Test Review

Question 1

Describe hypokalemia on cardiac conduction

Answer 1

Decreased extracellular potassium concentration (hypokalemia) results in decreased potassium conductance, which reduces potassium current. Hypokalemia is also shown by the appearance of U waves. Hypokalemia would also account for the woman’s muscle weakness (flaccid paralysis) as it decreases the voltage-gated sodium current in nerve, skeletal muscle, and cardiac muscle. In hypokalemia, decreased sodium current in atrial myocytes would increase the duration and decrease the amplitude of the P wave. Hypokalemia would decrease delayed rectifier potassium current in the SA node, which would make the slope of phase 4 steeper and increase heart rate. Excitability of cardiac myocytes would be decreased in hypokalemia due to decreased sodium current (threshold would be shifted more positive than normal). Increased plasma potassium concentration (hyperkalemia) would increase potassium current, which would increase the rate of phase 3 repolarization. The duration of the ventricular action potential would be decreased and a spiked T wave would be seen on the ECG.

Question 2

Describe the effects of hyperkalemia on cardiac conduction

Answer 2

In hyperkalemia, gK would be increased and EK would be less negative (more positive). The increased gK in hyperkalemia would increase potassium current, resulting in a faster phase 3 repolarization (spiked T wave). Hyperkalemia causes a resting depolarization of atrial and ventricular myocytes, which decreases the number of resting sodium channels. This would decrease the conduction velocity of the action potential through the atria and widen the P wave, and prolong the P-R interval. Hyperkalemia would increase potassium current, decreasing the duration of the ventricular action potential. This would decrease the QT interval. Hyperkalemia decreases sodium current in ventricular myocytes, which would decrease conduction velocity of the action potential. The time to fully depolarize the ventricles would be increased and seen as a wide QRS complex (with a lower amplitude and slower rate of rise than normal).

Question 3

How do pre and post ganglionic lengths compare in sympathetic vs para sympathetic?

Answer 3

Parasympathetic - Long Pre and short post

Sympathetic - short pre and long post

Question 4

Why does sympathetic discharge lead to increased blood flow to muscle and decreased to skin?

Answer 4

Muscle contains predominantly Beta receptors and skin has alpha

Question 5

Miosis

Answer 5

Excessive contraction of the pupil of eye

Question 6

Mydriasis

Answer 6

Excess dilation of the pupil

Question 7

What is the area of integration for the autonomic nervous system?

Answer 7

Hypothalamus

Question 8

Describe norepinephrine metabolism by MAO and COMT in respect to metabolites and location

Answer 8

MAO - Dihydroxymandelic acid and occurs within mitochondria

COMT - Normetanephrine and occurs within extra neuronal spaces

Question 9

Pilocarpine is a muscarinic _____?

Answer 9

Alkaloid

Question 10

Carbachol has what type of action on nicotine receptors?

Answer 10

Direct

Question 11

How do trimethaphan and hexamethonium block ganglions?

Answer 11

Both competitively block nicotinic Ach receptor without causing depolarization

Question 12

How do neostigmine/physostigmine inhibit AchE?

Answer 12

Act as substrates (competitive inhibition) and are slowly hydrolyzed

Question 13

How will administering edrophonium affect symptoms of cholinergic crisis?

Answer 13

Make symptoms worse

Question 14

How do sympathomimetic agents affect metabolism?

Answer 14

Excitation of metabolism mediated by B2 increased glycogenolysis

Question 15

Norepinephrine can stimulate what Beta receptors?

Answer 15

B1 - increase HR and contractility

Question 16

Eye effect: alpha 1

Answer 16

Radial muscle leading to mydriasis

Question 17

Eye effect: M3

Answer 17

Affecting circular and ciliary muscles leading to miosis and accomidation

Question 18

Eye effect: B2

Answer 18

ciliary body leading to aqueous humor secretion

Question 19

Mechanism: Tyramine

Answer 19

Acts by releasing NE from cytoplasmic neuronal pool to produce tachyphylaxis

Question 20

Pindolol/Timolol are used in the treatment of?

Answer 20

HTN and arrythmias

Question 21

Metryosine forms a compound with what inhibiting what?

Answer 21

Tyrosine hydroxylase leading to inhibition of rate limiting step

Question 22

Tachyphylaxis

Answer 22

Rapidly diminished effect of a drug after successive administration

Question 23

Sweat glands are innervated by

Answer 23

Sympathetic CHOLINERGIC nervous system

Question 24

Patients on MAO inhibitors are at increased risk for what?

Answer 24

Developing HTN crisis following ingestion of meals rich in tyramine

Question 25

General sympathetic discharge can lead to?

