Pharmacology Final Exam Questions PDF

**An 18-year-old female patient is brought to the emergency department due to drug overdose. Which of the following routes of administration is the most desirable for administering the antidote for the drug overdose?** A. Intramuscular B. Intravenous C. Oral D. Subcutaneous E. Transdermal **Dr...

**An 18-year-old female patient is brought to the emergency department due to drug overdose. Which of the following routes of administration is the most desirable for administering the antidote for the drug overdose?** A. Intramuscular B. Intravenous C. Oral D. Subcutaneous E. Transdermal **Drug A is a weakly basic drug with a pKa of 7.8. If administered orally, at which of the following sites of absorption will the drug be able to readily pass through the membrane?** A. Mouth (pH approximately 7.0) B. Stomach (pH of 2.5) C. Duodenum (pH approximately 6.1) D. Jejunum (pH approximately 8.0) E. Ileum (pH approximately 7.0) **KR2250 is an investigational cholesterol-lowering agent. KR2250 has a high molecular weight and is extensively bound to albumin. KR2250 will have a(n) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ apparent volume of distribution (Vd).** A. High B. Low C. Extremely high D. Normal **A 40-year-old male patient (70 kg) was recently diagnosed with infection involving methicillin-resistant S. aureus. He received 2000 mg of vancomycin as an IV loading dose. The peak plasma concentration of vancomycin was 28.5 mg/L. The apparent volume of distribution is:** A. 1 L/kg B. 7 L/kg C. 10 L/kg D. 14 L/kg E. 70 L/kg **A 55-year-old woman is brought to the emergency department because of seizures. She has a history of renal disease and currently undergoes dialysis. She receives an intravenous infusion of antiseizure Drug X. Which of the following is likely to be observed with use of Drug X in this patient?** Table Description automatically generated **A 68-year-old woman is brought to the emergency department for treatment of a myocardial infarction. She is currently taking clopidogrel (antiplatelet agent) and aspirin daily, as well as omeprazole (potent CYP inhibitor) for heartburn. Which of the following is the most likely contributor to her myocardial infarction today?** A. Reduced antiplatelet activity of clopidogrel due to aspirin B. Reduced antiplatelet activity of clopidogrel due to omeprazole C. Hypersensitivity reaction due to clopidogrel D. Increased antiplatelet activity of clopidogrel due to omeprazole E. Increased antiplatelet activity of clopidogrel due to aspirin **Which of the following reactions represents Phase II of drug metabolism?** A. Amidation B. Hydrolysis C. Oxidation D. Reduction E. Sulfation **A pharmacokinetic study of a new antihypertensive drug is being conducted in healthy human volunteers. The half-life of the drug after administration by continuous intravenous infusion is 12 hours. Which of the following best approximates the time for the drug to reach steady state?** A. 24 hours B. 48 hours C. 72 hours D. 120 hours E. 240 hours **A 64-year-old female patient (60 kg) is treated with experimental Drug A for type 2 diabetes. Drug A is available as tablets with an oral bioavailability of 90%. If the Vd is 2 L/kg and the desired steady-state plasma concentration is 3.0 mg/L, which of the following is the most appropriate oral loading dose of Drug A?** A. 6 mg B. 6.66 mg C. 108 mg D. 360 mg E. 400 mg **A 74-year-old man was admitted to the hospital for treatment of heart failure. He received 160 mcg of digoxin intravenously, and the plasma digoxin level was 0.4 ng/mL. If the desired plasma concentration of digoxin for optimal therapeutic activity in heart failure is 1.2 ng/mL, and the patient has an estimated Vd of 400 L, calculate the additional dose of digoxin needed for this patient to achieve the desired plasma concentration.** A. 128 mcg B. 160 mcg C. 320 mcg D. 480 mcg E. 640 mcg **Which of the following best describes how a drug that acts as an agonist at the A subtype of GABA receptors affects signal transduction in a neuron?** A. Activation of this receptor subtype alters transcription of DNA in the nucleus of the neuron. B. Activation of this receptor subtype opens ion channels that allow sodium to enter cells and increases the chance of generating an action potential. C. Activation of this receptor subtype opens ion channels that allow chloride to enter cells and decreases the chance of generating an action potential. D. Activation of this receptor subtype results in G protein activation and increased intracellular second messenger levels. **If 1 mg of lorazepam produces the same anxiolytic response as 10 mg of diazepam, which is correct?** A. Lorazepam is more potent than is diazepam. B. Lorazepam is more efficacious than is diazepam. C. Lorazepam is a full agonist, and diazepam is a partial agonist. D. Lorazepam is a better drug to take for anxiety than is diazepam. **If 10 mg of oxycodone produces a greater analgesic response than does aspirin at any dose, which is correct?** A. Oxycodone is more efficacious than is aspirin. B. Oxycodone is less potent than is aspirin. C. Aspirin is a full agonist, and oxycodone is a partial agonist. D. Oxycodone and aspirin act on the same drug target. **In the presence of propranolol, a higher concentration of epinephrine is required to elicit full antiasthmatic activity. Propranolol has no effect on asthma symptoms. Which is correct regarding these medications?** A. Epinephrine is less efficacious than is propranolol. B. Epinephrine is a full agonist, and propranolol is a partial agonist. C. Epinephrine is an agonist, and propranolol is a competitive antagonist. D. Epinephrine is an agonist, and propranolol is a noncompetitive antagonist. **In the presence of picrotoxin, diazepam is less efficacious at causing sedation, regardless of the dose. Picrotoxin has no sedative effect, even at the highest dose. Which of the following is correct regarding these agents?** A. Picrotoxin is a competitive antagonist. B. Picrotoxin is a noncompetitive antagonist. C. Diazepam is less efficacious than is picrotoxin. D. Diazepam is less potent than is picrotoxin. **Haloperidol, chlorpromazine, and clozapine are antipsychotic medications that bind to the D2 subtype of dopamine receptors, with a binding affinity of haloperidol \> chlorpromazine \> clozapine. Which statement would have to be correct to conclude that the mechanism of antipsychotic effects for these drugs is via binding to D2 receptors?** A. Haloperidol should have the lowest potency of the three antipsychotic drugs. B. D2 receptor binding should also be related to the potency of these drugs in causing Parkinson's-like adverse effects. C. A positive correlation should exist between the affinity of these drugs to bind to D2 receptors and their potency for antipsychotic actions. D. Clozapine would have to be more potent than chlorpromazine for decreasing psychosis. **If there were spare β1-adrenergic receptors on cardiac muscle cells, which statement would be correct?** A. The number of spare β1-adrenergic receptors determines the size of the maximum effect of the agonist epinephrine. B. Spare β1 adrenergic receptors make the cardiac tissue less sensitive to epinephrine. C. A maximal effect of epinephrine is seen when only a portion of β1 adrenergic receptors are occupied. D. Spare receptors are active even in the absence of epinephrine. **Which of the following up-regulates postsynaptic α1-adrenergic receptors?** A. Daily use of amphetamine that causes release of norepinephrine B. A disease that causes an increase in the activity of norepinephrine neurons C. Daily use of phenylephrine, an α1 receptor agonist D. Daily use of prazosin, an α1 receptor antagonist **Methylphenidate helps patients with attention deficit hyperactivity disorder (ADHD) maintain attention and perform better at school or work, with an ED50 of 10 mg. However, methylphenidate can also cause significant nausea at higher doses (TD50 = 30 mg). Which is correct regarding methylphenidate?** A. The therapeutic index of methylphenidate is 3. B. The therapeutic index of methylphenidate is 0.3. C. Methylphenidate is more potent at causing nausea than treating ADHD. D. Methylphenidate is more efficacious at causing nausea than treating ADHD. **Which is correct concerning the safety of using warfarin (with a small therapeutic index) versus penicillin (with a large therapeutic index)?** A. Warfarin is a safer drug because it has a low therapeutic index. B. Warfarin treatment has a high chance of resulting in dangerous adverse effects if bioavailability is altered. The high therapeutic index makes penicillin a safe drug for all patients. D. Penicillin treatment has a high chance of causing dangerous adverse effects if bioavailability is altered. **A 3-year-old is brought to the emergency department having just ingested a large overdose of chlorpropamide, an oral antidiabetic drug. Chlorpropamide is a weak acid with a pKa of 5.0. It is capable of entering most tissues. On physical examination, the heart rate is 110/min, blood pressure 90/50 mm Hg, and respiratory rate 30/min. Which of the following statements about this case of chlorpropamide overdose is most correct?** \(A) Urinary excretion would be accelerated by administration of NH4Cl, an acidifying agent \(B) Urinary excretion would be accelerated by giving NaHCO3, an alkalinizing agent \(C) Less of the drug would be ionized at blood pH than at stomach pH \(D) Absorption of the drug would be slower from the stomach than from the small intestine **2. Botulinum toxin is a large protein molecule. Its action on cholinergic transmission depends on an intracellular action within nerve endings. Which one of the following processes is best suited for permeation of very large protein molecules into cells?** \(A) Aqueous diffusion \(B) Endocytosis \(C) First-pass effect \(D) Lipid diffusion \(E) Special carrier transport **3. A 12-year-old child has bacterial pharyngitis and is to receive an oral antibiotic. She complains of a sore throat and pain on swallowing. The tympanic membranes are slightly reddened bilaterally, but she does not complain of earache. Blood pressure is 105/70 mm Hg, heart rate 100/min, temperature 37.8°C (100.1°F). Ampicillin is a weak organic acid with a pKa of 2.5. What percentage of a given dose will be in the lipid-soluble form in the duodenum at a pH of 4.5?** \(A) About 1% \(B) About 10% \(C) About 50% \(D) About 90% \(E) About 99% **4. Ampicillin is eliminated by first-order kinetics. Which of the following statements best describes the process by which the plasma concentration of this drug declines?** \(A) There is only 1 metabolic path for drug elimination \(B) The half-life is the same regardless of the plasma concentration \(C) The drug is largely metabolized in the liver after oral administration and has low bioavailability \(D) The rate of elimination is proportional to the rate of administration at all times \(E) The drug is distributed to only 1 compartment outside the vascular system **5. The pharmacokinetics of a new drug are under study in a phase 1 clinical trial. Which statement about the distribution of drugs to specific tissues is most correct?** \(A) Distribution to an organ is independent of blood flow \(B) Distribution of a lipid-soluble drug will be to adipose tissue initially \(C) Distribution into a tissue depends on the unbound drug concentration gradient between blood and the tissue \(D) Distribution is increased for drugs that are strongly bound to plasma proteins \(E) Distribution has no effect on the half-life of the drug **6. 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** \(A) Distribution \(B) Excretion \(C) First-pass effect \(D) First-order elimination \(E) Zero-order elimination 7**. Which of the following statements about animal testing of potential new therapeutic agents is most correct?