Pharma Flashcards
1.The pK a of lidocaine is 7.7. In infected tissue, which can be acidic, for example, at pH 6.7, the percentage of the drug in the nonionized form will be (A) 1% (B) 10% (C) 50% (D) 90% (E) 99%
10%
2.You have a vial containing 10 mL of a 2% solution of lidocaine. How much lidocaine is present in 1 mL? (A) 2mg (B) 5mg (C) 10 mg (D) 20 mg (E) 50 mg
20 mg
3.A vasoconstrictor added to a solution of lidocaine for a peripheral nerve block will
(A) Decrease the risk of a seizure
(B) Increase the duration of anesthetic action of the local anesthetic
(C) Both A and B
(D) Neither A nor B
A+B
4.Which statement about the toxicity of local anesthetics is correct?
(A) Bupivacaine is the safest local anesthetic to use in
patients at risk for cardiac arrhythmias
(B) In overdosage, hyperventilation (with
oxygen) is helpful to correct acidosis and lower
extracellular potassium
(C) Intravenous injection of local anesthetics may stimulate ectopic cardiac pacemaker activity
(D) Most local anesthetics cause vasoconstriction
(E) Serious cardiovascular reactions are more likely to occur with tetracaine than with bupivacaine
B) In overdosage, hyperventilation (with
oxygen) is helpful to correct acidosis and lower
extracellular potassium
5.A child requires multiple minor surgical procedures involving the nasopharynx. Which drug has high surface local anesthetic activity and intrinsic vasoconstrictor actions that reduce bleeding in mucous membranes? (A) Bupivacaine (B) Cocaine (C) Lidocaine (D) Mepivacaine (E) Tetracaine
Cocaine
6.An increase of chloride conductance is the most important result of activation of (A) Acetylcholine M 1 receptors (B) Beta 1 adrenoceptors (C) 5-HT 3 receptors (D) GABA A receptors (E) Glutamate NMDA receptors
GABA A receptors
7.Which of the following receptors shares the same potassium channel as the 5-HT 1A receptor? (A) Dopamine D 2 receptor (B) GABA B receptor (C) Mu opioid receptor (D) Muscarinic M 1 receptor (E) Substance P receptor
(B) GABA B receptor
8.Activation of metabotropic receptors located presynaptically causes inhibition by decreasing the inward flux of (A) Calcium (B) Chloride (C) Potassium (D) Sodium (E) None of the above
(A) Calcium
9.This transmitter is mostly located in diffuse neuronal systems in the CNS, with cell bodies particularly in the raphe nuclei. It appears to play a major role in the expression of mood states, and many antidepressant drugs are thought to increase its functional activity. (A) Acetylcholine (B) Dopamine (C) GABA (D) Glutamate (E) Serotonin
E) Serotonin
10.Which of the following chemicals does not satisfy the criteria for a neurotransmitter role in the CNS? (A) Acetylcholine (B) Cyclic AMP (C) Dopamine (D) Glycine (E) Substance P
B) Cyclic AMP
11.One of the first neurotransmitter receptors to be identified in the CNS is located on the Renshaw cell in the spinal cord. Activation of this receptor results in excitation via an increase in cation (Na + , K + ) conductance ndependently of G-protein-coupled mechanisms. Which of the following compounds is most likely to activate this receptor? (A) Dopamine (B) Glycine (C) GABA (D) Nicotine (E) Serotonin
Nicotine
12.This neurotransmitter, found in diffuse systems, can exert both excitatory and inhibitory actions. Multiple receptor subtypes and a transporter have been identified, some of which are targets for drugs that are used in major depressive disorder and attention deficit hyperactivity disorder. (A) Acetylcholine (B) Beta-endorphin (C) Glycine (D) Glutamate (E) Norepinephrine
(E) Norepinephrine
13.A 45-year-old man who has been injured in a car accident is brought into the
emergency department. His blood alcohol level at admission is 275 mg/dl. Hospital records show a prior hospitalization for alcohol-related seizures. His wife confirms that he has been drinking heavily for 3 weeks. What treatment should be provided to the patient if he goes into withdrawal?
