26.

Oral administration of grapefruit juice increases the bioavailability of a variety of drugs, including
felodipine, midazolam, saquinavir, and verapamil. After oral administration of any one of these drugs,
which of the following is most likely to be increased in the presence of grapefruit juice?
(A) Hepatic CYP3A4 activity
(B) Intestinal drug metabolism
(C) Peak serum concentration
(D) Total body clearance
(E) Volume of distribution
 C ./0123456 bioavailability 7859:;3 <=><?@/A2395B/CDE.>F8GH1.>F/G53456IJ5K7/?3GHB1 7L95.AL5MEB/
6CNK<.O02> 65CGH1 bioavailability A2395.PF18A;Q/ K<>3@?595/?54N8HR@58.AL8AL/<D3<S>B/ serum .PF18A;Q/ AL2
A KON B TF>./0123456:L5.PF81 A;Q/4NGJ5B7L bioavailability A2395O>O3 AL2 D KON E TF>./0123456.EU/EV44=9GH1
4N.6H19@AL237O=345695.AL5MEB/6CNK<.O02>KOL@

51. Four drugs produce the same therapeutic effect by the same mechanism, but each has a unique
toxicity. When used at a maximally effective therapeutic dose, the drug with which of the following sets
of characteristics is most likely to have the highest incidence of toxicity?
Median Toxic Dose1 /
Effective Dose Effective Dose99
(A) 0.5x 2.8
(B) 1x 2.1
(C) 5x 4.0
(D) 33x 3.0
 B b>9>D456R?5 certain safety factor (CSF) d;13 = LD1/ED99 7C02 TD1/ED99 /=1/.23 R?5GH1.EU/PFg<D3
4N8HR?5 certain safety factor I1J5 R02 A/5>95GH1GJ5B7LI597C02.6F>PFgB6OL.RH936=hA/5>95GH1B7LTO65CC=6g5
57. The circles represent the size of a patient's pupils without treatment and following treatment with
tyramine and with epinephrine. Which of the following is compatible with the findings shown for the left
eye?
(A) Blockade of α-adrenergic receptors
(B) Blockade of β-adrenergic receptors
(C) Blockade of muscarinic receptors
(D) Inhibition of cholinesterase
(E) Sympathetic denervation
 E AL2/HQIL234J5M>L@?5CNhhECN<5G sympathetic GJ5B7LCD8?5/I5A959T?5/G53 α-adrenergic B/AkNGH1
CNhhECN<5G parasympathetic GJ5B7LCD85? /I57>T?5/G53 muscarinic cholinergic 456CDE4N.7l/@?5CD8?5/I5
dL59.Ol66@?5CD8?5/I5A@5.8012M8?M>LC=6g5 K<>3@?58H65C6CNISL/ parasympathetic .PF18A;Q/ 7C026CNIS/L
sympathetic /L29O3B/I5dL59 .8012B7L tyramine d;13.EU/ indirect sympathomimetic Ph@?5M8?8HTOI?2I5dL59
4;3<2>ROL236=h sympathetic denervation A23I5dL59 <?@/65CC=6g5>L@9 epinephrine 8HTOI?2I5dL5929?53
856 4;3I=>AL2 A M>L./012345665C block α-adrenergic receptor 4N block TOA23 epinephrine, I=>AL2 B M>L
./0123456 β receptor M8?.6H91 @AL236=h65C7>7C02A959CD8?5/I5, I=>AL2 C M>L./0123456I5dL597>.8012M8?M>L
C=6g5 M8?M>LA95929?53GH1R@C4N.EU/B/6CkHGH1M8?8HI@= 85IL5/65C6CNIS/L sympathetic, I=>AL2 D M>L./0123456
tyramine 226mGnFoG53 adrenergic M8?Bp? cholinergic
58. A 50-year-old man being treated for increased serum LDL concentration has muscle pain that has
recently become more severe, especially with exercise. He is most likely to be taking a drug with which of
the following mechanisms of action?
(A) Binding bile acids
(B) Decreasing binding of bile acids
(C) Decreasing production of LDL
(D) Decreasing the activity of lipoprotein lipase
(E) Inhibiting the activity of 3-hydroxy-3-methylglutaryl (HMG) CoA reductase
 E ./01234568HC5935/@?5956OS?8 statins d;13.EU/ HMG CoA reductase inhibitors .EU/PFgI?26OL58./0Q2
KONGJ5B7L.6F> rhabdomyolysis

