pharma q bank 80 p Flashcards

1
Q

(Question ID: 444) A 74-year-old man with a long history of type 2 diabetes complained to his physician of diffcult urination. Further examination led to the diagnosis of a disorder, and treatment with bethanechol improved the symptoms. Which of the following was most likely the patient’s disorder?
a Prostatic hyperplasia
b Impaired diuresis
c Detrusor hyperreflexia
d Neurogenic atony of the bladder
e Urinary tract infection

A

Neurogenic atony of the bladder

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2
Q

(Question ID: 51) A 65-year-old woman who had been admitted to the hospital with a myocardial infarction developed ventricular tachycardia and received an intravenous injection of lidocaine. Her cardiologist knew that the dose given must be within the range of doses that have a high probability of therapeutic success. Which of the following terms best defines this range?
a) Intrinsic activity
b) Efficacy
c) Potency
d) Therapeutic index
e) Therapeutic window
f) Response variability

A

Therapeutic window

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3
Q

(Question ID: 83) A 2-year-old boy was admitted to the emergency department after a generalized tonic-colonic seizure. His mother reported that the boy apparently ingested several tablets of propranolol, a β-blocker, which he had found in his father’s dresser drawer. Vital signs on admission were blood pressure 85/50 mm Hg, heart rate 40 beats per minute (bpm), respiratory rate 20/min. The boy received an intramuscular injection of glucagon, a hormone that activates glucagon receptors in the heart, causing a significant increase in heart contractility. Which of the following terms best defines the antagonism between glucagon and β-blockers?
a) Chemical
b) Functional
c) Competitive
d) Pharmacokinetic
e) Pharmacological

A

Competitive

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4
Q

(Question ID: 90) During a phase 1 clinical trial, four different oral dosage forms of the same dose of a drug were administered to a healthy volunteer on four separate occasions. The plasm a concentration-time curves are plotted. Which of the following features best explains why formulation W produces the largest plasma concentration-time curve of the drug? (picture 90)
a) Highest absorption through gut wall
b) Lowest first-pass effect
c) Lowest hepatic clearance
d) Highest volume of distribution
e) Lowest drug elimination

A

[Y]Highest absorption through gut wall

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5
Q

(Question ID: 223) A graph of the therapeutic index of warfarin is shown in the following figure. Which of the following statements is true? (picture 223)
a) The therapeutic window is large
b) There is a small window of desired effect of this medication
c) Unwanted adverse events are unlikely with this agent
d) Unwanted adverse events are unlikely dose related

A

[Y]There is a small window of desired effect of this medication

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6
Q

(Question ID: 224) A 7-year-old girl recently diagnosed with persistent asthma started treatment with inhaled albuterol “as needed.” Which of the following adverse effects was most likely to occur during the therapy?
a) Atrioventricular block
b) Restlessness
c) Sleepiness
d) Postural hypotension
e) Ventricular tachycardia

A

[Y]Restlessness

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7
Q

(Question ID: 225) An 8-year-old boy was in an ophthalmologist’s office for the first time and received ophthalmic drops of a drug to prepare his eyes for measurement of refractive errors. A half hour later, he showed mental confusion, restlessness, incoherence, and hallucinatory behavior. His pulse rate was 120 bpm. Which of the following drugs most likely caused the patient’s adverse effects?
a) Phenylephrine
b) Epinephrine
c) Atropine
d) Timolol
e) Pilocarpine

A

[Y]Atropine

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8
Q

(Question ID: 226) A 63-year-old man underwent surgery to remove a laryngeal carcinoma. Before surgery, the anesthesiologist administered a drug intramuscularly to decrease bronchial secretions and to prevent bradycardia due to manipulation of the vagus nerve. Which of the following drugs would be most appropriate in this situation?
a) Ipratropium
b) Dopamine
c) Atropine
d) Isoproterenol
e) Epinephrine

A

[Y]Atropine

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9
Q

(Question ID: 227) A 25-year-old man experienced severe motion sickness whenever he traveled by air or sea. He felt much better after using a transdermal patch to apply a drug before traveling. Blockade of which of the following receptors most likely mediated the therapeutic effect of the drug in the patient’s disorder?
a) H1 histaminergic
b) β2 adrenergic
c) D2 dopaminergic
d) 5-HT3 serotoninergic
e) M1 cholinergic
f) Nn cholinergic

A

[Y]M1 cholinergic

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10
Q

(Question ID: 228) A 5-year-old girl who was on vacation in Venezuela with her parents was admitted to the local hospital with fever (103.7°F, 39.8°C), mental confusion, restlessness, and hallucinatory behavior. History revealed that the girl had eaten some honey bought from a local vendor. Physical examination revealed mydriasis; dry, hot, and red skin; and a distended abdomen. A diagnosis of atropine poisoning was made, and an appropriate therapy was started. Which of the following molecular actions most likely contributed to the atropine induced hyperthermia in this patient?
a) Skin vasoconstriction
b) Blockade of prostaglandin synthesis in the hypothalamus
c) Uncoupling of oxidative phosphorylation in skeletal muscle
d) Blockade of muscarinic receptors in the hypothalamus
e) Blockade of muscarinic receptors of sweat glands

A

e) [Y]Blockade of muscarinic receptors of sweat glands

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11
Q

(Question ID: 229) An 85-year-old male resident of a nursing facility complained of frequent urinary urges that often resulted in urine leakage. Darifenacin was prescribed to manage the patient’s incontinence. Which of the following actions most likely mediate the therapeutic effect of the drug?
a) Decreased bladder internal sphincter tone
b) Relaxation of the prostate capsule
c) Contraction of the detrusor muscle
d) Decreased diuresis
e) increased compliance of the bladder

A

[Y]Increased compliance of the bladder

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12
Q

(Question ID: 230) A 25-year-old woman complained to her physician of excessive axillary sweating and a sweaty forehead, primarily when she was anxious or excited. The woman stated that the symptoms were very disturbing and asked for a treatment. The physician prescribed glycopyrrolate cream, to apply to the affected areas. Blockade of which of the following receptors most likely mediated the therapeutic effect of the drug in the patient’s disorder?
a) β2 adrenergic
b) Nn cholinergic
c) D1 dopaminergic
d) α2 adrenergic
e) M3 muscarinic

A

[Y]M3 muscarinic

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13
Q

(Question ID: 231) A 23-year-old man complained to his physician of photophobia and difficulty in reading the newspaper. A few days earlier, the man had started using a nasal spray of ipratropium to manage profuse rhinorrhea associated with a cold. Which of the following molecular actions most likely mediated the adverse effects of the drug?
a) Blockade of M3 muscarinic receptors
b) Activation of M3 muscarinic receptors
c) Activation of M3 muscarinic receptors
d) Activation of β2 adrenoceptors
e) Blockade of α1 adrenoceptors
f) Activation of α1 adrenoceptors

