Pharmacology 1-200 Flashcards
In the stomach, aspirin will exist predominantly as the \_\_\_\_\_\_\_\_\_\_\_\_\_\_ form. A. Hydrophilic, ionized, polar B. Lipophilic, unionized, non-polar C. Hydrophilic, unionized, non-polar D. Lipophilic, ionized, polar E. Hydrophilic, unionized, polar
B
Review the Henderson-Hasselbach equation. Aspirin (acetylsalicyclic acid) is acidic in nature. In an acidic environment like the stomach, it will exist predominantly as the lipid-soluble, unionized, non-polar form
In the CHOP regimen for non-Hodgkin's lymphoma, which chemotherapeutic drug acts by inhibiting the mitotic spindle? A. Cyclophosphamide B. Hydroxyurea C. Oncovin D. Prednisone E. Doxorubicin
C
Oncovin is vincristine.
A patient with leprosy is taking a drug that casts a red color to the skin. He is probably taking: A. Dapsone B. Rifampin C. Clofazimine D. Ethambutol E. Phenylbutazone
C
Rifampin causes red discoloration of body fluids but not the skin.
What part of the pharmacokinetics of penicillin is affected by the drug probenecid? A. Glomerular filtration B. Tubular reabsorption C. Tubular secretion D. Hepatic uptake E. Protein-binding with albumin
C
Probenecid raises plasma concentration of penicillin by inhibiting its tubular secretion in the renal tubules.
Hoffman elimination is exhibited by: A. Succinylcholine B. Diazepam C. Phenobarbital D. Phenytoin E. Atracurium
E
Hoofman elimination aka exhaustive methylation
In a patient suffering from organophosphate poisoning with a cardiac rate of 45, what drug should be given? A. Neostigmine B. Atropine C. Epinephrine D. Pancuronium E. Edrophonium
B
Because of its antimuscarinic effect on the heart, atropine (the antidote for organophosphate poisoning) has a positive chronotropic effect.
Patients receiving cyclophosphamide should also be given: A. Mesna B. Leucovorin C. Vitamin B6 D. Thiamine E. Amifostine
A
Leucovorin for methotrexate. Pyridoxine for isoniazid. Thiamine for alcoholics.
Which statement is correct regarding the aminoglycosides?
A. They work in anaerobic conditions.
B. They exhibit concentrationdependent killing.
C. Most drugs of this class are myelosuppresive.
D. They cannot be given to patients allergic to penicillins.
E. They are acidic in nature.
B
Aminoglycosides only work in arebic conditions. They do not have crossreactivity with the penicillins. Most drugs are nephrotoxic and ototoxic.
What is the second messenger system for the receptors blocked by metoprolol? A. cAMP B. IP3 C. DAG D. cGMP E. PLC
A
Beta-2 receptors are coupled to the cAMP second messenger system.
In the treatment of Parkinson's disease, what drug is given with levodopa to increase the drug's bioavailability? A. Entacapone B. Selegiline C. Carbidopa D. Fluoxetine E. Pyridoxine
C
Carbidopa peripherally inhibits the enzyme DOPA decarboxylase, the enzyme that converts DOPA to dopamine. Dopamine itself is unable to cross the blood-brain barrier but DOPA can. Inhibition of the enzyme results in more DOPA available to enter the CNS. Within the CNS, DOPA is converted to dopamine by the same enzyme. However, it is not inhibited by carbidopa at this location
Which drug used in the treatment of depression possess a tricyclic ring? A. Imipramine B. Fluoxetine C. Trazodone D. Venlafaxine E. Bupropion
A
Imipramine is a tricyclic antidepressant.
Which antiretroviral drug acts through the M2 ion channel? A. Efavirenz B. Nevirapine C. AZT D. Amantadine E. Indinavir
D
Amantadine is also effective for influenza.
Drug X has greater affinity for albumin than Drug Y. Considering all other parameters are the same, what significant drug-drug interaction is expected to take place when both drugs are administered simultaneously?
