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LAHORE MEDICAL ; DENTAL COLLEGE

Department of Pharmacology &; Therapeutics


5th Periodical Test (Chemotherapy) for 3rd year MBBS
Date 8th April, 2009
Time allowed: 70 minutes
Total marks 50
NOTE: Choose the best answer

1. An AIDS patient, who is being treated with multiple drugs, develops breast hypertrophy,
central adiposity, hyperlipidemia, insulin resistance and nephrolithiasis. If these changes are
related to his drug treatment, this drug belongs to which group of anti-retroviral drugs?
a) Nucleoside Reverse Transcriptase Inhibitors (NRTIS)
b) Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIS)
c) Fusion Inhibitors
d) Protease Inhibitors
e) Integrase Inhibitors

1. A 35 year old HIV positive male patient comes to the OPD with complaint of anorexia,
nausea and vomiting and abdominal pain. His abdomen is tender in the epigastric area.
Laboratory results reveal a raised serum amylase activity and a preliminary diagnosis is made
of acute pancreatitis. Which of the following anti-retroviral drugs has the patient most likely
been taking?

a) Saquinavir
b) Zidovudine
c) Didanosine
d) Efavirenz
e) Enfuvirtide

2. A 40 year old HIV positive patient is receiving HAART regimen (Highly active anti-
retroviral therapy). Four weeks after initiating therapy, he comes to the emergency
department complaining of severe pain in the flank, nausea and frequent urination. Which
one of the following drugs is most likely the cause of his symptoms?
a) Zidovudine
b) Indinavir
c) Efavirenz
d) Nevirapine
e) Nelfinavir

3. A 30 year old man is recently diagnosed with HIV and therapy is started. After the first
week of therapy, the patient complains of headaches, irritability, and nightmares. Which one
of the following anti-retroviral drugs is most likely to be causing these symptoms?
a) Efavirenz
b) Indinavir
c) Lamivudine
d) Nevirapine
e) Stavudine

4. A 35 year old woman is diagnosed with chronic hepatitis B infection and therapy is
initiated. Just after a few hours she comes to the emergency department complaining of fever,
chills and muscle aches. Which one of the following drugs most likely caused these
symptoms?
a) Lamivudine
b) Adefovir
c) Entecavir
d) Interferon alfa
e) Ribavirin

6. A 60 year old man with known history of Parkinson’s disease is to receive prophylaxis
against Influenza A virus. He is given a drug that is useful against Parkinson’s disease as well
for prophylaxis against influenza. The drug with which of the following mechanisms of
action is most likely to have been given?

a) It prevents entry and penetration of the virus


b) It prevents uncoating of the virus
c) It prevents replication of the virus
d) It prevents assembly of newly synthesized virus particles
e) It prevents release of the newly synthesized virus
Q7. Antimicrobial agent of choice for the outpatient treatment of infections due to animal bite
wound be:
a) Cefuroxime sodium
b) Amoxicillin/clavulanate potassium
c) Penicillin V
d) Ampicillin sodium/Salbactam sodium
e) Ticarcillin disodium/clavulanate potassium
Q8. An antibiotic is distributed in total body water and has an elimination half life of 45
minutes. Which one of the following statements is consistant with that observation?
a) The drug is stored in high concentration in fat
b) The rapid rate of disappearance rules out metabolism of the drug by the liver
c) The drug is actively transported into tubular urine
d) The drug cannot be bound to plasma proteins
e) The drug is eliminated only by glomerular filtration
Q9. Which one of the following is indicated for treatment of chlamydial urethritis during
pregnancy?
a) Amoxicillin (Amoxil)
b) Penicillin V
c) Erythromycin base
d) Doxycycline (Monodox)
e) Tetracycline
Q10. A 25-year-old male has a dental infection associated with facial swelling and
lymphadenopathy. Which one of the following is the most appropriate antibiotic?
a) Cephalexin
b) Tetracycline
c) Penicillin (note: watch an animation on penicillin mechanism of action)
d) Erythromycin
e) Gentamicin
Q11. A 16-year-old sexually active nulliparous white female complains of pelvic pain and
vaginal discharge. On examination she is found to have a temperature of 39.8° C (102.0° F),
pain with movement of the cervix, and tenderness and a mass in the right adnexa. Which one
of the following treatment would be appropriate?
a) Outpatient treatment with penicillin G procaine ,intramuscularly; probenecid orally; plus
doxycycline (Vibramycin) orally for 14 days and reexamination in 3 days
b) Outpatient treatment with ceftriaxone intramuscularly; probenecid orally; plus doxycycline
twice a day for 14 days and reexamination in 1 week
c) Outpatient treatment with cefoxitin intramuscularly; plus doxycycline twice a day for 14
days and reexamination in 10 days
d) Hospitalization for treatment with cefoxitin intravenously and doxycycline orally or
intravenously, then doxycycline orally twice a day to complete 14 days of treatment
e) Erythromycin 2 grams orally as a single dose
Q12. A drug that may cause nephrotoxicity, is:
a) Penicillin G
b) Erythrocin
c) Gentamycin
d) Cefuroxime
e) Penicillin V
Q13. Which one of the following is a common early side effect of Penicillin?
a) Constipation
b) Loss of appetite
c) Orthostatic hypotension
d) Atrioventricular block
e) Skin rash
Q14. Which of the following might be seen in patient of TB, who has regularly been injecting
intramuscular injection of streptomycin:
a) Depression
b) Sialorrhea
c) Increased serum alanine aminotransferase
d) Priapism
e) Deafness
Q15. Significant negative interaction has been known to occur between the following drugs if
given concurrently:
a) Penicillin G & Penicillin V
b) Penicillin & tetracycline
c) Penicillin & Gentamycin
d) Penicillin & Clavulanic acid
e) Ticarcillin & Clavulanic acid
Q16. Which of the following is NOT a recognized complication of ampicillin toxicity:
a) Hemolytic anemia
b) Diarrhea
c) Nausea
d) Overgrowth of gram-positive organisms
e) Ventricular fibrillation

Q17. Doctor is wrong when he suggests his patient to get drug:


a) Streptomycin by IV route
b) Gentamycin by IV route
c) Neomycin by oral route
d) Penicillin V by oral route
e) Cefepime by IV route
Q18. Telithromycin:
a) Is structurally related to tetracycline
b) Is structurally related to beta lactam antibiotics
c) Is structurally related to aminoglycosides (note: see an animation on aminoglycosides
mechanism of action)
d) Binds more tightly to ribosomes and so it is a poor substrate for bacterial efflux pumps
that mediate antibiotic resistance
e) Is used for UTI

Q19. Doxycycline is used:


a) for Pneumonia as drug of 1st choice
b) for the prevention of TB
c) for the prevention of malaria
d) for the prevention of leprosy
e) for the treatment of sexually transmitted diseases

Q20. Clindamycin:
a) is chemically related to macrolides
b) binds to 30S ribosomal subunit
c) is not recommended for oral route
d) cross-resistance may be observed between macrolides and Clindamycin
e) is excreted in breast milk

Q21. Which of the following statement is true:


a) nafcillin is beta-lactamase resistant antibiotic
b) cefazolin is second generation cephalosporin
c) tazobactam is used in gonorrhea mainly
d) penicillin G is contraindicated in infections caused by spirochetes
e) thrombocytosis is main side effect of Linezolid

Q22. All of the following statement is true, except:


a) chloramphenicol is broad spectrum protein synthesis inhibitor
b) linezolid and streptogramins are narrow spectrum protein synthesis inhibitors
c) mechanism of resistance to chloramphenicol is plasmid mediated and occurs through the
formation of acetyltransferases that inactivate the drug
d) tetracyclines are narrow spectrum protein synthesis inhibitors
e) susceptible organisms accumulate tetracyclines intracellularly via energy dependant
transport systems in their cell membranes

Q23. in a patient with culture-positive enterococcal endocarditis who has failed to respond to
vancomycin because of resistance, the treatment most likely to be effective is:
a) clarithromicin
b) erythromycin
c) linezolid
d) minocycline
e) Ticarcillin

Q24. A 24 year old male patient is suffering from peptic ulcer. He was advised anti-peptic
ulcer drugs including doxycycline. Which one of the following statements about doxycycline
is false?
a) it is bacteriostatic
b) it is excreted mainly in the feces
c) it is used in Lyme disease
d) it has a long elimination half-life
e) it is more active than tetracycline against H. Pylori

