Pharma Flashcards by Haya Abu Shaban

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

B) Amenorrhea-galactorrhea syndrome

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Which mood-stabilizing  agent  is  most  likely  to decrease the thyroid function?
A. Carbamazepine
B. Valproic acid
C. Lithium
D. Chlorpromazine
E. Risperidone

C. Lithium

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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. Renal excretion of the drug
E. Redistribution of the drug from sites in the CNS

E. Redistribution of the drug from sites in the CNS

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The combination of ethanol and disulfiram results in nausea and hypotension as a result of the accumulation of
(A)  Pyruvate
(B)  Acetate
(C)  Methanol
(D)  NADH
(E)  Acetaldehyde

E) Acetaldehyde

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A 45-year-old man was started on therapy for hypertension and developed a persistent, drycough. Which is most likely responsible for this side effect?
A. Lisinopril
B. Losartan
C. Nifedipine
D. Atenolol
E. Amlodipine

Lisinopril

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Botulinum toxin blocks the release of acetylcholine from cholinergic nerve terminals. Which is a possible effect of botulinum toxin?
A. Skeletal muscle paralysis
B. Improvement of previous neuromuscular disease
C. Increased salivation
D. Reduced heart rate
E. Bronchodilation

A. Skeletal muscle paralysis

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Which physiological change occurs when the parasympathetic system is activated?
A. Increase in heart rate
B. Inhibition of lacrimation (tears)
C. Dilation of the pupil (mydriasis)
D. Increase in gastric motility
E. Increase contrcactility of heart

D. Increase in gastric motility

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Which is correct regarding activation of receptors on the effector organs in the ANS?
A. Acetylcholine activates muscarinic receptors.
B. Acetylcholine activates adrenergic receptors.
C. Epinephrine activates nicotinic receptors.
D. Norepinephrine activates muscarinic receptors.
E. Epinephrine blocks adrenergic receptors.

A. Acetylcholine activates muscarinic receptors.

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An asthma patient was given a nonselective beta agonist to relieve bronchoconstriction. Which adverse effect would you expect in this patient?
A. Bradycardia
B. Tachycardia
C. Hypotension (reduction in blood pressure)
D. Worsening bronchoconstriction
E. Cough

B. Tachycardia

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If a fibrinolytic drug is used for treatment of acute myocardial infarction or pulmonary embolism, which of the following adverse drug effects is most likely to occur?
A. Hemorrhagic stroke
B. Development of antiplatelet antibodies
C. Encephalitis secondary to liver dysfunction
D. Acute renal failure
E. Neutropenia

Hemorrhagic stroke

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While playing in the garden, a 7-year-old boy is stung by 3 bees. Because he has a previous history of bee sting allergy, he is brought to the emergency department by his mother who is very concerned about a possible anaphylactic reaction.
Following 2 questions;
Which of the following are probable signs of an anaphylactic reaction to bee stings?
A. Bronchodilation, tachycardia, hypertension, vomiting, diarrhea
B. Bronchospasm, tachycardia, hypotension, laryngeal edema
C. Diarrhea, bradycardia, vomiting
D. Laryngeal edema, bradycardia, hypotension, diarrhea
E. Miosis, tachycardia, vomiting, diarrhea

Bronchospasm, tachycardia, hypotension, laryngeal edema

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If this child has signs of anaphylaxis, what is the main treatment of choice?
A. Diphenhydramine (an antihistamine)
B. Epinephrine
C. Ephedrine
D. Isoproterenol
E. Methylprednisolone (a corticosteroid)

Epinephrine

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Which of the followings are the drugs of choice in emergency department management of acute asthma attack (crisis, exacerbation) in adults ?
A. Oxygen, Salbutamol, Ipratroprium, Methylprednisolone
B. Oxygen, Salmeterol, Atropine, Cromolyn
C. Epinephrine, Theophylline, Zileuton, Prednisone
D. Oxygen, Omalizumab, Montelukast, Tiotropium
E. Salbutamol, Ipratrorium, Aminophylline, Beclamethasone

Oxygen, Salbutamol, Ipratroprium, Methylprednisolone

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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

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Which of the following is an analgesic and antipyretic drug that lacks an anti-inflammatory action?
A. Probenecid
B. Celecoxib
C. Colchicine
D. Indomethacin
E Acetaminophen

Acetaminophen

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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

Propofol

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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)  Zonisamide
(D)  Tiagabine
(E)  Phenytoin

Phenytoin

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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.Salysilate
C.Acetaminophen
D.Methanol
E.Hexane

.Methanol

Among NSAIDs, aspirin is unique, why
A. Because it increases the risk of colon cancer
B. Because it prevents episodes of gouty arthritis with long-term use
C. Because it reduces fever
D. Because it irreversibly inhibits its target enzyme
E. Because it selectively inhibits the COX-2 enzyme

