PHARMACOLOGY PBBS601A&B

PRACTICE QUESTIONS, EXAM III

SELECT THE SINGLE BEST ANSWER
1.

Which of the following is an angiotensin converting enzyme (ACE) inhibitor that does NOT
require metabolic conversion for its activity (i.e. is not pro-drug)?
A.
B.
C.
D.
E.

2.

H.T.N. is a 55 year old male with diabetes mellitus who has been treated for hypertension
with hydrochlorothiazide and enalapril for approximately 4 years. His blood pressure has
been extremely well controlled, but, at his annual physical examination, he complains of a
persistent cough, although he has not been ill otherwise. Assuming that the cough is a side
effect of one of these medications, what change in his therapy would be most likely to
eliminate the cough?
A.
B.
C.
D.
E.

3.

captopril
enalapril
fosinopril
losartan
valsartan

continue the enalapril but discontinue the hydrochlorothiazide until the cough
subsides
continue the enalapril and replace the hydrochlorothiazide with amiloride
continue the hydrochlorothiazide and replace the enalapril with losartan
continue the hydrochlorothiazide and replace the enalapril with captopril
replace the hydrochlorothiazide with amiloride and replace the enalapril with
captopril

A female patient who is being treated for hypertension changes her method of birth control
from barrier to pharmacological (oral contraceptives). At a check-up two months later her
blood pressure has risen significantly from her previous check-up. Which medication has she
been taking to control her blood pressure?
A.
B.
C.
D.
E.

alpha-methyl-DOPA
enalapril
hydrochlorothiazide
minoxidil
propranolol

4.

A patient who has lived in the southwest his entire life changes jobs and moves to the
Chicago are in the late spring. At his job physical he is diagnosed with moderate
hypertension which responds to drug therapy. On a chilly day in the fall he develops severe
breathing problems while outside raking leaves. Which medication has he been taking to
control his blood pressure?
A.
B.
C.
D.
E.

5.

Identify the therapeutic mechanism by which doxazosin decreases blood pressure:

A.
B.
C.
D.
E.

6.

it blocks renin release

it decreases blood volume and renal blood flow
it decreases sympathetic tone in the vasculature
it is a centrally-acting sympatholytic
it produces a central depletion of catecholamine neurotransmitters

Which class of drugs is reserved for the rapid reversal of critically elevated blood pressure or
the control of severe hypertension that is refractory to other therapies?
A.
B.
C.
D.
E.

7.

alpha-methyl-DOPA
enalapril
hydrochlorothiazide
minoxidil
propranolol

alpha1-selective agonists
loop diuretics
proximal tubule diuretics
vasodilators
vasopressin agonists

What is the most likely side effect of minoxidil, hydralazine, and nifedipine?
A.
B.
C.
D.
E.

cough and bronchospasm

inhibition of renin release
prolonged CNS depression
reflexive tachycardia
reflexive vasoconstriction

A-1

8.

A 59 year old hypertensive patient has been poorly controlled on her current medication, and
you are considering switching her to prazosin. Which side effect(s) must you take into
consideration as you do this?
A.
B.
C.
D.
E.

9.

Which of the following contribute to the clinical benefit of a beta1-selective antagonist in the
treatment of hypertension?
A.
B.
C.
D.
E.

10.

arterial vasodilation and decreased afterload on the heart

depletion of neurotransmitter in sympathetic neurons
increased ventricular contractility and enhanced baroreceptor reflex
inhibition of renin release, reduced levels of angiotensin and aldosterone
venodilation and decreased preload on the heart

Which calcium channel blocker or vasodilator will cause a decrease in blood pressure but
will also supress the subsequent reflexive tachycardia?
A.
B.
C.
D.
E.

11.

bradycardia and fatigue

first dose phenomenon and postural hypotension
hypertension, headache and tremors
lupus-like syndrome
unusual hair growth

minoxidil
hydralazine
nifedipine
nitroglycerin
verapamil

Which of the following contribute to the mechanism of clinical benefit of lisinopril in the
treatment of congestive heart failure?
A.
B.
C.
D.
E.

AV nodal suppression to protect the ventricle

decreased afterload, decreased blood volume and decreased cardiac remodeling
improved Ca2+ availability in the cardiomyocytes and increased strength of
contraction
increased bradykinin breakdown and reduced inflammation
selective potentiation of beta2 adrenergic signaling

A-2

From the following list, select the correct drug described in items 12 to 16. EACH OF THE
CHOICES (A THROUGH E) MAY BE USED ONLY ONCE.
A.
B.
C.
D.
E.

adenosine
amiodarone
digoxin
procainamide
quinidine

12.

