Pharma Basics 2023

Question 1 of 153

A 44-year-old woman presents to the hospital ER with a low blood pressure of 77/40, a heart rate of 40, and normal pupils. She has an empty bottle of blood pressure pills that have a pKa of 7.5. In addition to hemodynamically supporting the patient, you want the patient to excrete the drug in the urine. Theoretically, of the following choices, what would be the most appropriate action?

Alkalinize the urine. This will protonate the drug, allowing it to be more soluble in the urine.
Alkalinize the urine. This will deprotonate the drug, allowing it to be more soluble in the urine.
Acidify the urine. This will protonate the drug, allowing it to be more soluble in the urine.
Acidify the urine. This will deprotonate the drug, allowing it to be more soluble in the urine.

Question 2 of 153

Which clinical trail phase primarily deals with dose-response on healthy volunteers?

Phase 2
Phase 1
Phase 4
Phase 0
Phase 3

Question 3 of 153

Which receptor type typically functions using cAMP as a mediator?

Ion channel
Tyrosine kinase receptor
G-protein coupled receptor
Transmembrane proteins
Steroid receptor

Question 4 of 153

What is the most commonly used antidote for organophosphate poisoning?

Leucovorin
Atropine
Benztropine
Flumazenil
Pralidoxime

Question 5 of 153

Which receptors typically occur in the brain, heart, and smooth muscles and mediate parasympathetic activity?

Nicotinic receptors
Muscarinic receptors
Dopaminergic receptors
Alpha adrenergic receptors
Beta adrenergic receptors

Question 6 of 153

A female presents to your clinic with occasional sporadic movements of her upper and lower extremities. She reports these symptoms started recently and have been progressively getting worse. She vaguely remembers her father had a similar condition, but he died when she was very young. Which of the following conditions is most likely?

Drug-induced dyskinesia
Wilson disease
Tourette Syndrome
Postural tremor
Huntington disease

Question 7 of 153

Which anesthetic drug is administered intravenously?

Methoxyflurane
Nitrous oxide
Propofol
Isoflurane
Halothane

Question 8 of 153

What most accurately describes the mechanism of action of tiagabine on gamma aminobutyric acid (GABA)?

GABA-B receptor agonist
GABA-A receptor antagonist
Inhibition of GAT-1
GABA-B receptor antagonist
GABA-A receptor agonist

Question 9 of 153

What is most accurate regarding fentanyl?

It is about 80 times more potent than morphine.
It is not used as a recreational drug.
It has a long duration of action.
Fentanyl is not appropriate for sedation in the ICU.
Fentanyl should not be coadministered with midazolam.

Question 10 of 153

A 5-year-old child overdoses on her mother’s anti-depression medications. The pKa of the drug is 3.9. The pH of the small bowel is 5.9. What is the correct ratio of protonated to unprotonated molecules?

1:1
100:1
10:1
1:10
1:100

Question 11 of 153

Post marketing surveillance of a new drug is performed during which clinical trial phase?

Phase 3
Phase 2
Phase 1
Phase 4
Phase 0

Question 12 of 153

Which of the following refers to a relatively sudden decrease in response to a drug after its administration?

Potency
Suicide inhibition
Prophylaxis
Tachyphylaxis
Reduced affinity

Question 13 of 153

What is not the origin of preganglionic parasympathetic fibers?

Cranial nerve IX
Cranial nerve III
Cranial nerve X
Thoracic segment of the spinal cord
Sacral segments of the spinal cord

Question 14 of 153

Which drug provides temporary relief during a myasthenic crisis?

Phenylephrine
Atropine
Edrophonium
Pralidoxime
Benztropine

Question 15 of 153

Which medication is commonly used in the acute treatment of dystonic reactions?

Betamethasone
Doxycycline
Phenylephrine
Benztropine
Clonidine

Question 16 of 153

A 17-year-old female presents to your clinic because of abnormal uncontrolled limb movements over the past few months. She has no history of a serious illness. On physical examination, her liver is slightly enlarged. Blood results reveal elevated liver enzymes. Which finding is associated with the most likely diagnosis in this patient?

Pill-rolling tremor
Kayser-Fleischer rings
Abnormal movements or speech patterns
Cotton wool spots and hemorrhages in the retina
Arcus senilis

Question 17 of 153

What statement is true regarding ethosuximide?

It has an unknown side effect profile in children.
It is contraindicated in neonatal seizures because of its sedative effect.
It is the drug of choice in the treatment of absence seizures.
It is the first-line choice in the management of status epilepticus.
It is used in detoxification programs.

Question 18 of 153

Which anti-seizure medication exerts its effects by blocking T-type calcium channels?

Retigabine
Tiagabine
Phenytoin
Phenobarbital
Ethosuxamide

Question 19 of 153

What is more likely a side effect of meperidine than other opiates?

