NURS 531 Rang & Dale’s Pharmacology, 7th Edition TestBank

NURS 531 Rang & Dale’s Pharmacology, 7th Edition TestBankRang: Rang & Dale’s Pharmacology, 7th Edition Test Bank Chapter 1: What is pharmacology? MULTIPLE CHOICE 1. The modern era of antimicrobial chemotherapy origin ...

NURS 531 Rang & Dale’s Pharmacology, 7th Edition TestBankRang: Rang & Dale’s Pharmacology, 7th Edition Test Bank Chapter 1: What is pharmacology? MULTIPLE CHOICE 1. The modern era of antimicrobial chemotherapy originated with the discovery of 1. penicillin 2. arsenical compounds 3. quinine 4. sulfonamides 5. calomel Answer b: arsenical compounds 1. Morphine was isolated from opium by 1. Paul Ehrlich 2. Gerhard Domagk 3. Friedrich Sertürner 4. Rudolf Buchheim 5. Henry Dale Answer c: Friedrich Sertürner 1. The use of genetic information to guide the choice of drug therapy is called 1. pharmacoepidemiology 2. pharmacogenetics 3. biotechnology 4. pharmacogenomics 5. pharmacoeconomics Answer d: pharmacogenomics Chapter 2: How drugs act: general principles MULTIPLE CHOICE 1. The concentration of a drug required to occupy 50 percent of its receptor sites is 1. the concentration required to produce the maximum physiological effect 2. directly proportional to the drug’s affinity for its receptor 3. inversely proportional to the drug’s affinity for its receptor 4. directly proportional to the drug’s intrinsic efficacy 5. usually determined with the Schild equation Answer c: inversely proportional to the drug’s affinity for its receptor 1. In the presence of a competitive antagonist, the agonist log-concentration effect curve is 1. shifted to the right without a change in slope or maximum effect 2. shifted to the left without a change in slope or maximum effect 3. shifted to the right with a decreased slope and maximum effect 4. shifted to the left with a decreased slope and maximum effect 5. not shifted right or left but shows a decreased maximum effect Answer a: shifted to the right without a change in slope or maximum effect 1. The magnitude of the response to a drug is related to the 1. total number of receptors for the drug 2. number of receptors occupied by the drug 3. number of vacant receptors in the tissue 4. number of spare receptors in the tissue 5. number of phosphorylated receptors in the tissue Answer b: number of receptors occupied by the drug 1. The Schild equation shows that the concentration ratio of an agonist required to occupy the same number of receptors in the absence and presence of a competitive antagonist is determined by the 1. equilibrium constant of the agonist 2. affinity of the agonist for its receptor 3. equilibrium constant of the antagonist 4. total number of available receptors 5. number of spare receptors in the tissue Answer c: equilibrium constant of the antagonist 1. A partial agonist is typically a drug that 1. has low affinity for its receptor 2. can only occupy a small fraction of its receptors 3. can only produce a submaximal response 4. requires high doses to produce a maximal response 5. increases the number of spare receptors Answer c: can only produce a submaximal response 1. A type of drug that reduces the slope and maximum response of an agonist is 1. a non-competitive antagonist 2. a competitive antagonist 3. a physiologic antagonist 4. an inverse agonist 5. a partial agonist Answer a: a non-competitive antagonist 1. Drugs that form covalent bonds with their receptors are usually 1. reversible competitive antagonists 2. irreversible competitive antagonists 3. partial agonists 4. inverse agonists 5. inverse antagonists Answer b: irreversible competitive antagonists 1. A gradual decrease in the number of drug receptors is most likely to result from exposure to 1. a competitive antagonist 2. a non-competitive antagonist 3. an agonist 4. an inverse agonist 5. an antimetabolite Answer c: an agonist 1. The total number of receptor binding sites in a preparation and the binding equilibrium constant can be determined from a 1. total binding versus drug concentration curve 2. dose-response curve 3. Hill-Langmuir equation 4. Scatchard plot 5. Schild plot Answer d: Scatchard plot 1. Receptor desensitization typically results from 1. endocytosis of receptors 2. exposure to an inverse agonist 3. irreversible agonist binding 4. spare receptors 5. phosphorylation of receptor protein Answer e: phosphorylation of receptor protein Chapter 3: How drugs act: molecular aspects MULTIPLE CHOICE 1. The Jak/Stat pathway of signal transduction responds to activation by 1. acetylcholine 2. steroid hormones 3. human growth hormone 4. cytokines 5. epinephrine Answer d: cytokines 1. In the growth factor kinase cascade, Map (mitogen-activated protein) kinase acts to phosphorylate 1. DNA 2. transcription factors 3. cyclic AMP 4. ion channels 5. transport proteins Answer b: transcription factors 1. Which second messenger in a G-protein coupled receptor signal transduction cascade typically increases intracellular calcium? 1. cyclic GMP 2. cyclic AMP 3. diacylglycerol 4. arachidonic acid 5. inositol triphosphate Answer e: inositol triphosphate 1. Which signal transduction pathway is most important in cell division, growth, and differentiation? 1. beta-adrenoceptor signal pathways 2. phospholipase C pathways 3. Ras/Raf/Map kinase 4. eicosanoid signal pathways 5. guanylate cyclic signal pathways Answer c: Ras/Raf/Map kinase 1. Coupling of a G-protein alpha subunit to an agonist-occupied receptor initially leads to 1. activation of the beta-gamma complex 2. hydrolysis of GTP 3. activation of adenylate cyclase 4. exchange of bound GDP with GTP 5. dissociation of the alpha-subunit from the receptor Answer d: exchange of bound GDP with GTP 1. The nicotinic receptor is an example of a 1. G-protein coupled receptor 2. ligand-gated ion channel 3. tyrosine-kinase linked receptor 4. cytokine receptor 5. transport protein Answer b: ligand-gated ion channel 1. In G-protein coupled receptor signal transduction, protein kinase A is typically activated by 1. inositol triphosphate 2. ATP 3. cyclic AMP 4. cyclic GMP 5. diacylglycerol Answer c: cyclic AMP 1. An agonist for a ligand-gated ion channel typically 1. increases channel conductance 2. increases the number of open channels 3. increases the rate of channel closing 4. alters channel ion selectivity 5. alters the open channel conformation Answer b: increases the number of open channels 1. Diacylglycerol produces its intracellular effects by 1. activating protein kinase C 2. activating protein kinase A 3. releasing intracellular calcium 4. activating adenylate cyclase 5. activating guanylate cyclase Answer a: activating protein kinase C 1. Class I nuclear receptors that control gene transcription 1. contain cysteine residues bound to iron 2. interact with nucleolar RNA 3. bind to hormone response elements of DNA 4. only act to inhibit DNA transcription 5. only act to stimulate DNA transcription Answer c: bind to hormone response elements of DNA 1. Myasthenia gravis is a disease in which 1. receptors have an abnormal amino acid sequence 2. G proteins have mutated 3. signal transmission pathways are defective 4. autoantibodies are directed against receptor proteins 5. nuclear receptors are down-regulated Answer d: autoantibodies are directed against receptor proteins 1. Receptors for insulin 1. contain tyrosine kinase in their intracellular domain 2. bind and activate intracellular kinases 3. exhibit phosphatase activity 4. phosphorylate DNA transcription factors 5. are linked to guanylate cyclase Answer a: contain tyrosine kinase in their intracellular domain 1. Which ion inhibits an enzyme (inositol-1-phosphatase) in the phosphoinositol cycle? 1. calcium 2. ferrous 3. sodium 4. potassium 5. lithium Answer e: lithium 1. The opening of chloride ion channels by gamma-amino butyric acid is facilitated by 1. tricyclic antidepressant drugs 2. benzodiazepine drugs 3. local anesthetics 4. opioid analgesics 5. central nervous system stimulants Answer b: benzodiazepine drugs 1. The most rapid response is produced by activation of 1. kinase-linked receptors 2. G-protein coupled receptors 3. receptors activating gene transcription 4. ionotropic receptors 5. insulin receptors Answer d: ionotropic receptors 1. Which type of receptors contains seven transmembrane helices? 1. nicotinic acetylcholine receptors 2. sodium channels 3. steroid hormone receptors 4. insulin receptors 5. G-protein-coupled receptors Answer e: G-protein-coupled receptors 1. The treatment of chronic myeloid leukemia with imatinib results from the ability of the drug to inhibit a specific 1. ligand-gated ion channel 2. G-protein-coupled receptor 3. tyrosine kinase 4. Map (mitogen-activated protein) kinase 5. nuclear receptor Answer c: tyrosine kinase 1. Which receptors are activated by proteolytic cleavage and inactivated by phosphorylation? 1. neurotransmitter receptors 2. cytokine receptors 3. growth factor receptors 4. thrombin receptors 5. insulin receptors Answer d: thrombin receptors 1. Which receptors are entirely located intracellularly? 1. G-protein-coupled receptors 2. nicotinic receptors 3. thyroid hormone receptors 4. cytokine and growth factor receptors 5. muscarinic receptors Answer c: thyroid hormone receptors Chapter 4: How drugs act: cellular aspects—excitation, contraction and secretion MULTIPLE CHOICE 1. L(long-lasting)-type calcium channels are correctly described as having 1. low activation threshold and slow inactivation 2. high activation threshold and slow inactivation 3. low activation threshold and fast inactivation 4. high activation threshold and fast inactivation 5. none of the above as correct Answer b: high activation threshold and slow inactivation 1. The extrusion of calcium from the cell cytoplasm primarily depends on 1. ligand-gated calcium channels 2. voltage-gated calcium channels 3. the sodium-calcium exchange transporter 4. the ATP-driven calcium pump 5. nuclear sequestration Answer d: the ATP-driven calcium pump 1. The mechanism by which monamine neurotransmitters are released from nerve terminals is 1. calcium-mediated exocytosis 2. carrier-mediated release 3. ATP-dependent active transport 4. diffusion through aqueous pores 5. diffusion through membrane lipid Answer a: calcium-mediated exocytosis 1. Batrachotoxin binds sodium channels and thereby 1. opens channels 2. prevents channel opening 3. prevents channel inactivation 4. closes channels 5. causes channels to remain closed Answer c: prevents channel inactivation 1. Closure of potassium channels in excitable membranes causes membrane 1. repolarization 2. depolarization 3. hyperpolarization 4. disintegration 5. inactivation Answer b: depolarization 1. In smooth muscle, inositol triphosphate releases calcium from the 1. Golgi body 2. mitochondria 3. cell nucleus 4. T-tubule 5. sarcoplasmic reticulum Answer e: sarcoplasmic reticulum 1. Calcium facilitates the release of nitric oxide by 1. causing exocytosis 2. causing membrane depolarization 3. activating nitric oxide synthase 4. activating transport carriers 5. activating G-protein-coupled receptors Answer c: activating nitric oxide synthase 1. Amiloride affects epithelial ion transport by blocking 1. the Na+/K+ exchange pump 2. the Na+/K+ co-transporter 3. sodium channels 4. potassium channels 5. calcium channels Answer c: sodium channels 1. In the colon, chloride transport is important in 1. potassium secretion 2. potassium reabsorption 3. fluid secretion 4. fluid reabsorption 5. sodium bicarbonate reabsorption Answer d: fluid reabsorption 1. A key step in causing smooth muscle contraction is the phosphorylation of 1. actin 2. myosin light chain 3. myosin heavy chain 4. guanylate cyclase 5. myosin phosphatase Answer b: myosin light chain 1. Adrenergic beta-receptor agonists cause smooth muscle relaxation by 1. increasing cyclic AMP formation 2. decreasing cyclic AMP formation 3. increasing cyclic GMP formation 4. decreasing cyclic GMP formation 5. inhibiting protein kinase A Answer a: increasing cyclic AMP formation Chapter 5: Cell proliferation, apoptosis, repair and regeneration MULTIPLE CHOICE 1. In the death receptor pathway, activation of tumor necrosis factor receptors causes the receptors to trimerize and complex an adapter protein, thereby leading to activation of 1. mitochondrial pathways 2. caspase-8 3. pro-apoptotic factor Bcl-2 4. a p53 protein 5. DNA transcription factors Answer b: caspase-8 1. The activation of primitive stem cells so as to replace a damaged tissue is called 1. healing 2. repair 3. restoration 4. regeneration 5. rejuvenation Answer d: regeneration 1. Defective apoptosis may contribute to the development of 1. cancer 2. Alzheimer’s disease 3. myocardial infarction 4. aplastic anemia 5. stroke Answer a: cancer 1. The activation of caspase-3 leads to 1. activation of transcription factors 2. inhibition of transcription factors 3. activation of the anti-apoptotic pathway 4. fragmentation of genomic DNA 5. stabilization of cell membranes Answer d: fragmentation of genomic DNA 1. Bortemozib causes accumulation of an apoptotic-promoter protein by inhibiting 1. mitochondrial DNA 2. suvivin 3. matrix metalolproteinases 4. pro-apoptotic Bcl-2 5. the proteasome Answer e: the proteasome 1. Matrix metalloproteinases are responsible for 1. inhibition of neoplastic cell growth 2. adjusting the cell cytoskeleton 3. degradation of extracellular matrix 4. initiating angiogenesis 5. activation of the cell cycle Answer c: degradation of extracellular matrix 1. Antisense compounds active against antiapoptotic factors are potentially useful for treating 1. myocardial infarction 2. leukemia 3. Parkinson’s disease 4. multiple sclerosis 5. impaired wound healing Answer b: leukemia 1. Bevacizumab is a monoclonal antibody that targets 1. caspase-3 2. metalollproteinase 3. cyclin 4. vascular endothelial growth factor 5. promoters of apoptosis Answer d: vascular endothelial growth factor 1. Mitochondria participate in apoptosis by releasing 1. apoptotic protease activating factor 2. caspase-9 3. cytochrome c 4. p53 protein 5. inhibitors of apoptosis Answer c: cytochrome c 1. Progress through the cell cycle is stimulated by 1. cyclin-dependent kinases 2. phosphorylated Rb protein 3. check point factors 4. p53 protein 5. inhibitors of kinases Answer a: cyclin-dependent kinases NO Chapter 6??????????????? Chapter 7: Method and measurement in pharmacology MULTIPLE CHOICE 1. A statistical technique used to pool data from several independent but related studies is called 1. double-blind technique 2. randomization 3. sequential studies 4. meta-analysis 5. high-powered trial Answer d: meta-analysis 1. The main problem with all types of bioassay is 1. human error 2. inadequate instrumentation 3. biological variation 4. high cost compared to other techniques 5. inability to determine potency Answer c: biological variation 1. If the dose-response curves of two drugs are parallel in a bioassay, it usually indicates that the two drugs 1. have the same potency 2. act on the same type of receptors 3. are identical 4. are clinically effective 5. produce a quantal response Answer b: act on the same type of receptors 1. Quantal dose-response curves are obtained when studying 1. all-or-nothing responses 2. submaximal responses 3. bimodal responses 4. partial agonists 5. pain intensity Answer a: all-or-nothing responses 1. The double-blind technique is employed in clinical trials to 1. facilitate meta-analysis 2. confuse regulatory agencies 3. avoid bias in assigning subjects to treatment groups 4. avoid bias of patients and investigators 5. obviate the need for a control group Answer d: avoid bias of patients and investigators 1. Transgenic mice that overexpress mutated forms of amyloid precursor protein provide a useful model for studying 1. Alzheimer’s disease 2. Parkinson’s disease 3. Huntington’s disease 4. amyotrophic lateral sclerosis 5. multiple sclerosis Answer a: Alzheimer’s disease 1. Transgenic animal models referred to as “knock-outs” 1. result from insertion of new genes 2. result from substitution of one gene for another 3. result from inactivation of an existing gene 4. result from mutation of an existing gene 5. typically cause overexpression of proteins Answer c: result