CNS Pharma Flashcards
1
Q
What is increased in central sensitization?
A
Calcium
2
Q
How does NAMDA receptor activation initiate central sensitization?
a. Increased intracellular calcium through activation of adenylate cyclase
b. decrease intracellular calcium through inhibition of adenylate cyclase
c. Increased calcium entry through linked receptors
d. decreased calcium entry through linked receptors
A
C
3
Q
How does NMDA receptor activation initiate central sensation?
a. Increase intracellular Ca+ through activation of adenyl cyclase
b. Decrease intracellular Ca+ through inhibition of adenyl cyclase
c. Increase Ca+ entry through linked receptor
d. Decrease Ca+ entry through linked receptor
e. Increase Cl- entry through linked receptor
A
C
4
Q
How does the NK-1 receptor participate in inducing central sensitization?
A
By increasing the release of calcium from intracellular stores by forming IP3
5
Q
What is responsible for central sensitization of pain?
a. GABA
b. Glycine
c. NMDA and NK1
A
C
6
Q
How does the NK-1 receptor participate in inducing central sensitization?
A
By increasing intracellular CA2+ release from stores by IP3
7
Q
Which receptor is responsible for serotonin excitatory action?
a. 5-HT1 receptor
b. 5-HT2 receptor
c. 5-HT3 receptor
d. 5-HT4 receptor
A
C
8
Q
What is the mechanism of action of neurokinin-1?
a. Increase Ca2+ release from intracellular stores via inositol trisphosphate
b. Increase intracellular Ca2+ through voltage-gated Ca2+ channels
A
A
9
Q
What describes the mechanism through which long term depression occurs?
A
Phosphorylation and internalization of AMPA receptors
10
Q
How does the NK-1 receptor work?
A
Increase the release of calcium from intracellular stores by increasing the synthesis of inositol
triphosphate (IP3)
11
Q
Long Term Potentiation
A
↑ entry of Ca & insertion of AMPA
12
Q
What is the consequence of NK-1 activation?
A
Intracellular Ca will increase by inositol triphosphate
13
Q
Noxious receptors
A
Increase Ca influx
14
Q
What receptor that once activated can also produce PG-I & PG E?
A
Bradykinin B2 receptor
15
Q
What type of receptor does the muscle relaxant baclofen work on?
a. GABA-A receptor
b. GABA-B receptor
c. GABA-C receptor
d. NMDA receptor
e. Histamine H1 receptor
A
B
16
Q
A patient recently diagnosed with MS has severe anxiety and can’t sleep. What drug can be used for her muscle cramps/ spasms?
a. Diazepam
b. Tiagabine
c. Valproate
A
A
17
Q
A young woman with a long history of depression, accompanied by body aches and pain. Which drug is useful for her?
a. Diazepam
b. Tiagabine
c. Valproate
A
A
18
Q
Which drug can be given to reduce anxiety and relieve muscle strain?
A
Diazepam
19
Q
Which of the following increases dopamine and noradrenaline in the synaptic cleft?
a. Nicotine
b. Amphetamine
c. Cocaine
A
B
20
Q
Mr.Ali has been addicted to a drug for a very long time. He ended up having cirrhosis and liver failure. Which of the following drugs of abuse he was addicted to?
a. Heroin
b. LSD
c. Cannabis
d. Ethanol
A
D
21
Q
What is the mechanism of action of cannabinoids on CB1 receptor?
A
Inhibition of adenylate cyclase, decreasing the production of cAMP
22
Q
Which drug inhibits the reuptake of noradrenaline, serotonin, and dopamine.
a. Caffeine
b. Nicotine
c. Cannabinoids
d. Cocaine
A
D
23
Q
Which drug inhibits Phosphodiesterase?
a. Caffeine
b. Nicotine
c. Cannabinoids
d. Cocaine
A
A
24
Q
What is the mechanism of action of Cannabis on the CB1 receptor?
A
Block AC, close Ca, open K
25
Which of the following drugs causes fatty liver upon chronic administration?
Ethanol
26
Which of the following inhibits phosphodiesterases?
Caffeine
27
What is the mechanism of action of cocaine?
Inhibits reuptake of monoamines
28
What is the mechanism of action of cocaine?
Blockage of presynaptic reuptake of monoamines
29
What is the mechanism of action of fluoxetine?
a. selective NE reuptake inhibitor
b. Monoamine oxidase inhibitors
c. Selectively inhibits serotonin reuptake
d. Serotonin and norepinephrine reuptake inhibitor
C
30
Which drug is used limitedly due to its complicated dietary restrictions?
a. Citalopram
b. Duloxetine
c. Phenelzine or tranylcypromine
d. Venlafaxine
C
31
What is the mechanism of action of imipramine?
a. Inhibits serotonin and NA reuptake
b. Inhibits serotonin and DA reuptake
A
32
What is the mechanism of action of the antidepressant citalopram?
