PHARMACOLOGY Sample Questions 1 Flashcards
1
Q
Which of the following is a local anesthetic subject to inactivation by plasma esterases? a. Procaine b. Lidocaine c. Prilocaine d. Mepivacaine e. Bupivacaine
A
A
2
Q
Procaine differs from lidocaine in that
a. Procaine is a p-aminobenzoic acid ester and lidocaine is not
b. Lidocaine is a meta-aminobenzoic acid ester and procaine is not
c. The duration of action of procaine is longer than that of an equal total dose of lidocaine
d. Procaine hydrochloride is metabolized into diethylaminoethanol
and benzoic acid
A
A
3
Q
Which of the following local anesthetics would be expected to produce a sensitization reaction in a patient allergic to lidocaine? a. Mepivacaine b. Tetracaine c. Procaine d. Prilocaine e. Dibucaine i. (a), (b) and (c) ii. (a), (d) and (e) iii. (b) and (c) only iv. (b), (c) and (d) v. (b), (d) and (e)
A
ii
4
Q
The hydrolysis of procaine occurs mainly in the
a. Liver
b. Lungs
c. Plasma
d. Muscles
e. Kidneys
A
C
5
Q
Which of the following is local anesthetic subject to inactivation by plasma esterases?
a. Lidocaine
b. Prilocaine
c. Tetracaine
d. Mepivacaine
e. Bupivacaine
A
C
6
Q
The activity of procaine is terminated by
a. Elimination by the kidney
b. Storage in adipose tissue
c. Metabolism in the liver only
d. Metabolism in the liver and by pseudocholinesterase in the
plasma
A
D
7
Q
All of the following factors are significant determinants of the duration of conduction block with amide-type local anesthetics EXCEPT the
a. pH of tissues in the area of injection
b. Degree of vasodilatation caused by the local anesthetic
c. Blood plasma cholinesterase levels
d. Blood flow through the area of conduction block
e. Concentration of the injected anesthetic solution
A
C
8
Q
Which of the following is contraindicated for a patient who had an
allergic reaction to procaine six months ago?
a. Nerve block with lidocaine
b. Topical application of lidocaine
c. Topical application of tetracaine
d. Infiltration with an antihistamine
A
C
9
Q
Bupivacaine (Marcaine ) has all of the following properties relative to
lidocaine (Xylocaine ) EXCEPT bupivacaine
a. Is more toxic
b. Is an ester-type local anesthetic
c. Has a slower onset of action
d. Has a longer duration of action
A
D
10
Q
Amide-type local anesthetics are metabolized in the
a. Serum
b. Liver
c. Spleen
d. Kidney
e. Axoplasm
A
B
11
Q
The duration of action of lidocaine would be increased in the presence of which of the following medications? a. Prazosin b. Propranolol c. Hydrochlorothiazide d. Lisinopril e. Digoxin
A
B
12
Q
Severe liver disease least affects the biotransformation of which of the following?
a. Lidocaine
b. Procaine
c. Prilocaine
d. Mepivacaine
A
B
13
Q
A patient has been given a large volume of a certain local anesthetic solution and subsequently develops cyanosis with methemoglobinemia. Which of the following drugs most likely was administered?
a. Procaine
b. Prilocaine
c. Dibucaine
d. Lidocaine
e. Mepivacaine
A
B
14
Q
Use of prilocaine carries the risk of which of the following adverse effects? a. Porphyria b. Renal toxicity c. Gastric bleeding d. Methemoglobinemia
A
D
15
Q
The most probable cause for a serious toxic reaction to a local
anesthetic is
a. Psychogenic
b. Deterioration of the anesthetic agent
c. Hypersensitivity to the vasoconstrictor
d. Hypersensitivity to the local anesthetic
e. Excessive blood level of the local anesthetic
A
E
16
Q
High plasma levels of local anesthetics may cause
a. Inhibition of peristalsis
b. stimulation of baroreceptors resulting in severe hypotension
c. Inhibition of the vagus nerve to the heart
d. Depression of inhibitory neurons in the CNS
A
D
17
Q
Unfortunately, you injected your lidocaine intra-arterially. The first sign of lidocaine toxicity that might be seen in the patient would be
a. Elevated pulse rate
b. Sweating
c. CNS excitation
d. Cardiovascular collapse
e. CNS depression
A
C
18
Q
The first sign that your patient may be experiencing toxicity from too much epinephrine would be
a. Cardiovascular collapse
b. Convulsions
c. Elevated pulse rate
d. Slurred speech
A
C
19
Q
Which disease condition would make the patient most sensitive to the epinephrine in the local anesthetic?
a. Grave’s disease
b. Diabetes
c. HIV
d. Alcoholism
e. Schizophrenia
A
A
20
Q
Cardiovascular collapse elicited by a high circulating dose of a local anesthetic may be caused by
a. Syncope
b. Vagal stimulation
c. Histamine release
d. Myocardial depression
e. Medullary stimulation
A
D
21
Q
The most serious consequence of systemic local anesthetic toxicity is
a. Vertigo
b. Hypertension
c. Hyperventilation
d. Post depressive central nervous system convulsions
e. Postconvulsive central nervous system depression
A
E
22
Q
Hypotensive shock may result from excessive blood levels of each of the following local anesthetics EXCEPT a. Cocaine b. Procaine c. Lidocaine d. Tetracaine e. Mepivacaine
A
A
23
Q
Which of the following anesthetic drugs produces powerful stimulation of the cerebral cortex? a. Cocaine b. Procaine c. Lidocaine d. Tetracaine e. Mepivacaine
A
A
24
Q
Local anesthetics block nerve conduction by
a. Depolarizing the nerve membrane to neutrality
b. Increasing membrane permeability to K+
c. Increasing membrane permeability to Na+
d. Preventing an increase in membrane permeability to K+
e. Preventing an increase in membrane permeability to Na+
A
E
25
Which of the following is true regarding the mechanism of action of local anesthetics?
a. Usually maintain the nerve membrane in a state of
hyperpolarization
b. Prevent the generation of a nerve action potential
c. Maintain the nerve membrane in a state of depolarization
d. Prevent increased permeability of the nerve membrane to potassium ions
e. Interfere with intracellular nerve metabolism
B
26
Local anesthetic agents prevent the generation of nerve impulses by
a. Decreasing threshold for stimulation
b. Decreasing resting membrane potential
c. Decreasing inward movement of sodium ion
d. Increasing inward movement of potassium ion
C
27
```
Local anesthetics interfere with the transport of which of the following
ions during drug-receptor interaction
a. Sodium
b. Calcium
c. Chloride
d. Potassium
e. Magnesium
```
A
28
If the pH of an area is lower than normal body pH, the membrane
theory of local anesthetic action predicts that the local anesthetic activity would be
a. Greater, owing to an increase in the free-base form of the drug
b. Greater, owing to an increase in the cationic form of the drug
c. Less, owing to an increase in the free-base form of the drug
d. Less, owing to a decrease in the free-base form of the drug
e. None of the above
D
29
A local anesthetic injected into an inflamed area will NOT give
maximum effects because
a. The pH of inflamed tissue inhibits the release of the free base
b. The drug will not be absorbed as rapidly because of the decreased blood supply
c. The chemical mediators of inflammation will present a chemical antagonism to the anesthetic
d. Prostaglandins stabilize the nerve membrane and diminish the effectiveness of the local anesthetic
A
30
The penetration of a local anesthetic into nervous tissue is a function
of the
a. Length of the central alkyl chain
b. Lipid solubility of the ionized form
c. Lipid solubility of the unionized form
d. Ester linkage between the aromatic nucleus and the alkyl chain
e. Amide linkage between the aromatic nucleus and the alkyl chain
C
31
At a pH of 7.8, lidocaine (pKa = 7.8) will exist in
a. the ionized form
b. the nonionized form
c. an equal mixture of ionized and nonionized forms
d. a mixture 10 times more ionized than nonionized forms
C
32
The more rapid onset of action of local anesthetics in small nerves is
due to
a. The slightly lower pH of small nerves
b. The greater surface-volume ratio of small nerves
c. The increased rate of penetration resulting from depolarization
d. Smaller nerves usually having a higher threshold
B
33
Which of the following statements are true regarding onset, degree and duration of action of local anesthetics?
