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Flashcards in Final Deck (160):
1

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?

Thiazide diuretic

2

What is the mechanism of action of cocaine?

Inhibition of re-uptake of monoamine neurotransmitters

3

What agents would interfere w/ erectile dysfunction NO promoters?

Nitrates

4

What agents would interfere w/ use of thiazide diuretics?

Calcium supplements

5

What agents would interfere w/ use of loop diuretics?

Calcium supplements

6

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)

7

Pharmacokinetics is the effect of the ____ & pharmacodynamics is the effect of the _______

Body on the drug; Drug on the body

8

Pts on statins should supplement with?

Co-enzyme Q

9

Phase II reaction products are:

Usually rapidly excreted in the urine

10

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)

11

Lipid soluble form of a base is ____ & lipid soluble form of an acid is ___?

Unprotonated; protonated

12

Decrease in drug-protein binding will lead to which of the following?

Increase in rate of drug elimination

13

Phase I makes drugs ____ polar for metabolism & phase II makes drugs ____ polar for excretion

More; more

14

Which direction would a partial agonist shift the dose-response curve when compared to full agonist?

Down

15

Which direction would a competitive antagonist (plus agonist) shift the dose-response curve when compared to a full agonist?

To the right

16

The classes of insecticides that produce inhibition of acetylocholinesterase are?

Organophosphates
Carbamates
(Both)

17

The classes of insecticides that impairs axonal transmission are:

Organochlorides

18

A major concern of individuals suffering from ethanol intoxication include:

Impaired judgement

19

A major concern of increased tolerance to ethanol includes:

Respiratory depression

20

Symptoms of alcohol withdrawal include

Seizures

21

Alcohol dehydrogenase has the highest affinity for:

Ethanol

22

Alcoholism is defined as:

Consumption despite adverse effects

23

Cadmium toxicity is exacerbated in:

Zinc deficiency

24

St. John's Wort has been shown to

Effectively block reuptake of monoamines similar to SSRIs

25

Ginko Biloba extract

Has been shown to improve cognitive function

26

The agent in garlic that has positive effects on CV functions also

Has antibacterial effects

27

The adverse effects of DDT on eagles...is evidence of

Biomagnification

28

First pass metabolism describes:

The proportion of drug metabolized when it first passes through the hepatic portal system prior to system circulation

29

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

30

Ligand-gated ion channels

Tend to have brief response times in response to binding (millisecs to secs)

31

Using a beta blocker to slow tachycardia from another drug would qualify as

Functional antagonism

32

Steroid receptor activation

Results in binding directly to DNA

33

Receptor desenesitization involves

- Sequestration of receptors in intracellular vesicles
- Degradation of receptors
(Both)

34

All of the following statements regarding incretin therapy are true except

Glucagon release is stimulated

35

The goal of insulin therapy in type I diabetes is?

To mimic normal basal & post-prandial glucose levels

36

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

37

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

38

Chelating agents:

May exacerbate heavy metals toxicity when given long after heavy metal exposure

39

"Aging" of acetylcholinerease inhibition occurs w/:
a. Organochlorine pesticides
b. Carbamate pesticides
c. Both
d. Neither

Neither (if "organoPHOSPHATE is a choice pick that)

40

This type of reaction is most often assoc. w/ drug activation or production of active metabolites

Phase I

41

This type of reaction converts lipophilic agents to a water soluble agent

Phase I
Phase II

42

This type of reaction that most often occurs in liver

Phase I
Phase II

43

This type of reaction increase polarity by unmasking a polar functional group

Phase I

44

This type of reaction involves conjugation w/ glucuronic acid, amino acids, sulfuric acid or acetic acid

Phase II

45

Which enzyme involved in ethanol metabolism experiences the most induction assoc w/ chronic excessive alcohol consumption?

Microsomal ethanol oxidizing system (MEOS)

46

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

47

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

48

Enzyme kinetics of an ethanol novice w/ a blood alcohol of 300mg/dl are best described as?

Zero order kinetics

49

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

50

Agents that those w/ PKU should avoid

Aspartame

51

Agents discovered while investigating non-food substances

Saccharine
Sucralose
Aspartame
(All the above)

52

For 1st order drug elimination, 1/2 life is ___ at two places on the curve & a constant ____ is lost per unit time

Equal; percentage

53

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.