A

[Y]Blockade of M3 muscarinic receptors

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14
Q

(Question ID: 232) A 42-year-old man came to the clinic for a follow-up visit 2 months after being diagnosed with essential hypertension. Therapy with propranolol and hydrochlorotiazide was started at the time of diagnosis. His blood pressure remained poorly controlled, and he admitted he had been taking the pills only once in a while, because of a disturbing adverse effect. Which of the following was most likely the effect mentioned by the patient?
a) Palpitations
b) Sexual dysfunction
c) Migraine headache
d) Tremor
e) Anginal pain

A

[Y]Sexual dysfunction

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15
Q

(Question ID: 233) A 31-year-old man was brought to the emergency department after the police found him shouting and acting irrationally in the street. The man admitted that for the past few hours he had been using amphetamines that he had obtained from a new dealer. He was agitated and anxious and exhibited psychotic behavior. Vital signs were blood pressure 230/150 mm Hg, heart rate 160 bpm, respirations 20/min. An emergency therapy was started, and the patient was treated with intravenous diazepam, but 30 minutes later his blood pressure was still 210/130. Which of the following pairs of drugs would be appropriate to include in the patient’s treatment at this time?
a) Phentolamine followed by propranolol
b) Clonidine followed by albuterol
c) Metyrosine followed by neostigmine
d) Bethanechol followed by phenylephrine

A

[Y]Phentolamine followed by propranolol

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16
Q

(Question ID: 234) A 55-year-old woman presented to a clinic because of a gradual onset of a scratchy sensation on both eyes and extreme dryness of the mouth and lips. Lab tests showed elevated levels of antibodies against gamma globulin. A diagnosis of Sjögren syndrome was made, and a drug was prescribed to relieve the patient’s xerostomia. Which of the following drugs was most likely administered?
a) Acetylcholine
b) Phenylephrine
c) Prazosin
d) Donepezil
e) Pilocarpine

A

[Y]Pilocarpine

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17
Q

(Question ID: 236) A 33-year-old man recently diagnosed with pheochromocytoma was scheduled for surgery. The week before the operation he received a treatment with a drug that acts by decreasing catecholamine biosynthesis. Which of the following drugs was most likely administered?
a) Phenoxybenzamine
b) Propranolol
c) Metyrosine
d) Dexamethasone
e) Levothyroxine

A

[Y]Phenoxybenzamine

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18
Q

(Question ID: 235) A 51-year-old woman presented to the clinic with a 1 month history of palpitations, insomnia, nervousness, fatigue, diarrhea, and heat intolerance. The physical examination revealed hyperreflexia, lid lag, and mild tremor. Vital signs were blood pressure 160/60, heart rate 95 bpm. Which of the following drugs was most likely appropriately included in the therapeutic management of this patient?
a) Albuterol
b) Propranolol
c) Labetalol
d) Prazosin
e) Phenoxybenzamine

A

[Y]Propranolol

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19
Q

(Question ID: 237) Five new antihypertensive drugs were tested in healthy volunteers. All of the drugs were found to be equally effective in controlling hypertension. The minimum effective plasma concentrations and the minimum toxic plasma concentrations were determined for each drug. Which of the drugs has the highest probability of therapeutic success? (picture 237)
a) Drug P
b) Drug Q
c) Drug R
d) Drug S
e) Drug T

A

[Y]Drug Q

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20
Q

Question ID: 238) The figure below depicts the concentration−time curve of a new drug after a single intravenous dose of 20 mg was administered to a laboratory animal. Which of the following drugs does the new agent most resemble? (picture 238)
a) Atropine
b) Propranolol
c) Ethanol
d) Phenylephrine
e) Clonidine

A

[Y]Ethanol

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21
Q

(Question ID: 239) A researcher who is interested in creating an anticholinergic agent that would be useful in patients with irritative bladder symptoms would be interested in targeting which of the following receptors?
a) M1
b) M2
c) M3
d) M4
e) M5

A

[Y]M3

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22
Q

(Question ID: 240) A 47-year-old man is given atropine to decrease dental secretions during a root canal procedure. This agent is most likely to have an effect on which of the following target organs/glands?
a) Adrenal medulla
b) Kidney
c) Pilomotor muscles
d) Salivary glands
e) Sweat glands

A

[Y]Salivary glands

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23
Q

(Question ID: 241) A 58-year-old woman with a history of myasthenia gravis presents to the emergency department complaining of generalized abdominal pain. Her current medications include nifedipine and neostigmine. Her caretaker reports that her bottle of neostigmine is empty but was full earlier in the day. Which of the following findings is likely in this patient?
a) Bronchodilation
b) Constipation
c) Dizziness
d) Hypotension
e) Xerostomia

A

[Y]Hypotension

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24
Q

(Question ID: 242) A 73-year-old man presents to his primary care physician complaining of a weak stream and nocturia four times at night. He is very sensitive to the medication side effects and is reluctant to take medications for this reason. Physical examination reveals a mildly enlarged prostate. Treatment of this condition may involve the use of which of the following agents to minimize side effects?
a) Alfuzosin
b) Doxazosin
c) Prazosin
d) Tamsulosin
e) Terazosin

A

[Y]Tamsulosin

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25
Q

(Question ID: 243) A group of teenage boys comes to the emergency department after ingesting a plant they heard would make them high. One member of the group still had some plant parts in his pocket, which you use to identify deadly nightshade that contains compounds metabolized to atropine. Which of the following is an effect of atropine?
a) Bronchospasm
b) Lacrimation
c) Mydriasis
d) Salivation
e) Urination

A

[Y]Mydriasis

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26
Q

(Question ID: 244) A 32-year-old man presents to his primary care physician because of a 2-week history of nasal stuffiness, cough, and sinus pain. He is prescribed with phenylephrine. He must be aware of which of the following potential adverse effects?
a) Constipation
b) Diarrhea
c) Epistaxis
d) Hypertension
e) Tinnitus

A

[Y]Hypertension

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27
Q

(Question ID: 245) Researchers are studying the intracellular effects of certain hormones and neurotransmitters on their respective receptors. After exposing a culture of cells to a catecholamine solution, they saw an increase in the intracellular calcium concentration. Stimulation of which of the following receptors would cause this?
a) Alpha 1-Adrenergic
b) Alpha 2-Adrenergic
c) Beta 1-Adrenergic
d) Beta 2-Adrenergic
e) Dopaminergic-1 (D1

A

[Y]Alpha 1-Adrenergic

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28
Q

(Question ID: 246) A patient takes an oral sympathomimetic agent for regulation of heart rate. This agent is taken orally. Which of the following systemic effects is likely a result of this medication?
a) Bronchoconstriction
b) Hypotension
c) Pupillary constriction
d) Tachycardia
e) Urinary frequency

