinically in the
treatment of chronic open-angle glaucoma as
well as secondary glaucoma. It is also used
for treatment of edema caused by congestive
heart failure or drug use, or associated with
certain forms of epilepsy. Because acetazolamide
increases the excretion of sodium,
potassium, bicarbonate, and water, many patients
develop alkaline urine. (3)

Answer 125

A

(A) Thiazide diuretics such as hydrochlorothiazide
(Esidrix, HydroDIURIL) increase the
renal excretion of sodium, chloride, and
potassium while decreasing the excretion of
calcium and uric acid. (3)

Answer 126

A

(D) Acetazolamide is a carbonic anhydrase
inhibitor that increases the excretion of
sodium, potassium, bicarbonate, and water,
thereby alkalinizing the urine. Sodium bicarbonate
directly alkalinizes the urine. (3)

Answer 127

A

(D) Cyclophosphamide (Cytoxan) is an alkylating
agent related to the nitrogen mustards.
Patients using this agent should be advised
to take the drug on an empty stomach. Since
hemorrhagic cystitis may occur with the use
of this drug, patients should be advised to
drink lots of fluids. (3)

Answer 128

A

(E) All of these drugs are aldehyde dehydrogenase
inhibitors. They cause intolerance to
alcohol so that consumption of even a small
amount may produce a broad array of unpleasant
effects. These include flushing,
throbbing headaches, nausea, sweating, and
palpitations. Disulfiram is used in the management
of selected chronic alcoholics. The
drug should only be used with the full
knowledge and understanding of the patient.
(3)

Answer 129

A

(E) Each of these agents are MAO inhibitors.
Patients using them should avoid tyramine containing
foods as well as cold and allergy
products. (3)

Answer 130

A

(C) Polycarbophil (Mitrolan) is a synthetic
hydrophilic compound that is capable of absorbing
large amounts of water. It is indicated
for use as a bulk laxative in the treatment
of constipation. It is also employed in
the treatment of diarrhea, in which it absorbs
excess free fecal water and helps create
formed stools. (5:605)

Answer 131

A

(D) Zileuton (Zyflo) and montelukast
sodium (Singulair) are leukotriene receptor
antagonists. Since leukotrienes are associated
with causing asthmatic symptoms, the use of these drugs reduces the likelihood of asthma
attacks. (3)

Answer 132

A

(B) Diazoxide (Hyperstat) is a nondiuretic
antihypertensive agent structurally related to
the thiazides. It is used in the emergency reduction
of elevated blood pressure. Because
diazoxide is rapidly and extensively bound
to serum protein, it must be administered by
rapid IV injection (bolus). Repeated administration
of the drug may cause sodium and
water retention and the need for adjuvant diuretic
therapy. An oral form of diazoxide
(Proglycem) is used in the management of
hypoglycemia. (3)

Answer 133

A

(B) Miconazole (Micatin, Monistat) is a
broad-spectrum antifungal agent effective
against yeast infections (Candida albicans) as
well as dermatophyte infections (tinea cruris,
tinea corporis). (5:1861)

Answer 134

A

(A) Mafenide (Sulfamylon) is a bacteriostatic
agent that is active against many gram-positive
and gram-negative organisms. Topical
products containing mafenide are applied to
2nd- and 3rd-degree burns in order to reduce
the chance of infection and increase the speed
of healing. (3)

Answer 135

A

(B) Lypressin (Diapid) is a synthetic vasopressin
analog possessing antidiuretic activity
without producing a pressor or oxytocic
effect. It is used clinically in the management
of symptoms of diabetes insipidus. Lypressin
is administered as a nasal spray. (3)

Answer 136

A

(C) Sotalol (Betapace) and amiodarone (Cordarone)
are both Group III antiarrhythmic
agents. This means that they both act to prolong
the repolarization phase (phase 3). (3)

Answer 137

A

(A) The sulfonylurea hypoglycemic agents
appear to reduce blood glucose levels by
stimulating the release of insulin from the
beta cells of the pancreas. They are only effective
in patients who have some capacity for
endogenously producing insulin. (5:1225)