54

Principle mechanism by which sublingual nitroglycerin terminates anginal episodes in pts w/ advanced atherosclerotic coronary vessel ds.

Decreased preload

55

Charac. of lithium in use for bipolar disorder include:

Mechanism of action is unknown

56

Most NSAIDs are:

Prostaglandin synthesis inhibitors

57

Anti-hyperlipidemia drug is assoc. w/ cutaneous vasodilation following ingestion:

Niacin

58

Possible effects of re-uptake inhibitors for depression include all except:

Manic symptoms in normal non-depressed people

59

Major concern of acetaminophen use is:

Overdose assoc. w/ use of combination preparations

60

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

61

Most likely mechanism of action of psychomotor effects of caffeine at plasma levels attained through routine consumption

Blockade of adenosine receptors

62

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?

Beta blocker

63

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)

64

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)

65

Symptoms of hypoglycemia diminished by:

- Autonomic neuropathy
- Beta blockers
(Both)

66

Agents useful in glycemic control for type I diabetes include:

Insulin

67

Benzodiazepines most assoc. w/ following neurotransmitter systems

GABA system

68

Lack of HA following the use of sublingual nitroglycerin could indicate:

- Nitrate tolerance
- Spontaneous degradation
(Both)

69

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/

70

Following the exposure to toxic cadmium levels:

Cadmium absorption is increased by zinc deficiency

71

Carrots are assoc w/ what toxic agent?

Myristicin
Carotatoxin

72

Electronic devices are assoc w/ what toxic agent?

Arsenic

73

Potatoes are assoc w/ what toxic agent?

Solanine

74

Lima beans are assoc w/ what toxic agent?

Hydrogen cyanide

75

CFL bulbs are assoc w/ what toxic agent?

Mercury

76

Stoner Jane was feeling a bit anxious..Skateboarding home, sprained ankle, most effective agent for amelioration of her injury is?

Ibuprofen

77

Mike Brady is attempting to quit smoking for the 20th time this year...best choice for this adjunctive tx would be?

Nicotine gum

78

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

79

A major concern for individuals suffering from ethanol intox. of any severity (even mild intoxication)

Respiratory depression

80

Angiotension receptor blockers are:

Slighlty less effective at ACE inhibitiors at lowering BP

81

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

82

Type of snakes assoc. w/ highest lethality are?

Coral snakes

83

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
d. None

None

84

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)

85

Which of the following reactions is a phase II reaction?

Conjugation

86

Symptoms of alcohol withdrawal include:

Seizures

87

The most important predictor of the type & severity of particulate pathology in the lung is?

Particle size; smaller is more injurious

88

Transduction is involved in the mechanism of action of the following drug types

- Agonist
- Antagonist
- Partial antagonists (agonists/antagonists)
(All of the ball)

89

This class of receptor is assoc. w/ a response duration of minutes to hours

Enzyme linked receptor

90

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)

91

For a drug antagonist to show an effect it requires

The presence of an agonist

92

Which class of drugs freq. exhibits structural similarities to a receptors natural ligand?

- Agonist
- Antagonist
- Partial agonist/antagonist
(All of the above)

93

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.

94

Watching General Hospital, actress takes entire bottle of pills, Dr. McHottie should suspect?

Possible benzodiazepine overdose (Follow-up Q: "Give another does of flumazenil")

95

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)

96

Type of reaction most often assoc. w/ cytochrome P450

Phase I rxn

97

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

98

Organic form is toxic, mercury or arsenic

Mercury

99

Produces a motor neuropathy, mercury or arsenic?

Neither

100

Blocks the action of sulfhydryl (-SH) groups on enzymes, mercury or arsenic?

Both

101

Enteroheptatic circulation involves recycling

Bile salts
Some drugs
(Both)

102

Organic nitrates produce a decrease in?

- Preload
- Afterload
- Myocardial O2 demand
(all of the above)

103

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

104

The following statements regarding statins are accurate except?

Adverse reactions are common but not potentially serious

105

The amount of drug that produces a therapeutic effect is?

Free drug in the plasma

106

The long term effect of diuretics that result in lowering high BP is?

Decreased peripheral vascular resistance

107

Enhanced excretion of a weak acid would best be promoted by?

