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Flashcards in ASIPP Pharmacology Questions Deck (242):
1

1350. Which of the following statements about antiplatelet
drugs is false?
A. Abciximab is a monoclonal antibody that binds to the
glycoprotein IIb/IIIa receptor
B. Decreased formation of thromboxane underlies the antiplatelet
action of aspirin
C. Ibuprofen reversibly inhibits cyclooxygenase in platelets
D. Ticlopidine is an inhibitor of the platelet thrombin
receptor
E. Dipyridamole is occasionally used with warfarin in patients
with artifi cial heart valves

1350. Answer: D

2

1351. Which of the following is an antidepressant agent that
selectively inhibits serotonin (5-HT) uptake with
minimal effect on norepinephrine uptake
A. Protriptyline
B. Maprotiline
C. Fuoxetine
D. Desipramine
E. Amoxapine

1351. Answer: C
Source: Smith H, Board Review 2005

3

1352. A patient with Zollinger-Ellison syndrome has been
receiving high doses of cimetidine for 7 weeks. A
frequent adverse effect of cimetidine is
A. Agranulocytosis
B. Systemic lupus erythematosus
C. Inhibition of hepatic metabolism of other drugs
D. Antiestrogenic effects
E. Hypertension

1352. Answer: C

4

1353. The opioid which has been implicated in Torsade de
Pointes is:
A. Morphine
B. Meperidine
C. Buprenorphine
D. Methadone
E. Propoxyphene

1353. Answer: D
Source: Smith H, Board Review 2005

5

1354. Which one of the following drugs is used in the
treatmentof male impotence and activates
prostaglandin E1 receptors?
A. Alprostadil
B. Fluoxetine
C. Mifepristone
D. Sildenafil
E. Zafirlukast

1354. Answer: A

6

1355. A phase II clinical trials typically involve
A. Measurement of the pharmacokinetics of the new drug
in normal volunteers
B. Double-blind evaluation of the new drug in thousands of
patients with target disease
C. Postmarketing surveillance of drug toxicities
D. Evaluation of the new drug in 50 to several hundred
patients with the target disease
E. Collection of data regarding late-appearing toxicities fro
patients previously studies in phase I trials

1355. Answer: D

7

1356. Recreational use of drugs sometimes leads to
dependence. Which of the following is LEAST likely to cause physical dependence?
A. Amphetamine
B. Cocaine
C. Heroin
D. Mescaline
E. Secobarbital

1356. Answer: D

8

1357. Morphine 300 mg po is equivalent to:
A. Morphine 10mg intrathecally
B. Sufentanyl 100mcg intrathecally
C. Morphine 1mg intrathecally
D. Fentanyl 1mcg intrathecally
E. Codeine 60 mg orally

1357. Answer: C
Explanation:
MSO4 300mg po is equivalent to 100mg IV, 10mg
epidurally, or 1mg intrathecally. Sufentanyl is 20 times as
potent as MSO4, and fentanyl is 3 times as potent.
Source: Trescot AM, Board Review 2004

9

1358. The most likely cause of these signs and symptoms is
overdosage of
A. Aspirin
B. Acetaminophen
C. Dextromethorphan
D. Diphenhydramine
E. Ethanol

1358. Answer: A

10

1359. Which of the following local anesthetics is the least
protein bound?
A. Lidocaine
B. Bupivacaine
C. Ropivacaine
D. Mepivacaine
E. Procaine

1359. Answer: E
Source: Day MR, Board Review 2004

11

1360. After an intravenous bolus injection of lidocaine,
the major factors determining the initial plasma
concentration are
A. Dose and clearance
B. Dose and apparent volume of distribution
C. Apparent volume of distribution and clearance
D. Clearance and half-life
E. Half-life and dose

1360. Answer: B

12

1361. Which one of the following effects of the opioid
analgesics is most likely to be mediated via activation
of mu receptors?
A. Cough suppression
B. Elevation of arterial PCO2
C. Emesis
D. Sedation
E. Vasodilation

1361. Answer: B

13

1362. A 38-year-old divorced woman who lived alone visited a
psychiatrist because she was depressed. Her symptoms
included low self-esteem, with frequent ruminations
on her worthlessness, and hypersomnia. She was
hyperphagic and complained that her limbs felt heavy.
An initial diagnosis was made of a major depressive
disorder with atypical symptoms. Treatment was
initiated with amitriptyline, but after 2 months the
patient had not improved signifi cantly. Which one of
the following drugs is MOST likely to have therapeutic
value in this depressed patient?
A. Buprenorphine
B. Diazepam
C. Paroxetine
D. Methylphenidate
E. Risperidone

1362. Answer: C

14

1363. In the management of this patient, which one of the
following procedures is not likely to have therapeutic
value?
A. Alkalinization of the urine
B. Correction of metabolic acidosis and electrolyte imbalance
C. Gastric lavage with an endotracheal tube in place
D. Hemodialysis, if pH or CNS signs are not readily controlled
E. Treatment with acetylcysteine

1363. Answer: E

15

1364. The phenothiazines have a variety of actions at different
receptor types. However, they do NOT appear to
interact with receptors for
A. Dopamine
B. Histamine
C. Nicotine
D. Norepinephrine
E. Muscarine

1364. Answer: A

16

1365. Of the following, which is a phase II biotransformation
reaction?
A. Sulfoxide formation
B. Nitro reduction
C. Ester hydrolysis
D. Sulfate conjugation
E. Deamination

1365. Answer: D
Source: Smith H, Board Review 2005

17

1366. Which of the following is a selective inhibitor of
monoamine oxidase type B (MAO-B) and, therefore,
useful in treating parkinsonism?
A. Bromocriptine
B. Carbidopa
C. Selegiline
D. Phenelzine
E. Tranylcypromine

1366. Answer: C
Explanation:
* Two types of MAO have been found:
- MAO-A, which metabolizes norepinephrine and
serotonin, and
- MAO-B, which metabolizes dopamine.
A. Bromocriptine is a dopamine receptor agonist.
B. Carbidopa inhibits the peripheral metabolism of Ldopa.
- It is also useful in the treatment of parkinsonism.
C. Selegiline is a selective inhibitor of MAO-B. It therefore inhibits the breakdown of dopamine and
prolongs the therapeutic effectiveness of L-dopa in
parkinsonism.
D. Phenelzine and tranylcypromine are nonselective
MAOIs.
Source: Katzung

18

1367. Psychiatric evaluation of a patient after 6 weeks of
treatment with a monoamine oxidase inhibitor
(MAOI) shows no improvement. The psychiatrist now
writes a prescription for fl uoxetine which the patient
starts two days after her fi nal dose of the MAOI. Since
the MAOIs used as antidepressants continue to exert
effects for 2 or more weeks after discontinuance, the
most likely result of the administration of fl uoxetine
now will be to cause
A. A rapid amelioration of her depressive symptoms
B. Electrocardiographic abnormalities
C. Extrapyramidal dysfunction
D. The serotonin syndrome
E. Weight gain

1367. Answer: D

19

1368. The antidepressant with the least sedation side effect is:
A. Desipramine
B. Trazadone
C. Nortriptyline
D. Maprotiline
E. Amitriptiline

1368. Answer: A
Explanation:
Tricyclic antidepressants (TCA) have been known to be
effective in managing chronic pain. Unfortunately, their
side effect profi le very often limits their clinical use. Some
of the major side effects include orthostatic hypotension,
anticholinergic effects, weight gain, sedation, cardiac
conduction disturbances, sexual dysfunction and
restlessness.
TCAā€™s with lower sedating effects include Protriptyline,
amoxapine, desipramine and imipramine. Trazadone is an
atypical antidepressant. It inhibits serotonin uptake, blocks
serotonin 5-HT2 receptors, a1 receptor antagonist. Its
most common side effects are sedation and orthostatic
hypotension. At low doses it is used an adjunct for
insomnia.
Source: Chopra P, 2004

20

1369. The side effects of intravenous (IV) local anesthetics are
related to central nervous system (CNS) toxicity. Signs
are all of the following EXCEPT
A. Metallic taste
B. Tinnitus
C. Agitation
D. Increased appetite
E. Convolusions

1369. Answer: D
Source: Raj P, Pain medicine - A comprehensive Review -
Second Edition

21

1370. Damage to dopamine neurons in the midbrain is a
central feature of the pathophysiology of Parkinsons
disease. The loss of midbrain dopamine in this disease
is accompanied by
A. An increase in the dopamine transporter
B. A decrease in dopamine 1 receptor density
C. An increase in dopamine 2 receptor density
D. A decrease in dopamine synthesis in remaining dopamine
neurons
E. An increase in both dopamine 1 and dopamine 2 receptor
density

1370. Answer: E
Explanation:
(Cooper, pp 317-322.)
Ā· Although there are hypotheses and models of
neurotransmitter dysfunction for many psychiatric and
neurologic diseases, Parkinsonā€™s disease remains the
model disorder in which damage to a specifi c neural
pathway characterized by a particular neurotransmitter
can explain most or all of the pathophysiology of the
disease.
Ā· Patients with Parkinsonā€™s disease have biochemical
evidence of greatly decreased dopamine function in the
brain because of degeneration of the nigrostriatal tract. A
neurotoxic model of the disease, produced in primates by
administration of a derivative of meperidine (MPTP),
demonstrated that severe damage to dopaminecontaining
nigrostriatal neurons produced nearly all of the signs and
symptoms of Parkinsons disease.
Ā· As dopamine neurons in the nigrostriatal tract
degenerate, compensatory changes occur that also
contribute to the pathophysiology. These changes include
a
matching loss of the dopamine transporter and a compensatory rise in both dopamine 1 and dopamine 2
postsynaptic receptor density. The remaining dopamine
neurons synthesize and release more dopamine as a
compensatory mechanism. These secondary physiologic
changes probably explain some of the signs and symptoms
seen in patients with advanced Parkinsonā€™s disease who are
being treated with agents that augment dopamine
production. One example is the ā€œon-off ā€™ phenomenon in
which patients have abnormal increases in movement after
administration of dopamine-augmenting agents, probably
because of hypersensitive dopamine receptors in
remaining neurons of the nigrostriatal tract.
Source: Ebert 2004

22

1371. Of the following characteristics, which is unlikely to be
associated with the process of facilitated diffusion of
drugs?
A. The transport mechanism becomes saturated at high
drug concentrations
B. The process is selective for certain ionic or structural
confi gurations of the drug
C. If two compounds are transported by the same mechanism,
one will competitively inhibit the transport of
the other
D. The drug crosses the membrane against concentration
gradient and the process requires cellular energy
E. The transport process can be inhibited noncompetitively
by substances that interfere with cellular metabolism

1371. Answer: D
Explanation:
Reference: Hardman, pp 3-4.
Drugs can be transferred across biologic membranes by
passive processes (i.e., fi ltration and simple diffusion) and
by specialized processes (i.e., active transport, facilitated
diffusion, and pinocytosis). Active transport is a carriermediated
process that shows all of the characteristics listed
in the question. Facilitated diffusion is similar to active
transport except that the drug is not transported against a
concentration gradient and no energy is required for this
carrier-mediated system to function. Pinocytosis usually
involves transport of proteins and macromolecules by a
complex process in which a cell engulfs the compound
within a membrane-bound vesicle.
Source: Stern-2004

23

1372. The three scales of the Minnesota Multiphasic Personality
Inventory (MMPI) included in the ā€œconversion Vā€ are:
A. Hypochondriasis, psychasthenia, depression
B. Hypochondriasis, depression, hysteria
C. Paranoia, hysteria, depression
D. Social introversion, depression, hysteria
E. Hypochondriasis, anxiety, somatization

1372. Answer: B
Explanation:
Many patients with prolonged chronic pain have elevation
of the hypochondriasis, depression, and hysteria scores of
2 or more standard deviations above the mean. This is
considered clinically signifi cant. Patients with acute pain
frequently have slightly elevated hypochondriasis,
depression, and hysteria scores, but not to a clinically
signifi cant degree. Once the pain resolves, the mild
elevation returns closer to or within the normal range.
Source: Kahn CH, DeSio JM. PreTest Self Assessment and
Review. Pain Management. New York, McGraw-Hill, Inc.,
1996.

24

1373. A young woman presents with a several-year history
of ulcerative colitis. Recently she has been treated
with alprazolam 0.5 mg Q 8 hrs. This pharmacologic
treatment can be expected to:
A. Reduce stress and anxiety
B. Result in long-term improvement
C. Reduce interpersonal dilemmas
D. Produce a mild stimulus
E. Be used without development of tolerance

1373. Answer: A
Explanation:
(Baum, pp 224.)
Ā· Traditionally, minor tranquilizers have been used as a
standard approach to the treatment of psychophysiologic
disorders. However, they fail to deal with the underlying
psychological, social, or physiologic problem, especially
on a long-term basis. They are effective in providing
short-term relief for high levels of stress or anxiety and
can be more effective if combined with behavior therapy or psychotherapy.
Ā·Interpersonal dilemmas are not affected, though they may
seem to be temporarily dulled with minor tranquilizers.
Ā· Minor tranquilizers often have the side effect of
drowsiness, can lead to tolerance with the need for
increased dosages, and can produce withdrawal symptoms
of insomnia, tremors, and even hallucinations.
Source: Ebert 2004

25

1374. Which of the following is highly selective inhibitor of
cyclooxygenase II?
A. Aspirin
B. Acetaminophen
C. Ibuprofen
D. Celecoxib
E. Piroxicam

1374. Answer: D
Explanation:
Reference: Katzung, p 603.
Celocoxib is a cyclooxygenase II inhibitor. Aspirin,
ibuprofen, and piroxicam are relatively nonselective
inhibitors of cyclooxygenases. Acetaminophen has no
effect on cyclooxygenases
Source: Stern - 2004

26

1375. The elimination half-life of which of the following
tetracyclines remains unchanged when the drug is
administered to an anuric patient?
A. Methacycline
B. Oxytetracycline
C. Doxycycline
D. Tetracycline
E. None of the above

1375. Answer: C
Explanation:
Reference: Hardman, pp 1129-1131.
All teracyclines can produce negative nitrogen balance and
increased blood urea nitrogen (BUN) levels. This is of
clinical importance in patients with impaired renal
function. With the exception of doxycycline, tetracyclines
should not be used in patients that are anuric. Doxycycline
is excreted by the GI tract under these conditions, and it
will not accumulate in the serum of patients with renal
insuffi ciency.
Source: Stern-2004

