appleton pharmacology Flashcards by Aidyl XXX

Q

Zafirlukast (Accolate) is a drug that can best
be classified as a (an)
(A) leukocyte stimulant
(B) carbonic anhydrase inhibitor
(C) monoamine oxidase inhibitor
(D) angiotensin-converting enzyme inhibitor
(E) Leukotriene formation inhibitor

A

(E) Zafirlukast (Accolate), zileuton (Zyflo),
and montelukast sodium (Singulair) are examples of leukotriene receptor antagonists.
Leukotriene production in the body has been
associated with the development of asthma
symptoms such as airway edema. By interfering with leukotriene receptors, these drugs
can be used for prophylaxis and long-term
treatment of asthma. They are not useful for
the treatment of acute asthmatic attacks. (3)

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Q

Which of the following is (are) true of milrinone lactate (Primacor)?
I. may be administered orally or parenterally
II. produces a positive inotropic action
III. produces vasodilation
(A) I only
(B) III only
(C) I and II only
(D) II and III
(E) I, II, and III

A

(D) Milrinone lactate (Primacor) and amrinone
lactate (Inocor) are classified as
inotropic agents. They are used only parenterally
for the short-term treatment of congestive
heart failure (CHF). They produce a
positive inotropic effect (ie, they increase the
force of cardiac contraction) and they produce
vasodilation. (3)

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Q

Which of the following is (are) true of finas teride (Proscar, Propecia)?
I. pregnancy category X
II. employed in the treatment of BPH
III. used in alopecia treatment
(A) I only (D) II and III only
(B) III only (E) I, II, and III
(C) I and II only
(D) II and III only
(E) I, II, and III

A

(E) Finasteride (Proscar, Propecia) is an agent
that is administered orally for the treatment
of benign prostatic hyperplasia (BPH). It is
also used in the treatment of alopecia (hair
loss) in men, particularly in male patients
who have male-pattern hair loss. Finasteride
acts to inhibit the formation of 5a-dihydrotestosterone, a potent androgen. It is
classified as a pregnancy category X drug.
Women who are or may become pregnant
should avoid contact with crushed finasteride tablets and with semen from patients
using the drug. (3)

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Q

Latanoprost (Xalatan) can best be described as an
(A) leukocyte stimulant
(B) carbonic anhydrase inhibitor
(D) prodrug
(C) monoamine oxidase inhibitor
(E) prostaglandin agonist

A

(E) Latanoprost (Xalatan) is a prostaglandin
F2a analog that is used as an ophthalmic solution
to reduce intraocular pressure by increasing
the outflow of aqueous humor from
the eye. Altered pigmentation of the iris may occur in 7 to 22% of patients using the drug
over a 3- to 12-month period. The drug may
be used in combination with other glaucoma
drugs. (5:1475)

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Q

Which of the following is (are) true of ticlopidine?

I. inhibit platelet aggregation
ii. dissolves blood clots
iii. only administered pareterally
(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

A

(A) Ticlopidine (Ticlid) is an inhibitor of
platelet aggregation that is administered
orally, with food, in doses of 250 mg twice
daily. Patients using this drug should have a
complete blood count (CBC) with differential
performed every two weeks for three months
to detect neutropenia (decreased number of
white blood cells). The drug’s antiplatelet effects are not maximal until at least 8 to 11
days of therapy have been completed. (5:3

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Q

Nicardipine (Cardene) is indicated for the
only treatment of

I. angina pectoris
II. hypertension
III. ventricular tachycardia

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

A

(C) Nicardipine (Cardene) is a calcium channel-
blocking agent employed in the treatment
of angina pectoris and hypertension. It is also
indicated for the treatment of congestive
heart failure. (3)

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Q

Alteplase (Activase) is an example of a tissue plasminogen activator. Which of the following describes the characteristics of this drug?

I. administered orally
II. stimulates erythrocyte production
III. produced by recombinant DNA technology

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

A

(B) Alteplase (Activase) and reteplase (Retavase)
are tissue plasminogen activators prepared
by recombinant DNA technology. They
are administered intravenously in order to
lyse thrombi in patients with acute myocardial
infarction. (3)

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Q

Which of the following is a gold compound?

I. aurothioglucose (Solganal)
II. goserelin acetate (Zoladex)
III. ergonovine

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

A

(A) Gold compounds such as aurothioglucose
(Solganal), auranofin (Ridaura), and gold
sodium thiomalate (Myochrysine) are used to
suppress or prevent, but not cure, arthritis
and synovitis. Aurothioglucose and gold
sodium thiomalate are administered intramuscularly
while auranofin is only administered
orally. All gold compounds may cause
serious adverse effects, including dermatitis,
renal damage, and blood dyscrasias. (5:1436)

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Q

As an antiarrhythmic drug, tocainide is most
similar in action to which one of the following agents?

(A) amiodarone
(B) propranolol
(C) digoxin
(D) verapamil
(E) mexiletine

A

(E) Tocainide (Tonocard) is most similar to
mexiletine (Mexitil). Both are classified as
Group IB antiarrhythmic drugs. These are
agents that slightly depress phase a and may
shorten the duration of the action potential.
(3)

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Q

Which of the following antiarrhythmic agents is (are) associated with an adverse effect
known as cinchonism?

(A) acebutolol
(B) moricizine
(C) quinidine
(D) lidocaine
(E) disopyramide

A

(C) Quinidine is an antiarrhythmic agent
that derived from the bark of the cinchona
tree. As does quinine, quinidine may cause
an array of adverse effects collectively referred
to as cinchonism. (3)

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Q

Which of the following are employed as intranasal steroids?

I. budesonide (Rhinocort)
I. administered orally II. fluticasone propionate (Flonase)
II. stimulates erythrocyte production III. nedocromil (Tilade)

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

A

(C) Budesonide (Rhinocort) and fluticasone
propionate (Flonase) are corticosteroids that
are employed clinically for the treatment of
seasonal and perennial allergic rhinitis. Nedocromil
(Tilade) is an inhalational product
that is used for maintenance therapy in the
management of bronchial asthma. (3)

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Q

Which of the following agents is (are) used as
anorexiants?

I. sibutramine (Meridia)
II. mazindol (Sanorex, Mazanor)
III. benzphetamine (Didrex)

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

A

(E) Sibutramine (Meridia), mazindol (Sanorex,
Mazanor), and benzphetamine (Didrex)
are central nervous system stimulants used
as anorexiants, ie, they are used to reduce appetite.
(3)

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Q

Colestipol HCl (Colestid) can best be classified as a (an) similar in action to which one of the following agents?
(B) vasopressor
(A) amiodarone (C) potassium-sparing diuretic
(B) propranolol (D) ACE inhibitor
(C) digoxin (E) bile acid sequestrant

A

(E) Colestipol (Colestid) is an anion exchange
resin that binds bile acids in the intestine,
causing them to be removed in the feces.
This causes further breakdown of cholesterol
to bile acids, as well as a decrease in lowdensity
lipoproteins (LDL) and serum cholesterollevels.
(5:361)

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Q

Which of the following is (are) true of simvastatin (Zocor)?

I. HMG-CoA reductase inhibitor
II. pregnancy category X
III. antiviral
(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

A

(C) Simvastatin (Zocor) is an HMG-CoA reductase
inhibitor. It is employed as an adjunct
to diet in treating hypercholesterolemia.
It is classified in pregnancy category X. (3)

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Q

Benzodiazepines appear to act as anxiolytics
by altering the sodium ion influx into the
CNS

(A) Altering the sodium ion influx into the CNS
(B) potentiating the effects of GABA
(C) altering the calcium ion influx into the
drug-induced bronchospasm is
CNS (A) cromolyn
(D) interfering with the amine pump
(E) inhibiting the action of monoamine oxidase

A

(B) Benzodiazepines are believed to act by
potentiating the effects of gamma-aminobutyric
acid (GABA), an inhibitory amino acid.
(3)

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Q

Which of the following is a COMT inhibitor?

(A) selegiline
(B) carbidopa
(C) disulfiram
(D) tolcapone
(E) pramipexole

A

(D) Tolcapone (Tasmar) is a COMT inhibitor
used in the treatment of Parkinson’s disease.
Its use has been associated with the potential
for the development of hepatic failure. It
should, therefore, not be used in patients who have any evidence of liver disease. Baseline
liver enzyme studies should be performed
before therapy is begun and at twoweek
intervals during the first year of therapy.
Such studies should be continued every
four weeks during the 12 to 18 months of
therapy and every eight weeks thereafter. (3)

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Q

Trifluridine is useful in the treatment of epithelial keratitis caused by

(A) herpes simplex
(B) Pseudomonas aeruginosa
(C) Staphylococcus aureus
(D) Clostridium difficile
(E) Escherichia coli

A

(A) Epithelial keratitis is an ophthalmic disorder
caused by the action of herpes simplex
virus. Trifluridine (Viroptic) blocks herpes
simplex virus reproduction and thereby
helps to control this condition. (3)

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Q

Which of the following is (are) employed as
an antifungal agent?
I. cycloserine
II. mafenide (A) I only
III. terbinafine (B) III only
(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

A

(B) Terbinafine (Lamisil) is an antifungal
agent used in treating onychomycosis of the
fingernail or toenail caused by dermatophytes.
Mafenide is for the treatment of
burns and cycloserine is an antitubercular
drug. (3)

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Q

Which of the following is (are) true of iso-
I. for the treatment of acute asthma attacks
tretinoin (Accutane)?

I. in pregnancy category X
II. indicated for the treatment of psoriasis
III. useful for treatment of alopecia
(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I,II and III

A

(A) Isotretinoin (Accutane) is a vitamin A
derivative that appears to be useful in the
treatment of acne because of its ability to
reduce the secretion of sebum. It is classified
in pregnancy category X. Female patients
should be advised to use an effective contraceptive
technique for at least one month prior
to starting isotretinoin and for at least one
month after discontinuing it. Such patients
must also have had a negative serum pregnancy
test within two weeks of starting the
drug. (5:1495)

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Q

An agent that would be most likely to cause
drug-induced bronchospasm is
(A) cromolyn
(B) benazepril
(C) isoproterenol
(D) fluvastatin
(E) sotalol

A

(E) Sotalol (Betapace) is a nonselective betaadrenergic
blocking agent. Such drugs
should be avoided in patients with bronchospastic
disorders because they may cause
bronchoconstriction. (3)

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Q

Which of the following is (are) true of dobutamine (Dobutrex)?
I. antidepressant
II. only administered parenterally
III. beta1 agonist

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

A

(D) Dobutamine (Dobutrex) is a parenterally
administered agent that is chemically related
to dopamine. It acts by stimulating primarily
beta1-adrenergic receptors to produce an inotropic
effect. It is commonly employed in
the treatment of shock syndrome. Unlike
dopamine, dobutamine does not cause the
endogenous release of norepinephrine. (5:398)

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Q

Which of the following is (are) dopaminergic
antiparkinson agents?

