MED PHARM 501/801 MIDTERM PRACTICE EXAM FALL SEMESTER December 6, 2005

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1 MED PHARM 501/801 MIDTERM PRACTICE EXAM FALL SEMESTER December 6, Promethazine is an antihistaminic drug. Knowing that it is a weak base with a pk a of 9.1, you can predict that: A. it s urinary excretion would be accelerated by administration of NH4Cl B. it s urinary excretion would be accelerated by giving NaHCO 3 C. more of the drug would be ionized at blood ph than at stomach ph D. the drug would be absorbed faster from the stomach than from the small intestine E. hemodialysis is the only effective therapy to reduce blood levels. For each numbered statement (2-5) select the ONE lettered heading that is MOST clearly associated with it. Each lettered heading may be selected once, more than once, or not at all. A. Affinity B. Efficacy C. Antagonist D. Receptor E. Agonist 2. A/An has no efficacy 3. This is the property of a chemical that indicates an ability to bind to a receptor. 4. This term refers to the ability of a receptor ligand to induce a maximum response. 5. A/An provides the recognition site for a drug 6. What is the basic relationship which defines and determines a steady-state plasma concentration? A. rate out/rate in B. rate in C. dose rate/clearance D. half-life 7. The apparent volume of distribution for most drugs is: A. a meaningful value which equals a real physiological space B. an indication of the extent of drug movement out of the blood stream C. equal to total body water D. based upon the measurement of tissue concentrations of the drug 1

2 8. A competitive antagonist A. decreases the maximum response that the agonist can produce B. shifts the agonist dose-response curve "to the left". C. interacts chemically with receptors to form permanent covalent bonds D. can be overcome by higher concentrations of agonist. 9. Biotransformation produces metabolites which: A. are chemically distinct from the parent B. have restricted distribution C. have increased renal tubular reabsorption D. have decreased biliary excretion E. A and B 10. In the aged there is: A. decreased GI absorption of drugs B. decreased distribution of drugs C. decreased renal excretion of drugs D. decreased biotransformation of drugs E. all of the above 11. Formation of a metabolite from a drug allows the body to do all of the following to the metabolite EXCEPT: A. Restrict its distribution. B. Increase its hepatic (biliary) excretion. C. Decrease its renal (tubular) reabsorption. D. Increase the metabolite's access to the brain. E. Usually make it more water soluble, so it is more easily excreted. 12. The dose of drug required to produce a desired therapeutic endpoint in one-half of the subjects tested is referred to as the: A. LD50 B. ED50 C. TD50 D. therapeutic index 13. Pharmacogenetics influences: A. are exhibited in polymorphic phase I biotransformation B. are inherited C. affect isoniazid acetylation D. affect pseudocholinesterase mediated reactions E. all of the above 2

3 Response (% of maximum) log dose ( g/kg) an agonist From data provided in the figure above determine the following: 14. The D-50 dose for drug A is? A..3 ug/kg B. 1 ug/kg C. 3 ug/kg D. 10 ug/kg E. 100 ug/kg 15. The D-50 dose for drug B is? A..3 ug/kg B. 1 ug/kg C. 3 ug/kg D. 10 ug/kg E. 100 ug/kg 16. The D-50 for drug C is? A..3 ug/kg B. 1 ug/kg C. 3 ug/kg D. 10 ug/kg E. 100 ug/kg 3

4 17. How much more potent is drug A than drug B? A. 2 times B. 10 times C. 100 times D. Equipotent E. Cannot determine based on inadequate data 18. How much more potent is drug B than drug C? A. 2 times B. 10 times C. 100 times D. Equipotent E. Cannot determine based on inadequate data 19. Drug C could best be described as: A. 2 times less potent than drug B B. 2 times less potent than drug A C. A competitive antagonist D. A partial agonist E. A full but weakly potent agonist 20. For a given drug a therapeutic index with a small value means: A. Only a small dose of the drug will be needed to produce a 100% response. B. The drug is so potent that only a small dose is needed to produce a therapeutic effect. C. The drug is so weakly potent that only a large dose will be needed to produce an adverse or lethal effect. D. The difference in doses to produce a therapeutic effect from an adverse effect is of no consequence. E. The difference in dose to produce an adverse effect from a therapeutic effect is small. 21. Creatinine clearance is an important consideration when administering drugs to: A. Children between the ages of 5 and 15 years B. Elderly male and female patients without known kidney disease C. College age athletes with very large muscle to fat ratios D. Patients on high protein low carbohydrate diets 22. The decrease in diastolic blood pressure induced by a low dose of epinephrine can be blocked by administration of: A. atropine B. propranolol C. prazosin D. phentolamine 4