27

1376. Which one of the following statements about cocaine
is false?
A. Blocks sodium channels in axonal membranes
B. Blood pressure increase is due to its ability to release norepinephrine
from sympathetic nerve terminals
C. Cardiac arrhythmias may occur at high doses
D. Derived from a botanical source
E. Topical application can provide local anesthesia and restrict
bleeding

1376. Answer: B

28

1377. With increasing concentrations of a local anesthetic, the
order of effect is
A. Pain fi bersā€”sensory fi bersā€”motor fi bers
B. Sensory fi bersā€”pain fi bersā€”motor fi bers
C. Pain fi bersā€”motor fi bersā€”sensory fi bers
D. Sensory fi bersā€”motor fi bersā€”pain fi bers
E. Sensory fi bersā€”motor fi bersā€”pain fi bers

1377. Answer: A
Explanation:
Reference: Katzung, pp 439-441.
The primary effect of local anesthetics is blockade of
voltage channel-gated Na channels.
Progressively increasing concentrations of local
anesthetics results in an increased threshold of excitation,
a slowing of impulse conduction, a decline in the rate of
rise of the action potential, a decrease in the height of the
action potential, and eventual obliteration of the action
potential.
Local anesthetics fi rst block small unmyelinated or lightly
myelinated fi bers (pain), followed by heavily myelinated
but small-diameter fi bers (sensory) and then largerdiameter
fi bers (proprioception, pressure, motor).
Source: Stern - 2004

29

1378. Two drugs may act on the same tissue or organ through
independent receptors, resulting in effects in opposite
directions. This is known as
A. Physical antagonism
B. Chemical antagonism
C. Competitive antagonism
D. Irreversible antagonism
E. Dispositional antagonism

1378. Answer: A
Explanation:
Reference: Hardman, p 68.
Physiologic, or functional, antagonism occurs when two
drugs produce opposite effects on the same physiologic
function, often by interacting with different types of
receptors. A practical example of this is the use of
epinephrine as a bronchodilator to counteract the
bronchoconstriction that occurs following histamine
release from mast cells in the respiratory tract during a
severe allergic reaction. Histamine constricts the
bronchioles by stimulating histamine H1 receptors in the
tissue; epinephrine relaxes this tissue through its agonistic
activity on b2-adrenergic receptors.
Chemical antagonism results when two drugs
combine with each other chemically and the activity of
one or both isblocked. For example, dimercaprol chelates
lead and reduces the toxicity of this heavy metal.
Competitive antagonism, or inactivation, occurs when two
compounds compete for the same receptor site; this is a
reversible interaction. Thus, atropine blocks the effects of
acetylcholine on the heart by competing with the
neurotransmitter for binding to cardiac muscarinic
receptors. Irreversible antagonism generally results from
the binding of an antagonist to the same receptor site as
the agonist by covalent interaction or by a very slowly
dissociating noncovalent interaction. An example of this
antagonism is the blockade produced by
phenoxybenzamine on a-adrenergic receptors, resulting in
a long-lasting reduction in the activity of
norepinephrine.
Dispositional antagonism occurs when one drug alters the
pharmacokinetics (absorption, distribution,
biotransformation, or excretion) of a second drug so that
less of the active compound reaches the target tissue. For
example, Phenobarbital induces the biotransformation of
warfarin, reducing its anticoagulant activity.
Source: Stern-2004

30

1379. Which of the following is most correct about modern
psychopharmacology?
A. There is a one-diagnosis-one-drug approach
B. Many variables affect the practice of psychopharmacology
C. Medications must be given in large dosages for months
to work
D. Monitoring is rarely necessary and dose adjustments are
infrequently warranted
E. Medications exert their effect with in hours.

1379. Answer: B
Source: Cole EB, Board Review 2003

31

1380. The drug of choice for the management of osteoporosis
caused by high-dose use of glucocorticoids is
A. Alendronate
B. Calcitonin
C. Mestranol
D. Oxandrolone
E. Vitamin D

1380. Answer: A

32

1381. Carisoprodol (SomaĀ®) is associated with all of the
following EXCEPT:
A. Potentially habituating, with potential for abuse
B. Hepatic impairment
C. Excessive sedation
D. Direct central brain stem activity
E. Dizziness, vertigo, ataxia and tremor

1381. Answer: D
Source: Hansen HC, Board Review 2004

33

1382. Synaptic action of catecholamines is terminated by
A. Monoamine oxidase
B. Tyrosine hyroxylase
C. Norepinephrine transporter
D. Catechol-O-methyl transferase
E. Aromatic amino transferase

1382. Answer: B

34

1383. The correct arrangement of local anesthetics in order
of their ability to produce cardiotoxicity from most to
least is
A. Bupivacaine, lidocaine, ropivacaine
B. Bupivacaine, ropivacaine, lidocaine
C. Ropivacaine, bupivacaine, lidocaine
D. Lidocaine, ropivacaine, bupivacaine
E. Lidocaine, bupivacaine, ropivacaine

1383. Answer: B
Explanation:
* All local anesthetics have a dose-dependent effect on
cardiac contractility and conduction velocity. The
cardiodepressant effect generally parallels the anesthetic potency.
* Bupivacaine has been shown to be 16 times more toxic
than lidocaine, well out of proportion to the potency ratio
and two times more toxic than ropivacaine despite similar
nerve-blocking potency

35

1384. The primary determinant of local anesthetic potency is
A. pKa
B. Molecular weight
C. Lipid solubility
D. Concentration
E. Protein binding

1384. Answer: C

36

1385. Among the local anesthetics used for intravenous
regional anesthesia (Bier block), the most rapidly
metabolized and thus least toxic is the following:
A. Etidocaine
B. Lidocaine
C. Ropivacaine
D. Prilocaine
E. Mepivacaine

1385. Answer: D
Explanation:
Prilocaine is the most rapidly metabolized of the amide
local anesthetics and therefore least toxic.
2-chloroprocaine is hydrolyzed rapidly in the blood and,
therefore would appear to be ideal, but it has been
associated with a high incidence of thrombophlebitis and
is therefore not recommended.
Maximum doses of local anesthetics are as follows:
prilocaine, 3 to 4 mg/kg; lidocaine, 1.5 to 3 mg/kg;
ropivacaine, 1.2 to 1.8 mg/kg.

37

1386. Acetyl salicylic acid (aspirin) exerts its action by:
A. Prostaglandin synthesis
B. Inhibiting platelet aggregation
C. Antipyretic action at the hypothalamus
D. Inactivating cyclooxygenase
E. All of the above

1386. Answer: E
Source: Hansen HC, Board Review 2004

38

1387. Adrenergic receptors are coupled to
A. G proteins
B. Tyrosine kinase
C. Sodium channels
D. Cyclo-oxygenase
E. Nerve growth factor

1387. Answer: A

39

1388. The pKa of Lidocaine is:
A. 7.4
B. 7.6
C. 7.7
D. 8.0
E. 8.2

1388. Answer: C
Source: Day MR, Board Review 2004

40

1389. The nephrogenic diabetes insipidus may be caused by:
A. Fluoxetine
B. Haloperidol
C. Lithium
D. Phenytoin
E. Diazepam

1389. Answer: C
Explanation:
Reference: Katzung, p 493.
Lithium treatment frequently causes polyuria and
polydipsia. The collecting tubule of the kidney loses the
capacity to conserve water via antidiuretic hormone. This
results in signifi cant free-water clearance, which is
referred to as nephrogenic diabetes insipidus.
Source: Stern - 2004

41

1390. Clinically signifi cant methemoglobinemia may result
from administration of large doses of
A. Chloroprocaine
B. Bupivacaine
C. Etidocaine
D. Prilocaine
E. Lidocaine

1390. Answer: D
Explanation:
Large doses of prilocaine, usually greater than 600 mg
epidurally, can result in clinically signifi cant
methemoglobinemia. Prilocaine is metabolized by the
liver to o-toluidine, which is responsible for the oxidation
of hemoglobin to methemoglobin. Methemoglobinemia
can be treated with IV methylene blue, or it will resolve
spontaneously.
Source: Hall and Chantigan.

42

1391. Which of the following statements is most correct?
A. Maximum effi cacy of a drug is directly correlated with
its potency
B. The therapeutic index if the LD50 (or TD50) divided by
the ED50
C. A partial agonist has no effect on its receptors unless
another drug is present
D. Graded dose-response data provide information about
the standard deviation of sensitivity to the drug in the
population studied
E. Quantal dose-response curves provide information
about the effi cacy of a drug

1391. Answer: B

43

1392. The toxicity spectrum of aspirin does not include
A. Increased risk of encephalopathy in children with viral
infections
B. Increased risk of peptic ulcers
C. Hyperprothrombinemia
D. Metabolic acidosis
E. Respiratory alkalosis

1392. Answer: C

44

1393. The earliest sign of lidocaine toxicity is:
A. Shivering
B. Nystagmus
C. Lightheadedness and dizziness
D. Tonic-clonic seizures
E. Nausea and vomiting

1393. Answer: C
Explanation:
* The initial symptoms of local anesthetic toxicity are
lightheadedness and dizziness. Patients also may note
perioral numbness and tinnitus.
* Progressive central nervous system (CNS) excitatory
effects include visual and auditory disturbances, shivering,
twitching, and ultimately generalized tonic-clonic seizures.
* CNS depression can ensue, leading to respiratory
depression or arrest.

45

1394. Of the following antiepileptic agents, which is associated
with causing psychosis?
A. Phenobarbital
B. Ethosuximide
C. Phenytoin
D. Vigabatrin
E. Valproic acid

1394. Answer: D
Explanation:
Reference: Katzung, pp 404-405.
Vigabatrin can induce psychosis. It is recommended that it
not be used in patients with preexisting depression and
psychosis.
Source: Stern - 2004

46

1395. A patient on Lorazepam for fi bromyalgia has been out
of drug for four days. He presents with rhinorrhea, etc.
Treatment of choice is:
A. Clonidine
B. Gabapentin
C. Diazepam
D. Oxycodone
E. Methadone

1395. Answer: C

47

1396. The quinolone derivative that is most effective against
Pseudomonas aeruginosa is
A. Norfl oxacin
B. Ciprofl oxacin
C. Ofl oxacin
D. Enoxacin
E. Lomefl oxacin

1396. Answer: B
Explanation:
Reference: Hardman, p 1065
Ciprofl oxacin is a fl uorinated quinolone derivative highly
effective against P.aeruginosa.
Other derivatives in this class have less activity toward
this organism, although they are effective against other
common Gram-negative organisms.
Source: Stern-2004

48

1397. Akathisia, Parkinson-like syndrome, galactorrhea, and
amenorrhea are side effects of perphenazine, caused
by
A. Blockade of muscarinic receptors
B. Blockade of Alpha-adrenergic receptors
C. Blockade of dopamine receptors
D. Supersensitivity of dopamine receptors
E. Stimulation of nicotinic receptors

1397. Answer: C
Explanation:
Reference: Hardman, pp 414-416.
Unwanted pharmacologic side effects produced by
phenothiazine antipsychotic drugs (e.g., perphenazine)
include Parkinson-like syndrome, akathisia, dystonias,
galactorrhea, amenorrhea, and infertility. These side effects
are due to the ability of these agents to block dopamine
receptors.
The phenothiazines also block muscarinic and aadrenergic
receptors, which are responsible for other
effects.
Source: Stern - 2004

49

1398. A 59-year-old woman with a 60 pack-year smoking
history was diagnosed with lung cancer 2 months
ago. She now enters the hospital in coma. Her serum
calcium is 16 mg/dL. Which of the following (given
with IV fl uids) would be most useful to reduce serum
calcium in this patient rapidly?
A. Acetazolamide
B. Furosemide
C. Hydrochlorothiazide
D. Mannitol
E. Spironolactone

1398. Answer: B

50

1399. Which of the following is considered to be the most
cardio-toxic?
A. Bupivacaine S-isomer
B. Bupivacaine racemic mixture
C. Bupivacaine R-isomer
D. Ropivacaine
E. Lidocaine

1399. Answer: C
Explanation: (Raj, Practical Mgmt of Pain, 3rd Ed, page 566, Stoelting,
Pharmacology and Physiology of Anesthetic Practice, 3rd
Ed., page 170-171)
All local anesthetics can produce a dose dependent
depression of cardiac conduction velocity, including intraatrial,
AV nodal, His-Purkinje, and intraventricular
pathways. Part of local anesthetic cardiac toxicity is due to
blockade of cardiac sodium channels. Accidentally
administered bupivacaine can lead to precipitous
hypotension, dysrhythmias, and A-V heart block. The
dissociation of highly lipid soluble bupivacaine from Na+
channels is slow.
Bupivacaine is a racemic mixture, wherein the R
enantiomer is more toxic than the S-enantiomer.
Ropivacaine is a pure S-enantiomer which is intermediate
in toxicity between lidocaine and bupivacaine
Source: Shah RV, Board Review 2004

51

1400. A patient with terminal cancer is suffering from pain that
is gradually increasing in intensity. In the management
of pain in such a patient
A. Physical dependency occurs universally in later stages of
the disease
B. To delay the development of dependency, opioid analgesics
should never be given for initial management of
chronic pain
C. Meperidine is more effective than morphine in cancer
pain states
D. Nonsteroidal anti-infl ammatory drugs may control
symptoms during a signifi cant portion of the course
of the disease
E. The placebo effect is absent

1400. Answer: D

52

1401. Intrathecal baclofen may be indicated for
A. Spasticity
B. Neuropathic Pain
C. nociceptive Pain
D. somatic Pain
E. Pelvic pain

1401. Answer: A
Source: Lou Etal. Pain Practice: march 2001

53

1402. The consumption of shellfi sh harvested during a ā€œred
tideā€ (due to a large population of a dinofl agellate
species) is not recommended. This is because the
shellfi sh are likely to contain
A. Arsenic
B. Botulinum toxins
C. Cyanide
D. Saxitoxin
E. Tetrodotoxin

1402. Answer: D

54

1403. A 23-year-old heroin addict was brought to a hospital
suffering from marked bradykinesia, muscle rigidity,
and tremor at rest. Unfortunately, the extrapyramidal
dysfunction was permanent in this patient, since he
had self-administered this agent this is cytotoxic to
nigrostriatal dopaminergic neurons.
A. MDMA
B. MPTP
C. Ma-huang
D. Meperidine
E. Mescaline

1403. Answer: B

55

1404. Which of the following local anesthetics may cause
methemoglobinemia?
A. Prilocaine
B. Ropivacaine
C. Bupivacaine
D. Procaine
E. Chloroprocaine