Because it irreversibly inhibits its target enzyme

An 18-month-old boy dies from an accidental overdose of acetaminophen. Which of the following is the most likely cause of this patient’s death?
(A)  Liver failure
(B)  Hemorrhagic stroke
(C)  Arrhythmia
(D)  Noncardiogenic pulmonary edema
(E)  Ventilatory failure

(A) Liver failure

A 54-year-old woman presented with signs and symptoms consistent with an early stage of rheumatoid arthritis. The decision was made to initiate NSAID therapy.
Which of the following patient characteristics is the most compelling reason for avoiding celecoxib in the treatment of her arthritis?
(A) History of alcohol abuse
(B) History of myocardial infarction
(C) History of gout
(D) History of osteoporosis
(E) History of peptic ulcer disease

(B) History of myocardial infarction

Note: COX-2 inhibition without COX-1 inhibition will therefore preserve the synthesis of the vasoconstrictive thromboxane A2 and inhibit production of the vasodilator prostacyclin, tipping the balance toward vasoconstriction and thrombosis.

A 23-year-old woman is admitted to the emergency department with difficulty breathing. Examination reveals significant laryngeal edema. Past medical history indicates that she suffers from recurrent episodes of angioneurotic edema with release of histamine and other mediators. Which of the following drugs is the most effective physiologic antagonist of histamine in smooth muscle?
(A)  Sumatriptan
(B)  Loratadine
(C)  Ondansetron
(D)  Ranitidine
(E)  Epinephrine

Epinephrine

A 20-year-old woman is taking over-the-counter diphenhydramine for severe hay fever. Which of the following adverse effects is she most likely to report?
(A)  Muscarinic increase in bladder tone
(B)  Nausea
(C)  Sedation
(D)  Nervousness, anxiety
(E)  Vertigo

Sedation

``` A 40-year-old patient with breast cancer is about to undergo cancer chemotherapy with a highly emetogenic (nausea- and vomiting-causing) drug combination. The antiemetic drug most likely to be included in her regimen is (A) Bromocriptine (B) Cetirizine (C) Cimetidine (D) Ondansetron (E) Ketanserin ```

Ondansetron

Which of the following endogenous molecules is elevated in heart failure and when given as a drug is a vasodilator with significant renal toxicity? (A) Brain Natriuretic Peptide-BNP (nesiritide) (B) Angiotensin II (C) Angiotensin I (D) Histamine (E) Vasoactive intestinal peptide

Brain Natriuretic Peptide-BNP (nesiritide)

``` Which mechanism explains aspirin’s inhibition of thromboxane synthesis? A. Blocks lipoxygenase B. Blocks cyclooxygenase C. Blocks phospholipase A 2 D. Blocks PGE 1 receptors E. Blocks PGI 2 receptors ```

Blocks cyclooxygenase

``` Inflammation is a complex tissue reaction that includes the release of cytokines, leukotrienes, prostaglandins, and peptides. Leukotrienes involved in inflammatory processes are typically produced from arachidonic acid by which of the following enzymes? (A) Cyclooxygenase-1 (B) Cyclooxygenase-2 (C) Glutathione-S-transferase (D) Phospholipase A 2 (E) Lipoxygenase ```

Lipoxygenase

``` A patient with a positive fecal blood test is referred to the gastroenterology clinic. He is apparently taking large amounts of an unidentified drug that inhibits platelet activity. Which of the following is taken orally and directly and reversibly inhibits platelet cyclooxygenase? (A) Ibuprofen (B) Aspirin (C) Alprostadil (D) Leukotriene LTC 4 (E) Misoprostol ```

Ibuprofen

An 80-year-old man is taking warfarin indefinitely for the prevention of deep venous thrombosis. He is compliant, has a stable INR, and denies bleeding or bruising. He is diagnosed with a urinary tract infection and is prescribed sulfamethoxazole/trimethoprim (drug-drug interaction, it inibits warfarin metabolism) . What are the expected effects on his warfarin therapy? A. Decreased anticoagulant effect of warfarin B. Increased anticoagulant effect of warfarin C. Activation of platelet activity D. No change in anticoagulation status E. Ineased antiplatelet action

Increased anticoagulant effect of warfarin

The graph at the bottom of this page shows the plasma concentration of free warfarin as a function of time for a patient who was treated with 2 other agents, drugs B and C, on a daily basis at constant dosage starting at the times shown. Which of the following is the most likely explanation for the observed changes in warfarin concentration? A. Drug B displaces warfarin from plasma proteins; drug C displaces warfarin from tissue-binding sites B. Drug B inhibits hepatic metabolism of warfarin; drug C displaces drug B from tissue-binding sites C. Drug B stimulates hepatic metabolism of warfarin; drug C displaces warfarin from plasma protein D. Drug B increases renal clearance of warfarin; drug C inhibits hepatic metabolism of drug B E. Drug B decresed plasma proteins,; drug C increased plasma proteins

