Pharmacology Test 3

104 Questions

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Pharmacology Test 3

Endocrine, Reproduction and Central Nervous System


Questions and Answers
  • 1. 
    Which drug used in management of seizure disorders is most likely to elevate the plasma concentration of other drugs administered concomitantly?
    • A. 

      Carbamazepine

    • B. 

      Clonazepine

    • C. 

      Gabapentin

    • D. 

      Valproic Acid

    • E. 

      Vigabatrin

  • 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

  • 3. 
    Which of the following best describes the mechanism of action of benzodiazepines?
    • A. 

      Activate GABAb receptors in the spinal cord

    • B. 

      Block glutamate receptors in hierarchical neuronal pathways in the brain

    • C. 

      Increase frequency of opening of chloride ion channels coupled to GABAa receptors

    • D. 

      Inhibit GABA transaminase to increase brain levels of GABA

    • E. 

      That if he stops taking the drug abruptly, he will experience withdrawal signs

    • F. 

      Stimulate release of GABA from nerve endings in the brain

  • 4. 
    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

  • 5. 
    Which of the following contributes to the therapeutic effects of benzodiazepines?
    • A. 

      Increase GABA release

    • B. 

      Activation of GABAb receptors

    • C. 

      Blockade of glutamate receptors

    • D. 

      Inhibition of GABA transaminase

    • E. 

      Increased frequency of chloride channel opening

  • 6. 
    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

  • 7. 
    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

  • 8. 
    Benzodiazepines can worsen the condition in a patient with which of the following?
    • A. 

      Myasthenia gravis

    • B. 

      Panic disorders

    • C. 

      Tonic-clonic seizures

    • D. 

      Febrils convulsions in children

  • 9. 
    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

  • 10. 
    Which drug used in the maintenance treatment of patients with tonic-clonic or partial seizure states increases the hepatic metabolism of many drugs including both warfarin and phenytoin?
    • A. 

      Buspirone

    • B. 

      Chlordiazepoxide

    • C. 

      Eszopiclone

    • D. 

      Phenobarbital

    • E. 

      Triazolam

  • 11. 
    A 24-year-old man with a history of partial seizures has been treated with standard anticonvulsants for several years. He is currently taking valproic acid, which is not fully effective, and his neurologist prescribes another drug approved for adjunctive use in partial seizures. Unfortunately, the patient develops a toxic epidermal necrolysis. The second drug prescribed was
    • A. 

      Diazepam

    • B. 

      Ethosuximide

    • C. 

      Lamotrigine

    • D. 

      Phenobarbital

  • 12. 
    Which of the following adverse effects represents potential problems when flurazepam is used as a hypnotic? (Check all that apply)
    • A. 

      Daytime sedation

    • B. 

      Early awakening

    • C. 

      Irritability

    • D. 

      Apnea

  • 13. 
    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

  • 14. 
    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

  • 15. 
    Regarding the clinical use of antidepressant drugs, which statement is accurate?
    • A. 

      Chronic use of antidepressants increases the activity of hepatic drug metabolizing enzymes

    • B. 

      In the treatment of major depressive disorders, sertaline is usually more effective that fluoxetine

    • C. 

      Tricyclics are highly effective in depressions with attendant anxiety, phobic features, and hypochondriasis

    • D. 

      Weight gain often occurs during the first few months in patients taking SSRIs

    • E. 

      When selecting an appropriate drug for treatment of depression, the history of patient response to specific drugs is a valuable guide

  • 16. 
    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

  • 17. 
    Which of the following drugs is most likely to cause hypoglycemia when used as monotherapy in the treatment of a patient with type 2 diabetes?
    • A. 

      Acarbose

    • B. 

      Glipizide

    • C. 

      Metformin

    • D. 

      Miglitol

    • E. 

      Rosiglitazone

  • 18. 
    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

  • 19. 
    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

  • 20. 
    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

  • 21. 
    Which of the following drugs is most likely to cause hypoglycemia when used as monotherapy in the treatment of type 2 diabetes?
    • A. 

      Acarbose

    • B. 

      Glyburide

    • C. 

      Metformin

    • D. 

      Miglitol

    • E. 

      Rosiglitazone

  • 22. 
    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

  • 23. 
    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

  • 24. 
    • A. 

      Inhibition of glucose transporters in pancreas cell membranes

    • B. 

      Phosphorylation of tyrosine kinase receptors

    • C. 

      Activation of ATP-sensitive K+ channels in target cells

    • D. 

      Stimulation of hormone sensitive lipase

    • E. 

