Pharmacology Toughest Exam Quiz!

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  • 1/195 Questions

    Pindolol and some other β adrenergic receptor antagonists have an additional property that is referred to as intrinsic sympathomimetic activity (ISA). This additional property indicates these agents are:

    • Full agonists
    • Inverse agonist
    • Neutral antagonists
    • Noncompetitive antagonists
    • Partial agonists
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About This Quiz

Pharmacology Toughest Exam Quiz assesses advanced knowledge in pharmacology, focusing on drug interactions, effects, and medical responses. It's ideal for students and professionals aiming to deepen their understanding of pharmacological principles and their application in clinical settings.

Pharmacology Toughest Exam Quiz! - Quiz

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  • 2. 

    Calcitonin is a hormone produced and secreted from the thyroid parafollicular C cells and is regulated by the serum concentration of

    • Potassium.

    • Calcium

    • Zinc

    • Iron

    • Sodium

    Correct Answer
    A. Calcium
    Explanation
    Calcitonin is a hormone that is produced and secreted by the thyroid parafollicular C cells. It is primarily regulated by the serum concentration of calcium. When the calcium levels in the blood are too high, calcitonin is released to help lower the calcium levels by inhibiting the activity of osteoclasts, which are responsible for breaking down bone tissue and releasing calcium into the blood. Therefore, calcium is the correct answer as it directly influences the production and secretion of calcitonin.

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  • 3. 

    The neurotransmitter at the neuromuscular junction is

    • Acetylcholine.

    • Norepinephrine.

    • Serotonin.

    • Aspartate.

    • Epinephrine.

    Correct Answer
    A. Acetylcholine.
    Explanation
    Acetylcholine is the correct answer because it is the primary neurotransmitter responsible for transmitting signals from motor neurons to muscle fibers at the neuromuscular junction. It is released by the motor neuron and binds to receptors on the muscle fiber, leading to muscle contraction. Norepinephrine, serotonin, aspartate, and epinephrine are all neurotransmitters involved in other functions within the nervous system, but they are not specifically associated with the neuromuscular junction.

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  • 4. 

    A 24-year-old woman has increased her dosage of hydrocodone to achieve the same analgesic effect. This is a demonstration of

    • Physical dependence.

    • First-pass metabolism.

    • Tolerance

    • An adverse effect.

    • Addiction

    Correct Answer
    A. Tolerance
    Explanation
    Tolerance refers to the phenomenon where an individual requires a higher dosage of a drug to achieve the same desired effect over time. In this case, the 24-year-old woman has increased her dosage of hydrocodone to achieve the same analgesic effect, indicating the development of tolerance. This suggests that her body has adapted to the drug, requiring a higher dosage to produce the desired pain-relieving effect.

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  • 5. 

    A 32-year-old woman has chronic hypertension and a family history of cardiomyopathy. She has no history herself of heart problems and no symptoms of heart failure. Which drug is most appropriate to prevent or slow the development of heart failure in this patient?

    •  Lisinopril

    • Verapamil

    • Digoxin

    • Dobutamine

    Correct Answer
    A.  Lisinopril
    Explanation
    Lisinopril is the most appropriate drug to prevent or slow the development of heart failure in this patient. Lisinopril is an ACE inhibitor that helps lower blood pressure and reduce the workload on the heart. It is commonly used in patients with hypertension and has been shown to improve outcomes in patients with heart failure. Verapamil is a calcium channel blocker that is not typically used for heart failure prevention. Digoxin and dobutamine are drugs used for the management of heart failure symptoms, but they are not indicated for preventing or slowing the development of heart failure.

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  • 6. 

    A 33-year-old woman with a brain infection (meningitis) is administered her antibiotic directly into the cerebrospinal fluid because the

    • Bacteria causing the brain infection are not sensitive to the antibiotic.

    • Blood brain barrier excludes the antibiotic if it is administered systemically.

    • Antibiotic binds to brain cells and is not available to the bacteria.

    • Antibiotic is activated by the cerebrospinal fluid.

    • Bacteria are mostly located in the cerebrospinal fluid.

    Correct Answer
    A. Blood brain barrier excludes the antibiotic if it is administered systemically.
    Explanation
    The correct answer is that the blood brain barrier excludes the antibiotic if it is administered systemically. The blood brain barrier is a protective barrier that separates the circulating blood from the brain and spinal cord. It is composed of specialized cells that tightly regulate what substances can pass through into the brain. Many antibiotics are unable to cross this barrier when administered systemically, which can limit their effectiveness in treating brain infections. Therefore, administering the antibiotic directly into the cerebrospinal fluid bypasses the blood brain barrier and allows for direct delivery to the site of infection.

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  • 7. 

    A 22-year-old woman is being treated with amitriptyline or depression. She, and her family, should be cautioned about not seeing a therapeutic effect for

    • 24 hours.

    • 12 hours.

    • 3 days.

    • 1 week.

    • 3 to 4 weeks.

    Correct Answer
    A. 3 to 4 weeks.
    Explanation
    The therapeutic effect of amitriptyline for depression may take 3 to 4 weeks to become noticeable. It is important for the woman and her family to be aware of this timeframe to manage their expectations and avoid premature discontinuation of the medication.

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  • 8. 