Respiratory depression
Sedation
Miosis
Convulsive seizures
Less dopamine stimulation

Question 20 of 153

A patient has overdosed on pyrimethamine, with a pKa of 7.42. What percentage of the drug will be trapped in the urine if the urine pH is 5.42?

9%
99%
90%
1%

Question 21 of 153

Nortriptyline is metabolized by cytochrome P450 2D6. Which of the following regarding homozygotes for inactive alleles of cytochrome P450 2D6 is most accurate?

They require a higher dose of nortriptyline to achieve the same concentration seen in heterozygotes.
They require a higher dose of nortriptyline to achieve the same concentration seen patients with 2 active genes
They have lower nortriptyline levels in the blood than patients with 2 active genes.
They have higher nortriptyline levels in the blood than heterozygotes.

Question 22 of 153

Drug X has a Kd of 700 pg/mL and an EC50 of 700 pg/mL, which of the following is most accurate?

EC50 represents the point at which 50% of the population will experience a toxic effect from the drug.
Drug X requires that all receptors be bound to produce 50% of the maximal effect.
If the Kd of Drug X was 200 pg/ml, that would mean a greater affinity.
Drug X produces 100% of the maximal effect when 50% of the receptors are bound.
Kd represents the concentration at which 50% of the drug is metabolized.

Question 23 of 153

What is not regulated by the parasympathetic pathway?

Sinoatrial node
Nerve terminals
Renal vascular smooth muscles
Atrioventricular node
Ciliary body

Question 24 of 153

Which of the following signs/symptoms is LEAST likely during a cholinergic crisis?

Abdominal cramps
Blurred vision
Urinary retention
Diarrhea
Facial muscle twitching

Question 25 of 153

What is not a side effect of atropine?

Diarrhea
Pupillary mydriasis
Dry mouth
Anhidrosis
Decreased airway secretions

Question 26 of 153

Pharmacotherapy for Tourette syndrome includes dopamine antagonism. Which drug is the most appropriate in this regard?

Tetrabenazine
Omeprazole
Pergolide
Bromocriptine
Carbidopa

Question 27 of 153

What is a common sedative medication in the ICU?

Ketamine
Flumazenil
Diazepam
Propofol
Phenobarbital

Question 28 of 153

Both barbiturates and benzodiazepines (BDZ) work by affecting gamma-aminobutyric acid (GABA)-A activity on the chloride channel, but by different mechanisms. What best describes this difference?

BDZ works via sodium channel blockade while barbiturates work via potassium channel activation.
BDZ increases the refractory period, while barbiturates decrease the reuptake of GABA.
BDZ works via calcium channel blockade, while barbiturates work via potassium channel activation.
BDZ works via increasing the release of GABA, while barbiturates decrease the reuptake of GABA.
BDZ increases the frequency of opening, while barbiturates increase the duration of opening.

Question 29 of 153

What is NOT a side effect of morphine?

Renal calculi
Hypotension
Nausea
Constipation
Respiratory depression

Question 30 of 153

A patient has overdosed on pyrimethamine (weak base). It has a pKa of 7.42. What portion of the drug will be hydrophilic at a urine pH of 8.42?

10%
1%
99%
90%

Question 31 of 153

Which of the following medications is a P-glycoprotein inhibitor?

Phenytoin
Carbamazepine
Verapamil
Rifampin

Question 32 of 153

Which of the following best describes first-pass metabolism?

The fraction of drug reabsorbed through the gut wall after bile excretion
The fraction of drug lost due to metabolization during the process of absorption through the gut wall or the liver
The fraction of drug gained during the process of reabsorption through the liver
The fraction of drug gained during the process of reabsorption through the gut wall
The fraction of drug metabolized during the bile excretion process

Question 33 of 153

What organ is a major site for non-central nervous system dopamine receptors?

Eye
Kidney
Intestine
Lung
Liver

Question 34 of 153

What is LEAST likely to activate beta-adrenergic receptors?

Intermediate dose dopamine
Dobutamine
Isoproterenol
Phenylephrine
Epinephrine

Question 35 of 153

Which medication may be used to treat anticholinergic poisoning?

Atropine
Phenytoin
Physostigmine
Benztropine
Dexamethasone

Question 36 of 153

What is most accurate regarding the use of valproate during pregnancy?

Valproate should not be used to treat pregnant women with bipolar disorder.
Valproate should not be used to treat pregnant women with epilepsy.
Despite causing congenital malformations, valproate does not affect IQ.
Valproate should not be used to treat pregnant women with epilepsy unless other medications have failed to provide adequate symptom control.
Folic acid coadministration can reduce the risk of congenital neural tube defects.

Question 37 of 153

What best describes the mechanism of action of depolarizing muscle relaxants?

Acetylcholine receptor antagonism
Acetylcholinesterase inhibition
Hyperpolarization of the muscle end-plate
Extended repolarization of the muscle end-plate
Extended depolarization of the muscle end-plate

Question 38 of 153

Which statement is correct regarding pancuronium?

