BEFORE YOU START: PLEASE NOTE THESE IMPORTANT ITEMS

Transcription

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 (300 POINTS TOTAL) CONTAINS 113 MULTIPLE CHOICE QUESTIONS (1-70 and X01 X43) AND 2 SHORT ANSWER QUESTIONS ON 25 PAGES MAKE SURE ALL PAGES ARE PRESENT. PUT ANSWERS FOR ITEMS 1-70 ON THE FRONT, AND FOR ITEMS X01 X43 ON THE BACK OF THE BACK OF THE ANSWER SHEET USING #2 PENCIL BE SURE TO TURN IN ANSWER SHEET AND THE SHORT ANSWER PAGE YOU MAY KEEP YOUR COPY OF THE EXAMINATION 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 CHF congestive heart failure COPD chronic obstructive pulmonary disease ER estrogen receptor GERD gastroesophageal reflux disease HT hypertension IM intramuscular, intramuscularly PRN (as needed) QID (four times daily) SOB shortness of breath BP blood pressure camp cyclic adenosine monophosphate CYP cytochrome P450 enzyme 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 Final Examination December 9, 2005 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 43 select the ONE lettered answer or statement that is BEST. 1. Acts on the central nervous system after systemic administration: A) echothiophate B) ipratropium C) methacholine D) physostigmine E) succinylcholine 2. A beta-adrenergic antagonist is contraindicated in a patient with: A) anxiety B) asthma C) glaucoma D) hypertension E) pheochromocytoma 3. Indicated with 2-PAM (pralidoxime) in the treatment of organophosphate poisoning: A) atenolol B) atropine C) phentolamine D) succinylcholine E) none of the above 4. The change in heart rate due to IV administration of phenoxybenzamine could be blocked by pretreatment with: A) botulinum toxin B) mecamylamine C) propranolol D) reserpine E) all of the above 5. Would potentiate the vasopressor effect due to subsequent administration of norepinephrine: A) acetylcholine B) cocaine C) labetalol D) phentolamine E) prazosin HuBio 543 Final Examination December 9, 2005 Page 2

3 SELECT ONE BEST (4 points each). 6. Indicated in the treatment of malignant hyperthermia: A) acetylcholine B) dantrolene C) neostigmine D) pilocarpine E) tiotropium 7. IV administration causes an increase in total peripheral resistance and a decrease in heart rate: A) acetylcholine B) dobutamine C) isoproterenol D) phenylephrine E) none of the above 8. The main pathway for the termination of the action of norepinephrine is mediated by: A) catechol-o-methyltransferase B) dopa decarboxylase C) monoamine oxidase D) tyrosine hydroxylase E) none of the above 9. A low IV dose of dopamine would: A) block beta-adrenergic receptors in the heart B) cause vasodilation of mesenteric vasculature C) cause vasodilation of skeletal muscle vasculature D) cause vasoconstriction of skeletal muscle vasculature E) none of the above 10. A five year old male is brought into the emergency room in an abnormal mental state. His skin is red and dry, and he has a fever and tachycardia. The pupils are widely dilated. It is suspected that he may have accidentally ingested one of a number of agents available in the home of his grandparents. Given the symptoms, it appears that he may be overdosed on any of the following EXCEPT: A) atropine B) chlorpheniramine C) imipramine D) pilocarpine E) scopolamine HuBio 543 Final Examination December 9, 2005 Page 3

4 SELECT ONE BEST (4 points each). 11. Adverse reactions caused by thiazides include each of the following EXCEPT: A) hypercalcemia B) hypoglycemia C) hypokalemia D) hyperlipidemia E) hyperuricemia 12. The usefulness of nitroglycerin in the treatment of stable angina is limited by each of the following EXCEPT: A) headache B) negative inotropic effect C) short duration of action D) tachycardia E) tolerance 13. A 28 year old college student with a history of moderately persistent asthma presents to the emergency department with dyspnea. He is sweating, anxious and using all accessory muscles to breath. Vital signs are: pulse 120, BP 140/95, RR 30, T 37.2 C, O2 saturation on room air is 92%. The diagnosis is acute asthma. In addition to oxygen and magnesium each of the following agents may be appropriate in the initial management of this patient EXCEPT: A) albuterol B) epinephrine C) ipratropium bromide D) prednisone E) salmeterol 14. A 58 year old male with hyperlipidemia has been treated with a statin drug for the past year. Control of lipid levels has been less than anticipated. Thus, it was recommended that an agent that inhibits the absorption of bile acids be tried instead. Which of the following agents would be most appropriate? A) atorvastatin B) cholesterol C) colestipol D) gemfibrozil E) niacin HuBio 543 Final Examination December 9, 2005 Page 4