5 23. Mrs. Smith is being treated for open-angle glaucoma with a drug that produces miosis and an increase in outflow of aqueous humor. Which of the following is the drug she is taking? A. atropine B. timolol C. pilocarpine D. phenylephrine 24. The vasodilation and decreased blood pressure produced by the intravenous administration of this drug is mediated by the release of nitric oxide: A. norepinephrine B. bethanechol C. atropine D. nicotine 25. Military personnel expecting exposure to "nerve gas" should be provided with: A. propranolol B. atropine C. neostigmine D. discharges E. bethanechol 26. Mr. Jones is taking neostigmine for his myasthenia gravis. He has problems of G.I. cramping, watery eyes and sweating. Which drug can best reduce these side effects? A. phenylephrine B. propranolol C. pilocarpine D. physostigmine E. atropine 27. Which one of the following would be contraindicated for patients with asthma? A. atropine B. prazosin C. propranolol D. phenylephrine E. ipratropium 28. The change in heart rate associated with intravenous administration of isoproterenol would be blocked by: A. atropine B. propranolol C. prazosin D. clonidine 5

6 For each numbered statement (29-33) select the ONE lettered heading that is MOST closely associated with it. Each lettered heading may be selected once, more than once, or not at all. A. Pilocarpine D. Atropine B. Clonidine E. Dobutamine C. Dopamine 29. This drug will produce contractions of the iris constrictor (sphincter) muscle and ciliary muscle. 30. Acts at presynaptic alpha-2 adrenergic receptors to reduce nerve impulse-induced release of norepinephrine. 31. A drug that effectively increases renal blood flow. 32. A patient presenting with fever, dilated pupils, urinary retention, dry skin and mouth, tachycardia and delirium is most likely suffering from intoxication with: 33. This drug increases cardiac contractile force without significant changes in peripheral vascular resistance. 34. All of the following are typical cholinergic effects EXCEPT: A. a decrease in heart rate B. a decrease in conduction velocity through the AV node C. an increase in sweat secretion D. contraction of bronchial muscle E. an increase in pupillary diameter 35. A patient arrives at your office after having taken a "few extra" decongestant pills. She is agitated and has a heart rate of 120. You determine that she took ephedrine. Which one of the following, if given, would you expect to reduce her heart rate? A. scopolamine B. metoprolol C. isoproterenol D. dobutamine E. epinephrine 36. A contraindication to the use of streptokinase or tissue type plasminogen activator (t-pa): A. recent pulmonary embolism B. acute myocardial infarction C. recent ophthalmic surgery D. treated hypertension E. heart failure 6

7 37. Your patient has hypertension and moderately severe congestive heart failure. The best choice for outpatient management using a single drug would be: A. metoprolol B. captopril C. furosemide D. sodium nitroprusside E. sublingual nitroglycerin 38. Digoxin causes all of the following EXCEPT: A. + + inhibits a cell membrane Na -Ka activated ATP-ase B. + causes the loss of K from myocardial cells C. causes an increase in intra-myocardial cell Na + D. 2+ causes a loss of Ca from myocardial cells 39. Which of the following is a phosphodiesterase inhibitor with a small therapeutic index and produces a bronchodilator effect at a serum concentration of 5-15 mcg/ml? A. beclomethasone B. theophylline C. atropine D. prednisone E. ipratropium 40. All of the following are side effects of theophylline EXCEPT: A. nausea B. tremor C. insomnia D. osteoporosis E. agitation 41. Which of the following drugs used in treating obstructive airway disease inhibits the effect of acetylcholine at muscarinic receptors on bronchial smooth muscle? A. albuterol B. theophylline C. prednisone D. ipratropium E. epinephrine 42. Propranolol administration will cause all of the following EXCEPT: A. increase in systemic vascular resistance B. renin suppression C. increase in myocardial contractility D. reduction in heart rate 7