from inactivation of an existing gene Chapter 8: Drug absorption and distribution MULTIPLE CHOICE 1. Concerning the effect of pH on the urinary excretion of drugs, it can be correctly stated that 1. urinary acidification accelerates excretion of weak acids and bases 2. urinary alkalinization accelerates excretion of weak acids and bases 3. urinary acidification accelerates excretion of weak acids 4. urinary alkalinization accelerates excretion of weak acids 5. urinary alkalinization has no effect on excretion of weak bases Answer d: urinary alkalinization accelerates excretion of weak acids 1. Bioavailability is defined as the proportion of ingested drug that 1. is absorbed from the gastrointestinal tract 2. reaches the systemic circulation in an active form 3. crosses the blood-brain barrier 4. is unbound to plasma proteins 5. is distributed to the target tissue Answer b: reaches the systemic circulation in an active form 1. The rectal route of administration 1. provides nearly 100 percent bioavailability 2. is only used for localized effects 3. is suitable for persons with nausea and vomiting 4. is subject to a high degree of first-pass metabolism 5. is used for administration of nitroglycerin Answer c: is suitable for persons with nausea and vomiting 1. The passage of drugs across the blood-brain barrier 1. is facilitated by a high degree of drug ionization 2. is most rapid for drugs with low lipid solubility 3. occurs more readily in the chemoreceptor trigger zone 4. is reduced by inflammation of the meninges 5. is rapid with aminoglycoside antibiotics Answer c: occurs more readily in the chemoreceptor trigger zone 1. A calculated volume of distribution greater than total body water is most likely to occur with drugs that are 1. highly ionized 2. highly lipid soluble 3. subject to a high degree of first-pass inactivation 4. highly bound to plasma proteins 5. very large molecules Answer b: highly lipid soluble 1. Drugs are most readily absorbed across cells of the 1. gastrointestinal tract 2. renal tubules 3. vascular endothelium 4. lung parenchyma 5. liver Answer c: vascular endothelium 1. The binding of drugs to plasma albumin 1. is usually irreversible 2. is saturable 3. is most important for basic drugs 4. accelerates drug metabolism 5. accelerates drug excretion Answer b: is saturable 1. Most drugs are absorbed across cell membranes of the gut by the process of 1. diffusing through lipid 2. pinocytosis 3. diffusing through aqueous pores 4. carrier-mediated transport 5. ion trapping Answer c: diffusing through lipid 1. Which drug is absorbed by a membrane carrier that transports phenylalanine? 1. insulin 2. propranolol 3. levodopa 4. aspirin 5. penicillin Answer c: levodopa 1. Transdermal drug administration 1. is most suitable for highly polar drugs 2. is not subject to first-pass hepatic metabolism 3. provides rapid and complete absorption 4. is only used for localized effects 5. is most suitable for unconscious persons Answer b: is not subject to first-pass hepatic metabolism Chapter 9: Drug metabolism and elimination MULTIPLE CHOICE 1. Hepatic cytochrome P450 drug-metabolizing enzymes are primarily found in 1. cell nuclei 2. plasma membranes 3. the cytoplasm 4. the smooth endoplasmic reticulum 5. mitochondria Answer d: the smooth endoplasmic reticulum 1. Phase II drug metabolism 1. includes hydrolytic reactions 2. produces low molecular weight products 3. usually forms inactive metabolites 4. takes place mainly in the kidneys 5. requires NADPH as a cofactor Answer c: usually forms inactive metabolites 1. Ketoconazole produces non-competitive inhibition of cytochrome P450 by 1. binding to the ferric form of heme iron 2. binding to the active site of the enzyme 3. causing enzyme autolysis 4. oxidizing NADPH 5. binding covalently to the P450 protein Answer a: binding to the ferric form of heme iron 1. In first-order drug elimination 1. drug half-life is directly proportional to drug concentration 2. the rate of elimination is directly proportional to drug concentration 3. drug clearance is directly proportional to plasma drug concentration 4. the rate of elimination is constant 5. the rate of elimination is unpredictable Answer b: the rate of elimination is directly proportional to drug concentration 1. If a drug is administered repeatedly at the same dose and dosage interval, the time required to reach the steady-state plasma drug concentration is proportional to the 1. dose 2. route of administration 3. dosage interval 4. bioavailability 5. elimination half-life Answer e: elimination half-life 1. If a drug exhibits saturation (zero-order) kinetics, then 1. the rate of drug elimination is constant 2. drug half-life is constant 3. drug clearance is constant 4. plasma drug concentration is constant 5. plasma drug concentration falls exponentially Answer a: the rate of drug elimination is constant 1. In the two-compartment pharmacokinetic model, orally administered drugs are 1. absorbed into the peripheral compartment 2. distributed from the central to the peripheral compartment 3. metabolized in the central compartment 4. excreted in the peripheral compartment 5. none of the above Answer b: distributed from the central to the peripheral compartment 1. Which of the following will be increased if the rate of drug absorption from the gut is reduced? 1. oral bioavailability 2. volume of distribution 3. peak plasma drug concentration 4. elimination half-life 5. duration of action Answer e: duration of action 1. The volume of plasma from which a drug is eliminated in a unit of time is known as the 1. volume of elimination 2. volume of distribution 3. clearance 4. elimination rate constant 5. kinetic volume Answer c: clearance 1. Inactive prodrugs have been developed to 1. reduce drug toxicity 2. increase drug half-life 3. decrease hepatic drug metabolism 4. increase drug absorption 5. slow drug excretion Answer d: increase drug absorption Chapter 10: Pharmacokinetics MULTIPLE CHOICE 1. Hepatic cytochrome P450 drug-metabolizing enzymes are primarily found in 1. cell nuclei 2. plasma membranes 3. the cytoplasm 4. the smooth endoplasmic reticulum 5. mitochondria Answer d: the smooth endoplasmic reticulum 1. Phase II drug metabolism 1. includes hydrolytic reactions 2. produces low molecular weight products 3. usually forms inactive metabolites 4. takes place mainly in the kidneys 5. requires NADPH as a cofactor Answer c: usually forms inactive metabolites 1. Ketoconazole produces non-competitive inhibition of cytochrome P450 by 1. binding to the ferric form of heme iron 2. binding to the active site of the enzyme 3. causing enzyme autolysis 4. oxidizing NADPH 5. binding covalently to the P450 protein Answer a: binding to the ferric form of heme iron 1. In first-order drug elimination 1. drug half-life is directly proportional to drug concentration 2. the rate of elimination is directly proportional to drug concentration 3. drug clearance is directly proportional to plasma drug concentration 4. the rate of elimination is constant 5. the rate of elimination is unpredictable Answer b: the rate of elimination is directly proportional to drug concentration 1. If a drug is administered repeatedly at the same dose and dosage interval, the time required to reach the steady-state plasma drug concentration is proportional to the 1. dose 2. route of administration 3. dosage interval 4. bioavailability 5. elimination half-life Answer e: elimination half-life 1. If a drug exhibits saturation (zero-order) kinetics, then 1. the rate of drug elimination is constant 2. drug half-life is constant 3. drug clearance is constant 4. plasma drug concentration is constant 5. plasma drug concentration falls exponentially Answer a: the rate of drug elimination is constant 1. In the two-compartment pharmacokinetic model, orally administered drugs are 1. absorbed into the peripheral compartment 2. distributed from the central to the peripheral compartment 3. metabolized in the central compartment 4. excreted in the peripheral compartment 5. none of the above Answer b: distributed from the central to the peripheral compartment 1. Which of the following will be increased if the rate of drug absorption from the gut is reduced? 1. oral bioavailability 2. volume of distribution 3. peak plasma drug concentration 4. elimination half-life 5. duration of action Answer e: duration of action 1. The volume of plasma from which a drug is eliminated in a unit of time is known as the 1. volume of elimination 2. volume of distribution 3. clearance 4. elimination rate constant 5. kinetic volume Answer c: clearance 1. Inactive prodrugs have been developed to 1. reduce drug toxicity 2. increase drug half-life 3. decrease hepatic drug metabolism 4. increase drug absorption 5. slow drug excretion Answer d: increase drug absorption Chapter 11: Individual variation and drug interaction MULTIPLE CHOICE 1. In babies born at term, the ability to conjugate drugs with glucuronate reaches adult levels in about 1. one week 2. one month 3. 8 weeks 4. 6 months 5. 1 year Answer c: 8 weeks 1. The bimodal distribution of plasma isoniazid concentrations in a typical human population is the result of a genetically determined variation in 1. acetyltransferase activity 2. glucuronyl transferase activity 3. cytochrome P450 enzymes 4. plasma cholinesterase activity 5. plasma protein binding Answer a: acetyltransferase activity 1. Carbamazepine may cause acute porphyria in susceptible persons because the drug 1. inhibits porphyrin excretion 2. increases porphyrin excretion 3. induces d-amino levulinic acid synthase 4. inhibits d-amino levulinic acid synthase 5. induces cytochrome P450 enzymes Answer c: induces d-amino levulinic acid synthase 1. Mercaptopurine doses should be reduced in persons receiving allopurinol because 1. mercaptopurine induces metabolism of allopurinol 2. mercaptopurine inhibits metabolism of allopurinol 3. allopurinol induces metabolism of mercaptopurine 4. allopurinol inhibits metabolism of mercaptopurine 5. allopurinol has the same toxicity as mercaptopurine Answer d: allopurinol inhibits metabolism of mercaptopurine 1. Idiosyncratic reactions are defined as drug effects that occur in 1. all persons 2. most persons 3. a few persons 4. persons taking a toxic overdose 5. persons abusing a drug Answer c: a few persons 1. Drugs that inhibit the metabolism of other drugs by cytochrome P450 enzymes include 1. disulfiram 2. allopurinol 3. phenobarbital 4. rifampicin 5. ketoconazole Answer e: ketoconazole 1. Atropine slows the absorption of other drugs from the gut primarily by 1. forming an insoluble complex with other drugs 2. causing vasoconstriction 3. inhibiting gastric acid secretion 4. inhibiting gastric emptying 5. increasing intestinal motility Answer d: inhibiting gastric emptying 1. Plasma concentrations of digoxin are increased by amiodarone as a result of 1. decreased renal tubular secretion of digoxin 2. increased reabsorption of digoxin in the nephron 3. decreased hepatic metabolism of digoxin 4. increased hepatic metabolism of digoxin 5. increased absorption of digoxin from the gut Answer a: decreased renal tubular secretion of digoxin Chapter 12: Chemical mediators and the autonomic nervous system MULTIPLE CHOICE 1. The release of acetylcholine from cholinergic nerve terminals is stimulated by 1. nitric oxide 2. norepinephrine 3. acetylcholine 4. prostaglandins 5. endothelin Answer a: nitric oxide 2. Co-transmitters released from postganglionic sympathetic neurons include 1. acetylcholine 2. vasoactive intestinal peptide 3. nitric oxide 4. adenosine triphosphate 5. gamma-aminobutyric acid Answer d: adenosine triphosphate 3. Constriction of bronchi is typically produced by activation of 1. adrenergic beta-1 receptors 2. adrenergic beta-2 receptors 3. muscarinic M1 receptors 4. muscarinic M2 receptors 5. muscarinic M3 receptors Answer e: muscarinic M3 receptors 4. Activation of adrenergic beta-2 receptors produces 1. contraction of the iris sphincter muscle 2. relaxation of the iris sphincter muscle 3. relaxation of the ciliary muscle 4. contraction of the ciliary muscle 5. lacrimal gland secretion Answer c: relaxation of the ciliary muscle 5. The enteric nervous system is primarily concerned with the regulation of 1. the urinary tract 2. gastrointestinal motility 3. male sex organs 4. respiration 5. vascular smooth muscle Answer b: gastrointestinal motility 6. The co-transmitter known as neuropeptide Y enhances the 1. vasodilative effect of acetylcholine 2. vasodilative effect of nitric oxide 3. vasodilative effect of dopamine 4. vasoconstrictive effect of norepinephrine 5. vasoconstrictive effect of endothelin Answer d: vasoconstrictive effect of norepinephrine 7. The final step in the release of norepinephrine from sympathetic neurons is 1. docking 2. loading 3. diffusion 4. synthesis 5. exocytosis Answer e: exocytosis 8. In the parasympathetic nervous system, neurotransmitter action is terminated by 1. diffusion from the synapse 2. active reuptake into presynaptic nerves 3. inactivation by inhibitors 4. enzymatic degradation 5. endocytosis Answer d: enzymatic degradation 9. The enteric nervous system 1. receives input only from the sympathetic nervous system 2. receives input only from the parasympathetic nervous system 3. releases several peptide neurotransmitters and nitric oxide 4. cannot function without the central nervous system 5. has cell bodies lying in plexuses outside the intestinal wall Answer c: releases several peptide neurotransmitters and nitric oxide Chapter 13: Cholinergic transmission MULTIPLE CHOICE 1. Activation of muscarinic M2 receptors 1. increases calcium conductance 2. increases potassium conductance 3. increases cardiac rate and force 4. causes central nervous system excitation 5. produces vascular smooth muscle relaxation Answer b: increases potassium conductance 1. Succinylcholine is characteristically an agonist at 1. muscarinic M1 receptors 2. muscarinic M2 receptors 3. muscarinic M3 receptors 4. nicotinic receptors in skeletal muscle 5. nicotinic receptors in autonomic ganglia Answer d: nicotinic receptors in skeletal muscle 1. The second messengers formed by activation of muscarinic acetylcholine receptors include 1. inositol triphosphate 2. cyclic AMP 3. cyclic GMP 4. eicosanoids 5. guanosine triphosphate Answer a: inositol triphosphate 1. Pilocarpine lowers intraocular pressure by 1. decreasing aqueous humor formation 2. contracting the iris sphincter muscle 3. contracting the ciliary muscle 4. relaxing the iris sphincter muscle 5. relaxing the ciliary muscle Answer c: contracting the ciliary muscle 1. The increased release of potassium from denervated muscles by succinylcholine is due to 1. inhibition of cholinesterase 2. desensitization of nicotinic receptors 3. nicotinic receptor up-regulation 4. denervation supersensitivity 5. destruction of the motor end plate Answer d: denervation supersensitivity 1. Edrophonium produces reversible inhibition of cholinesterase by 1. binding the anionic site 2. binding the esteratic site 3. binding both anionic and esteratic sites 4. reversibly binding an allosteric site 5. forming a complex with acetylcholine Answer a: binding the anionic site 1. Pyridostigmine enhances neuromuscular transmission in myasthenia gravis patients by 1. increasing release of acetylcholine 2. inhibiting degradation of acetylcholine 3. causing up-regulation of nicotinic receptors 4. reactivating cholinesterase 5. blocking autoantibodies Answer b: inhibiting degradation of acetylcholine 1. Activation of muscarinic M3 receptors leads to 1. smooth muscle relaxation 2. cardiac slowing 3. central nervous system stimulation 4. vasoconstriction 5. exocrine gland secretion Answer e: exocrine gland secretion 1. The effects produced by topical ocular administration of atropine include 1. miosis 2. mydriasis 3. lacrimation 4. decreased intraocular pressure 5. conjunctivitis Answer b: mydriasis 1. If a test dose of edrophonium increases muscle weakness in a myasthenia gravis patient being treated with pyridostigmine, it means that 1. the patient does not actually have myasthenia gravis 2. the dose of pyridostigmine is too low 3. the dose of pyridostigmine is too high 4. atropine should be administered 5. none of the above is correct Answer c: the dose of pyridostigmine is too high 1. Atropine poisoning in children typically causes 1. respiratory depression 2. muscle paralysis 3. sweating 4. hyperthermia 5. sedation Answer d: hyperthermia 1. Persons with a genetic variant conferring abnormal plasma cholinesterase activity may exhibit prolonged muscle paralysis following administration of 1. tubocurarine 2. pilocarpine 3. pancuronium 4. atracurium 5. succinylcholine Answer e: succinylcholine 1. The release of acetylcholine from cholinergic nerve terminals is blocked by 1. atropine 2. bungarotoxin 3. botulinum toxin 4. batrachotoxin 5. tetrodotoxin Answer c: botulinum toxin 1. Scopolamine is employed clinically in the prevention or treatment of 1. motion sickness 2. asthma 3. peptic ulcer 4. glaucoma 5. constipation Answer a: motion sickness 1. The neuromuscular blockade produced by atracurium can be reversed by administration of 1. atropine 2. neostigmine 3. succinylcholine 4. pilocarpine 5. nicotine Answer b: neostigmine 1. Transient muscle fasciculations followed by paralysis typically occur after administration of 1. succinylcholine 2. tubocurarine 3. vecuronium 4. gallamine 5. atropine Answer a: succinylcholine Chapter 14: Noradrenergic transmission MULTIPLE CHOICE 1. An intravenous infusion of norepinephrine typically 1. increases peripheral resistance and heart rate 2. decreases peripheral resistance and heart rate 3. increases peripheral resistance and decreases heart rate 4. decreases peripheral resistance and increases heart rate 5. has no consistent effect on peripheral resistance and heart rate Answer c: increases peripheral resistance and decreases heart rate 1. In the liver, epinephrine acts via adrenergic beta-2 receptors to 1. stimulate both phosphorylase and glycogen synthase 2. inhibit both phosphorylase and glycogen synthase 3. inhibit phosphorylase and stimulate glycogen synthase 4. stimulate phosphorylase and inhibit glycogen synthase 5. stimulate phosphorylase, glycogen synthase, and lipase Answer d: stimulate phosphorylase and inhibit glycogen synthase 1. Which drug inhibits the transport of norepinephrine into synaptic vesicles, thereby leading to neurotransmitter depletion? 