HOWARD UNIVERSITY DEPARTMENT OF PHARMACOLOGY ALL RIGHTS RESERVED 1996 FINAL E XAMINATION IN P HARMACOLOGY MULTIPLE CHOICE: 1.

The prodrug, dipivalyl epinephrine (dipiverin), is used for the therapy of glaucoma and is administered locally. The local site of its conversion to its active metabolite is a. b. c. d. e. 2. Retinal ganglion cells Plasma Retinal photoreceptors Sclera Cornea

Administration of this drug or class of drugs might produce cataracts upon chronic administration a. b. c. d. e. Chloramphenicol Penicillins Cephalosporins Corticosteroids Aminoglycosides

3.

This drug of class of drugs is indicated for use against cytomegalovirus retinitis in immunocompromised individuals, including patients with acquired immunodeficiency syndrome a. b. c. d. e. Ganciclovir Cortisol Dexamethasone Cephalosporins Penicillins

4.

This drug reduces the formation of aqueous by the nonpigmented cells of the ciliary processes a. b. c. d. e. Mannitol Urea Isosorbide Glycerin Acetazolamide

HOWARD UNIVERSITY COLLEGE OF MEDICINE 1996 FINAL EXAMINATION IN PHARMACOLOGY 5. During which phase of the drug development process are we most likely to observe a higher incidence of serious, unexpected adverse drug reactions a. b. c. d. e. 6. phase I phase II phase III phase IV phase V

The FDA medwatch program relies on health professional reporting of serious adverse drug reactions. These include all of the following EXCEPT: a. b. c. d. e. Intervention to prevent permanent disability Expected but prolonged hospitalization due to ADR Excess pharmacological effects Death Congenital abnormality

7.

Which of the following are mechanisms that might result in a serious ADR or drug interaction? a. b. c. d. e. allergic reaction idio syneratic reaction excess pharmacologic (toxic) effect genetic abnormalities of cytodrome P450 All of the above

8.

All of the following patient factors markedly increase the risks of have an ADR EXCEPT: a. b. c. d. e. renal function age number of other drugs co-administered outpatient status serum protein concentrations

9.

Which of the following agents are know to induce allergic reactions? a. b. c. d. e. Barium Tartrazine yellow #5 Latex Metabisulfites All of the above

DEPARTMENT OF PHARMACOLOGY ALL RIGHTS RESERVED 10. A complicated surgical procedure is scheduled for your patient who is being treated with warfarin for recurrent pulmonary embolus. Which of the following statement would provide the best care for this patient? a. stop warfarin on the morning of surgery, but add heparin during the procedure b. stop warfarin 3-5 days prior to surgery and restart warfarin 3 days after surgery c. stop warfarin 3-5 days prior to surgery and give heparin instead until the morning of surgery d. stop warfarin on the morning of surgery, and give no anticoagulation during surgery e. warfarin can be continued during the intraoperative period; no additional anticoagulation is required 11. Heparin a. b. c. d. e. 12. dissolves clots interferes with the hepatic synthesis of factor II, VII, IX and X blocks hepatic vitamin K regeneration is anticoagulant in vivo and in vitro none of the above

Warfarin: a. b. c. d. e. activity measured by the activated PTT can be given orally, IV, IM or SC action can be reversed by giving vitamin K inhibits the biosynthesis of factors V, VII, XI and XII all of the above

13.

Which one of the following medications acts by enhancing gastric mucosal protection when given at low doses; and is currently approved by the FDA to be used to prevent ulcers in patients taking non-steroidal anti-inflammatory medications? a. b. c. d. e. Omeprazole Sucralfate Propulsid Ranitidine Misoprostol

14.