A. Drug X will have a higher plasma concentration than Drug Y.
B. Drug Y will not be filtered by the renal glomerulus.
C. Drug Y will not be available to interact with its receptors in the tissues.
D. The free plasma drug concentration of Drug Y will increase.
E. Drug X can exert its full biologic activity.
D
Only the free, unbound drug can interact with receptors, exert biologic activity, and be excreted by the kidneys.
Dissociative anesthesia is effectively achieved by the combination of:
A. Thiopental, diazepam, ketamine
B. Ketamine, nitrous oxide, fentanyl
C. Succinylcholine, thiopental, diazepam
D. Nitrous oxide, halothane, fentanyl
E. Succinylcholine, halothane, thiopental
B
Among the inhaled anesthetics, nitrous oxide has the \_\_\_\_\_\_\_ MAC and the \_\_\_\_\_\_ potency. A. Lowest, lowest B. Lowest, highest C. Highest, lowest D. Highest, highest E. Intermediate, intermediate
C
The MAC is a measure of an inhaled anesthetic’s potency. The relationship is inverse.
Which properties of digoxin make it an effective treatment in cases of heart failure?
A. Positive inotrope, positive chronotrope
B. Positive inotrope, negative chronotrope
C. Negative inotrope, negative chronotrope
D. Negative inotrope, positive chronotrope
E. None of the above
B
Digoxin also slows AV conduction (negative dromotrope)
In anticoagulation, warfarin therapy is usually overlapped with heparin for the first 1-2 days. Why is this so?
A. To achieve supraoptimal anticoagulation during critical periods of illness as warfarin and heparin have synergistic effects.
B. To prevent bleeding as heparin partially counteracts warfarin’s hemorrhagic property.
C. Warfarin is metabolized slowly thus leading to a delay in anticoagulation if heparin is not also given.
D. To compensate for warfarin’s initial prothrombotic property.
E. Heparin decreases the clearance of warfarin thus achieving greater plasma drug concentration of warfarin.
D
Warfarin acts by vitamin K anatagonism. The initial prothrombotic effect of warfarin is because the synthesis of protein S, an anticoagulant, also depends on vitamin K. Thus, protein S levels decline initially and the effect of protein C (for which it serves as a co-factor) is also diminshed.
A commercial product for colds contain the following: Phenylephrine, chlorpheniramine, and paracetamol. Which acts as the decongestant?
A. Paracetamol
B. Chlorpheniramine
C. Phenylephrine
D. Both chlorpheniramine and phenylephrine
E. This product does not contain a decongestant.
C
Phenylephrine constricts blood vessels through stimulation of adrenergic receptors. This acts as a decongestant
Which antimalarial drug should not be given to a patient with glucose-6- phosphate dehydrogenase deficiency? A. Chloroquine B. Quinine C. Atovaquoneproquanil D. Mefloquine E. Primaquine
E
What drug should be given to an immunocompromised patient with CMV retinitis? A. Acyclovir B. Vidarabine C. Indinavir D. Ganciclovir E. AZT
D
Ganciclovir is the drug of choice for CMV. Foscarnet is an alternative.
What is the pharmacologic basis of using Timolol in open angle glaucoma?
A. Increaed outflow via dilatation of uveoscleral veins
B. It leads to opening of trabecular meshwork
C. It suppresses the ciliary epithelium from producing aqueous humor
D. lt decrease production of aqueous humor by decreasing levels of bicarbonate through cAMP mediated pathway.
E. none of the above
C
MOA: letter A- alpha agonist and epinephrine; B- Cholinomimetics ( physostigmine, pilocarpine) D- there is no such thing cAMP dependent decrease in bicarbonate; however inhibition of Carbonic anhydrase leads to decrease humor production via decreased bicarbonate levels.
A 7 yo male was brought to ER secondary to symptoms suggestive of botulinum toxin ingestion, which of the following are likely included in the symptoms of the patient? A. Muscle fasciculation B. Bronchoconstriction C. Increased bowel movement D. blurred near vision E. hypertension
D
Botulinum toxin inhibits the release of vesicular contents from all types of cholinergic nerve endings. Since both ganglionic/autonomic and peripheral motor synapse are affected. Patient will present with hypotension and lack of muscular contraction. Blurred near vision is a result of paralysis of ciliary muscle aka cycloplegia
Which of the following will increase the arrythmogenic side effect of digoxin? A. Decrease sympathetic discharge B. Increase serum Potassium C. Decrease serum Calcium D. Increase Parasympathetic discharge E. None of the above
D
hypokalemia, hypomagnesemia, hypercalcemia, and increase vagal tone increases the risk for digoxin induced arrhytmia
Which of the following is correct regarding isosorbide mononitrate?
