Practice For Pharmacodynamics Exam 3

In the occipital lobe, the orthodromic impulse refers to a nerve impulse that travels in the normal direction along a neuron. In this case, the orthodromic impulse results in an antidromic impulse, which means that the nerve impulse travels in the opposite direction. This antidromic impulse moves up to the dura mater, a thick membrane that surrounds the brain, where it activates the release of vasodilating neuropeptides such as CGRP, substance P, and NKA. Additionally, the release of bradykinin and albumin from the blood vessels occurs, leading to inflammation. Therefore, the statement is true.

Nausea is a common symptom that often occurs during a migraine attack. Many individuals who experience migraines also report feeling nauseous or even vomiting during an episode. This gastrointestinal symptom is believed to be caused by the activation of certain brain pathways that control both pain and nausea. Therefore, it is accurate to say that nausea is the most common gastrointestinal symptom associated with migraines.

Triptans are a class of medications commonly used to treat migraines. While they are effective in relieving migraine symptoms, one of the potential side effects is chest tightness and pressure. This occurs because triptans can cause constriction of blood vessels, including those in the chest. This side effect is usually temporary and not dangerous, but it is important to be aware of it and consult a healthcare professional if it occurs. Therefore, the statement "Triptans can cause tightness and pressure in the chest as a side effect" is true.

Cisapride, like metoclopramide, is a medication that affects the gastrointestinal (GI) system. Atropine is a medication that blocks certain actions in the body, including some GI actions. Therefore, it is reasonable to conclude that the GI actions of cisapride, similar to metoclopramide, would also be blocked by atropine. Hence, the statement is true.

Cortisol deficiency can lead to impaired renal function because cortisol plays a role in regulating blood pressure and fluid balance. Without enough cortisol, the kidneys may not be able to properly filter waste products from the blood, resulting in reduced glomerular filtration rate (GFR). Additionally, cortisol deficiency can cause an increase in the release of antidiuretic hormone (ADH). ADH helps regulate water balance in the body by increasing water reabsorption in the kidneys. Therefore, with cortisol deficiency, ADH release increases, further affecting renal function.

Extrapyramidal syndromes are movement disorders that can occur as a side effect of certain medications, including metoclopramide. These syndromes are characterized by symptoms such as tremors, muscle stiffness, and abnormal body movements. At high doses, metoclopramide can block dopamine receptors in the brain, leading to the development of extrapyramidal syndromes. Therefore, the statement "Extrapyramidal syndromes can occur at high doses of metoclopramide" is true.

Triptans are selective agonists at 5-HT1B and 5-HT1D receptors. This means that they specifically bind and activate these receptors in the brain. By doing so, triptans help to constrict blood vessels and reduce inflammation, which can relieve symptoms of migraines and cluster headaches. Dopamine, norepinephrine, and cholinergic receptors are not the primary targets of triptans, making options b), c), and d) incorrect.

Metoclopramide, a medication used to treat nausea and vomiting, can be used in pregnancy. It is considered safe for use during pregnancy and has been used for many years without any significant adverse effects on the developing fetus. Metoclopramide helps to relieve symptoms of nausea and vomiting, which are common discomforts experienced by pregnant women. It works by increasing the movement of the stomach and intestines, helping to reduce nausea and improve digestion. However, it is always important to consult with a healthcare provider before taking any medication during pregnancy.

Cisapride is a medication used to treat gastrointestinal disorders, particularly gastroesophageal reflux disease (GERD). It acts by increasing the movement of the stomach and intestines. Unlike other medications that block dopamine D2 receptors, cisapride does not have any effect on these receptors. As a result, it does not influence the concentration of prolactin in the plasma or cause extrapyramidal symptoms, which are movement disorders commonly associated with dopamine blockade. Therefore, the statement that cisapride does not block D2 receptors and does not affect prolactin concentration or cause extrapyramidal symptoms is true.

Triptans are a class of medications commonly used to treat migraines. They are known to be generally well tolerated by most individuals. The side effects associated with triptans are typically minimal and are often related to the dosage of the medication. This means that higher doses may increase the likelihood of experiencing side effects. Therefore, the statement "Triptans: These agents are generally well tolerated. Side effects are minimal and are dose-related" is true.

The most common adverse effect of ergotamine derivatives is nausea and vomiting. Ergotamine derivatives are medications used to treat migraines and cluster headaches. These drugs work by constricting blood vessels in the brain, which can lead to gastrointestinal side effects such as nausea and vomiting. While painful extremities, peripheral ischemia, and continuous paresthesias are possible adverse effects of ergotamine derivatives, they are less common compared to nausea and vomiting.

Antidepressants are not typically used in the acute treatment of migraine headaches. While they may be prescribed for the prevention of migraines, they are not considered a first-line treatment for the immediate relief of migraine symptoms. Other options such as ergot alkaloids, NSAIDs, serotonin agonists, and acetaminophen are commonly used for acute migraine treatment.

