Test 1

Question 1

Which of the following would be associated with a noradrenergic terminal?
A. tyrosine hydroxylase
B. dopamine beta hydroxylase
C. alpha 2 adrenergic receptors
D. all of the above

Answer 1

Answer: D. all of the above

A. tyrosine hydroxylase (changes tyrosine to dopamine, an early step in synthesis of norepinephrine)
B. dopamine beta hydroxylase (changes dopamine to norepinephrine)
C. alpha 2 adrenergic receptors (can act as an autoreceptor or post synaptic receptor for NE)

Question 2

A farm worker is poisoned by a pesticide and presents in an emergency room with symptoms such as blurred vision, excess salivation, twitching, and decreased heart rate. He/she would likely be treated with
A. an acetylcholinesterase inhibitor
B. a muscarinic antagonist
C. a sympathomimetic
D. an acetylcholine transporter inhibitor

Answer 2

Answer: B. a muscarinic antagonist. (All the symptoms are due to increased Ach activity at muscarinic receptors)

A. an acetylcholinesterase inhibitor (this would increase the amount of acetylcholine in the synapse)

C. a sympathomimetic (would not affect Ach systems)
D. an acetylcholine transporter inhibitor (would also increase the amount of Ach in the synapse)

Question 3

Preganglionic sympathetic and parasympathetic fibers release ____, postganglionic sympathetic fibers release ____ (for adrenergic receptors), and postganglionic parasympathetic fibers release ____ (for muscarinic receptors).

Answer 3

acetylcholine; norepinephrine; acetylcholine

Question 4

What is the main pharmacological difference between the drugs prazosin and phentolamine?
A. prazosin blocks the primary effects of atenolol when administered together.
B. phentolamine increases muscarinic activity by blocking acetylcholine
C. phentolamine can reduce blood pressure by blocking alpha 2 receptors
D. Prazosin increases heart rate by activating alpha 1 receptors

Answer 4

Answer: C. phentolamine can reduce blood pressure by blocking alpha 2 receptors

prazosin is a selective alpha-1 antagonist, while phentolamine is a non-selective alpha 1 and alpha 2 antagonist.

A. prazosin blocks the primary effects of atenolol when administered together (prazosin for alpha 1, atenolol for beta 1)
B. phentolamine increases muscarinic activity by blocking acetylcholine (phentolamine has nothing to do with Ach systems)
D. Prazosin increases heart rate by activating alpha 1 receptors (prazosin is an antagonist of the sympathetic systems, so, if anything, it would lower heart rate if it even acted on the heart)

Question 5

Select the incorrect statements:
A. decreased GABA activity can result in seizures
B. Reduction in memory after a seizure is referred to as the aura effect.
C. increased flow of Cl- through GABA channels increases incidence of grand mal seizures
D. durgs that block inward Ca++ flow into CNS neurons could have antiseizure properties
E. topiramate typically has more side effects than carbamazepine when used to treat generalized onset tonic-clonic seizures
F. Levetiracetam (Keppra) is a recen drug used as adjunctive therapy for treatment of non-responsive seizures
G. Extreme loss of weight is a common side effect of phenytoin
H. Lamotrigine is a newer antiseizure drug also used to treat bipolar disorder

Answer 5

Answers:
B. Reduction in memory after a seizure is referred to as the aura effect.
C. increased flow of Cl- through GABA channels increases incidence of grand mal seizures (GABA channels are chloride channels so if there is increased flow of chloride through the channel there is increased GABA activity. Increased GABA activity would prevent seizures, not cause them)
E. topiramate typically has more side effects than carbamazepine when used to treat generalized onset tonic-clonic seizures (topiramate is a newer seizure drug compared to carbamazepine and has less side effects)
G. Extreme loss of weight is a common side effect of phenytoin (phenytoin, along with many other seizure meds actually causes weight gain)

The other choices are true.
A. decreased GABA activity can result in seizures
D. durgs that block inward Ca++ flow into CNS neurons could have antiseizure properties
F. Levetiracetam (Keppra) is a recen drug used as adjunctive therapy for treatment of non-responsive seizures
H. Lamotrigine is a newer antiseizure drug also used to treat bipolar disorder

Question 6

Which of the following is NOT a side effect of phenytoin?
A. GI upset
B. Gingival hyperplasia
C. Hirsuitism
D. Rare hepatitis
E. CNS hyperexcitability

