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Questions and Answers
A patient presents with moderate signs and symptoms of Parkinson disease that are progressively getting worse. Current therapy is carbidopa/levodopa alone. The patient is advised to continue current treatment and start a new medication that requires adherence to dietary restrictions of foods containing high levels of tyramine, which includes aged cheeses and smoked meats. Which is the mechanism of action of the medication that the physician is advising to start?
A patient presents with moderate signs and symptoms of Parkinson disease that are progressively getting worse. Current therapy is carbidopa/levodopa alone. The patient is advised to continue current treatment and start a new medication that requires adherence to dietary restrictions of foods containing high levels of tyramine, which includes aged cheeses and smoked meats. Which is the mechanism of action of the medication that the physician is advising to start?
Selegiline is a selective inhibitor of monoamine oxidase-A (MAO-A).
Selegiline is a selective inhibitor of monoamine oxidase-A (MAO-A).
False
MAO-B is an enzyme present in the central nervous system that works to break down monoamine neurotransmitters, predominantly dopamine. The inhibition of its activity leads to increased levels of dopamine.
MAO-B is an enzyme present in the central nervous system that works to break down monoamine neurotransmitters, predominantly dopamine. The inhibition of its activity leads to increased levels of dopamine.
True
Selegiline is approved for adjunct therapy in patients with Parkinson disease.
Selegiline is approved for adjunct therapy in patients with Parkinson disease.
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Tyramine is a vasoactive amine that causes blood pressure reduction.
Tyramine is a vasoactive amine that causes blood pressure reduction.
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Tyramine is a substrate of MAO.
Tyramine is a substrate of MAO.
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Which statement regarding the minimum anesthetic concentration (MAC) value is most accurate?
Which statement regarding the minimum anesthetic concentration (MAC) value is most accurate?
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Phenothiazines are grouped into three different categories depending on their side effects. To which group does fluphenazine belong?
Phenothiazines are grouped into three different categories depending on their side effects. To which group does fluphenazine belong?
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A patient, who is taking medication for a psychiatric illness, develops tremors, thyroid enlargement, edema, and acneiform facial eruptions. Most likely, the patient is taking
A patient, who is taking medication for a psychiatric illness, develops tremors, thyroid enlargement, edema, and acneiform facial eruptions. Most likely, the patient is taking
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A patient is brought to the Emergency Department after taking an overdose (unknown amount) of extended-release theophylline 2 hours ago. The patient has significant gastrointestinal distress, with vomiting, agitation, hyperreflexia and hypotension,. A short-acting antidote that may reduce the tachycardia in this patient is
A patient is brought to the Emergency Department after taking an overdose (unknown amount) of extended-release theophylline 2 hours ago. The patient has significant gastrointestinal distress, with vomiting, agitation, hyperreflexia and hypotension,. A short-acting antidote that may reduce the tachycardia in this patient is
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A patient was prescribed ibuprofen 400 mg three times a day for arthritis. Which statement by the patient indicates that he should receive additional information
A patient was prescribed ibuprofen 400 mg three times a day for arthritis. Which statement by the patient indicates that he should receive additional information
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A 19-year-old woman complains of severe dysmenorrhea. A uterine stimulant originating from the membrane lipids of the endometrium is
A 19-year-old woman complains of severe dysmenorrhea. A uterine stimulant originating from the membrane lipids of the endometrium is
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A 40-year-old obese man (BMI 33) was examined in the cardiopulmonary clinic for pulmonary hypertension and a heart murmur. He has been taking phenformine for several years in an attempt to lose weight. The mechanism by which phenformine suppresses appetite is
A 40-year-old obese man (BMI 33) was examined in the cardiopulmonary clinic for pulmonary hypertension and a heart murmur. He has been taking phenformine for several years in an attempt to lose weight. The mechanism by which phenformine suppresses appetite is
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A 22-year-old patient weighing 66 kg presents to the chest clinic with frequent asthma exacerbations with multiple ICU admissions.. Her asthma is generally triggered by pollen and house dust mites. Physical examination shows significant cushingoid features. She takes beclometasone/formoterol and montelukast. Her blood investigations demonstrate eosinophilia; she has a total IgE of 400 IU/ml. What is the most appropriate next step in her management?
A 22-year-old patient weighing 66 kg presents to the chest clinic with frequent asthma exacerbations with multiple ICU admissions.. Her asthma is generally triggered by pollen and house dust mites. Physical examination shows significant cushingoid features. She takes beclometasone/formoterol and montelukast. Her blood investigations demonstrate eosinophilia; she has a total IgE of 400 IU/ml. What is the most appropriate next step in her management?