1. reserpine 2. methyldopa 3. bretylium 4. 6-hydroxydopamine 5. guanethidine Answer a: reserpine 1. Doxazosin is an example of a 1. nonselective alpha-adrenoceptor antagonist 2. selective alpha-1 adrenoceptor antagonist 3. selective alpha-2 adrenoceptor antagonist 4. selective alpha-1 adrenoceptor agonist 5. selective alpha-2 adrenoceptor agonist Answer b: selective alpha-1 adrenoceptor antagonist 1. Irreversible blockade of alpha-adrenoceptors results from covalent binding of these receptors by 1. phentolamine 2. phenylephrine 3. prazosin 4. phenoxybenzamine 5. pseudoephedrine Answer d: phenoxybenzamine 1. The reuptake of norepinephrine by presynaptic nerve terminals (uptake 1) is inhibited by 1. guanethidine 2. reserpine 3. methyldopa 4. methyltyrosine 5. cocaine Answer e: cocaine 1. The first-line treatment for acute severe type I hypersensitivity reactions is 1. dopamine 2. epinephrine 3. isoproterenol 4. norepinephrine 5. phenylephrine Answer b: epinephrine 1. Which adrenergic receptor antagonist increases heart rate at rest but reduces it during exercise? 1. pindolol 2. propranolol 3. prazosin 4. timolol 5. phentolamine Answer a: pindolol 1. In the peripheral tissues, the primary end product of norepinephrine metabolism is 1. 3-methoxy, 4-hydroxyphenylglycol 2. normetanephrine 3. vanillylmandelic acid 4. 3,4-dihydroxymandelic acid 5. 3,4-dihydroxyphenylglycol Answer c: vanillylmandelic acid 1. The adverse effects of beta-adrenoceptor antagonists include 1. hyperglycemia 2. cardiac arrhythmias 3. myocardial ischemia 4. anxiety 5. bronchoconstriction Answer e: bronchoconstriction 1. Selective beta-3 adrenoceptor agonists are potentially useful in treating obesity because of their ability to 1. suppress appetite 2. inhibit digestion of fats 3. uncouple oxidative phosphorylation 4. increase thermogenesis 5. increase thyroid function Answer d: increase thermogenesis 1. Symptoms of urinary retention due to benign prostatic hyperplasia may be improved by 1. alpha-1 adrenoceptor antagonists 2. alpha-2 adrenoceptor antagonists 3. alpha-1 adrenoceptor agonists 4. alpha-2 adrenoceptor agonists 5. nonselective adrenoceptor agonists Answer a: alpha-1 adrenoceptor antagonists 1. Persons with acute thyrotoxicosis are often treated with propranolol because it 1. reduces peripheral vascular resistance 2. increases cardiac output 3. decreases cardiac stimulation 4. decreases blood glucose levels 5. inhibits thyroid hormone secretion Answer c: decreases cardiac stimulation 1. Persons with pheochromocytoma may benefit from administration of methyltyrosine because of its ability to 1. block alpha-1 adrenoceptors 2. block beta-1 adrenoceptors 3. inhibit norepinephrine release 4. inhibit norepinephrine synthesis 5. inhibit norepinephrine storage Answer d: inhibit norepinephrine synthesis Chapter 15: 5-Hydroxytryptamine and the pharmacology of migraine MULTIPLE CHOICE 1. Urinary levels of 5-hydroxyindole acetic acid provide an indication of the body’s production of 1. adenosine 2. serotonin 3. adenosine triphosphate 4. histamine 5. endothelin Answer b: serotonin 1. Some of the effects of theophylline are attributed to antagonism of 1. glutamate 2. 5-hydroxytrypamine 3. adenosine 4. norepinephrine 5. histamine Answer c: adenosine 1. The effects of chemical mediators on platelets include 1. stimulation of platelet aggregation by adenosine diphosphate 2. stimulation of platelet aggregation by adenosine 3. inhibition of platelet aggregation by adenosine diphosphate 4. inhibition of platelet aggregation by histamine 5. inhibition of platelet aggregation by serotonin Answer a: stimulation of platelet aggregation by adenosine diphosphate 1. Cyproheptadine is useful in treating carcinoid syndrome because of its ability to 1. activate 5-HT1 receptors 2. block 5-HT1 receptors 3. activate 5-HT2 receptors 4. block 5-HT2 receptors 5. activate 5-HT4 receptors Answer d: block 5-HT2 receptors 1. In persons with irritable bowel syndrome whose predominant symptom is constipation, intestinal peristaltic activity may be increased by drugs that 1. activate 5-HT1 receptors 2. block 5-HT1 receptors 3. activate 5-HT2 receptors 4. block 5-HT2 receptors 5. activate 5-HT4 receptors Answer e: activate 5-HT4 receptors 1. Activation of 5-HT1D receptors is usually beneficial in persons suffering from 1. carcinoid syndrome 2. nausea and vomiting 3. migraine headache 4. constipation 5. anxiety Answer c: migraine headache 1. Retroperitoneal and mediastinal fibrosis is a characteristic adverse effect of 1. methysergide 2. ergotamine 3. bromocriptine 4. sumatriptan 5. tegaserod Answer a: methysergide 1. Blockade of 5-HT3 receptors in vagal afferent neurons is useful in preventing 1. migraine headache 2. serotonin syndrome 3. platelet aggregation 4. nausea and vomiting 5. constipation Answer d: nausea and vomiting ******Chapter 15 & 16 are the same??????!! Chapter 17: Local hormones: cytokines, biologically active lipids, amines and peptides MULTIPLE CHOICE 1. The conversion of fibrinogen to fibrin is accelerated by 1. plasmin 2. plasminogen 3. kallikrein 4. complement 5. thrombin Answer e: thrombin 1. The release of histamine from mast cells is activated by 1. complement component C3a 2. complement component C4b 3. opsonin 4. chemotaxin 5. plasmin Answer a: complement component C3a 1. Type I hypersensitivity reactions results from the production of 1. natural killer cells 2. interleukin-2 3. immunoglobulin E 4. leukotriene D4 5. thromboxane Answer c: immunoglobulin E 1. Prostanoids and leukotrienes are both formed from 1. cyclic endoperoxides 2. arachidonic acid 3. linolenic acid 4. lipoxins 5. 5-hydroperoxyeicosatetraenoic acid Answer b: arachidonic acid 1. Vasodilation and inhibition of platelet aggregation are the primary effects of 1. prostacyclin 2. prostaglandin E2 3. thromboxane 4. prostaglandin F1a 5. prostaglandin F2a Answer a: prostacyclin 1. The formation of 5-hydroperoxyeicosatetraenoic acid is inhibited by 1. montelukast 2. nonsteroidal anti-inflammatory drugs 3. prostaglandins 4. zileuton 5. platelet-activating factor Answer d: zileuton 1. Leukotriene B4 causes 1. coronary vasoconstriction 2. vasodilation in most vascular bed 3. bronchoconstriction 4. bronchodilation 5. chemotaxis and activation of leukocytes Answer e: chemotaxis and activation of leukocytes 1. The structure of bradykinin is that of 1. a prostanoid 2. a nonapeptide 3. a leukotriene 4. a monoamine 5. a glycopeptide Answer b: a nonapeptide 1. It is postulated that bradykinin plays a role in 1. peptic ulcer 2. gastroesophageal reflux disease 3. diarrhea 4. inflammatory bowel disease 5. gallstones Answer c: diarrhea 1. Substance P, neurokinin A, and calcitonin gene-related peptide are partly responsible for 1. neurogenic inflammation 2. acute anaphylactic reactions 3. septic shock 4. rheumatoid arthritis 5. coronary vasoconstriction Answer a: neurogenic inflammation 1. Latanoprost is used clinically to 1. dilate the pupil 2. constrict the pupil 3. correct strabismus 4. lower intraocular pressure 5. treat uveitis Answer d: lower intraocular pressure 1. The treatment of primary pulmonary hypertension may include administration of 1. prostaglandin F2a 2. prostaglandin I2 3. thromboxane 4. misoprostol 5. dinoprostone Answer b: prostaglandin I2 1. The release of arachidonate from cell membrane phospholipids is inhibited by 1. non-steroidal anti-inflammatory drugs 2. zileuton 3. glucocorticoids 4. histamine H1 receptor antagonists 5. zafirlukast Answer c: glucocorticoids 1. Activation of prostaglandin EP3 receptors leads to 1. contraction of bronchial smooth muscle 2. inhibition of platelet aggregation 3. relaxation of gastrointestinal smooth muscle 4. increased gastric mucus secretion 5. contraction of uterine smooth muscle Answer d: increased gastric mucus secretion 1. Intradermal injection of histamine produces a “triple response” in which the wheal is caused by 1. dilation of small arterioles and precapillary sphincters 2. increased permeability of postcapillary venules 3. increased capillary permeability 4. an axon reflex 5. release of calcitonin gene-related peptide Answer b: increased permeability of postcapillary venules 1. A bradykinin antagonist would be expected to 1. cause vasodilation 2. increase vascular permeability 3. increase gastrointestinal fluid secretion 4. contract intestinal smooth muscle 5. decrease stimulation of nociceptive neurons Answer e: decrease stimulation of nociceptive neurons 1. During the induction of lymphocytes by antigen, the proliferation of T-helper-1 cells is increased by 1. interleukin-2 2. interleukin-4 3. interferon-gamma 4. tumor necrosis factor-beta 5. glucocorticoids Answer a: interleukin-2 Chapter 18: Peptides and proteins as mediators MULTIPLE CHOICE 1. Peptide and protein mediators typically 1. function as fast neurotransmitters 2. contain intramolecular diphosphate bonds 3. are easily crystallized 4. have highly rigid structures 5. activate cell surface receptors Answer e: activate cell surface receptors 1. As pharmacologic agents, most peptides are 1. easily absorbed from the gastrointestinal tract 2. rapidly distributed to the brain 3. usually administered by the transdermal route 4. rapidly degraded by plasma and tissue enzymes 5. inexpensive to manufacture Answer d: rapidly degraded by plasma and tissue enzymes 1. Bosentan is an antagonist of 1. opioid receptors 2. angiotensin AT1 receptors 3. endothelin receptors 4. bradykinin receptors 5. platelet fibrinogen receptors Answer c: endothelin receptors 1. Most neural and endocrine peptide mediators 1. act on G-protein-coupled receptors 2. activate ligand-gated ion channels 3. exhibit protein kinase activity 4. cause receptor up-regulation 5. bind to membrane transport proteins Answer a: act on G-protein-coupled receptors 1. Cyclosporine is a fungal polypeptide used clinically to 1. diagnose endocrine disease 2. cause immunosuppression 3. treat cystic fibrosis 4. treat thromboembolism 5. induce labor Answer b: cause immunosuppression 1. Which agent blocks substance P (neurokinin NK1) receptors and thereby prevents nausea and vomiting? 1. granisetron 2. promethazine 3. diphenhydramine 4. aprepitant 5. scopolamine Answer d: aprepitant Chapter 19: Cannabinoids MULTIPLE CHOICE 1. Activation of the cannabinoid CB1 receptor in nerve endings leads to 1. activation of neurotransmitter release 2. inhibition of potassium channels 3. inhibition of calcium channels 4. activation of adenylate cyclase 5. inhibition of Map (mitogen-activated protein) kinase Answer c: inhibition of calcium channels 1. Cannabinoids have been used therapeutically for the purpose of 1. increasing appetite 2. treating obesity 3. improving memory 4. treating drug dependence 5. treating anxiety Answer a: increasing appetite 1. Anandamide is correctly described as a substance that 1. is synthesized from amino acid precursors 2. is stored in synaptic vesicles 3. is a cannabinoid receptor antagonist 4. inhibits retrograde neuronal transmission 5. exerts endocannabinoid activity Answer e: exerts endocannabinoid activity 1. The effects produced by cannabinoid administration include 1. increased intraocular pressure 2. decreased intraocular pressure 3. vasoconstriction 4. bronchoconstriction 5. emesis Answer b: decreased intraocular pressure 1. Rimonabant is a new drug for the treatment of 1. obesity 2. nausea and vomiting 3. asthma 4. neuropathic pain 5. Parkinson’s disease Answer a: obesity Chapter 20: Nitric oxide & related mediators MULTIPLE CHOICE 1. The effects exerted by nitric oxide include 1. stimulation of platelet aggregation 2. vasoconstriction 3. inhibition of smooth muscle proliferation 4. increased atherogenesis 5. inhibition of host defenses Answer c: inhibition of smooth muscle proliferation 1. The primary action of inhaled nitric oxide is 1. vasoconstriction 2. pulmonary vasodilation 3. bronchoconstriction 4. cardiac stimulation 5. respiratory distress Answer b: pulmonary vasodilation 1. Nitric oxide causes vasodilation by 1. decreasing formation of cyclic GMP 2. increasing formation of cyclic GMP 3. decreasing formation of cyclic AMP 4. increasing formation of cyclic AMP 5. increasing calcium influx Answer b: increasing formation of cyclic GMP 1. In the gastrointestinal tract, nitric oxide serves to 1. inhibit gastric emptying 2. stimulate gastric emptying 3. inhibit peristalsis 4. inhibit gastric acid formation 5. cause constipation Answer b: stimulate gastric emptying 1. Nitroprusside produces its effects by acting as 1. a nitric oxide donor 2. a substrate for nitric oxide synthase 3. an inducer of nitric oxide synthase 4. an inhibitor of nitric oxide degradation 5. an agonist at nitric oxide receptors Answer a: a nitric oxide donor 1. Glucocorticoids may be beneficial in treating sepsis in part due to their ability to 1. inhibit constitutive nitric oxide synthase 2. stimulate constitutive nitric oxide synthase 3. stimulate inducible nitric oxide synthase 4. inhibit inducible nitric oxide synthase 5. inhibit both constitutive and inducible nitric oxide synthase Answer d: inhibit inducible nitric oxide synthase Chapter 21: The heart MULTIPLE CHOICE 1. Delayed after-depolarizations in cardiac tissue typically result from an increased influx of 1. sodium 2. potassium 3. calcium 4. chloride 5. sodium and potassium Answer c: calcium 1. The re-excitation of cardiac tissue prior to the next cardiac impulse occurs in the process known as 1. re-entry 2. ectopic automaticity 3. atrioventricular block 4. atrial fibrillation 5. bradycardia Answer a: re-entry 1. In persons with atrial fibrillation, digoxin may slow the ventricular rate by 1. decreasing sinoatrial node automaticity 2. increasing ventricular contractility 3. inhibiting the Na+/K+ pump 4. reducing the calcium transient 5. slowing atrioventricular conduction Answer e: slowing atrioventricular conduction 1. Sotalol exerts an antiarrhythmic effect primarily by 1. slowing ventricular conduction 2. blocking sodium channels 3. slowing atrioventricular conduction 4. increasing the effective refractory period 5. decreasing action potential duration Answer d: increasing the effective refractory period 1. Drugs that increase serum digoxin levels include 1. furosemide 2. cholestyramine 3. amiodarone 4. enalapril 5. hydrochlorothiazide Answer c: amiodarone 1. Verapamil is indicated for the treatment of 1. supraventricular tachycardia 2. ventricular tachycardia 3. atrial fibrillation 4. ventricular fibrillation 5. cardiac asystole Answer a: supraventricular tachycardia 1. In persons who have had a myocardial infarction, flecainide has been shown to 1. decrease the incidence of ventricular fibrillation 2. decrease the incidence of atrial fibrillation 3. decrease the incidence of sudden death 4. increase the frequency of ventricular ectopic beats 5. increase the incidence of sudden death Answer e: increase the incidence of sudden death 1. The pharmacokinetic attributes of amiodarone include 1. rapidly metabolized and excreted 2. a very short elimination half-life 3. a very long elimination half-life 4. distributed only to extracellular fluid 5. limited binding to plasma proteins Answer c: a very long elimination half-life 1. Dobutamine is useful in treating acute heart failure because of its ability to 1. increase heart rate more than contractile force 2. increase contractile force more than heart rate 3. produce a negative dromotropic effect 4. cause cardiac stimulation and vasoconstriction 5. inhibit phosphodiesterase Answer b: increase contractile force more than heart rate 1. Digoxin slows AV conduction and decreases heart rate by 1. activating cardiac muscarinic receptors 2. blocking cardiac adrenergic beta-1 receptors 3. antagonizing cardiac calcium channels 4. increasing vagal outflow from the CNS 5. increasing cardiac contractile force Answer d: increasing vagal outflow from the CNS 1. The half-life of digoxin is considerably longer in persons with 1. renal insufficiency 2. pulmonary edema 3. atrial fibrillation 4. hypertension 5. endocarditis Answer a: renal insufficiency 1. Which drug has been shown to reduce mortality in persons who have had a myocardial infarction? 