Which one of the following medications is best for treating patients with erosive esophagitis? a. b. c. d. e. Misoprostol Sucralfate Omeprazole Ranitidine Cimetidine 3

HOWARD UNIVERSITY COLLEGE OF MEDICINE 1996 FINAL EXAMINATION IN PHARMACOLOGY 15. Which one of the following medication - major side effect combinations is NOT correct? a. Misoprostol - Diarrhea b. Sucralfate - Constipation c. Omeprazole - ECL cell hyperplasia (enterochromaffin cell hyperplasia) d. Ranitidine & Cimetidine - altered metabolism of warfarin & theophylline through cytochrome p450 enzymes e. Aluminum Hydroxide (amphojel) - Diarrhea 16. H2 receptor antagonists inhibit acid secretion stimulated by histamine and gastrin but not acid secretion stimulated by the vagus nerve. a. b. 17. True False

Nephrotoxicity is a major adverse effect of which of the following immunosuppressive agents? a. b. c. d. e. Corticosteriods Azathioprine Cyclophosphamide Methotrexate Cyclosporine

18.

Which of the following immunosuppressive agents is LEAST likely to suppress bone marrow function? a. b. c. d. e. Corticosteriods Azathioprine Cyclophosphamide Methotrexate OKT3 (Muromonoab-CD3)

19.

Cyclosporine a. Must be given after proliferative response of T cells to antigen in order to be an effective immune suppressive agent b. Significantly impairs B cell activity c. Produces significant bone marrow suppression d. Inhibits the early stages of T cell differentiation e. Enhances the production and release of IL-2

DEPARTMENT OF PHARMACOLOGY ALL RIGHTS RESERVED 20. All of the following agents are useful in treating autoimmune disease EXCEPT: a. b. c. d. e. 21. Azathioprine Cyclosporine Glucocorticoids Cyclophosphamide Interferons

Maternal physiological changes occur during pregnancy that can alter drug pharmacokinetics. These include all of the following EXCEPT: a. b. c. d. e. prolonged transit in the gut increased volume of distribution of both water and fat soluble drugs inhibition of glucuronic conjugation increase in renal blood flow increase in the tubular reabsorption of sodium

22.

Select the TRUE statement with respect to the function of the human placenta. a. b. c. d. e. Most drug cross the placenta by an active transport mechanism. It contains enzymes responsible for drug oxidation, reduction and glucuronidation. It is the major site of steroid biosynthesis and degradation during gestation. Drug transfer is greater during the first and second trimesters that during the third. Genetic predisposition determines the amount of drug that crosses the placenta.

23.

Factors influencing the effect that a drug has on the fetus include a. b. c. d. e. the duration of exposure to a drug the stage of fetal development at the time of exposure the amount of drug reaching the fetus the distribution of drug in fetal tissue all of the above

24.

Choose the FALSE statement with respect to fetal pharmacokinetics. a. b. c. d. e. In early embryonic development, drug tend accumulate in neural tissue. The size of the fetal water compartment decreases with increasing gestational age. Biotransforming enzyme systems are first detectable at 5 to 8 weeks of gestation. The liver is the major site of drug metabolism in the fetus. The placenta is the major excretory organ for the fetus.

HOWARD UNIVERSITY COLLEGE OF MEDICINE 1996 FINAL EXAMINATION IN PHARMACOLOGY 25. Naltrexone has been used to treat all of the following EXCEPT: a. b. c. d. e. 26. opiate addiction alcohol craving bulimia depression infertility in women

Neurochemicals altered by alcohol include a. b. c. d. e. dopamine serotonin GABA endorphins/opioids all of the above

27.

A 29 year old anxious woman has diabetes and is taking cimetidine for her ulcer. A blood test shows considerable elevation in her plasma prolactin level. Before suggesting the possibility of a tumor you may suspect any one of the following EXCEPT: a. b. c. d. e. She could be pregnant The elevated prolactin could be induced by cimetidine The elevated prolactin could be due to hyperglycemia She could have been anxious when blood sample was collected She could have hypothyroidism

28.