A. No pharmacological treatment is necessary.
B. Lorazepam.
C. Phenytoin.
D. Buspirone.
B. Lorazepam
14.An 18-year-old woman is admitted to the emergency room after an accidental overdose of alprazolam. She is unconscious and not considered a regular user of any medications or illicit drugs. Which treatment could be used to reverse the effect of the alprazolam overdose? A. Diazepam B. Ramelteon C. Flumazenil D. Naloxone
Flumazenil
15.Flumazenil will counteract the action of each of the following drugs except
(A) Alprazolam (B) Buspirone (C) Diazepam (D) Eszopiclone (E) Zaleplon
(B) Buspirone
16.Which drug used in the maintenance treatment of patients with tonic-clonic or partial seizure states increases the hepatic metabolism of many drugs including both phenytoin and warfarin? (A) Buspirone (B) Clonazepam (C) Eszopiclone (D) Phenobarbital (E) Triazolam
D) Phenobarbital
17.A 43-year-old very overweight man complains of not sleeping well and feeling tired during the day. He says that his wife is the cause of the problem because she wakes him up several times during the night because of his loud snores. This appears to be a breathing-related sleep disorder, so you should probably write a prescription for (A) Clorazepate (B) Diazepam (C) Flurazepam (D) Pentobarbital (E) weight loss
(E) weight loss
18.A 42-year-old man with a history of alcoholism is brought to the emergency department in a confused and delirious state. He has truncal ataxia and ophthalmoplegia. The most appropriate immediate course of action is to administer diazepam plus (A) Chlordiazepoxide (B) Disulfiram (C) Folic acid (D) Glucosamine (E) Thiamine
E) Thiamine
19.A freshman student (weight 70 kg)
attends a college party where he rapidly consumes a quantity of an alcoholic beverage that results in a blood level of 500 mg/dL. Assuming that this young man has not had an opportunity to develop tolerance to ethanol, his present condition is best characterized as (A) Able to walk, but not in a straight line
(B) Alert and competent to drive a car
(C) Comatose and near death
(D) Sedated with increased reaction times
(E) Slightly inebriated
C) Comatose and near death
20.A homeless middle-aged male patient presents in the emergency department in a state of intoxication. You note that he is behaviorally disinhibited and rowdy. He tells you that he has recently consumed about a pint of a red-colored liquid that his friends were using to “get high.” He complains that his vision is blurred and that it is “like being in a snowstorm.” His breath smells a bit like formaldehyde. He is acidotic.Consumption of which of the following is the most likely cause of this patient’s intoxicated state? (A) Ethanol (B) Ethylene glycol (C) Isopropanol (D) Hexane (E) Methanol
(E) Methanol
.After assessing and stabilizing the patient’s airway, respiration, and circulatory status, fomepizole was administered intravenously. Which of the following most accurately describes the therapeutic purpose of the fomepizole administration?
(A) Accelerate the rate of elimination of the toxic liquid that he consumed
(B) Combat acidosis
(C) Inhibit the metabolic production of toxic
metabolites
(D) Prevent alcohol withdrawal seizures
(E) Sedate the patient
C) Inhibit the metabolic production of toxic
metabolites
22.The regular ingestion of moderate or heavy amounts of alcohol predisposes to hepatic damage after overdose of acetaminophen because chronic ethanol ingestion
(A) Blocks acetaminophen metabolism
(B) Causes thiamine deficiency
(C) Displaces acetaminophen from plasma proteins
(D) Induces hepatic drug-metabolizing enzymes (E) Inhibits renal clearance of acetaminophen
(D) Induces hepatic drug-metabolizing enzymes
23.The combination of ethanol and disulfiram results in nausea and hypotension as a result of the accumulation of (A) Acetaldehyde (B) Acetate (C) Methanol (D) NADH (E) Pyruvate
Acetaldehyde
24.A 23-year-old pregnant woman with alcoholism presented to the emergency department in the early stages of labor. She had consumed large amounts of alcohol throughout her pregnancy. This patient’s infant is at high risk of a syndrome that includes
(A) Ambiguous genitalia in a male fetus and normal genitalia in a female fetus