Drug B stimulates hepatic metabolism of warfarin; drug C displaces warfarin from plasma protein

Which medication, when used in combination with local anesthetics, reduces systemic toxicity and increases the duration of action of local anesthetics and what is the probable mechanism? A. Acetylcholine, by inducing a local vasodilation B. Acetylcholine, by inducing a local vasoconstriction C. Epinephrine, by inducing a local vasodilation D. Epinephrine, by inducing a local vasoconstriction alpha and beta agonist E. Noradrenaline, by inducing a local vasodilation

Epinephrine, by inducing a local vasoconstriction alpha and beta agonist

A 63 years old male patient was diagnosed atheroschlerotic heart disease and effort (classical) angina. Which of the following drugs can be added to the prescription for rapid relief of acute anginal pain symptoms? A. Nitroglycerin sublingual tablet or spray B. Metoprolol oral tablet C. Nitroglycerin transdermal patch D. Nitroglycerin oral tablet E. Diltiazem oral tablet

Nitroglycerin sublingual tablet or spray

``` Beta adrenergic blocking drugs have broad clinical applications. Which of the following is not a clinical application of beta blockers? A. Hypertension B. Acute heart failure C. Angina pectoris D. Arrhytmias E. Glaucoma ```

Acute heart failure

Which of the following adverse effect- drug class match is wrong? A. Othostatic hypotension, reflex tachycardia - Alpha adrenergic antagonists B. Constipation- Calcium channel blockers C. Reflex tachycardia- Beta adrenergic antagonists D. Cough – ACE inhibitors E. Major renal damage in the fetus- Angiotensin antagonists

Reflex tachycardia- Beta adrenergic antagonists

``` A 60-year-old woman was told she had hypertension and should be taking antihypertensive medication. She decides to take an herbal medication from an online “holistic pharmacy.” One week after starting the medication, she is found unconscious in her apartment. In the emergency department, her blood pressure is 50/0 mm Hg and heart rate is 40 bpm. Respirations are 20/min; pupils are slightly constricted. Bowel sounds are present. Which of the following would be the most effective cardiovascular stimulant? A. Amphetamine B. Norepinephrine /Epinephrine C. Clonidine D. MAO inhibitors E. Tyramine ```

Norepinephrine /Epinephrine

``` A 12-year-old boy with a peanut allergy is brought to the emergency room after accidental consumption of peanuts. He is in anaphylactic shock. Which of the following drugs is most appropriate to treat this patient? A. Norepinephrine B. Phenylephrine C. Epinephrine D. Dobutamine E. Fenoldopam ```

Epinephrine

``` Which of the following is commonly present in nasal sprays to treat nasal congestion? A. Alpha agonists B. Beta blockers C. Alpha blockers D. Beta agonists E. Nitrates ```

. Alpha agonists

``` A 32-year-old woman with hypertension wishes to become pregnant. Her physician informs her that she will have to switch to another antihypertensive drug. Which of the following drugs is absolutely contraindicated in pregnancy? A. Atenolol B. Losartan C. Methyldopa D. Nifedipine E. Propranolo ```

Losartan

Which arrhythmia can be treated with lidocaine? A. Paroxysmal supraventricular tachycardia B. Atrial fibrillation C. Atrial flutter D. Ventricular tachycardia E. AV nodal reentry

Ventricular tachycardia

Which of the following is the best-documented mechanism of beneficial action of cardiac glycosides? (A) A decrease in calcium uptake by the sarcoplasmic reticulum (B) An increase in a late transmembrane sodium current (C) A modification of the actin molecule (D) An increase in systolic cytoplasmic calcium levels (E) A block of cardiac β adrenoceptors

An increase in systolic cytoplasmic calcium levels

``` A 68-year-old man with a history of chronic heart failure goes on vacation and abandons his low-salt diet. Three days later, he develops severe shortness of breath and is admitted to the local hospital emergency department with significant pulmonary edema. The first-line drug of choice in most cases of acute decompensation in patients with chronic heart failure is A. Enalapril B. Furosemide C. Metoprolol D. Spironolactone E. Diltiazem ```

Furosemide

``` 1. Which of the following substances are the most reliable diagnostically and accessible analytically for biochemical analysis of cerebrospinal fluid? A. Lactate B. Glucose and protein C. Immunoglobulin D. Albumin E. Myelin Basic Protein (MBP) ```

B. Glucose and protein

2. Which one of the following conditions is not clinically informative in disorders of CSF and provides only confirmation of hyperglycemia? A. Disorder in carrier-mediated transport of glucose, e.g. TB meningitis, sarcoidosis B. Active metabolism of glucose by cells or organisms, e.g. acute purulent, amebic, and fungal meningitis C. Increased CSF [glucose] D. Increased metabolism of glucose by the CNS, e.g. CNS neoplasm E. Normal CSF [glucose], e.g. viral meningitis

C. Increased CSF [glucose]