All of the following may be true about growth hormone (GH) therapy EXCEPT: a. b. c. d. e. Growth hormone (GH) might aggravate diabetes The claimed restoration of vigor by GH is exaggerated GH might cause nerve entrapment (carpal tunnel) syndrome GH would elevate body fat Its actions are mediated by somatomedin C (IGF 1)

29.

A patient is manifesting symptoms of polyuria and polydipsia following an accident. All of the following may confirm the presence of a central diabetes insipidus EXCEPT: a. b. c. d. e. High serum osmolality High serum sodium Low urine osmolality Elevated vasopressin levels following a water deprivation test The patient responds well to Desmopressin

DEPARTMENT OF PHARMACOLOGY ALL RIGHTS RESERVED 30. The preferred route of Desmopressin administration is: a. b. c. d. e. 31. Oral Sublingual I.V. Subcutaneous Nasal insufflation

Growth hormone secretion may be increased in all of the following EXCEPT: a. b. c. d. e. Hypoglycemia REM sleep L-dopa in a normal individual L-dopa in an acromegalic individual Arginine administration

32.

Select the False statement on vasopressin (ADH) . a. b. c. d. e. Clofibrate stimulates its release Ethanol inhibits its release It may be used in intractable gastrointestinal bleeding It may be used in post-operative abdominal distension It should never be given in conjunction with a local anesthetic

33.

Select the False statement about octreotide (Sandostatin). a. b. c. d. e. It has a longer half life than somatostatin Its mechanism of action is suppression of growth hormone release It may be used in certain carcinoid tumors It is contraindicated for acromegaly It s adverse effect may include gallbladder abnormality

34.

Hyperprolactinemia may be associated with all of the following medications EXCEPT: a. b. c. d. e. Haloperidol Chlorpromazine Pergolide Reserpine Metoclopromide

HOWARD UNIVERSITY COLLEGE OF MEDICINE 1996 FINAL EXAMINATION IN PHARMACOLOGY 35. Select the false statement about gonadotropin-releasing hormone (GnRH). a. b. c. d. e. 36. It may be used in advanced prostatic cancer It may be used in diagnostic evaluation of the pituitary-gonadal axis Its release may be inhibited by prolactin Its release may be stimulated by cortisol Its side effects may include nausea and headache

Estrogenic compounds may be used in all of the following EXCEPT: a. b. c. d. e. Oral contraceptives First trimester of pregnancy Menopause Some breast cancers Osteoporosis

37.

Which of the following may NOT be a side effect of oral contraceptives? a. b. c. d. e. Hypertension Impaired hepatic function Dizziness and headache Cervical and vaginal cancer Endometriosis

38.

Danazol a. b. c. d. e. Is an inhibitor of 5-alpha reductase May be used in treatment of endometriosis May act as an abortifacient Is a very potent androgenic compound May stimulate the release of gonadotropins

39.

Side effects of androgens may include all of the following EXCEPT: a. b. c. d. e. Acne Jaundice Increased spermatogenesis Hepatic carcinoma Increased risk of atherosclerosis

DEPARTMENT OF PHARMACOLOGY ALL RIGHTS RESERVED 40. Which of the following is a 5-alpha-reductase inhibitor that may be used in benign prostatic hyperplasia? a. b. c. d. e. 41. Cyproterone Flutamide Ketoconazole Finasteride Fluoxymesterone

CORTICOTROPIN-RELEASING HORMONE (CRH) a. b. c. d. e. Should not be used diagnostically because of short half-life Is found only in the hypothalamus May inhibit the release of gonadotropin-releasing hormone Its release may be stimulated by cortisol Its release may be stimulated by ACTH

42.

Select the False statement a. b. c. d. e. Cosyntropin is a synthetic compound with ACTH activity Side effect of ACTH may include hypertension Side effect of ACTH may include pigmentation Cosyntropin administration may induce multiple sclerosis ACTH would not be effective orally

43.

Which of the following is the longest acting and most potent anti-inflammatory glucocorticoid? a. b. c. d. e. Cortisol Corticosterone Prednisolone Dexamethasone Triamcinolone

44.

