Professional Documents
Culture Documents
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Amino acid neurotransmitters............................................................................................3
Analgesic drugs...............................................................................................................4
Antibacterial drugs...........................................................................................................6
Antidepressant drugs.......................................................................................................8
Antiepileptic drugs...........................................................................................................9
Antifungal drugs............................................................................................................10
Anthelminthic drugs.......................................................................................................11
Antipsychotic drugs........................................................................................................12
Antiviral drugs...............................................................................................................13
Anxiolytic and hypnotic drugs..........................................................................................14
Atherosclerosis and lipoprotein metabolism.......................................................................15
Bone metabolism...........................................................................................................16
Cancer chemotherapy.....................................................................................................16
Cannabinoids.................................................................................................................18
Cell proliferation and apoptosis........................................................................................19
Chemical mediators and the autonomic nervous system......................................................20
Chemical transmission and drug action in the central nervous system...................................21
Cholinergic transmission.................................................................................................22
CNS stimulants and psychotomimetic drugs......................................................................24
Drug addiction, dependence and abuse.............................................................................25
Drug elimination and pharmacokinetics.............................................................................27
Drugs used in the treatment of infections and cancer.........................................................28
General anesthetic agents...............................................................................................29
Haemostasis and thrombosis...........................................................................................30
How drugs act cellular aspects-excitation, contraction and secretion.....................................32
How drugs act general principles......................................................................................33
Local anaesthetics and other drugs affecting sodium channels.............................................34
Local hormones, inflammation, and immune reactions........................................................35
Method and measurement in pharmacology.......................................................................37
Molecular aspects of drug action......................................................................................38
Neurodegenerative diseases............................................................................................41
Nitric oxide....................................................................................................................42
Noradrenergic transmission.............................................................................................43
Obesity.........................................................................................................................45
Other peripheral mediators, 5-hydroxytryptamine and purines.............................................46
Other transmitters and modulators...................................................................................47
Peptides and proteins as mediators..................................................................................48
The endocrine pancreas and the control of blood glucose....................................................49
The gastrointestinal tract................................................................................................50
The haemopoietic system................................................................................................51
The heart......................................................................................................................52
The kidney....................................................................................................................54
The pituitary and the adrenal cortex.................................................................................55
The reproductive system.................................................................................................57
The respiratory system...................................................................................................58
The thyroid...................................................................................................................59
The vascular system.......................................................................................................60
E) ion trapping
9. Which drug is absorbed by a membrane carrier that transports phenylalanine?
A) insulin
B) propranolol
C) levodopa
D) aspirin
E) penicillin
10. Transdermal drug administration
A) is most suitable for highly polar drugs
B) is not subject to first-pass hepatic metabolism
C) provides rapid and complete absorption
D) is only used for localized effects
E) is most suitable for unconscious persons
Key: 1D, 2B, 3C, 4C, 5B, 6C, 7B, 8C, 9C, 10B
Amino acid neurotransmitters
1. The N-methyl-D-aspartate receptor for excitatory amino acids is positively modulated by
A) -amino butyric acid
B) tyrosine
C) glycine
D) phenylalanine
E) alanine
2. The pathway leading to long-term potentiation of neuronal activity includes
A) inhibition of nitric oxide synthase
B) sustained blockade of N-methyl-D-aspartate receptors
C) feedback inhibition by nitric oxide
D) activation of protein kinase C by calcium
E) inhibition of metabotropic receptors
3. Baclofen is a selective agonist for the
A) kainite receptor for excitatory amino acids
B) N-methyl-D-aspartate receptor for excitatory amino acids
C) metabotropic receptor for excitatory amino acids
D) -amino butyric acid-A (GABAA) receptor
E) -amino butyric acid-B (GABAB) receptor
4. Activation of AMPA (-amino-5-hydroxy-3-methyl-4-isoxazole propionic acid) receptors for
excitatory amino acids leads to
A) fast inhibitory neurotransmission
B) fast excitatory neurotransmission
C) modulation of postsynaptic excitatory neurotransmission
0) slow excitatory neurotransmission
E) slow inhibitory neurotransmission
5. The glycine receptor blocked by strychnine is a
A) ligand-gated chloride channel
B) ligand-gated calcium channel
C) voltage-gated calcium channel
D) G-protein-coupled receptor
E) protein kinase receptor
6. The binding of -amino butyric acid (GABA) to the GABA receptor is increased by
A) flumazenil
B) picrotoxin
C) diazepam
D) baclofen
E) gabapentin
7. Which substance blocks ion channels of N-methy1-D-aspartate receptors for excitatory amino
acids?
A) ketamine
B) cycloserine
C) kynurenic acid
D) cyclothiazide
E) kainite
8. Activation of metabotropic excitatory amino acid receptors leads to
A) opening of chloride ion channels
B) opening of cation channels
C) formation of inositol triphosphate
D) formation of cyclic AMP
E) activation of protein kinase A
Key: 1C, 2D, 3E, 4B, 5A, 6C, 7A, 8E
Analgesic drugs
1. Opioids activate descending pathways that inhibit pain transmission by acting on neurons in
the
A) dorsal horn
B) thalamus
C) periaqueductal grey matter
D) nucleus raphe magnus
E) locus coeruleus
2. The vaniioid receptor activated by capsaicin is a
A) ligand gated cation channel
8) ligand-gated chloride ion channel
C) ATP-sensitive potassium channel
D) G-protein-coupled receptor
E) protein kinase receptor
3. The analgesic effect of morphine is mostly due to activation of
A) delta opioid receptors
B) kappa opioid receptors
C) mu opioid receptors
D) sigma opioid receptors
E) tau receptors
4. Simulation of opioid receptors leads to
A) increased guanylate cyclase activity
B) decreased guanylate cyclase activity
C) increased adenylate cyclase activity
D) decreased adenylate cyclase activity
E) dosing of potassium channels
5. Opioid drugs that exhibit partial agonist or mixed agonist-antagonist properties include
A) naloxone and naltrexone
B) methadone and meperidine
C) fentanyl and sufentanil
D) dynorphin and endorphin
F) nalbuphine and pentazocine
6. The best example of a partial agonist at mu opioid receptors is
A) pentazocine
B) bupienorphine
C) cyclazocine
D) nalbuphine
E) codeine
7. Which short-acting opioid agonist is administered as a transdermal skin patch?
A) fentanyl
B) methadone
C) meperidine
D) codeine
E) propoxyphene
8. Activation of Kappa opioid receptors is primarily responsive for causing
A) supraspinal analgesia
B) euphoria
C) dysphoria
D) respiratory depression
E) physical dependence
9. Which finding typically occurs in opioid poisoning but not in central nervous system
depression due to other causes?
