Test 5

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Questions and Answers

A group of volunteers are included in a phase I clinical trial of a new drug acting on the autonomic nervous system. With intravenous bolus administration of the drug, blood pressure increases. When the same drug is administered orally for a week, blood pressure is lowered. The effects of which of the specified standard drugs resemble the tested drug?

  • Phentolamine (alpha-blocker)
  • Phenylephrine
  • Atropin
  • Clonidine (correct)
  • Propranolol (beta-blocker)

A 22-year-old patient involved in a driving under the influence (DUI) related car accident is brought into the ED by ambulance. Due to the patient's severe injuries and high risk for gastric aspiration, the ED physician decides to initiate a rapid sequence intubation to maintain and protect his airway prior to surgery. An intravenous line is placed in the patients arm, and the patient is given a bolus of propofol (general anesthetic) mixed with lidocaine. This injection is followed immediately by a bolus of a rapidly acting depolarizing neuromuscular blocking agent. Once the muscles in the neck become relaxed, an endotracheal tube is inserted, and mechanical ventilation is initiated, followed by maintenance of general anesthesia using inhaled sevoflurane. What was the most likely drug given to produce rapid skeletal muscle relaxation immediately prior to intubation?

  • Pancuronium
  • Succinylcholine (correct)
  • Atracurium
  • Neostigmine

A nurse prepares to administer medication to several patients. In which case should the nurse ask for clarification?

  • Diazepam in a patient with narrow-angle glaucoma (correct)
  • Antibody test for acetylcholine receptors in a patient with myasthenia gravis
  • Dantrolene sodium in a patient with muscle spasms
  • Chlorzoxazone in a patient with muscle trauma

A 33-year-old White female presents to the clinic complaining of difficulty carrying out daily chores for the last week. Her history is remarkable for the diagnosis of Multiple Sclerosis made one year ago. She has numbness and painful spasms in the upper and lower extremities. She denies blurry or double vision, incontinence, vertigo, or tingling sensation. Vital signs are within normal limits. There is increased spasticity in all four limbs, and hyperreflexia is also present in lower extremities. Which of the following would be the most appropriate medication for this patient?

<p>Baclofen (C)</p> Signup and view all the answers

Neuronal cells located in the substantia nigra have external projections to the striatum. The neurotransmitter that is released, which only has an inhibitory effect, is most likely?

<p>Dopamine (D)</p> Signup and view all the answers

Like many other drugs used in treating different psychiatric disorders, atypical "antipsychotics" have been approved for treating more than one type of psychiatric disorder. Which other condition are these drugs commonly used for?

<p>depression (B)</p> Signup and view all the answers

Emetics are not used as frequently as they were in the past to treat cases of drug overdose or poisoning. One situation where they are absolutely contraindicated is in the treatment of:

<p>kerosene poisoning (F)</p> Signup and view all the answers

A patient prescribed infliximab (anti-TNF-alfa antibody) for rheumatoid arthritis developed a temperature of 39°C, chills, nausea, vomiting and dizziness. What should this patient be advised?

<p>The patient should seek medical attention for further evaluation (C)</p> Signup and view all the answers

Which statement about prostacyclin is true?

<p>Causes pulmonary vasodilation (D)</p> Signup and view all the answers

A 17-year-old female patient presents to the hospital due to recurrent headaches for the past two years. The patient describes headaches as right-sided, throbbing in nature, 9/10 in intensity, and lasting throughout the day's work. She also notes occasional nausea and photophobia. She associates these symptoms with increasing stress in her school. Which of the following best describes the prophylaxis for this patient?

<p>Adherence to prophylactic medications is improved by the use of long-acting formulations (A)</p> Signup and view all the answers

What is the reason that some countries in the world require part of the names of some drugs to be written in capital letters in the prescriptions (eg buSPIron and buPROpion) (the “tall man" letters)?

<p>For safety reasons, as some drug names are very similar to each other (A)</p> Signup and view all the answers

A patient was prescribed nitroglycerin 55 mcg/min. It is available as a 25 mg/250 ml (100 mcg/ml) solution. What is the infusion rate?