Excess glucocorticoid levels may be associated with all of the following EXCEPT: a. b. c. d. e. Hypertension Diabetes insipidus Diabetes mellitus Peptic ulcer Amenorrhea

HOWARD UNIVERSITY COLLEGE OF MEDICINE 1996 FINAL EXAMINATION IN PHARMACOLOGY 45. Glucocorticoids may exert the following effects EXCEPT: a. b. c. d. e. 46. Inhibit protein synthesis Accelerate protein breakdown Activate the thymus gland Stimulate platelet production Inactivate lymphoid tissues

Side effects of glucocorticoids may include all of the following EXCEPT: a. b. c. d. e. Hypertension Diabetes Ulcer Osteoporosis Allergic reactions

47.

Select the FALSE statement a. b. c. d. e. Cortisol formation may be blocked by metyrapone Cortisol formation may be blocked by aminoglutethamide Cortisol formation may be blocked by ketoconazole Cortisol levels in plasma is remarkably low in depression Cortisol secretion is reduced with dexamethasone administration

48.

The least important consideration in therapeutic applications of glucocorticoids is: a. b. c. d. e. Duration of therapy Dosage Termination of therapy Suppression of the HPA axis Intracellular localization of receptors

48.

Indicate the unit below which determines who may prescribe legend medications a. b. c. d. e. The FDA The DEA The Federal Government The State The County

10

DEPARTMENT OF PHARMACOLOGY ALL RIGHTS RESERVED 49. To write a prescription for a controlled substance the following statements are true EXCEPT: a. The prescriber must be registered with the DEA b. Schedule I drugs must be written in ink and presented to the pharmacist c. Schedule II drugs must be written in ink and presented to the pharmacist d. Schedule III and IV can be ordered by written prescription or by phone e. Schedules III and IV may have five refills, but must have a new prescription beyond six months 50. To write a prescription the following facts must be known EXCEPT: a. b. c. d. e. 51. The name of the drug for the condition The trade name of the drug The size and strength of the drug to be prescribed The frequency of the drug administration The duration of the therapy or the total amount of the drug needed

The following drugs are oxytocic drugs EXCEPT: a. b. c. d. e. oxytocin Ergotamine Ritodrine Ergonovine Prostaglandin PGF2

52.

A patient with distal ulcerative colitis is started on oral sulfasalazine. After three weeks of treatment, she has not improved, and flexible sigmoidoscopy reveals active inflammation at the distal 25cm. Which of the following would be an appropriate response or responses? a. b. c. d. Increase the dose at sulfasalazine only Add steroid enemas Add oral prednisone Add Imuran (Azathiaprine)

53.

In the treatment of a patient with malabsorption associated with intestinal scleroderma (systemic sclerosis). Which of the following would most probably be effective? a. b. c. d. e. Diphenoxylate hydrochloride and atropine sulfate (Lomotil) Pancreatic extract Anticholinergic drugs Broad spectrum - antibiotics A gluten - free diet

11

HOWARD UNIVERSITY COLLEGE OF MEDICINE 1996 FINAL EXAMINATION IN PHARMACOLOGY 54. The drug prescribed for the maintenance of remission in ulcerative colitis is: a. b. c. d. e. 55. Prednisone Sulfasalazine Metronidazole Methotrexate Diphenoxylate

Specifically indicated for the treatment of some secretory diarrheas are: a. b. c. d. Anticholergics Oral rehydration solutions Obiate analogues, such as diphenoxylate Bismuth compounds

56.

The hypothyroid state MAY BE satisfactorily reversed using which of the following preparations? a. b. c. d. e. Dessicated thyroid extract Liotrix Levothyroxine sodium All of the above None of the above

57.

Which one of the following is the most PRACTICAL drug to use as replacement therapy for hypothyroidism? a. b. c. d. e. Dessicated thyroid extract Thyroglobulin Levothyroxine sodium Liothyronine sodium Liotrix

58.