a. The greater the drug concentration, the faster the onset and the greater the degree of effect
b. Local anesthetics block only myelinated nerve fibers at the nodes of Ranvier
c. The larger the diameter of the nerve fiber, the faster the onset of effect
d. The faster the penetrance of the drug, the faster the onset of
effect
i. (a), (b), and (c)
ii. (a), (b) and (d)
iii. (a) and (c) only
iv. (b), (c) and (d)
ii
34
A dentist administers 1.8 ml of a 2% solution of lidocaine. How many mg of lidocaine did the patient receive?
a. 3.6
b. 9
c. 18
d. 36
e. 180
D
| 2% solution = 20 mg/ml X 1.8 ml = 36 mg lidocaine.
35
Three ml of a local anesthetic solution consisting of 2% lidocaine with 1:100,000 epinephrine contains how many milligrams of each?
a. 6 mg. lidocaine, 0.3 mg. epinephrine
b. 6 mg. lidocaine, 0.03 mg. epinephrine
c. 60 mg. lidocaine 0.3 mg. epinephrine
d. 60 mg. lidocaine 0.03 mg epinephrine
e. 600 mg lidocaine, 0.3 mg. epinephrine
f. 600 mg. lidocaine, 0.03 mg. epinephrine
D
| 2% lidocaine = 20 mg/ml x 3 = 60 mg lidocaine 1:100,000 epi = 0.01 mg/ml x 3 = 0.03 mg epi
36
The maximum allowable adult dose of mepivacaine is 300 mg. How many milliliters of 2% mepivacaine should be injected to attain the maximal dosage in an adult patient?
a. 5
b. 10
c. 15
d. 20
e. 25
C
| 2% mepivacaine = 20 mg/ml, so 300 mg / 20 mg/ml = 15 ml
37
A recently introduced local anesthetic agent is claimed by the manufacturer to be several times as potent as procaine. The product is available in 0.05% buffered aqueous solution in 1.8 ml. cartridge. The maximum amount recommended for dental anesthesia over a 4- hour period is 30 mg. The amount is contained in approximately how many cartridges?
a. 1-9
b. 10-18
c. 19-27
d. 28-36
e. Greater than 36
D
0.05% = 0.5 mg/ml . To give 30 mg, you have to give 30mg/0.5 mg/ml or 60 ml. 1 cartridge = 1.8 ml, thus 60ml /1.8ml = 33.3 cartridges. - first express the percentage of solution as a fraction of 100, then add the units gm/ml. 0.05% equals 0.5 or 1/2 gms per 100 ml. The cartridge is 1.8 ml which you can round off to almost 2 mls total. In this 2 ml you would have 1 gm of the local anesthetic. You need to give 30 gms, which would require 30 cartridges.
38
According to AHA guidelines, the maximum # of carpules of local anesthetic containing 1:200,000 epinephrine that can be used in the patient with cardiovascular disease is
a. 1
b. 2
c. 3
d. 4
e. 11
D
39
For treating most oral infections, penicillin V is preferred to penicillin G
because penicillin V
a. Is less allergenic
b. Is less sensitive to acid degradation
c. Has a greater gram-negative spectrum
d. Has a longer duration of action
e. Is bactericidal, whereas penicillin G is not
B
40
The sole therapeutic advantage of penicillin V over penicillin G is
a. Greater resistance to penicillinase
b. Broader antibacterial spectrum
c. More reliable oral absorption
d. Slower renal excretion
e. None of the above
C
41
```
Which of the following penicillins is administered ONLY by deep
intramuscular injection?
a. Ampicillin
b. Dicloxacillin sodium
c. Penicillin G procaine
d. Penicillin V potassium
```
C
42
The principal difference among potassium, procaine and benzathine salts of penicillin G is their
a. Potency
b. Toxicity
c. Duration of action
d. Antibacterial spectrum
e. Diffusion into the cerebrospinal fluid
C
43
Which of the following antibiotics is cross-allergenic with penicillin and should NOT be administered to the penicillin-sensitive patient?
a. Ampicillin
b. Erythromycin
c. Clindamycin
d. Lincomycin
e. Tetracycline
A
44
Which of the following antibiotics may be cross-allergenic with penicillin?
a. Neomycin
b. Cephalexin
c. Clindamycin
d. Erythromycin
e. All of the above
B
45
Which of the following antibiotics shows an incidence of approximately 8% cross-allergenicity with penicillins?
a. neomycin
b. cephalexin
c. bacitracin
d. vancomycin
e. tetracycline
B
46
Which of the following groups of antibiotics is related both structurally and by mode of action to the penicillins?
a. Polymyxins
b. Cycloserines
c. Cephalosporins
d. Chloramphenicols
C
47
For the dentist, the most reliable method of detecting a patient's allergy to penicillin is by
a. Injecting penicillin intradermally
b. Taking a thorough medical history
c. Placing a drop of penicillin on the eye
d. Having the patient inhale a penicillin aerosol
e. Injecting a small amount of penicillin intravenously
B
48
Which of the following antibiotics is the substitute of choice for penicillin in the penicillin-sensitive patient?
a. Bacitracin
b. Erythromycin
c. Tetracycline
d. Chloramphenicol
B
49
Most anaphylactic reactions to penicillin occur
a. When the drug is administered orally
b. In patients who have already experienced an allergic reaction to the drug
c. In patients with a negative skin test to penicillin allergy
d. When the drug is administered parenterally
e. Within minutes after drug administration
i. (a), (b) and (d)
ii. (b), (c) and (d)
iii. (b), (d) and (e)
iv. (b) and (e) only
v. (c), (d) and (e)
iii
50
Which of the following penicillins has a broader gram-negative spectrum than penicillin G?
a. Nafcillin
b. Ampicillin
c. Cephalexin
d. Methicillin
e. Penicillin V
B
51
Which of the following penicillins has the best gram-negative spectrum?
a. Nafcillin
b. Ampicillin
c. Methicillin
d. Penicillin V
e. Phenethicillin
B
52
Which of the following antibiotics should be considered the drug of
choice in the treatment of infection caused by a penicillinase- producing staphylococcus?
a. Neomycin
b. Ampicillin
c. Tetracycline
d. Penicillin V
e. Dicloxacillin
E
53
Oral infections caused by organisms that produce penicillinase should be treated with
a. Ampicillin
b. Dicloxacillin
c. Erythromycin
d. Any of the above
e. Only (a) or (c) above
B
54
Which of the following antibiotics is LEAST effective against penicillinase-producing microorganisms?