A

[Y]Tachycardia

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29
Q

(Question ID: 247) A 6-month-old male infant is hospitalized for nausea, vomiting, fevers, and failure to tolerate oral medications. He is placed on Phenergan per rectum once daily to treat the nausea and vomiting. Which of the following statements is true about this route of administration?
a) Allows destruction of the medication by gastric enzymes
b) Maximal biotransformation of the drug by the liver
c) Rectal administration of medications is well accepted
d) Rectal irritation following administration is uncommon
e) Useful if patient is unconscious or vomiting

A

[Y]Useful if patient is unconscious or vomiting

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30
Q

(Question ID: 248) A researcher is studying the bioavailability of commonly used antimuscarinics to treat irritable bowel syndrome. Medication A is administered in a 100 mg daily dose orally and 60 mg of the drug is absorbed from the gastrointestinal tract unchanged. Thus, the bioavailability of Medication A is
a) 50%
b) 60%
c) 70%
d) 80%
e) 90%

A

[Y]60%

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31
Q

(Question ID: 249) A 38-year-old woman presents to the ophthalmologist for a routine eye examination. She is given intraocular pilocarpine. She was supposed to be administered two drops in each eye for the examination. Unfortunately, the eyedrops were administered by a new technician who inadvertently administered 10 drops of pilocarpine in each eye. Which of the following agents should be immediately given to the patient?
a) Atropine
b) Carbachol
c) Donepezil
d) Galantamine
e) Rivastigmine

A

[Y]Atropine

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32
Q

(Question ID: 250) A medical student is performing a summer research project evaluating the pharmacologic effects of atropine at varying doses. Doses are extrapolated from normal human doses of this agent. Slow infusion of this agent to a steady state dose of 0.5 mg would be expected to produce which of the following effects?
a) Bradykinesia
b) Coma
c) Dilation of the pupils
d) Dry mouth
e) Tachycardia

A

[Y]Dry mouth

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33
Q

(Question ID: 251) A medical student is involved in a summer research project evaluating the potencies of the a-adrenergic agonists at different receptor sites. Which of the following a-adrenergic agonists would be expected to have the strongest potency at the a-receptor?
a) Acetylcholine
b) Epinephrine
c) Isoproterenol
d) Metanephrine
e) Norepinephrine

A

[Y]Norepinephrine

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34
Q

(Question ID: 252) A new autonomic drug was administered locally in the conjunctival sac of a healthy volunteer during a phase 1 clinical
trial. Twenty minutes later, measurement of several eye parameters gave the following results:
Pupillary diameter: decreased
Lens curvature: increased
Intraocular pressure: decreased
Which of the following receptors did the drug most likely activate?
a) α1
b) α2
c) Nm
d) M3
e) β2

A

[Y]M3

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35
Q

(Question ID: 253) A 77-year-old woman was found to have elevated intraocular pressure during a routine eye examination. History indicated that she had recently been taking several antimuscarinic medications to treat her bladder hyperreflexia. The ophthalmologist told her that he believed the increased intraocular pressure was an adverse effect of those medications. Which of the following ocular actions most likely mediated this adverse effect?
a) Relaxation of the ciliary muscle
b) Increased aqueous humor production
c) Dilation of ciliary body vessels
d) Relaxation of the radial muscle of the iris
e) Decreased episcleral aqueous humor outflow
f) Relaxation of the tarsal muscle

A

[Y]Relaxation of the ciliary muscle

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36
Q

(Question ID: 254) A 77-year-old man suffering from chronic obstructive pulmonary disease had been taking ipratropium by inhalation. Shortly after inadvertently spraying the medication on his face, which of the following effects did the patient most likely experience?
a) Urge incontinence
b) Drowsiness
c) Salivation
d) Atrioventricular (AV) block
e) Difficulty in near vision
f) Hallucinations

A

[Y]Hallucinations

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37
Q

(Question ID: 255) Which of the following cholinomimetics is used in the treatment of atropine intoxication?
a) Neostigmine
b) Carbochol
c) Physostigmine
d) Lobeline

A

[Y]Physostigmine

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38
Q

(Question ID: 256) Subtype-selective alpha 1 receptor antagonists such as tamsulosin, terazosin, alfusosin are efficacious in:
a) Hyperthyroidism
b) Cardiac arrhythmias
c) Benign prostatic hyperplasia (BPH)
d) Asthma

A

[Y]Benign prostatic hyperplasia (BPH)

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39
Q

(Question ID: 257) Beta 1 receptor stimulation includes all of the following effects EXCEPT:
a) Increase in contractility
b) Bronchodilation
c) Tachycardia
d) Increase in conduction velocity in the atrioventricular node

A

[Y]Bronchodilation

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40
Q

(Question ID: 258) A 14-year-old girl suffering from seasonal rhinitis started a therapy with loratadine, a drug that binds to H1 histamine receptors. Which of the following terms describes a characteristic of loratadine binding to the H1 receptor?
a) Intrinsic activity
b) Affnity
c) Stereoselectivity
d) Potency
e) Variability
f) Maximal efficacy

A

[Y]Stereoselectivity

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41
Q

(Question ID: 259) Selective beta-1 blockers are preferred over nonselective beta blockers in some patients because they
a) Cause less cardiodepression
b) [Y]Are less likely to cause bronchoconstriction
c) Are more effective for migraine prophylaxis
d) Are more effective as an antiarrhythmics
e) Have greater prophylactic value post-MI

A

Are less likely to cause bronchoconstriction

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42
Q

(Question ID: 260) What term is used to describe a decrease in responsiveness to a drug which develops in a few minutes?
a) Refractoriness
b) Cumulative effect
c) Tolerance
d) Tachyphylaxis

A

[Y]Tachyphylaxis

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43
Q

(Question ID: 261) Indicate the location of M2 cholinoreceptor type:
a) Heart
b) Glands
c) Smooth muscle
d) Endothelium

A

[Y]Heart

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44
Q

(Question ID: 262) Epinephrine produces all of the following effects EXCEPT:
a) Positive inotropic and chronotropic actions on the heart (beta1 receptor)
b) Increase peripheral resistance (alpha 1 receptor)
c) Predominance of alpha effects at low concentration
d) Skeletal muscle blood vessel dilatation (beta 2 receptor)

A

[Y]Predominance of alpha effects at low concentration

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45
Q

(Question ID: 263) Which of the following sympathomimetics is an effective mydriatic?
a) Salmeterol
b) Phenylephrine
c) Dobutamine
d) Norepinephrine

A

[Y]Phenylephrine

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46
Q

(Question ID: 264) Clonidine works by:
a) Activating beta 1-adrenergic receptors
b) Activating alpha 1-adrenergic receptors
c) Activating beta 2-adrenergic receptors
d) Activating alpha 2-adrenergic receptors
e) Blocking beta-adrenergic receptors