Selective Serotonin Reuptake Inhibition
33
What drug causes blurred vision, dry mouth, and urinary retention?
a. Imipramine
b. Phenelzine
A
34
Which drug acts on A2 and 5-HT receptors?
a. Mirtazapine
b. Imipramine
c. Phenytoin
A
35
Typical cyclic antidepressant that is used in the case of severe depression
a. Fluoxetine
b. Citalopram
c. Venlafaxine
d. Duloxetine
e. Mirtazapine
f. Imipramine
g. Phenelzine
h. Clozapine
F
36
Which of the following drugs predisposes to serotonin syndrome when taken with SSRI?
a. Imipramine
b. Phenelzine
c. Clozapine
B
37
A patient should avoid tyramine containing food in which drug?
Phenelzine
38
What is the mechanism of action of amitriptyline?
Inhibit neuronal reuptake of noradrenaline and 5-hydroxytryptamine
39
What is the mechanism of action of fluoxetine
a. Inhibit serotonin uptake
b. Increase monoamine A
c. Decrease monoamine A
d. Increase monoamine B
A
40
What are the indications for Istradefylline?
a. Used to treat dyskinesias in late disease
b. Used to treat ‘off’ episodes
B
41
Parkinson symptomes treated with a drug and get better in one year
Levodopa
42
Which drug decreases the side effects of levodopa peripherally?
a. Domperidone
b. Carbidopa
A
43
Istradefylline is used in the treatment of the “off” symptoms of Parkinson's disease. What is the mechanism by which it works?
Act on A2A adenosine receptors
44
What drug causes purple mottling of skin?
Amantadine
45
What drug causes insomnia if administered after mid afternoon
Selegiline
46
Which of the following drugs blocks nicotinic receptors and stimulates dopamine release for the treatment of Parkinson?
a. Valproate
b. Benztropine
c. Amantadine
C
47
What is the best treatment plan for a patient diagnosed with Parkinson’s disease?
a. Carbidopa-selegiline-amantadine
b. Levodopa-carbidopa-entacapone
c. Carbidopa-domperidone-benztropine
d. Domperidone-ropinirole-amantadine
B
48
What drug needs to cross the blood brain barrier?
a. Domperidone
b. Selegiline
c. Benserazide
B
49
What is the mechanism of action of ropinirole?
a. Dopamine agonist
b. Increases dopamine release
A
50
What drug decreases the peripheral side effects of levodopa?
a. Benztropine
b. Carbidopa
B
51
What is the mechanism of action of ropinirole?
Agonist of dopamine D2 receptor in the CNS
52
Which drug is a peripheral DOPA decarboxylase inhibitor
a. Benserazide
b. Ropinirole
c. Tolcapone
d. Selegiline
e. Benztropine
A
53
Which drug is a muscarinic antagonist
a. Benserazide
b. Ropinirole
c. Tolcapone
d. Selegiline
e. Benztropine
E
54
Which of the following is a drug that prevents the metabolism of levodopa to 3-o-methyldopa?
a. Selegiline
b. Benserazide
c. Entacapone
C
55
What drug is a precursor of dopamine that crosses the blood brain barrier?
a. Levodopa
b. Domperidone
c. Carbidopa
A
56
Which drug causes gambling with excessive shopping as side effects?
Ropinirole
57
Which of the following is an antagonist to peripheral dopaminergic receptors used to treat the side effects of L-dopa such as anorexia and nausea?
Domperidone
58
Entacapone is a Levodopa optimizer given with it to enhance its CNS concentration. What is its mechanism of action?
Inhibition of catechol-o-methyl-transferase
59
Which drug has an on-off effect?
Levodopa
60
What drug is a Muscarinic acetylcholine antagonist?
Benztropine
61
MOA-B inhibitor?
Selegiline
62
Which drug blocks levodopa effect in the periphery by binding to the receptors?
Domperidone
63
Patient receiving antipsychotic drugs & she's diagnosed with parkinson's disease, what is the best drug to treat her?
Benztropine
64
L-dopa 3- methyl transferase?
Tolcapone
65
Which drug inhibits dopamine metabolism in the brain?
Selegiline
66
Which drug is a dopa decarboxylase inhibitor?
