Flashcards in Final Deck (160):
A 45 yr old male w/ a history of well controlled HTN presents to you w/ a complaint of a painful swollen great toe....which agent would you suspect most likely to exacerbate his gout?
What is the mechanism of action of cocaine?
Inhibition of re-uptake of monoamine neurotransmitters
What agents would interfere w/ erectile dysfunction NO promoters?
What agents would interfere w/ use of thiazide diuretics?
What agents would interfere w/ use of loop diuretics?
What determines the degree of movement of a drug b/w body compartments?
- Degree of ionization
- pH of the compartment
- Size of the drug
(All of the above)
Pharmacokinetics is the effect of the ____ & pharmacodynamics is the effect of the _______
Body on the drug; Drug on the body
Pts on statins should supplement with?
Phase II reaction products are:
Usually rapidly excreted in the urine
Pt tx'ed w/ drug A...administered in amounts that don't exceed the binding capacity of albumin. Drug B is added 3 months later...administered in amounts 100x the binding capacity of albumin. Most likely result:
Significant increase in the levels of free drug A (may flip-flop drugs, look at which has greater amount)
Lipid soluble form of a base is ____ & lipid soluble form of an acid is ___?
Decrease in drug-protein binding will lead to which of the following?
Increase in rate of drug elimination
Phase I makes drugs ____ polar for metabolism & phase II makes drugs ____ polar for excretion
Which direction would a partial agonist shift the dose-response curve when compared to full agonist?
Which direction would a competitive antagonist (plus agonist) shift the dose-response curve when compared to a full agonist?
To the right
The classes of insecticides that produce inhibition of acetylocholinesterase are?
The classes of insecticides that impairs axonal transmission are:
A major concern of individuals suffering from ethanol intoxication include:
A major concern of increased tolerance to ethanol includes:
Symptoms of alcohol withdrawal include
Alcohol dehydrogenase has the highest affinity for:
Alcoholism is defined as:
Consumption despite adverse effects
Cadmium toxicity is exacerbated in:
St. John's Wort has been shown to
Effectively block reuptake of monoamines similar to SSRIs
Ginko Biloba extract
Has been shown to improve cognitive function
The agent in garlic that has positive effects on CV functions also
Has antibacterial effects
The adverse effects of DDT on eagles...is evidence of
First pass metabolism describes:
The proportion of drug metabolized when it first passes through the hepatic portal system prior to system circulation
Bioavailability of a drug can be increased by:
a. Dissolving it in water
b. Using 1st pass metabolism
c. Using it as shampoo
d. None of the above
None of the above
Ligand-gated ion channels
Tend to have brief response times in response to binding (millisecs to secs)
Using a beta blocker to slow tachycardia from another drug would qualify as
Steroid receptor activation
Results in binding directly to DNA
Receptor desenesitization involves
- Sequestration of receptors in intracellular vesicles
- Degradation of receptors
All of the following statements regarding incretin therapy are true except
Glucagon release is stimulated
The goal of insulin therapy in type I diabetes is?
To mimic normal basal & post-prandial glucose levels
Which of the following would be an appropriate addition to insulin management of longstanding type I diabetes:
a. An insulin secretogogue
b. An insulin sensitizer
c. A dipeptidyl-peptidase-4 inhibitor
d. None of the above
None of the above
Mechanism employed to mitigate first pass metabolism:
a. Changing the chemical formula of an agent
b. Changing the dose
c. Changing the route of administration
d. All of the above
All of the above
May exacerbate heavy metals toxicity when given long after heavy metal exposure
"Aging" of acetylcholinerease inhibition occurs w/:
a. Organochlorine pesticides
b. Carbamate pesticides
Neither (if "organoPHOSPHATE is a choice pick that)
This type of reaction is most often assoc. w/ drug activation or production of active metabolites
This type of reaction converts lipophilic agents to a water soluble agent
This type of reaction that most often occurs in liver
This type of reaction increase polarity by unmasking a polar functional group
This type of reaction involves conjugation w/ glucuronic acid, amino acids, sulfuric acid or acetic acid
Which enzyme involved in ethanol metabolism experiences the most induction assoc w/ chronic excessive alcohol consumption?
Microsomal ethanol oxidizing system (MEOS)
Which of the following are most at risk for toxic effects from exposure to modestly increased carbon monoxide levels?