** \(A) Requires at least 3 years to discover late toxicities \(B) Requires at least 1 primate species (eg, rhesus monkey) \(C) Requires the submission of histopathologic slides and specimens to the FDA for evaluation by government scientists \(D) Has good predictability for drug allergy-type reactions \(E) May be abbreviated in the case of some very toxic agents used in cancer **8. The "dominant lethal" test involves the treatment of a male adult animal with a chemical before mating; the pregnant female is later examined for fetal death and abnormalities. The dominant lethal test therefore is a test of** \(A) Teratogenicity \(B) Mutagenicity \(C) Carcinogenicity \(D) Sperm viability **9. In a phase 1 clinical trial, "Novexum," a new drug, was administered intravenously to 25 volunteers, and blood samples were taken for several hours. Several inactive metabolites were found as well as declining concentrations of Novexum. A graph was prepared as shown below, with the Novexum plasma levels plotted on a logarithmic ordinate and time on a linear abscissa. It was concluded that the drug has first-order kinetics. From this graph, what is the best estimate of the elimination half-life of Novexum?** \(A) 0.5 h \(B) 1 h \(C) 3 h \(D) 4 h \(E) 7 h **10. A large pharmaceutical company has conducted extensive animal testing of a new drug for the treatment of advanced prostate cancer. The chief of research and development recommends that the company now submit an IND application in order to start clinical trials. Which of the following statements is most correct regarding clinical trials of new drugs?** \(A) Phase 1 involves the study of a small number of normal volunteers by highly trained clinical pharmacologists \(B) Phase 2 involves the use of the new drug in a large number of patients (1000--5000) who have the disease to be treated under conditions of proposed use (eg, outpatients) \(C) Chronic animal toxicity studies must be complete and reported in the IND \(D) Phase 4 involves the detailed study of toxic effects that have been discovered in phase 3 \(E) Phase 2 requires the use of a positive control (a known effective drug) and a placebo **11. Which of the following would probably not be included in an optimal phase 3 clinical trial of a new analgesic drug for mild pain?** \(A) A negative control (placebo) \(B) A positive control (current standard analgesic therapy) \(C) Double-blind protocol (in which neither the patient nor immediate observers of the patient know which agent is active) \(D) A group of 1000--5000 subjects with a clinical condition requiring analgesia \(E) Prior submission of an NDA (new drug application) to the FDA **12. The Ames test is frequently carried out before clinical trials are begun. The Ames test is a method that detects** \(A) Carcinogenesis in primates \(B) Carcinogenesis in rodents \(C) Mutagenesis in bacteria \(D) Teratogenesis in any mammalian species \(E) Teratogenesis in primates **13. Which of the following statements about new drug development is most correct?** \(A) If the need is great, drugs that test positive for teratogenicity, mutagenicity, or carcinogenicity can be tested in humans but the IND must specify safety measures to be taken \(B) Food supplements and herbal (botanical) remedies must be shown to be effective for the target condition before marketing is approved by the FDA \(C) All new drugs must be studied in at least 1 primate species before NDA submission \(D) Orphan drugs are drugs that are no longer produced by the original manufacturer \(E) Phase 4 (surveillance) is the most rigidly regulated phase of clinical drug trials **14. Which statement about the development of new drugs is most correct?** \(A) Because they may cause anaphylaxis, proteins cannot be used as drugs \(B) Most drugs fall between 100 and 1000 in molecular weight \(C) Drugs for systemic action that are to be administered orally should be highly water soluble and insoluble in lipids \(D) Water solubility is minimal in highly polarized (charged) drug molecules **A 55-year-old man is seen in the clinic with hypertension of 150/95 mm Hg (millimeters of mercury). His personal medical history and physical examination are otherwise unremarkable but his family history is positive for early deaths due to cardiovascular disease. A decision is made to treat his hypertension, starting with a calcium channel blocker. Blocker A in a dose of 5 mg produces the same decrease in blood pressure as 500 mg of blocker B. Which of the following predictions is most accurate?** \(A) Blocker A will be more efficacious than blocker B \(B) Blocker A will be about 100 times more potent than blocker B \(C) Toxicity of blocker A will be less than that of blocker B \(D) Blocker A will have a wider therapeutic window than blocker B \(E) Blocker A will have a longer half-life than blocker B **2. Graded and quantal dose-response curves are being used for evaluation of a new analgesic drug in the animal laboratory and in clinical trials. Which of the following statements best describes graded dose-response curves?** \(A) More precisely quantitated than quantal dose-response curves \(B) Obtainable from isolated tissue preparations but not from the study of intact subjects \(C) Used to determine the maximal efficacy of the drug \(D) Used to determine the therapeutic index of the drug \(E) Used to determine the variation in sensitivity of subjects to the drug **3. 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?** \(A) Drug A is most effective \(B) Drug B is least potent \(C) Drug C is most potent \(D) Drug B is more potent than drug C and more effective than drug A \(E) Drug A is more potent than drug B and more effective than drug C **A study was carried out in isolated intestinal smooth muscle preparations to determine the action of a new drug "novamine," which in separate studies bound to the same receptors as acetylcholine, an agonist. In the absence of other drugs, acetylcholine caused contraction of the muscle. Novamine alone caused relaxation of the preparation. In the presence of a low concentration of novamine, the EC50 of acetylcholine was unchanged, but the Emax was reduced. In the presence of a high concentration of novamine, extremely high concentrations of acetylcholine had no effect. Which of the following expressions best describes novamine?** \(A) A chemical antagonist \(B) An irreversible antagonist \(C) A partial agonist \(D) A physiologic antagonist \(E) A spare receptor agonist **Beta adrenoceptors in the heart regulate cardiac rate and contractile strength. Several studies have indicated that in humans and experimental animals, about 90% of β adrenoceptors in the heart are spare receptors. Which of the following statements about spare receptors is most correct?** \(A) Spare receptors, in the absence of drug, are sequestered in the cytoplasm \(B) Spare receptors may be detected by finding that the drug-receptor interaction lasts longer than the intracellular effect \(C) Spare receptors influence the maximal efficacy of the drug-receptor system \(D) Spare receptors activate the effector machinery of the cell without the need for a drug \(E) Spare receptors may be detected by finding that the EC50 is smaller than the Kd for the agonist **Two cholesterol-lowering drugs, X and Y, were studied in a large group of patients, and the percentages of the group showing a specific therapeutic effect (35% reduction in low-density lipoprotein \[LDL\] cholesterol) were determined. The results are shown in the following table.** **Which of the following statements about these results is correct?** \(A) Drug X is safer than drug Y \(B) Drug Y is more effective than drug X \(C) The 2 drugs act on the same receptors \(D) Drug X is less potent than drug Y \(E) The therapeutic index of drug Y is 10 **7. Sugammadex is a drug that reverses the action of rocuronium and certain other skeletal muscle-relaxing agents (nondepolarizing neuromuscular blocking agents). It appears to interact directly with the rocuronium molecule and not at all with the rocuronium receptor. Which of the following terms best describes sugammadex?** \(A) Chemical antagonist \(B) Noncompetitive antagonist \(C) Partial agonist \(D) Pharmacologic antagonist \(E) Physiologic antagonist **QUESTIONS: 8--10. Each of the curves in the graph below may be considered a concentration-effect curve or a concentration- binding curve.**  **Which of the curves in the graph describes the percentage of binding of a large dose of full agonist to its receptors as the concentration of a partial agonist is increased from low to very high levels?** \(A) Curve 1 \(B) Curve 2 \(C) Curve 3 \(D) Curve 4 \(E) Curve 5 **9. Which of the curves in the graph describes the percentage effect observed when a large dose of full agonist is present throughout the experiment and the concentration of a partial agonist is increased from low to very high levels?** \(A) Curve 1 \(B) Curve 2 \(C) Curve 3 \(D) Curve 4 \(E) Curve 5 **10. Which of the curves in the graph describes the percentage of binding of the partial agonist whose effect is shown by Curve 4 if the system has many spare receptors?** \(A) Curve 1 \(B) Curve 2 \(C) Curve 3 \(D) Curve 4 \(E) Curve 5 **Mr Jones has zero kidney function and is undergoing hemodialysis 3 days per week while awaiting a kidney transplant. He takes metformin for type 2 diabetes mellitus and was previously stabilized (while his kidney function was adequate) at a dosage of 500 mg twice daily, given orally. The plasma concentration at this dosage with normal kidney function was found to be 1.4 mg/L. He has had 6 dialysis procedures and metformin toxicity is suspected. A blood sample now shows a metformin concentration of 4.2 mg/L. What was Mr Jones' clearance of metformin while his kidney function was normal?** \(A) 238 L/d \(B) 29.8 L/h \(C) 3 L/d \(D) 238 L/h \(E) 30 L/min **2. Ms Smith, a 65-year-old woman with pneumonia, was given tobramycin, 150 mg, intravenously. After 20 minutes, the plasma concentration was measured and was found to be 3 mg/L. Assuming no elimination of the drug in 20 minutes, what is the apparent volume of distribution of tobramycin in Ms Smith?** \(A) 3 L/min \(B) 3 L \(C) 50 L \(D) 7 L \(E) 0.1 mg/min **3. St. John's Wort, a popular botanical remedy, is a potent inducer of hepatic phase I CYP3A4 enzymes. Verapamil and phenytoin are both eliminated from the body by metabolism in the liver. Verapamil has a clearance of 1.5 L/min, approximately equal to liver blood flow, whereas phenytoin has a clearance of 0.1 L/min. Based on this fact, which of the following is most correct?** \(A) St. John's Wort will increase the half-life of phenytoin and verapamil \(B) St. John's Wort will decrease the volume of distribution of CYP3A4 substrates \(C) St. John's Wort will decrease the hepatic extraction of phenytoin \(D) St. John's Wort will decrease the first-pass effect for verapamil \(E) St. John's Wort will increase the clearance of phenytoin **A 45-year-old woman with small cell lung cancer has elected to participate in the trial of a new chemotherapeutic agent. It is given by constant intravenous infusion of 10 mg/h. Plasma concentrations (Cp) are measured with the results shown in the following table** **What conclusion can be drawn from these data?** \(A) Clearance is 2.0 L/h \(B) Doubling the rate of infusion would result in a plasma concentration of 16 mg/L at 40 h \(C) Elimination follows zero-order kinetics \(D) Half-life is 2 h \(E) Volume of distribution is 30 L **You are the only physician in a clinic that is cut off from the outside world by violent storms, flooding, and landslides. A 15-year-old girl is brought to the clinic with severe asthmatic wheezing. Because of the lack of other drugs, you decide to use intravenous theophylline for treatment. The pharmacokinetics of theophylline include the following average parameters: Vd 35 L; CL 48 mL/min; half-life 8 h. If an intravenous infusion of theophylline is started at a rate of 0.48 mg/min, how long would it take to reach 93.75% of the final steady-state concentration?