BEFORE YOU START: PLEASE NOTE THESE IMPORTANT ITEMS

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1 BEFORE YOU START: PLEASE NOTE THESE IMPORTANT ITEMS USING #2 PENCIL, MAKE SURE THAT BOTH YOUR NAME, UW AND SCHOOL OF MEDICINE TEST ID (SPECIAL CODES) NUMBERS ARE CODED ON THE ANSWER SHEET AND WRITTEN ON ALL SHORT-ANSWER PAGES NOW - BEFORE YOU BEGIN. PAGES WITHOUT STUDENT NAME AND NUMBERS MAY NOT BE RECORDED. THIS EXAMINATION IS TIME LIMITED ANSWER SHEETS TURNED IN LATE WILL NOT BE GRADED. THIS EXAMINATION (100 POINTS TOTAL) CONTAINS 49 MULTIPLE CHOICE QUESTIONS (1-28 and X01 X21) ON 10 PAGES MAKE SURE ALL PAGES ARE PRESENT. PUT ANSWERS FOR ITEMS 1 28 ON THE FRONT, AND FOR ITEMS X01 X21 ON THE BACK OF THE BACK OF THE ANSWER SHEET USING #2 PENCIL BE SURE TO TURN IN ANSWER SHEET and KEEP YOUR COPY OF THE QUIZ Some useful formulae: natural logarithm of 2 = F = AUCoral/AUCIV CL = Kelim * Vd Kelim = 0.693/half life half life = * Vd/CL CL = * Vd/half life Css = dosing rate * F/CL Vd = dose/conc Some commonly encountered abbreviations BID (twice daily) BPM beats per minute COPD chronic obstructive pulmonary disease GERD gastroesophageal reflux disease HT hypertension IM intramuscular, intramuscularly PRN (as needed) QID (four times daily) SOB shortness of breath BP blood pressure CHF congestive heart failure FEV 1 forced expired volume in 1 sec HR heart rate HS (at bedtime) IV intravenous, intravenously QD (daily) SubQ subcutaneous, subcutaneously TID (three times daily) HuBio 543 Quiz #3 November 12, 2004 Page 1

2 I. SELECT ONE BEST (4 points each). Each numbered item or incomplete statement in this section is followed by answers or completions of the statement. For items 1 through 14 select the ONE lettered answer or statement that is BEST. 1. A 56-year-old male with atrial fibrillation is being treated with digoxin (0.5 mg daily, PO [a fairly high dose]) to control ventricular rate. The patient is, nevertheless, experiencing some mild edema and the attending physician wishes to add a diuretic agent. Which of the following possible agents would be the most likely to promote digoxin toxicity in this patient? A) acetazolamide B) bumetanide C) mannitol D) triamterene E) spironolactone 2. Which of the following is the most likely mechanism of the therapeutic effect of sublingual nitroglycerin in patients with stable angina? A) activation of endothelial muscarinic receptors causing release of NO B) blockade of vascular smooth muscle alpha receptors causing hypotension C) decreased demand for oxygen by the heart D) increased coronary blood flow E) prevention of coronary artery spasm 3. Which of the following drugs is LEAST appropriate for treating a patient with hypertension and heart failure? A) enalapril B) hydrochlorothiazide C) losartan D) prazosin E) verapamil 4. Treatment of hyperlipidemia with gemfibrozil plus simvastatin is associated with an increased risk of: A) constipation B) glucose intolerance C) myopathy D) coronary heart disease E) thrombocytopenia HuBio 543 Quiz #3 November 12, 2004 Page 2

