pharmacology_block_3_quizzes_20151122010426 Flashcards
Isoflurane and halothane are good examples of volatile liquid general anesthetics. Which of the following statements best compares or contrasts their actions?A. Halothane is associated with a higher risk of hepatic toxicity, especially in patients who have been anesthetized with this drug before.B. Halothane and Isoflurane typically raise BP, via direct vasoconstrictor effects.C. Isoflurane sensitizes the myocardium to the arrhythmmogenic effects of catecholamines much more than halothane does.D. Isoflurane prolongs the QT interval (ventricular repolarization), and is associated with a much higher risk of causing potentially fatal ventricular tachyarrhythmias, than halothane.E. Use of Isoflurane for balanced anesthesia requires adjunctive use of nitrous oxide and neuromuscular blockers, use of halothane does not.
A. Halothane is associated with a higher risk of hepatic toxicity, especially in patients who have been anesthetized with this drug before.
A patient has been taking an oral monoamine oxidase inhibitor MAOI, but the fact is unknown to the health team who is now taking care of her, for unrelated medical conditions in the hospital. The patient receives a drug that leads to a fatal response characterized by profound fever, delirium, psychotic behavior, and status epileptics. It was found to have occurred because of an interaction with the MAO. Which of the following drugs, or class of drugs, was most likely administered by the attending health team?A. PehytoinB. DiazepamC. MeperidineD. A BarbiturateE. Morphine
C. Meperidine
A young boy is diagnosed with asthma. His primary symptom is frequent cough, not bronchospasm or wheezing. Other asthma medications are started, but until their effects develop fully we wish to suppress the cough without running a risk of suppressing ventilatory drive or causing sedation or other unwanted effects. Which of the following would best meet these needs?A. DextromethorphanB. CodeineC. HydrocodoneD. DiphenhydramineE. Promethazine
A. Dextromethorphan
A 20 year old man is brought to the ER by his girlfriend after she found him unconscious in the bathroom of his apartment. He smokes 20 cigarettes a day and has a history of methamphetamine, cocaine, and heroin use. Temperature is 36.4° HR is 71 beats/min, respirations are 9 breaths/min, BP is 94/56 mm Hg, and oxygen saturation is 92%. Physical examination shows pinpoint pupils. Which of the following is the mechanism of action of the antidote that will be given to this patient?A. Production of glutathione reserves.B. Competitive binding with sulfhydryl groups on ionsC. Binding ot benzodiazepine receptorsD. Antagonism of opioid receptorsE. Interaction with alcohol dehydrogenase.
D. Antagonism of opioid receptorsMorphine(full agonist) OD = Antidote: Naloxone (Opioid receptor antagonist)
A 36 y/o man complains to his physician of an inability to concentrate on his work, diminished interest in social and recreational activities, difficulty sleeping, and a general feeling of hopelessness. After a thorough evaluation, his physician prescribes psychotherapy and medication. Four weeks later, the man returns to his physician indicating that his symptoms have improved but that he is experienced delayed ejaculation and anorgasmmia. The drug prescribed for this patient most likely acts by which mechanism? A. Blockade of presynaptic receptorsB. Inhibition of neuronal reuptake of DopamineC. Inhibition of neuronal repute of norepinephrineD. Inhibition of neuronal repute of serotoninE. Inhibition of monoamine oxidase
D. Inhibition of neuronal repute of serotoninAE of SSRIs which include Fluoxetine, Paroxetine, Fluvoxamine, Citalopram and Sertraline areAnxietyAgitation (may need sedative)BruxismSexual dysfunction(anorgasmia)Seizures(in OD).Weight loss but regained after 12 months treatment
34 A 29 y/o patient is taking antidepressant. He complains of feeling jittery and agitated at times and if he takes his medication in the afternoon he finds it difficult to get to sleep at night. He seems to have lost weight during the 6 months that he has been taking the drug. He has been warned not to take other drugs without consultation because severe reactions occurreed with opioid analgesics. The patient is probably takingA. AlprazolamB. ParoxetineC. TrazodoneD. BupropionE. CHhlorpromazine
B. Paroxetine
A 51 y/o woman with symptoms of major depression also has narrow-angle glaucoma. Which of the following should be avoided this patient?A. SertralineB. MirtazepineC. AmitriptylineD. FluvoxamineE. Bupropion
C. Amitriptyline
A 25 y/o woman had a long history of depressive symptoms accompanied by body aches. Physical and laboratory tests were unremarkable. Which of the following drugs might be useful in this patient?A. DuloxetineB. SertralineC. PhenelzineD. MirtazapineE. Fluoxetine
A. Duloxetine
A patient has frequent facial tics and spontaneous outburst of foul language (coprolalia). Which of the following drugs would most likely be and probably most efficacious and safe initial treatment for this, assuming no specific contraindications to using it?A. ClozapineB. LevodopaC. PhenpbarbitalD. MethylphenidateE. Haloperidol
E. Haloperidol