5 SELECT ONE BEST (4 points each). 15. Drug synergism is also known as: A) denervation supersensitivity B) desensitization C) physiological antagonism D) potentiation E) tolerance 16. Some potential for abuse. Use may lead to low to moderate physical dependence or high psychological dependence. Prescriptions may be oral or written. Up to 5 renewals are permitted within 6 months. The controlled substance classification that best fits this description is: A) I B) II C) III D) IV E) V 17. Each of the following agents that reduces arterial blood pressure does so by interfering with the activity of some part the sympathetic nervous system EXCEPT: A) amlodipine B) bretylium C) guanethidine D) propranolol E) reserpine 18. Which of the following is the best description of Phase III Clinical Drug Investigation? A) large number of normal human volunteers to determine toxicity in people B) large number of patients with a target illness C) patients in clinical practices monitored for toxicity D) small number of normal human volunteers to determine dose in people E) small number of patients with a target illness HuBio 543 Final Examination December 9, 2005 Page 5

6 SELECT ONE BEST (4 points each). 19. A 29 year old female research lab technician has recently become pregnant. She describes to you that she is willing to take any drugs that you feel are needed during her pregnancy. She is even willing to take drugs for which there have been reports of risk in animals as long there is no evidence of risk in humans. In essence, she is telling you that she is willing to take drugs with the FDA Use-in-Pregnancy Rating of: A) A B) B C) C D) D E) X 20. One CYP isoenzyme is noteworthy in that it is highly expressed in the small intestine as well as the liver: A) 1A2 B) 2C9 C) 2C19 D) 2D6 E) 3A4 21. Each of the following drugs used in the treatment of asthma, is considered to be a controller EXCEPT A) beclomethasone dipropionate B) montelukast C) salmeterol D) terbutaline E) zileuton 22. A 40 year old female hospital administrator presents in the emergency department with diffuse pruritis, generalized urticaria and moderate wheezing and dyspnea. Her lips and face are swollen. The diagnosis is anaphylaxis. In addition to oxygen, each of the following medications is indicated EXCEPT: A) albuterol B) digoxin immune Fab C) diphenhydramine D) epinephrine E) prednisone HuBio 543 Final Examination December 9, 2005 Page 6

7 SELECT ONE BEST (4 points each). 23. A 72-year old male, former smoker presents to the emergency department with a severe exacerbation of his underlying COPD and a possible pneumonia on top of long-standing hypertension. In addition to (titrated) oxygen each of the following drugs is indicated EXCEPT: A) albuterol to help relax airways B) an antibiotic selected to treat the pneumonia C) ipratropium to help relax airways and reduce bronchiolar secretions D) nadolol to reduce blood pressure E) prednisone to reduce inflammatory responses 24. The pd2 of drug Y in an isolated tissue chamber is the negative logarithm of the concentration of drug Y that: A) produces a 2-fold increase in contractions B) produces a 2-fold increase in the contraction produced by an agonist drug Z C) produces a two-fold shift to higher concentrations of the concentration effect relationship of the agonist drug Z D) causes a half-maximal effect E) increases by two-fold the maximal response produced by an agonist drug Z 25. A 50 year old female school bus driver with paroxysmal supraventricular tachycardia is being treated with digoxin (0.5 mg daily, PO [a fairly high dose]) to control ventricular rate. She has been having some coughing and wheezing during an air pollution alert. Which of the following agents would be most useful to minimize ventricular rate in this patient without increasing digoxin toxicity or exacerbating her asthma? A) atenolol B) diltiazem C) furosemide D) propranolol E) spironolactone 26. Each of the following mechanisms is involved in the therapeutic effect of sublingual nitroglycerin in patients with stable angina EXCEPT: A) activation of guanylate cyclase B) decreased demand for oxygen by the heart C) efflux of Ca from vascular smooth muscle cells D) increased total coronary blood flow E) release of NO HuBio 543 Final Examination December 9, 2005 Page 7

