I Neuropharmacology and Autonomic Review Questions  

II Antimicrobial Drugs

III Principles of Pharmacology

IV Local Anesthetics

V Pharmacokinetics

 

1.   Which of the following lowers the threshold for convulsion (makes a convulsion more likely) in a person with tonic-clonic seizures.

     a.   carbamazepine

     b.   amitriptyline

     c.   phenobarbital

     d.   phenytoin

 

2.   Which of the following adverse effects of antipsychotic drugs like fluphenazine is considered irreversible or only very slowly reversible when the drug is removed?

      a.   tardive dyskinesia

      b.   parkinson tremor

      c.   acute dystonias

      d.   sedation

 

3.   In comparing amitriptyline (Elavil) to fluoxetine (Prozac) for depression, which of the following would be correct?

      a.   The patient on fluoxetine would be expected to experience more xerostomia.

      b.   The patient on fluoxetine would experience more sedation especially early in therapy.

      c.   Fluoxetine is a selective serotonin reuptake inhibitor whereas amitriptyline inhibits reuptake of both serotonin and norepinephrine.

      d.   Both fluoxetine and amitriptyline are potent inhibitors of dopamine receptors.

 

4.   The administration of terazosin or prazosin prior to injection of epinephrine intravenously would tend to have what effect?

      a.   block most of the increase in heart rate due to epinephrine

      b.   block most of the bronchodilation effect of  epinephrine

      c.   block most of the vasoconstriction effect of epinephrine

      d.   block most of the vasodilation effect of epinephrine

 

5.   Which skeletal muscle relaxer acts by causing a depolarizing block at the peripheral neuromuscular end plate?

      a.   d-tubocurarine

      b.   succinylcholine

      c.   diazepam

d.      pancuronium

 

6.      The pathway, site, or tract that is MOST implicated in pseudoparkinsonism caused by phenothiazines is the

a.      mesocortical pathway.

b.     mesolimbic pathway.

c.       spinal cord.

      d.   nigral-striatal tract.

 

 

Identify the following drugs

 

  7. __     pilocarpine                             a.   a muscarinic receptor blocker

  8. __     atenolol                                 b.   a b2 adrenergic receptor agonist

  9. __     atropine                                 c.   a b1 adrenergic receptor antagonist

10. __     neostigmine                            d.   a muscarinic receptor agonist

11. __     albuterol                                e.   a cholinesterase inhibitor

 

 

 

STUDY QUESTIONS

Antimicrobial Pharmacology

 

1-6 Matching.  Use each choice only once.

1.   __    inhibition of dihydrofolate reductase                                         a.   clarithromycin

2.   __    inhibition of transpeptidase                                                       b.   ciprofloxacin

3.   __    inhibition of DNA gyrase                                                         c.   vancomycin

4.   __    inhibition of the initiation phase of ribosomal                             d.   trimethoprim

              protein synthesis causing misreading                                         e.   penicillin V

5. __      blocks translocation step in protein synthesis                            f.    gentamicin

              but not the initiation phase

6. __      inhibits transglycosylase by binding to D-ala D-ala site on the peptidoglycan

 

Multiple Choice.  Choose the one best answer.

7.      Methicillin-resistant Staphylococcus aureus is an indication for which drug?

a.       ampicillin

b.      penicillin V

c.       clindamycin

d.      vancomycin

 

8.      Which of the following is correct concerning metronidazole?

a.       useful against aerobic bacteria

b.      stimulates the conversion of acetaldehyde to acetic acid

c.       damages the structure of DNA   

d.      used to treat oral fungal infections

 

9.      Of the following choices, what is the GREATEST difference between amikacin and gentamicin?

  1. One is used primarily for gram positive organisms, the other for gram negative bacilli.
  2. One has minimal effects on eighth cranial nerve function, the other has a great deal.
  3. One is more resistant to enzymatic attack.
  4. Only one can be given orally for systemic purposes.