a. Ampicillin
b. Cephalexin
c. Methicillin
d. Clindamycin
e. Erythromycin
A
55
Which of the following is a bactericidal antibiotic used specifically in the treatment of infections caused by Pseudomonas species and indole-positive Proteus species?
a. Ampicillin
b. Penicillin V
c. Tetracycline
d. Dicloxacillin
e. Carbenicillin
E
56
Penicillin's effectiveness against rapidly growing cells is primarily due to its effect on
a. Protein synthesis
b. Cell wall synthesis
c. Nucleic acid synthesis
d. Chelation of metal ions
e. Cell membrane permeability
B
57
Chlortetracycline acts by interfering with
a. Cell wall synthesis
b. Nuclear acid synthesis
c. Protein synthesis on bacterial but not mammalian ribosomes
d. Protein synthesis on mammalian but not bacterial ribosomes
C
58
The probable mechanism of the bacteriostatic action of sulfonamides involves
a. Disruption of the cell membrane
b. Coagulation of intracellular proteins
c. Reduction in oxygen utilization by the cells
d. Inhibition of metabolism by binding acetyl groups
e. Competition with para-aminobenzoic acid in folic acid synthesis
E
59
The sulfonamides act by
a. Suppressing bacterial protein synthesis
b. Inhibiting the formation of the cytoplasmic bacterial membrane
c. Inducing the formation of "lethal" bacterial proteins
d. Inducing a deficiency of folic acid by competition with para-
aminobenzoic acid
D
60
Which antibiotic is able to achieve a higher concentration in bone than in serum?
a. penicillin
b. erythromycin
c. clindamycin
d. metronidazole
e. amoxicillin
C
61
Tetracycline reduces the effectiveness of concomitantly administered penicillin by
a. Reducing absorption of penicillin
b. Increasing metabolism of penicillin
c. Increasing renal excretion of penicillin
d. Increasing binding of penicillin to serum proteins
e. None of the above
E
tetracycline is bacteriostatic and would slow the rapid growth of the microbial population that a bactericidal drug such as penicillin needs to be effective, sine only when rapidly dividing are the cells making cell walls
62
The action of which of the following drugs will most likely be impaired by concurrent administration of tetracycline?
a. Clarithromycin
b. Erythromycin
c. Sulfonamide
d. Penicillin
e. Lincomycin
D
63
Which of the following antibiotics is most likely to cause liver damage?
a. Streptomycin
b. Penicillin G
c. Tetracycline
d. Cephalosporins
e. Amphotericin B
C
64
Which of the following erythromycins associated with an allergic cholestatic hepatitis?
a. Erythromycin base
b. Erythromycin stearate
c. Erythromycin estolate
d. Erythromycin succinate
C
65
Which of the following antibiotics is LEAST likely to cause superinfection?
a. Gentamicin
b. Tetracycline
c. Penicillin G
d. Streptomycin
e. Chloramphenicol
C
66
Gastrointestinal upset and pseudomembranous colitis has been prominently associated with
a. Nystatin
b. Cephalexin
c. Clindamycin
d. Polymyxin B
e. Erythromycin
C
67
Symptoms that may be characterized as allergic manifestations during penicillin therapy are
a. Deafness, dizziness and acute anemia
b. Crystalluria, nausea, vomiting and anaphylactic shock
c. Oliguria, hematuria, bronchoconstriction and cardiovascular collapse
d. Dermatitis, stomatitis, bronchoconstriction and cardiovascular collapse
D
68
Aplastic anemia is a serious toxic effect that occurs particularly after a course of treatment with which of the following antibiotics?
a. Penicillin
b. Lincomycin
c. Tetracycline
d. Streptomycin
e. Chloramphenicol
E
69
Each of the following is a side effect of prolonged tetracycline
hydrochloride therapy EXCEPT:
a. Suprainfection
b. Photosensitivity
c. Vestibular disturbances
d. Discoloration of newly forming teeth
e. Gastrointestinal symptoms (when administered orally)
C
70
Colitis that results following clindamycin therapy is caused by an overgrowth of
a. C. dificile
b. Staph aureus
c. Pseudomonas
d. Candida albicans
A
71
Which antibiotic is appropriate for premedication in the penicillin allergic patient?
a. Cephalexin
b. Clindamycin
c. Erythromycin
d. Amoxicillin
e. Ampiciilin
B
72
Acyclovir is useful for treating
a. Candidiasis
b. Colitis
c. Herpes simplex
d. HIV
e. ANUG
C
73
A distinct advantage that tetracyclines have over penicillins is that tetracyclines
a. Have no side effects
b. Do not cause superinfections
c. Are safer to use during pregnancy
d. Have a wider range of antibacterial activity
e. Produce higher blood levels faster after oral administration
D
74
Which of the following has the broadest antimicrobial spectrum?
a. Vancomycin (Vancocin )
b. Clindamycin (Cleocin )
c. Erythromycin (Erythrocin )
d. Chlortetracycline (Aureomycin )
e. A third generation cephalosporin
D
75
Sulfonamides and trimethoprim are synergistic bacteriostatic agents because in bacteria they
a. Both inhibit folic acid synthesis
b. Interfere sequentially with folic acid production
c. Are both antimetabolites of para-aminobenzoic
d. Are both inhibitors of dihydrofolic acid reductase
e. Are both transformed in vivo into a single active compound
B
76
Which of the following substances is the most effective agent against
fungus infections of the mucous membrane?
a. Nystatin ointment
b. Undecylenic acid
c. Polymyxin ointment
d. Saturated magnesium sulfate
e. 10 per cent aluminum chloride solution
A
77
The most desirable property of an antibiotic when used to treat an odontogenic infection is
a. Rapid absorption
b. Little allergenicity
c. Ability to achieve and maintain adequate concentrations at the
site of infection
d. Lack of significant binding to plasma proteins
e. No effects on drug metabolism
C
78
Nystatin is of greatest clinical usefulness in treating
a. viral infections
b. fungal infections
c. spirochetal infections
d. Bacterroides infections
e. penicillin resistant gram positive infections
B
79
42. Which of the following drugs chelates with calcium?
a. Erythromycin
b. Polymyxin B
c. Tetracycline
d. Penicillin G
e. Chloramphenicol
C
80
Which of the following is NOT characteristic of tetracycline
antibiotics?
a. Absorption is impaired when taken with antacids
b. They predispose to monilial superinfection
c. They form a stable complex with the developing tooth matrix
d. They have a low tendency for sensitization, but a high
therapeutic index
e. They are effective substitutes for penicillin prophylaxis against
infective endocarditis
E
81
The concurrent administration of penicillin G and probenecid results in
a. Increased metabolism of penicillin G.
b. Increased renal excretion of probenecid
c. Decreased renal excretion of penicillin G
d. Decreased bactericidal effect of penicillin G
e. Increased excretion of probenecid in the feces
C
82
Interaction between penicillin and probenicid is best described by which of the following mechanisms?
a. competition at the receptor site
b. acceleration of drug biotransformation
c. alteration in the acid-base balance
d. alteration in the rate of renal clearance
D
83
When broad-spectrum antibiotics are administered with coumarin anticoagulants, the anticoagulant action may be
a. Reduced because of enhanced hepatic drug metabolism
b. Reduced because of increased protein-binding
c. Increased because of reduction of vitamin K sources
d. Increased because of decreased renal excretion of the anticoagulant
C
84
The therapeutic effectiveness of which of the following drugs will be most affected by concomitant ingestion of antacids?