(B) Failure of closure of the atrial septum or ventricular septum
(C) Limb or digit malformation
(D) Mental retardation and craniofacial
abnormalities
(E) Underdevelopment of the lungs
D) Mental retardation and craniofacial
abnormalities
25.A 9-year-old child is having learning difficulties at school. He has brief lapses of awareness with eyelid fluttering that occur every 5–10 min. Electroencephalogram (EEG) studies reveal brief 3-Hz spike and wave discharges appearing synchronously in all leads. Which drug would be effective in this child without the disadvantages of excessive sedation or tolerance development? (A) Clonazepam (B) Diazepam (C) Ethosuximide (D) Gabapentin (E) Phenobarbital
(C) Ethosuximide
26.With chronic use in seizure states, the adverse effects of this drug include coarsening of facial features, hirsutism, and gingival hyperplasia. (A) Carbamazepine (B) Ethosuximide (C) Phenytoin (D) Tiagabine (E) Zonisamide
C) Phenytoin
27.Abrupt withdrawal of antiseizure drugs can result in increases in seizure frequency and severity. Withdrawal is most easily accomplished if the patient is treated with (A) Carbamazepine (B) Clonazepam (C) Ethosuximide (D) Phenobarbital (E) Phenytoin
C) Ethosuximide
20.A homeless middle-aged male patient presents in the emergency department in a state of intoxication. You note that he is behaviorally disinhibited and rowdy. He tells you that he has recently consumed about a pint of a red-colored liquid that his friends were using to “get high.” He complains that his vision is blurred and that it is “like being in a snowstorm.” His breath smells a bit like formaldehyde. He is acidotic.Consumption of which of the following is the most likely cause of this patient’s intoxicated state? (A) Ethanol (B) Ethylene glycol (C) Isopropanol (D) Hexane (E) Methanol
E) Methanol
21.After assessing and stabilizing the patient’s airway, respiration, and circulatory status, fomepizole was administered intravenously. Which of the following most accurately describes the therapeutic purpose of the fomepizole administration?
(A) Accelerate the rate of elimination of the toxic liquid that he consumed
(B) Combat acidosis
(C) Inhibit the metabolic production of toxic
metabolites
(D) Prevent alcohol withdrawal seizures
(E) Sedate the patient
C) Inhibit the metabolic production of toxic
metabolites
22.The regular ingestion of moderate or heavy amounts of alcohol predisposes to hepatic damage after overdose of acetaminophen because chronic ethanol ingestion
(A) Blocks acetaminophen metabolism
(B) Causes thiamine deficiency
(C) Displaces acetaminophen from plasma proteins
(D) Induces hepatic drug-metabolizing enzymes (E) Inhibits renal clearance of acetaminophen
(D) Induces hepatic drug-metabolizing enzymes
23.The combination of ethanol and disulfiram results in nausea and hypotension as a result of the accumulation of (A) Acetaldehyde (B) Acetate (C) Methanol (D) NADH (E) Pyruvate
Acetaldehyde
A 23-year-old pregnant woman with alcoholism presented to the emergency department in the early stages of labor. She had consumed large amounts of alcohol throughout her pregnancy. This patient’s infant is at high risk of a syndrome that includes
(A) Ambiguous genitalia in a male fetus and normal genitalia in a female fetus
(B) Failure of closure of the atrial septum or ventricular septum
(C) Limb or digit malformation
(D) Mental retardation and craniofacial
abnormalities
(E) Underdevelopment of the lungs
(D) Mental retardation and craniofacial
abnormalities
25.A 9-year-old child is having learning difficulties at school. He has brief lapses of awareness with eyelid fluttering that occur every 5–10 min. Electroencephalogram (EEG) studies reveal brief 3-Hz spike and wave discharges appearing synchronously in all leads. Which drug would be effective in this child without the disadvantages of excessive sedation or tolerance development? (A) Clonazepam (B) Diazepam (C) Ethosuximide (D) Gabapentin (E) Phenobarbital
(C) Ethosuximide
26.With chronic use in seizure states, the adverse effects of this drug include coarsening of facial features, hirsutism, and gingival hyperplasia.
