Pharmacology Test 3
104 Questions
| Attempts: 142
Endocrine, Reproduction and Central Nervous System
Questions and Answers
- 1.
A 27-year-old obese woman in her 26th week of pregnancy was diagnosed with gestational diabetes mellitus after a positive glucose tolerance test. Dietary management failed to control the blood glucose and the physician decided to prescribe drug therapy. Which of the following drugs would be most appropriate for this patient?
- A.
Acarbose
- B.
Pioglitazone
- C.
Glyburide
- D.
Insulin
Correct Answer
D. InsulinExplanation
Gestational diabetes mellitus (GDM) is defined as a carbohydrate intolerance that develops or is recognized during pregnancy, regardless of severity or time of onset. Gestational diabetes affects about 4% of all pregnancies in the USA. Since gestational diabetes carries several risks for both the mother and the offspring treatment is mandatory. Most gestational diabetics can control their glucose with diet and regular exercise, so drug therapy is needed only if these procedures are failing, like in the present case. Insulin is the only drug given to a pregnant woman since it does not cross the placenta and therefore cannot have significant effects (mainly hypoglycemia) on the fetus. C) The oral hypoglycemic agents have been used in patients with GDM with success but more data need to be obtained. Insulin is the drug of choice for GDM. A and B) Acarbose and pioglitazone are oral hypoglycemic agents but they have not been used in GDMRate this question:
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- 2.
A 16-year-old boy suffering from type I diabetes is seen in the emergency room with the chief complaint of severe right-sided chest pain. Two hours earlier he felt feverish and experienced a teeth-chattering chill. The diabetes of the patient is presently well controlled on 2 daily doses of insulin. The patient also is very compliant with his prescribed diet. After physical examination and laboratory tests a diagnosis of atypical pneumonia is made. Which of the following should be included in an appropriate treatment plan for this patient?
- A.
Increase the daily insulin dosage
- B.
Start a course of ampicillin therapy
- C.
Start a course of vancomycin therapy
- D.
Add a daily administration of metformin
Correct Answer
A. Increase the daily insulin dosageExplanation
Insulin requirement always increases in the presence of stressful situations, including acute illnesses. This is because of the hyperglycemia induced by the high plasma cortisol levels associated with stress. B, C) These antibiotics are not effective against Mycoplasma pneumoniae or Chlamydia pneumoniae, the causative agents of atypical pneumonia. D) Since the insulin requirement is increased the best course of action is to increase the daily insulin dosage, not to add an oral antidiabetic agent.Rate this question:
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- 3.
For the four insulin preparations listed below, what is the rank order of absorption from slowest to fastest? 1. Insulin Glargine 2. Lispro insulin 3. NPH insulin 4. Regular insulin
- A.
1,2,4,3
- B.
1,3,4,2
- C.
2,1,4,3
- D.
2,4,3,1
- E.
3,4,2,1
- F.
3,2,4,1
- G.
4,2,1,3
- H.
4,1,3,2
Correct Answer
B. 1,3,4,2Explanation
Insulin formulations differ one from another in the absorption rate of the drug from subcutaneous tissue, which in turn affects the duration of action of the drug. Regular crystalline insulin naturally self-a ssociates into a hexameric (six insulin molecules) structure when injected subcutaneously. Before absorption through a blood capillary can occur, the hexamer must dissociate first to dimers, and then to monomers. Addition of protamine (NPH) or excess zinc (lente or ultralente insulin) delays onset, peak, and duration of the insulin's effect. Insulin analogs are modified human insulin molecules (modifications in the amino acids of endogenous insulin) which alter the pharmacokinetics: Lispro and aspart insulins dissociate rapidly to monomers, thus absorption is rapid. The analog glargine insulin is buffered to a pH of 4, a level at which it is completely soluble, resulting in a clear colorless solution. When injected into the
neutral pH of the body, it rapidly forms microprecipitates that slowly dissolve into monomers and dimers which are then subsequently absorbed. The result is a long-acting, peakless, 24-hour duration insulin analog. (Protamine is a mixture of basic, arginine-rich peptides with an average molecular weight of 4400. A complex of approximately 1 molecule of protamine to 6 molecules of insulin is formed. After subcutaneous injection, proteolytic enzymes degrade the protamine to permit absorption of insulin.)Rate this question:
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- 4.
A 24-year-old woman with type I diabetes was brought unconscious to the emergency room. Her blood glucose level was 395mg/dL. An intravenous infusion of insulin was started and the patient’s blood glucose decreased to a normal level after 6 hours. Which of the following molecular actions most likely contributed to the therapeutic effect of the drug in this patient?
- A.
