Quiz 2 Andrea's Sedative Hypnotic Drugs of Abuse Anti-seizue Anti-Parkinson's

Question 1

We have a patient with Parkinson's disease and administer a drug that acts in the CNS as an agonist for dopamine receptors. It has no direct effects on dopamine synthesis, neuronal repute, or metabolic inactivation. Which of the following drugs best fits this description?
A. Benztropine
B. Amantadine
C. Tolcapone
D. Roperinole
E. Selegiline

Answer 1

D. Roperinole

Question 2

A 5 y/o boy consumed a liquid from a container in the family garage. He presents with central nervous system CNS depression, obtunded reflexes, and ventilatory depression. A blood sample indicates profound metabolic acidosis. A check of the urine reveals crystals that are presumed to be oxalate. Which of the following is the most likely cause of the poisoning?
A. Paint thinner such as acetone
B. An insecticide (organophosphate cholinesterase inhibitor)
C. Ethylene glycol
D. Gasoline
E. Halogenated hydrocarbon from a can of spray paint

Answer 2

C. Ethylene glycol

Question 3

Trihexyphenidyl is prescribed as an adjunct to other drugs being used to manage a patient with Parkinson’s Disease. Which of th following si the most likely purpose or action of this drug as part of the overall drug treatment plan?
A. To counteract sedation that is likely to be caused by the other medications
B. TO manage cutaneous allergic responses that are so common with “typical” anti-Parkinson’s drugs.
C. To help correct further the dopamine -Ach imbalance that accounts for Parkinsonian signs and symptoms.
D. To reverse tardive dyskinesias if the Parkinsonism was induced by an antipsychotic drug
E. To prevent the development of mani-hypomanic responses to other anti-Parkison drugs

Answer 3

C. To help correct further the dopamine -Ach imbalance that accounts for Parkinsonian signs and symptoms.

Question 4

A 42 y/o woman develops akanthisias, Parkinsonian-like symptoms, galactorrhea, and amenorrhea, during drug therapy. Which of the following drug-receptor-based mechanisms, occurring in the central nervous system, most likely caused these responses?
A. Blockade of alpha - adrenergic receptors
B. Blockade of dopamine receptors
C. Blockade of muscarinic receptors
D. Stimulation of nicotinic receptors
E. Supersensitivity of dopamine receptors

Answer 4

B. Blockade of dopamine receptors

Question 5

A patient has a long history excessive alcohol consumption. He was arrested for drunk driving and was referred to a physician for therapy. The MD prescribed a drug to stifle further alcohol ingestion, to be used along with other interventions. The patient was instructed not to consume any alcohol, not to use alcohol-containing mouthwashes, or even apply alcohol based toiletries, because alcohol may cause a distrubgin, if not dangerous interaction with his medication. The patient ignored the advice and decided to have a cocktail. Within minutes he develops flushing, a throbbing headache, nausea, and vomiting. Which of the following medications was he most likely taking?
A. Disulfiram
B. Naltrexone
C. Diazepam
D. Phenobarbital
E. Tranylcypromine

Answer 5

A. Disulfiram

Question 6

A 63 y/o man is evaluated during a follow up visit. He was hospitalized 7 days ago with a non ST elevation myocardial infarction and underwent intracoronary stent placement. he is now pain free, but whats help with smoking cessation; he has smoked one pack of cigarettes daily for 40 years. His past medical history is notable for coronary artery disease, hyperlipidemia, hypertension, and a seizure disorder. His prescription medications included atenolol, clopidogrel, hydrochlorothiazide, phenytoin, and simvastatin. On exam, he is afebrile with a blood pressure of 124/68 mm Hg and a pulse rate of 62/min. His jugular venous pressure is not elevated, his heart sounds are normal, and his lungs are clear. In addition to counseling for smoking cessation techniques, which of the following is the most appropriate drug treatment in this patient?
A. Varenicline
B. All of the above
C. Nicotine replacement
D. Fluoxetine
E. Bupropion

Answer 6

A. Varenicline

Question 7

A 24 year woman comes to clinic for routine health examination. She reports that she has been feeling well except for a nagging cough she has had for the last 2 weeks following an URT infection. She says she is interested in a medication to help her quit smoking. ON examination she is thin with a BMI of 17.5 kg/m2. The remainder of her examination is unremarkable. What is the mechanism of action for the best medication for smoking cessation in this patient?
A. inhibits serotonin reuptake
B. Inhibits acetaldehyde dehydrogenase
C. Inhibits dopamine reuptake
D. Antagonist of Nicotinic receptor
E. Partial agonist of nicotinic receptor

