pharma last min 29 Flashcards
“A 35-year-old man undergoes surgery for a hernia repair. After the surgery,
he complains of diffuse muscle aches, which the anesthesiologist states is
likely caused by the skeletal muscle relaxant. He has a temperature of
37.8°C (100°F). Which of the following is the most accurate statement?
a The agent also commonly causes hypokalemia
b The agent blocks ACh at the nicotinic receptor.
c The agent causes persistent endplate depolarization and desensitization
d The patient likely has malignant hyperthermia
[Y] The agent causes persistent endplate depolarization and desensitization
“Continued exposure of muscle endplates to succinylcholine results
in their:”
a Conversion to ion channels
b Enhanced sensitivity to ACh
c Regeneration of ACh receptors
d Repolarization
[Y] Repolarization
“A 65-year-old woman is admitted to the intensive care unit (ICU) of the hospital
with sepsis caused by a urinary tract infection. She is hypotensive, with
a blood pressure of 80/40 mm Hg and has an elevated heart rate (tachycardia)
and decreased urine output (oliguria). Along with the institution of appropriate
antibiotic therapy and IV fluids, a decision is made to start her on an IV
infusion of dopamine to attempt to raise her blood pressure. What effects occur with higher dose dopamine and which receptors
mediate these?”
a Vasoconstriction mediated by α-receptors
b Vasoconstriction mediated by α-receptors and M2 receptors
c Vasoconstriction mediated by α-receptors and Nm2 receptors
d Vasodilation mediated by α-receptors and beta-3 receptors
[Y] Vasoconstriction mediated by α-receptors
Which of the following is the most accurate statement?
a α-Adrenoceptor sympathomimetic agonists are used to reduce mucous membrane congestion.
b α-Adrenoceptor agonists are used to treat bronchospasm
c β-Adrenoceptor agonists are used to reduce surgical bleeding
d β2-Adrenoceptor agonist agents are used to prolong local anesthesia
“[Y] α-Adrenoceptor sympathomimetic agonists are used to reduce
mucous membrane congestion.”
“A 70-year-old man is seen in follow-up at your office after he has been hospitalized
for a myocardial infarction (MI). He underwent successful angioplasty
and is currently asymptomatic. Prior to his MI, he was not on medications. He
is not a smoker and is not diabetic. During his hospitalization, he was noted
to have persistently elevated blood pressure readings. He had asthma as a
child, but has not had any recent wheezing episodes. While in the hospital, he
was started on oral metoprolol. What effects do agents such as metoprolol have on the
cardiovascular system?”
a) Reduction of sympathetic-stimulated increases in heart rate,
contractility, and cardiac output; lower blood pressure as a result of
effects on the heart, renin-angiotensin system, and CNS; Decreased
atrioventricular (AV) conduction time and refractoriness”
b) Reduction of sympathetic-stimulated increases in heart rate,
contractility, and cardiac output; lower blood pressure as a result of
effects on the heart, renin-angiotensin system, and CNS; increased
atrioventricular (AV) conduction time and refractoriness”
c) Reduction of sympathetic-stimulated increases in heart rate,
contractility, and cardiac output; lower blood pressure as a result of
effects on the heart, decrease renin-angiotensin system, and CNS; increased
atrioventricular (AV) conduction time and refractoriness”
d) “Reduction of sympathetic-stimulated increases in heart rate,
contractility, and decreases cardiac output; lower blood pressure as a result of
effects on the heart, renin-angiotensin system, and CNS; increased
atrioventricular (AV) conduction time and refractoriness”
“[Y] Reduction of sympathetic-stimulated increases in heart rate,
contractility, and cardiac output; lower blood pressure as a result of
effects on the heart, renin-angiotensin system, and CNS; increased
atrioventricular (AV) conduction time and refractoriness”
A 34-year-old man is prescribed labetalol for hypertension. The effect
on the cardiovascular system is a result of its action as an antagonist at
which of the following?
a α-Adrenoceptors
b β-Adrenoceptors
c Both α- and β-adrenoceptors
d Muscarinic cholinoreceptors
[Y] Both α- and β-adrenoceptors
“A 64-year-old woman with a history of two previous myocardial infarctions
(MIs) comes to the emergency room with shortness of breath. In the previous
2 weeks, she has developed dyspnea with exertion and swelling of her legs.
She sleeps on three pillows because she coughs and gets short of breath if she
tries to lie flat. In the emergency department, she is sitting upright, appears to
be in moderate respiratory distress, and is tachycardic and hypertensive. She
has jugular venous distension to the angle of her jaw. On auscultation of her
lungs, wet rales are heard bilaterally. She has pitting edema of both lower legs
up to her knees. A chest x-ray confirms the diagnosis of pulmonary edema.