A) coma
B) hallucinations
C) hypertension
D) respiratory depression
E) pinpoint pupils
10. The pharmacologic properties of morphine are
A) well absorbed from the gut
B) high oral bioavailability
C) rapidly metabolized in neonates
D) converted to active morphine-6-glucuronide
E) excreted unchanged in the urine
11. Descending inhibition of dorsal horn pain transmission is mediated by neurons that release
A) acetylcholine and dopamine
B) enkephalins, 5-hydroxytryptamine, and noradrenaline
C) glutamate and substance P
D) bradykinin and prostanoids
E) neuropeptides
12. Opioid drugs inhibit neurotransmitter release partly by
A) opening potassium and calcium channels
B) dosing potassium and calcium channels
C) opening potassium channels and closing calcium channels
D) opening calcium channels and closing potassium channels
E) depolarizing pre-synaptic neuronal membranes
13. Which transmitter is released at the first synapse in the dorsal horn ascending nociceptive
A) glutamate
B) enkephalin
C) substance P
D) -amino-butyric acid
E) noradrenaline
14. Actions of opioids that are not related to activation of mu, delta, or kappa opioid receptors
include
A) euphoria
B) respiratory depression
C) pupillary constriction
D) constipation
E) bronchospasm
Key: 1C, 2A, 3C, 4D, 5E, 6B, 7A, 8C, 9E, 10D, 11B, 12C, 13A, 14E
Antibacterial drugs
1. Benzylpenicillin is the first drug of choice for treatment of infections due to
A) Pseudomonas aeruginosa
B) Legionella pneumophila
C) Haemophilus influenzae
D) Treponema pallidum
E) Pasteurelia multocida
2. Red-green color blindness is a dose-related adverse effect of
A) cycloserine
B) ethambutol
C) rifampicin
D) isoniazid
E) streptomycin
3. Resistance to cephalosporin antibiotics is most likely to result from
A) phosphorylation by bacterial kinases
B) inactivation by bacterial -lactamase
C) decreased affinity of dihydrofolate reductase
D) increased efflux by bacterial transport proteins
E) decreased ribosomal affinity for the drugs
4. Penicillins that are active against strains of Pseudomonas aeruginosa include
A) piperacillin
B) ampicillin
C) benzylpenicillin
D) amoxicillin
E) phenoxymethylpenicillin
5. Respiratory tract infections caused by Nocardia or Pneumocystis are often treated with
A) co-trimoxazole
B) gentamicin
C) azithromycin
D) tetracycline
E) chloramphenicol
Antidepressant drugs
1. The mechanisms that contribute to the development of mood depression include increased
A) cortisol
B) noradrenaline
C) brain-derived neurotrophic factor
D) 5-hydroxytryptamine
E) -amino-butyric acid
2. Alternatives to lithium for the prevention and treatment of manic episodes include
A) fluoxetine
B) sertraline
C) carbamazepine
D) phenelzine
E) bupropion
3. Mirtazapme is believed to produce its antidepressant effect by
A) activating 5-hydroxytryptamine 5-HT2 receptors
B) activating 5-hydroxytryptamine 5-HT3 receptors
C) activating presynaptic 2 adrenoceptors
D) blocking presynaptic 2 adrenoceptors
E) blocking neuronal reuptake of noradrenaline
4. Which antidepressant drug is used as an adjunct to smoking cessation?
A) fluoxetine
B) bupropion
C) sertraline
D) mirtazapine
E) paroxetine
5. Ingestion of foods containing tyramine may lead to a hypertensive crisis in persons taking
A) A tricyclic antidepressant
B) mirtazapine
C) a selective serotonin reuptake inhibitor
D) lithium
E) a nonselective monoamine oxidase inhibitor
6. Selective serotonin uptake inhibitors cause
A) immediate inhibition of serotonin reuptake and mood improvement
B) delayed inhibition of serotonin reuptake and mood improvement
C) immediate inhibition of serotonin reuptake and delayed mood improvement
D) immediate mood improvement and delayed inhibition of serotonin reuptake
E) mood depression followed by mood improvement
7. Severe cardiac arrhythmias are most likely to result from an overdose of
A) fluoxetine
B) phenelzine
C) mirtazapine
D) sertraline
E) nortriptyline
8. Serum lithium levels are increased by the concurrent administration of
A) thiazide diuretics
B) desipramine
C) trazodone
D) phenelzine
E) propranolol
E) topiramate
4. Carbamazepine is used in treating all of the following conditions except
A) bipolar disorder
B) neuropathic pain
C) absence seizures
D) partial seizures
E) generalized tonic-clonic seizures
5. The antiepileptic effect of zonisamide is due to its ability to
A) block T (transient)-type calcium channels
B) block voltage-gated sodium channels
C) Inhibit -aminobutyric acid (GABA) degradation
D) inhibit glutamate release
E) block glutamate receptors
6. Hirsutism, megaloblastic anemia, and gum hypertrophy are potential adverse effects of
A) carbamazepine
B) ethosuximide
C) lamotrigine
D) phenobarbital
E) phenytoin
7. Gabapentin, tiagabine, and zonisamide are primarily used in treating
A) partial seizures
B) generalized tonic-clonic seizures
C) absence seizures
D) myoclonic seizures
E) status epilepticus
8. Mood depression and psychotic reactions may occur in some patients receiving
A) gabapentin
B) tiagabine
C) lamotrigine
D) vigabatrin
E) zonisamide
Key: 1E, 2C, 3A, 4C, 5B, 6E, 7A, 8D
Antifungal drugs
1. The conversion of squalene to lanosterol in fungi is inhibited by
A) flucytosine
B) itraconazole
C) griseofulvin
D) amphotericin B
E) terbinafine
2. The synthesis of a component of the fungal cell wall is inhibited by
A) ketoconazole
B) caspofurgin
C) amphotericin B
D) griseofulvin
E) flucytosine
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A) viral attachment
B) viral disassembly
C) replication of viral nucleic acid
D) assembly of new virions
E) budding of new virions
Key: 1D, 2A, 3B, 4E, 5B, 6C, 7A, 8E
Anxiolytic and hypnotic drugs
1. Benzodiazepines enhance the effect of -amino-butyric acid (GABA) on chloride ion channels
by increasing
A) the chloride conductance of each channel
B) the frequency of channel opening
C) the amount of time each channel remains open
D) the affinity of chloride for the channel
E) the recovery time of each channel
2. When used to induce sleep in persons with insomnia, benzodiazepines act to increase
A) subjective ratings of sleep quality
B) the proportion time spent in slow-wave sleep
C) the amount of time taken to get to sleep
D) the amount of rapid eye movement sleep
E) the secretion of growth hormone during sleep
3. The atributes of zolpidem include
A) a benzodiazepine structure
B) being useful in treating anxiety
C) an ultrashort duration of action
D) a significant hangover effect
E) a high risk of drug dependence
4. Flumazenil interacts with the -amino-butyric add (GABA) receptor so as to competitively
inhibit the binding of
A) only GABA
B) only benzodiazepine drugs
C) only -carboline drugs
D) both GABA and benzodiazepine drugs
E) both benzodiazepine and -carboline drugs
5. The use of buspirone in the treatment of anxiety disorders is characterized by
A) a rapid onset of action
B) a risk of drug dependence
C) sedation and motor incoordination
D) a lack of withdrawal effects
E) blockade of 5-hydroxytryptamine 5-HT1A receptors
6. Midazolam is most commonly used as
A) a hypnotic
B) an anxiolytic
C) an intravenous anesthetic
D) an anticonvulsant
E) a muscle relaxant
7. The short-acting benzodiazepines that are converted to inactive glucuronide metabolites
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include
A) diazepam
B) lorazepam
C) chlordiazepoxide
D) triazolam
E) alprazolam
Key: 1B, 2A, 3C, 4E, 5D, 6C, 7B
Atherosclerosis and lipoprotein metabolism
1. Activation of the peroxisome proliferator-activated receptor-alpha is produced by
administration of
A) ezetimibe
B) fenofibrate
C) simvastatin
D) niacin
E) colesevelam
2. Ezetimibe reduces serum LDL-cholesterol levels by
A) inhibiting cholesterol synthesis
B) increasing HDL-cholesterol levels
C) inhibiting cholesterol absorption
D) inhibiting bile acid reabsorption
E) stimulate lipoprotein lipase
3. Myositis leading to rhabdomyolysis is a potentially severe adverse effect of
A) atorvastatin
B) niacin
C) colestipol
D) ezetimibe
E) cholestyramine
4. Increased expression of apoproteins A-I and A-II occurs in persons receiving
A) colestipol
B) niacin
C) simvastatin
D) ezetimibe
E) gemfibrozil
5. Simvastatin and related drugs have been shown to reduce mortality in persons with
A) hypertriglyceridemia
B) low HDL-cholesterol levels
C) an inability to make LDL receptors
D) symptomatic coronary artery disease
E) myositis
6. Which drug inhibits hepatic triglyceride synthesis and VLDL secretion?
A) fenofibrate
B) colestipol
C) niacin
D) ezetimibe
E) atorvastatin