    A 50-year-old woman with back pain is administered an opiate agonist. After 2 weeks of therapy, she notices that she needs to increase the dose to get the same analgesic effect. She is experiencing

    • Physical dependence.

    • Addiction.

    • Tolerance.

    • Withdrawal.

    • Drug-seeking behavior.

    Correct Answer
    A. Tolerance.
    Explanation
    Tolerance refers to the phenomenon where the body becomes less responsive to a drug over time, requiring higher doses to achieve the same effect. In this case, the woman's need to increase the dose of the opiate agonist to achieve the same analgesic effect indicates the development of tolerance. Physical dependence refers to the body's adaptation to a drug, resulting in withdrawal symptoms upon discontinuation. Addiction refers to a psychological and behavioral dependence on a drug, characterized by compulsive drug-seeking behavior. Withdrawal refers to the symptoms experienced upon discontinuation of a drug. Drug-seeking behavior refers to the actions taken by an individual to obtain drugs.

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  • 9. 

    If the patient in Question 11-4 is anesthetized with equipment in which the CO2 absorbent is not well hydrated, she is at risk of poisoning with

    • NO

    • O2

    • CO

    • H2S

    • He

    Correct Answer
    A. CO
    Explanation
    If the CO2 absorbent in the anesthesia equipment is not well hydrated, it can lead to the accumulation of carbon monoxide (CO) in the patient's body. This is because the CO2 absorbent is responsible for removing CO2 from the patient's exhaled breath. If it is not properly hydrated, it can undergo a chemical reaction with the anesthetic gases, such as desflurane or sevoflurane, resulting in the production of CO. This can lead to CO poisoning, which can be life-threatening if not promptly treated.

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  • 10. 

    A 55-year-old man with benign prostatic hypertrophy is being treated with finasteride. Finasteride acts by blocking the conversion of

    • Testosterone to estradiol.

    • Testosterone to dihydrotestosterone.

    • Cortisol to cortisone.

    • Cholesterol to pregnenolone.

    • Progesterone to androstenedione.

    Correct Answer
    A. Testosterone to dihydrotestosterone.
    Explanation
    Finasteride is a medication used to treat benign prostatic hypertrophy. It acts by blocking the conversion of testosterone to dihydrotestosterone (DHT). DHT is a more potent form of testosterone and is responsible for the enlargement of the prostate gland. By inhibiting the conversion of testosterone to DHT, finasteride helps to reduce the size of the prostate gland and alleviate symptoms associated with benign prostatic hypertrophy.

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  • 11. 

    A 36-year-old woman with the diagnosis of Trichomonas vaginalis returns to your office one day after receiving a 2 g oral dose of metronidazole with complaints of flushing, headache, vomiting, and abdominal pain. She states that her symptoms began after she and her husband celebrated their 10th wedding anniversary at a restaurant. The most likely cause of her symptoms is

    • Chocolate.

    • Red wine.

    • Cabbage.

    • Pork.

    • Coffee.

    Correct Answer
    A. Red wine.
    Explanation
    The symptoms of flushing, headache, vomiting, and abdominal pain after consuming red wine suggest an alcohol intolerance or sensitivity. This can be a common side effect of metronidazole, an antibiotic used to treat Trichomonas vaginalis. Red wine contains alcohol, which can exacerbate these symptoms. The other options, such as chocolate, cabbage, pork, and coffee, are not typically associated with these symptoms in this context.

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  • 12. 

    A 23-year-old man has deliberately ingested an organophosphate insecticide. His initial symptoms of salivation, lacrimation, and diarrhea are a consequence of inhibition of

    • Butyrylcholinesterase.

    • Acetylcholinesterase.

    • Na+, K+-A Pase.

    • Tyrosine hydroxylase.

    • Monoamine oxidase.

    Correct Answer
    A. Acetylcholinesterase.
    Explanation
    The initial symptoms of salivation, lacrimation, and diarrhea are consistent with the effects of increased acetylcholine activity. Organophosphate insecticides inhibit acetylcholinesterase, the enzyme responsible for breaking down acetylcholine. This inhibition leads to an accumulation of acetylcholine in the body, causing excessive stimulation of cholinergic receptors and resulting in symptoms such as increased salivation, tearing, and gastrointestinal disturbances. Therefore, the correct answer is acetylcholinesterase.

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  • 13. 

    A 36-year-old woman presents with symptoms of major depression that are unrelated to a general medical condition, bereavement, or substance abuse. She is not currently taking any prescription or over-the-counter medications. Drug treatment is to be initiated with sertraline. In your information to the patient, you would tell her that

    • Sertraline may take 2 weeks or more to become effective

    • It is preferable that she take the drug in the morning

    • Muscle cramps and twitches can occur

    • She should notify you if she anticipates using other prescription drugs

    • All of the above

    Correct Answer
    A. All of the above
    Explanation
    The explanation for the correct answer "All of the above" is that all of the statements provided are true and relevant to the patient's treatment with sertraline. Sertraline is an antidepressant medication that may take 2 weeks or more to show its full effectiveness. It is generally recommended to take the drug in the morning to minimize the risk of insomnia. Muscle cramps and twitches can be potential side effects of sertraline. It is important for the patient to notify the healthcare provider if she anticipates using other prescription drugs to avoid potential drug interactions.

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  • 14. 