1404. Answer: A
Explanation:
(Stoelting, 3rd Ed, pa 164-5)
Prilocaine is an amide local anesthetic that is metabolized
to orthotoluidine. Orthotoluidine is an oxidizing
compound that is capable of converting hemoglobin to
methemoglobin. If the dose of prilocaine exceeds 600mg,
there may be enough methemoglobin (3-5 g/dl) to cause
the patient to appear cyanotic. Methemoglobinemia is
readily reversed by the administration of methylene blue,
1-2 mg/kg intravenously over 5 minutes. This effect,
however, may be short lived, since the methylene blue may
be cleared before converting all of the methemoglobin to
hemoglobin.
Source: Shah RV, Board Review 2004

56

1405. A 24-year-old schizophrenic man has been treated for
several years with haloperidol but, since parkinsonismlike
effects are worsening, the drug is discontinued and
treatment is started with olanzapine. Which one of
the following statements about the new medication is
false?
A. Antipsychotic effects may take several weeks to develop
B. Alleviates some of the negative symptoms of schizophrenia
C. Causes agranulocytosis
D. Has a greater affi nity for serotonin receptors than for
dopamine receptors in the CNS
E. Less effect on pituitary function than haloperidol

1405. Answer: C

57

1406. Of the following, which is unlikely to be associated
with receptors bound to plasma membranes, their
interaction with ligands, and the biologic response to
this interaction?
A. Structurally, these receptors have hydrophobic amino
acid domains, which are in contact with the membrane,
and hydrophilic regions, which extend into the extracellular
fl uid and the cytoplasm
B. Chemical interactions of ligands with these receptors
may involve the formation of many types of bonds, including
ionic, hydrogen, van der Waalsā€™, and covalent
C. Ligand-receptor interactions are often stereospecifi c
(i.e., one stereoisomer is usually more potent than the
other)
D. In some cases, a ligand that acts as an agonist at membrane-
bound receptors increases the activity of an intracellular second messenger
E. Activation of membrane-bound receptors and subsequent
intracellular events elicit a biologic response
through the transcription of DNA

1406. Answer: E
Explanation:
Reference: Hardman, pp 31-34.
* Based upon the molecular mechanisms with which
receptors transduce signals, four major classes of
receptors have been identifi ed:
- ion channel receptors,
- receptors that interact with G proteins,
- receptors with tyrosine kinase activity, and
- nuclear receptors.
* The fi rst three types of receptors are complex membrane
bound proteins with hydrophilic regions located within
the lipoid cell membrane and hydrophilic regions located
within the lipoid cell membrane and hydrophilic portions
found protruding into the cytoplasm of the cell and the
extracellular milieu; when activated, all of these receptors
transmit (or transduce) information presented at the
extracellular surface into ionic or biochemical signals
within the cell (i.e., second messengers). Nuclear receptors
are found in the nucleus of the cell, not bound to plasma
membranes. In addition, these receptors do not transduce
information by second-messenger systems; rather, they
bind to nuclear chromatin and elicit a biologic response
through the transcription of DNA and alterations in the
formation of cellular proteins. Ligand binding to all types
of receptors may involve the formation of ionic, hydrogen,
hydrophobic, van der Waalsā€™, and covalent bonds. In most
cases, ligand-receptor interactions are stereospecifi c; for
example, natural (-)-epinephrine is 1000 times more
potent than (+)-epinephrine.
Source: Stern-2004

58

1407. Although it does not act at any histamine receptor,
epinephrine reverses many effects of histamine.
Epinephrine is a
A. Competitive inhibitor of histamine
B. Noncompetitive antagonist of histamine
C. Physiologic antagonist of histamine
D. Chemical antagonist of histamine
E. Metabolic inhibitor of histamine

1407. Answer: C

59

1408. Which of the following is a true labeled indication
for prescribing CNS stimulants?
A. Narcolepsy
B. Enhanced alertness for driving
C. Reversing opioid induced sedation
D. Chronic pain associated with thalamic strokes
E. Fibromaylgia syndrome

1408. Answer: A
Source: Cole EB, Board Review 2003

60

1409. Which of the following are hydrolyzed by plasma
pseudocholinesterases?
A. Lidocaine
B. Ropivacaine
C. Bupivicaine
D. Tetracaine
E. Etidocaine

1409. Answer: D
Explanation:
(Raj, Practical Mgmt of Pain, 3rd Ed. Page 558)
Plasma pseudocholinesterases hydrolyze the ester linkage
of ester local anesthetics. Amide local anesthetics undergo
biotransformation in the liver.
Source: Shah RV, Board Review 2004

61

1410. The serum concentration of lidocaine would be highest
with which route of administrationā€¦..specifi cally at
60 minutes after administration?
A. Intravenous
B. Epidural
C. Brachial Plexus
D. Intercostal
E. Subarachnoid

1410. Answer: D
Explanation:
(Raj, Practical Mgmt of Pain, 3rd Ed., page 565)Similarly
the peak concentrations would be
Intercostal > Epidural > Intravenous = Brachial Plexus >
Subcutaneous
Source: Shah RV, Board Review 2004

62

1411. The serum concentration of lidocaine would be highest
with which route of administrationā€¦..specifi cally at 5
minutes after administration?
A. Intravenous
B. Intercostal
C. Epidural
D. Brachial Plexus
E. Subcutaneous

1411. Answer: A
Explanation:
(Raj, Practical Mgmt of Pain, 3rd Ed., page 565, fi gure 39-
6) Ok, a trick question.
The actual peak concentrations of these routes at 5
minutes would be on the order of micrograms per
milliliter IV> Intercostal> Epidural> Brachial Plexus >
Subcutaneous
Source: Shah RV, Board Review 2004

63

1412.Which one of the following statements about pentazocine
is false?
A. Analgesia is at least equivalent to that of codeine
B. Causes sedation
C. Classifi ed as a mixed agonist-antagonist
D. Full agonist at mu receptors
E. May interfere with the analgesic effects of morphine

1412. Answer: D

64

1413. Absorption is most dependent upon which of the
following?
A. Gastric pH >7
B. Liver metabolism
C. Gastric & intestinal motility
D. Presence of some liquid in stomach when medications
are taken
E. Amount and volume of drug administered

1413. Answer: C
Source: Cole EB, Board Review 2003

65

1414. A patient has been taking aspirin for rheumatoid
arthritis for 8 years. Exacerbations are becoming
worse and she asks the physician about drugs that
might stop the progression of the disease. Which
one of the following is not a disease-modifying (slowacting)
antirheumatic drug?
A. Auranofi n
B. Hydroxychloroquine
C. Methotrexate
D. Penicillamine
E. Rofecoxib

1414. Answer: E

66

1415. Accidental poisonings are common with both aspirin
and ibuprofen, two OTC drugs available in tasty
chewable tablets. In cases of overdose, aspirin is more
likely than ibuprofen to cause
A. Autonomic instability
B. Hepatic necrosis
C. Metabolic acidosis
D. Thrombocytopenia
E. Ventricular arrhythmias

1415. Answer: C

67

1416. All of the following medications can cause sexual
dysfunction. However, the following drug does not
inhibit desire or decrease arousal.
A. Amphetamines
B. Phenothiazines
C. alpha -Methyldopa
D. Guanethidine
E. Tricyclic Anti-Depressents

1416. Answer: A
Explanation:
(Sierles, pp 393-397.)
- Side effects on sexual function are frequently
produced by antihypertensives, other cardiovascular
compounds, and psychotropic medications
.
- Sexual dysfunctions can be produced through
anticholinergic parasympathetic and sympathetic
ganglionic-blocking, antiandrogenic, Ɵ-adrenergic,
progestational, antihistaminic, and dopamine antagonist
actions.
- Tricyclics, phenothiazines,lpha-methyldopa, and
guanethidine all have the effect of decreasing sexual
arousal. They can also inhibit desire and produce orgasmic
diffi culties.
- Amphetamines can produce orgasmic diffi culties, but
do not appear to inhibit desire or decrease arousal.
- The physician must always consider that drug
combinations can create untoward effects on sexual
function.
Source: Ebert 2004

68

1417. Which of the following statements is true?
A. Acetaminophen leads to more toxicity annually than
NSAIDs
B. Aspirin is known to have a lower annual associated toxicity
cost compared to acetaminophen
C. NSAIDs cause fewer GI toxicity events than acetaminophen
and aspirin
D. Acetaminophen use is associated with a lower annual
toxicity cost
E. Aspirin produces a temporary effect on platelet aggregation

1417. Answer: D
Source: Jackson KC. Board Review 2003

69

1418. Distribution of medication into the brain is most
commonly governed by which of the following?
A. Regional cerebral blood fl ow
B. Abnormalities in the blood-brain barrier
C. Percent of the drug that is protein bound
D. Relative density of target receptors for binding
E. Gastric and intestinal motility

1418. Answer: A
Source: Cole EB, Board Review 2003

70

1419. Norepinephrine will cause contraction of the smooth
muscle in
A. Bronchioles
B. Pupils
C. Intestine
D. Arterioles
E. Ciliary body

1419. Answer: D
Explanation:
(Guyton, pp 701-703.)
The catecholamines nor,
epinephrine and epinephrine will activate both alpha and
Ɵ-adrenergic receptors. When the a1-adrenergic receptors
are stimulated, they activate a G protein, which in turn
activates phospholipase C that hydrolyzes PIP2 and
produces IP3 and DAG. The IP3 causes the release of Ca2+
from the sarcoplasmic reticulum, which in turn increases
muscle contraction. alpha1 adrenergic receptors
predominate on arteriolar smooth muscle, so theses
muscles contract when stimulated with norepinephrine.
The bronchi, pupillary, and ciliary smooth muscles all
contain beta receptors, which cause smooth muscle
relaxation. The intestinal smooth muscle relaxation is
initiated by an alpha2-aradrenergic receptor

71

1420. When an inactive substance or condition induces a
therapeutic change, the procedure (result) is called
A. Nonpharmaceutical reaction
B. Modulated conditioning
C. Placebo effect
D. Reaction formation
E. Fantasy reaction

1420. Answer: C
Explanation:
(Carlson, pp 352-359.)
Ā· Testosterone administered postpubertally to castrated
rats can restore aggressiveness to almost normal levels.
Similarly, neonatal female mice develop masculine
aggressive behavior on receiving androgens. Androgens
also promote aggression in humans.
Ā· Boys are more aggressive than girls at ages 3 to 10, as
has been demonstrated in studies of children.
Source: Ebert 2004

72

1421. A 35-year-old female who has never been pregnant
suffers each month from pain, discomfort, and mood
depression at the time of menses. She may benefi t
from the use of this selective inhibitor of the reuptake
of serotonin.
A. Amitriptyline
B. Bupropion
C. Mirtazapine
D. Paroxetine
E. Trazodone

1421. Answer: D

73

1422. Carbidopa is useful in the treatment of Parkinsonā€™s
disease because it
A. Is a precursor of levodopa
B. Is a dopaminergic receptor agonist
C. Prevents peripheral biotransformation of L-dopa
D. Prevents a breakdown of dopamine
E. Promotes a decreased concentration of L-dopa in the
nigrostriatum

1422. Answer: C
Explanation:
Reference: Hardman, pp 510
Carbidopa is an inhibitor of aromatic L-amino acid
decarboxylase. It cannot readily penetrate the central
nervous system (CNS) and, thus, decreases the
decarboxylation of L-dopa in the peripheral tissues. This
promotes an increased concentration of L-dopa in the
nigrostriatum, where it is converted to dopamine. In
addition, the effective dose of L-dopa can be reduced.
Source: Stern - 2004

74

1423. Which of the following best describes the protein
binding properties of albumin for local anesthetics?
A. Low affi nity, low capacity
B. Low affi nity, high capacity
C. High affi nity, low capacity
D. High affi nity, high capacity
E. High affi nity only

1423. Answer: B
Source: Day MR, Board Review 2004

75

1424. Intractable itching is best treated with:
A. Chlorpromazine
B. Pimozide
C. Haloperidol
D. Risperidone
E. Clozapine

1424. Answer: A

76

1425. Which of the following local anesthetics has the lowest
ratio of dosage for cardiovascular collapse to dosage
required for central nervous system toxicity?
A. Lidocaine
B. Etidocaine
C. Bupivacaine
D. Prilocaine
E. Chloroprocaine

1425. Answer: C
Explanation:
In general, there is an overall direct correlation between
anestheticā€™s potency and its direct depressant effect on
myocardial contractility.
A. Ratio for lidocaine and mepivacaine is 7.1.
B. Ratio for etidocaine is 4.4
C. The ratio of dosage required for cardiovascular
collapse in animal models compared with that required to
produce neurologic symptoms is the lowest for
bupivacaine and levo-bupivacaine (2.0)
- Ratio for ropivacaine is 2.2
D. Ratio for prilocaine is 3.1;
E. Ratio for procaine and chloroprocaine is 3.7

77

1426. Which of the following corticosteroids has the highest
anti-infl ammatory potency
A. Cortisone
B. Prednisone
C. Triamcinolone
D. Methylprednisone
E. Dexamethasone

1426. Answer: E
Source: Smith H, Board Review 2005

78

1427. Which best describes the mechanism of interaction of
cimetidine with benzodiazepine?
A. It decreases benzodiazepineā€™s metabolism
B. It decreases benzodiazepineā€™s sensitivity at the site of
action
C. It decreases benzodiazepineā€™s renal excretion
D. It decreases benzodiazepineā€™s plasma protein binding
E. It decreases benzodiazepineā€™s intestinal absorption

1427. Answer: A
Explanation:
Reference: Hardman, p 906. Katzung, p 1127.
Cimetidine inhibits the activity of cytochrome P450,
slowing benzodiazepam metabolism.
Source: Stern - 2004

79

1428. The first local anesthetic used clinically was
A. Cocaine
B. Tetracaine
C. Lidocaine
D. Bupivacaine
E. Mepivacaine

1428. Answer: A

80

1429. The highest concentration of phenol clinically used in
neurolytic blocks is:
A. 6%
B. 10%
C. 20%
D. 40%
E. 100%

1429. Answer: B
Source: Day MR, Board Review 2004

81

1430. Among the following agents, the selective dopamine
receptor (D2) agonist is:
A. Fluphenazine
B. Bromocriptine
C. Promethazine
D. Haloperidol
E. Chlorpromazine

1430. Answer: B
Explanation:
Reference: Hardman, pp 282-283.
Central dopamine receptors are divided into D1 and D2
receptors. Antipsychotic activity is better correlated to
blockade of D2 receptors.
Haloperidol, a potent antipsychotic, selectively antagonizes
at D2 receptors.
Phenothiazine derivatives, such as chlorpromazine,
fl uphenazine, and promethazine, are not selective for D2
receptors.
Bromocriptine, a selective D2 agonist, is useful in the
treatment of parkinsonism and hyperprolactinemia. It
produces fewer adverse reactions than do nonselective
dopamine receptor agonists.
Source: Stern - 2004

82

1431. One of the following antipsychotics requires weekly
blood counts.
A. Chlorpromazine
B. Clozapine
C. Haloperidol
D. Olanzapine
E. Molindone

1431. Answer: B
Explanation:
Reference: Katzung, p 486.
Clozapine causes agranulocytosis in 1% to 2% of treated
patients. It is generally reversible on discontinuation of the
drug.
Weekly blood tests are recommended for patients who are
treated with clozapine.
Agranulocytosis occurs rarely with other high-potency
antipsychotic agents.
Source: Stern - 2004

83

1432. The maximum dose of lidocaine containing 1:200,000
epinephrine that can be administered to a 70-kg
patient for regional anesthesia is
A. 50 mg
B. 100 mg
C. 200 mg
D. 500 mg
E. 1000 mg

1432. Answer: D
Explanation:
The maximum dose of local anesthetics containing
1:200,000 epinephrine that can be used for major nerve
blocks is:
Lidocaine, 500mg
Mepivacaine, 500mg
Prilocaine, 600mg
Bupivacaine, 225mg
Etidocaine, 400mg
Tetracaine, 200mg.

84

1433. Which one of the following drugs mimics the activity of
metenkephalin in the dorsal horn of the spinal cord?
A. Deprenyl (selegiline)
B. Trihexyphenidyl
C. Baclofen
D. Morphine
E. Phenobarbital

1433. Answer: D
Explanation:
Reference: Hardman, pp 521-522.
* The enkephalins are endogenous agonists of the opioid
receptors.
- The enkephalins are located in areas of the brain and
spinal cord related to the perception of pain. These areas
include the laminae I and II of the spinal cord, the spinal
trigeminal nucleus, and the periaqueductal gray.
* Selegiline and trihexyphenidyl are anti-Parkinsonism
drugs.
* Baclofen is a skeletal muscle relaxant agonist for the
GABA receptor.
Source: Stern - 2004

85

1434. Which of the following local anesthetics is useful for
topical (surface) administration only?
A. Procaine
B. Bupivacaine
C. Etidocaine
D. Benzocaine
E. Lidocaine

1434. Answer: D
Explanation:
Reference: Katzung, p 437.
Local anesthetics are agents that, when applied locally,
block nerve conduction; they also prevent generation of a
nerve impulse. All contain a lipophilic (benzene)
functional group and most a hydrophilic (amine) group.
Benzocaine does not contain the therminal hydrophilic
amine group; thus, it is only slightly soluble in water and is
slowly absorbed with a prolonged duration. It is,
therefore, only useful as a surface anesthetic.
Source: Stern -2004

86

1435. A drug that specifi cally enhances metabolically the
activity of brain dopamine is
A. Benztropine
B. Selegiline
C. Trihexyphenidyl
D. Bromocriptine
E. Chlorpromazine

1435. Answer: B
Explanation:
Reference: Hardman, p 451.
Selegiline inhibits MAO-B, thus delaying the metabolic
breakdown of dopamine.
Selegiline is effective alone in parkinsonism and increases
the effectiveness of L-dopa.
Benztropine and trihexyphenidyl are cholinergic
antagonists in the brain.
Bromocriptine is a dopamine receptor agonist.
Chlorpromazine is an antipsychotic drug with
antiadrenergic properties.
Source: Stern - 2004

87

1436. A 45-year-old patient is to have reconstructive surgery
on a hand that was recently injured in an accident. The
anesthesiologist plans to use regional anesthesia of the
arm for a fairly long procedure. The amide-type local
anesthetic with the longest duration of action is
A. Cocaine
B. Bupivacaine
C. Lidocaine
D. Procaine
E. Tetracaine

1436. Answer: B

88

1437. Which of the following NSAIDs is the most likely to
promote headache?
A. Sulindac
B. Peroxicam
C. Diclofenac
D. Ketoprofen
E. Indomethacin

1437. Answer: E
Source: Smith H, Board Review 2005

89

1438. Among the local anesthetics used for intravenous
regional anesthesia (Bier block) the most rapidly
metabolized and thus least toxic accentis:
A. Etidocaine
B. Lidocaine
C. Ropivacaine
D. Prilocaine
E. Mepivacaine

1438. Answer: B
Source: Smith H, Board Review 2005

90

1439. The antidepressant below with the highest risks of
inducing seizures is:
A. Doxepin
B. Trazadone
C. Amitriptyline
D. Maprotiline
E. Nortriptyline

1439. Answer: D
Source: Smith H, Board Review 2005

91

1440. In comparing the following possible routes, which is
associated with the excretion of quantitatively small
amounts of drugs or their metabolic derivatives?
A. Biliary tract
B. Kidneys
C. Lungs
D. Feces
E. Milk

1440. Answer: E
Source: Smith H, Board Review 2005

92

1441. Seizures occur at what serum concentration range for
lidocaine?
A. 10-12 Ī¼g/mL
B. 10-12 ng/mL
C. 100-120Ī¼g/mL
D. 1-1.2 mg/mL
E. 10-12 mg/mL

1441. Answer: A
Explanation:
(Raj, Practical Mgmt of Pain 3rd Ed., pag 565)
As the serum levels of lidocaine rise, the patient may be at
increased risk for seizures. At 10 to 12 micrograms/ml.,
inhibitory pathways in the brain are selectively inhibited,
but facilitatory neurons are unopposed.
Seizures originate in the amygdale and hippocampus.
Lidocaine toxicity presents with prodromal symptoms,
before seizures: slow speech, jerky movements, tremors,
and hallucinations
Source: Shah RV, Board Review 2004

93

1442. Inhibitors of serotonin (5-HT) uptake such as paroxetine
(PaxilĀ®) interact signifi cantly with which of the
following drugs?
A. Chlorpromazine
B. Tranylcypromine
C. Halothane
D. Benztropine
E. Digoxin

1442. Answer: B
Explanation:
Reference: Katzung, p 1130.
Fatalities have been reported when fl uoxetine and MAO
inhibitors (MAOIs) such as tranylcypromine have been
given simultaneously.
The MAOIs should be stopped at least two weeks before
the administration of fl uoxetine or paroxetine.
Source: Stern - 2004

94

1443. True comments regarding COX II specifi c inhibitors
include immunity from:
A. Potential Nephrotoxicity
B. Platelet Inhibition
C. Gastrointestinal Erosion
D. None of the Above
E. All of the above

1443. Answer: D
Source: Hansen HC, Board Review 2004

95

1444. Which best describes the primary actions of nonsteroidal
anti-infl ammatory drugs (NSAIDS)?
A. Their predominant classic activity is in the CNS
B. They have no analgesic ceiling effect
C. They are potent inhibitors of cyclooxygenase
D. They promote neutrophil phagocytosis

1444. Answer: C
Source: Smith H, Board Review 2005

96

1445. Haloperidol may best be characterized by which of the
following statements?
A. It is classifi ed as a phenothiazine
B. It is a selective D2 receptor agonist
C. Its mechanism of action is completely different from that
of chlorpromazine
D. It is more potent as an antipsychotic drug than is chlorpromazine
E. It produces a lower incidence of

1445. Answer: D
Explanation:
Reference: Hardman, pp 407-412.
Haloperidol is a butyrophenone derivative with the same
mechanism of action as the phenothiazines, that is,
blockade of dopaminergic receptors.
It is more selective for D2 receptors.
Haloperidol is more potent on a weight basis than the
phenothiazines, but produces a higher incidence of extrapyramidal reactions than does chlorpromazine
Source: Stern - 2004

97

1446. Concomitant SSRI and TCA therapy can lead to which
of the following:
A. Elevated TCA blood levels
B. Decreased TCA blood levels
C. Increased SSRI blood levels
D. Decreased SSRI blood levels
E. Increased TCA and SSRI blood levels

1446. Answer: A
Source: Smith H, Board Review 2005

98

1447. In addition to its use in the treatment of schizophrenia,
chlorpromazine is effective
A. In reducing nausea and vomiting
B. As an antihypertensive agent
C. As an antihistaminic
D. In the treatment of depression
E. For treating bipolar affective disorder

1447. Answer: A
Explanation:
Reference: Hardman, pp 418-419, 930.
Chlorpromazine is the prototype compound of the
phenothiazine class of antipsychotic drugs. It is indicated
for use in the treatment of a variety of psychoses, which
includes schizophrenia, and in the treatment of nausea
and vomiting, in both adults and children, from a number
of causes. The drug can be administered orally, rectally, or
intramuscularly for this purpose. It is believed that the
effectiveness of the compound is based on the inhibition
of dopaminergic receptors in the chemoreceptor trigger
zone of the medulla.
Other phenothiazine derivatives are also used for emesis,
including thiethylperazine, prochlorperazine and
perphenazine.
Although chlorpromazine may cause orthostatic
hypotension and has mild H1-histamine receptor blocking
activity, the drug is never used as an antihypertensive or as
an antihistaminic.
Chlorpromazine is not an effective antidepressant drug,
and lithium salts are used for treating the mania that is
associated with bipolar affective disorder.
Source: Stern - 2004

99

1448. The pharmacologic effects of acetylsalicylic acid
(AspirinĀ®) include
A. Reduction in elevated body temperature
B. Promotion of platelet aggregation
C. Alleviation of pain by stimulation of prostaglandin
synthesis
D. Effi cacy equal to that of acetaminophen as an anti-infl
ammatory agent
E. Less gastric irritation than other salicylates

1448. Answer: A
Explanation:
Reference: Katzung, pp 599-603
Aspirin (acetylsalicylic acid) is the most extensively used
analgesic, antipyretic, and anti infl ammatory agent of the
group of compounds known as NSAIDs, or nonopiod
analgesics. Most of its therapeutic and adverse effects
appear to be related to the inhibition of prostaglandin
synthesis. Nonsteroidal anti-infl ammatory drugs inhibit
the activity of the enzyme cyclooxygenase, which mediates
the conversion of arachidonic acid to prostaglandins that
are involved in pain, fever, and infl ammation. Aspirin may
produce irritation and ulceration of the gastrointestinal
(GI) tract, an adverse effect that is about equal to other
salicylates. It also inhibits platelet aggregation.
Acetaminophen, like aspirin, has analgesic and antipyretic
properties, but it does not have clinically signifi cant antiinfl
mmatory activity and is not irritating to the GI tract.
Source: Stern - 2004

100

1449. Which of the following drugs increase alprazolamā€™s half
life?
A. Fluoxetine (ProzacĀ®)
B. Fluvoxamine (LuvoxĀ®)
C. Paroxetine (PaxilĀ®)
D. Sertraline (ZoloftĀ®)
E. Clozapine (ClozarilĀ®)

1449. Answer: B Explanation:
Among the SSRIs, fl uvoxamine appears to present the
greatest risk of drug-drug interactions. Fluvoxamine is
metabolized by CYP 3A4. Fluvoxamine may increase the
half-lives of alprazolam and diazepam and should not be
coadministered with these agents. Fluvoxamine may
increase theophylline concentrations 3-fold and warfarin
concentrations 2-fold, with important clinical
consequences. Fluvoxamine raises concentrations and
may
increase the activity of clozapine, carbamazepine,
methadone, propranolol, and diltiazem.
Source: Laxmaiah Manchikanti, MD

101

1450. If one patient is taking amitriptyline (ElavilĀ®) and
another patient is taking chlorpromazine (ThorazineĀ®),
they are both likely to experience the following:
A. Excessive salivation
B. Extrapyramidal dysfunction
C. Gynecomastia
D. Increased gastrointestinal motility
E. Postural hypotension

1450. Answer: E

102

1451. Which one of the following statements about
scopolamine is false?
A. It has depressant actions of the CNS
B. It may cause hallucinations
C. It is poorly distributed across the placenta to the fetus
D. It may prevent motion sickness and vertigo when applied
as a patch to the skin
E. It is similar to atropine in reducing gastrointestinal motility

1451. Answer: C

103

1452. The most common adverse effect associated with the
tricyclic antidepressants is
A. Anticholinergic effects
B. Seizures
C. Arrythmias
D. Hepatotoxicity
E. Nephrotoxicity

1452. Answer: A
Source: Smith H, Board Review 2005

104

1453. A young mother is breast-feeding her 2-month-old
infant. Which one of the following drug situations
involving the mother is MOST likely to be safe for the
nursing infant?
A. Doxycycline, for Lyme disease
B. Metronidazole, for trichomoniasis
C. Nystatin, for a yeast infection
D. Phentermine, used for weight reduction
E. Triazolam, used as a sleeping pill

1453. Answer: C

105

1454. Which of the following is described as a competitive
benzodiazepine receptor antagonist?
A. Ketamine
B. Chlordiazepoxide
C. Flumazenil
D. Midazolam
E. Triazolam

1454. Answer: C
Explanation:
Reference: Katzung, pp 373-374.
antagonist. The drug reverses the CNS sedative effects of
benzodiazepines and is indicated where general anesthesia
has been induced by or maintained with benzodiazepines
such as diazepam, lorazepam, or midazolam.
Source: Stern - 2004

106

1455. Risk factors for induction of gastropathy and induction
of gastroduodenal ulcers include:
A. Age over 60
B. Alcohol use
C. Steroid use
D. Multiple NSAID use
E. All of the Above

1455. Answer: E
Source: Hansen HC, Board Review 2004

107

1456. The intrathecal equivalent of the epidural administration
of 10 mg of morphine is:
A. 0.1 mg
B. 1 mg
C. 5 mg
D. 10 mg
E. 0.5 mg

1456. Answer: B
Explanation:
* The site of action of spinally administered opiates is the
substantia gelatinosa of the spinal cord.
* Epidural administration is complicated by factors
related to dural penetration, absorption in fat, and
systemic uptake; therefore, the quantity of intrathecally
administered opioid required to achieve effective analgesia
is typically much smaller.
* The ratio of epidural to intrathecal dose of morphine is
approximately 10:1.
* Morphine is typically given in doses of 3 to 10mg in the
lumbar epidural space. 5) Intrathecal morphine dosage is
0.2 to 1.0 mg.
* Onset time for epidural administration is 30 to 60
minutes with a peak effect in 90 to 120 minutes.
* Onset time for intrathecal administration is shorter than
epidural administration. Duration of 12 to 24 hours of
analgesic effect can be expected by either route.