<p>33 ml/h (A)</p> Signup and view all the answers

A patient is taking 100 mg of hydrocortisone IV every 8 hours and is being switched to oral prednisone. What is the equivalent dose?

<p>25 mg (C)</p> Signup and view all the answers

A 36-year-old woman presents to the clinic with a complaint of pain and swelling in both hands and wrists. She reports morning stiffness that lasts for approximately 30 minutes, which later improves. She was diagnosed with rheumatoid arthritis 3 months ago following a positive anti-CCP and rheumatoid factor and elevated ESR and CRP. She was started on methotrexate and folic acid during that time. Despite taking the medication, she is still experiencing symptoms and complains the medication is not working. On the physical exam, there is decreased grip strength bilaterally and tenderness to palpation and swelling of the proximal interphalangeal joints and metacarpophalangeal joints. A JAK inhibitor targeting JAK-3 and JAK-1 enzymes is being considered. Which of the following adverse effects is most likely to occur with the use of this medication in this patient?

<p>Upper respiratory tract infection (D)</p> Signup and view all the answers

Glucocorticoid-mediated suppression of the inflammatory response has important pharmacologic implications for the treatment of conditions such as organ transplantation, asthma, rheumatoid arthritis & other autoimmune disorders such as lupus. The anti-inflammatory effects of glucocorticoids are known to be mediated by multiple mechanisms. Which of the following is one such mechanism?

<p>Decreased release of cytokines by monocytes &amp; macrophages (A)</p> Signup and view all the answers

Which of the following statements about the pharmacokinetics of antiepileptic drugs is most accurate?

<p>To reduce gastrointestinal toxicity, ethosuximide is usually taken twice daily. (D)</p> Signup and view all the answers

Which statement concerning herbal supplements is NOT true?

<p>certification labels on herbal supplements indicate the herbal supplement contains active ingredients (C)</p> Signup and view all the answers

Which drug is used to treat myasthenia gravis by increasing muscle strength?

<p>Neostigmine bromide (D)</p> Signup and view all the answers

According to the American Urological Association (AUA), with which class of drugs should B-3 agonists be used?

<p>α-1 blockers (C)</p> Signup and view all the answers

Which of the following statements is correct regarding screening for prostate cancer as recommended?

<p>An inclusion of patients in making informed screenig decisions is supported (C)</p> Signup and view all the answers

Flashcards

What is the mechanism of action of a drug that initially elevates blood pressure, but with long-term use, lowers blood pressure?

A medication that initially causes vasoconstriction by acting as an alpha-receptor agonist, but with long-term use, accumulates in the central nervous system and reduces sympathetic tone through alpha-2 effects. This results in an overall decrease in blood pressure.

What drug is used for rapid skeletal muscle relaxation for intubation?

A rapidly acting, depolarizing neuromuscular blocking agent used for rapid skeletal muscle relaxation, often for intubation in emergency situations. It has a rapid onset of action, achieving paralysis within 60 seconds.

What medication is contraindicated in patients with narrow-angle glaucoma?

A benzodiazepine medication that increases intraocular pressure and is contraindicated in patients with narrow-angle glaucoma.

What medication is most effective for spasticity in MS patients?

A GABA-B receptor agonist that is the most effective monotherapy for patients with multiple sclerosis (MS) who experience spasticity.

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What neurotransmitter is primarily released by neurons in the substantia nigra that project to the striatum?

A neurotransmitter that exerts slow inhibitory activity in specific neuronal systems, including the nigrostriatal projections, through G-protein-coupled activation of postsynaptic potassium channels or through inhibition of presynaptic calcium channels.

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Besides their antipsychotic effects, for what other psychiatric disorder are atypical antipsychotics often utilized?

Atypical antipsychotics are frequently used to treat major depressive disorder, especially when traditional SSRIs and SNRIs are ineffective, or as an alternative to lithium in the treatment of bipolar disorder.

