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MED PHARM 501/801MIDTERM PRACTICE EXAM

FALL SEMESTERDecember 6, 2005

a1. Promethazine is an antihistaminic drug. Knowing that it is a weak base with a pK of 9.1,you can predict that:

4A. it’s urinary excretion would be accelerated by administration of NH Cl

3B. it’s urinary excretion would be accelerated by giving NaHCOC. more of the drug would be ionized at blood pH than at stomach pHD. the drug would be absorbed faster from the stomach than from the small intestineE. hemodialysis is the only effective therapy to reduce blood levels.

For each numbered statement (2-5) select the ONE lettered heading that is MOST clearlyassociated with it. Each lettered heading may be selected once, more than once, or not at all.

A. AffinityB. EfficacyC. AntagonistD. ReceptorE. 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 plasmaconcentration?A. rate out/rate inB. rate inC. dose rate/clearanceD. half-life

7. The apparent volume of distribution for most drugs is:A. a meaningful value which equals a real physiological spaceB. an indication of the extent of drug movement out of the blood streamC. equal to total body waterD. based upon the measurement of tissue concentrations of the drug

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8. A competitive antagonistA. decreases the maximum response that the agonist can produceB. shifts the agonist dose-response curve "to the left".C. interacts chemically with receptors to form permanent covalent bondsD. can be overcome by higher concentrations of agonist.

9. Biotransformation produces metabolites which:A. are chemically distinct from the parentB. have restricted distributionC. have increased renal tubular reabsorptionD. have decreased biliary excretionE. A and B

10. In the aged there is:A. decreased GI absorption of drugsB. decreased distribution of drugsC. decreased renal excretion of drugsD. decreased biotransformation of drugsE. all of the above

11. Formation of a metabolite from a drug allows the body to do all of the following to themetabolite 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 thesubjects tested is referred to as the:A. LD50B. ED50C. TD50D. therapeutic index

13. Pharmacogenetics influences:A. are exhibited in polymorphic phase I biotransformationB. are inheritedC. affect isoniazid acetylationD. affect pseudocholinesterase mediated reactionsE. all of the above

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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/kgB. 1 ug/kgC. 3 ug/kgD. 10 ug/kgE. 100 ug/kg

15. The D-50 dose for drug B is?A. .3 ug/kgB. 1 ug/kgC. 3 ug/kgD. 10 ug/kgE. 100 ug/kg

16. The D-50 for drug C is?A. .3 ug/kgB. 1 ug/kgC. 3 ug/kgD. 10 ug/kgE. 100 ug/kg

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17. How much more potent is drug A than drug B?A. 2 timesB. 10 timesC. 100 timesD. EquipotentE. Cannot determine based on inadequate data

18. How much more potent is drug B than drug C?A. 2 timesB. 10 timesC. 100 timesD. EquipotentE. Cannot determine based on inadequate data

19. Drug C could best be described as:A. 2 times less potent than drug BB. 2 times less potent than drug AC. A competitive antagonistD. A partial agonistE. 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 yearsB. Elderly male and female patients without known kidney diseaseC. College age athletes with very large muscle to fat ratiosD. Patients on high protein low carbohydrate diets

22. The decrease in diastolic blood pressure induced by a low dose of epinephrine can beblocked by administration of:A. atropine B. propranolol C. prazosinD. phentolamine

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23. Mrs. Smith is being treated for open-angle glaucoma with a drug that produces miosis andan increase in outflow of aqueous humor. Which of the following is the drug she istaking?A. atropine B. timololC. pilocarpine D. phenylephrine

24. The vasodilation and decreased blood pressure produced by the intravenousadministration of this drug is mediated by the release of nitric oxide: A. norepinephrine B. bethanechol C. atropineD. nicotine

25. Military personnel expecting exposure to "nerve gas" should be provided with:A. propranololB. atropineC. neostigmineD. dischargesE. 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. phenylephrineB. propranololC. pilocarpineD. physostigmineE. atropine

27. Which one of the following would be contraindicated for patients with asthma?A. atropineB. prazosinC. propranololD. phenylephrineE. ipratropium

28. The change in heart rate associated with intravenous administration of isoproterenolwould be blocked by:A. atropine B. propranololC. prazosinD. clonidine

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For each numbered statement (29-33) select the ONE lettered heading that is MOST closelyassociated with it. Each lettered heading may be selected once, more than once, or not at all.