A. Can be use along with PDE inhibitors compared to other forms of nitroglycerin
B. It has a similar mechanism of action with Nitroprusside by phosphorylation of myosin light chain phosphate
C. It has no direct effect on cardiac muscle
D. the primary mechanism for decrease in BP is due to decrease in afterload
E. B and C are correct
C
ISMN is the oral form of nitroglycerin. Its mechanism is by activating guanylyl cyclase causing an increase in cGMP eventually leading dephosphorylation of MLC. Its antihypertensive effect is primarily via venodilation. It has no direct inotropic or chronotropic effect to the heart. all forms of nitroglycerin should not concomitantly use with anyform of PDEI ( sildenafil) since it will cause profound hypotension and hypoperfusion of critical organs
This drug when given IV and supraphysiologic dose will cause conduction block on AV node via increasing K efflux? A. Verapamil IV B. Adenosine C. Fleicanide D. Amiodarone E. None of the above
B Verapamil can also decrease AV node conduction however via blocking L type Ca channels and not K channels. Fleicanide is a class IC drug that affects primarily Na channels present in both atria and ventricles. Amiodarone is the most efficacious of all antiarrhythmic drug since it blocks Na, Ca, K and Beta receptors. the question is specific on its action in reference to AV node. the best answer is adenosine.
Which of the following drugs can cause prolonged QT interval leading to Torsade de Pointes arrhytmia? A. Esmolol B. Propafenone C. Procainamide D. Verapamil E. None of the above
C
antiarrhytmic drugs that affects the K channel at phase 3 causes prolongation of Action Potential leading prolonged QT interval. These drugs are of the Class IA and III. Class IA drugs - procainamide, quinidine, disopyramide. Class IIIIbutilide, sotalol, dofetilide
Which in the following drugs is classified as 5HT1D agonist? A. Tegaserod B. Ketanserin C. Ondansetron D. Naratriptan E. None of the above
D
Naratriptan and its prototype Sumatriptan are 5HT 1D agonist use for the treatment of acute migraine and cluster headache. Tegaserod indicated for constipation is a 5HT4 partial agonist.Ondansetron is a 5-HT3 antagonist ise for antiemesis in post operative and postchemotherapy patients. Ketanserin is a 5HT2 antagonist use for controlling the systemic effects of carcinoid syndrome.
The primary indication of Epoprostenol? A. Open angle glaucoma - increase outflow of aqueous humor B. Severe pulmonary hypertension C. Postpartum bleeding D. All of the above E. None of the above
B
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE last aug 2014. Epoprostenol is a Prostacyclin analog use for dialysis to prevent platelet aggregation and also for pulmonary hypertension. Latanoprost or PGF2a analog is the one use for glaucoma. Misoprostol or RU 486 (PGE1 analog) has an off label indication for induction of labor. it primarily acts as an abortifacient
What is the site of action of corticosteroids in terms of its antiinflammatory effect? A. Cyclooxygenase 1 and 2 B. Phospholipase C C. Phospholipase A2 D. Thromboxane synthase E. All of the above
C
Corticosteroids exerts its anti inflammatory effect by inhibiting the Phospholipase A2 enzyme which is responsible for generation of arachidonic acid from membrane lipids. Phospholipase C is not connected with corticosteroids and its function is to generate IP3 and DAG. Cyclooxygenase and thromboxane synthase is primarily inhibit by Coxibs and NSAIDS
the major systemic side effects of systemic corticosteroids are much more likely to occur if at least the duration of treatment is more than\_\_\_\_\_? A. 14 days B. 4 weeks C. 3 weeks D. 20 days E. 2 months
A
Katzung Review of pharmacology 8th ed pp 171. .