** \(A) Approximately 48 min \(B) Approximately 7.4 h \(C) Approximately 8 h \(D) Approximately 24 h \(E) Approximately 32 h **6. A 74-year-old retired mechanic is admitted with a myocardial infarction and a severe acute cardiac arrhythmia. You decide to give lidocaine to correct the arrhythmia. A continuous intravenous infusion of lidocaine, 1.92 mg/min, is started at 8 AM. The average pharmacokinetic parameters of lidocaine are: Vd 77 L; clearance 640 mL/min; half-life 1.4 h. What is the expected steady-state plasma concentration?** \(A) 40 mg/L \(B) 3.0 mg/L \(C) 0.025 mg/L \(D) 7.2 mg/L \(E) 3.46 mg/L **7. A new drug is under study in phase 1 trials. It is found that this molecule is avidly taken up by extravascular tissues so that the final total amount in the extravascular compartment at steady state is 100 times the amount remaining in the blood plasma. What is the probable volume of distribution in a hypothetical person with 8 L of blood and 4 L of plasma?** \(A) Insufficient data to calculate \(B) 8 L \(C) 14.14 L \(D) 100 L \(E) 404 L **8. A 63-year-old woman in the intensive care unit requires an infusion of procainamide. Its half-life is 2 h. The infusion is begun at 9 am. At 1 pm on the same day, a blood sample is taken; the drug concentration is found to be 3 mg/L. What is the probable steady-state drug concentration after 16 or more hours of infusion?** \(A) 3 mg/L \(B) 4 mg/L \(C) 6 mg/L \(D) 9.9 mg/L \(E) 15 mg/L **10. Gentamicin, an aminoglycoside antibiotic, is sometimes given as a single large intravenous bolus dose of once a day to achieve a highly active peak plasma concentration. Gentamicin's volume of distribution is about 20 L in a 70 kg patient and, in your patient, the half-life is 4 h. If your patient is given an IV bolus dose of 360 mg, what will the trough concentration of gentamicin be 24 hours later just before the next intravenous bolus?** \(A) 18 mg/L \(B) 4.5 mg/L \(C) 1.13 mg/L \(D) 0.56 mg/L \(E) 0. 28 mg/L **Drug metabolism in humans usually results in a product that is** \(A) Less lipid soluble than the original drug \(B) More likely to distribute intracellularly \(C) More likely to be reabsorbed by kidney tubules \(D) More lipid soluble than the original drug \(E) Less water soluble than the original drug **2. If therapy with multiple drugs causes induction of drug metabolism in your depressed patient, it will** \(A) Be associated with increased smooth endoplasmic reticulum \(B) Be associated with increased rough endoplasmic reticulum \(C) Be associated with decreased enzymes in the soluble cytoplasmic fraction \(D) Require 3--4 months to reach completion \(E) Be irreversible **3. Which of the following factors is likely to increase the duration of action of a drug that is metabolized by CYP3A4 in the liver?** \(A) Chronic administration of rifampin during therapy with the drug in question \(B) Chronic therapy with amiodarone \(C) Displacement from tissue-binding sites by another drug \(D) Increased cardiac output \(E) Chronic administration of carbamazepine **4. Reports of cardiac arrhythmias caused by unusually high blood levels of 2 antihistamines, terfenadine, and astemizole, led to their removal from the market. Which of the following best explains these effects?** \(A) Concomitant treatment with rifampin \(B) Use of these drugs by chronic alcoholics \(C) Use of these drugs by chronic smokers \(D) Treatment of these patients with ketoconazole, an azole antifungal agent **5. Which of the following agents, when used in combination with other anti-HIV drugs, permits dose reductions?** \(A) Cimetidine \(B) Efavirenz \(C) Ketoconazole \(D) Procainamide \(E) Quinidine \(F) Ritonavir \(G) Succinylcholine \(H) Verapamil **6. Which of the following drugs may inhibit the hepatic microsomal P450 responsible for warfarin metabolism?** \(A) Amiodarone \(B) Ethanol \(C) Phenobarbital \(D) Procainamide \(E) Rifampin 7**. Which of the following drugs, if used chronically, is most likely to increase the toxicity of acetaminophen?** \(A) Cimetidine \(B) Ethanol \(C) Ketoconazole \(D) Procainamide \(E) Quinidine \(F) Ritonavir \(G) Succinylcholine \(H) Verapamil **8. Which of the following drugs has higher first-pass metabolism in men than in women?** \(A) Cimetidine \(B) Ethanol \(C) Ketoconazole \(D) Procainamide \(E) Quinidine \(F) Ritonavir \(G) Succinylcholine \(H) Verapamil **9. Which of the following drugs is an established inhibitor of P-glycoprotein (P-gp) drug transporters?** \(A) Cimetidine \(B) Ethanol \(C) Ketoconazole \(D) Procainamide \(E) Quinidine \(F) Ritonavir \(G) Succinylcholine \(H) Verapamil **10. Which of the following cytochrome isoforms is responsible for metabolizing the largest number of drugs?** \(A) CYP1A2 \(B) CYP2C9 \(C) CYP2C19 \(D) CYP2D6 \(E) CYP3A4 **1. A 3-year-old is brought to the emergency department having just ingested a large overdose of diphenhydramine, an antihistaminic drug. Diphenhydramine is a weak base with a pKa of 8.8. It is capable of entering most tissues, including the brain. On physical examination, the heart rate is 100/min, blood pressure 90/50 mm Hg, and respiratory rate 20/min. Which of the following statements about this case of diphenhydramine overdose is most correct?** A. Urinary excretion would be accelerated by administration of NH4Cl, an acidifying agent. B. Urinary excretion would be accelerated by giving NaHCO3, an alkalinizing agent C. More of the drug would be ionized at blood pH than at stomach pH D. Absorption of the drug would be faster from the stomach than from the small intestine E. Hemodialysis is the only effective therapy **A 60-year-old patient with severe cancer pain is given 10 mg of morphine by mouth. The plasma concentration is found to be only 30% of that found after intravenous administration of the same dose. Which of the following terms describes the process by which the amount of active drug in the body is reduced after administration but before entering the systemic circulation?** A. Excretion B. First-order elimination C. First-pass effect D. Metabolism E. Pharmacokinetics **Which of the following statements is most correct regarding the termination of drug action?** A. Drugs must be excreted from the body to terminate their action B. Metabolism of drugs always increases their water solubility C. Metabolism of drugs always abolishes their pharmacologic activity D. Hepatic metabolism and renal excretion are the two most important mechanisms involved E. Distribution of a drug out of the bloodstream terminates the drug's effects **The pharmacokinetic process that distinguishes the elimination of ethanol and high doses of phenytoin and aspirin from the elimination of most other drugs is called** A. Distribution B. Excretion C. First-pass effect D. First-order elimination E. Zero-order elimination **The set of properties that characterize the effects of a drug on the body is called** A. Distribution B. Permeation C. Pharmacodynamics D. Pharmacokinetics E. Protonation **Phase 3 clinical trials typically involve** A. Collection of data regarding late-appearing toxicities from patients previously studied in phase 1 trials B. Double-blind, closely monitored evaluation of the new drug in hundreds of patients with the target disease by specialists in academic centers C. Evaluation of the new drug under conditions of actual use in 1000--5000 patients with the target disease D. Measurement of the pharmacokinetics of the new drug in normal volunteers E. Postmarketing surveillance of drug toxicities **A 55-year-old woman with hypertension is to be treated with a vasodilator drug. Drugs X and Y have the same mechanism of action. Drug X in a dose of 5 mg produces the same decrease in blood pressure as 500 mg of drug Y. Which of the following statements best describes these results?** A. Drug Y is less efficacious than drug X B. Drug X is about 100 times more potent than drug Y C. Toxicity of drug X is less than that of drug Y D. Drug X has a wider therapeutic window than drug Y E. Drug X will have a shorter duration of action than drug Y because less of drug X is present over the time course of drug action **Graded and quantal dose-response curves are being used for evaluation of a new antiasthmatic drug in the animal laboratory and in clinical trials. Which of the following statements best describes quantal dose-response curves?** A. More precisely quantitated than graded dose-response curves B. Obtainable from the study of intact subjects but not from isolated tissue preparations C. Used to determine the maximal efficacy of the drug D. Used to determine the statistical variation (standard deviation) of the maximal response to the drug E. Used to determine the variation in sensitivity of subjects to the drug **A study was carried out in isolated, perfused animal hearts.In the absence of other drugs, pindolol, a β-adrenoceptor ligand, caused an increase in heart rate. In the presence of highly effective β stimulants, however, pindolol caused a dose-dependent, reversible decrease in heart rate. Which of the following expressions best describes pindolol?** A. A chemical antagonist B. An irreversible antagonist C. A partial agonist D. A physiologic antagonist E. A spare receptor agonist **Drug X produces maximal contraction of cardiac muscle in a manner similar to epinephrine. Drug X is considered to be a(n)** A. Agonist. B. Partial agonist. C. Competitive Antagonist. D. Irreversible antagonist. E. Inverse agonist. **Which of the following statements is correct?** A. If 10 mg of Drug A produces the same response as 100 mg of Drug B, Drug A is more efficacious than Drug B. B. The greater the efficacy, the greater the potency of a drug. C. In selecting a drug, potency is usually more important than efficacy. D. A competitive antagonist increases the ED50. E. Variation in response to a drug among different individuals is most likely to occur with a drug showing a large therapeutic index. **Variation in the sensitivity of a population of individuals to increasing doses of a drug is best determined by which of the following?** A. Efficacy. B. Potency. C. Therapeutic index. D. Graded dose--response curve. E. Quantal dose--response curve. **Which of the following statements most accurately describes a system having spare receptors?** A. The number of spare receptors determines the maximum effect. B. Spare receptors are sequestered in the cytosol. C. A single drug--receptor interaction results in many cellular response elements being activated. D. Spare receptors are active even in the absence of agonist. E. Agonist affinity for spare receptors is less than their affinity for nonspare receptors. **Mr Jones is admitted to the hospital with cough, shortness of breath, and fever. History, physical examination, and culture of the sputum lead to a diagnosis of pneumonia due to gram-negative bacteria. The antibiotic tobramycin is ordered. The clearance and Vd of tobramycin in Mr Jones are 80 mL/min and 40 L, respectively. What maintenance dose should be administered intravenously every 6 h to eventually obtain average steady-state plasma concentrations of 4 mg/L?** A. 0.32 mg B. 19.2 mg C. 115 mg D. 160 mg E. 230 mg **Verapamil and phenytoin are both eliminated from the body by metabolism in the liver. Verapamil has a clearance of 1.5 L/min, approximately equal to liver blood flow, whereas phenytoin has a clearance of 0.1 L/min. When these compounds are administered along with rifampin, a drug that markedly increases hepatic drug-metabolizing enzymes, which of the following is most likely?** A. The half-lives of both verapamil and phenytoin will be markedly increased B. The clearance of both verapamil and phenytoin will be markedly decreased C. The clearance of verapamil will be unchanged, whereas the clearance of phenytoin will be increased D. The half-life of phenytoin will be unchanged, whereas the half-life of verapamil will be increased E. The clearance of both drugs will be unchanged **A 74-year-old retired mechanic is admitted with a myocardial infarction and a severe acute cardiac arrhythmia. You decide to give lidocaine to correct the arrhythmia. A continuous intravenous infusion of lidocaine, 1.92 mg/min,is started at 8 AM. The average pharmacokinetic parameters of lidocaine are: Vd 77 L; clearance 640 mL/min; half-life 1.4 h.What is the expected steady-state plasma concentration?