Module4Pharm

Question 1

Which medications are approved for hypertension during pregnancy?

a) metoprolol
b) guanfacine
c) methyldopa
d) methyldopate

Answer 1

Answer: c) methyldopa

Others include labetalol and nifedipine

Question 2

Parasympathetic drugs excess (cholinergic response is best known by what acronym)?

Answer 2

SLUDGE: salivation, lacrimation, urination, defecation, gastric upset, emesis

Question 3

What does SLUDGE refer to?

Answer 3

EXCESS cholinergic response

Question 4

Muscarinic agonist symptoms would be similar to which of the following?

a) dry mouth and defecation
b) GI upset and constipation
c) salivation and blurred vision
d) lacrimation and emesis

Answer 4

Answer: d) lacrimation and emesis

Remember: muscarinic agonists are generating cholinergic responses so they are the same as SLUDGE.

Question 5

Muscarinic antagonist symptoms might include:

a) urinary retention
b) secretions
c) defecation
d GI upset
e) one or more of the above
f) none of the above

Answer 5

Answer: a) urinary retention

Think opposite of SLUDGE.

S&S include: dry eyes, constipation, dry skin, urinary retention, blurred vision

Question 6

Which of the following is a side effect of oxybutynin?

a) CNS stimulation
b) bradycardia
c) diarrhea
d) dry mouth

Answer 6

Answer: d) dry mouth

Other SE: blurred vision, urinary retention, constipation, tachycardia, hallucination

Question 7

Which is not a drug for overactive bladder (OAB)?

a) oxybutynin
b) prazosin
c) fesoterodine
d) darifenacin

Answer 7

Answer: b) prazosin

Prazosin is used for HTN and BPH

Question 8

Sequence the following steps of synaptic transmission:

1) transmitter storage
2) transmitter termination
3) transmitter synthesis
4) transmitter release
5) transmitter binding to receptor cell

Answer 8

answer: 3,1,4,5,2 (synthesis, storage, release, binding, termination)

Question 9

What are the roles of the autonomic nervous system?

a) regulation of heart
b) regulation of skeletal muscles
c) regulation of smooth & skeletal muscle
d) regulation of secretory glands
e) one or more of the above

Answer 9

Answer: a) regulation of heart and d)regulation of secretory glands

Other function is regulation of SMOOTH muscles

Question 10

The parasympathetic nervous system does which of the following:

a) vasoconstict
b) slows HR
c) pupil dilation
d) bronchial constriction
e) decrease gastric secretion
f) one or more of the above

Answer 10

Answer: f) one or more of the above

Functions: slow HR, bronchial constriction, increase gastric secretions, empty bladder/bowel, pupil constrict to facilitate near vision

Question 11

What are functions of the sympathetic nervous system:

a) vasoconstrict at skin level
b) vasoconstrict at skeletal muscles
c) increase HR
d) bronchial dilation
e) mobilize stored energy
f) one or more of the above

Answer 11

Answer: f) one or more of the above

Functions are: vasoconstriction at skin level, vasoDILation at skeletal muscles, increase HR/BP (increases CO), bronchial dilation, mobilize stored energy, dilate pupils

Question 12

The baroreceptor reflex is an example of what mechanism involving a sensor, effector, and neurons connecting the two?

Answer 12

Feedback.

The baroreceptor reflex involves blood pressure regulation.

Question 13

Which part of the ANS implements fight or flight?

a) sympathetic
b) parasympathetic
c) somatic
d) none of the above

Answer 13

a) sympathetic

Question 14

Which condition is a contraindication for bethanechol (muscarinic agonist)?

a) asthma
b) renal failure
c) peptic ulcer disease
d) hypertension
e) one or more of the above
f) two or more of the above

Answer 14

Answer: f) two or more of the above

Contraindications are peptic ulcer disease, urinary tract obstruction, GI obstruction, coronary insufficiency, hypotension, asthma, hyperthyroidism

Question 15

What treats anti-muscarinic (muscarinic antagonist) poisoning?

a) atropine
b) pyridostigmine
c) physostigmine
d) pralidoxime

Answer 15

Answer: c) physostigmine

Note: pyridostigmine is used for M. gravis

Question 16

What can treat irreversible cholinesterase inhibition?