Answer 138

A

(C) Finasteride (Propecia, Proscar) is an androgen
hormone inhibitor used to treat benign
prostatic hyperplasia (BPH) as well as
male-pattern hair loss (alopecia). (3)

Answer 139

A

(D) Vidarabine (Vira-A) is an antiviral agent
that possesses activity against herpes simplex
virus. It is administered by slow IV infusion
for the treatment of herpes simplex encephalitis
and is used ophthalmically for the
treatment of herpes simplex infections of the
eye. (3)

Answer 140

A

(B) Dalteparin sodium (Fragmin) is a lowmolecular-
weight heparin derivative used in
preventing or treating thromboembolic complications
following surgery or ischemic complications
of unstable angina and MI. (3)

Answer 141

A

(B) Zidovudine (Retrovir) inhibits replication
of some retroviruses, including HIV. It is used
orally in managing patients with HIV infection
who have evidence of impaired immunity.
The intravenous form is used for some
adult patients with symptomatic HIV infection
who have a confirmed presence of pneumocystis
carinii pneumonia (PCP). (5:1938)

Answer 142

A

(E) Alteplase (Activase) is a tissue plasminogen
activator produced by recombinant DNA
technology. It is used intravenously in the
management of acute myocardial infarction
(AMI) patients in order to lyse thrombi obstructing
coronary arteries. It is administered
as soon as possible after the onset of AMI. (3)

Answer 143

A

(A) Dyphylline is a theophylline derivative.
These agents act by inhibiting the enzyme
phosphodiesterase, thereby increasing cyclicAMP
levels and producing bronchodilation.
Salmeterol is a beta2-adrenergic agonist,
and nedocromil sodium is an inhaled agent
that inhibits mediator release from mast
cells. (3)

Answer 144

A

(B) Diclofenac sodium (Voltaren) and
oxaprozin (Daypro) are both nonsteroidal
anti-inflammatory drugs (NSAIDs). (3)

Answer 145

A

(D) Cromolyn sodium (Intal, Nasalcrom,
Opticrom) is a drug with anti-asthmatic, antiallergy,
and mast cell stabilizing activity. It has no bronchodilator or anti-inflammatory
activity. Cromolyn appears to inhibit degranulation
of sensitized and nonsensitized mast
cells that may occur after exposure to certain
antigens. Cromolyn products are used prophylactically
to treat bronchial asthma, allergic
rhinitis, and mastocytosis. Cromolyn
should not be used in treating acute asthmatic
attacks. (5:449)

Answer 146

A

(A) Verapamil (Calan, Isoptin) is a calcium
channel-blocking agent used orally and parenterally
in the treatment of cardiac arrhythmias.
The other calcium channel-blocking
agents listed are used in the treatment of
angina pectoris and/or essential hypertension.
Oral verapamil is also used for these indications.
(5:239)

Answer 147

A

(D) Cefixime (Suprax) is a third-generation
cephalosporin. Third-generation cephalosporins
generally have greater gram-negative
activity, less gram-positive activity, greater
penetration of the central nervous system,
and higher cost than cephalosporins in firstor
second-generation groups. (3)

Answer 148

A

(A) Reflex tachycardia is commonly seen
with the use of peripheral vasodilators such
as minoxidil (Loniten) and hydralazine
(Apresoline). The drop in blood pressure produced
by the use of these agents causes increased
renin secretion, heart rate, and output
as well as sodium and water retention.
This may worsen both angina and congestive
heart failure. These adverse effects observed
with the use of peripheral vasodilators may
be managed by the concurrent administration
of a beta-adrenergic blocking agent
and/or a diuretic. (3)

Answer 149

A

(C) Buprenorphine (Buprenex) is an opioid
narcotic agonist-antagonist. As an analgesic,
it is about 30 times as potent as morphine. It
is administered intramuscularly or intravenously
for the relief of moderate to severe
pain. (5:1019)

Answer 150

A

(C) Mestranol is an estrogen commonly employed
in several oral contraceptive products
(eg, Norinyl, Ortho-Novum). (3