A

[Y]Activating alpha 2-adrenergic receptors

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47
Q

(Question ID: 265) A new autonomic drug was given intravenously to dog during a lab experiment. It was found that the drug was able to increase cholinergic transmission in both the peripheral and central nervous systems. Which of the following drugs does the new agent most resemble?
a) Acetylcholine
b) Carbachol
c) Bethanechol
d) Neostigmine
e) Physostigmine

A

[Y]Physostigmine

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48
Q

(Question ID: 266) Which of the following statements is most correct regarding the termination of drug action?
a) Drugs must be excreted from the body to terminate their action
b) Metabolism of drugs always increases their water
c) Metabolism of drugs always abolishes their pharmacologic activity
d) Hepatic metabolism and renal excretion are the two most important mechanisms involved
e) Distribution of a drug out of the bloodstream terminates the drug’s effects

A

[Y]Hepatic metabolism and renal excretion are the two most important mechanisms involved

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49
Q

(Question ID: 267) A patient receives a single dose of antibiotics following a prostate needle biopsy. He takes 500 mg of ciprofloxacin immediately after completion of the procedure. The half-life of the medication is 8 h. At approximately how many half-lives will it take for 90% of the drug to be excreted from the body?
a) 1
b) 2
c) 3
d) 3.3
e) 5

A

[Y]3.3

50
Q

(Question ID: 268) A study was carried out in isolated, perfused animal hearts. In the absence of other drugs, pindolol, a β-adrenoceptor ligand, caused an increase in heart rate. In the presence of highly effective β stimulants, however, pindolol caused a dose-dependent, reversible decrease in heart rate. Which of the following expressions best describes pindolol?
a) A chemical antagonist
b) An irreversible antagonist
c) A partial agonist
d) A physiologic antagonist

A

[Y]A partial agonist

51
Q

(Question ID: 269) The activation of muscarinic receptors in bronchiolar smooth muscle is associated with:
a) Activation of adenylyl cyclase
b) Decrease in cAMP formation mediated by G-proteins
c) Increase in IP3 and DAG
d) Inhibition of protein kinase C
e) Opening of Na+/K+ cation channels

A

[Y]Inhibition of protein kinase C

52
Q

(Question ID: 270) A 79-year-old man with end-stage Alzheimer’s disease and dysphagia is taking multiple medications. Physical examination reveals xerostomia and a limited gag reflex. Which of the following routes of medication administration would provide the lowest serum drug concentration?
a) Enteral
b) Intramuscular
c) Intrathecal
d) Intravenous
e) Transdermal

A

[Y]Enteral

53
Q

(Question ID: 1587) The pharmacokinetic properties of a new drug are being studied in normal volunteers during phase I clinical trials. The volume of distribution and clearance determined in the first subject are 80 L and 4 L/hr, respectively. The half-life of the drug in this subject is approximately
a) 0.03 hours
b) 222 hours
c) 139 hours
d) 14 hours
e) 78 hours

A

[Y]14 hours

54
Q

(Question ID: 1586) Mean arterial blood pressure (MAP) and heart rate (HR) measurements were recorded during the IV administration of two different drugs (see picture). Select the most likely drugs given at the indicated points (picture-1586)
a) X - Acetylcholine Y - Phentolamine
b) X-Norepinephrine Y-Hexamethonium
c) X-isoproterenol Y-propranolol
d) X-metaproterenol Y-propranolol
e) X-Phenylephrine Y-Phentolamine

A

[Y]X-Norepinephrine Y-Hexamethonium

55
Q

(Question ID: 1585) A 62-year-old woman is being prepared for cardiac bypass surgery. Before she is intubated, she is given a skeletal muscle relaxant that causes her to have muscle fasciculations prior to muscle relaxation. Which of the following drugs was most likely administered?
a) Atracurium
b) Pancuronium
c) Rocuronium
d) Vecuronium
e) Succinylcholine

A

[Y]Succinylcholine

56
Q

(Question ID: 271) A 43-year-old man is stabbed in the chest and is brought to the emergency department for evaluation. Because of hemodynamic instability, he is brought to the operating room for thoracotomy. An adequate anesthesia history could not be obtained from the patient. No family member was present at the time of surgery. Upon induction of anesthesia with succinylcholine, the patient’s heart rate increased to 150 beats/minute and experienced muscular rigidity. What is the most appropriate treatment for this patient?
a) Dantrolene
b) Rapid warming with blanket
c) Sodium bicarbonate administered intravenously
d) Succinylcholine intravenous drip at steady state
e) Tubocurarine intravenous bolus

A

[Y]Dantrolene

57
Q

(Question ID: 272) A 40-year-old man with chronic anxiety and alcohol abuse has difficulty getting to sleep. He has no other medical problems. Physical examination of the heart, lungs, and abdomen are within normal limits. Which of the following is the best agent to help this patient get to sleep?
a) Clonazepam
b) Diazepam
c) Flurazepam
d) Temazepam
e) Triazolam

A

[Y]Triazolam

58
Q

(Question ID: 273) A 78-year-old man with generalized anxiety disorder and mild dementia is being seen by his primary care physician. Physical examination of the heart, lungs, and abdomen are within normal limits. Which of the following would be the best treatment option for his generalized anxiety disorder?
a) Alprazolam
b) Buspirone
c) Flumazenil
d) Temazepam
e) Triazolam

A

[Y]Buspirone

59
Q

(Question ID: 274) A 47-year-old man with a history of intermittent panic disorders presents to his primary care physician desiring therapy. He has no other pertinent past medical or surgical history. Physical examination of the heart, lungs, and abdomen are within normal limits. What is the most appropriate treatment for this patient?
a) Alprazolam
b) Lorazepam
c) Temazepam
d) Triazolam
e) Zolpidem

A

[Y]Alprazolam

60
Q

(Question ID: 275) A 57-year-old man with a seizure disorder takes antiepileptic medications. His physician would like to use a medicine that is metabolized only by the CYP1A2 receptor (member of P450 complex). Which of the following agents would be preferred?
a) Carbamazepine
b) Divalproex
c) Felbamate
d) Phenobarbital
e) Phenytoin

A

[Y]Carbamazepine

61
Q

(Question ID: 276) A 53-year-old woman with seizure disorder, bipolar disorder, and trigeminal neuralgia presents to her primary care physician for follow-up and treatment. She has no new complaints. Which of the following medications may serve to treat all of her earlier mentioned problems?
a) Carbamazepine
b) Ethosuximide
c) Felbamate
d) Gabapentin
e) Lacosamide

A

[Y]Carbamazepine

62
Q

(Question ID: 277) A mother brings her unconscious 14-year-old son to the emergency department. He was found unresponsive in his bedroom. His respirations are 10 breaths per minute. The mother suspects that her son has been abusing her prescription diazepam, showing her empty pill bottle. What should be given to him to counteract the diazepam?
a) Amphetamine
b) Epinephrine
c) Flumazenil
d) Phenobarbital
e) Theophylline