Carbidopa
67
Which drug is an inducer of an enzyme leading to many drug-drug interactions?
a. Phenytoin
b. Ethosuximide
c. Vigabatrin
d. Cannabinoids
A
68
Which of the following antiepileptic drugs at more than 50 mg/min in an adult can evoke cardiac arrhythmia?
a. Carbamazepine
b. Diazepam
c. Phenobarbital
d. Clonazepam
e. Phenytoin
A
69
What is the drug of choice for absence seizures?
a. Ethosuximide
b. Vigabatrin
c. Carbamazepine
A
70
Which drug causes irreversible visual field defects in some patients?
a. Ethosuximide
b. Tiagabine
c. Phenytoin
d. Lamotrigine
e. Vigabatrin
E
71
Which drug induce metabolism of other antiepileptics, anticoagulants, and oral contraceptives?
a. Ethosuximide
b. Tiagabine
c. Phenytoin
d. Lamotrigine
e. Vigabatrin
C
72
Which drug inhibits the reuptake of GABA?
Tiagabine
73
What is the drug of choice for status epilepticus?
Phenytoin
74
Which anti-epileptic drug is relegated for refractory cases because of its side effects?
Vigabatrin
75
What is the mechanism of action of vigabatrin?
Inhibits degradation of GABA by GABA transaminase
76
What is the mechanism of action of carbamazepine?
a. Block Ca channel
b. Block Na channel
B
77
Which drug irreversibly inhibits the enzyme GABA transaminase?
Vigabatrin
78
What is the mechanism of action of phenytoin?
Blocks Na+ channels
79
How would benzodiazepines mediate their anti-epileptic activity?
Enhance GABA-A transmission through increased chloride ion influx
80
Carbamazepine is prescribed to a patient. At first it has a half-life of 10-20 hours. After chronic administration the half-life decreased to 4 hours. What is the cause?
It induces CYP enzymes and accelerates its own destruction
81
Which drug has a narrow spectrum of activity and blocks T calcium channels?
Ethosuximide
82
Which drug acts by inhibiting GABA transaminase and increasing the activity of glutamate decarboxylase
Valproic acid
83
Which drug will increase the plasma concentration of drugs taken with it?
Valproic acid (it inhibits metabolism so the drug will be active longer)
84
What is the mechanism of action of benzodiazepine?
Potentiation of GABA Chloride Pore
85
What drug is used for partial seizures and induces liver enzymes?
Carbamazepine
86
What drug is used to treat Lennox Gastant syndrome?
Felbamate
87
What is the mechanism of Midazolam?
GABA-A modulators → enhance GABA-mediated synaptic inhibition
88
Which anxiolytic-hypnotic drug causes endocrine changes like increasing prolactin and decreasing testosterone levels?
a. Ramelteon
b. Zolpidem
c. Zaleplon
A
89
What is the mechanism of action of benzodiazepines?
a. Enhance GABA-A mediated inhibition through binding to the receptor active site
b. Enhance GABA-A mediated inhibition through binding to the modulatory site of the receptor
B
90
Which drug can be used as an anxiolytic and reduce muscle tone?
Diazepam
91
What drug is used to treat muscle spasms in patients with multiple sclerosis and cerebral palsy
Diazepam
92
Which drug blocks 5HT1A-receptor?
Buspirone
93
Which drug causes a hangover when used for a long period of time?
Nordazepam
94
What activates melatonin 1 and 2 receptors in the suprachiasmatic nucleus?
Ramelteon
95
Which drug activates the inhibitory 5HT1A-receptor?
Buspirone
96
A baby is brought by his mother because he has problems sleeping. The physician prescribes drug X, which resolves the problem but the mother then reports that it produces a bad odor from his mouth. What was the drug prescribed?
Chloral hydrate
97
Which of the following drugs has anxiolytic but no sedative or hypnotic effects?
Buspirone
98
A patient complained to his doctor that he suffers from insomnia. However, once he falls asleep, he can sleep for 6 hours. Which drug can be given to this patient?
Zolpidem
99
Tolerance to which of the following effects doesn’t develop with the repeated use of benzodiazepines
Anxiolytic effect
100
What is the mechanism of action of Benzodiazepines?
a. GABA-A receptor, enhancing GABA- receptor mediated inhibition
b. GABA-A modulators, enhancing GABA- Mediated synaptic inhibition
B
101
What is the antidote for midazolam?
Flumazenil
102
Which drug is used to treat sleep-onset insomnia?
Zolpidem
103
What is the mechanism by which tramadol works?
a. M receptor agonist and serotonin norepinephrine reuptake inhibitor
b. GABA
c. Increase intracellular calcium
A
104
Which of the following is NOT associated with opioid
A. Bronchoconstriction
B. Diarrhea
C. Nausea
D. Pupil constriction
B
105
What opioid has less GI and respiratory effects?
