EXAM 1 SAMPLE QUESTIONS (answers to questions are at the end) Pharmacology Introductory/Drug Development 1.

Which statement concerning a drugs generic (nonproprietary) name is correct? A. each drug can have multiple generic names B. the generic name may be related to the chemical or pharmacological class of the compound C. the company developing the drug has the final decision on the generic name D. drugs are usually marketed using the generic name E. none of the above statements are true. Drug Absorption, Distribution and Elimination 2. A major advantage of the rectal route of administration is that the drug is A. subjected to a full (100%) first-pass effect. B. subjected to about half of the first-pass effect. C. not subjected to any (0%) first-pass effect. D. absorbed as rapidly as when applied intravenously. E. always absorbed extremely slowly. 3. A. B. C. D. E. 4. A. B. C. D. E. 5. A. B. C. D. E. 6. A. B. C. D. E. The apparent volume of distribution of a drug will be increased by active transport of the drug out of blood cells. tight binding to plasma proteins. exclusion from the intracellular space. increasing the plasma half-life. tight binding to peripheral tissues. The loading dose of a drug can be calculated knowing the desired plasma concentration and rate of excretion. rate of metabolism. apparent volume of distribution. rate of elimination. its fractional binding to plasma proteins. Sulfation is an example of Phase I drug metabolism. Phase 2 drug metabolism. drug oxidation. drug reduction. biliary recycling. A weakly acidic drug at a pH above its pKa: Will be more lipophilic than at low pH (below the pKa) Its unionized form will be more abundant than its ionized form Its rate of passive diffusion across a biological membrane would be less than at low pH Its ability to enter a lipid phase will be increased relative to at low pH Its protonated form will be most abundant relative to low pH

Pharmacokinetics 7. Which of the following statements most accurately describes a zero-order elimination? A. The half-life is independent of dose B. The drug concentration decreases exponentially with time C. A constant amount of drug is lost per hour D. Acetaminophen is eliminated by zero-order processes at therapeutic doses E. Enzymatic degradation is zero-order when the drug concentration is small compared with the Michaelis constant of the metabolizing enzyme 8. A. B. C. D. E. What is the clearance of a drug in a 70 kg patient in which the elimination is first-order with a half time of 3 hours and a volume of distribution of 0.43 liter/kg? 0.5 liter/hour 1 liter/hour 2 liter/hour 5 liter/hour 7 liter/hour

9.

A. B. C. D. E.

A patient on digoxin therapy reports signs of toxicity, nausea with occasional vomiting. The plasma digoxin level in this patient is 4 ng/mL. The half-life for elimination of digoxin is 2 days. How long should you withhold digoxin in order to reach a safer yet propably therapuetic level of one ng/mL? 12 hours one day two days four days six days

10. Which of the following actions would decrease the fluctuations (peaks and troughs) without altering the average steady state drug level for a person on an intermittent dose regimen? A. Double the size of the dose and keep dose interval the same B. Double the dose interval and keep the size of the dose the same C. Double the dose interval and the decrease the size of the dose by one-half D. Decrease the dose interval by one half and decrease the size of the dose by one half 11. A patient taking vancomycin by intravenous infusion is changed to intermittent dosing with a bolus intravenous injection given at a dose interval of every 6 hours. Which of the following pharmacokinetic parameters for vancomycin change as a result of this new dose schedule? A. Volume of distribution B. Clearance C. Half-life for elimination D. The mode of elimination changes from first-order to zero-order E. None of the above Dose-Response Relationships 12. A quantal (all-or-none) dose-response relationship A. is useful to estimate a drug dose that produces 50% of a biological systems maximal response. B. relates the dose of a drug that produces a pre-defined response in a number of individuals. C. defines the maximal response a biological system can produce. D. indicates the variability of a drug response in a group of individuals. E. Both B and D are correct

13. In the graph, curve X represents a concentration-response of a full agonist. In comparison to curve X, which curve represents the concentration-response of this agonist in the presence of a non-competitive antagonist? A. Curve A B. Curve B C. Curve C D. Curve D E. Curve X

14. A. B. C. D. E. 15. A. B. C. D. E. 16. A. B. C. D. E.

If maximum efficacy of a drug X diminishes over time, the most likely explanation involves: Desensitization of the receptor system presence of a competitive antagonist. Drug X is a partial agonist. Change in potency Both B and C are correct. Therapeutic index: Indicates amount of drug absorbed to maintain concentration within therapeutic window Is an indication of a drugs half-life Is a measure of a drugs efficacy compared to partial agonist Defines the therapeutic window of a drug Is a ratio of the TD50 to ED50 and provides information on safety Which receptor system has the fastest response encompassing receptor activation to cellular effect: Steroid (nuclear) receptors Kinase-linked receptors Cytokine receptors. Channel-linked receptors G-protein coupled receptors.