8 43. When considering digoxin therapy for Mr. Jones, which would be an unlikely risk factor for digoxin intoxication that you would consider: A. renal failure B. diuretic use C. hypokalemia D. liver failure E. old age 44. This can reverse the action of warfarin: A. heparin B. streptokinase C. vitamin K D. aspirin E. protamine sulfate 45. An antihypertensive drug that lowers blood pressure 10 mm Hg in one-half of patients tested at a dose of 8 mg and produces liver damage in one-half of patients tested at a dose of 80 mg. A. has a therapeutic index of 10 in terms of benefit to risk of hepatotoxicity B. will produce liver damage in most patients given any dose of the drug C. has a therapeutic index of 0.1 in terms of benefit to risk of hepatotoxicity D. will not produce liver damage in patients who receive less than 80 mg. 46. When given intravenously the effect of this drug on preload is secondary to vasodilation and a reduction in afterload due to resistance vessel dilation along with coronary artery dilation: A. captopril B. nitroglycerin C. prazosin D. propranolol 47. Degree of anticoaguability produced by this drug is monitored with the INR: A. aspirin B. streptokinase C. warfarin D. protamine sulfate 48. Drug interaction at the receptor level makes it impossible to use this antiarrhythmic drug in the patient receiving theophylline: A. propranolol B. lidocaine C. adenosine D. digoxin 8

9 49. Useful in the prevention of postoperative deep venous thrombosis and pulmonary embolism: A. aspirin B. streptokinase C. tissue plasminogen activator D. mini-dose subcutaneous heparin E. warfarin For each numbered statement (50-54) select the ONE lettered heading that is MOST closely associated with it. Each lettered heading may be selected once, more than once, or not at all. A. Acetazolamide D. Furosemide B. Mannitol E. Triamterene C. Spironolactone 50. An inhibitor of carbonic anhydrase that is NOT useful in long-term diuretic therapy. 51. Used by neurosurgeons to reduce cerebral swelling. 52. A competitive inhibitor of aldosterone. 53. Useful in the management of hypercalcemia, i.e., this drug promotes renal calcium excretion. 54. A drug acting on the late distal tubule and collecting duct which is not associated with a loss of potassium. For each numbered statement (55-59) select the ONE lettered heading that is MOST closely associated with it. Each lettered heading may be selected once, more than once, or not at all. A. Clonidine D. Prazosin B. Nifedipine E. Metoprolol C. Hydrochlorothiazide F. Captopril 55. Alpha -1 adrenergic receptor antagonist. 56. Alpha 2 adrenergic receptor agonist. 57. Angiotensin converting enzyme inhibitor. 58. Calcium channel antagonist. 59. Diuretic 9

10 For each numbered statement (60-62) select the ONE lettered heading that is MOST closely associated with it. Each lettered heading may be selected once, more than once, or not at all. A. Digoxin D. Verapamil B. Lidocaine E. Dobutamine C. Amiodarone 60. A drug with negative inotropic actions related to the impairment of calcium movement into cardiac muscle cells. 61. A drug used in sudden cardiac arrest that blocks sodium and potassium channels and is sympatholytic. 62. A drug with positive inotropic action that also impairs A-V nodal transmission 63. The mechanism of action of the anticoagulant effect of coumarin derivatives involves: A. interfering with actions of vitamin K in the synthesis of factors VII, IX and X B no effect on vitamin K C. an action that blocks the release of preformed prothrombin by the liver D. fibrinolysis 64. Which of the following has been associated with reflex tachycardia? A. nifedipine B. propranolol C. captopril D. metoprolol 65. Captopril has all of the following disadvantages EXCEPT: A. can only be used for mild to moderate hypertension B. may increase serum potassium C. may cause chronic cough D. is a teratogen 66. A drug whose actions can intensify the AV block caused by the digitalis glycosides is: A. nitroglycerin B. hydralazine C. epinephrine D. losartan E. verapamil 10

11 67. All of the following might be acceptable alternatives to the digitalis glycosides for the long-term management of CHF, EXCEPT: A. 1-adrenergic agonists B. antihypertensive drugs C. diuretic drugs D. dietary sodium restriction E. angiotensin-converting-enzyme inhibitors 68. Identify drug X from the above graph: A. physostigmine B. propranolol C. prazosin D. scopolamine 69. Which of the following drugs used to lower cholesterol is not absorbed to any extent: A. simvastatin B. cholestyramine C. nicotinic Acid D. gemfibrozil 70. Glucocorticoids are used to treat all of the following diseases EXCEPT: A. asthma B. ulcerative colitis C. rheumatoid arthritis D. osteoporosis 71. Which of the following drugs is used to treat amenorrhea - galactorrhea syndrome? A. raloxifene B. metyrapone C. mifepristone D. bromocriptine E. clomiphene 11