I. ropinirole (Requip)
II. pergolide (Permax)
III. procyclidine (Kemadrin)

(A) I only
(C) I and II only
(D) II and III only
(B) III only
(E) I, II, and III

A

(C) Ropinirole (Requip) and pergolide (Permax)
are dopaminergic agents that enhance
dopamine activity and provide palliative
treatment of Parkinson’s disease. Procyclidine
is an anticholinergic drug used to treat
Parkinson’s disease. (3)

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Q

Which of the following is (are) true of salmeterol (Serevent)?

I. for the treatment of acute asthma attacks
II. available in an aerosol and inhalation
powder form
III. beta2 agonist

(A) I only
(B) III only
(C) I and II only
(D) II and III
(E) I, II and III

A

(D) Salmeterol (Serevent) is an agonist acting
primarily on beta2-adrenergic receptors to
produce bronchodilation. It is the longestacting
sympathomimetic bronchodilating
agent with a duration of approximately 12
hours. It is available as an aerosol (Serevent)
and as a powder for inhalation (Serevent
Diskus). Because of its rather slow onset of
action it is used only for maintenance and
prophylaxis. It is not used for treating acute
asthma attacks. (3)

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Q

Which of the following drugs is (are) H1-histamine receptor antagonists?
I. diphenhydramine
II. hydroxyzine
III. famotidine
(A) I only
(B) III only
(C) I and II only
(D) II and III
(E) I, II, and III

A

(C) Diphenhydramine and hydroxyzine are
HI-receptor antagonists. They antagonize actions
of histamine such as vasodilation.
Famotidine is an H2-receptor antagonist that
is used to reduce gastric acid secretion. (3)

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25. Which of the following is (are) considered to be prokinetic agents? I. lansoprazole II. diphenoxylate cillin disodium III. metoclopramide (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and II

25. (B) Metoclopramide (Reglan) is a prokinetic agent that increases the motility of the upper GI tract without increasing the production of secretions. It appears to act by increasing the sensitivity of GI tissues to the action of acetylcholine. (5:593)

26. Effects expected as a result of inhaling the smoke of cannabis I. decreased pulse rate II. perceptual changes III. vascular congestion of the eye (A) I only (B) III only (C) I and II (D) II and III only (E) I, II, and III

26. (D) Inhalation of the smoke of cannabis generally results in increased pulse rate, perceptual changes, and vascular congestion of the eye. (3)

27. Of the following glucocorticoids, which one has the greatest anti-inflammatory potency when administered systemically? (A) hydrocortisone (Corte£) (B) prednisone (Meticorten) (C) triamcinolone (Aristocort) D) betamethasone (Celestone) (E) cortisone (Cortone)

27. (D) Betamethasone is about 25 times as potent as hydrocortisone, 5 to 6 times as potent as prednisone, 4 to 6 times as potent as triamcinolone, and about 30 times as potent as cortisone. (3)

28. Benzoyl peroxide is commonly employed in the treatment of (A) psoriasis (B) pinworms (C) seborrheic dermatitis (D) trichomonal infections (E) acne

28. (E) Benzoyl peroxide is an oxidizing agent found in many aTe products that are used in the treatment of acne. It is believed to exert an antibacterial effect, thereby reducing the level of Propionibacterium acnes on the skin surface. (3)

29. Timentin is a product that contains ticarcillin disodium and clavulanate potassium. Clavulanate potassium (A) inhibits beta-Iactamase enzymes (B) prevents the urinary excretion of ticarcillin disodium C) prevents first-pass metabolism of ticarcillin disodium (D) is a buffer (E) is an antifungal agent

29. (A) Clavulanate potassium is an agent capable of inactivating beta-lactamase enzymes that are often found in microorganisms resistant to penicillins. The addition of clavulanate potassium to ticarcillin disodium extends the spectrum of antimicrobial coverage of this penicillin to include beta-lactamaseproducing organisms. (3)

30. Which of the following hormones is released from the posterior pituitary gland? I. growth hormone II. follicle-stimulating hormone (FSH) III. oxytocin (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

30. (B) Oxytocin is an endogenous hormone produced by the posterior pituitary gland. It is a uterine stimulant that promotes uterine contractions, particularly during labor. The other hormones listed are released by the anterior pituitary gland. (3)

31. During ovulation, peak plasma concentration(s) of which of the following hormone(s) will be reached? I. luteinizing hormone (LH) II. follicle-stimulating hormone (FSH) III. progesterone when administered systemically? (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

31. (C) During the menstrual cycle, levels of follicle- stimulating hormone (FSH) and luteinizing hormone (LH) vary widely. At the time of ovulation, the concentration of each of these hormones reaches a peak, coinciding with the release of the ovum and the complete development of a mature endometrial wall. (3)

32. Liotrix is a thyroid preparation that contains I. desiccated thyroid II. levothyroxine sodium III. liothyronine sodium (A) I only (B) III only (C) I and II (D) II and III only (E) I, II, and III

32. (D) Liotrix consists of a uniform mixture of synthetic levothyroxine sodium (T4) and liothyronine sodium (T3) in a ratio of 4:1 by weight. It is used in products such as Euthroid and Thyrolar as a thyroid hormone supplement. (5:1258)

33. Propylthiouracil is used for the same therapeutic indication as (A) methoxsalen (B) danazol (C) azathioprine aminopenicillins? (D) omeprazole (E) methimazole

33. (E) Propylthiouracil and methimazole (Tapazole) are antithyroid agents that inhibit synthesis of thyroid hormone and thus are useful in the treatment of hyperthyroidism. (3)

34. Most antipsychotic drugs can be said to have which of the following actions? (A) cholinergic (B) dopaminergic (C) COMT inhibition (D) dopamine inhibition (E) alpha1-adrenergic agonist

34. (D) Most antipsychotic agents are believed to act by antagonizing dopamine receptors. They may also cause some blockade of cholinergic, alphaI-adrenergic, and histamine receptors. (3)

35. Which of the following agents is (are) indicated for the treatment of convulsive disorders I. clonidine II. tiagabine III. topiramate (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

35. (D) Tiagabine (Gabitril) and topiramate (Topamax) are anticonvulsants utilized for the treatment of partial seizures. (3)

36. Which of the following antianxiety agents causes the least sedation? (A) diazepam (Valium) (B) buspirone (BuSpar) (C) chlordiazepoxide (Librium) (D) meprobamate (E) oxazepam (Serax)

36. (B) Buspirone (BuSpar) is an antianxiety agent that, unlike the benzodiazepines, barbiturates, and carbamates, does not produce significant sedative, muscle relaxant, or anticonvulsant effects. (3)

37. Which of the following drugs is (are) classified as protease inhibitors? I. cidofovir II. acyclovir III. nelfinavir (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

37. (B) Nelfinavir (Viracept) is the only protease inhibitor. Cidofovir is an inhibitor of DNA polymerase that is used for the treatment of CMV retinitis. Acyclovir (Zovirax) also acts by interfering with DNA polymerase and is used for the treatment of herpes simplex and herpes zoster infections. (3)

38. Which of the following is (are) classified as aminopenicillins? I. bacampicillin II. amoxicillin III. ampicillin (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

38. (E) All of these are aminopenicillins. They are easily recognized by the " ... am ..." in their name. (3)

39. Which of the following antimicrobial products is (are) prodrugs? I. cefpodoxime proxetil II. dirithromycin III. clindamycin (A) I only III. topiramate (B) III only (C) I and II only (D) II and III only (E) I, II, and III

39. (C) Cefpodoxime proxetil (Vantin) and dirithromycin (Dynabac) are prodrugs, ie, they are pharmacologically inactive until they are enzymatically converted to their active forms in the body. (3)

40. Which one of the following agents can be administered with ampicillin and other penicillins to achieve higher blood levels of the causes the least sedation? penicillin? (A) clavulanic acid (B) penicillamine (Cuprimine) (C) probenecid (Benemid) (D) colchicine (E) sulbactam

40. (C) Probenecid is a uricosuric and renal tubular blocking agent. It is capable of inhibiting the tubular secretion of penicillins and cephalosporins, thereby increasing the plasma levels of these drugs and prolonging their action in the body. (3)

41. Three hundred milligrams of phenoxymethyl penicillin is equivalent to approximately how many units of penicillin activity? (A) 480,000 (B) 300,000 (C) 1600 (D) 270,000 (E) 960,000

41. (A) The strength of phenoxymethyl penicillin is usually measured in milligrams or units. Each milligram of the pure drug is equivalent to 1600 units of activity. Thus, 300 mg of phenoxymethyl penicillin is approximately equivalent to 480,000 units of activity. (3)

42. Which one of the following agents is most similar in action to cloxacillin? (A) amoxicillin (Amoxil) (B) bacampicillin (Spectrobid) (C) penicillin V potassium (Pen Vee K) (D) nafcillin (Unipen,

42. (D) Nafcillin and cloxacillin are both betalactamase- resistant penicillins. They are employed primarily in treating infections caused by beta-lactamase-producing staphylococci. (3)

43. Which of the following agents is (are) classi- fied as antiseptics or germicides? I. chlorhexidine gluconate (Hibiclens) II. glutaraldehyde (Cidex) by competitively inhibiting the action of III. benzalkonium chloride (Zephiran) (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

43. (E) Chlorhexidine gluconate (Hibiclens, Betasept), glutaraldehyde (Cidex), and benzalkonium chloride (Zephiran) are antiseptic agents used either as surgical scrubs or for the disinfection of surgical and dental equipment. (3)

44. Diflunisal (Dolobid) is most likely to be used commonly in the treatment of (A) Wilson's disease (B) rheumatoid arthritis (C) cysteinuria (D) psoriasis (E) Hansen's disease

44. (B) Diflunisal (Dolobid) is a salicylate that is employed in the treatment of mild to moderate pain, rheumatoid arthritis, and osteoarthritis. (5:1452)

45. Which of the products listed below are vaccines? I. Sandimmune II. Prograf (D) alpha-adrenergic agonist III. LYMErix (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

45. (B) LYMErix is a vaccine that is used to prevent Lyme disease, a tick-borne infection. Cyclosporine (Sandimmune) and tacrolimus (Prograf) are immunosuppressive agents employed in preventing rejection of transplanted organs. (3)

46. Sumatriptan (Imitrex) is most commonly employed in the treatment of (A) partial seizures (B) arthritic pain (C) arrhythmias (D) psoriasis (E) migraine headaches

46. (E) Sumatriptan (Imitrex) and other "triptans" such as naratriptan (Amerge), rizatriptan (Maxalt), and zolmitriptan (Zomig) are primarily used for the treatment of migraine headaches. (3)