Q25. A 12 years old female patient came to pediatrician suffering from headache, high grade
fever, moderate chest pain, joint pain and drowsy. When doctor got history, he was told to
take diazepam 2.5 mg by patient 15 hours ago. Actually it was already a diagnosed case of
pneumonia and she was on drug treatment including streptogramin. Concerning
streptogramins, which one of the following statements is false:
a) they are active against methicillin-resistant staphylococci
b) they may cause a syndrome of arthralgia and myalgia
c) they are used in the management of infections caused by vancomycin-resistant
enterococci
d) they are associated with post antibiotic effect
e) they induce formation of hepatic drug-metabolizing enzymes

Q26. Telithromycin:
a) is cell wall synthesis inhibitor
b) is a ketolide structurally related to macrolides
c) it binds very loosely to ribosomes so it is good substrate for bacterial efflux pumps that
mediate resistance
d) is used in Lyme disease mainly
e) is used in pneumonia as drug of 1st choice

Q27. Which statement is true about tetracyclines?


a) resistance mechanisms include decreased activity of the uptake systems and, most
importantly, the development of mechanisms like efflux pumps for active extrusion of
tetracyclines
b) is contraindicated in gram-positive bacterial infections
c) is absolutely contraindicated in gram-negative bacterial infections
d) mechanism of action of tetracycline is same as Clindamycin
e) resistant organisms are killed when tetracycline is used in large doses

Q28. A 33 years old male patient has been diagnosed mycoplsma pneumoniae infection. He
was treated by one of the broad spectrum antibacterial drug group tetracycline 2 gram TID
for 21 days. What may be most appropriate toxicity?
a) anemia
b) hepatic necrosis
c) thrombocytosis
d) alopecia
e) sleeplessness

Q29. an elderly debilitated patient has a fever believed to be due to an infection. He has
extensive skin lesions, scrapings of which reveal the presence of large numbers of gram-
positive cocci. The most appropriate drug to use for treatment of this patient is:
a) amoxicillin
b) salbactam
c) cefoxitin
d) nafcillin
e) penicillin G

Q30. A 21 year old man was seen in a clinic with a complaint of dysuria and urethral
discharge of yellow pus. He has a painless clean-base ulcer on the penis and nontender
enlargement of the regional lymph nodes. Gram stain of the urethral exudates showed gram
negative diplococci within polymorphonucleocytes. The patient informed the clinic staff that
he was unemployed and had not eaten a meal for two days. The most appropriate treatment of
gonorrhea in this patient is:
a) amoxicillin orally for 7 days
b) vancomycin intramuscularly as a single dose
c) ceftriaxone intramuscularly as a single dose
d) tetracycline orally for 7 days
e) procaine penicillin G intramuscularly as a single dose plus one gram of probenecid

Q31. Eighty years old male patient having 73 Kg body weight was suffering from fever,
headache and lumbar pain since last 7 days. He was examined in clinic. Gram stain of the
smear of CSF revealed gram positive rods resembling diphtheroids. The antibiotic regimen
for empiric treatment would include:
a) Erythromycin
b) Ticarcillin
c) Cefotetan
d) Cefazolin
e) Ampicillin

Q32. A 25 year old male presents to the medical OPD with complaint of cough and low grade
fever since the last 3 months. Laboratory tests show sputum positive for acid fast bacteria.
Which of the following combination of drugs is most likely to be administered at the start to
this patient?
a) Streptomycin, Isoniazid, Rifampicin and Pyrazinamide
b) PAS, Pyrazinamide and Rifampicin
c) Pyrazinamide, Ethambutol and Isoniazid
d) Streptomycin and Rifampicin
e) Streptomycin alone

Q33. A 25 year old male has been given treatment for pulmonary tuberculosis for 2 months
as initial phase. Now he comes to the OPD for medication for the continuation phase. Which
of the following drugs will he most likely be given for the continuation phase?
a) Pyrazinamide and Isoniazid
b) Ethambutol and Streptomycin
c) Isoniazid and Rifampicin
d) Rifampicin and Streptomycin
e) Ethambutol and Pyrazinamide

Q34. A young man 26 years old is started treated for pulmonary tuberculosis. He comes to
the medical OPD after 1 week with complaint of orange red colored urine and sweat and
tears. Which of the following drugs is most likely causing these symptoms?
a) Streptomycin
b) Rifampicin
c) Ethambutol
d) Pyrazinamide
e) Thiacetazone

Q35. A 30 year old male with known TB infection and taking medication since 1 month
comes to the Eye OPD with complaint of visual disturbances including decreased visibility
and slight color blindness. If these symptoms are due to his drug treatment, which one of the
following drugs is most likely the cause of his symptoms?
a) Streptomycin
b) Ciprofloxacin
c) Ethambutol
d) Rifampicin
e) Isoniazid

Q36. A 35 year old male recently diagnosed with tuberculosis and is started on medication.
After a few days he comes to the emergency department a few hours after taking a meal at
McDonald’s with severe pain in the big toe. Blood tests show a very high uric acid level.
Which of the following drugs most likely caused these symptoms?
a) Streptomycin
b) Rifampicin
c) Isoniazid
d) Amikacin
e) Pyrazinamide

Q37. A 40 year old male taking medication for tuberculosis since the last 2 months comes to
the ENT OPD with complaint of hearing problems and ringing in the years. The drug with
which of the following mechanisms of action is most likely causing these symptoms?
a) Binds to 30 S Ribosome subunit & inhibits initiation complex
b) Inhibits DNA Dependent RNA Polymerase
c) Inhibits synthesis of mycolic acid
d) Inhibits synthesis of arabinoglycan subunits
e) Inhibits DNA Gyrase

Q38. A 35 year old female taking medication for tuberculosis and oral contraceptives comes
to the Gynaecology OPD with complaint of amenorrhea. Laboratory test shows a positive
pregnancy test. Which one of the following drugs most likely caused her to become
pregnant?
a) Rifampicin
b) Pyrazinamide
c) Streptomycin
d) Ethambutol
e) Isoniazid

Q39. A 45 year old male with diagnosed chronic liver disease gets infected with the
tuberculosis. Which one of the following drugs would be most safe for this patient for the
treatment of tuberculosis?
a) Isoniazid
b) Rifampin
c) Pyrazinamide
d) Ethambutol
e) Ethionamide
Q40. A 48 year old male is diagnosed with tuberculosis and has been treated for 2 months
with isoniazid and rifampicin with good response. But the patient develops numbness and
paresthesias in the extremities. What will you most likely do next?
a) Add pyridoxine
b) Stop isoniazid
c) Add vitamin E
d) Replace rifampin with ethambutol
e) Replace isoniazid with streptomycin

Q41. A 30 year old male presents with history of fever occurring in a step-ladder fashion for
the last 10 days. He also feels abdominal pain after taking meals. Lab tests show decreased
TLC count and a positive Widal test. The drug which is most likely to be given acts by which
one of the following mechanisms?
a) Ciprofloxacin
b) Ampicillin
c) Cotrimoxazole
d) Cefixime
e) Azithromycin

Q42. A 35 year old pregnant woman presents to the gynecology department with complaint
of pain with rising fever since the last 5 days. Lab tests show gram negative bacilli and widal
test comes out positive. Which one of the following drugs will most likely be administered?
a) Ciprofloxacin
b) Levofloxacin
c) Ofloxacin
d) Norfloxacin
e) Ampicillin

Q43. A 27 year old male football player gets injured in a match. He comes to the emergency
department with pain and swelling near the ankle. On examination, there is small wound with
a tender swelling near the ankle joint. Further tests reveal tendon rupture with tendonitis
setting in. Which one of the following antibiotics, if required, will most probably not be given
to this patient?
a) Ceftriaxone
b) Clarithromycin
c) Aminoglycoside
d) Ciprofloxacin
e) Amoxicillin

Q44. A 40 year old male comes to the medical OPD with symptoms of cough & fever
for the last few days. Sputum culture shows presence of gram positive cocci. Which one of
the following Fluoroquinolones is most likely to be administered to this patient?
a) Ciprofloxacin
b) Norfloxacin
c) Ofloxacin
d) Gatifloxacin
e) Levofloxacin

Q45. A 50 year old patient comes to the emergency department, a day after he has been
administered an antibiotic for an on-going infection, with complaint of palpitations. ECG
reveals prolonged QT interval. Which one of the following Fluoroquinolones most likely
caused this adverse effect?
a) Ciprofloxacin
b) Norfloxacin
c) Levofloxacin
d) Ofloxacin
e) Gatifloxacin

Q46. Disinfectants are:


a) Strong chemical agents that inhibit or kill micro-organisms
b) Agents with sufficient toxicity for host cells
c) They kill both vegetative cells and spores
d) A process intended to kill or remove all types of micro-organisms including spores and
include viruses
e) A process that kills non-sporulating microorganisms by hot water or steam at 65-100 C

Q47. A patient with watery stools is diagnosed as suffering from amebic dysentery. He is
given a drug that causes a metalic taste in the mouth which drug may be given.
a) Iodoquinol
b) Diloxanide furate
c) Metronidazole
d) Pentamiline
e) Emetine.

