(P2) Lab 9 Q&A Set 3

Question 1

A 44-year-old man complained to his physician of burning pain on his chest, especially when his clothes rubbed against it, and an itchy feeling in the same area. The patient was diagnosed with herpes zoster 3 weeks ago, but the painful rush on his chest disappeared after 8 days. The physician made a presumptive diagnosis and ordered a drug to allay pain. Which of the following drugs would be appropriate for this patient?

Answer 1

Tramadol

Question 2

A44-year-old man who underwent surgery to remove a lung cancer exhibited pronounced shivering upon recovering from surgery. An appropriate therapy was started that included fluid warming and an intravenous injection of a drug. Which of the following drugs was most likely administered?

Answer 2

Meperidine

Question 3

Indomethacin

• Define:*
• USE:*

Answer 3

is a nonsteroidal anti-inflammatory drug (NSAID) commonly used as a

prescription medication* to *reduce fever, pain, stiffness, and swelling from inflammation.

Question 4

Indomethacin

MOA :

Answer 4

It works by inhibiting the production of prostaglandins, endogenous signaling molecules known to cause these symptoms.

It does this by inhibiting cyclooxygenase, an enzyme that catalyzes the production of prostaglandins.

Question 5

indomethacin

AE :

Answer 5

Many NSAIDs, but particularly indometacin, cause lithium retention by reducing its excretion by the kidneys. Thus indometacin users have an elevated risk of lithium toxicity. For patients taking lithium (e.g. for treatment of depression or bipolar disorder), less toxic NSAIDs such as sulindac or aspirin are preferred.

All NSAIDs, including indometacin, also increase plasma renin activity and aldosterone levels, and increase sodium and potassium retention. Vasopressin activity is also enhanced.

Together these may lead to:

Edema (swelling due to fluid retention)

Hyperkalemia (high potassium levels)

Hypernatremia (high sodium levels)

Hypertension

Question 6

A baby boy, born after normal delivery, presented with re- spiratory depression, pinpoint pupils, and low Apgar scores. His mother received two intramuscular injections of an analgesic drug 3 and 2 hours before the delivery because of strong erratic and very painful contractions. Which of the following drugs would be appropriate for the baby at this time?

Answer 6

Naloxone

Question 7

Albuterol and ipratropium

Are considered to be what type of agents?

Answer 7

Albuterol and ipratropium

are bronchodilating agents -

therefore useless in case of depression of the respiratory center.

Question 8

Flumazenil can counteract the depressive CNS effects induced by ______, but not the ones induced by ______

Answer 8

-Benzodiazepines

-opioids

Question 9

A baby boy, born after normal delivery, presented with respiratory depression, pinpoint pupils, and low Apgar scores. His mother received two intramuscular injections of an analgesic drug 3 and 2 hours before the delivery because of strong erratic and very painful contractions

Q:

diazepam is an analgesic drug and causes all the symptoms shown by the baby.

T or F

Answer 9

False

diazepam _is not an analgesic dru_g

Diazepam**, first marketed as **Valium-medicine of the benzodiazepine family that typically produces a calming effect.

• It is commonly used to treat a range of conditions, including anxiety, seizures, alcohol withdrawal syndrome, benzodiazepine withdrawal syndrome, muscle spasms, trouble sleeping, and restless legs syndrome.*
• It may also be used to cause memory loss during certain medical procedures*

Question 10

A 58-year-old woman was about to be discharged from the hospital after a hysterectomy. Her past medical history was significant for duodenal ulcer, which healed 1 year ago after appropriate therapy. Because the patient still complained of some episodic abdominal pain, a postdischarge analgesic was prescribed. Which of the following drug combinations would be appropriate for this patient?

Answer 10

Codeine/acetaminophen

Question 11

A 34-year-old heroin addict was determined to “quit the habit” and started a detoxification program supervised by a certified physician. The program included the administration of a buprenorphine/naloxone combination to be given by the sublingual route. Which of the following was most likely the reason for using naloxone in the patient’s detoxication program?

Answer 11

To discourage the intravenous abuse of buprenorphine

Question 12

A 68-year-old woman with breast cancer metastases complained to her physician of a dull bone pain that had been increasing over the past few days. The pain was initially relieved by ibuprofen, but now the drug was unable to control it. The patient described the pain as continuous but moderate. The physician decided to add to ibuprofen a drug whose analgesic effect is most likely due to its conversion to morphine. Which of the following drugs was most likely prescribed?

Answer 12

Codeine

Question 13

This drug is sometimes used to decrease alcohol craving in alcoholics?

