Block 1 exam Flashcards
There are, rightfully, concern about cocaine abuse, and too many deaths have occurred from smoking” crack cocaine or injecting or nasally inhaling the drug. Which of the following statements best describes the main mechanism by which cocaine exerts its deleterious effects in the CNS or in the periphery?
A) Directly activates, as an agonist, both alpha and beta 1 adrenergic receptors
B) Enhances neuronally-mediated adrenergic receptor activation by inhibiting neuronal- norepinephrine reuptake
C) Inhibits catecholamine inactivation by inhibiting MAO and COMT
D) Produces bradycardia and vasodilation, leading to hypotension and acute heart failure, by blocking neuronal NE release
E) Stimulates autonomic nerve conduction effectively, leading to increased neuronal NE release
Answer is B
a patient complains of paroxysmal of both being able to catch her breath. When no abnormalities are detected with conventional pulmonary function screening, the pulmonologist orders a methacholoine challenge test. Which if the following will increase as a result of stimulating cholinergic receptors on the bronchial smooth muscle?
A) lung compliance B) airway diameter C) Elastic work of breathing D) Restrictive work of breathing E) anatomic dead space
Answer is D
A patient has supra ventricular tachycardia. We inject a drug and heart rate fall to a normal or at least more acceptable level. Although this drug caused the desired response, it did so without any direct effect on or on the heart. Which of the following drugs was most likely used?
A) Edrophonium B) Esmolol C) Phenyephrine D) Propranolol E) Verapmil
Answer is C
Which of the following statements is more correct regarding the use of drugs in hypertension?
A) ACE inhibitors are contraindicated if the patient is pregnant
B) Beta blockers are contraindicated if hypertension is associated with heart failure
C) Calcium channel blockers are contraindicated if the patient also has obstructive pulmonary disease
D) Diuretics are contraindicated in hypertension associated with diabetes
E) Vasodilators are contraindicated in a patient taking a diuretic
Answer is A
A patient who experiences migraines has accidentally overdose with methysergide, a weak base of pKa=6.5. If urinary pH in this patient is 5.5, which if the following statements regarding elimination of methysergide form the body is accurate?
A) increase in urinary pH will increase excretion rate
B) Urinary excretion is already maximal, and change in pH will have no effect
C) Attempts should be made to acidify the urine to at lear 4 units below drug pKa.
D) At a urinary pH of 5.5, methysergide is 99% ionized
E) None of the above
Answer is E
In the case of a drug that follows first order elimination,
A) The rate of elimination is constant
B) The elimination half lives varies with the dose
C)The volume of distribution varies with the dose
D) The clearance varies with the dose
E) The rate of elimination varies directly with the dose
Answer is E
An elderly man with COP is being managed with several drugs, one of which is inhaled ipratropium. Which if the following is the main mechanism that accounts for the beneficial effects of this drugs?
A) Blocks of an endogenous bronchoconstrictoor mediator
B) enhances release of epinephrine from adrenal medulla
C) Inhibits cAMP breakdown via phosphodiesterase inhibition
D) Prevents antigen-antibody reaction that lead to mast cell mediated release
E) Stimulates ventilory rates
F) Suppresses synthesis and release of inflammatory mediators
Answer is A
A patient with hypertension also suffers from essential tremor. Optimal treatment of the patient should includes management with:
A) Prazosin B) Clonidine C) metoprolol D) lidocaine E) propranolol
Answer is E
Receptors actions of Ach are mimicked by nicotine at which one of the following sites?
A) adrenal medullary chomaffin cells
B) urinary bladder smooth muscle cells
C) Iris circular ( constrictor) muscle
D) Heart senatorial pacemaker cells
Answer is A
A 76 year old man has suffered from atrial fibrillation for many years. This condition has been under good control with aminodarone and diltiazam until recently. When he started experiencing palpitations and came back to see you decide to start the patient on digoxin therapy. How does this medication work?
A) it decreases intracellular sodium and increases intracellular potassium
B) It lowers intracellular calcium
C) It decreases stroke volume and cardiac output
D) It dimities elimination of sodium and water
E) it increases vagal activity and decreases sympathetic tone
Answer is E
A 50 year old man with a 15 year history of asymptomatic hyperuricemia will be started on drug therapy for newly diagnosed essential hypertension. Which one of the following antihypertensive drugs is most likely to increase his serum uric acid levels further and in doing so, pose the greatest risk of precipitating an acute gout attack?
A) Hydrochlorothiazide B) labetalol C) Losartan D) Ramipril E) Verapamil
Answer is A
You are on you GP placement and you are asked to see a 69 year old Tongan man who has a background of hypertension. he complains of chest pain when he walks and comments that is particularly bad when he walks up hill or stairs. It get better when he rests. You note that he is obese. You make a diagnosis of stable angina. One of the treatments of angina is Verapamil. Verapamil is beneficial in the treatment of anigina because it does which of the following?
A) Dilates veins B) Decreases cardiac contractility C) Increases oxygen extraction by myocardium D) Reduces diastolic fiber tension E) slows atrioventricular
Answer is b
to achieve a loading dose of a drug where the volume of distribution of the drug is 35L and the clearance rate is 70ml/min, and the desired dose is 3.5 mg/L, one should administer how many mg of drug initially?
A) 70mg B)122 mg C) 175 mg D) 200 mg E) 225 mg
Answer is B
A 42 year old white male with rheumatic mitral insufficiency is seen with symptoms and finding of initial left ventricular failure. You give him digitalis and recall that all of the folllowing are pharmacologic effects of digitalis except:
A) decrease conduction velocity in the AV node
B) increases the effects of normal vagal activity of the heart
C) Shortens the effective refractory period of the Purkinje fibers
D) weaken myocardial contractility
E) Prolongs the functional refractory period of the AV node
Answer is D
Which of the following is an action of noncompetitive antagonist?
A) Alters the mechanism of action of an agonist
B) alters the potency of an agonist
C) Shifts the dose response curve of agonist to the right
D) Decrease the max. response to an agonist
E) Binds to the same site on the receptor as the agonist
Answer is D
Choline esters like carbachol are most likely to cause which of the following adverse effects?
A) Anhydrosis
B) Delirium
C) Salivation
D) Tachycardia
Answer is C
A 33 year old woman with a history of Graves disease is brought to the emergency department unresponsive following a bout of confusion and agitation. On physical examination her temperature is 39.2 C (102.5), her blood pressure is 100/70mmHg, and her pulse is 165/min. A systolic ejection murmur is heard at the apex, and the patient has 3+ pitting edema at the ankles. Following primary stabilization, which of the following would constitute appropriate pharmacotherapy for this patient’s underlying condition?
A) aspirin B) dobutamine C) iodine D) Levothyroxine E) Propylthiouracil
answer is E
A 7 year old boy is brought to the clinic by his mother. He complains of sharp pain in his flanks, as well as dysuria and frequency. The doctor orders a 24 hour urine calcium test, and the results come back abnormal. After additional work up, the child is diagnosed with idiopathic-hypercalciuria. What is a common type of medication used for this aliment?
A) loop diuretic B) Carbonic anhydrase inhibitors C) thiazide diuretics D) Potassium sparing diuretics E) Osmotic diuretics
Answer is C