What is the most serious side effect of Methanol ingestion? A. Retinal damage B. Hepatotoxicity C. Blood dyscrasia D. Nephrotoxicity E. Neurotoxicitystatus epilepticus
A
Methanol or wood alcohol is metabolized by alcohol dehydrogenase to produce a product called Formaldehyde and formic acid. This metabolite causes severe acidosis and prominent retinal damage. Nephrotoxicity is a major side effect of ethylene glycol poisoning via its oxalic acid metabolite. treatment for both alcohol is by administration of Fomepizole ( inhibitor alcohol dehydrogenase) and ethanol ( competitive substrate for alcohol dehydrogenase)
which of the following antiseizure drugs can inhibit cytochrome isoenzymes leading to increase plasma concentration of other drugs? A. Phenobarbital B. Lorazepam C. Oxcarbazepine D. Valproic acid E. None of the above
D
Oxcarbazepine, carbamazepine, Barbiturates, Phenytoin are all drug metabolizing inducers. Only Valproic acid in the choice is an inhibitor. Benzodiazepines do not affect the function of the cytochromes.
Which of the following antiparkinsonian drugs can cause exacerbation of psychosis and produce ergot related effects such as pulmonary fibrosis and erythromelalgia A. Amantadine B. Bromocriptine C. Entacapone D. Haloperidol E. None of the above
B
Katzung Review of pharmacology 8th ed pp 233. Both Levodopa and bromocriptine can cause exacerbation of schizophrenia by increasing brain dopamine levels. However, only bromocriptine can cause ergot related side effects.
Prolonged treatment with a PPAR alpha ligand in the treatment of hyperlipidemia will increase the risk for the following condition? A. Cutaneous flushing B. Hyperuricemia leading to Gout C. Intestinal malabsorption D. Gallstones E. hepatotoxicit
D
PPAR alpha ligands is the MOA of fibric acid derivatives ( Gemfibrozil and fenofibrate). It increases the supersaturation of bile leading cholelithiasis. Risk for hepatotoxicity only significantly increase if gemfibrozil is combined with HMG CoA inhibitor. Cutaneous flushing and hyperuricemia are toxicity profile of Niacin. Intestinal malabsorption is a primary side effect of resins ( cholestyramine, colestipol, colsevelam)
Which of the following is not true in the pharmacologic profile of Aminoglycosides?
A. The primary mechanism of resistance is due to plasmid mediated group transferases
B. Bactericidal action continuous even if the plasma drug concentration is below measuring levels
C. It does not have an activity against anaerobic organisms
D. high dose can cause respiratory paralysis
E. none of the above
E
Aminoglycoside exerts concentration dependent killing and post antibiotic effect. It also has curare like action at high dose leading to respiratory paralysis. Aminoglycosides needs Oxygen dependent transport to exerts inhibitory effect 30s ribosome. therefore, it has no activity to anaerobes. acetylation by plasmid mediated group transferase is the major mode of resistance.
Which of the following is a drug of choice for daily dose prophylaxis in AIDS patient with a CD4 count of 50/UL? A. Cotrimoxazole B. Kanamycin C. Azithromycin D. Erythromycin E. Clarithromycin
E
AIDS patient with a CD4 count of less than 50/UL are prone to have Mycobacterium Avum Intracellulare infection. The only approved prophylactic treatment are daily dose of clarithromycin with or without rifabutin and once weekly dose of azithromycin
Which in the following choices can be primarily use for the treatment of hemolymphatic stage of trypanosomiasis and for Pneumocystis jiroveci infection A. Sodium Stibogluconate B. Metronidazole C. Nifurtimox D. Pentamidine E. Cotrimoxazole
D
Sodium stibogluconate - treatment of all forms of leishmaniasis infection; Metronidazole is not effective in the said infection, it is use for giardia and trichomonas infection. Nifurtimox is for chagas diseae ( T cruzi infection). Cotrimoxazole is used for P jiroveci but not effective in Trypanosomiasis infection
What is the drug of choice for all forms of schistosomiasis and paragonimiasis? A. Diethylcarbamazine B. Praziquantel C. Ivermectin D. Albendazole E. Piperazine
B
DEC is the drug of choice for loa loa infection, it is also an alternative drug for elephantiasis. Ivermectin - DOC for onchocerciasis, cutaneous larva migransm and strongyloides. Albendazole- ascariasis, hookworm, pinworm, whipworm, cysticercosis and hydatid disease. Piperazine is an alternative drug for ascariasis.