1. amiodarone 2. lidocaine 3. propranolol 4. amiodarone 5. verapamil Answer c: propranolol 1. Hypothyroidism is most likely to occur in persons who are taking 1. sotalol 2. flecainide 3. timolol 4. amiodarone 5. adenosine Answer d: amiodarone 1. Nitroglycerin relieves typical angina pectoris in part by 1. increasing cardiac stroke volume 2. dilating coronary arterioles 3. decreasing cardiac oxygen consumption 4. constricting collateral vessels in the heart 5. increasing blood pressure Answer c: decreasing cardiac oxygen consumption 1. Nitroglycerin and other organic nitrates produce their vasodilator effect by 1. increasing formation of cyclic AMP 2. increasing formation of cyclic GMP 3. blocking calcium channels 4. blocking adrenergic alpha receptors 5. activating potassium channels Answer b: increasing formation of cyclic GMP Chapter 22: The vascular system MULTIPLE CHOICE 1. Which vasoconstrictor substance is produced by vascular endothelial cells? 1. nitric oxide 2. bradykinin 3. prostacyclin 4. natriuretic peptide 5. endothelin Answer e: endothelin 1. The opening of membrane potassium channels by minoxidil leads to 1. increased potassium influx 2. increased calcium influx 3. inactivation of calcium channels 4. membrane depolarization 5. formation of cyclic GMP Answer c: inactivation of calcium channels 1. Both valsartan and enalapril 1. increase serum potassium levels 2. often cause a dry cough 3. block angiotensin AT1 receptors 4. inhibit formation of angiotensin II 5. increase bradykinin levels Answer a: increase serum potassium levels 1. Bosentan is an antagonist of 1. endothelin ETA and ETB receptors 2. angiotensin AT1 receptors 3. angiotensin AT2 receptors 4. nitric oxide receptors 5. prostaglandin FP receptors Answer a: endothelin ETA and ETB receptors 1. In persons with heart failure, enalapril typically increases 1. cardiac afterload 2. cardiac preload 3. vascular resistance 4. cardiac output 5. aldosterone secretion Answer d: cardiac output 1. Which drug reduces sympathetic outflow from the central nervous system? 1. fosinopril 2. clonidine 3. terazosin 4. felodipine 5. hydralazine Answer b: clonidine 1. Captopril is a structural analog of the terminal dipeptide of 1. renin 2. nitric oxide synthase 3. endothelin 4. angiotensin converting enzyme 5. angiotensin I Answer e: angiotensin I 1. Effects similar to those of angiotensin converting enzyme inhibitors may be obtained in heart failure patients by administering 1. furosemide 2. digoxin 3. hydralazine and isosorbide dinitrate 4. dobutamine 5. nitroglycerin Answer c: hydralazine and isosorbide dinitrate 1. The adverse effects of terazosin and related drugs typically include 1. hypokalemia 2. drowsiness and dry mouth 3. urinary retention in older men 4. postural hypotension and edema 5. bradycardia and syncope Answer d: postural hypotension and edema 1. In persons with decompensated heart failure, nesiritide activates 1. adrenergic alpha receptors 2. adrenergic beta receptors 3. adenylate cyclase 4. guanylate cyclase 5. myosin phosphatase Answer d: guanylate cyclase 1. The preferred drugs for the initial treatment of most patients with mild hypertension include 1. hydralazine 2. minoxidil 3. hydrochlorothiazide 4. methyldopa 5. prazosin Answer c: hydrochlorothiazide 1. Fenoldopam is useful in treating hypertensive emergencies because of its ability to 1. block adrenergic beta receptors 2. block adrenergic alpha receptors 3. block calcium channels 4. open potassium channels 5. activate dopamine D1 receptors Answer e: activate dopamine D1 receptors 1. Beginning therapy with low doses that are gradually increased over several months is appropriate when treating heart failure with 1. digoxin 2. furosemide 3. dobutamine 4. carvedilol 5. nitroglycerin Answer d: carvedilol 1. The progression of diabetic nephropathy may be slowed by 1. propranolol 2. enalapril 3. hydrochlorothiazide 4. amlodipine 5. doxazosin Answer b: enalapril 1. The use of eplerenone in the treatment of heart failure is based on its ability to 1. cause vasodilation 2. inhibit sympathetic nervous system activity 3. antagonize aldosterone 4. inhibit angiotensin II formation 5. increase cardiac contractile force Answer c: antagonize aldosterone Chapter 23: Atherosclerosis and lipoprotein metabolism MULTIPLE CHOICE 1. Activation of the peroxisome proliferator-activated receptor-alpha is produced by administration of 1. ezetimibe 2. fenofibrate 3. simvastatin 4. niacin 5. colesevelam Answer b: fenofibrate 1. Ezetimibe reduces serum LDL-cholesterol levels by 1. inhibiting cholesterol synthesis 2. increasing HDL-cholesterol levels 3. inhibiting cholesterol absorption 4. inhibiting bile acid reabsorption 5. stimulate lipoprotein lipase Answer c: inhibiting cholesterol absorption 1. Myositis leading to rhabdomyolysis is a potentially severe adverse effect of 1. atorvastatin 2. niacin 3. colestipol 4. ezetimibe 5. cholestyramine Answer a: atorvastatin 1. Increased expression of apoproteins A-I and A-II occurs in persons receiving 1. colestipol 2. niacin 3. simvastatin 4. ezetimibe 5. gemfibrozil Answer e: gemfibrozil 1. Simvastatin and related drugs have been shown to reduce mortality in persons with 1. hypertriglyceridemia 2. low HDL-cholesterol levels 3. an inability to make LDL receptors 4. symptomatic coronary artery disease 5. myositis Answer d: symptomatic coronary artery disease 1. Which drug inhibits hepatic triglyceride synthesis and VLDL secretion? 1. fenofibrate 2. colestipol 3. niacin 4. ezetimibe 5. atorvastatin Answer c: niacin Chapter 24: Haemostasis and thrombosis MULTIPLE CHOICE 1. Warfarin inhibits coagulation by 1. inactivating prothrombin 2. inhibiting active factor Xa 3. inhibiting vitamin K oxidase 4. inhibiting vitamin K reductase 5. activating antithrombin III Answer d: inhibiting vitamin K reductase 1. Which drug competes with ADP (adenosine diphosphate) for its platelet receptor? 1. clopidogrel 2. epoprostenol 3. hirudin 4. aspirin 5. tirofiban Answer a: clopidogrel 1. Abciximab is a monoclonal antibody to receptors for 1. thrombin 2. thromboxane 3. glycoprotein IIb/IIIa 4. adenosine diphosphate 5. von Willebrand factor Answer c: glycoprotein IIb/IIIa 1. Dipyridamole and aspirin are used together primarily for the prevention of 1. pulmonary embolism 2. ischemic stroke 3. myocardial infarction 4. deep vein thrombosis 5. unstable coronary syndromes Answer b: ischemic stroke 1. Acute thrombotic stroke may be effectively treated within 3 hours of onset with 1. warfarin 2. tranexamic acid 3. eptifibatide 4. aspirin 5. tenecteplase Answer e: tenecteplase 1. Clinical trials of adding clopidogrel to aspirin for preventing thromboembolic disease found that combined therapy is 1. less effective than aspirin alone 2. less effective than clopidogrel alone 3. equally effective as clopidogrel alone 4. equally effective as aspirin alone 5. more effective than aspirin alone Answer e: more effective than aspirin alone 1. Enoxaparin increases the activity of antithrombin III against 1. primarily thrombin 2. primarily factor Xa 3. thrombin and factor Xa equally 4. neither thrombin nor factor Xa 5. fibrin stabilizing factor Answer b: primarily factor Xa 1. One of the adverse effects of high-dose or long-term therapy with heparin is 1. hyponatremia 2. hypernatremia 3. hypokalemia 4. hyperkalemia 5. hypophosphatemia Answer d: hyperkalemia 1. Eptifibatide is used to prevent thrombosis in persons undergoing 1. coronary angioplasty 2. fibrinolysis 3. blood transfusion 4. abdominal surgery 5. hip-replacement surgery Answer a: coronary angioplasty 1. Fondaparinux is correctly described as a 1. hirudin derivative 2. cyclic peptide from snake venom 3. low-molecular-weight heparin 4. warfarin analogue 5. synthetic pentasaccharide Answer e: synthetic pentasaccharide Chapter 25: Haemopoietic system and treatment of anaemia MULTIPLE CHOICE 1. Ascorbic acid influences iron absorption from the gastrointestinal tract by 1. forming an insoluble iron-chelate 2. oxidizing iron to the ferric state 3. reducing iron to the ferrous state 4. stimulating the iron transport protein 5. activating haem oxidase Answer c: reducing iron to the ferrous state 1. Neural tube birth defects can be prevented by the administration to pregnant women of 1. folic acid 2. cyanocobalamin 3. ferrous gluconate 4. epoetin 5. filgrastim Answer a: folic acid 1. Desferrioxamine is administered for the purpose of treating 1. iron deficiency anemia 2. megaloblastic anemia 3. pernicious anemia 4. iron toxicity 5. hemosiderosis Answer d: iron toxicity 1. Persons with an elevated blood level of methylmalonyl-Coenzyme A may have a deficiency of 1. erythropoietin 2. iron 3. formyl-tetrahydrofolic acid 4. colony-stimulating factors 5. vitamin B12 Answer e: vitamin B12 1. Filgrastim is conjugated with polyethylene glycol to 1. increase its absorption from the gut 2. increase its elimination half-life 3. reduce its duration of action 4. decrease its adverse effects 5. increase its potency Answer b: increase its elimination half-life 1. Epoetin is indicated for the treatment of 1. pernicious anemia 2. anemia of renal failure 3. megaloblastic anemia 4. neutropenia 5. platelet deficiency Answer b: anemia of renal failure Test Bank Chapter 26: Anti-inflammatory and immunosuppressant drugs MULTIPLE CHOICE 1. N-acetyl-p-benzoquinone is the hepatotoxic metabolite of 1. aspirin 2. indomethacin 3. ketorolac 4. acetaminophen 5. ibuprofen Answer d: acetaminophen 1. The cyclooxygenase-2 isozyme forms products that cause 1. inflammation 2. platelet aggregation 3. fever 4. gastric acid secretion 5. vasoconstriction Answer a: inflammation 1. The most common adverse effect of most non-steroidal anti-inflammatory drugs is 1. thrombosis 2. skin rash 3. gastrointestinal distress 4. renal impairment 5. hepatitis Answer c: gastrointestinal distress 1. High therapeutic doses of aspirin are most likely to cause 1. metabolic acidosis 2. metabolic alkalosis 3. respiratory acidosis 4. respiratory alkalosis 5. hypothermia Answer d: respiratory alkalosis 1. Which drug forms a complex that inhibits activation of transcription factors for interleukin-2 by calcineurin? 1. tacrolimus 2. sirolimus 3. azathioprine 4. muromonab-CD3 5. mycophenolate Answer a: tacrolimus 1. Which antihistamine lacks significant sedative and muscarinic receptor antagonist actions? 1. meclizine 2. fexofenadine 3. chlorpheniramine 4. diphenhydramine 5. promethazine Answer b: fexofenadine 1. Allopurinol is used in treating gout because of its ability to 1. increase uric acid formation 2. decrease uric acid formation 3. increase uric acid excretion 4. increase uric acid degradation 5. inhibit leukocyte migration Answer b: decrease uric acid formation 1. Which disease-modifying anti-rheumatoid drug typically has the greatest efficacy and fewest adverse effects? 1. gold sodium thiomalate 2. auranofin 3. penicillamine 4. hydroxychloroquine 5. methotrexate Answer e: methotrexate 1. The most common serious adverse effect of cyclosporine is 1. peripheral neuropathy 2. congestive heart failure 3. nephrotoxicity 4. hypotension 5. alopecia Answer c: nephrotoxicity 1. Which drug is a monoclonal antibody to tumor necrosis factor-alpha? 1. leflunomide 2. etanercept 3. muromonab-CD3 4. infliximab 5. methotrexate Answer d: infliximab 1. Which drug inhibits a regulatory kinase involved in cytokine-driven T-cell proliferation? 1. prednisone 2. cyclosporine 3. tacrolimus 4. mycophenolate 5. sirolimus Answer e: sirolimus 1. Selective cyclooxygenase-2 inhibitors have been associated with an increased risk of 1. congestive heart failure 2. thromboembolic disorders 3. hypertension 4. atherosclerosis 5. diabetes mellitus Answer b: thromboembolic disorders 1. In the treatment of rheumatoid arthritis, anakinra acts as an antagonist of 1. interleukin-1 2. interleukin-2 3. tumor necrosis factor-alpha 4. calcineurin 5. leukotriene receptors Answer a: interleukin-1 1. The de novo synthesis of pyrimidines required for T cell proliferation is inhibited by 1. azathioprine 2. hydroxychloroquine 3. leflunomide 4. etanercept 5. allopurinol Answer c: leflunomide No chapter 27 Skin ?????? Chapter 28: Respiratory system MULTIPLE CHOICE 1. The clinical uses of formoterol include 1. prevention of nocturnal bronchospasm 2. treatment of acute bronchospasm 3. long-term prevention of airway inflammation 4. prevention and treatment of allergic rhinitis 5. stabilization of mast cells in persons with atopic dermatitis Answer a: prevention of nocturnal bronchospasm 1. The cysteinyl leukotriene CysLT1 receptor is blocked by 1. tiotropium 2. theophylline 3. nedocromil 4. zafirlukast 5. omalizumab Answer d: zafirlukast 1. Persons with aspirin-sensitive asthma 1. can safely use naproxen or ibuprofen 2. seldom have nasal polyps 3. exhibit hyper-responsiveness to inhaled leukotrienes 4. are effectively treated with antihistamines 5. have few cysteinyl leukotriene receptors Answer c: exhibit hyper-responsiveness to inhaled leukotrienes 1. Which drug inhibits phosphodiesterase and blocks adenosine receptors? 