** A. 40 mg/L B. 3.0 mg/L C. 0.025 mg/L D. 7.2 mg/L E. 3.46 mg/L **A 30-year-old man is brought to the emergency department in a deep coma. Respiration is severely depressed and he has pinpoint pupils. His friends state that he self-administered a large dose of morphine 6 h earlier. An immediate blood analysis shows a morphine blood level of 0.25 mg/L. Assuming that the Vd of morphine in this patient is 200 L and the half-life is 3 h, how much morphine did the patient inject 6 h earlier?** A. 25 mg B. 50 mg C. 100 mg D. 200 mg E. Not enough data to predict **Gentamicin, an aminoglycoside antibiotic, is sometimes given in intermittent intravenous bolus doses of 100 mg 3 times a day to achieve target peak plasma concentrations of about 5 mg/L. Gentamicin's clearance (normally 5.4 L/h/70 kg) is almost entirely by glomerular filtration. Your patient, however, is found to have a creatinine clearance one third of normal. What should your modified dosage regimen for this patient be?** A. 20 mg 3 times a day B. 33 mg 3 times a day C. 72 mg 3 times a day D. 100 mg 2 times a day E. 150 mg 2 times a day **A drug, given as a 100-mg single dose, results in a peak plasma concentration of 20 μg/mL. The apparent volume of distribution is (assume a rapid distribution and negligible elimination prior to measuring the peak plasma level):** A. 0.5 L. B. 1 L. C. 2 L. D. 5 L. E. 10 L. **A drug with a half-life of 12 hours is administered by continuous intravenous infusion. How long will it take for the drug to reach 90 percent of its final steady-state level?** A. 18 hours. B. 24 hours. C. 30 hours. D. 40 hours. E. 90 hours. **Which of the following results in a doubling of the steady-state concentration of a drug?** A. Doubling the rate of infusion. B. Maintaining the rate of infusion but doubling the loading dose. C. Doubling the rate of infusion and doubling the concentration of the infused drug. D. Tripling the rate of infusion. E. Quadrupling the rate of infusion. **A heart failure patient shows digoxin toxicity. She received 125 mcg as standard dose. Serum levels were reported to be 2 ng /mL (2 mcg/L). Target therapeutic level is 0.8 ng/mL. What dose should she receive?** A. 25 mcg. B. 50 mcg. C. 75 mcg. D 100 mcg. E. 125 mcg. **The addition of glucuronic acid to a drug:** A. Decreases its water solubility. B. Usually leads to inactivation of the drug. C. Is an example of a Phase I reaction. D. Occurs at the same rate in adults and newborns. E. Involves cytochrome P450. **3-year-old child has swallowed the contents of 2 bottles of a nasal decongestant whose primary ingredient is a potent, selective α-adrenoceptor agonist drug. Which of the following is a sign of α receptor activation that may occur in this patient?** \(A) Bronchodilation \(B) Cardiac acceleration (tachycardia) \(C) Pupillary dilation (mydriasis) \(D) Renin release from the kidneys \(E) Vasodilation of the splanchnic vessels **Ms Green is a 60-year-old woman with poorly controlled hypertension of 170/110 mm Hg. She is to receive minoxidil. The active metabolite of minoxidil is a powerful arteriolar vasodilator that does not act on autonomic receptors. Which of the following effects will be observed if no other drugs are used?** \(A) Tachycardia and increased cardiac contractility \(B) Tachycardia and decreased cardiac output \(C) Decreased mean arterial pressure and decreased cardiac contractility \(D) Decreased mean arterial pressure and increased salt and water excretion by the kidney \(E) No change in mean **Full activation of the sympathetic nervous system, as in the fight-or-flight reaction, may occur during maximal exercise. Which of the following effects is likely to occur?** \(A) Bronchoconstriction \(B) Increased intestinal motility \(C) Decreased renal blood flow \(D) Miosis \(E) Decreased heart rate (bradycardia)  **4. Norepinephrine acts at which of the following sites in the diagram?** \(A) Sites 1 and 2 \(B) Sites 3 and 4 \(C) Sites 5 and 6 **5. If the effector cell in the diagram is a thermoregulatory sweat gland, which of the following transmitters is released from structure 5?** \(A) Acetylcholine \(B) Dopamine \(C) Epinephrine \(D) Norepinephrine **6. Nicotinic receptor sites do not include which one of the following sites?** \(A) Bronchial smooth muscle \(B) Adrenal medullary cells \(C) Parasympathetic ganglia \(D) Skeletal muscle end plates \(E) Sympathetic ganglia **7. Several children at a summer camp were hospitalized with symptoms thought to be due to ingestion of food containing botulinum toxin. Which one of the following signs or symptoms is consistent with the diagnosis of botulinum poisoning?** \(A) Bronchospasm \(B) Cycloplegia \(C) Diarrhea \(D) Skeletal muscle spasms \(E) Hyperventilation **8. Which one of the following is the neurotransmitter agent normally released in the sino atrial node of the heart in response to a blood pressure increase?** \(A) Acetylcholine \(B) Dopamine \(C) Epinephrine \(D) Glutamate \(E) Norepinephrine Diagram Description automatically generated **9. Which of the following blocks the carrier represented by "y" in the diagram?** \(A) Amphetamine \(B) Botulinum toxin \(C) Cocaine \(D) Hemicholinium \(E) Reserpine **10. Which of the following inhibits the carrier denoted "z" in the diagram?** \(A) Cocaine \(B) Dopamine \(C) Hemicholinium \(D) Reserpine \(E) Vesamicol **Which one of the following statements concerning the parasympathetic nervous system is correct?** A. The parasympathetic system uses norepinephrine as a neurotransmitter. B. The parasympathetic system often discharges as a single, functional system. C. The parasympathetic division is involved in accommodation of near vision, movement of food, and urination. D. The postganglionic fibers of the parasympathetic division are long compared to those of the sympathetic nervous system. E. The parasympathetic system controls the secretion of the adrenal medulla. **12. Which one of the following is characteristic of parasympathetic stimulation?** A. Decrease in intestinal motility. B. Inhibition of bronchial secretion. C. Contraction of sphincter muscle in the iris of the eye (miosis). D. Contraction of sphincter of urinary bladder. E. Increase in heart rate. **Which of the following is characteristic of the sympathetic nervous system?** A Discrete response to activation. B. Actions mediated by muscarinic and nicotinic receptors. C. Effects only mediated by norepinephrine. D. Responses predominate during physical activity or when experiencing fright. E. Subjected to voluntary control. **Patient presents with salivation, lacrimation, urination and defecation as side elects of a medication. Which one of the following receptors mediates the actions of this drug?** A. Nicotinic receptors. B. α -adrenoreceptors. C. Muscarinic receptors. D. β --adrenoreceptors. **1. A 30-year-old woman undergoes abdominal surgery. In spite of minimal tissue damage, complete ileus (absence of bowel motility) follows, and she complains of severe bloating. She also finds it difficult to urinate. Mild cholinomimetic stimulation with bethanechol or neostigmine is often effective in relieving these complications of surgery. Neostigmine and bethanechol in moderate doses have significantly different effects on which one of the following?** \(A) Gastric secretion \(B) Neuromuscular end plate \(C) Salivary glands \(D) Sweat glands \(E) Ureteral tone **2. Parathion has which one of the following characteristics?** \(A) It is inactivated by conversion to paraoxon \(B) It is less toxic to humans than malathion \(C) It is more persistent in the environment than DDT \(D) It is poorly absorbed through skin and lungs \(E) If treated early, its toxicity may be partly reversed by pralidoxime **3. Ms Brown has been treated for myasthenia gravis for several years. She reports to the emergency department complaining of recent onset of weakness of her hands, diplopia, and difficulty swallowing. She may be suffering from a change in response to her myasthenia therapy, that is, a cholinergic or a myasthenic crisis. Which of the following is the best drug for distinguishing between myasthenic crisis (insufficient therapy) and cholinergic crisis (excessive therapy)?** \(A) Atropine \(B) Edrophonium \(C) Physostigmine \(D) Pralidoxime \(E) Pyridostigmine **4. A crop duster pilot has been accidentally exposed to a high concentration of a highly toxic agricultural organophosphate insecticide. If untreated, the cause of death from such exposure would probably be** \(A) Cardiac arrhythmia \(B) Gastrointestinal bleeding \(C) Heart failure \(D) Hypotension \(E) Respiratory failure 5**. Mr Green has just been diagnosed with dysautonomia (chronic idiopathic autonomic insufficiency). You are considering different therapies for his disease. Pyridostigmine and neostigmine may cause which one of the following?** \(A) Bronchodilation \(B) Cycloplegia \(C) Diarrhea \(D) Irreversible inhibition of acetylcholinesterase \(E) Reduced gastric acid secretion **6. Parasympathetic nerve stimulation and a slow infusion of bethanechol will each:** \(A) Cause ganglion cell depolarization \(B) Cause skeletal muscle end plate depolarization \(C) Cause vasodilation \(D) Increase bladder tone \(E) Increase heart rate **7. Actions and clinical uses of muscarinic cholinoceptor agonists include which one of the following?** \(A) Bronchodilation (asthma) \(B) Improved aqueous humor drainage (glaucoma) \(C) Decreased gastrointestinal motility (diarrhea) \(D) Decreased neuromuscular transmission and relaxation of skeletal muscle (during surgical anesthesia) \(E) Increased sweating (fever) **8. Which of the following is a direct-acting cholinomimetic that is lipid-soluble and is used to facilitate smoking cessation?** \(A) Acetylcholine \(B) Bethanechol \(C) Neostigmine \(D) Physostigmine \(E) Varenicline **9. A 3-year-old child is admitted after taking a drug from her parents' medicine cabinet. The signs suggest that the drug is an indirect-acting cholinomimetic with little or no CNS effect and a duration of action of about 2--4 h. Which of the following is the most likely cause of these effects?** \(A) Acetylcholine \(B) Bethanechol \(C) Neostigmine \(D) Physostigmine \(E) Pilocarpine **10. Which of the following is the primary second-messenger process in the contraction of the ciliary muscle when focusing on near objects?** \(A) cAMP (cyclic adenosine monophosphate) \(B) DAG (diacylglycerol) \(C) Depolarizing influx of sodium ions via a channel \(D) IP3 (inositol 1,4,5-trisphosphate) \(E) NO (nitric oxide) **A 2-year-old child has been admitted to the emergency department. Antimuscarinic drug overdose is suspected. Probable signs of atropine overdose include which one of the following?** A. Gastrointestinal smooth muscle cramping B. Increased heart rate C. Increased gastric secretion D. Pupillary constriction E. Urinary frequency **2. Which of the following is the most dangerous effect of belladonna alkaloids in infants and toddlers?** \(A) Dehydration \(B) Hallucinations \(C) Hypertension \(D) Hyperthermia \(E) Intraventricular heart block **3. Which one of the following can be blocked by atropine?** \(A) Decreased blood pressure caused by hexamethonium \(B) Increased blood pressure caused by nicotine \(C) Increased skeletal muscle strength caused by neostigmine \(D) Tachycardia caused by exercise \(E) Tachycardia caused by infusion of acetylcholine Questions 4--5. Two new synthetic drugs (X and Y) are to be studied for their cardiovascular effects. The drugs are given to three anesthetized animals while the blood pressure is recorded. The first animal has received no pretreatment (control), the second has received an effective dose of a long-acting ganglion blocker, and the third has received an effective dose of a longacting muscarinic antagonist. **4. Drug X caused a 50 mm Hg rise in mean blood pressure in the control animal, no blood pressure change in the ganglionblocked animal, and a 75 mm mean blood pressure rise in the atropine-pretreated animal. Drug X is probably a drug similar to** \(A) Acetylcholine \(B) Atropine \(C) Epinephrine \(D) Hexamethonium \(E) Nicotine **5. The net changes induced by drug Y in these experiments are shown in the following graph.