Inhibition of GLUTs in the pancreas cell
- B.
Phosphorylation of tyrosine kinase receptor
- C.
Activation of ATP-sensitive K+ channels
- D.
Stimulation of hormone sensitive lipase
- E.
Inhibition of liver glucokinase
Correct Answer
B. Phosphorylation of tyrosine kinase receptorExplanation
Insulin binds to a specific transmembrane tyrosine-kinase linked receptor located in cell membranes of most tissues. The receptor consists of two alpha subunits linked to two beta subunits. Insulin binding to the alpha subunits causes the activation of the beta-receptor subunit, which contain the tyrosine kinase. The enzyme is phosphorylated and this turn leads to cascade pathways which ultimately lead to a hypoglycemic effect. A, C; D; E) Actually all these action would lead to hyperglycemia, not hypoglycemiaRate this question:
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- 5.
A 18-year-old girl was admitted to the emergency room following a motor vehicle accident. She was obtunded and responded only to pain. Medical history obtained from her mother was unremarkable. Physical examination showed contusions on face and arms but no sings of cranial trauma. Vital signs: T 97°F, RR 22/min, pulse 124 bpm, BP 90/70 mm Hg. Blood values: HCO3- 6 mEq/L, glucose 847 mg/dL, creatinine 1.1 mg/dL. Urinalysis: specific gravity 1.036, glucose 4+, ketones 4+. Which of the following statements correctly pairs the most likely disorder of the patient with the appropriate emergency treatment?
- A.
Acute renal failure-IV furosemide
- B.
Diabetic ketoacidosis- IV insulin
- C.
Respiratory acidosis- IV bicarbonate
- D.
Diabetic ketoacidosis- SC NPH insulin
Correct Answer
B. Diabetic ketoacidosis- IV insulinExplanation
Metabolic conditions may be the result of received injuries or may be the cause of altered consciousness leading to the traumatic event, as in the present patient. Most likely the girl had an undetected diabetes that lead to the motor accident. The marked hyperglycemia, glycosuria and ketosis indicated that the patient has diabetic ketoacidosis and therefore must receive IV regular insulin at once.
A) Acute renal failure can result from a motor accident. However the lab results do not indicate kidney insufficiency. C) Even if the patient is acidotic (see the very low bicarbonate level) acidosis is due to
diabetes and therefore is metabolic not respiratory. In fact respiratory frequency is increased in the present patient. D) SC lente insulin has a slow onset of action and therefore is not useful in an
emergency situation.Rate this question:
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- 6.
A 22-year-old man with type I diabetes mellitus noticed symptoms of tachycardia, sweating, nausea, headache and dizziness following his participation in a game of football. The man has been maintained with twice daily injections of regular insulin and NPH insulin. Which of the following would be the most appropriate treatment for this patient?
- A.
SC regular insulin
- B.
Oral propanolol
- C.
IM glucagon
- D.
Oral glucose
Correct Answer
D. Oral glucoseExplanation
The symptoms and history of the patient indicate that he is experiencing exercise-induced hypoglycemia, which often occurs in patients under insulin treatment after a vigorous exercise. Oral glucose is the mo
st logical way to offset these symptoms. C) IM glucagon can be an appropriate therapy when hypoglycemia makes the patient unconscious, but not when the patient is able to take glucose by mouth.
A, B) Actually these drugs would be contraindicated in this patient.Rate this question:
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- 7.
A 42-year-old obese man with a 5-year history of type 2 diabetes has been reasonably well controlled with diet and 3 daily human insulin injections. Recently a lab test has shown a high titer of circulating IgG anti-insulin antibodies. The patient is most likely at an increased risk of which of the following disorders?
- A.
Urticaria
- B.
Hypoglycemic reaction
- C.
Insulin lipodystrophy
- D.
Hyperglycemia
Correct Answer
D. HyperglycemiaExplanation
Although there has been a dramatic decrease in the incidence of insulin resistance with the use of human insulin or purified preparations of the hormone, resistance can still develop especially in diabetics who are obese or have a long history of interrupted insulin therapy. In these patients there is a high titer of circulating IgG anti-insulin antibodies and therefore the risk of hyperglycemia is increased. A) Insulin urticaria is a type I allergic reactions and therefore is mediated by IgE anti-insulin antibodies. B) Since the patient has developed insulin resistance a hypoglycemic reaction is unlikely. C) Insulin lipohypertrophy is due to the anabolic actions of insulin. Since some of the injected insulin is neutralized by insulin antibodies the risk of this reaction should be decreased, not increased. D) The risk of diabetic ketoacidosis is theoretically increased but is much less likely than the risk of a simple hyperglycemia.Rate this question:
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- 8.