108

1457. The concentration of epinephrine corresponding to a 1:
200,000 mixture is:
A. 0.5 Ī¼g/mL
B. 5 Ī¼g/mL
C. 50 Ī¼g/mL
D. 0.5 Ī¼g/mL
E. 0.1 mg/mL

1457. Answer: B
Explanation:
Epinephrine is commonly packaged as followos:
1:1000 1000 mg per 1,000 mL = 1 mg/ mL
1:10,000 1000 mg per 10,000 mL = 0.1 mg/mL
1:200,000 means 1 g = 1000mg = 1,000,000 Ī¼g per
200,000mL
1,000,000 Ī¼g /200,000 mL = 5 mg/mL
Source: Hall and Chantigan

109

1458. The main advantage of neurolytic nerve blockade with
phenol versus alcohol is
A. Denser blockade
B. Blockade is permanent
C. The effects of the block can be evaluated immediately
D. The block is less painful
E. Phenol is selective for sympathetic fi bers

1458. Answer: D
Explanation:
A. At concentrations less than 5% phenol produces
protein denaturation whereas greater than 5% cause
protein coagulation and non-specifi c segmental
demyelination
- Density of blockade is similar with phenol and
alcohol
B. The initial block wears off over a 24-hour period,
during which time neurolysis occurs.
C. One must wait a day to determine effectiveness of the
neurolytic block.
D. Neurolytic blockade with phenol (6% to 10% in
glycerine) is painless because phenol has a dual action as
both a local anesthetic and a neurolytic agent.
- Alcohol (100% ethanol) is painful on injection and
should be preceded by local anesthetic injection.
E. None of the neurolytic agents affect only sympathetic
fibers.

110

1459. In comparing the following neuroleptics, which is most
likely to cause marked sedation?
A. Chlorpromazine
B. Haloperidol
C. Resperidone
D. Ziprasidone
E. Sertindole

1459. Answer: A
Explanation:
Reference: Katzung, p 482.
Phenothiazines as a class and, in particular, the aliphatic
phenothiazines are most likely to produce marked
sedation.
The mechanism of action for this effect is associated with
its ability to block histamine and acetylcholine receptors.
Source: Stern - 2004

111

1460. The amount of local anesthetic should be administered
per spinal segment to patients between 20 and 40 years
of age receiving an epidural is:
A. 0.5 mL
B. 1.0 mL
C. 1.5 mL
D. 2.0 mL
E. 2.5 mL

1460. Answer: B
Explanation:
Each milliliter of local anesthetic will anesthetize about
one spinal segment. Two thirds of these would be above
the epidural entry side and one third would be below.

112

1461. The polyethylene glycol in depot steroids
A. Does not cause degenerative lesions in nerves of experimental
animals
B. Is present in methylprednisolone but not triamcinolone
C. Is not concentrated enough in the commercial preparation
to block nerve transmission
D. Does not cause arachnoiditis when injected intrathecally
E. All of the above

1461. Answer: C
Source: Raj P, Pain medicine - A comprehensive Review -
Second Edition

113

1462. Clonidine
A. preferentially inhibits alpha 1 receptors
B. only binds to alpha 2 receptors
C. prolongs the sensory block of subarachnoid bupivacaine
D. does produce pruritis, when administered epidurally
E. does not reduce shivering

1462. Answer: C
Explanation:
(Stoelting 3rd Ed., chapter 15)
Clonidine preferentially activates alpha 2 receptors over
alpha 1 by 220:1. Hence it does not inhibit alpha 1
receptors and it does not only bind to alpha 2 receptors.
Clonidine is often used to prolong the effects of
subarachnoid bupivacaine and tetracaineā€¦specifi cally,
motor and sensory blockade. Intravenous fl uids may be
needed to prevent hypotension. Oral clonidine, 150-200
mcg, may prolong spinal anesthesia, but may increase the
risk of hypotension and bradycardia. Clonidine does not
cause the side effects associated with spinal or epidural
opioids: pruritis, nausea and vomiting, delayed gastric
emptying. Clonidine does stop shivering, when given IV
(75 mcgs), by inhibiting central thermoregulatory control.
Source: Shah RV, Board Review 2005 for Smith

114

1463. Which of the following agents does not act on
prostaglandins peripherally, and as such does not
block local infl ammation?
A. AcetaminophenĀ®
B. IbuprofenĀ®
C. NaproxenĀ®
D. CelebrexĀ®
E. AspirinĀ®

1463. Answer: A
Source: Jackson KC. Board Review 2003

115

1464. Acetaminophen is a proven analgesic and anti-pyretic
through action at:
A. Hypothalamus
B. Dorsal horn of the spinal cord
C. Modulation of neurotransmitter activity at the locus
ceruleus
D. By cholinergic enhancement of the GABA-B receptor
complex
E. Acetaminophen is superior to aspirin in providing analgesia.

1464. Answer: A
Source: Hansen HC, Board Review 2004

116

1465. The earliest sign of lidocaine toxicity is:
A. Shivering
B. Nystagmus
C. Lightheadedness and dizziness
D. Toxic-clonic seizures
E. Nausea and vomiting

1465. Answer: B
Source: Smith H, Board Review 2005

117

1466. Effi cacy with TCAs in treating depression is generally
thought to be seen in____
A. 1 to 3 days
B. 3 to 7 days
C. 3 to 7 weeks
D. 6 to 8 weeks
E. After 2 months

1466. Answer: C
Source: Smith H, Board Review 2005

118

1467. A psychiatric patient taking medications develops a
tremor, thyroid enlargement, and leukocytosis. The
drug he is taking is most likely to be
A. Clomipramine (AnafranilĀ®)
B. Haloperidol (HaldolĀ®)
C. Imipramine(TofranilĀ®)
D. Lithium
E. Sertraline( ZoloftĀ®)

1467. Answer: D

119

1468. The correct arrangement of local anesthetics in order
of their ability to produce cardiotoxicity from most to
least is:
A. Bupivacaine, lidocaine, ropivacaine
B. Bupivacaine, ropivacaine, lidocaine
C. Ropivacaine, bupivacaine, lidocaine
D. Lidocaine, ropivacaine, bupivacaine
E. Lidocaine, bupivacaine, ropivacaine

1468. Answer: A
Source: Smith H, Board Review 2005

120

1469. The antidepressant below with the least anticholinergic
and least sedating effects is:
A. Amitriptyline
B. Imipramine
C. Doxepin
D. Trazadone
E. Desipramine

1469. Answer: E
Source: Smith H, Board Review 2005

121

1470. Which of the following is false?
A. the rate of renal dose dopamine is 1-3mcg/kg/minute
B. renal dose dopamine promotes diuresis
C. renal dose dopamine has been conclusively demonstrated
to prevent acute renal failure
D. renal dose dopamine may exacerbate bacterial translocation
in the presence of mesenteric ischemia
E. metoclopramide may interfere with dopamine effects on
the kidney

1470. Answer: C
Explanation:
(Stoelting 3rd Ed., Chapter 12)
Renal dose dopamine may promote diuresis, but it is not
conclusive whether it may protect against acute renal
failure. Dopamine antagonists, such as metoclopramide or
droperidol, interfere with dopamine effects on the kidney.
Low dose dopamine may exacerbate GI mucosal ischemia
and contribute to multiple organ dysfunction syndrome.
Source: Shah RV, Board Review 2005 for Smith

122

1471. Catecholamines are all of the following, except
A. drugs that contain a 3,4 dihydroxybenzene structure
B. are produced by monoamine oxidase
C. are inactivated by catechol-O-methyl transferase
D. are most effectively inactivated by synaptic re-uptake
E. broken down into byproducts, one of which is metanephrine

1471. Answer: B
Explanation:
(Stoelting, 3rd Ed., Chapter 12)
In order for a drug to be classifi ed as a catechol, hydroxyl
groups must be present on the 3 and 4 carbon positions of
the benzene ring. Catecholamines are rapidly inactivated
by monoamine oxidase and catechol-O-methyl transferase.
MAO is found in the GI tract, liver, and kidneys and
catalyzes oxidative deamination. COMT methylates the
hydroxyl group of catecholamines and these inactive
methylated metabolites are conjugated with glucuronic
acid and appear in the urine as breakdown products.
These byproducts include metanephrine, nometanephrine
, and 3-methoxy-4-hydroxymandelic acid.
Despite the importance of enzymatic breakdown, the
actions of catecholamines are principally stopped by
uptake back into the post-ganglionic sympathetic nerve
endings. The synapse is between the post-ganglionic nerve
terminal and the effector tissue.
Source: Shah RV, Board Review 2005 for Smith

123

1472. What would be the most appropriate dose of ephedrine,
for a patient that has a fall in blood pressure, following
epidural anesthesia?
A. 10-25 mg
B. 100-250 micrograms
C. 10-25 micrograms
D. 1-2.5 micrograms
E. 100-250 mg

1472. Answer: A
Explanation:
(Stoelting, 3rd Ed., Chapter 12)
Ephedrine 10-25 mg is administered to adults that drop
their BP following regional anesthesia. Ephedrine is an
indirect acting synthetic non-catecholamine that
stimulates alpha and beta receptors. Ephedrine is more
effective in correcting non-cardiac circulatory changes as
compared to selective alpha and beta agonists. The doses
of ephedrine are1/250th that of epinephrine.
Tachyphylaxis may occur.
Source: Shah RV, Board Review 2005 for Smith

124

1473. Which of the following irreversibly inhibits alpha
receptors?
A. Phentolamine
B. Prazosin
C. Phenoxybenzamine
D. Esmolol
E. Clonidine

1473. Answer: C
Explanation:
(Stoelting, 3rd Ed.)
Phentolamine and prazosin are reversible alpha blockers.
Phenoxybenzamine is an irreversible alpha blocker.
Esmolol is a selective Beta-1 blocker. Clonidine is a
selective partial alpha 2 agonist.
Source: Shah RV, Board Review 2005 for Smith

125

1474. Which is true? Propanololā€¦
A. does not decrease heart rate and cardiac contractility
B. is not subject to a signifi cant hepatic fi rst pass effect
C. is not poorly protein bound
D. does not reduce the clearance of local anesthetics
E. does not increase airway resistance

1474. Answer: C
Explanation:
(Stoelting, 3rd Ed., Chapter 14)
Nonselective Beta Blockers do reduce heart rate and
cardiac contractility. They are highly absorbed by the gut,
but are subject to a signifi cant fi rst pass effect. They are
highly protein bound. They do reduce the clearance of
local
anesthetics, by affecting hepatic blood fl ow. They do
increase airway resistance.
Source: Shah RV, Board Review 2005 for Smith

126

1475. Plasma monitoring should be considered with a tricyclic
antidepressant in the following situation:
1. Lack of effi cacy
2. Suspected Non-compliance
3. Dosing in excess of 50 mg
4. Concurrent therapies with potential cardiac toxicity

1475. Answer: A (1, 2, & 3)
Source: Jackson KC. Board Review 2003

127

1476. Hypercalcemia may lead to the following:
1. Delirium and confusion
2. Fatigue
3. Anorexia
4. Constipation

1476. Answer: E (All)
Source: Reddy Etal. Pain Practice: Dec 2001, march 2002

128

1477. Which of the following local anesthetic/s has/have
inherent vasoconstriction activity?
1. Ropivacaine
2. Cocaine
3. Mepivacaine
4. Lidocaine

1477. Answer: A ( 1, 2, & 3)
Source: Day MR, Board Review 2004

129

1478. Duration of action of local anesthetics may be increased
by
1. Adding vasoconstrictors
2. Adding bicarbonate
3. Increasing the dose
4. Use of carbonated solutions

1478. Answer: B (1 & 3)
Explanation:
Addition of CO2 or HCO3ĀÆ to local anesthetic solutions
hastens the onset of the anesthetic block but does not
increase its duration. Vasoconstrictors decrease
absorption (and metabolism) of local anesthetics. A larger
dose results in longer anesthetic duration, as well as denser
blockade.

130

1479. Tramadol might be considered a medication to use with
caution in those taking:
1. Monoamine oxidase inhibitors.
2. Serotonin reuptake inhibitors.
3. Concomitant use of tricyclic anti-depressants.
4. Benzodiazepines.

1479. Answer: A (1,2, & 3)
Source: Hansen HC, Board Review 2004

131

1480. Symptoms of salicylate toxicity include:
1. Tinnitus
2. Acid-Base disturbances.
3. Dehydration
4. Mydriasis

1480. Answer: A (1,2, & 3)
Source: Hansen HC, Board Review 2004

132

1481. Hypercalcemia can occur in the following:
1. Renal cell carcinoma
2. Cushingā€™s syndrome
3. Hyperparathyroidism
4. Pituitary Adenoma

1481. Answer: B (1 & 3) Source: Reddy Etal. Pain Practice: Dec 2001, march 2002

133

1482. Para-aminobenzoic acid is a metabolite of
1. Mepivacaine
2. Benzocaine
3. Bupivacaine
4. Tetracaine

1482. Answer: C (2 & 4)
Explanation:
* Para-aminobenzoic acid is a metabolite of the ester-type
local anesthetics.
* Local anesthetics may be placed into two distinct
categories based on their chemical structure: ester or
amide.
* All of the amides contain the letter ā€œiā€ twice, once in
ā€œcaineā€ and once elsewhere in the name (e.g., lidocaine,
etidocaine, prilocaine, mepivacaine, and bupivacaine).
These are metabolized in the liver.
* The ester local anesthetics are cocaine, procaine,
chloroprocaine, tetracaine, and benzocaine. These drugs
are metabolized by the enzyme pseudocholinesterase
found in the blood. Their half-lives in blood are very short
, about 60 seconds.
* Para-aminobenzoic acid is a metabolic breakdown
product of ester anesthetic and is responsible for allergic
reactions in some individuals

134

1483. Serious drug interactions may occur with MAO
inhibitors and which of the following drugs?
1. Fluoxetine
2. Amitriptyline
3. Sumatriptan
4. Meperidine

1483. Answer: E (All)
Source: Boswell MV, Board Review 2004

135

1484. Phase II reactions
1. Are oxidative processes
2. Increase water solubility
3. Are typically microsomal
4. Occur in the kidney

1484. Answer: C (2 & 4)
Explanation:
Metabolism of drugs occurs in the liver (most important)
as well as the kidneys, lungs and gastrointestinal tract.
Phase II reactions are conjugation reactions, which involve
covalent binding of adducts to drugs to increase water
solubility and enhance renal excretion. Most conjugation
reactions occur in the cytosol (except for glucuronidation,
which is microsomal).
Source: Boswell MV, Board Review 2004

136

1485. The following agents are Alpha-2 agonists:
1. Clonidine
2. Dexmedetomidine
3. Tizanidine
4. Antipamezole

1485. Answer: A
Source: Smith H, Board Review 2005

137

1486. Factor(s) that infl uence systemic absorption of local
anesthetics include
1. Site of injection of the local anesthetic
2. Lipid solubility of the local anesthetic
3. Addition of vasoconstrictor substances to the local
anesthetic
4. Concentration of the local anesthetic

1486. Answer: E (All)
Explanation:
The amount of systemic absorption of a local anesthetic
depends on the total dose injected, the vascularity of the
injection site, the speed of injection, whether or not a
vasoconstrictor is added to the local anesthetic solution,
and the physicochemical properties of the local anesthetic,
such as protein and tissue binding, lipid solubility, and the
degree of ionization at physiologic pH. For all local
anesthetics, systemic absorption is greatest after injection
for intercostal nerve and caudal blocks, intermediate for
epidural blocks, and least for brachial plexus and sciatic
nerve blocks.