    An 84-year-old woman being treated for hypertension, mild heart failure (NYHA class II), and persistent atrial fibrillation is taking several different medications: aspirin, sotalol, diltiazem, metoprolol, captopril, chlorothiazide, and warfarin. Over the past several weeks, she has begun to complain that she is no longer able to take her dog for long walks because she tires easily. She also complains of shortness of breath. The drug-drug interactions most likely contributing to the patient’s recent symptoms are

    • Sotalol and diltiazem.

    • Diltiazem and metoprolol.

    • Sotalol and metoprolol.

    • All of the above

    Correct Answer
    A. All of the above
    Explanation
    The patient is experiencing symptoms of fatigue and shortness of breath, which are indicative of heart failure worsening. The combination of sotalol and diltiazem can lead to additive negative effects on cardiac conduction and contractility, exacerbating heart failure symptoms. Diltiazem and metoprolol can also have additive negative effects on heart rate and blood pressure, further worsening heart failure. Additionally, sotalol and metoprolol can have additive negative effects on heart rate and rhythm, contributing to atrial fibrillation symptoms. Therefore, all of the listed drug-drug interactions are likely contributing to the patient's symptoms.

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  • 15. 

    A patient is being started on statin therapy. What should be considered in choosing which statin to use?

    • Efficacy in reducing LDL-C

    • Cost

    • Safety

    • All of the above

    • None of the above

    Correct Answer
    A. All of the above
    Explanation
    When choosing a statin therapy for a patient, all of the above factors should be considered. Efficacy in reducing LDL-C is important as it determines the effectiveness of the medication in lowering cholesterol levels. Cost is also a crucial factor as it affects the patient's affordability and adherence to the treatment. Safety is another important consideration to ensure that the chosen statin has a favorable side effect profile and does not pose any significant risks to the patient. Therefore, considering all of these factors is necessary in making an informed decision about which statin to use.

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  • 16. 

    A 25-year-old woman has been treated with thyroxine for hypothyroidism. She has become pregnant. She complains now of being constantly fatigued. The proper course of action would be to

    • Do nothing, fatigue is normal during pregnancy.

    • Increase the iodine in her diet.

    • Measure her serum TSH during the first trimester and adjust her thyroxine dose based on the result

    • Double her dose of thyroxine.

    •  decrease the dose of thyroxine as the need for thyroid replacement therapy decreases during pregnancy

    Correct Answer
    A. Measure her serum TSH during the first trimester and adjust her thyroxine dose based on the result
    Explanation
    During pregnancy, the demand for thyroid hormones increases due to changes in metabolism. In this case, the woman is already being treated with thyroxine for hypothyroidism. Therefore, it is important to monitor her thyroid function by measuring her serum TSH levels during the first trimester. This will help determine if her current dose of thyroxine is adequate or needs adjustment to ensure that her thyroid hormone levels are within the appropriate range for a healthy pregnancy. Adjusting the thyroxine dose based on the TSH result will help alleviate her constant fatigue and ensure the well-being of both the mother and the developing fetus.

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  • 17. 

    Esomeprazole has a plasma half -life of a few hours yet suppresses acid secretion for 24 to 48 hours. The reason for this paradox is

    • Acid suppression continues until new H+,K+-ATPase molecules are synthesized

    • Gastrin depletion occurs long after esomeprazole disappears from the plasma

    • Prostaglandin synthesis is enhanced by esomeprazole

    • H. pylori is effectively suppressed by esomeprazole for 24 to 48 hours

    • Acid suppression continues until new H2 receptors are synthesized

    Correct Answer
    A. Acid suppression continues until new H+,K+-ATPase molecules are synthesized
    Explanation
    Esomeprazole is a proton pump inhibitor (PPI) that works by irreversibly binding to the H+,K+-ATPase enzyme, which is responsible for acid secretion in the stomach. This binding inhibits the enzyme's activity and reduces acid production. The plasma half-life of esomeprazole is short, meaning that it is quickly eliminated from the bloodstream. However, the effects of esomeprazole on acid secretion last much longer because the drug's binding to the H+,K+-ATPase enzyme is irreversible. Therefore, acid suppression continues until new H+,K+-ATPase molecules are synthesized, which takes time. This explains the paradox of a short plasma half-life but long-lasting acid suppression.

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  • 18. 
    Prior to clinical trials in patients with heart failure, an animal study was carried out to compare two new positive inotropic drugs (A and B) to a current standard agent (C). The results of cardiac output measurements are shown in the graph below. Which of the following statements is correct? - ProProfs

    Prior to clinical trials in patients with heart failure, an animal study was carried out to compare two new positive inotropic drugs (A and B) to a current standard agent (C). The results of cardiac output measurements are shown in the graph below. Which of the following statements is correct?

    • Drug A is most effective

    • Drug B is least potent

    • Drug C is most potent

    • Drug B is more potent than drug C and more effective than drug A

    • Drug A is more potent than drug B and more effective than drug C

    Correct Answer
    A. Drug B is more potent than drug C and more effective than drug A
    Explanation
    Based on the graph, the cardiac output for drug B is higher than drug C, indicating that drug B is more potent than drug C. Additionally, the cardiac output for drug A is lower than both drug B and drug C, suggesting that drug B is more effective than drug A. Therefore, the correct statement is "Drug B is more potent than drug C and more effective than drug A."