A 44-year-old man with type 1 diabetes started an intensive therapy in order to achieve a tight control of his diabetes. The man will most likely have an increased risk of which of the following conditions?
- A.
Loss of vision
- B.
Hypertension
- C.
Nephropathy
- D.
Hypoglycemia
- E.
Weight loss
- F.
Allergic reactions
Correct Answer
D. HypoglycemiaExplanation
A large, long term study has shown that a close control of blood glucose with multiple insulin injections or insulin pump, is associated with a lower incidence of long term complications of diabetes. However intensively treated patients had a threefold greater risk of hypoglycemia A, C) These pathological conditions are decreased, not increased, in patient with close control of blood glucose. B) Hypertension is not affected by a close control of blood glucose. On the other hand, another study has shown that a tight control of hypertension has a beneficial effect on diabetic microvascular complication. E) Patients tightly controlled have an increased risk of weight gain, not weight loss. F) Allergic reactions to insulin are not dose-dependent and therefore it is unlikely that they are affected by a close control of blood glucose.Rate this question:
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- 9.
A 45 year old chain smoker male visits his doctor for an annual check-up. Upon examination, his blood pressure was 158/98 mmHg. Which one of the following health complications is he likely to experience if he keeps his smoking habit, and his high blood pressure is untreated?
- A.
Arousal dysfunction
- B.
Depression
- C.
Impaired erection
- D.
Penile stiffness
- E.
Unlimited sexual arousal
Correct Answer
C. Impaired erection -
- 10.
Which one of the following neurohumoral factors is synthesized and released by the carvenous nerve in response to sexual arousal?
- A.
Acetylcholine
- B.
Dopamine
- C.
Nitrous oxide
- D.
Nitrogen dioxide
- E.
Nitric oxide
Correct Answer
E. Nitric oxide -
- 11.
Activation of which one of the following mechanisms favors penile erection for sexual activities in humans?
- A.
The parasympathetic nervous system
- B.
The sympathetic nervous system
- C.
Somatic nerve-cremaster muscle system
- D.
A and C
- E.
B and C
- F.
A, B, and C
Correct Answer
A. The parasympathetic nervous system -
- 12.
The activation of which one of the following enzymatic activities best explains the relaxation of penile arterial smooth muscle cells in response to sexual arousal?
- A.
NOS1
- B.
NOS2
- C.
NOS3
- D.
NOS1 and NOS2
- E.
NOS2 and NOS3
Correct Answer
C. NOS3 -
- 13.
The therapeutic effect of which of the following drugs is mediated by inhibiting a phosphodiesterase (PDE) other than PDE5?
- A.
Alprostadil
- B.
Apomorphine
- C.
Papaverine
- D.
Phentolamine
- E.
Sidenafil
Correct Answer
C. Papaverine -
- 14.
A 60 year old man reported to his doctor's office complaining that, although he still desires sex he has difficulty maintaining an erection. He is amenable to drug therapy but he is concerned about having to time his drug administration with anticipated sexual activity. Which one of the following drugs would be most appropriate for this patient?
- A.
Sildenafil
- B.
Tadalafil
- C.
Vardenafil
Correct Answer
B. Tadalafil -
- 15.
Yohimbine is a useful alternative medication for treating erectile dysfunction because it competitively blocks which of the following receptors?
- A.
Central 5-HT1 and 5-HT2A receptors
- B.
Central pre- and post-synaptic alpha2 receptors
- C.
Central pre-synaptic alpha 2 receptors
- D.
Peripheral 5-HT1 and 5-HT2A receptors
- E.
Peripheral alpha 1 receptors
- F.
A and C
- G.
B and D
Correct Answer
F. A and C -
- 16.
Which one of the following properties is the same for the clinically available PDE5 inhibitors in the treatment of erectile dysfunction?
- A.
Equal effectiveness and duration of action
- B.
High-fat foods decrease time to peak concentration
- C.
Metabolism by CYP3A4
- D.
Same half-life and adverse effects
- E.
Same time to peak concentration
Correct Answer
C. Metabolism by CYP3A4 -
- 17.
Which of the following conditions will prompt a reduction in the dose of sildenafil in a patient with erectile dysfunction?
- A.
Ashtma
- B.
Hyperthyroidism
- C.
Liver cirrhosis
- D.
Renal failure
- E.
Pulmonary hypertension
Correct Answer
C. Liver cirrhosis -
- 18.
A 16 year old female suffers from depression. Which of the following neurotransmitters is most likely deficient in this patient?
- A.
Acetylcholine
- B.
Dopamine
- C.
Epinephrine
- D.