Answer 6

Answer E. CNS hyperexcitability (phenytoin is a seizure med, so it should decrease the excitability of the CNS)

A. GI upset (side effect of most seizure drugs)
B. Gingival hyperplasia (unique to phenytoin)
C. Hirsuitism (unique to phenytoin)
D. Rare hepatitis (side effect of phenytoin, valproate, and carbamazepine)

Question 7

Select the incorrect statement concerning Alzheimer’s disease.
A. occurs in ~50% of the population who are >80 years of age
B. often associated with excess cholinergic activity in the nucelus basalis
C. appears to be associated with chronic inflammation caused by abnormal protein precipitation
D. linked to abnormal amyloid precursor protein

Answer 7

Answer: B. often associated with excess cholinergic activity in the nucelus basalis. (Alzheimers is characterized by a deficiency of cholinergic activity/neurons in the nucleus basalis, which is the site of cholinergic neurons in the brain that projects to the hippocampus)

The rest of the choices are true.
A. occurs in ~50% of the population who are >80 years of age
C. appears to be associated with chronic inflammation caused by abnormal protein precipitation (the beta amyloid protein is the culprit)
D. linked to abnormal amyloid precursor protein

Question 8

Select the correct statements:
A. Multiple sclerosis is most likely to occur in females of Scandinavian heritage
B. CNS damage with multiple sclerosis is due to destruction of microglia
C. Chronic relapsing form of multiple sclerosis can be fatal
D. Methyltrexate is used to treat severe multiple sclerosis
E. Amyotrophic lateral sclerosis is associated with the death of neurons in the pain pathways
F. Cholinergic agonist drugs cure myasthenia gravis
G. Guillan-Barre syndrome typically associated with respiratory or gastrointenstinal viral infections
H. Extrapyramidal disorders are usually associated with alterations in muscle control, posture, or locomotor mechanisms

Answer 8

Answers:
A. Multiple sclerosis is most likely to occur in females of Scandinavian heritage
C. Chronic relapsing form of multiple sclerosis can be fatal
D. Methyltrexate is used to treat severe multiple sclerosis
G. Guillan-Barre syndrome typically associated with respiratory or gastrointenstinal viral infections
H. Extrapyramidal disorders are usually associated with alterations in muscle control, posture, or locomotor mechanisms

B. CNS damage with multiple sclerosis is due to destruction of microglia (it is due to destruction of oligodendrocytes in the CNS that make myelin)
E. Amyotrophic lateral sclerosis is associated with the death of neurons in the pain pathways (ALS is a disease of the motor neurons, not the pain neurons)
F. Cholinergic agonist drugs cure myasthenia gravis (there is no known cure for myasthenia gravis, though cholinergic agonists or acetylcholinesterase inhibitors can be used to treat the symptoms of the disease)

Question 9

For each of the following, name the type/site of pain processing and then the drugs that act at that site:
A. Plexus of Raschkow
B. Periaqueductal gray area
C. Dorsal horn
D. Peripheral axons
E. Cerebral cortex

types/sites: transmission, transduction, perception, modulation

drugs: ibuprofen, xylocaine, substance P, hydrocodone, dynorphin, cymbalta

Answer 9

A. Plexus of Raschkow - transduction (nociceptor) - blocked by ibuprofen (NSAIDs) and substance P (secondary activation of nociceptors)
B. periaqueductal gray area - modulation - ibuprofen, substance P, hydrocodone, dynorphin
C. dorsal horn - modulation - ibuprofen, substance P, hydrocodone, dynorphin
D. peripheral axons - transmissision - xylocaine and substance P
E. Cerebral cortex - perception and modulation - hydrocodone, cymbalta, ibuprofen, substance P, hydrocodone, and dynorphin

Question 10

Which of the following two drugs are most likely to be effective in treating trigeminal neuralgia?
A. Celebrex
B. hydrocodone
C. Acetaminophen
D. Capsaicin
E. ibuprofen
F. Cymbalta
G. Gabapentin

Answer 10

Answers: F. Cymbalta and G. Gabapentin

trigeminal neuralgia is a type of neuropathic pain which is why cymbalta (antidepressant, mised NE/5HT reuptake blocker) and gabapentin (lyrica, anticonvulsant) are used.

the other choices are more traditional analgesics that are not effective for neuropathic pain.