**  **Drug Y is probably a drug similar to** \(A) Acetylcholine \(B) Edrophonium \(C) Hexamethonium \(D) Nicotine \(E) Pralidoxime **6. A 30-year-old man has been treated with several autonomic drugs for 4 weeks. He is now admitted to the emergency department showing signs of drug toxicity. Which of the following signs would distinguish between an overdose of a ganglion blocker versus a muscarinic blocker?** \(A) Blurred vision \(B) Dry mouth, constipation \(C) Mydriasis \(D) Postural hypotension \(E) Tachycardia **7. Accepted therapeutic indications for the use of antimuscarinic drugs include all of the following except** \(A) Atrial fibrillation \(B) Motion sickness \(C) Parkinson's disease \(D) Postoperative bladder spasm \(E) To antidote parathion poisoning **8. Which of the following is an expected effect of a therapeutic dose of an antimuscarinic drug?** \(A) Decreased cAMP (cyclic adenosine monophosphate) in cardiac muscle \(B) Decreased DAG (diacylglycerol) in salivary gland tissue \(C) Increased IP3 (inositol trisphosphate) in intestinal smooth muscle \(D) Increased potassium efflux from smooth muscle \(E) Increased sodium influx into the skeletal muscle end Plate **9. Which one of the following drugs causes vasodilation that can be blocked by atropine?** \(A) Benztropine \(B) Bethanechol \(C) Botulinum \(D) Cyclopentolate \(E) Edrophonium \(F) Neostigmine \(G) Pralidoxime **10. Which one of the following drugs has a very high affinity for the phosphorus atom in parathion and is often used to treat life-threatening insecticide toxicity?** \(A) Atropine \(B) Benztropine \(C) Bethanechol \(D) Botulinum \(E) Cyclopentolate \(F) Neostigmine \(G) Pralidoxime **A 75-year-old man who was a smoker is diagnosed with chronic obstructive pulmonary disease and suffers from occasional bronchospasm. Which of the following would be effective in treating him?** A. Ipratropium aerosol. B. Scopolamine patches. C. Mecamylamine. D. Oxygen. E. Nicotine. **Which of the following may precipitate an attack of open-angle glaucoma if instilled into the eye?** A. Physostigmine. B. Atropine. C. Pilocarpine. D. Echothiophate. E. Tropicamide. **The prolonged apnea sometimes seen in patients who have undergone an operation in which succinylcholine was used as a muscle relaxant has been shown to be due to:** A. Urinary atony. B. Depressed levels of plasma cholinesterase. C. A mutation in acetylcholinesterase. D. A mutation in the nicotinic receptor at the neuromuscular junction. E. Weak histamine-releasing action. **A 50-year-old male farm worker is brought to the emergency room. He was found confused in the orchard and since then has lost consciousness. His heart rate is 45, and his blood pressure is 80/40 mm Hg. He is sweating and salivating profusely. Which of the following treatments is indicated?** A. Physostigmine. B. Norepinephrine. C. Trimethaphan. D. Atropine. E. Edrophonium. **Nondepolarizing neuromuscular blockers are associated with all of the following except:** A. Initial activation of ACh receptor and depolarization of the motor end plate. B. Effects are reversed by acetylcholinesterase inhibitors. C. Intermediate to long duration of action. D. Bind but do not activate ACh receptor. E. Most of these agents have minimal cardiovascular effects. **A 7-year-old boy with a previous history of bee sting allergy is brought to the emergency department after being stung by 3 bees. Which of the following are probable signs of the anaphylactic reaction to bee stings?** A. Bronchodilation, tachycardia, hypertension, vomiting, diarrhea B. Bronchospasm, tachycardia, hypotension C. Bronchodilation, bradycardia, vomiting, diarrhea D. Bronchospasm, bradycardia, hypotension, diarrhea E. Bronchodilation, tachycardia, vomiting, diarrhea **2. If this child has signs of anaphylaxis, what is the treatment of choice?** \(A) Diphenhydramine (an antihistamine) \(B) Ephedrine \(C) Epinephrine \(D) Methylprednisolone (a corticosteroid) \(E) Phenylephrine **3. A 65-year-old woman with long-standing diabetes mellitus is admitted to the ward from the emergency department, and you wish to examine her retinas for possible changes. Which of the following drugs is a good choice when pupillary dilation---but not cycloplegia---is desired?** \(A) Isoproterenol \(B) Norepinephrine \(C) Phenylephrine \(D) Pilocarpine \(E) Tropicamide **4. A 30-year-old man is admitted to the emergency department after taking a suicidal overdose of reserpine. His blood pressure is 50/0 mm Hg and heart rate is 40 bpm. Which of the following would be the most effective cardiovascular stimulant?** \(A) Amphetamine \(B) Clonidine \(C) Cocaine \(D) Norepinephrine \(E) Tyramine **5. An anesthetized dog is prepared for recording blood pressure and heart rate in a study of a new blocking drug. Results show that the new drug prevents the tachycardia evoked by isoproterenol? Which of the following standard agents does the new drug most resemble?** \(A) Atropine \(B) Hexamethonium \(C) Phentolamine (an α blocker) \(D) Physostigmine \(E) Propranolol (a β blocker) **6. Your new 10-year-old patient has asthma, and you decide to treat her with a β2 agonist. In considering the possible drug effects in this patient, you would note that β2 stimulants frequently cause** \(A) Direct stimulation of renin release \(B) Hypoglycemia \(C) Increased cGMP (cyclic guanine monophosphate) in mast cells \(D) Skeletal muscle tremor \(E) Vasodilation in the skin **7. Mr Green, a 54-year-old man, had a cardiac transplant 6 months ago. His current blood pressure is 120/70 mm Hg and heart rate is 100 bpm. Which of the following drugs would have the least effect on Mr Green's heart rate?** \(A) Albuterol \(B) Epinephrine \(C) Isoproterenol \(D) Norepinephrine \(E) Phenylephrine Questions 8--9. Several new drugs with autonomic actions are being studied in phase 1 clinical trials. Autonomic drugs X and Y were given in moderate doses as intravenous boluses to normal volunteers. The systolic and diastolic blood pressures changed as shown in the diagram below. Diagram, schematic Description automatically generated **8. Which of the following drugs most resembles drug X?** \(A) Atropine \(B) Bethanechol \(C) Epinephrine \(D) Isoproterenol \(E) Norepinephrine **9. Which of the following most resembles drug Y?** \(A) Atropine \(B) Bethanechol \(C) Epinephrine \(D) Isoproterenol \(E) Norepinephrine 10\. A new drug was given by subcutaneous injection to 25 normal subjects in a phase 1 clinical trial. The cardiovascular effects are summarized in the table below.  **Which of the following drugs does the new experimental agent most resemble?** \(A) Atropine \(B) Epinephrine \(C) Isoproterenol \(D) Phenylephrine \(E) Physostigmine **A 68-year-old man presents to the emergency department with acute heart failure. The patient requires immediate drug therapy to improve his cardiac function. Which one of the following drugs would be most beneficial?** A. Albuterol. B. Dobutamine. C. Epinephrine. D. Norepinephrine. E. Phenylephrine. **Remedies for nasal stuffiness often contain which one of the following drugs?** A. Albuterol. B. Atropine. C. Epinephrine. D. Norepinephrine. E. Phenylephrine. **Which one of the following drugs, when administered intravenously, can decrease blood flow to the skin, increase blood flow to skeletal muscle, and increase the force and rate of cardiac contraction?** A. Epinephrine. B. Isoproterenol. C. Norepinephrine. D. Phenylephrine. E. Terbutaline. **A 60-year-old immigrant from Latin America was told she had hypertension and should be taking antihypertensive medication. She decides to take an herbal medication from an online "holistic pharmacy." One week after starting the medication, she is found unconscious in her apartment. In the emergency department, her blood pressure is 50/0 mm Hg and heart rate is 40 bpm. Respiration are 20/min; pupils are slightly constricted. Bowel sounds are present. Which of the following would be the most effective cardiovascular stimulant?** A. Amphetamine B. Clonidine C. Isoproterenol D. Norepinephrine E. Tyramine **A group of volunteers are involved in a phase 1 clinical trial of a new autonomic drug. When administered by intravenous bolus, the blood pressure increases. When given orally for 1 week, the blood pressure decreases. Which of the following standard agents does the new drug most resemble?** A. Atropine B. Clonidine C. Phentolamine (an α blocker) D. Phenylephrine E. Propranolol (a β blocker) **Which of the following is correct regarding adrenergic neurotransmission?** A. Epinephrine is the major neurotransmitter released from sympathetic nerve terminals. B. Norepinephrine is mainly released from the adrenal glands. C. Tricyclic antidepressants and cocaine prevent reuptake of norepinephrine into the nerve terminals. D. Monoamine oxidase (MAO) converts dopamine to norepinephrine in the nerve terminal. **All of the following are correct regarding adrenergic receptors, except:** A. α1 Receptors are primarily located on the postsynaptic membrane in the effector organs. B. α2 Receptors are primarily located on the presynaptic sympathetic nerve terminals. C. β1 Receptors are found mainly in the heart. D. β2 Receptors are found mainly in adipose tissue. **A hypertensive patient was accidentally given an α2 agonist instead of an α1 blocker. Which of the following is correct in this situation?** A. α2 Agonists can increase the release of norepinephrine from sympathetic nerve terminals. B. α2 Agonists can reduce blood pressure in this patient. C. α2 Agonists can increase blood pressure in this patient. D. α2 Agonists will not affect blood pressure in this patient. **Which of the following is correct regarding responses mediated by adrenergic receptors?** A. Stimulation of α1 receptors increases blood pressure. B. Stimulation of α1 receptors reduces blood pressure. C. Stimulation of sympathetic presynaptic α2 receptors increases norepinephrine release. D. Stimulation of β2 receptors increases heart rate (tachycardia). E. Stimulation of β2 receptors causes bronchoconstriction. **An asthma patient was given a nonselective β agonist to relieve bronchoconstriction. Which of the following adverse effects would you expect to see in this patient?** A. Bradycardia. B. Tachycardia. C. Hypotension (reduction in blood pressure). D. Worsening bronchoconstriction. **Which of the following adrenergic agonists is most likely to cause CNS side effects when administered systemically?** A. Epinephrine. B. Norepinephrine. C. Isoproterenol. D. Dopamine. E. Ephedrine. **A 12-year-old boy who is allergic to peanuts was brought to the emergency room after accidentally consuming peanuts contained in fast food. He is in anaphylactic shock. Which of the following drugs would be most appropriate to treat this patient?** A. Norepinephrine. B. Phenylephrine. C. Dobutamine. D. Epinephrine. **1. A patient is to receive epinephrine. She has previously received an adrenoceptor-blocking agent. Which of the following effects of epinephrine would be blocked by phentolamine but not by metoprolol?** \(A) Cardiac stimulation \(B) Increase of cAMP (cyclic adenosine monophosphate) in fat \(C) Mydriasis \(D) Relaxation of bronchial smooth muscle \(E) Relaxation of the uterus **2. Clinical studies have shown that adrenoceptor blockers have many useful effects in patients. However, a number of drug toxicities have been documented. Adverse effects that limit the use of adrenoceptor blockers include which one of the following?