Malignant hyperthermia is one of the life-threatening complications of pancuronium.
It can block the muscarinic cholinergic receptors in the heart.
Its main site of action is the presynaptic terminal.
Fasciculations are expected in the first phase of the blockade.
It has no antidote.

Question 39 of 153

Which medication may be appropriate for neonatal abstinence syndrome with a history of opioid abuse during pregnancy?

Flumazenil
Nicotine patch
Naloxone
Fentanyl patch
Buprenorphine

Question 40 of 153

Which category of substances is most likely to increase agonist efficacy?

Negative allosteric modulator
None
Allosteric inhibitor
Competitive inhibitor
Allosteric agonist

Question 41 of 153

Which of the following terms refers to the ability of a drug to activate the mechanisms to cause a biologic effect?

Affinity
Potency
Efficacy
Agonism

Question 42 of 153

Which of the following routes of administration is most likely to have the highest bioavailability for a given drug?

Intramuscular
Intravenous
Oral
Sublingual
Rectal

Question 43 of 153

What organ is a major site of M2 muscarinic cholinergic receptors?

Lung
Intestine
Kidney
Eye
Heart

Question 44 of 153

What is the mechanism of botulinum?

Prevents the release of acetylcholine
Increases the conversion of tyrosine to norepinephrine and dopamine
Augments release of norepinephrine from the presynaptic nerve terminal
Blocks the reuptake of dopamine from the synaptic cleft
Binds directly to alpha-adrenergic receptors

Question 45 of 153

What is a common side effect of levodopa?

Restless leg syndrome
Sedation
Reduced risk-taking ability
Hypertension
Nausea

Question 46 of 153

What is the most appropriate pharmacotherapy in newly diagnosed childhood absence epilepsy?

Lamotrigine
Valproate
Lithium
Phenytoin
Ethosuximide

Question 47 of 153

Which patient would be an appropriate candidate for succinylcholine therapy?

A 47-year-old male with chronic liver disease and ascites with concern on spontaneous bacterial peritonitis due to his liver condition.
An 85-year-old female with a history of undiagnosed muscle weakness.
A 79-year-old female with a history of cardiovascular disease, renal disease, and gastroesophageal reflux disease.
A 49-year-old firefighter in the emergency department with burns covering 75% of his body.
A 34-year-old pregnant woman with a history of pelvic inflammatory disease and pyelonephritis.

Question 48 of 153

What is true about succinylcholine?

It stimulates the cholinergic receptors in the central nervous system.
It is only active on receptors in the heart.
It causes tachycardia and hypotension in the first phase of the injection.
It is not reversed by acetylcholine esterase inhibitors.
It has a slow onset of action.

Question 49 of 153

What is the most frequent adverse effect of levetiracetam?

Sleepiness
Stevens-Johnson syndrome
Suicide
Psychosis
Anaphylaxis

Question 50 of 153

Which drug characteristic makes a drug more likely to enter a cell through a protein channel?

Water solubility
Acidophilic property
Neutrality
Fat solubility
Basophilic property

Question 51 of 153

Which of the following better describes the selectivity of a drug?

The amount of preference a receptor has for a particular drug
The ability to activate the mechanisms to cause a biological effect
The proportion of preference a receptor has for a drug
The strength of the bond between a drug and a receptor

Question 52 of 153

Drug X has a bioavailability of 90% when administered rectally, but only 40% when administered orally. Which of the following statements best explains this discrepancy?

Rectal administration undergoes the enterohepatic circulation.
The oral form has a higher dose.
The rectally administered form is more readily absorbed.
The oral form undergoes first pass metabolism.
The volume of distribution is lower when administered rectally.

Question 53 of 153

Activation of what type of receptor results in mydriasis?

Beta-1 adrenergic receptor
Nicotinic cholinergic receptor
Beta-2 adrenergic receptor
M1 muscarinic cholinergic receptor
Alpha-1 adrenergic receptor

Question 54 of 153

Receptors in the autonomic ganglions are mainly of which type?

Nicotinic adrenergic
Nicotinic cholinergic
Muscarinic cholinergic
Muscarinic adrenergic
None of the options provided is correct.

Question 55 of 153

Levodopa should be avoided with which condition?

Multiple sclerosis
Parkinson disease
Psychosis
Restless leg syndrome
Elevated blood pressure

Question 56 of 153

Phenobarbital should be avoided in which types of seizure?

Absence seizures
Partial seizures
Neonatal seizures
Myoclonic seizures
Tonic-clonic seizures

Question 57 of 153

Why will pyridostigmine NOT reverse succinylcholine?