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inhibited by
A) crisantaspase
B) anastrozole
C) imatinib
D) rituximab
E) aldesleukin
2. Cumulative dose-related cardiac toxicity typically results from administration of
A) doxorubicin
B) bleomycin
C) vincristine
D) imatinib
E) irinotecan
3. Goserelin is used in treating advanced prostate cancer because of its ability to
A) increase gonadotrophin secretion
B) reduce gonadotrophin secretion
C) block testosterone receptors
D) activate estrogen receptors
E) inhibit estrogen synthesis
4. Vincristine inhibits mitosis of cancer cells at metaphase by
A) inhibiting telomerase
B) increasing tubulin degradation
C) inhibiting synthesis of tubulin
D) inhibiting polymerization of tubulin
E) stabilizing microtubules
5. Cytarabine is converted to an active triphosphate metabolite that inhibits
A) DMA polymerase
B) adenine deaminase
C) dihydrofolate reductase
D) telomerase
E) thymidylate synthetase
6. Folinic acid can be administered to counteract the toxic effects of
A) fludarabine
B) gemcitabine
C) cytarabine
D) fluorouracil
E} methotrexate
7. 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
A) cisplatin
B) bleomycin
C) doxorubicin
D) etoposide
E) cyclophosphamide
8. Which anticancer drug is most effective in the G2 phase of the cell cycle?
A) paclitaxel
B) methotrexate
C) bleomycin
D) iriinotecan
E) cytarabine
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E) muscarinic M3 receptors
4. Activation of adrenergic beta-2 receptors produces
A) contraction of the iris sphincter muscle
B) relaxation of the iris sphincter muscle
C) relaxation of the ciliary muscle
D) contraction of the ciliary muscle
E) lacnmal gland secretion
5. The enteric nervous system is primarily concerned with the regulation of
A) the urinary tract
B) gastrointestinal motility
C) male sex organs
D) Respiration
E) vascular smooth muscle
6. The co-transmitter known as neuropeptide enhances the
A) vasodilative effect of acetylcholine
B) vasodilative effect of nitric oxide
C) vasodilative effect of dopamine
D) vasoconstrictive effect of norepinephrine
E) vasoconstrictive effect of endothelin
7. The final step in the release of norepinephrine from sympathetic neurons is
A) docking
B) loading
C) diffusion
D) synthesis
E) exocytosis
8. In the parasympathetic nervous system, neurotransmitter action is terminated by
A) diffusion from the synapse
B) active reuptake into presynaptic nerves
C) inactivation by inhibitors
D) enzymatic degradation
E) endocytosis
9. The enteric nervous system
A) receives input only from the sympathetic neivous system
B) receives input only from the parasympathetic nervous system
C) releases several peptide neurotransmitters and nitric oxide
D) cannot function without the central nervous system
E) has cell bodies lying in plexuses outside the intestinal wall
Key: 1A, 2D, 3E, 4C, 5B, 6D, 7E, 8D, 9C
Chemical transmission and drug action in the central nervous system
1. Fast neurotransmitters in the central nervous system include
A) glutamate
B) dopamine
C) substance P
D) prostanoids
E) nerve growth factor
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E) succinylcholine
13. The release of acetylcholine from cholinergic nerve terminals is blocked by
A) atropine
B) bungarotoxm
C) botulinum toxin
D) batrachotoxin
E) tetrodotoxin
14. Scopolamine is employed clinically in the prevention or treatment of
A) motion sickness
B) asthma
C) peptic ulcer
D) glaucoma
E) constipation
15. The neuromuscular blockade produced by atracurium can be reversed by administration of
A) atropine
B) neostigmine
C) succinylcholine
D) pilocarpine
E) nicotine
16. Transient muscle fasciculations followed by paralysis typically occur after administration of
A) succinylcholine
B) Tubocurarine
C) vecuronium
D) gallamine
E) atropine
Key: 1B, 2D, 3A, 4C, 5D, 6A, 7B, 8E, 9B, 10C, 11D, 12E, 13C, 14A, 15B, 16A
CNS stimulants and psychotomimetic drugs
1. Phencyclidine is believed to cause psychotomimetic effects by
A) activating receptors for -aminobutyric acid
B) blocking receptors for -aminobutyric acid
C) activating N-methyl-D-aspartate-operated ion channels
D) blocking N-methyl-D-aspartate receptor-operated ion channels
E) increasing neuronal release of 5-hydroxytryptamine
2. Both lysergic acid diethylamine (LSD) and phencyclidine may cause
A) acute hyperthermia and muscle damage
B) physical dependence
C) schizophrenic symptoms
D) analgesia
E) inhibition of monoamine transporters
3. The psychotomimetic activity of lysergic acid diethylamide (LSD) is believed to result from its
ability to
A) activate 5-hydroxytryptamine 5-HT2 receptors
B) block 5-hydroxytryptamine 5-HT2 receptors
C) inhibit neuronal reuptake of noradrenaline and dopamine
D) release 5-hydroxytryptamine and block its neuronal reuptake
E) block receptors for -aminobutyric acid
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4. Progressive myocardial damage leading to heart failure is most likely to occur in persons who
A) lysergic acid diethylamide (LSD)
B) phencyclidine
C) mescaline
D) psilocybin
E) cocaine
5. Methylphenidate is primarily used in the treatment of
A) narcolepsy
B) mood depression
C) attention deficit-hyperactivity disorder
D) obesity
E) asthma
6. The adverse effects of methylenedioxymethamphetamine (MDMA) typically include
A) drug addiction
B) skeletal muscle damage
C) hypothermia
D) liver failure
E) bone marrow depression
Key: 1D, 2C, 3A, 4E, 5C, 6B
Drug addiction, dependence and abuse
1. All dependence-producing drugs act via different pathways to cause
A) depletion of norepinephrine in the locus coeruleus
B) depletion of dopamine in nigrostriatal pathways
C) depletion of glutamate in meso-limbic pathways
D) the release of glutamate in the frontal cortex
E) the release of dopamine in the nucleus accumbens
2. Chronic administration of morphine is believed to cause tolerance by
A) increasing expression of adenylate cyclase
B) decreasing expression of adenylate cyclase
C) increasing expression of guanylate cyclase
D) decreasing expression of guanylate cyclase
E) increasing expression of -adrenoceptors
3. Nicotine use often leads to drug dependence by activation of nicotinic receptors in the
A) nucleus accumbens
B) hippocampus
C) ventral tegmental area
D) cerebral cortex
E) striatum
4. Disulfiram has been used to facilitate abstinence from ethanol based on its ability to inhibit
A) the mesollimbic dopaminergic pathway
B) ethanol withdrawal symptoms
C) alcolhol dehydrogenase
D) aldehyde dehydrogenase
E) aldehyde oxidase
5. The effects that result from smoking marijuana include
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Key: 1E, 2A, 3C, 4D, 5E, 6A, 7C, 8C, 9D, 10C, 11D, 12C
Drug elimination and pharmacokinetics
1. Hepatic cytochrome P450 drug-metabolizing enzymes are primarily found in
A) cell nuclei
B) plasma membranes
C) the cytoplasm
D) the smooth endoplasmic reticulum
E) mitochondria
2. Phase II drug metabolism
A) includes hydrolytic reactions
B) produces low molecular weight products
C) usually forms inactive metabolites
D) takes place mainly in the kidneys
E) requires NADPH as a cofactor
3. Ketoconazole produces non-competitive inhibition of cytochrome P450 by
A) binding to the ferric form of heme iron
B) binding to the active site of the enzyme
C) causing enzyme autolysis
D) oxidizing NADPH
E) binding covalently to the P450 protein
4. In first-order drug elimination
A) drug half-life is directly proportional to drug concentration
B) the rate of elimination is directly proportional to drug concentration
C) drug clearance is directly proportional to plasma drug concentration
D) the rate of elimination is constant
E) the rate of elimination is unpredictable
5. 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
A) Dose
B) route of administration
C) dosage interval
D) bioavailability
E) elimination half-life
6. If a drug exhibits saturation (zero-order) kinetics, then
A) the rate of drug elimination is constant
B) drug half-life is constant
C) drug clearance is constant
D) plasma drug concentration is constant
E) plasma drug concentration falls exponentially
7. In the two-compartment pharmacokinetic model, orally administered drugs are
A) absorbed into the peripheral compartment
B) distributed from the central to the peripheral compartment
C) metabolized in the central compartment
D) excreted in the peripheral compartment
E) none of the above
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8. Which of the following will be increased if the rate of drug absorption from the gut is
reduced?