** \(A) Bronchoconstriction from α-blocking agents \(B) Acute heart failure exacerbation from β blockers \(C) Impaired blood sugar response with α blockers \(D) Increased intraocular pressure with β blockers \(E) Sleep disturbances from α-blocking drugs Questions 3--6. Four new synthetic drugs (designated W, X, Y, and Z) are to be studied for their cardiovascular effects. They are given to 4 anesthetized animals while the heart rate is recorded. The first animal has received no pretreatment (control); the second has received an effective dose of hexamethonium; the third has received an effective dose of atropine; and the fourth has received an effective dose of phenoxybenzamine. The net changes induced by the new drugs (not by the blocking drugs) are described in the following questions. **3. Drug W increased heart rate in the control animal, the atropine-pretreated animal, and the phenoxybenzaminepretreated animal. However, drug W had no effect on heart rate in the hexamethonium-pretreated animal. Drug W is probably a drug similar to** \(A) Acetylcholine \(B) Edrophonium \(C) Isoproterenol \(D) Nicotine \(E) Norepinephrine **4. Drug X had the effects shown in the table below.** Table Description automatically generated with medium confidence **Drug X is probably a drug similar to** \(A) Acetylcholine \(B) Albuterol \(C) Edrophonium \(D) Isoproterenol \(E) Norepinephrine **5. Drug Y had the effects shown in the table below.**  **Drug Y is probably a drug similar to** \(A) Acetylcholine \(B) Edrophonium \(C) Isoproterenol \(D) Norepinephrine \(E) Prazosin **6. The results of the test of drug Z are shown in the graph.** Chart, box and whisker chart Description automatically generated **Drug Z is probably a drug similar to** \(A) Acetylcholine \(B) Edrophonium \(C) Isoproterenol \(D) Norepinephrine \(E) Pralidoxime **7. When given to a patient, phentolamine blocks which one of the following?** \(A) Bradycardia induced by phenylephrine \(B) Bronchodilation induced by epinephrine \(C) Increased cardiac contractile force induced by norepinephrine \(D) Miosis induced by acetylcholine \(E) Vasodilation induced by isoproterenol **8. Your 75-year-old patient with angina and glaucoma is to receive a β-blocking drug. Which of the following statements is most correct regarding β-blocking drugs?** \(A) Esmolol's pharmacokinetics are compatible with chronic topical use \(B) Metoprolol blocks β2 receptors selectively \(C) Nadolol lacks β2-blocking action \(D) Pindolol is a β antagonist with high membrane-stabilizing (local anesthetic) activity \(E) Timolol lacks the local anesthetic effects of propranolol **9. A 56-year-old man has hypertension and an enlarged prostate, which biopsy shows to be benign prostatic hyperplasia. He complains of urinary retention. Which of the following drugs would be the most appropriate initial therapy?** \(A) Albuterol \(B) Atenolol \(C) Metoprolol \(D) Prazosin \(E) Timolol **10. A new drug was administered to an anesthetized animal with the results shown here. A large dose of epinephrine (epi) was administered before and after the new agent for comparison.**  **Which of the following agents does the new drug most closely resemble?** \(A) Atenolol \(B) Atropine \(C) Labetalol \(D) Phenoxybenzamine \(E) Propranolol **A 38-year-old male has recently started monotherapy for mild hypertension. At his most recent office visit, he complains of tiredness and not being able to complete three sets of tennis. Which one of the following drugs is he most likely to be taking for hypertension?** A. Albuterol. B. Atenolol. C. Ephedrine. D. Phentolamine. E. Prazosin. **A 60-year-old asthmatic man comes in for a checkup and complains that he is having some difficulty in "starting to urinate." Physical examination indicates that the man has a blood pressure of 160/100 mm Hg and a slightly enlarged prostate. Which of the following medications would be useful in treating both of these conditions?** A. Doxazosin. B. Labetalol. C. Phentolamine. D. Propranolol. E. Isoproterenol. **A 60-year-old female patient started on a new antihypertensive medication recently. Her blood pressure seems to be under control, but she complains of fatigue, drowsiness, and fainting when she gets up from the bed (orthostatic hypotension). Which of the following drugs is she most likely taking?** A. Metoprolol. B. Propranolol. C. Prazosin. D. Clonidine. **A 30-year-old male patient was brought to the ER with amphetamine overdose. He presented with high blood pressure and arrhythmia. Which of the following is correct regarding this patient?** A. Amphetamine can activate all types of adrenergic receptors. B. β-Blockers are the ideal antidotes for amphetamine poisoning. C. α-Blockers can normalize the blood pressure in this patient. D. Miosis could be a possible symptom of amphetamine poisoning. **A new antihypertensive drug was tested in an animal model of hypertension. The drug when given alone reduces blood pressure in the animal. Norepinephrine when given in the presence of this drug did not cause any significant change in blood pressure or heart rate in the animal. The new drug is similar to which of the following drugs in terms of its pharmacological mechanism of action?** A. Prazosin. B. Clonidine. C. Propranolol. D. Metoprolol. E. Carvedilol. **A β-blocker was prescribed for hypertension in a female asthma patient. After about a week of treatment, the asthma attacks got worse, and the patient was asked to stop taking the β-blocker. Which of the following β-blockers would you suggest as an alternative in this patient that is less likely to worsen her asthma?** A. Propranolol. B. Metoprolol. C. Labetalol. D. Carvedilol. **A 70-year-old male needs to be treated with an α-blocker for overflow incontinence due to his enlarged prostate. Which of the following drugs would you suggest in this patent that will not affect his blood pressure significantly?** A. Prazosin. B. Doxazosin. C. Phentolamine. D. Tamsulosin. E. Terazosin. **A 50-year-old male was brought to the emergency room after being stung by a hornet. The patient was found to be in anaphylactic shock, and the medical team tried to reverse the bronchoconstriction and hypotension using epinephrine. However, the patient did not fully respond to the epinephrine treatment. The patient's wife mentioned that he is taking a prescription medication for his blood pressure, the name of which she does not remember. Which of the following medications is he most likely taking that could have prevented the effects of epinephrine?** A. Doxazosin. B. Propranolol. C. Metoprolol. D. Acebutolol. **Which of the following is correct regarding α-adrenergic blockers?** A. α-Adrenergic blockers are used in the treatment of hypotension in anaphylactic shock. B. α-Adrenergic blockers are used in the treatment of benign prostatic hyperplasia (BPH). C. α-Adrenergic blockers may cause bradycardia. D. α-Adrenergic blockers are used in the treatment of asthma. E. α-Adrenergic blockers reduce the frequency of urination. **Which of the following is correct regarding β-blockers?** A. Treatment with β-blockers should not be stopped abruptly. B. Propranolol is a cardioselective β-blocker. C. β-Blockers may cause orthostatic hypotension. D. Cardioselective β-blockers worsen asthma. E. β-Blockers decrease peripheral resistance by causing vasorelaxation. **Which of the following drugs is commonly used topically in the treatment of glaucoma?** A. Atropine. B. Timolol. C. Tropicamide. D. Scopolamine. **Which of the following is correct regarding carvedilol?** A. Carvedilol is a cardioselective β-blocker. B. Carvedilol is safe for use in asthma patients. C. Carvedilol has α1-blocking activity. D. Carvedilol is contraindicated in the treatment of stable chronic heart failure. **A 30-year-old patient in the intensive care unit is to receive a β-antagonist drug. Typical responses to β-receptor blockade include** \(A) Bradycardia \(B) Increased renin secretion \(C) Increased skeletal muscle tremor \(D) Glycogen synthesis \(E) Lipolysis **A 66-year-old patient is diagnosed with hypertension and angina. A drug with benefits in both conditions is suggested. Which of the following drugs has both nonselective β-blocking and α1-selective blocking action?** \(A) Atenolol \(B) Carvedilol \(C) Nadolol \(D) Pindolol \(E) Timolol **Which is correct regarding the sympathetic nervous system?** A. It generally mediates body functions in "rest-and-digest" mode. B. The neurotransmitter at the sympathetic ganglion is norepinephrine (NE). C. The neurotransmitter at the sympathetic ganglion is acetylcholine (ACh). D. Sympathetic neurons release ACh in the effector organs. **Why does the somatic nervous system enable a faster response compared to the ANS?** A. Somatic motor neurons have ganglia where neurotransmission is mediated by Ach B.. Somatic motor neurons have ganglia where neurotransmission is mediated by NE. C.. Somatic motor neurons are not myelinated. D. Somatic motor neurons are myelinated and do not have ganglia. **Which physiological change occurs when the parasympathetic system is activated?** A. Increase in heart rate B. Inhibition of lacrimation (tears) C. Dilation of the pupil (mydriasis) D. Increase in gastric motility **Which physiological change is expected when the sympathetic system is inhibited using a pharmacological agent?** A. Reduction in heart rate B. Increase in blood pressure C. Decrease in fluid secretions D. Constriction of blood vessels **Which is correct regarding activation of receptors on the effector organs in the ANS?** A. Acetylcholine activates muscarinic receptors. B. Acetylcholine activates adrenergic receptors. C. Epinephrine activates nicotinic receptors. D. Norepinephrine activates muscarinic receptors **Which statement concerning the parasympathetic nervous system is correct?** A. The parasympathetic system often discharges as a single, functional system. B. The parasympathetic division is involved in near vision, movement of food, and urination. C. The postganglionic fibers of the parasympathetic division are long, compared to those of the sympathetic nervous system. D. The parasympathetic system controls the secretion of the adrenal medulla **Which is correct regarding neurotransmitters and neurotransmission?** A. Neurotransmitters are released from the presynaptic nerve terminals. B. Arrival of an action potential in the postsynaptic cell triggers release of neurotransmitter. C. Intracellular calcium levels drop in the neuron before the release of neurotransmitter. D. Serotonin and dopamine are the primary neurotransmitters in the ANS **An elderly man is brought to the emergency room after ingesting a large quantity of prazosin tablets, a drug that blocks α1 adrenergic receptors, which mediate effects of epinephrine and norepinephrine on the blood vessels and urinary bladder. Which symptom is most likely to be seen in this patient?** A. Reduced heart rate (bradycardia) B. Dilation of blood vessels (vasorelaxation) C. Increased blood pressure D. Reduction in urinary frequency **Which statement is correct regarding the autonomic nervous system?** A. Afferent neurons carry impulses from the central nervous system (CNS) to the effector organs. B. Preganglionic neurons of the sympathetic system arise from the cranial nerves, as well as from the sacral region. C. When there is a sudden drop in blood pressure, the baroreceptors send signals to the brain to activate the parasympathetic system. D. The heart receives both sympathetic and parasympathetic innervation. **Which is correct regarding membrane receptors and signal transduction?** A. ANS neurotransmitters bind to membrane receptors on the effector cells, which leads to intracellular events. B. Cholinergic muscarinic receptors are ionotropic receptors.C. Cholinergic nicotinic receptors are metabotropic receptors. D Metabotropic receptors activate ion channels directly **Botulinum toxin blocks the release of acetylcholine from cholinergic nerve terminals. Which is a possible effect of botulinum toxin?** A. Skeletal muscle paralysis B. Improvement of myasthenia gravis symptoms C. Increased salivation D. Reduced heart rate **A patient develops urinary retention after an abdominal surgery. Urinary obstruction was ruled out in this patient. Which strategy would be helpful in promoting urination?