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Toxicology > Final > Flashcards

Final Flashcards

1
Q

A 45 yr old male w/ a history of well controlled HTN presents to you w/ a complaint of a painful swollen great toe….which agent would you suspect most likely to exacerbate his gout?

A

Thiazide diuretic

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2
Q

What is the mechanism of action of cocaine?

A

Inhibition of re-uptake of monoamine neurotransmitters

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3
Q

What agents would interfere w/ erectile dysfunction NO promoters?

A

Nitrates

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4
Q

What agents would interfere w/ use of thiazide diuretics?

A

Calcium supplements

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5
Q

What agents would interfere w/ use of loop diuretics?

A

Calcium supplements

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6
Q

What determines the degree of movement of a drug b/w body compartments?

A
  • Degree of ionization
  • pH of the compartment
  • Size of the drug
    (All of the above)
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7
Q

Pharmacokinetics is the effect of the ____ & pharmacodynamics is the effect of the _______

A

Body on the drug; Drug on the body

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8
Q

Pts on statins should supplement with?

A

Co-enzyme Q

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9
Q

Phase II reaction products are:

A

Usually rapidly excreted in the urine

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10
Q

Pt tx’ed w/ drug A…administered in amounts that don’t exceed the binding capacity of albumin. Drug B is added 3 months later…administered in amounts 100x the binding capacity of albumin. Most likely result:

A

Significant increase in the levels of free drug A (may flip-flop drugs, look at which has greater amount)

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11
Q

Lipid soluble form of a base is ____ & lipid soluble form of an acid is ___?

A

Unprotonated; protonated

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12
Q

Decrease in drug-protein binding will lead to which of the following?

A

Increase in rate of drug elimination

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13
Q

Phase I makes drugs ____ polar for metabolism & phase II makes drugs ____ polar for excretion

A

More; more

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14
Q

Which direction would a partial agonist shift the dose-response curve when compared to full agonist?

A

Down

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15
Q

Which direction would a competitive antagonist (plus agonist) shift the dose-response curve when compared to a full agonist?

A

To the right

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16
Q

The classes of insecticides that produce inhibition of acetylocholinesterase are?

A

Organophosphates
Carbamates
(Both)

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17
Q

The classes of insecticides that impairs axonal transmission are:

A

Organochlorides

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18
Q

A major concern of individuals suffering from ethanol intoxication include:

A

Impaired judgement

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19
Q

A major concern of increased tolerance to ethanol includes:

A

Respiratory depression

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20
Q

Symptoms of alcohol withdrawal include

A

Seizures

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21
Q

Alcohol dehydrogenase has the highest affinity for:

A

Ethanol

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22
Q

Alcoholism is defined as:

A

Consumption despite adverse effects

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23
Q

Cadmium toxicity is exacerbated in:

A

Zinc deficiency

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24
Q

St. John’s Wort has been shown to

A

Effectively block reuptake of monoamines similar to SSRIs

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25
Q

Ginko Biloba extract

A

Has been shown to improve cognitive function

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26
Q

The agent in garlic that has positive effects on CV functions also

A

Has antibacterial effects

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27
Q

The adverse effects of DDT on eagles…is evidence of

A

Biomagnification

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28
Q

First pass metabolism describes:

A

The proportion of drug metabolized when it first passes through the hepatic portal system prior to system circulation

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29
Q

Bioavailability of a drug can be increased by:

a. Dissolving it in water
b. Using 1st pass metabolism
c. Using it as shampoo
d. None of the above

A

None of the above

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30
Q

Ligand-gated ion channels

A

Tend to have brief response times in response to binding (millisecs to secs)

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31
Q

Using a beta blocker to slow tachycardia from another drug would qualify as

A

Functional antagonism

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32
Q

Steroid receptor activation

A

Results in binding directly to DNA

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33
Q

Receptor desenesitization involves

A
  • Sequestration of receptors in intracellular vesicles
  • Degradation of receptors
    (Both)
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34
Q

All of the following statements regarding incretin therapy are true except

A

Glucagon release is stimulated

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35
Q

The goal of insulin therapy in type I diabetes is?