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  • 19. 

    A 35-year-old man has ingested Amanita muscaria mushrooms. He is experiencing a heart rate of 40 beats per minute. This bradycardia is most likely due to an interaction of the chemical(s) in the mushrooms with which receptors at the sinoatrial node?

    • α1 Adrenergic

    • β1 Adrenergic

    • β2 Adrenergic

    • M2 muscarinic

    • Nicotinic

    Correct Answer
    A. M2 muscarinic
    Explanation
    The bradycardia observed in the 35-year-old man who ingested Amanita muscaria mushrooms is most likely due to an interaction of the chemical(s) in the mushrooms with M2 muscarinic receptors at the sinoatrial node. M2 muscarinic receptors are found in the heart and their activation leads to a decrease in heart rate.

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  • 20. 

    A 43-year-old man is being treated with amphotericin B for esophageal candidiasis. Which of the following serum laboratory tests should be monitored closely?

    • Bilirubin

    • Cholesterol

    • Glucose

    • Creatinine

    • Sodium

    Correct Answer
    A. Creatinine
    Explanation
    Amphotericin B is an antifungal medication that can cause kidney damage as a side effect. Therefore, it is important to monitor the patient's creatinine levels closely. Creatinine is a waste product produced by muscles and filtered by the kidneys. Elevated levels of creatinine in the blood indicate impaired kidney function. Monitoring creatinine levels helps to assess the patient's renal function and detect any potential kidney damage caused by amphotericin B treatment.

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  • 21. 

    A 28-year-old woman is brought to the emergency department after overdosing on oxycodone, an opiate analgesic. She is unconscious and barely breathing when she arrives at the hospital, but revives and is breathing normally within 2 minutes after receiving an injection of naloxone. After about an hour, she requires another dose of naloxone as the symptoms of opiate overdose begin to redevelop. Naloxone is likely acting as a:

    • Strong stimulant that counteracts the CNS-depressant effects of the opiate.

    • Diuretic that increases renal excretion of the opiate.

    • Drug that stimulates respiratory centers in the brain.

    • Competitive antagonist of opioid receptors.

    • Noncompetitive antagonist of opioid receptors.

    Correct Answer
    A. Competitive antagonist of opioid receptors.
    Explanation
    Naloxone is a competitive antagonist of opioid receptors. Opioid receptors are the targets of opioids like oxycodone, and naloxone competes with these opioids for binding to the receptors. By binding to the receptors, naloxone blocks the effects of the opioids, reversing their depressant effects on the central nervous system. This explains why the woman revives and begins breathing normally after receiving naloxone. However, since naloxone has a shorter half-life than oxycodone, the symptoms of opiate overdose start to redevelop after some time, requiring another dose of naloxone.

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  • 22. 

    The term “first-pass effect” refers to the

    • Effect a new drug has on the body after its first administration.

    • Time it takes for a drug to be detected in the urine or feces after oral administration.

    • Ability of the intestines and liver to reduce the bioavailability of a drug.

    • Time it takes for a drug to reach therapeutic concentrations in the target tissue.

    • Initial effect a drug has on target tissues.

    Correct Answer
    A. Ability of the intestines and liver to reduce the bioavailability of a drug.
    Explanation
    The term "first-pass effect" refers to the ability of the intestines and liver to reduce the bioavailability of a drug. This means that after oral administration of a drug, the drug may undergo metabolism and elimination in the intestines and liver before it can reach systemic circulation and exert its therapeutic effects. This can result in a lower concentration of the drug reaching the target tissues, reducing its effectiveness.

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  • 23. 

    A 53-year-old woman with COPD is using an albuterol inhaler for symptomatic relief of bronchospasm. She does not like using her inhaler because it causes

    • Her lips to turn black.

    • Her heart to beat faster.

    • Numbness in her fingers and toes.

    • Transient blindness.

    • Transient diminished hearing

    Correct Answer
    A. Her heart to beat faster.
    Explanation
    The correct answer is "her heart to beat faster." Albuterol is a bronchodilator medication that works by relaxing the muscles in the airways, allowing for easier breathing. One of the common side effects of albuterol is an increased heart rate or palpitations. This occurs because albuterol can stimulate the beta-2 adrenergic receptors in the heart, leading to an increase in heart rate. It is important for patients with COPD to be aware of this side effect and to monitor their heart rate while using albuterol.

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  • 24. 

    A 34-year-old woman has been frequently using a nasal spray containing the α adrenergic receptor agonist oxymetazoline for nasal decongestion. She has recently noticed that it is less effective and her symptoms are worse. T is loss of efficacy is most likely due to

    • The act that her spray container is empty.

    • Degradation of the oxymetazoline.

    • A manufacturing defect in the nasal spray container.

    • A loss of innervation to her nasal mucosa.

    • Rebound hyperemia of her nasal mucosa

    Correct Answer
    A. Rebound hyperemia of her nasal mucosa
    Explanation
    The loss of efficacy of the nasal spray is most likely due to rebound hyperemia of the nasal mucosa. Rebound hyperemia occurs when the blood vessels in the nasal mucosa dilate excessively after the vasoconstrictive effects of the nasal spray wear off. This can lead to worsening symptoms and decreased effectiveness of the spray.