A) oral bioavailability
B) volume of distribution
C) peak plasma drug concentration
D) elimination half-life
E) duration of action
9. The volume of plasma from which a drug is eliminated in a unit of time is known as the
A) volume of elimination
B) volume of distribution
C) clearance
D) elimination rate constant
E) kinetic volume
10. inactive prodrugs have been developed to
A) reduce drug toxicity
B) increase drug half-life
C) decrease hepatic drug metabolism
D) increase drug absorption
E) slow drug excretion
Key: 1D, 2C, 3A, 4B, 5E, 6A, 7B, 8E, 9C, 10D
Drugs used in the treatment of infections and cancer
1. Which drug selectively inhibits bacterial RNA polymerase?
A) cytarabine
B) zidovudine
C) dactinomiydn
D) rifampin
E) acyclovir
2. Conjugation is an important mechanism for transfer of drug resistance genes between
A) coliform bacteria
B) staphylococci
C) enterococci
D) streptococci
E) spirochetes
3. Cycloserine prevents the addition of terminal ________ residues to the peptide side chain on
N-acetylmuramic acid
A) glycine
B) leucine
C) methionine
D) alanine
E) tyrosine
4. Induction of bacterial proteins that enable energy-dependent efflux of drug molecules is an
important mechanism of resistance to the
A) penicillins
B) aminoglycoside antibiotics
C) tetracycline antibiotics
D) macrolide antibiotics
E) folate reduction inhibitors
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5. Which drug is correctly paired with the type of organism in which it selectively inhibits
dihydrofolate reductase?
A) trimethoprim
B) pyrimethamine
C) methotrexate
6. Ciprofloxacin selectively binds and inhibits
A) bacterial RNA polymerase
B) bacterial topoisomerase II
C) bacterial DNA polymerase
D) mammalian DNA polymerase
E) mammalian topoisomerase II
7. Which antibiotic inhibits translocation of the bacterial peptide chain from the A (acceptor) to
the P (peptide) site of the 50S ribosomal subunit?
A) erythromycin
B) puromycin
C) streptomycin
D) tetracycline
E) chloramphenicol
8. Inhibition of bacterial transpeptidase and carboxypeptidase is the mechanism of action of
A) bacitracin
B) vancomycin
C) -lactam antibiotics
D) cycloserine
E) fusidic acid
9. Bacterial drug resistance may occur due to expression of a dihydropteroate synthetase that
has decreased affinity for
A) penicillin
B) chloramphenicol
C) trimethoprim
D) sulfonamides
E) erythhromycin
Key: 1D, 2A, 3D, 4C, 5C, 6E, 7A, 8C, 9D
General anesthetic agents
1. Bone marrow depression may occur following prolonged administration of
A) halothane
B) nitrous oxide
C) etomidate
D) enflurane
E) thiopental
2. The minimum alveolar concentration (MAC) is an expression of an inhalational anesthetic's
A) margin of safety
B) rate of induction
C) potency
D) water solubility
E) duration of action
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A) thrombin
B) thromboxane
C) glycoprotein IIb/IIIa
D) adenosine diphosphate
E) von Willebrand factor
4. Dipyridamole and aspirin are used together primarily for the prevention of
A) pulmonary embolism
B) ischemic stroke
C) myocardial infarction
D) deep vein thrombosis
E) unstable coronary syndromes
5. Acute thrombotic stroke may be effectively treated within 3 hours of onset with
A) warfarin
B) tranexamic acid
C) eptifibatide
D) aspirin
E) tenecteplase
6. Clinical trials of adding clopidogrel to aspirin for preventing thromboembolic disease found
that combined therapy is
A) less effective than aspirin alone
B) less effective than clopidogrel alone
C) equally effective as clopidogrel alone
D) equally effective as aspirin alone
E) more effective than aspirin alone
7. Enoxaparin increases the activity of antithrombin III against
A) primarily thrombin
B) primarily factor Xa
C) thrombin and factor Xa equally
D) neither thrombin nor factor Xa
E) fibrin stabilizing factor
8. One of the adverse effects of high-dose or long-term therapy with heparin is
A) hyponatremia
B) hypernatremia
C) hypokalemia
D) hyperkalemia
E) hypophosphatemia
9. Eptifibatide is used to prevent thrombosis in persons undergoing
A) coronary angioplasty
B) fibrinolysis
C) blood transfusion
D) abdominal surgery
E) hip-replacement surgery
10. Fondaparinux is correctly described as a
A) hirudin derivative
B) cyclic peptide from snake venom
C) low-molecular-weight heparin
D) warfarin analogue
E) synthetic pentasaccharide
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Key: 1D, 2A, 3C, 4B, 5E, 6E, 7B, 8D, 9A, 10E
How drugs act cellular aspects-excitation, contraction and secretion
1. L(long-lasting)-type calcium channels are correctly described as having
A) low activation threshold and slow inactivation
B) high activation threshold and slow inactivation
C) low activation threshold and fast inactivation
D) high activation threshold and fast inactivation
E) none of the above as correct
2. The extrusion of calcium from the cell cytoplasm primarily depends on
A) ligand-gated calcium channels
B) voltage-gated calcium channels
C) the sodium-calcium exchange transporter
D) the ATP-driven calcium pump
E) nuclear sequestration
3. The mechanism by which monamine neurotransmitters are released from nerve terminals
A) calcium-mediated exocytosis
B) carrier-mediated release
C) ATP-dependent active transport
D) diffusion through aqueous pores
E) diffusion through membrane lipid
4. Batrachotoxin binds sodium channels and thereby
A) opens channels
B) prevents channel opening
C) prevents channel inactivation
D) closes channels
E) causes channels to remain closed
5. Closure of potassium channels in excitable membranes causes membrane
A) Repolarization
B) Depolarization
C) Hyperpolarization
D) Disintegration
E) Inactivation