A. Cocaine
B. Morphine
C. Pethidine
D. Tramadol
D
106
What is the mechanism of action of morphine?
a. Activates AC, Opens K+ channels, Opens Ca2+ channels
b. Activates AC, Closes K+ channels, Closes Ca2+ channels
c. Inhibits AC, Opens K+ channels, Closes Ca2+ channels
d. Inhibits AC, Closes K+ channels, Closes Ca2+ channels
C
107
What is used as a cough suppressor at a sub-analgesic dose?
Codeine
108
Which opioid is prescribed to asthamtic patients?
Pethidine
109
Tolerance does not develop to which of the following effects of opioids?
Pupillary constriction [also constipation]
110
Which of the following is not an effect of opioids?
Constipation
111
What antipsychotic causes the strongest EPS?
Haloperidol
112
What is true regarding haloperidol?
Increased extrapyramidal tract symptoms due to high potency
113
What is a contraindication for treatment with all antipsychotics?
a. Sickle cell anemia
b. Alzheimer’s disease
c. Epilepsy
d. MS
e. Arthritis
C
114
Why does the majority of antipsychotic drugs cause extra pyramidal symptoms?
a. Low affinity binding to D2R
b. Binding to nAch receptors
c. Blocking D2R in the nigrostriatal pathway
C
115
A young man who was recently diagnosed with schizophrenia. What will help treat his apathy and bluntness?
a. Olanzapine
b. Thioridazine
c. Haloperidol
d. Chlorpromazine
e. Carbidopa
A
116
What drug causes serious side effects such as bone marrow suppression and orthostatic hypertension?
a. Valproate
b. Clozapine
c. Amantadine
d. Chloramphenicol
e. Tiagabine
B
117
Which antipsychotic drug doesn’t have an antiemetic effect?
a. Aripiprazole
b. Thioridazine
c. Fluphenazine
d. Haloperidol
A
118
Why are second generation antipsychotics preferred over 1st generation?
Less likely to cause extrapyramidal symptoms
119
What is used to treat the negative symptoms associated with schizophrenia?
a. Fluoxetine
b. Citalopram
c. Venlafaxine
d. Duloxetine
e. Mirtazapine
f. Imipramine
g. Phenelzine
h. Clozapine
H
120
What drug can cause QT prolongation?
a. Phenelzine
b. Fluoxetine
c. Thioridazine
d. Mirtazapine
e. Haloperidol
f. Chlorpromazine
g. Aripiprazole
C
121
What can lead to Extrapyramidal motor effects (EPS) due to its strong affinity (tight binding) to dopaminergic receptors?
a. Phenelzine
b. Fluoxetine
c. Thioridazine
d. Mirtazapine
e. Haloperidol
f. Chlorpromazine
g. Aripiprazole
E
122
A young man who was recently diagnosed with schizophrenia. What will help treat his apathy and bluntness affect?
a. Olanzapine
b. Thioridazine
c. Haloperidol
d. Chlorpromazine
e. Carbidopa
A
123
What is the difference between antipsychotics that preferentially block the D2Rs and those that have strong anticholinergic activity such as thioridazine?
Thioridazine has lower incidence of extrapyramidal signs
124
Which drug inhibits DNA synthesis and is used to treat Cytomegalovirus- induced cephalitis?
a. Ganciclovir
b. Ampicillin
c. Acyclovir
A
125
What are the characteristics of a drug that crosses the blood brain barrier?
a. A
b. B
c. C
d. D
C
126
A 15 year old boy presented to the ER with fever, headache, and seizures. HSV1 was identified by the PCR in the CSF. What is the appropriate treatment for this patient?
a. Acyclovir
b. Ampicillin
c. Cefotaxime and vancomycin
d. Gentamycin
A
127
What is a prodrug?
drug that gets into its active form after being metabolized
128
Which drug crosses the blood brain barrier and is effective in treating herpes-simplex induced encephalitis?
Acyclovir
129
A drug that has side effects like neuromuscular paralysis and nephrotoxicity?
Gentamicin
130
Which of the following best represents the properties of a drug that passes the blood-brain barrier?
High lipid solubility, low molecular weight, low amount of hydrogen bonds with water
131
What does amoxicillin inhibit?
A. Cell wall
B. DNA
C. Protein
A
132
What is the mechanism of action of ampicillin?
Inhibition of bacterial cell wall synthesis
133
What is the drug of choice to treat HSV?