a) atropine
b) pyridostigmine
c) physostigmine
d) pralidoxime

Answer 16

Answer: d) pralidoxime

Will not reduce CNS depression (mechanical ventilation required)

Atropine needed to reduce muscarinic stimulation

Question 17

Which OAB drug has the most M3 receptor selectivity?

a) oxybutynin
b) darifenacin
c) solifenacin
d) trospium

Answer 17

Answer: b) darifenacin

Question 18

Which is NOT a drug for OAB?

a) trospium
b) pralidoxime
c) darifenacin
d) fesoterodine

Answer 18

Answer: b) pralidoxime

“Our Darling Son Tinkles Frequently (on) Trips”
^mnemonic for OAB drugs

Question 19

Which OABs are selective (choose all that apply):

a) tolterodine
b) solifenacin
c) oxybutynin
d) fesoterodine
e) trospium

Answer 19

Answer: b,c are selective

Selective OAB: oxybutynin, darifenacin, solifenacin

Nonselective: Tolterodine, fesoterodine, trospium

Question 20

Which OAB drug can prolong the QT interval?

a) tolterodine
b) solifenacin
c) oxybutynin
d) fesoterodine
e) trospium

Answer 20

Answer: b) solifenacin (at high doses)

Note: tolterodine can also prolong the QT

Question 21

What are the normal functions of alpha 1?

Answer 21

vasoconstriction, ejaculation, bladder neck contraction and prostate

Question 22

What are the normal functions of alpha 2?

Answer 22

Presynaptic junction-minimal clinical use

Question 23

What are the normal functions of beta 1?

Answer 23

Heart (increases HR/force of contraction/velocity of conduction in AV); stimulates renin in kidney

Question 24

What are the normal functions of beta 2?

Answer 24

Bronchodilation, uterine muscle relaxation, vasodilation, glycogenolysis (glycogen –> glucose)

Question 25

What is the normal function for dopamine?

Answer 25

Dilates renal blood vessels.

Question 26

MAO-I's inhibit which of the following: a) acetylcholine b) norepinephrine c) epinephrine c) two or more of the above d) none of the above

Answer 26

Answer: c)two or more of the above. MAO-Is inhibit norepinephrine and epinephrine.

Question 27

Which of the following is an indicated use for Bechanechol? a) urinary retention b) mydriasis c) myosis d) GI reflux e) one of the above f) two or more of the above

Answer 27

Answer: f) two or more of the above Bechanechol is used for urinary retention and GI reflux.

Question 28

What is not a side effect of muscarinic agonists? a) dysrhythmias b) asthma exacerbation c) constipation d) increased salivation

Answer 28

Answer: c) constipation Muscarinic agonists "rest and digest" or think "SLUDGE" Note: dysrhythmias occur in patients with HYPERTHYROIDISM The other 3 choices are correct.

Question 29

What site do muscarinic antagonists work? a) all cholinergic receptors b) adronergic receptors c) muscarinic receptors d) one or more of the above

Answer 29

Answer: c) muscarinic receptors Note: they block both Ach and muscarine at the MUSCARINIC sites

Question 30

Which is a use for Cevimeline? a) Sjogren's syndrome b) urinary retention c) topical glaucoma d) rapid miosis

Answer 30

Answer: a) Sjogren's syndrome treats dry mouth

Question 31

Which is a use for Pilocarpine? a) Sjogren's syndrome b) urinary retention c) topical glaucoma d) rapid miosis e) one or more of the above

Answer 31

Answer: e) one or more of the above It is used for topical glaucoma and dry mouth due to Sjogren's syndrome. Rapid miosis is achieved with acetylcholine for after cataract sx.

Question 32

What are the effects of atropine?