In what phase of the cell cycle does vinca alkaloid exerts its effect? A. G0 B. G1 C. S D. G2 E. M
E Vinca alkaloids ( vinblastine, vincristine, vinorelbine) blocks the formation of mitotic spindle by preventing the assembly of tubin dimers into microtubules. Therefore it acts on the M phase.
Which of the following drugs/drug regimen is primarily used for Hodgkin’s Lymphoma
A. ABVD- adriamycin, bleomycin, vincristine, dacarbazine, prednisone
B. PEB - cisplatin, etoposide, bleomycin
C. Gemcitabine + 5 FU + radiation
D. EMACO- etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine
E. all of the above
A
B- testicular cancer, C- pancreatic cancer, D- choriocarcinoma. Aug 2014 SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE.
25 year old female came in with chief complaint of cough of 3 weeks duration, this was accompanied by night sweats, weight loss, body malaise. PE revealed slightly pale palpebral conjunctiva, multiple bilateral posterior cervical lymphadenopathies but with no adventitious breath sounds on bilateral lung fields. The rest of the physical examination was unremarkable, which of the following drugs is considered to be the most active for her condition? A. Rifampicin B. Isoniazid C. Pyrazinamide D. Ethambutol E. streptomycin
B
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE.,Considered as the most active anti-TB drug, in fact the only drug given to treat latent tuberculosis
A 56 year old patient diagnosed with rheumatic heart disease underwent mitral valve replacement and is placed on oral anticoagulant Warfarin, she comes to your clinic for a follow up check up and complaints of heartburn and epigastric pain, which of the following medications will you avoid prescribing? A. Cimetidine B. Aluminum Magnesium Hydroxide C. lansoprazole D. ranitidine E. sucralfate
A
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, which asked us directly which of the following is a CYP inhibitor: cimetidine, Warfarin is majorly metabolized by CYP 2C9, cimetidine inhibits this enzyme among others which inhibits warfarin metabolism which increases its toxicity
Which of the following medications is considered as an inhibitor of glucocorticoid synthesis which could be used in the treatment of cushing's syndrome and some types of cancers? A. Methylprednisolone B. anastrozole C. Danazol D. Aminogluthetimide E. Flutamide
D
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, I couldnメt believe this was actually asked, aminoglutethimide inhibits desmolase blocking conversion of cholesterol to pregnenolone reduces synthesis of all hormonally active steroids, anastrozole inhibits only estrogen synthesis, danazol is an androgen, flutamide is androgen antagonist
Which of the following drugs can cause cataract formation? A. allopurinol B. pyrazinamide C. propanolol D. omeprazole E. ciprofloxacin
A
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, one of the hardes pharma questions we encountered, we did not know at that time that allopurinol was associated with cataracts :)
Which of the following chemotherapeutic regimens could be used for the treatment of advanced hodgkin's disease? A. FOLFOX B. MOPP C. CHOP D. 7+3 E. BEP
B
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE - MOPP nitrogen mustard, oncovin, procarbazine, prednisone, take time to know the common regimens for other cancers as well, ex: folfox colorectal, CHOP nonhodgkins, BEP testicular, 7+3 AML
Which of the following medications causes mydriasis but without cycloplegia? A. tropicamide B. homatropine C. cylopentolate D. phenylephrine E. atropine
D
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE also a difficult one, only phenylephrine among the choices causes mydriasis without affecting accomodation
When a pregnant 18 year old female delivered her child, her baby was noted to have characteristic small palpebral fissures, smooth philtrum and thin upper lip, which of the following substances when ingested by the mother during pregnancy could potentially be the cause of such changes? A. phenytoin B. warfarin C. ethanol D. captopril E. isotretinoin
C
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, know the common syndromes and teratogen, answer here is fetal alcohol syndrome
What is the predominant reason why nitroglycerin is generally preferred not to be given via the oral route?