6. In smooth muscle, inositol triphosphate releases calcium from the
A) Golgi body
B) Mitochondria
C) Cell nucleus
D) T-tubule
E) Sarcoplasmic reticulum
7. Calcium facilitates the release of nitric oxide by
A) causing exocytosis
B) causing membrane depolanzation
C) activating nitric oxide synthase
D) activating transport carriers
E) activating G-protein-coupled receptors
8. Amiloride affects epithelial ion transport by blocking
A) the Na+/K+ exchange pump
B) the Na+/K+ co-transporter
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C) sodium channels
D) potassium channels
E) calcium channels
9. In the colon, chloride transport is important in
A) potassium secretion
B) potassium reabsorption
C) fluid secretion
D) fluid reabsorption
E) sodium bicarbonate reabsorption
10. A key step in causing smooth muscle contraction is the phosphorylation of
A) Actin
B) myosin light chain
C) myosin heavy chain
D) guanylate cyclase
E) myosin phosphatase
11. Adrenergic beta-receptor agonists cause smooth muscle relaxation by
A) increasing cyclic AMP formation
B) decreasing cyclic AMP formation
C) increasing cyclic GMP formation
D) decreasing cyclic GMP formation
E) inhibiting protein kinase A
Key: 1B, 2D, 3A, 4C, 5B, 6E, 7C, 8C, 9D, 10B, 11A
How drugs act general principles
1. The concentration of a drug required to occupy 50 percent of its receptor sites is
A) the concentration required to produce the maximum physiological effect
B) directly proportional to the drug's affinity for its receptor
C) inversely proportional to the drug's affinity for its receptor
D) directly proportional to the drug's intrinsic efficacy
E) usually determined with the Schild equation
2. In the presence of a competitive antagonist the agonist log-concentration effect curve is
A) shifted to the right without a change in slope or maximum effect
B) shifted to the left without a change in slope or maximum effect
C) shifted to the right with a decreased slope and maximum effect
D) shifted to the left with a decreased slope and maximum effect
E) not shifted right or left but shows a decreased maximum effect
3. The magnitude of the response to a drug is related to the
A) total number of receptors for the drug
B) number of receptors occupied by the drug
C) number of vacant receptors in the tissue
D) number of spare receptors in the tissue
E) number of phosphorylated receptors in the tissue
4. 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
A) equilibrium constant of the agonist
B) affinity of the agonist for its receptor
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D) limb surgery
E) abdominal surgery
2. Local anesthetics have greater affinity for sodium channels in the
A) resting state
B) open and inactivated states
C) open and resting states
D) inactivated and resting states
E) closed state
3. Which local anesthetic is characterized by rapid onset, medium duration of action, and good
tissue penetration?
A) procaine
B) cocaine
C) lidocaine
D) bupivacaine
E) prilocaine
4. Use-dependent blockade of nerve conduction results from sodium channel binding by local
A) in the cationic form on the inner membrane surface
B) in the uncharged form on the inner membrane surface
C) in the cationic form on the outer membrane surface
D) in the uncharged form on the outer membrane surface
E) in the anionic form on the inner membrane surface
Key: 1D, 2B, 3C, 4A
Local hormones, inflammation, and immune reactions
1. The conversion of fibrinogen to fibrin is accelerated by
A) Plasmin
B) Plasminogen
C) Kallikrein
D) Complement
E) thrombin
2. The release of histamine from mast cells is activated by
A) complement component C3a
B) complement component C4b
C) opsonin
D) chemotaxin
E) plasmin
3. Type I hypersensitivity reactions results from the production of
A) natural killer cells
B) interleukin-2
C) immunoglobulin E
D) leukotriene D4
E) thromboxane
4. Prostanoids and leukotrienes are both formed from
A) cyclic endoperoxides
B) arachidonic acid
C) linolenic acid
D) Lipoxins
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E) 5-hydroperoxyeicosatetraenoic acid
5. Vasodilation and inhibition of platelet aggregation are the primary effects of
A) Prostacyclin
B) prostaglandin E2
C) Thromboxane
D) prostaglandin F1
E) prostaglandin F2
6. The formation of 5-hydroperoxyeicosatetraenoic acid is inhibited by
A) Montelukast
B) nonsteroidal anti-inflammatory drugs
C) Prostaglandins
D) Zileuton
E) platelet-activating factor
7. Leukotriene B4 causes
A) coronary vasoconstriction
B) vasodilation in most vascular bed
C) bronchoconstriction
D) Bronchodilation
E) chemotaxis and activation of leukocytes
8. The structure of bradykinin is that of
A) a prostanoid
B) a nonapeptide
C) a leukotriene
D) a monoamine
E) a glycopeptide
9. It is postulated that bradykinin plays a role in
A) peptic ulcer
B) gastroesophageal reflux disease
C) Diarrhea
D) inflammatory bowel disease
E) gallstones
10. Substance P, neurokinin A, and calcitonin gene-related peptide are partly responsible for
A) neurogenic inflammation
B) acute anaphylactic reactions
C) septic shock
D) rheumatoid arthritis
E) coronary vasoconstnction
11. Latanoprost is used clinically to
A) dilate the pupil
B) constrict the pupil
C) correct strabismus
D) lower intraocular pressure
E) treat uveitis
12. The treatment of primary pulmonary hypertension may include administration of
A) prostaglandin F2
B) prostaglandin I2
C) thromboxane
D) misoprostol
E) dinoprostone
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B) cyclic AMP
C) Diacylglycerol
D) arachidonic acid
E) inositol triphosphate
4. Which signal transduction pathway is most important in cell division, growth, and
differentiation?