A

To mimic normal basal & post-prandial glucose levels

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36
Q

Which of the following would be an appropriate addition to insulin management of longstanding type I diabetes:

a. An insulin secretogogue
b. An insulin sensitizer
c. A dipeptidyl-peptidase-4 inhibitor
d. None of the above

A

None of the above

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37
Q

Mechanism employed to mitigate first pass metabolism:

a. Changing the chemical formula of an agent
b. Changing the dose
c. Changing the route of administration
d. All of the above

A

All of the above

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38
Q

Chelating agents:

A

May exacerbate heavy metals toxicity when given long after heavy metal exposure

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39
Q

“Aging” of acetylcholinerease inhibition occurs w/:

a. Organochlorine pesticides
b. Carbamate pesticides
c. Both
d. Neither

A

Neither (if “organoPHOSPHATE is a choice pick that)

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40
Q

This type of reaction is most often assoc. w/ drug activation or production of active metabolites

A

Phase I

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41
Q

This type of reaction converts lipophilic agents to a water soluble agent

A

Phase I

Phase II

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42
Q

This type of reaction that most often occurs in liver

A

Phase I

Phase II

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43
Q

This type of reaction increase polarity by unmasking a polar functional group

A

Phase I

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44
Q

This type of reaction involves conjugation w/ glucuronic acid, amino acids, sulfuric acid or acetic acid

A

Phase II

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45
Q

Which enzyme involved in ethanol metabolism experiences the most induction assoc w/ chronic excessive alcohol consumption?

A

Microsomal ethanol oxidizing system (MEOS)

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46
Q

Which of the following are most at risk for toxic effects from exposure to modestly increased carbon monoxide levels?

A

23 yr old pregnant female w/ 26 wk gestation

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47
Q

The following statements regarding receptor desensitization are accurate except:

a. serves to protect the cell from damage d/t overstimulation
b. it involves the sequesatration of receptors intracellularly
c. it involves the degradation of receptors
d. all of the above

A

All the above

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48
Q

Enzyme kinetics of an ethanol novice w/ a blood alcohol of 300mg/dl are best described as?

A

Zero order kinetics

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49
Q

Type of kinetics that describes the metabolism of a substrate when the concentration of substrate far exceeds the number of enzymes involved in its metabolism

A

Zero order kinetics

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50
Q

Agents that those w/ PKU should avoid

A

Aspartame

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51
Q

Agents discovered while investigating non-food substances

A

Saccharine
Sucralose
Aspartame
(All the above)

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52
Q

For 1st order drug elimination, 1/2 life is ___ at two places on the curve & a constant ____ is lost per unit time

A

Equal; percentage

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53
Q

Pt has been using albuteral intake for the past 3 yrs…After 3rd dose, she noticed palpations. Your explanation should be:

A

Lack of beta receptor specificity resulting in some beta-1 agonism causing an increased heart rate.

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54
Q

Principle mechanism by which sublingual nitroglycerin terminates anginal episodes in pts w/ advanced atherosclerotic coronary vessel ds.

A

Decreased preload

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55
Q

Charac. of lithium in use for bipolar disorder include:

A

Mechanism of action is unknown

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56
Q

Most NSAIDs are:

A

Prostaglandin synthesis inhibitors

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57
Q

Anti-hyperlipidemia drug is assoc. w/ cutaneous vasodilation following ingestion:

A

Niacin

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58
Q

Possible effects of re-uptake inhibitors for depression include all except:

A

Manic symptoms in normal non-depressed people

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59
Q

Major concern of acetaminophen use is:

A

Overdose assoc. w/ use of combination preparations

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60
Q

All of the following factors in poor compliance w/ pharmacologic tx of HTN except:

A

Lowering of high BP has not been shown to decrease incidence of sequala of HTN

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61
Q

Most likely mechanism of action of psychomotor effects of caffeine at plasma levels attained through routine consumption

A

Blockade of adenosine receptors

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62
Q

Skipper was type II diabetic & developed class 3 angina. He used sublingual nitroglycerine on island. Which of the following is added w/ the most caution?

A

Beta blocker

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63
Q

Tox instructor slumped/mumbling incoherently. Sees “snow”. Receipt for whiskey, rubbing alcohol, sterno, & windshield wiper fluid. Intoxication w/?