138

1487. Opioid peptides are derived from larger prohormones
that include
1. proenkephalin A
2. Proopiomelanocortin
3. proenkephalin B
4. alpha neoendorphin

1487. Answer: A (1, 2, & 3 )
Explanation:
Over 20 different opioid peptides have been identifi ed by
biochemical techniques.
These peptides derived from three types of larger
prohormonesā€”proopiomelanocortin, proenkephalin A,
and proenkephalin Bā€”which are biologically inactive
precursors. These large protein molecules are cleaved by
proteolytic enzymes within the peptide neuron to form
mixtures of smaller peptides.
The dynorphins, including alpha-neoendorphin, are
formed from proenkephalin B and are intermediate size.
Source: Kahn and Desio

139

1488. The common side effects of clonidine may include the
following:
1. Orthostatic hypotension
2. Dry mouth
3. Bradycardia
4. Sedation

1488. Answer: E
Source: Smith H, Board Review 2005

140

1489. Side effect/s of corticosteroids is/are:
1. Hypoglycemia
2. Hyperkalemia
3. Decreased intraocular pressure
4. Psychosis

1489. Answer: D (4 Only)
Source: Day MR, Board Review 2004

141

1490. Which is true about the lumbar epidural instillation of
local anesthetics?
1. Ropivacaine and bupivacaine at identical concentrations
will provide identical depths and durations of
motor block
2. Local anesthetics diffuse across the dura and act on the
spinal cord and exiting nerve roots
3. Hypotension, bradycardia, and high thoracic levels of
sensor-motor block that occurs 10-15 minutes after an
epidural test dose, suggest a subarachnoid block
4. Local anesthetics exit the intervertebral foramina and
cause multilevel paravertebral nerve blocks

1490. Answer: C (2 & 4)
Explanation:
(Raj, Practical Mgmt of Pain 3rd Ed. Chapter 39
,Stoelting, 3rd Ed., page 174-5.)
There are 2 prevailing theories of how epidural local
anesthetics work. These are choices 2 and 4. Ropivacaine is
thought to produce a less dense and less prolonged motor
block compared to bupivacaine. Additionally, ropivacaine
is less cardiotoxic and is thus advantageous in the obstetric
population. Delayed onset of hypotension, bradycardia,
and a high motor-sensory block, suggests a subdural block
. A test dose, by defi nition, is a small volume of local
anesthetic (with/without an admixture of epinephrine [to
check for vascular uptake]) that is used to exclude an
subarachnoid injection. The delay in presentation suggests
a subdural block.
The hypotension is due to sympatholysis. The bradycardia is due to interruption of the cardiac accelerator fi bers and
the Bezold-Jarisch refl ex.
Source: Shah RV, Board Review 2004

142

1491. Factor(s) that antagonize local anesthetics include
1. Tissue acidosis
2. Presence of myelin
3. Increasing fi ber diameter
4. Rapid fi ring rate

1491. Answer: B (1 & 3)
Explanation:
* The presence of myelin and a rapid neuronal fi ring rate
actually enhance the ability of local anesthetics to block
the neuron.
* Local anesthetics gain access to receptors when the
sodium channels are open, as occurs during an action
potential.
* Larger-diameter fi bers are more diffi cult to block than
smaller-diameter fi bers.
* Tissue acidosis results in formation of the ionized form
of the local anesthetics. This form does not readily
transverse the lipophilic cell membrane.

143

1492. Local anesthetic blockade is
1. Ionic
2. Reversible
3. Frequency-dependant
4. Depolarizing

1492. Answer: A (1, 2, & 3 )

144

1493. Which of the following are metabolized by monoamine
oxidase?
1. Norepinephrine
2. Dopamine
3. Epinephrine
4. Serotonin

1493. Answer: E (All)

145

1494. Local anesthetics are added to an infusion to treat
following type(s) of pain.
1. nociceptive Pain
2. visceral Pain
3. somatic pain
4. neuropathic pain

1494. Answer: D (4 Only)
Source: Lou Etal. Pain Practice: march 2001

146

1495. Which of the following are correct regarding drugs
bound to plasma proteins?
1. Have large volumes of distribution
2. Are typically biologically active
3. Displaced by other drugs
4. Filtered by the glomerulus

1495. Answer: B (1 & 3)
Source: Boswell MV, Board Review 2004

147

1496. Methemoglobin associated with prilocaine
1. Requires liver metabolism of local anesthetic
2. Is of little clinical consequence
3. Is treated with methylene blue
4. Arises from oxidation of hemoglobin

1496. Answer: E (All)

148

1497. Concomitant use of a COX-2 selective NSAID with
an ACE inhibitor potentially produces which of the
following adverse effects:
1. Hypotension via an additive pharmacodynamic effect
2. Hypertension via an additive pharmacokinetic effect
3. Hypotension via an opposing pharmacokinetic effect
4. Hypertension via an opposing pharmacodynamic effect

1497. Answer: D (4 Only)
Source: Jackson KC. Board Review 2003

149

1498. Which of the following antidepressant classes maintains
the best evidence for treating neuropathic pain?
1. Selective Serotonin Reuptake Inhibitors
2. Heterocyclic Antidepressants
3. Serotonin Norepinephrine reuptake inhibitors
4. Tricyclic Antidepressants

1498. Answer: D (4 Only)
Source: Jackson KC. Board Review 2003

150

1499. Epidurally administered opioids encompass the
following true statements.
1. Posterior radicular arteries transfer opioids to the dorsal
horn
2. The epidural venous system carries opioids through the
systemic circulation
3. Epidural fat and opioids bind
4. Opioids are carried through the dura by diffusing across
arachnoid granulations and enter the cerebrospinal
fluid (CSF)

1499. Answer: E (All)
Explanation:
When an opioid is delivered to the epidural space, all the
listed actions occur. These characteristics affect the
clinical effects of various opioids in the following way:
Lipid-soluble agents (e.g., fentanyl) have rapid onset of
analgesia, short duration, and early respiratory depression
associated with the degree of systemic uptake. Hydrophilic
agents (e.g., morphine) have slow onset of analgesia,
prolonged duration, and late respiratory depression
associated with rostral spread via the CSF to the
brainstem.
Source: Kahn CH, DeSio JM. PreTest Self Assessment and
Review. Pain Management. New York, McGraw-Hill, Inc.,
1996

151

1500. Ziconotide
1. is a N-type voltage sensitive calcium channel antagonist.
2. has been reported to be beneficial in spinal cord injury.
3. has side effects including nystagmus, ataxa, hallucinations
etc.
4. is a L-type voltage sensitive calcium channel antagonist.

1500. Answer: A (1, 2, & 3)
Source: Lou Etal. Pain Practice: march 2001

152

1501. The duration of epidural anesthesia is affected by
1. Height of patient
2. Age of patient
3. Weight of patient
4. Addition of epinephrine (1:200,000) to the local anesthetic

1501. Answer: D (4 Only)

153

1502.Frequency-dependant anesthetic blockade is
characterized by
1. Enhanced binding in open state
2. Reduced release in resting state
3. State-dependent phasic block
4. Deeper blockade at higher frequency

1502. Answer: E (All)

154

1503. Receptors involved in opioid activity include:
1. Mu
2. Delta
3. Kappa
4. Gamma

1503. Answer: A (1, 2, & 3)
Source: Trescot A, Board Review 2003

155

1504. The following agents are Alpha-2 agonists,
1. Clonidine
2. Dexmedetomidine
3. Tizanidine
4. Antipamezole

1504. Answer: A (1, 2, & 3)
Explanation:
Clonidine, Tizanidine and Dexmedetomidine are a2 (alpha
-2) agonists. Antipamazole is an a2-antagonist. a2 agonists
have been used in the management of hypertension for
many years. Their role has now expanded to chronic pain
management and as muscle relaxants. One proposed
mechanism of analgesic action of a2 agonists is by
reducing sympathetic outfl ow by a direct action on the
preganglionic outfl ow at the spinal level.
Clonidine is available in oral, transdermal and epidural or
intrathecal use form. It is used for the treatment of
Complex Regional Pain Syndromes, cancer pain,
headaches, post herpetic neuralgia and peripheral
neuropathy.
Tizanidine has been used for painful conditions involving
spasticity. Dexmedetomidine is currently used as sedative
in the Intensive Care Unit.
Source: Chopra P, 2004

156

1505. Glycerin is
1. Weakly neurolytic
2. Hyperbaric relative to CSF
3. Used for trigeminal neuralgia
4. Usually mixed with ethyl alcohol

1505. Answer: A (1, 2, & 3 )

157

1506. Traditional NSAIDs (e.g. Ibuprofen) are now known to
effect their pharmacodynamic activity via inhibition
of:
1. Cyclooxygenase 1
2. Prostaglandin synthetase
3. Thromboxane synthetase
4. Cyclooxygenase 2

1506. Answer: D (4 Only)
Source: Jackson KC. Board Review 2003

158

1507. Glucocorticoids enhance
1. Phospholipase A2
2. Gluconeogenesis
3. Cytokines
4. Lipolysis

1507. Answer: C (2 & 4)

159

1508. Which of the following best describes the receptor
effects of psychoactive medications?
1. Some agents are agonists for receptors and stimulate the
specifi c biological activity of the receptor
2. Some agents are antagonists for receptors and inhibit
biological activity
3. Some agents are partial agonists because they cannot
fully activate a specifi c receptor
4. All antagonists stimulate receptor activity

1508. Answer: A (1, 2, & 3 )
Source: Cole EB, Board Review 2003

160

1509. As compared to adults, which of the following typify
pediatric osseous development?
1. Lower energy absorption
2. Greater mineral content
3. Thinner periosteum
4. Greater porosity

1509. Answer: D (4 Only)
Source: Boswell MV, Board Review 2004

161

1510. Which of the following are true statements concerning
NSAIDs:
1. Do not produce pharmacological dependence
2. May be opioid sparing
3. Are extensively protein bound
4. Do not maintain an analgesic ceiling

1510. Answer: A (1, 2, & 3)
Source: Jackson KC. Board Review 2003

162

1511. Pharmacogenetic variability in drug effects occur by:
1. Differences in drug metabolism
2. Altered levels of normal receptor protein
3. Variations in drug receptor binding
4. Acquired variations due to mutations

1511. Answer: E (All)
Explanation:
Important variations in drug response occur in
microorganisms, such as HIV and bacteria, which
accounts
for resistance to drugs

163

1512. Which of the following drugs produce sodium channel
blockade?
1. Lidocaine
2. Phenytoin
3. Quinidine
4. Amitritpyline

1512. Answer: E (All)

164

1513. Which of the following classes of pharmacologic agents
is(are) useful for nausea?
1. Butyrophenones (Haloperidol and droperidol)
2. Benzodiazepines (midazolam, Diazepam)
3. Antiserotonergic agents (ondansetron)
4. Opioids (fentanyl, Sufentanyl, Demerol)

1513. Answer: B (1 & 3)
Source: Reddy Etal. Pain Practice: Dec 2001, march 2002

165

1514. Hepatic toxicity and NSAID is related to:
1. Class of NSAID
2. Pharmacokinetics of drug
3. Dose of drug
4. Cholestatic activity

1514. Answer: A (1,2, & 3)
Source: Hansen HC, Board Review 2004

166

1515. Clonidine has been found to be a useful drug for
1. nociceptive Pain
2. somatic Pain
3. psychogenic pain
4. neuropathic Pain

1515. Answer: D (4 Only)
Source: Lou Etal. Pain Practice: march 2001

167

1516. Which of the following statements about routes of
administration of opioids is/are true:
1. The rectal route may be used safely in patients with
thrombocytopenia.
2. The intravenous route is more effective than the subcutaneous
route.
3. The transdermal route yields predictable and stable
blood levels.
4. The transmucosal route may be effective in certain situations
but it is expensive.

1516. Answer: D (4 Only)
Source: Reddy Etal. Pain Practice: Dec 2001, march 2002

168

1517. The following statements about drug therapy for
insomnia are accurate.
1. Barbiturates gradually lead to an increase in the activity
of hepatic enzymes
2. Patients develop tolerance for benzodiazepines much
more rapidly than for pentobarbital
3. Barbiturates suppress REM sleep
4. There is no cross-tolerance to other hypnotics

1517. Answer: B (1 & 3)
Explanation:
(Kandel, pp 498-959.)
Ā· Even though many sleeping pills are initially helpful,
they lose their effectiveness within 2 weeks.
Ā· The repeated administration of barbiturates (e.g.,
pentobarbital or phenobarbital) results in a gradual
increase in hepatic enzymes, which normally are
responsible for the degradation of the barbiturates. Not
only is their pharmacologic action decreased, but since the
liver enzymes are relatively nonspecifi c, the result is often
a broad cross-tolerance to other hypnotics. Barbiturates
are known to suppress REM sleep, so when the drug is
withdrawn, a marked REM rebound results, often
aggravating insomnia.
Ā· The benzodiazepines are addictive. Flurazepam
increases hepatic enzymes at a much slower rate; hence
patients develop a tolerance much more slowly than for
pentobarbital. However, an active metabolite of
fl urazepam remains in the body for a longer period of
time (more than 24 h), which results in a gradual increase
of these breakdown substances in the blood. Thus, the
effects of the drug are often felt during the daytime as
diminished alertness and hand-eye coordination. These
symptoms are also aggravated by alcohol.
Source: Ebert 2004

169

1518. Which of the following drugs will decrease the plasma
clearance of amide-type local anesthetics?
1. Propranolol
2. Cimetidine
3. Halothane
4. Phenytoin

1518. Answer: A (1, 2, & 3)
Explanation:
Sympathomimetics, Ɵ(beta)-adrenergic receptor
antagonist, volatile anesthetics, and the H2 - receptor
antagonist cimetidine reduce hepatic blood fl ow, thereby
reducing plasma clearance of amide-type local anesthetics.
There is also evidence that propranolol directly inhibits
mixed-function oxidase activity of hepatocytes. Phenytoin
increases clearance of lidocaine by enzyme induction.