A. could potentially cause dangerous systemic hypotension
B. is considerably less effective when given through this route
C. is immediately inactivated by exposure to low gastric pH
D. there is high first pass effect
E. food in the stomach significantly retards absorption
D
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, high first pass effect is the best answer, low bioavailability through the oral route due to liver metabolism
Which of the following is an inhalational anesthetic of choice for asthmatic patient because it causes the least bronchospasm? A. halothane B. desflurane C. sevoflurane D. thiopental E. propofol
A
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, halothane generally is the inhaled agent of choice, sevoflurane is debatable, desflurane is pungent, the others are IV anesthetics
Which of the following drugs given contains an effect which suppresses nausea and vomiting ? A. propanolol B. procarbazine C. chlorambucil D. chlorpromazine E. chloramphenicol
D SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, difficult because chlorpromazine usually is used as a antipsychotic but has antiemetic effects belonging to the phenothiazine class along with other drugs used to control nausea vomiting like promethazine
Which of the following medications could be given to high risk or immunocompromised patients with RSV infections? A. Acyclovir B. Fosamprenavir C. Indinavir D. Ganciclovir E. Ribavirin
E
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, acyclovir and ganciclovir for herpes group, indinavir and fosamprenavir for hiv
Using drugs to block which of the following chemical mediators could potentially decrease leukocyte chemotaxis? A. prostaglandin H B. cyclooxygenase C. bradykinin D. leukotrienes E. serotonin
D
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, but leukotrienes could also serve as chemotactic factors
A patient is taking fenofibrate for elevated trigylceride levels, which of the following laboratory examinations should the doctor request to monitor for potential side effects upon follow up after 3 to 6 months?
A. CBC with differential count
B. urinalysis C. AST, ALT
D. fasting blood glucose levels
E. serum total cholesterol and triglycerides
C
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, fibrates can potentially increase liver enzymes
Which of the following medications can be used as part of a regimen for migraine prophylaxis? A. ibuprofen B. acetaminophen C. sumatriptan D. propranolol E. dihydroergotamine
D
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, prophylaxis: pizotifen, TCA, anticonvulsants and beta blockers, methysergide, flunarizine
Which of the following medications can decrease conduction through the AV node? A. nifedipine B. verapamil C. lithium D. prazosin E. dypyridamole
B
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, verapamil is a non dihydropyridine calcium channel blocker which exerts its actions more on the heart decreasing AV nodal conduction
A 24 year old female is taking oral contraceptives as family planning method. Which of the following drugs is considered a CYP450 enzyme inducer which can cause rapid metabolism of other drugs such as oral contraceptives which can potentially decrease their effectiveness? A. isoniazid B. trimethoprim sulfamethoxazole C. griseofulvin D. Amiodarone E. ketoconazole
C
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, what came out as an enzyme inducer in ours was phenobarbital, griseofulvin is an inducer all the others are inhibitors, memorize at least the most common of them inducers and inhibitors, topnotch handouts are good reference
Which of the following chemotherapeutic agents can produce pulmonary fibrosis as toxicity? A. bleomycin B. doxorubicin C. irinotecan D. etoposide E. carmustine
A
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, know the characteristic adverse effects and toxicities, the peculiar ones, the ones that make the drugs famous, pulmo fibrosis = bleomycin
Which among the following cardiac drugs can decrease preload, afterload and contractility? A. digoxin B. captopril C. amlodipine D. Hydrochlorthiazide E. propranolol
E
know the mechanism understand them, know and master normal physiology, digoxin is a negative chronotropic but positive inotropic inc contractility, captopril inhibits ACE, acts on the RAAS decreases preload by decreasing aldosterone and sodium water retention hence decrease blood volume dec venous return, amlodipine calcium antagonist predominantly on the vessels decrease afterload by dilating resistance vessels, hydrochlorthiazide decreases preload by increasing secretion of both sodium water, propranolol, non selective beta blocker, decreases renin secretion hence RAAS through B1 blockage this includes angiotensin 2 so decreased both preload afterload, decreases contractilitty through B1 blockade,
Which of the following antibiotics are highly protein bound which can act to displace other substances from albumin binding and increase free drug levels A. chloramphenicol B. ciprofloxacin C. cotrimoxazole D. tetracycline E. gentamicin
C
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, sulfa drugs are usually highly protein bound drugs which can displace other drugs making the free drug available to easily permeate cell membranes or bind to receptors, it can also displace bilirubin from albumin raising bilirubin levels in neonates
Which of the following drugs with mechanism of action that inhibits protein synthesis by inhibiting binding of the tRNA to the mRNA ribosome complex A. tetracycline B. clindamycin C. gentamycin D. erythromycin E. chloramphenicol
A
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, please know the mechanism of action of each drug class
If a single dose of a known drug with first order elimination is given intravenously, how long will it take for 75% of the drug to be eliminated if the half-life is 1.5 hours? A. 1.5 hours B. 2 hours C. 2.5 hours D. 3 hours E. 6 hours
D
Review first-order elimination. 50% is one half-life, 75% is 2 X half-life and so on..