Succinylcholine binds to a different part of the acetylcholine receptor and so it is not affected by pyridostigmine.
Pyridostigmine is not specific and affects the postsynaptic neurons.
Pyridostigmine is very specific and only affects the acetylcholinesterase enzymes in some but not all neurons.
Pyridostigmine increases the concentration of synaptic cleft acetylcholine without affecting the succinylcholine-activated receptor.
Pyridostigmine decreases the concentration of synaptic cleft acetylcholine without affecting the succinylcholine-activated receptor.

Question 58 of 153

What affects the central nervous system?

Tubocurarine
Rocuronium
Pancuronium
Diazepam
Succinylcholine

Question 59 of 153

What will not enhance the activity of local anesthetics?

Increased blood flow to the area
Decreased calcium levels
Elevated pH
Increased potassium levels
Myelinated fibers

Question 60 of 153

According to Fick’s law, change of which parameter will increase passive diffusion into a cell?

Low diffusion constant of the drug
Increased membrane thickness
Increased surface area
Decrease in surface area to membrane thickness ratio
Decreased concentration gradient

Question 61 of 153

Which of the following statements most accurately describes a drug with high efficacy and high potency?

It requires a large dose to exert a significant effect.
Even a large dose will not cause a significant effect.
It requires only a small dose to exert a significant effect.
The maximum dose does not cause a significant effect.

Question 62 of 153

Dosing rate is inversely proportional to which of the following?

Desired plasma concentration
Loading dose
Clearance
Volume of distribution
Bioavailability

Question 63 of 153

Which cholinergic receptor is responsible for reducing the rate of SA node firing?

M5
M3
Nicotinic
M2
M1

Question 64 of 153

What best describes hexamethonium?

Muscarinic receptor agonist
Dopamine receptor antagonist
Nicotinic receptor antagonist
Muscarinic receptor antagonist
Nicotinic receptor agonist

Question 65 of 153

Which drug and receptor type are paired correctly?

Pramipexole:D1
Bromocriptine:D2
Diphenhydramine:D3
Carbidopa:D2
Ropinirole:D1

Question 66 of 153

What is the first-line treatment for convulsive status epilepticus?

Intravenous benzodiazepines
Oxygen
Oral benzodiazepines
Phenobarbital
Phenytoin

Question 67 of 153

What is a depolarizing muscle relaxant that is eliminated through the liver?

Pancuronium
Rocuronium
Tubocurarine
Succinylcholine
Dancuronium

Question 68 of 153

What most likely reduces the chance of a nerve block by local anesthetic?

Small nerve fiber size
Hypomagnesemia
Hypercalcemia
The superficial location of fiber within the nerve bundle
Hyperkalemia

Question 69 of 153

Which distinguishes serotonin syndrome from pyrexia syndrome?

Hypertension
Urinary incontinence
Confusion
Hyperthermia
Muscle rigidity

Question 70 of 153

Which of the following statements regarding hydrophilic drugs is most accurate?

They are generally more likely to have cerebral effects than lipophilic drugs.
They are more likely to cross the placenta than lipophilic drugs.
They generally require a protein channel to cross cell membranes.
They are essentially nonpolar molecules.

Question 71 of 153

Which of the following statements regarding steroids is most accurate?

They are hydrophilic and bind with a specific receptor in the nucleus.
They are lipophilic and bind with a specific receptor on the cell membrane.
They are hydrophilic and bind with a specific receptor in the cytoplasm.
They are lipophilic and bind with a specific receptor in the cytoplasm.

Question 72 of 153

Loading dose is proportional to which of the following factors?

Half-life
Volume of distribution
Clearance
Bioavailability

Question 73 of 153

Which of the following is categorized as a non-selective alpha-adrenergic blocker?

Atenolol
Yohimbine
Prazosin
Phentolamine
Butaxamine

Question 74 of 153

Which drug is most likely to increase peripheral resistance?

Phenylephrine
Intermediate dose dopamine
Albuterol
Clonidine
Terbutaline

Question 75 of 153

Which medication is most appropriate when motor symptoms of Parkinson disease begin to interfere with daily function and quality of life?

Respiridone
Selegiline
Bromocriptine
Bupropion
Amantadine

Question 76 of 153

What is an adverse effect of phenytoin?

Peptic ulcer disease
Weight gain
Inhibition of cytochrome P450
Gingival hyperplasia
Syndrome of inappropriate ADH

Question 77 of 153

Which list is in the following order: shortest acting to longest acting?

Succinylcholine, pancuronium, rocuronium
Tubocurarine, pancuronium, rocuronium
Succinylcholine, rocuronium, pancuronium
Rocuronium, succinylcholine, tubocurarine
Succinylcholine, tubocurarine, rocuronium

Question 78 of 153

Where do local anesthetics act?

Skeletal muscle
Neural tissue
Skin and adipose
Tendons and ligaments
Cardiac muscle

Question 79 of 153

Which statement is correct regarding fentanyl?