** A. Activating nicotinic receptors B. Inhibiting the release of acetylcholine C. Inhibiting cholinesterase enzyme D. Blocking muscarinic receptors **Which of the following drugs could theoretically improve asthma symptoms?** A. Bethanechol B. Pilocarpine C. Pyridostigmine D. Atropine **If an ophthalmologist wants to dilate the pupils for an eye examination, which drug/class of drugs is theoretically useful?** A. Muscarinic receptor activator (agonist) B. Muscarinic receptor inhibitor (antagonist) C. Pilocarpine D. Neostigmine **In Alzheimer disease, there is a deficiency of cholinergic neuronal function in the brain. Theoretically, which strategy is useful in treating symptoms of Alzheimer disease?** A. Inhibiting cholinergic receptors in the brain B. Inhibiting the release of acetylcholine in the brain C. Inhibiting the acetylcholinesterase enzyme in the brain D. Activating the acetylcholinesterase enzyme in the brain **An elderly female who lives in a farmhouse was brought to the emergency room in serious condition after ingesting a liquid from an unlabeled bottle found near her bed, apparently in a suicide attempt. She presented with diarrhea, frequent urination, convulsions, breathing difficulties, constricted pupils (miosis), and excessive salivation. Which of the following is correct regarding this patient?** A. She most likely consumed an organophosphate pesticide. B. The symptoms are consistent with sympathetic activation. C. Her symptoms can be treated using an anticholinesterase agent. D. Her symptoms can be treated using a cholinergic agonist. **A patient who received a nondepolarizing neuromuscular blocker (NMB) for skeletal muscle relaxation during surgery is experiencing mild skeletal muscle paralysis after the surgery. Which drug could reverse this effect of NMBs?** A. Pilocarpine B. Bethanechol C. Neostigmine D. Atropine **A 60-year-old female who had a cancerous growth in the neck region underwent radiation therapy. Her salivary secretion was reduced due to radiation and she suffers from dry mouth (xerostomia). Which drug would be most useful in treating xerostomia in this patient?** A. Acetylcholine B. Pilocarpine C. Echothiophate D. Atropine **A 40-year-old male presents to his family physician with drooping eyelids, difficulty chewing and swallowing, and muscle fatigue even on mild exertion. Which agent could be used to diagnose myasthenia gravis in this patient?** A. Atropine B. Edrophonium C. Pralidoxime D. Echothiophate **Atropa belladonna is a plant that contains atropine (a muscarinic antagonist). Which of the following drugs or classes of drugs will be most useful in treating poisoning with belladonna?** A. Malathion B. Physostigmine C. Muscarinic antagonists D. Nicotinic antagonists **During an ophthalmic surgical procedure, the surgeon wanted to constrict the pupil using a miotic drug. However, he accidentally used another drug that caused dilation of the pupil (mydriasis). Which drug was most likely used?** A. Acetylcholine B. Pilocarpine C. Tropicamide D. Bethanechol **Sarin is a nerve gas that is an organophosphate cholinesterase inhibitor. Which agent could be used as an antidote to sarin poisoning?** A. Pilocarpine B. Carbachol C. Atropine D. Physostigmine **A patient with Alzheimer disease needs treatment for overactive bladder (OAB). Which drug is the best choice for this patient?** A. Darifenacin B. Solifenacin C. Tolterodine D. Trospium **A patient with asthma was prescribed a β2 agonist for acute relief of bronchospasm, but did not respond to treatment. Which drug is the most likely next option for this patient?** A. Benztropine B. Ipratropium C. Oxybutynin D. Physostigmine **A 50-year-old male who is noncompliant with medications was recently diagnosed with chronic obstructive pulmonary disease (COPD). His physician would like to prescribe an inhaled anticholinergic that is dosed once or twice daily. Which drug is most appropriate for this patient?** A. Atropine B. Ipratropium C. Tiotropium D. Trospium **Which is the most effective drug for motion sickness for a person planning to go on a cruise?** A. Atropine B. Fesoterodine C. Scopolamine D. Tropicamide **Which is correct regarding ganglion-blocking drugs?** A. Blockade of sympathetic ganglia could result in reduced blood pressure. B. Blockade of parasympathetic ganglia could result in reduced heart rate. C. Nicotine is a nondepolarizing ganglion blocker. D. Atropine is a nondepolarizing ganglion blocker **Which drug is useful in treating sinus bradycardia?** A. Atropine B. Cisatracurium C. Neostigmine D. Succinylcholine **An ICU patient with severe lung injury requires a neuromuscular blocking agent to assist in his ventilator management. He has liver disease and is currently in renal failure. Which neuromuscular blocker is the best choice for this patient?** A. Cisatracurium B. Pancuronium C. Vecuronium D. Rocuronium **Where would you expect to see the first return of function in skeletal muscles following discontinuation of a nondepolarizing neuromuscular blocking agent?** A. Arms B. Diaphragm C. Fingers D. Pupils **Which of the following is correct regarding adrenergic neurotransmission?** A. Norepinephrine is the major neurotransmitter released from sympathetic nerve terminals. B. Norepinephrine is mainly released from the adrenal glands. C. Tricyclic antidepressants and cocaine prevent the release of norepinephrine from the nerve terminals. D. Monoamine oxidase (MAO) converts dopamine to norepinephrine in the nerve terminal **Which of the following adrenergic drugs is used in the treatment of overactive bladder?** A. Epinephrine B. Dobutamine C. Phenylephrine D. Mirabegron **Which of the following classes of adrenergic agents has utility in the management of hypertension?** A. α1 Agonist B. α2 Agonist C. β1 Agonist D. β3 Agonist **An asthma patient was given a nonselective β agonist to relieve bronchoconstriction. Which adverse effect would you expect in this patient?** A. Bradycardia B. Tachycardia C. Hypotension (reduction in blood pressure) D. Worsening bronchoconstriction **22-year-old male is brought to the emergency room with suspected cocaine overdose. Which of the following symptoms is most likely in this patient?** A. Hypertension B. Bronchoconstriction C. Bradycardia D. Miosis (constriction of pupil) **A 12-year-old boy with a peanut allergy is brought to the emergency room after accidental consumption of peanuts. He is in anaphylactic shock. Which of the following drugs is most appropriate to treat this patient?** A. Norepinephrine B. Phenylephrine C. Dobutamine D. Epinephrine **An elderly patient is brought to the emergency room with a blood pressure of 76/60 mm Hg, tachycardia, and low cardiac output. He is diagnosed with acute heart failure. Which of the following drugs is most appropriate to improve his cardiac function?** A. Epinephrine B. Fenoldopam C. Dobutamine D. Isoproterenol **Which of the following adrenergic agonists is commonly present in nasal sprays available over-the-counter (OTC) to treat nasal congestion?** A. Clonidine B. Albuterol C. Oxymetazoline D. Formoterol **A patient who has hypertension and mild asthma attacks bought a herbal remedy for asthma online. He does not take any prescription medications for asthma, but takes a β1 -selective blocker for hypertension. The herbal remedy relieves the asthma attacks, but his blood pressure seems to increase despite the β-blocker therapy. Which of the following drugs is most likely present in the herbal remedy?** A. Phenylephrine B. Norepinephrine C. Ephedrine D. Salmeterol **A 60-year-old patient started a new antihypertensive medication. His blood pressure is well controlled, but he complains of fatigue, drowsiness, and fainting** **when he gets up from the bed (orthostatic hypotension). Which of the following drugs is he most likely taking?** A. Metoprolol B. Propranolol C. Prazosin D. Alfuzosin **A 30-year-old male patient was brought to the ER with amphetamine overdose. He presented with high blood pressure and arrhythmias. Which drug is the most appropriate to treat the cardiovascular symptoms of amphetamine overdose in this patient?** A. Metoprolol B. Prazosin C. Labetalol D. Nebivolol **A β-blocker was prescribed for hypertension in a patient with asthma. After a week of treatment, the asthma attacks got worse, and the patient was asked to stop taking the β-blocker. Which β-blocker would you suggest as an alternative that is less likely to worsen the asthma?** A. Propranolol B. Metoprolol C. Labetalol D. Carvedilol **A 70-year-old male is treated with doxazosin for overflow incontinence due to his enlarged prostate. He complains of dizzy spells while getting up from bed at night. Which drug would you suggest as an alternative that may not cause dizziness?** A. Propranolol B. Phentolamine C. Tamsulosin D. Terazosin **A 50-year-old male was in anaphylactic shock after being stung by a hornet. The medical team tried to reverse the bronchoconstriction and hypotension using epinephrine; however, the patient did not fully respond to the treatment. The patient's wife mentioned that he is taking a prescription medication for blood pressure. Which medication is he most likely taking that contributed to a reduced response to epinephrine?** A. Doxazosin B. Propranolol C. Metoprolol D. Acebutolol **Which of the following drugs has the highest potential to worsen orthostatic hypotension when given together with prazosin?** A. Propranolol B. Atenolol C. Nebivolol D. Labetalol 1. Phenoxybenzamine is not indicated for the treatment of: a. Pheochromocytoma b. ~~Hypertensive crisis secondary to adrenergic agonist or MAO inhibitor overdosage~~ c. Orally for preoperative management of hypertension in case of pheochromocytoma d. For long-term use in case of arterial hypertension 2. Side effects and toxicity of epinephrine comprise the following, except: a. Palpitations, arrhythmias, hypertension b. Anxiety c. Tremor d. Hypoglycemia 05\. Side effects of muscarinic recptors blockade include: a. Diarrhea b. Bradycardia c. Constipation d. Hypotension 07\. Atropine is contraindicated in cases of: a. Severe tachycardia b. Poisoning with anticholinesterases c. Gastrointestinal spasm d. ~~Bronchial asthma~~ 09\. Choose the depolarizing blockers that bind to skeletal muscles nicotinic recpeotrs and cause depolarization (agonists). a. Tubocurarine b. Pancuronium c. Vecuronium d. Succinylcholine 11\. Choose the contraindication for use of beta-blocking agents: a. Arterial hypertension b. ~~Ischemic heart disease~~ c. Prophylaxis of migraine d. Severe bronchial asthma 12\. Side effects of ganglionic blocking agents due to sympathetic blockade include: a. Orthostatic hypotension b. Constipation c. Blurred vision d. ~~Urinary retension~~ 13\. Over-dosage with muscarinic antagonists (e.g. atropine) produce: a. Delirium b. Severe salivation c. Hyperhidrosis d. AV conduction block 15\. The stimulation of beta-2-adrenoreceptors caused the following effects, except: a. ~~Bronchodilation~~ b. Promotes potassium uptake by skeletal muscles c. Activates glucogenolysis d. Activates lipolysis 16\. Choose the wrong answer: a. Isoproterenol lowers peripheral vascular resistance b. Dobutamine has positive inotropic effect similar to dopamine but has less chronotropic effect and causes fewer arrhythmias and less ischemic than dopamine c. Dobutamine is relatively selective beta-1-adrenoceptor agonist drug d. Isoproterenol contracts bronchial and gastrointestinal smooth muscle 17\. Choose the M-muscarinic cholinoceptors antagonist for application in ophthalmology: a. Benztropin b. Ipratropium c. Tropicamide d. Dicyclomine 18\. The alpha-1-adrenoceptors selective blockers are used for the treatment of the following situations, except for: a. Arterial hypertension b. Prostatic hyperplasia c. Raynauds phenomenon d. Hypertensive crises associated with pheochromocytoma 19\. Norepinephrine side effects include the following, except: a. ~~Ischemic damage due to potent vasoconstriction and tissue hypoxia.