Which of the following teratogenic effects is associated with valproic acid use in pregnancy? A. Craniofacial anomalies B. Neural tube defects C. Ebstein anomaly D. Fetal hydantoin syndome E. Microcephaly
B
A is carbamazepine; C is Lithium, D is phenytoin
You are assigned to go on duty as an intern of the toxicology department of the hospital. You recall that activated charcoal will NOT be effective adsorbing which of the following? A. Iron B. Theophylline C. Phenobarbital D. Amitryptiline E. Digoxin
A
Iron, lithium, cyanide, alcohol are poorly adsorbed by activated charcoal
Which of the following Cholinomimetic drugs are used exclusively in the treatment of Alzheimer's disease? A. Donepezil B. Physostigmine C. Rivastigmine D. A and B E. A and C
E
Donepezil, Rivastigmine, Tacrine used exclusively in Alzheimer’s
You prescribe a cancer patient who is undergoing chemotherapy with allopurinol to address hyperuricemia. Upon reviewing his chart, you realize caution is needed because of risk of toxicity. Which of the following chemotherapeutic drus is most likely being given to the patient? A. Azathioprine B. Methotrexate C. Fluorouracil D. Cytarabine E. All of the above
A
Azathioprine/Mercaptopurine metabolism is inhibited by allopurinol.
Adrenoreceptor blockers such as acebutolol and pindolol are unique for having intrinsic sympathetic activity. What is meant by this characteristic? A. has a membranestabilizing activity B. has partial agonist activity C. has receptor selectivity D. A and B E. All of the above
B
Which of the following drugs that used in gout has been associated with cataract formation? A. Colchicine B. Allopurinol C. Probenecid D. Indomethacin E. Acetaminophen
B
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE
You are treating a patient HIV-patient for an opportunistic viral infection affecting the eyes. If you suspect viral strains that are thymidine-kinase deficient, you decide to choose an antiviral drug that is exclusively phosphorylated by host cell kinases but which doesn't require viral kinase phosphorylation. Which of the following will you choose? A. Acyclovir B. Ganciclovir C. Cidofovir D. Foscarnet E. Lamivudine
C
Cidofovir is phosphorylated by host kinases while Foscarnet doesnメt reqauire phosphorylation. Both are used in thymidine-deficient resistant strains of CMV
A 63 year old male patient presenting with intermittent complaints of chest pain upon walking several blocks or climbing several flights of stairs is prescribed with nitroglycerin to used on an as needed basis. What will be the expected physiologic changes as a result of this drug?
A. Increased HR and and decreased left ventricular end-systolic volume
B. Decreased HR and decreased left ventricular end-systolic volume
C. Decreased HR and increased left ventricular end-systolic volume
D. Increased HR and increased left ventricular end-systolic volume
E. None of the above
A
Nitroglcerin decreases afterload, thus, decreasing end systolic volume. Compensatory sympathetic activity increases heart rate.
Which of the following mechanism indicates high-level resistance in a TB patient being treated with Isoniazid?