A. Pilocarpine D. AtropineB. Clonidine E. DobutamineC. Dopamine

___ 29. This drug will produce contractions of the iris constrictor (sphincter) muscle andciliary muscle.

___ 30. Acts at presynaptic alpha-2 adrenergic receptors to reduce nerve impulse-inducedrelease of norepinephrine.

___ 31. A drug that effectively increases renal blood flow.

___ 32. A patient presenting with fever, dilated pupils, urinary retention, dry skin andmouth, tachycardia and delirium is most likely suffering from intoxication with:

___ 33. This drug increases cardiac contractile force without significant changes inperipheral vascular resistance.

34. All of the following are typical cholinergic effects EXCEPT:A. a decrease in heart rateB. a decrease in conduction velocity through the AV nodeC. an increase in sweat secretionD. contraction of bronchial muscleE. an increase in pupillary diameter

35. A patient arrives at your office after having taken a "few extra" decongestant pills. She isagitated and has a heart rate of 120. You determine that she took ephedrine. Which oneof the following, if given, would you expect to reduce her heart rate?A. scopolamineB. metoprololC. isoproterenolD. dobutamineE. epinephrine

36. A contraindication to the use of streptokinase or tissue type plasminogen activator (t-PA):A. recent pulmonary embolismB. acute myocardial infarctionC. recent ophthalmic surgeryD. treated hypertensionE. heart failure

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37. Your patient has hypertension and moderately severe congestive heart failure. The bestchoice for outpatient management using a single drug would be:A. metoprololB. captoprilC. furosemideD. sodium nitroprussideE. 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. causes a loss of Ca from myocardial cells2+

39. Which of the following is a phosphodiesterase inhibitor with a small therapeutic indexand produces a bronchodilator effect at a serum concentration of 5-15 mcg/ml?A. beclomethasoneB. theophyllineC. atropineD. prednisoneE. ipratropium

40. All of the following are side effects of theophylline EXCEPT:A. nauseaB. tremorC. insomniaD. osteoporosisE. agitation

41. Which of the following drugs used in treating obstructive airway disease inhibits theeffect of acetylcholine at muscarinic receptors on bronchial smooth muscle?A. albuterolB. theophyllineC. prednisoneD. ipratropiumE. epinephrine

42. Propranolol administration will cause all of the following EXCEPT:A. increase in systemic vascular resistanceB. renin suppressionC. increase in myocardial contractilityD. reduction in heart rate

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43. When considering digoxin therapy for Mr. Jones, which would be an unlikely risk factorfor digoxin intoxication that you would consider:A. renal failureB. diuretic useC. hypokalemiaD. liver failureE. old age

44. This can reverse the action of warfarin:A. heparinB. streptokinaseC. vitamin KD. aspirinE. protamine sulfate

45. An antihypertensive drug that lowers blood pressure 10 mm Hg in one-half of patientstested at a dose of 8 mg and produces liver damage in one-half of patients tested at a doseof 80 mg.A. has a therapeutic index of 10 in terms of benefit to risk of hepatotoxicityB. will produce liver damage in most patients given any dose of the drugC. has a therapeutic index of 0.1 in terms of benefit to risk of hepatotoxicityD. 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 vasodilationand a reduction in afterload due to resistance vessel dilation along with coronary arterydilation:A. captoprilB. nitroglycerinC. prazosinD. propranolol

47. Degree of anticoaguability produced by this drug is monitored with the INR:A. aspirinB. streptokinaseC. warfarinD. protamine sulfate

48. Drug interaction at the receptor level makes it impossible to use this antiarrhythmic drugin the patient receiving theophylline:A. propranololB. lidocaineC. adenosineD. digoxin

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49. Useful in the prevention of postoperative deep venous thrombosis and pulmonaryembolism:A. aspirinB. streptokinaseC. tissue plasminogen activatorD. mini-dose subcutaneous heparinE. warfarin

For each numbered statement (50-54) select the ONE lettered heading that is MOST closelyassociated with it. Each lettered heading may be selected once, more than once, or not at all.

A. Acetazolamide D. FurosemideB. Mannitol E. TriamtereneC. Spironolactone

___ 50. An inhibitor of carbonic anhydrase that is NOT useful in long-term diuretictherapy.

___ 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 calciumexcretion.

___ 54. A drug acting on the late distal tubule and collecting duct which is not associatedwith a loss of potassium.

For each numbered statement (55-59) select the ONE lettered heading that is MOST closelyassociated with it. Each lettered heading may be selected once, more than once, or not at all.

A. Clonidine D. PrazosinB. Nifedipine E. MetoprololC. Hydrochlorothiazide F. Captopril

-1___ 55. Alpha adrenergic receptor antagonist.

2___ 56. Alpha adrenergic receptor agonist.