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Mr William Short is a 27 year old stock clerk who you have been treating for the past 2 years after he was diagnosed with CHF caused by a viral cardiomyopathy. After being maintained on drug therapy for a year, Mr Short underwent a heart transplant procedure, and is now being maintained on an immunosuppressive drug regiment consisting of cyclosporine, azathioprine and prednisone. In addition, he is being treated with enalapril (an ACE-inhibitor) & hydrochlorothiazide diuretic, as well as valganaciclovir (an antiviral medication) to alleviate drug-induced side effects. Which drug in this regimen exerts its therapeutic effects by selectively interfering with activation of transcription factors involved in stimulating the transcription and production of IL-2?
Mr William Short is a 27 year old stock clerk who you have been treating for the past 2 years after he was diagnosed with CHF caused by a viral cardiomyopathy. After being maintained on drug therapy for a year, Mr Short underwent a heart transplant procedure, and is now being maintained on an immunosuppressive drug regiment consisting of cyclosporine, azathioprine and prednisone. In addition, he is being treated with enalapril (an ACE-inhibitor) & hydrochlorothiazide diuretic, as well as valganaciclovir (an antiviral medication) to alleviate drug-induced side effects. Which drug in this regimen exerts its therapeutic effects by selectively interfering with activation of transcription factors involved in stimulating the transcription and production of IL-2?
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It is recommended to limit the use of paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) to this number of days per month to prevent rebound headache:
It is recommended to limit the use of paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) to this number of days per month to prevent rebound headache:
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An immunosuppressed 35-year-old male patient with human immunodeficiency virus presents for a new consultation. He complains of ongoing burning pain in the left maxillary (V2) distribution which has not responded to a three-week trial of gabapentin 300 mg thrice a day prescribed by his provider. He states that he did have a rash along the area of pain that crusted over and resolved 18 weeks ago. Which of the following is most likely true about the pain associated with this condition?
An immunosuppressed 35-year-old male patient with human immunodeficiency virus presents for a new consultation. He complains of ongoing burning pain in the left maxillary (V2) distribution which has not responded to a three-week trial of gabapentin 300 mg thrice a day prescribed by his provider. He states that he did have a rash along the area of pain that crusted over and resolved 18 weeks ago. Which of the following is most likely true about the pain associated with this condition?
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Verapamil 60 mg orally 4 times a day was prescribed. Verapamil 120 mg tablets are available. How many tablets should be applied at each reception.
Verapamil 60 mg orally 4 times a day was prescribed. Verapamil 120 mg tablets are available. How many tablets should be applied at each reception.
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A patient with advanced pancreatic cancer agrees to participate in a clinical trial for a new chemotherapy regimen and asks the investigator to which group he will be assigned. What is the correct answer to this patient
A patient with advanced pancreatic cancer agrees to participate in a clinical trial for a new chemotherapy regimen and asks the investigator to which group he will be assigned. What is the correct answer to this patient
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A 16-year-old boy with osteosarcoma participates in a drug trial for a new chemotherapeutic drug for bone tumors. The trial group consists of 100 healthy volunteers and 100 patients with osteosarcoma. The goal of the trial is to assess the safety, efficacy, dosage, and adverse effects of the new drug. This trial can be classified as which of the following?
A 16-year-old boy with osteosarcoma participates in a drug trial for a new chemotherapeutic drug for bone tumors. The trial group consists of 100 healthy volunteers and 100 patients with osteosarcoma. The goal of the trial is to assess the safety, efficacy, dosage, and adverse effects of the new drug. This trial can be classified as which of the following?
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A 22-year-old man has developed a rash around his trunk that has been extremely itchy. Shortly after he notices the rash, it spreads to his face and arms. The itchy lesions continue to multiply. He presents to his provider, who diagnoses the patient with an active Varicella zoster infection. The provider is considering prescribing famciclovir, a prodrug. What is the action of the drug's active form?
A 22-year-old man has developed a rash around his trunk that has been extremely itchy. Shortly after he notices the rash, it spreads to his face and arms. The itchy lesions continue to multiply. He presents to his provider, who diagnoses the patient with an active Varicella zoster infection. The provider is considering prescribing famciclovir, a prodrug. What is the action of the drug's active form?
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Which factor most commonly affects drug absorption (multiple answers possible)
Which factor most commonly affects drug absorption (multiple answers possible)
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A 66-year-old man presents with headaches, blurring of vision, and nausea for the past 3 days. His medical history is significant for type 2 diabetes mellitus with nephropathy. His blood pressure is 150/90 mm Hg. The patient is prescribed a drug that antagonizes the effect of angiotensin II on angiotensin I receptors. Which of the following parameters should you be most concerned about monitoring?