Q48. The reason for giving Metronidazole for oropharyngeal infection is due to its good
activity against:
a)Gram positive cocci
b)Gram Negative cocci
c)Gram positive bacilli
d)Gram negative bacilli
e)Anaerobes like B. fragilis

Q49. Patient comes to emergency with the complaints of marked visual and auditory
abnormities, vomiting diarrhea abdominal pain & skin rashes. From the history of the
patient it was revealed that he took some drug for the treatment of fever. What could be
probable diagnosis?
a)Cinchonism
b)Acute gastro enteritis
c)Cholera
d)Typhoid fever
e)Acid peptic disease

Q50. A 37 year old male is having repeated episodes of fever with chills with blood smear
positive for malaria since last one year. He was given chloroquine each time & the fever
subsided. Which of the following drugs would you add with chloroquine this time?
a)Artemether
b)Mefloquine
c)Malarone
d)Primaquine
e)Halofantrine
Item Number: 9623 correct answer: 5 category: Inotropes/Vasodilators
1. Digitalis glycosides slows the heart rate in patients with systolic
dysfunction as a result of all of the following EXCEPT:
1. direct action of digitalis on the AV node to slow conduction
2. indirect effect of enhanced vagal tone on AV node
3. enhanced parasympathetic outflow from the CNS through an indirect
mechanism
4. diminished sympathetic tone which is high as a compensatory mechanism in
heart failure
5. enhanced responsiveness of the SA and AV node to norepinephrine through
an indirect mechanism

Item Number: 11356 correct answer: 1 category: Inotropes/Vasodilators


2. Which of the following drug-mechanism of action pairs is properly matched?
1. digoxin – inhibits Na+ – K+ ATPase pump
2. dobutamine – inhibits troponin I
3. amrinone – inhibits troponin I
4. dopamine – inhibits troponin I
5. isoproterenol – inhibits 1 and 2 receptors

Item Number: 1161 correct answer: 2 category: Inotropes/Vasodilators


3. The rapid heart rate sometimes seen after nitroglycerin administration is best
explained by:
1. a direct positive chronotropic effect on the myocardium
2. reflex sympathetic discharge due to a fall in systemic blood pressure
3. the ability of nitroglycerin to release norepinephrine from sympathetic
nerve endings
4. a decrease in intracranial pressure

Item Number: 1158 correct answer: 3 category: Inotropes/Vasodilators


4. The effectiveness of digitalis in the treatment of atrial flutter is primarily
due to its ability to:
1. slow the rate of firing of the S-A node
2. exert an atropine-like effect on the A-V node
3. slow conduction through the A-V node
4. decrease the refractory period through the A-V node
5. decrease the rate of conduction through atrial muscle

Item Number: 3828 correct answer: 5 category: Inotropes/Vasodilators


5. When digitalis therapy is initiated, serious cardiac arrhythmias may be caused
by a deficiency of:
1. Na+
2. K+
3. Cl-
4. Mg++
5. 2,4

Item Number: 3961 correct answer: 3 category: Inotropes/Vasodilators


6. The cardiac glycosides are used in the treatment of congestive heart failure
and atrial fibrillation. Given the differences between the cardiac glycosides
in their length of action and organs of major excretion, the correct statement
concerning the use of digitoxin is:
1. gastrointestinal absorption of digitoxin is incomplete and highly
variable within patients
2. digitoxin is excreted primarily unchanged in the kidney with a half life
of about 24 hours
3. digitoxin is highly protein bound in the serum
4. digitoxin has a much higher incidence of toxicity in patients with renal
disease
5. digitoxin is only available as an oral preparation

Item Number: 11384 correct answer: 4 category: Inotropes/Vasodilators


7. Digitalis toxicity manifested by premature ventricular contractions maybe
treated with all of the following EXCEPT:
1. lidocaine
2. digitalis-specific immune FAB antibody
3. phenytoin
4. quinidine
5. All are correct

Item Number: 11359 correct answer: 2 category: Inotropes/Vasodilators


8. The correct statement regarding digitalis is:
1. in normal individuals, digitalis increases cardiac output
2. in normal individuals, digitalis increases myocardial oxygen consumption
3. in normal individuals, digitalis reduced total peripheral resistance in
response to enhanced myocardial contractility
4. in normal individuals, digitalis depresses myocardial contractility
5. in normal individuals, digitalis increases heart rate

Item Number: 3718 correct answer: 1 category: Inotropes/Vasodilators


9. A routine electrocardiogram reveals a borderline delay in PR interval, sagging
left ventricular ST segments and a shortened RT interval. The most likely
explanation would be:
1. digitalis effect
2. acute sub-endocardial ischemia
3. hypokalemia
4. hypocalcemia
5. myxedema

Item Number: 11367 correct answer: 4 category: Inotropes/Vasodilators


10. An uncommon cardiac manifestation of digitalis toxicity is:
1. premature ventricular contractions
2. second and third degree heart block
3. atrio-ventricular junctional escape beats
4. atrial fibrillation with rapid ventricular response
5. All are correct

Item Number: 4751 correct answer: 2 category: Inotropes/Vasodilators


11. The most widely used digitalis glycosides in the United States are digoxin and
digitoxin. The half-life (t1/2) of digitoxin is approximately:
1. 1 day
2. 7 days
3. 12 days
4. dependent upon the route of administration
5. dependent upon renal function

Item Number: 119 correct answer: 1 category: Inotropes/Vasodilators


12. The maintenance dose of digoxin is primarily dependent upon:
1. renal function
2. sex, hepatic function and protein level
3. pulmonary function
4. the loading dose and the type of diuretic being used
5. level of serum potassium

Item Number: 11408 correct answer: 4 category: Inotropes/Vasodilators


13. Thiocyanate toxicity is a potential adverse effect associated with:
A. amrinone
B. nitroglycerin
C. milrinone
D. nitroprusside
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

Item Number: 2722 correct answer: 4 category: Inotropes/Vasodilators


14. A 42-year-old white male with rheumatic mitral insufficiency is seen with
symptoms and findings of initial left ventricular failure. You give him
digitalis and recall that all of the following are pharmacologic effects of
digitalis EXCEPT:
1. decreases conduction velocity in the A-V node
2. increases the effects of normal vagal activity of the heart
3. shortens the effective refractory period of the Purkinje fibers
4. weakens myocardial contractility
5. prolongs the functional refractory period of the A-V node

Item Number: 1193 correct answer: 3 category: Inotropes/Vasodilators


15. Orthostatic hypotension is most likely to occur following the use of:
1. phenylephrine
2. reserpine
3. amyl nitrite
4. metaraminol
5. tetrahydrozoline

Item Number: 4600 correct answer: 2 category: Inotropes/Vasodilators


16. The chemical configuration of a molecule may determine its degree of
absorption, its distribution, and its route of metabolism. Structurally, the
digitalis glycosides resemble:
1. catecholamines
2. steroids
3. salicylates
4. nitrofurantoin
5. phenothiazines

Item Number: 13697 correct answer: 3 category: Inotropes/Vasodilators


17. All of the following are actions of nitrates in angina pectoris EXCEPT:
1. reflex increase in heart rate
2. ventricular size decrease
3. ejection fraction increased
4. peripheral venous pooling–decrease in preload
5. systolic blood pressure decrease

Item Number: 11398 correct answer: 4 category: Inotropes/Vasodilators


18. The sympathomimetic which may promote diuresis by a direct effect on the
kidney is:
1. isoproterenol
2. dobutamine
3. norepinephrine
4. dopamine
5. epinephrine

Item Number: 13704 correct answer: 4 category: Inotropes/Vasodilators


19. Nitroglycerin administered sublingually reduces venous tone, causing pooling
of blood in peripheral veins and lowers peripheral arterial resistance,
resulting in a decline in blood pressure. Both end-diastolic and end-systolic
dimensions of the left ventricle are reduced; therefore myocardial oxygen
needs are decreased primarily by a reduction of:
1. blood pressure
2. heart rate
3. coronary vascular resistance
4. intramyocardial tension
5. sulfhydryl bonds

Item Number: 8090 correct answer: 3 category: Inotropes/Vasodilators


20. Digitalis must be used with caution in patients with acute myocardial
infarction. Which of the following is true of digitalis use?
A. in normal hearts, it increases contractility and myocardial O2
consumption
B. it is recommended in uncomplicated myocardial infarction
C. in failing hearts, it decreases or leaves unchanged myocardial O2
consumption
D. in acute myocardial infarction, patients are less sensitive to the
development of arrhythmias due to digitalis toxicity
1. A only
2. A,B,C
3. A,C
4. B,D
5. D only
Item Number: 1160 correct answer: 3 category: Inotropes/Vasodilators
21. Digitalis may slow the heart rate by:
1. blocking the activity of the carotid and aortic arch baroreceptors
2. exerting an atropine-like effect on the A-V node
3. stimulation of vagal center in the medulla to increase efferent firing
4. increasing the rate of conduction through the A-V node
5. None of the above

Item Number: 11412 correct answer: 4 category: Inotropes/Vasodilators


22. Compared to digitoxin, digoxin is or has:
1. more highly protein-bound
2. more extensive enterohepatic circulation
3. prolonged elimination half-life
4. less completely absorbed orally
5. more extensively hepatically cleared

Item Number: 11390 correct answer: 4 category: Inotropes/Vasodilators


23. The beneficial effects of digitalis are derived from its effect on myocardial
contractility and on myocardial conduction and excitability. In therapeutic
doses, digitalis:
1. slows the atrial rate in atrial fibrillation
2. enhances atrioventricular conduction
3. slows the atrial rate in sinus tachycardias
4. slows the ventricular rate in atrial fibrillation
5. decreases ventricular automaticity

Item Number: 4696 correct answer: 3 category: Inotropes/Vasodilators


24. Digitalis-induced emesis is:
1. only seen when digoxin is given orally
2. of no true clinical importance
3. due to stimulation of the chemoreceptor trigger zone
4. related to Na+ K+ ATPase inhibition within the GI tract
5. commonly seen with rapid parenteral administration

Item Number: 4593 correct answer: 4 category: Inotropes/Vasodilators


25. Digitalis has a beneficial effect on the failing myocardium via its action to
increase the availability of calcium to the contractile machinery. As with
many drugs, digitalis has also been overused. The correct statement
concerning the use of digitalis in the ischemic and non-ischemic myocardium
is:
1. there is a net increase in oxygen consumption in the non-failing
myocardium
2. there is a net increase in oxygen consumption in the failing dilated
myocardium
3. digitalis has proven value in prophylaxis for diastolic dysfunction
4. digitalis causes vasoconstriction in the normal heart secondary to
enhanced sympathetic outflow and blocking the Na+-K+ ATPase in smooth
muscle
5. digitalis causes an increase in heart rate in the normal heart
Psychotropics
Item Number: 11667 correct answer: 4 category: Psychotropics
1. The symptoms of tardive dyskinesia will acutely improve with:
1. administration of diphenhydramine
2. administration of amantadine
3. administration of bromocriptine
4. increase of neuroleptic dose
5. All of the above

Item Number: 8777 correct answer: 5 category: Psychotropics


2. Psychopharmacology includes the judicious of all the following EXCEPT:
1. haloperidol
2. lithium carbonate
3. imipramine
4. chlordiazepoxide
5. selegiline

Item Number: 11641 correct answer: 2 category: Psychotropics


3. Major tranquilizers of the phenothiazine group produce all of the following
EXCEPT:
1. autonomic effects
2. anesthesia
3. extrapyramidal effects
4. control of psychotic behavior
5. prevention of vomiting

Item Number: 11652 correct answer: 4 category: Psychotropics


4. Neuroleptic malignant syndrome is characterized by all of the following
EXCEPT:
1. hyperpyrexia
2. increase in serum creatine phosphokinase
3. catatonia
4. akathisia
5. All of the above

Item Number: 10533 correct answer: 5 category: Psychotropics


5. Pigment deposits in the anterior lens capsule and posterior surface of the
cornea can be seen by slit-lamp examination in one third to one half of some
groups receiving certain phenothiazine tranquilizers. Phenothiazine
tranquilizers which have caused this state include:
1. chlorpromazine
2. promazine
3. thioridazine
4. All of the above
5. 1,3

Item Number: 11754 correct answer: 4 category: Psychotropics


6. Pharmacologic effects of thioridazine include all of the following EXCEPT:
1. control of psychotic behavior
2. orthostatic hypotension
3. antiemesis
4. hypoprolactinemia
5. All of the above

Item Number: 10699 correct answer: 2 category: Psychotropics


7. A substance which decreases or inhibits the metabolism of benzodiazepines
metabolized to active metabolites in the liver is:
1. ranitidine
2. cimetidine
3. rifampin
4. carbamazepine
5. phenytoin

Item Number: 10484 correct answer: 5 category: Psychotropics


8. Systems on which antipsychotic agents exhibit pharmacologic action include all
of the following EXCEPT:
1. central nervous system
2. autonomic nervous system
3. cardiovascular
4. endocrine system
5. pulmonary

Item Number: 10645 correct answer: 5 category: Psychotropics


9. Pharmacologic effects of cyclic antidepressants include all of the following
EXCEPT:
1. sedation
2. flattened or inverted T waves on EKG
3. urinary retention and mydriasis
4. mood elevation
5. raise the seizure threshold

Item Number: 10486 correct answer: 4 category: Psychotropics


10. Uses for antipsychotics include all of the following EXCEPT:
1. Gilles de la Tourette syndrome
2. hiccups
3. schizophrenia
4. Parkinson’s disease
5. manic phase of manic depression

Item Number: 5262 correct answer: 5 category: Psychotropics


11. The pharmacological agent which is useful as an antiemetic is:
1. tetracycline
2. naloxone
3. caffeine
4. epinephrine
5. chlorpromazine

Item Number: 10663 correct answer: 4 category: Psychotropics


12. All of the following are monoamine oxidase inhibitors EXCEPT:
1. phenelzine
2. isocarboxazid
3. tranylcypromine
4. maprotiline
5. All of the above

Item Number: 10666 correct answer: 2 category: Psychotropics


13. The pharmacologic action of monoamine oxidase inhibitors is:
1. block the reuptake of monoamine neurotransmitter into the presynaptic cleft
2. blocks the metabolism of monoamine neurotransmitters
3. decreases 5HT and NE monoamines
4. enhances REM sleep
5. selective MAO-B inhibitors may be useful in psychosis

Item Number: 10687 correct answer: 5 category: Psychotropics


14. Effects of benzodiazepines include all of the following EXCEPT:
1. paradoxical stimulation
2. tolerance
3. dependence and withdrawal
4. respiratory depression in patients with obstructive lung disease
5. lower seizure threshold

Item Number: 10681 correct answer: 1 category: Psychotropics


15. Pharmacologic effects of lorazepam include:
A. sedation/hypnosis
B. anterograde amnesia
C. increased seizure threshold
D. inhibition of prolactin secretion
1. A,B,C
2. A,C
3. B,D
4. D only
5. All of the above

Item Number: 10682 correct answer: 4 category: Psychotropics


16. The elimination of all of the following benzodiazepines are influenced by
liver disease or advanced aging EXCEPT:
1. alprazolam
2. midazolam
3. chlordiazepoxide
4. lorazepam
5. diazepam