Super-fast and short-acting drug that opens potassium channels in the AV node_

13.

Cardiotonic drug that also acts as an AV nodal depressant_

14.

Class I antiarrhythmic that blocks the sodium and potassium channels, alpha adrenergic
receptors, and muscarinic (M2) receptors_

15.

A long-acting antiarrhythmic that imitates Classes I, II, III, and IV and produces a variety of
serious and unusual side effects, including pulmonary fibrosis and blue coloration of the
skin_

16.

A sodium channel blocker that is usually given IV to minimize the production of metabolites
that can induce a lupus-like syndrome and torsades de pointes, a rare ventricular tachycardia
with prolonged QT intervals_

17.

What is the mechanism of the cardiotonic, physiologic benefit of digoxin?

A.
B.
C.
D.
E.

18.

it retains residual calcium in myocytes after each action potential

it stimulates Na+-K+ ATPase
it acts as a beta1 adrenergic agonist
it releases Ca2+ from sarcoplasmic reticulum
it opens Ca2+ channels in myocardium

What is the mechanism of action of inamrinone (amrinone)?

A.
B.
C.
D.
E.

it blocks Na+-K+ ATPase

it blocks the Na+-Ca2+ antiporter
it closes inwardly-rectifying K+ channels in the myocardium
it inhibits phosphodiesterase
it is an alpha1 adrenergic antagonist

A-3

19.

Which of the following therapies is most appropriate for correcting hypertension in a patient
with heart failure?
A.
B.
C.
D.
E.

20.

Why is nitroglycerin frequently administered sublingually for relief of angina pectoris?

A.
B.
C.
D.
E.

21.

alkaline pH, such as that of saliva, is required to activate it

it has high potential for producing esophageal irritation
it is completely ineffective when administered by any other route
onset of its action is delayed with this route of administration
to avoid extensive first pass metabolism by the liver

For a hypertensive patient with variant (Prinzmetal's type) angina and no concomitant
atherosclerotic disease, which drug could be used alone for controlling blood pressure AND
prevention of chest pain?
A.
B.
C.
D.
E.

22.

ACE inhibitor and beta1 blocker

alpha blocker and vasodilator
beta2 agonist and proximal tubule diuretic
ganglionic blocker and thiazide diuretic
muscarinic agonist

atenolol
furosemide
losartan
propranolol
verapamil

Which of the following drugs would be appropriate for treating a patient who has typical
angina (angina of effort), hypertension and also is subject to AV node-associated
arrhythmias?
A.
B.
C.
D.
E.

atenolol
hydralazine
lisinopril
sildenafil
valsartan

A-4

23.

In preventing a second myocardial infarction, which drug will provide long-term suppression
of heart work, prevent angina, and suppress the onset of ventricular arrhythmias?
A.
B.
C.
D.
E.

24.

A 49 year old man with long-standing hypertension, presents to the emergency department
with crushing chest pain. An ECG reveals ST segment elevation in leads V2, V3, and V4
along with marked Q waves. While he is being prepared for further testing, he collapses;
ECG now shows ventricular fibrillation and electrical defibrillation is attempted. After 2
shocks of 200 and 300J, he is given a bolus of epinephrine and you elect to add an
antiarrhythmic agent before the 3rd shock of 350J. Which of the following antiarrhythmic
agents is currently recommended for patients in this situation?
A.
B.
C.
D.
E.

25.

amiodarone
diltiazem
flecainide
lidocaine
metoprolol

Of the following agents, which one may be used in asthmatic patients to produce a rapid,
acute bronchodilation?
A.
B.
C.
D.
E.

26.

adenosine
gemfibrozil
metoprolol
nifedipine
nitroglycerin

albuterol
budesonide
cromolyn
formoterol
montelukast

Which of the drug combinations listed below might be expected to give an enhanced effect
because each of the two drugs produces bronchodilation through a different mechanism?
A.
B.
C.
D.
E.

albuterol - budesonide
albuterol - ipratropium
cromolyn - fluticasone
cromolyn - zafirlukast
formoterol - salmeterol

A-5

27.

When considered for use in the treatment of an asthmatic patient, systemic corticosteroids:
A.
B.
C.
D.
E.

28.

