Download Pharmacology 2004

Pharmacology 2004 - part 2
1. What is the incorrect statement regarding acetylcholine secretion from a
cholinergic nerve end?
a. It is inhibited following the stimulation of pre-synaptic muscarinic
receptors
b. It is inhibited following the stimulation of pre-synaptic nicotinic
receptors
c. It is inhibited following the stimulation of pre-synaptic 2-adrenergic
receptors
d. It is inhibited by the botulinum toxin
e. It is inhibited by gallamin, following the blockage of pre-synaptic
sodium channels in the neuromuscular junction of voluntary muscles
2. What is the most correct combination of effect and reason regarding the effect
of bethanechol upon the cardiovascular system?
a. Arterial constriction - following binding to muscarinic receptors upon
the endothelium and release of nitric oxide (NO)
b. Venous relaxation - following binding to muscarinic receptors and NO
release
c. Bradycardia - following increased release of acetylcholine in the SA
node
d. Bradycardia - following the stimulation of nicotinic receptors in the
autonomic ganglia
e. Neither of the above is correct
3. What is the incorrect statement regarding clinical use of muscarinic agonists?
a. Muscarine is a specific muscarinic agonist given systemically to
increase urinary tract activity after surgeries
b. Pilocarpine, which is given PO, is efficient in treating xerostomia
(losing the activity of salivary glands) that develops following
irradiation of the head or the neck
c. Acetylcholine can be used in direct drip into the eye, in order to
achieve short term miosis during cataract surgery
d. Asthma is a contraindication to usage of muscarinic agonists
e. IV injected acetylcholine is degraded too fast, being thus ineffective
therapeutically
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4. What is the correct statement regarding acetylcholine esterase inhibitors?
a. Physostigmine is a naturally derived inhibitor comprising a quaternary
aminic nitrogen, thus having no effect on the CNS
b. Neostigmine is a synthetic inhibitor comprising a quaternary aminic
nitrogen, which creates only weak bonding with the enzyme, only at
the anionic site
c. Echothiophate is an organophosphate inhibitor that creates a long term
bond with the enzyme, and is used as a chronic treatment of wide/open
angle glaucoma
d. Pralidoxime (PAM) can prevent the reaction to organophosphate
inhibitors only when given as pre-treatment, before the exposure to the
toxin
e. The high safety of malathion as compared to parathion is the result of
its conversion to malaoxon in the liver of mammals
5. What is the incorrect statement regarding drugs that are effective in glaucoma
treatment and the mechanism of their action?
a. Pilocarpine drops act as muscarinic agonist, causing constriction of the
iris and increasing the drainage of chamber water
b. Edrophonium drops act as acetylcholine esterase inhibitor
c. Timolol drops act as beta-adrenergic inhibitor, decreasing the
production of chamber water
d. Phenylephrine drops act as alpha-adrenergic agonist, increasing the
drainage of chamber water
e. Acetazolamide acts as carbonic anhydrase inhibitor, decreasing the
production of chamber water
6. A patient, who suffers from myasthenia gravis, is treated by the combination
of pyridostigmine and atropine. This treatment:
a. Corrects the basic cause of the disease
b. Treats the symptoms without treating the cause of the disease
c. Is intended for short periods only and it is advised to be discontinued
following several days
d. Is only intended for myasthenia gravis patients who also suffer from
bradycardia
e. Is not appropriate, as atropine is unnecessary and can even be harmful
7. What is the correct order of the effects of consumption of increasing doses of
atropine PO?
Low dose

High dose
a. Tachycardia, bradycardia, hallucinations, mydriasis
b. Mydriasis, bradycardia, tachycardia, hallucinations
c. Tachycardia, mydriasis, bradycardia, hallucinations
d. Bradycardia, tachycardia, mydriasis, hallucinations
e. Hallucinations, bradycardia, tachycardia, mydriasis
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8. What is the incorrect statement regarding muscarinic receptor antagonists?
a. Ipratropium is efficient and specific as bronchodilator when
administered as oral spray, but when given systemically it causes
nicotinic ganglionic inhibition as well
b. Tropicamide as eye drops causes short-term mydriasis and cycloplegia
c. Scopolamine a very lipophilic anti-muscarinic alkaloid that is efficient
in prevention of the symptoms of vestibular (equilibrium) diseases
d. Atropine can cause an increase in the body temperature, especially in
babies, due to its high efficiency in inhibition of perspiration
e. There is no danger in systemic administration of therapeutic doses of
atropine in all types of glaucoma patients
9. What is the correct statement regarding succinylcholine?
a. It is a short-acting depolarizatory nicotinic blocker, quickly degraded
by acetylcholine esterase
b. It is a short-acting depolarizatory nicotinic blocker, being quickly
excreted by the kidneys
c. At low dosage it causes bradycardia that can be blocked by atropine
d. At relatively high dosage it stimulates nicotinic receptors in autonomic
ganglia
e. Its effect as a muscle relaxant is weakened in a patient treated with
antibiotics
10. What is the most correct statement regarding curare?
a. It is a short-acting competitive nicotinic blocker, quickly degraded by
acetylcholine esterase
b. Its effect upon striated muscle is increased by high dosage of
edrophonium
c. Its effect upon striated muscle is inhibited by low dosage of
succinylcholine
d. At relatively low dosage it causes increase in the blood pressure due to
inhibition of histamine release from mast cells
e. At relatively high dosage it causes increase in the blood pressure due to
stimulation of ganglionic nicotinic receptors
11. What is the most correct statement regarding tetanic stimulation of a neuron
while blocking the neuromuscular junction with nicotinic blockers?