Alkalinization of the urine (raise the pH)

108

Identify the physical factors involved in drug absorption

- Blood flow
- Surface area
- Contact time
(All of the above)

109

Drugs tightly bound to plasma proteins:

Often have a longer duration of effect than drugs not bound to albumin

110

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

111

Bioavailabilty is expressed as the amount of drug in the systemic circulation divided by the amount of drug:

Administered

112

The most important effect of CHF on drug interaction is d/t?

Increased volume of distribution

113

Which enteral route of administration involves the most variable?

Oral

114

Which of the following transfer mechanisms depends on the agent's concentration gradient to promote absorption across the GI tract?

Facilitated diffusion

115

Mary Poppins drinks a lot & base-jumps, twists ankles...which pain med would be the least appropriate?

Oxycodone

116

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

117

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

118

Opiates possess all of the following charac. except

Block pain transmission in the anterior horn of the spinal cord

119

Which of the following is not a therapeutic effect of acetaminophen?

Anti-inflammatory

120

A major concern of acetaminophen use is?

Overdose assoc. w/ the use of combination preparations

121

Ricky Ricardo has severely burned oral cavity...Alternative method of administration?

Take it rectally

122

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

123

Mr. Connor is otherwise healthy & w/o risk factors for CVD...initial management is a lot of stuff and?

Nothing else at this time

124

Which of the following drugs would interfere w/ the therapeutic effect of furosemide (lasix) a loop diuretic?

NSAID

125

The only acutely effective tx of severe depression is?

Electroconvulsive therapy

126

The 2-3 week delay in the onset of the therapeutic effect of SSRIs is d/t?

Desensitization of inhibitory presynaptic receptors

127

Abrupt discontinuation of which of these agents may be assoc. w/ an acutely life threatening syndrome?

Beta-blockers

128

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

129

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

130

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)

131

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

132

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

133

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

134

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

135

While on the island Maryann developed asthama & class II angina, which of following agents would be least appropriate?

Beta-blocker

136

A drug which binds w/ greater affinity to its receptor will likely be more _______ than a drug that binds w/ less affinity?

Efficacious

137

Which of the following is not an advantage of rectal over sublingual drug administration?

Avoidance of 1st pass metabolism

138

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

139

What is echinacea most often used for?

To enhance immune function in individuals w/ colds or other respiratory tract infections

140

What is garlic used for?

Reduces total cholesterol, some cancers

141

In addition to improving cognitive function, what other effect does Ginkgo have?

May improve mild-to-moderate PVD

142

What can ginseng be used for?

Early type II DM glucose control & possibly preventing URI's

143

What are the effects of milk thistle?

May have beneficial effects on the liver (cirrhoss, Hep C)

144

What is saw palmetto used for?

urologic symptoms of BPH

145

Other than paint, what is lead found in?

Soldering of circuit boards & other device components

146

What is beryllium found in?

Significant portions of electrical connectors & battery contacts

147

What electronic parts is arsenic found in?

Integrated circuits & semiconductors

148

What electrical components is mercury found in?

Batteries & circuit boards

149

What electrical components is Antimony found in?

Diodes & batteries. Pure form in semiconductors

150

What electrical components is cadmium found in?

Soldering, semiconductors, & chip resistors

151

What is Cadmium found in?

- Cigarette smoke
- Batteries
- Refined foods
- Water pipes, galvanized metals
- Coffee & Tea
- Coal
- Shell Fish
- Ceramics
- Dental materials
- Cereal grains & root veggies

152

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

153

Adverse effects of organic nitrates include the following except:

Bradycardia

154

The main anti-anginal effect of this agent is a decrease in after-load

Nifedipine (Ca++ channel blocker)

155

The addictive quality of nicotine is most likely d/t its ability to promote?

Stimulation of dopamine release in the CNS

156

Amphetamine produces its effect via:

Neurotransmitter reuptake inhibition into the presynaptic terminal
Uncontrolled neurotransmitter release from the presynaptic terminal
(Both)

157

LSD functions as an agonist of

Serotonin

158

What clinical trial phase usually involves small doses to determine a drugs pharmacokinetic properties?

Phase I

159

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)

160

Stoner Marge has a slight HA...after firing up her 3rd fatty...least effective tx?

Tylenol