A) beta-adrenoceptor signal pathways
B) phospholipase C pathways
C) Ras/Raf/Map kinase
D) eicosanoid signal pathways
E) guanylate cyclic signal pathways
5. Coupling of a G-protein alpha subunit to an agonist-occupied receptor initially leads to
A) activation of the beta-gamma complex
B) hydrolysis of GTP
C) activation of adenylate cyclase
D) exchange of bound GDP with GTP
E) dissociation of the alpha-subunit from the receptor
6. The nicotinic receptor is an example of a
A) G-protein coupled receptor
B) ligand-gated ion channel
C) tyrosine-kinase linked receptor
D) cytokine receptor
E) transport protein
7. In G-protein coupled receptor signal transduction, protein kinase A is typically activated by
A) inositol triphosphate
B) ATP
C) cyclic AMP
D) cyclic GMP
E) Diacylglycerol
8. An agonist for a ligand-gated ion channel typically
A) increases channel conductance
B) increases the number of open channels
C) increases the rate of channel closing
D) alters channel ion selectivity
E) alters the open channel conformation
9. Diacylglycerol produces its intracellular effects by
A) activating protein kinase C
B) activating protein kinase A
C) releasing intracellular calcium
D) activating adenylate cyclase
E) activating guanylate cyclase
10. Class I nuclear receptors that control gene transcription
A) contain cysteine residues bound to iron
B) interact with nucleolar RNA
C) bind to hormone response elements of DNA
D) only act to inhibit DNA transcription
ID E) only act to stimulate DNA transcription
11. Myasthenia gravis is a disease in which
A) receptors have an abnormal amino acid sequence
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B) nicotinic receptors
C) thyroid hormone receptors
D) cytokine and growth factor receptors
E) muscarinic receptors
Key: 1D, 2B, 3E, 4C, 5D, 6B, 7C, 8B, 9A, 10C, 11D, 12A, 13E, 14B, 15D, 16E, 17C, 18D, 19C
Neurodegenerative diseases
1. An essential factor in neuronal excitotoxicity is
A) depletion of intracellular calcium
B) excessive levels of intracellular calcium
C) depletion of adenosine triphosphate
D) inhibition of intracellular proteases
E) depletion of intracellular glutamate
2. The accumulation of -amy1oid protein is believed to cause neuronal degeneration in
A) Huntington s disease
B) Parkinson's disease
C) Creutzfeldt-Jakob disease
D) amyotrophic lateral sclerosis
E) Alzheimer's disease
3. Levodopa is usually administered with a peripheral dopa decarboxylase inhibitor such as
A) carbidopa
B) selegiline
C) entacapone
D) amantadine
E) pergolide
4. Factors that contribute to the development of Alzheimer's disease include
A) absence of A40 peptides
B) decreased proportion of A42 peptides
C) mutations in the apoEA gene
D) increased expression of -secretase
E) decreased expression of -secretase
5. The use of selegiline in Parkinson's disease is based on its ability to
A) selectively inhibit type A monoamine oxidase
B) slow progression of Parkinson's disease
C) inhibit peripheral degradation of levodopa
D) protect dopamine from intra-neuronal degradation
E) exert the neuroprotectrve effects shown in clinical trials
6. Memantine may produce a small improvement in cognitive function in persons with
Alzheimer's disease because it acts to
A) inhibit Cholinesterase
B) activate cholinergic nicotinic receptors
C) block N-methyl-D-aspartate receptors
D) activate N-methyl-D-aspartate receptor
E) activate dopamine D1 receptors
7. Entacapone reduces end of dose motor fluctuations in Parkinson's disease because
entacapone inhibits the degradation of levodopa by
A) catechol-O-methyltransferase
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B) monoamine oxidase-A
C) monoamine oxidase-B
D) dopa decarboxylase
E) dopamine -hydroxylase
8. Expansion of CAG (cyotosine-adenine-guanine) trinucleotide repeats in certain genes occurs
in persons with
A) spongiform encephalopathy
B) Parkinsons disease
C) Alzheimers disease
D) amyotrophic lateral sclerosis
E) Huntington's disease
9. In the treatment of Alzheimer's disease, rivastigmine typically causes
A) rapidly irreversible inhibition of acetyl- and butyryl-cholinesterase
B) slowly reversible inhibition of acetyl- and butyryl-cholinesterase
C) allostenc enhancement of nicotinic receptor activation
D) allostenc enhancement of muscarinic receptor activation
E) cholinergic side effects that increase over time
10. The acute side effects of levodopa in Parkinson's disease patients include
A) involuntary writhing movements
B) rapid fluctuations in clinical state
C) nausea and anorexia
D) hypertension
E) urinary retention
Key: 1B, 2E, 3A, 4C, 5D, 6C, 7A, 8E, 9B, 10C
Nitric oxide
1. The effects exerted by nitric oxide include
A) stimulation of platelet aggregation
B) vasoconstriction
C) inhibition of smooth muscle proliferation
D) increased atherogenesis
E) inhibition of host defenses
2. The primary action of inhaled nitric oxide is
A) Vasoconstriction
B) pulmonary vasodilation
C) bronchoconstriction
D) cardiac stimulation
E) respiratory distress
3. Nitric oxide causes vasodilation by
A) decreasing formation of cyclic GMP
B) increasing formation of cyclic GMP
C) decreasing formation of cyclic AMP
D) increasing formation of cyclic AMP
E) increasing calcium influx
4. In the gastrointestinal tract nitric oxide serves to
A) inhibit gastric emptying
B) stimulate gastric emptying
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C) inhibit peristalsis
D) inhibit gastric acid formation
E) cause constipation
5. Nitroprusside produces its effects by acting as
A) a nitric oxide donor
B) a substrate for nitric oxide synthase
C) an inducer of nitric oxide synthase
D) an inhibitor of nitric oxide degradation
E) an agonist at nitric oxide receptors
6. Glucocorticoids may be beneficial in treating sepsis in part due to their ability to
A) inhibit constitutive nitric oxide synthase
B) stimulate constitutive nitric oxide synthase
C) stimulate inducible nitric oxide synthase
D) inhibit inducible nitric oxide synthase
E) inhibit both constitutive and inducible nitric oxide synthase
Key: 1C, 2B, 3B, 4B, 5A, 6D
Noradrenergic transmission
1. An intravenous infusion of norepinephrine typically
A) increases peripheral resistance and heart rate
B) decreases peripheral resistance and heart rate
C) increases peripheral resistance and decreases heart rate
D) decreases peripheral resistance and increases heart rate
E) has no consistent effect on peripheral resistance and heart rate
2. In the liver, epinephrine acts via adrenergic beta-2 receptors to
A) stimulate both phosphorylase and glycogen synthase
B) inhibit both phosphorylase and glycogen synthase
C) inhibit phosphorylase and stimulate glycogen synthase
D) stimulate phosphorylase and inhibit glycogen synthase
E) stimulate phosphorylase, glycogen synthase, and lipase
3. Which drug inhibits the transport of norepinephrine into synaptic vesicles, thereby leading to
neurotransmitter depletion?
A) reserpine
B) methyldopa
C) bretylium
D) 6-hydroxydopamine
E) guanethidine
4. Doxazosin is an example of a
A) nonselective alpha-adrenoceptor antagonist
B) selective alpha-1 adrenoceptor antagonist
C) selective alpha-2 adrenoceptor antagonist
D) selective alpha-1 adrenoceptor agonist
E) selective alpha-2 adrenoceptor agonist
5. Irreversible blockade of alpha-adrenoceptors results from covalent binding of these receptors
by
A) phentolamine
B) phenylephrine
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C) prazosin
D) phenoxybenzamine
E) pseudoephednne
6. The reuptake of norepinephrine by presynaptic nerve terminals (uptake 1) is inhibited by
A) guanethidine
B) reserpine
C) methyldopa
D) methyltyrosine
E) cocaine
7. The first-line treatment for acute severe type I hypersensitivity reactions is
A) dopamine
B) epinephrine
C) isoproterenol
D) norepinephrine
E) phenylephrine
8. Which adrenergic receptor antagonist increases heart rate at rest but reduces it during
exercise?