Serotonin and Norepinephrine
Correct Answer
D. Serotonin and Norepinephrine -
- 19.
Which of the following options best describes the characteristics that are general to all antidepressants?
- A.
Equal effectiveness in depressed patients
- B.
Tricyclics are preferred to all other groups
- C.
Delayed onset of action
Correct Answer(s)
A. Equal effectiveness in depressed patients
C. Delayed onset of action -
- 20.
Which one of the following drugs is a prototype for tri-cyclic antidepressants?
- A.
Imipramine
- B.
Fluoxetine
- C.
Fluphenazine
- D.
Risperidone
- E.
Selegiline
Correct Answer
A. Imipramine -
- 21.
Mirtazapine is an atypical antidepressant that increases the synaptic y p levels of norepinephrine and serotonin by blocking which of the following receptor mechanisms?
- A.
Alpha 1 adrenoceptors
- B.
Alpha 2 adrenoceptors
- C.
Dopamine 2 receptors
- D.
5-HT receptors
Correct Answer
B. Alpha 2 adrenoceptors -
- 22.
A 45 year old female seeks treatment for depression, which has begun to seriously interfere with her ability to function. Her only other medical condition is hypertension. Which antidepressant would most likely exhibit added benefits in ameliorating her hypertension?
- A.
Venlafaxine
- B.
Duloxetine
- C.
Citalopram
- D.
Bupropion
- E.
Amitriptyline
Correct Answer
E. Amitriptyline -
- 23.
A patient was brought into the emergency department with a blood pressure of 210/140 mm Hg. He was having dinner which included several different types of cheese, wine, and after dinner drinks. His past medical history is significant for depression for which he has been taking appropriate drug therapy. Which of the following drugs has he most likely been taking?
- A.
Fluoxetine
- B.
Imipramine
- C.
Tranylcypromine
- D.
Venlafaxine
Correct Answer
C. Tranylcypromine -
- 24.
Which one of the following antidepressant agents inhibits hepatic microsomal enzymes to cause clinically significant drug-drug interactions?
- A.
Amitriptyline
- B.
Fluoxetine
- C.
Imipramine
- D.
Phenelzine
- E.
Trazodone
Correct Answer
B. Fluoxetine -
- 25.
The table summarizes the degree of blocking activity of five antidepressant drugs on norepinephrine and serotonin reuptake, as well as muscarinic (M) and histamine (H1) receptors (see table in supplement).
- A.
Drug 1
- B.
Drug 2
- C.
Drug 3
- D.
Drug 4
- E.
Drug 5
Correct Answer
E. Drug 5 -
- 26.
A 26 year old female is diagnosed with a major depressive disorder. The patient consents to counseling and medical treatment, but she is engaged to be married in 2 months and is concerned that antidepressants may lower her libido. Given her concerns, which of the following drugs would be the best option?
- A.
Venlafaxine
- B.
Fluoxetine
- C.
Duloxetine
- D.
Citalopram
- E.
Bupropion
Correct Answer
E. Bupropion -
- 27.
In a patient undergoing treatment for depression with venlafaxine, the potential for serotonin syndrome increases when in combination with which of the following classes of therapy?
- A.
Monoamine oxidase inhibitors
- B.
5-HT receptor antagonists
- C.
Tricyclic antidepressants
- D.
A and B
- E.
A and C
- F.
A, B, and C
Correct Answer
E. A and C -
- 28.
A 53 year old man visits the clinic for depression. He has had decreased interest and a depressed mood for the past 6 months and has been prescribed with a medication that causes him constipation, cycloplegia, and postural hypotension. Which class of antidepressant medication was he probably taking?
- A.
Atypical antidepressants
- B.
SSRIs
- C.
SNRIs
- D.
Tricyclic antidepressants
Correct Answer
D. Tricyclic antidepressants -
- 29.
An 69 year old retired male patient complains of sexual dysfunction and worsening weight loss for some time. A review of his chart discloses that he is on fluoxetine (an antidepressant drug). Which of the following drugs is a suitable substitute medication for managing this patient’s depression, and minimize his side effect profiles?
- A.
Citalopram
- B.
Clomipramine
- C.
Mirtazapine
- D.
Paroxetine
- E.
Venlafaxine
Correct Answer
C. Mirtazapine -
- 30.
The activation of which one of the following enzymatic activities best explains the relaxation of penile arterial smooth muscle cells in response to sexual arousal?
- A.
NOS1
- B.
NOS2
- C.
NOS3
- D.
NOS1 and NOS2
- E.
NOS1 and NOS3
- F.
NOS1, NOS2 and NOS3
Correct Answer
E. NOS1 and NOS3 -
- 31.