3 SELECT ONE BEST (4 points each). 5. A 77-year old retired carpenter presents with poorly controlled hypertension and complains of palpitations and dyspnea. His electrocardiogram reveals atrial fibrillation with an irregular ventricular rate of beats per minute. Administration of digoxin to this patient would be expected to slow the ventricular rate by: A) decreasing vagal tone B) decreasing ventricular automaticity C) decreasing ventricular preload D) increasing the AV nodal refractory period E) increasing the stroke volume 6. Which of the following anticancer drugs is not considered to be cell cycle dependent? A) methotrexate B) 5-fluoruracil C) hydroxyurea D) mechlorethamine E) paclitaxel (taxol) 7. Which of the following drugs cause their therapeutic effects primarily by production of free radicals? A) doxorubicin B) bleomycin C) vincristine D) traztuzumab (Herceptin ) E) cisplatin 8. Most nitrogen mustards cause cellular necrosis if extravasated during injection. Cyclophosphamide does not because it: A) is not a nitrogen mustard B) is rapidly destroyed by extracellular enzymes C) does not produce free radicals D) lacks phospholipid binding activity E) requires activation in the liver HuBio 543 Quiz #3 November 12, 2004 Page 3

4 SELECT ONE BEST (4 points each). 9. In a patient with impaired renal function (creatinine clearance = 30 ml/min) it is essential to lower the loading dose of: A) tobramycin B) chloramphenicol C) doxycycline D) erythromycin E) none of the above 10. You are asked by your resident to compare the properties of ketoconazole and fluconazole. Each of the following would be an appropriate response EXCEPT: A) both are active orally B) fluconazole penetrates into the CSF better C) ketoconazole has a greater tendency to disturb steroid synthesis D) both are more effective than amphotericin B for serious systemic infections E) both act by inhibiting ergosterol synthesis 11. Your patient has an initial tumor burden of cells and after a single treatment with cyclophosphamide and vincristine you find that 10 6 cells remain. What is the log kill of this treatment? A) 4 B) 5 C) 6 D) 7 E) not enough data given 12. What is the basis for the selective toxicity of acyclovir to HSV infected cells? A) acyclovir inhibits viral protein synthesis B) acyclovir is preferentially phosphorylated in HSV infected cells C) acyclovir inhibits a protease required for processing of viral coat proteins D) acyclovir binds to viral coat proteins and prevents assembly E) inhibition is due to intercalation of the drug into the viral DNA HuBio 543 Quiz #3 November 12, 2004 Page 4

5 SELECT ONE BEST (4 points each). 13. Your patient is being treated with multiple drugs for a suspected systemic fungal infection complicated by bacterial pneumonia. During the course of therapy the patient begins to show an elevated blood urea nitrogen, high creatinine, and hypokalemia. Which of the drugs listed below would be the most likely to cause these side effects? A. fluconazole B. flucytosine C. amphotericin B D. meropenem E. ciprofloxacin 14. Which one of the following antiviral drugs is NOT correctly paired with the mechanism by which it acts? A) Acyclovir causes DNA chain termination B) Indinavir inhibits the HIV protease C) Lamivudine inhibits reverse transcriptase D) Efavirenz inhibits reverse transcriptase E) Foscarnet blocks viral attachment and uptake HuBio 543 Quiz #3 November 12, 2004 Page 5

6 II. A, B, BOTH, NEITHER (2 points each). For items 15 through 23 select: A) if A is correct B) if B is correct C) if BOTH A AND B are correct D) if NEITHER A NOR B is correct 15. Bone marrow toxicity may occur and can be life-threatening after treatment with: A) etoposide B) chloramphenicol 16. Mechanism of therapeutic action involves disruption of a DNA gyrase/topoisomerase type enzyme: A) ciprofloxacin B) irinotecan 17. Drug combinations that act synergistically because of their mechanisms of action: A) amphotericin B and itraconazole B) trimethoprim and sulfamethoxazole 18. Requires enzymatic modification to an active form for therapeutic effect: A) isoniazid B) cytosine arabinoside HuBio 543 Quiz #3 November 12, 2004 Page 6