a. Cephalexin
b. Erythromycin
c. Tetracycline
d. Sulfisoxazole
e. Penicillin V
C
85
Erythromycin should be avoided in the patient taking
a. Aspirin
b. Seldane
c. Benadryl
d. Ibuprofen
e. Propranolol
B
86
Quinidine is principally used to treat
a. Hypertension
b. Angina pectoris
c. Congestive heart failure
d. Supraventricular tachyarrhythmias
D
87
Quinidine is used to treat
a. Hypertension
b. Angina pectoris
c. Atrial fibrillation
d. Ventricular fibrillation
e. Congestive hear failure
C
88
Verapamil is most efficacious in the treatment of
a. Atrial fibrillation
b. Atrial tachycardia
c. Ventricular tachycardia
d. Catecholamine-induced arrhythmias
A
89
Which of the following drugs is most useful in treating or preventing angina pectoris?
a. Digitalis
b. Quinidine
c. Propranolol
d. Procainamide
e. Pentobarbital
C
90
```
Each of the following drugs can be used in the prevention and
treatment of angina pectoris EXCEPT
a. Digitalis
b. Propranolol
c. Nitroglycerin
d. Isosorbide dinitrate
e. Pentaerythritol tetranitrate
```
A
91
All of the following drugs are useful in the treatment of hypertension EXCEPT
a. Ephedrine
b. Reserpine
c. Methyldopa
d. Thiazide diuretics
A
92
Digitalis is useful in the treatment of which of the following conditions?
a. Atrial fibrillation
b. Congestive heart failure
c. Paroxysmal atrial tachycardia
d. All of the above
D
93
All of the following drugs are useful in the treatment of cardiac arrhythmias EXCEPT
a. Digitalis
b. Lidocaine
c. Phenytoin
d. Procainamide
e. Aminophylline
E
94
The drug of choice for initial therapy for mild hypertension is
a. Reserpine
b. Guanethidine
c. Phenobarbital
d. Chlorothiazide
e. Alpha-methyldopa
D
95
Which of the following antihypertensives are usually reserved for treatment of severe hypertension?
a. Sedatives and reserpine
b. Thiazide diuretics and reserpine
c. Sedatives and thiazide diuretics
d. Guanethidine and ganglionic blocking agents
D
96
Which of the following beta-adrenergic receptor blocking agents is thought to be cardioselective?
a. Nadolol
b. Timolol
c. Metoprolol
d. Propranolol
C
97
Antiarrhythmic drugs, such as quinidine, suppress certain cardiac arrhythmias by
a. Stimulating the beta-adrenergic receptor
b. Suppressing cardiac ATP-ase activity
c. Increasing ectopic pacemaker activity
d. Increasing the refractory period of cardiac muscle
D
98
Most drugs useful in the treatment of cardiac arrhythmias act primarily by
a. Blocking Purkinje fibers
b. Blocking the alpha-adrenergic receptor
c. Suppressing SA node impulse formation
d. Causing a positive inotropic effect
e. Increasing the refractory period of cardiac muscle
E
99
The most important pharmacologic action of drugs that suppress cardiac arrhythmias is
a. Blockade of the vagus nerve
b. Stimulation of cardiac ATP-ase activity
c. Blockade of the Beta-adrenergic receptor
d. Stimulation of the beta-adrenergic receptor
e. Increased refractory period of cardiac muscle
E
100
Lidocaine produces its antiarrhythmic effects by
a. Increasing AV conduction
b. Decreasing cardiac excitability
c. Increasing cardiac conduction velocity
d. Increasing spontaneous pacemaker activity
B
101
When digitalis is used in atrial fibrillation, the therapeutic objective is to
a. Abolish cardiac decompensation
b. Inhibit vagal impulses to the heart
c. Decrease the rate of A-V conduction
d. Increase the rate of cardiac repolarization
e. Produce a decrease in the rate of atrial contraction
C
102
Nitroglycerin dilates the coronary arteries in angina pectoris by
a. Decreasing the heart rate reflexly
b. Increasing the metabolic work of the myocardium
c. Direct action on smooth muscle in the vessel walls
d. Increasing the effective refractory period in the atrium
e. Blocking beta-adrenergic receptors
C
103
Propranolol is of value in treating angina pectoris because it
a. Has a direct action on vascular smooth muscle
b. Blocks autoregulatory mechanisms in the heart
c. Inhibits oxygen metabolism in cardiac cells
d. Provides relief within seconds of an acute anginal attack
e. Prevents chronotropic responses to endogenous epinephrine emotions and exercise
E
104
Administration of angiotensin results in
a. Anti-inflammatory effects
b. Antihistaminic effects
c. Increased blood pressure
d. Increased heart rate
e. A sedative effect
C
105
The primary antihypertensive effect of captopril (Capoten) is due to accumulation of
a. Serotonin
b. Angiotensin I
c. Angiotensin III
d. Bradykinin metabolites
B
106
Administration of angiotensin results in
a. A sedative effect
b. Increased heart rate
c. Increased blood pressure
d. Antihistaminic effects
e. Anti-inflammatory effects
C
107
Which of the following is NOT characteristic of the thiazide diuretics?
a. Increase renal excretion of sodium and chloride
b. Increase renal excretion of potassium
c. Increase the toxicity of digitalis
d. Exacerbate existing diabetes
e. Cause hypokalemia
f. Cause hypoglycemia
F
108
The most useful diuretic drugs act by
a. Increasing the glomerular filtration rate
b. Decreasing the renal reabsorption of sodium
c. Decreasing the renal excretion of chloride
d. Increasing the renal reabsorption of potassium
e. Increasing the secretion of antidiuretic hormone
B
109
Which of the following drugs act by inhibiting renal reabsorption of sodium?
a. Urea
b. Chlorothiazide
c. Theophylline
d. digitalis glycosides
e. Procainamide
B
110
Digoxin exerts its positive inotropic effect by
a. Activation of adenylcyclase
b. Inhibition of phosphodiesterase
c. An agonist effect of beta-receptors
d. Inhibition of Na+, K+ ATPASE leading to increased calcium
influx
e. Decreasing the amount of calcium available for excitation-
contraction coupling
D
111
Digitoxin is effective in the treatment of cardiac failure because it
a. Is primarily a diuretic
b. Reduces the ventricular rate
c. Decreases abnormal cardiac rhythms
d. Produces peripheral vasoconstriction
e. Has a positive cardiac inotropic action
E
112
The primary action of therapeutic doses of digitalis on cardiac muscle is an increase in
a. Force of contraction
b. Ventricular excitability
c. Refractory period of the atrial muscle
d. Refractory period of the ventricular muscle
e. Rate of conduction of impulse to the muscle
A
113
The beneficial effects of digitalis in congestive heart failure result in part from the fact that digitalis causes
a. A decrease in end-diastolic volume
b. A decrease in end-diastolic pressure
c. An increase in stroke volume and cardiac output
d. A decrease in central venous pressure
e. A decrease in rate of the hear where tachycardia exists
i. (a), (b) and (c)
ii. (a) and (c) only
iii. (c) and (d)
iv. (e) only
v. All of the above
v
114
The cardiac glycosides will increase the concentration of which ion in an active heart muscle?
a. Sodium
b. Bromide
c. Calcium
d. Chloride
e. Potassium
C
115
Which of the following ions augments the inotropic effect of digitalis?