23 yr old pregnant female w/ 26 wk gestation
The following statements regarding receptor desensitization are accurate except:
a. serves to protect the cell from damage d/t overstimulation
b. it involves the sequesatration of receptors intracellularly
c. it involves the degradation of receptors
d. all of the above
All the above
Enzyme kinetics of an ethanol novice w/ a blood alcohol of 300mg/dl are best described as?
Zero order kinetics
Type of kinetics that describes the metabolism of a substrate when the concentration of substrate far exceeds the number of enzymes involved in its metabolism
Zero order kinetics
Agents that those w/ PKU should avoid
Agents discovered while investigating non-food substances
(All the above)
For 1st order drug elimination, 1/2 life is ___ at two places on the curve & a constant ____ is lost per unit time
Pt has been using albuteral intake for the past 3 yrs...After 3rd dose, she noticed palpations. Your explanation should be:
Lack of beta receptor specificity resulting in some beta-1 agonism causing an increased heart rate.
Principle mechanism by which sublingual nitroglycerin terminates anginal episodes in pts w/ advanced atherosclerotic coronary vessel ds.
Charac. of lithium in use for bipolar disorder include:
Mechanism of action is unknown
Most NSAIDs are:
Prostaglandin synthesis inhibitors
Anti-hyperlipidemia drug is assoc. w/ cutaneous vasodilation following ingestion:
Possible effects of re-uptake inhibitors for depression include all except:
Manic symptoms in normal non-depressed people
Major concern of acetaminophen use is:
Overdose assoc. w/ use of combination preparations
All of the following factors in poor compliance w/ pharmacologic tx of HTN except:
Lowering of high BP has not been shown to decrease incidence of sequala of HTN
Most likely mechanism of action of psychomotor effects of caffeine at plasma levels attained through routine consumption
Blockade of adenosine receptors
Skipper was type II diabetic & developed class 3 angina. He used sublingual nitroglycerine on island. Which of the following is added w/ the most caution?
Tox instructor slumped/mumbling incoherently. Sees "snow". Receipt for whiskey, rubbing alcohol, sterno, & windshield wiper fluid. Intoxication w/?
- Methanol (Follow-up Q: metabolic acidosis)
- (W/O "Snow" Isopropyl alcohol)
Charac. of insulin:
- Made of amino acids
- Secreted in pro-form that requires activation in peripheral tissue
- C-peptide, lacks metabolic activity
(All of the above)
Symptoms of hypoglycemia diminished by:
- Autonomic neuropathy
- Beta blockers
Agents useful in glycemic control for type I diabetes include:
Benzodiazepines most assoc. w/ following neurotransmitter systems
Lack of HA following the use of sublingual nitroglycerin could indicate:
- Nitrate tolerance
- Spontaneous degradation
The following exposures have been assoc. w/ elevated carboxyhemoglobin levels except:
- 2nd-hand cigarette smoke
- Marijuana smoke
- Urban pollution
- All are assoc. w/ it
All are assoc. w/
Following the exposure to toxic cadmium levels:
Cadmium absorption is increased by zinc deficiency
Carrots are assoc w/ what toxic agent?
Electronic devices are assoc w/ what toxic agent?
Potatoes are assoc w/ what toxic agent?
Lima beans are assoc w/ what toxic agent?
CFL bulbs are assoc w/ what toxic agent?
Stoner Jane was feeling a bit anxious..Skateboarding home, sprained ankle, most effective agent for amelioration of her injury is?
Mike Brady is attempting to quit smoking for the 20th time this year...best choice for this adjunctive tx would be?
In functional antagonism:
Ligand binding to a receptor elicits a response that opposes (or counteracts) the bindings of a different ligand to a separate receptor
A major concern for individuals suffering from ethanol intox. of any severity (even mild intoxication)
Angiotension receptor blockers are:
Slighlty less effective at ACE inhibitiors at lowering BP
Type of kinetics that describes the metabolism of a substrate when the number of enzymes involved in its metabolism far exceeds the concentration of substrate B
Second order kinetics
Type of snakes assoc. w/ highest lethality are?
The noble St. Bernard...Which of the effects of ethanol would be beneficial for hypothermia?
a. Cardiac inotrope
b. Decreased blood viscosity
c. Peripheral vasodilation
John B. 39yr old overweight....has HTN...Avid runner...Which anti-hypertensive = unacceptable therpeutic effect in the big man?