It should not be used in combination with acetaminophen.
It is a high-potency opioid.
It acts as a weak partial agonist at the μ-opioid receptor.
It is used in the management of opioid overdose.
It is used to reduce symptoms associated with opioid withdrawal syndrome.

Question 80 of 153

One hundred units of drug A are administered to a patient intravenously. The volume of distribution of the drug is 2.5 liters. What is the concentration of the drug in the blood?

2.5 units/L
40 units/L
5 units/L
25 units/L

Question 81 of 153

Which cells lack cytochrome P450 enzymes?

Liver cells
Brain cells
Kidney cells
White blood cells
Red blood cells

Question 82 of 153

Which of the following statements regarding the therapeutic window is CORRECT?

Therapeutic drug monitoring (TDM) assumes that the plasma level of the drug is at a steady state.
The peak level corresponds to the minimum toxic concentration.
Theophylline has a wide therapeutic window.
Most medications require therapeutic monitoring.
The minimum toxic concentration corresponds best with the trough level.

Question 83 of 153

Which statement about labetalol is incorrect?

It has a wide therapeutic window.
It is more selective for β1 receptors.
It significantly increases placental flow.
It is commonly used as a antihypertensive medication during pregnancy.
It has partial agonist activity on β2 receptors in vascular smooth muscles.

Question 84 of 153

What best describes the mechanism of action of clonidine?

It primarily stimulates alpha 1 receptors.
It blocks both alpha and beta receptors.
It directly induces vasodilation.
It acts centrally leading to a reduction in sympathetic outflow.
It induces hypotension through nitric oxide release.

Question 85 of 153

What is the benefit of adding carbidopa to levodopa?

Carbidopa inhibits central DOPA decarboxylase to reduce side effects.
Carbidopa pierces the blood-brain barrier to allow levodopa to enter the central nervous system.
Carbidopa inhibits peripheral DOPA decarboxylase.
Carbidopa binds to levodopa and carries it into the central nervous system.
Carbidopa induces peripheral DOPA decarboxylase to increase peripheral dopamine.

Question 86 of 153

What is most accurate regarding the pharmacokinetics of inhaled anesthetics?

The higher the brain-blood partition coefficient, the higher the solubility in the blood.
The higher the blood-gas partition coefficient, the lower the solubility in the blood.
The lower the blood-gas partition coefficient, the faster the induction time.
The higher the brain-blood partition coefficient, the lower the solubility in brain tissue.
The lower the blood-gas partition coefficient, the slower the induction time.

Question 87 of 153

Where in the body does cyclobenzaprine act directly?

Muscles
Peripheral nervous system
Brainstem
Brain cortex
Cerebellum

Question 88 of 153

What is the most accurate comparison between amide and ester local anesthetics?

Amide anesthetics are more potent.
Ester anesthetics are more likely to cause an allergic reaction.
Amide anesthetics have a high potential for abuse.
Amide anesthetics are metabolized in the serum by esterases.
Ester anesthetics cause less toxicity.

Question 89 of 153

Which of the following increases volume of distribution?

High plasma protein binding
High rate of ionization
High lipid solubility
High degree of polarity

Question 90 of 153

Excretion of conjugates and their metabolites from cells primarily occurs during which phase(s) of drug metabolism?

Phases 2 and 3
Phases 1 and 2
Phase 3
Phase 1
Phase 2

Question 91 of 153

Which of the following is the correction factor used for females in the Cockcroft-Gault formula?

0.95
0.75
0.55
0.85
0.65

Question 92 of 153

What is NOT an indication for beta-blocker therapy?

Hypertension in pregnancy
Social/performance anxiety
Supraventricular tachycardia management
Unstable heart failure
Rate control in atrial fibrillation

Question 93 of 153

What is not seen with phenylephrine administration?

High blood pressure
Nasal decongestant
Vasopressor effect
Reflex tachycardia
Pupillary dilation

Question 94 of 153

Which medication most significantly increases the risk of serotonin syndrome when administered with selegiline?

Benzodiazepines
Selective serotonin reuptake inhibitors
First-generation antihistamines
Dopamine agonists
Atypical antipsychotics

Question 95 of 153

What is the relationship between ventilation rate and induction of anesthesia?

A faster ventilation rate will not change the induction of anesthesia.
A faster ventilation rate increases the induction of anesthesia.
Hypoventilation will not change the induction of anesthesia.
Hypoventilation increases the induction of anesthesia.
Ventilation rate and hypoventilation do not have any effect on the induction of anesthesia.

Question 96 of 153

What is the mechanism of action of diazepam?

Diazepam acts as an agonist of the acetylcholine receptor.
Diazepam interacts with the GABA-A receptor to increase the frequency of channel opening.
Diazepam interacts with GABA-B receptors to inhibit adenylyl cyclase.
Diazepam interacts with GABA-B receptors to inhibit G protein-coupled receptors (GPCR).
Diazepam interacts with the GABA-A receptors to increase intracellular sodium.