___ 57. Angiotensin converting enzyme inhibitor.

___ 58. Calcium channel antagonist.

___ 59. Diuretic

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For each numbered statement (60-62) select the ONE lettered heading that is MOST closelyassociated with it. Each lettered heading may be selected once, more than once, or not at all.

A. Digoxin D. VerapamilB. Lidocaine E. DobutamineC. Amiodarone

___ 60. A drug with negative inotropic actions related to the impairment of calciummovement into cardiac muscle cells.

___ 61. A drug used in sudden cardiac arrest that blocks sodium and potassium channelsand 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 XB no effect on vitamin KC. an action that blocks the release of preformed prothrombin by the liverD. fibrinolysis

64. Which of the following has been associated with reflex tachycardia?A. nifedipineB. propranololC. captoprilD. metoprolol

65. Captopril has all of the following disadvantages EXCEPT:A. can only be used for mild to moderate hypertensionB. may increase serum potassiumC. may cause chronic coughD. is a teratogen

66. A drug whose actions can intensify the AV block caused by the digitalis glycosides is:A. nitroglycerinB. hydralazineC. epinephrineD. losartanE. verapamil

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67. All of the following might be acceptable alternatives to the digitalis glycosides for thelong-term management of CHF, EXCEPT:

1A. $ -adrenergic agonistsB. antihypertensive drugsC. diuretic drugsD. dietary sodium restrictionE. angiotensin-converting-enzyme inhibitors

68. Identify drug X from the above graph:A. physostigmineB. propranololC. prazosinD. scopolamine

69. Which of the following drugs used to lower cholesterol is not absorbed to any extent:A. simvastatinB. cholestyramineC. nicotinic AcidD. gemfibrozil

70. Glucocorticoids are used to treat all of the following diseases EXCEPT:A. asthmaB. ulcerative colitisC. rheumatoid arthritisD. osteoporosis

71. Which of the following drugs is used to treat amenorrhea - galactorrhea syndrome?A. raloxifeneB. metyraponeC. mifepristoneD. bromocriptineE. clomiphene

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72. Cardiovascular morbidity in women using progestin-estrogen oral contraceptive isincreased by all of the following factors EXCEPT:A. hypertensionB. smokingC. amount of estrogen in the combination estrogen-progesterone pillD. obesityE. use before the age of eighteen

73. Which of the following agents is used to treat patients with hypoparathyroidism?A. parathormoneB. calcitoninC. Vitamin DD. alendronate

74. Which of the following compounds is used to treat diabetes insipidus?A. glipizideB. hydrochlorothiazideC. furosemideD. bromocriptine

75. The mineralocorticoid activity of some of the anti-inflammatory steroids would be mostlikely to induce:A. peptic ulcerB. hypokalemic alkalosisC. psychosisD. buffalo humpE. abdominal striae

76. Corticosteroids:A. may cause severe inflammatory responsesB. stimulate protein synthesisC. cause fluid retention and edemaD. may produce hypoglycemia

77. The following is characteristic of first-order elimination kinetics:A. half-life increases with doseB. clearance decreases with doseC. plasma concentration does not change with doseD. none of the aboveE. all of the above

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78. Saturable or nonlinear elimination kinetics implies that:A. plasma concentration and dose are directly related at all dosesB. response bears a predictable relationship to doseC. clearance decreases with doseD. all of the aboveE. none of the above

79. Drugs which undergo an extensive first-pass effect have the following factor in common:A. they are water-solubleB. they are primarily excreted by the kidneyC. they have a low oral bioavailabilityD. none of the above

80. When designing a dosing regimen for an individual patient one should consider:A. average pharmacokinetic parameter valuesB. characteristics of the individual patientC the therapeutic concentration rangeD. all of the above

81. Recent evidence suggests that the first choice for treatment of peptic ulcer is:A. prostaglandinsB. antibiotics and a proton pump inhibitor

2C. antacids and H histamine antagonistD. sucralfate and kaolin/pectin

82. The appropriate clinical strategy for patients suspected of peptic ulcer is:A. loperamideB. testing for H. pylori infectionC. antacidsD. sucralfate

83. Which of the following drugs has no demonstrated clinical efficacy in the management ofdiarrhea:A. cholestyramine (Questran)B. bismuth subsalicylate (PeptoBismol)C. diphenoxylate/atropine (Lomotil)D. loperamide (Immodium)E. kaolin and pectin (Kaopectate)

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84. Mrs. Jones is a 68 year old woman with metastatic breast cancer who was admitted to thehospital for radiation therapy of painful bone metastases. She was given large amounts ofmeperidine to control her pain. Due to other problems she developed progressive renalfailure and her serum creatinine increased from 1.4 mg/dl to 4.2 mg/dl. On her fifthhospital day she developed severe muscle jerking movements and then grand malseizures.