8 SELECT ONE BEST (4 points each). 27. Treatment of hyperlipidemia with atorvastatin plus niacin is associated with an increased risk of: A) constipation B) coronary heart disease C) glucose intolerance D) myopathy E) thrombocytopenia 28. Filgrastim (G-CSF) would be expected to be useful in limiting the toxicity associated with: A) tobramycin B) cyclophosphamide C) imatinib (Gleevec ) D) trastuzumab (Herceptin ) E.) glucocorticoids 29. Which of the following statements about the estrogen receptor (ER) is incorrect? A) when ERalpha binds estradiol it can interact with DNA elements to induce gene expression B) ERbeta can bind to tamoxifen and lead to gene induction C) estrogen receptors must bind directly to DNA to cause cellular effects D) tamoxifen acts as both an antagonist and agonist of ER depending on the tissue E) MAP kinase signaling pathways are induced by ER ligands 30. Irreversible aplastic anemia is a rare but frequently fatal side effect associated with: A) clindamycin B) bleomycin C) acyclovir D) chloramphenicol E) erythromycin 31. Induction of metallothionein in cancer cells could lead to resistance to: A) mechlorethamine B) methotrexate C) doxorubicin D) taxol E) irinotecan HuBio 543 Final Examination December 9, 2005 Page 8

9 SELECT ONE BEST (4 points each). 32. The neurotoxicity of this drug can be prevented by co-administering pyridoxine (vitamin B6): A) gentamicin B) sulfamethoxazole C) chloramphenicol D) isoniazid E) erythromycin 33. Your patient has a tumor burden of 10 9 cells before treatment and after 1 dose with cisplatin you estimate the number of tumor cells at What would be the log kill? A) 3 B) 4 C) 5 D) 6 E) can not be determined 34. Most likely to cause anaphylactic immune reactions: A) doxycycline B) chloramphenicol C) ticarcillin D) trimethoprim E) acyclovir 35. Resistance to vancomycin: A) involves the synthesis of a novel peptidoglycan precursor B) involves production of a novel pump protein that increases efflux of the drug C) can be avoided by co-administering clavulanic acid D) has not yet been observed clinically E) usually occurs by covalent modification of the drug HuBio 543 Final Examination December 9, 2005 Page 9

10 SELECT ONE BEST (4 points each). 36. Aminoglycosides are: A) well absorbed orally B) sensitive to inactivation by plasmid encoded enzymes C) associated with anemia and leukopenia D) highly toxic to the liver E) able to penetrate into the CNS 37. Paclitaxel (Taxol ) acts by: A) inhibiting topoisomerase II B) forming free radicals C) binding to DNA D) blocking the estrogen receptor E) stabilizing microtubules 38. Clavulanic acid is inactive as an antibacterial drug but is sometimes given together with amoxicillin because it: A) inhibits the anion pump in the kidney and prolongs the half life B) tends to reduce the potential for allergic reactions C) inhibits many beta-lactamases D) slows the absorption of drug and prolongs the duration of action of a single dose E) reduces gastric irritation 39. The major toxicities of aminoglycosides are thought to be caused by either binding of drug to phospholipids or: A) inhibition of ion channel function B) generation of free radicals C) inhibition of mitochondrial protein synthesis D) inhibition of axonal transport E) accumulation of high concentrations in the CSF HuBio 543 Final Examination December 9, 2005 Page 10

11 SELECT ONE BEST (4 points each). 40. In cells pretreated with interferon, an infecting virus: A) can not penetrate protected cells B) results in RNA degradation and inhibition of protein synthesis C) is degraded by secreted proteases D) becomes mutated during replication E) attaches to the cell surface and is attacked by a complement mediated immune response 41. Bilirubin displacement from serum binding proteins in newborns can lead to kernicterus. Which of the following is most likely to be associated with this toxicity? A) clindamycin B) doxycycline C) chloramphenicol D) vancomycin E) sulfisoxazole 42. Foscarnet is active against both CMV and HSV infections and can be useful when treating virus that have become resistant to other first line drugs. What is the basis for the selective toxicity of foscarnet? A) foscarnet concentrates specifically in virus infected cells B) foscarnet is selectively activated in virally infected cells by thymidine kinase C) the induction of interferon in virally infected cells makes them sensitive to activation of 2,5 A synthetase by foscarnet D) foscarnet inhibits the specific aspartate protease required for processing of the viral coat proteins E) foscarnet preferentially binds the pyrophosphate site on viral but not host DNA polymerase 43. You are treating a 23 year old female patient with bacterial meningitis and need to choose a drug without knowing the pathogen. Which one would be the best from the following: A. cefaclor B. ceftriaxone C. penicillin G D. isoniazid E. tobramycin HuBio 543 Final Examination December 9, 2005 Page 11