1. salmeterol 2. budesonide 3. zileuton 4. cromoglycate 5. theophylline Answer e: theophylline 1. In the treatment of asthma, glucocorticoids 1. increase secretion of interleukin-4 2. up-regulate adrenergic beta-2 receptors 3. increase microvascular permeability 4. increase formation of vasodilator prostanoids 5. are usually administered orally Answer b: up-regulate adrenergic beta-2 receptors 1. Tremor and tachycardia are common side effects of 1. theophylline 2. salbutamol 3. montelukast 4. fluticasone 5. cromoglycate Answer b: salbutamol 1. Tiotropium is useful in the treatment of chronic obstructive pulmonary disease because of its ability to 1. reduce airway inflammation 2. improve gas transfer 3. inhibit proteolytic enzymes 4. relax bronchial smooth muscle 5. stimulate respiration Answer d: relax bronchial smooth muscle 1. Omalizumab is a humanized monoclonal antibody to 1. immunoglobulin G 2. immunoglobulin E 3. cysteinyl leukotriene receptors 4. chemokines 5. interleukin IL-3 Answer b: immunoglobulin E Chapter 29: The kidney MULTIPLE CHOICE 1. Excessive doses of hydrochlorothiazide may cause 1. hyperkalemic metabolic acidosis 2. hyperkalemic metabolic alkalosis 3. hyperchloremic metabolic acidosis 4. hypokalemic metabolic alkalosis 5. hypokalemic metabolic acidosis Answer d: hypokalemic metabolic alkalosis 1. Amiloride exerts its diuretic effect by 1. blocking epithelial sodium channels 2. inhibiting the epithelial sodium pump 3. inhibiting the sodium chloride transporter 4. blocking aldosterone receptors 5. inhibiting chloride channels Answer a: blocking epithelial sodium channels 1. The Na+/K+/2Cl- transporter is inhibited by 1. amiloride 2. furosemide 3. acetazolamide 4. hydrochlorothiazide 5. triamterene Answer b: furosemide 1. A mild hyperchloremic metabolic acidosis may occur following administration of 1. amiloride 2. hydrochlorothiazide 3. mannitol 4. bumetanide 5. acetazolamide Answer e: acetazolamide 1. Hydrochlorothiazide decreases the urinary excretion of 1. calcium 2. sodium 3. potassium 4. chloride 5. bicarbonate Answer a: calcium 1. The usual therapeutic doses of aspirin 1. inhibit uric acid reabsorption 2. stimulate uric acid reabsorption 3. inhibit uric acid secretion 4. stimulate uric acid secretion 5. lower serum uric acid levels Answer c: inhibit uric acid secretion 1. Hyperkalemia is most likely to occur following the administration of 1. furosemide and amiloride 2. losartan and amiloride 3. hydrochlorothiazide and amiloride 4. hydrochlorothiazide and losartan 5. losartan and amiloride Answer e: losartan and amiloride 1. Testicular atrophy and gynecomastia are most likely to result from the administration of 1. eplerenone 2. spironolactone 3. amiloride 4. acetazolamide 5. bumetanide Answer b: spironolactone 1. Before exerting its diuretic effect, furosemide undergoes 1. metabolic activation in the liver 2. passive reabsorption from the nephron 3. glomerular filtration in the kidneys 4. passive diffusion into the nephron 5. active renal tubular secretion Answer e: active renal tubular secretion 1. The electroneutral sodium and chloride cotransporter in the distal tubule is inhibited by 1. metolazone 2. amiloride 3. acetazolamide 4. bumetanide 5. spironolactone Answer a: metolazone 1. The uricosuric effect of sulfinpyrazone results from inhibition of 1. uric acid formation 2. uric acid transport 3. uric acid secretion 4. uric acid reabsorption 5. uric acid degradation Answer d: uric acid reabsorption Chapter 30: The gastrointestinal tract MULTIPLE CHOICE 1. The symptomatic treatment of diarrhea may include administration of 1. loperamide 2. lactulose 3. omeprazole 4. bisacodyl 5. cimetidine Answer a: loperamide 1. Omeprazole reduces gastric acid secretion by 1. reversibly inhibiting the H+/Na+ ATPase 2. irreversibly inhibiting the H+/Na+ ATPase 3. reversibly inhibiting the H+/K+ ATPase 4. irreversibly inhibiting the H+/K+ ATPase 5. irreversibly inhibiting the Na+/K+ ATPase Answer d: irreversibly inhibiting the H+/K+ ATPase 1. According to the two-cell hypothesis of gastric acid secretion, the parietal cell has receptors for 1. only histamine and acetylcholine 2. only histamine and gastrin 3. only gastrin and acetylcholine 4. only gastrin 5. histamine, gastrin, and acetylcholine Answer c: only gastrin and acetylcholine 1. The use of misoprostol in treating gastric damage caused by nonsteroidal anti-inflammatory drugs is partly due to its ability to 1. increase secretion of mucus and bicarbonate 2. decrease secretion of mucus and bicarbonate 3. increase gastrointestinal motility 4. decrease mucosal blood flow 5. inhibit release of histamine Answer a: increase secretion of mucus and bicarbonate 1. Nausea and vomiting caused by vestibular stimulation is most effectively prevented by 1. ondansetron 2. metoclopramide 3. nabilone 4. promethazine 5. prochlorperazine Answer d: promethazine 1. Sucralfate is best described as a 1. proton pump inhibitor 2. histamine H1 receptor antagonist 3. substituted benzimidazole 4. prostaglandin E2 analogue 5. complex of aluminum hydroxide and sulfated sucrose Answer e: complex of aluminum hydroxide and sulfated sucrose 1. Which drug increases electrolyte and water secretion by the intestinal mucosa? 1. sucralfate 2. lactulose 3. bisacodyl 4. docusate sodium 5. methylcellulose Answer c: bisacodyl 1. The antiemetic effect of ondansetron is primarily based on its ability to block 1. 5-HT3 receptors in vestibular nuclei 2. 5-HT3 receptors in the chemoreceptor trigger zone 3. 5-HT3 receptors in the vomiting center 4. 5-HT4 receptors in visceral afferent neurons 5. histamine and muscarinic receptors in the solitary tract Answer b: 5-HT3 receptors in the chemoreceptor trigger zone Chapter 31: The control of blood glucose and drug treatment of diabetes mellitus MULTIPLE CHOICE 1. The characteristics of type 2 diabetes mellitus typically include 1. insulin resistance 2. absence of 1st and 2nd phase insulin secretion 3. absence of 2nd phase insulin secretion only 4. excessive insulin secretion 5. impaired glucagon secretion Answer a: insulin resistance 1. The actions of insulin include 1. inhibition of glycogen synthesis 2. inhibition of triglyceride synthesis 3. inhibition of gluconeogenesis 4. inhibition of protein synthesis 5. inhibition of glucose uptake by muscle Answer c: inhibition of gluconeogenesis 1. Which drug binds to the peroxisome proliferator-activated receptor-gamma in adipose tissue, muscle, and liver? 1. metformin 2. pioglitazone 3. repaglinide 4. glipizide 5. acarbose Answer b: pioglitazone 1. The effects of metformin include 1. increased appetite 2. increased hepatic glucose output 3. decreased hepatic glucose output 4. hypoglycemia 5. increased low-density lipoproteins Answer c: decreased hepatic glucose output 1. The mechanism of action of glipizide is 1. stimulation of glucose transporters 2. stimulation of insulin synthesis 3. blockade of calcium channels 4. activation of ATP-sensitive potassium channels 5. blockade of ATP-sensitive potassium channels Answer e: blockade of ATP-sensitive potassium channels 1. Weight gain and fluid retention are most likely to occur in persons receiving 1. metformin 2. insulin lispro 3. nateglinide 4. pioglitazone 5. acarbose Answer d: pioglitazone 1. The characteristics of insulin glargine include: 1. rapidly and completely absorbed after injection 2. provides a constant basal insulin supply 3. has an intermediate duration of action 4. used in treating diabetic ketoacidosis 5. contains a lysine-proline amino acid transposition Answer b: provides a constant basal insulin supply 1. The most common adverse effect of glipizide is 1. hypoglycemia 2. weight loss 3. fluid retention 4. liver dysfunction 5. lactic acidosis Answer a: hypoglycemia Chapter 32: Obesity MULTIPLE CHOICE 1. Food intake is increased by 1. increased neuropeptide Y secretion 2. decreased neuropeptide Y secretion 3. increased alpha-melanocyte stimulating hormone secretion 4. increased leptin secretion 5. increased insulin secretion Answer a: increased neuropeptide Y secretion 1. Sibutramine produces weight loss in obese patients primarily by 1. decreasing intestinal absorption of carbohydrates 2. decreasing intestinal absorption of fats 3. decreasing intestinal absorption of proteins 4. increasing satiety 5. increasing thermogenesis Answer d: increasing satiety 1. A person with a body mass index of 28 kg/m2 is considered to be 1. anorectic 2. thin 3. normal 4. overweight but not obese 5. obese Answer d: overweight but not obese 1. Factors contributing to the development of obesity include 1. increased responsiveness to leptin 2. increased thermogenesis 3. decreased b3 adrenoceptor tone 4. uncoupling of oxidative phosphorylation 5. increased secretion of thyroid hormone Answer c: decreased b3 adrenoceptor tone 1. The incidence of which disease increases most sharply as a function of body mass index? 1. coronary heart disease 2. hypertension 3. asthma 4. cholelithiasis 5. type 2 diabetes mellitus Answer e: type 2 diabetes mellitus 1. Orlistat acts in part by inhibiting 1. leptin secretion 2. pancreatic lipase 3. neuropeptide Y receptors 4. food intake 5. storage of fat Answer b: pancreatic lipase Chapter 33: The pituitary and the adrenal cortex MULTIPLE CHOICE 1. The anabolic effects of growth hormone are mediated primarily by 1. somatotropin 2. somatostatin 3. somatomedin 4. somatotrophin 5. somatorelin Answer c: somatomedin 1. During breast feeding, prolactin inhibits the release or response to 1. oxytocin 2. estradiol 3. progesterone 4. gonadotrophins 5. hydrocortisone Answer d: gonadotrophins 1. The effects of fludrocortisone can be antagonized by 1. spironolactone 2. beclomethasone 3. metyrapone 4. aldosterone 5. aminoglutethimide Answer a: spironolactone 1. Octreotide is correctly described as a 1. short-acting analogue of somatotrophin 2. long-acting analogue of somatotrophin 3. short-acting analogue of somatostatin 4. long-acting analogue of somatostatin 5. long-acting analogue of somatomedin Answer d: long-acting analogue of somatostatin 1. In the basic transactivation mechanism of glucocorticoid receptor control of gene expression, the ligand- bound glucocorticoid receptor dimer binds to 1. nuclear factor kappa B sites 2. regulatory sites of Fos/Jun transcription factors 3. negative glucocorticoid response elements 4. positive glucocorticoid response elements 5. negative transcription factors Answer d: positive glucocorticoid response elements 1. Metyrapone inhibits the biosynthesis of 1. only corticosterone 2. only hydrocortisone 3. only dehydroepiandrosterone 4. both corticosterone and hydrocortisone 5. corticosterone, hydrocortisone, and dehydroepiandrosterone Answer d: both corticosterone and hydrocortisone 1. Insulin-like growth factor-1 causes feedback inhibition of the secretion of 1. prolactin 2. melanocyte-stimulating hormone 3. growth hormone 4. corticotropin 5. thyrotropin Answer c: growth hormone 1. Polyuria may result from inhibition of antidiuretic hormone by 1. desmopressin 2. oxytocin 3. carbamazepine 4. ibuprofen 5. lithium Answer e: lithium 1. The adverse effects of high-dose or chronic administration of prednisone include 1. muscle hypertrophy 2. cataracts 3. decreased abdominal fat 4. thickened skin 5. hypotension Answer b: cataracts 1. Cabergoline inhibits the anterior pituitary secretion of 1. prolactin 2. melanocyte-stimulating hormone 3. thyrotropin 4. somatotrophin 5. corticotrophin Answer a: prolactin 1. The treatment of diabetes insipidus includes nasal administration of 1. vasopressin 2. desmopressin 3. demeclocycline 4. octreotide 5. budesonide Answer b: desmopressin Chapter 34: The thyroid MULTIPLE CHOICE 1. The characteristics of triiodothyronine (T3) include 1. a large pool in the body 2. a low turnover rate 3. formed from thyroxine (T4) intracellularly 4. interacts with a cytoplasmic receptor 5. represses transcription Answer c: formed from thyroxine (T4) intracellularly 1. Iodination of tyrosine residues of thyroglobulin is inhibited by 1. propranolol 2. methimazole 3. liothyronine 4. protirelin 5. hydrogen peroxide Answer b: methimazole 1. The characteristics of radioactive iodine (131I) in the treatment of hyperthyroidism include 1. a rapid onset of action 2. a maximum effect in 8 days 3. a cytotoxic effect produced by g rays 4. safe use in children and pregnant women 5. hypothyroidism as a typical later-onset disease Answer e: hypothyroidism as a typical later-onset disease 1. The long elimination half-life of thyroxine (T4) is primarily due to 1. slow absorption from the gut 2. slow excretion in the urine 3. strong binding to thyroxine-binding globulin 4. slow hepatic inactivation 5. storage in fat cells Answer c: strong binding to thyroxine-binding globulin 1. An uncommon but serious adverse effect associated with the use of propylthiouracil is 1. granulocytopenia 2. hemolytic anemia 3. a lupus erythematosus-like syndrome 4. cholestatic hepatitis 5. Hypoglycemia Answer a: granulocytopenia Chapter 35: The reproductive system MULTIPLE CHOICE 1. The expression of estrogen receptors in the mammary gland is increased by 1. oxytocin 2. progesterone 3. prolactin 4. gonadotrophins 5. androgens Answer c: prolactin 1. The secretion of progesterone from the corpus luteum is primarily stimulated by 1. follicle-stimulating hormone 2. luteinizing hormone 3. estrogen 4. prolactin 5. oxytocin Answer b: luteinizing hormone 1. Compared to the combination estrogen-progestogen contraceptive, the progestogen-only pill is more likely to 1. cause hypertension 2. prevent conception 3. cause breast cancer 4. cause myocardial infarction 5. produce irregular bleeding Answer e: produce irregular bleeding 1. Administration of sildenafil leads to 1. activation of guanylate cyclase 2. inhibition of guanylate cyclase 3. activation of phosphodiesterase V 4. inhibition of phosphodiesterase V 5. release of nitric oxide Answer d: inhibition of phosphodiesterase V 1. In the estrogen-progestogen contraceptive pill, the estrogen component acts primarily by inhibiting 1. secretion of LH 2. secretion of FSH 3. ovulation 4. passage of sperm 5. mucus secretion Answer b: secretion of FSH 1. The prevention and treatment of postpartum hemorrhage may include injections of 1. estrogen 2. progestogen 3. oxytocin 4. ritodrine 5. prolactin Answer c: oxytocin 1. The benefits of using estrogen-progestogen contraceptive pills include 1. decreased risk of hypertension 2. improved glucose tolerance 3. decreased risk of breast cancer 4. decreased menstrual irregularities 5. decreased risk of stroke Answer d: decreased menstrual irregularities 1. The use of atosiban to delay premature labor is based on its ability to 1. block b2-adrenoceptors 2. activate b2-adrenoceptors 3. block progesterone receptors 4. activate progesterone receptors 5. block oxytocin receptors Answer e: block oxytocin receptors 1. When finasteride is used in treating benign prostatic hypertrophy, it acts by 1. blocking androgen receptors 2. inhibiting gonadotrophin secretion 3. inhibiting 5a-reductase 4. inhibiting testosterone secretion 5. blocking a1 adrenoceptors Answer c: inhibiting 5a-reductase 1. The interaction between nitroglycerin and sildenafil results from the 1. inhibition of sildenafil metabolism by nitroglycerin 2. inhibition of nitroglycerin metabolism by sildenafil 3. similar effect of the drugs on phosphodiesterase V 4. similar effect of the drugs on cyclic GMP levels 5. antagonistic effect of the drugs on cyclic GMP levels Answer d: similar effect of the drugs on cyclic GMP levels Chapter 36: Bone metabolism MULTIPLE CHOICE 1. Substances that stimulate osteoblasts to express the Receptor Activator of Nuclear factor Kappa B (RANK) ligand include 1. alendronate 2. raloxifene 3. fluoride 4. calcitriol 5. osteoprotegerin Answer d: calcitriol 1. Which type of vitamin D is formed in the skin by the action of ultraviolet radiation? 