1. Foods containing tyramine should not be eaten by patients taking: a. Fluvoxamine b. Imipramine c. Maprotiline d. Nefazodone e.

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Various Pharmacology Questions 1. Foods containing tyramine should not be eaten by patients taking: a. Fluvoxamine b. Imipramine c. Maprotiline d. Nefazodone e. Tranylcypromine 2.

1 Various Pharmacology Questions 1. Foods containing tyramine should not be eaten by patients taking: a. Fluvoxamine b. Imipramine c. Maprotiline d. Nefazodone e. Tranylcypromine 2. Which is true of Selective serotonin reuptake inhibitors? a. Are potent antagonists at cholinergic, histaminergic and dopaminergic receptors b. Can be administered intravenously c. Have less side effects compared to tricyclic antidepressants d. Have significant risk of fatal overdose e. Have marked withdrawal symptoms 3. A 19-year old female is being treated with phenobarbital to control seizures. Hepatic enzyme induction by phenobarbital can alter significantly the optimal dose of: a. Insulin b. Lithium c. Penicillin d. Tobramycin e. Warfarin 4. In the treatment of Parkinson s disease, L-dopaa. Alleviates tremor and rigidity b. Cures the disease c. Stops progression of disease d. Prevents non motor symptoms 5. Selegiline is used in the treatment of Parkinson s disease: a. As monotherapy b. Because it causes dopamine release c. Blocks peripheral catabolism of dopamine d. Blocks central metabolism of L-dopa e. to block peripheral metabolism of L-dopa

2 6. Which best describes the actions of opiates? a. Analgesics, antitussives, antidiarrheal b. Analgesics, antitussives, antiemetics c. Analgesics, sedatives, antipsychotics d. Analgesics, hypnotics, antidiarrheal e. Analgesics, anticonvulsants, antiemetics 7. An example of gaseous anesthetic which can cause B12 deficiency is: a. Halothane b. Isoflurane c. Methoxyflurane d. Nitrous oxide e. Thiopental 8. Benzodiazepines are classified as: a. Antidepressants b. Antipsychotics c. Anticonvulsants d. Analgesics e. Skeletal muscle relaxants 9. A 67-year-old male uses a topical preparation to control his open angle glaucoma and subsequently experiences episodes of tachyarrhythmias. Which of the following is most likely to produce this effect? a. Carbachol b. Epinephrine c. Pilocarpine d. Phenylephrine e. Physostigmine 10. A 59 year old comes in to the hospital with chest pain and the ER doctor starts altepase. The patient does well and is discharged after 2 days. Altepase is best described as a: a. Coronary vasodilator b. Fibrinolytic agent c. Oral anticoagulant d. Bronchodilator e. Heparinoid 11. The diuretic agent which has a tendency to cause ototoxicity is: a. Spironolactone b. Mannitol c. Acetazolamide d. Ethacrynic acid 12. The tachyphylaxis that occurs following the application of ephedrine is due to:

3 a. Blockade of nerve conduction in adrenergic nerve terminals b. Compensatory parasympathetic response c. Decreased stores of catecholamimes d. Increased breakdown of the agent ANSWERS 1. Answer E 1.Tranylcypromine, a non-hydrazine reversible MAO inhibitor, is indicated for the symptomatic treatment of depression. 2. The drug may be used to treat psychotic depressive states such as: Depressive phases of manic-depressive psychosis, involutional melancholia, reactive depressions and psychoneurotic depressions of moderate to severe intensity. 3. In combination with cheese or other foods with a high tyramine content, hypertensive crises have sometimes occurred during tranylcypromine therapy after ingestion of foods with a high tyramine content. 4. Tyramine is normally metabolized by monoamine oxidase in the intestinal and hepatic cells. When monoamine oxidase is inhibited, tyramine absorbed from the gastrointestinal tract passes freely into the circulation. 2. Answer C 1. Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants. They act within the brain to increase the amount of the neurotransmitter, serotonin (5- hydroxytryptamine or 5-HT), in the synaptic gap by inhibiting its reuptake. 2. One notable characteristic of SSRIs is that, unlike other classes of antidepressants, SSRIs were rationally designed drugs. SSRIs are frequently prescribed for anxiety disorders, obsessive-compulsive disorder, and eating disorders. SSRIs are not addictive, but suddenly discontinuing their use is known to produce both somatic and psychological withdrawal symptoms, a phenomenon known as "SSRI discontinuation syndrome". 3. Compared to the withdrawal symptoms of such drugs as opiates, alcohol or cocaine, these are slight. Their effectiveness does not appear to be higher than tricyclic antidepressants, which were the most commonly used class of antidepressants before the development of SSRIs. 4. However, SSRIs have the important advantage that their toxic dose is high, and, therefore, they are much more difficult to use as a means to commit suicide. Further, they have fewer or milder side effects. 3. Answer E 1. Phenobarbital reduces the effect of antipyrine, cimetidine, chlorpromazine, haloperidol, nortriptyline, bishydroxycoumarin and warfarin. 2. Because of the stimulation of the liver microsomal enzymes, warfarin metabolism is increased and an increase dose is required. 4. Answer A 1. L-dopa is used to alleviate some of the symptoms of Parkinson's disease,

4 particularly trembling, rigidity, and slow movements. 2. Parkinson's disease results when the concentration of dopamine in the brain is depleted (see catecholamine). Medical administration of dopamine itself is ineffective since that chemical apparently does not enter the brain from the blood. 3. A metabolic precursor of dopamine, L-dopa does enter the brain via the bloodstream and is probably converted into dopamine there. Because there are many brain disorders with similar symptoms, many patients do not show any improvement when treated with the drug. 4. Furthermore, virtually all patients on l-dopa experience side effects including nausea, loss of appetite, cardiac irregularities, and psychological changes. 5. Answer C 1. Selegeline inhibits MAO enzymes (type B) and prevents the breakdown of dopamine. 6. Answer A 1. Opioids are widely used in medicine as strong analgesics (pain relievers). 2. One of the advantages of opioids is that there is no upper limit to the dosage and the achievable pain relief as long as the dose is increased gradually to allow tolerance to develop to adverse effects (especially respiratory depression). 3. The main clinical indications of opioids include moderate-to-severe acute pain and chronic pain, cough (mainly codeine), diarrhea (mainly loperamide and diphenoxylate used therapeutically) and relief of severe dyspnea (e.g. lung cancer, terminal COPD) 7. Answer D 1. Nitrous oxide is a dissociative anesthetic which causes euphoria, dizziness, and, in some cases, a mild aphrodisiac effect. It can also result in mild nausea or lingering dizziness if too much is inhaled in too short a time. 2. The anaesthetic function of nitrous oxide is not completely understood, but it is thought that the gas interacts with the plasma membranes of nerve cells in the brain and thus affects the communication among such cells at their synapses. 3. Some people use nitrous oxide for its psychological effects. While the gas itself is not toxic, death can result if it is inhaled in such a way that not enough oxygen is breathed in. 4. Long-term use in large quantities has been associated with symptoms similar to vitamin B12 deficiency: anemia and neuropathy. It can be habit-forming, mainly because of its short-lived effect and ease of access. 8. Answer E 1. The benzodiazepine family of drugs are used therapeutically to produce sedation, induce sleep, relieve anxiety, muscle spasms, and to prevent seizures. 2. In general, benzodiazepines act as hypnotics in high doses, anxiolytics in moderate doses, and sedatives in low doses. 3. Of the drugs marketed in the United States that affect central nervous system function, benzodiazepines are among the most widely prescribed medications.

5 9. Answer B 1. Epinephrine s primary effects, when given topically or intravenously, include peripheral vasoconstriction with resultant increase in diastolic and systolic blood pressures, small increases in cardiac output and an increase in heart rate. 10. Answer B 1. Alteplase can dissolve blood clots that form in the heart, blood vessels, or lungs after a heart attack, or some other disease process. 2. Alteplase is called a thrombolytic agent and works best when it is given soon after the onset of heart attack symptoms. Generic alteplase injections are not yet available 11. Answer D 1. Deafness, tinnitus and vertigo with a sense of fullness in the ears, and blurred vision have occurred. Anorexia, malaise, abdominal discomfort or pain, dysphagia, nausea, vomiting, and diarrhea have occurred. 2. These are more frequent with large doses or after one to three months of continuous therapy. 3. A few patients have had sudden onset of profuse, watery diarrhea. Discontinue edecrin if diarrhea is severe and do not give it again. 4. Gastrointestinal bleeding has occurred in some patients. 12. Answer C 1. The tachyphylaxis is the result of a rapid emptying of the transmitter substance from the synaptic vesicles. 2. Ephedrine per se has no direct effect on the smooth muscle receptors that mediate the change in blood pressure. Rather, the elevated blood pressure is produced indirectly by stimulating the release of the neurotransmitter from nerve terminals. 3. Repeated dosages of the drug in rapid succession release the transmitter faster than it can be replaced, and the effectiveness of the drug declines. 4. These conclusions are further supported by the observations that norepinephrine administration not only produces an increase in blood pressure, but it also partially restores the effectiveness of ephedrine. 5. The restoration occurs because the reuptake process incorporates some of the norepinephrine into the vesicles where it can be released by the next dosage of ephedrine. Check out our Continuing Education offers!

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