7 A, B, BOTH, NEITHER (2 points each). 19. Radiation recall might be a potential problem with: A) fluorouracil B) doxorubicin 20. The multidrug resistance gene (mdr-1) codes for a transporter that pumps which of these drugs out of cancer cells, making them resistant to therapy. A) actinomycin D B) doxorubicin 21. The development of isoniazid resistant tuberculosis has become an emerging problem worldwide. Isoniazid resistance is likely to occur by: A) mutation of a catalase like gene required for activation of drug B) induction of isoniazid acetylase 22. Potentially useful in the treatment of digoxin overdosage: A) potassium B) propranolol 23. Inhibitor of cyclic nucleotide phosphodiesterase (PDE): A) milrinone B) sildenafil HuBio 543 Quiz #3 November 12, 2004 Page 7

8 III. GREATER THAN LESS THAN (1 point each) For items 24 through 28 select: A) if A is GREATER THAN B B) if B is GREATER THAN A C) if BOTH A and B are EQUAL or NEARLY EQUAL 24. Dependence on intracellular stores of calcium ion for excitation-contraction coupling: A) skeletal muscle B) smooth muscle 25. Free ionized calcium concentration (Ca 2+ ) in: A) cytosol of contracting heart muscle cells B) blood plasma 26. Predicted duration of standardized exercise in a patient with stable angina treated with: A) placebo B) propranolol 27. Duration of action of: A) nitroglycerin in the treatment of stable asthma B) isosorbide dinitrate in the treatment of stable angina 28. Refractory period of the AV node in a digitalized patient with a: A) normal heart B) transplanted heart HuBio 543 Quiz #3 November 12, 2004 Page 8

9 NOTE: IN ORDER FOR YOU TO PROPERLY ANSWER ITEMS X01 X21, YOU MUST PUT YOUR ANSWERS ON THE BACK OF THE ANSWER SHEET. Matching. Below is a list of drugs arranged alphabetically by their generic names. For items X01- X21 choose the corresponding letter which BEST matches the description. Use each item once and only once (one point each). A) amiodarone B) amlodipine C) atorvastatin D) bretylium E) cholestyramine F) creatinine G) hydralazine H) hydrochlorothiazide I) imipramine J) lidocaine K) lisinopril L) losartan M) milrinone N) niacin O) nitroglycerin P) quinidine Q) sodium nitroprusside R) spironolactone S) torsemide T) triamterene U) verapamil HuBio 543 Quiz #3 November 12, 2004 Page 9

10 Matching (1 point each) (we suggest removal of this page for ease of matching) X01. agent given intravenously for the treatment of malignant hypertension X02. antagonizes the antihypertensive effect of guanethidine X03. antagonizes angiotensin receptors (AT-1) X04. antagonist of mineralocorticoid receptors in kidney cells X05. antiarrhythmic drug that prevents release of catecholamines from sympathetic nerve terminals X06. sequesters bile acids and decreases plasma cholesterol levels X07. class IB antiarrhythmic X08. class III antiarrhythmic X09. commonly employed indicator of glomerular filtration rate X10. decreases cholesterol levels, flushing a common dose-limiting side effect X11. direct acting inhibitor of vascular smooth muscle X12. drug of choice for the treatment of acute attacks in patients with stable angina X13. inhibitor of cyclic nucleotide phosphodiesterase in cardiac muscle X14. inhibitor of an early enzymatic step in the synthesis of cholesterol X15. inhibitor of Na channels in renal epithelial cells X16. inhibitor of Na-Cl symport mechanism in kidney X17. inhibitor of Na-K-2Cl symport mechanism in kidney X18. inhibitor of plasma membrane Ca channels in heart and smooth muscle X19. inhibitor of plasma membrane Ca channels, selective for vascular smooth muscle X20. may cause accumulation of bradykinin X21. overdosage leads to a cluster of signs and symptoms known as cinchonism This is the end of the quiz. Good Luck. Have a great weekend. HuBio 543 Quiz #3 November 12, 2004 Page 10