1. calcitriol 2. calcifediol 3. ergocalciferol 4. alfacalcidol 5. cholecalciferol Answer e: cholecalciferol 1. Alendronate is useful in treating osteoporosis because of its ability to 1. stimulate bone formation by osteoblasts 2. inhibit bone resorption by osteoclasts 3. block receptor activator of nuclear factor kappa B 4. cause apoptosis of osteoclasts 5. cause differentiation of osteoblast precursor cells Answer b: inhibit bone resorption by osteoblasts 1. Activation of calcium-sensing receptors by cinacalcet causes 1. a rise in plasma calcium concentration 2. increased secretion of parathyroid hormone 3. decreased secretion of parathyroid hormone 4. decreased secretion of calcitonin 5. increased formation of calcitriol Answer c: decreased secretion of parathyroid hormone 1. Teriparatide is useful in the treatment of osteoporosis because of its ability to 1. increase plasma calcium concentrations 2. decrease plasma calcium concentrations 3. recruit osteoclast precursor cells 4. inhibit osteoclast activity 5. increase osteoblast activity Answer e: increase osteoblast activity 1. Which agent is used to prevent excessive bone turnover and relieve bone pain in Paget’s disease of bone? 1. calcitonin 2. ergocalciferol 3. calcium gluconate 4. parathyroid hormone 5. prednisone Answer a: calcitonin Chapter 37: Chemical transmission and drug action in the central nervous system MULTIPLE CHOICE 1. Fast neurotransmitters in the central nervous system include 1. glutamate 2. dopamine 3. substance P 4. prostanoids 5. nerve growth factor Answer a: glutamate 1. Slow neurotransmitters and neuromodulators act mainly through 1. ligand-gated ion channels 2. G-protein-coupled receptors 3. enzymes 4. transcription factors 5. release of nitric oxide Answer b: G-protein-coupled receptors 1. Drugs that are transported out of vascular endothelial cells in the central nervous system by P-glycoprotein include 1. most non-polar compounds 2. amino acid derivatives such as levodopa 3. highly ionized compounds 4. many anticancer and antibacterial drugs 5. most mood-altering drugs Answer d: many anticancer and antibacterial drugs 1. The relationship between the biochemical and cellular effects of a drug and its behavioral and therapeutic effects are best understood for drugs used in treating 1. mood depression 2. epilepsy 3. Parkinson’s disease 4. schizophrenia 5. mania Answer c: Parkinson’s disease Chapter 38: Amino acid neurotransmitters MULTIPLE CHOICE 1. The N-methyl-D-aspartate receptor for excitatory amino acids is positively modulated by 1. g-amino butyric acid 2. tyrosine 3. glycine 4. phenylalanine 5. alanine Answer c: glycine 1. The pathway leading to long-term potentiation of neuronal activity includes 1. inhibition of nitric oxide synthase 2. sustained blockade of N-methyl-D-aspartate receptors 3. feedback inhibition by nitric oxide 4. activation of protein kinase C by calcium 5. inhibition of metabotropic receptors Answer d: activation of protein kinase C by calcium 1. Baclofen is a selective agonist for the 1. kainite receptor for excitatory amino acids 2. N-methyl-D-aspartate receptor for excitatory amino acids 3. metabotropic receptor for excitatory amino acids 4. g-amino butyric acid-A (GABAA) receptor 5. g-amino butyric acid-B (GABAB) receptor Answer e: g-amino butyric acid-B (GABAB) receptor 1. Activation of AMPA (a-amino-5-hydroxy-3-methyl-4-isoxazole propionic acid) receptors for excitatory amino acids leads to 1. fast inhibitory neurotransmission 2. fast excitatory neurotransmission 3. modulation of postsynaptic excitatory neurotransmission 4. slow excitatory neurotransmission 5. slow inhibitory neurotransmission Answer b: fast excitatory neurotransmission 1. The glycine receptor blocked by strychnine is a 1. ligand-gated chloride channel 2. ligand-gated calcium channel 3. voltage-gated calcium channel 4. G-protein-coupled receptor 5. protein kinase receptor Answer a: ligand-gated chloride channel 1. The binding of g-amino butyric acid (GABA) to the GABA receptor is increased by 1. flumazenil 2. picrotoxin 3. diazepam 4. baclofen 5. gabapentin Answer c: diazepam 1. Which substance blocks ion channels of N-methyl-D-aspartate receptors for excitatory amino acids? 2. 3. 1. ketamine 2. cycloserine 3. kynurenic acid 4. cyclothiazide 5. kainite Answer a: ketamine 1. Activation of metabotropic excitatory amino acid receptors leads to 1. opening of chloride ion channels 2. opening of cation channels 3. formation of inositol triphosphate 4. formation of cyclic AMP 5. activation of protein kinase A Answer c: formation of inositol triphosphate Chapter 39: Other transmitters and modulators MULTIPLE CHOICE 1. The 5-hydroxytryptamine 5-HT2 receptors are 1. primarily inhibitory 2. chiefly found in the area postrema 3. mostly presynaptic 4. abundant in the cortex and limbic system 5. predominantly presynaptic autoreceptors Answer d: abundant in the cortex and limbic system 1. Agonists at 5-hydroxytryptamine 5-HT2A receptors typically cause 1. sleep 2. vigilance 3. hallucinations 4. hyperphagia 5. euphoria Answer c: hallucinations 1. The major functions of cholinergic pathways in the central nervous system include 1. learning and memory 2. mood and emotion 3. control of body temperature 4. appetite 5. drug dependence Answer a: learning and memory 1. The effects of jet lag can be alleviated by administration of 1. methylxanthine drugs 2. melatonin 3. histamine H2 receptor antagonists 4. 5-hydroxytryptamine 5-HT3 agonists 5. cholinesterase inhibitors Answer b: melatonin 1. The predominant site containing cell bodies of noradrenergic neurons is the 1. raphe nuclei 2. nigrostriatal pathway 3. locus coeruleus 4. nucleus accumbens 5. nucleus basalis Answer c: locus coeruleus 1. The 5-hydroxytryptamine 5-HT3 receptors are 1. excitatory ligand-gated cation channels 2. inhibitory ligand-gated cation channels 3. G-protein-coupled receptors 4. inhibitory ligand-gated chloride channels 5. presynaptic autoreceptors Answer a: excitatory ligand-gated cation channels 1. The dopamine transporter located in presynaptic nerve terminals is inhibited by 1. bromocriptine 2. levodopa 3. ondansetron 4. haloperidol 5. cocaine Answer e: cocaine 1. Degeneration of the nucleus basalis of Meynert is associated with the development of 1. obesity 2. narcolepsy 3. schizophrenia 4. Alzheimer’s disease 5. mood depression Answer d: Alzheimer’s disease 1. A deficiency of dopamine in the nigrostriatal pathway contributes to the development of 1. drug dependence 2. Parkinson’s disease 3. obesity 4. schizophrenia 5. insomnia Answer b: Parkinson’s disease 1. Functions associated with noradrenergic pathways in the central nervous system include 1. feeding behavior 2. induction of sleep 3. control of mood 4. pleasure and reward 5. release of hormones Answer c: control of mood Chapter 40: Neurodegenerative diseases MULTIPLE CHOICE 1. An essential factor in neuronal excitotoxicity is 1. depletion of intracellular calcium 2. excessive levels of intracellular calcium 3. depletion of adenosine triphosphate 4. inhibition of intracellular proteases 5. depletion of intracellular glutamate Answer b: excessive levels of intracellular calcium 1. The accumulation of b-amyloid protein is believed to cause neuronal degeneration in 1. Huntington’s disease 2. Parkinson’s disease 3. Creutzfeldt-Jakob disease 4. amyotrophic lateral sclerosis 5. Alzheimer’s disease Answer e: Alzheimer’s disease 1. Levodopa is usually administered with a peripheral dopa decarboxylase inhibitor such as 1. carbidopa 2. selegiline 3. entacapone 4. amantadine 5. pergolide Answer a: carbidopa 1. Factors that contribute to the development of Alzheimer’s disease include 1. absence of Ab40 peptides 2. decreased proportion of Ab42 peptides 3. mutations in the apoE4 gene 4. increased expression of a-secretase 5. decreased expression of g-secretase Answer c: mutations in the apoE4 gene 1. The use of selegiline in Parkinson’s disease is based on its ability to 1. selectively inhibit type A monoamine oxidase 2. slow progression of Parkinson’s disease 3. inhibit peripheral degradation of levodopa 4. protect dopamine from intra-neuronal degradation 5. exert the neuroprotective effects shown in clinical trials Answer d: protect dopamine from neuronal degradation 1. Memantine may produce a small improvement in cognitive function in persons with Alzheimer’s disease because it acts to 1. inhibit cholinesterase 2. activate cholinergic nicotinic receptors 3. block N-methyl-D-aspartate receptors 4. activate N-methyl-D-aspartate receptor 5. activate dopamine D1 receptors Answer c: block N-methyl-D-aspartate receptors 1. Entacapone reduces “end of dose” motor fluctuations in Parkinson’s disease because entacapone inhibits the degradation of levodopa by 1. catechol-O-methyltransferase 2. monoamine oxidase-A 3. monoamine oxidase-B 4. dopa decarboxylase 5. dopamine b-hydroxylase Answer a: catechol-O-methyltransferase 1. Expansion of CAG (cyotosine-adenine-guanine) trinucleotide repeats in certain genes occurs in persons with 1. spongiform encephalopathy 2. Parkinson’s disease 3. Alzheimer’s disease 4. amyotrophic lateral sclerosis 5. Huntington’s disease Answer e: Huntington’s disease 1. In the treatment of Alzheimer’s disease, rivastigmine typically causes 1. rapidly irreversible inhibition of acetyl- and butyryl-cholinesterase 2. slowly reversible inhibition of acetyl- and butyryl-cholinesterase 3. allosteric enhancement of nicotinic receptor activation 4. allosteric enhancement of muscarinic receptor activation 5. cholinergic side effects that increase over time Answer b: slowly reversible inhibition of acetyl- and butyryl-cholinesterase 1. The acute side effects of levodopa in Parkinson’s disease patients include 1. involuntary writhing movements 2. rapid fluctuations in clinical state 3. nausea and anorexia 4. hypertension 5. urinary retention Answer c: nausea and anorexia Chapter 41: General anaesthetic agents MULTIPLE CHOICE 1. Bone marrow depression may occur following prolonged administration of 1. halothane 2. nitrous oxide 3. etomidate 4. enflurane 5. thiopental Answer b: nitrous oxide 1. The minimum alveolar concentration (MAC) is an expression of an inhalational anesthetic’s 1. margin of safety 2. rate of induction 3. potency 4. water solubility 5. duration of action Answer c: potency 1. The main disadvantage of ketamine as an anesthetic is its tendency to cause 1. hypotension 2. respiratory depression 3. bradycardia 4. delirium and hallucinations 5. liver toxicity Answer d: delirium and hallucinations 1. Metabolites of halothane are believed to be responsible for infrequent episodes of 1. renal toxicity 2. hepatic toxicity 3. peripheral neuritis 4. hemolytic anemia 5. pulmonary fibrosis Answer b: hepatic toxicity 1. The attributes of propofol as an intravenous anesthetic include: 1. rapid metabolism and recovery 2. slow metabolism and recovery 3. risk of adrenocortical suppression 4. raises intracranial pressure 5. considerable hangover effect Answer a: rapid metabolism and recovery 1. Coughing and laryngospasm are most likely to occur during administration of 1. sevoflurane 2. nitrous oxide 3. halothane 4. desflurane 5. isoflurane Answer d: desflurane 1. The primary factor determining the rate of induction and recovery of an inhalational anesthetic is its 1. molecular weight 2. rate of metabolic inactivation 3. anesthetic potency 4. oil:gas partition coefficient 5. blood:gas partition coefficient Answer e: blood:gas partition coefficient Chapter 42: Analgesic drugs MULTIPLE CHOICE 1. Opioids activate descending pathways that inhibit pain transmission by acting on neurons in the 1. dorsal horn 2. thalamus 3. periaqueductal grey matter 4. nucleus raphe magnus 5. locus coeruleus Answer c: periaqueductal grey matter 1. The vanilloid receptor activated by capsaicin is a 1. ligand-gated cation channel 2. ligand-gated chloride ion channel 3. ATP-sensitive potassium channel 4. G-protein-coupled receptor 5. protein kinase receptor Answer a: ligand-gated cation channel 1. The analgesic effect of morphine is mostly due to activation of 1. delta opioid receptors 2. kappa opioid receptors 3. mu opioid receptors 4. sigma opioid receptors 5. tau receptors Answer c: mu opioid receptors 1. Stimulation of opioid receptors leads to 1. increased guanylate cyclase activity 2. decreased guanylate cyclase activity 3. increased adenylate cyclase activity 4. decreased adenylate cyclase activity 5. closing of potassium channels Answer d: decreased adenylate cyclase activity 1. Opioid drugs that exhibit partial agonist or mixed agonist-antagonist properties include 1. naloxone and naltrexone 2. methadone and meperidine 3. fentanyl and sufentanil 4. dynorphin and endorphin 5. nalbuphine and pentazocine Answer e: nalbuphine and pentazocine 1. The best example of a partial agonist at mu opioid receptors is 1. pentazocine 2. buprenorphine 3. cyclazocine 4. nalbuphine 5. codeine Answer b: buprenorphine 1. Which short-acting opioid agonist is administered as a transdermal skin patch? 1. fentanyl 2. methadone 3. meperidine 4. codeine 5. propoxyphene Answer a: fentanyl 1. Activation of kappa opioid receptors is primarily responsible for causing 1. supraspinal analgesia 2. euphoria 3. dysphoria 4. respiratory depression 5. physical dependence Answer c: dysphoria 1. Which finding typically occurs in opioid poisoning but not in central nervous system depression due to other causes? 1. coma 2. hallucinations 3. hypertension 4. respiratory depression 5. pinpoint pupils Answer e: pinpoint pupils 1. The pharmacologic properties of morphine are 1. well absorbed from the gut 2. high oral bioavailability 3. rapidly metabolized in neonates 4. converted to active morphine-6-glucuronide 5. excreted unchanged in the urine Answer d: converted to active morphine-6-glucuronide 1. Descending inhibition of dorsal horn pain transmission is mediated by neurons that release 1. acetylcholine and dopamine 2. enkephalins, 5-hydroxytryptamine, and noradrenaline 3. glutamate and substance P 4. bradykinin and prostanoids 5. neuropeptides Answer b: enkephalins, 5-hydroxytryptamine, and noradrenaline 1. Opioid drugs inhibit neurotransmitter release partly by 1. opening potassium and calcium channels 2. closing potassium and calcium channels 3. opening potassium channels and closing calcium channels 4. opening calcium channels and closing potassium channels 5. depolarizing pre-synaptic neuronal membranes Answer c: opening potassium channels and closing calcium channels 1. Which transmitter is released at the first synapse in the dorsal horn ascending nociceptive pathway? 1. glutamate 2. enkephalin 3. substance P 4. g-amino-butyric acid 5. noradrenaline Answer a: glutamate 1. Actions of opioids that are not related to activation of mu, delta, or kappa opioid receptors include 1. euphoria 2. respiratory depression 3. pupillary constriction 4. constipation 5. bronchospasm Answer e: bronchospasm Chapter 43: Local anaesthetics and other drugs affecting sodium channels MULTIPLE CHOICE 1. Intravenous regional anesthesia with lidocaine is used to provide anesthesia for 1. childbirth 2. removal of superficial foreign bodies 3. neurosurgery 4. limb surgery 5. abdominal surgery Answer d: limb surgery 1. Local anesthetics have greater affinity for sodium channels in the 1. resting state 2. open and inactivated states 3. open and resting states 4. inactivated and resting states 5. closed state Answer b: open and inactivated states 1. Which local anesthetic is characterized by rapid onset, medium duration of action, and good tissue penetration? 