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  • 25. 

    A 32-year-old woman is taking ramelteon for chronic insomnia. Ramelteon binds to

    • Melatonin receptors M1 and M2.

    • Muscarinic receptors M3.

    • Nicotinic receptors.

    • α1-adrenergic receptors.

    • D2 dopaminergic receptors.

    Correct Answer
    A. Melatonin receptors M1 and M2.
    Explanation
    Ramelteon is a medication used to treat chronic insomnia. It works by binding to melatonin receptors M1 and M2. Melatonin is a hormone that regulates the sleep-wake cycle, and by binding to these receptors, ramelteon helps to promote sleep. This explanation aligns with the information provided in the question and accurately describes the mechanism of action of ramelteon.

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  • 26. 

    A 33-year-old Japanese man becomes flushed and light-headed after one glass of wine. T is reaction is likely due to

    • The rate he drank the glass of wine.

    • Increased absorption of the alcohol.

    • Inhibition of monoamine oxidase.

    • Decreased renal excretion of alcohol.

    • A variant in aldehyde dehydrogenase.

    Correct Answer
    A. A variant in aldehyde dehydrogenase.
    Explanation
    The correct answer is a variant in aldehyde dehydrogenase. This is because the symptoms described, such as flushing and light-headedness, are commonly seen in individuals with a genetic variant in the enzyme aldehyde dehydrogenase. This variant leads to an accumulation of acetaldehyde, a toxic byproduct of alcohol metabolism, causing these symptoms. The other options, such as rate of drinking, absorption, inhibition of monoamine oxidase, or renal excretion, do not explain the specific symptoms mentioned in the question.

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  • 27. 

    A 32-year-old woman has been taking an oxycodone-acetaminophen product for chronic arthritic pain. On a follow-up appointment her serum aminotranserases are elevated and she is slightly jaundiced. She admits to increasing the dose of the oxycodone combination product over the past several weeks. The most likely cause of her liver injury is

    • Oxycodone.

    • Hepatitis A.

    • Hepatitis C.

    • Arthritis.

    •  acetaminophen

    Correct Answer
    A.  acetaminophen
    Explanation
    The most likely cause of the woman's liver injury is acetaminophen. Elevated serum aminotransferases and jaundice are indicative of liver injury. Acetaminophen is a known hepatotoxin, and increasing the dose of the oxycodone-acetaminophen product can lead to hepatotoxicity. Acetaminophen overdose can cause liver damage, especially when taken in high doses or in combination with alcohol. Hepatitis A and C are viral infections that can cause liver damage, but the woman's symptoms are more consistent with acetaminophen-induced liver injury rather than viral hepatitis. Arthritis is not a likely cause of liver injury.

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  • 28. 

    Current evidence supports the view that most intravenous general anesthetics act predominantly through

    • 5-HT receptors.

    • D2 dopamine receptors.

    • GABAA receptors.

    • α2-adrenergic receptors.

    • β1-adrenergic receptors.

    Correct Answer
    A. GABAA receptors.
    Explanation
    Current evidence suggests that most intravenous general anesthetics primarily act through GABAA receptors. GABAA receptors are a type of receptor in the brain that respond to the neurotransmitter gamma-aminobutyric acid (GABA), which is an inhibitory neurotransmitter. Activation of GABAA receptors leads to an increase in inhibitory signaling in the brain, resulting in sedation and anesthesia. This explanation is supported by research studies that have shown the involvement of GABAA receptors in the mechanism of action of intravenous general anesthetics.

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  • 29. 

    A 44-year-old man is undergoing surgery on the fifth finger of his right hand. A local anesthetic without epinephrine is used because epinephrine in this setting may cause

    • Methemoglobinemia.

    • Renal impairment.

    • Liver injury.

    • Gangrene.

    • Necrosis of the optic nerve.

    Correct Answer
    A. Gangrene.
    Explanation
    Epinephrine is a vasoconstrictor, meaning it narrows blood vessels and reduces blood flow to the area where it is applied. In this case, using epinephrine in the surgery on the fifth finger of the man's right hand could potentially reduce blood flow to the area, leading to inadequate oxygen supply and tissue death. This condition is known as gangrene, which is characterized by the death of body tissues due to a lack of blood supply. Therefore, a local anesthetic without epinephrine is used to avoid the risk of gangrene in this situation.

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  • 30. 

    A 19-year-old woman is being treated with ethosuximide, most likely for which type of seizure?

    • Simple partial

    • Complex partial

    • Tonic-clonic

    • Absence

    • Status epilepticus

    Correct Answer
    A. Absence
    Explanation
    The correct answer is "Absence." Ethosuximide is a medication commonly used to treat absence seizures, also known as petit mal seizures. Absence seizures are characterized by brief episodes of staring or loss of awareness, often accompanied by subtle body movements such as eye blinking or lip smacking. Ethosuximide works by reducing abnormal electrical activity in the brain, which helps to control and prevent absence seizures.

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  • 31. 

    Which NSAID permanently inactivates TxA2 synthesis by platelets?