12 72. Cardiovascular morbidity in women using progestin-estrogen oral contraceptive is increased by all of the following factors EXCEPT: A. hypertension B. smoking C. amount of estrogen in the combination estrogen-progesterone pill D. obesity E. use before the age of eighteen 73. Which of the following agents is used to treat patients with hypoparathyroidism? A. parathormone B. calcitonin C. Vitamin D D. alendronate 74. Which of the following compounds is used to treat diabetes insipidus? A. glipizide B. hydrochlorothiazide C. furosemide D. bromocriptine 75. The mineralocorticoid activity of some of the anti-inflammatory steroids would be most likely to induce: A. peptic ulcer B. hypokalemic alkalosis C. psychosis D. buffalo hump E. abdominal striae 76. Corticosteroids: A. may cause severe inflammatory responses B. stimulate protein synthesis C. cause fluid retention and edema D. may produce hypoglycemia 77. The following is characteristic of first-order elimination kinetics: A. half-life increases with dose B. clearance decreases with dose C. plasma concentration does not change with dose D. none of the above E. all of the above 12

13 78. Saturable or nonlinear elimination kinetics implies that: A. plasma concentration and dose are directly related at all doses B. response bears a predictable relationship to dose C. clearance decreases with dose D. all of the above E. none of the above 79. Drugs which undergo an extensive first-pass effect have the following factor in common: A. they are water-soluble B. they are primarily excreted by the kidney C. they have a low oral bioavailability D. none of the above 80. When designing a dosing regimen for an individual patient one should consider: A. average pharmacokinetic parameter values B. characteristics of the individual patient C the therapeutic concentration range D. all of the above 81. Recent evidence suggests that the first choice for treatment of peptic ulcer is: A. prostaglandins B. antibiotics and a proton pump inhibitor C. antacids and H 2 histamine antagonist D. sucralfate and kaolin/pectin 82. The appropriate clinical strategy for patients suspected of peptic ulcer is: A. loperamide B. testing for H. pylori infection C. antacids D. sucralfate 83. Which of the following drugs has no demonstrated clinical efficacy in the management of diarrhea: A. cholestyramine (Questran) B. bismuth subsalicylate (PeptoBismol) C. diphenoxylate/atropine (Lomotil) D. loperamide (Immodium) E. kaolin and pectin (Kaopectate) 13

14 84. Mrs. Jones is a 68 year old woman with metastatic breast cancer who was admitted to the hospital for radiation therapy of painful bone metastases. She was given large amounts of meperidine to control her pain. Due to other problems she developed progressive renal failure and her serum creatinine increased from 1.4 mg/dl to 4.2 mg/dl. On her fifth hospital day she developed severe muscle jerking movements and then grand mal seizures. Other information: (1) Meperidine is cleared predominantly by Phase I biotransformation to normeperidine. (2) Normeperidine is excreted primarily by the kidneys. (3) Normeperidine is a CNS stimulant. Mrs. Jones side effects occurred because: A. Large amounts of meperidine will be formed in the liver but slowly cleared by the kidneys. B. Large amounts of normeperidine will be formed in the liver but slowly cleared by the kidneys. C. Meperidine was not adequately biotransformed by Phase II metabolism. D. Enterohepatic reabsorption of meperidine has resulted in toxic blood levels of meperidine. 85. Taking an oral tablet of acetaminophen lying down has been shown to delay esophageal transit which results in a delay in the rate of absorption but not the extent of absorption. Based on this finding, which of the following pharmacokinetic changes do you expect? A. Delay in the appearance of acetaminophen in the systemic blood when taking the drug lying down. B. Increased maximum plasma acetaminophen concentration when taking the drug lying down C. Decreased area under the plasma acetaminophen concentration-time profile when taking the drug lying down. D. All of the above 86. The following factor should be considered when calculating the loading dose of a drug for a clinical indication that needs quick onset of drug response A. Drug clearance B. Volume of distribution C. Maintenance dose D. All of the above 14