Answer 151

A

(E) Propranolol (Inderal) is a nonspecific
beta-adrenergic blocking agent that exhibits a
high degree of lipid solubility. As a result, it
is more likely than other beta blockers to enter
the CNS and produce CNS adverse effects.
(3)

Answer 152

A

(E) Danazol (Danocrine) is a synthetic androgen
that suppresses the pituitary-ovarian
axis by inhibiting the production of pituitary
gonadotropins. It is used clinically in the
treatment of endometriosis, in which it
causes the normal and ectopic endometrial
tissue to become inactive and atrophic. Danazol
is also employed in the prevention of
attacks related to hereditary angioedema.
(5:1350)

Answer 153

A

(A) Torsemide (Demadex) and bumetanide
(Bumex) are both loop diuretics. (3)

Answer 154

A

(B) Triamterene (Dyrenium) is one of three
potassium-sparing diuretics currently on the
market. The others include spironolactone
(Aldactone) and amiloride (Midamor). These
drugs are primarily used to enhance the action
and counteract the potassium-depleting
effect of thiazides and loop diuretics. (3)

Answer 155

A

(D) Acyclovir (Zovirax) is an antiviral agent
used in the treatment of infections caused by
herpes simplex virus types 1 and 2 (HSV-l
and HSV-2) and varicella-zoster virus. Shingles
is a painful and potentially debilitating
disorder caused by varicella-zoster virus. (3)

Answer 156

A

(B) Methohexital sodium (Brevital Sodium)
is a highly lipid-soluble barbiturate. It can,
therefore, rapidly cross the blood-brain barrier
and produce a rapid onset of action and a
short duration. Methohexital is employed for
the induction and maintenance of anesthesia.
(3)

Answer 157

A

(B) Lansoprazole (Prevacid) is a proton pump
inhibitor that dramatically reduces the secretion
of hydrochloric acid in the stomach. (3)

Answer 158

A

(D) Metoclopramide (Reglan) and cisapride
(Propulsid) increase the motility of the upper
GI tract without stimulating gastric, biliary,or pancreatic secretions. They are most commonly
employed in the treatment of diabetic
gastroparesis. (3)

Answer 159

A

(D) Olsalazine sodium (Dipentum) is a salicylate
compound that is converted to 5aminosalicylic
acid (5-ASA) in the colon. This
exerts an anti-inflammatory effect useful in
treating ulcerative colitis. (5:577)

Answer 160

A

(A) Salmeterol (Serevent)) and isoproterenol
(Isuprel) are sympathomimetic bronchodilators
that affect predominantly betaz-adrenergic
receptors. Salmeterol is believed, however,
to have less beta1-activity than isoproterenol.
This would make it less likely to
stimulate the heart. (3)

Answer 161

A

(D) Ramipril (Altace) is an angiotensin-converting
enzyme (ACE) inhibitor indicated for
the treatment of hypertension. When administered
orally, antihypertensive action generally
occurs within 1 to 2 hours. The drug’s action
persists for 24 hours. This permits single
daily dosing. (3)

Answer 162

A

(D) Beclomethasone dipropionate (Beclovent,
Vanceril) is a synthetic corticosteroid
used by inhalation to control bronchial
asthma. It is generally reserved for patients
in whom bronchodilators and other nonsteroidal
medications have not been totally
successful in controlling asthmatic attacks.
When used with a bronchodilator administered
by inhalation, the beclomethasone
dipropionate should be administered several
minutes after the bronchodilator in order to
enhance the penetration of the beclomethasone
into the bronchial tree. (3)

Answer 163

A

(A) Naratriptan (Amerge) is a 5-HT1-receptor
antagonist used to treat acute migraine
headaches. It is not used prophylactically. (3)

Answer 164

A

(E) Antimetabolites are a diverse group of
compounds that interfere with normal metabolic
processes and thereby disrupt nucleic
acid synthesis and normal cell function. (3)

Answer 165

A

(D) Loratidine (Claritin), cetirizine (Zyrtec),
astemizole (Hismanal), and fexofenadine (AI

Answer 166

A

(C) Methylphenidate (Ritalin) is an amphetamine-
like cortical stimulant employed in
treating attention deficit disorders as well as
narcolepsy. Nervousness and insomnia are
common adverse effects associated with
methylphenidate use. (5:1047)