A

[Y]Flumazenil

63
Q

(Question ID: 278) A 78-year-old man with a long history of seizure disorder controlled with phenytoin presents to his dentist for routine follow-up. Which of the following findings must the dentist be concerned about and evaluate for?
a) Dental caries
b) Exposed nerve roots
c) Jaw bone exposure
d) Gingival overgrowth
e) Teeth erosion

A

[Y]Gingival overgrowth

64
Q

(Question ID: 279) A 16-year-old boy is brought to the urgent care clinic after suffering an episode of lip smacking followed by stiffness and convulsions. His mother explains that this is the third such attack in the past 2 years and that each attack has lasted about a minute. The pediatrician prescribes carbamazepine to control his seizures. What is the mechanism of action of this agent?
a) Inhibition of calcium channels
b) Inhibition of potassium channels
c) Inhibition of sodium channels
d) Potentiation of GABA receptors
e) Stimulation of chloride channels

A

[Y]Inhibition of sodium channels

65
Q

(Question ID: 280) A 31-year-old female is brought to the emergency department by friends who said she has been “taking drugs.” They did not know specifically what she had taken. She presents with respiratory depression and dysphoria. Stimulation of which receptor is likely causing her dysphoria?
a) Cannabinoid receptor
b) GABA receptor
c) k-Opioid receptor
d) Serotonin receptor

A

[Y]k-Opioid receptor

66
Q

(Question ID: 281) A 21-year-old man complains of depressed mood, lack of pleasure in activities he previously enjoyed, and lack of energy. This has been going on for 2.5 years now. His physician prescribes fluoxetine. Which of the following side effects is most likely to occur in this patient?
a) Abdominal pain
b) Peptic ulcers
c) Impotence
d) Loss of taste
e) Pancreatitis

A

[Y]Impotence

67
Q

(Question ID: 282) A 35-year-old man who is employed as a salesman complains of fatigue. He also mentions that he no longer likes to fly his model airplanes, which has been a hobby of his since childhood and was a major occupier of his free time. The physician prescribes the antidepressant bupropion. What else is bupropion commonly used for?
a) Alcoholism
b) Delirium tremens
c) Opioid overdose
d) Smoking cessation

A

[Y]Smoking cessation

68
Q

) A 53-year-old woman with schizophrenia managed for years with chlorpromazine complains of a dry mouth, constipation, blurred vision, and feeling tired. Low-potency typical antipsychotics such as chlorpromazine are known to interfere with many neurotransmitter receptors aside from their target. Which of the following type of receptors is spared from antagonism by chlorpromazine?
a) alpha-Adrenergic receptors
b) beta-Adrenergic receptors
c) Dopamine receptors
d) Histamine receptors
e) Muscarinic cholinergic receptors

A

[Y]beta-Adrenergic receptors

69
Q

(Question ID: 284) A 44-year-old man with schizophrenia is being treated with a low-potency typical antipsychotic. He complains that his medication’s side effects are more than he can handle and wants to try another medication. If he was to switch from a low-potency to a high potency antipsychotic drug, which of the following side effects would likely diminish?
a) Anticholinergic effects
b) Parkinsonism
c) Perioral tremor
d) Tardive dyskinesia
e) Torticollis

A

[Y]Anticholinergic effects

70
Q

(Question ID: 285) A 21-year-old male college student complains of difficulty falling asleep at night. He asks if there is anything “mild” he can take to help him get to sleep. Which of the following hypnotics mimics an endogenous hormone?
a) Diazepam
b) Lorazepam
c) Phenobarbital
d) Ramelteon
e) Zolpidem

A

[Y]Zolpidem

71
Q

(Question ID: 286) A 54-year-old man is elected to undergo a total knee replacement following a knee arthroscopy. He arrives the day of the surgery in good health. The anesthesiologist induces sedation using phenobarbital. Which of the following parameter changes may be evident in this patient because of the phenobarbital?
a) Decreased AST/ALT
b) Decreased serum bilirubin
c) Increased serum amylase
d) Increased serum bilirubin
e) Increased serum CK

A

[Y]Decreased serum bilirubin

72
Q

(Question ID: 287) An 83-year-old man is brought to the clinic by his family with complaints stating he can no longer perform his daily activities or be trusted to live on his own. During his neurological exam, he presents with moderate memory loss, apraxia, and anomia. Also, he displays aggressive behaviors throughout the physical exam. He was diagnosed to be in an early stage of Alzheimer’s disease. What class of drugs would be most helpful in treating the patient?
a) Cholinesterase stimulants
b) Cholinesterase inhibitors
c) Dopamine agonists
d) Muscarinic receptor inhibitors
e) NMDA glutamate receptor agonists

A

[Y]Cholinesterase inhibitors

73
Q

(Question ID: 288) A 56-year-old man came to the clinic with complaints of tremor, bradykinesia, and “a feeling of persistent restlessness” after beginning a new antipsychotic regimen 2 months ago. The patient has a history of schizophrenia and depression. He is afraid he may have Parkinson’s syndrome. The doctor recommended cessation of the new regimen and assures the patient the symptoms will clear after a few weeks or months after withdrawal. What antipsychotic was the most likely to have caused the patient’s symptoms?
a) Aripiprazole
b) Clozapine
c) Haloperidol
d) Olanzapine
e) Ziprasidone

A

[Y]Haloperidol

74
Q

(Question ID: 289) A 72-year-old man is brought to his physician by his son. The son complains that this patient has been becoming forgetful, confused, moody, and aggressive over the past few months. One drug that may be used to treat this patient’s symptoms is donepezil. Which of the following describes an effect of donepezil?
a) Decreases synaptic acetylcholine
b) Decreases synaptic dopamine
c) Decreases synaptic norepinephrine
d) Increases synaptic acetylcholine
e) Increases synaptic dopamine

A

[Y]Increases synaptic acetylcholine

75
Q

(Question ID: 290) A 64-year-old man presents with a shuffling gait, cogwheel rigidity, and a resting tremor. His physician prescribes levodopa and his symptoms greatly improve, supporting a diagnosis of Parkinson’s disease. How does levodopa help this patient’s symptoms?
a) Increase dopamine production
b) Inhibit acetylcholinesterase
c) Stimulate acetylcholine receptors
d) Stimulate dopamine receptors
e) Stimulate release of preformed dopamine

A

[Y]Increase dopamine production

76
Q

(Question ID: 291) A 73-year-old woman with Alzheimer’s disease is in a long-term care facility. She also has a history of hypertension, diabetes mellitus, and mild anxiety. Modest improvement in the memory of patients with Alzheimer’s disease may occur with drugs that increase transmission at which of the following receptors?
a) Adrenergic
b) Cholinergic
c) Dopaminergic
d) GABAergic
e) Serotonergic