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 thekidneys.

B. Large amounts of normeperidine will be formed in the liver but slowly cleared bythe 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 esophagealtransit 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 thedrug lying down.

B. Increased maximum plasma acetaminophen concentration when taking the druglying down

C. Decreased area under the plasma acetaminophen concentration-time profile whentaking the drug lying down.

D. All of the above

86. The following factor should be considered when calculating the loading dose of a drug fora clinical indication that needs quick onset of drug response

A. Drug clearanceB. Volume of distributionC. Maintenance doseD. All of the above

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87. Physostigmine and bethanechol in small doses have significantly different effects onwhich one of the following:

A. Gastric secretionB. Neuromuscular junction (skeletal muscle)C. Salivary glandsD. Sweat glandsE. Bladder muscle

88. Epinephrine can be used to treat:

A Anaphylactic shockB. GlaucomaC. Prolong the duration of action of local anestheticsD. Cardiac arrestE. All of the above

89. Which of the following is a quaternary analogue of atropine and is poorly absorbed intothe circulation when inhaled?

A. AlbuterolB. Ipratropium bromideC. TheophyllineD. MontelukastE. Prednisone

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The illustration depicts the results of a trial designed to assess the effects of digoxin on morbidityand mortality of persons with moderate to severe left ventricular failure. Subjects wererandomized to digoxin or placebo in addition to standard therapy including ACE inhibitors.

90. The data shown in Panel A suggests:

A. ACE inhibitors should not be used to treat left ventricular failure.B. Diuretics should be added to a regimen of therapy for heart failure in order to

provide a survival benefit.C. There is no difference in mortality from any cause between treatment groups.D. Digoxin should not be used in the treatment of heart failure.E. Placebo therapy conferred survival benefit as compared to digoxin therapy.

91. The data shown in Panel B suggests:

A. Fewer persons in the digoxin group were hospitalized due to worsening heartfailure.

B. Digoxin is of no value in treating heart failure.C. Digoxin reduces “any cause” mortality.D. Digoxin exerts a positive inotropic action.E. Digoxin has a small therapeutic index.

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92. Side effects associated with this drug include pulmonary fibrosis, skin discoloration andretinal pigmentation:

A. AdenosineB. LidocaineC. AmiodaroneD. DigoxinE. Metoprolol

93. When administered to the hypertensive patient you can expect a 10 mm lowering of theblood pressure from all of the following EXCEPT:

A. HydrochlorothiazideB. CaptoprilC. NifedipineD. AcetazolamideE. Metoprolol

94. Test of control for warfarin therapy

A. Activated partial thromboplastin timeB. Bleeding timeC. Platelet countD. Prothrombin time/INR

95. Contraindicated for the patient taking isosorbide dinitrate

A. MetoprololB. PropranololC. SildenafilD. DigoxinE. Warfarin

96. Drugs with a relatively large volume of distribution (>200 L) probably have whichcharacteristics:

A. Highly water solubleB. Highly bound to proteins and tissuesC. High clearance valuesD. None of the above

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PlasmaConcentrationug/ml

Hrs.

A 10.9 mg IV dose of drug X was administered to a patient producing the blood level patternshown 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 eliminationB. Zero order, mono exponential eliminationC. Zero order, multi-exponential eliminationD. First order, multi-exponential elimination

98. What is the apparent volume of distribution, if concentration is 10.9 :g/ml?

A. 10 LB. 1 LC. 900 LD. 90 L

99. This selective estrogen receptor modulator is used for the treatment of osteoporesis.

A. RaloxifeneB. ClomipheneC. RosiglitazoneD. Alendronate

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MIDTERM PRACTICE EXAMANSWER SHEET

1. A2. C3. A4. B5. D6. C7. B8. D9. E10. E11. D12. B13. E14. B15. D16. D17. B18. D19. D20. E21. B22. B23. C24. B25. B26. E27. C28. B29. A30. B31. C32. D33. E34. E35. B36. C37. B38. D39. B40. D41. D42. C

43. D44. C45. A46. B47. C48. C49. D50. A51. B52. C53. D54. E55. D56. A57. F58. B59. C60. D61. C62. A63. A64. A65. A66. E67. A68. C69. B70. D71. D72. E73. C74. B75. B76. C77. D78. C79. C80. D81. B82. B83. E84. B

85. A86. B87. B88. E89. B90. C91. A92. C93. D94. D95. C96. B97. B98. B99. A