Answer 13

Naloxone

Question 14

This drug acts mainly by increasing the nonvesicular release of dopamine from dopaminergic neurons.

Answer 14

Amphetamine

There are three main types:

1. amphetamine sulphate, more commonly known as “Speed”(also known by its trade name, Benzedrine );

2. dextroamphetamine ( Dexedrine or “Dexy’s Midnight Runners”)

3. methamphetamine (Methedrine or “Meth”), the most potent of the three.

Question 15

The elimination of this drug follows mainly zero-order kinetics.

Answer 15

Ethanol

Question 16

This drug is used in heroin detoxification programs.

Answer 16

Buprenorphine

Question 17

The central effects of this drug are most likely mediated by the activation of type B gamma- aminobutyric acid (GABAB) receptors.

Answer 17

Gamma-hydroxybutyric acid

Question 18

A 28-year-old man was brought to the psychiatric clinic by the police after he attempted to assault a woman in the street. The man presented with elevated mood, rapid speech, muscle twitching, and dilated pupils. He kept on scratching himself repeatedly because he stated that “bugs are crawling under my skin.” Vital signs were blood pressure 170/105, heart rate 120 bpm, respirations 20 /min. After a short time, stereotyped behavior developed accompanied by paranoid delusions, but the man remained oriented and alert. Which of the following drugs most likely caused the patient’s syndrome?

Answer 18

Cocaine

Question 19

A 44-year-old man was a regular user of high doses of cocaine. Which of the following signs and symptoms was most likely prominent in this person, shortly after the administration of the drug?

Answer 19

Stereotyped behavior

Question 20

The mother of a 16-year-old boy noticed a change in her son’s behavior. When he returned home in the evening after meeting with his friends, he was always very hungry, despite having eaten his dinner. He always appeared happy, would find everything amusing, and laughed a lot. Occasionally, his eyes would be rather red. In the morning he was reluctant to go to school and did not appear to care whether he did well or not. A drug with which of the following mechanisms of action was he most likely abusing?

Answer 20

Activation of cannabinoid receptors

Question 21

An 18-year-old girl who had never used recreational drugs joined in smoking multiple marijuana cigarettes at a party. Which of the following signs and symptoms did the girl most likely experience just after smoking?

Answer 21

Increased heart rate

Question 22

A 33-year-old man was in his physician’s office because he started to perceive flashes of colors and fleeting movements of strange objects as he entered a dark room. The man, who was an alcoholic and an occasional user of recreational drugs, took two tablets of an illegal drug while at a party 2 months ago. Which of the following syndromes most likely accounted for the patient’s symptoms?

Answer 22

LSD flashbacks

Question 23

A 42-year-old woman complained to her doctor about in- creasing anxiety, insomnia, irritability, and severe craving for cigarettes. The patient, who was a two-pack-a-day smoker for 15 years, had recently quit smoking. The physician prescribed a drug that could relieve her symptoms.

Which of the following drugs would be most appropriate for this patient?

Answer 23

Bupropion

Question 24

morphine (opioid) crosses the placenta

T** or **F

Answer 24

TRUE

Question 25

codeine/acetaminophen combination

is the one most frequently used to treat?

Answer 25

treat mild or moderate postsurgical pain.

The onset of action is rapid, and it can be titrated to effect.

Question 26

Buprenorphine/ibuprofen

Morphine/indomethacin

Fentanyl/ketorolac

Methadone/aspirin

all these combinations are considered ____ _____ drug. These agents are contraindicated in patients with present or past history ___ ____.

Answer 26

non-steroidal anti-inflamatory drug.

These agents are contraindicated in patients with present or past history of peptic ulcer

Question 27

naloxone

Used for what ?

Answer 27

Used to block the effects of opioids

(Opioid antagonist)

reverses the respiratory and CNS effects of opioids.

It can also be combined with an opioid, to decrease the risk of opioid misuse.

Question 28

• Buprenorphine*
• Used for what?*

Answer 28

is an OPIOID used to treat opioid use disorder, acute pain and chronic pain.

It can be used under the tonque, in the cheek, by injection, as a skin patch or as an implant.

NOTE: UNDER tongue to discourage the intravenous abuse of buprenorphine

Question 29

Imipramine

Belongs to what group of drugs;

name 4 additional from this group

Answer 29

TRICYCLICS-Antidepressants

Amitriptyline

Doxepin

Clomipramine

Trimipramine

Question 30

What is the mechanism of action of all the tricyclics?