A 66-year-old man presents with headaches, blurring of vision, and nausea for the past 3 days. His medical history is significant for type 2 diabetes mellitus with nephropathy. His blood pressure is 150/90 mm Hg. The patient is prescribed a drug that antagonizes the effect of angiotensin II on angiotensin I receptors. Which of the following parameters should you be most concerned about monitoring?
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A 57-year-old man presents with confusion, disorientation, and gait imbalance. He is unable to provide his medical history. On physical examination, he is thin and disheveled, and bilateral paresis of conjugate gaze is noted. A head CT is normal. Which vitamin deficiency is most likely?
A 57-year-old man presents with confusion, disorientation, and gait imbalance. He is unable to provide his medical history. On physical examination, he is thin and disheveled, and bilateral paresis of conjugate gaze is noted. A head CT is normal. Which vitamin deficiency is most likely?
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As a cardiovascular drug, dopamine can produce remarkably different effects depending on the dose administered. At high doses the predominant effect of dopamine would be to cause vasoconstriction by stimulating:
As a cardiovascular drug, dopamine can produce remarkably different effects depending on the dose administered. At high doses the predominant effect of dopamine would be to cause vasoconstriction by stimulating:
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Study Notes
Test 3
- A patient presents with worsening Parkinson's disease symptoms, currently treated with carbidopa/levodopa. The patient is advised to start a medication requiring a specific diet, avoiding foods high in tyramine (e.g., aged cheeses, smoked meats).
Mechanism of Action
- The medication's mechanism is selective inhibition of monoamine oxidase-B (MAO-B).
MAO-B Enzyme
- MAO-B is an enzyme in the central nervous system that breaks down monoamine neurotransmitters, primarily dopamine.
- Inhibiting MAO-B increases dopamine levels.
Selegiline's Use
- Selegiline is approved for Parkinson's disease treatment.
- Tyramine, a vasoactive amine that elevates blood pressure, is a substrate of MAO.
- When MAO-B is inhibited, tyramine isn't metabolized, leading to potential severe blood pressure elevation (hypertensive crisis).
Minimum Anesthetic Concentration (MAC)
- MAC is inversely proportional to potency.
- Low MAC means high potency.
- MAC values are lower in older patients.
- MAC doesn't show the dose-response curve's slope.
- Concomitant use of opioid analgesics lowers MAC.
- Halothane has the lowest MAC value of inhaled anesthetics.
Phenothiazines
- Classified into three groups based on side effects
- Fluphenazine belongs to the piperazine group
Patient Taking Medication
- A patient taking medication for a psychiatric illness may develop tremors, thyroid enlargement, edema, and acneiform facial eruptions.
- This may indicate lithium use.
Theophylline Overdose
- A short-acting beta-blocker (esmolol) helps manage tachycardia caused by theophylline overdose.
Ibuprofen Use
- Ibuprofen is prescribed for arthritis.
- Patients should maintain sufficient water intake.
- The medication is contraindicated during the third trimester of pregnancy.
- Potential side effects include gastrointestinal discomfort and diarrhea.
Uterine Stimulant
- A 19-year-old experiencing dysmenorrhea may have a uterine stimulant originating from endometrium lipids.
- Examples include prostaglandin PGF2alpha and Prostacyclin.
5-HT2 Receptors
- Phenformine is a 5-HT2 receptor agonist and serotonin releaser.
Asthma Management
- A patient with frequent asthma exacerbations, eosinophilia, and elevated IgE levels requires omalizumab.
Drug Trial Phases
- Phase II trials involve a larger group of participants (typically 100-300 people) with the target disease to evaluate efficacy and safety further. Phase I trials only use healthy volunteers.
Varicella-Zoster Infection
- Famciclovir converts to penciclovir via viral enzymes and is a guanosine analog, inhibiting DNA polymerase.
Wernicke-Korsakoff Syndrome
- A thiamine deficiency may result in symptoms such as gait ataxia, confusion, and ocular disturbances. It frequently occurs in those with alcohol misuse or nutritional deficiencies.
Dopamine's Effects
- High doses of dopamine stimulate alpha receptors causing vasoconstriction and increasing blood pressure.
- Low doses of dopamine increase blood flow to certain organs (kidneys, coronary, and cerebral beds).
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Description
This quiz explores the treatment of Parkinson's disease with a focus on the use of Selegiline, its mechanism of action, and dietary considerations regarding tyramine. You'll learn about monoamine oxidase-B inhibition and its effects on dopamine levels and blood pressure management in patients. Test your understanding of these key concepts related to pharmacology in Parkinson's disease.