Question 11

Which of the following phenomena is best described as the convergence of visceral and somatic pain in the dorsal horn to influence the ascending pain message in the spinothalamic projections?
A. neuropathic pain
B. allodynia
C. Gate control
D. Referred pain

Answer 11

Answer: D. Referred pain (visceral pain from organs translates to a “referred” and poorly defined somatic pain)

A. neuropathic pain (pain that is continuous or periodic but not associated with activation of nociceptors)
B. allodynia (pain evoked from non-painful stimuli)
C. Gate control (inhibition of pain by touch)

Question 12

Match the following diseases to the correct mechanism and the correct drug used to treat them.
A. Huntington's disease
B. Myasthenia gravis
C. Parkinson's disease
D. Multiple sclerosis

mechanisms:

1. antibodies destroy nicotinic receptors at the neuromuscular junction
2. striatal cell bodies of GABA neurons with NMDA receptors destroyed
3. Viral infection initiates autoimmune damage to CNS oligodendrocytes
4. Damage to dopamine nigro-striatal and locus coeruleus pathways

drugs:
entacapone
methyltrexate
haloperidol
neostigmine

Answer 12

A. Huntington’s disease - 2. striatal cell bodies of GABA neurons with NMDA receptors destroyed - haloperidol
B. Myasthenia gravis - 1. antibodies destroy nicotinic receptors at the neuromuscular junction - neostigmine
C. Parkinson’s disease - 4. Damage to dopamine nigro-striatal and locus coeruleus pathways - entacapone
D. Multiple sclerosis - 3. Viral infection initiates autoimmune damage to CNS oligodendrocytes - methyltrexate

Question 13

Which of the following is NOT a characteristic of a selective Cox-2 inhibitor?
A. eliminates gastric mucosal protection against acid reflux
B. increases the incidence of heart or blood vessel disease
C. does not alter bleeding time after tissue trauma
D. relieves pain associated with prostaglandin-mediated inflammation

Answer 13

Answer: A. eliminates gastric mucosal protection against acid reflux (this would be a Cox-1 associated side effect)

Question 14

What is the associated condition with a blood alcohol level of 0.4%?
A. Alert and legally competent to drive an automobile
B. Sedated with decreased reaction times
C. Slurred speech and vomiting
D. Comatose and near death

Answer 14

Answer: D. comatose and near death

A. Alert and legally competent to drive an automobile (BAC = less than ~0.05%)
B. Sedated with decreased reaction times (BAC = 0.05 - 0.1%)
C. Slurred speech and vomiting (BAC = 0.2 - 0.3%)

Question 15

Select the incorrect statement about alcohol
A. it causes vasodilation of blood vessels in the skin
B. it is metabolized according to first-order kinetics
C. it increases gastric acid secretion
D. it decreases anti-diuretic hormone secretion

Answer 15

Answer: B. it is metabolized according to first-order kinetics (it is metabolized via zero-order kinetics)

Question 16

What is the best analgesic to give to a person that is currently taking Pradaxa and has a history of alcohol use disorder?
A. percodan
B. dolobid
C. celecoxib
D. naloxone

Answer 16

Answer: celecoxib (lacks the Cox-1 platelet effects and would not exacerbate the patient’s bleeding)

A. percodan (opioid)
B. dolobid (related to aspirin; NSAID that would affect bleeding)
D. naloxone (reversal agent for opioids so not an analgesic)

Question 17

Which of the following opioid agonists is the most potent?
A. hydrocodone
B. morphine
C. oxymorphone
D. oxycodone
E. hydrocodone with acetaminophen

Answer 17

Answer: C. oxymorphone

order of potency for opioids from most to least potent:
fentanyl (0.1 mg) 
oxymorphone (1 mg)
hydromorphone (1.5 mg)
morphine (10 mg)
oxycodone (20 mg)
hydrocodone (30 mg)
codeine (200 mg)

Question 18

Which of the following is a moderately potent mixed agonsit/antagonist opioid drug used to treat pain and opioid use disorder?
A. buprenorphine
B. methadone
C. meperidine
D. fentanyl

Answer 18

Answer: A. buprenorphine

B. methadone (moderate to strong analgesic that is used to treat opioid dependence and addiction, but it lacks the agonist/antagonist action)
C. meperidine (demerol, moderate analgesic)
D. fentanyl (very potent opioid)