A 36 y/o man presents with symptoms of compulsive behavior. He must repeatedly align and realign the items on his desk thoughout the day. If anything is out of order he feels that “work will not be accomplished effectively or efficiently.” He realized that his behavior is interfering with his ability to accomplish his daily tasks, but cannot seem to stop himself, Which of the following drugs would be most helpful to this patient?A. ClozapineB. FluvoxamineC. PhenobarbitalD. MethylphenidateE. Haloperidol
B. Fluvoxamine
A 51 y/o woman requires drug therapy for major depression. Her records indicate that she is currently being treated with Guanethidine for hypertension. Which agent would be appropriate for the patient’s mood disorder but would most likely interfere with or antagonize her antihypterensive therapy?A. CarbamazepineB. HaloperidolC. MidazolamD. NortriptylineE. Sertraline
D. Nortriptyline
Anesthesia protocols for day surgery may include sevoflurane because recovery from this agent is more rapid than that for older inhaled anesthetics. Rapid recovery from anesthesia with sevoflurane is associated with itsA. Redistribution from brain to skeletal muscleB. Low MAC valueC. Rapid metabolism of liver enzymesD. Low blood-gas partition coefficientE. None of the above
D. Low blood-gas partition coefficient
A patient develops profound fever, skeletal muscle rigidity, and autonomic and systemic electrolyte imbalances as part of a severe adverse response to psychoactive drug. The working diagnosis is neuroleptic malignant syndrome. In addition to adminstering dantrolene in an attempt to restore some resemblance of normal skeletal muscle function, which of the following other drugs is most likely to be given to help provide additional symptom relief?A. NaloxoneB. BromocriptineC. FlumazenilD. DiazepamE. BenztropineF. Propranolol?
B. Bromocriptine
A 55 y/o teacher began to experience changes in mood. He was losing interest in his work and lacked the desire to play his daily tennis match. He began to have difficult thinking and concentrating and lacked decisiveness. He was preoccupied with feelings of guilt, worthlessness, and hopelessness. In addition to the psychiatric symptoms, the patient complained of muscle aches throughout his body. Physical and laboratory tests were unremarkable. After six weeks of therapy with fluoxetine, the patients symptoms resolve. However, that patient complains of sexual dysfunction. Which of the following drugs might be useful in this patient?A. LithiumB. SertralineC. ParoxeteneD. FluvoxamineE. Mirtazapine
E. Mirtazapine
A 55 y/o hospitalized man who has not responded to first-line antidepressant medications is being treated with a drug considered to be a second line treatment for depression. The hospital staff has been advised not to give him and foods containing tyramine. Tyramine is an indirect acting amine found in dietary sources such as cheese, preserved sausages, and wine. The amine stimulates the sympathetic response by releasing norepinephrine from the synaptic vesicles. Which of the following antidepressant drugs was most likely prescribed to treat this patient?A. EscitalopramB. BupropionC. ImipramineD. BuspironeE. Tranylcypromine
E. Tranylcypromine
About one year ago you diagnosed schizophrenia signs and symptoms in a 23 y/o otherwise healthy man. As a result of intensive psychotherapy, careful titration of chlorpromazine dosages, and remarkably good compliance on the patient’s part, he is well enough to return to work. Several months later at a scheduled visit, you observe numerous S/S of drug induced parkinsonism, and the patient reports rather distressing symptoms of akathisias. However, he states no recurrences of schizophrenia manifestations. Which of the following approves is most likely to alleviate the motor an subjective parkinsonian responses, and poses the lowest risk of causing schizophrenia signs and symptoms to reappear?A. Add a centrally acting cholinesterase inhibitor (e.g., donepezil or tacrineB. Add levodopa or levodopa plus carbidopaC. Add benztropineD. Switch from chlorpromazine to haloperidolE. Add a catechol-O-methyltransferase inhibitor (e.g., tolcapone)
C. Add benztropine
A patient suffering from bipolar affective disorder becomes pregnant. A drug that has been shown to have some clinical value in alleviated BAD symptoms and that is unlikely to cause problems regarding fetal development is?A. CarbamezepineB. ClonazepamC. Valproic acidD. PhenytoinE. Methylphenidate
B. Clonazepam
A 33 y/o female patient treated with haloperidol for a hx of schizophrenia is seen in the ED because of complaints of fever, stiffness, and tremor. Her temperature is 104°F, and her serum creatine kinase (CK) level is elevated. What has occurred?A. OverdoseB. ParkinsonismC. AllergyD. Tardive DyskinesiaE. Neuroleptic malignant syndrome (NMS)
E. Neuroleptic malignant syndrome (NMS)
Which of the following drugs is a full agonist at opioid receptors; has excellent oral bioavailability, analgesic activity equivalent to that of morphine, and a longer duration of action; and milder withdrawal signs on abrupt D/C than morphine?A. NalbuphineB. OxycodoneC. FentanylD. MethadoneE. Propoxyphene
D. Methadone
A 45 y/o male with alcoholic cirrhosis is seen in the ED because of a laceration of the scalp. Of the following local anesthetics, which would be potentially toxic?A. Chlor ProcaineB. BenzocaineC. TetracaineD. LidocaineE. Procaine
D. Lidocaine