Question 97 of 153

What is a side effect of topical anesthetics?

Increased inotropy
Lightheadedness
Pulmonary fibrosis
Sedation
Vasodilation

Question 98 of 153

The volume of distribution for drug A is 8L. What is the total dose required to reach a plasma concentration of 4 units/L?

0.5 units
2 units
32 units
4 units

Question 99 of 153

Which of the following drugs is an inducer of cytochrome P450?

Amiodarone
Fluconazole
Grapefruit juice
Rifampin
Cimetidine

Question 100 of 153

Which of the following refers to the difference between the minimum effective concentration and maximum therapeutic concentration of a drug?

The therapeutic window
The duration of action
The therapeutic index
The toxic range
The therapeutic effect

Question 101 of 153

Which beta blocker also acts on alpha receptors?

Atenolol
Propranolol
Acebutolol
Labetalol
Metoprolol

Question 102 of 153

What is a significant side effect of high-dose dopamine administration?

Orthostatic hypotension
End organ ischemia
Bradycardia
Bronchoconstriction
Hypothermia

Question 103 of 153

What is most accurate about tolcapone, in comparison to entacapone?

Tolcapone has less blood-brain barrier penetration.
Tolcapone has less liver toxicity.
Tolcapone has a reduced risk of depression.
Tolcapone has a longer 'off time'.
Tolcapone has a longer half-life.

Question 104 of 153

What speeds up anesthesia induction?

Slower ventilation rate
Greater solubility
Greater partial pressure
Greater blood flow
Greater AV gradient

Question 105 of 153

Which statement is correct regarding malignant hyperthermia?

Dantrolene should be administered as soon as malignant hyperthermia is suspected.
Reverse the effect of dantrolene as soon as possible.
Propofol is an anesthetic drug that is commonly associated with malignant hyperthermia.
Malignant hyperthermia has a subacute onset and usually starts within 2 weeks after the surgery.
Myoglobinuria is one of the earliest clinical markers of malignant hyperthermia.

Question 106 of 153

A 27-year-old female presents to the emergency department with extensive pruritic hives and excoriations on her arms and legs after dental surgery and local anesthesia with procaine. She has no history of a serious illness and takes no medications. What is the mechanism of this condition?

C1 esterase inhibitor deficiency
Idiopathic porphyria
Ester anesthetic breakdown byproducts
Amide anesthetic breakdown byproducts
Factitious disorder

Question 107 of 153

Which clinical trial phase consists of randomized controlled multicenter trials on large patient groups aimed at establishing the effectiveness of a drug?

Phase 4
Phase 0
Phase 3
Phase 1
Phase 2

Question 108 of 153

A patient currently takes drug (A), which is metabolized by CYP450. How would you change the prescription for drug (A) once the patient tells you that they are now taking St. John’s Wort?

Increase the dose of the drug (A) since St. John’s Wort is a CYP450 inducer.
No need to change the dose of the drug (A) since St. John’s Wort is a CYP450 inhibitor.
Decrease the dose of the drug (A) since St. John’s Wort is a CYP450 suicide inhibitor.
Decrease the dose of the drug (A) since St. John’s Wort is a CYP450 inducer.
Increase the dose of the drug (A) since St. John’s Wort is a CYP450 suicide inhibitor.

Question 109 of 153

Which of the following equations can be used to calculate the loading dose of a drug?

Target concentration / bioavailability
Volume of distribution / renal clearance
(Volume of distribution × target concentration) / bioavailability
(Volume of distribution × half-life) / bioavailability
Bioavailability / half-life

Question 110 of 153

Which of the following is LEAST likely to be caused by beta blockers?

Exacerbation of asthma symptoms
Excessive bradycardia
Masked symptoms of hypoglycemia
Sexual dysfunction
Hypertension

Question 111 of 153

What most likely decreases with isoproterenol administration?

Positive dromotropic effect
Positive atrial inotropic effect
Refractory period of the atrioventricular node
Positive ventricular inotropic effect
Positive chronotropic effect

Question 112 of 153

What is a concerning side effect of tolcapone?

Liver toxicity
Urinary infections
Acute renal failure
Breast cancer
Psychosis

Question 113 of 153

Which effect is NOT associated with general anesthesia?

Decreased intracranial pressure
Nausea
Respiratory depression
Myocardial depression

Question 114 of 153

Which medication does not decrease intracranial pressure?

Ketamine
Thiopental
Midazolam
Acetazolamide
Propofol

Question 115 of 153

What is NOT considered an effect of opioids?

Cough suppression
Nausea
Positive inotropy
Sedation
Constipation

Question 116 of 153

A parent drug is primarily polarized during which phase(s) of drug metabolism?

Phase 1
Phase 3
Phase 2
Phases 2 and 3

Question 117 of 153

A patient takes a drug that has a Kd of 100 micrograms. The patient had been on a drug that had a Kd of 100 milligrams. Which of the following is TRUE?