Which one of the following drugs would you expect to produce a form of mumps as one of its adverse effects? a. b. c. d. e. Propylthiouracil Methimazole Potassium perchlorate Saturated solution of potassium iodide None of the above

12

DEPARTMENT OF PHARMACOLOGY ALL RIGHTS RESERVED 59. Concerning the mechanism of action of the antithyroid drug, propylthiouracil, which one of the following statements is most correct? a. b. c. d. 60. It blocks intestinal absorption of iodine It blocks thyroid gland trapping of iodine It blocks organization of iodine and coupling of tyrosyl radicles in the thyroid gland It blocks thyroid hormone release

You are managing a patient with hyperthyroidism for which you prescribe propylthiouracil. After four weeks of taking the drug , the patient complains of sore throat and a fever. Examination reveals a body temperature of 102 degrees F. and a pharynx which is fiery red but lacking exudate. You might reasonably conclude that the patient is experiencing which one of the following? a. b. c. d. e. Acute streptococcal pharyngitis Acute viral mumps (parototis) Agranulocytosis from propylthiouracil Acute toxic hepatitis from prophylthiouracil Acute viral upper respiratory infection

61.

Which of the following statements concerning the autonomic nervous system is/are correct? a. The autonomic nervous system is composed afferent and efferent neurons. b. The cholinergic division is activated in response to stressful situations. c. The parasympathetic division of originates from cell bodies in the peripheral nervous system. d. The control of blood pressure is mainly a sympathetic activity, with essentially no participation by the parasympathetic system. e. The sympathetic division contains , and delta receptors.

62.

Which of the following statements concerning the parasympathetic nervous system is/are correct? a. The actions of the parasympathetic division similar to the effects of the sympathetic division b. The parasympathetic system often discharges as a single, functional system c. The parasympathetic division is involved in accommodation of near vision, movement of food, and urination. d. The postganglionic fibers of the parasympathetic division are long, compared to those of the sympathetic nervous system.

13

HOWARD UNIVERSITY COLLEGE OF MEDICINE 1996 FINAL EXAMINATION IN PHARMACOLOGY For questions 63 and 64 use the diagram shown on the next, which represents the parasympathetic, sympathetic and somatic nervous systems. 63. Norepinephrine acts as a neurotransmitter at which of the following? a. b. c. d. e. 64. Site A Site B Site C and D Site D Sites D and E.

Acetycholine acts as a neurotransmitter at which of the following? a. b. c. d. e. Site A only Site B only Sites C and D only Sites D and B only Sites A, C, D and E only

65.

Acetycholine acts as a neurotransmitter at which of the following sites? a. b. c. d. e. Site A only Site B only Sites C and D only Sites D and B only Sites A, C, D and E only

66.

Which of the following correctly match a cholinergic agonist with its pharmacological actions? a. b. c. d. e. Bethanechol: Stimulates atonic bladder Carbachol: Induces release of epinephrine from the adrenal medulla Acetylcholine: Decrease heart rate and cardiac output Pilocarpine: Reduces intraocular pressure All of the above

67.

Physostigmine: a. b. c. d. e. Acts at peripheral muscarinic and nicotinic receptors Produces CNS effects Can be used to treat an overdose of atropine Is not hydrolyzed by acetylcholinesterase All of the above

14

DEPARTMENT OF PHARMACOLOGY ALL RIGHTS RESERVED 68. Which of the following are useful in treating poisoning with an organophosphate poison, such as parathion? a. b. c. d. 69. Atropine and pralidoxime, when administered within hours of exposure to poison neostigmine Pilocarpine Carbachol

Dopamine cause which of the following actions: a. b. c. d. e. Increase cardiac output Dilates renal vasculature Increases production of urine Increases blood pressure All of the above

Answer question 70 by using the following diagram.

70.