A. deletions in inhA gene that encodes target enzyme
B. changes in drug sensitivity to RNA polymerase
C. expression of drug efflux system
D. expression of inactivating enzymes
E. deletion in katG gene involved in the bioactivation of the drug
E
E is INH high level resistance; A is INH low level resistance; B is rifampicin resistance
A drug with diuretic activity is being studied based on its effects on electrolyte levels in the urine. It was found to moderately increase urine NaCl and urine K while decreasing urine Ca with associated slight increase in body pH and minimal change in urine HCO3-. This drug has characteristics similar to that of? A. Loop diuretic B. Carbonic anhydrase inhibitor C. K-sparing diuretic D. Thiazide diuretic E. Osmotic diuretic
D
Thiazide increases Na and K excretion and causes metabolic alkalosis. It increases Ca reabsorption
Which of the following steroid antagonists inhibits cytochrome P450 enxymes necessary for all steroids? A. Ketoconazole B. Aminogluthetimide C. Metyrapone D. Spinorolactone E. Mifepristone
A
Ketoconazole is a potent cytochrome p450 inhibitor. Aminoglutethimide inhibits conversion of cholesterol to pregnenolone. Metyrapone inhibits cortisol synthesis. Spinorolactone inhibits aldosterone. Mifepristone inhibits progesterone
A patient with warfarin as a maintenance medication is treated for pneumonia. Prothrombin time monitoring during treatment of the respiratory infection reveals elevated INR but it decrease back to baseline levels after treatment with the antibiotic is completed. Which of the following is most likely given? A. Amoxicillin B. Ceftriaxone C. Clindamycin D. Erythromycin E. TMP-SMX
D
Erythromycin inhibits metabolism of warfarin causing an increase In INR
A COPD patient with severe concomitant heart condition is being prescribed a drug that will relieve his dyspnea and shortness of breath. Which of the following bronchodilators will be the primary choice? A. Salmeterol B. Salbutamol C. Terbutaline D. Atropine E. Ipratropium
E
Ipratoropium is an anticholinergic used in COPD because of less cardiac effects
A physician prescribes a diabetic patient with an antidiabetic agent that activates a nuclear receptor that increases transcription of GLUT-4 transporters in adipose tissue. The drug prescribed is most likely: A. Methotrexate B. Insulin C. Pioglitazone D. Glyburide E. Sitagliptin
C
Thiozolidinediones - activates PPAR, a nuclear receptor to improve sensitivity to insulin
A patient presented to your clinic with complaints of dyspnea and chronic cough. He states that he frequently gets short of breath and is unable to take a deep breath. History is significant for prolonged treatment of rheumatoid arthritis. Chest X-ray revealed fine reticulonodular densities. Which drug is most likely responsible? A. Glucocorticoids B. Methotrexate C. Infliximab D. Cyclosporine E. Anakinra
B
Methotrexate is known to cause pulmonary fibrosis
If you need to give a skeletal muscle relaxant to a burn patient, you will AVOID prescribing which of the following drugs? A. Pancuronium B. Baclofen C. Dantrolene D. Vecuronium E. Succinylcholine
E
Succinylcholine is contraindicated in patient with rhabdomyolysis, hyperkalemia, burn patients, malignant hyperthermia
Which of the following medications exert its anticoagulant effect through the inactivation of thrombin? A. Fondaparinux B. Unfractionated heparin C. Low molecular weight heparin D. Apixaban E. All of the above
B
Fondaparinux and LMW heparin combines with antithrombin and selectively inhibits factor X but NOT thrombin. Apixaban is a direct Xa inhibitor
One of the following drugs is effective in reducing the risk of ulcers in chronic NSAID users. Diarrhea is a frequent side effect. Which is it? A. Sucralfate B. Ranitidine C. Omeprazole D. Misoprostol E. Cimetidine
D
Knowledge of potency and solubility is important in general anesthetic medications. Which of the following characteristics refers to high potency?
A. Low minimum alveolar concentration
B. High minimum alveolar concentration
C. Low blood:gas partition coefficient
D. High blood:gas partition coefficient
E. None of the above
A
Low MAC - high potency; High MAC - low potency; Low blood:gas coefficient - low solubility; High blood:gas coeeficient - high solubility