Individuality and Drugs 17. Sulfonamides can displace non-conjugated bilirubin from plasma albumen. If one administers sulfonamides to a jaundiced newborn, one can expect A. an increased plasma concentration of total (bound and free) non-conjugated bilirubin. B. a decreased efficacy of the sulfonamide in comparison to its efficacy in a non-jaundiced infant. C. an increased risk for kernicterus associated with any given plasma concentration of total (bound and free) non-conjugated bilirubin. D. a decreased brain concentration of non-conjugated bilirubin. E. a decrease in the rate glomerular filtration of non-conjugated bilirubin. 18. A. B. C. D. E. Which of the following statements about the 2nd trimester maternal-fetal relationship is most valid? A healthy placenta is not permeable to most drugs. The fetus actively metabolizes most drugs, and the metabolites diffuse into mother for renal elimination. Most drugs accumulate in the fetus (relative to maternal concentrations) because fetal drug metabolism is very slow. The elimination of most drugs from the fetus depends on maternal liver and/or kidney. The fetal lung metabolizes most drugs quite rapidly in large part because of the fetal circulation.

Autonomic Pharmacology 19. Which of the following would result from sympathetic stimulation? A. dilation of the pupil B. reduced salivary gland secretion C. constriction of vascular smooth muscle D. enhanced urination E. both A and C are correct 20. A. B. C. D. E. 21. A. B. C. D. E. Which of the following nerves and paired neurotransmitter release is INCORRECT? Preganglionic parasympathetic nerve to ganglia: acetylcholine Postganglionic parasympathetic nerve to heart: acetylcholine Preganglionic sympathetic nerve to ganglia: acetylcholine Preganglionic sympathetic nerve to adrenal gland: norepinephrine Postganglionic sympathetic nerve to vascular smooth muscle: norepinephrine Stimulation of muscarinic receptors can mediate all of the following responses EXCEPT: slowing of heart rate slowing of atrio-ventricular conduction stimulation of eccrine sweating pupil contraction increase in ventricular contractility

22. A. B. C. D. E. 23. A. B. C. D. E.

Postganglionic sympathetic nerves are tonically active. never use acetylcholine as a transmitter. have cell bodies with perikarya in the thoracic region. have the same nicotinic receptors on their cell bodies as are found on striated muscle cells. have all of the above characteristics. Which of the following would you most likely observe after administering a low dose of bethanechol IV? reduced GI motility mydriasis increased blood pressure increased lacrimal gland secretions increased glycogenolysis in skeletal muscle

24. Which of the following potential effects of di-isopropylfluorophosphate (DFP) would you MOST LIKELY expect to be blocked by high dose atropine? A. increased neuromuscular transmission B. reduced neuromuscular transmission C. increased blood pressure D. miosis E. reduced blood pressure 25. A. B. C. D. E. 26. A. B. C. D. E. 27. A. B. C. D. E. 28. A. B. C. D. E. 29. A. B. C. D. E. Which of the following would you MOST LIKELY expect after IV administration of acetylcholine and atropine, together? increased GI motility arteriole constriction improved memory increased lacrimal gland secretions bradycardia Sympathetic activation is most likely to increase lipolysis and improve eye accommodation. increase lipolysis and reduce insulin secretion. cause miosis and reduce hepatic glycogenolysis. cause miosis and increase hepatic gluconeogenesis. slow heart rate and increase stomach motility and tone. Alpha-1 adrenergic selective agonist Phentolamine Phenylephrine Propranolol Metoprolol Isoproterenol All of the following drugs cause vasodilation in skeletal muscle EXCEPT: Isoproterenol Norepinephrine Epinephrine (low dose) Albuterol There are no exceptions, all cause vasodilation in skeletal muscle. Which of the following drugs will NOT significantly change mean arterial blood pressure? Phentolamine Norepinephrine Prazosin Isoproterenol Phenoxybenzamine

30. A. B. C. D. E. 31. A. B. C. D. E.

Which of the following drugs does NOT cause a reflex change in heart rate? Propranolol Norepinephrine Phenylephrine Phentolamine All of the drugs produce reflex changes in heart rate Which of the following drugs has the LEAST effect on peripheral vascular resistance after acute administration? Norepinephrine Propranolol Metoprolol Epinephrine (low dose) Phentolamine