The administration of three sympathomimetic agents has produced curves A, B, and C. Curve C is produced by which one of the following agents? a. b. c. d. e. Amphetamine Epinephrine Isoproterenol Norephinephrine Phenylephrine 15

HOWARD UNIVERSITY COLLEGE OF MEDICINE 1996 FINAL EXAMINATION IN PHARMACOLOGY 71. A 17-year old person was brought to the emergency room by the police because of acting crazy. The person was found nude, incoherent, wandering about aimlessly and had trouble seeing. On examination the persons skin was flushed and drug and hot to the touch; moreover, the pupils were dilated with minimal response to light. What is the most probable drug ingested? a. b. c. d. e. 72. an organophosphate-containing insecticide a nicotine-containing insecticide amphetamine-containing diet pills phenylephrine-containing cold medication atropine-containing medication

Signs of atropine poisoning include: a. b. c. d. e. salivation constriction of pupils blurred vision bradycardia hypopyrexia

73.

Which of the following is effect of epinephrine? a. b. c. d. e. contraction of bronchial smooth muscle contraction of detrusor muscle of bladder reduction of intestinal tone and motility decreased glycogenolysis release of histamine

74.

When used chronically to treat hypertension, thiazide diuretics have all of the following properties or effects EXCEPT: a. b. c. d. e. reduce blood volume or vascular resistance or both have maximal effects on blood pressure at doses below the maximal diuretic dose may cause an elevation of plasma uric acid and triglyceride levels decrease the urinary excretion of calcium cause ototoxicity

75.

Which of the following agents would be least harmful in a patient with severe hyperkalemia? a. b. c. d. e. amiloride captopril hydrochlorothiazide spironolactone triamterene

16

DEPARTMENT OF PHARMACOLOGY ALL RIGHTS RESERVED 76. Which of the following would be most useful in a patient with cerebral edema? a. b. c. d. e. 77. acetazolamide amiloride ethacrynic acid furosemide mannitol

In a hypertensive patient who is taking insulin to treat diabetes mellitus, which of the following drugs is to be used with extra caution and advice to the patient? a. b. c. d. e. hydralazine prazosin (Minipress) guanethidine (Ismelin) propranolol (Inderal) methyldopa (Aldomet)

78.

Verapamil exerts its effects through which of the following actions? a. b. c. d. e. preventing entry of calcium through slow channels preventing depolarization of the cell membrane increasing sodium entry antagonizing the opening of the fast sodium channel enhancing potassium efflux

79.

Drugs that block the catecholamine uptake process - such as cocaine, tricyclic antidepressants, and phenothiazines - are apt to block the antihypertensive action of which of the following drugs: a. b. c. d. e. propranolol guanethidine prazosin hydralazine diazoxide

80.

For the monotherapy of mild-to-moderate hypertension, all the following drugs would be suitable EXCEPT: a. b. c. d. e. metoprolol minoxidil verapamil enalapril nifedipine

17

HOWARD UNIVERSITY COLLEGE OF MEDICINE 1996 FINAL EXAMINATION IN PHARMACOLOGY 81. Angiotensin converting enzyme (ACE) inhibitors are associated with a high incidence of which of the following adverse reactions? a. b. c. d. e. 82. hepatitis hypokalemia agranulocytosis proteinuria hirsutism

Each of the following can cause bradycardia EXCEPT: a. b. c. d. e. clonidine propranolol reserpine hydralazine guanethidine

83.

In comparing methyldopa and guanethidine, which of the following is CORRECT: a. guanethidine, but not methyldopa, results in salt and water retention if used without a diuretic b. guanethidine is less efficacious than methyldopa in severe hypertension c. guanethidine causes fewer central nervous system adverse effects (such as sedation) than methyldopa d. methyldopa causes more orthostatic hypotension than guanethidine e. guanethidine causes more immunologic adverse effects than methyldopa (e.g., hemolytic anemia)

84.