    • Aspirin

    • Acetaminophen

    • Ibuprofen

    • Naproxen

    • Celecoxib

    Correct Answer
    A. Aspirin
    Explanation
    Aspirin permanently inactivates TxA2 synthesis by platelets. This is because aspirin irreversibly inhibits the enzyme cyclooxygenase (COX), which is responsible for the production of thromboxane A2 (TxA2) in platelets. TxA2 is a potent platelet aggregator and vasoconstrictor. By inhibiting TxA2 synthesis, aspirin prevents platelet aggregation and reduces the risk of clot formation.

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  • 32. 

    A 56-year-old woman with an intact uterus is being treated with hormone replacement therapy with a product that contains an estrogen/progestin combination (estradiol/norethindrone). The progestin is added to

    • Decrease the risk of endometrial cancer.

    • Decrease the incidence of breast cancer

    • Increase the effectiveness in treating vasomotor symptoms.

    • Decrease the risk of coronary heart disease.

    • Decrease the risk of cognitive impairment..

    Correct Answer
    A. Decrease the risk of endometrial cancer.
    Explanation
    The progestin is added to decrease the risk of endometrial cancer. Estrogen alone can stimulate the growth of the endometrium, which may increase the risk of endometrial cancer. Progestin helps to counteract this effect by opposing the estrogen's action on the endometrium. This combination therapy is commonly used in hormone replacement therapy to provide the benefits of estrogen while minimizing the risk of endometrial cancer.

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  • 33. 

    A 63-year-old man with type 2 diabetes and osteoarthritis in his left knee is given an intra-articular injection of a glucocorticoid to decrease pain in his knee. An elevation in his blood sugar for the next 3 days is likely due to an effect of the glucocorticoid on

    • Diminished peripheral glucose utilization.

    • Increased protein breakdown.

    • Activation of lipolysis.

    • Increased glucose synthesis in the liver.

    • All of the above

    Correct Answer
    A. All of the above
    Explanation
    Glucocorticoids have a wide range of effects on glucose metabolism. They can cause diminished peripheral glucose utilization by reducing insulin sensitivity in peripheral tissues. They can also increase protein breakdown, leading to increased release of amino acids which can be converted to glucose in the liver through a process called gluconeogenesis. Glucocorticoids can also activate lipolysis, which releases fatty acids that can be converted to glucose in the liver. Therefore, all of the above options are likely contributing to the elevation in blood sugar seen in the patient after receiving the glucocorticoid injection.

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  • 34. 

    A-47-year-old man is receiving intravenous vancomycin. He develops flushing, tachycardia, and hypotension. The flushing, caused by the rapid infusion of vancomycin (referred to as “red man” syndrome), is caused by

    • Testosterone released by sertoli cells.

    • Glucagon released by hepatic cells.

    • Histamine released by mast cells.

    • Dopamine released by endothelial cells.

    • Growth hormone released by pituitary cells.

    Correct Answer
    A. Histamine released by mast cells.
    Explanation
    The correct answer is histamine released by mast cells. Red man syndrome is a hypersensitivity reaction caused by the rapid infusion of vancomycin. It is characterized by flushing, tachycardia, and hypotension. Histamine is released by mast cells during this reaction, leading to the flushing and other symptoms.

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  • 35. 

    A 25-year-old woman is receiving tetracycline for the treatment of acne. She should be warned against the concurrent ingestion of

    • Milk.

    • Caffeine.

    • Chocolate.

    • Green leafy vegetables.

    • Water.

    Correct Answer
    A. Milk.
    Explanation
    Tetracycline is a type of antibiotic that can bind to calcium in milk, forming insoluble complexes that reduce its absorption. This can decrease the effectiveness of the medication. Therefore, the woman should be warned against the concurrent ingestion of milk while taking tetracycline.

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  • 36. 

    The therapeutic window is an indication of the:

    • Length of time a drug should be administered to achieve optimal effects

    • Time of day when a drug should be administered or optimal effects

    • Range of concentrations over which a drug is maximally effective for all patients

    • Range of concentrations over which a drug is safe and efficacious for most patients

    • Age range of patients that is optimal for a given drug

    Correct Answer
    A. Range of concentrations over which a drug is safe and efficacious for most patients
    Explanation
    The therapeutic window refers to the range of concentrations at which a drug is both safe and effective for most patients. This means that the drug is within the desired therapeutic range, where it can produce the desired therapeutic effects without causing significant adverse effects. It is important to monitor drug concentrations within this window to ensure optimal treatment outcomes.

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  • 37. 

    A 23-year-old man is accosted by 3 men late at night. Immediately his heart rate increases due to an increase in epinephrine in his circulation. This release of epinephrine from the adrenal medulla is the result of the action of acetylcholine on

    • Muscarinic receptors.

    • α adrenergic receptors.

    • Nicotinic receptors.

    • β adrenergic receptors.

    • Glutamate receptors.

    Correct Answer
    A. Nicotinic receptors.
    Explanation
    Acetylcholine is the neurotransmitter responsible for activating nicotinic receptors in the adrenal medulla. When acetylcholine binds to nicotinic receptors, it triggers the release of epinephrine from the adrenal medulla, leading to an increase in heart rate. Therefore, the correct answer is nicotinic receptors.

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  • 38. 

    The typical dose of oral propranolol for the treatment of hypertension is 320 mg/day. The typical dose of IV propranolol to treat a life-threatening arrhythmia is 1 to 3 mg administered slowly. The reason for the discrepancy in these doses is

    • β adrenergic receptors are more sensitive to IV than oral propranolol.