12 II. A, B, BOTH, NEITHER (2 points each). For items 44 through 59 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 44. Preferentially acts as an agonist at alpha1 over alpha2 receptors: A) clonidine B) prazosin 45. Causes postural hypotension after systemic administration: A) bretylium B) mecamylamine 46. Decreases the production of the aqueous humor: A) physostigmine B) timolol 47. Causes fasciculations prior to paralysis: A) succinylcholine B) d-tubocurarine 48. Methacholine can be used for the diagnosis of : A) airway hyperreactivity B) atropine poisoning HuBio 543 Final Examination December 9, 2005 Page 12

13 A, B, BOTH, NEITHER (2 points each) 49. Acts on the adrenal medulla after systemic administration: A) guanethidine B) reserpine 50. Bethanechol acts as an agonist at acetylcholine receptors in: A) cardiac muscle B) skeletal muscle 51. Antiarrhythmic with prominent anticholinergic effects: A) lidocaine B) quinidine 52. Increased potassium conductance, as caused by activation of muscarinic cholinergic receptors, results in increased refractory period in: A) atrial muscle cells B) AV nodal cells 53. Is a potassium sparing diuretic because it acts as an inhibitor of Na-K-2Cl symport: A) spironolactone B) triamterene HuBio 543 Final Examination December 9, 2005 Page 13

14 A, B, BOTH, NEITHER (2 points each) 54. Antiarrhythmic drug in class Ia: A) amiodarone B) bretylium 55. A 58-year old male smoker presents to the emergency department with 2 hours of chest pressure. He has vomited and is diaphoretic. The diagnosis is acute coronary syndrome. In addition to oxygen, morphine, aspirin and heparin what other medication(s) is (are) indicated acutely? A) metoprolol B) nitroglycerin 56. The mechanism of bleomycin action involves: A) free radical generation B) crosslinking of G residues in the DNA 57. The selective toxicity of acyclovir is due to: A) preferential phosphorylation by the viral thymidine kinase B) specific inhibition of the viral DNA polymerase 58. Which of the following basic mechanisms /drug combinations are correct? A) inhibit formation of peptidoglycan precursor: cycloserine B) inhibit cross-linking of peptidoglycans: meropenem HuBio 543 Final Examination December 9, 2005 Page 14

15 A, B, BOTH, NEITHER (2 points each) 59. Inhibitor of mycolic acid biosynthesis that is useful in the treatment of tuberculosis: A. pyrazinamide B. linezolid C. Both D. Neither III. GREATER THAN LESS THAN (1 point each). For items 60 through 70 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 60. Duration of action of: A) ephedrine B) epinephrine 61. Duration of action of: A) acetylcholine B) carbachol 62. Duration of action of: A) nadolol B) propranolol 63. Cardioselectivity of: A) nadolol B) propranolol 64. Reflex tachycardia due to administration of: A) phentolamine B) prazosin HuBio 543 Final Examination December 9, 2005 Page 15

16 GREATER THAN LESS THAN (1 point each). 65. Clinical efficacy for suppression of gastric acid secretion of: A) anticholinergic compounds B) proton pump inhibitors 66. Nitroglycerin, when given in low doses decreases: A) afterload B) preload 67. Dependence on intracellular stores of calcium ion for excitation-contraction coupling: A) cardiac muscle B) smooth muscle 68. Clinical efficacy of a diuretic drug that maximally decreases sodium reabsorption by A) 5% B) 10% 69. Refractory period of the AV node in a patient treated with: A) digoxin B) atropine plus digoxin 70. Apparent affinity of binding to its receptor of a(n): A) antagonist drug with pd2 of 5 B) partial agonist drug with pa2 of 5 HuBio 543 Final Examination December 9, 2005 Page 16