47. Which of the following morphine derivatives is most likely to cause dependence? (A) diacetylmorphine (B) ethylmorphine (C) methylmorphine (D) hydrocodone (E) oxycodone

47. (A) Diacetylmorphine is another name for heroin. Because of its great ability to cause dependence, diacetylmorphine may not be legally prescribed in the United States. (3)

48. Sulfonamides exert their antimicrobial effect by competitively inhibiting the action of (A) monoamine oxidase (B) p-aminobenzoic acid (C) pyrimidine (D) beta lactamase (E) DNA polymerase

48. (B) Sulfonamides exert their antimicrobial action by competitively antagonizing paminobenzoic acid (PABA). Sulfonamide resistance may occur if an organism produces excessive amounts of PABA or if PABAcontaining products are used concurrently with a sulfonamide drug. (3)

49. Sulfones such as dapsone are employed commonly in the treatment of (A) Wilson's disease (B) psoriasis (C) urinary incontinence (D) atrial flutter (E) leprosy

49. (E) Dapsone is a sulfone that is bactericidal and bacteriostatic against Mycobacterium leprae, the organism believed to be the cause of leprosy (Hansen's disease). (3)

50. Clonidine may best be described as a (an) (A) alpha-adrenergic blocker (B) beta-adrenergic blocker (C) MAO inhibitor (D) alpha-adrenergic agonist (E) beta-adrenergic agonist

50. (0) Clonidine is a central alpha-adrenergic stimulant. Its primary action is to stimulate alpha-adrenergic receptors to reduce sympathetic outflow from the CNS, thereby reducing peripheral vascular resistance and reducing heart rate and blood pressure. (3)

51. Minoxidil is an antihypertensive agent that works by (A) potentiating GABA activity (B) directly dilating peripheral blood vessels (C) blocking alpha-adrenergic receptors (D) inhibiting COMT (E) blocking beta-adrenergic receptors

51. (B) Minoxidil is a direct-acting peripheral vasodilator. Because of its potential for producing a number of serious adverse effects, minoxidil is not a first-choice antihypertensive agent. Its ability to produce excess hair growth (hirsutism, hypertrichosis) has led to its topical use for the treatment of alopecia as the product Rogaine. (5:142-3)

52. Agent(s) indicated for the treatment of de pression include(s) I. bupropion (Wellbutrin) II. venlafaxine (Effexor) III. citalopram (Celexa) (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

52. (E) Bupropion (Wellbutrin), venlafaxine (Effexor), and citalopram (Celexa) are each antidepressants. (3)

53. A common adverse effect associated with the chronic use of magnesium antacids is (A) nausea and vomiting (B) gastrointestinal bleeding (C) flatulence (D) diarrhea (E) constipation

53. (D) Magnesium-containing antacids (eg, magnesium hydroxide) may cause diarrhea because of their saline cathartic action on the GI tract. They may also cause hypermagnesemia in renal failure patients. (3)

54. Reduced clotting ability of the blood is asso ciated with the administration of I. clopidogrel (Plavix) (E) Crohn's disease II. abciximab (ReoPro) III. filgrastim (Neupogen) (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

54. (C) Clopidogrel (Plavix) and abciximab (ReoPro) are platelet aggregation inhibitors. Filgrastim (Neupogen) is a human granulocyte colony-stimulating factor. (3)

55. Carbidopa can best be classified as a drug (A) reverses symptoms of Parkinson's disease (B) exerts an anticholinergic action (C) is a dopaminergic agent (D) is a neuromuscular blocking agent (E) is a dopa-decarboxylase inhibitor

55. (E) Carbidopa is a dopa-decarboxylase inhibitor that prevents peripheral decarboxylation of levodopa in the body. This reduces the adverse effects associated with peripheral dopa decarboxylation and reduces the dose of levodopa required to control a patient with Parkinson's disease. Carbidopa is available alone (Lodosyn) or in combination with levodopa (Sinemet). (3)

56. Selegeline (Eldepryl) can best be described as (A) MAO inhibitor (B) anticholinergic C) COMT inhibitor (D) anticonvulsant E) alpha! agonist

56. (A) Selegeline (Eldepryl) is an MAO-B inhibitor that is used in the adjunctive treatment of Parkinson's disease. (5:1006)

57. Which of the following is (are) true of fentanyl? (A) I only I. available as a transdermal system II. used as a local anesthetic III. may be used as a cough suppressant (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

57. (A) Fentanyl is a potent narcotic agonist analgesic used 1M or IV to promote analgesia during anesthesia. It is also available in a transmucosal (Fentanyl Oralet, Actiq) and transdermal (Duragesic) dosage form. (3)

58. Lactase enzyme is available for the treatment of (A) lactose intolerance (B) galactokinase deficiency (C) cystic fibrosis (D) phenylketonuria (E) Crohn's disease

58. (A) Lactase enzyme is effective in treating symptoms of lactose intolerance. These symptoms are most evident shortly after consuming a lactose-containing food and may include bloating and diarrhea. Lactase enzyme is available as a liquid (Lactaid), caplets (Lactaid), capsules (Lactrase), or as chewable tablets (Dairy Ease). It is also added to some commercial dairy products. (3)

59. Isotretinoin (Accutane) is a drug employed in the treatment of severe recalcitrant cystic (A) I only acne. Which one of the following is NOT an adverse effect associated with its use? (A) hypertriglyceridemia (B) hyperglycemia (C) pseudotumor cerebri (D) conjunctivitis (E) fetal abnormalities

59. (B) Hyperglycemia is not a problem commonly associated with the use of isotretinoin (Accutane). Cheilitis (cracked margins of the lips), conjunctivitis, and dry mouth occur in a large proportion of patients receiving this drug. Hypertriglyceridemia, pseudotumor cerebri have also been reported. Isotretinoin is classified in pregnancy category X and will, therefore, potentially cause fetal abnormalities. (3)

60. Which of the following is (are) true of isoease tretinoin (Accutane)? (A) may be used safely in pregnant patients after the first trimester (B) a derivative of vitamin D (C) is applied topically to severe acne lesions (D) contraindicated in patients with diabetes (E) commonly causes cheilitis

60. (E) The use of isotretinoin (Accutane), a vitamin A derivative, is associated with an incidence of cheilitis (cracking around the margin of the lips) greater than 90%. The drug is administered orally and must not be used in pregnant women because it carries a high risk of causing fetal deformities. (3)

61. Endorphins are (A) endogenous neurotransmitters (B) a new class of topical anti-inflammatory agents (C) neuromuscular blocking agents (D) biogenic amines believed to cause schizophrenia (E) endogenous opioid peptides

61. (E) Endorphins are endogenous (naturally found in the body) opioid peptides that are released in response to stress. (3)

62. Which of the following statements is (are) true of "crack"? I. It is a free-base form of cocaine. II. Its use results in CNS depression. III. It is generally injected intravenously. (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

62. (A) Crack is a free-base form of cocaine. It is generally smoked and rapidly absorbed through the respiratory membranes. Within seconds, it reaches the brain and produces central nervous system stimulation and euphoria. Dependence may occur with only a single dose of the drug. (3)

63. A uricosuric drug is one that (A) decreases urine flow (B) promotes excretion of uric acid in the urine (C) blocks excretion of uric acid in the urine (D) aids in the tubular reabsorption of uric acid (E) increases urine flow

63. (B) A uricosuric drug is one that promotes the excretion of uric acid in the urine. Uricosuric agents such as probenecid (Benemid) and sulfinpyrazone (Anturane) inhibit tubular reabsorption of urate and promote urate excretion. They are used to treat hyperuricemia associated with gout or gouty arthritis. (3)

64. Alteplase (Activase) is employed clinically as a (an) (A) xanthine oxidase inhibitor (B) proteolytic enzyme (C) monoamine oxidase inhibitor (D) ulcer adherent complex (E) tissue plasminogen activator

64. (E) Alteplase (Activase) is a tissue plasminogen activator produced by recombinant DNA technology. It is used in the management of acute myocardial infarction, acute ischemic stroke, and pulmonary embolism. Once injected into the circulation, alteplase binds to fibrin in a thrombus and converts the entrapped plasminogen to plasmin. This produces local fibrinolysis and assists in reopening a blocked blood vessel. (5:219)

65. A disadvantage in the use of cimetidine (Tagamet) is its ability to cause (A) cheilosis (B) aplastic anemia (C) inhibition of hepatic enzyme activity (D) gastric hyperparesis (E) decreased prolactin secretion

65. (C) Cimetidine (Tagamet) is an Hz-histamine receptor antagonist used to decrease gastric acid secretion in patients with peptic ulcer disease. It has been shown to inhibit the hepatic metabolism of drugs metabolized via the cytochrome P-450 pathway, thereby delaying metabolism and increasing serum levels. Cimetidine may affect the metabolism of drugs such as theophylline, some benzodiazepines, phenytoin, and warfarin. (3)

66. A drug that decreases the formation of uric acid is (A) miglitol (B) allopurinol (C) probenecid (D) ketamine (E) propylthiouracil

66. (B) Allopurinol (Zyloprim) is a xanthine oxidase inhibitor that does not exert a uricosuric effect but does prevent the conversion of hypoxanthine to uric acid. It is employed in the treatment of gout as well as in the management of patients receiving therapy for leukemia and other malignancies that increase uric acid formation. (5:1463)

67. Hypoparathyroidism is a disorder that would most logically be treated with (A) entacapone (B) prednisone (C) liothyronine (D) phytonadione (E) dihydrotachysterol

67. (E) Dihydrotachysterol is a synthetic product of tachysterol, a substance similar to vitamin D. It is used in combination with calcium and parathyroid hormone in the treatment of hypoparathyroidism. (3)

68. Drugs employed in reducing elevated serum cholesterol include(s) I. gemfibrozil (Lopid) II. cerivastatin (Baycol) III. pioglitazone (Aetos) (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

68. (C) Gemfibrozil (Lopid) is a fibric acid derivative that reduces serum triglycerides and very low-density lipoprotein (VLDL) and increases HDL cholesterol by inhibiting peripheral lipolysis and descreasing the hepatic extraction of free fatty acids. Cerivastatin (Baycol) is an HMG-CoA reductase inhibitor that is employed as a cholesterol-lowering agent used to reduce elevated total and LDL cholesterol levels in patients with primary hypercholesterolemia when response to diet and other nondrug approaches have not been successful. Its use is associated with hepatic dysfunction and danger to the developing fetus. (3)

69. The agent most similar in pharmacological action to miglitol (Glyset) is (A) glipizide (B) lispro insulin (C) pioglitazone (D) repaglinide (E) acarbose

69. (E) Acarbose (Precose) and miglitol (Glyset) are both alpha-glucosidase inhibitors. Since they act to reduce the GI absorption of carbohydrates, they are best taken three times a day with the first bite of each main meal. (3)