Answer 25

Hyperglycemia - Beta 2

Question 26

Ephedrine, Amphetamines and Tyramine all produce?

Answer 26

Tachyphylaxis

Question 27

Toxic activation of nicotinic effects

Answer 27

Stimulation followed by paralysis of ganglia of skeletal muscle

Question 28

Tubocurarine

Answer 28

Competitive antagonist at ganglia and adrenal medulla leadin to decreased BP, tachycardia, and histamine Also blocks nicotinic receptor at NMJ producing paralysis

Question 29

Skeletal muscles have what type of receptors?

Answer 29

Post synaptic NICOTINIC receptors

Question 30

Epinephrine metabolis

Answer 30

Uptake

Question 31

Phentolamine before isoproteranol would?

Answer 31

Create greater drop in BP than isoproteranol alone due to decreased sympathetic reflex following Beta receptor stimulation

Question 32

Butoxamine

Answer 32

B2 selective antagonist

Question 33

Why is pilocarpine resistant to AchE?

Answer 33

It is not a choline ester

Question 34

What is the primary control of autoregulation

Answer 34

CO2 which diffuses through the BBB to decrease the pH of the CSF. This will in turn lead to increased respirations

Question 35

Thiazide diuretics can lead to?

Answer 35

Increased blood calcium and cause kidney stones

Question 36

GnRH is released in what type of fashion?

Answer 36

Pulsatile fashion to increased FSH/LH

Question 37

Neuropeptide Y

Answer 37

PNS vasoconstrictor and role in appetite

Question 38

Estrogen, tamoxifen and methadone effects on TBG?

Answer 38

Increase TBG leading to decreased free T

Question 39

Sign of primary hyperaldosteronism

Answer 39

Increased urine aldosterone even in presence of high salt diet

Question 40

Octreotide/somatostatin decrease

Answer 40

PORTAL and splanchnic blood flow

Question 41

Sucralfate

Answer 41

Protects GI by binding to ulcerated tissue can lead to constipation, requires acid pH for activation

Question 42

Toxicity: Ergot alk

Answer 42

Drowsiness and Hallucinations PROLONGED VASOSPASM LEADING TO GANGRENE Uterine contraction

Question 43

Uses of Vitamin D

Answer 43

Nutritional rickets Osteoporosis Osteomalacia

Question 44

Older individuals have what to clotting factors

Answer 44

Decreased levels of vitamin K dependent clotting factors

Question 45

Cyprohepatidine

Answer 45

Used for treatment of serotonin syndrome

Question 46

Toxicity - H1 antagonist

Answer 46

Sedation, urinary retention and blurred vision

Question 47

lipophilic drugs are easier to travel?

Answer 47

Pass placental barrier and concentrate in milk

Question 48

FDA pharmacogenetic tests

Answer 48

Warfarin, Isoniazid, mercaptopurine, Ironotecan, Codeine

Question 49

Inducers of CYP450

Answer 49

ACIRS

Question 50

Inhibitors of CYP450

Answer 50

VAIG

Question 51

Lipophilic teritary amines are able to go where easier?

Answer 51

Cross blood brain barrier

Question 52

Compare locations of acetylcholinesterase vs butyrylcholinesterases

Answer 52

AchE - found in neurons and RBCs | BchE - found in plasma, glia, and liver

Question 53

Ipratropium

Answer 53

Antimuscarinic that inhibits vagal stimulation and decreases bronchoconstriction

Question 54

Mepolizumab/Reslizumab

Answer 54

Anti-IL 5 inhibit IL-5 binding to mast cells and decrease action of eosinophils

Question 55

Cromolym/Nedocromil

Answer 55

Reduce mast cell degranulation and release of histamine

Question 56

Theophylline

Answer 56

Methylxanthine adenosine receptor antagonist

Question 57

Diazoxide

Answer 57

Hyperpolarizing cell and activation of K+ channels

Question 58

Indapamide

Answer 58

NaCl inhibitor at DCT

Question 59

Metolazone

Answer 59

NaCl inhibitor at DCT

Question 60

Bumetanide

Answer 60

Loop diuretic

Question 61

Torsemide

Answer 61

Loop diuretic

Question 62

Acetazolamide can lead to what when taken in excess?

Answer 62

Metabolic acidosis (Type II RTA) Hyponatremia Hypokalemia Decreased Bicarb

Question 63

Indication: Tamulosin

Answer 63

Used in the treatment of only BPH

Question 64

Indication: Terazosin

Answer 64

Used in the treatment of HTN and BPH

Question 65

Cholestyramine effects of digoxin

Answer 65

Due to effects on bile resins it would cause malabsorption

Question 66

Atenolol is a B1 selective blocker so it does not

Answer 66

so it does not tend to exacerbate asthma

Question 67

MUST KNOW: BEST COMBINATION FOR AFRICAN AMERICANS IN HF

Answer 67

Hydralazine and isosorbide dinitratie

Question 68

Mexiletine is also used in the treatment of?