A 60 year old man reported to his doctor's office complaining that, although he still desires sex he has difficulty maintaining an erection. He is amenable to drug therapy but he is concerned about having to time his drug administration with anticipated sexual activity. Which one of the following drugs would be most appropriate for this patient and why??
- A.
Sildenafil, Long T1/2
- B.
Tadalafil, Long T1/2
- C.
Vardenafil, Long T1/2
- D.
Sildenafil, Less side effects
- E.
Tadalafil, Few side effects
Correct Answer
B. Tadalafil, Long T1/2 -
- 32.
Yohimbine is a useful alternative medication for treating erectile dysfunction because it completely blocks which of the following receptors?
- A.
Central 5-HT receptors in general
- B.
Central pre- and post-synaptic alpha 2 receptors
- C.
Central pre-synaptic alpha 2 receptors
- D.
Peripheral 5-HT1 and 5-HT 2A receptors
- E.
A and C
- F.
B and D
Correct Answer
C. Central pre-synaptic alpha 2 receptors -
- 33.
A 60-year old man presents to an outpatient clinic, reporting that he can no longer maintain an erection sufficient for intercourse. His medical history includes stable coronary artery disease for which he is being treated with an organic nitrate. The doctor placed him on alprostadil, which he uses prior to sexual activity. By which of the following mechanisms does this medication cause erection in this patient?
- A.
Increase cAMP
- B.
Increase cGMP
- C.
Decrease Ca2+sensitivity in penile smooth muscle
- D.
A and B
- E.
A and C
- F.
A, B, and C
Correct Answer
E. A and C -
- 34.
A 60-year old man presents to an outpatient clinic, reporting that he can no longer maintain an erection sufficient for intercourse. His medical history includes stable coronary artery disease for which he is being treated with an organic nitrate. The doctor placed him on alprostadil, which of the following ED medications is contraindicated in this kind of patient?
- A.
Apomorphine
- B.
Papaverine
- C.
Tadalafil
- D.
Yohimbine
- E.
A, B, and C
Correct Answer
C. Tadalafil -
- 35.
A 65-year old man presents to an out-patient clinic reporting that he can no longer maintain an erection sufficient for intercourse. His medical history includes a stable coronary artery disease for which he is using an organic nitrate. Which of the following reasons best explains why tadalafil is contraindicated for this patient?
- A.
Additive erectile effect
- B.
Additive ejaculatory effect
- C.
Additive hypertensive effect
- D.
Additive hypotensive effect
- E.
Additive SM contractile effect
Correct Answer
D. Additive hypotensive effect -
- 36.
The diagram below depicts the response for increasing amounts of agonist stimulation of a signalling pathway mediated by cyclic GMP in corpus cavernosa. There are four curves, one for absence of the inhibitor and three for different concentration levels of the inhibitor. Which curve represents the response in the presence of the lowest concentration of the phosphodiesterase inhibitor?
- A.
Curve D
- B.
Curve C
- C.
Curve B
- D.
Curve A
Correct Answer
B. Curve C -
- 37.
The diagram on the right depicts the response for increasing amounts of agonist stimulation of a signaling pathway mediated by cyclic GMP in corpus cavernosum. p There are four curves, one for absence of the inhibitor and three for different concentration levels of the inhibitor. Which curve represents the response in the absence of the phosphodiesterase inhibitor?
- A.
Curve D
- B.
Curve C
- C.
Curve B
- D.
Curve A
Correct Answer
A. Curve D -
- 38.
A 55-year-old obese man has been recently diagnosed with type 2 diabetes mellitus. The patient has been suffering from chronic obstructive pulmonary disease for 5 years and from hypertension for 3 years. His current therapy includes ipratropium and captopril. Which of the following antidiabetic drugs would be contraindicated in this patient?
- A.
Acarbose
- B.
Metformin
- C.
Regular insulin
- D.
Regaplinide
Correct Answer
B. MetforminExplanation
Biguanides are contraindicated in all conditions that predispose to acidosis. This patient is suffering from chronic obstructive pulmonary disease and is under treatment with an ACE inhibitor. The respiratory disease predisposes to respiratory acidosis and ACE inhibitors predispose to metabolic acidosis because they lower aldosterone levels. A, C, D) All these drugs are not contraindicated in this patientRate this question:
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- 39.
Which of the following drugs mimics the effects of GLP-1?
- A.
Exenatide
- B.
Glyburide
- C.
NPH Insulin
- D.
Lispro Insulin
- E.
Metformin
- F.
Pioglitazone
- G.
Regular Insulin
- H.
Repaglinide
- I.