70. Nerves in the human body that transmit their impulses by releasing acetylcholine are known as nerves. (A) adrenergic (B) cholinergic (C) sympathetic (D) anticholinergic (E) neurogenic

70. (B) The autonomic nervous system consists of two major branches: the sympathetic (adrenergic) branch and the parasympathetic (cholinergic) branch. Each branch utilizes different neurotransmitters. For example, the sympathetic branch utilizes norepinephrine, whereas the parasympathetic branch utilizes acetylcholine. (3)

71. Patients receiving amiodarone (Cordarone) should be monitored for the development of (A) pulmonary toxicity (B) pseudomembranous enterocolitis (C) ptosis (D) stasis dermatitis (E) tinnitus

71. (A) Amiodarone (Cordarone) is an antiarrhythmic agent used in treating ventricular arrhythmias. It may cause a number of serious adverse effects, the most serious being pulmonary toxicity. Baseline chest x-rays and pulmonary function studies should be performed before therapy begins. Studies should be repeated at 3- to 6-month intervals. (5:250)

72. Methadone (Dolophine) is a (an) I. analgesic drug II. controlled substance III. narcotic antagonist (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

72. (C) Methadone (Dolophine) is a narcotic agonist analgesic with actions similar to those of morphine. It is twice as potent when used parenterally than when used orally. It is employed in the treatment of severe pain and in maintenance treatment of narcotic addiction. (5:1098)

73. Which one of the following is an example of a pure narcotic antagonist? (A) butorphanol (Stadol) (B) buprenorphine (Buprenex) (C) nalbuphine HCl (Nubain) (E) Parkinson's disease (D) naltrexone (ReVia) (E) sufentanil (Sufenta)

73. (D) A pure narcotic antagonist is one that reverses the effects of opioids without producing agonist action of its own. Naltrexone (ReVia) is an example of a pure narcotic antagonist. Other drugs listed have agonist and some antagonist activity. (3)

74. Which of the following agents is (are) used for the treatment of migraine headaches? I. rizatriptan benzoate II. methysergide maleate III. succinylcholine chloride (A) I only (B) III only (C) I and II only (D) II and (E) I, II, and III

74. (C) Rizatriptan benzoate (Maxalt), a serotonin 5HT1-receptor agonist and methysergide (Sansert), a semisynthetic ergot derivative, are used in treating migraine headaches. (3)

75. Morphine can be expected to produce which of the following pharmacological effects? I. dilation of the pupils II. respiratory depression III. constipation (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

75. (D) Constipation is a common effect because morphine decreases peristaltic activity in the GI tract. Constriction of the pupils, CNS and respiratory depression, and nausea and vomiting are all effects also associated with morphine use. (3)

76. Which of the following is an active metabolite of primidone (Mysoline)? I. acetylcholine II. phenylethylmalonamide III. phenobarbital (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

76. (D) Primidone (Mysoline) is an anticonvulsant drug used in a variety of convulsive disorders. Primidone and its two active metabolites, phenobarbital and phenylethylmalonamide (PEMA), have anticonvulsant activity. (5:967)

77. Pamidronate sodium (Aredia) is indicated for the treatment of (A) Crohn's disease (B) Meniere's syndrome (C) Paget's disease (D) Hansen's disease (E) Parkinson's disease

77. (C) Pamidronate (Aredia) is an agent used in treating Paget's disease of the bone, a condition characterized by abnormal bone resorption and the development of fractures. The use of the drug seems to decrease the dissolution of hydroxyapatite crystals, the building blocks of bone tissue. (3)

78. Repaglinide (Prandin) is believed to work by (A) decreasing the absorption of carbohydrates (B) decreasing hepatic gluconeogenesis (C) stimulating the release of insulin from the pancreas (D) increasing hepatic gluconeogenesis (E) reducing glucagon secretion from the

78. (C) Repaglinide (Prandin) acts by stimulating the release of insulin from the pancreas. (3)

79. Prednisone is an agent that is employed in I. fungal infections II. Crohn's disease III. rheumatic disorders (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

79. (D) The naturally occurring adrenal cortical steroids exert both salt-retaining (mineralocorticoid) and anti-inflammatory (glucocorticoid) activity. The synthetic steroids prednisone and prednisolone exert similar actions on the body. The use of these agents is often associated with fluid and sodium retention. (3)

80. Which of the following agents is (are) indicated for use in the treatment of emesis? I. dronabinol II. granisetron (Kytril) III. nalbumetone (Relafen) roxine sodium (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

80. (C) Dronabinol (Marinol) is a marijuana derivative and granisetron (Kytril) is a selective serotonin receptor antagonist used for the prevention of nausea and vomiting associated with cancer chemotherapy. (5:593)

81. Amrinone (Inocor) is most similar in action to which of the following (A) nadolol (Corgard) (B) lidocaine (Xylocaine) I. aluminum hydroxide (C) valsartan (Diovan) II. sodium bicarbonate (D) disopyramide (Norpace) III. calcium carbonate (E) digoxin (Lanoxin)

81. (E) Amrinone (Inocor), like digoxin, is a drug that produces a positive inotropic effect. In addition, amrinone also produces vasodilation. The drug is used for the short-term management of congestive heart failure in patients who have not responded adequately to digoxin, diuretics, or vasodilators. Use of the drug has been associated with the development of thrombocytopenia, arrhythmias, and GI upset. It is administered by IV bolus or infusion. (3)

82. In monitoring a patient receiving warfarin for the treatment of acute myocardial infarction, it is important to maintain the INR between (A) 2-3 (B) 3-5 (C) 5-7 (D) 7-9 (E) 9-14

82. (A) The International Normalization Ratio (INR) is a measure of the degree of anticoagulation of the patient. Ideally, for a patient who has experienced a myocardial infarction, the INR should be maintained at about 2 to 3. Higher levels do not seem to improve the therapeutic outcome and are likely to increase the chance of bleeding. (3)

83. Lactulose (Cephulac, Chronulac) I. is a laxative II. decreases blood ammonia levels III. is an artificial sweetener (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

83. (C) Lactulose (Cephulac, Chronulac), a synthetic disaccharide, is an analog of lactose. Unlike lactose, which is hydrolyzed enzymatically to its monosaccharide components, oral doses of lactulose pass to the colon virtually unchanged. In the colon, bacteria chemically convert the lactulose to low-molecularweight acids and carbon dioxide. The acids produce an osmotic effect that draws water into the colon and makes the stools more watery. They also permit ammonia in the body to be converted to ammonium ion in the acidic colon and allow it to be eliminated in the stool. (5:611, 624)

84. Which of the following can be classified as an osmotic laxative? (A) milk of magnesia (B) senna (C) cascara sagrada (D) docusate sodium (E) castor oil

84. (A) Milk of magnesia contains magnesium hydroxide as its active ingredient. This acts osmotically to produce a laxative effect. (3)

85. The dose of liothyronine sodium that is approximately equivalent to 100 ).!g of levothyroxine sodium (Synthroid) USP is (A) 120 ).!g (B) 0.4 ).!g (C) 250 ).!g (D) 25 ).!g (E) 100 ).!g

85. (D) Liothyronine sodium (Cytomel) is a synthetic form of the natural thyroid hormone T3. Approximately 25 )..lg of liothyronine sodium is equivalent to 100 )..lg of levothyroxine sodium (T4). (3)

86. Phosphate binding is likely to occur when to which of the following antacids are administered? I. aluminum hydroxide II. sodium bicarbonate III. calcium carbonate (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

86. (A) Aluminum hydroxide reacts with phosphate ion in the intestine to form insoluble aluminum phosphate which is eliminated in the feces. This may be of value in treating hyperphosphatemia in chronic renal failure. (3)

87. Which of the following agents is (are) indIcated for the treatment of chronic inflammatory bowel disease? (A) misoprostol (Cytotec) (B) ritodrine (Yutopar) (C) mesalamine (Asacol) D) metoclopramide (Reglan) (E) omeprazole (Prilosec)

87. (C) Mesalamine (Asacol) or 5-aminosalicylic acid (5-ASA) is a breakdown product of sulfasalazine that is believed to be useful in treating chronic ulcerative colitis. (3)

88. Patients who are sensitive to aspirin should avoid the use of I. codeine II. oxaprozin III. ibuprofen (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

88. (D) Ibuprofen (Motrin) and oxaprozin (Daypro) are nonsteroidal anti-inflammatory drugs (NSAIDs) and should be avoided in patients who are sensitive to aspirin because of possible cross-sensitivity reactions. (3)

89. Aspirin is believed to inhibit clotting by its action on which of the following endogenous substances? (A) endorphin A (B) xanthine oxidase (C) fibrinogen (D) cyclooxygenase (E) dopa decarboxylase

89. (D) Single aspirin doses are known to inhibit platelet aggregation. This is believed to occur by the acetylation of platelet cyclooxygenase by aspirin. This in turn prevents the synthesis of thromboxane A2, a prostaglandin that is a potent vasoconstrictor and an inducer of platelet aggregation. (3)

The primary site of action of triamterene (Dyrenium) and spironolactone (Aldactone) is the (A) glomerulus (B) descending loop of Henle (C) ascending loop of Henle (D) proximal tubule (E) distal tubule

90. (E) Both triamterene (Dyrenium) and spironolactone (Aldactone) inhibit sodium reabsorption in the distal tubule. Spironolactone is an aldosterone antagonist that prevents the formation of a protein important for sodium transport in the distal tubule. Triamterene inhibits sodium reabsorption induced by aldosterone and inhibits basal sodium reabsorption. Triamterene is not an aldosterone antagonist. (3)

91. Which of the following beta-adrenergic blocking agents also exhibit alpha1-adrenergic blocking action? I. timolol (Blocadren) II. sotalol (Betapace) III. labetalol (Normodyne, Trandate) (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

91. (B) Labetalol (Normodyne, Trandate) is a nonselective beta-adrenergic blocking agent primarily used for the management of hypertension. In addition to its beta-blocking action, labetalol is also able to block alpha1adrenergic receptors. This lowers standing blood pressure and may result in hypotension and syncope. (5:139)

92. Which one of the following drugs is employed in treating acute attacks of gout? (A) colchicine (B) ergonavine maleate (Ergotrate) (C) buspirone (BuSpar) (D) alendronate (Fosamax) (E) allopurinol (Zyloprim)

92. (A) Colchicine is a substance that may be employed orally or parenterally to relieve the pain of acute gout. It appears to act by reducing the inflammatory response to deposited urate crystals and by diminishing phagocytosis. Although it relieves pain in cases of acute gout, colchicine is not an analgesic or a uricosuric agent. Vomiting, diarrhea, abdominal pain, and nausea have all been reported with the use of colchicine. Bone marrow suppression and thrombocytopenia have also been associated with colchicine use. (3)