~~ b. Decreased perfusion of kidneys and extremities with high doses (Limits use in treatment of shock) c. Necrosis due to extravasation at the injection site d. Uterine muscle relaxation 1. **Your 37-year-old patient has been diagnosed with a rare metastatic carcinoid tumor. This neoplasm is releasing serotonin, bradykinin, and several unknown peptides. The effects of serotonin in this patient are most likely to include:** a. Constipation b. Episodes of bronchospasm c. Hypersecretion of gastric acid d. Hypotension e. Urinary retension 2. **A 23-year-old woman is admitted to the emergency department with difficulty breathing. Examination reveals significant laryngeal edema. Past medical history indicates that she suffers from recurrent episodes of angioneurotic edema. Which of the following drugs is the most effective physiologic antagonist of histamine in episodes of angioneurotic edema?** f. Epinephrine g. Fexofenadine h. Promethazine i. Ranitidine j. Tegaserod 3. **A 20-year-old woman is take over-the-counter diphenhydramine for severe hay fever. Which of the following adverse effects is she most likely to report?** k. Muscarinic increase in baldder tone l. Nausea m. Nervousness, anxiety n. Sedation o. Vertigo 4. **A laboratory study of new H2 blockers is planned. Which of the following will result from blockade of H2 receptors?** p. Increased cAMP (cyclic adenosine monophosphate) in cardiac muscle q. Decreased channel opening in enteric nerves r. Decreased cAMP in gastric mucosa s. Increased IP3 (inositol trisphosphate) in platelets t. Increased IP3 in smooth muscle 5. **An obese 40-year-old man (BMI 33) is being seen in the cardio-pulmonary clinic for pulmonary hypertension and a cardiac murmur. He took fenfluramine for several years in an attempt to reduce his weight. The mechanism by which fenfluramine affected appetite is:** u. Activation of 5-HT2 receptors v. Amphetamine-mimetic action w. Anti-opioid/antidepressant action x. Glucagon-like peptide (GLP-1) agonist action y. Intestinal lipase inhibition 6. **You are asked to consult on a series of cases of drug toxicities. Which of the following is a recognized adverse effect of cimetidine?** **Dihydroergotamine:** A. Causes vasodilation. B. Exerts its actions by binding to specific ergotamine receptors. C. Is useful in treating acute migraine headaches. D. Is useful for maintaining uterine muscle tone during pregnancy. E. Has actions similar to those of nitroprusside. **A 43-year-old ship's captain complains of seasonal allergies. Which one of the following would be indicated?** A. Cyclizine. B. Doxepin. C. Doxylamine. D. Hydroxyzine. E. Fexofenadine. **Which one of the following statements concerning H1 antihistamines is correct?** A. Second-generation H1 antihistamines are relatively free of adverse effects. B. Because of the established long-term safety of first-generation H1 antihistamines, they are the first choice for initial therapy. C. The motor coordination involved in driving an automobile is not affected by the use of first generation H1 antihistamines. D. H1 antihistamines can be used in the treatment of acute anaphylaxis. E. Both first- and second-generation H1 antihistamines readily penetrate the blood-brain barrier. **Which one of the following drugs could significantly impair the ability to drive an automobile?** A. Diphenhydramine. B. Ergotamine. C. Fexofenadine. D. Ranitidine. E. Sumatriptan. **Field workers exposed to a plant toxin develop painful fluid-filled blisters. Analysis of the blister fluid reveals high concentrations of a peptide. Which of the following is a peptide that causes increased capillary permeability and edema?** A. Angiotensin II B. Bradykinin C. Captopril D. Histamine E. Losartan 7. **A 40-year-old patient with breast cancer is about to undergo cancer chemotherapy with a highly emetogenic (nausea- and vomiting- causing) drug combination. The antiemetic drug most likely to be included in her regimen is:** z. Bromocriptine a. Cetirizine b. Cimetidine c. Ketanserin d. Ondansetron **The hospital Pharmacy Committee is preparing a formulary for staff use. Which of the following is a correct application of the drug mentioned?** \(A) Alosetron: for obstetric bleeding \(B) Cetirizine: for hay fever \(C) Ergonovine: for Alzheimer's disease \(D) Ondansetron: for acute migraine headache \(E) Ranitidine: for Parkinson's disease 8. **A 43-year-old man with severe depression has been taking a selective serotonin reuptake inhibitor. He has recently experimented with several street drugs. He is now admitted to the emergency department with marked hyperthermia, tachycardia, and coma. What therapy should be initiated immediately for his serotonin syndrome?** e. Cyprohepatadine f. Dantrolene g. Diphenhydramine h. Lasmiditan i. Ranitidine 9. **A 26-year-old woman presents with amenorrhea and galactorrhea. Her prolactin level is markedly elevated (200 ng/mL vs normal 20 ng/mL). which of the following is most useful in the treatment of hyperprolactinemia?** j. Bromocriptine k. Cimetidine l. Ergotamine m. Ketanserin n. LSD o. Ondansetron p. Sumatriptan 10. **A 28-year-old office worker suffers from intense migrane headaches. Which of the following Is a serotonin 5-HT~1D/1B~ agonist useful for aborting an acute migraine headache?** q. Bromocriptine r. Cimetidine s. Ephredrine t. Ketanserin u. Loratadine v. Ondansetron w. Sumatriptan 11. **A 33-year-old woman attempted to induce an abortion using ergotamine. She is admitted to the emergency department with severe pain in both legs. On examination, her legs are cold and pale with absent arterial pulses. Which of the following is the most useful antidote for reversing severe ergot-induced vasospasm?** x. Bromocriptine y. Cimetidine z. Epinephrine a. Ketanserin b. Lorcaserin c. Nitroprusside d. Sumatriptan e. Ondansetron 12. **A 35-year-old woman with moderately severe arthritis has been treated with nonsteroidal anti-inflammatory drugs for 6 months. Her arthritis symptoms have been well controlled. She now complains of heartburn and indigestion. You give her a prescription for a drug to be taken along with the anti-inflammatory agent, but 2 days later she calls the office complaining that your last prescription has caused severe diarrhea and cramping that resembles her periods. Which of the following is most likely to be associated with increased gastrointestinal motility and uterine cramping?** a. Aspirin b. Famotidine c. Leukotriene LTB4 d. Misoprostol e. Zileuton **You have been treating a 50-year-old woman with moderately severe arthritis with nonsteroidal anti-inflammatory drugs for 6 months. She now complains of heartburn and indigestion. You give her a prescription for a drug to be taken along with the anti-inflammatory agent, but 2 days later she calls the office complaining that your last prescription has caused severe diarrhea. Which of the following is most likely to be associated with increased gastrointestinal motility and diarrhea?** A. Aspirin B. Corticosteroids C. Leukotriene LTB4 D. Misoprostol E. Zileuton 13. **Which mechanism explains aspirin\'s inhibition of thromboxane synthesis?** f. Blocks cyclooxygenase g. Blocks lipoxygenase h. Blocks phospholipasc A2 i. Blocks PGE1 receptors j. Blocks PGl2 receptors **1.** **You have been treating a 50-year-old woman with moderately severe arthritis with nonsteroidal anti-inflammatory drugs for 6 months. She now complains of heartburn and indigestion. You give her a prescription for a drug to be taken along with the anti-inflammatory agent, but 2 days later she calls the office complaining that your last prescription has caused severe diarrhea. Which of the following is most likely to be associated with increased gastrointestinal motility and diarrhea?** \(A) Aspirin \(B) Corticosteroids \(C) Leukotriene LTB4 \(D) Misoprostol \(E) Zileuton **2. Which of the following drugs inhibits thromboxane synthesis much more effectively than prostacyclin synthesis?** \(A) Aspirin \(B) Hydrocortisone \(C) Ibuprofen \(D) Indomethacin \(E) Zileuton 14. **A 57-year-old man has severe pulmonary hypertension and right ventricular hypertrophy. Which of the following agents causes vasodilation and may be useful in pulmonary hypertension?** k. Acetylcholine l. Bradykinin m. Prostaglandin PGFza n. Prostacyclin o. Thromboxane 15. **A 19-year-old woman complains of severe dysmenorrhea. A uterine stimulant derived from membrane lipid in the endometrium is** p. Angiotensin II q. Oxytocin r. Prostacyclin (PGI2) s. Prostaglandin PGE2 t. Serotonin 16. **Inflammation is a complex tissue reaction that includes the release of cytokines, leukotrienes, prostaglandins, and peptides. Leukotrienes involved in inflammatory processes are typically produced from arachidonic acid by which of the following enzymes?** u. Cyclooxygenase-I v. Cyclooxygenase-2 w. Glutathione-S-transferase x. Lipoxygenase y. Phospholipase A2 17. **Inflammation is a complex tissue reaction that includes the release of cytokines, leukotrienes, prostaglandins, and peptides. Prostaglandins involved in inflammatory processes are typically produced from arachidonic acid by which of the following enzymes?** 18. **A newborn infant is diagnosed with transposition of the great vessels, wherein the aorta exits from the right ventricle and the pulmonary artery from the left ventricle. Which of the following drugs is likely to be used in preparation for surgical correction of this anomaly?** z. Aspirin a. Leukotriene LTC4 b. Prednisone c. Prostaglandin PGE1 d. Prostaglandin PGF2α 19. **A patient with a positive fecal blood test is referred to the gastroenterology clinic. He is apparently taking large amounts of an unidentified drug that inhibits platelet activity. Which of the following is taken orally and directly and reversibly inhibits platelet cyclooxygenase?** e. Alprostadil f. Aspirin g. Ibuprofen h. Leukotriene LTC4 i. Misoprostol j. Prednisone k. Prostacyclin l. Zafirlukast m. Zileuton **A patient with a bleeding tendency presents in the hematology clinic. He is apparently taking large amounts of an unidentified drug that inhibits platelet activity. Which of the following directly and reversibly inhibits platelet cyclooxygenase?** \(A) Alprostadil \(B) Aspirin \(C) Ibuprofen \(D) Leukotriene LTC4 \(E) Misoprostol \(F) Prednisone \(G) Prostacyclin \(H) Zafirlukast \(I) Zileuton 20. **Which of the following is a component of slow-reacting substance of anaphylaxis (SRS-A)?** n. Alprostadil o. Aspirin p. Leukotriene LTB4 q. Leukotriene LTC4 r. Misoprostol s. Prednisone t. Prostacyclin u. Zafirlukast v. Zileuton 21. **A 17-year-old patient complains that he develops wheezing and severe shortness of breath whenever he takes aspirin for headache. Increased levels of which of the following may be responsible, in part, for some cases of aspirin hypersensitivity?** w. Alprostadil x. Hydrocortisone y. Ibuprofen z. Leukotriene LTC4 a. Misoprostol b. PGE2 c. Prostacyclin d. Thromboxane e. Zileuton **Which of the following is a leukotriene receptor blocker?** \(A) Alprostadil \(B) Aspirin \(C) Ibuprofen \(D) Leukotriene LTC4 \(E) Misoprostol \(F) Prednisone \(G) Prostacyclin \(H) Zafirlukast \(I) Zileuton **In which one of the following conditions would aspirin be contraindicated?** A. Myalgia. B. Fever. C. Peptic ulcer. D. Rheumatoid arthritis. E. Unstable angina. **Which one of the following statements concerning COX2 inhibitors is correct?** A. The COX-2 inhibitors show greater analgesic activity than traditional NSAIDs. B. The COX-2 inhibitors decrease platelet function. C. The COX-2 inhibitors do not affect the kidney. D. The COX-2 inhibitors show anti-inflammatory activity similar to that of the traditional NSAIDs. E. The COX-2 inhibitors are cardio protective. **An 8-year-old girl has a fever and muscle aches from a presumptive viral infection. Which one of the following drugs would be most appropriate to treat her symptoms?** A. Acetaminophen. B. Aspirin. C. Celecoxib. D. Codeine. E. Indomethacin. **A 70-year-old man has a history of ulcer disease. He has recently experienced swelling and pain in the joints of his hands. His physician wants to begin therapy with an NSAID. Which one of the following drugs might also be pres