(A) Carbamazepine (B) Ethosuximide (C) Phenytoin
(D) Tiagabine
(E) Zonisamide
C) Phenytoin
27.Abrupt withdrawal of antiseizure drugs can result in increases in seizure frequency and severity. Withdrawal is most easily accomplished if the patient is treated with
(A) Carbamazepine (B) Clonazepam (C) Ethosuximide
(D) Phenobarbital
(E) Phenytoin
C) Ethosuximide
28.Postoperative vomiting is uncommon with this intravenous agent, and patients are often able to ambulate sooner than those who receive other anesthetics. (A) Enflurane (B) Etomidate (C) Midazolam (D) Propofol (E) Thiopental
D) Propofol
29.Which mood-stabilizing agent is most likely to decrease the thyroid function? A. Carbamazepine B. Lithium C. Valproic acid D. Chlorpromazine
B. Lithium
0.An adolescent male is newly diagnosed with schizophrenia. Which antipsychotic agent may have the best chance to improve his apathy and blunted affect? A. Chlorpromazine B. Fluphenazine C. Haloperidol D. Risperidone
Risperidone
31.Which of the following antipsychotic agents is considered to be the most potent and thus have the highest risk of extrapyramidal symptoms? A. Thioridazine B. Haloperidol C. Quetiapine D. Chlorpromazine
B. Haloperidol
32.Which of the following determines the speed of recovery from intravenous anesthetics used for induction?
A. Liver metabolism of the drug
B. Protein binding of the drug
C. Ionization of the drug
D. Redistribution of the drug from sites in the CNS
D. Redistribution of the drug from sites in the CNS
33.Which one of the following is a potent intravenous anesthetic and analgesic? A. Propofol B. Midazolam C. Ketamine D. Fentanyl
C. Ketamine
34.Which local anesthetic is metabolized by plasma cholinesterase? A. Tetracaine B. Bupivacaine C. Lidocaine D. Ropivacaine
A. Tetracaine
35.A 35-year-old man presents with appendicitis and requires a surgical intervention. He has a family history of malignant hyperthermia. Which anesthetic agent is most appropriate to use in this patient? A. lsoflurane B. Propofol C. Succinylcholine D. Sevoflurane
B. Propofol
36.Which of the following drugs is the most effective in the emergency management of malignant hyperthermia? (A) Atropine (B) Dantrolene (C) Haloperidol (D) Succinylcholine (E) Vecuronium
Dantrolene
37.Myalgias are a common postoperative complaint of patients who receive large doses of succinylcholine, possibly the result of muscle fasciculations caused by depolarization. Which drug administered in the operating room can be used to prevent postoperative pain caused by succinylcholine? (A) Atracurium (B) Baclofen (C) Dantrolene (D) Diazepam (E) Lidocaine
A) Atracurium
38.A 51-year-old patient with parkinsonism is being maintained on levodopa-carbidopa with adjunctive use of low doses of tolcapone but continues to have off-periods of akinesia. A drug used to “rescue” the patient that provides temporary relief is (A) Apomorphine (B) Benztropine (C) Carbidopa (D) Pramipexole (E) Selegiline
A) Apomorphine
39.Haloperidol is not an appropriate drug for management of (A) Acute mania (B) Amenorrhea-galactorrhea syndrome (C) Phencyclidine intoxication (D) Schizoaffective disorders (E) Tourette syndrome
Amenorrhea-galactorrhea syndrome
40.Which of the following drugs is established to be both effective and safe to use in a pregnant patient suffering from bipolar disorder?
(A) Carbamazepine (B) Fluphenazine (C) Lithium
(D) Olanzapine
(E) Valproic acid
Olanzapine
41.A patient under treatment for a major depressive disorder is brought to the emergency department after ingesting 30 times the normal daily therapeutic dose of imipramine. Which of the following would be least useful?
(A) Administer bicarbonate and potassium chloride (to
correct acidosis and hypokalemia)
(B) Administer lidocaine (to control cardiac arrhythmias)
(C) Initiate hemodialysis (to hasten drug
elimination
(D) Maintain heart rhythm by electrical pacing (E) Use intravenous diazepam to control seizures
C) Initiate hemodialysis (to hasten drug
elimination
42.Genetic polymorphisms in certain hepatic enzymes involved in drug metabolism are established to be responsible for variations in analgesic response to (A) Buprenorphine (B) Codeine (C) Fentanyl (D) Methadone (E) Tramadol
Codeine
43.Which drug, a partial agonist at nicotinic acetylcholine receptors, is used in smoking cessation programs but may cause seizures in overdose? (A) Acamprosate (B) Buprenorphine (C) Nalbuphine (D) Rimonabant (E) Varenicline
Varenicline
44.A young man is brought to the emergency department suf-fering from an intravenous overdose of cocaine. His signs and symptoms are not likely to include (A) Agitation (B) Bradycardia (C) Hyperthermia (D) Myocardial infarct (E) Seizures
Bradycardia