Anithypertensives and Heart Failure 32. Produces a decrease in peripheral vascular resistance, little or mild tachycardia and hypotension usually on initial dosing. A. Prazosin B. Clonidine C. alpha-methyldopa D. Losartan E. Propranolol 33. A. B. C. D. E. 34. A. B. C. D. E. 35. A. B. C. D. E. 36. A. B. C. D. E. 37. A. B. C. D. 38. A. B. C. D. For which of the following conditions would you most likely avoid giving a nonselective beta-blocker hyperlipidema chronic obstructive pulmonary disease diabetes peripheral vascular disease with ischemia Both B and D are correct Compensatory mechanisms to maintain cardiac output during heart failure include all of the following EXCEPT: ventricular dilation vasoconstriction venoconstriction increased parasympathetic nervous system activity enhanced renin release from the kidney Digoxin increases cardiac contractility by stimulating norepinephrine release. an atropine like effect, blocking muscarinic receptors. inhibiting phosphodiesterase activity. stimulating calcium channels. inhibiting Na-K-ATPase activity leading to an increase in intracellular calcium. Common characteristics of dopamine, and dobutamine include all of the following EXCEPT: beta-adrenergic receptor agonists pro-arrhythmic tachycardia tolerance dilates renal arterioles Decreases cardiac output and lowers plasma angiotensin II levels. Enalapril Prazosin Propranolol alpha-methyl dopa Common characteristics of verapamil and propranolol include all of the following except: Lowers blood pressure Decrease cardiac contractility Constriction of airways with pre-existing asthma Decreases A-V conduction

39. A. B. C. D. 40. A. B. C. D. 41. A. B. C. D. 42. A. B. C. D.

Positive inotropic agent that can also lower heart rate and increase the atrio-ventricular node refractory period. Dopamine Nitroglycerin Digoxin Milrinone Selectively decreases afterload with a reflex increase in heart rate and atrio-ventricular conduction. Propranolol Enalapril Dobutamine Hydralazine Anti-hypertensive drug that lowers heart rate and cardiac contractility. Hydralazine Losartan Prazosin Clonidine Dilates veins and arterioles, with no increase in blood volume. Propranolol Alpha-methyl dopa Hydralazine Enalapril

43. Vasodilator that directly blocks calcium channels and can cause reflex tachycardia. A. Verapamil B. Prazosin C. Nifedupine D. Losartan 44. A. B. C. D. Digoxin can be useful in slowing a rapid ventricular response during atrial fibrillation because: usually suppresses the atrial arrhythmia decreases firing rate of the S-A node increases cardiac contractility reduces A-V conduction

45. A.P., a 71-year-old female with a blood pressure of 168/96 on 2 clinic visits also has a history of mild asthma and recurrent atrial fibrillation. She takes digoxin to control the ventricular beating rate and albuterol to manage the asthma. What therapeutic approach should be considered for the high blood pressure? A. propranolol B. nifedipine C. captopril D. hydralazine 46. J.L. is a 60-year-old male with hypertension that is currently controlled with enalapril. He has recently experienced frequent nocutia and has been diagnosed with bladder outlet obstruction due to benign prostatic hypertrophy (BPH). The following change to which drug might be benefit J.L. A. Hydrochlorothiazide B. Prazosin C. Metoprolol D. Clonidine 47. C.J. is in the coronary care unit recovering from am acute myocardial infarction. His blood pressure is barely adequate at 90/60 mmHg, he is tachycardiac (150b/m), and hemodynamic parameters reveal that he has a low cardiac output, normal vascular resistance, and adequate filling pressures. You wish to administer a drug that will rapidly improve the contractility of the heart without having a marked effect on heart rate. Which would you choose? A. digoxin B. atropine C. isoproterenol D. hydralazine E. dobutamine

Diuretics 48. Which one of the following diuretics increases urine pH? A. Hydrochlorothiazide B. Triamterene C. Furosemide D. Mannitol E. Acetazolamide 49. A. B. C. D. E. 50. A. B. C. D. E. 51. A. B. C. D. E. Which one of the following drugs activates lipoprotein lipase and promotes delivery of triglycerides to adipose tissues? Lovastatin Colestipol Gemfibrozil Nicotinic acid Vitamin E Which one of the following drugs is an aldosterone antagonist? Hydrochlorothiazide Furosemide Spironolactone Amiloride Acetazolamide Which one of the following statements about thiazide diuretics is incorrect? They inhibit sodium reabsorption by acting on the Na+/Cl- cotransporter in the distal convoluted tubule. They can decrease potassium secretion resulting in hyperkalemia. They can cause hyperglycemia. Are less efficacious than loop diuretics in producing diuresis. They are ineffective in renal disease when the GFR is low.

ANSWERS 1. B 2. A, E 3. E 4. C 5. B 6. C 7. C 8. E 9. D 10. D 11. E 12. E 13. C 14. A 15. E 16. D 17. C 18. D 19. E 20. D 21. E 22. A 23. D 24. D 25. B 26. B 27. B 28. B 29. D 30. A 31. C

32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51.

A E D E E C C C D D D C D C B E E C C B