      Inhibition of liver glucokinase

  • 25. 
    Which of the following drugs is taken during the first part of a meal for the purpose of delaying the absorption of dietary carbohydrates?
    • A. 

      Acarbose

    • B. 

      Exenatide

    • C. 

      Glipizide

    • D. 

      Pioglitazone

    • E. 

      Repaglinide

  • 26. 
    • A. 

      Ethosuximide

    • B. 

      Valproic Acid

    • C. 

      Carbamazepine

    • D. 

      Gabapentin

    • E. 

      Lorazepam

  • 27. 
    Triazolam is devoid of which of the following effects?
    • A. 

      Sedative

    • B. 

      Hypnotic

    • C. 

      Muscle relaxant

    • D. 

      Antipsychotic

    • E. 

      Anticonvulsant

  • 28. 
    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

  • 29. 
    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

  • 30. 
    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

  • 31. 
    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

  • 32. 
    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

  • 33. 
    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

  • 34. 
    Benzodiazepines can be quite dangerous when given together with which of the following drugs?
    • A. 

      Ethanol

    • B. 

      Flumazenil

    • C. 

      Naloxone

    • D. 

      Naproxen

  • 35. 
    Which one of the following drugs promotes the release of endogenous insulin?
    • A. 

      Acarbose

    • B. 

      Glipizide

    • C. 

      Metformin

    • D. 

      Miglitol

    • E. 

      Pioglitazone

  • 36. 
    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

  • 37. 
    Which of the following is a prominent feature of the metabolites of benzodiazepines?
    • A. 

      Short half-lives

    • B. 

      Pharmacologically active

    • C. 

      Mainly distributed in the plasma

    • D. 

      Potent inducers of microsomal enzymes

  • 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

  • 39. 
    In a laboratory study of a new agent, the activity of a membrane-bound enzyme was found to be increased by the drug. Analysis of this enzyme molecule revealed that it is an integral tyrosine kinase, the extracellular domain of which binds ligands while the intracellular domain phosphorylates tyrosine residues. Which of the following receptors communicate their activation by turning on an integral intracellular tyrosine kinase domain?
    • A. 

      Acetylcholine nicotinic receptors

    • B. 

      G-protein coupled receptors

    • C. 

      Insulin receptors

    • D. 

      Steroid receptors

    • E. 

      Vitamin D receptors

  • 40. 
    A 34-year-old male patient who was prescribed citalopram for depression has decided he wants to stop taking the drug. When questioned, he said that it was affecting his sexual performance. You ascertain that he is also trying to overcome his dependency on tobacco products. If you decide to reinstitute drug therapy in this patient, the best choice would be
    • A. 

      Bupropion

    • B. 

      Fluoxetine

    • C. 

      Imipramine

    • D. 

      Paroxetine

    • E. 

      Venlafaxine

  • 41. 
    Which of the following drugs used in the treatment of type 2 diabetes inhibits hepatic gluconeogenesis?
    • A. 

      Glyburide

    • B. 

      Metformin

    • C. 

      Sitagliptin

    • D. 

      Exenatide

    • E. 

      Pioglitazone

  • 42. 
    A 24-year-old woman with type 1 diabetes wishes to try tight control of her diabetes to improve her long-term prognosis. Which of the following regimens is most appropriate?
    • A. 

      Morning injections of mixed insulin lispro and insulin aspart

    • B. 

      Evening injections of mixed regular insulin and insulin glargine

    • C. 

      Morning and evening injections of regular insulin, supplemented by small amounts of insulin lispro at mealtimes

    • D. 

      Morning injections of insulin glargine, supplemented by small amounts of insulin lispro at mealtimes

    • E. 

      Morning injections of NPH insulin and evening injection of regular insulin

  • 43. 
    Which one of the following drugs is a prototype for tri-cyclic antidepressants?
    • A. 

      Imipramine

    • B. 

      Fluoxetine

    • C. 

      Fluphenazine

    • D. 

      Risperidone

    • E. 

      Selegiline

  • 44. 
    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

  • 45. 
    Which of the following is an oral antidiabetic drug that inhibits an enzyme in the gastrointestinal tract that converts polysaccharides to monosaccharides and thereby reduces postprandial hyperglycemia?
    • A. 

      Acarbose

    • B. 

      Glipizide

    • C. 

      Metformin

    • D. 

      Rosiglitazone

    • E. 

      Sitagliptin

  • 46. 
    A 46-year-old man consults you regarding his sexual performance issues. A drug that is used in the treatment of male erectile dysfunction and inhibits a phosphodiesterase is?
    • A. 

      Finasteride

    • B. 

      Fluoxetine

    • C. 