A

[Y]Cholinergic

77
Q

(Question ID: 292) A 28-year-old alcoholic man is brought to the emergency department after a binge drinking. The treating physician is concerned about the risk of alcohol withdrawal and associated risk of withdrawal seizures. Which of the following medications would be most helpful in this patient to decrease these risks?
a) Alcohol
b) Thiopental
c) Oxazepam
d) Tramadol

A

[Y]Oxazepam

78
Q

(Question ID: 293) A physician has a choice in benzodiazepines to prescribe for patients. A particular patient (a 53-year-old man with anxiety) has a difficult time with compliance to medications. The physician is concerned about the patient going into withdrawal because of abrupt discontinuation of the antianxiety medication. Which of the following medications would have the least severe withdrawal reaction?
a) Diazepam
b) Flurazepam
c) Temazepam
d) Triazolam

A

[Y]Flurazepam

79
Q

(Question ID: 294) A 19-year-old man is brought to the emergency department after being found by his roommate to have snorted cocaine several times in the past few days, the last time being 10 h previously. He was given a drug that sedated him, and he fell asleep. The drug that was used to counter this patient’s apparent cocaine withdrawal was very likely which of the following?
a) Cocaine
b) Fluoxetine
c) Hydroxyzine
d) Lorazepam
e) Phenobarbital

A

[Y]Lorazepam

80
Q

(Question ID: 295) An 8-year-old boy presents to the emergency department after seizure-like activity. During class, the teacher noted that the boy stare off for about 45 s. He has done this three times in the past. He would not respond to her during the episode and was confused for about 1 min following it. What is the most appropriate first-line therapy for this child?
a) Carbamazepine
b) Ethosuximide
c) Lamotrigine
d) Phenytoin
e) Valproic acid

A

[Y]Ethosuximide

81
Q

(Question ID: 296) A 15-year-old boy presents to clinic for follow-up for his tonic-clonic seizures. He reports that he has not had a seizure in the past 6 months. However, he has been more tired recently and is unsure why. A complete blood count is performed and shows megaloblastic anemia. The physician told the patient that this was most likely a side effect of his antiseizure medication. What is the most likely medication he was taking?
a) Carbamazepine
b) Ethosuximide
c) Phenobarbital
d) [Y]Phenytoin
e) Valproic acid

A

[Y]Phenytoin

82
Q

(Question ID: 297) An 83-year-old woman with Parkinson’s disease is currently being treated with carbidopa/levodopa, but her Parkinson’s symptoms are worsening. She has normal liver function and no history of liver disease. Selegiline is added to her regimen. How does selegiline help in Parkinson’s disease?
a) Increased norepinephrine synthesis
b) Inhibition of COMT
c) Inhibition of MAO
d) Stimulation of acetylcholine release
e) Stimulation of norepinephrine release

A

[Y]Inhibition of MAO

83
Q

(Question ID: 298) A 58-year-old man with Parkinson’s disease presents to the clinic for follow-up. Recently, he has experienced an increase in his resting tremor and rigidity. He was wondering if there is a medication that could help these symptoms. What anticholinergic is the most appropriate treatment?
a) Benztropine
b) Bromocriptine
c) Ipratropium
d) Scopolamine
e) Tropicamide

A

[Y]Benztropine

84
Q

(Question ID: 299) A 43-year-old woman with a history of fibromyalgia and depression presents to her primary care physician for treatment. She complains of feeling sad and worthless in addition to multiple somatic complaints. Which of the following treatments would be best for this patient?
a) Duloxetine
b) Fluoxetine
c) Mirtazapine
d) Sertraline
e) Watchful waiting

A

[Y]Duloxetine

85
Q

(Question ID: 300) An 18-year-old woman presents to clinic because of difficulty with school. She recently started college and is living on her own for the first time. She is constantly preoccupied with wondering if the door is locked. She checks the lock at least 20 times before she is able to leave her apartment. This often makes her late for class. She had been on selective serotonin reuptake inhibitors in the past, but they are ineffective. What is the most appropriate treatment for this patient?
a) Amitriptyline
b) Clomipramine
c) Lithium
d) Quetiapine
e) Venlafaxine

A

[Y]Clomipramine

86
Q

(Question ID: 301) A 53-year-old man with long-standing schizophrenia has failed therapy with both first- and second-generation antipsychotic agents. He still has significant problems with mood, delusions, and hallucinations. He is placed on clozapine. Which of the following effects must the treating physician be aware of?
a) Agranulocytosis
b) Cholelithiasis
c) Pancreatitis
d) Pituitary adenoma
e) Polycythemia

A

[Y]Agranulocytosis

87
Q

(Question ID: 302) A 34-year-old woman with depression presents to the ambulatory care clinic with altered mental status. She is confused and unsure where she is. Her blood pressure is 240/152 mm Hg. Her Cr is 2.93 mg/dL, which is above her baseline of 0.90 mg/dL. Her husband says she never had a problem with high blood pressure before. Everything was normal 3 h ago prior to her having three glasses of wine and cheese at a party. She recently started a new medication for her depression. What is the most likely medication she started?
a) Amitriptyline
b) Duloxetine
c) Fluoxetine
d) Phenelzine
e) Trazodone

A

[Y]Phenelzine

88
Q

(Question ID: 303) A 67-year-old woman complained to her physician of obstinate constipation. The woman, who was suffering bone pain from metastatic breast cancer, had started a therapy with morphine 2 weeks previously. Which of the following actions most likely mediated the adverse effect of the drug in this patient?
a) Decreased anal sphincter tone
b) Increased colonic tone
c) Increased intestinal peristalsis
d) Increased reflex response to rectal distention
e) Increased softening of feces

A

[Y]Increased colonic tone

89
Q

(Question ID: 303) A 67-year-old woman complained to her physician of obstinate constipation. The woman, who was suffering bone pain from metastatic breast cancer, had started a therapy with morphine 2 weeks previously. Which of the following actions most likely mediated the adverse effect of the drug in this patient?
a) Decreased anal sphincter tone
b) Increased colonic tone
c) Increased intestinal peristalsis
d) Increased reflex response to rectal distention
e) Increased softening of feces

A

[Y]Increased colonic tone

90
Q

(Question ID: 304) A 59-year-old woman with metastatic breast cancer complained of increasing bone pain, no longer managed with acetaminophen and codeine. A daily treatment with oral morphine was started. Which of the following drugs should be given concomitantly to prevent one of the most common adverse effects of opioids?
a) Diazepam
b) Fluoxetine
c) Lactulose
d) Propranolol
e) Nifedipine
f) Omeprazole

A

[Y]Lactulose

91
Q

(Question ID: 305) A 47-year-old man complained of severe pain 3 days after surgery to remove a colon cancer. Physical examination and x-ray confirmed the diagnosis of postoperative adynamic ileus. An analgesic treatment was prescribed. Which of the following analgesic drugs would be contraindicated for this patient?
a) Acetaminophen
b) Morphine
c) Ibuprofen
d) Ketorolac
e) Indomethacin