Answer 68

Diabetic neuropathy

Question 69

Choice of drugs used for patients with wide complex tachycardia?

Answer 69

Procainamide and amiodarone

Question 70

Extremely short acting Beta blocker with half life of 9 minutes

Answer 70

esmolol

Question 71

Diuretic contraindicated in patients with severe hepatic cirrhosis

Answer 71

Acetazolamide

Question 72

Weight loss drug that can lead to progression of pulmonary HTN

Answer 72

Fenfluramine/phertermine

Question 73

Alpha acting drug that can be administered every 7 days

Answer 73

clonidine

Question 74

Ergot alkaloid with strongest stimulation on uterus

Answer 74

Ergonovine

Question 75

Prostaglandin to most likely cause bronchoconstriction in asthamtic

Answer 75

TXA2

Question 76

Endocrine drug that will enhance renal clearance of digoxin

Answer 76

Thyroxine

Question 77

Increased parasympathetic action and prolonged PR segment are most beneficial qualities of this drug

Answer 77

Digoxin

Question 78

Class 1 antiarrythmic that undergoes extensive 1st pass metabolism

Answer 78

Lidocaine

Question 79

African americans tend to have better responses to these drugs

Answer 79

Thiazide diuretics and Ca channel blockers

Question 80

BNP analog that leads to diuresis and arteriolar/venous vasodilation

Answer 80

Nesiritide

Question 81

What are the predominating signals through the body with a nicotinic agonist

Answer 81

Sympathetic - vasculature | Para - everywhere else

Question 82

Abnormal lab value with increased conductance to K+

Answer 82

Hyperkalemia

Question 83

Anti-arrhythmic that can precipitate digoxin toxicity

Answer 83

Quinidine

Question 84

Anti-arrhythmic that is contraindicated in prostatism

Answer 84

Disopyramide

Question 85

Anti-arrhythmic that is contraindicated in chronic arthritis

Answer 85

Procainamind

Question 86

Anti-arrhythmic that is contraindicated in lung disease

Answer 86

Amiodarone

Question 87

MOA: Omega 3

Answer 87

Activated PPAR alpha in hepatocytes and decrease plasma triglycerides

Question 88

Rapidly inhibits proteolysis and release of T3/T4 and is used against thyrotoxicosis - maximal effect in 2 weeks

Answer 88

Iodide salts

Question 89

Thyroid drugs that take 2-4 months to achieve euthyroid status

Answer 89

PTU/Methimazole

Question 90

Inhibits 5' deiodinase leading to decreased T3

Answer 90

Iohexol and diatrizoate

Question 91

Drug given to determine the location of metastatic thyroid carcinomas

Answer 91

Thyrotropin

Question 92

ACTH produces a positive effect on ?

Answer 92

BOTH glucocorticoids and androgens

Question 93

ACTH has why type of pattern

Answer 93

Diurnal pattern - peaks and troughs are dependent on individual sleep wake cycle

Question 94

Muscle wasting syndrome due to increased SYNTHESIS OF METABOLIC enzymes relative to structural

Answer 94

Cushings syndrome

Question 95

Most potent time to dose ACTH

Answer 95

Evening dose of ACTH would prevent the morning surge of cortisol

Question 96

These levels are not altered by ACTH

Answer 96

Aldosterone

Question 97

This deficiency will progress to salt wasting syndrome and decreased BP

Answer 97

21 - hydroxylase deficiency

Question 98

Systemic steroids are not helpful in the treatment of

Answer 98

Skin diseases

Question 99

Increased non protein nitrogen is an early sign of danger in what

Answer 99

Adrenocortical insufficiency

Question 100

This diabetic drug is preferred in elderly due to relatively short half life a lower potency

Answer 100

Tolbutamide

Question 101

Diabetes drug that is most likely to cause a disulfuram like reaction following ingestion of ethanol

Answer 101

Chlorpropamide

Question 102

Drug class created to avoid problems like disulfuram rxns

Answer 102

Repaglinide

Question 103

Best treatment for patients in hypoglycemic states

Answer 103

Glucagon

Question 104

Blood lactate levels are often a good indicator of

Answer 104

volume replacement

Question 105

How to distinguish between anaphylactic and hypovolumic shock

Answer 105

Cardiac output

Question 106

Alteration of ECG by Beta 1 antagonist

Answer 106

Increased PR interval

Question 107

What happens to T waves during exercise

Answer 107

Shortened and spiked due to increased repolarization rate in ventricular myocytes