Answer 30

These drugs are thought to increase levels of norepinephrine and serotonin in the synaptic cleft by blocking reuptake. They also block histamine, cholinergic, and α- adrenergic receptors, which accounts for a large proportion of their side effects. Tricyclics are also thought to cause a down-regulation of monoamine receptors; this may account for some of their therapeutic benefit.

Question 31

What are the clinical indications for tricyclics?

Answer 31

Mood disorders (depression primarily)

Panic disorder
Generalized anxiety disorder

Posttraumatic stress disorder

Obsessive-compulsive disorder (clomipramine)
Pain disorders
Enuresis in children (imipramine) causes contraction of the internal sphincter of the bladder.

Question 32

Do these TCA drugs elevate mood in normal individuals?

Answer 32

No.

These drugs are not CNS stimulants.

Question 33

What are the physiological differences between tertiary amine and secondary amine tricyclics?

Answer 33

The secondary amine tricyclics in general

are less likely to cause

sedation

hypotension

anticholinergic effects

However:

more likely to induce psychosis.

Question 34

Methyldopa

MOA:

Answer 34

Methyldopa stimulates central presynaptic

α2-adrenergic receptors and

inhibits the release of norepinephrine

Question 35

Methyldopa

What is its primary effect?

Answer 35

The decreased sympathetic outflow results in decreased peripheral vascular resistance.

It also creates some reduction in cardiac output.

Question 36

What is the clinical indication for methyldopa?

Answer 36

Moderate hypertension.

Methyldopa is often given to patients with renal insufficiency since it does not decrease blood flow to the kidney.

It can be used safely in pregnancy.

Question 37

What are the potential toxicities

of

methyldopa?

Answer 37

A drug-induced positive Coombs test that is sometimes associated with hemolytic anemia

Lactation associated with increased prolactin release

Edema

Sedation

Impotence

Dry mouth

Hepatitis

Question 38

Bromocriptine

Use:

Define:

EX OF DISEASE:

Answer 38

Drug used to treat

CNS DEGENERATIVE DISORDERS

PARKINSONS DISEASE

Question 39

What is Parkinson’s disease?

Answer 39

A movement disorder that has the following four cardinal characteristics:

1. Resting tremors
2. Muscle rigidity
3. Bradykinesia
4. Abnormal posture and gait

Question 40

What is the pathophysiology of

PARKINSON’S

disease?

Answer 40

loss of dopamine in the nigrostriatal pathway

The loss of dopamine disrupts the delicate balance between the cholinergic and dopaminergic systems within the striatum and basal ganglia.

Question 41

In the case of Parkinson’s Disease

What is the treatment strategy?

Answer 41

The ultimate goal is to reestablish the balance* between *dopamine and acetylcholine in the brain.

This can be accomplished by either:

(1) increasing dopamine in the nigrostriatal system

or

(2) reducing the cholinergic output of the striatum.

Question 42

BROMOCRIPTINE

Define:

Use:

Answer 42

Bromocriptine (ergotamine derivative**) that acts as a dopamine receptor agonist at D2 receptors.

USE: TX of pituitary tumors,

Parkinson’s disease (PD), amenorrhea associated with hyperprolactinaemia, neuroleptc malignant syndrome, acromegaly, infertility, and hypogonadism, prolactin-secreting adenomas, used to prevent ovarian hyperstimulation syndrome

It is a second-line drug after levodopa.

Question 43

BROMOCRIPTINE

What are its therapeutic uses?

Answer 43

Bromocriptine is used in conjunction with levodopa. It may allow reduction in the maintenance dosage of levodopa and therefore reduce the occurrence of side effects associated with long-term levodopa use.

Bromocriptine has very little effect on parkinsonian symptoms when used alone; however, when used in conjunction with levodopa, it helps effects on bradykinesia.
In addition to being used to treat Parkinson’s disease, it is the drug of choice to treat cases of hyperprolactinemia ( common board question).

Question 44

BROMOCRIPTINE

What are the adverse effects of this drug?

Answer 44

Hallucination and delirium occur more often with bromocriptine than with levodopa

Nausea and vomiting
Cardiac arrhythmia, postural hypotension Erythromelalgia—a condition

characterized by red, painful, and swollen feet or hands

Question 45

Hyperalgesia

define:

Answer 45

an abnormally increased sensitivity to pain, which may be caused by damage to nociceptors or peripheral nerves and can cause hypersensitivity to stimulus.

Prostaglandins E and F are largely responsible for sensitizing the nociceptors.