      Mifepristone

    • D. 

      Sildenafil

    • E. 

      Timolol

  • 47. 
    Which of the following statements correctly pairs the antiepileptic drug with one of its potential adverse effects? (Check all that apply)
    • A. 

      Phenytoin- hypoglycemia

    • B. 

      Valproic Acid- acute hepatitis

    • C. 

      Ethosuximide- gingival hyperplasia

    • D. 

      Carbamazepine- exacerbate absence seizures

    • E. 

      Phenobarbital- nystagmus

  • 48. 
    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

  • 49. 
    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

  • 50. 
    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

  • 51. 
    Which of the following is an important effect of insulin?
    • A. 

      Increased conversion of amino acids into glucose

    • B. 

      Increased gluconeogenesis

    • C. 

      Increased glucose transport into cells

    • D. 

      Inhibition of lipoprotein lipase

    • E. 

      Stimulation of glycogenolysis

  • 52. 
    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

  • 53. 
    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

  • 54. 
    A 35-year-old woman who has never been pregnant suffers each month from pain, discomfort, and mood depression at the time of menses. She may benefit from the use of this selective inhibitor of the reuptake of serotonin in a form that can be taken once weekly.
    • A. 

      Amoxapine

    • B. 

      Bupropion

    • C. 

      Fluoxetine

    • D. 

      Mirtazapine

    • E. 

      Tranylcypromine

  • 55. 
    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

  • 56. 
    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

  • 57. 
    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

  • 58. 
    A 55-year-old man being treated with a monoamine oxidase inhibitor for resistant major depressive disorder is admitted to the emergency department with a stroke after consuming a large meal in a restaurant. His blood pressure on admission is 180/110 mmHg. When monoamine oxidase inhibitors are used as antidepressant drugs, some patients may suffer hemodynamic effects caused by tyramine in their diet. Which of the following is the primary site of action of tyramine?
    • A. 

      Ganglionic receptors

    • B. 

      Gut and liver catechol-O-methyltransferase

    • C. 

      Postganglionic sympathetic nerve terminals

    • D. 

      Preganglionic sympathetic nerve terminals

    • E. 

      Vascular smooth muscle receptors

  • 59. 
    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

  • 60. 
    A 54-year-old obese patient with type 2 diabetes has a history of alcoholism. In this patient, metformin should either be avoided or used with extreme caution because the combination of metformin and ethanol increases the risk of which of the following?
    • A. 

      A disulfiram-like reaction

    • B. 

      Excessive weight gain

    • C. 

      Hypoglycemia

    • D. 

      Lactic acidosis

    • E. 

      Serious hepatotoxicity

  • 61. 
    Abrupt withdrawal of antiseizure drugs can result in increases in seizure frequency and severity. Withdrawal is most easily accomplished if the patient is being treated with
    • A. 

      Carbamazepine

    • B. 

      Diazepam

    • C. 

      Ethosuximide

    • D. 

      Phenobarbital

    • E. 

      Phenytoin

  • 62. 
    A 56-year-old man was brought to the emergency department complaining of blurred vision and an increased sensitivity to light. He has a history of erectile dysfunction for which he uses appropriate drug therapy. Which of the following drugs did he most likely take?
    • A. 

      Vardenafil

    • B. 

      Alprostadil

    • C. 

      Papaverine

    • D. 

      Phentolamine

  • 63. 
    After ingestion of a meal that included sardines, cheese, and red wine, a patient taking phenelzine experienced a hypertensive crisis. The most likely explanation for this untoward effect is that phenelzine
    • A. 

      Acts to release tyramine from these foods

    • B. 

      Inhibits MAO type B

    • C. 

      Inhibits the metabolism of catecholamines

    • D. 

      Is an activator of tyrosine hydroxylase

    • E. 

      Promotes the release of norepinephrine from sympathetic nerve endings

  • 64. 
    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

  • 65. 
    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

  • 66. 
    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

  • 67. 
    A 13-year-old boy with type 1 diabetes is brought to the hospital complaining of dizziness. Laboratory findings include severe hyperglycemia, ketoacidosis, and a blood pH of 7.15. Which of the following is the most likely complication of insulin therapy in this patient?
    • A. 

      Dilutional hyponatremia

    • B. 

      Hypoglycemia

    • C. 

      Increased bleeding tendency

    • D. 

      Pancreatitis

    • E. 

      Severe hypertension

  • 68. 
    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

  • 69. 
    • A. 

      Propanolol

    • B. 

      Diltiazem

    • C. 

      Nitroglycerin

    • D. 

      Nifedipine

    • E. 