71. A 40-year-old woman receives an intravenous infusion of drug X that selectively constricts the
efferent arterioles in her kidneys. Following the infusion, total cardiac output and renal afferent arteriolar
tone are unchanged, but renal efferent arteriolar tone and total renal vascular resistance have both
increased. Which of the following sets of changes most likely occurred following the infusion of drug X?
Glomerular Filtration Rate Filtration Fraction Renal Blood Flow
(A) ↓ ↓ ↑
(B) ↓ ↑ ↓
(C) ↓ ↑ ↓
(D) ↑ ↓ ↓
(E) ↑ ↑ ↓

.tO9 E ./0123456.O02>M7O456 afferent arteriole .AL5MEB/ capillary A23 glomerulus KOL@226456

glomerulus .AL5MEB/ efferent arteriole :L5 afferent arteriole 8H resistance .PF18A;Q/4NGJ5B7L glomerular
filtration rate (GFR), renal blood flow KONR@58>=/.O02>B/ capillary O>O3 KI?:L5 efferent arteriole 8H
resistance .PF18A;Q/ (IC36=hb4G9vd;13h26@?5 efferent arteriole 8H tone .PF18A;Q/) 4NGJ5B7L glomerular filtration
rate KON capillary blood pressure .PF18A;Q/B/AkNGH1 renal blood flow O>O3
96. A 45-year-old woman who is being treated for hypertension and hypercholesterolemia develops
diffuse muscle pain and weakness. Her serum creatine kinase activity is increased. Which of the following
drugs is most likely to have caused this clinical picture?
(A) Captopril
(B) Hydrochlorothiazide
(C) Lovastatin
(D) Nicotinic acid
(E) Propranolol
 C >L@9.7ISTO.>H9@6=hAL2 58.

99. A 30-year-old woman being treated for hypertension has the sudden onset of fever and malaise. Her
temperature is 38.3°C (101°F), and blood pressure is 120/80 mm Hg. Physical examination shows a malar
rash, swelling and tenderness of the wrists and knees, and a friction rub at the lower left sternal border.
Which of the following drugs is the most likely cause of these findings?
(A) Captopril
(B) Hydralazine
(C) Minoxidil
(D) Nitroprusside
(E) Propranolol
 B ./01234562565CA23TDLEz@9.AL5M>L6h= lupus erythematosus (LE) 95B/ choice GH1 induce lupus
erythematosus R02 hydralazine (95201/{ M>LK6? chlorpromazine, isoniazid, methyldopa, penicillamine,
procainamide, quinidine, sulfasalazine .EU/IL/)
100. A 52-year-old man with chronic obstructive pulmonary disease who has been taking theophylline for
14 years now requires treatment for hypertension, peptic ulcer, and tuberculosis. After 2 weeks of therapy,
he has a toxic plasma theophylline concentration. Which of the following drugs is most likely to have
caused the theophylline toxicity?
(A) Cimetidine
(B) Hydrochlorothiazide
(C) Prazosin
(D) Rifampin
 A ./012345665CGH1R@58.AL8AL/A23 theophylline B/ plasma <D3A;Q/4/.6F>PFgK<>3@?595/?54N:D6
metabolize /L29O3 95B/ choice GH19=h9=Q3CNhh cytochrome P-450 microsomal enzyme R02 cimetidine (95
201/{ .p?/ ciprofloxacin)