A

[Y]Morphine

92
Q

(Question ID: 306) A 28-year-old woman has sporadic attacks of intense anxiety with marked physical symptoms, including hyperventilation, tachycardia, and sweating. If she is diagnosed as suffering from a panic disorder, the most appropriate drug to use is:
a) Clonazepam
b) Eszopiclone
c) Propranolol
d) Ramelteon

A

[Y]Clonazepam

93
Q

(Question ID: 307) Which of the following best describes the mechanism of action of benzodiazepines?
a) Activate GABA-B receptors in the spinal cord
b) Block glutamate receptors in hierarchical neuronal pathways in the brain
c) Increase frequency of opening of chloride ion channels coupled to GABA-A receptors
d) Inhibit GABA transaminase to increase brain levels of GABA
e) Inhibit GABA transaminase to increase brain levels of GABA

A

[Y]Increase frequency of opening of chloride ion channels coupled to GABA-A receptors

94
Q

(Question ID: 308) 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 warfarin and phenytoin?
a) Buspirone
b) Chlordiazepoxide
c) [Y]Phenobarbital
d) Triazolam

A
95
Q

(Question ID: 308) 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 warfarin and phenytoin?
a) Buspirone
b) Chlordiazepoxide
c) Phenobarbital
d) Triazolam

A

[Y]Phenobarbital

96
Q

(Question ID: 309) With chronic use in seizure states, the adverse effects of this drug include coarsening of facial features, hirsutism, and gingival hyperplasia.
a) Carbamazepine
b) Felbamate
c) Phenytoin
d) Phenobarbital

A

[Y]Phenytoin

97
Q

(Question ID: 310) The mechanism of antiseizure activity of carbamazepine is:
a) Block of sodium ion channels
b) Block of calcium ion channels
c) Facilitation of GABA actions on chloride ion channels
d) Glutamate receptor antagonism
e) Inhibition of GABA transaminase

A

[Y]Block of sodium ion channels

98
Q

(Question ID: 311) A 20-year-old male patient scheduled for hernia surgery was anesthetized with halothane and nitrous oxide; tubocurarine was provided for skeletal muscle relaxation. The patient rapidly developed tachycardia and became hypertensive. Generalized skeletal muscle rigidity was accompanied by marked hyperthermia. Laboratory values revealed hyperkalemia and acidosis. This unusual complication of anesthesia is most likely caused by:
a) Acetylcholine release from somatic nerve endings at skeletal muscle
b) Activation of brain dopamine receptors by halothane
c) Block of autonomic ganglia by tubocurarine
d) Pheochromocytoma
e) Release of calcium from the sarcoplasmic reticulum

A

[Y]Release of calcium from the sarcoplasmic reticulum

99
Q

(Question ID: 312) 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) Cisatracurium
b) Dantrolene
c) Lidocaine
d) Morphine

A

[Y]Cisatracurium

100
Q

(Question ID: 313) Which of the following drugs is the most effective in the emergency management of malignant hyperthermia?
a) Baclofen
b) Dantrolene
c) Gabapentin
d) Secobarbital
e) Vecuronium

A

[Y]Dantrolene

101
Q

(Question ID: 314) A recently bereaved 73-year-old female patient was treated with a benzodiazepine for several weeks after the death of her husband, but she did not like the daytime sedation it caused even at low dosage. Living independently, she has no major medical problems but appears rather infirm for her age and has poor eyesight. Because her depressive symptoms are not abating, you decide on a trial of an antidepressant medication. Which of the following drugs would be the most appropriate choice for this patient?
a) Amitriptyline
b) Mirtazapine
c) Phenelzine
d) Sertraline
e) Trazodone

A

[Y]Sertraline

102
Q

(Question ID: 315) SSRIs are much less effective than tricyclic antidepressants in the management of:
a) Bulimia
b) Chronic pain of neuropathic origin
c) Generalized anxiety disorder
d) Obsessive-compulsive disorder
e) Premenstrual dysphoric disorder

A

[Y]Chronic pain of neuropathic origin

103
Q

(Question ID: 316) It is possible that this patient will have to increase the dose of the analgesic as his condition progresses as a result of developing tolerance. However, tolerance will not develop to a significant extent with respect to:
a) Biliary smooth muscle
b) Constipation
c) Nausea and vomiting
d) Sedation
e) Urinary retention

A

[Y]Constipation

104
Q

(Question ID: 317) Which drug does not activate opioid receptors, has been proposed as a maintenance drug in treatment programs for opioid addicts, and with a single oral dose, will block the effects of injected heroin for up to 48 h?
a) Amphetamine
b) Buprenorphine
c) Naloxone
d) Naltrexone
e) Propoxyphene

A

[Y]Naltrexone

105
Q

(Question ID: 318) A young male patient is brought to the emergency department of a hospital suffering from an overdose of cocaine after its intravenous administration. His symptoms are not likely to include
a) Agitation
b) Bradycardia
c) Hyperthermia
d) Myocardial infarct
e) Seizures

A

[Y]Bradycardia

106
Q

(Question ID: 319) 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) Ethosuximide
c) Gabapentin
d) Felbamate
e) Phenobarbital

A

[Y]Ethosuximide

107
Q

(Question ID: 109) A 43-year-old woman with long-standing diabetes was recently noted to have hypertension. She was started on a medication, and subsequent laboratory tests revealed hyperlipidemia and hyperuricemia. Given this patient’s recent history, what other laboratory abnormality may be present?
a) Gynecomastia
b) Hyperglycemia
c) Hyperkalemia
d) Hypermagnesemia
e) Hypernatremia

A

[Y]Hyperglycemia

108
Q

(Question ID: 110) An 80-year-old man diagnosed 2 months ago with hypertension presents to his primary care physician with 1 month of difficulty with urination. He complains of increased urinary frequency, nocturia, and the sensation of incomplete voiding. Physical examination reveals a nonnodular prostate. Prostate-specific antigen levels are 0.1 ng/ml_. Because the patient’s blood pressure at this examination is still elevated at 150/80 mm Hg, the physician prescribes a medication to treat both complaints. However, when the patient takes the first dose of this medication, he experiences intense dizziness on standing. Which medication did the physician prescribe for this patient?
a) Clonidine
b) Dobutamine
c) Mirtazapine
d) Phenoxybenzamine
e) Phenylephedrine
f) Prazosin

A

[Y]Prazosin

109
Q

(Question ID: 111) A 66-year-old woman with osteoporosis and two prior myocardial infarctions presents to her cardiologist complaining of fatigue, orthopnea, and nocturnal dyspnea. Physical examination reveals mild pitting edema of her lower extremities, pulmonary rales, and a prominent S3 on cardiac auscultation. This woman’s osteoporosis makes the physician cautious to prescribe a certain drug. Which of the following medications is most likely to exacerbate her osteoporosis?
a) Acetazolamide
b) Amiloride
c) Captopril
d) Furosemide
e) Hydrochlorothiazide
f) Metoprolol