The toxicity of the new drug is much higher than the toxicity of the old drug.
The binding affinity of the new drug is much higher than the binding affinity of the old drug.
The strength of the new drug is greater than the strength of the old drug.
More people in a population will respond to the new drug than the old drug.

Question 118 of 153

Which of the following equations can be used to calculate the dosing interval of a drug?

(Volume of distribution × target concentration) / bioavailability
Plasma concentration peak / clearance
*(Plasma concentration peak – plasma concentration trough) / clearance
Target concentration / bioavailability
(Plasma concentration trough – plasma concentration peak) / elimination rate

Question 119 of 153

Which beta blocker also stimulates nitric oxide?

Levobunolol
Nebivolol
Propranolol
Acebutolol
Labetalol

Question 120 of 153

What drug class reduces intraocular pressure by reducing aqueous production?

Beta blockers
Cholinomimetics
Prostaglandins
Non-selective alpha adrenergic agonists
All of the answers reduce aqueous production.

Question 121 of 153

A man presents to the emergency room with schizophrenia-like symptoms. He is belligerent, combative, and raving about aliens in his room. Moments after treatment with haloperidol, he complains of muscle rigidity and cannot seem to turn his head from an abnormal, twisted posture. What is the most appropriate next step in management?

Increased dose of haloperidol
Benztropine
Bromocriptine
Buspirone
Amantadine

Question 122 of 153

During general anesthesia, a patient develops tachypnea and a rise in end-tidal CO2 followed by hyperthermia and generalized muscle rigidity. What is the most appropriate next step in pharmacotherapy?

Dantrolene
Increase in anesthetic dose
Haloperidol
Propranolol
Midazolam

Question 123 of 153

Which condition is an appropriate indication for management with baclofen?

Generalized tonic-clonic seizures
Parkinson's disease
Ischemic stroke
Low back pain
Cerebral palsy

Question 124 of 153

A reduced capacity for which side effect makes nalbuphine a safer alternative to morphine?

Acute renal failure
Sedation
Respiratory depression
Arrhythmia
Dizziness

Question 125 of 153

Conjugation primarily refers to which phase of drug metabolism?

Phases 1 and 2
Phase 1
Phase 3
Phase 2

Question 126 of 153

Which of the following best describes EC50?

The dose required to achieve 50% mortality from toxicity.
The dose required to get 50% of the population reporting toxic side effects.
The effective concentration of a drug that produces 50% of the maximal effect.
The dose required to achieve 50% of the desired response in 50% of the population.

Question 127 of 153

Which of the following equations can be used to calculate the maintenance dose of a drug?

(Plasma concentration peak – plasma concentration trough) / clearance
Serum concentration / bioavailability
Serum concentration / half-life
Serum concentration * clearance
Serum concentration / clearance

Question 128 of 153

Which substance would activate a muscarinic cholinergic receptor but NOT a nicotinic cholinergic receptor?

Pilocarpine
Methacholine
Labetalol
Acetylcholine
Carbachol

Question 129 of 153

What drug might improve symptoms of urinary incontinence?

Neostigmine
Ephedrine
Bethanechol
Tamsulosin
Valium

Question 130 of 153

Which statement is CORRECT about amantadine?

It causes severe extrapyramidal symptoms.
It is an effective antipsychotic agent.
Renal dose adjustments are not required in patients with renal failure.
It is used in the treatment of dyskinesia associated with Parkinson disease.
It is used in the treatment of some bacterial infections.

Question 131 of 153

What is the best screening method for malignant hyperthermia?

A cold saline test
Medical history
A trial of anesthesia and monitoring
Temperature monitoring
Muscle biopsy

Question 132 of 153

Which drug is INCORRECTLY matched to its target receptor?

Tizanidine:alpha-2 receptor
Diazepam:Gamma-aminobutyric acid (GABA) A receptor
Tizanidine:alpha-1 receptor
Cyclobenzaprine:muscarinic acetylcholine receptor
Baclofen:Gamma-aminobutyric acid (GABA) B receptor

Question 133 of 153

What is the downside to using buprenorphine?

A high rate of arrhythmias prevents chronic use for withdrawal.
It has a significantly higher risk of respiratory depression compared to morphine.
Buprenorphine is contraindicated during pregnancy.
Because of its strong binding affinity, buprenorphine prevents the use of other, stronger opioids for pain management.
Buprenorphine is very addictive and should not be prescribed to any patient with a history of substance abuse.

Question 134 of 153

What is true about competitive inhibitors?

They promote the binding of an agonist at an active site.
Competitive and allosteric inhibitors act at the same place of the molecule.
They are less effective than agonists.
They bind to a different place on the same molecule.
They act at the same site as the drug.

Question 135 of 153

Which of the following is more likely to decrease the volume of distribution?