Captopril and enalapril do all of the following EXCEPT: a. b. c. d. e. increase renin concentration in the blood inhibit an enzyme competitively block angiotensin II at its receptor decrease angiotensin II concentration in the blood increase sodium and decrease potassium in the urine

85.

After several weeks of treatment, which of the following reduces the release of norepinephrine from the sympathetic nerve terminal in response to vasomotor center discharge: a. b. c. d. e. hydralazine prazosin minoxidil guanethidine propranolol

18

DEPARTMENT OF PHARMACOLOGY ALL RIGHTS RESERVED 86. Postural hypotension is a common adverse effect of all of the following types of drugs EXCEPT: a. b. c. d. e. 87. those that cause venodilation those that cause ganglionic blockade those that cause alpha-receptor blockade those that cause beta-receptor blockade those that cause excessive diuresis and decreased blood volume

Important (through uncommon) adverse effects of vasodilators include all of the following EXCEPT: a. b. c. d. e. lupus erythematosus with hydralazine reduced cardiac output or atrioventricular block with verapamil precipitation of gout with prazosin pericardial abnormalities with minoxidil cyanide toxicity with nitroprusside

88.

Comparison of guanethidine and propranolol shows that: a. b. c. d. both increase heart rate both diminish central sympathetic outflow both decrease cardiac output both produce orthostatic hypotension

90.

Which of the following would rule out the use of hemodialysis? a. b. c. d. e. comatose patient poison with a large volume of distribution poison with a small volume of distribution pediatric patient patient with hyperthermia

91.

A comatose poisoned patient is brought into the emergency room. Which of the following actions is inappropriate? a. b. c. d. e. monitoring of respiratory status collection of blood samples administration of oxygen placement of an i.v. catheter measurement of blood pressure and heart rate

19

HOWARD UNIVERSITY COLLEGE OF MEDICINE 1996 FINAL EXAMINATION IN PHARMACOLOGY 92. In the treatment of a patient in which time of ingestion and type of poison is known, the use of the Henderson-Hasselbalch equation is most useful in determining which of the following parameters about the poison: a. b. c. d. e. 93. ratio of ionized to nonionized concentration dissociation constant pH solubility blood concentration

If a poison has already passed the pyloric valve, which of the following therapies would most probably be ineffective? a. b. c. d. e. administration of osmotic diuretics urinary alkalinization hemodialysis administration of activated charcoal use of a chelator

94.

The term plumbism refers to toxic symptoms produced by chronic ingestion of which of the following metals? a. b. c. d. e. Zinc Lead Iron Arsenic Cadmium

95.

Lead poisoning can be positively identified by determining the urinary concentrations for precursors to heme synthesis. A positive indication for lead intoxication would be: a. b. c. d. Increased delta-aminolevulinic acid (ALA) ; increased co-proporphyrins Increased delta- ALA; decreased co-proporphyrins Decreased delta-ALA; decreased co-proporphyrins decreased delta-ALA; increased co-proporphyrins

96.

Which of the following is the chelator of first choice for treating a toxic ingestion of lead? a. b. c. d. e. Succimer Penicillamine Calcium Disodium Edetate Deferoxamine Dimercaprol

20

DEPARTMENT OF PHARMACOLOGY ALL RIGHTS RESERVED MATCHING: Use once/more than once/ or not at all. Match the drug with the process which might induce an ADR. A. B. C. D. E. 97. 98. 99. 100. 101. 102. 103. 104. Terfenadine Methotrexate Tobramycin Radiocontrast Media Heparin

Cytochrome P4503A4 deficiency Prolonged AT interval and ventricular arrthymias Nephro-and oto-toxicity Erythromycin Toxicity seen if trough levels consistently above 2 g/ml Iodine allergy Quinine Thromboaytopenia and thrombosis A. B. C. D. E. Activated P.T.T. INR (International Normalized Ratio) Streptokinase Warfarin Vitamin K

105. 106. 107. 108.