A

[Y]Furosemide

110
Q

(Question ID: 112) A 64-year-old man with a history of congestive heart failure presents at the local emergency department (ED) complaining of blurry vision, dizziness, and nausea. The patient notes that the ED “must have very cheap light bulbs” because everything in the room “looks yellowish and hazy.” An accidental overdose of one of the patient’s regular medications is suspected. What primary electrolyte abnormality would one expect to see with an overdose of the drug most likely involved?
a) Hypercalcemia
b) Hyperkalemia
c) Hypernatremia
d) Hypocalcemia
e) Hypokalemia
f) Hypomagnesemia
g) Hyponatremia

A

[Y]Hyperkalemia

111
Q

(Question ID: 113) A 68-year-old man is hospitalized with a congestive heart failure exacerbation and severe peripheral edema. After 1 day of treatment the patient becomes tachypneic and begins gasping for air. Crackles and tactile fremitus are noted bilaterally from the base to mid-lung. Review of the patient’s chart reveals a medication that is worsening his condition. Which of the following medications is most likely responsible for exacerbating this patient’s condition?
a) Acetazolamide
b) Furosemide
c) Hydrochlorothiazide
d) Mannitol
e) Spironolactone
f) Triamterine

A

[Y]Mannitol

112
Q

(Question ID: 114) In the emergency department, an 80-year-old man with an implantable cardiac defibrillator has persistent episodes of ventricular tachycardia despite attempted cardioversion. He is admitted and started on oral amiodarone. His ventricular tachycardia improves, and he is released. However, weeks later he begins to manifest drug-associated adverse effects. Which of the following signs and symptoms would suggest amiodarone toxicity?
a) Deep venous thrombosis
b) Dyspnea on exertion and decreased FEV1:FVC ratio on pulmonary function tests
c) Dysuria, hematuria, and flank pain
d) Hypertension
e) Weight loss, hyperreflexia, and chest palpitations

A

[Y]Weight loss, hyperreflexia, and chest palpitations

113
Q

(Question ID: 115) A 60-year-old man is noted to have a delta wave on a routine ECG. His physician prescribes a Class I antiarrhythmic to manage his arrhythmia. Class I antiarrhythmics are sodium channel blockers that slow or block cardiac conduction, especially in depolarized cells. Which of the following antiarrhythmics will increase both the action potential duration and the effective refractory period?
a) Encainide
b) Mexiletine
c) Procainamide
d) Propafenone
e) Tocainide

A

[Y]Procainamide

114
Q

(Question ID: 116) A 57-year-old man with newly diagnosed type 2 diabetes and hypertension consults his endocrinologist regarding what medications he should consider taking to improve his overall health. The physician recommends a medication that can both reduce his hypertension and slow the damaging effects of diabetes on his renal and cardiovascular systems. The physician should inform the patient of which of the follow adverse effects before prescribing this drug?
a) Angioedema
b) Hyperlipidemia
c) Hypokalemia
d) Impotence
e) Myositis
f) Ototoxicity

A

[Y]Angioedema

115
Q

(Question ID: 117) A 63־year־old African-American woman with type 2 diabetes mellitus visits her physician with complaints of chest pain on exertion. She smokes two packs of cigarettes a day. Physical examination reveals a blood pressure of 155/105 mm Hg and a heart rate of 70/min. Blood tests are significant for an LDL cholesterol level of 200 mg/dL and an HDL cholesterol level of 36 mg/dL. Her physician prescribes a common medication that inhibits the rate-limiting step of the hepatic production of certain molecules that have been implicated in the pathogenesis of coronary artery disease. Which of the following is the most common serious adverse reaction associated with this medication?
a) Bilirubinuria
b) Hyperglycemia
c) Metabolic alkalosis
d) Myoglobinuria

A

[Y]Myoglobinuria

116
Q

(Question ID: 118) A 67־year־old woman who has recently begun to take a new antihypertensive medication presents to her primary care physician with complaints of new- onset fatigue and depressed mood. Her physical examination is unremarkable. Laboratory studies show:
Na+: 137 mEq/L
K+: 4.0 mEq/L
Blood urea nitrogen: 12 mg/dL
Creatinine: 0.5 mg/dL
Glucose: 82 mg/dL
Which of the following is most likely the new medication that this patient has started?
a) Furosemide
b) Hydrochlorothiazide
c) Losartan
d) Metoprolol
e) Nifedipine
f) Prazosin

A

[Y]Metoprolol

117
Q

(Question ID: 119) A 70-year-old male patient with hypertension, chronic obstructive pulmonary disease (COPD), benign prostatic hyperplasia, and peripheral vascular disease is being treated with numerous medications for recalcitrant high blood pressure (170/105 mm Hg). His medications include prazosin, lisinopril, and HCTZ. Recently he has been hospitalized to optimize management of his blood pressure. Hydralazine was added to his medication regimen. Which of the following symptoms would be most concerning after administration of hydralazine?
a) Angina
b) Bradycardia
c) Dysuria
d) Dyspnea

A

[Y]Angina

118
Q

(Question ID: 120) A 64-year-old white man presents with chest pain. His medications include diltiazem, furosemide, insulin, nitroglycerin, and procainamide. X-ray of the chest reveals a left basilar pleural effusion. Serum is positive for antinuclear antibodies with speckled pattern, anti-double-stranded DNA, and anti-histone antibodies. What drug in this patient’s medication regimen most likely caused his symptoms?
a) Diltiazem
b) Furosemide
c) Insulin
d) Nitroglycerin
e) Procainamide

A

[Y]Procainamide

119
Q

(Question ID: 121) One highly effective class of antiarrhythmic agents acts by decreasing the slope of phase 0 depolarization and can be used in atrial and ventricular arrhythmias. These highly effective drugs require close monitoring due to their adverse effects. What is the most dangerous adverse effect associated with this class of drugs?
a) Cinchonism
b) Lupus-like syndrome
c) Thrombocytopenia
d) Tinnitus
e) Torsades des pointes

A

[Y]Torsades des pointes

120
Q

(Question ID: 122) An 85-year-old man with a history of congestive heart failure, diabetes, and alcohol-induced dilated cardiomyopathy presents to the emergency department with a chief complaint of shortness of breath. In an effort to treat himself, he recently restarted a course of calcium channel blockers prescribed years ago by his previous cardiologist. Physical examination yields significant jugular venous distention, an S3 heart sound, and diffuse bilateral rales. X-ray film of the chest reveals pulmonary edema with cardiomegaly. Which of the following drugs would be most effective in treating this patient?
a) Acetazolamide
b) Furosemide
c) Hydrochlorothiazide
d) Mannitol
e) Nitroglycerin

A

Furosemide