A) pindolol
B) propranolol
C) prazosin
D) timolol
E) phentolamine
9. In the peripheral tissues, the primary end product of norepinephrine metabolism is
A) 3-methoxy, 4-hydroxyphenylglycol
B) normetanephrine
C) vanillylmandelic acid
D) 3,4-dihydroxymandelic acid
E) 3,4-dihydroxyphenyiglycol
10. The adverse effects of beta-adrenoceptor antagonists include
A) hyperglycemia
B) cardiac arrhythmias
C) myocardial ischemia
D) anxiety
E) bronchoconstriction
11. Selective beta-3 adrenoceptor agonists are potentially useful in treating obesity because of
their ability to
A) suppress appetite
B) inhibit digestion of fats
C) uncouple oxidative phosphorylation
D) increase thermogenesis
E) increase thyroid function
12. Symptoms of urinary retention due to benign prostatic hyperplasia may be improved by
A) alpha-1 adrenoceptor antagonists
B) alpha-2 adrenoceptor antagonists
C) alpha-1 adrenoceptor agonists
D) alpha-2 adrenoceptor agonists
E) nonselective adrenoceptor agonists
13. Persons with acute thyrotoxicosis are often treated with propranolol because it
A) reduces peripheral vascular resistance
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C) neuropeptide receptors
D) food intake
E) storage of fat
Key: 1A, 2D, 3D, 4C, 5E, 6B
Other peripheral mediators, 5-hydroxytryptamine and purines
1. Urinary levels of 5-hydroxyindole acetic add provide an indication of the body's production of
A) adenosine
B) serotonin
C) adenosine triphosphate
D) histamine
E) endothelin
2. Some of the effects of theophylline are attributed to antagonism of
A) Glutamate
B) 5-hydroxytrypamine
C) adenosine
D) norepinephrine
E) histamine
3. The effects of chemical mediators on platelets indude
A) stimulation of platelet aggregation by adenosine diphosphate
B) stimulation of platelet aggregation by adenosine
C) inhibition of platelet aggregation by adenosine diphosphate
D) inhibition of platelet aggregation by histamine
E) inhibition of platelet aggregation by serotonin
4. Cyproheptadine is useful in treating cardnoid syndrome because of its ability to
A) activate 5-HT1 receptors
B) block 5-HT1 receptors
C) activate 5-HT2 receptors
D) block 5-HT2 receptors
E) activate 5-HT4 receptors
5. In persons with irritable bowel syndrome whose predominant symptom is constipation,
intestinal peristaltic activity may be increased by drugs that
A) activate 5-HT1 receptors
B) block 5-HT1 receptors
C) activate 5-HT2 receptors
D) block 5-HT2 receptors
E) activate 5-HT4 receptors
6. Activation of 5-HT1D receptors is usually beneficial in persons suffering from
A) carcinoid syndrome
B) nausea and vomiting
C) migraine headache
D) Constipation
E) anxiety
7. Retroperitoneal and mediastinal fibrosis is a characteristic adverse effect of
A) methysergide
B) Ergotamine
C) Bromocriptine
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D) Sumatriptan
E) tegaserod
8. Blockade of 5-HT3 receptors in vagal afferent neurons is useful in preventing
A) migraine headache
B) serotonin syndrome
C) platelet aggregation
D) nausea and vomiting
E) Constipation
Key: 1B, 2C, 3A, 4D, 5E, 6C, 7A, 8D
Other transmitters and modulators
1. The 5-hydroxytryptamine 5-HT2 receptors are
A) primarily inhibitory
B) chiefly found in the area postrema
C) mostly presynaptic
D) abundant in the cortex and limbic system
E) predominantly presynaptic autoreceptors
2. Agonists at 5-hydroxytryptamine 5-HT2A receptors typically cause
A) sleep
B) vigilance
C) hallucinations
D) hyperphagia
E) euphona
3. The major functions of cholinergic pathways in the central nervous system include
A) learning and memory
B) mood and emotion
C) control of body temperature
D) appetite
E) drug dependence
4. The effects of jet lag can be alleviated by administration of
A) methylxanthine drugs
B) melatonin
C) histamine H2 receptor antagonists
D) 5-hydroxytryptamine 5-HT3 agonists
E) Cholinesterase inhibitors
5. The predominant site containing cell bodies of noradrenergic neurons is the
A) raphe nuclei
B) nigrostnatal pathway
C) locus coeruleus
D) nucleus accumbens
E) nucleus basalis
6. The 5-hydroxytryptamine 5-HT3 receptors are
A) excitatory ligand-gated cation channels
B) inhibitory ligand-gated cation channels
C) G-protein-coupled receptors
D) inhibitory ligand-gated chloride channels
E) presynaptic autoreceptors
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C) pernicious anemia
D) iron toxicity
E) hemosiderosis
4. Persons with an elevated blood level of methylmalonyl-Coenzyme A may have a deficiency of
A) erythropoietin
B) iron
C) formyl-tetrahydrofolic acid
D) colony-stimulating factors
5. Filgrastim is conjugated with polyethylene glycol to
A) increase its absorption from the gut
B) increase its elimination half-life
C) reduce its duration of action
D) decrease its adverse effects
E) increase its potency
6. Epoetin is indicated for the treatment of
A) pernicious anemia
B) anemia of renal failure
C) megaloblastic anemia
D) neutropenia
E) platelet deficiency
Key: 1C, 2A, 3D, 4E, 5B, 6B
The heart
1. Delayed after-depolarizations in cardiac tissue typically result from an increased influx of
A) sodium
B) potassium
C) calcium
D) chloride
E) sodium and potassium
2. The re-excitation of cardiac tissue prior to the next cardiac impulse occurs in the process
known as
A) re-entry
B) ectopic automaticity
C) atrioventricular block
D) atrial fibrillation
E) bradycardia
3. In persons with atrial fibrillation, digoxin may slow the ventricular rate by
A) decreasing sinoatrial node automaticity
B) increasing ventricular contractility
C) inhibiting the Na+/K+ pump
D) reducing the calcium transient
E) slowing atrioventricular conduction
4. Sotalol exerts an antiarrhythmic effect primarily by
A) slowing ventricular conduction
B) blocking sodium channels
C) slowing atrioventricular conduction
D) increasing the effective refractory period
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E) adenosine
13. Nitroglycerin relieves typical angina pectoris in part by
A) increasing cardiac stroke volume
B) dilating coronary arterioles
C) decreasing cardiac oxygen consumption
D) constricting collateral vessels in the heart
E) increasing blood pressure
14. Nitroglycerin and other organic nitrates produce their vasodilator effect by
A) increasing formation of cyclic AMP
B) increasing formation of cyclic GMP
C) blocking calcium channels
D) blocking adrenergic alpha receptors
E) activating potassium channels
Key: 1C, 2A, 3E, 4D, 5A, 6E, 7C, 8B, 9D, 10A, 11C, 12D, 13C, 14B
The kidney
1. Excessive doses of hydrochlorothiazide may cause
A) hyperkalemic metabolic acidosis
B) hyperkalemic metabolic alkalosis
C) hyperchloremic metabolic acidosis
D) hypokalemic metabolic alkalosis
E) hypokalemic metabolic acidosis
2. Amiloride exerts its diuretic effect by
A) blocking epithelial sodium channels
B) inhibiting the epithelial sodium pump
C) inhibiting the sodium chloride transporter
D) blocking aldosterone receptors
E) inhibiting chloride channels
3. The Na+/K+/2CI- transporter is inhibited by
A) amiloride
B) furosemide
C) acetazolamide
D) hydrochlorothiazide
E) triamterene
4. A mild hyperchloremic metabolic acidosis may occur following administration of
A) amiloride
B) hydrochlorothiazide
C) mannitol
D) bumetanide
E) acetazolamide
5. Hydrochlorothiazide decreases the urinary excretion of
A) calcium
B) sodium