      Verapamil

  • 70. 
    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

  • 71. 
    • A. 

      Carbamazepine

    • B. 

      Ethosuximide

    • C. 

      Lamotrigine

    • D. 

      Topiramate

  • 72. 
    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

  • 73. 
    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

  • 74. 
    A young female patient suffers from absence seizures. Which of the following statements about her proposed drug management is NOT accurate?
    • A. 

      Ethosuximide and Valproic Acid are preferred drugs

    • B. 

      GI side effects are common with ethosuximide

    • C. 

      She should be examined every 2 or 3 months for deep tendon reflex activity

    • D. 

      The use of valproic acid in pregnancy may cause congenital malformations

    • E. 

      Weight gain is common in patients on valproic acid

  • 75. 
    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

  • 76. 
    A young woman suffering from myoclonic seizures was receiving effective single-drug therapy. Because she was planning a pregnancy, her physician switched her to an alternative medication with much less potential for teratogenicity. The original antiseizure drug prescribed for this patient was most likely to have been
    • A. 

      Baclofen

    • B. 

      Diazepam

    • C. 

      Ethosuximide

    • D. 

      Olanzapine

    • E. 

      Valproic Acid

  • 77. 
    The mechanism of antiseizure activity of carbamazepine is
    • A. 

      Block of Na+ channels

    • B. 

      Block of Ca2+ channels

    • C. 

      Facilitation of GABA actions on chloride ion channels

    • D. 

      Glutatmate receptors antagonism

    • E. 

      Inhibition of GABA transaminase

  • 78. 
    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

  • 79. 
    The PPAR-γ receptor that is activated by thiazolidinediones increases tissue sensitivity to insulin by which of the following mechanisms?
    • A. 

      Activating adenylyl cyclase and increasing the intracellular concentration of cAMP

    • B. 

      Inactivating an a cellular inhibitor of the GLUT2 glucose transporter

    • C. 

      Inhibiting acid glucosidase, a key enzyme in glycogen breakdown pathways

    • D. 

      Regulating transcription of genes involved in glucose utilization

    • E. 

      Stimulating the activity of a tyrosine kinase that phosphorylates the insulin receptor

  • 80. 
    A 61-year-old obese man complained of difficulty in falling asleep and asked his physician for a sleeping pill. The man has been recently diagnosed with obstructive sleep apnea, most likely due to obesity. Which of the following drugs should be used with caution or not at all in this patient? (Check all that apply)
    • A. 

      Flurazepam

    • B. 

      Temazepam

    • C. 

      Triazolam

    • D. 

      Zolpidem

  • 81. 
    A young male patient suffers from a seizure disorder characterized by tonic rigidity of the extremities followed in 15–30 s of tremor progressing to massive jerking of the body. This clonic phase lasts for 1 or 2 min, leaving the patient in a stuporous state. Of the following drugs, which is most suitable for longterm management of this patient?
    • A. 

      Carbamazepine

    • B. 

      Clonazepam

    • C. 

      Ethosuximide

    • D. 

      Felbamate

    • E. 

      Tiagabine

  • 82. 
    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

  • 83. 
    The most likely explanation for the increased sensitivity of elderly patients after administration of a single dose of a benzodiazepine is
    • A. 

      Changes in brain function accompanying aging

    • B. 

      Changes in plasma protein binding

    • C. 

      Decreased hepatic metabolism of lipid-soluble drugs

    • D. 

      Decreases in renal function

    • E. 

      Increased cerebral blood flow

  • 84. 
    A 55-year-old woman with type 2 diabetes was going to be started on metformin. Before initiating therapy, it is important to confirm that the patient has normal renal function because patients with unrecognized renal insufficiency who take normal doses of metformin are at increased risk of which of the following?
    • A. 

      Hypoglycemia

    • B. 

      Interstitial nephritis

    • C. 

      Lactic acidosis

    • D. 

      Liver failure

  • 85. 
    After a very large overdose of diazepam a 2-year-old child is admitted to the hospital. Along with general supportive care, the administration of which of the following is most likely to be used to reverse the action of the benzodiazepine?
    • A. 

      Acetylcysteine

    • B. 

      Atropine

    • C. 

      Flumazenil

    • D. 

      Fomepizole

    • E. 

      Naloxone

  • 86. 
    Which statement about nitric oxide is most correct?
    • A. 

      Nitric oxide is syntheized in vascular endothelium and the brain

    • B. 

      Nitric oxide is released from storage vesicles by acetylcholine

    • C. 

      Nitric oxide synthase is stimulated by nitroprusside

    • D. 

      Nitric oxide synthase is inhibited by histamine

    • E. 