15 87. Physostigmine and bethanechol in small doses have significantly different effects on which one of the following: A. Gastric secretion B. Neuromuscular junction (skeletal muscle) C. Salivary glands D. Sweat glands E. Bladder muscle 88. Epinephrine can be used to treat: A Anaphylactic shock B. Glaucoma C. Prolong the duration of action of local anesthetics D. Cardiac arrest E. All of the above 89. Which of the following is a quaternary analogue of atropine and is poorly absorbed into the circulation when inhaled? A. Albuterol B. Ipratropium bromide C. Theophylline D. Montelukast E. Prednisone 15

16 The illustration depicts the results of a trial designed to assess the effects of digoxin on morbidity and mortality of persons with moderate to severe left ventricular failure. Subjects were randomized to digoxin or placebo in addition to standard therapy including ACE inhibitors. 90. The data shown in Panel A suggests: A. B. C. D. E. 91. ACE inhibitors should not be used to treat left ventricular failure. Diuretics should be added to a regimen of therapy for heart failure in order to provide a survival benefit. There is no difference in mortality from any cause between treatment groups. Digoxin should not be used in the treatment of heart failure. Placebo therapy conferred survival benefit as compared to digoxin therapy. The data shown in Panel B suggests: A. B. C. D. E. Fewer persons in the digoxin group were hospitalized due to worsening heart failure. Digoxin is of no value in treating heart failure. Digoxin reduces any cause mortality. Digoxin exerts a positive inotropic action. Digoxin has a small therapeutic index. 16

17 92. Side effects associated with this drug include pulmonary fibrosis, skin discoloration and retinal pigmentation: A. Adenosine B. Lidocaine C. Amiodarone D. Digoxin E. Metoprolol 93. When administered to the hypertensive patient you can expect a 10 mm lowering of the blood pressure from all of the following EXCEPT: A. Hydrochlorothiazide B. Captopril C. Nifedipine D. Acetazolamide E. Metoprolol 94. Test of control for warfarin therapy A. Activated partial thromboplastin time B. Bleeding time C. Platelet count D. Prothrombin time/inr 95. Contraindicated for the patient taking isosorbide dinitrate A. Metoprolol B. Propranolol C. Sildenafil D. Digoxin E. Warfarin 96. Drugs with a relatively large volume of distribution (>200 L) probably have which characteristics: A. Highly water soluble B. Highly bound to proteins and tissues C. High clearance values D. None of the above 17

18 Plasma Concentration ug/ml Hrs. A 10.9 mg IV dose of drug X was administered to a patient producing the blood level pattern shown in the Figure above. Based on this pattern answer the following questions. 97. Drug X exhibits what type of elimination pattern A. First order, mono exponential elimination B. Zero order, mono exponential elimination C. Zero order, multi-exponential elimination D. First order, multi-exponential elimination 98. What is the apparent volume of distribution, if concentration is 10.9 g/ml? A. 10 L B. 1 L C. 900 L D. 90 L 99. This selective estrogen receptor modulator is used for the treatment of osteoporesis. A. Raloxifene B. Clomiphene C. Rosiglitazone D. Alendronate 18

19 1. A 2. C 3. A 4. B 5. D 6. C 7. B 8. D 9. E 10. E 11. D 12. B 13. E 14. B 15. D 16. D 17. B 18. D 19. D 20. E 21. B 22. B 23. C 24. B 25. B 26. E 27. C 28. B 29. A 30. B 31. C 32. D 33. E 34. E 35. B 36. C 37. B 38. D 39. B 40. D 41. D 42. C MIDTERM PRACTICE EXAM ANSWER SHEET 43. D 44. C 45. A 46. B 47. C 48. C 49. D 50. A 51. B 52. C 53. D 54. E 55. D 56. A 57. F 58. B 59. C 60. D 61. C 62. A 63. A 64. A 65. A 66. E 67. A 68. C 69. B 70. D 71. D 72. E 73. C 74. B 75. B 76. C 77. D 78. C 79. C 80. D 81. B 82. B 83. E 84. B A 86. B 87. B 88. E 89. B 90. C 91. A 92. C 93. D 94. D 95. C 96. B 97. B 98. B 99. A