a. Sodium
b. Lithium
c. Calcium
d. Chloride
e. Magnesium
C
116
In the treatment of congestive heart failure, digitalis glycosides generally decrease all of the following EXCEPT
a. Edema
b. Urine flow
c. Heart size
d. Heart rate
e. Residual diastolic volume
B
117
The mechanism of action of prazosin, an antihypertensive agent is to
a. Block beta-adrenergic receptors
b. Inhibit formation of angiotensin II
c. Inhibit nerve-induced release of norepinephrine
d. Stimulate central inhibitory alpha-adrenergic receptors
e. Inhibit the postsynaptic action of norepinephrine on vascular
smooth muscle
E
118
Which of the following owes a significant amount of its
antihypertensive effect to a central action?
a. Methyldopa
b. Metoprolol
c. Hydralazine
d. Propranolol
e. Guanethidine
A
119
Which of the following drugs is thought to reduce arterial blood
pressure by activating alpha receptors in the vasomotor center of the medulla?
a. Prazosin
b. Clonidine
c. Propranolol
d. Guanethidine
e. Chlorothiazide
B
120
Propranolol (Inderal) can be useful in the treatment of hypertension because it blocks
a. Alpha-1 adrenergic receptors
b. Sodium reabsorption in the kidney
c. The release of renin from juxtaglomerular cells
d. The release of norepinephrine from nerve terminals
e. The reflex tachycardia seen with the use of other
antihypertensives
i. (a) and (b)
ii. (a) and (d)
iii. (b), (c) and (d)
iv. (c), (d) and (e)
v. (c) and (e) only
v
121
One of the proposed mechanisms of the antihypertensive effect of
beta-adrenergic receptor blocking agents is
a. Sedation
b. A diuretic effect
c. An antirenin effect
d. A vagal blocking effect
e. An increase in cardiac output
C
122
Selective beta-1 adrenergic agonists will produce which of the following effects?
a. Glycogenolysis
b. Increased cardiac output
c. Decreased diastolic pressure
d. Decreased peripheral resistance
e. Relaxation of bronchial smooth muscle
B
123
Ototoxicity with deafness may encountered occasionally in patients taking which of the following diuretic agents?
a. Osmotic
b. Thiazide
c. Mercurial
d. High-ceiling
D
124
Symptoms of digitalis toxicity include all of the following EXCEPT
a. Extrasystoles
b. Nausea and vomiting
c. Yellow-green vision
d. A-V conduction block
e. Decreased P-R interval
E
125
Administration of which of the following drugs increases the likelihood of a toxic response to digitalis?
a. Diazepam
b. Lidocaine
c. Spironolactone
d. Chlorothiazide
e. Acetylsalicylic acid
D
126
The therapeutic effect of the salicylates is explained on the basis of the ability of the drug to
a. Activate autonomic reflexes
b. Uncouple oxidative phosphorylation
c. Inhibit the synthesis of prostaglandins
d. Competitively antagonize prostaglandins at the receptor site
C
127
The mechanism of the antipyretic action of salicylates probably results from
a. Inhibition of prostaglandin synthesis in the CNS affecting
hypothalamic temperature regulation
b. Inhibition of bradykinin in the periphery leading to sweating
c. Depression of oxidative enzymes leading to decreased heat production
d. Suppression of cholinergic mediators in the hypothalamus
e. Stimulation of norepinephrine in the hypothalamus
A
128
The antipyretic action of salicylates is explained in part by
a. Analgesia leading to sedation
b. Increased blood flow through the hypothalamus
c. Cutaneous vasodilation leading to increased heat loss
d. Depression of oxidative processes leading to decreased heat production
C
129
The locus of action of aspirin's central antipyretic effect is the
a. Brain stem
b. Hypothalamus
c. Basal ganglia
d. Limbic system
e. Cerebral cortex
B
130
A patient who has been taking large quantities of aspirin might show increased postoperative bleeding because aspirin inhibits
a. Synthesis of thromboxane A2 and prevents platelet
aggregation
b. Synthesis of prostacyclin and prevents platelet aggregation
c. Synthesis of prostaglandin and prevents production of blood platelets
d. Thrombin and prevents formation of the fibrin network
e. G.I. absorption of vitamin K and prevents synthesis of blood clotting factors
A
131
Anti-inflammatory agents, such as aspirin, interfere with hemostasis by
a. Activating antithrombin
b. Preventing vasoconstriction
c. Inhibiting thrombin generation
d. Inhibiting platelet aggregation
e. Inhibiting polymerization of fibrin
D
132
Which of the following anti-inflammatory agents does NOT act primarily by inhibiting activity of prostaglandin synthetase?
a. Diflunisal
b. Ibuprofen
c. Triamcinolone
d. Oxyphenbutazone
e. Acetylsalicylic acid
C
133
A nonsteroidal, anti-inflammatory agent that appears to produce fewer
gastrointestinal disturbances than high does of aspirin is
a. Ibuprofen
b. Probenecid
c. Pentazocine
d. Acetaminophen
e. Phenylbutazone
A
134
Prolonged use of which of the following drugs does NOT cause a predisposition to gastric irritation and bleeding?
a. Phenytoin
b. Ibuprofen
c. Indomethacin
d. Phenylbutazone
e. Acetylsalicylic acid
A
135
Each of the following agents has been associated with gastric irritation EXCEPT
a. Aspirin
b. Alcohol
c. Ibuprofen
d. Indomethacin
e. Acetaminophen
E
136
Which of the following is NOT produced by excessive doses of acetylsalicylic acid?
a. Delirium
b. Tinnitus
c. Hypothermia
d. Hyperventilation
e. Metabolic acidosis
C
137
All of the following are pharmacologic and toxicologic properties of aspirin EXCEPT
a. Tinnitus
b. Analgesia
c. Salicylism
d. Antipyresis
e. Suppression of the immune response
E
138
Therapeutic effects of aspirin include
a. Analgesia
b. Tranquilization
c. Pyretic action
d. Anti-inflammatory action
e. Antirheumatic action
i. (a), (b) and (c)
ii. (a), (c) and (d)
iii. (a), (d) and (e)
iv. (b), (c) and (d)
v. (b), (d) and (e)
iii
139
All of the following are pharmacologic or toxicologic properties of acetylsalicylic acid EXCEPT
a. Tinnitus
b. Analgesia
c. Antipyresis
d. Methemoglobinemia
e. Inhibition of prostaglandin synthesis
D
140
All of the following are possible effects of aspirin EXCEPT
a. Reduction of fever
b. Shortening of bleeding time
c. Suppression of inflammatory response
d. Bleeding from the gastronintestinal tract
e. Increase in the renal excretion of uric acid at high doses
B
141
Of the following, aspirin does NOT cause
a. Occult bleeding
b. Nausea and vomiting
c. Acid-base disturbance
d. Suppression of the cough reflex
e. Decreased tubular reabsorption of uric acid
D
142
Which of the following is NOT true about acetaminophen?
a. Is a non-prescription drug
b. Is cross-allergenic with aspirin
c. Possesses both analgesic and antipyretic effects
d. May induce methemoglobinemia at high doses
e. May be the pharmacologically active form of acetophenetidin
(phenacetin)
B
143
Which of the following is NOT true regarding acetaminophen?
a. It has antipyretic properties
b. It may induce methemoglobinemia
c. It can be combined with codeine
d. It has anti-inflammatory properties
e. It is not cross-allergenic with aspirin
D
144
```
The most prominent acute toxic effect associated with
acetaminophen use is
a. Hemorrhage
b. Renal necrosis
c. Hepatic necrosis
d. Gastric ulceration
e. Respiratory alkalosis
```
C
145
Which of the following anti-inflammatory agents does NOT act primarily by inhibiting the activity of cyclooxygenase?
a. Ibuprofen
b. Diflunisal
c. Prednisone
d. Indomethacin
e. Phenylbutazone
C
146
Which of the following is the most appropriate drug to use to lower fever in a child under 12?
a. Aspirin
b. Ibuprofen
c. Acetaminophen
d. Salicylate
e. Diflunisal
C
147
Which analgesic from the following list has the longest half-life?
a. Acetaminophen
b. Aspirin
c. Diflunisal (Dolobid)
d. Ibuprofen
C
148
```
Occurrence of which of the following is LEAST characteristic of
narcotic ingestion?
a. Vomiting
b. Diarrhea
c. Urinary retention
d. Bronchiolar constriction
e. Increase in intracranial pressure
```
B
149
Therapeutic doses of morphine administered intramuscularly may produce
a. Constipation
b. Euphoria
c. Dysphoria
d. Mental clouding
e. Decreased response to pain
i. (a) and (b) only
ii. (a), (b) and (d)
iii. (a), (d) and (e)
iv. (c), (d) and (e)
v. All of the above
v
150
Which of the following are pharmacologic effects of morphine?
a. Respiratory depression
b. Euphoria
c. Sedation
d. Constipation
e. Dysphoria
i. (a), (b) and (c)
ii. (a), (b) and (d)
iii. (a) and (e)
iv. (c), (d) and (e)
v. All of the above
v
151
Which of the following drugs acts to suppress the cough reflex?
a. ASA
b. Codeine
c. Meperidine
d. Acetaminophen
e. Phenyibutazone
B
152
Morphine binds to which site to produce analgesia?
a. By binding to specific receptors in the CNS
b. By decreasing the influx of sodium
c. By decreasing the synthesis of prostaglandins
d. By decreasing nerve activating at the site of injury
A
153
Morphine causes vomiting by
a. A direct irritant action on the gastric mucosa
b. Stimulation of the nodose ganglion of the vagus nerve
c. Stimulation of the medullary chemoreceptor trigger zone
d. Direct stimulation of the gastrointestinal musculature
C
154
The decrease in ventilation caused by morphine, meperidine and some of the related opioids depends chiefly upon
a. Depression of cortical activity
b. Peripheral blockade of chemoreceptor impulses
c. An increase in carbon dioxide concentration in the blood
d. Blockade of afferent autonomic impulses from the lungs
e. Loss of sensitivity of the medullary respiratory center to carbon dioxide
E
155
Small doses of barbiturates and morphine depress respiration
primarily by
a. A parasympathominetic action
b. Inhibiting the Herine-Bueuer reflex
c. Rendering the aortic chemoreceptor system insensitive to O2
d. Rendering the respiratory centerin the brain stem less sensitive to changes in CO2
e. A specific effect at myoneural junctions of phrenic and
intercostal nerves
D
156
Which of the following are pathognomonic symptoms of narcotic overdose?
a. Miosis, coma and depressed respiration
b. Mydriasis, coma and smooth muscle spasms
c. Mydriasis, coma and depressed respiration
d. Miosis, convulsions and depressed respiration
e. Mydriasis, convulsions and depressed respiration
A
157
The cause of death with opioid intoxication is
a. Oxygen apnea
b. Cardiac arrest
c. Terminal convulsions
d. Circulatory collapse
e. Respiratory depression
E
158
Which of the following is an opioid that has both agonistic and antagonistic activities?
a. Codeine
b. Methadone
c. Naloxone
d. Meperidine
e. Pentazocine
E
159
A heroin-dependent patient should NOT be given nalbuphine (Nubain) for pain because
a. It has no analgesic properties
b. It may produce respiratory depression
c. As a mixed agonist-antagonist, it can elicit withdrawal symptoms
d. The high abuse potential of nalbuphine may add to the patient's problems
C
160
A patient while not currently taking drugs has a history (6 months ago) of narcotic dependency. Which of the following analgesics should be avoided in this patient?
a. Aspirin
b. Pentazcine
c. propoxyphene
d. Indomethacin
e. Acetaminophen
f. None of the above
B
161
Which of the following statements does NOT characterize pentazocine?
a. It is equianalgesic with codeine
b. It is a partial opioid antagonist
c. Its abuse potential is less than that of heroin
d. It may induce dysphoria and mental aberrations
e. It is effective only on parenteral administration
E
162
The antagonist of choice in the treatment of opioid overdosage is
a. Naloxone
b. Nalorphine
c. Pentazocine
d. Levallorphan
e. Propoxyphene
A
163
Which of the following is a complete antagonist of the opioid receptor and the agent of choice in the treatment of narcotic overdose?
a. Naloxone
b. Nalorphine
c. Cyclazocine
d. Levallorphan
e. None of the above
A
164
Methadone is used in detoxification (drug withdrawal) of patients physically dependent on morphine because methadone
a. Precipitates withdrawal reactions
b. Antagonizes the depressant actions of morphine
c. Will not in itself produce physical dependence
d. Withdrawal reactions are less intense and stressful than those of morphine
D
165
Which of the following drugs is currently widely used in treating opioid-dependent individuals?
a. Codeine
b. Methadone
c. Alphaprodine
d. Pentazocine
e. Meperidine
B
166
Meperidine (Demerol) is
a. An antidepressant
b. An opioid analgesic
c. A sedative
d. A long-acting local anesthetic
e. An antipsychotic
B
167
Atropine and propantheline exert their effects on peripheral structures by
a. preventing release of acetylcholine
b. preventing synthesis of acetylcholine
c. enhancing destruction of acetylcholine
d. competeing with acetylcholine for receptor sites
e. producing physiologic effects opposite to those of acetylcholine
D
168
Neostigmine produces its effect by
a. depressing acetylcholinesterase release
b. inhibiting acetylcholinesterase activity
c. increasing the rate of acetylcholine synthesis
d. acting like acetylcholine at ganglionic sites
e. increasing the amount of acetylcholine released from nerve terminals
B
169
Organophosphate insecticides and nerve gases inhibit the action of which of the following enzymes?
a. adenylate cyclase
b. monoamine oxidase
c. phosphodiesterase
d. acetylcholinesterase
e. carbonic anhydrase
D
170
Drugs which are additive with or potentiate the effects of acetylcholine include
(a) methacholine
(b) scopolamine
(c) pralidoxime
(d) neostigmine
(e) pilocarpine
1. (a), (b), and (c)
2. (a), (c), and (d)
3. (a), (d) and (e)
4. (b), (d), and (e)
5. (c), (d) and (e)
3
171
Which of the following drugs is best to administer after poisoning by an
organophosphate cholinesterase inhibitor?
a. atropine
b. phenytoin
c. pralidoxime
d. propantheline
e. phenobarbital
C
172
Which of the following compounds is a ganglionic blocking agent?
a. curarine
b. edrophonium
c. mecamylamine
d. succinylcholine
e. gallamine triethodide
C
173
Which of the following acts by antagonizing cholinesterase?