Question 108

High doses of AchE can form a

Answer 108

NM blockade

Question 109

Only used COX-2 inhibitor

Answer 109

Celecoxib

Question 110

Aspirin and Salicylic acid are

Answer 110

Salicylates

Question 111

These are critical inflammatory mediators in IBD

Answer 111

Leukotrienes

Question 112

Antihistamine that has greater incidience of HI disturb

Answer 112

Pyrlamine

Question 113

Antihistamine that is used for sedation

Answer 113

Promethazine

Question 114

This converts histidine to histamine

Answer 114

L-Histidine carboxylase

Question 115

Histamines effects on the heart are mediated through

Answer 115

Baroreceptors

Question 116

Bisacodyl is

Answer 116

Irritant cathartic given as a suppository

Question 117

Aluminum/Mg and MgOx/CaCarbonate are given because

Answer 117

These combinations of antacids avoid constipation and diarrhea

Question 118

This antacid interferes with absorption of phosphate and is beneficial in renal insufficiency

Answer 118

Aluminum hydroxide

Question 119

This drug should be used with caution in renal patients leading to solmnence

Answer 119

Magnesium containing

Question 120

Food aggrivates what type of ulcers

Answer 120

Gastric

Question 121

Excessive carcium carbonate antacids can lead to

Answer 121

Hypercalcemia Hyperphosphatemia Nephrolithiasis

Question 122

Use of sodium bicarbonate is limited in its use due to

Answer 122

Precipitation of renal stones and can cause metabolic alkalosis Also cardiac failurem HTN and Renal Insufficiency

Question 123

Partial 5-HT4 agonist used for IBS treatmetn

Answer 123

Tegaserod

Question 124

Used for treatment of postpartum hemorrhage if oxytocin doesnt work

Answer 124

Ergonovine

Question 125

Direct histamine LIBERATORS

Answer 125

Morphine and Tubocurarine

Question 126

Hydrocortisone is more or less potent than dexamethasone

Answer 126

less

Question 127

Corticosteroids leads to (increased/decreased) lipocortin and (increased/decreased) AA metabolites

Answer 127

Increased lipocortin and decreased AA metabolites

Question 128

This is measured in urine to follow endogenous progesterone

Answer 128

Pregnanediol

Question 129

Oral contraceptives run the risk of

Answer 129

iron deficiency

Question 130

Used in the treatment of AIDS associated wasting syndrome

Answer 130

Oxandrolone

Question 131

This diruetic leads to increased prostaglandin levels leading to increased renal blood flow and increased cardiopulm fxn

Answer 131

furosemide

Question 132

1st choich of monotherapy of HTN in AA patients

Answer 132

Thiazide diuretics

Question 133

This drug is used in acute settings to reverse decrease CO, decrease BP and decrease urinary output

Answer 133

Dopamine

Question 134

Digoxin works to increase urinary output by acting on the

Answer 134

heart

Question 135

What changes will be noticed in HR when a patient is given tyramine following treatment with reserpine

Answer 135

NONE

Question 136

These layers of the adrenals respond to ACTH

Answer 136

Fasiculata and reticularis

Question 137

Minimal change disease is mediated by

Answer 137

T cells and cytokines

Question 138

Nephritic syndrome + Hemoptysis =

Answer 138

Goodpastures

Question 139

This stimulates the release of NE from neurons leading to systolic and diastolic increase

Answer 139

Epherdrine

Question 140

These are sex chord stromal tumors that secrete estrogens that can lead to unopposed endometrial hyperplasia

Answer 140

Fibromas and thecomas

Question 141

1st generation antihismamine used to treat motion sickness with decreased sedative effects

Answer 141

Cyclizine

Question 142

Medicare criteria

Answer 142

Over 65 disability for more than 24 months dialysis ALS diagnosis

Question 143

How will osteomalacia present differently from osteoporosis

Answer 143

Osteomalacia will have decreased vitamin D and osteoporosis will have normal levels

Question 144

PPIs lead to what

Answer 144

Increased H+ and Cl- in the body

Question 145

GnRH receptor agonist

Answer 145

Leuprolide

Question 146

Clomiphene is a

Answer 146

estrogen receptor agonist

Question 147

Characterized by hyponatremia and low serum osmo treated with demeclocycline

Answer 147

SIADH

Question 148

Tamoxifene

Answer 148

Breast cancers

Question 149

Raloxifene

Answer 149

Osteoporosis

Question 150

Clomiphene

Answer 150

Ovulation Induction

Question 151

Mefipristone

Answer 151

Postcoital abortifactant

Question 152

Danazol

Answer 152

Suppression of ovarian function