17 NOTE: IN ORDER FOR YOU TO PROPERLY ANSWER ITEMS X01 X43, YOU MUST PUT YOUR ANSWERS ON THE BACK OF THE ANSWER SHEET. IV. AUTONOMIC CHECKERBOARD (4 POINTS EACH) DIRECTIONS: (Items X01-X05) Please refer to the chart on page 18 (you may wish to remove page 18 for ease of comparison). Assume that each VERTICAL COLUMN represents a different animal which was pretreated with one or more drugs before the test drug sequence. Assume the pretreatment drugs are used in doses at least adequate to elicit their most characteristic pharmacological effects and that all pretreatment drugs act throughout the experiment. Assume further that test drugs are short-acting. The chart indicates the acute qualitative change (increase, decrease, no change, respectively) in TOTAL PERIPHERAL RESISTANCE after intravenous injection of each test drug. With careful attention to the key, you should choose the MINIMUM number of pretreatment drugs which would be required to account for and still be compatible with the observed results. SELECT: A Atropine B Cocaine C Nadolol D Famotidine E Phentolamine F Reserpine G Atropine and Prazosin H Nadolol and reserpine I Phenoxybenzamine and reserpine J Prazosin and propranolol K Atropine, propranolol, and phentolamine L Cocaine, phentolamine, and scopolamine M Atropine, mecamylamine, prazosin, and reserpine N Bretylium, mecamylamine, scopolamine, and timolol O Ipratropium, nadolol, prazosin, and reserpine P Chlorpheniramine, guanethidine, propranolol, ranitidine and scopolamine Q Cimetidine, diphenhydramine, propranolol, reserpine and scopolamine FOR EACH ITEM, FILL IN ONLY ONE CIRCLE ON YOUR ANSWER SHEETS. X01. Animal I was pretreated with: X02 Animal II was pretreated with: X03. Animal III was pretreated with: X04. Animal IV was pretreated with: X05. Animal V was pretreated with: HuBio 543 Final Examination December 9, 2005 Page 17

18 CONTROL NO PRETREATMENT ANIMAL I ANIMAL II ANIMAL III ANIMAL IV ANIMAL ACh AMP DMPP EPI HIST ISO MCN NE PHENYL V Where: ACh = acetylcholine AMP = amphetamine DMPP = dimethylphenylpiperazinium EPI = epinephrine HIST = histamine ISO = isoproterenol McN = McN-A343 NE = norepinephrine PHENYL = phenylephrine Suggestion: remove this page for easy comparison. HuBio 543 Final Examination December 9, 2005 Page 18

19 V. MATCHING (1 POINT EACH). For items X06-X26 choose the corresponding letter for the item on page 20 which BEST matches the description. Use each item once and only once. We suggest you remove page 20 for ease of matching. X06. Agent that blocks histamine receptors, useful in the treatment of Zollinger-Ellison syndrome X07. Agent that inhibits the release of histamine X08. Agent the inhibits the release of acetylcholine at synapses X09. Agent that promotes the release of histamine from mast cells X10. Agent with positive inotropic properties based on inhibition of PDE3 X11. Agonist with selectivity for beta-2 receptors X12. Antihistamine agent with significant anticholinergic properties X13. Antihypertensive agent that blocks smooth muscle Ca channels X14. Anticholinergic selective for M3 receptors X15. Ca channel blocker with significant negative inotropic effects X16. Extremely short acting vasodilator used to diagnose coronary artery disease X17. Glucocorticoid given orally in inflammatory disorders such as asthma X18. Hepatotoxic inhibitor of cyclooxygenase X19. Indirectly acting sympathomimetics amine X20. Inhibitor of carbonic anhydrase that reduces the incidence of acute mountain sickness X21. Inhibitor of the presynaptic amine re-uptake pump X22. Intravenously administered agent for the treatment of malignant hypertension X23. Leukotriene modifier (LTM) that acts as an antagonist of leukotriene receptors X24. Rapidly acting cardiac glycoside X25. Second generation H1 receptor antagonist X26. So-called high ceiling diuretic HuBio 543 Final Examination December 9, 2005 Page 19

20 Below is a list of drugs arranged alphabetically by their generic names. For items X06-X26 on page 19 choose the corresponding letter which BEST matches the description. Use each item once and only once. A) acetaminophen B) acetazolamide C) adenosine D) amlodipine E) botulinum toxin F) bumetanide G) chlorpheniramine H) cocaine I) famotidine J) milrinone K) montelukast L) nedocromil M) ouabain N) prednisone O) ranitidine P) sodium nitroprusside Q) terbutaline R) tiotropium S) tyramine T) vancomycin U) verapamil Suggestion: remove this page for easy comparison. HuBio 543 Final Examination December 9, 2005 Page 20