1. procaine 2. cocaine 3. lidocaine 4. bupivacaine 5. prilocaine Answer c: lidocaine 1. Use-dependent blockade of nerve conduction results from sodium channel binding by local anesthetics 1. in the cationic form on the inner membrane surface 2. in the uncharged form on the inner membrane surface 3. in the cationic form on the outer membrane surface 4. in the uncharged form on the outer membrane surface 5. in the anionic form on the inner membrane surface Answer a: in the cationic form on the inner membrane surface Chapter 44: Anxiolytic and hypnotic drugs MULTIPLE CHOICE 1. Benzodiazepines enhance the effect of g-amino-butyric acid (GABA) on chloride ion channels by increasing 1. the chloride conductance of each channel 2. the frequency of channel opening 3. the amount of time each channel remains open 4. the affinity of chloride for the channel 5. the recovery time of each channel Answer b: the frequency of channel opening 1. When used to induce sleep in persons with insomnia, benzodiazepines act to increase 1. subjective ratings of sleep quality 2. the proportion time spent in slow-wave sleep 3. the amount of time taken to get to sleep 4. the amount of rapid eye movement sleep 5. the secretion of growth hormone during sleep Answer a: subjective ratings of sleep quality 1. The attributes of zolpidem include 1. a benzodiazepine structure 2. being useful in treating anxiety 3. an ultrashort duration of action 4. a significant hangover effect 5. a high risk of drug dependence Answer c: an ultrashort duration of action 1. Flumazenil interacts with the g-amino-butyric acid (GABA) receptor so as to competitively inhibit the binding of 1. only GABA 2. only benzodiazepine drugs 3. only b-carboline drugs 4. both GABA and benzodiazepine drugs 5. both benzodiazepine and b-carboline drugs Answer e: both benzodiazepine and b-carboline drugs 1. The use of buspirone in the treatment of anxiety disorders is characterized by 1. a rapid onset of action 2. a risk of drug dependence 3. sedation and motor incoordination 4. a lack of withdrawal effects 5. blockade of 5-hydroxytryptamine 5-HT1A receptors Answer d: a lack of withdrawal effects 1. Midazolam is most commonly used as 1. a hypnotic 2. an anxiolytic 3. an intravenous anesthetic 4. an anticonvulsant 5. a muscle relaxant Answer c: an intravenous anesthetic 1. The short-acting benzodiazepines that are converted to inactive glucuronide metabolites include 1. diazepam 2. lorazepam 3. chlordiazepoxide 4. triazolam 5. alprazolam Answer b: lorazepam Chapter 45: Antiepileptic drugs MULTIPLE CHOICE 1. Gabapentin is believed to exert its antiepileptic effect by 1. increasing the synthesis of g-aminobutyric acid (GABA) 2. increasing the release of g-aminobutyric acid (GABA) 3. activating g-aminobutyric acid (GABA)-gated chloride ion channels 4. blocking g-aminobutyric acid (GABA)-gated chloride ion channels 5. inhibiting the release of several neurotransmitters Answer e: inhibiting the release of several neurotransmitters 1. The efficacy of ethosuximide in the treatment of absence seizures is based on its ability to 1. block voltage-dependent sodium channels 2. activate voltage-dependent sodium channels 3. block T (transient)-type calcium channels 4. activate T (transient)-type calcium channels 5. activated g-aminobutyric acid (GABA)-gated chloride ion channels Answer c: block T (transient)-type calcium channels 1. Which antiepileptic agent inhibits g-aminobutyric acid (GABA) transaminase and thereby increases the brain content of GABA? 1. vigabatrin 2. carbamazepine 3. tiagabine 4. lamotrigine 5. topiramate Answer a: vigabatrin 1. Carbamazepine is used in treating all of the following conditions except 1. bipolar disorder 2. neuropathic pain 3. absence seizures 4. partial seizures 5. generalized tonic-clonic seizures Answer c: absence seizures 1. The antiepileptic effect of zonisamide is due to its ability to 1. block T (transient)-type calcium channels 2. block voltage-gated sodium channels 3. inhibit g-aminobutyric acid (GABA) degradation 4. inhibit glutamate release 5. block glutamate receptors Answer b: block voltage-gated sodium channels 1. Hirsutism, megaloblastic anemia, and gum hypertrophy are potential adverse effects of 1. carbamazepine 2. ethosuximide 3. lamotrigine 4. phenobarbital 5. phenytoin Answer e: phenytoin 1. Gabapentin, tiagabine, and zonisamide are primarily used in treating 1. partial seizures 2. generalized tonic-clonic seizures 3. absence seizures 4. myoclonic seizures 5. status epilepticus Answer a: partial seizures 1. Mood depression and psychotic reactions may occur in some patients receiving 1. gabapentin 2. tiagabine 3. lamotrigine 4. vigabatrin 5. zonisamide Answer d: vigabatrin Chapter 46: Antipsychotic drugs MULTIPLE CHOICE 1. The glutamate hypothesis of schizophrenia is based in part on the 1. increased glutamate receptor densities found in schizophrenic brains 2. decreased glutamate receptor densities found in schizophrenic brains 3. reduction of schizophrenic symptoms by glutamate antagonists 4. reduction of schizophrenic symptoms by glutamate agonists 5. occurrence of psychotic symptoms in persons given glutamate agonists Answer b: decreased glutamate receptor densities found in schizophrenic brains 1. Because of the risk of agranulocytosis, periodic blood counts are required in persons receiving 1. haloperidol 2. quetiapine 3. risperidone 4. clozapine 5. sulpiride Answer d: clozapine 1. The dopamine hypothesis of schizophrenia is primarily supported by the 1. decreased dopamine synthesis found in schizophrenic patients 2. increased excretion of dopamine metabolites in schizophrenic patients 3. increased dopamine D2 receptor density found in schizophrenic patients 4. decreased dopamine D2 receptor density found in schizophrenic patients 5. correlation between dopamine D2 receptor binding and clinical potency of antipsychotic drugs Answer e: correlation between dopamine D2 receptor binding and clinical potency of antipsychotic drugs 1. The primary endocrine effect of most antipsychotic drugs is 1. increased secretion of prolactin 2. decreased secretion of prolactin 3. increased secretion of growth hormone 4. decreased secretion of growth hormone 5. increased secretion of thyrotropin Answer a: increased secretion of prolactin 1. Compared to typical antipsychotic drugs such as haloperidol, atypical drugs such as clozapine 1. are more effective in reducing the positive symptoms of schizophrenia 2. are less effective in reducing the positive symptoms of schizophrenia 3. cause fewer extrapyramidal motor side effects 4. cause more extrapyramidal motor side effects 5. are proven to be more efficacious in treating schizophrenia Answer c: cause fewer extrapyramidal motor side effects 1. When antipsychotic drugs are administered chronically, the activity of dopaminergic neurons 1. decreases throughout therapy 2. increases throughout therapy 3. decreases transiently then increases 4. increases transiently then decreases 5. fluctuates randomly throughout therapy Answer d: increases transiently then decreases 1. The adverse effects of antipsychotic drugs attributed to blockade of muscarinic receptors include 1. hypotension 2. tardive dyskinesia 3. obstructive (cholestatic) jaundice 4. weight gain 5. increased intraocular pressure Answer e: increased intraocular pressure 1. The antipsychotic malignant syndrome is characterized by 1. muscle paralysis and hypothermia 2. muscle rigidity and hyperthermia 3. muscle atrophy 4. myositis and rhabdomyolysis 5. leukopenia and agranulocytosis Answer b: muscle rigidity and hyperthermia Chapter 47: Antidepressant drugs MULTIPLE CHOICE 1. The mechanisms that contribute to the development of mood depression include increased release of 1. cortisol 2. noradrenaline 3. brain-derived neurotrophic factor 4. 5-hydroxytryptamine 5. g-amino-butyric acid Answer a: cortisol 1. Alternatives to lithium for the prevention and treatment of manic episodes include 1. fluoxetine 2. sertraline 3. carbamazepine 4. phenelzine 5. bupropion Answer c: carbamazepine 1. Mirtazapine is believed to produce its antidepressant effect by 1. activating 5-hydroxytryptamine 5-HT2 receptors 2. activating 5-hydroxytryptamine 5-HT3 receptors 3. activating presynaptic a2 adrenoceptors 4. blocking presynaptic a2 adrenoceptors 5. blocking neuronal reuptake of noradrenaline Answer d: blocking presynaptic a2 adrenoceptors 1. Which antidepressant drug is used as an adjunct to smoking cessation? 1. fluoxetine 2. bupropion 3. sertraline 4. mirtazapine 5. paroxetine Answer b: bupropion 1. Ingestion of foods containing tyramine may lead to a hypertensive crisis in persons taking 1. A tricyclic antidepressant 2. mirtazapine 3. a selective serotonin reuptake inhibitor 4. lithium 5. a nonselective monoamine oxidase inhibitor Answer e: a nonselective monoamine oxidase inhibitor 1. Selective serotonin uptake inhibitors cause 1. immediate inhibition of serotonin reuptake and mood improvement 2. delayed inhibition of serotonin reuptake and mood improvement 3. immediate inhibition of serotonin reuptake and delayed mood improvement 4. immediate mood improvement and delayed inhibition of serotonin reuptake 5. mood depression followed by mood improvement Answer c: immediate inhibition of serotonin reuptake and delayed mood improvement 1. Severe cardiac arrhythmias are most likely to result from an overdose of 1. fluoxetine 2. phenelzine 3. mirtazapine 4. sertraline 5. nortriptyline Answer e: nortriptyline 1. Serum lithium levels are increased by the concurrent administration of 1. thiazide diuretics 2. desipramine 3. trazodone 4. phenelzine 5. propranolol Answer a: thiazide diuretics 1. The concurrent administration of a selective serotonin reuptake inhibitor and a monoamine oxidase inhibitor is most likely to cause 1. bradycardia 2. suicidal thoughts 3. postural hypotension 4. dry mouth and blurred vision 5. hyperthermia and muscle rigidity Answer e: hyperthermia and muscle rigidity 1. Desipramine blocks the neuronal reuptake of 1. only noradrenaline 2. only serotonin 3. noradrenaline and serotonin equally 4. noradrenaline more than serotonin 5. serotonin more than noradrenaline Answer d: noradrenaline more than serotonin 1. Sexual dysfunction is most likely to occur in persons taking 1. amitriptyline 2. fluoxetine 3. mirtazapine 4. desipramine 5. nortriptyline Answer b: fluoxetine 1. The adverse effects of amitriptyline caused by muscarinic receptor blockade include 1. urinary retention 2. insomnia 3. hypotension 4. diarrhea 5. salivation Answer a: urinary retention Chapter 48: CNS stimulants and psychotomimetic drugs MULTIPLE CHOICE 1. Phencyclidine is believed to cause psychotomimetic effects by 1. activating receptors for g-aminobutyric acid 2. blocking receptors for g-aminobutyric acid 3. activating N-methyl-D-aspartate-operated ion channels 4. blocking N-methyl-D-aspartate receptor-operated ion channels 5. increasing neuronal release of 5-hydroxytryptamine Answer: d: blocking N-methyl-D-aspartate receptor-operated ion channels 1. Both lysergic acid diethylamine (LSD) and phencyclidine may cause 1. acute hyperthermia and muscle damage 2. physical dependence 3. schizophrenic symptoms 4. analgesia 5. inhibition of monoamine transporters Answer c: schizophrenic symptoms 1. The psychotomimetic activity of lysergic acid diethylamide (LSD) is believed to result from its ability to 1. activate 5-hydroxytryptamine 5-HT2 receptors 2. block 5-hydroxytryptamine 5-HT2 receptors 3. inhibit neuronal reuptake of noradrenaline and dopamine 4. release 5-hydroxytryptamine and block its neuronal reuptake 5. block receptors for g-aminobutyric acid Answer a: activate 5-hydroxytryptamine 5-HT2 receptors 1. Progressive myocardial damage leading to heart failure is most likely to occur in persons who abuse 1. lysergic acid diethylamide (LSD) 2. phencyclidine 3. mescaline 4. psilocybin 5. cocaine Answer e: cocaine 1. Methylphenidate is primarily used in the treatment of 1. narcolepsy 2. mood depression 3. attention deficit-hyperactivity disorder 4. obesity 5. asthma Answer c: attention deficit-hyperactivity disorder 1. The adverse effects of methylenedioxymethamphetamine (MDMA) typically include 1. drug addiction 2. skeletal muscle damage 3. hypothermia 4. liver failure 5. bone marrow depression Answer b: skeletal muscle damage Chapter 49: Drug addiction, dependence, and abuse MULTIPLE CHOICE 1. All dependence-producing drugs act via different pathways to cause 1. depletion of norepinephrine in the locus coeruleus 2. depletion of dopamine in nigrostriatal pathways 3. depletion of glutamate in meso-limbic pathways 4. the release of glutamate in the frontal cortex 5. the release of dopamine in the nucleus accumbens Answer e: the release of dopamine in the nucleus accumbens 1. Chronic administration of morphine is believed to cause tolerance by 1. increasing expression of adenylate cyclase 2. decreasing expression of adenylate cyclase 3. increasing expression of guanylate cyclase 4. decreasing expression of guanylate cyclase 5. increasing expression of a-adrenoceptors Answer a: increasing expression of adenylate cyclase 1. Nicotine use often leads to drug dependence by activation of nicotinic receptors in the 1. nucleus accumbens 2. hippocampus 3. ventral tegmental area 4. cerebral cortex 5. striatum Answer c: ventral tegmental area 1. Disulfiram has been used to facilitate abstinence from ethanol based on its ability to inhibit 1. the mesolimbic dopaminergic pathway 2. ethanol withdrawal symptoms 3. alcohol dehydrogenase 4. aldehyde dehydrogenase 5. aldehyde oxidase Answer d: aldehyde dehydrogenase 1. The effects that result from smoking marijuana include 1. improved motor coordination 2. improved memory 3. increased creativity 4. loss of appetite 5. conjunctival vasodilatation Answer e: conjunctival vasodilatation 1. Which drug is used in the treatment of drug dependence because of its ability to reduce withdrawal symptoms? 1. clonidine 2. methadone 3. bupropion 4. naltrexone 5. acamprosate Answer a: clonidine 1. The fetal alcohol syndrome is associated with malformations that typically include 1. increased cranial circumference 2. abnormal limb development 3. abnormal facial development 4. neural tube birth defects 5. cleft palate Answer c: abnormal facial development 1. A sustained-release formulation of bupropion is used to facilitate abstinence in persons who are addicted to 1. ethanol 2. cocaine 3. nicotine 4. heroin 5. marijuana Answer c: nicotine 1. Metabolism of the amount of ethanol contained in substantial quantities of alcoholic beverages may lead to a depletion of 1. essential amino acids 2. acetaldehyde 3. reduced nicotinamide adenine dinucleotide (NADH) 4. nicotinamide adenine dinucleotide (NAD+) 5. lactate Answer d: nicotinamide adenine dinucleotide (NAD+) 1. Moderate ingestion of ethanol reduces mortality associated with 1. lung cancer 2. liver disease 3. coronary heart disease 4. hypertension 5. renal disease Answer: c: coronary artery disease 1. In this decade, the incidence of cigarette smoking is 1. increasing in developing countries 2. decreasing in developing countries 3. increasing in the UK but decreasing in developing countries 4. decreasing in the UK but increasing in developing countries 5. increasing in all countries studied Answer d: decreasing in the UK but increasing in developing countries 1. Ingestion of ethanol typically increases the secretion of 1. testosterone 2. antidiuretic hormone 3. adrenocorticotrophic hormone 4. growth hormone 5. glucagon Answer c: adrenocorticotrophic hormone Chapter 50: Basic principles of antimicrobial chemotherapy MULTIPLE CHOICE 1. Which drug selectively inhibits bacterial RNA polymerase? 1. cytarabine 2. zidovudine 3. dactinomycin 4. rifampin 5. acyclovir Answer d: rifampin 1. Conjugation is an important mechanism for transfer of drug resistance genes between 1. coliform bacteria 2. staphylococci 3. enterococci 4. streptococci 5. spirochetes Answer a: coliform bacteria 1. Cycloserine prevents the addition of terminal residues to the peptide side chain on N- acetylmuramic acid 1. glycine 2. leucine 3. methionine 4. alanine 5. tyrosine Answer d: alanine 1. Induction of bacterial proteins that enable energy-dependent efflux of drug molecules is an important mechanism of resistance to the 1. penicillins 2. aminoglycoside antibiotics 3. tetracycline antibiotics 4. macrolide antibiotics 5. folate reduction inhibitors Answer c: tetracycline antibiotics 1. Which drug is correctly paired with the type of organism in which it selectively inhibits dihydrofolate reductase? 1. trimethoprim-mammalian 2. pyrimethamine-mammalian 3. methotrexate-bacterial 4. methotrexate-protozoan 5. methotrexate-mammalian Answer e: methotrexate-mammalian 1. Ciprofloxacin selectively binds and inhibits 1. bacterial RNA polymerase 2. bacterial topoisomerase II 3. bacterial DNA polymerase 4. mammalian DNA polymerase 5. mammalian topoisomerase II Answer b: bacterial topoisomerase II 1. Which antibiotic inhibits translocation of the bacterial peptide chain from the A (acceptor) to the P (peptide) site of the 50S ribosomal subunit? 