Used to monitor warfarin therapy Used to monitor heparin therapy A fibrinolytic agent Cannot be used in pregnancy

Match the proper treatment for each case scenario. A. B. C. D. Erythropoietin Desferrioxamine Red blood cell transfusion Ferrous sulfate

109. A 44 year old man with bleeding esophageal varices 110. A 33 year old woman with fibroids whose hematocrit is 25% and whose mean corpuscular red cell volume is 65 microns 111. A 50 year old man with a blood urea nitrogen of 150 mg/ dl and a creatinine of 10 mg/dl 21

HOWARD UNIVERSITY COLLEGE OF MEDICINE 1996 FINAL EXAMINATION IN PHARMACOLOGY 112. An 18 year old man with Cooleys anemia (beta-thalassemia) who has received over 100 red blood cell transfusions Match the proper treatment with each case scenario. A. B. C. D. Vitamin B12 Folic acid Prednisone Daunorubrincin and Cytosine Arabinoside

113. A 50 year old woman with a white blood cell count of 62,000/mm3, with 80% myeloblasts 114. A 44 year old woman with a hemoglobin of 6 g/dl, reticulocyte count of 15%, and a positive Coombs test 115. A 56 year old woman with a hemoglobin of 7 g/dl, mean corpuscular red cell volume of 115 microns, and who had an illectomy for Crohns disease 116. A 32 year old man with a hemoglobin of 8 g/dl, mean corpuscular red cell volume of 112 microns and who has sickle cell (SS) disease Match each drug with the MOST CORRECT statement pertaining to its use in an 85 year old woman. A. B. C. D. 117. 118. 119. 120. Digoxin Diazepam Penicillin Propanolol

Pharmacodynamic effect may be less intense No dose adjustment necessary Dose adjustment required in accordance with liver function Dose adjustment required in accordance with renal function

A. B. C. D. E.

LEVONOGESTREL CLOMIPHENE TAMOXIFEN MIFEPRISTONE (RU486) AMINOGLUTETHAMIDE

121. An estrogenic antagonist that may be used in treatment of disseminated breast cancer 122. A progestinic compound in implanted contraceptives

22

DEPARTMENT OF PHARMACOLOGY ALL RIGHTS RESERVED MATCHING: A. B. C. D. E. 123. 124. 125. 126. 127. Oxytocin Bromcriptine Ergonovine Methysergide Dihydroergotamine

5HT antagonist used in prophylaxis of migraine headache Sustained contracture of uterus in last trimester of pregnancy Contraction followed by relaxed of uterus in third trimester of pregnancy Use to decrease secretion of Prolactin Effective in treatment of severe migraine headache

For each numbered word, phrase, or statement 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. Concerning thyroid drug preparations ... A. B. C. D. 128. 129. 130. 131. 132. Used as an ancillary antithyroid drug Used as an only drug to treat post-operative hypothyroidism May have atypical mumps as a complication of use May have fatal agranulocytosis as a complication of use

Lugols Solution (iodine) Propylthiouracil Methimazole Levothyroxine sodium Propranolol

Concerning the following hypolipidemic drugs ... A. B. C. 133. 134. 135. 136. Lovastatin Gemfibrozil Cholestyramine

Lowers LDL cholesterol primarily by interfering with entero-hepatic circulation of bile acids Lowers triglyceride & VLDL primarily Has constipation as major side effect Lowers LDL cholesterol primarily by interfering with synthesis of cholesterol

23

HOWARD UNIVERSITY COLLEGE OF MEDICINE 1996 FINAL EXAMINATION IN PHARMACOLOGY Concerning the side effects of the hypolipidemic drugs ... A. B. C. D. E. 137. 138. 139. 140. 141. Myalgia Prolongation of Q-T interval on ECG with serious cardiac arrhythmias Drug interaction with anticoagulants Flushing & Pruritus May cause malabsorption of digoxin

Nicotinic acid Lovastatin Cholestyramine Gemfibrozil Probucol

24