Answer 167

A

(B) Azithromycin (Zithromax) is a macrolide
antimicrobial agent related to erythromycin,
clarithromycin (Biaxin), and dirithromycin
(Dynabac). (3)

Answer 168

A

(A) Stavudine (Zerit) is an antiviral agent
used in treating patients with HIV. Its use has
been associated with the development of peripheral
neuropathy. (3)

Answer 169

A

(D) Beta carotene is also known as provitamin
A. It is a precursor that is converted to
vitamin A in the body. (3)

Answer 170

A

(B) Simvastatin (Zocor) is an HMG-CoA reductase
inhibitor. It and similar agents such
as fluvastatin, lovastatin, cerivastatin, atorvastatin,
and pravastatin inhibit HMG-CoA
reductase, an enzyme that catalyzes an early
step in the synthesis of cholesterol in the
body. (3)

Answer 171

A

(E) Fentanyl is a narcotic agonist analgesic
that is significantly more potent than morphine.
It may be administered parenterally
(1M or IV) for induction or as an adjunct to
general anesthesia. It may also be used transdermally
(Duragesic) to manage chronic pain
for up to 72 hours. It is also available as a
transmucosal system (Fentanyl Oralet, Actiq)
and for use as a preanesthetic medication or
as an adjunct to anesthesia. (3)

Answer 172

A

(C) Anabolic steroids are related to androgens.
Their use results in enhanced tissue
building. They are used in the treatment of
certain types of anemia and in treating
metastatic breast cancer in women. (3)

Answer 173

A

(C) Amrinone (Inocor) is an agent that produces
a positive inotropic effect as well as vasodilation.
It is used to treat congestive heart
failure (CHF) in patients who have not responded
adequately to digitalis glycosides,
diuretics, or vasodilators. (5:165)

Answer 174

A

(D) Potassium is the principal intracellular
cation of a number of body tissues. It is essential
for proper transmission of nerve impulses;
contraction of cardiac, skeletal, and
smooth muscles; and in the transport of glucose
across cell membranes. (3)

Answer 175

A

(A) Finasteride (Proscar, Propecia) is an androgen
hormone inhibitor employed in the
treatment of benign prostatic hyperplasia
(BPH). Because prostatic development is dependent
on androgen activity, finasteride can
effectively reduce prostate gland size. Finasteride
is also used to treat alopecia. (3)

Answer 176

A

(D) Pemoline (Cylert) and methamphetamine
(Desoxyn) stimulate the central nervous
system and increase alertness and a heightened
awareness of surroundings. High doses
may produce hyperactivity, autonomic effects
on the heart, and muscle tremor. (3)

Answer 177

A

(C) Lactulose is a synthetic disaccharide
that is broken down by gut bacteria to lowmolecular-
weight acids and carbon dioxide.
These cause an osmotic laxative effect. The
acidity produced also causes ammonia to be
converted to ammonium ion. Ammonium
ion cannot be reabsorbed so it is eliminated
from the body. This effect may be useful in
patients with portal-systemic encephalopathy
to prevent ammonia accumulation in the
body. (5:611)

Answer 178

A

(D) Simethicone is a mixture of inert silicon
polymers. It is employed as an ingredient in
antacid products because of its defoaming action
in the GI tract. It acts to reduce the surface
tension of gas bubbles, thereby causing
them to break and release their entrapped
gases. (3)

Answer 179

A

(C) Pentamidine isethionate (Pentam, NebuPent,
Pentacarinat) is an agent that has activity
against Pneumocystis carinii, the cause of
pneumocystis carinii pneumonia (PCP). It is
administered by inhalation to prevent PCP in
high-risk, HIV patients. It is administered
parenterally to treat PCP. (3)

Answer 180

A

(B) Metronidazole (Flagyl) is an agent that is
primarily used because of its antiprotozoal
activity, particularly in the treatment of trichomoniasis.
It is also employed as an antibacterial
in treating certain anaerobic bacterial
infections. Patients using metronidazole
should avoid alcoholic beverages to avoid
disulfiram-like effects when the combination
is used. (3)

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