a. Following the administration of non-depolarizing blocker, the tetany is
weakened, but sustained stable
b. Following the administration of depolarizing blocker, the tetany is not
sustained
c. Following the administration of non-depolarizing blocker, the tetanic
stimulation will cause deepening of the blockade immediately after the
tetanus
d. Following the administration of depolarizing blocker, the tetanic
stimulation will cause deepening of the blockade immediately after the
tetanus
e. Following the administration of depolarizing blocker, the tetanic
stimulation will cause a transient effect of post tetanic potentiation
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12. What is the incorrect statement?
a. The angiotensin converting enzyme (ACE) is found in the membrane
of endothelial cells
b. We won't prescribe ACE inhibitors to a patient suffering from renal
artery stenosis, as they increase the risk that this patient develops renal
insufficiency
c. Administration of AT1 angiotensin receptor blockers causes indirect
stimulation of AT2 angiotensin receptors
d. ACE inhibitors in therapeutic dosage have less side effects than AT1
angiotensin receptor blockers in therapeutic dosage
e. Stimulation of AT2 angiotensin receptor causes NO-dependent smooth
muscle relaxation
13. Which of the following effects of angiotensin is not blocked by losartan?
a. Activation of the sympathetic nervous system
b. Aldosterone secretion from the adrenal cortex
c. Apoptosis
d. Production of superoxide anion
e. Hypertrophy of vascular smooth muscle cells
14. What is the incorrect statement?
a. Enalapril is a prodrug that undergoes hepatic metabolism into the
active metabolite following PO administration
b. AT1 angiotensin receptor blockers are not recommended to pregnant
women after the second trimester
c. The enzyme ACE2 converts angiotensin II (1-8) into angiotensin II (17)
d. Angiotensin II and angiotensin III have similar potency for AT1
angiotensin receptor
e. ACE inhibitors increase the cardiovascular effects of bradykinin
15. What is the correct statement regarding bosentan?
a. It is a selective antagonist to ETA endothelin receptor
b. It is effective in treatment of pulmonary arterial hypertension
c. It stimulates vasopressin secretion
d. It activates the enzyme NADPH oxidase
e. It does not harm the fetus
16. What is the incorrect statement regarding caffeine?
a. It is a non-selective inhibitor of phosphodiesterase
b. It passes the placental barrier easily
c. It inhibits norepinephrine secretion in the CNS
d. It blocks adenosine receptors
e. It causes sleep disturbances
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17. What is the incorrect statement?
a. Aprotinin is a selective antagonist of the B2 bradykinin receptor
b. Icatibant is a selective antagonist of the B2 bradykinin receptor
c. Bradykinin is produced from kininogens by the kallikrein enzymes
d. Bradykinin increases capillary permeability
e. Bradykinin is a potent nociceptive substance
18. What is the incorrect statement regarding digoxin?
a. It increases the concentration of free and intra-cellular calcium through
inhibition of the Na-K ATPase enzyme
b. At low dosage its effect is more evident in the ventricles than in the
atria
c. Its absorption in the intestine is low, therefore its bioavailability is low
d. It undergoes extensive hepatic biotransformation
e. Its efficacy is increased in the state of hyperkalemia
19. What is the incorrect statement?
a. When diltiazem undergoes hepatic metabolism, a pharmacologically
active metabolite is produced
b. When verapamil undergoes hepatic metabolism, a pharmacologically
active metabolite is produced
c. Nifedipine and verapamil have similar ability to relax vascular smooth
muscle at therapeutic dosage
d. Dihydropyridine type calcium channel blockers are less efficient than
phenylalkylamine type blockers in their effect upon the SA node
e. Benzothiazepine type calcium channel blockers decrease automaticity
in the atrioventricular node
20. What is the incorrect statement?
a. Production of nitric oxide (NO) from NO donor drugs depends upon the
interaction between the drug and thiol groups of the proteins in the
blood and in the cells
b. Arginine analogues can inhibit NO synthase
c. NO is neutralized by superoxide anions to produce peroxynitrite
d. NO productin from sodium nitroprusside is an enzyme-dependent
process
e. NO activates the lipid oxidation chain in concentration higher than 1
M
21. What is the incorrect statement?
a. Stimulation of 1 adrenergic receptors increases calcium conductance
b. Stimulation of 1 adrenergic receptors decreases the automaticity in
the AV node
c. Stimulation of 1 adrenergic receptors increases the rate of phase 4
depolarization in the SA node
d. Stimulation of M2 muscarinic receptors decreases calcium
conductance
e. Stimulation of M2 muscarinic receptors in the heart causes membrane
hyperpolarization via opening of potassium channels
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22. A 65-years old patient suffers from heart failure. One day he appears in the ER
complaining of vision disturbances. Upon examination, an abnormal ECG is
obtained, demonstrating extrasystolic contractions. Those symptoms lead to
the possibility of side effects of which of the following drugs?
