2012 Pharm II- Quiz 3
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A review of the material for second semester pharmacology, test #1.
- 1.Seizure disorders are most likely caused by:
- A.
A focus of hyperexcitable neurons that fire in the absence of appropriate stimuli
- B.
Too little dopaminergic input from the substantia nigra into the striam
- C.
5 HT serotonin in excess in the synaptic cleft.
- D.
Spending too much time standing under strobe lights
- 2.Which of the following is true regarding the nigrostriatal pathway?
- A.
Controlls vomiting
- B.
Affected by parkinsons disease
- C.
Regulates prolactin release
- D.
Responsible for neurotransmission of norepinephrine and serotonin.
- 3.The majority of the bodies serotonin is stored where?
- A.
Pineal Body in the brain
- B.
In the intermediate lobe of pituitary gland
- C.
Enterochromaffin cells of small intestine
- D.
Serovessicle cells of large intestine
- 4.The majority of the acetylcholine receptors in the brain are…
- A.
MAO-A
- B.
5 HT-1 and 5 HT-2 receptors
- C.
Nicotinic
- D.
Muscarinic
- 5.Which of the following is an inhibitory neurotransmitter which is stimulated by many sedative drugs?
- A.
Gamma-amino butyric acid
- B.
Acetycholine
- C.
Glutamate
- D.
Dopamine
- 6.Which of the following drugs is not ambiphillic?
- A.
Fluoxetine
- B.
Lithium
- C.
Imipramine
- D.
Phenelzine
- 7.What is the Mechanism of Action of SSRI’s?
- A.
Potentiate effects biogenic amines by inhibiting reuptake of norepi and serotonin thus making more available in the synaptic space
- B.
Forms a stabe, irreversible complex with MAO to prevent demaination of monoamines.
- C.
Selectively block the reuptake of serotonin and thus enhance serotogenic activity.
- D.
Converts to dopamine by dopa decarboxylase enzyme to replenish stores in the basal ganglia
- 8.You are the SRNA for Mrs. Viano who was recently started on Fluoxetine. She is having a minor procedure today but you make note that this patient may be more susceptible to…
- A.
Seizures
- B.
Post-op delirium
- C.
Ataxia
- D.
Post op nausea and vomiting
- 9.What is the ½ life of fluoxetine for a patient who is taking the drug chronically?
- A.
4-6 days
- B.
1-3 days
- C.
6-16 days
- D.
12-24 hours
- 10.You are doing an outpatient pre-op assessment for a patient who is taking a tricyclic antidepressant. What pre-op instructions would you give to this patient regarding their antidepressant medication?
- A.
Discontinue medication 5 weeks prior to surgery
- B.
Continue to take medication as normal, but you will make sure to be aware of possible interactions.
- C.
Discontinue drug 4-6 days prior to surgery.
- D.
They should increase the dosage to relieve anxiety related to surgery.
- 11.Which of the following 2nd generation antidepressants has a greater incidence of seizures?
- A.
Trazodone
- B.
Paroxetine
- C.
Bupropion
- D.
Venlafaxine
- 12.Which of the following 2nd generation antidepressants has the greatest sedative potency?
- A.
Venlafaxine
- B.
Paroxetine
- C.
Bupropion
- D.
Trazodone
- 13.Which of the following should not be administered concurrently with and MAO inhibitor?
- A.
Fluoxetine
- B.
Sertraline
- C.
Nefazodone
- D.
All the above
- 14.You are the SRNA for Mr. Cumpeo today. You see a past history of hypothyroidism, HTN and anxiety. Her medication list includes Fluoxetine administered once daily. How might you anticipate this medication to effect your anesthesia for this case?
- A.
May prolong effects of muscle relaxants such as vecuronium
- B.
May make this patient more prone to bleeding.
- C.
Patient will be more prone to severe hypertension in response to ephedrine
- D.
This patient should NOT be given any opioids during the procedure.
- 15.Which of the following drugs would be useful in the treatment of chronic neuropathic pain?
- A.
Fluvoxamine
- B.
Imipramine
- C.
Phenelzine
- D.
Alprazolam
- 16.What is the Mechanism of Action of tricyclic antidepressants?
- A.
Potentiate effects biogenic amines by inhibiting reuptake of norepi and serotonin thus making more available in the synaptic space
- B.
Forms a stabe, irreversible complex with MAO to prevent demaination of monoamines.
- C.
Selectively block the reuptake of serotonin and thus enhance serotogenic activity.
- D.
Converts to dopamine by dopa decarboxylase enzyme to replenish stores in the basal ganglia
- 17.What is the elimination half time of tricyclic antidepressants?
- A.
1-3 days
- B.
17-30 hours
- C.
4-6 days
- D.
1-2 weeks
- 18.What side effects would you expect to see on a patient who is taking tricyclic antidepressants? (Check all that apply)
- A.
Tachycardia and prolonged PR interval
- B.
Dry mouth and slowed gastric emptying
- C.
Insomnia and agitation
- D.
Impotence and orthostatic hypotension
- 19.You are caring for Mrs. Noopy who is having a Left BKA today. Her medication list includes Amitriptyline, Insulin, Avandia & Nexium. During surgery Mrs. Noopy becomes hypotensive and requires pharmacologic intervention. Which drug would be the best choice for this patient?
- A.
Ephedrine, full dose since only indirect acting sympathomimetics are safe.
- B.
Levophed drip, you can not use either of your standard drugs on this patient.
- C.
Neosynephrine, but cut dose to 1/3 due to possibility of pronounced response.
- D.
Just keep giving fluid boluses to control the hypotension.
- 20.Tricyclic antidepressants have a wide therapeutic index and are relatively safe when taken in overdose when compared to SSRI’s which produce life threatening overdose symptoms.
- A.
True
- B.
False
- 21.You are caring for Mr. Press who is admitted to ER after having overdosed Amitriptyline. The patient appears to be suffering from psychosis due to the overdose. What medication should you administer to help treat this?
- A.
Naloxone 1-4 mcg/kg IV
- B.
Diazepam 0.1 mg/kg
- C.
IV infusion of Lidocaine at 1mg/min
- D.
Physostigmine 0.5-2 mg IV
- 22.What is the Mechanism of action of MAO inhibitors?
- A.
Potentiate effects biogenic amines by inhibiting reuptake of norepi and serotonin thus making more available in the synaptic space
- B.
Forms a stabe, irreversible complex with MAO to prevent demaination of monoamines.
- C.
Selectively block the reuptake of serotonin and thus enhance serotogenic activity.
- D.
Converts to dopamine by dopa decarboxylase enzyme to replenish stores in the basal ganglia
- 23.What is the most likely cause of orthostatic hypotension in patients taking MAO inhibitors?
- A.
Drug induced inhibition of norepinephrine uptake
- B.
Accumulation of serotonin in synaptic cleft
- C.
Accumulation of octopamine, a false neurotransmitter
- D.
Action on sodium channels which causes smooth muscle relaxation and dilation of vessels.
- 24.You are the SRNA for Hannibal Lector. He has recently been placed on an MAO inhibitor. You ask about his diet and he tells you this about his favorite foods: Liver, fava beans, & chianti. He has a really creepy grin on his face.... What do you tell Mr. Lector?
- A.
Ummm, pardon me but I have to leave. (Then, RUN LIKE HELL!!)
- B.
That sounds very nutritionally balanced! It sounds like you are properly adhering to all dietary restrictions.
- C.
You need to try to cut out the wine, but your other food choices are just fine.
- D.
Mr. Lector I am afraid you may not eat any of those foods anymore, they are all listed as very unsafe for you.
- 25.You are the SRNA for Mrs. Loc who is having a removal of foreign mass from the bottom of her right foot. She is having a peripheral block for the procedure. In her medication list you see she takes: Phenelzine, Ultram, Celebrex & a daily aspirin. What medication would you choose for the local blockade of this patient?
- A.
Lidocaine mixed with 25 mcg fentanyl
- B.
Tetracaine mixed with epi
- C.
Bupivicaine plain.
- D.
All the above would be fine, none of the listed meds are known to cause problems here
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