Answer 7

E. Partial agonist of nicotinic receptor

Question 8

A 26 y/o man with a known history of substance abuse is exhibiting violent and aggressive behavior and is brought to the emergency department. Examination of the patient shows the presence of extreme agitation, hyperthermia, hypertension, tachycardia, tachypnea, horizontal and vertical nystagmus, mydriasis, and numbness of the distal extremities The patient is most likely intoxicated with 
A. Diazepam
B. Ethanol
C. Phencyclidine
D. Heroin
E. Lysergic acid diethlamid (LSD)

Answer 8

C. Phencyclidine

Question 9

Chlorpromazine (anti-psychotic drug (anti dopaminergic)) has been prescribed for a patient with schizophrenia, and the patient has been taking the drug, at usually effective doses, for about 6 months. Today he comes to the hospital with other medical conditions that require surgery and the administration of other drugs, and we decide it is unwise to stop the chlorpromazine and run the risk of psychotic behavior while we perform other interventions. Which of the following other signs/symptoms that the patient may also have or acquire as the result of surgery and drug therapy is most likely to be affected beneficially by the continued use of chlorpromazine?
A. Epilepsy and the risk of seizures
B. Hypotension
C. Zerostomia (dry mouth) caused by antimuscarinic drugs used to prevent intraoperative bradycardia
D. Nausea and vomiting
E. Urinary retention caused by abdominal surgery

Answer 9

D. Nausea and vomiting

Question 10

A patient of age 65 years having insomnia is using various drugs and the patient is abusing these drugs. Now he is asking the physician to prescribe the drug without abusing potential. Physician suggested psychotherapy and long with psychotherapy physician prescribed a drug. The drug prescribed was most likely to have been
A. Diazepam
B. Zolpidem
C. Alprazolam
D. Midazolam
E. Phenobarbital

Answer 10

B. Zolpidem

Question 11

A 34 y/o man with mild anxiety and depression symptoms has heard about buspirone on television and asks whether it might be suitable for him. According to the latest diagnostic criteria, the drug would be appropriate, particularly for short term symptom control. Which of the following best describes an important property of this drug?
A. Has a significant potential for abuse
B. Requires almost daily dosage titrations in order to optimize the response
C. Is likely to potentiate the CNS depressant effects of alcohol, benzodiazepines, and sedative antihistamines, so such interactants must be avoided at all cost
D. Seldom causes drowsiness
E. Associated with a withdrawal syndrome that, if unsupervised, is frequently lethal

Answer 11

D. Seldom causes d

Question 12

A 14 y/o is brought to the ED by her mother, who has observed that her daughter has abruptly experienced frequent impairments of consciousness associated with episodes of staring into space lasting approximately 30 second. With which of the following drugs should we start treatment?
A. Alprazolam
B. Ethosuximide
C. Midazolam
D. Diazepam
E. Phenytoin

Answer 12

B. Ethosuximide

Question 13

A nine year old boy is sent for neurologic evaluation because of episodes of "confusion." Over the past year, the child has experienced episodes during which he develops a blank look on his face and fails to respond to questions. However, it appears to take several minutes before the boy recovers from the episodes. Which one of the following therapies would be most appropriate in this patient?
A. Ethosuximide
B. Carbamazepine
C. Diazepam
D. Buspirone
E. Thiopental

Answer 13

A. Carbamazepine

Question 14

A young boy who has been treated for epilepsy for a year is referred to a periodontist for evaluation and probably treatment of massive overgrowth of his gingival tissues. Some teeth are almost completely covered with hyper plastic tissue. Which of the following drugs was the most likely cause of the oral pathology?
A. Carbamazepine
B. Lorazepam
C. Pehnobarbital
D. Phenytoin
E. Valproic acid

Answer 14

D. Phenytoin

Question 15

A 74 y/o man with Parkinson's disease has been managed with levodopa/carbidopa for 3 years. An additional drug is now added to the therapeutic regimen to further improve control of symptoms. The drug added that prevents the oxidative deamination of dopamine. The drug is
A. Entacapone
B. Benztropine
C. Ripirenole
D. Tranylcypromine
E. Selegeline

Answer 15

E. Selegeline

Question 16

A 37 y/o bipolar, hypertensive woman takes multiple medications. Concurrent use of which of the following drugs could decrease the effectiveness of her estrogen-progestin combination oral contraceptive?
A. Carbamazepine
B. Enalapril
C. Lithium
D. Valproic acid
E. Metoprolol