Temporary increased sensitivity to pain also occurs as part of sickness behavior, the evolved response to infection

Question 46

define

Stereotyped behavior

Answer 46

repetitive or ritualistic movement, posture, or utterance.

Stereotypies may be simple movements such as body rocking, or complex, such as self-caressing, crossing and uncrossing of legs, and marching in place.

They are found in people with intellectual disabilities, autism spectrum disorders, tardive dyskinesia and stereotypic movement disorder, but may also be encountered in neurotypical individuals as well.

It may occur in persons with schizophrenia.

Question 47

Phencyclidine

also known as?

Define:

Answer 47

PCP

Phencyclidine or PCP, also known as “angel dust,” is a dissociative anesthetic (analgesia and catatonia without loss of consciousness) that blocks N-methyl, D- aspartic acid (NMDA) receptors (i.e., glutamate receptors).

It is also a ketamine analogue.

Question 48

Phencyclidine (PCP)

What is this drug’s mechanism of action?

Answer 48

It blocks

serotonin (5-hydroxytryptamine [5-HT]) uptake.

Question 49

What are the

central physiologic actions of PCP?

Answer 49

PCP causes a schizophrenia-like psychosis involving distortion of time, space, and body image.

Extremely high doses can cause seizures and coma.

Question 50

What are the

peripheral physiological effects of PCP?

Answer 50

Increased blood pressure and heart rate

Limb numbness
Ataxia
Hypersalivation

Nystagmus

Question 51

LSD

what is it?

Answer 51

Lysergic acid diethylamide

Question 52

What are the physiological actions of LSD

on the CNS?

Answer 52

Visual hallucinations

flashbacks

Arousal
Excitation
Disturbed perception

Disturbed mood Panic

Question 53

What are the peripheral physiological effects?

Answer 53

Mydriasis
Tachycardia
Flushing, lacrimation, salivation

Increased blood pressure

Question 54

What drug can block the hallucinatory effects of LSD?

Answer 54

Haloperidol

Question 55

MARIJUANA

Define:

Answer 55

Marijuana’s s active component is ∆-9 THC (tetrahydrocannabinol), which is derived from the flowering tops of the hemp plant (Cannabis sativa).

Question 56

What are marijuana’s effects on the CNS?

Answer 56

Sedation
Euphoria
Decreased psychomotor activity

Impaired judgment, memory, and time

sense

Question 57

What peripheral physiological effects does marijuana have?

Answer 57

Increased heart rate and blood pressure

Injected (red) conjunctiva
Dry mouth
Bronchodilation

Increased appetite

Question 58

Does marijuana have any clinical indications?

Answer 58

Yes.

Dronabinol is a pharmaceutical

preparation of ∆-9 THC that is used to treat anorexia related to terminal conditions and as an antiemetic in chemotherapy.

Question 59

What is cocaine’s mechanism of action?

Answer 59

Cocaine blocks the reuptake of norepinephrine, serotonin, and dopamine (5-HT) into presynaptic nerve terminals. This blockade results in enhanced activity of these neurotransmitters.

Question 60

What physiological changes occur as a result of cocaine use?

Answer 60

Cocaine causes mydriasis;

increases heart rate,

alertness, and self-confidence;

and

induces a temporary state of euphoria by stimulating the limbic system.

Question 61

Cocaine

What are the signs of overdose?

Answer 61

Excitation
Hallucinations and psychosis Seizures
Hypertension
Respiratory depression Arrhythmias secondary to coronary vasospasm

Coma

Question 62

Does cocaine have any clinical use?

Answer 62

Yes.

It is sometimes used as a local anesthetic and vasoconstrictor during ENT procedures.

Question 63

Gamma-hydroxybutyric acid

Answer 63

known as 4-hydroxybutanoic acid, is a naturally occurring neurotransmitter and a psychoactive drug.

It is a precursor to GABA, glutamate, and glycine in certain brain areas. It acts on the GHB receptor and is a weak agonist at the GABAB receptor. GHB has been used in the medical setting as a general anesthetic and as a treatment for cataplexy, narcolepsy, and alcoholism. It is al

so used illegally as an intoxicant, as an athletic performance enhancer, as a date rape drug, and as a recreational drug.

Question 64

nigrostriatal pathway

define:

Answer 64

is a bilateral dopaminergic pathway in the brain that connects the substantia nigra pars compacta (SNc) in the midbrain with the dorsal striatum (i.e., the caudate nucleus and putamen) in the forebrain.

It is one of the four major dopamine pathways in the brain, and is critical in the production of movement as part of a system called the basal ganglia motor loop.