93. Prolonged activity (8 to 10 hours) is an advantage in the use of which of the following topical decongestants? I. phenylephrine II. oxymetazoline III. xylometazoline (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

93. (D) Oxymetazoline (Afrin, Duration) and xylometazoline (Otrivin), when used as topical nasal decongestants, produce an effect that may persist for 8 to 12 hours. This is in sharp contrast to other topical nasal decongestant drugs such as phenylephrine, naphazoline, and tetrahydrozoline, which require dosing at 3- to 4-hour intervals. (3)

94. Auranofin (Ridaura) is employed in the treatment of (A) rheumatoid arthritis (B) multiple sclerosis (C) ulcerative colitis (D) recalcitrant cystic acne (E) ear infections

94. (A) The use of gold compounds such as auranofin (Ridaura), gold sodium thiomalate (Myochrysine), and aurothioglucose (Solganal) has been associated with a wide variety of adverse effects, including blood dyscrasias, dermatitis, and renal disorders. Patients using such compounds must be monitored constantly for adverse effects. (3)

95. Which of the following agents is NOT likely to reduce blood sugar in a patient with type II diabetes mellitus? I. glucagon II. pioglitazone III. repaglinide (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

95. (A) Glucagon is a polypeptide secreted by the pancreas. It acts to enhance gluconeogenesis and glycogenolysis, thereby causing higher levels of glucose in the blood. Glucagon is used to treat severe hypoglycemia. It is generally administered intramuscularly or intravenously. Pioglitazone (Actos) and repaglinide (Prandin) are oral antidiabetic agents. (3)

96. After oral administration, the greatest amount of iron absorption occurs in the (A) ascending colon (B) stomach (C) duodenum (D) transverse colon (E) sigmoid colon

96. (C) Iron is primarily absorbed in the duodenum and the jejunum by an active transport mechanism. The ferrous salt form is absorbed approximately three times more readily than the ferric form. The presence of food, particularly dairy products, eggs, coffee, and tea, in the GI tract may decrease the absorption of iron significantly, although the concurrent administration of vitamin C maintains iron in the ferrous state, thereby enhancing its absorption from the GI tract. (5:1532)

97. Iron is required by the body to maintain normal (A) leukocyte development cated for the treatment of primary nocturnal (B) ascorbic acid absorption (C) bone growth (D) immune function (E) oxygen transport

97. (E) Iron is an essential component of hemoglobin, myoglobin, and several enzymes. Approximately two-thirds of total body iron is in the circulating red blood cells as part of hemoglobin, the most important carrier of oxygen in the body. (3)

98. Prolonged use of organic nitrates (eg, nitro- (E) mannitol (Osmitrol) glycerin) is likely to result in the development of (A) hepatotoxicity fied as a selective serotonin reuptake inhib- (B) tolerance itor (SSRI)? (C) aplastic anemia I. citalopram (Celexa) (D) nephrotoxicity II. sertraline (Zoloft) (E) pseudomembranous enterocolitis

98. (B) The development of tolerance to the action of nitroglycerin and other nitrates may occur with repeated use. Sensitivity to the action of nitroglycerin is generally restored after several hours of withdrawal from the drug. (3)

99. Which of the following statements is (are) true of regular insulin? I. It is a suspension. II. It may be administered either SC or IV. III. It is longer acting than lispro insulin. (A) I only (B) III only (C) I and II (D) II and III only (E) I, II, and III

99. (D) Regular insulin is secreted by the beta cells of the pancreas. In its unmodified form, regular insulin is clear, has a short (0.5 to 1 hr) onset of action, and a relatively short (6 to 8 hr) duration of action. Lispro insulin solution has a more rapid onset and shorter duration of action than regular insulin. Because regular insulin is a clear product, it can be administered either SC or IV. (3)

100. Fluvastatin (Lescol) is contraindicated for use in patients who are (A) pregnant (B) hypersensitive to sulfa drugs (C) chronic asthmatics (D) more than 25% over ideal body weight (E) diabetic

100. (A) Fluvastatin (Lescol) is a cholesterollowering agent contraindicated for use during pregnancy because of its great potential for causing fetal harm. The drug is in FDA pregnancy category X. (3)

101. Which of the following drugs are available in a transdermal form for the prevention of motion sickness? (A) metoclopramide (B) ondansetron (C) granisetron (D) clonidine (E) scopolamine

101. (E) Scopolamine is available in a transdermal patch dosage form (Transderm Scop) for prevention of nausea and vomiting associated with motion sickness in adults. It is applied to the skin behind the ear at least 4 hours before the antiemetic effect is required. The drug is then released from the transdermal product for 3 days. (5:595)

102. Which one of the following drugs is indicated for the treatment of primary nocturnal enuresis? (A) ritodrine (Yutopar) (B) amoxapine (Asendin) (C) desmopressin acetate (DDAVP) (D) metolazone (Zaroxolyn)

102. (C) Desmopressin acetate (DDAVP) is the synthetic analog of naturally occurring human antidiuretic hormone (ADH) produced by the posterior pituitary gland. It is administered intranasally for the treatment of primary nocturnal enuresis. A single dose of the drug will produce an antidiuretic effect lasting from 8 to 20 hours. (3)

103. Which of the following drugs is (are) classified as a selective serotonin reuptake inhibitor (SSRI)? I. citalopram (Celexa) II. sertraline (Zoloft) III. venlafaxine (Effexor) (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

103. (C) Citalopram (Celexa) and sertraline (Zoloft) are classified as SSRIs. Venlafaxine (Effexor) is not an SSRI or a tricyclic antidepressant. It acts to inhibit neuronal uptake of serotonin and norepinephrine. (3)

104. Which one of the following antimicrobial agents would be MOST useful in the treatment of an infection caused by beta-Iactamase-producing staphylococci? (A) dicloxacillin (B) cephapirin (C) cephalexin (D) amoxicillin (E) bacampicillin

104. (A) Dicloxacillin (Dynapen, Pathocil) is a beta-Iactamase-resistant penicillin and would be suitable for treating an infection caused by beta-Iactamase-producing staphylococci. Other penicillins that would also be suitable include oxacillin (Prostaphlin, Bactocill), cloxacillin (Cloxapen, Tegopen), and nafcillin (Nafcil, Unipen). All of these products are available for oral use. (3)

105. Gastric intrinsic factor is a glycoprotein that is required for the gastrointestinal absorption of (A) medium chain triglycerides (B) folic acid (C) iron (D) cyanocobalamin (E) tocopherols

105. (D) Cyanocobalamin, or vitamin B12, is essential for proper growth, cell reproduction, formation of blood components, and many other functions. In order for cyanocobalamin to be absorbed properly from the GI tract, it must combine with a glycoprotein called intrinsic factor. In the absence of proper levels of intrinsic factor, cyanocobalamin is administered parenterally or intranasally. (3)

106. Gingival hyperplasia, hirsutism, and ataxia are adverse effects associated with the use of ropine on the human body? (A) minoxidil (Loniten) (B) phenytoin (Dilantin) (C) ginseng root (D) chlorpromazine (Thorazine) (E) ciprofloxacin (Cipro)

106. (B) Phenytoin (Dilantin) is an anticonvulsant used in controlling grand mal and psychomotor seizures as well as other convulsive disorders. Adverse effects commonly associated with phenytoin use include nystagmus, gingival hyperplasia, ataxia, and many other neurologic, dermatologic, and hematologic disorders. Because of the high frequency of adverse effects associated with the use of this drug, patients must be monitored closely during therapy. (5:967)

107. Latanoprost (Xalatan) is a drug used in the treatment of glaucoma. Which one of the following describes the mechanism of action? (A) It interferes with the synthesis of histamine in the body. (B) decreases the production of aqueous humor (C) interferes with the enzyme carbonic anhydrase (D) prostaglandin agonist (E) mydriatic

107. (D) Latanoprost (Xalatan) is a prostaglandin F2a analog that reduces intraocular pressure by increasing the outflow of aqueous humor. (3)

108. Which of the following beta-adrenergic block- the stomach. ing agents is beta1-selective? I. betaxolol (Betoptic) II. metipranolol HCl (OptiPranolol) III. timolol (Timoptic) (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

108. (A) Betaxolol (Betoptic) is a beta-adrenergic blocking agent used ophthalmically to reduce intraocular pressure, particularly in patients with chronic open-angle glaucoma. Unlike other ophthalmic beta-blockers, the action of betaxolol is more specific for beta1-adrenergic receptors than for beta2-receptors, making it less likely to affect respiratory function. (3)

109. Which of the following is true of pilocarpine (Isopto Carpine, Pilostat)? I. similar pharmacologic action to dorzolamide (Trusopt) II. direct-acting mydriatic III. ingredient in Ocusert ocular therapeutic system (A) I only (B) III only (C) I and II only II (D) II and III only (E) I, II, and III

109. (B) Pilocarpine (Isopto Carpine, Pilostat) is a direct-acting miotic agent used to decrease elevated intraocular pressure. By causing miosis (constriction of the pupil), greater outflow of aqueous humor is promoted and intraocular pressure falls. Carbachol (Isopto Carbachol) is another direct-acting miotic used in situations in which pilocarpine is ineffective or causes adverse effects. Dorzolamide (Trusopt) acts by inhibiting the action of carbonic anhydrase. (5:1472)

110. Which one of the following is an effect of atropine on the human body? (A) decreased heart rate (B) decreased sweating C) produces miosis (D) increased gastrointestinal motility (E) stimulates gastric secretion

110. (B) Atropine is a belladonna alkaloid capable of causing a wide range of effects in the human body. Increased heart rate, diminished sweating, reduction of gastric secretion and tone, and mydriasis (dilation of the pupil of the eye) are commonly associated with its administration. (3)

111. Which one of the following statements best treatment of glaucoma. Which one of the fol- describes the mechanism of action of ranitidine (Zantac)? (A) It interferes with the synthesis of hista- (B) It forms an inactive complex with histamine. (C) It stimulates the metabolism of endogenous histamine. (D) It blocks the receptor sites on which histamine is acting (E) It directly inhibits the action of mucin in the stomach.