170

1519. Which of the following factors must be true for two
drugs to be considered bioequivalent?
1. Identical Area Under the Curve data for both drugs
2. Drugs given by the same route of administration
3. Time to peak plasma concentrations the same
4. Equal peak plasma concentrations

1519. Answer: E (All)
Source: Boswell MV, Board Review 2004

171

1520. The following drugs produce pharmacologic effects by
inhibition of prostaglandin synthesis:
1. Indomethacin
2. Ibuprofen
3. Piroxicam
4. Acetaminophen

1520. Answer: A (1, 2, & 3)
Explanation:
All of the drugs used, with the exception of
acetaminophen, achieve their therapeutic and toxic effects
by inhibition of prostaglandin synthesis.
NSAIDs, include salicylates as well as sulindac and
fenoprofen.
Acetaminophen is equal in analgesic potency to NSAIDs, but has no effect on prostaglandins.

172

1521. Phenol is
1. Hyperbaric relative to CSF
2. Produces selective coagulation of proteins
3. Has a local anesthetic effect
4. Causes selective small fi ber destruction

1521. Answer: B (1 & 3)

173

1522. Local anesthetics are organic
1. Amines
2. Aromatic
3. Alkaloids
4. Acids

1522. Answer: A (1, 2, & 3 )

174

1523. Dopamine effects include regulation of
1. Memory
2. Cognition
3. Motivation
4. Emotion

1523. Answer: E (All)

175

1524. Ergot alkaloid drugs include:
1. Ergonovine
2. Lysergic acid
3. Methysergide
4. Bromocriptine

1524. Answer: E (All)

176

1525. Which of the following drugs are serotonin antagonists?
1. Ondansetron (Zofran)
2. Granisotron (Kytril)
3. Dolasetron (Anzemet)
4. Metoclopramide (Reglan)

1525. Answer: E (All)

177

1526. The triptan class of drugs are selective
1. Muscarinic agonists
2. Dopamine agonists
3. Cholinergic agonists
4. Serotonin agonists

1526. Answer: D (4 Only)

178

1527. Dopamine agonists include
1. Bromocriptine (Parlodel)
2. Pergolide (Permax)
3. Ropinirole (Requip)
4. Prochlorperazine (Compazine)

1527. Answer: A (1, 2, & 3 )

179

1528. True statements concerning local anesthetics include
the following:
1. The un-ionized form of a local anesthetic binds to the
nerve membrane to actually block conduction
2. If one node of Ranvier is blocked, conduction will be
reliably interrupted
3. The ability of a local anesthetic to block nerve conduction
is directly proportional to the diameter of the
fi ber
4. The presence of myelin enhances the ability of a local
anesthetic to block nerve conduction

1528. Answer: D (4 Only)
Explanation:
1. The un-ionized form of the local anesthetic traverses the
nerve membrane whereas the ionized form actually blocks
conduction. About three nodes of Ranvier must be
blocked to achieve anesthesia.
2. The ability of a local anesthetic to block conduction is
inversely proportional to the diameter of the fiber.
3. The presence of myelin enhances the ability of a local
anesthetic to block conduction, as does rapid fi ring.

180

1529. Most commonly observed side effects in adults who use
Gabapentin include:
1. Somnolence
2. Peripheral edema.
3. Dizziness.
4. Amnesia.

1529. Answer: A (1,2, & 3)
Source: Hansen HC, Board Review 2004

181

1530. Gabapentin is labeled by the Food and Drug
Administration for use in:
1. Epilepsy
2. Myofascial pain syndrome.
3. Post herpetic neuralgia.
4. Bi-polar disease

1530. Answer: B (1 & 3)
Source: Hansen HC, Board Review 2004

182

1531. Characteristics of Prilocaine is/are:
1. Can oxidize oxyhemoglobin to methemoglobin
2. Equipotent ot Lidocaine
3. Rapid onset
4. Most toxic of the amino-amide local anesthetics

1531. Answer: A ( 1, 2, & 3)
Source: Day MR, Board Review 2004

183

1532. Which of the following drugs have sodium channel
blocking properties?
1. Lidocaine
2. Ziconotide
3. Quinidine
4. Strychnine

1532. Answer: B (1 & 3)

184

1533. The elimination of Gabapentin is primarily by:
1. Hepatitis
2. Hepatitis degradation and hydrolysis.
3. Plasma protein transferase degradation.
4. Renal excretion as unchanged drug.

1533. Answer: D (4 Only)
Source: Hansen HC, Board Review 2004

185

1534. Which of the following local anesthetics depend on
hepatic blood fl ow for plasma clearance?
1. Procaine
2. Prilocaine
3. Tetracaine
4. Lidocaine

1534. Answer: C (2 & 4)

186

1535. Norepinephrine is a
1. Pulmonary bronchodilator
2. Arterial vasoconstrictor
3. Muscular vasodilator
4. Cardiac stimulant

1535. Answer: C (2 & 4)

187

1536. Cautions when using the lidocaine 5% transdermal
patch delivery system includes:
1. Contraindications or hypersensitivity to amide local
anesthetics
2. Hepatic disease
3. Allergy or sensitivity to hepaba derivatives
4. The elderly or infi rmed

1536. Answer: E (All)
Source: Hansen HC, Board Review 2004

188

1537. If ketorolac 30 mg were substituted for meperidine 100
mg after an outpatient inguinal herniorrhaphy, the
patient would experience less
1. Respiratory depression
2. Analgesia
3. Nausea
4. Bleeding

1537. Answer: A (1, 2, & 3)

189

1538. Which one of the following best describes the
implications of aging on the activity of psychoactive
medications?
1. Absorption is increased due to decreased surface villi,
gastric motility, intestinal perfusion & delayed gastric
emptying
2. Increased albumin lessens the amount of free medication
carried in the blood
3. Changes in liver & kidney function along with drugdrug
interactions lead to increased metabolism, shortened
half-lives, and less likely toxicity
4. Distribution is altered due to decrease in total body
water & lean body mass

1538. Answer: D (4 Only)
Source: Cole EB, Board Review 2003

190

1539. Newer COX-2 selective NSAIDs were believed to be
preferred agents based on which of the following
criteria:
1. Diminished renal toxicity
2. Diminished hepatic toxicity
3. Diminished platelet effects
4. Diminished gastrointestinal toxicity

1539. Answer: D (4 Only)
Source: Jackson KC. Board Review 2003

191

1540. Of the following agents is/are effective topical anesthetics
when applied to mucous membranes
1. Lidocaine
2. Cocaine
3. Tetracaine
4. Procaine

1540. Answer: A (1, 2, & 3)
Explanation:
* Lidocaine, tetracaine, and cocaine are all effective topical
anesthetics when applied to mucous membranes.
* Cocaine is unique among local anesthetics in that it is a
vasoconstrictor.
* Procaine penetrates the mucous membranes poorly and
is
not useful as a topical agent.

192

1541. The seizure threshold for local anesthetics is raised by
1. Hypokalemia
2. Hyperoxia
3. Hypocarbia
4. Acidosis

1541. Answer: B (1 & 3)
Explanation:
* Hyperventilation of the lungs and hypocarbia decrease
cerebral blood fl ow, thus reducing delivery of local
anesthetic to the brain.
* The alkalosis and hypokalemia that occur as a result of
hyper-ventilation lead to hyperpolarization of the resting
transmembrane potential of neurons, thus increasing the
seizure threshold for local anesthetics.
* Acidosis and hypercarbia decrease the seizure threshold
for local anesthetics.
* Hyperoxia does nothing to prevent seizures.

193

1542. Indentify accurate statements of central nervous system
effects of anti-infl ammatory drugs?
1. Reduction of hyperalgesia at the spinal level
2. Decreasing prostanoid production
3. Action at the central opioid mechanisms responsible
for analgesia
4. Inhibition of magnesium activation at the N-Methyl D
Aspartate Receptor

1542. Answer: A (1, 2, & 3)
Source: Hansen HC, Board Review 2004

194

1543. Examples of phenanthrene class of opioid include all
except:
1. Morphine
2. Fentanyl
3. Codeine
4. Meperidine

1543. Answer: B
Source: Smith H, Board Review 2005

195

1544. The following statements are true regarding fentanyl as
a good agent for transdermal use:
1. Low molecular weihjt
2. Adequate lipid solubility
3. High analgesic potency
4. Low abuse potential

1544. Answer: A
Source: Smith H, Board Review 2005

196

1545. The following are true choices which may lead to
decreased opioid requirements:
1. Combined treatment with local anesthetics
2. Advance age
3. Decreased renal function
4. Combined treatment with gabapentin

1545. Answer: E
Source: Smith H, Board Review 2005

197

1546. The following drugs are effective in a treatment of
pruritus from administration of neuraxial opiates:
1. Nalbuphine 5mg IV
2. Diphenhydramine 50mg IV
3. Hydroxyzine 20mg IM
4. Propofol 10mg IV

1546. Answer: E
Source: Smith H, Board Review 2005

198

1547. Enkephalins are found in the:
1. Sympathetic nervous system
2. Gastrointestinal tract
3. Periaqueductal gray
4. Adrenal Medulla

1547. Answer: E
Source: Smith H, Board Review 2005

199

1548. The adverse effects of L-dopa therapy improved by
adding carbidopa include:
1. Mydriasis
2. Cardiac arrhythmia
3. Nausea
4. Depression

1548. Answer: A (1, 2, & 3)
Explanation:
Reference: Katzung, pp 464-467.
Adding carbidopa decreases the amount of dopamine that
is formed peripherally from dopa by dopa decarboxylase.
Depression, psychosis, and other psychiatric adverse
effects of L-dopa are mediated by CNS dopamine, so
adding carbidopa does not make them less likely. The
combination of L-dopa and carbidopa reduces the
extracerebral metabolism of L-dopa, resulting in decreased
peripheral adverse effects.
Source: Stern - 2004

200

1549. Factor(s) that determine the proportion of local
anesthetic that exists in the un-ionized (freebase) and
ionized (cation) forms include
1. Local anesthetic concentration
2. Tissue pH
3. Local anesthetic volume
4. pKa of the local anesthetic

1549. Answer: C (2 & 4)
Explanation:
* Local anesthetics are weak bases with pKas ranging from
7.6 to 8.9.
* A low pH will result in the formation of the ionized
species because more protons (hydrogen ions) are
available to bind to the nitrogen atoms in the local
anesthetics.
* Local anesthetic concentration and volume have nothing
to do with the fraction of anesthetics in the ionized form.

201

1550. True statements regarding additives to local anesthetics
for neuraxial blocks include
1. Intrathecal clonidine has analgesic properties
2. Intrathecal phenylephrine has analgesic properties
3. Intrathecal epinephrine has analgesic properties
4. Addition of epinephrine to epidural local anesthetics
increases the incidence of hypotension

1550. Answer: E (All)
Explanation:
Clonidine alone, when administered neuraxially, is an
effective analgesic. Intrathecal drugs possessing alphaagonist
(phenylephrine/epinephrine) properties will also
produce analgesia. Intrathecal epinephrine will reduce
systemic/vascular uptake of local anesthetics, thereby
enhancing their effects, including hypotension.

202

1551. Drugs that will decrease the plasma clearance of estertype
local anesthetics include
1. Echothiophate
2. N2O
3. Neostigmine
4. Phenytoin

1551. Answer: B (1 & 3)
Explanation:
* Ester-type local anesthetics are broken down partly in
the
blood by pseudocholinesterase and red cell esterase and
partly in the liver.
* Anticholinesterase drugs, such as echothiophate,
neostigmine, pyridostigmine, and edrophonium, inhibit
pseudocholinesterase and thus slow the plasma clearance
of ester-type local anesthetics.
* Phenytoin is an enzyme inducer that may hasten the
metabolism of amide-type local anesthetics, such as
lidocaine but would have little, if any, effect on ester-type
local anesthetics and would certainly not impede their
plasma clearance.

203

1552. Epinephrine is effective in increasing the clinical
duration of action of
1. Procaine
2. Lidocaine
3. Tetracaine
4. Etidocaine

1552. Answer: A (1, 2, & 3)
Explanation:
1. Epinephrine or phenylephrine is frequently added to
local anesthetic solutions to produce vasoconstriction.
This decrease systemic absorption of the local anesthetic
and prolongs the duration of action of the local anesthetic.
2. The extent to which epinephrine prolongs the block
depends on both the site of injection and the specifi c local
anesthetic. These benefi cial effects are limited when
vasoconstrictors are used with epidural etidocaine and
bupivacaine.