 

10.  Vancomycin-resistant enterococci are treated with which of the following?

a.       tetracycline

b.      a first generation cephalosporin

c.       clarithromycin

d.      quinupristin/dalfopristin

 

11.  The highest risk of crystalluria is seen in which drug.

a.       sulfadiazine

b.      penicillin G

c.       sulfamethoxazole

d.      sulfisoxazole

 

12.  b-lactams that are usually resistant to hydrolysis by penicillinase elaborated by Staphylococcus aureus include which of the following?

a.       amoxicillin

b.      cloxacillin

c.       penicillin G

d.      clavulanic acid

 

13.  Immediate allergic reactions to penicillins mediated by IgE antibodies would be a contraindication for which of the following?

a.       cephalexin

b.      aztreonam

c.       clarithromycin

d.      vancomycin

 

14.  A high percentage of non-urticarial rash in patients with mononucleosis is seen with which of the following?

a.       penicillin V

b.      piperacillin

c.       sulbactam

d.      amoxicillin

 

15.  Against which organism would penicillin V be MOST EFFECTIVE?

a.   Salmonella typhi

  1. Streptococcus viridans  

            c.   Pseudomonas aeruginosa

d.   Chlamydia trachomatis  

 

 

Study Questions on Principles of Pharmacology

 


1.   What adverse effect of a drug is mediated by an immune reaction?

      a.   toxicity

            b.   allergy  

      c.   idiosyncrasy

      d.   physical dependence

 

2.   A drug that inhibits the elimination of another drug from the body would MOST LIKELY have what effect on the second drug, if the two drugs did not have overlapping pharmacological effects?

      a.   additive effect

      b.   synergistic effect  

      c.   antagonistic effect

      d.   no interaction

 

3.      Favism is due to which genetic abnormality?

a.       excess in delta amino-levulinate synthase (dALA)

b.      deficiency in plasma esterases

c.       deficiency in NADH methemoglobin reductase

d.      deficiency in glucose-6-phosphate dehydrogenase  

 

4.      What cell type undergoes lysis to the greatest extent when glucose-6-phosphate dehydrogenase is lacking

a.       hepatocytes.

b.      erythrocytes. 

c.       cardiac muscle cells.

d.      neurons.

 

5.      Drug physical dependence is characterized by which two of the following?

a.       idiosyncrasy and allergy

b.      tolerance and withdrawal symptoms  

c.       carcinogenesis and toxicity

d.      favism and formation of methemoglobin

 

  Study Questions on Local Anesthetics

 

1.      Exposing a local anesthetic like lidocaine to an acid environment (e.g. pH 4) upon injection, would have what effect on the drug.

a.       It would lead to a higher ratio of protonated to non-protonated form of the drug.

b.      It would lead to a lower aqueous solubility of the drug.

c.       It would result in a more rapid onset of action.

d.      It would permanently inactivate the drug.

 

  2.      What is the principle urinary metabolite of lidocaine?

a.       monoethylglycinexylidide

b.      para aminobenzoic acid

c.       4-hydroyxylidine

d.      glycinexylidide

 

 3.      Pain nerve fibers are usually of what type?

a.       A-a, b

b.      A-g, Ab

c.       b only

d.      A-d, C  

 

4.      The reduction of liver blood flow by a b-adrenergic receptor blocking drug (b-blocker) would be expected to have the least effect on the disposition of which of the following drugs?

a.       lidocaine

b.      procaine   

c.       mepivacaine

d.      prilocaine


Pharmacokinetic questions

Question 1

 A patient (85 kg) has been given a first dose of a drug, 120 mg by IV infusion over 30 minutes, and two plasma concentrations were measured at 0.5 and 8 hours after the infusion was stopped. These results were 5.47 and 2.85 mg/L, respectively. Assume a linear one-compartment model and calculate the drug pharmacokinetic parameters, kel and Vd, for this patient. Calculate a suitable dosage regimen, bolus IV dose and maintenance IV infusion, to achieve and maintain a plasma concentration of 6 mg/L.

 

 

Question 2

 Using semilog graph paper, determine the approximate plasma concentration at zero time (beta phase) for this drug in this patient, given the following plasma concentrations at the specified times after an intravenous injection.

Plasma conc. (mg/L)

Time (hrs)

41

0.1

15

0.2

 7

1.0

    3.8

2.0

    2.0

3.0

      1.15

4.0

    0.7

5.0

      0.35

6.0

 

3.                  Calculate the maintenance dose (MD) of a drug required to achieve and average plasma concentration (Cpss(ave)) of 10mg / ml, if the drug has a clearance of 1250ml / hr.

a.      12.5 mg/4hr

b.      20 mg/4hr

c.      50mg/4hr

d.      125mg/4hr

 

 4.                  A patient is brought into the emergency room having ingested a drug 3 hours earlier. You know the identity of the drug and you know that typically it has a Vd of 175 L in this size of patient, and an elimination half time of 3 hours. A blood sample gives a concentration of the drug of 0.35 mg / ml. How much drug did the patient ingest? (Assume 100% absorption.)

                a.    32 mg

                 b.    62.5 mg

                 c.    122.5 mg

                 d.     225 mg