A
  • Methanol (Follow-up Q: metabolic acidosis)

- (W/O “Snow” Isopropyl alcohol)

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64
Q

Charac. of insulin:

A
  • Made of amino acids
  • Secreted in pro-form that requires activation in peripheral tissue
  • C-peptide, lacks metabolic activity
    (All of the above)
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65
Q

Symptoms of hypoglycemia diminished by:

A
  • Autonomic neuropathy
  • Beta blockers
    (Both)
66
Q

Agents useful in glycemic control for type I diabetes include:

A

Insulin

67
Q

Benzodiazepines most assoc. w/ following neurotransmitter systems

A

GABA system

68
Q

Lack of HA following the use of sublingual nitroglycerin could indicate:

A
  • Nitrate tolerance
  • Spontaneous degradation
    (Both)
69
Q

The following exposures have been assoc. w/ elevated carboxyhemoglobin levels except:

  • 2nd-hand cigarette smoke
  • Marijuana smoke
  • Urban pollution
  • All are assoc. w/ it
A

All are assoc. w/

70
Q

Following the exposure to toxic cadmium levels:

A

Cadmium absorption is increased by zinc deficiency

71
Q

Carrots are assoc w/ what toxic agent?

A

Myristicin

Carotatoxin

72
Q

Electronic devices are assoc w/ what toxic agent?

A

Arsenic

73
Q

Potatoes are assoc w/ what toxic agent?

A

Solanine

74
Q

Lima beans are assoc w/ what toxic agent?

A

Hydrogen cyanide

75
Q

CFL bulbs are assoc w/ what toxic agent?

A

Mercury

76
Q

Stoner Jane was feeling a bit anxious..Skateboarding home, sprained ankle, most effective agent for amelioration of her injury is?

A

Ibuprofen

77
Q

Mike Brady is attempting to quit smoking for the 20th time this year…best choice for this adjunctive tx would be?

A

Nicotine gum

78
Q

In functional antagonism:

A

Ligand binding to a receptor elicits a response that opposes (or counteracts) the bindings of a different ligand to a separate receptor

79
Q

A major concern for individuals suffering from ethanol intox. of any severity (even mild intoxication)

A

Respiratory depression

80
Q

Angiotension receptor blockers are:

A

Slighlty less effective at ACE inhibitiors at lowering BP

81
Q

Type of kinetics that describes the metabolism of a substrate when the number of enzymes involved in its metabolism far exceeds the concentration of substrate B

A

Second order kinetics

82
Q

Type of snakes assoc. w/ highest lethality are?

A

Coral snakes

83
Q

The noble St. Bernard…Which of the effects of ethanol would be beneficial for hypothermia?

a. Cardiac inotrope
b. Decreased blood viscosity
c. Peripheral vasodilation
d. None

A

None

84
Q

John B. 39yr old overweight….has HTN…Avid runner…Which anti-hypertensive = unacceptable therpeutic effect in the big man?

A

Beta blockers (Follow-up Q: Blunting exercise-induced tachycardia)

85
Q

Which of the following reactions is a phase II reaction?

A

Conjugation

86
Q

Symptoms of alcohol withdrawal include:

A

Seizures

87
Q

The most important predictor of the type & severity of particulate pathology in the lung is?

A

Particle size; smaller is more injurious

88
Q

Transduction is involved in the mechanism of action of the following drug types

A
  • Agonist
  • Antagonist
  • Partial antagonists (agonists/antagonists)
    (All of the ball)
89
Q

This class of receptor is assoc. w/ a response duration of minutes to hours

A

Enzyme linked receptor

90
Q

This class of receptor shows specificity for the ligand which binds & results in transduction

A
  • Ligand gated ion channel
  • G-protein couple receptor
  • Enzyme linked receptor
    (all of the above)
91
Q

For a drug antagonist to show an effect it requires

A

The presence of an agonist

92
Q

Which class of drugs freq. exhibits structural similarities to a receptors natural ligand?

A
  • Agonist
  • Antagonist
  • Partial agonist/antagonist
    (All of the above)
93
Q

The main mechanism of bile acid binding resins lowering plasma cholesterol is by?

A

Binding bile acids in the small intestine, blocking their enterohepatic circulation & forcing the liver to convert more cholesterol to bile salts.

94
Q

Watching General Hospital, actress takes entire bottle of pills, Dr. McHottie should suspect?

A

Possible benzodiazepine overdose (Follow-up Q: “Give another does of flumazenil”)

95
Q

An 8 yr old male presents to your office w/ the above x-ray, they are indicative of exposure to?

A

An old dilapidated house (lead) (Follow-up Q: All of the above)

96
Q

Type of reaction most often assoc. w/ cytochrome P450

A

Phase I rxn

97
Q

Cardiac problems may be assoc. w/:

a. binge alcohol consumption
b. chronic alcohol consumption
c. alcohol withdrawal
d. all of the above

A

All of the above

98
Q

Organic form is toxic, mercury or arsenic

A

Mercury

99
Q

Produces a motor neuropathy, mercury or arsenic?