Answer 16

A. Carbamazepine

Question 17

In Parkinsonian patients who have prostatic hypertrophy or obstructive gastro intestinal disease, great caution must be exercised in the use of which of the following drugs?
A. Carbidopa
B. Benztropine
C. Slegiline
D. Entacapone
E. Levodopa

Answer 17

B. Benztropine

Question 18

A patient who has been treated with levodopa is switched to a regimen with a proprietary product that contains both levodopa and carbidopa. Which of the following is the main action of carbidopa that provides the rationale for using it in this combined approach?
A. Blocks Ach release in the CNS, thereby facilitating levodopa’s ability to restore a dopamine Ach balance
B. Helps activate dietary vitamin B6, a deficiency of which of occurs during levodopa therapy
C. Reduces levodop-induced hypotension by blocking vascular dopamine receptors
D. Increases the permeability of the blood-brain barrier to levodopa, giving levodopa better access to the CNS
E. Inhibits metabolic conversion of levodopa to dopamine outside the CNS

Answer 18

E

Question 19

A young woman is taken to the emergency department by some of her friends. It seems they were out on "bar night" and someone slipped something into her alcoholic beverage, the first and only one she consumed that night. She is now extraordinarily drowsy and has little recall of what happened between the time she sipped her drink and now. Someone overheard another bar patron talking about "roofs". Being knowledgable about your pharmacology you suspect her drink was spiked with rohypnol. Assuming your guess is correct, which of the following drugs is most likely to reverse the flunitrazepam's effects?
A. Triazolam
B. Flumazenil
C. Ketamine
D. Naltrexone
E. Diazepam

Answer 19

B. Flumazenil

Question 20

A 72 y/o woman with a long history of anxiety that has been treated with diazepam decides to triple her daily dose because of increasing fearfulness about "environmental noises." Two days after her attempt at self prescribing, she is found extremely lethargic and non responsive with markedly obtunded reflexes and reaction to painful stimuli. Respirations are 8/min and shallow. Which of the following drugs should we give specifically to reverse these signs and symptoms?
A. Naltrexone
B. Dextroamphetamine
C. Pralidoxime
D. Physostigmine
E. Flumazenil

Answer 20

E. Flumazenil

Question 21

A 58 year old man presenting with difficulty in initiating movement and a resting tremor. On physical examination his face appears expressionless and he has a slow shuffling gait. He is started on medication. After using the drug, the patient came with complaints of edema and skin mottling. What drug is the patient might be using?
A. Entacapone
B. Levodopa
C. Tolcapone
D. Carbidopa
E. Amantadine

Answer 21

E. Amantadine

Question 22

We have a patient who will start taking one of the drugs listed. As we hand them the prescription we advise them not to take supplemental vitamin B6 (pyridoxine), whether alone or as part of a multivitamin supplement, because the vitamin is likely to counteract a desired effect of the prescribed drug. To which of the following drugs does this advice apply?
A. Haloperiodl for Tourette’s syndrome
B. Captopril for heart failure or hypertension
C. Levodopa/Carbidopa
D. Niacin for hypertriglyceridemia
E. Phenytoin for epilepsy

Answer 22

C. Levodopa/Carbidopa

Question 23

A 39 year old man who has partial seizures with secondary generalized tonic-clonic seizures has been treated with phenytoin for 4 years. The therapy has been only minimally successful, and the physician plans to add another drug to the treatment regimen. Which of the following game-aminobutyric acid analogues would be most appropriate to add as adjunct therapy for the prevention of seizures in this patient?
A. Gabapentin
B. Diazepam
C. Ethosuximide
D. Lamotrigine
E. Topiramate

Answer 23

A. Gabapentin

Question 24

A 52 y/o woman with a history of alcoholism is brought to the emergency department by her brother. The brother reports that the woman had been a heavy drinker for years, but that she decided to "go on the wagon" 3 days ago. When the brother saw her this morning, she was acting confused and then had a "rum fit". Now she is suffering from hallucinations, agitation, tachycardia, and fever. Immediate treatment of the patient would include administration of
A. Disulfiram
B. Buspirone
C. Naltrexone
D. Diasepam
E. Flumazenil

Answer 24

D. Diasepam

Question 25

A woman has been taking a prescribed drug throughout her pregnancy. Starting about a month before her expected delivery date we start administering oral vitamin K supplements, and when the baby is born he/she is given an injection of vitamin K. The goal is to reduce the risks of excessive or abnormal bleeding, caused by drug-induced impairments of hepatic vitamin K- depended clotting factors, in the newborn. For which of the following drugs are these precautions most likely to be needed?
A. Naloxone
B. Diazepam
C. Methadone
D. Phenobarbital
E. Bupropion

Answer 25

Phenytoin