Beta blockers (Follow-up Q: Blunting exercise-induced tachycardia)
Which of the following reactions is a phase II reaction?
Symptoms of alcohol withdrawal include:
The most important predictor of the type & severity of particulate pathology in the lung is?
Particle size; smaller is more injurious
Transduction is involved in the mechanism of action of the following drug types
- Partial antagonists (agonists/antagonists)
(All of the ball)
This class of receptor is assoc. w/ a response duration of minutes to hours
Enzyme linked receptor
This class of receptor shows specificity for the ligand which binds & results in transduction
- Ligand gated ion channel
- G-protein couple receptor
- Enzyme linked receptor
(all of the above)
For a drug antagonist to show an effect it requires
The presence of an agonist
Which class of drugs freq. exhibits structural similarities to a receptors natural ligand?
- Partial agonist/antagonist
(All of the above)
The main mechanism of bile acid binding resins lowering plasma cholesterol is by?
Binding bile acids in the small intestine, blocking their enterohepatic circulation & forcing the liver to convert more cholesterol to bile salts.
Watching General Hospital, actress takes entire bottle of pills, Dr. McHottie should suspect?
Possible benzodiazepine overdose (Follow-up Q: "Give another does of flumazenil")
An 8 yr old male presents to your office w/ the above x-ray, they are indicative of exposure to?
An old dilapidated house (lead) (Follow-up Q: All of the above)
Type of reaction most often assoc. w/ cytochrome P450
Phase I rxn
Cardiac problems may be assoc. w/:
a. binge alcohol consumption
b. chronic alcohol consumption
c. alcohol withdrawal
d. all of the above
All of the above
Organic form is toxic, mercury or arsenic
Produces a motor neuropathy, mercury or arsenic?
Blocks the action of sulfhydryl (-SH) groups on enzymes, mercury or arsenic?
Enteroheptatic circulation involves recycling
Organic nitrates produce a decrease in?
- Myocardial O2 demand
(all of the above)
Aunt Ethel uses sublingual NTG 2x/wk...climbing stairs at church...feels chest pressure...least appropriate course of action fro Ethel is?
Take a long acting nitrate sublingual so it takes effect quickly
The following statements regarding statins are accurate except?
Adverse reactions are common but not potentially serious
The amount of drug that produces a therapeutic effect is?
Free drug in the plasma
The long term effect of diuretics that result in lowering high BP is?
Decreased peripheral vascular resistance
Enhanced excretion of a weak acid would best be promoted by?
Alkalinization of the urine (raise the pH)
Identify the physical factors involved in drug absorption
- Blood flow
- Surface area
- Contact time
(All of the above)
Drugs tightly bound to plasma proteins:
Often have a longer duration of effect than drugs not bound to albumin
42 yr old Body builder Bob...takes super-roid...3 days after starting passes out...Most likely cause is?
Elevated plasma level of free antihypertensive agent
Bioavailabilty is expressed as the amount of drug in the systemic circulation divided by the amount of drug:
The most important effect of CHF on drug interaction is d/t?
Increased volume of distribution
Which enteral route of administration involves the most variable?
Which of the following transfer mechanisms depends on the agent's concentration gradient to promote absorption across the GI tract?
Mary Poppins drinks a lot & base-jumps, twists ankles...which pain med would be the least appropriate?
Irwin Fletcher 54 yr old w/ stable angina...take NTG...climbs steps at gf's apartment...continues to have chest pain & no HA...What is the explanation?
Acute tolerance to nitrates
Pt has esophageal reflux...wife is a bad cook...regularly consumes antacids & complains of worsening degenerative arthritis, you suspect?
Daily antacid use has upset the production of intrinsic factor..the absorption of Ca++ causing a decrease in bony repair
Opiates possess all of the following charac. except
Block pain transmission in the anterior horn of the spinal cord
Which of the following is not a therapeutic effect of acetaminophen?
A major concern of acetaminophen use is?
Overdose assoc. w/ the use of combination preparations
Ricky Ricardo has severely burned oral cavity...Alternative method of administration?
Take it rectally
Dan Connor is 46 yr old...avg BP 142/90...Most appropriate step in management at this point would be?
Evaluation of the cause of hypertension
Mr. Connor is otherwise healthy & w/o risk factors for CVD...initial management is a lot of stuff and?
Nothing else at this time
Which of the following drugs would interfere w/ the therapeutic effect of furosemide (lasix) a loop diuretic?
The only acutely effective tx of severe depression is?
The 2-3 week delay in the onset of the therapeutic effect of SSRIs is d/t?
Desensitization of inhibitory presynaptic receptors
Abrupt discontinuation of which of these agents may be assoc. w/ an acutely life threatening syndrome?
Mildred 79 yr old, HTN asthmatic...had BP meds increased...noticed asthma has been bothering her more since then, you suspect?
The increase in Beta-1 antagonist resulted in antagonism at the Beta-2 receptors on bronchiole smooth muscle promoting bronchospasm
Mildred had a bronchoscopy...2 days she complains she can't remember what happened...You would tell her?
A beneficial side effect of short acting benzos when used prior to invasive procedures is anterograde amnesia
George Kostanza suffered a lat. wall MI 8 months ago...complains of dry, non-productive cough...no evidence of pneumonia or pulmonary mass..Which med do you suspect?
ACE inhibitor (Follow-up Q: Angiotensin II receptor blocker for the ACE inhibitor)
Alice Kramden..husband Ralph...takes two meds for DM II...purchased total gym...which dietary interventions would be the least appropriate?
Start each day w/ a whole grapefruit
George Jetson..strict control of DM II...3 episodes of hypoglycemia cause he's missing meals...You would tell him all of the following except?
Strict control will prevent the occurrence of both macro- & micro- vascular complications of DM
Aunt Ethel couldn't stand nasty taste of nitro...swallowed tablet....no HA...went to mailbox & feels chest pain...most likely explanation?
1st pass hepatic metabolism inactivated most of the nitroglycerin
Farmer John used sublingual nitro...started a Ca+ blocker & baby aspirin, hasn't needed nitro as often...not getting HA anymore...you should conclude?
His nitroglycerin has become ineffective
While on the island Maryann developed asthama & class II angina, which of following agents would be least appropriate?
A drug which binds w/ greater affinity to its receptor will likely be more _______ than a drug that binds w/ less affinity?
Which of the following is not an advantage of rectal over sublingual drug administration?
Avoidance of 1st pass metabolism
A drug is administered in the form of a pro-drug....With chronic administration of the pro-drug, which of the following will be observed?
The potency will increase
What is echinacea most often used for?
To enhance immune function in individuals w/ colds or other respiratory tract infections
What is garlic used for?
Reduces total cholesterol, some cancers
In addition to improving cognitive function, what other effect does Ginkgo have?
May improve mild-to-moderate PVD
What can ginseng be used for?
Early type II DM glucose control & possibly preventing URI's
What are the effects of milk thistle?
May have beneficial effects on the liver (cirrhoss, Hep C)
What is saw palmetto used for?
urologic symptoms of BPH
Other than paint, what is lead found in?
Soldering of circuit boards & other device components
What is beryllium found in?
Significant portions of electrical connectors & battery contacts
What electronic parts is arsenic found in?
Integrated circuits & semiconductors
What electrical components is mercury found in?
Batteries & circuit boards
What electrical components is Antimony found in?
Diodes & batteries. Pure form in semiconductors
What electrical components is cadmium found in?
Soldering, semiconductors, & chip resistors
What is Cadmium found in?
- Cigarette smoke
- Refined foods
- Water pipes, galvanized metals
- Coffee & Tea
- Shell Fish
- Dental materials
- Cereal grains & root veggies
A 5yr old boy is brought to a hospital..w/ empty aspirin bottle..What type of acid/base findings are likely to be found from an arterial blood gas?
Mixed respiratory alkalosis & metabolic acidosis
Adverse effects of organic nitrates include the following except:
The main anti-anginal effect of this agent is a decrease in after-load
Nifedipine (Ca++ channel blocker)
The addictive quality of nicotine is most likely d/t its ability to promote?
Stimulation of dopamine release in the CNS
Amphetamine produces its effect via:
Neurotransmitter reuptake inhibition into the presynaptic terminal
Uncontrolled neurotransmitter release from the presynaptic terminal
LSD functions as an agonist of
What clinical trial phase usually involves small doses to determine a drugs pharmacokinetic properties?
Some users of methamphetamine will consume substances to _____ their urine to promote excretion of meth in their urine...etc.
Acidify (Follow up Q: It decreases distal tubular reabsorption)