      Nitric oxide causes pulmonary vasoconstriction

  • 87. 
    A 9-year-old child is having learning difficulties at school. He has brief lapses of awareness with eyelid fluttering that occur every 5–10 min. Electroencephalogram (EEG) studies reveal brief 3-Hz spike and wave discharges appearing synchronously in all leads. Which drug would be effective in this child without the disadvantages of excessive sedation or tolerance development?
    • A. 

      Clonazepam

    • B. 

      Ethosuximide

    • C. 

      Gabapentin

    • D. 

      Felbamate

    • E. 

      Phenobarbital

  • 88. 
    S.K. is a 55-year-old white female with a recent history of atrial fibrillation who requires long-term anticoagulation therapy with warfarin. She and her daughter are concerned about the potential for bleeding. Pharmacogenomic testing for polymorphisms of which of the following CYPs may aid in predicting whether S.K. will have a serious bleeding event from warfarin?
    • A. 

      1A2

    • B. 

      1B1

    • C. 

      2B6

    • D. 

      2C9

    • E. 

      3A4

  • 89. 
    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

  • 90. 
    The mechanism of action of the hypnotic drug zolpidem is
    • A. 

      Activation of GABAb receptors

    • B. 

      Antagonism of glycine receptors in the spinal cord

    • C. 

      Blockade of the actions of glutamic acid

    • D. 

      Increased GABA-mediated chloride ion conductance

    • E. 

      Inhibition of GABA aminotransferase

  • 91. 
    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

  • 92. 
    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

  • 93. 
    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. 

      Glucagon

    • B. 

      Metformin

    • C. 

      Repaglinide

    • D. 

      Exenatide

    • E. 

      Pioglitazone

  • 94. 
    With chronic use in seizure states, the adverse effects of this drug include coarsening of facial features, hirsutism, and gingival hyperplasia.
    • A. 

      Carbamazepine

    • B. 

      Felbamate

    • C. 

      Phenytoin

    • D. 

      Phenobarbital

    • E. 

      Valproic acid

  • 95. 
    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

  • 96. 
    A young patient has a seizure disorder with recurrent contractions starting in muscles of the right hand that spread through the arm and the right side of the face. The attacks last for only a minute or two with no loss of consciousness. Which of the following drugs is least likely to be useful in the treatment of this patient?
    • A. 

      Carbamazepine

    • B. 

      Ethosuximide

    • C. 

      Lamotrigine

    • D. 

      Phenobarbital

    • E. 

      Phenytoin

  • 97. 
    • A. 

      Displaces sulfonamides from plasma proteins

    • B. 

      Drug of choice in myoclonic seizures

    • C. 

      Half-life is increased if used with phenobarbital

    • D. 

      Isoniazid decreases steady-state blood levels of phenytoin

    • E. 

      Toxic effects may occur with only small increments in dose

  • 98. 
    An 82-year-old woman, otherwise healthy for her age, has difficulty sleeping. Triazolam is prescribed for her at one half of the conventional adult dose. Which statement about the use of triazolam in this elderly patient is accurate?
    • A. 

      Ambulatory dysfunction does not occur in elderly patients taking one-half of the conventional adult dose

    • B. 

      Hypertension is a common adverse effect of benzodiazepines in elderly patients

    • C. 

      Over-the-counter cold medications may antagonize the hypnotic effects of the drug

    • D. 

      The patient may experience amnesia, especially if she also consumes alcoholic beverages

    • E. 

      Triazolam is distinctive in that it does not cause rebound insomnia on abrupt discontinuance

  • 99. 
    To be effective in breast cancer, tamoxifen must be converted to an active form by CYP2D6. Cases of inadequate treatment of breast cancer have occurred when tamoxifen was administered to patients who were being treated with
    • A. 

      Buproprion

    • B. 

      Clomipramine

    • C. 

      Fluoxetine

    • D. 

      Imipramine

    • E. 

      Phenelzine

  • 100. 
    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

  • 101. 
    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

  • 102. 
    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

  • 103. 
    Which statement concerning the proposed mechanisms of action of anticonvulsant drugs is inaccurate?
    • A. 

      Diazepam facilitates GABA-mediated inhibitory actions

    • B. 

      Ethosuximide selectively blocks potassium ion channels in thalamic neurons

    • C. 

      Phenobarbital has multiple actions, including enhancement effects of GABA, antagonism of glutamate receptors, and blockade of sodium ion channels

    • D. 

      Phenytoin prolongs the inactivated state of the Na+ channel

    • E. 

      Zonisamide blocks voltage-gated Na+ channels

  • 104. 
    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