Sitagliptin
Correct Answer
A. ExenatideExplanation
A) Exenatide is a GLP-1 agonist B) Glyburide is a sulfonylureas which binds to a specific receptor (SUR) on pancreatic β cells. Binding closes an ATP-dependent K+ channel, leading to decreased potassium influx and subsequent depolarization of the membrane ultimately causing release of insulin.
C,D,G) Insulin initiates its actions by binding to cell-surface receptors which belong to the family of receptor tyrosine kinases. Binding of insulin to its receptor activates a cascade of downstream signaling events which contribute to the array of biological responses elicited by insulin including promoting translocation of GLUT4 to cell membranes of muscle and adipose tissue to stimulate glucose uptake. E) Metformin activates AMP-dependent protein kinase which decreases hepatic glucose production (inhibits hepatic gluconeogenesis and glycogenolysis) and, as a secondary effect, enhances insulin sensitivity of both hepatic and peripheral (muscle) tissues allowing for increased uptake of glucose into these insulin-sensitive tissues F) Pioglitazone, glitazone, works by binding to the peroxisome proliferator activator receptorγ (PPAR-γ), which are primarily located on fat cells, which activate genes involved in glucose and lipid metabolism. H) Repaglinide stimulates insulin secretion from the β cells in a manner similar to that of the sulfonylureas I) Sitagliptin inhibits DPP-IV, the enzyme responsible for inactivation and degradation of the incretin hormones including GLPRate this question:
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- 40.
A 45-year-old woman with a 3-year history of type 2 diabetes has been reasonably well controlled with diet and glyburide. Recently her fasting blood glucose started rising and the physician decided to add a second antidiabetic drug that acts on a nuclear receptor and decreases insulin resistance in target cells. Which of the following drugs was most likely prescribed?
- A.
Glyburide
- B.
Metformin
- C.
Miglitol
- D.
Pioglitazone
- E.
Repaglinide
Correct Answer
D. PioglitazoneExplanation
A secondary failure to oral antidiabetic agents occurs when a poor diabetic control follows an extended period of good response to the therapy. Secondary failure to sulfonylureas is fairly common and occurs at a rate of 5% to 10% per year in patients previously well controlled on these drugs, as in the present case. When secondary failure to any oral agent occurs another agent should always added to the therapeutic regimen. Glitazones (thiazolidinediones) like pioglitazone decrease insulin resistance in muscle and liver. Their precise molecular mechanism of action is still uncertain, but it is most likely related to the fact that these drugs bind and activate a nuclear receptor, peroxisome proliferator-activated receptor γ, present in mostly in adipose cells. This activation regulates the transcription of insulin responsive genes that influence glucose and lipid metabolism. A, E) Since the patient showed a poor response to one sulfonylurea it is illogical to add another drug of the same class or a drug with a very close mechanism of action like repaglinide. B, C) Metformin is an insulin sensitizer whereas miglitol inhibits alpha-glucosidase. These drugs could be added to the therapy, but they do not act on nuclear receptors.Rate this question:
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- 41.
An 81-year-old obese man has been recently diagnosed with type 2 diabetes (fasting blood glucose 160 mg/dL). The man has a 5-year history of mild renal failure. The physician is concerned about the possibility of hypoglycemia that is more frequent in older persons. Which of the following drugs would be most appropriate as a starting therapy for this patient?
- A.
Glyburide
- B.
Metformin
- C.
Miglitol
- D.
Repaglinide
Correct Answer
C. MiglitolExplanation
Miglitol, an alpha-glucosidase inhibitor, does not cause hypoglycemia even when given in very high doses. Other antidiabetic drugs that do not cause hypoglycemia are biguanides and thiazolidinediones (glitazones). However biguanides are contraindicated in this patient because of the renal failure. A) Sulfonylureas can cause hypoglycemia in about 20% of cases. B) Metformin is contraindicated in this pat
ient because it is eliminated via the kidney. D) Meglitinides can cause hypoglycemia in about 15% of cases.Rate this question:
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- 42.
A 72-year-old woman who was taking a drug for type 2 diabetes mellitus was hospitalized because of malaise, respiratory distress, nausea and vomiting, and lethargy. On admission vital signs were: blood pressure 134/90 mm Hg, pulse 80 bpm, respiration 32 breaths/min. Laboratory data showed an anion gap of 24 mmol/L (normal<12), plasma lactate of 6 mmol/L (normal 0.5-1.5), creatinine 3.2 mg/dL, and arterial blood pH 7.24. The patient was most likely receiving which of the following drugs?
- A.
Exenatide
- B.
Glucagon
- C.
Metformin
- D.
Pioglitazone
- E.