Which of the following adverse effects can be associated with the use of inhaled beta 2agonist in asthma?
A.
B.
C.
D.
E.

29.

C.
D.

relaxation when beta-adrenergic receptors are not available

down-regulation of beta-adrenergic receptors to avoid sensitization of beta 2receptors
dual action on adrenergic (beta 2) and cholinergic (M3) receptors
inhibition of the inflammatory response and decrease bronchial reactivity

What is the mechanism of action of montelukast?

A.
B.
C.
D.
E.

31.

anxiety, restlessness, and tachycardia

depression and fatigue
hypercapnia
hyperkalemia
hypoglycemia

What is the rationale of using corticosteroids in asthma?

A.
B.

30.

can be abruptly discontinued following a course of treatment that does not exceed 12
days
can be safely used long-term in place of a leukotriene antagonist
provide the advantage over inhalant corticosteroids of producing bronchodilation as
well as reducing inflammation
should always be avoided, even in cases of severe, persistent asthma in adults
should be administered only once in order to avoid severe side effects

adenosine (A1) receptor antagonist

beta 2 agonist
beta 2 antagonist
leukotriene antagonist
muscarinic muscarinic receptor antagonist

Mechanisms of antiepileptic drug action include all of the following EXCEPT:

A.
B.
C.
D.
E.

decreased excitatory amino acid neurotransmitter release

inhibition of low threshold calcium (T) currents in the thalamus
inhibition of sodium channel activity and delayed recovery from inactivation
potentiation of GABA-mediated neuronal inhibition
stimulation of the glutamate NMDA receptor

A-6

32.

The mineral content of bone may be diminished in patients who receive long-term therapy
with:
A.
B.
C.
D.
E.

33.

Each of the following is believed to represent a pharmacologic mechanism of antiepileptic

drug action EXCEPT:
A.
B.
C.
D.
E.

34.

5-hydroxytryptamine receptors
dopamine receptors
GABA receptors
glutamate receptors
norepinephrine receptors

What is the primary advantage of the novel or atypical antipsychotic agents?

A.
B.
C.
D.
E.

36.

blockade of cholinergic receptors

blockade of glutamate receptors
inhibition of calcium currents in thalamic neurons
inhibition of Na+-channel operation
potentiation of GABA-ergic neurotransmission

Typical antipsychotic drugs are believed to exert their therapeutic effects via blockade of
dopamine receptors. The newer atypical agents also antagonize:
A.
B.
C.
D.
E.

35.

clonazepam
gabapentin
lamotrigine
phenytoin
valproic acid

they have a lower propensity for inducing extrapyramidal side effects

they are less likely to cause glucose intolerance
they are less likely to cause weight gain
they are less likely to induce agranulocytosis
they are more efficacious

Which antipsychotic agent may have particular utility in patients who are treatment-resistant
to typical antipsychotic drugs?
A.
B.
C.
D.
E.

bupropion
chlorpromazine
clozapine
fluphenazine
haloperidol
A-7

37.

Pharmacologic responses to diazepam include all of the following EXCEPT:

A.
B.
C.
D.
E.

38.

Flumazenil is an agent used to specifically reverse the central nervous system depressant
effects of which class of drugs?
A.
B.
C.
D.
E.

39.

changes in the conformation of membrane lipids

hepatic metabolism
rapid development of tolerance
redistribution of the drug to less well vascularized tissues
renal excretion of unchanged drug

In addition to their primary application, venlafaxine and fluoxetine may also be used to treat
some patients with:
A.
B.
C.
D.
E.

41.

barbiturates
benzodiazepines
hallucinogens
monoamine oxidase inhibitors
selective serotinin uptake inhibitors

After intravenous administration of single doses, the central nervous system effects of
ultrashort acting barbiturates such as thiopental are terminated primarily via:
A.
B.
C.
D.
E.

40.

anti-anxiety effects
antiarrhythmic effects
anticonvulsant effects
sedation
skeletal muscle relaxation

anorexia
epilepsy
generalized anxiety disorder
hypertension
insomnia

Compared with barbiturates, benzodiapzepines are more likely to:

A.
B.
C.
D.
E.

be used to treat generalized anxiety disorder

cause death in overdose
depress respiratory drive and blood pressure
directly impair sodium channel function in nerve membranes
induce hepatic cytochrome P450 enzymes

A-8

42.

The selective serotonin uptake inhibitors may be preferred over the tricyclic antidepressants
for initial use in patients with moderate depression because:
A.
B.
C.
D.
E.