C) potassium
D) chloride
E) bicarbonate
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B) estradiol
C) progesterone
D) gonadotrophins
E) hydrocortisone
3. The effects of fludrocortisone can be antagonized by
A) spironolactone
B) beclomethasone
C) metyrapone
D) aldosterone
E) ammoglutethimide
4. Octreotide is correctly described as a
A) short-acting analogue of somatotrophin
B) long-acting analogue of somatotrophin
C) short-acting analogue of somatostatin
D) long-acting analogue of somatostatin
E) long-acting analogue of somatomedin
5. In the basic transactivation mechanism of glucocorticoid receptor control of gene expression,
the ligand-bound glucocorticoid receptor dimer binds to
A) nuclear factor kappa B sites
B) regulatory sites of Fos/Jun transcription factors
C) negative glucocorticoid response elements
D) positive glucocorticoid response elements
E) negative transcription factors
6. Metyrapone inhibits the biosynthesis of
A) only corticosterone
B) only hydrocortisone
C) only dehydroepiandrosterone
D) both corticosterone and hydrocortisone
E) corticosterone, hydrocortisone, and dehydroepiandrosterone
7. Insulin-like growth factor-1 causes feedback inhibition of the secretion of
A) prolactin
B) melanocyte-stimulating hormone
C) growth hormone
D) corticotropin
E) thyrotropin
8. Polyuria may result from inhibition of antidiuretic hormone by
A) desmopressin
B) oxytocin
C) carbamazepine
D) ibuprofen
E) lithium
9. The adverse effects of high-dose or chronic administration of prednisone include
A) muscle hypertrophy
B) cataracts
C) decreased abdominal fat
D) thickened skin
E) hypotension
10. Cabergoline inhibits the anterior pituitary secretion of
A) prolactin
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B) melanocyte-stimulating hormone
C) thyrotropin
D) somatotrophin
E) corticotrophm
11. The treatment of diabetes insipidus includes nasal administration of
A) vasopressin
B) desmopressin
C) demeclocycline
D) octreotide
E) budesonide
Key: 1C, 2D, 3A, 4D, 5D, 6D, 7C, 8E, 9B, 10A, 11B
The reproductive system
1. The expression of estrogen receptors in the mammary gland is increased by
A) oxytocin
B) progesterone
C) prolactin
D) gonadotrophins
E) androgens
2. The secretion of progesterone from the corpus luteum is primarily stimulated by
A) follicle-stimulating hormone
B) luteinizing hormone
C) estrogen
D) prolactin
E) oxytocin
3. Compared to the combination estrogen-progestogen contraceptive, the progestogen-only pill
is more likely to
A) cause hypertension
B) prevent conception
C) cause breast cancer
D) cause myocardial infarction
E) produce irregular bleeding
4. Administration of sildenafil leads to
A) activation of guanylate cyclase
B) inhibition of guanylate cyclase
C) activation of phosphodiesterase V
D) inhibition of phosphodiesterase V
E) release of nitnc oxide
5. In the estrogen-progestogen contraceptive pill, the estrogen component acts primarily by
inhibiting
A) secretion of LH
B) secretion of FSH
C) ovulation
D) passage of sperm
E) mucus secretion
6. The prevention and treatment of postpartum hemorrhage may include injections of
A) estrogen
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B) progestogen
C) oxytocin
D) ritodrine
E) prolactin
7. The benefits of using estrogen-progestogen contraceptive pills include
A) decreased risk of hypertension
B) improved glucose tolerance
C) decreased risk of breast cancer
D) decreased menstrual irregularities
E) decreased risk of stroke
8. The use of atosiban to delay premature labor is based on its ability to
A) block 2-adrenoceptors
B) activate 2-adrenoceptors
C) block progesterone receptors
D) activate progesterone receptors
E) block oxytocin receptors
9. When finasteride is used in treating benign prostatic hypertrophy, it acts by
A) blocking androgen receptors
B) inhibiting gonadotrophin secretion
C) inhibiting 5-reductase
D) inhibiting testosterone secretion
E) blocking 1 adrenoceptors
10. The interaction between nitroglycerin and sildenafil results from the
A) inhibition of sildenafil metabolism by nitroglycerin
B) inhibition of nitroglycerin metabolism by sildenafil
C) similar effect of the drugs on phosphodiesterase V
D) similar effect of the drugs on cyclic GMP levels
E) antagonistic effect of the drugs on cyclic GMP levels
Key: 1C, 2B, 3E, 4D, 5B, 6C, 7D, 8E, 9C, 10D
The respiratory system
1. The clinical uses of formoterol include
A) prevention of nocturnal bronchospasm
B) treatment of acute bronchospasm
C) long-term prevention of airway inflammation
D) prevention and treatment of allergic rhinitis
E) stabilization of mast cells in persons with atopic dermatitis
2. The cysteinyl leukotriene CysLT1 receptor is blocked by
A) tiotropium
B) theophylline
C) nedocromil
D) zafirlukast
E) omalizumab
3. Persons with aspirin-sensitive asthma
A) can safely use naproxen or ibuprofen
B) seldom have nasal polyps
C) exhibit hyper-responsiveness to inhaled leukotrienes
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E) hydrogen peroxide
3. The characteristics of radioactive iodine (131I) in the treatment of hyperthyroidism include
A) a rapid onset of action
B) a maximum effect in 8 days
C) a cytotoxic effect produced by y rays
D) safe use in children and pregnant women
E) hypothyroidism as a typical later-onset disease
4. The long elimination half-life of thyroxine (T4) is primarily due to
A) slow absorption from the gut
B) slow excretion in the urine
C) strong binding to thyroxine-binding globulin
D) slow hepatic inactivation
E) storage in fat cells
5. An uncommon but serious adverse effect associated with the use of propylthiouracil is
A) granulocytopenia
B) hemolytic anemia
C) a lupus erythematosus-like syndrome
D) cholestatic hepatitis
E) hypoglycemia
Key: 1C, 2B, 3E, 4C, 5A
The vascular system
1. Which vasoconstrictor substance is produced by vascular endothelial cells?
A) nitric oxide
B) bradykinin
C) prostacyclin
D) natriuretic peptide
E) endothelin
2. The opening of membrane potassium channels by minoxidil leads to A) increased potassium
influx
B) increased calcium influx
C) inactivation of calcium channels
D) membrane depolarization
E) formation of cyclic GMP
3. Both valsartan and enalapril
A) increase serum potassium levels
B) often cause a dry cough
C) block angiotensin AT1 receptors
D) inhibit formation of angiotensin II
E) increase bradykinin levels
4.Bosentan is an antagonist of
A) endothelin ETA and ETB receptors
B) angiotensin AT1 receptors
C) angiotensin AT2 receptors
D) nitric oxide receptors
E) prostaglandin FP receptors
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13. Beginning therapy with low doses that are gradually increased over several months is
appropriate when treating heart failure with
A) digoxin
B) furosemide
C) dobutamine
D) carvedilol
E) nitroglycerin
14. The progression of diabetic nephropathy may be slowed by
A) propranolol
B) enalapril
C) hydrochlorothiazide
D) amlodipine
E) doxazosin
15. The use of eplerenone in the treatment of heart failure is based on its ability to
A) cause vasodilation
B) inhibit sympathetic nervous system activity
C) antagonize aldosterone
D) inhibit angiotensin II formation
E) increase cardiac contractile force
Key: 1E, 3C, 3A, 4A, 5D, 6B, 7E, 8C, 9D, 10D, 11C, 12E, 13D, 14B, 15C
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