1. Your 37-year-old patient has been diagnosed with a rare metastatic carcinoid tumor.

This neoplasm is releasing sero- tonin, bradykinin, and several unknown peptides. The
effects of serotonin in this patient are most likely to include

(A) Constipation
(B) Episodes of bronchospasm (C) Hypersecretionofgastricacid (D) Hypotension
(E) Urinary retention

2. A 23-year-old woman suffers from recurrent episodes of angioneurotic edema with

release of histamine and other mediators. Which of the following drugs is the most
effective physiologic antagonist of histamine in smooth muscle?

(A) Cetirizine (B) Epinephrine (C) Granisetron (D) Ranitidine (E) Sumatriptan

3. A 20-year-old woman is taking diphenhydramine for severe hay fever. Which of the
following adverse effects is she most likely to report?
(A) Muscarinic increase in bladder tone

(B) Nausea
(C) Nervousness,anxiety (D) Sedation
(E) Vertigo

4. A laboratory study of new H2 blockers is planned. Which of the following will result
from blockade of H2 receptors?

(A) Increased cAMP (cyclic adenosine monophosphate) in cardiac muscle

(B) Decreased channel opening in enteric nerves (C) DecreasedcAMPingastricmucosa

(D) Increased IP3 (inositol trisphosphate) in platelets (E) Increased IP3 in smooth muscle

5. You are asked to consult on a series of cases of drug toxici- ties. Which of the
following is a recognized adverse effect of cimetidine?
(A) Blurred vision

(B) Diarrhea
(C) Orthostatichypotension
(D) P450 hepatic enzyme inhibition (E) Sedation

6. A40-year-oldpatientisabouttoundergocancerchemother- apy with a highly emetogenic

(nausea- and vomiting-causing) drug combination. The antiemetic drug most likely to be
included in her regimen is

(A) Bromocriptine (B) Cetirizine

(C) Cimetidine (D) Ketanserin (E) Ondansetron

7. The hospital Pharmacy Committee is preparing a formulary for staff use. Which of the
following is a correct application of the drug mentioned?
(A) Alosetron: for obstetric bleeding

(B) Cetirizine: for hay fever

(C) Ergonovine:forAlzheimer’sdisease
(D) Ondansetron: for acute migraine headache (E) Ranitidine: for Parkinson’s disease

8. A 26-year-old woman presents with amenorrhea and galac- torrhea. Her prolactin
level is grossly elevated (200 ng/mL vs normal 20 ng/mL). Which of the following is
most useful in the treatment of hyperprolactinemia?

(A) Bromocriptine (B) Cimetidine (C) Ergotamine (D) Ketanserin (E) LSD

(F) Ondansetron (G) Sumatriptan

9. A 28-year-old office worker suffers from intense migraine headaches. Which of the
following is a serotonin agonist use- ful for aborting an acute migraine headache?
(A) Bromocriptine

(B) Cimetidine (C) Ephedrine (D) Ketanserin (E) Loratadine (F) Ondansetron (G)
Sumatriptan

10. A 33-year-old woman attempted to induce an abortion using ergotamine. She is

admitted to the emergency department with severe pain in both legs. On examination,
her legs are cold and pale with absent arterial pulses. Which of the fol- lowing is the
most useful antidote for reversing severe ergot- induced vasospasm?

(A) Bromocriptine (B) Cimetidine (C) Ergotamine (D) Ketanserin (E) LSD

(F) Nitroprusside (G) Sumatriptan (H) Ondansetron

37.1 A 43-year-old heavy machine operator complains of seasonal allergies. Which medication is most
appropri- ate for management of his allergy symptoms?

A. Diphenhydramine B. Doxylamine
C. Hydroxyzine
D. Fexofenadine

37.2 Which statement concerning H, antihistamines is correct?

A. Second-generation H1 antihistamines are relatively free of adverse effects.

B. Because of the established long-term safety of first-generation H1 antihistamines, they are the first
choice for allergic rhinitis.

c. The motor coordination involved in driving an auto- mobile is not affected by the use of first-
generation H, antihistamines.

D. H1 antihistamines can be used in the treatment of acute anaphylaxis.

37.3 Which histamine receptor antagonist is known to enter the central nervous system readily and
cause sedation?
A. Hydroxyzine B. Cetirizine
C. Desloratadine D. Loratadine
37.4 Which drug is an H,-receptor antagonist that also has serotonin receptor antagonism on the
appetite center, with the ability to stimulate appetite?
A. Hydroxyzine
B. Loratadine
C. Diphenhydramine D. Cyproheptadine
37.5 Which drug for headache is contraindicated in patients with peripheral vascular disease?
A. Ergotamine
B. Aspirin
C. Acetaminophen D. Naproxen
37.6 A 29-year-old woman complains of migraine headaches associated with early onset vomiting.
Currently, she uses ibuprofen as needed for her migraines, but it is not very effective. Which
triptan would be ideal for this patient?
A. Naratriptan B. Zolmitriptan C. Frovatriptan D. Almotriptan
37.7 A35-year-oldwomanishavingseveralseveremigraines per month. The migraines are usually
relieved with one or two doses of triptan drugs. Which is most appro- priate for prophylaxis to
reduce the frequency of her migraines?
A. Dihydroergotamine B. Ibuprofen
C. Propranolol
D. Sumatriptan
37.8 A 27-year-old married woman is asking about treat- ment options for obesity. She recently
stopped taking her birth control medications, as she felt they were contributing to her weight
gain. Which medication should be avoided in this patient?
A. Phentermineltopiramate B. Orlistat
C. Diethylpropion
D. Lorcaserin
37.9 A fellow health care provider is concerned about pre- scribing orlistat to adolescent patients.
Many of his adolescent patients are stopping the medication dur- ing the first month of treatment.
Which side effect is the most likely reason the adolescents are stopping orlistat?
A. Valvulopathy
B. Suicidal ideation C. Drowsiness
D. Flatulence
37.10 A 38-year-old obese man with depression is consider- ing a weight loss medication following
several failed attempts with diet and exercise. Which medication could be considered in this
individual?
A. Liraglutide
B. Bupropion + naltrexone C. Orlistat
D. Lorcaserin