Repaglinide
Correct Answer
C. MetforminExplanation
The symptoms of the patient and the lab data indicate that she was suffering from lactic acidosis, a serious adverse effect of biguanides. Lactic acidosis is extremely rare, but can occur more frequently in old patients or in patient with renal insufficiency, like in the present case (see creatinine value). The syndrome, which is highly lethal (50% mortality) seems due to drug induced inhibition of gluconeogenesis which in turn impairs the hepatic uptake of lactic acid. A, B, D, E) These drugs do not cause lactic acidosis.Rate this question:
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- 43.
Which of the following drugs inhibits dipeptidyl peptidase IV?
- A.
Exenatide
- B.
Glyburide
- C.
NPH Insulin
- D.
Lispro Insulin
- E.
Metformin
- F.
Pioglitazone
- G.
Regular Insulin
- H.
Repaglinide
- I.
Sitagliptin
Correct Answer
I. SitagliptinExplanation
A) Exenatide is a GLP-1 agonist B) Glyburide is a sulfonylureas which binds to a specific receptor (SUR) on pancreatic β cells. Binding closes an ATP-dependent K+ channel, leading to decreased potassium influx and subsequent depolarization of the membrane ultimately causing release of insulin.
C,D,G) Insulin initiates its actions by binding to cell-surface receptors which belong to the family of receptor tyrosine kinases. Binding of insulin to its receptor activates a cascade of downstream signaling events which contribute to the array of biological responses elicited by insulin including promoting translocation of GLUT4 to cell membranes of muscle and adipose tissue to stimulate glucose uptake.
E) Metformin activates AMP-dependent protein kinase which decreases hepatic glucose production (inhibits hepatic gluconeogenesis and glycogenolysis) and, as a secondary effect, enhances insulin sensitivity of both hepatic and peripheral (muscle) tissues allowing for increased uptake of glucose into these insulin-sensitive tissues F) Pioglitazone, glitazone, works by binding to the peroxisome proliferator activator receptor-γ (PPAR-γ), which are primarily located on fat cells, which activate genes involved in glucose and lipid metabolism. H) Repaglinide stimulates insulin secretion from the β cells in a manner similar to that of the sulfonylureas I) Sitagliptin inhibits DPP-IV, the enzyme responsible for inactivation and degradation of the incretin hormones including GLPRate this question:
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- 44.
A 21-year-old obese man with a 2-year history of type 2 diabetes mellitus is found to have a fasting blood glucose level of 220 mg/dL and a blood pressure of 165/105. His diabetes has been reasonably well controlled in the past with diet and glipizide. The physician decides to switch to insulin treatment and to start an antihypertensive therapy. Which of the following antihypertensive drugs would be relatively contraindicated in this patient?
- A.
Captopril
- B.
Propanolol
- C.
Clonidine
- D.
Hydralazine
- E.
Diltiazem
Correct Answer
B. PropanololExplanation
A relative contraindication is a condition which makes a particular treatment or procedure somewhat inadvisable but does not rule it out. For example, X-rays in pregnancy are relatively contraindicated (because of concern for the developing fetus) unless the X-rays are absolutely necessary. Nonselective beta-blockers are relatively contraindicated in diabetic patients under insulin therapy since they can mask symptoms of hypoglycemia and block glycogenolysis, so impairing the body’s capacity to
recover from hypoglycemia. A, C, D, E) These drugs are not contraindicated in diabetic patients.Rate this question:
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- 45.
The mechanism of action of antiseizure drugs includes which of the following?
- A.
Activation of glutamate receptors
- B.
Enhancement of GABA-mediated synaptic inhibition
- C.
Blockade of resting Na+ channels
- D.
Enhancement of Ca2+ current through T -type Ca2+ channels
- E.
Blockade of K+ channels
Correct Answer
B. Enhancement of GABA-mediated synaptic inhibitionExplanation
The mechanisms of action of antiseizure drugs are still not well understood but have been found to concern mainly: a) Blockade of voltage-operated ion channels b) Enhancement of inhibitory synaptic functions c) Inhibition of excitatory synaptic functions Enhancement GABA-mediated synaptic inhibition, which mediates the bulk of inhibitory synaptic transmission in mammalian brain, seems to be the mechanism of action of many antiseizure drugs, including barbiturates, valproic acid, benzodiazepines, gabapentin, and tiagabine. Blockade of voltage-sensitive T-type Ca++ channels is the main mechanism of action of ethosuximide; valproic acid also blocks these channels. Carbamazepine, lamotrigine, phenytoin, topiramate, and valproic acid all block inactivated voltage-gated Na+ channels. A, D, E) These actions would cause membrane depolarization and therefore would increase, not decrease, the risk of epileptic seizure. C) Antiseizure drugs block Na+ channels in the inactivated state but they have no effects on resting Na+ channelsRate this question:
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- 46.