    • The IV dose avoids the “first pass” metabolism of oral propranolol.

    • Treatment of hypertension requires a higher dose of propranolol than does treatment of a cardiac arrhythmia.

    • The density of β2 receptors in the heart is greater than the density of β2 receptors on blood vessels.

    • Oral propranolol is excreted by the kidney at a faster rate than IV propranolol.

    Correct Answer
    A. The IV dose avoids the “first pass” metabolism of oral propranolol.
    Explanation
    The reason for the discrepancy in the doses of oral and IV propranolol is that the IV dose avoids the "first pass" metabolism of oral propranolol. When a drug is taken orally, it first passes through the liver before entering the systemic circulation. This process, known as first pass metabolism, can lead to the breakdown and inactivation of a significant portion of the drug. By administering propranolol intravenously, the drug bypasses the liver and enters the systemic circulation directly, resulting in a higher bioavailability and therefore a lower required dose compared to oral administration.

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  • 39. 

    A 28-year-old man is being treated with phenytoin for tonic-clonic seizures. His drug plasma concentration is in the low therapeutic range and he is still having foccasional seizures. His dose is increased slightly. Within 2 weeks he is ataxic, lethargic, and has nystagmus. A repeat of his plasma concentration shows that he is now slightly above the upper limit of the therapeutic range. The reason for the dramatic rise in his plasma concentration following a modest increase in his dose is most likely because of

    • Renal failure.

    • Liver failure.

    • Nonlinear elimination.

    • Metabolic acidosis.

    • Poor GI absorption of Ca2+.

    Correct Answer
    A. Nonlinear elimination.
    Explanation
    The reason for the dramatic rise in the man's plasma concentration following a modest increase in his dose is most likely due to nonlinear elimination. Nonlinear elimination occurs when the rate of elimination of a drug is not proportional to its concentration. In this case, the man's plasma concentration increased significantly even with a slight increase in his dose, indicating that the drug is being eliminated from his body at a slower rate than expected. This can lead to drug accumulation and toxicity, resulting in symptoms such as ataxia, lethargy, and nystagmus.

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  • 40. 

    A 20-year-old woman is taking topiramate as monotherapy for refractory generalized tonic-clonic seizures. She should be warned to increase her dose of

    • Levothyroxine.

    • Metoprolol.

    • Insulin

    • Botox

    • Oral contraceptive.

    Correct Answer
    A. Oral contraceptive.
    Explanation
    The correct answer is oral contraceptive. Topiramate is known to decrease the effectiveness of hormonal contraceptives, including oral contraceptives. Therefore, the woman should be warned to increase her dose of oral contraceptive or consider alternative methods of contraception to ensure effectiveness.

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  • 41. 

    A patient is prescribed niacin to reduce his/her triglyceride and LDL-C levels. The side effect(s) of niacin that most commonly limits patient compliance include

    • Bloating.

    • Flushing and dyspepsia.

    • Tinninus

    • Dry cough

    • Chills

    Correct Answer
    A. Flushing and dyspepsia.
    Explanation
    Niacin is known to cause flushing and dyspepsia as common side effects. Flushing is characterized by redness and warmth of the skin, usually on the face and neck, and it can be uncomfortable for patients. Dyspepsia refers to indigestion or stomach discomfort, which can also be bothersome. These side effects can often lead to patient non-compliance with niacin therapy. Bloating, tinnitus, dry cough, and chills are not commonly associated with niacin use.

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  • 42. 

    A 45-year-old woman with type 2 diabetes is noticing an increase in her basal insulin dose needed to achieve the same effect. This is likely because of

    • Increased insulin secretion.

    • Insulin resistance in target tissues.

    • Improper formulation of her insulin.

    • Increased glucagon secretion.

    • . increased consumption of carbohydrates.

    Correct Answer
    A. Insulin resistance in target tissues.
    Explanation
    The correct answer is insulin resistance in target tissues. In type 2 diabetes, the body's cells become resistant to the effects of insulin, leading to a decrease in glucose uptake from the bloodstream. As a result, the pancreas compensates by producing more insulin to try and overcome this resistance. Over time, however, the insulin resistance worsens, requiring higher doses of insulin to achieve the same effect. This is why the woman is noticing an increase in her basal insulin dose needed to control her blood sugar levels.

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  • 43. 

    The pharmacokinetic process or property that distinguishes the elimination of ethanol and high doses of phenytoin and aspirin from the elimination of most other drugs is called

    • Distribution

    • Excretion

    • First-pass effect

    • First-order elimination

    • Zero-order elimination

    Correct Answer
    A. Zero-order elimination
    Explanation
    Zero-order elimination is the pharmacokinetic process or property that distinguishes the elimination of ethanol and high doses of phenytoin and aspirin from the elimination of most other drugs. In zero-order elimination, the rate of elimination remains constant regardless of the concentration of the drug in the body. This is different from first-order elimination, where the rate of elimination is proportional to the drug concentration. Zero-order elimination is typically seen when the elimination pathways for the drug become saturated at higher doses, resulting in a constant rate of elimination.

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  • 44. 

    A 49-year-old woman is treated with pilocarpine hydrochloride for xerostomia (dry mouth) following head and neck radiation treatments. As a result of taking this drug she may experience which of the following side effects?