a. atropine
b. muscarine
c. neostigmine
d. pilocarpine
e. acetylcholine
C
174
When neostigmine is administered before acetylcholine, the action of
acetylcholine will be
a. blocked
b. enhanced and prolonged
c. less intense and of shorter duration
d. none of the above. The action of acetylcholine is not affected by
neostigmine
B
175
Neostigmine can stimulate denervated skeletal muscle because it
a. is a congener of acetylcholine
b. is a competitive blocking agent
c. has no effect on acetylcholinesterase
d. is more potent than diisopropylfluorophosphate
e. is capable of acting directly on the end-plate
E
176
Which of the following is used to prevent laryngospasm?
a. atropine
b. epinephrine
c. diazepam (Valium)
d. neostigmine (Prostigmine)
e. succinylcholine (Anectine)
E
177
In treating xerostomia, which of the following might be prescribed?
a. atropine
b. ephedrine
c. neostigmine
d. scopolamine
e. mecamylamine
C
178
Which of the following drugs is most likely to dry secretions in the oral cavity?
a. diazepam
b. promethazine
c. physostigmine
d. propantheline
e. diphenhydramine
D
179
The most useful drug to induce salivation is one which has properties that are
a. adrenergic
b. cholinergic
c. ganglionic blocking
d. adrenergic blocking
e. cholinergic blocking
B
180
Drugs that are commonly used in the control of excessive salivation include
(a) meprobamate
(b) atropine
(c) methantheline
(d) codeine
(e) chlorpromazine
1. (a) and (b) only
2. (a), (b), and (c)
3. (b) and (c) only
4. (b), (c), and (d)
5. (d) and (e)
3
181
Administration of ganglionic blocking agents will result in
a. miosis
b. diarrhea
c. copious salivation
d. orthostatic hypotension
e. enhanced activity of the parasympathetic nervous system
D
182
Tachycardia in a patient administered with atropine or scopolamine results from
a. release of adrenal catecholamines
b. blockade of vagus nerve activity
c. blockade of the nicotinic cholinergic receptor
d. stimulation of the alpha adrenergic receptor
e. stimulation of the beta adrenergic receptor
B
183
All of the following are possible effects of cholinomimetic drugs
except
a. mydriasis
b. bradycardia
c. increased peristalsis
d. stimulation of sweat glands
e. increased secretion by bronchial glands
A
184
A paralyzing dose of succinylcholine initially elicits
a. CNS stimulation
b. CNS depression
c. decreased salivation
d. muscle fasiculation
e. extrapyramidal reactions
D
185
Based on its known mechanism and sites of action, scopolamine
should theoretically be useful in (a) treatment of peptic ulcer
(b) providing euphoria and amnesia prior to surgery
(c) relieving bronchoconstriction
(d) relieving some of the symptoms of Parkinson disease
(e) visualization of the retina
1. (a), (b), (d) and (e)
2. (a), (b), and (e) only
3. (a),and (c)
4. (b) and (e) only
5. All of the above
5
186
Symptoms of poisoning by an organophosphate insecticide include all of the following except:
a. skeletal muscle fasiculation
b. excessive salivation
c. bronchoconstriction
d. hot, dry skin
e. diarrhea
D
187
All of the following symptoms are associated with neostigmine poisoning except
a. diarrhea
b. salivation
c. convulsions
d. bonchiolar constriction
e. skeletal muscle paralysis
E
188
Symptoms of atropine poisoning in man include
(a) decreased intraocular pressure
(b) burning dry mouth
(c) nausea, vomiting and diarrhea
(d) hyperthermia
(e) orthostatic hypotension
1. (a) and (c)
2. (b) and (d)
3. (b), (d), and (e)
4. (d) and (e)
5. All of the above
2
189
The most likely signs or symptoms of overdosage with atropine are
a. CNS excitation and tachycardia
b. intestinal cramps and diarrhea
c. skin rash and cutaneous itching
d. ptyalism and increased sweating
e. constriction of the pupils and blurring of vision
A
190
Disorientation, confusion and hallucinations resulting from an overdose of scopolamine are most efficaciuosly treated by administering
a. atropine
b. levodopa
c. acetylcholine
d. physostigmine
D
191
The immediate cause of death from irreversible cholinesterase inhibitors is
a. shock
b. convulsion
c. cardiac arrhythmia
d. respiratory paralysis
e. dehydration from vomiting and diarrhea
D
192
Each of the following is a symptom of cholinergic crisis except
a. bradycardia
b. lacrimation
c. vasoconstriction
d. extreme salivation
e. weakness of voluntary muscles
C
193
Succinylcholine is a short-acting neuromuscular junction blocking
agent useful for providing a brief paralysis to aid in intubating patients. It is short-acting because
a. it is subject to rapid metabolism in the liver
b. it rapidly redistributes away from the NMJ
c. it is subject to inactivation by plasma esterases
d. it undergoes rapid inactivation in the GI tract
C
194
Atropine-like drugs are classed as
a. anti-adrenergic
b. cholinomimetic
c. sympatholytic
d. anti-cholinergic
e. sympathomimetic
D
195
Alpha or beta-adrenergic blocking drugs act by
a. Inhibiting synthesis of norepinephrine.
b. Increasing the metabolism of norepinephrine
c. Competitive inhibition of postjunctional adrenergic receptors
d. A local anesthetic effect on the adrenergic nerve terminal
e. Depleting norepinephrine from adrenergic nerve terminals
C
196
A mechanism for the antiadrenergic action of guanethidine is
a. Inhibition of dopa decarboxylase
b. Increased rate of metabolism of norepinephrine
c. Depletion of norepinephrine from the nerve terminals
d. Substitution for norepinephrine and subsequent action as a false transmitter
e. Uncoupling of the action potential from the norepinephrine release mechanism
E
197
Which of the following statements most accurately describes the effectiveness of action of methyldopa?
a. It causes marked cardiac slowing
b. It directly relaxes vascular smooth muscle
c. It causes rapid depletion of norepinephrine from adrenergic nerve terminals
d. It causes formation of a false transmitter that is released at vascular smooth muscle
e. It produces a false transmitter, the effect of which is primarily at central nuclei
E
198
The mechanism of action of reserpine is to
a. Inhibit monoamine oxidase
b. Inhibit catechol-O-methyltransferase
c. Block the passage of the nerve action potential in the postganglionic nerve fibers
d. Stabilize the axon terminal membrane thus preventing release of norepinephrine
D
199
Amphetamine acts by
a. Promoting storage of the mediator
b. Causing a rapid release of the mediator
c. Causing a slow depletion of the mediator
d. Combining with a receptor substance on the effector cell
e. Interfering with the response of the receptor to the mediator
B
200
Which of the following characterizes the mechanism of action on levodopa?
a. It acts through a direct anticholinergic action
b. It stimulates specific L-dopa receptors in basal ganglia
c. It replenishes the otherwise deficient dopamine in patients with parkinsonism
d. It increases concentrations of norepinephrine in the brain to
counterbalance an otherwise overactive cholinergic system
C
201
Which of the following combinations of agents would be necessary to block the cardiovascular effects produced by the injection of a sympathomimetic drug?
a. Atropine and prazosin
b. Atropine and propranolol
c. Prazosin and propranolol
d. Phenoxybenzamine and curare
e. Amphetamine and propranolol
C
202
Which of the following drugs competitively blocks the action of norepinephrine at beta-adrenergic receptors?
a. Atropine
b. Naloxone
c. Propranolol
d. Phentolamine
e. Hexamethonium
C
203
Pretreatment with reserpine prevents a response to which of the following agents?