111. (D) Ranitidine (Zantac) and other histamine H2-receptor antagonists competitively block H2-receptor sites, particularly those found in gastric parietal cells. These agents do not block histamine release, antibody production, or antigen-antibody reactions and they do not bind histamine. (3)

112. Haloperidol (Haldol) differs from chlorpromazine (Thorazine) in that haloperidol (A) is not an antipsychotic agent (B) does not produce extrapyramidal effects (C) cannot be administered parenterally (D) does not cause sedation (E) is not a phenothiazine

112. (E) Haloperidol (Haldol) is an antipsychotic agent available in oral and parenteral forms. It has pharmacologic actions similar to the phenothiazines (sedation, extrapyramidal effects, etc.). Chemically, haloperidol is a butyrophenone. (5:1051)

113. Tamoxifen (Nolvadex) can best be characterized as a (an) (A) gonadotropin-releasing hormone analog (B) estrogen (C) antiestrogen (D) progestin (E) androgen

113. (C) Tamoxifen (Nolvadex) is an agent that has potent antiestrogenic effects because of its ability to compete with estrogen for binding sites in target tissues such as the breast. It is used in the treatment of metastatic breast cancer in women, particularly in patients with tumors that are estrogen-receptor-positive. It is also used to reduce the incidence of breast cancer in high-risk women. (3)

114. Which of the following is true of permethrin (Nix, Elimite)? I. It is only used topically. II. It is used to treat topical fungal infections. III. It is used to enhance permeation of drugs through the skin. (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

114. (A) Permethrin (Nix, Elimite) is a topical scabicide and pediculocide. It acts by disrupting the nerve cell membranes of parasites, resulting in their paralysis. (3)

115. Advantages of acetaminophen (Tylenol, APAP) over aspirin include all of the followingEXCEPT (A) greater anti-inflammatory action (B) less gastric irritation (C) no occult blood loss (D) no appreciable effect on uric acid excretion (E) no alteration of bleeding time

115. (A) Acetaminophen (Tylenol, APAP) is an agent with analgesic and antipyretic actions similar to aspirin. Unlike aspirin, acetaminophen does not significantly inhibit peripheral prostaglandin synthesis, which may account for its relative lack of anti-inflammatory activity. Acetaminophen does not inhibit platelet function, affect prothrombin time, or produce GI distress. (3)

116. The use of clozapine (Clozaril) has been associated with the development of (A) thrombocytopenia (B) hypocalcemia (C) meningitis (D) agranulocytosis (E) hematuria

116. (D) Clozapine (Clozaril) is an antipsychotic agent indicated for use in patients who do not respond to standard antipsychotic therapy (phenothiazines, etc.). Use of clozapine has been associated with the development of agranulocytosis, a potentially life-threatening blood disorder. Patients being treated with clozapine must have a baseline white blood cell (WBC) and differential count performed before initiation of treatment, as well as a WBC count every week during treatment and for 4 weeks after discontinuing therapy. (5:1129)

117. Didanosine (Videx) can best be described as a (an) (A) antiprotozoal (B) reverse transcriptase inhibitor (C) protease inhibitor (D) beta-lactamase inhibitor (E) antifungal

117. (B) Didanosine (Videx) is a reverse transcriptase inhibitor that is active against the human immunodeficiency virus (HIV). Its use has been associated with the development of peripheral neuropathy and pancreatitis. (3)

118. Although classified as antibiotics, dactinomycin (Cosmegen) and plicamycin (Mithracin) are used in cancer chemotherapy because they have a (an) (A) immunosuppressant effect (B) antiviral effect (C) antiemetic effect (D) cytotoxic effect (E) anabolic effect

118. (D) Dactinomycin (Cosmegen) and plicamycin (Mithracin) are antineoplastic agents classified as antibiotics because they are derived from a microbial source. These agents appear to act in a cytotoxic fashion by interfering with DNA and/or RNA synthesis. Their use is associated with the development of nausea and vomiting as well as with bone marrow depression. (3)

119. The anti-inflammatory effect of NSAIDs is due to their ability to 1. inhibit prostaglandin synthesis II. inhibit the stimulation of the chemoreceptor trigger zone (CTZ) III. reset the hypothalamic "setpoint" (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

119. (A) The anti-inflammatory and analgesic action of NSAIDs is believed to result from inhibition of prostaglandin synthesis. (3)

120. The "first-dose" effect is characterized by marked hypotension and syncope on taking the first few doses of medication. This effect is seen with the use of 1. doxazosin (Cardura) II. enalapril (Vasotec) III. sotalol (Betapace) (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III only

120. (A) Doxazosin (Cardura) is an alpha1-adrenergic blocking agent used in the treatment of hypertension. By causing dilation of arterioles and veins, the drug causes the lowering of both supine and standing blood pressures. The "first-dose" effect is the development of marked hypotension and syncope (fainting) on administration of the first few doses of the drug. Administering low initial doses of the drug at bedtime can minimize this effect. Dosage may be increased gradually until the drug is better tolerated. (3)

121. Carbon monoxide exerts its toxic effects primarily by (A) inhibiting the gag reflex (B) decreasing the oxygen-carrying capacity of the blood (C) reacting with amino acids in the body to form ammonia (D) reacting with body enzymes to produce respiratory acidosis (E) paralyzing the muscles of the diaphragm

121. (B) Carbon monoxide is a colorless and odorless product of the incomplete combustion of hydrocarbons. When it is inhaled and carried to the blood, it reacts with hemoglobin to form carboxyhemoglobin. This reaction dramatically reduces the oxygencarrying capacity of the blood and, unless corrected quickly, results in the death of the individual. (

122. The most serious potential consequence of ingestion of a liquid hydrocarbon such as kerosene or gasoline is (A) inactivation of hepatic enzymes (B) the corrosive action of the poison on the stomach lining (C) the paralysis of peristaltic motion of the GI tract (D) dissolution of the mucus coat of the esophagus (E) the aspiration of the poison into the respiratory tract

122. (E) Aspiration of a liquid hydrocarbon such as gasoline or kerosene may result in severe inflammation of pulmonary tissues, interference with gas exchange, pneumonitis, and possible death. Emesis or gastric lavage is avoided in such patients to avoid aspiration. Catharsis using magnesium or sodium sulfate may be attempted. Supportive therapy is recommended for such patients unless antimicrobial agents are required to treat respiratory infection. (3)

123. Deferoxamine mesylate (Desferal) is considered to be a specific antidote for the treatment of poisoning caused by (A) anticholinergic agents (B) heavy metals (C) benzodiazepines (D) iron-containing products (E) alkylating agents

123. (D) Deferoxamine mesylate (Desferal) is a chelating agent that has a high affinity for ferric iron and a relatively low affinity for calcium. It is usually administered parenterally in the treatment of acute iron poisoning. (5:83)

124. Which of the following agents is (are) classified pharmacologically as carbonic anhydrase inhibitors? I. fluvastatin II. nitroprusside III. acetazolamide (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III only

124. (B) Acetazolamide (Diamox) is a carbonic anhydrase inhibitor used clinically in the treatment of chronic open-angle glaucoma as well as secondary glaucoma. It is also used for treatment of edema caused by congestive heart failure or drug use, or associated with certain forms of epilepsy. Because acetazolamide increases the excretion of sodium, potassium, bicarbonate, and water, many patients develop alkaline urine. (3)

125. Thiazide diuretics decrease the excretion of (A) chloride (B) uric acid (C) sodium (D) potassium (E) creatinine

125. (A) Thiazide diuretics such as hydrochlorothiazide (Esidrix, HydroDIURIL) increase the renal excretion of sodium, chloride, and potassium while decreasing the excretion of calcium and uric acid. (3)

126. The renal excretion of amphetamines can be diminished by alkalinization of the urine. Which of the following would tend to diminished the excretion rate of amphetamine sufate? kerosene or gasoline is I. methenamine mandelate II. acetazolamide III. sodium bicarbonate (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III only

126. (D) Acetazolamide is a carbonic anhydrase inhibitor that increases the excretion of sodium, potassium, bicarbonate, and water, thereby alkalinizing the urine. Sodium bicarbonate directly alkalinizes the urine. (3)

127. Cyclophosphamide (Cytoxan) is an example of a (an) (A) antibiotic (B) estrogen antagonist (C) antimetabolite (D) alkylating agent (E) prostaglandin inhibitor

127. (D) Cyclophosphamide (Cytoxan) is an alkylating agent related to the nitrogen mustards. Patients using this agent should be advised to take the drug on an empty stomach. Since hemorrhagic cystitis may occur with the use of this drug, patients should be advised to drink lots of fluids. (3)

128. Which of the following drugs may interfere with ethanol metabolism? I. metronidazole (Flagyl) II. chlorpropamide (Diabinese) III. disulfiram (Antabuse) (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III only

128. (E) All of these drugs are aldehyde dehydrogenase inhibitors. They cause intolerance to alcohol so that consumption of even a small amount may produce a broad array of unpleasant effects. These include flushing, throbbing headaches, nausea, sweating, and palpitations. Disulfiram is used in the management of selected chronic alcoholics. The drug should only be used with the full knowledge and understanding of the patient. (3)

129. Which of the following is (are) classified as a monoamine oxidase inhibitor? I. isocarboxazid (Marplan) II. phenylzine (Nardi!) III. tranylcypromine (Parnate) (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III only

129. (E) Each of these agents are MAO inhibitors. Patients using them should avoid tyramine containing foods as well as cold and allergy products. (3)

130. A drug indicated for the treatment of both diarrhea and constipation is (A) bisacodyl (Dulcolax) (B) lactulose (Cephulac) (C) polycarbophil (Mitrolan) (D) senna (Senokot) (E) magnesium sulfate

130. (C) Polycarbophil (Mitrolan) is a synthetic hydrophilic compound that is capable of absorbing large amounts of water. It is indicated for use as a bulk laxative in the treatment of constipation. It is also employed in the treatment of diarrhea, in which it absorbs excess free fecal water and helps create formed stools. (5:605)

131. Which of the following agents is (are) classi- fied as a leukotriene receptor antagonist? I. ipratropium bromide II. zileuton III. montelukast sodium (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III only

131. (D) Zileuton (Zyflo) and montelukast sodium (Singulair) are leukotriene receptor antagonists. Since leukotrienes are associated with causing asthmatic symptoms, the use of these drugs reduces the likelihood of asthma attacks. (3)

132. The thiazide derivative diazoxide (Hyperstat) (A) is a more potent diuretic than hydrochlorothiazide (B) is not a diuretic (C) produces about the same diuretic response as an equal dose of hydrochlorothiazide the pancreas (D) is used in the treatment of shock (E) must be used with a potassium supplement

132. (B) Diazoxide (Hyperstat) is a nondiuretic antihypertensive agent structurally related to the thiazides. It is used in the emergency reduction of elevated blood pressure. Because diazoxide is rapidly and extensively bound to serum protein, it must be administered by rapid IV injection (bolus). Repeated administration of the drug may cause sodium and water retention and the need for adjuvant diuretic therapy. An oral form of diazoxide (Proglycem) is used in the management of hypoglycemia. (3)

133. Which of the following is (are) classified as a broad-spectrum antifungal agent? I. Fluorouracil II. mebendazole III. miconazole (A) I only (B) III only (C) I and II only (D) II and III only III. a corticosteroid (E) I, II, and III

133. (B) Miconazole (Micatin, Monistat) is a broad-spectrum antifungal agent effective against yeast infections (Candida albicans) as well as dermatophyte infections (tinea cruris, tinea corporis). (5:1861)