The most suitable option is b) because it provides a specific dosing regimen over a period of 6 days, gradually decreasing the number of tablets each day. This allows for a controlled tapering of the medication, which is important when taking methylprednisone to minimize potential side effects and prevent abrupt discontinuation of the medication. The "as directed" instruction on the 5th and 6th day allows for flexibility in dosing based on the patient's condition.

Both domperidone and metoclopramide are medications used to treat gastrointestinal disorders. They both have anti-emetic activity, meaning they help to prevent nausea and vomiting. They also enhance gastric motility, which means they help to improve the movement of food through the digestive system. However, extrapyramidal effects are not shared by both medications. Extrapyramidal effects are movement disorders that can occur as a side effect of certain medications, including metoclopramide. Domperidone, on the other hand, does not commonly cause extrapyramidal effects.

Linaclotide is a guanylate cyclase-C receptor agonist that is used to treat chronic idiopathic constipation or irritable bowel syndrome with constipation. However, the statement that it causes no major side effects other than increased incidence of stomach pain and flatulence is false. Linaclotide can also cause diarrhea, headache, nausea, and abdominal distension. Therefore, it is not accurate to say that it has no major side effects other than stomach pain and flatulence.

Beta-blockers are commonly used for migraine prophylaxis due to their ability to reduce the frequency and severity of migraines. However, beta-blockers with intrinsic sympathomimetic activity (ISA) may not be appropriate for migraine prophylaxis. ISA beta-blockers have partial agonist activity, meaning they partially stimulate beta receptors while also blocking them. This partial stimulation can potentially worsen migraines or cause other adverse effects. Therefore, it is best to avoid beta-blockers with intrinsic sympathomimetic activity for migraine prophylaxis.

Migraine pain is believed to result from activity in the trigeminovascular system. This system involves the trigeminal nerve, which is responsible for transmitting sensory information from the head and face to the brain. When this system becomes activated, it can lead to the release of certain chemicals that cause inflammation and pain in the blood vessels surrounding the brain. This activation is thought to be a key factor in the development of migraine pain.

Glucocorticoids are a type of steroid hormone that are produced and secreted by the adrenal glands. They play a role in regulating various physiological processes in the body, including the immune response and metabolism. In order to maintain homeostasis, the secretion of glucocorticoids needs to be tightly regulated. Adrenocorticotropic hormone (ACTH) is a hormone that is produced by the pituitary gland and stimulates the release of glucocorticoids from the adrenal glands. Therefore, by inhibiting the secretion of ACTH, glucocorticoids can regulate their own secretion.

Cortisone is not the active form of hydrocortisone. While both cortisone and hydrocortisone are corticosteroids, they have different chemical structures. Hydrocortisone is the active form of cortisone, and it is the primary glucocorticoid hormone produced by the adrenal glands. Cortisone, on the other hand, is a prodrug that gets converted into hydrocortisone in the body. Therefore, the statement that cortisone is the active form of hydrocortisone is false.

Aldosterone is synthesized in the zona glomerulosa of the adrenal cortex. This region of the adrenal cortex is responsible for producing mineralocorticoids, such as aldosterone. Aldosterone plays a crucial role in regulating electrolyte and fluid balance in the body. It acts on the kidneys to increase the reabsorption of sodium and water and promote the excretion of potassium. This helps to maintain blood pressure and electrolyte levels within a normal range.

Cyproheptadine is an antihistamine that also has serotonin antagonist properties. Serotonin plays a role in regulating bowel movements, and antagonizing serotonin receptors in the gut can lead to constipation. Therefore, the most likely cause of the patient's mild constipation while taking cyproheptadine is the drug's ability to antagonize serotonin receptors in the gut.

Metoclopramide is a benzamide D2 receptor antagonist that enhances the motility of smooth muscle from the esophagus through the proximal small intestine. It also facilitates gastric emptying from the duodenum to the ileocecal valve and reduces reflux from the duodenum and the stomach into the esophagus. However, it does not increase receptive relaxation in the upper stomach and decrease antral contractions.

Lubiprostone does not increase intestinal fluid by activating and opening specific potassium channels in the luminal cells of the intestines. This statement is false because lubiprostone actually increases intestinal fluid secretion by activating chloride channels in the intestinal epithelium, leading to increased fluid in the intestines.

All of the substances mentioned in options a) to d) - CGRP, NK-A, bradykinin, and Substance P - contribute to membrane inducing vasodilation. This means that they all have the ability to cause the widening of blood vessels. Therefore, option e) stating that "all of the above do cause vasodilation" is the correct answer.

Cyproheptadine is not a steroidogenic inhibitor because it is an antihistamine and serotonin antagonist. It is commonly used to treat allergies and has no direct effect on steroid hormone production. On the other hand, mitotane, ketoconazole, and aminoglutethimide are all known steroidogenic inhibitors. Mitotane is used to treat adrenal cancer by inhibiting steroid synthesis. Ketoconazole is an antifungal medication that also inhibits steroid synthesis. Aminoglutethimide is an aromatase inhibitor that blocks the conversion of androgens to estrogens.