Answer 32

Increased HR, decreased secretions, bronchodilation, decreased bladder tone of detrusor, decreased tone/motility of GI, mydriasis (pupil dilation) and cycloplegia (Hot as a hare=increased temp and decreased sweating, mad as a hatter, red as a beet=tachycardia+sweating, dry as a bone=decreased secretions)

Question 33

What type of drug is atropine considered? a) muscarinic agonist b) muscarinic antagonist c) cholinesterase inhibitor d) adrenergic agonist

Answer 33

Answer: b)muscarinic antagonist Used to reverse muscarinic AGONIST poisoning

Question 34

Dicyclomine is used for what? a) OAB b) Sjogren's syndrome c) pre-anesthesia secretion drying d) IBS

Answer 34

Answer: d) IBS

Question 35

Symptoms of anti-muscarinic poisoning? a) SLUDGE b) Can't see can't pee can't spit can't shit c) respiratory depression d) seizures, respiratory depression

Answer 35

Answer: b) excess ANTIcholinergic so think Can't see can't pee can't spit can't shit. Caused by belladonna, anti-musarinic drugs, anti-histamines

Question 36

What is the drug of choice to treat anti-muscarinic poisoning? a) atropine b) pyrimidine c) oxybutynin d) physostigmine

Answer 36

Answer: d) physostigmine It inhibits acetylcholinesterase which increases available Ach

Question 37

Ipratropium bromide uses include: a) asthma b) COPD c) rhinitis d) nasal congestion e) one or more of the above

Answer 37

Answer: e) one or more of the above Answers a,b,c are correct.

Question 38

Mydiratic cycoplegics are used for: a) eye constriction b) eye dilation

Answer 38

Answer: b) eye dilation in eye surgery

Question 39

Oxybutynin is used for: a) OAB b) Sjogren's syndrome c) pre-anesthesia secretion drying d) mydriasis

Answer 39

Answer: a) OAB

Question 40

True or false, most OAB drugs will cause anticholinergic effects?

Answer 40

True

Question 41

Side effects of oxybutynin include: a) bradycardia b) bronchodilation c) tachycardia d) hallucination e) one or more of the above

Answer 41

Answer: e) one or more of the above Oxybutynin (OAB drug) has SE: tachycardia and hallucination

Question 42

Which OAB drug has the greatest degree of M3 selectivity (acts without impacting brain or heart receptors)? a) Tolterodine b) Trospium c) Darifenacin d) Solifenacin

Answer 42

Answer: c) Darifenacin

Question 43

Which drugs are used in M. Gravis to strengthen muscles? a) pralidoxime b) neostigmine c) isoproterenol d) pyridostigmine

Answer 43

Answer: b&d Neostigmine and pyridostigmine They are both REVERSIBLE cholinesterase inhibitors

Question 44

What are side effects of cholinesterase inhibitors such as neostigmine and pyridostigmine? a) salivation b) dry mouth c) urinary elimination d) bradycardia e) one or more of the above

Answer 44

Answer: e) one or more of the above SE: Think normal parasympathetic functions (bradycardia, bronchoconstriction, urinary urgency, increased secretions, increased GI mobility/tone, focus eye for near vision),

Question 45

What is the origin of most irreversible cholinesterase inhibitors?

Answer 45

Pesticides Only clinical use is glaucoma

Question 46

What are the treatment basics for irreversible cholinesterase inhibitors? a) mechanical ventilation b) acetylcholine c) fluids d) atropine

Answer 46

Answer: a & d Treatment basics for irreversible cholinesterase inhibitors (pesticides) is atropine and mechanical ventilation

Question 47

Which adrenergic agonist has the benefit of crossing the BBB and is not metabolized by COMT? a) catecholamines b) noncatecholamines

Answer 47

Answer: b) noncatecholamines They are also metabolized slower and can be given orally.

Question 48

Which receptors is epinephrine effective at? a) alpha 1 b) alpha 2 c) beta 1 d) beta 2

Answer 48

Answer: a,b,c,d

Question 49

Which receptors is norepinephrine effective at? a) alpha 1 b) alpha 2 c) beta 1 d) beta 2

Answer 49

Answer: a,b,c Alpha 1, alpha 2, beta 1

Question 50

Which receptors is isoproterenol effective at? a) alpha 1 b) alpha 2 c) beta 1 d) beta 2

Answer 50

Answer: c, d Beta 1 and beta 2

Question 51

"Every every night I deliver dogs peanut-butter apples" Is the acronym to remember the sequence of adrenergic agonists. See answer slide.