134. Which of the following drugs is (are) sulfonamides? (A) mafenide (B) tacrolimus (C) tramadol (D) busulfan (E) milrinone

134. (A) Mafenide (Sulfamylon) is a bacteriostatic agent that is active against many gram-positive and gram-negative organisms. Topical products containing mafenide are applied to 2nd- and 3rd-degree burns in order to reduce the chance of infection and increase the speed of healing. (3)

135. Which of the following drugs may be used in the treatment of diabetes insipidus? (A) chlorpropamide (Diabinese) (B) lypressin (Diapid) (C) insulin (D) glyburide (Micronase) (E) glucagon

135. (B) Lypressin (Diapid) is a synthetic vasopressin analog possessing antidiuretic activity without producing a pressor or oxytocic effect. It is used clinically in the management of symptoms of diabetes insipidus. Lypressin is administered as a nasal spray. (3)

136. In the treatment of cardiac arrhythmias, sotalol (Betapace) is most similar in action to (A) tocainide (B) verapamil (C) amiodarone (D) digoxin (E) flecainide

136. (C) Sotalol (Betapace) and amiodarone (Cordarone) are both Group III antiarrhythmic agents. This means that they both act to prolong the repolarization phase (phase 3). (3)

137. The sulfonylureas (eg, Diabinese, Glucotrol) are believed to exert their hypoglycemic effect by (A) stimulating the release of insulin from the pancreas (B) inhibiting the breakdown of endogenous (C) decreasing the absorption of dietary glucose (D) decreasing the sensitivity of insulin receptors (E) decreasing the desire for sugar con-

137. (A) The sulfonylurea hypoglycemic agents appear to reduce blood glucose levels by stimulating the release of insulin from the beta cells of the pancreas. They are only effective in patients who have some capacity for endogenously producing insulin. (5:1225)

138. Which of the following is true of finasteride (Propecia, Proscar)? I. useful in treating BPH II. used to treat some types of alopecia III. a corticosteroid (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III only

138. (C) Finasteride (Propecia, Proscar) is an androgen hormone inhibitor used to treat benign prostatic hyperplasia (BPH) as well as male-pattern hair loss (alopecia). (3)

139. Vidarabine (Vira-A) is an antiviral agent indicated for the treatment of (A) rubella (B) AIDS (C) influenza (D) herpes simplex encephalitis (E) pneumocystis carinii pneumonia (PCP)

139. (D) Vidarabine (Vira-A) is an antiviral agent that possesses activity against herpes simplex virus. It is administered by slow IV infusion for the treatment of herpes simplex encephalitis and is used ophthalmically for the treatment of herpes simplex infections of the eye. (3)

140. Dalteparin sodium (Fragmin) acts in the body to (A) regulate menstrual activity (B) prevent blood dot formation (C) inhibit thyroid function (D) inhibit viral replication (E) reduce the secretion of acid in the stomach

140. (B) Dalteparin sodium (Fragmin) is a lowmolecular- weight heparin derivative used in preventing or treating thromboembolic complications following surgery or ischemic complications of unstable angina and MI. (3)

141. Zidovudine (Retrovir) is indicated for the treatment of patients with I. hepatitis B infection II. herpes simplex infections III. human immunodeficiency virus (HIV) infection (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

141. (B) Zidovudine (Retrovir) inhibits replication of some retroviruses, including HIV. It is used orally in managing patients with HIV infection who have evidence of impaired immunity. The intravenous form is used for some adult patients with symptomatic HIV infection who have a confirmed presence of pneumocystis carinii pneumonia (PCP). (5:1938)

142. Which of the following is (are) true of alteplase (Activase)? (A) derived from bovine tissue (B) administered intramuscularly (C) derived from porcine tissue (D) an anticoagulant (E) a thrombolytic agent

142. (E) Alteplase (Activase) is a tissue plasminogen activator produced by recombinant DNA technology. It is used intravenously in the management of acute myocardial infarction (AMI) patients in order to lyse thrombi obstructing coronary arteries. It is administered as soon as possible after the onset of AMI. (3)

143. Which of the following bronchodilators act by inhibiting phosphodiesterase? I. dyphylline (Lufyllin) II. salmeterol (Serevent) III. nedocromil sodium (Tilade) (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

143. (A) Dyphylline is a theophylline derivative. These agents act by inhibiting the enzyme phosphodiesterase, thereby increasing cyclicAMP levels and producing bronchodilation. Salmeterol is a beta2-adrenergic agonist, and nedocromil sodium is an inhaled agent that inhibits mediator release from mast cells. (3)

144. Didofenac sodium (Voltaren) is most similar in action to (A) buspirone (BuSpar) (B) oxaprozin (Daypro) (C) chlorzoxazone (Paraflex) (D) dicydomine (Bentyl) (E) mecamylamine (Inversine)

144. (B) Diclofenac sodium (Voltaren) and oxaprozin (Daypro) are both nonsteroidal anti-inflammatory drugs (NSAIDs). (3)

145. Cromolyn sodium (Intal, Nasalcrom, Opticrom) is a drug that is (A) effective in acute asthmatic attacks (B) a synthetic corticosteroid (C) a histamine antagonist (D) a mast cell stabilizer (E) a leukotriene inhibitor

145. (D) Cromolyn sodium (Intal, Nasalcrom, Opticrom) is a drug with anti-asthmatic, antiallergy, and mast cell stabilizing activity. It has no bronchodilator or anti-inflammatory activity. Cromolyn appears to inhibit degranulation of sensitized and nonsensitized mast cells that may occur after exposure to certain antigens. Cromolyn products are used prophylactically to treat bronchial asthma, allergic rhinitis, and mastocytosis. Cromolyn should not be used in treating acute asthmatic attacks. (5:449)

146. Which of the following calcium channel blockers may be employed parenterally in the treatment of cardiac arrhythmias? I. verapamil (Isoptin, Calan) II. isradipine (DynaCirc) III. amlodipine (Norvasc) (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

146. (A) Verapamil (Calan, Isoptin) is a calcium channel-blocking agent used orally and parenterally in the treatment of cardiac arrhythmias. The other calcium channel-blocking agents listed are used in the treatment of angina pectoris and/or essential hypertension. Oral verapamil is also used for these indications. (5:239)

147. Which one of the following antibiotics is a third-generation cephalosporin? (A) cefoxitin (Mefoxin) (B) cefonicid (Monocid) (C) cephalexin (Keflex) (D) cefixime (Suprax) (E) cefador (Cedor)

147. (D) Cefixime (Suprax) is a third-generation cephalosporin. Third-generation cephalosporins generally have greater gram-negative activity, less gram-positive activity, greater penetration of the central nervous system, and higher cost than cephalosporins in firstor second-generation groups. (3)

148. Reflex tachycardia is an adverse effect most likely to be associated with the use of which of the following drugs? (A) minoxidil (Loniten) (B) losartan (Cozaar) (C) moexipril (Univasc) (D) nadolol (Corgard) (E) clonidine (Catapres)

148. (A) Reflex tachycardia is commonly seen with the use of peripheral vasodilators such as minoxidil (Loniten) and hydralazine (Apresoline). The drop in blood pressure produced by the use of these agents causes increased renin secretion, heart rate, and output as well as sodium and water retention. This may worsen both angina and congestive heart failure. These adverse effects observed with the use of peripheral vasodilators may be managed by the concurrent administration of a beta-adrenergic blocking agent and/or a diuretic. (3)

149. Which of the following statements is (are) TRUE of buprenorphine (Buprenex)? I. It is a narcotic agonist-antagonist drug. II. It is only administered parenterally. III. It is a phenothiazine derivative. (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

149. (C) Buprenorphine (Buprenex) is an opioid narcotic agonist-antagonist. As an analgesic, it is about 30 times as potent as morphine. It is administered intramuscularly or intravenously for the relief of moderate to severe pain. (5:1019)

150. Which one of the following is NOT a progestin? (A) norethynodrel (B) norethindrone (C) mestranol (D) levonorgestrel (E) ethynodiol diacetate

150. (C) Mestranol is an estrogen commonly employed in several oral contraceptive products (eg, Norinyl, Ortho-Novum). (3

151. Which one of the following beta-adrenergic blocking agents has the greatest lipid solubility? (A) esmolol (Brevibloc) (B) atenolol (Tenormin) (C) pindolol (Visken) (D) acebutolol (Sectral) (E) propranolol HCl (Inderal)

151. (E) Propranolol (Inderal) is a nonspecific beta-adrenergic blocking agent that exhibits a high degree of lipid solubility. As a result, it is more likely than other beta blockers to enter the CNS and produce CNS adverse effects. (3)

152. Danazol (Danocrine) can best be classified as a (an) (A) anti-inflammatory corticosteroid (B) estrogen (C) progestin (D) neuromuscular blocking agent (E) androgen

152. (E) Danazol (Danocrine) is a synthetic androgen that suppresses the pituitary-ovarian axis by inhibiting the production of pituitary gonadotropins. It is used clinically in the treatment of endometriosis, in which it causes the normal and ectopic endometrial tissue to become inactive and atrophic. Danazol is also employed in the prevention of attacks related to hereditary angioedema. (5:1350)

153. Torsemide (Demadex) is most similar in action to (A) bumetanide (Bumex) (B) risperidone (Risperdal) (C) spironolactone (Aldactone) (D) chlorthalidone (Hygroton) (E) acetazolamide (Diamox)

153. (A) Torsemide (Demadex) and bumetanide (Bumex) are both loop diuretics. (3)

154. Potassium depletion is LEAST likely to occur in a patient using (A) ethacrynic acid (Edecrin) (B) triamterene (Dyrenium) (C) torsemide (Demadex) (D) acetazolamide (Diamox) (E) chlorthalidone (Hygroton)

154. (B) Triamterene (Dyrenium) is one of three potassium-sparing diuretics currently on the market. The others include spironolactone (Aldactone) and amiloride (Midamor). These drugs are primarily used to enhance the action and counteract the potassium-depleting effect of thiazides and loop diuretics. (3)

155. Acyclovir (Zovirax) is indicated for the treatment of (A) multiple sclerosis (B) psoriasis (C) HIV infection (D) shingles (E) mononucleosis

155. (D) Acyclovir (Zovirax) is an antiviral agent used in the treatment of infections caused by herpes simplex virus types 1 and 2 (HSV-l and HSV-2) and varicella-zoster virus. Shingles is a painful and potentially debilitating disorder caused by varicella-zoster virus. (3)

156. Which one of the following barbiturates is likely to be the shortest acting? (A) amobarbital sodium (B) methohexital sodium (C) pentobarbital sodium (D) mephobarbital (E) phenobarbital