43.

Which of the following classes of drugs is most likely to produce adverse effects that include
blurred vision, dizziness, sedation, increased appetite, weight gain, sexual dysfunction, and
orthostatic hypotension?
A.
B.
C.
D.
E.

44.

benzodiazepines
monoamine oxidase inhibitors
selective serotonin and norepinephrine uptake inhibitors
selective serotonin uptake inhibitors
tricyclic antidepressants

Which of the following drugs is used as a mood-stabilizing in patients with bipolar disorder
and requires therapeutic drug monitoring because concentrations in excess of the effective
range can produce neurologic symptoms that may progress rapidly to convulsions and death?
A.
B.
C.
D.
E.

45.

a larger percentage of patients respond to an adequate therapeutic trial

they are less likely to produce withdrawal symptoms when treatment is discontinued
they exhibit a much more rapid onset of action
they have a more favorable side effect profile and are safer in overdose
they lack the potential for drug-drug interactions

carbamazepine
lamotrigine
lithium
selegiline
valproic acid

Various controlled substances, including methamphetamine, are approved for treating patients in
whom obesity is refractory to other therapy. In addition to the potential for drug abuse, what
major side effects must be considered when prescribing these drugs?
A.
B.
C.
D.
E.

an initial, transient increase in appetite and hyperphagia

depressed basal metabolic rate and cold intolerance
drug-induced narcolepsy and fatigue
exacerbation of hypertension and tachycardia
insulin resistance and hyperglycemia

A-9

46.

For which clinical application is sumatriptan succinate appropriate?

A.
B.
C.
D.
E.

47.

Which drug would you choose for prophylaxis of migraine headache in an asthmatic patient?
A.
B.
C.
D.
E.

47.

metoprolol
prochlorperazine
promethazine
propranolol
sumatriptan succinate

Various controlled substances, including methamphetamine, are approved for treating patients in
whom obesity is refractory to other therapy. In addition to the potential for drug abuse, what
major side effects must be considered when prescribing these drugs?
A.
B.
C.
D.
E.

48.

acute migraine headache in patients with significant cardiovascular diseases

prevention of the prodrome symptoms associated with classical migraine
prophylactic treatment of cluster headaches
prophylactic treatment of migraine headaches
reversal of acute migraine attacks

an initial, transient increase in appetite and hyperphagia

depressed basal metabolic rate and cold intolerance
drug-induced narcolepsy and fatigue
exacerbation of hypertension and tachycardia
insulin resistance and hyperglycemia

Which of the following mechanisms contributes to the effects of the opioid analgesics on
pain processing cells?
A.
B.
C.
D.
E.

attenuation of K+ currents in peripheral sensory neurons

increased release of substance P, glutamate, and epinephrine from presynaptic
neurons
inhibition of Ca2+ influx and activation of K+ channels in the dorsal horn of the spinal
cord
inhibition of Cl- currents at supraspinal levels
inhibition of serotonin and norepinephrine release from the medulla

A-10

49.

A 64-year old white male with a history of prostate cancer is being treated with
chemotherapy for metastatic bone disease. With time his pain can no longer be managed
with moderate opioid agonists, such as oxycodone. Which of the following agents would be
most likely to alleviate pain for this patient?
A.
B.
C.
D.
E.

50.

In addition to being a very effective analgesic agent, methadone, is also used therapeutically
for treatment of:
A.
B.
C.
D.
E.

51.

codeine
levorphanol
loperamide
meperidine
pentazocine

Which of the following is an opioid receptor agonist used to treat diarrhea?

A.
B.
C.
D.
E.

53.

constipation
cough
nausea
opioid dependance
opioid overdose

Which of the following agents is a weak opioid receptor antagonist or partial agonist but is
a opioid receptor agonist and has low abuse potential, especially in the oral form?
A.
B.
C.
D.
E.

52.

codeine
dextromethorphan
fentanyl
naloxone
naltrexone

butorphanol
cocaine
codeine
dextromethorphan
loperamide

What restriction is placed on the prescription for a Schedule II substance, such as morphine?
A.
B.
C.
D.

it can be refilled after 6 months

it can be refilled up to 3 times
it cannot be refilled
it is prescribed only in hospital
A-11

54.

What are the psychoactive agents in marijuana?

A.
B.
C.
D.
E.

55.

What is the mechanism for the euphoric actions of psychostimulant drugs, such as
amphetamine?
A.
B.
C.
D.