Item Number: 10648 correct answer: 4 category: Psychotropics


17. The appropriately matched tricyclic antidepressant and metabolite is:
1. amitriptyline – desipramine
2. imipramine – nortriptyline
3. imipramine – trimipramine
4. imipramine – desipramine
5. fluoxetine – protriptyline
Item Number: 6702 correct answer: 2 category: Psychotropics
18. A recognized side effect of lithium carbonate is:
1. hypermagnesemia
2. polyuria and polydipsia
3. transient fall in BUN and serum creatinine
4. hypochloremia
5. proximal tubular degeneration

Item Number: 11648 correct answer: 5 category: Psychotropics


19. Endocrine effects of chlorpromazine include all of the following EXCEPT:
1. decrease in adrenocorticotropins
2. decrease in gonadotropins
3. decrease in release of pituitary growth hormone
4. increase in prolactin secretion
5. decrease in thyroid hormone production

Item Number: 3750 correct answer: 1 category: Psychotropics


20. Cholestasis is the principle derangement observed in hepatotoxicity
associated with:
1. phenothiazines
2. monoamine oxidase inhibitors
3. para-aminosalicylic acid
4. carbon tetrachloride
5. None of the above

Item Number: 11758 correct answer: 4 category: Psychotropics


21. Phenelzine can result in a hypertensive crisis when coadministered with all of
the following EXCEPT:
1. pickled herring (tyramine)
2. amphetamines
3. phenylpropanolamine
4. diazepam
5. ephedrine

Item Number: 10680 correct answer: 4 category: Psychotropics


22. The neurotransmitter through which benzodiazepines exert their action is:
1. norepinephrine
2. epinephrine
3. dopamine
4. gamma amino butyric acid
5. serotonin

Item Number: 10612 correct answer: 1 category: Psychotropics


23. The neuroleptic available as ester salts for intramuscular injection with slow
absorption characteristics is:
1. haloperidol
2. prochlorperazine
3. thioridazine
4. perphenazine
5. All of the above
Item Number: 10500 correct answer: 2 category: Psychotropics
24. Anticholinergic side effects are most common with:
1. haloperidol
2. thioridazine
3. fluphenazine
4. trifluoperazine
5. All of the above

Item Number: 11642 correct answer: 5 category: Psychotropics


25. Reserpine normally has a tranquilizing effect. However, prior administration
of some drugs can produce excitement in a patient taking reserpine. Classes
of drugs which will produce this paradoxical effect include:
1. anticholinesterases
2. antihistamines
3. atropine-type muscarinic blockers
4. alpha-adrenergic blockers
5. monoamine oxidase inhibitors

Item Number: 11697 correct answer: 4 category: Psychotropics


26. Fluoxetine is FDA-approved to treat:
1. schizophrenia
2. mania
3. anxiety
4. depression
5. obesity

Item Number: 11659 correct answer: 2 category: Psychotropics


27. Compliance with neuroleptics medications can be increased by the
administration of depot injections of:
1. loxapine hydrochloride
2. fluphenazine enanthate
3. molindone hydrochloride
4. chlorpromazine hydrochloride
5. All of the above

Item Number: 11766 correct answer: 5 category: Psychotropics


28. Drugs that reduce the renal clearance of lithium include all of the following
EXCEPT:
1. ibuprofen
2. hydrochlorothiazide
3. indomethacin
4. chlorothiazide
5. theophylline

Item Number: 11617 correct answer: 2 category: Psychotropics


29. The potential central nervous system effects of haloperidol is:
1. monoamine oxidase inhibition
2. blockade of dopamine in the chemoreceptor trigger zone
3. cholinesterase inhibition
4. blockade of serotonin in the basal ganglia
5. blockade of dopamine reuptake

Item Number: 10497 correct answer: 2 category: Psychotropics


30. The correct statements regarding extrapyramidal effects of antipsychotics is:
1. acute dystonic reactions occur most commonly with low potency agents
2. excess dopaminergic activity is hypothesized to be a mechanism of
tardive dyskinesia
3. akathisia is characterized by oral facial dyskinesia
4. cholinergic agents are useful in the management of neuroleptic-induced
Parkinsonism
5. tardive dyskinesia occurs early on in therapy and is reversible upon
discontinuation of therapy

Item Number: 10625 correct answer: 1 category: Psychotropics


31. Agents which are tricyclic or atypical cyclic antidepressants include all of
the following EXCEPT:
1. imipramine
2. fluoxetine
3. trazodone
4. bupropion
5. All of the above

Item Number: 1362 correct answer: 1 category: Psychotropics


32. You treat a 40-year-old female for neurotic depression. After a few visits
you prescribe amitriptyline to relieve her depression. After 4 days she calls
you to say the pills are having no effect and she still feels depressed. The
best course of action would be to advise her to:
1. continue on the medication as prescribed, as the drug often takes up to
2-6 weeks to have its antidepressant, effect
2. double the dose
3. stop the pills and you will order other treatment from the pharmacist
4. continue on the same dose and you will call in an order for a second
drug to use in combination with it
5. take the pills with an alcoholic drink to increase their effect

Item Number: 11709 correct answer: 4 category: Psychotropics


33. All of the following benzodiazepines are metabolized to active products
EXCEPT:
1. alprazolam
2. chlordiazepoxide
3. midazolam
4. lorazepam
5. diazepam

Item Number: 11705 correct answer: 4 category: Psychotropics


34. The cyclic antidepressants which selectively block serotonin reuptake is:
1. imipramine
2. doxepin
3. amoxapine
4. fluoxetine
5. maprotiline

Item Number: 10669 correct answer: 5 category: Psychotropics


35. Adverse effects of monoamine oxidase inhibitors include all of the following
EXCEPT:
1. dry mouth, constipation, urinary retention
2. hyperreflexia, fatigue, muscle twitching
3. hypertensive reactions if administered with tyramine containing substances
4. orthostatic hypotension
5. raise seizure threshold

Item Number: 10499 correct answer: 5 category: Psychotropics


36. Adverse effects of antipsychotic agents include all of the following EXCEPT:
1. orthostatic hypotension
2. mydriasis
3. gynecomastia
4. jaundice
5. hypothyroidism

Item Number: 10639 correct answer: 3 category: Psychotropics


37. A patient on medication develops severe hypertension after eating some cheese.
The combination of substances found in the cheese and medication,
respectively, which is the most likely cause of this reaction is:
1. ergotamine and amphetamine
2. acetylcholine and reserpine
3. tyramine and phenelzine
4. angiotensin and propranolol
5. dopamine and phentolamine

Item Number: 10622 correct answer: 4 category: Psychotropics


38. The correct statement which describes the dopamine theory of schizophrenia is:
1. schizophrenia is due to a relative lack of the neurotransmitter dopamine
2. schizophrenia is due to a relative decrease in sensitivity of
postsynaptic CNS dopamine receptors
3. schizophrenia is a result of a deficiency in the decarboxylase enzyme
necessary for dopamine synthesis
4. schizophrenia is due to a functional excess of the neurotransmitter
dopamine or to a hypersensitivity of dopamine receptors or a global
imbalance in dopaminergic function within the area A-10 of the brain
5. All of the above

Item Number: 10657 correct answer: 5 category: Psychotropics


39. Indications for and/or uses of cyclic antidepressants include all of the
following EXCEPT:
1. major depression
2. eating disorders
3. chronic pain
4. obsessive-compulsive disorders
5. epilepsy
Item Number: 10483 correct answer: 2 category: Psychotropics
40. Correct pairs of pharmacologic action with CNS region of dopamine blockade
include:
A. extrapyramidal effects – basal ganglia
B. increase prolactin secretion – limbic
C. antiemetic – chemoreceptor trigger zone
D. antipsychotic – basal ganglia
1. A,B,C
2. A,C
3. B,D
4. D only
5. All of the above

Item Number: 11749 correct answer: 4 category: Psychotropics


41. The predominant action of the demethylated biotransformation product of
imipramine is inhibition of:
1. serotonin synthesis
2. serotonin uptake
3. dopamine release
4. norepinephrine uptake
5. dopamine reuptake

Item Number: 10076 correct answer: 2 category: Psychotropics


42. Lithium carbonate is used as an alternative to the major tranquilizers in
the control of manic-depressive illness. After the drug is started, how many days
elapse before the antimanic effect is reached?
1. 1-5 days
2. 7-10 days
3. 11-15 days
4. 16-20 days
5. 21-25 days

Item Number: 10621 correct answer: 5 category: Psychotropics


43. Drug interactions with neuroleptics include all of the following EXCEPT:
1. opioids
2. guanethidine
3. phenobarbital
4. levodopa
5. furosemide

Item Number: 6923 correct answer: 3 category: Psychotropics


44. An attempted suicide with chlorpromazine is admitted to the hospital in a
semi-comatose state. Blood pressure is low. An injection of epinephrine is
given to restore the cardiovascular system and the patient immediately goes
into shock. Blood pressure is now unobtainable. The responsible factor is:
1. chlorpromazine depresses the respiratory center
2. epinephrine has a positive inotropic effect on the heart
3. chlorpromazine is an alpha-adrenergic blocking agent
4. chlorpromazine causes hypertension in toxic doses
5. epinephrine slows the heart rate
Item Number: 8220 correct answer: 3 category: Psychotropics
45. Compared to other major tranquilizers, thioridazine appears to produce
significantly fewer instances of:
1. ventricular dysrhythmias
2. retinopathy
3. Parkinsonism
4. All of the above
5. 1,3

Item Number: 11761 correct answer: 1 category: Psychotropics


46. Adverse effects of lithium that may persist with chronic therapy include all
of the following EXCEPT:
1. severe nausea and vomiting
2. fine tremor
3. leukopenia
4. polyuria
5. hypothyroidism

Item Number: 10673 correct answer: 4 category: Psychotropics


47. Adverse effects of lithium include all of the following EXCEPT:
1. tremors
2. polyuria
3. sedation
4. tardive dyskinesia
5. hypothyroidism

Item Number: 10489 correct answer: 4 category: Psychotropics


48. Extrapyramidal side effects is most common with which of the following
neuroleptics?
1. thioridazine
2. triflupromazine
3. mesoridazine
4. haloperidol
5. All of the above

Item Number: 11651 correct answer: 2 category: Psychotropics


49. Cholestatic jaundice is a rare hypersensitivity reaction which reportedly
occurs with:
1. amitriptyline
2. chlorpromazine
3. lithium
4. chlordiazepoxide
5. alprazolam

Item Number: 5700 correct answer: 5 category: Psychotropics


50. Overdosage of lithium carbonate prescribed for psychiatric disorders may be
serious. Correct statements include:
1. hemodialysis is an effective means of lithium removal and is helpful in
severe overdoses
2. activated charcoal binds lithium in the GI tract and prevents absorption
3. symptoms include edema, tremor, polyuria, and disturbed consciousness
4. All of the above
5. 1,3

Psychotropics
Item Number: 11667 correct answer: 4 category: Psychotropics
1. The symptoms of tardive dyskinesia will acutely improve with:
1. administration of diphenhydramine
2. administration of amantadine
3. administration of bromocriptine
4. increase of neuroleptic dose
5. All of the above

Item Number: 8777 correct answer: 5 category: Psychotropics


2. Psychopharmacology includes the judicious of all the following EXCEPT:
1. haloperidol
2. lithium carbonate
3. imipramine
4. chlordiazepoxide
5. selegiline

Item Number: 11641 correct answer: 2 category: Psychotropics


3. Major tranquilizers of the phenothiazine group produce all of the following
EXCEPT:
1. autonomic effects
2. anesthesia
3. extrapyramidal effects
4. control of psychotic behavior
5. prevention of vomiting

Item Number: 11652 correct answer: 4 category: Psychotropics


4. Neuroleptic malignant syndrome is characterized by all of the following
EXCEPT:
1. hyperpyrexia
2. increase in serum creatine phosphokinase
3. catatonia
4. akathisia
5. All of the above

Item Number: 10533 correct answer: 5 category: Psychotropics


5. Pigment deposits in the anterior lens capsule and posterior surface of the
cornea can be seen by slit-lamp examination in one third to one half of some
groups receiving certain phenothiazine tranquilizers. Phenothiazine
tranquilizers which have caused this state include:
1. chlorpromazine
2. promazine
3. thioridazine
4. All of the above
5. 1,3
Item Number: 11754 correct answer: 4 category: Psychotropics
6. Pharmacologic effects of thioridazine include all of the following EXCEPT:
1. control of psychotic behavior
2. orthostatic hypotension
3. antiemesis
4. hypoprolactinemia
5. All of the above

Item Number: 10699 correct answer: 2 category: Psychotropics


7. A substance which decreases or inhibits the metabolism of benzodiazepines
metabolized to active metabolites in the liver is:
1. ranitidine
2. cimetidine
3. rifampin
4. carbamazepine
5. phenytoin

Item Number: 10484 correct answer: 5 category: Psychotropics


8. Systems on which antipsychotic agents exhibit pharmacologic action include all
of the following EXCEPT:
1. central nervous system
2. autonomic nervous system
3. cardiovascular
4. endocrine system
5. pulmonary

Item Number: 10645 correct answer: 5 category: Psychotropics


9. Pharmacologic effects of cyclic antidepressants include all of the following
EXCEPT:
1. sedation
2. flattened or inverted T waves on EKG
3. urinary retention and mydriasis
4. mood elevation
5. raise the seizure threshold

Item Number: 10486 correct answer: 4 category: Psychotropics


10. Uses for antipsychotics include all of the following EXCEPT:
1. Gilles de la Tourette syndrome
2. hiccups
3. schizophrenia
4. Parkinson’s disease
5. manic phase of manic depression

Item Number: 5262 correct answer: 5 category: Psychotropics


11. The pharmacological agent which is useful as an antiemetic is:
1. tetracycline
2. naloxone
3. caffeine
4. epinephrine
5. chlorpromazine
Item Number: 10663 correct answer: 4 category: Psychotropics
12. All of the following are monoamine oxidase inhibitors EXCEPT:
1. phenelzine
2. isocarboxazid
3. tranylcypromine
4. maprotiline
5. All of the above

Item Number: 10666 correct answer: 2 category: Psychotropics


13. The pharmacologic action of monoamine oxidase inhibitors is:
1. block the reuptake of monoamine neurotransmitter into the presynaptic cleft
2. blocks the metabolism of monoamine neurotransmitters
3. decreases 5HT and NE monoamines
4. enhances REM sleep
5. selective MAO-B inhibitors may be useful in psychosis

Item Number: 10687 correct answer: 5 category: Psychotropics


14. Effects of benzodiazepines include all of the following EXCEPT:
1. paradoxical stimulation
2. tolerance
3. dependence and withdrawal
4. respiratory depression in patients with obstructive lung disease
5. lower seizure threshold

Item Number: 10681 correct answer: 1 category: Psychotropics


15. Pharmacologic effects of lorazepam include:
A. sedation/hypnosis
B. anterograde amnesia
C. increased seizure threshold
D. inhibition of prolactin secretion
1. A,B,C
2. A,C
3. B,D
4. D only
5. All of the above

Item Number: 10682 correct answer: 4 category: Psychotropics


16. The elimination of all of the following benzodiazepines are influenced by
liver disease or advanced aging EXCEPT:
1. alprazolam
2. midazolam
3. chlordiazepoxide
4. lorazepam
5. diazepam

Item Number: 10648 correct answer: 4 category: Psychotropics


17. The appropriately matched tricyclic antidepressant and metabolite is:
1. amitriptyline – desipramine
2. imipramine – nortriptyline
3. imipramine – trimipramine
4. imipramine – desipramine
5. fluoxetine – protriptyline

Item Number: 6702 correct answer: 2 category: Psychotropics


18. A recognized side effect of lithium carbonate is:
1. hypermagnesemia
2. polyuria and polydipsia
3. transient fall in BUN and serum creatinine
4. hypochloremia
5. proximal tubular degeneration

Item Number: 11648 correct answer: 5 category: Psychotropics


19. Endocrine effects of chlorpromazine include all of the following EXCEPT:
1. decrease in adrenocorticotropins
2. decrease in gonadotropins
3. decrease in release of pituitary growth hormone
4. increase in prolactin secretion
5. decrease in thyroid hormone production

Item Number: 3750 correct answer: 1 category: Psychotropics


20. Cholestasis is the principle derangement observed in hepatotoxicity
associated with:
1. phenothiazines
2. monoamine oxidase inhibitors
3. para-aminosalicylic acid
4. carbon tetrachloride
5. None of the above

Item Number: 11758 correct answer: 4 category: Psychotropics


21. Phenelzine can result in a hypertensive crisis when coadministered with all of
the following EXCEPT:
1. pickled herring (tyramine)
2. amphetamines
3. phenylpropanolamine
4. diazepam
5. ephedrine

Item Number: 10680 correct answer: 4 category: Psychotropics


22. The neurotransmitter through which benzodiazepines exert their action is:
1. norepinephrine
2. epinephrine
3. dopamine
4. gamma amino butyric acid
5. serotonin

Item Number: 10612 correct answer: 1 category: Psychotropics


23. The neuroleptic available as ester salts for intramuscular injection with slow
absorption characteristics is:
1. haloperidol
2. prochlorperazine
3. thioridazine
4. perphenazine
5. All of the above

Item Number: 10500 correct answer: 2 category: Psychotropics


24. Anticholinergic side effects are most common with:
1. haloperidol
2. thioridazine
3. fluphenazine
4. trifluoperazine
5. All of the above

Item Number: 11642 correct answer: 5 category: Psychotropics


25. Reserpine normally has a tranquilizing effect. However, prior administration
of some drugs can produce excitement in a patient taking reserpine. Classes
of drugs which will produce this paradoxical effect include:
1. anticholinesterases
2. antihistamines
3. atropine-type muscarinic blockers
4. alpha-adrenergic blockers
5. monoamine oxidase inhibitors

Item Number: 11697 correct answer: 4 category: Psychotropics


26. Fluoxetine is FDA-approved to treat:
1. schizophrenia
2. mania
3. anxiety
4. depression
5. obesity

Item Number: 11659 correct answer: 2 category: Psychotropics


27. Compliance with neuroleptics medications can be increased by the
administration of depot injections of:
1. loxapine hydrochloride
2. fluphenazine enanthate
3. molindone hydrochloride
4. chlorpromazine hydrochloride
5. All of the above

Item Number: 11766 correct answer: 5 category: Psychotropics


28. Drugs that reduce the renal clearance of lithium include all of the following
EXCEPT:
1. ibuprofen
2. hydrochlorothiazide
3. indomethacin
4. chlorothiazide
5. theophylline

Item Number: 11617 correct answer: 2 category: Psychotropics


29. The potential central nervous system effects of haloperidol is:
1. monoamine oxidase inhibition
2. blockade of dopamine in the chemoreceptor trigger zone
3. cholinesterase inhibition
4. blockade of serotonin in the basal ganglia
5. blockade of dopamine reuptake

Item Number: 10497 correct answer: 2 category: Psychotropics


30. The correct statements regarding extrapyramidal effects of antipsychotics is:
1. acute dystonic reactions occur most commonly with low potency agents
2. excess dopaminergic activity is hypothesized to be a mechanism of
tardive dyskinesia
3. akathisia is characterized by oral facial dyskinesia
4. cholinergic agents are useful in the management of neuroleptic-induced
Parkinsonism
5. tardive dyskinesia occurs early on in therapy and is reversible upon
discontinuation of therapy

Item Number: 10625 correct answer: 1 category: Psychotropics


31. Agents which are tricyclic or atypical cyclic antidepressants include all of
the following EXCEPT:
1. imipramine
2. fluoxetine
3. trazodone
4. bupropion
5. All of the above

Item Number: 1362 correct answer: 1 category: Psychotropics


32. You treat a 40-year-old female for neurotic depression. After a few visits
you prescribe amitriptyline to relieve her depression. After 4 days she calls
you to say the pills are having no effect and she still feels depressed. The
best course of action would be to advise her to:
1. continue on the medication as prescribed, as the drug often takes up to
2-6 weeks to have its antidepressant, effect
2. double the dose
3. stop the pills and you will order other treatment from the pharmacist
4. continue on the same dose and you will call in an order for a second
drug to use in combination with it
5. take the pills with an alcoholic drink to increase their effect

Item Number: 11709 correct answer: 4 category: Psychotropics


33. All of the following benzodiazepines are metabolized to active products
EXCEPT:
1. alprazolam
2. chlordiazepoxide
3. midazolam
4. lorazepam
5. diazepam

Item Number: 11705 correct answer: 4 category: Psychotropics


34. The cyclic antidepressants which selectively block serotonin reuptake is:
1. imipramine
2. doxepin
3. amoxapine
4. fluoxetine
5. maprotiline

Item Number: 10669 correct answer: 5 category: Psychotropics


35. Adverse effects of monoamine oxidase inhibitors include all of the following
EXCEPT:
1. dry mouth, constipation, urinary retention
2. hyperreflexia, fatigue, muscle twitching
3. hypertensive reactions if administered with tyramine containing substances
4. orthostatic hypotension
5. raise seizure threshold

Item Number: 10499 correct answer: 5 category: Psychotropics


36. Adverse effects of antipsychotic agents include all of the following EXCEPT:
1. orthostatic hypotension
2. mydriasis
3. gynecomastia
4. jaundice
5. hypothyroidism

Item Number: 10639 correct answer: 3 category: Psychotropics


37. A patient on medication develops severe hypertension after eating some cheese.
The combination of substances found in the cheese and medication,
respectively, which is the most likely cause of this reaction is:
1. ergotamine and amphetamine
2. acetylcholine and reserpine
3. tyramine and phenelzine
4. angiotensin and propranolol
5. dopamine and phentolamine

Item Number: 10622 correct answer: 4 category: Psychotropics


38. The correct statement which describes the dopamine theory of schizophrenia is:
1. schizophrenia is due to a relative lack of the neurotransmitter dopamine
2. schizophrenia is due to a relative decrease in sensitivity of
postsynaptic CNS dopamine receptors
3. schizophrenia is a result of a deficiency in the decarboxylase enzyme
necessary for dopamine synthesis
4. schizophrenia is due to a functional excess of the neurotransmitter
dopamine or to a hypersensitivity of dopamine receptors or a global
imbalance in dopaminergic function within the area A-10 of the brain
5. All of the above

Item Number: 10657 correct answer: 5 category: Psychotropics


39. Indications for and/or uses of cyclic antidepressants include all of the
following EXCEPT:
1. major depression
2. eating disorders
3. chronic pain
4. obsessive-compulsive disorders
5. epilepsy

Item Number: 10483 correct answer: 2 category: Psychotropics


40. Correct pairs of pharmacologic action with CNS region of dopamine blockade
include:
A. extrapyramidal effects – basal ganglia
B. increase prolactin secretion – limbic
C. antiemetic – chemoreceptor trigger zone
D. antipsychotic – basal ganglia
1. A,B,C
2. A,C
3. B,D
4. D only
5. All of the above

Item Number: 11749 correct answer: 4 category: Psychotropics


41. The predominant action of the demethylated biotransformation product of
imipramine is inhibition of:
1. serotonin synthesis
2. serotonin uptake
3. dopamine release
4. norepinephrine uptake
5. dopamine reuptake

Item Number: 10076 correct answer: 2 category: Psychotropics


42. Lithium carbonate is used as an alternative to the major tranquilizers in
the control of manic-depressive illness. After the drug is started, how many days
elapse before the antimanic effect is reached?
1. 1-5 days
2. 7-10 days
3. 11-15 days
4. 16-20 days
5. 21-25 days

Item Number: 10621 correct answer: 5 category: Psychotropics


43. Drug interactions with neuroleptics include all of the following EXCEPT:
1. opioids
2. guanethidine
3. phenobarbital
4. levodopa
5. furosemide

Item Number: 6923 correct answer: 3 category: Psychotropics


44. An attempted suicide with chlorpromazine is admitted to the hospital in a
semi-comatose state. Blood pressure is low. An injection of epinephrine is
given to restore the cardiovascular system and the patient immediately goes
into shock. Blood pressure is now unobtainable. The responsible factor is:
1. chlorpromazine depresses the respiratory center
2. epinephrine has a positive inotropic effect on the heart
3. chlorpromazine is an alpha-adrenergic blocking agent
4. chlorpromazine causes hypertension in toxic doses
5. epinephrine slows the heart rate

Item Number: 8220 correct answer: 3 category: Psychotropics


45. Compared to other major tranquilizers, thioridazine appears to produce
significantly fewer instances of:
1. ventricular dysrhythmias
2. retinopathy
3. Parkinsonism
4. All of the above
5. 1,3