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For which type of poisoning are emetics strictly contraindicated?

Emetics are generally not preferred for treating drug overdose or poisoning. One situation where they are absolutely contraindicated is in the case of kerosene poisoning, due to the risk of pulmonary aspiration.

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What should a patient taking infliximab do if they develop a high fever (39°C) along with other symptoms like chills, nausea, vomiting, and dizziness?

The development of a fever (39°C), chills, nausea, vomiting and dizziness in a patient taking infliximab, an anti-TNF-alpha antibody used for treating rheumatoid arthritis. This suggests a severe infection due to immunosuppression, and immediate medical attention is needed.

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What is the primary effect of prostacyclin on blood vessels?

Prostacyclin is a vasodilator that specifically acts on pulmonary blood vessels, causing pulmonary vasodilation.

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What are some key considerations regarding the use of prophylactic medications for migraine headaches?

Migraine headaches are often characterized by throbbing pain, worsened by movement or exertion. Prophylactic medications for migraine are typically started at a low dose and gradually titrated to an effective dose, which can take more than two weeks. Long-acting formulations can improve patient adherence.

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What is one mechanism by which glucocorticoids suppress inflammation?

Glucocorticoids can suppress inflammation by decreasing the release of cytokines from monocytes and macrophages, reducing the production of inflammatory mediators. Glucocorticoids also upregulate the expression of annexin A1, which further inhibits phospholipase A2 activity.

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What is a potential drug interaction between phenytoin and carbamazepine with opioids?

Phenytoin and carbamazepine, both antiepileptic drugs, can accelerate the metabolism of opioids. This can lead to opioid withdrawal symptoms, including respiratory depression, in patients taking opioid maintenance therapy.

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How often is ethosuximide typically administered to reduce gastrointestinal side effects?

Ethosuximide, an antiepileptic drug, is often administered twice daily to minimize gastrointestinal toxicity.

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Why are certain drug names written with some letters in capitals (e.g.,

In some countries, certain drug names are written with some letters in capitals (e.g., buSPIron and buPROpion) to reduce errors in prescribing or dispensing, as these names are very similar and confusion can lead to medication errors.

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Calculate the infusion rate for nitroglycerin 55 mcg/min using a solution of 25 mg/250 ml (100 mcg/ml).

The infusion rate for nitroglycerin is 33 ml/hour.

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What is the equivalent oral dose of prednisone for a patient receiving 100 mg of hydrocortisone IV every 8 hours?

Prednisone has four times the anti-inflammatory potency of hydrocortisone. Therefore, an equivalent dose of prednisone is one-fourth the dose of hydrocortisone.

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What is a common adverse effect of tofacitinib, a JAK inhibitor, when used for rheumatoid arthritis?

Tofacitinib, a JAK inhibitor targeting JAK-1 and JAK-3 enzymes, is commonly used for rheumatoid arthritis. One of its most common side effects is upper respiratory tract infection.

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What are the current recommendations regarding prostate-specific antigen (PSA) screening for prostate cancer?

Prostate-specific antigen (PSA) screening is not recommended annually for all men. It is generally recommended that men aged 55 to 69 years make informed decisions about screening based on their individual risk factors and in consultation with a healthcare provider.

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What is a common misconception regarding herbal supplements?

Herbal supplements are often marketed with sweeping claims, even though strong scientific evidence may not always support these claims. Certification labels on herbal supplements usually only verify the presence of certain ingredients and the absence of harmful contaminants; they do not guarantee effectiveness.

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For what condition are β-3 agonists approved, and in what circumstances are they often used?

β-3 agonists, specifically mirabegron and vibegron, are approved for overactive bladder but not for benign prostatic hyperplasia (BPH). They are typically used in combination with α-1 blockers for men with storage-predominant LUTS to improve symptoms.

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Which drug is used to treat myasthenia gravis by increasing muscle strength?

Neostigmine bromide, a cholinesterase inhibitor, is used to treat myasthenia gravis by increasing the concentration of acetylcholine at the neuromuscular junction, thereby improving muscle strength.