a. Captopril
b. Digoxin
c. Propranolol
d. Prazosin
e. Clonidine
23. A 60-years old patient is treated for hypertension. One day he appears in the
ER complaining of dry cough and disturbance in taste sensation. Additionally,
skin rash and angioedema are found upon examination. Those symptoms lead
to the possibility of side effects of which of the following drugs?
a. Losartan
b. Prazosin
c. Nitroglycerin
d. Methyldopa
e. Captopril
24. What is the most correct statement regarding production and secretion of
histamine?
a. Histamine is produced in mast cells only, and is released following
their stimulation by allergens
b. Histamine is produced in all the cells of the body, because the
precursor histidine is present in all the cells
c. Histamine is produced only in enterochromaffin-like cells that are
located in the gastric mucosa
d. Histamine is constantly released from the enterochromaffin-like cells
in the gastric mucosa, while mast cells release histamine following
their stimulation
e. Histamine is produced by enterochromaffin-like cells, while mast cells
uptake histamine while passing in the bloodstream
25. A patient treated by diphenhydramine is considering discontinuing the
treatment due to fatigue sensation. Which alternative drug can you
recommend?
a. Dimenhydrinate
b. Fexofenadine
c. Paracetamol
d. Ibuprofen
e. There is no alternative drug, and the patient should be persuaded to
continue the treatment
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26. Which of the following substances does not take part in the regulation of
gastric acidity?
a. Histamine
b. Serotonin (5-HT)
c. Acetylcholine
d. Gastrin
e. PGE2
27. Which receptor is affected by sumatriptan?
a. 5-HT1A
b. 5-HT1B and 5-HT1D
c. 5-HT2A
d. 5-HT3
e. 5-HT4
28. Where in the body is 5-HT produced?
a. In the platelets
b. In enterochromaffin cells in the gastrointestinal tract
c. In certain neurons
d. a + b are correct
e. b + c are correct
f. a + b + c are correct
29. What is the degradation product of 5-HT?
a. 5-hydroxyindole acetic acid
b. 5-lipoxygenase
c. N-methylimidazole acetic acid
d. Arachidonic acid
e. Vanyl mandelic acid
30. Which disease is sometimes treated by 5-HT4 receptor agonists?
a. Anxiety
b. Depression
c. Migraine
d. Gastroesophageal reflux disease
e. Carcinoid syndrome
31. Which disease is often treated by a drug that is kind of prostaglandin?
a. Ischemic heart disease
b. Asthma
c. Glaucoma
d. Peptic ulcer
e. Chemotherapy-induced nausea
32. What is common to cyclooxygenase and 5-lipoxygenase?
a. Both are expressed in gastric mucosa
b. Both act on the same substrate
c. Both act as a receptor to arachidonic acid
d. Both act in cholesterol removal path
e. They have no common properties
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33. What is the t1/2 of a prostaglandin like PGE2 in the human body?
a. Several days
b. Several hours
c. 1-5 minutes
d. It depends, as their half live is increased following inflammation
e. Their half live is unknown
34. The positive effect of aspirin in prevention of thrombosis is the result of its
ability to reduce the production of:
a. TXA2
b. PGI2
c. Arachidonic acid
d. All types of prostaglandins
e. The mechanism of action of aspirin is unknown
35. Which NSAID is an irreversible inhibitor?
a. Aspirin
b. Ibuprofen
c. Paracetamol
d. Naproxen
e. Indomethacin
36. Why is aspirin not recommended to children?
a. Because it dilutes the blood and it can be dangerous in children
b. Because the toxic concentration is too close to the therapeutic action
c. Because aspirin is not efficient in children
d. Because it is related to a rare complication called Reye's syndrome
e. All of the above are correct
37. A patient is suffering from gastric damage following daily usage of NSAID
(indomethacin). Several changes in his treatment can be suggested that could
improve his situation. Which of the following options is not appropriate for
this patient?
a. Addition of misoprostol
b. Replacement of indomethacin by rofecoxib
c. Replacement of indomethacin by ibuprofen
d. Addition of omeprazole
e. Addition of ondansetron
38. The gaseous anesthetic isoflurane causes all of the following, except:
a. Decrease in the blood flow to the brain
b. Negative inotropic effect upon the heart
c. