Ivms-USMLE Step 1 Review Course- Summative Assessment-pharmacology

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  • 1/75 Questions

    Which of the following is an antineoplastic agent that has been shown to help patients with rheumatoid arthritis?

    • Valdecoxib
    • Ketorolac
    • Methotrexate
    • Entocort
    • Auranofin
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About This Quiz


Directions: Each of the numbered items orincomplete statements in this section is followed by answers or by completionsof the statement. Select the ONE lettered answer or completion that is BEST ineach case.

Ivms-USMLE Step 1 Review Course- Summative Assessment-pharmacology - Quiz

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  • 2. 

    Which of the following is an antidote for iron overdose?

    • Protamine

    • Deferoxamine

    • Vitamin K

    • Fresh frozen plasma

    • Charcoal

    Correct Answer
    A. Deferoxamine
    Explanation
    The answer is B. Deferoxamine is an iron-chelating agent and as such can be given in cases of iron supplement overdose. Protamine (A) is an antidote for heparin. Vitamin K (C) and fresh frozen plasma (D) are given for coumarin reversal. Charcoal is an agent sometimes used for gastric lavage.

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  • 3. 

    . Which of the following would be useful in treating nocturnal enuresis?

    • . Mannitol

    • Indomethacin

    • Furosemide

    • Vasopressin

    • Probenecid

    Correct Answer
    A. Vasopressin
    Explanation
    The answer is D. Vasopressin use can be tried in cases of recalcitrant nocturnal enuresis. Mannitol is most commonly used in management of cerebral edema (choice A). Indomethacin can occasionally be used as an antidiuretic agent in diabetic patients (choice B). Furosemide is used in congestive heart failure (choice C). Probenecid is used in treatment of gout (choice E).

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  • 4. 

    Which of the following can be used to treat a 22-year-old with a recent diagnosis of schizophrenia?

    • Baclofen

    • Haloperidol

    • . Chloral hydrate

    • Phenobarbital

    • Imipramine

    Correct Answer
    A. Haloperidol
    Explanation
    The answer is B. Haloperidol is an antipsychotic used in acute psychotic attacks and for the treatment of schizophrenia. It functions predominately as a dopamine-receptor blocker, predominately at the D2 receptor. Baclofen is a GABAB receptor antagonist that is used in the treatment of spinal cord injuries. Choral hydrate is a hypnotic agent that works similarly to ethanol. Phenobarbital is a barbiturate used in the treatment of seizures and as an anesthetic. Imipramine is a tricyclic antidepressant and is not used in schizophrenia.

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  • 5. 

    A 32-year-old woman being treated for an acute exacerbation of lupus erythematosus complains of pain on eating. What is the most likely causative agent?

    • Oxytocin

    • Androlone

    • Vasopressin

    • Prednisone

    • Clomiphene

    Correct Answer
    A. Prednisone
    Explanation
    The answer is D. Prednisone, a steroid commonly used to treat exacerbations of lupus erythematosus, can cause peptic ulcer disease due to the inhibition of the prostaglandins that normally protect the mucosa.

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  • 6. 

    Which of the following should be considered to treat an acetominophen (APAP) overdose in a 17-year-old female?

    • Trientine

    • Sorbitol

    • N-acetylcysteine

    • Ipecac

    • Diazepam

    Correct Answer
    A. N-acetylcysteine
    Explanation
    The answer is C. N-acetylcysteine is used in the case of APAP toxicity. It provides sulfhydryl groups for the regeneration of glutathione stores in the body. Trientine is a copper-chelating agent sometimes used in Wilson's disease. Sorbitol is used as a cathartic to help remove toxins from the gastrointestinal tract. Ipecac has been used to induce emesis in cases of toxic ingestions. Diazepam can be used to prevent seizures when strychnine is ingested.

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  • 7. 

    Which of the following inhibit HMG-CoA reductase?

    • Nicotinic acid

    • Rosuvastatin

    • Ezetimibe

    • Cholestyramine

    • Gemfibrozil

    Correct Answer
    A. Rosuvastatin
    Explanation
    The answer is B. Rosuvastatin is an HMG—CoA reductase inhibitor. Nicotinic acid (A) inhibits the process of esterification of fatty acids, thereby reducing plasma triglyceride levels. Ezetimibe (C) reduces cholesterol absorption. Cholestyramine can bind bile acids and prevents their enterohepatic circulation (D). Gemfibrozil (E) reduces hepatic synthesis of cholesterol.

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  • 8. 

    A Which of the following is a potential side effect of clozapine?

    • Cholestatic jaundice

    • QT prolongation

    • Agranulocytosis

    • Photosensitivity

    • Galactorrhea

    Correct Answer
    A. Agranulocytosis
    Explanation
    The answer is C. Agranulocytosis occurs more frequently with clozapine than with other agents, requiring routine blood tests. It is the only agent that improves the negative symptoms of schizophrenia. Cholestatic jaundice and photosensitivity are common with chlorpromazine. Galactorrhea is a side effect of older high-potency agents that block dopamine. QT prolongation is a complication of agents such as thioridazine and ziprasidone.

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  • 9. 

    Clonidine works by

    • Activating β1-adrenergic receptors

    • Activating α1-adrenergic receptors

    • Activating β2-adrenergic receptors

    • Activating α2-adrenergic receptors

    • Blocking β-adrenergic receptors

    Correct Answer
    A. Activating α2-adrenergic receptors
    Explanation
    The answer is D. Clonidine activates prejunctional α2-adrenergic receptors in the CNS to reduce sympathetic tone, thereby decreasing blood pressure. Activation of α1-adrenergic receptors increases blood pressure, and such agonists are used in the treatment of hypotension. β 1-adrenergic agonists are used primarily for increasing heart rate and contractility. β2-adrenergic agonists are used to dilate airways in the management of asthma. β-blockers are used in the treatment of angina and hypertension.

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  • 10. 

    Which of the following drugs inhibits xanthine oxidase?

    • Colchicine

    • Indomethacin

    • Probenecid

    • Clofibrate

    • Allopurinol

    Correct Answer
    A. Allopurinol
    Explanation
    The answer is E. Allopurinol is a xanthine oxidase inhibitor and is most commonly used in treatment of gout. It is not used for acute attacks, but rather for prevention of recurrent episodes. Colchicine (choice A) may be used for an acute episode, as well as in long-term therapy; however, it has a high incidence of side effects. Indomethacin (choice B) is useful for symptomatic treatment of gout. Probenecid (choice C) is also useful for prophylaxis of gout; however, it is not a xanthine oxidase inhibitor. This agent inhibits secretion of organic acids. Clofibrate (choice D) is used in treatment of hypercholesterolemia.

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  • 11. 

    Which of the following is a common adverse effect of quinidine?

    • Cinchonism

    • Lupuslike syndrome

    • Seizures

    • Constipation

    • Pulmonary fibrosis

    Correct Answer
    A. Cinchonism
    Explanation
    The answer is A. Cinchonism, or ringing in the ears and dizziness, is common after quinidine use. Lupuslike syndrome (B) can be observed after the use of procainamide. Seizures may occur with lidocaine use (C). Diarrhea can occur with the use of quinidine, not constipation (D). Pulmonary fibrosis is a long-term complication of amiodarone use (E).

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  • 12. 

    Which of the following is a complication of phenytoin use?

    • Hepatotoxicity

    • Gingival hyperplasia

    • Thrombocytopenia

    • Aplastic anemia

    • Stevens-Johnson syndrome

    Correct Answer
    A. Gingival hyperplasia
    Explanation
    The answer is B. Gingival hyperplasia is a unique side effect of phenytoin, which can be partially avoided by meticulous oral hygiene. Several anticonvulsants can cause hepatotoxicity, including valproic acid and felbamate. Aplastic anemia is a rare, but potential complication of carbamazepine, ethosuximide, and felbamate. Valproic acid is also associated with thrombocytopenia. Ethosuximide has been associated with a severe form of erythema multiforme, the Steven-Johnson syndrome.

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  • 13. 

    An 81-year-old man with a history of coronary artery disease and a recent diagnosis of hypothyroidism presents to the emergency department with an acute myocardial infarction (MI). What is the most likely causative agent?

    • Medroxyprogesterone

    • Levothyroxine

    • Thiocyanate

    • Flutamide

    • Diethylstilbestrol (DES)

    Correct Answer
    A. Levothyroxine
    Explanation
    The answer is B. Elderly patients with subclinical hypothyroidism are at risk for arrhythmias, angina, or myocardial infarction (MI) if they have underlying cardiovascular disease when they begin treatment with thyroid hormones such as levothyroxine. These potential adverse effects occur because of increased cardiovascular work load as well as the direct effect of thyroid hormone on the heart.

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  • 14. 

    What is the mechanism of action of β-blockers in heart disease?

    • Prolongation of AV conduction

    • Activation of the sympathetic system

    • Promotion of automaticity

    • Increase in heart rate

    • Arteriolar vasodilation

    Correct Answer
    A. Prolongation of AV conduction
    Explanation
    The answer is A. Beta-blockers prolong AV conduction. The reduce sympathetic stimulation (B). These agents depress automaticity (C). Beta-blockers decrease heart rate (D), and can cause arteriolar vasoconstriction (E).

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  • 15. 

    A neurosurgeon decides to start a patient on a diuretic that works by altering the diffusion of water relative to sodium (an osmotic diuretic) that is helpful in reducing cerebral edema. Which agent did the physician likely prescribe?

    • Furosemide

    • Hydrochlorothiazide

    • Spironolactone

    • . Acetazolamide

    • Mannitol

    Correct Answer
    A. Mannitol
    Explanation
    The answer is E. Mannitol is an osmotic diuretic frequently used in management of cerebral edema caused by various insults. This agent works by altering the diffusion of water relative to sodium by “binding” the water, with a resultant reduction of sodium reabsorption. Furosemide and hydrochlorothiazide act by directly altering reabsorption of sodium in various parts of the nephron (choices A and B). Spironolactone (choice C) antagonizes mineralocorticoid receptor. Acetazolamide inhibits carbonic anhydrase (choice D).

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  • 16. 

    AOrganophosphate poisoning is treated with

    • Pralidoxime (2-PAM)

    • Parathion

    • Amyl nitrate

    • Bethanechol

    • Nicotine

    Correct Answer
    A. Pralidoxime (2-PAM)
    Explanation
    The answer is A. Pralidoxime reactivates acetylcholinesterase to reverse the effects of exposure to organophosphates, of which parathion is actually an example. Amyl nitrate can be used in cases of ingestion of the cytochrome oxidase inhibitor cyanide. Bethanechol is a direct-acting cholinergic agonist used to treat urinary retention and overdose and can result in symptoms similar to organophosphate poisoning. Nicotine is sometimes found in insecticides and can cause vomiting, weakness, seizures, and respiratory arrest.

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  • 17. 

    A 63-year-old male, with a history of multiple myocardial infarctions is admitted for shortness of breath. A diagnosis of congestive heart failure is made on clinical grounds, and a cardiologist orders a positive inotropic agent for his heart failure. He is also concerned about maintaining perfusion to the kidneys, so an agent that increases renal blood flow is also desirable. Which of the following agents produces both of these desired effects?

    • Epinephrine

    • Dopamine

    • Isoproterenol

    • Terbutaline

    Correct Answer
    A. Dopamine
    Explanation
    The answer is B. Dopamine is useful in the management of congestive heart failure, as it has both positive inotropic effects on the heart and preserves blood flow to the kidneys. Epinephrine and isoproterenol increase cardiac contractility while decreasing peripheral resistance. Albuterol is a β1 agonist used in the management of asthma, and terbutaline is another β agonist used to suppress labor, in the event of threatened labor of a premature fetus.

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  • 18. 

    Which of the following is an alkylating agent that may cause hemorrhagic cystitis and cardiomyopathy?

    • Azathioprine

    • Cyclosporine

    • Tacrolimus

    • Cyclophosphamide

    • Basiliximab

    Correct Answer
    A. Cyclophosphamide
    Explanation
    The answer is D. Cyclophosphamide has been successfully used for treatment of lupus nephritis; however, it does carry significant morbidity associated with its use. Azathioprine works by suppressing T-cell activity (A). Cyclosporine inhibits T-helper cell activation (B). Tacrolimus inhibits transcription of T-cell-specific lymphokines (C). Baciliximab is a monoclonal antibody against CD-25 used to reduce the incidence and severity of renal transplant rejection.

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  • 19. 

    Adverse effects seen with high blood levels of theophylline include

    • Seizures

    • Arrhythmias

    • Nervousness

    • Nausea and vomiting

    • All of the above

    Correct Answer
    A. All of the above
    Explanation
    The answer is E. Theophylline is associated with all of the reactions listed. They usually occur at elevated blood levels, generally accepted as greater than 20 µg/dL. However, adverse drug reactions may occur at any blood level.

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  • 20. 

    Which of the following drugs is a selective α-adrenergic receptor agonist that is available over-the-counter?

    • Epinephrine

    • Phenylephrine

    • Isoproterenol

    • Norepinephrine

    • Phentolamine

    Correct Answer
    A. Phenylephrine
    Explanation
    The answer is B. Phenylephrine is a selective α1-adrenergic agonist that decreases nasal secretions by causing nasal vasoconstriction, decreasing the formation of such secretions. Epinephrine is the most potent of the adrenergic receptor agonists, followed by norepinephrine. Isoproterenol is the weakest antagonist. But the previous three agents also bind β-adrenergic receptors and are not available over the counter. Phentolamine is just the opposite, an α1-adrenergic antagonist.

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  • 21. 

    A 43-year-old high-profile attorney sees a psychiatrist with expertise in addiction medicine. He explains that he has recently received his third drunk driving citation and fears losing his license to practice unless he stops drinking altogether. He says he “just can't stop” once he starts. He tells the physician that he doesn't have time to attend Alcoholic Anonymous and “wants a pill.” The physician explains that there is something that might work if the patient is truly serious. What agent is the physician considering?

    • Lorazepam

    • Flumazenil

    • Naloxone

    • Disulfiram

    • Carbamazepine

    Correct Answer
    A. Disulfiram
    Explanation
    The answer is D. Disulfiram is an inhibitor of aldehyde dehydrogenase, which blocks the breakdown of acetaldehyde to acetate during the metabolism of alcohol. The buildup of acetaldehyde results in flushing, tachycardia, hypertension and nausea to invoke a conditioned response to avoid alcohol ingestion. Lorazepam is useful in the prevention of seizures as a result of alcohol withdrawal, whereas carbamazepine is used should they develop. Flumazenil is used for benzodiazepine overdose and naloxone for opioid overdose.

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  • 22. 

    A 57-year-old male with a strong family history of Parkinson's disease sees a neurologist for an evaluation. On examination, the neurologist notes a slight pill-rolling tremor and subtle gait abnormalities. He begins treatment with levodopa, along with the addition of carbidopa. How does carbidopa work in this setting?

    • . Restores dopamine levels in the substantia nigra

    • Inhibits monoamine oxidase (MAOI)

    • Inhibits catechol-O-methyltransferase (COMT)

    • Functions as a dopamine agonist

    • Inhibits the metabolism of levodopa outside the CNS

    Correct Answer
    A. Inhibits the metabolism of levodopa outside the CNS
    Explanation
    The answer is E. Carbidopa, unlike levodopa, does not penetrate the CNS; it does inhibit levodopa's metabolism in the gut, leading to lower doses of levodopa and decreased side effects. Levodopa is a precursor to dopamine and can help restore levels of dopamine in the substantia nigra. Monoamine oxidase inhibitors should not be used with caution along with levodopa, as this can lead to a hypertensive crisis. Bromocriptine is a dopamine agonist used in the treatment of Parkinson's disease. COMT inhibitors are yet another class of agents used in the treatment of Parkinson's disease.

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  • 23. 

    Dantrolene

    • Inhibits calcium release from the sarcoplasmic reticulum

    • Functions as a GABAB receptor agonist

    • Facilitates GABA activity in the CNS

    • Reactivates acetylcholinesterase

    • Competitively inhibits the effects of acetylcholine

    Correct Answer
    A. Inhibits calcium release from the sarcoplasmic reticulum
    Explanation
    The answer is A. Dantrolene is used in the treatment of malignant hyperthermia and works by inhibiting the release of calcium from the sarcoplasmic reticulum. Baclofen, an antispasmatic used in the treatment of multiple sclerosis, inhibits synaptic transmission as a GABAB-receptor agonist. Benzodiazepines function to facilitate GABA activity in the CNS and spinal cord. Pradoxime reactivates acetylcholinesterase. Nondepolarizing neuromuscular junction blockers such as atracurium competitively inhibit the effects of acetylcholine.

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  • 24. 

    A 23-year-old female presents with hypertension, anxiety, and palpitations. Her thyroid-stimulating hormone levels are normal, but she has increased levels of urinary catecholamines. She is referred to a endocrine surgeon after a CT scan shows a unilateral pheochromocytoma. The surgeon should start therapy with which of the following agents prior to removing the lesion?

    • Dopamine

    • Phentolamine

    • . Pancuronium

    • Pseudoephedrine

    • Isoproterenol

    Correct Answer
    A. Phentolamine
    Explanation
    The answer is B. An α-adrenergic blocker such as phentolamine is indicated for the treatment of pheochromocytomas in the preoperative state as well as if the tumor is inoperable. β-blockers are then used systemically, following effective α blockade, to prevent the cardiac effects of excessive catecholamines. Pseudoephedrine is an α -adrenergic antagonist available over the counter to relieve nasal discharge. There is no role for adrenergic receptor agonists such as dopamine or isoproterenol or for that matter nondepolarizing muscle relaxants such as pancuronium.

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  • 25. 

    Vasopressin

    • Reduces ADH levels

    • Increases permeability of the collecting duct

    • Inserts aquaporins into the plasma membrane of collecting duct cells

    • Increases diffusion of sodium

    • Reduces production of prostaglandins

    Correct Answer
    A. Inserts aquaporins into the plasma membrane of collecting duct cells
    Explanation
    The answer is C. Vasopressin causes specific water channels termed aquaporins II to be inserted into the plasma membrane of the luminal surface of the medullary collecting ducts. This directly affects permeability of the collecting duct (choice B). Under the conditions of dehydration, as is the case with this patient, the ADH levels increase (choice A). Choice D represents the mechanism of action of osmotic diuretics. Production of prostaglandins is reduced with the use of agents such as indomethacin (choice E).

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  • 26. 

    A 32-year-old male complains of persistently dry cough for several days with a mild fever and fatigue. The family physician suspects a diagnosis of “walking pneumonia” on clinical grounds, presumably due to Mycoplasma pneumoniae. Which of the following groups of antibiotics would be effective?

    • Penicillins

    • Cephalosporins

    • Vancomycin

    • Chloramphenicol

    • Macrolides

    Correct Answer
    A. Macrolides
    Explanation
    The answer is E. Macrolides such as azithromycin or clarithromycin are the agents of choice for the treatment of mycoplasmal diseases. As mycoplasma have no cell wall, such drugs as penicillins, cephalosporins, or vancomycin are ineffective. Chloramphenicol is relatively toxic and reserved for select infections.

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  • 27. 

    Which of the following is a side effect of clindamycin?

    • Dizziness

    • Bruising

    • Difficulty hearing

    • Diarrhea

    • Tendon pain

    Correct Answer
    A. Diarrhea
    Explanation
    The answer is D. Diarrhea due to pseudomembranous colitis with Clostridium difficile overgrowth is common with many broad-spectrum antibiotics, especially clindamycin. Bruising can occur with some cephalosporins. Dizziness is common with tetracyclines such as minocycline. Ototoxicity can result in hearing loss with vancomycin and aminoglycosides. Tendon pain is possible due to the cartilage toxicity associated with fluoroquinolones.

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  • 28. 

    A 54-year-old diabetic female was seen in the emergency room 3 weeks ago with complaints of swelling, warmth, and pain in her foot. She was diagnosed with cellulitis and sent home on a 10-day course of an oral first-generation cephalosporin. She returns with severe diarrhea, and Clostridium difficile is suspected. What is the initial treatment for this condition?

    • Clindamycin

    • Metronidazole

    • Ciprofloxacin

    • Neomycin

    • Silver sulfadiazine

    Correct Answer
    A. Metronidazole
    Explanation
    The answer is B. Metronidazole is the preferred treatment for Clostridium difficile colitis, which probably resulted from the patient's use of a broad-spectrum antibiotic for her initial infection. Vancomycin is considered in the treatment of Clostridium difficile colitis in refractory cases. Clindamycin use is often associated with Clostridium difficile colitis. Ciprofloxacin can be used for the treatment of diverticulitis, but not colitis. Neomycin is used to sterilize the bowel, which is not the goal in this case. Silver sulfadiazine is used to treat skin infections in burn patients.

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  • 29. 

     Which of the following is a short-acting acetylcholinesterase inhibitor?

    • Pyridostigmine

    • Bethanechol

    • Edrophonium

    • Scopolamine

    • Methantheline

    Correct Answer
    A. Edrophonium
    Explanation
    The answer is C. In myasthenia gravis, autoantibodies develop to nicotinic acetylcholine receptors, causing impaired neuromuscular dysfunction that results in muscular fatigue. This fatigue can be treated with acetylcholinesterase inhibitors. Edrophonium is the shortest-acting agent in this class and used to diagnosis this disorder, with such weakness immediately corrected with its use. Pyridostigmine is a longer-acting agent used in the treatment of the disease. Bethanecol is a direct-acting muscarinic cholinergic agonist, whereas both scopolamine and methantheline are both muscarinic-receptor antagonists.

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  • 30. 

    Which of the following is a good choice to treat newly diagnosed generalized anxiety disorder (GAD) in a patient who is a truck driver?

    • Alprazolam

    • Triazolam

    • Buspirone

    • Trazodone

    • Thiopental

    Correct Answer
    A. Buspirone
    Explanation
    The answer is C. Buspirone is a partial agonist of the 5-HT1A receptor that has efficacy comparable to that of benzodiazepines for the treatment of anxiety, although they are significantly less sedating. Alprazolam is an intermediate-acting benzodiazepine used in the treatment of GAD but still has some sedation, which would be undesirable in this situation. Triazolam is a short-acting benzodiazepine, and trazodone is a heterocyclic antidepressant, both used to induce sleep. Thiopental is a barbiturate sometimes used to induce anesthesia.

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  • 31. 

    A 35-year-old intravenous drug abuser in a methadone maintenance program is admitted to the hospital for a work-up of suspected pulmonary tuberculosis. While in the hospital, he complains of diarrhea and cramping. After stool studies return with a negative result, you decide to begin an antidiarrheal. Which of the following is a good choice for this patient?

    • Kaolin

    • Codeine

    • Diphenoxylate

    • Loperamide

    • Propantheline

    Correct Answer
    A. Loperamide
    Explanation
    The answer is D. Loperamide would be a good choice in this patient as it effectively controls diarrhea. Both codeine and diphenoxylate are opioids with abuse potential, especially in patients with abusive histories. Diphenoxylate is available in combination with atropine to reduce the potential for abuse. Anticholinergics such as propantheline prevent cramping but have little effect on diarrhea. Kaolin is good for absorbing toxins from the intestines.

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  • 32. 

    A 7-year-old boy is brought to the neurologist by his mother. She says that the boy's teacher says there are times in class when he stares “out into space” and smacks his lips. In the office the boy has one such episode while having an EEG, which demonstrates a 3-per-second spike and wave tracing. Which drug is the best for this absence seizure?

    • Phenytoin

    • Carbamazepine

    • Prednisone

    • Lorazepam

    • Ethosuximide

    Correct Answer
    A. Ethosuximide
    Explanation
    The answer is E. Ethosuximide is the drug of choice for absence seizures in children. Valproic acid has more side effects and therefore is a second-line drug. Prednisone is used in infantile seizures. Phenytoin and carbamazepine can be used in partial seizures or in tonic-clonic seizures. Lorazepam is often used in the treatment of status epilepticus.

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  • 33. 

    Which of the following is true regarding infliximab?

    • It is a recombinant antibody to TNF-α

    • It is a humanized antibody to TNF-α

    • It is a fusion protein that binds to TNF-α receptor

    • It is a recombinant protein resembling IL-1

    • It is a recombinant protein composed of a portion of LFA-3

    Correct Answer
    A. It is a recombinant antibody to TNF-α
    Explanation
    The answer is A. Infliximab is a recombinant antibody to TNF-α it has been successfully used in the treatment of Crohn's disease, rheumatoid arthritis, and some other autoimmune conditions. Choice B represents Humira, an agent also used for rheumatoid arthritis. Choice C is Etanercept, a subcutaneous agent approved for treatment of rheumatoid arthritis. Choice D represents anakinra, an IL-1 blocker also used for rheumatoid arthritis. Choice E is alefacept, an agent used for psoriasis.

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  • 34. 

    A 17-year-old male was placed on carbamazepine therapy by his neurologist to control newly developed seizures of unknown etiology. The patient was also recently given a macrolide antibiotic by his family physician for a presumed “walking pneumonia.” Halfway through his antibiotic course, the patient again developed seizures. What could account for this new seizure activity?

    • Inhibition of the cytochrome P-450 monooxygenase system

    • Induction of the cytochrome P-450 monooxygenase system

    • Impairment of renal excretion of the antiseizure medication

    • Induction of glucuronyl transferase activity in the liver

    • Reduction in the amount of nicotinamide adenine dinucleotide phosphate (NADPH)

    Correct Answer
    A. Induction of the cytochrome P-450 monooxygenase system
    Explanation
    1. The answer is B. Both carbamazepine and macrolide antibiotics are known inducers of the cytochrome P-450 system. Thus it is likely that the original therapeutic levels of antiseizure medicine was decreased to nontherapeutic levels when the metabolism of the drug was increased with the addition of the antibiotic. Some common drugs that inhibit P-450 include cimetidine, chloramphenicol, and disulfiram. Impaired renal excretion results in increased, not decreased, levels of drugs. The induction of glucuronyl transferase is a possible drug interaction, although less likely in this case. The P-450 system requires NADPH, and therefore a deficiency would result in decreased, not increased, activity by the system.

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  • 35. 

    Which of the following is useful in an acute gout attack?

    • Probenecid

    • Sulfinpyrazone

    • Allopurinol

    • Colchicine

    • Celecoxib

    Correct Answer
    A. Colchicine
    Explanation
    The answer is D. Colchicine is often used to treat an acute gouty attack. Probenecid (A) and sulfinpyrazone (B) reduce urate levels by preventing reabsorption of uric acid. These agents are used for chronic gout. Allopurinol (C) is a xanthine oxidase inhibitor; it is also used for treatment of chronic gout. Celecoxib is a COX-2 inhibitor that has been removed from the market.

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  • 36. 

    Chromosomal studies in a 56-year-old male indicate a (9:22) translocation, the Philadelphia chromosome, confirming the diagnosis of chronic myelocytic leukemia (CML). Which of the following might be used in his treatment?

    • Anastrozole

    • Rituximab

    • Imatinib

    • Gefitinib

    • Amifostine

    Correct Answer
    A. Imatinib
    Explanation
    The answer is C. Imatinib is an orally active small molecule inhibitor of the oncogenic bcr-abl kinase produced as a result of the Philadelphia chromosome, used to treat CML. It also inhibits the c-Kit receptor and can be used in gastrointestinal stromal tumors (GISTs). Anastrozole is used in the management of breast cancer. Rituximab is and antibody used in the treatment of non-Hodgkin's lymphoma. Gefitinib is an orally active small molecule inhibitor of the EGF receptor, used in the treatment of some lung cancer. Amifostine is used as a radio-protectant, with or without cisplatin.

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  • 37. 

    Which of the following would be a good option to help a patient fall asleep with minimal “hangover”?

    • Secobarbital

    • Zolpidem

    • Chlordiazepoxide

    • Flumazenil

    • Buspirone

    Correct Answer
    A. Zolpidem
    Explanation
    The answer is B. Zolpidem has actions similar to those of benzodiazepines, although it is structurally unrelated. It is used as a hypnotic and anxiolytic with minimal abuse potential. Barbiturates such as secobarbital are rarely used because of their lethality on overdose. Chlordiazepoxide is a long-acting benzodiazepine, whereas most hypnotics are short-acting benzodiazepines. Flumazenil is a benzodiazepine antagonist that will not reverse the effects of zolpidem. Buspirone is not used as a hypnotic and has little sedative effect.

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  • 38. 

    A 56-year-old female with severe rheumatoid arthritis returns to see her rheumatologist. She had been referred to a gastroenterologist, who had found multiple gastric ulcers on esophogastroduodenoscopy. She is reluctant to give up the use of NSAIDS and afraid of the potential cardiovascular toxicity of COX-2 inhibitor. At this point, what would be reasonable for the rheumatologist to prescribe?

    • Omeprazole

    • Lansoprazole

    • Nizatidine

    • Metronidazole

    • Misoprostol

    Correct Answer
    A. Misoprostol
    Explanation
    The answer is E. Misoprostol is approved for use in patients taking NSAIDS, both to decrease acid production and to increase bicarbonate and mucous production. Both omeprazole and lansoprazole are proton inhibitors that would not increase the protective mucous and bicarbonate. Nizatidine is an H2-blocker that would also do nothing to increase the production of protective prostaglandins. Metronidazole is an antibiotic used to treat Helicobacter pylori.

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  • 39. 

    A 37-year-old female recently had a large soft tissue sarcoma surgically resected from her retroperitoneum. She is to receive both radiation and chemotherapy, with cyclophosphamide as part of her chemotherapy. Which agent should be given in conjunction with this drug?

    • MESNA

    • Allopurinol

    • Leucovorin

    • Cilastatin

    • MOPP

    Correct Answer
    A. MESNA
    Explanation
    The answer is A. MESNA is often given with cyclophosphamide and ifosfamide to help detoxify metabolic products that can cause hemorrhagic cystitis. Allopurinol is given with chemotherapy agents such as busulfan to reduce renal precipitation of urate. Leucovorin is given to rescue patients in the case of methotrexate toxicity. Cilastatin is an inhibitor of imipenem degradation. MOPP is a multidrug regimen (Mechlorethamine, Oncovin (vincristine), Procarbazine, and Prednisone) used in the treatment of Hodgkin's disease.

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  • 40. 

    A 54-year-old female is undergoing an experimental high-dose regimen with adriamycin and cyclophosphamide for breast cancer. As this treatment is particularly myelosuppressive, the oncologist is worried that her white blood cell count will drop dangerously low, making her susceptible to opportunistic infections. In addition to the chemotherapy, what is the oncologist likely to administer to prevent neutropenia?

    • Epoetin alpha

    • Filgrastim

    • Interferon-α

    • Oprelvekin

    • Amifostine

    Correct Answer
    A. Filgrastim
    Explanation
    The answer is B. Filgrastim is a recombinant form of granulocyte colony-stimulating factor (G-CSF) given to prevent chemotherapy-induced neutropenia. Epoetin alpha is commonly used to prevent anemia while on chemotherapy. Oprelvekin is an agent used to help treat chemotherapy- induced thrombocytopenia. Interferon-α is used in the management of specific leukemias and lymphomas. Amifostine is given to patients receiving radiation to the head and neck to preserve salivary function.

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  • 41. 

    Which of the following is a noncompetitive NMDA receptor inhibitor that can be used to treat Alzheimer's disease?

    • Memantine

    • Donepezil

    • Tacrine

    • Tolcapone

    • Pergolide

    Correct Answer
    A. Memantine
    Explanation
    The answer is A. Memantine is an NMDA-receptor inhibitor that is well tolerated and shown to slow the rate of cognitive decline in Alzheimer's patients. Donepezil and tacrine are acetylcholinesterase inhibitors, which have shown similar activities. Tolcapone is a COMT inhibitor rarely used in Parkinson's disease because of the possibility of hepatic necrosis. Pergolide is an ergot derivative used as a dopamine agonist in the management of Parkinson's disease.

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  • 42. 

    A 21-year-old male sustains multiple blunt traumas after being beaten with a baseball bat by a gang. Aside from his fractures, a serum creatine kinase measurement is dramatically elevated and the trauma team is worried as the myoglobinuria caused by the trauma can cause kidney failure. They immediately begin to administer bicarbonate to alkalinize the urine. How does this serve to decrease myoglobin levels?

    • Increasing glomerular filtration

    • Promoting renal tubular secretion

    • Inhibiting renal tubular reabsorption

    • Increasing hepatic first-pass metabolism

    • Inducing the P-450 system

    Correct Answer
    A. Inhibiting renal tubular reabsorption
    Explanation
    The answer is C. Alterations in urinary pH alters renal reabsorption of substances. In this case, alkalinization traps filtered myoglobin in the urine so that it cannot be reabsorbed, which leads to decreased levels in the serum. The other mechanisms such as increasing glomerular filtration, promoting tubular secretion are other potential ways to alter plasma drug/metabolite levels. Myoglobin is not hepatically metabolized; therefore, hepatic or P-450 metabolism would not alter myoglobin levels.

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  • 43. 

    Pilocarpine is what type of pharmacologic agent?

    • Indirect muscarinic agonist

    • α2-Adrenergic agonist

    • Carbonic anhydrase inhibitor

    • β-Adrenergic antagonist

    • Direct-acting muscarinic agonist

    Correct Answer
    A. Direct-acting muscarinic agonist
    Explanation
    The answer is E. Pilocarpine is a direct-acting muscarinic agonist used in the management of acute narrow-angle glaucoma, often along with an indirect-acting muscarinic agonist like physostigmine. Carbonic anhydrase inhibiters (e.g., acetazolamide), β-adrenergic agonists, and even α2-adrenergic agonists can be used in the treatment of glaucoma.

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  • 44. 

    A 5-year-old boy is brought to the emergency room by his parents after they found him with an empty bottle of aspirin. They are not sure how many tablets the boy consumed. On examination, the child is hyperpneic and lethargic. While the emergent treatment is started, a sample is drawn for an arterial blood determination. What pattern is most likely to be indicated by the arterial blood gas values?

    • Mixed metabolic alkalosis and respiratory alkalosis

    • Mixed respiratory alkalosis and metabolic acidosis

    • Mixed respiratory acidosis and metabolic acidosis

    • Mixed respiratory acidosis and metabolic alkalosis

    • Mixed metabolic acidosis and metabolic alkalosis

    Correct Answer
    A. Mixed respiratory alkalosis and metabolic acidosis
    Explanation
    The answer is B. Salicylate toxicity initially increases the medullary response to carbon dioxide, with resulting hyperventilation and respiratory alkalosis. Increases in lactic acid and ketone body formation result in a metabolic acidosis. All other choices are incorrect in this particular setting. Treatment includes correction of acid—base disturbances, replacement of electrolytes and fluids, cooling, alkalinization of urine, and forced diuresis.

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  • 45. 

    AcA 45-year-old male with a 60-pack/year history of smoking presents to his primary care provider with loss of appetite, nausea, vomiting, and muscle weakness. His chest CT reveals enlarged hilar lymph nodes and a suspicious mass in the left hilar region. A presumptive diagnosis of lung cancer is made. Laboratory results reveal low levels of sodium, which in this setting has likely contributed to the syndrome of inappropriate ADH secretion. Which medication might be helpful for this patient's symptoms?

    • Clofibrate

    • Demeclocycline

    • Allopurinol

    • Acetazolamide

    • Furosemide

    Correct Answer
    A. Demeclocycline
    Explanation
    The answer is B. Demeclocycline is an ADH antagonist and as such is useful in treatment of SIADH, which is commonly seen in patients with lung cancer. Clofibrate (choice A) increases the release of ADH centrally. Allopurinol, acetazolamide, and furosemide do not affect actions of ADH to an appreciable degree (choices C, D, and E).

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  • 46. 

    Which of the following would be useful in the management of arrhythmia due to Wolf-Parkinson-White syndrome?

    • Digoxin

    • Lidocaine

    • Amiodarone

    • Adenosine

    • Atropine

    Correct Answer
    A. Adenosine
    Explanation
    The answer is D. Adenosine, a class V antiarrhythmic, is used for the treatment of paroxysmal supraventricular tachycardias, including those of Wolf-Parkinson-White syndrome. Digoxin (A) and amiodarone (C) can be used for management of atrial fibrillation. Lidocaine is used in treatment of many arrhythmias (B). Atropine is used for bradyarrhythmias.

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  • 47. 

    Soon after drug administration, the patient in the above question begins making odd faces with spastic movements of his neck. Which of the following should be administered to treat these dystonic reactions?

    • Fluphenazine

    • Bromocriptine

    • Dantrolene

    • Prolactin

    • Benztropine

    Correct Answer
    A. Benztropine
    Explanation
    The answer is E. Acute dystonias are a complication of antipsychotics that work primarily through dopamine D2 receptors and therefore have a high incidence of extrapyramidal effects. Haloperidol and agents such as fluphenazine are the most likely offenders. Such reactions are best managed with an anticholinergic such as benztropine. Another complication of haloperidol is the neuroleptic malignant syndrome, which is treated with the dopamine agonist bromocriptine as well as dantrolene. Hyperprolactinemia with galactorrhea is common with agents that block dopamine's actions, as dopamine normally represses prolactin release.

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  • 48. 

    Risperidone works primarily through inhibition of receptors for

    • Dopamine

    • Serotonin

    • Histamine

    • Acetylcholine

    • Norepinephrine

    Correct Answer
    A. Serotonin
    Explanation
    The answer is B. The unique affinities of various antipsychotics result in their unique activities and their unique side effects. Risperidone is an atypical antipsychotic that works by blocking the 5-HT2A serotonin receptor. The older high-potency antipsychotics inhibit dopamine receptors. Agents such as clozapine inhibit histamine receptors. Chloropyramine has affinity for cholinergic as well as adrenergic receptors.

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  • 49. 

    Which of the following agents is approved for treatment of diabetic neuropathy?

    • Phenytoin

    • Carbamazepine

    • Acetazolamide

    • Valproic acid

    • Gabapentin

    Correct Answer
    A. Gabapentin
    Explanation
    The answer is E. Many antiseizure drugs find applications for other diseases. Gabapentin is approved for the treatment of diabetic nephropathy, an unfortunate consequence in this patient's presentation. Phenytoin is also used for the treatment of arrhythmias. Carbamazepine is used in the management of trigeminal neuralgia. Acetazolamide, sometimes used as an treatment for absence seizure control, is used in the treatment of glaucoma. Valproic acid can be used in the prophylaxis of migraine headaches.

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Quiz Review Timeline (Updated): Mar 20, 2023 +

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  • Current Version
  • Mar 20, 2023
    Quiz Edited by
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  • Jan 02, 2010
    Quiz Created by
    Drimhotep

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