    • Sweating

    • Dry eyes

    • Dry skin

    • Confusion

    • Tachycardia

    Correct Answer
    A. Sweating
    Explanation
    Pilocarpine hydrochloride is a medication that stimulates the sweat glands, leading to increased sweating. Therefore, it is expected that a 49-year-old woman who is being treated with this drug for xerostomia may experience sweating as a side effect.

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  • 45. 

    The mechanism underlying the life-threatening interaction of organic nitrates and PDE5 inhibitors is that

    • PDE5 inhibitors block the degradation of organic nitrates in the liver.

    • PDE inhibitors block the degradation of cyclic GMP in vascular smooth muscle.

    • PDE inhibitors enhance the conversion of organic nitrates to NO.

    • PDE5 inhibitor degradation is blocked by organic nitrates.

    • PDE5 inhibitor excretion is blocked by organic nitrates.

    Correct Answer
    A. PDE inhibitors block the degradation of cyclic GMP in vascular smooth muscle.
    Explanation
    The correct answer is that PDE inhibitors block the degradation of cyclic GMP in vascular smooth muscle. This is the mechanism underlying the life-threatening interaction of organic nitrates and PDE5 inhibitors. Organic nitrates are commonly used to treat angina, as they release nitric oxide (NO) which activates guanylate cyclase, leading to the production of cyclic GMP. Cyclic GMP relaxes smooth muscle in blood vessels, resulting in vasodilation and increased blood flow. PDE5 inhibitors, such as sildenafil (Viagra), block the degradation of cyclic GMP, leading to prolonged vasodilation. When both organic nitrates and PDE5 inhibitors are taken together, there is an excessive increase in cyclic GMP levels, which can cause severe hypotension and cardiovascular collapse.

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  • 46. 

    Used prophylactically in pregnant women to prevent neural tube defects in the fetus:

    • Riboflavin

    • Pyridoxine

    • Iron

    • Vitamin B12

    • Folic acid

    Correct Answer
    A. Folic acid
    Explanation
    Folic acid is used prophylactically in pregnant women to prevent neural tube defects in the fetus. Neural tube defects are birth defects that occur when the neural tube, which forms the baby's brain and spinal cord, does not close properly during early pregnancy. Folic acid is essential for the development of the neural tube and helps prevent these defects. It is recommended that women who are planning to become pregnant or are in the early stages of pregnancy take folic acid supplements to ensure the proper development of their baby's neural tube.

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  • 47. 

    A physician is planning to treat a 27-year-old woman with primaquine for a documented P. vivax infection. Prior to beginning treatment, the physician must test the patient for

    • Elevated serum amylase

    • Glucose-6-phosphate dehydrogenase deficiency

    • Iron deficiency

    • Elevated serum calcium

    • Vitamin B12 deficiency.

    Correct Answer
    A. Glucose-6-phosphate dehydrogenase deficiency
    Explanation
    Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an inherited condition that affects the red blood cells. Primaquine is known to cause hemolytic anemia in individuals with G6PD deficiency. Therefore, it is important to test the patient for G6PD deficiency before starting treatment with primaquine to avoid potential complications. Elevated serum amylase, iron deficiency, elevated serum calcium, and vitamin B12 deficiency are not directly related to the use of primaquine for P. vivax infection.

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  • 48. 

    Chloroquine-resistance is now common in most parts of the world. The cause of chloroquine-resistance is

    • Enhanced metabolism by the P. falciparum parasite.

    • Poor absorption in the human GI tract.

    • Induced metabolism by the human liver after repeat dosing.

    • Sequestration of the drug in at stores.

    • Enhanced efflux of drug from the digestive vacuoles of drug-resistant parasites.

    Correct Answer
    A. Enhanced efflux of drug from the digestive vacuoles of drug-resistant parasites.
    Explanation
    Chloroquine-resistance is now common in most parts of the world because of the enhanced efflux of the drug from the digestive vacuoles of drug-resistant parasites. This means that the parasites have developed mechanisms to quickly remove the drug from their system, making it less effective in killing them. This resistance mechanism allows the parasites to survive and continue to multiply, leading to the spread of chloroquine-resistance globally.

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  • 49. 

    The term “blood-brain barrier” (BBB) refers to a:

    • Noncellular barrier that prevents drugs from entering the CNS unless transported by specific carriers.

    • Cellular barrier that includes brain capillary endothelial cells that limits drug entry into the brain.

    • Virtual or conceptual barrier that can explain the behavior of some drug effects on the CNS.

    • Physical barrier that prevents blood from entering the brain.

    • Device that is used to prevent blood-borne drugs from entering the brain

    Correct Answer
    A. Cellular barrier that includes brain capillary endothelial cells that limits drug entry into the brain.
    Explanation
    The term "blood-brain barrier" refers to a cellular barrier that includes brain capillary endothelial cells that limits drug entry into the brain. This barrier is formed by tight junctions between the endothelial cells of the brain capillaries, which prevents the free diffusion of drugs and other substances from the blood into the brain. Only certain molecules that are transported by specific carriers can cross this barrier and enter the central nervous system.

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Quiz Review Timeline (Updated): Mar 22, 2023 +

Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

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  • Mar 22, 2023
    Quiz Edited by
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