Serotonin acts as an agonist at presynaptic 5-HT4 receptors, which leads to an increase in the release of acetylcholine (ACh) and calcitonin gene-related peptide (CGRP) from submucosal intrinsic primary afferent neurons (IPANs). This increase in ACh and CGRP release enhances gastrointestinal motility. Therefore, the statement that serotonin acting at presynaptic 5-HT4 receptors increases the release of ACh and CGRP from submucosal IPANs is true.

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The correct answer is b) No, this drug may aggravate the patient's Parkinsonism. Metoclopramide is a medication commonly used to treat nausea and vomiting, but it can have adverse effects on patients with Parkinson's disease. It works by blocking dopamine receptors, which can worsen the symptoms of Parkinson's disease, such as tremors, stiffness, and difficulty with movement. Therefore, substituting metoclopramide for ondanesetron ODT would not be appropriate in this case.

The majority of cases of ACTH-dependent Cushing's syndrome are caused by pituitary adenoma. This is because pituitary adenomas can produce excessive amounts of adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to produce cortisol. The excess cortisol leads to the symptoms of Cushing's syndrome. Adrenal carcinoma, primary pigmented nodular adrenal disease, and adrenal adenoma can also cause Cushing's syndrome, but they are less common causes compared to pituitary adenomas.

Increased afferent input to the chemoreceptor trigger zone and vomiting center can have two effects: increased likelihood of emesis and nausea, and activation of 5HT3 receptors. This suggests that both options b) and c) are correct. Option a) is incorrect because increased afferent input would not lead to decreased serotonin release. Therefore, the correct answer is d) b,c.

Vasoconstriction of anastomoses is not a cause of migraines. Migraines are typically caused by vasodilation, which is the widening of blood vessels, leading to increased blood flow and pressure in the brain. Sterile inflammation, which is inflammation without infection, can also contribute to migraines. Cholinergic reflux, the backward flow of cholinergic neurotransmitters, has been associated with migraines as well. However, vasoconstriction of anastomoses, which is the narrowing of blood vessels, is not a known cause of migraines.

Frovatriptan has the longest half-life among the given oral triptans, which means it stays in the body for a longer duration. However, it has the slowest onset of action, meaning it takes a longer time to start working compared to the other triptans. This can be beneficial for individuals who experience prolonged or recurring migraine attacks, as it provides a longer-lasting effect.

Spironolactone is the treatment of choice for bilateral adrenal hyperplasia-dependent aldosteronism. This condition is characterized by the overproduction of aldosterone by both adrenal glands, leading to excessive salt and water retention and high blood pressure. Spironolactone is an aldosterone antagonist that blocks the effects of aldosterone, helping to reduce fluid retention and lower blood pressure. It is commonly used to treat this condition and has been shown to be effective in normalizing blood pressure and improving symptoms in patients with bilateral adrenal hyperplasia-dependent aldosteronism.

The correct answer is c) Contraindication is increased risk of constipation in addition to the risk already posed by alosetron. This means that the addition of amlodipine and furosemide, which can also cause constipation, may further increase the risk of constipation for the patient.

Methysergide is a medication that is commonly used for the prevention of migraines. The potential mechanism of action for methysergide includes inhibiting the endothelial release of nitric oxide, as well as inhibiting the release of histamine from mast cells. Nitric oxide is a potent vasodilator, so inhibiting its release can help prevent the dilation of blood vessels that occurs during a migraine. Histamine is also involved in the inflammatory response and can contribute to migraines, so inhibiting its release can provide additional relief. Therefore, the correct answer is e) b and c.

The statement is incorrect. Hypomotility refers to decreased or slowed movement in the gastrointestinal tract. While cholinomimetic agents like bethanecol can increase gastric motility, they are not the primary treatment for hypomotility. Other medications like prokinetic agents (e.g., metoclopramide) or laxatives may be more commonly used to treat hypomotility. Therefore, the correct answer is false.

A triptan may be preferred over ergotamine because it works quicker. Ergotamine is a medication used to treat migraines and cluster headaches, but it has a slower onset of action compared to triptans. Triptans are specifically designed to target serotonin receptors in the brain, which helps to alleviate migraine symptoms. They are known to provide faster relief and are generally more effective in treating migraines. Therefore, if a patient needs immediate relief from migraine symptoms, a triptan would be a better choice over ergotamine.

Patients who will be taking glucocorticoids long term should be warned about weight gain and insomnia often occurring when starting treatment, chronic use leading to osteoporosis and glaucoma for which they must be monitored, and the importance of wearing medical identification stating they are on chronic steroid therapy. However, they do not need to decrease the dose during times of increased stress.