A 10-year-old boy was brought to the hospital after his parents had observed repeated episodes in which he stopped speaking in midsentence, dropped what was in his hands, and stared into space for a few moments. An EEG showed 3 second spike wave activity. Which of the following drugs would be appropriate for this patient?
- A.
Phenobarbital
- B.
Carbamazepine
- C.
Ethosuximide
- D.
Gabapentin
- E.
Tiagabine
Correct Answer
C. EthosuximideExplanation
The boy was most likely affected by absence seizure, a common epileptic seizure in children. Ethosuximide is the preferred drug in absence seizures. It prevents the attacks in about 60% of patients and diminishes their frequency in 20-30% of patients. The earlier the treatment, the greater the efficacy of the therapy; best results are obtained if therapy is started within 1-3 months since the beginning of attacks. A, B, D, E) These drugs are not effective in absence seizures.Rate this question:
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- 47.
Which of the following statements correctly pairs the antiepileptic drug with its main therapeutic indication?
- A.
Carbamazepine- myoclonic
- B.
Lorazepam- partial seizures
- C.
Tiagabine- status epilepticus
- D.
Valproic acid- tonic-clonic seizures
Correct Answer
D. Valproic acid- tonic-clonic seizuresExplanation
Valproic acid is very effective in tonic-clonic seizures, especially those which are primarily generalized. A, B, C) All these drug are not effective against the mentioned seizures.Rate this question:
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- 48.
A 23-year-old woman suddenly lost consciousness in the dining room, became rigid and fell to the floor. Her respiration temporarily ceased. About 1 minute later, jerking of all four limbs supervened for about 3 minutes, then the woman was unconscious for about 4 minutes. She was brought to the emergency room by the ambulance. On examination the patient was drowsy, but the neurologic examination was otherwise unremarkable and vital signs were normal. A CT scan turned out to be negative. Which of the following drugs represent therapeutic options for this patient? (Check all that apply)
- A.
Carbamepine
- B.
Ethosuximide
- C.
Lorazepam
- D.
Lamotrigine
Correct Answer(s)
A. Carbamepine
D. LamotrigineExplanation
The patient most likely suffered from a tonic-clonic seizure. Since the CT scan was normal a secondary seizure due to a brain disorder (infarct, hemorrhage, tumor, etc.) is unlikely and the diagnosis of generalized epilepsy is the most probable. Carbamazepine, lamotrigine, topiramate, and valproate are first-line drugs for treating generalized tonic-clonic seizures. B) This drug is a first-line drug in treating absence seizures C) This drug is a first-line drug in treating status epilepticusRate this question:
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- 49.
A 31-year old woman, recently diagnosed with myoclonic seizures, presented to her neurologist complaining of impaired balance. The woman has been taking an anticonvulsant drug for 1 month. Physical examination showed truncal ataxia and a positive Romberg test. The neurologist decided to decrease the dose of the drug the patient was taking. Which of the following drugs was the patient most likely taking?
- A.
Valproic acid
- B.
Ethosuximide
- C.
Lorazepam
- D.
Phenytoin
Correct Answer
A. Valproic acidExplanation
A Romberg test is done with the patient standing up with their arms extended in front of them. They are asked to do this first with their eyes open and then with them closed. The test is positive if they are unsteady with the eye closed. This indicates a loss of proprioceptive control. Ataxia is an inability to coordinate muscle activity causing jerkiness and incoordination. Many antiseizure drugs, including valproic acid can cause an array of adverse effects that are related to cerebellovestibular impairment. These include nystagmus, diplopia and, ataxia. B, C, D) Although some of these drugs may cause ataxia, they are not first-line drugs or myoclonic seizures.Rate this question:
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- 50.
Which of the following antiseizure drugs is most likely to decrease the plasma levels of other drugs administered concomitantly?
- A.
Valproic Acid
- B.
Topiramate
- C.
Lamotrigine
- D.
Gabapentin
- E.
Phenobarbital
Correct Answer
E. PhenobarbitalExplanation
Phenobarbital is a classic inducer of liver P450 enzymes (2C and 3A families of enzymes) and so can decrease the plasma levels of many drugs. Carbamazepine and phenytoin also can induce the same enzymes. Carbamazepine is noteworthy because it induces its own metabolism (autoinduction). A, B, C, D) These drugs are not inducers of liver P450 system.Rate this question:
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Mar 21, 2022Quiz Edited by
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Apr 07, 2014Quiz Created by
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