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Study Notes

Clinical Trial of New Drug

  • A group of volunteers is participating in a phase I clinical trial of a novel drug affecting the autonomic nervous system.
  • Intravenous administration of the drug increases blood pressure.
  • Oral administration of the drug for one week lowers blood pressure.
  • The drug's effects mimic those of a standard drug, potentially clonidine (alpha-2 agonist).

Patient with DUI Accident

  • A 22-year-old patient involved in a DUI-related car accident is admitted to the emergency department (ED).
  • The patient is suffering significant injuries and a high risk of gastric aspiration.
  • Rapid sequence intubation is performed to secure the airway.
  • Propofol and succinylcholine (a rapid-acting depolarizing neuromuscular blocking agent) are administered.

Nurse Medication Administration

  • A nurse is preparing to administer medications to several patients.
  • Drowsiness might be an adverse effect of the medication
  • For a patient with muscle spasms, dantrolene sodium is administered.
  • For a patient with narrow-angle glaucoma, diazepam is contraindicated due to its effects on intraocular pressure.
  • Anti-acetylcholine receptor antibody tests are performed on patients with myasthenia gravis
  • A patient with muscle injury could be treated with chlorzoxazone.

Multiple Sclerosis Patient

  • A 33-year-old woman with a history of multiple sclerosis (MS) experiences increasing muscle spasms and pain in her upper and lower limbs.
  • Increased spasticity and hyperreflexia in her lower extremities are observed.
  • Baclofen, a muscle relaxant, is the appropriate medication for the patient.

GABA Receptor

  • Baclofen, a GABA-B receptor agonist, is considered an effective monotherapy for treating MS-related spasticity.
  • Tizanidine (alpha-2 adrenergic agonist) and diazepam (benzodiazepine) are also used for the same purpose.
  • Acute exacerbations of MS are treated with glucocorticoids.

Neurotransmitter in Substantia Nigra

  • Dopamine is a neurotransmitter in the substantia nigra, which has external projections to the striatum.
  • Dopamine's effect in the synapses is slow and inhibitory.

Drugs for Psychiatric Conditions

  • Atypical antipsychotics are approved to treat multiple psychiatric disorders.
  • These drugs are used to treat major depressive disorder in cases of resistance to other treatments such as SSRIs or SNRIs.

Drug Overdose

  • Emetics (e.g., ipecac syrup) are less commonly used for drug overdoses compared to the past.
  • They are contraindicated in kerosene poisoning due to the risk of pulmonary aspiration.

Medication for Rheumatoid Arthritis

  • Tofacitinib, a JAK inhibitor, is used to manage rheumatoid arthritis.
  • The common adverse effects associated with Tofacitinib include upper respiratory tract infections (URTI), rash, nausea, diarrhea, hypertension, and anemia.

Prostate Cancer Screening

  • Yearly prostate-specific antigen (PSA) screening is not recommended.
  • The decision for screening should be made on an individual basis, considering the patient's risk factors. African American men have a higher risk of prostate cancer.

Hydrocortisone Equivalent Dose

  • For a patient receiving 100 mg of intravenous hydrocortisone every 8 hours, an equivalent dose of oral prednisone would be 25 mg.
  • An equivalent dose of a steroid depends on its anti-inflammatory potency, with hydrocortisone as 1:1 and dexamethasone as having greater than 30:1 potency.

Tofacitinib

  • Tofacitinib is an FDA-approved Janus kinase (JAK) inhibitor, used in the management of rheumatoid arthritis.
  • Common adverse effects include upper respiratory tract infections, nasopharyngitis, diarrhea, gastrointestinal issues, nausea, headache, skin rashes, increased blood cholesterol and elevated blood creatine phosphokinase.

Herbal Supplements

  • "Blanket statements" about the effects of herbal supplements are not accurate, as there is often insufficient evidence to support claims.
  • Herbal supplements are categorized as food, not drugs.

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