56.

methadone has a long half-life

methadone has minimal bioavailability
methadone has no addictive properties
methadone is a mu opioid receptor antagonist

Which class of drugs is useful in treating opioid withdrawal syndrome?

A.
B.
C.
D.
E.

58.

blockade and/or reversal of dopamine transporters

blockade and/or reversal of glutamate transporters
direct binding and activation of dopamine receptors
direct binding and activation of mu opioid receptors

Why is methadone a useful treatment for addiction to opioids?

A.
B.
C.
D.

57.

indolamines
lysergic acids
opiate alkaloids
serotonin-like drugs
tetrahydrocannabinoids

2 noradrenergic agonists
amphetamine derivatives
CB1 receptor antagonists
kappa opioid receptor antagonists
mu opioid receptor antagonists

A 24 year-old female is brought to the emergency room at 2 a.m. with irritability,

tachycardia, hypertension and other symptoms of profound autonomic and psychomotor
stimulation. Which of the following agents or preparations has she most likely taken?
A.
B.
C.
D.
E.

diazepam
heroin
lysergic acid diethylamide
marijuana
methamphetamine

A-12

59.

What is the mechanism of action of commonly abused dissociative anesthetics, such as

phencyclidine?
A.
blockade of dopamine D1 receptors
B.
blockade of dopamine D2 receptors
C.
blockade of NMDA glutamate receptors
D.
increased sodium-potassium ATPase activity
E.
opening of potassium channels

60.

A group of coworkers meets after work to celebrate a birthday. They consume alcoholic
beverages but no food. All but one of them (E) are usually moderate drinkers and do not
differ significantly except as stated. Who will have the highest blood alcohol concentration
one hour after rapidly drinking as described?
A.
B.
C.
D.
E.

61.

An unconscious 16 year old male is brought to the emergency room by his friends.
According to one of the friends, they had been drinking vodka (40% v/v alcohol), and the
patient, who normally did not drink alcohol, had been drinking rapidly and consumed many
more shots than anyone else in the group. Initially, his speech had become slurred and he
was ataxic, then he became extremely belligerent, and then he passed out. When they
could not awaken him, they brought him to the ER. Of the following blood alcohol levels,
which is the lowest that would account for his condition at the time he was seen in the ER?
A.
B.
C.
D.
E.

62.

a female who drinks two scotch (distilled spirits) and sodas

a female who drinks three glasses of red wine
a male who drinks two scotch and sodas
a male who drinks three cans of beer
a chronic alcoholic male who drinks two Scotch and sodas

0.003 %
0.03 %
30 mg/dl
300 mg/dl
3000 mg/dl

Chronic ethanol abuse induces biochemical adaptations in the expression of receptor proteins
in the brain that allow the brain to function more normally in the presence of:
A.
B.
C.
D.
E.

acute depressant effects of ethanol

acute tolerance
ethanol withdrawal
mixed function oxidases
reducing equivalents

A-13

63.

A 30 year old female comes to your emergency clinic shortly after midnight with tremors,
anxiety, nausea, sweating, and diarrhea. She says he has been unable to sleep the past two
nights since suddenly breaking a habit of drinking a bottle (750 ml) of red wine before bed
every night. Upon examination you find that her pupils are dilated, and her pulse, blood
pressure, and temperature are elevated. Which of the following is appropriate for the initial
treatment to relieve her symptoms?
A.
B.
C.
D.
E.

64.

Fetal alcohol syndrome is diagnosed in a newborn on the basis of three features, which
include growth retardation, CNS effects (microcephaly, mental retardation, learning and
behavioral problems) and:
A.
B.
C.
D.
E.

65.

elevated growth hormone in cord blood

elevated thyroid hormone in cord blood
hepatic cirrhosis
specific abnormalities of the extremities
specific abnormalities of facial structure

Naltrexone may be used as an oral agent to treat:

A.
B.
C.
D.
E.

66.

amphetamine
diazepam
disulfiram
levorphanol
naltrexone

alcohol dependence (alcoholism)

fetal alcohol syndrome
nicotine dependence
symptoms of alcohol withdrawal
symptoms of opioid withdrawal

Which of the following is the mechanism of action of disulfiram?

A.
B.
C.
D.
E.

induction and stabilization of CYP2E1

inhibition of aldehyde dehydrogenase
prevention of the absorption of alcohol
stimulation of alcohol dehydrogenase
stimulation of aldehyde oxidase in the stomach

A-14