Question 19

Patient initially shows no facial expression in response to humorous comments and is almost completely non-communicative. After being on a medication for a month he is much more animated and responding appropriately to questions. Which of the following is the most likely?
A. patient likely had GI problems
B. patient likely was prescribed phenelzine by his gastroenterologist.
C. patient was most likely diagnosed by a psychiatrist to have cyclothymia and was prescribed amytriptaline
D. patient most likely was diagnosed with major depression and prescribed lithium carbonate
E. patient was likely to have residual schizophrenia and prescribed olanzepine

Answer 19

Answer: E. patient was likely to have residual schizophrenia and prescribed olanzepine. (Residual schizophrenia is characterized by negative symptoms; olanzepine is an atypical antipsychotic that is more effective at treating negative symptoms)

A. patient likely had GI problems
B. patient likely was prescribed phenelzine by his gastroenterologist. (phenelzine is an MAOI used for treatment of major depression and is probably not prescribed by the gastroenterologist)
C. patient was most likely diagnosed by a psychiatrist to have cyclothymia and was prescribed amytriptyline (cyclothymia is minor bipolar and is rarely treated pharmacologically; amytriptyline is a tri-cyclic antidepressant and usually causes prominent anti-cholinergic side effects)
D. patient most likely was diagnosed with major depression and prescribed lithium carbonate (lithium carbonate is a mood stabilizer used to treat major bipolar disorder)

Question 20

What is the mechanism of olanzepine?
A. anti-cholinergic activity
B. stimulation of the dopamine system
C. blockade of D2 and 5HT2A receptors
D. blockade of uptake of norepinephrine and seratonin

Answer 20

Answer: C. blockade of D2 and 5HT2A receptors

A. anti-cholinergic activity
B. stimulation of the dopamine system (olanzepine blocks dopamine receptors)
D. blockade of uptake of norepinephrine and seratonin (this is the mechanism of monoamine uptake blockers or SSRIs such as fluoxetine/Prozac and sertraline/Zoloft)

Question 21

Select the correct statements:
A. Schizophrenia in females generally has a better prognosis than schizophrenia in males
B. treatment of schizophrenia with chlorpromazine is more likely to cause tardive dyskinesias than treatment with the butyrophenones (haloperidol)
C. treatment of major depression with amytriptyline is likely to cause xerostomia
D. treatment of major depression with desipramine tends to have fewer side effect than treatment with duloxetine (Cymbalta)
E. if treatment of major depression with sertraline (Zoloft) is not effective, sometimes treatment with venalafaxine (Effexor) will be effective
F. antiseizure medications such as lamotrigine (Lamictal) are used to treat major bipolar disorder
G. Benzodiazepines are thought to exert their antianxiety effects because they are allosteric modulators of NMDA receptors
H. sometimes the benzodiazepines cause excitation in children
I. Zolpidem (Ambien) is used to treat sleep disorders and causes less drowsiness than lorazepam (Ativan)
J. Sertraline is approved for treatment of panic attacks

Answer 21

Answers:
A. Schizophrenia in females generally has a better prognosis than schizophrenia in males
C. treatment of major depression with amytriptyline is likely to cause xerostomia
(amytriptyline is a tricyclic antidepressant with
prominent anticholinergic side effects)
E. if treatment of major depression with sertraline (Zoloft) is not effective, sometimes treatment with venalafaxine (Effexor) will be effective
(venalafaxine is a mixed NE/5HT transport blocker
for treatment of depression)
F. antiseizure medications such as lamotrigine (Lamictal) are used to treat major bipolar disorder
H. sometimes the benzodiazepines cause excitation in children
I. Zolpidem (Ambien) is used to treat sleep disorders and causes less drowsiness than lorazepam (Ativan)
J. Sertraline is approved for treatment of panic attacks
(panic attacks treated with antidepressants or
Paxil)

incorrect answers:
B. treatment of schizophrenia with chlorpromazine is more likely to cause tardive dyskinesias than treatment with the butyrophenones (haloperidol)
(Haloperidol is the drug that causes tardive
dyskinesias. Chlorpromazine is a phenothiazine
and has less side effects)
D. treatment of major depression with desipramine tends to have fewer side effect than treatment with duloxetine (Cymbalta)
(desipramine is a TCA with many more side
effects than duloxetine, which is an monoamine
uptake blocker)
G. Benzodiazepines are thought to exert their antianxiety effects because they are allosteric modulators of NMDA receptors
(BDZs are allosteric modulators of GABA a
receptors)