She is placed on oxygen and immediately given an IV injection of furosemide. What is the mechanism of action of furosemide?
a Inhibit active NaCl reabsorption
in the ascending limb of the loop of Henle, increasing water and electrolyte reabsorbtion
b Inhibit active NaCl reabsorption
in the ascending limb of the loop of Henle, increasing water and electrolyte excretion c Inhibit active NaCl, PO3- reabsorption
in the ascending limb of the loop of Henle, increasing water and electrolyte excretion
d Accelaretes active NaCl reabsorption
in the ascending limb of the loop of Henle, increasing water and electrolyte excretion
e Inhibit active NaCl reabsorption
in the descending limb of the loop of Henle, increasing water and electrolyte excretion
[Y] Inhibit active NaCl reabsorption
in the ascending limb of the loop of Henle, increasing water and
electrolyte excretion
Following his third episode of gouty arthritis, a 50-year-old man sees you in
the clinic. Each case was successfully treated acutely; however, your patient is
interested in trying to prevent future episodes. He is not on regular medications
and has a normal physical examination today. Blood work reveals an elevated
serum uric acid level and otherwise normal renal function and electrolytes. A
24-hour urine collection for uric acid reveals that he is under-excreting uric
acid. Suspecting that this is the cause of his recurrent gout, you place him on
probenecid. What is the mechanism of action of probenecid?
“[Y] Inhibits secretion of organic
acids and decreases reabsorption of uric acid, causing a net increase in
secretion”
An 18-year-old man who is known to have non-penicillinase-producing
gonococcal urethritis is given an injection of penicillin and probenecid.
What is the mechanism used by probenecid that makes penicillin more
efficacious?
“[Y] Increases the half-life and serum level by decreasing the renal
excretion of penicillin”
A 72-year-old man presents to the office for routine follow-up. He is under
treatment for hypertension and congestive heart failure with enalapril and a
diuretic. His blood pressure is under acceptable control and he has no symptoms
of heart failure at present. He does complain that he has been coughing
frequently in the past few months. History and examination reveal no other
cause of a chronic cough, so you decide to discontinue his enalapril and start
him on losartan. Mechanism of action of enalapril:
“[Y] Inhibits the conversion of
angiotensin I to angiotensin II, this also inhibits the angiotensin
II-stimulated release of aldosterone. Angiotensin-converting enzyme
(ACE) inhibitors also impair the inactivation of bradykinin”
A 69-year-old man sees you in the office for follow-up of his chronic congestive
heart failure. He has a marked reduction in his ejection fraction following
a series of MIs. He also has hypertension and type II diabetes mellitus. His
symptoms include dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea,
and peripheral edema. He has normal renal function. He is on appropriate
treatment of his diabetes, along with an ACE inhibitor and a loop diuretic. You
decide to add digoxin to his regimen. What is the effect of digoxin on the normal heart?
“[Y] Inhibition of the activity of the Na -K -ATPase; this indirectly increases
intracellular Ca2 “
A 62-year-old man is being managed in the intensive care unit following a
large anterior wall MI. He has been appropriately managed with oxygen,
aspirin, nitrates, and β-adrenergic receptor blockers but has developed recurrent
episodes of ventricular tachycardia. During these episodes he remains
conscious but feels dizzy, and he becomes diaphoretic and hypotensive. He is
given an IV bolus of lidocaine and started on an IV lidocaine infusion. To what class of antiarrhythmic does lidocaine belong and What is lidocaine’s mechanism of action?
“[Y] Ib, Specific Na+ channel blocker, reduces the rate of
phase 0 depolarization, primarily in damaged tissue”
“A 71-year-old man is noted to have dilated cardiomyopathy with atrial
fibrillation and a rapid ventricular rate. An agent is used to control the
ventricular rate, but the cardiac contractility is also affected, placing
him in pulmonary edema. Which of the following agents was most
likely used?”
[Y] Verapamil
“A 65-year-old retired military man with hypertension and type II diabetes comes in for a
follow-up visit. Along with making appropriate diet and lifestyle changes, he
is taking an ACE inhibitor-thiazide diuretic combination for his hypertension
and metformin for his diabetes. His blood pressure and diabetes are under
acceptable control. Routine blood work revealed normal electrolytes, renal
function, and liver enzymes. He is noted to have elevated total cholesterol and
low-density lipoprotein (LDL) levels, which have remained high in spite of
his lifestyle changes. In an effort to reduce his risk of developing coronary
artery disease, you start him on a 3-hydroxy-3-methylglutaryl-coenzyme A
(HMG-CoA) reductase inhibitor. Mechanism of action of HMG-CoA reductase inhibitors”
” [Y] Competitive inhibition of the rate-limiting enzyme in cholesterol
biosynthesis results in compensatory increase in plasma cholesterol
uptake in the liver mediated by an increase in the number of LDL
receptors.”
“A 19-year-old man is brought to the physician’s office by his very concerned
mother. He has been kicked out of the dormitory at college for his “bizarre”
behavior. He has accused several fellow students and professors of spying on
him for the CIA. He stopped attending his classes and spends all of his time
watching TV because the announcers are sending him secret messages on how
to save the world. He has stopped bathing and will only change his clothes
once a week. In your office you find him to be disheveled, quiet, and unemotional.
The only spontaneous statement he makes is when he asks why his
mother brought him to the office of “another government spy.” His physical
examination and blood tests are normal. A drug screen is negative. You diagnose
him with acute psychosis secondary to schizophrenia, admit him to the
psychiatric unit of the hospital, and start him on haloperidol. Describe mechanism of therapeutic action of haloperidol”
“[Y] Antagonist activity at
postjunctional dopamine D2-receptors in the mesolimbic and mesocortical
areas of the brain”