204

1553. 30mg of MS04 orally are equivalent to:
1. 10mg MS04 IV
2. 20mg of oral oxycodone
3. 1.5mg hydromorphone IV
4. 20mg methadone

1553. Answer: E
Source: Smith H, Board Review 2005

205

1554. Which best describes the mechanism of interaction of
nonsteroidal anti-infl ammatory drugs (NSAIDs) with
lithium salts?
1. They increase lithium intestinal absorption
2. They increase lithium plasma protein binding
3. They increase lithium sensitivity at its site of action
4. They increase lithium renal reabsorption

1554. Answer: D (4 Only)
Explanation:
Reference: Hardman, p 448. Katzung, p 493, 1130.
Some NSAIDs can increase proximal tubular reabsorption
of lithium salts, which can create toxic levels of lithium in
the plasma.
Source: Stern - 2004

206

1555. Which of the following drugs induces the activity of
CYP 3A4?
1. Carbamazepine
2. Phenobarbital
3. Phenytoin
4. Fluoxetine

1555. Answer: A ( 1, 2, & 3)
Explanation:
Fluoxetine is an inhibitor of CYP 2D6
Source: Boswell MV, Board Review 2004

207

1556. Dose-response curves of drugs describe
1. Activity
2. Potency
3. Affinity
4. Slope

1556. Answer: E (All)
Source: Boswell MV, Board Review 2004

208

1557. COX II selectivity of NSAIDs:
1. Is associated with prostaglandin inhibition that is associated
with pain and hyperalgesia
2. Preserves normal function of the GI mucosa
3. Is characterized by the ability to decrease sensitization in
the central nervous system by inhibition of prostanoid
formation, and action of substance P at the NMDA
receptor
4. Related to sexual dysfunction in males over age 60

1557. Answer: A (1,2, & 3)
Source: Hansen HC, Board Review 2004

209

1558. Beta-endorphin is found in the:
1. Locus ceruleus
2. Hypothalamus
3. Periaqueductal gray
4. Pituitary

1558. Answer: E
Source: Smith H, Board Review 2005

210

1559. True statement regarding alpha 1-acid glycoprotein
include that it:
1. Has high capacity and low affi nity
2. Has a high affi nity for basic drugs
3. Remains unaffected by recent trauma
4. Is an acute-phase reactant

1559. Answer: C
Source: Smith H, Board Review 2005

211

1560. Pharmacodynamics is concerned with:
1. Absorption
2. Signaling pathways coupled to receptors
3. Distribution
4. Receptor binding

1560. Answer: C
Source: Smith H, Board Review 2005

212

1561. Choose the true statement:
1. Alpha - 1 acid glycoprotein predominantly binds basic
drugs
2. Local pH may affect the volume of distribution
3. the volume of distribution is inversely related to protein
binding
4. Morphine is mostly bound to albumin

1561. Answer: A
Source: Smith H, Board Review 2005

213

1562. Opioid peptides are derived from larger prohormones
that include:
1. Proenkephalin A
2. Proopiomelanocortin
3. Proenkephalin B
4. Alpha neoendorphin

1562. Answer: A
Source: Smith H, Board Review 2005

214

1563. Tricyclic antidepressant toxicities include which of the
following?
1. Delirium
2. Weight gain
3. Urinary retention
4. Prolongation of QT interval

1563. Answer: E (All)
Source: Boswell MV, Board Review 2004

215

1564. Which of the following statements about alcoholics
withdrawing from alcohol are true?
1. Overhydration more likely than dehydration
2. Well-nourished patients should receive vitamins
3. Often dependent also on other CNS depressants
4. Withdrawal syndrome followed by insomnia

1564. Answer: E (All)
Explanation:
Physical symptoms of withdrawal from alcohol usually
occur 6-48 hours after last drink, subside in 5-7 days
without treatment, but irritability nd insomnia may last 10
days or longer. Nutritional and vitamin defi ciences are
common even if the individual appears well nourished.
The patient must be watced for overhydration especially
during IV fl uid replacement.
Source: Psychiatry specialty Board Review By William M.
Easson, MD and Nicholas L. Rock, MD

216

1565. Prototypic kappa-receptor agonists include:
1. Dynorphin
2. N-allyl normetazocaine
3. Ketocyclazocaine
4. DADL

1565. Answer: B
Source: Smith H, Board Review 2005

217

1566. The elimination half-life of an amide local anesthetic is
prolonged in which of the following the conditions?
1. Liver disease
2. Term pregnancy
3. Heart failure
4. Kidney disease

1566. Answer: B (1 & 3)

218

1567. Non Steroidal Anti Infl ammatory medicines should be
used with caution with the following cotherapeutic
agents:
1. Coumadin
2. Methotrexate
3. Lithium Carbonate
4. H2 Antagonists

1567. Answer: A (1,2, & 3)
Source: Hansen HC, Board Review 2004

219

1568. Which of the following is true about local anesthetics?
1. they pass through the nerve membrane as in their base
form
2. once in the axoplasm, the ionized form that binds to the
Na+ channel
3. those local anesthetics with PKa of 7.6 would be expected
to have a faster onset of action compared to those
with a PKa of 8.0
4. the benzene ring is an important moiety in determing
the lipid solubility of ester local anesthetics

1568. Answer: E (All)
Explanation:
( Raj, Practical Mgmt of Pain, 3rd E. , Chapter 39)
The benzene ring is an aromatic moiety that is a major
contributor to the lipid solubility of a local anesthetic.
Local anesthetics need to be lipid soluble, i.e., unionized or
in their base form, in order to cross the neural membrane
and enter the axoplasm. Once in the axoplasm, the local
anesthetic can acquire a proton and become ionized. The
ionized form will bind to the active portion of the Na+
channel
Source: Shah RV, Board Review 2004

220

1569. Medications used for the pharmacologic treatment of
mania include:
1. Carbamazepine
2. Gabapentin
3. Valproate
4. Verapamil

1569. Answer: E (All)
Explanation:
Anticonvulsants are effective more quickly than lithium,
and potentiate the effect. Centrally acting L type calcium
channel blockers are also helpful.
Source: Boswell MV, Board Review 2004

221

1570. Anti Infl ammatory medications exert their action at the
tissue level by blocking:
1. Phospholipase A2
2. Arachidonic Acid Liberation at the Lipid Membrane
3. Functional Leukotrienes
4. Lipoxygenase

1570. Answer: D (4 Only)
Source: Hansen HC, Board Review 2004

222

1571. Tricyclic toxicities are best described by which of the
following?
1. Diarrhea and urinary frequency
2. Adverse effect on cardiac rhythm
3. No effect on other mental disorders other than relief of
Major Depression
4. Delirium may result from central cholinergic blockade

1571. Answer: C (2 & 4)
Source: Cole EB, Board Review 2003

223

1572. Pharmacokinetic properties and toxicity of NSAIDs
appear to be related to:
1. Plasma half life
2. Protein binding
3. Dose of the drug
4. Hepatic function

1572. Answer: A (1,2, & 3)
Source: Hansen HC, Board Review 2004

224

1573. Medical conditions and/or factors which may affect the
amount of free circulating drug include:
1. Hepatic Cirrhosis
2. Burns
3. Renal suffi ciency
4. Trauma

1573. Answer: E
Source: Smith H, Board Review 2005

225

1574. Which of the following would indicate alcohol
dependence?
1. Persistent drinking, even though worsens gastric ulcers
2. Job effi ciency impaired due to repeated hangovers
3. Several unsuccessful attempts to cut down on drinking
4. Family history of alcoholism

1574. Answer: A (1, 2, & 3)
Explanation:
Alcohol dependence is characterized by the inability to cut
down and stop drinking, despite repeated efforts to control
drinking (ā€œgoing on the wagonā€), binges, and amnesia
periods, and continued drinking while knowing a serious
physical condition is being exacerbated by alcohol.
Source: Psychiatry specialty Board Review By William M.
Easson, MD and Nicholas L. Rock, MD

226

1575. A patient in the intensive care unity is receiving
an infusion of epinephrine, after exsanguinating
signifi cantly following a total hip replacement. The
order states that epinephrine should be titrated, but
kept in the range of 10-20 micrograms/minute. The
ICU nurse, however, accidentally writes for 1-2 mcg/
minute. One would expect:
1. An increase in the systolic blood pressure
2. A reduction in mean arterial blood pressure
3. An increase in blood fl ow to the muscles
4. An increase in blood fl ow to the skin

1575. Answer: C (2 & 4)
Explanation:
(Stoelting, 3rd Ed., Chapter 12)
Epinephrine demonstrates:
- Beta-2 receptor agonism at 1-2 mcg/minute
- Beta-1 receptor agonism at 4-6 mcg/minute
- Alpha and Beta agonism at 10-20 mcg/minute
Thus, at
- High doses: Beta 1 will increase systolic
BP/HR/Cardiac Output
Beta 2 will reduce diastolic BP
Hence, mean arterial pressure will marginally increase,
and pulse pressure will increaseā€”refl ex bradycardia will
not occur
High to Low doses: reduced alpha agonism implies
increased perfusion to the skin. Since Beta-2 agonism is
preserved at low doses, then skeletal muscle perfusion will
be preserved
Source: Shah RV, Board Review 2005 for Smith

227

1576. NSAIDs which are considered ā€œprodrugsā€ include:
1. Piroxicam
2. Nabumetone
3. Diflunisal
4. Sulindac

1576. Answer: C
Source: Smith H, Board Review 2005

228

1577. A 29-year-old male requires suturing for a deep laceration
in his palm. He is allergic to benzocaine. Which of the
following local anesthetics could safely be used?
1. Cocaine
2. Tetracaine
3. Procaine
4. Bupivacaine

1577. Answer: D (4 Only)
Explanation:
Reference: Hardman, p 340. Katzung, p 437.
Of the listed agents, only bupivacaine is an amide. Allergy
to amide-type local anesthetics is much less frequent than
with ester-type local anesthetics, such as benzocaine;
patients who demonstrate an allergy to one such drug will
be allergic to all of them.
Source: Stern - 2004

229

1578. Which of the following are true statements concerning
NSAIDs?
1. Do not produce pharmacological dependence
2. May be opioid sparing
3. Are extensively protein bound
4. Do not maintain an analgesic ceiling

1578. Answer: A
Source: Smith H, Board Review 2005

230

1579. Therapy with acetylsalicylic acid needs to be carefully
evaluated in patients with ā€œFranklinā€™s triadā€ which
includes:
1. Nasal polyps
2. Athsma
3. Urticaria
4. Rhinorrhea

1579. Answer: A
Source: Smith H, Board Review 2005

231

1580. Which of the following is true?
1. dopamine is an important neurotransmitter in the peripheral
nervous system
2. dopamine-2 receptors are principally presynaptic and
inhibit release of norepinephrine
3. dopamine-1 receptors are principally mediate vasodilation
of the renal, mesenteric, and coronary vessels.
4. dopamine receptors are associated with ā€˜rewardā€™ mechanisms
in patients that abuse alcohol

1580. Answer: E (All)
Explanation:
(Stoelting, 3rd Ed., Chapter 12)
All of the above statements are true
Dopamine is a neurotransmitter in the peripheral and
central nervous systems. D1 receptors are located postsynaptically
and mediate vasodilation of the renal,
mesenteric, and coronary vessels.
D2 receptors re presynaptic and inhibit release of
norepinephrine. D2 receptors are responsible for
dopamine induced nausea and vomiting. D2 receptors are
responsible for the reward mechanisms associated with
EtOH and cocaine abuse.
Source: Shah RV, Board Review 2005 for Smith

232

1581. The antidepressant(s) which is/are secondary amine(s)
TCA:
1. Desipramine
2. Doxepin
3. Nortriptyline
4. Imipramine

1581. Answer: B
Source: Smith H, Board Review 2005

233

1582. Glucocorticoids enhance:
1. Phopholipase A2
2. Gluconeogenesis
3. Cytokines
4. Lypolysis

1582. Answer: C
Source: Smith H, Board Review 2005

234

1583. Ethyl alcohol
1. Causes selective small fi ber destruction
2. Produces a more profound block than phenol
3. Has a local anesthetic effect
4. Hypobaric relative to CSF

1583. Answer: C
Source: Smith H, Board Review 2005

235

1584.The volume of distribution for a particular
pharmacologic agent is infl uenced by its:
1. Ionization state
2. Polarity
3. Lipophilicity
4. Molecular weight

1584. Answer: E
Source: Smith H, Board Review 2005

236

1585. Local anesthetic metabolized by ester hydrolysis include
1. Lidocaine
2. Cocaine
3. Mepivacaine
4. Tetracain

1585. Answer: C (2 & 4)

237

1586. Adverse effects of traditional NSAIDs (e.g. Ibuprofen)
may include:
1. Renal
2. Cutaneous
3. Gastrointestinal
4. Central nervous system

1586. Answer: E
Source: Smith H, Board Review 2005

238

1587. Which of the following local anesthetic concentrations
is(are) isobaric?
1. 2% Lidocaine
2. 0.5% Tetracaine
3. 0.5% Bupivacaine
4. 0.75% Bupivacaine

1587. Answer: E (All)
Explanation:
All of these local anesthetic concentrations are isobaric.
Tetracaine 0.5% is prepared by mixing equal volumes of
1% tetracaine and preservative-free saline. Hyperbaric
solutions can be prepared by mixing equal volumes of 1%
tetracaine and 10% dextrose, resulting in 0.5% tetracaine
in 5% dextrose, or by mixing equal volumes of 0,75%
bupivacaine with 10% dextrose, yielding a 0.375%
solution of bupivacaine in 5% dextrose. Alternatively,
factory-mixed preparations of 0.75% bupivacaine in
8.25% dextrose and 5% lidocaine in 7.5% dextrose are
available. To prepare hypobaric tetracaine, 10mg (1 mL of
1% tetracaine) are mixed with 9 mL of sterile H2O to yield
10 mL of 0.1% tetracaine. This has a baricity of 1.0.

239

1588. Non-selective NSAID agents inhibit both:
1. Cyclooxygenase-I Constitutive Pathway
2. Leukotrienes Pathway
3. Cyclooxygenase-II Inducible Pathway
4. Arachidonic Acid Lipid Membrane Cascade

1588. Answer: B (1 & 3)
Source: Hansen HC, Board Review 2004

240

1589. High risk factors for NSAID-induced renal insuffi ciency
include:
1. Signifi cant hypovolemia
2. Sever congestive heart failure
3. Hepatic cirrhosis
4. Older age

1589. Answer: A
Source: Smith H, Board Review 2005

241

1590. Which of the following can be administered orally?
1. Albuterol
2. Epinephrine
3. Ephedrine
4. Dopamine

1590. Answer: B (1 & 3)
Explanation:
(Stoelting, 3rd Ed., chater 12)
Albuterol is a selective beta 2 agonist that is given for the
treatment of acute bronchospasm due to asthma.
Although it can be given orally, it is usually given via
nebulization or as a metered dose inhaler.
Ephedrine is resistant to MAO in the gut and is absorbed
unchanged into the circulation after oral administration.
Endogenous catecholamine can be broken down by GI
mucosal and hepatic enzymes
Source: Shah RV, Board Review 2005 for Smith

242

1591. Epinephrine causes which of the following?
1. Relaxation of gastrointestinal smooth muscle
2. Relaxation of the trigone
3. Contraction of the urinary sphincter
4. Contraction of the detrusor muscle

1591. Answer: B (1 & 3)
Explanation:
(Stoelting, 3rd Ed., chapter 12)
Epinephrine relaxes the detrusor and the gastrointestinal
smooth muscle. Epinephrine contracts the trigone and
urinary sphincter. During a ā€˜fi ght or fl ightā€™ resoponse, one
does not want to pee or defecate.
Source: Shah RV, Board Review 2005 for Smith