A

Neither

100
Q

Blocks the action of sulfhydryl (-SH) groups on enzymes, mercury or arsenic?

A

Both

101
Q

Enteroheptatic circulation involves recycling

A

Bile salts
Some drugs
(Both)

102
Q

Organic nitrates produce a decrease in?

A
  • Preload
  • Afterload
  • Myocardial O2 demand
    (all of the above)
103
Q

Aunt Ethel uses sublingual NTG 2x/wk…climbing stairs at church…feels chest pressure…least appropriate course of action fro Ethel is?

A

Take a long acting nitrate sublingual so it takes effect quickly

104
Q

The following statements regarding statins are accurate except?

A

Adverse reactions are common but not potentially serious

105
Q

The amount of drug that produces a therapeutic effect is?

A

Free drug in the plasma

106
Q

The long term effect of diuretics that result in lowering high BP is?

A

Decreased peripheral vascular resistance

107
Q

Enhanced excretion of a weak acid would best be promoted by?

A

Alkalinization of the urine (raise the pH)

108
Q

Identify the physical factors involved in drug absorption

A
  • Blood flow
  • Surface area
  • Contact time
    (All of the above)
109
Q

Drugs tightly bound to plasma proteins:

A

Often have a longer duration of effect than drugs not bound to albumin

110
Q

42 yr old Body builder Bob…takes super-roid…3 days after starting passes out…Most likely cause is?

A

Elevated plasma level of free antihypertensive agent

111
Q

Bioavailabilty is expressed as the amount of drug in the systemic circulation divided by the amount of drug:

A

Administered

112
Q

The most important effect of CHF on drug interaction is d/t?

A

Increased volume of distribution

113
Q

Which enteral route of administration involves the most variable?

A

Oral

114
Q

Which of the following transfer mechanisms depends on the agent’s concentration gradient to promote absorption across the GI tract?

A

Facilitated diffusion

115
Q

Mary Poppins drinks a lot & base-jumps, twists ankles…which pain med would be the least appropriate?

A

Oxycodone

116
Q

Irwin Fletcher 54 yr old w/ stable angina…take NTG…climbs steps at gf’s apartment…continues to have chest pain & no HA…What is the explanation?

A

Acute tolerance to nitrates

117
Q

Pt has esophageal reflux…wife is a bad cook…regularly consumes antacids & complains of worsening degenerative arthritis, you suspect?

A

Daily antacid use has upset the production of intrinsic factor..the absorption of Ca++ causing a decrease in bony repair

118
Q

Opiates possess all of the following charac. except

A

Block pain transmission in the anterior horn of the spinal cord

119
Q

Which of the following is not a therapeutic effect of acetaminophen?

A

Anti-inflammatory

120
Q

A major concern of acetaminophen use is?

A

Overdose assoc. w/ the use of combination preparations

121
Q

Ricky Ricardo has severely burned oral cavity…Alternative method of administration?

A

Take it rectally

122
Q

Dan Connor is 46 yr old…avg BP 142/90…Most appropriate step in management at this point would be?

A

Evaluation of the cause of hypertension

123
Q

Mr. Connor is otherwise healthy & w/o risk factors for CVD…initial management is a lot of stuff and?

A

Nothing else at this time

124
Q

Which of the following drugs would interfere w/ the therapeutic effect of furosemide (lasix) a loop diuretic?

A

NSAID

125
Q

The only acutely effective tx of severe depression is?

A

Electroconvulsive therapy

126
Q

The 2-3 week delay in the onset of the therapeutic effect of SSRIs is d/t?

A

Desensitization of inhibitory presynaptic receptors

127
Q

Abrupt discontinuation of which of these agents may be assoc. w/ an acutely life threatening syndrome?

A

Beta-blockers

128
Q

Mildred 79 yr old, HTN asthmatic…had BP meds increased…noticed asthma has been bothering her more since then, you suspect?

A

The increase in Beta-1 antagonist resulted in antagonism at the Beta-2 receptors on bronchiole smooth muscle promoting bronchospasm

129
Q

Mildred had a bronchoscopy…2 days she complains she can’t remember what happened…You would tell her?