Answer 51

``` Epinephrine-A1,A2,B1,B2 Ephedrine- all but poorly selective Isoproterenol-B1, B2 Dopamine-depends on dose (low-dop; moderate-b1, high-a1) Dobutamine-B1 Phenylephrine-A1 Albuterol-B2 (asthma=think two lungs) ```

Question 52

At low doses, dopamine activates ___ receptors. At moderate doses, dopamine activates ____ receptors. At high doses dopamine activates ___ receptors.

Answer 52

Answer: At low doses, dopamine activates dopmaine receptors. At moderate doses, dopamine activates beta 1 receptors. At high doses dopamine activates alpha 1 receptors.

Question 53

What are uses for dopamine? a) hypotensive state b) shock c) epistaxis d) decrease BP

Answer 53

Answer: b) shock Also used for heart failure. It stimulates various receptors depending on the dose.

Question 54

What are uses for dobutamine? a) hypotensive state b) shock c) epistaxis d) heart failure

Answer 54

Answer: d) heart failure It stimulates beta 1

Question 55

What are uses for isoproterenol? a) AV block b) epistaxis c) bronchodilation d) cardiac arrest e) one or more of the above

Answer 55

Answer: e) one or more of the above It is used for: AV block, cardiac arrest, increase cardiac output after shock

Question 56

What is a side effect of alpha 2 blockade? a) liver failure b) hepatotoxicity c) reflex tachycardia d) rebound hypertension

Answer 56

Answer: c) reflex tachycardia Remember: BP is low due to vasodilation which is “sensed” and the compensatory measure is to increase HR to perfuse the organs)note the inhibition of alpha 2 increases the release of NE which further potentiates reflex tachycardia

Question 57

Activation of alpha 2 receptors can achieve: a) reduced sympathetic outflow b) pain relief c) vasoconstriction d) urinary retention

Answer 57

Answer: a & b

Question 58

What is an adverse effect of alpha 1 activation? a) bronchoconstriction b) urinary retention c) bradycardia d) myosis

Answer 58

Answer: c) bradycardia Due to baroreceptor reflex

Question 59

Pre-surgical treatment of pheochromocytoma should be achieved with what medication? a) atropine b) alpha 1 antagonist c) alpha agonist d) cholinesterase inhibitor

Answer 59

Answer: b) alpha 1 antagonist to help prevent massive release of catecholamines during the tumor removal from the adrenal medulla

Question 60

Which of these are uses for alpha-adrenergic antagonists? a) Raynauds b) BPH c) angina d) essential HTN e) one or more of the above

Answer 60

Answer: e) one or more of the above Uses include (think block alpha 1 and alpha 2): Raynauds, BPH, essential HTN, reversal of toxicity of alpha agonists, and pheochromocytoma (tumor on adrenal medulla)

Question 61

Side effects of alpha-adrenergic antagonists? a) sodium retention b) sodium excretion c) orthostatic hypotension d) nasal decongestion e) one or more of the above

Answer 61

Answer: e) one or more of the above Think (block alpha 1 and alpha 2): SE: orthostatic hypotension (due to vasodilation), nasal congestion, impaired ejaculation, impotence, sodium and water retention due to reduced blood pressure

Question 62

Which is a use for beta-adrenergic blocking agents? a) BPH b) hypothyroidism c) heart failure d) HTN e) one or more of the above

Answer 62

Answer: e) one or more of the above Uses include: HTN, angina, cardiac arrhythmias, MI, hyperthyroidism, migraine prevention, glaucoma, pheochromocytoma, heart failure (carvedilol, metoprolol succinate, bisoprolol),

Question 63

Which beta blockers are safe in asthma (cardioselective)?

Answer 63

ABEAM: atenolol, bisoprolol, esmolol, acebutolol, and metoprolol

Question 64

Which patients should we be careful with our selection of a beta blocker? a) asthmatics b) COPD c) diabetics d) immunocompromised

Answer 64

Answer: a & c

Question 65

Which of these are non-selective beta blockers? a) metoprolol b) bisprolol c) bismoprolol d) carvedilol