Question 22

Which of the following drugs is likely to be most helpful in the long-term management of a patient young patient with ADHD?
A. lorazepam
B. alprazolam
C. buspirone
D. modafinil

Answer 22

Answer: D. modafinil

A. lorazepam (BDZ used to treat anxiety; it is considered a hypnotic and is shorter acting)
B. alprazolam (BDZ used to treat anxiety; it is considered a sedative and is longer acting)
C. buspirone (this is a non-sedating and low abuse potential anxiolytic that may have some NE agonist action)

Question 23

Select the incorrect statment:
A. Down’s syndrome is related to a trisomy 21 autosomal genetic abnormality
B. Down’s syndrome can be associated with Alzheimer’s disease
C. Edward’s syndrome is related to a trisomy 18 and micrognathia
D. the incidence of Autism spectrum disorder is completely determined by genetics

Answer 23

Answer: D. the incidence of Autism spectrum disorder is completely determined by genetics ( it is partially determined by environment/toxins as well)

Question 24

Select the incorrect statement concerning eating diseases:
A. they tend to be more prevalent in females than in males
B. there is more damage to the teeth and mouth associated with anorexia nervosa than in bulimia
C. Fluoxetine is often used to treat bulimia
D. Both types of eating disorders are associated with a pathologic self-body image.

Answer 24

Answer: B. there is more damage to the teeth and mouth associated with anorexia nervosa than in bulimia (bulimia causes more damage to the teeth)

fluoxetine is an SSRI used to treat bulimia and depression

Question 25

Select the incorrect statements concerning drugs of abuse:
A. Tobacco is addicting because of its ability to indirectly release dopamine by activating dopamine D2 receptors
B. Amphetamine and methamphetamine can damage nigrostriatal dopamine pathways because of excessive release of dopamine
C. Opioid narcotics are addicting despite the fact that these drugs actually reduce the activity of reward dopamine pathways
D. A substance use disorder can be considered an Axis I diagnosis according to DSM V.
E. Opioid dependence is the same as opioid addiction
F. Persons who suffer from addiction to prescription narcotics get most of their drugs illegally from drug dealers on the streets
G. Cognitive therapy used to treat patients with substance use disorders is intended to help restore normal frontal cortex function
H. DOPL databases are available in Utah for dentists to check on their patients’ histories of using controlled (scheduled) prescription drugs.

Answer 25

Answers:
A. Tobacco is addicting because of its ability to indirectly release dopamine by activating dopamine D2 receptors
- Tobacco activates nicotine receptors, not dopamine receptors
C. Opioid narcotics are addicting despite the fact that these drugs actually reduce the activity of reward dopamine pathways
- opioid increase the activity of the reward pathways
E. Opioid dependence is the same as opioid addiction
- dependence refers to developing tolerance and withdrawal symptoms; addiction is pathologic decision making with compulsive destructive behavior.
F. Persons who suffer from addiction to prescription narcotics get most of their drugs illegally from drug dealers on the streets
- most common is getting the drugs from friends and family

Question 26

Which of the following are naturally occurring opioid peptides that primarily activate the kappa-opioid receptors and are dysphoric?
A. enkephalin
B. dynorphins
C. b-endorphins
D. substance P

Answer 26

Answer: B. dynorphins

A. enkephalin (activates mu and delta receptors; only 5 amino acids long)
C. beta-endorphins (activates mu and delta receptors, 91 amino acids long)
D. substance P (not an opioid, can cause secondary activation of nociceptors and modulate pain transmission)

Question 27

Which of the following is not an NSAID?
A. Indomethacin
B. Diflunisal
C. Naprosyn
D. Meperidine

Answer 27

Answer: D. Meperidine (demerol, opioid analgesic more mild/moderate pain)

A. Indomethacin (potent, nonselective NSAID that has major side effects and is not used regularly for pain managment)
B. Diflunisal (related to salicylates/aspirin and is supposedly good for bone pain)
C. Naprosyn (long lasting ibuprofen-type NSAID)