Kidney failure
Increased lipid solubility
Increased binding to plasma proteins
Increased polarity
All decrease the volume of distribution.

Question 136 of 153

Jill takes a pill for depression. The pharmacokinetic properties show a Kd of 344 pg/ml, and a ED50 of 200 pg/ml. What does this mean?

Jill has taken a medication that is not effective.
This medication has high binding affinity but low effectiveness.
Jill has spare receptors for this medication.
None

Question 137 of 153

Which of the following regarding loading dose is most accurate?

A dose sufficient to produce a plasma concentration below the therapeutic window.
It is smaller than the dose rate needed to maintain the concentration.
It is larger than the dose rate needed to maintain the concentration.
A dose sufficient to produce a plasma concentration above the therapeutic window.

Question 138 of 153

What is NOT a potential use for acetylcholinesterase inhibitors?

Chemical weapon
Diagnosis of neuromuscular junction disease
Pesticide
Muscle relaxant
Treatment for myasthenia gravis

Question 139 of 153

Which receptors are primarily stimulated during tocolysis caused by terbutaline?

Dopamine receptor
Beta-1 adrenergic receptor
Alpha-2 adrenergic receptor
Alpha-1 adrenergic receptor
Beta-2 adrenergic receptors

Question 140 of 153

What is true regarding the dopamine hypothesis of schizophrenia?

Negative symptoms are caused by the depleted dopaminergic signal transduction.
Positive symptoms are caused by the depleted dopaminergic signal transduction.
Positive symptoms are not related to dopaminergic signal transduction.
Negative symptoms are caused by hyperactive dopaminergic signal transduction.
Positive symptoms are caused by hyperactive dopaminergic signal transduction.

Question 141 of 153

What is the most appropriate step in the management of phenobarbital toxicity?

Intravenous diazepam
Intravenous bicarbonate
Supportive therapy
Reversal of flumazenil
High flow oxygen

Question 142 of 153

What is the mechanism that allows local anesthetics to pass the polarized membrane and into nerve cells?

The medication interacts with the extracellular matrix, resulting in a secondary messengers cascade to cause anesthesia.
Active transport pumps the medication into the nerve cells.
The medication is converted into a base locally, with the use of a bicarbonate adjuvant. Once modified, the medication is activated in the kidney and returned to locally anesthetize the tissue.
The medications pass through the membrane in a non-polar form. Once inside, they form the active, polar form.
They enter the cell through endocytosis at the synaptic cleft.

Question 143 of 153

What is not expected after naloxone administration for opioid toxicity?

Sweating
Vomiting
Improved spontaneous respirations
Hallucination
Agitation

Question 144 of 153

Which of the following regarding lipophilic drugs is most accurate?

They cannot cross the blood-brain barrier.
They act similarly to hydrophilic drugs.
They are typically nonpolarized.
They typically cross cell membranes through protein channels.
They do not cross the placenta.

Question 145 of 153

Which of the following is not performed in the preclinical phase of drug testing?

In vivo testing
Environmental testing
In vitro testing
Testing on healthy human volunteers
Testing on human tissues

Question 146 of 153

Which of the following describes a constant rate of elimination over time, regardless of the concentration?

Zero order elimination kinetics
First order elimination kinetics
Non-linear elimination kinetics
Michaelis-Menten kinetics

Question 147 of 153

Why are normal serum creatinine levels for adult men (0.9 to 1.3 mg/dL) higher than those for adult women (0.6 to 1.1 mg/dL)?

Men have more muscle mass.
Increased estrogen in women interferes with the measurement.
Major hormonal differences exist between the two groups.
Women have smaller kidneys.

Question 148 of 153

What is the usual cause of death caused by sarin (acetylcholinesterase inhibitor)?

Hemorrhagic shock
Cardiac arrest
Brain edema
Delusional state
Asphyxia

Question 149 of 153

Which receptor is typically present in the neuromuscular junction of skeletal muscles?

Nicotinic
Muscarinic
Dopaminergic
Adrenergic

Question 150 of 153

Which dopamine pathway is associated with hallucinations in schizophrenia?

Mesolimbic tract
Tuberoinfundibular tract
Mesocortical tract
Nigrostriatal tract
Chemoreceptor zone

Question 151 of 153

What is NOT a side effect of ketamine when used as a general anesthetic?

Vomiting
Priapism
Disorientation
Hallucination
Abnormal heart rhythm

Question 152 of 153

According to the lecture, which of the following factors is least likely to influence nerve block?

Distribution of nodes of Ranvier
Location of the fiber in the nerve bundle
Type of nerve fiber
Size of the nerve fiber
Myelination of the nerve fiber

Question 153 of 153

What is true about hyperpyrexia syndrome?

Related to the use of levetiracetam
Related to the use of SSRIs
Related to the use of phenytoin
Related to the use of SNRIs
Related to the use of MAO Inhibitors

Pharma Basics 2023

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