Answer 65

Answer: d) carvedilol Other non-selective beta blockers include propranolol and nadolol

Question 66

True or false, alpha 1 is blocked with carvedilol and labetolol ( in addition to beta 1 and beta 2)?

Answer 66

True.

Question 67

Best beta-blockers for heart failure include: a) acebutolol b) carvedilol c) propranolol d) metoprolol succinate e) atenolol f) bisoprolol g) esmolol

Answer 67

Answer: b, d, f Carvedilol, metoprolol succinate, bisoprolol Heart failure MNEUMONIC for beta blockers: "My Cardiac Beats"?

Question 68

Adverse effects of beta 1 adrenergic blocking: a) heart failure b) tachycardia c) rebound excitation d) sodium retention

Answer 68

Answer: a & c SE: bradycardia, reduced CO (due to decreased HR and force), cause heart failure (EDUCATE YOUR PATIENT ABOUT S&S), AV heart block, rebound excitation (taper these drugs)

Question 69

What mechanism do clonidine, guanabenz, guanfacine, and methyldopate work? a) block alpha 1 b) block beta 1 c) block alpha 1 & beta 1 d) block CNS transmission

Answer 69

Answer: d) block CNS transmission ( they act indirectly)

Question 70

What are therapeutic uses for cloinidine? a) HTN b) smoking cessation c) Tourettes d) severe pain e) one or more of the above

Answer 70

Answer: a&d Therapeutic uses are HTN, severe pain, ADHD Off label uses include: opioid/methadone withdrawal, smoking cessation, Tourettes

Question 71

Which is not a side effect of Clonidine? a) abuse potential b) seizures c) rebound HTN d) gynecomastia

Answer 71

Answer: b) seizures Other SE: drowsiness, impotence, CNS, xerostomia, constipation, teratogen

Question 72

Uses for Guanabenz and Guanfacine: a) HTN b) smoking cessation c) ADHD d) severe pain e) one or more of the above

Answer 72

Answer: e) one or more of the above Uses are HTN and ADHD

Question 73

Which is a side effect of methyldopa (IV) or methyldopate? a) xerosomia b) opioid and methadone withdrawal c) rebound HTN d) hemolytic anemia e) one or more of the abovce

Answer 73

Answer: d) hemolytic anemia Other SE: hepatic necrosis

Question 74

Which medication is the only one indicated for depression in Parkinson's? a) Fluoxetine b) Amantidine c) Amitryiptyline d) Sertraline

Answer 74

Answer: c) Amitriptyline SSRIs cause psychosis

Question 75

Parkinson's is characterized by a deficiency of what transmitter?

Answer 75

Dopamine (note: excess Ach and insufficient dopamine)

Question 76

What is the most effective treatment for Parkinson's disease? a) pramipexole+ropinirole b) Selegiline+ dopamine c) Levodopa+Carbidopa d) Bromocriptine

Answer 76

Answer: c) levodopa+carbidopa

Question 77

True or false, the combination of Levodopa/Carbidopa causes dyskinesias and psych issues which occur sooner and are more intense than when Levodopa is given alone.

Answer 77

True

Question 78

What are the cardinal signs of Parkinson's disease (4).

Answer 78

Tremor at rest, rigidity, postural instability, bradykinesia

Question 79

True or false, Carbidopa has no side effects on its' own.

Answer 79

True. The side effects from the Levo/Carbidopa combination come from Levo.

Question 80

How can we manage the "off" periods associated with Parkinson's disease drugs? a) increase dose interval b) give a dopamine antagonist c) Give a COMT inhibitor d) Give a MAO-B inhibitor e) one or more of the above

Answer 80

Answer: c &d Giving a COMT inhibitor (increases half life and level of Levodopa) and MAO-B inhibitor. We can also shorten the drug interval and give a dopamine AGONIST.

Question 81

To makage dyskinesias seen in Parkinson's disease we can: a) increase the Levo dosage b) give with a COMT inhibitor c) surgery d) give Amantidine e) one or more of the above

Answer 81

Answer: c & d Give amantidine (antiviral found to be beneficial in PD), surgery, and REDUCE the Levo dosage.