a. Amphetamine
b. Epinephrine
c. Phenylephrine
d. Isoproterenol
e. Norepinephrine
A
204
Each of the following drugs is considered to be a direct-acting catecholamine EXCEPT
a. Epinephrine
b. Amphetamine
c. Isoproterenol
d. Norepinephrine
B
205
After pretreatment with phentolamine, intravenous administration of epinephrine should result in
a. Relaxation of bronchial smooth muscle
b. Positive chronotropic and inotropic effects
c. Splanchnic vasoconstriction
d. Dilation of skeletal muscle vascular beds
e. Secretion of a mucoid viscous saliva
i. a, and b only
ii. a, b and d
iii. a, d and e
iv. c and d only
v. c, d and e
ii
206
Which of the following changes produced by intravenous administration of epinephrine result from stimulation of beta- adrenergic receptors?
a. Respiratory inhibition
b. Cardiac acceleration
c. Dilation of the pupil
d. Increased systolic pressure
e. Decreased diastolic pressure
i. a, b and c
ii. a, b and d
iii. b and e
iv. c, d and e
v. c and e only
iv
207
Which of the following is NOT an action of epinephrine when administered intravenously in a high dose?
a. Increases liver glycogenolysis
b. Causes bronchiolar constriction
c. Produces a rise in blood pressure
d. Evokes extrasystoles in the heart
e. Produces restlessness and anxiety
B
208
"Epinephrine reversal" of blood pressure can best be demonstrated by injecting epinephrine intravenously after pretreatment with
a. Prazosin
b. Atropine
c. Propranolol
d. Neostigmine
e. Isoproterenol
A
209
Each of the following is a predictable adverse effect of drugs that block the sympathetic nervous system EXCEPT
a. Gastrointestinal disturbance
b. Postural hypotension
c. Nasal congestion
d. Urinary retention
e. Miosis
D
210
Injection of a pressor dose of norepinephrine may result in a decreased heart rate because of
a. Activation of baroreceptor reflexes
b. Direct stimulation of alpha receptors
c. Direct stimulation of beta-1 receptors
d. Direct stimulation of beta-2receptors
e. Direct stimulation of muscarinic receptors
A
211
Alpha-adrenergic agonists are used in combination with local anesthetics to
a. Stimulate myocardial contraction
b. Reduce vascular absorption of the local anesthetic
c. Increase the rate of liver metabolism of the local anesthetic
d. Increase the concentration of the local anesthetic at its receptor site
e. Antagonize the vasodilating effects of the local anesthetic
i. (a), (b) and (c)
ii. (b), (c) and (d)
iii. (b), (d) and (e)
iv. (c), (d) and (e)
v. (d) and (e) only
iii
212
Administration of an otherwise effective pressor dose of epinephrine could cause an "epinephrine reversal" in a patient taking which of the following drugs?
a. Reserpine
b. Propranolol
c. Amphetamine
d. Chlorpromazine
e. Lithium carbonate
D
213
Of the following sympathomimetic agents, the most potent bronchodilator is
a. Amphetamine
b. Norepinephrine
c. Phenylephrine
d. Isoproterenol
e. Methoxamine
D
214
Administration of which of the following drugs would produce vasoconstriction of the gingival vessels?
a. Levonordefrin
b. Phentolamine
c. Epinephrine
d. Propranolol
e. Phenylephrine
i. (a) and (b)
ii. (a) and (c) only
iii. (a), (c) and (e)
iv. (b), (d) and (e)
v. (b) and (d) only
iii
215
Carbidopa, a dopa-decarboxylase inhibitor, is often used in the treatment of parkinsonism because it
a. Potentiates the central action of dopamine
b. Potentiates the central action of norepinephrine
c. Decreases the peripheral metabolism of levodopa
d. Inhibits the peripheral stimulatory fibers from the central nervous system
e. Increases the permeability of the blood-brain barrier to
levodopa
C
216
Of the following, one of the most effective treatments currently available in the U.S. for most patients suffering from parkinsonism involves oral administration of
a. Dopamine
b. Amantadine
c. Benztropine
d. Levodopa alone
e. Levodopa plus carbidopa
E
217
Levodopa therapy for Parkinson disease may result in each of the following effects EXCEPT:
a. Development of abnormal, involuntary movements, especially in the face
b. Extreme sensitivity to sympathomimetic drugs
c. Exacerbation of an acute psychosis
d. Nausea and vomiting
e. Extreme sedation
E
218
Adverse effects of levodopa include:
a. Arrhythmias
b. Psychotic disturbances
c. Nausea and vomiting
d. Abnormal involuntary movements
i. (a), (b), and (c)
ii. (a), (b) and (d)
iii. (a), (c) and (d)
iv. (b), (c) and (d)
v. All of the above
v
219
Which of the following drugs would be most likely taken by an asthmatic patient?
a. Phenylephrine
b. Albuterol
c. Pseudoephedrine
d. Prazosin
e. Propranolol
B
220
A pharmacologic agonist is a chemical substance that
a. Binds to a specific receptor and produces a response
b. Elicits a pharmacologic response without binding to a receptor
c. Possesses the property of affinity but not of intrinsic activity
d. Exhibits no activity except to oppose the effect of an antagonist
A
221
When comparing drugs with respect to intensity of response, the drug that produces the greatest maximum effect is the one with the highest
a. Affinity
b. Potency
c. Efficacy
d. Therapeutic index
C
222
If drug has a greater efficacy than drug B, then drug A
a. Is more toxic than drug B
b. Has a greater affinity for the receptor than drug B
c. Has a greater margin of safety than drug B
d. Is capable of producing a greater maximum effect than drug B
D
223
A drug with a high LD50 and a low ED50
has a
a. High therapeutic index and is, therefore, very dangerous
b. High therapeutic index and is, therefore, relatively safe
c. Low therapeutic index and is, therefore, very dangerous
d. Low therapeutic index and is, therefore, relatively safe
B
| LD50/ED50
224
The ratio of the median lethal dose (LD50) to the median effective dose (ED50) is the
a. Morbidity index
b. Mortality index
c. Anesthetic ratio
d. Therapeutic index
D
225
The therapeutic index of a drug is the ratio of
a. The effective dose to the toxic dose
b. Half the toxic dose to half the effective dose
c. The maximum tolerated dose to the minimum effective dose
d. The lethal dose for 50% of animals to the effective dose for 50% of animals
D
226
The phenomenon in which two drugs produce opposite effects on a physiologic system but do not act at the same receptor site is
a. Potentiation
b. Chemical Antagonism
c. Competitive antagonism
d. Physiologic antagonism
e. Noncompetitive antagonism
D
227
Epinephrine antagonizes the effects of histamine by
a. Preventing the release of histamine
b. Acting on the central nervous system
c. Producing physiologic actions opposite to that of histamine
d. Competitively blocking histamine at the cellular receptor site
C
228
Interaction between nitroglycerin and epinephrine is what type of antagonism?
a. Allosteric
b. Physiologic
c. Biochemical
d. Competitive
e. Pharmacologic
B
229
When the combined action of two drugs is greater than the sum of their individual actions, this is
a. Induction
b. Synergism
c. Idiosyncrasy
d. Hypersensitivity
e. Cumulative action
B
230
Which of the following responses is least predictable in occurrence?
a. Toxicity
b. Side-effects
c. Idiosyncrasy
d. Tachyphylaxis
e. Therapeutic effects
C
231
Idiosyncrasies to drugs are related to
a. Species
b. Genetic factors
c. Age of the patient
d. All of the above
B