156. (B) Methohexital sodium (Brevital Sodium) is a highly lipid-soluble barbiturate. It can, therefore, rapidly cross the blood-brain barrier and produce a rapid onset of action and a short duration. Methohexital is employed for the induction and maintenance of anesthesia. (3)

157. Which of the following agents decreases the production of hydrochloric acid in the stomach? I. olsalazine II. calcium carbonate III. lansoprazole (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

157. (B) Lansoprazole (Prevacid) is a proton pump inhibitor that dramatically reduces the secretion of hydrochloric acid in the stomach. (3)

158. Metoclopramide (Reglan) is most similar to which of the following drugs? (A) bisacodyl (B) orlistat (C) loperamide (D) cisapride (E) dicyclomine

158. (D) Metoclopramide (Reglan) and cisapride (Propulsid) increase the motility of the upper GI tract without stimulating gastric, biliary,or pancreatic secretions. They are most commonly employed in the treatment of diabetic gastroparesis. (3)

159. Olsalazine sodium (Dipentum) is employed in the treatment of II. It may be administered orally or by inhalation. (A) diabetes mellitus III. It must be used regularly to prevent mi- (B) duodenal ulcers graine headaches. (C) urinary tract infections (A) I only (D) ulcerative colitis (B) III only (E) diabetes insipidus

159. (D) Olsalazine sodium (Dipentum) is a salicylate compound that is converted to 5aminosalicylic acid (5-ASA) in the colon. This exerts an anti-inflammatory effect useful in treating ulcerative colitis. (5:577)

160. An advantage of salmeterol (Serevent) over isoproterenol (Isuprel) in the treatment of bronchial asthma is that salmeterol (A) is more selective for beta2-adrenergic receptors (B) has more beta-agonist activity than isoproterenol (C) has alpha-adrenergic activity (D) causes less cardiac stimulation (E) has a more rapid onset of action

160. (A) Salmeterol (Serevent)) and isoproterenol (Isuprel) are sympathomimetic bronchodilators that affect predominantly betaz-adrenergic receptors. Salmeterol is believed, however, to have less beta1-activity than isoproterenol. This would make it less likely to stimulate the heart. (3)

161. Ramipril HCl (Altace) can best be classified as a (an) (A) beta-adrenergic blocking agent (B) vasodilator (C) calcium channel blocker (D) angiotensin-converting enzyme inhibitor (E) alpha-adrenergic blocking agent

161. (D) Ramipril (Altace) is an angiotensin-converting enzyme (ACE) inhibitor indicated for the treatment of hypertension. When administered orally, antihypertensive action generally occurs within 1 to 2 hours. The drug's action persists for 24 hours. This permits single daily dosing. (3)

162. Which one of the following statements is TRUE of beclomethasone dipropionate (A) It should only be used in the treatment of an acute asthmatic attack. (B) It should not be used in a patient who is currently using a theophylline product. (C) Beclomethasone is not systemically absorbed by this route. (D) If used in conjunction with a bronchodilator administered by inhalation, (E) The aerosol form is also useful in the treatment of status asthmaticus

162. (D) Beclomethasone dipropionate (Beclovent, Vanceril) is a synthetic corticosteroid used by inhalation to control bronchial asthma. It is generally reserved for patients in whom bronchodilators and other nonsteroidal medications have not been totally successful in controlling asthmatic attacks. When used with a bronchodilator administered by inhalation, the beclomethasone dipropionate should be administered several minutes after the bronchodilator in order to enhance the penetration of the beclomethasone into the bronchial tree. (3)

163. Which of the following is true of naratriptan (E) dicyclomine (Amerge)? I. It is a 5-HT1-receptor antagonist. II. It may be administered orally or by inhalation. III. It must be used regularly to prevent migraine headaches. (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

163. (A) Naratriptan (Amerge) is a 5-HT1-receptor antagonist used to treat acute migraine headaches. It is not used prophylactically. (3)

164. Which of the following cancer chemotherapeutic agents is (are) classified as an anticeptors metabolite? I. mercaptopurine (Purinethol) II. fluorouracil (Adrucil) III. cytarabine (Cytosar-U) (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

164. (E) Antimetabolites are a diverse group of compounds that interfere with normal metabolic processes and thereby disrupt nucleic acid synthesis and normal cell function. (3)

165. Which one of the following antihistamines would be LEAST likely to cause sedation? (A) azatadine (Optimine) (B) dimenhydrinate (Dramamine) (C) clemastine (Tavist) (D) loratidine (Claritin) (E) tripelennamine (PBZ)

165. (D) Loratidine (Claritin), cetirizine (Zyrtec), astemizole (Hismanal), and fexofenadine (AI

166. The pharmacological properties of which one of the following agents is similar to amphetamine (A) methdilazine (B) lithium carbonate (C) methylphenidate (D) haloperidol (E) methoxsalen

166. (C) Methylphenidate (Ritalin) is an amphetamine- like cortical stimulant employed in treating attention deficit disorders as well as narcolepsy. Nervousness and insomnia are common adverse effects associated with methylphenidate use. (5:1047)

167. Which of the following agents are classified as macrolides? I. amikacin II. polymyxin B III. azithromycin (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

167. (B) Azithromycin (Zithromax) is a macrolide antimicrobial agent related to erythromycin, clarithromycin (Biaxin), and dirithromycin (Dynabac). (3)

168. Stavudine (Zerit) is an antiviral agent employed in the treatment of (A) HIV infection (B) influenza A virus (C) lupus erythematosus (D) herpes zoster (E) Mycobacterium avium complex

168. (A) Stavudine (Zerit) is an antiviral agent used in treating patients with HIV. Its use has been associated with the development of peripheral neuropathy. (3)

Beta carotene is considered to be a precursor for (A) betaseron (B) beta interferon (C) tocopherol (D) vitamin A cells. (E) carteolol

169. (D) Beta carotene is also known as provitamin A. It is a precursor that is converted to vitamin A in the body. (3)

170. Simvastatin (Zocor) acts by (A) inhibiting xanthine oxidase (B) inhibiting HMG-CoA reductase (C) inhibiting acetylcholinesterase (D) acting as a bile sequestrant (E) interfering with fat absorption from the GI

170. (B) Simvastatin (Zocor) is an HMG-CoA reductase inhibitor. It and similar agents such as fluvastatin, lovastatin, cerivastatin, atorvastatin, and pravastatin inhibit HMG-CoA reductase, an enzyme that catalyzes an early step in the synthesis of cholesterol in the body. (3)

171. Which of the following statements is true of fentanyl? I. It is a narcotic agonist analgesic. II. It is available as a transmucosal III. It is available as a transdermal system (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

171. (E) Fentanyl is a narcotic agonist analgesic that is significantly more potent than morphine. It may be administered parenterally (1M or IV) for induction or as an adjunct to general anesthesia. It may also be used transdermally (Duragesic) to manage chronic pain for up to 72 hours. It is also available as a transmucosal system (Fentanyl Oralet, Actiq) and for use as a preanesthetic medication or as an adjunct to anesthesia. (3)

172. Which of the following agents is (are) an anabolic steroid? I. oxandrolone II. stanozolol III. fluorometholone (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

172. (C) Anabolic steroids are related to androgens. Their use results in enhanced tissue building. They are used in the treatment of certain types of anemia and in treating metastatic breast cancer in women. (3)

173. Amrinone (Inocor) is a drug that produces (A) bronchodilation (B) antidepressant action (C) positive inotropism (D) narcotic antagonism (E) enhanced protein utilization

173. (C) Amrinone (Inocor) is an agent that produces a positive inotropic effect as well as vasodilation. It is used to treat congestive heart failure (CHF) in patients who have not responded adequately to digitalis glycosides, diuretics, or vasodilators. (5:165)

174. Which of the following statements is (are) true of potassium? I. It is a divalent cation. II. It facilitates the utilization of glucose by III. It is the principal intracellular ion. (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

174. (D) Potassium is the principal intracellular cation of a number of body tissues. It is essential for proper transmission of nerve impulses; contraction of cardiac, skeletal, and smooth muscles; and in the transport of glucose across cell membranes. (3)

175. Finasteride (Proscar, Propecia) can best be de- GI scribed as a (an) (A) androgen inhibitor (B) estrogen inhibitor (C) androgen (D) estrogen (E) progestin analog

175. (A) Finasteride (Proscar, Propecia) is an androgen hormone inhibitor employed in the treatment of benign prostatic hyperplasia (BPH). Because prostatic development is dependent on androgen activity, finasteride can effectively reduce prostate gland size. Finasteride is also used to treat alopecia. (3)

176. Which of the following agents have cortical stimulant action? I. buspirone II. pemoline III. methamphetamine (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

176. (D) Pemoline (Cylert) and methamphetamine (Desoxyn) stimulate the central nervous system and increase alertness and a heightened awareness of surroundings. High doses may produce hyperactivity, autonomic effects on the heart, and muscle tremor. (3)

177. Lactulose is used to treat I. constipation II. portal-systemic encephalopathy III. renal tubular necrosis (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

177. (C) Lactulose is a synthetic disaccharide that is broken down by gut bacteria to lowmolecular- weight acids and carbon dioxide. These cause an osmotic laxative effect. The acidity produced also causes ammonia to be converted to ammonium ion. Ammonium ion cannot be reabsorbed so it is eliminated from the body. This effect may be useful in patients with portal-systemic encephalopathy to prevent ammonia accumulation in the body. (5:611)

178. The primary function of simethicone in antacid products is to act as a (an) (A) suspending agent (B) adsorbent (C) buffer (D) antiflatulent (E) flavoring agent

178. (D) Simethicone is a mixture of inert silicon polymers. It is employed as an ingredient in antacid products because of its defoaming action in the GI tract. It acts to reduce the surface tension of gas bubbles, thereby causing them to break and release their entrapped gases. (3)

179. Which of the following is (are) true of pen- tamidine isethionate (Pentam, NebuPent, Pentacarinat)? I. may be administered by inhalation II. may be administered parenterally III. used to treat RSV infections (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

179. (C) Pentamidine isethionate (Pentam, NebuPent, Pentacarinat) is an agent that has activity against Pneumocystis carinii, the cause of pneumocystis carinii pneumonia (PCP). It is administered by inhalation to prevent PCP in high-risk, HIV patients. It is administered parenterally to treat PCP. (3)

180. Which of the following statements is (are) true of metronidazole (Flagyl)? I. It is indicated for the treatment of mi- graine headaches. II. It is used to treat superficial fungal infec- tions. III. It has antiprotozoal activity. (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

180. (B) Metronidazole (Flagyl) is an agent that is primarily used because of its antiprotozoal activity, particularly in the treatment of trichomoniasis. It is also employed as an antibacterial in treating certain anaerobic bacterial infections. Patients using metronidazole should avoid alcoholic beverages to avoid disulfiram-like effects when the combination is used. (3)