Acyclovir
134
Which of the following drugs causes nephrotoxicity, neuromuscular paralysis?
Gentamicin
135
What is the mechanism of action of amphotericin B?
Binds to ergosterol and causes leakiness
136
Which of the following drugs has the longest duration of action in the treatment of Alzheimer’s disease?
a. Rivastigmine
b. Galantamine
c. Tacrine
d. Donepezil
D
137
What is the main side effect for Tacrine?
A. Ototoxicity
B. Hepatotoxicity
C. Nephrotoxicity
D. Cardiovascular toxicity
B
138
What is the mechanism of action of donepezil?
a. Inhibition of GABA A
b. Inhibition of GABA B
c. Inhibition of Butyrylcholinesterase
d. Inhibition of Acetylcholinesterases
D
139
What is the side effect of tacrine that makes it not used in Alzheimer's patients?
a. Nephrotoxicity
b. Hepatotoxicity
c. Cardiotoxicity
B
140
What is true about Alzheimer’s?
ApoE4 increases the risk
141
What is the mechanism of action of Memantine?
NMDA antagonist
142
What is the mechanism by which Rivastigmine treats dementia?
Anticholinesterase
143
Which drug combination produces neurolept analgesia?
a. Droperidol-fentanyl
b. Ketamine
c. Propofol
d. Morphine
A
144
What drug causes malignant hyperthermia?
Halothane
145
Dr. Bushra wants to perform a minor surgical procedure on her patient but she wants him to remain responsive to simple commands yet in a deep state of sedation and analgesia. Which combination of drugs will she use?
A. Propofol and fentanyl
B. INNOVAR Preparation Droperidol and fentanyl
B
146
Which drug is an NMDA-receptor antagonist?
Ketamine
147
Which drug is given before a procedure to reduce anxiety and ease amnesia?
Midazolam
148
What would you use to maintain anesthesia in someone with heart disease and has vitamin B12 deficiency anemia who is undergoing a three-hour-long knee procedure?
Isoflurane
[You can’t use Nitric oxide since it causes bone marrow depression neither can you use halothane since it sensitizes the heart to catecholamines]
149
Which drug is redistributed in fat and thus has a very short half life?
Thiopental
150
What anxiolytic drug is used to induce sedation and amnesia before procedure?
Midazolam
151
What type of receptor does the muscle relaxant baclofen work on?
a. GABA-A receptor
b. GABA-B receptor
c. GABA-C receptor
d. NMDA receptor
e. Histamine H1 receptor
B
152
A patient recently diagnosed with MS has severe anxiety and can’t sleep. What drug can be used for her muscle cramps/ spasms?
a. Diazepam
b. Tiagabine
c. Valproate
A
153
A young woman with a long history of depression, accompanied by body aches and pain. Which drug is useful for her?
a. Diazepam
b. Tiagabine
c. Valproate
A
154
Which drug can be given to reduce anxiety and relieve muscle strain?
Diazepam
155
What channel does lidocaine (local anesthetic) work on?
a. Na+
b. K+
c. Cl-
d. Ca2+
A
156
What is the mechanism of procaine, a local anesthetic?
A. Block Na channels
B. Block K channels
C. Block Ca channels
A
157
What is a characteristic of local anesthetics?
a. Adrenaline is used as an adjunct to prolong duration of action
b. Weak acids
c. Amides have short duration of action
d. Esters have long duration of action
A
158
What is the mechanism of action of local anesthetics?
Block Na channel
159
What is a property of local anesthetics?
They are weak bases
160
What is the mechanism of action of lidocaine at normal doses?
It blocks voltage-gated sodium channels
161
Which type of nerve fibers is first blocked by local anesthesia?
A delta
162
Which of the following drugs has the longest duration of action in the treatment of Alzheimer’s disease?
a. Rivastigmine
b. Galantamine
c. Tacrine
d. Donepezil
D
163
What is the main side effect for Tacrine?
A. Ototoxicity
B. Hepatotoxicity
C. Nephrotoxicity
D. Cardiovascular toxicity
B
164
What is the mechanism of action of donepezil?
a. Inhibition of GABA A
b. Inhibition of GABA B
c. Inhibition of Butyrylcholinesterase
d. Inhibition of Acetylcholinesterases
D
165
What is the side effect of tacrine that makes it not used in Alzheimer's patients?
a. nephrotoxicity
b. Hepatotoxicity
c. Cardiotoxicity
B
166
What is true about Alzheimer’s?
ApoE4 increases the risk
167
What is the mechanism of action of Memantine?
NMDA antagonist
168
What is the mechanism by which Rivastigmine treats dementia?
Anticholinesterase