122. The diagram shows the equilibrium between active and inactive forms of a receptor (R), its
interaction with a drug (V), and the coupling of the active form of the receptor to a signal transduction
pathway. Drug W acts at site Y of the signal transduction pathway to diminish the physiologic effect of
drug V. Which of the following terms accurately describes the effect of drug W on the dose-response
curve for drug V?
(A) Competitive antagonism
(B) Full agonism
(C) Noncompetitive antagonism
(D) Partial agonism
(E) Reverse agonism
 C ./012345695 W )TOA2395 V (antagonism) b>9226mGnFoG*H1 +,-./01+236=h95 V
(noncompetitive)
128. A 12-year-old boy has a pruritic, coin-shaped, scaly erythematous lesion with a raised border
and central clearing on his right arm. Potassium hydroxide preparation results are consistent with
tinea corporis. A drug with which of the following mechanisms of action is most likely to be effective?
(A) Blockade of ergosterol synthesis
(B) Inhibition of DNA synthesis
(C) Inhibition of ribosomal protein synthesis
(D) Interference with mycolic acid synthesis
(E) Irreversible binding to DNA-dependent RNA polymerase
 A b4G9v/HQ.EU/65C7595GH1BpLC=6g56O56 AL2 A .EU/6OM665C226mGnFoA23956OS?8 azoles (.p?/
miconazole) d;13BpLC=6g56O56M>L

130. A 55-year-old man develops loss of visual accommodation while taking an antidepressant
drug. The most likely cause is blockade of which of the following receptors?
(A) α-Adrenergic
(B) β-Adrenergic
(C) Histaminergic
(D) Muscarinic
(E) Serotoninergic
 D ./012345665CGH1 visual accommodation KON papillary reactivity O>O3d;13GJ5B7L.7l/|5P.hO28=6.EU/
2565CAL53.RH93G53 anticholinergic 95K6Ld;8.}CL5h53I=@29?53.p?/6OS8? tricyclic antidepressants GJ5B7L.6F>
2565C/HQC?@86=h2565CG53 anticholinergic 201/{ .p?/ GL23TD6 E56K7L3
132. A 30-year-old man with peptic ulcer disease suddenly develops pain, redness, and swelling of his
right first metatarsophalangeal joint. There is no history of injury. Serum uric acid concentration is 8
mg/dL. Examination of joint aspirate shows birefringent crystals. Which of the following drugs is most
appropriate to treat the acute symptoms in this patient?
(A) Allopurinol
(B) Colchicine
(C) Morphine
(D) Probenecid
(E) Sulfinpyrazone
 B ./0123456b4G9v:58:;395C=6g5 acute symptoms A23 gout AL2 A, D KON E BpLC=6g5 gout 6l4CF3KI?
M8?Bp?.8012.6F>2565CE@> K>3 h@8.tH9hPO=/ /26456/HQ sulfinpyrazone 9=38H2565CAL53.RH93I?2G53.>F/
2575C KONGJ5B7L peptic ulcer CS/KC3A;Q/ 4;3M8?.785N<86=hTDLEz@9B/b4G9v <?@/AL2 C M8?M>LBpL6=h2565C
E@>B/ gout

150. A semicomatose 16-year-old boy is brought to the emergency department by his parents. He recovers
full consciousness in 2 hours. He quit high school last month. While he is in the hospital, a friend is
caught sneaking cocaine to him. He appears irritable and depressed, and says he uses drugs to feel "high."
Which of the following neurotransmitters are most likely to be involved in the development of
dependence in this patient?
(A) Acetylcholine and serotonin
(B) γ-Aminobutyric acid (GABA) and epinephrine
(C) Histamine and glycine
(D) Nitric oxide and neurotensin
(E) Norepinephrine and dopamine
 E b4G9v.PH93KI?:58@?5<5C<012ECN<5GB>GJ5B7L.6F> euphoria KONGJ5B7LIF>95 I2h dopamine 4N
:D6IL23GH1<S> (cocaine .EU/ dopamine reuptake inhibitor, noradrenaline reuptake inhibitor KON serotonin
reuptake inhibitor)