Question 82

SE of Levo/Carbidopa: a) orange secretions b) hepatotoxic c) dark sweat d) constipation

Answer 82

Answer: c) dark sweat Other se: dark urine, and activates malignant melanoma

Question 83

When would the use of a dopaminergic drug be appropriate in manging Parkinson's disease? a) any stage b) mild stage c) severe stage d) any time but as an adjunct to other therapy

Answer 83

Answer: b) mild stage These drugs include pramipexole and ropinirole

Question 84

When would pramipexole or Ropinirole be used in Parkinson's disease? a) any stage b) mild stage c) severe stage d) any time but as an adjunct to other therapy

Answer 84

Answer: b) mild stage

Question 85

What is a SE of pramipexole and ropinirole? a) risk taking behavior b) liver failure c) fatal serotonin syndrome if given with SSRI d) seizures

Answer 85

Answer: a) risk taking behavior

Question 86

For a patient with mild symptoms of Parkinson's, which drug is FIRST LINE (choose all that apply) a) Benztropine b) Entacapone c) Rasagiline d) Pramipexole

Answer 86

Answer: c) Rasagiline (and selegiline) and d)pramipexole (and ropinirole)

Question 87

Which medications can be given for mild Parkinson's? a) pramipexole b) rasagiline c) benztropine d) bromocriptine

Answer 87

Answer: All

Question 88

What are side effects of selegiline and rasagiline? a) risk taking behavior b) liver failure c) hyperprolactinemia d) increased suicidal thoughts

Answer 88

Answer: d) increased suicidal thoughts when used with SSRI in adolescents/children Other SE: fatal serotonin syndrome if given with SSRI

Question 89

COMT inhibitors side effects include: a) risk taking behavior b) liver failure c) hyperprolactinemia d) increased suicidal thoughts e) two or more of the above

Answer 89

Answer: e) two or more of the above SE: liver failure BBW- tolcapone; risk taking behavior; impulse control; hallucinations; orthostatic hypotension COMT inhibitors work to increase levels of Levo and Levo's half life "Al capone Killed COMT"

Question 90

When can rotigotine be used in Parkinson's disease? a) any stage b) mild stage c) severe stage d) any time but as an adjunct to other therapy

Answer 90

Answer: a) any stage

Question 91

Apomorphine is used: a) for pain in Parkinson's disease b) to decrease dyskinesias c) to prolong life of Levo d) to treat hypomobility in "off" periods

Answer 91

Answer: d) to treat hypomobility in "off" periods

Question 92

What is the benefit of Stalevo?

Answer 92

It is a combo pill of Levodopa/Carbidopa/Entacapone but it is only immediate release and 3 strengths.

Question 93

What is used to treat psychosis in Parkinson's? a) SSRIs b) amitryptyline c) 1st generation antipsychotic d) 2nd generation antipsychotic

Answer 93

Answer: d) second generation antipsychotic

Question 94

Nonmotor symptoms of Parkinson's disease:

Answer 94

Sleep issues, periodic limb movement, depression, psychosis

Question 95

For limb movement issues in Parkinson's disease, what can we use? a) pramipexole/ropirinole b) levodopa/carbidopa c) amitryptyline d) benztropine

Answer 95

Answer: a) pramipexole/ropirinole

Question 96

What can manage insomnia in Parkinson's? a) melatonin b) pramipexole/ropirinole c) levodopa/carbidopa d) apomorphine

Answer 96

Answer: a & c

Question 97

Cholinesterase inhibitors are appropriate for which stage of Alzheimers? a) mild to moderate b) moderate to severe

Answer 97

Answer: a) mild to moderate

Question 98

Memantine, an NMDA receptor antagonist is appropriate for which stage of Alzheimer's? a) mild to moderate b) moderate to severe

Answer 98

Answer: b) moderate to severe

Question 99

Carbamezpine is linked to an increased risk of SJS in Asians with what genetic marker? a) HL-B1504:01 b) HLA-B5801 c) HLA-B5802:01 d) HL-B1502

Answer 99

Answer: d) HL-B1502