A

A beneficial side effect of short acting benzos when used prior to invasive procedures is anterograde amnesia

130
Q

George Kostanza suffered a lat. wall MI 8 months ago…complains of dry, non-productive cough…no evidence of pneumonia or pulmonary mass..Which med do you suspect?

A

ACE inhibitor (Follow-up Q: Angiotensin II receptor blocker for the ACE inhibitor)

131
Q

Alice Kramden..husband Ralph…takes two meds for DM II…purchased total gym…which dietary interventions would be the least appropriate?

A

Start each day w/ a whole grapefruit

132
Q

George Jetson..strict control of DM II…3 episodes of hypoglycemia cause he’s missing meals…You would tell him all of the following except?

A

Strict control will prevent the occurrence of both macro- & micro- vascular complications of DM

133
Q

Aunt Ethel couldn’t stand nasty taste of nitro…swallowed tablet….no HA…went to mailbox & feels chest pain…most likely explanation?

A

1st pass hepatic metabolism inactivated most of the nitroglycerin

134
Q

Farmer John used sublingual nitro…started a Ca+ blocker & baby aspirin, hasn’t needed nitro as often…not getting HA anymore…you should conclude?

A

His nitroglycerin has become ineffective

135
Q

While on the island Maryann developed asthama & class II angina, which of following agents would be least appropriate?

A

Beta-blocker

136
Q

A drug which binds w/ greater affinity to its receptor will likely be more _______ than a drug that binds w/ less affinity?

A

Efficacious

137
Q

Which of the following is not an advantage of rectal over sublingual drug administration?

A

Avoidance of 1st pass metabolism

138
Q

A drug is administered in the form of a pro-drug….With chronic administration of the pro-drug, which of the following will be observed?

A

The potency will increase

139
Q

What is echinacea most often used for?

A

To enhance immune function in individuals w/ colds or other respiratory tract infections

140
Q

What is garlic used for?

A

Reduces total cholesterol, some cancers

141
Q

In addition to improving cognitive function, what other effect does Ginkgo have?

A

May improve mild-to-moderate PVD

142
Q

What can ginseng be used for?

A

Early type II DM glucose control & possibly preventing URI’s

143
Q

What are the effects of milk thistle?

A

May have beneficial effects on the liver (cirrhoss, Hep C)

144
Q

What is saw palmetto used for?

A

urologic symptoms of BPH

145
Q

Other than paint, what is lead found in?

A

Soldering of circuit boards & other device components

146
Q

What is beryllium found in?

A

Significant portions of electrical connectors & battery contacts

147
Q

What electronic parts is arsenic found in?

A

Integrated circuits & semiconductors

148
Q

What electrical components is mercury found in?

A

Batteries & circuit boards

149
Q

What electrical components is Antimony found in?

A

Diodes & batteries. Pure form in semiconductors

150
Q

What electrical components is cadmium found in?

A

Soldering, semiconductors, & chip resistors

151
Q

What is Cadmium found in?

A
  • Cigarette smoke
  • Batteries
  • Refined foods
  • Water pipes, galvanized metals
  • Coffee & Tea
  • Coal
  • Shell Fish
  • Ceramics
  • Dental materials
  • Cereal grains & root veggies
152
Q

A 5yr old boy is brought to a hospital..w/ empty aspirin bottle..What type of acid/base findings are likely to be found from an arterial blood gas?

A

Mixed respiratory alkalosis & metabolic acidosis

153
Q

Adverse effects of organic nitrates include the following except:

A

Bradycardia

154
Q

The main anti-anginal effect of this agent is a decrease in after-load

A

Nifedipine (Ca++ channel blocker)

155
Q

The addictive quality of nicotine is most likely d/t its ability to promote?

A

Stimulation of dopamine release in the CNS

156
Q

Amphetamine produces its effect via:

A

Neurotransmitter reuptake inhibition into the presynaptic terminal
Uncontrolled neurotransmitter release from the presynaptic terminal
(Both)

157
Q

LSD functions as an agonist of

A

Serotonin

158
Q

What clinical trial phase usually involves small doses to determine a drugs pharmacokinetic properties?

A

Phase I

159
Q

Some users of methamphetamine will consume substances to _____ their urine to promote excretion of meth in their urine…etc.

A

Acidify (Follow up Q: It decreases distal tubular reabsorption)

160
Q

Stoner Marge has a slight HA…after firing up her 3rd fatty…least effective tx?

A

Tylenol

Toxicology (3 decks)

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