1. erythromycin 2. puromycin 3. streptomycin 4. tetracycline 5. chloramphenicol Answer a: erythromycin 1. Inhibition of bacterial transpeptidase and carboxypeptidase is the mechanism of action of 1. bacitracin 2. vancomycin 3. b-lactam antibiotics 4. cycloserine 5. fusidic acid Answer c: b-lactam antibiotics 1. Bacterial drug resistance may occur due to expression of a dihydropteroate synthetase that has decreased affinity for 1. penicillin 2. chloramphenicol 3. trimethoprim 4. sulfonamides 5. erythromycin Answer d: sulfonamides Chapter 51: Antibacterial drugs MULTIPLE CHOICE 1. Benzylpenicillin is the first drug of choice for treatment of infections due to 1. Pseudomonas aeruginosa 2. Legionella pneumophila 3. Haemophilus influenzae 4. Treponema pallidum 5. Pasteurella multocida Answer d: Treponema pallidum 1. Red-green color blindness is a dose-related adverse effect of 1. cycloserine 2. ethambutol 3. rifampicin 4. isoniazid 5. streptomycin Answer c: rifampicin 1. Resistance to cephalosporin antibiotics is most likely to result from 1. phosphorylation by bacterial kinases 2. inactivation by bacterial b-lactamase 3. decreased affinity of dihydrofolate reductase 4. increased efflux by bacterial transport proteins 5. decreased ribosomal affinity for the drugs Answer b: inactivation by bacterial b-lactamase 1. Penicillins that are active against strains of Pseudomonas aeruginosa include 1. piperacillin 2. ampicillin 3. benzylpenicillin 4. amoxicillin 5. phenoxymethylpenicillin Answer a: piperacillin 1. Respiratory tract infections caused by Nocardia or Pneumocystis are often treated with 1. co-trimoxazole 2. gentamicin 3. azithromycin 4. tetracycline 5. chloramphenicol Answer a: co-trimoxazole 1. Cilastatin inhibits the degradation of imipenem by 1. hepatic enzymes 2. gut wall enzymes 3. renal enzymes 4. pulmonary enzymes 5. plasma enzymes Answer c: renal enzymes 1. Chloramphenicol is not used for trivial infections because it may rarely cause 1. liver failure 2. pancytopenia 3. heart failure 4. pulmonary fibrosis 5. convulsive seizures Answer b: pancytopenia 1. Infections due to penicillinase-producing strains of Neisseria gonorrhoeae may be most effectively treated with 1. tetracycline 2. gentamicin 3. erythromycin 4. vancomycin 5. ofloxacin Answer e: ofloxacin 1. A genetically determined variation of hepatic acetyltransferase activity accounts for differences in the elimination half-life of 1. rifampicin 2. isoniazid 3. pyrazinamide 4. ethambutol 5. cycloserine Answer b: isoniazid 1. Tetracycline should not be given to pregnant women or young children because of the risk of 1. retarded bone development 2. ototoxicity 3. bone marrow depression 4. myositis and rhabdomyolysis 5. hypoplasia and staining of the teeth Answer e: hypoplasia and staining of the teeth 1. Arthropathy manifested as painful joints is most likely to occur in younger individuals treated with 1. ciprofloxacin 2. tetracycline 3. azithromycin 4. trimethoprim 5. vancomycin Answer a: ciprofloxacin 1. Quinupristin-dalfopristin is active against some strains of 1. Pseudomonas aeruginosa 2. Enterococcus faecium 3. Escherichia coli 4. Proteus mirabilis 5. Legionella pneumophila Answer b: Enterococcus faecium Chapter 52: Antiviral drugs MULTIPLE CHOICE 1. Which reverse transcriptase inhibitor achieves the highest percentage of plasma drug concentrations in the cerebrospinal fluid? 1. lamivudine 2. abacavir 3. stavudine 4. zidovudine 5. efavirenz Answer d: zidovudine 1. The mortality due to Lassa fever is significantly reduced in persons treated with 1. tribavirin (ribavirin) 2. foscarnet 3. ganciclovir 4. interferon alpha 5. oseltamivir Answer a: tribavirin (ribavirin) 1. Efavirenz inhibits human immunodeficiency virus reverse transcriptase by 1. competing with nucleotides for the active site of the enzyme 2. binding near the catalytic site and denaturing it 3. incorporation into nascent DNA, causing chain termination 4. inhibiting formation of nucleotide triphosphates 5. inhibiting maturation of viral polyproteins Answer b: binding near the catalytic site and denaturing it 1. The preferred drug for treating active infections of cytomegalovirus is 1. acyclovir 2. foscarnet 3. lamivudine 4. nevirapine 5. ganciclovir Answer e: ganciclovir 1. Which virus is most susceptible to acyclovir? 1. cytomegalovirus 2. Herpes simplex virus 3. Herpes zoster virus 4. respiratory syncytial virus 5. Epstein-Barr virus Answer b: Herpes simplex virus 1. Which agent has been used to reduce mother-to-baby transmission of human immunodeficiency virus? 1. abacavir 2. ritonavir 3. nevirapine 4. enfuvirtide 5. lamivudine Answer c: nevirapine 1. The use of foscarnet is restricted because of its propensity to cause 1. nephrotoxicity 2. hepatotoxicity 3. cardiotoxicity 4. pulmonary toxicity 5. ototoxicity Answer a: nephrotoxicity 1. Oseltamivir effectively prevents influenza because of its ability to inhibit 1. viral attachment 2. viral disassembly 3. replication of viral nucleic acid 4. assembly of new virions 5. budding of new virions Answer e: budding of new virions Chapter 53: Antifungal drugs MULTIPLE CHOICE 1. The conversion of squalene to lanosterol in fungi is inhibited by 1. flucytosine 2. itraconazole 3. griseofulvin 4. amphotericin B 5. terbinafine Answer e: terbinafine 1. The synthesis of a component of the fungal cell wall is inhibited by 1. ketoconazole 2. caspofungin 3. amphotericin B 4. griseofulvin 5. flucytosine Answer b: caspofungin 1. Dermatophyte infections of the nailbed can be effectively treated by oral administration of 1. nystatin 2. amphotericin B 3. flucytosine 4. itraconazole 5. caspofungin Answer d: itraconazole 1. Fever, chills, nausea, and vomiting occur frequently in persons administered 1. amphotericin B 2. caspofungin 3. fluconazole 4. terbinafine 5. griseofulvin Answer a: amphotericin B 1. Cases of invasive aspergillosis that are refractory to amphotericin B have been successfully treated with 1. nystatin 2. itraconazole 3. caspofungin 4. fluconazole 5. terbinafine Answer c: caspofungin Chapter 54: Antiprotozoal drugs MULTIPLE CHOICE 1. Neuropsychiatric reactions are most likely to occur in persons treated with 1. atovaquone 2. halofantrine 3. quinine 4. mefloquine 5. artemisinin derivatives Answer d: mefloquine 1. The attributes of suramin include 1. being active against trypanosomes 2. few adverse effects 3. oral administration 4. being rapidly eliminated from the body 5. low plasma protein binding Answer a: being active against trypanosomes 1. Susceptible protozoans convert metronidazole to a compound that 1. inhibits amino acid metabolism 2. damages DNA 3. disrupts phospholipid metabolism 4. inhibits folate synthesis 5. uncouples oxidative phosphorylation Answer b: damages DNA 1. Which drug may enable a radical cure of malaria due to Plasmodium vivax? 1. primaquine 2. mefloquine 3. chloroquine 4. quinine 5. proguanil Answer a: primaquine 1. Malarial resistance to proguanil results from single-point mutations in genes encoding 1. DNA polymerase 2. RNA polymerase 3. folate synthase 4. dihydrofolate reductase 5. glucose-6-phosphate dehydrogenase Answer d: dihydrofolate reductase 1. Acute amebic dysentery is most effectively treated with 1. diloxanide only 2. tinidazole only 3. tinidazole followed by diloxanide 4. diloxanide followed by tinidazole 5. tinidazole followed by metronidazole Answer c: tinidazole followed by diloxanide 1. Inhibition of mitochondrial electron transport in susceptible protozoans is the likely mechanism of action of 1. artemisinin derivatives 2. pyrimethamine 3. halofantrine 4. chloroquine 5. atovaquone Answer e: atovaquone 1. Which drug is administered orally in the treatment of visceral leishmaniasis and causes few side effects? 1. miltefosine 2. sodium stibogluconate 3. pentamidine 4. suramin 5. amphotericin B Answer a: miltefosine Chapter 55: Anthelminthic drugs MULTIPLE CHOICE 1. Praziquantel is effective in treating blood fluke infections because of its ability to 1. block voltage-gated calcium channels 2. induce muscle contracture and paralysis 3. open chloride ion channels 4. inhibit tubulin polymerization 5. prevent glucose uptake Answer b: induce muscle contracture and paralysis 1. A single dose of niclosamide is effective in treating infections of 1. Enterobius vermicularis 2. Schistosoma japonicum 3. Trichuris trichiura 4. Trichinella spiralis 5. Taenia solium Answer e: Taenia solium 1. Ivermectin is believed to kill filarial roundworm parasites partly by 1. blocking glutamate-gated chloride channels 2. opening glutamate-gated chloride channels 3. blocking voltage-gated calcium channels 4. opening voltage-gated calcium channels 5. inhibiting oxidative phosphorylation Answer b: opening glutamate-gated chloride channels 1. Which anthelminthic drug interferes with microtubule-dependent functions such as glucose uptake? 1. albendazole 2. diethylcarbamazine 3. piperazine 4. niclosamide 5. levamisole Answer a: albendazole Chapter 56: Anticancer drugs MULTIPLE CHOICE 1. A cytoplasmic kinase (Bcr/Abl) involved in the pathogenesis of chronic myeloid leukemia is inhibited by 1. crisantaspase 2. anastrozole 3. imatinib 4. rituximab 5. aldesleukin Answer c: imatinib 1. Cumulative dose-related cardiac toxicity typically results from administration of 1. doxorubicin 2. bleomycin 3. vincristine 4. imatinib 5. irinotecan Answer a: doxorubicin 1. Goserelin is used in treating advanced prostate cancer because of its ability to 1. increase gonadotrophin secretion 2. reduce gonadotrophin secretion 3. block testosterone receptors 4. activate estrogen receptors 5. inhibit estrogen synthesis Answer b: reduce gonadotrophin secretion 1. Vincristine inhibits mitosis of cancer cells at metaphase by 1. inhibiting telomerase 2. increasing tubulin degradation 3. inhibiting synthesis of tubulin 4. inhibiting polymerization of tubulin 5. stabilizing microtubules Answer d: inhibiting polymerization of tubulin 1. Cytarabine is converted to an active triphosphate metabolite that inhibits 1. DNA polymerase 2. adenine deaminase 3. dihydrofolate reductase 4. telomerase 5. thymidylate synthetase Answer a: DNA polymerase 1. Folinic acid can be administered to counteract the toxic effects of 1. fludarabine 2. gemcitabine 3. cytarabine 4. fluorouracil 5. methotrexate Answer e: methotrexate 1. Reactive carbonium ions that attack guanine bases of DNA and lead to crosslinking of DNA strands are formed in the body from drugs such as 1. cisplatin 2. bleomycin 3. doxorubicin 4. etoposide 5. cyclophosphamide Answer e: cyclophosphamide 1. Which anticancer drug is most effective in the G2 phase of the cell cycle? 1. paclitaxel 2. methotrexate 3. bleomycin 4. irinotecan 5. cytarabine Answer c: bleomycin 1. Thymidylate synthetase is inhibited by the active metabolite of 1. pentostatin 2. fluorouracil 3. doxorubicin 4. gemcitabine 5. fludarabine Answer b: fluorouracil 1. Anastrozole is used in treating advanced breast cancer because of its ability to 1. inactivate tumor growth factors 2. block estrogen receptors 3. inhibit aromatase 4. decrease gonadotropin secretion 5. cross-link strands of DNA Answer c: inhibit aromatase 1. Sulfhydryl donors such as mesna are useful in reducing ifosfamide-induced 1. bone marrow depression 2. nausea and vomiting 3. cardiac toxicity 4. hemorrhagic cystitis 5. gastrointestinal ulceration Answer d: hemorrhagic cystitis 1. Trastuzumab is useful in treating breast cancer because of its ability to bind 1. telomerase 2. human epidermal growth factor receptor 2 3. DNA transcription factors 4. insulin-like growth factor 5. calcium channel forming proteins Answer b: human epidermal growth factor receptor 2 Chapter 57: Harmful effects of drugs MULTIPLE CHOICE 1. The teratogenic effect of thalidomide usually causes 1. abnormal heart valves 2. mental retardation 3. testicular atrophy 4. absence of long bones of limbs 5. spina bifida Answer d: absence of long bones of limbs 1. Female offspring of women who received stilbestrol during pregnancy have an increased risk of 1. lung cancer 2. breast cancer 3. vaginal cancer 4. endometrial cancer 5. heart valve defects Answer c: vaginal cancer 1. The toxic metabolite of paracetamol, N-acetyl-p-benzoquinone imine, is believed to cause liver failure by 1. inhibiting cytochrome P450 enzymes 2. inhibiting lipid peroxidation 3. depleting reactive oxygen species 4. depleting reduced glutathione 5. activating Ca2+ ATPases Answer d: depleting reduced glutathione 1. Which drug may elicit antibodies to the surface of red blood cells and thereby cause hemolytic anemia? 1. methyldopa 2. hydrochlorothiazide 3. propranolol 4. minoxidil 5. clozapine Answer a: methyldopa 1. Promoters are substances that increase the likelihood of cancer when administered 1. alone 2. before a co-carcinogen 3. after a co-carcinogen 4. before a primary carcinogen 5. after a primary carcinogen Answer e: after a primary carcinogen 1. Liver toxicity resulting from an overdose of paracetamol can be prevented by the administration of 1. oxygen 2. acetylcysteine 3. folinic acid 4. ethanol 5. vitamin K Answer b: acetylcysteine 1. Nephrotoxicity resulting from inhibition of prostaglandin synthesis is most likely to result from excessive administration of 1. gentamicin 2. captopril 3. methicillin 4. ibuprofen 5. cyclosporin Answer d: ibuprofen 1. Exposure to mercury during pregnancy primarily causes abnormal development of the fetal 1. brain 2. bones 3. face 4. kidneys 5. limbs Answer a: brain 1. Thrombocytopenia is the most common type II hypersensitivity reaction to 1. chloramphenicol 2. penicillin 3. quinine 4. sulfonamides 5. methyldopa Answer c: quinine Chapter 58: Lifestyle drugs and drugs in sport MULTIPLE CHOICE 1. Clenbuterol, a b-adrenoceptor antagonist, has been used by athletes because it 1. cannot be detected in urine 2. is not banned by sporting organizations 3. has anabolic effects 4. increases erythropoiesis 5. has mild stimulant properties Answer c: has anabolic effects 1. The effects caused by long-term use of anabolic steroids include 1. hypotension 2. increased aggressiveness 3. lung tumors 4. tolerance and physical dependence 5. overgrowth of the jaw and fingers Answer b: increased aggressiveness 1. The “lifestyle use” of botulinum toxin is for the purpose of 1. weight loss 2. re-growth of hair 3. improving muscle strength 4. facilitating social interactions 5. cosmetic improvement Answer e: cosmetic improvement Chapter 59: Biopharmaceuticals and gene therapy MULTIPLE CHOICE 1. A tetracycline-inducible system has been used experimentally to control the expression of 1. hemoglobin 2. erythropoietin 3. insulin 4. thyroxine 5. growth hormone Answer b: erythropoietin 1. Transfection of the herpes simplex virus gene for thymidylate kinase enables tumor cells to activate 1. methotrexate 2. cytarabine 3. foscarnet 4. fluorouracil 5. ganciclovir Answer e: ganciclovir 1. The first proof of gene therapy was obtained by transfection of the gene for 1. hemoglobin 2. erythropoietin 3. adenine deaminase 4. a1-antitrypsin 5. phosphorylase Answer c: adenine deaminase 1. Clinical trials are in progress involving injection of adenoviral vectors containing the human p53 tumor suppressor gene into 1. head and neck tumors 2. ovarian tumors 3. breast tumors 4. glioblastoma 5. colon tumors Answer a: head and neck tumors 1. Oral gene therapy may be possible using 1. viral vectors for gene transfection 2. microspheres loaded with plasmid DNA 3. liposomes containing plasmids 4. naked plasma DNA 5. DNA enclosed in cyclodextrin Answer b: microspheres loaded with plasmid DNA 1. One of the disadvantages of using adenoviruses as vectors for gene transfection is the 1. long-lasting expression of the transfected gene 2. transfer of genes to the cytoplasm 3. strong host immune response 4. persistence of the vector in nervous tissue 5. incorporation of the virus into host DNA Answer c: strong host immune response 1. Retroviral vectors are used to transfer 1. genomic DNA 2. single-stranded DNA 3. transfer RNA 4. messenger RNA 5. a RNA-DNA hybrid Answer d: messenger RNA Chapter 60: Drug discovery and development MULTIPLE CHOICE 1. Since 1980, the drug development process has been characterized by 1. rising sales and development costs 2. rising sales and declining development costs 3. declining sales and rising development costs 4. declining sales and development costs 5. increasing registration of new compounds Answer a: rising sales and development costs 1. Phase II clinical trials are primarily concerned with determining 1. drug safety in a small group of normal subjects 2. drug efficacy and dosage in a small group of diseased patients 3. drug pharmacokinetics in a large group of diseased patients 4. statistical evidence of drug efficacy in thousands of subjects 5. long-term adverse effects after a drug has been marketed Answer b: drug efficacy and dosage in a small group of diseased patients 1. The main disadvantage of natural products as lead compounds for drug development is their 1. rarity 2. complexity 3. toxicity 4. inactivity 5. insolubility Answer b: complexity 1. The simultaneous preparation of hundreds or thousands of related compounds uses a process called 1. high throughput chemistry 2. chaotic chemistry 3. fractal chemistry 4. optimized chemistry 5. combinatorial chemistry Answer e: combinatorial chemistry