21 VI. DATA MATCHING (2 POINTS EACH). Many types of data in pharmacology are plotted in graphical form with the horizontal axis designated as the X axis and the vertical axis as the Y axis. For items X27-X36, match the ONE lettered graph on page 22 that BEST describes the usual relationship between the X and Y variables. You may use each graph, once, more than once or not at all. Match the graph of the relationship when: X27. The X axis is plasma level of a drug in a population of human volunteers (some of whom are slow metabolizers) given a fixed dose of the drug and the Y axis is number of people in the population with a given plasma level of the drug X28. The X axis is time following IV injection of a drug that exhibits two-compartment behavior and is cleared by first order kinetics and the Y axis is logarithm of the plasma concentration of the drug X29. The X axis is concentration of an agonist drug in a chamber containing isolated strip of heart muscle and the Y axis is magnitude of the heart muscle contractions X30. The X axis is dose of a drug and the Y axis is cumulative percentage of patients responding to the drug with a given quantal response X31. The X axis is logarithm of the concentration of an agonist drug in a chamber containing an isolated strip of smooth muscle and the Y axis is magnitude of contractions produced by the drug X32. The X axis is time and the Y axis is fraction of the total amount of drug eliminated per hour for a drug eliminated by first order kinetics X33. The X axis is the dose of atropine in humans and the Y axis is the resting heart rate X34. The X axis is time during chemotherapeutic treatments that result in a reproducible log kill and the Y axis is the logarithm of the theoretical number of cancer cells in an experimental animal during multiple treatments X35. The X axis is time following the administration of a (perfectly calculated) loading dose and continued IV infusion at a constant rate of a drug and the Y axis is plasma concentration of the drug. X36. The X axis is time during steady state oral maintenance dosage of a drug and the Y axis is the plasma level of the drug HuBio 543 Final Examination December 9, 2005 Page 21

22 A B C D E F G H I J K L Suggestion: remove this page for easy comparison. HuBio 543 Final Examination December 9, 2005 Page 22

23 VII. For items X37 through X43 AND SA1 AND SA2 use the Table of Pharmacokinetic Values on page 24 (we suggest you remove that page for ease of consulting the data). For items X37 through X43 (2 points each) choose the ONE BEST drug (letter A through U) from the first column of the Table of Pharmacokinetic Values. Each drug may be chosen once, more than once, or not at all. X37. Which drug (all of which are bases) would be most ionized (i.e., have the greatest percentage of its molecules in an ionized state) in the stomach at a ph of 1.4? X38. Of drugs in this table for which appropriate information is available, which would be most likely to cause a pharmacokinetic augmentation of the effects of metoprolol? X39. Based on effective total plasma concentration, and ignoring other pharmacokinetic parameters, which drug appears to be the least potent on a weight basis? X40. Following time for distribution, which drug is present in the smallest total amount in the body of a patient when present at, the effective (i.e., therapeutic) concentration? X41. Of drugs in this table for which appropriate information is available, which drug appears to have the largest first pass effect? X42. Of the drugs in this table for which appropriate information is available, which appears to have the smallest 'therapeutic window', relatively speaking? X43. If dosing were begun at a constant rate, for which drug would it require the shortest time to achieve a steady state plasma concentration? HuBio 543 Final Examination December 9, 2005 Page 23

24 Suggestion: remove this page for easy comparison. HuBio 543 Final Examination December 9, 2005 Page 24

25 Name: Student Number: VIII. SHORT ANSWER QUESTIONS (5 points each) Based on the information available from the Table of Pharmacokinetic Values (page 24) answer items SA1 and SA2 in the spaces provided. Show your calculations. Please clearly write your answers in the spaces below. (Note : answers that are not sufficiently legible to be deciphered will be assumed to be incorrect!) SA1. A 60 kg female patient with acute anaphylaxis is being seen in the Emergency Department. After administration of epinephrine, it is desired to give a loading dose of diphenhydramine to bring her total plasma concentration up to the effective level. Theoretically, how much diphenhydramine would need to be injected IV to accomplish this goal? SA2. A 90 kg patient is to be given diltiazem by mouth. What is the daily dosage to theoretically achieve an effective average steady state plasma concentration of diltiazem in this patient? Be sure to turn in this page with your answer sheet and make sure your name is clearly written. This is the end of the EXAM. Good Luck on this and others. Have a great holiday! HuBio 543 Final Examination December 9, 2005 Page 25