Item Number: 11761 correct answer: 1 category: Psychotropics


46. Adverse effects of lithium that may persist with chronic therapy include all
of the following EXCEPT:
1. severe nausea and vomiting
2. fine tremor
3. leukopenia
4. polyuria
5. hypothyroidism

Item Number: 10673 correct answer: 4 category: Psychotropics


47. Adverse effects of lithium include all of the following EXCEPT:
1. tremors
2. polyuria
3. sedation
4. tardive dyskinesia
5. hypothyroidism

Item Number: 10489 correct answer: 4 category: Psychotropics


48. Extrapyramidal side effects is most common with which of the following
neuroleptics?
1. thioridazine
2. triflupromazine
3. mesoridazine
4. haloperidol
5. All of the above

Item Number: 11651 correct answer: 2 category: Psychotropics


49. Cholestatic jaundice is a rare hypersensitivity reaction which reportedly
occurs with:
1. amitriptyline
2. chlorpromazine
3. lithium
4. chlordiazepoxide
5. alprazolam
Item Number: 5700 correct answer: 5 category: Psychotropics
50. Overdosage of lithium carbonate prescribed for psychiatric disorders may be
serious. Correct statements include:
1. hemodialysis is an effective means of lithium removal and is helpful in
severe overdoses
2. activated charcoal binds lithium in the GI tract and prevents absorption
3. symptoms include edema, tremor, polyuria, and disturbed consciousness
4. All of the above
5. 1,3

phants - Presentation Transcript

1. Pharmacology of Antidepressants Douglas L. Geenens, D.O. The University of Health Sciences


2.
3.
4. Classes of Antidepressants Tricyclic-tertiary amines
o amitriptyline (Elavil)
o imipramine (Tofranil)
o doxepin (Sinequan)
o clomipramine (Anafranil)
o trimipramine (Surmontil)
5. Classes of Antidepressants Tricyclic-secondary amines
o desipramine (Norpramin)
o nortriptyline (Pamelor)
o protriptyline (Vivactyl)
o amoxapine (Ascendin)
6. Classes of Antidepressants Atypical (non-tricyclic)
o maprotiline (Ludiomil)
o trazodone (Desyrel)
o bupropion (Wellbutrin)
o venlafaxine (Effexor)
o nefazodone (Serzone)
o mirtazapine (Remeron)
7. Classes of Antidepressants Specific serotonin reuptake inhibitors (SSRIs)
o fluoxetine (Prozac)
o sertraline (Zoloft)
o paroxetine (Paxil)
o fluvoxamine (Luvox)
o citalopram (Celexa)
8. Classes of Antidepressants Monoamine oxidase inhibitors (MAOIs)
o phenelzine (Nardil)
o isocarboxazid (Marplan)
o tranylcypromine (Parnate)
o selegiline (Deprenyl)
9. Classes of Antidepressants Psychostimulants
o methylphenidate (Ritalin)
o dextro-amphetamine (Dexedrine)
o magnesium pemoline (Cylert)
o dex + amphetamine (Adderall)
o methamphetamine (Desoxyn)
o modafinil (Provigil)
10. Evaluation of the depressed patient Goals of the evaluation
o Establish a diagnosis
o Identify specific target symptoms
o Consider comorbidity
o Quantify depression and/or specific symptoms
11. Evaluation of the depressed patient
o Obtain psychiatric history and perform mental status exam
o Identify and r/o underlying medical problems
o Physical exam in the past year
12. Evaluation of the depressed patient
o Optional exams:
 Laboratory
 Neurological exam
 Dexamethasone suppression test
 TRH test
13. Is an antidepressant indicated?
o The decision to treat a patient with antidepressants should be based on the following:
 Severity of symptoms and ability to identify target symptoms
 Impairment of functioning
 Patient’s view of medication
 Not necessarily the specific diagnosis
14. Predictors of antidepressant response.
o Acute onset
o Severe depressive symptoms
o Positive previous response to medication
o Patient’s willingness to accept medication as an aid to successful treatment
15. How to start antidepressants?
o Start low to assess tolerance of side effects
o Increase dosage rapidly as tolerated
o Maintain typical dose for at least 4 to 8 weeks
16. Most common reasons antidepressants fail
o Dosage too low
o Duration of trial to short
o Poor compliance
o Intolerable side effects
17. What is an adequate trial?
o Adequate dose:
 5 mg/kg/d
 Nortriptyline 100 to 150/d (therapeutic window)
 Fluoxetine 20 mg/d
o Adequate duration:
 4 – 8 weeks
18.
19. Indications for serum levels
o Unequivocally useful for:
 Patients who are not responding to usual doses
 Patients who are at increased risk for toxicity, e.g. cardiac patients
o May be useful for:
 Patients where prompt response is critical
 Determining compliance and metabolic availability
20. Therapeutic Blood Levels for antidepressants
o Known:
 imipramine
 desipramine
 nortriptyline
o Possibly known:
 amitriptyline
o Under assessment:
 All other antidepressants
21. How Antidepressants Work
o Most of the important clinical actions of antidepressant drugs cannot be fully accounted for
on the basis of “synaptic pharmacology”.
o There are two important observations that contribute to this rationale.
22. How Antidepressants Work
o Many drugs require long term administration to be effective.
o Drugs of abuse require repeated administration to produce tolerance and physical
dependence.
23. How Antidepressants Work
o Clinical effects would appear to result from the slow onset adaptive changes that occur
within neurons, not within the synapse.
o That is, activation of intraneuronal messenger pathway and regulation of neural gene
expression play a central role. (drug-induced neural plasticity).
24. “Synaptic Pharmacology” of antidepressants
o Acute:
 Block reuptake or degradation of monoamines and post-synaptic alpha-1
receptor.
o Chronic:
 Down regulation of the post-synaptic receptors
 Alteration of second messenger systems
 Alteration of protein synthesis.
25. After Dosing Antidepressants (days) Series 1 Synaptic effects: hours to days Side effects: hours to days
Therapeutic effect: 1 to 6 weeks
26. Pharmacokinetics of Antidepressants
o Absorption is rapid
o Metabolism: extensive 1 st pass
o Oxidation, hydroxylation, demethylation
o 5% = “slow acetylators”
o Protein bound: 90 – 95%
27.
28. Antidepressant half-lives (hrs)
29. Cardiac Side-effects of tricyclic antidepressants
o Cardiac conduction delay
o Anti-arrhythmic at therapeutic doses
o Arrhythmigenic at toxic doses
o Minimal effects on cardiac output
30. Cardiac Side-effects of tricyclic antidepressants
o Monitoring EKG parameters:
o QTc = 450 msec
o PR = 210 msec
o QRS - >30% above baseline
31.
32. How to choose an antidepressant
o Rationale should be based on side effects, not efficacy
o The SSRIs, secondary amines, and atypical antidepressants, are generally better choices.
 Why?
33. Norepinephrine uptake blockade Possible clinical consequences
o Tremors
o Tachycardia
34. Norepinephrine uptake blockade (potency)
35. Serotonin reuptake blockade Possible clinical consequences
o Gastrointestinal disturbances
o Anxiety (dose – dependent)
o Sexual dysfunction
36. Serotonin uptake blockade (potency)
37. Blocking selectivity 5-HT vs. NE
38.
39. Dopaminergic uptake blockade Possible clinical consequences
o Psychomotor activation
o Antiparkinsonian effects
o Psychoses
o Increased attention/concentration
40. Dopamine uptake blockade (potency)
41. Histamine H 1 blockade Possible clinical consequences
o Sedation, drowsiness
o Weight gain
o hypotension
42. Histamine H 1 receptor blockade (affinity)
43. Muscarinic receptor blockade possible clinical consequences
o Blurred vision
o Dry mouth
o Sinus tachycardia
o Constipation
o Urinary retention
o Memory dysfunction
44. Muscarinic receptor blockade (affinity)
45. alpha – 1 receptor blockade possible clinical consequences
o Postural hypotension
o Reflex tachycardia
o Dizziness
46. alpha-1 receptor blockade (affinity)
47.
48. imipramine (Tofranil) receptor affinities
49. fluoxetine (Prozac) receptor affinities
50.

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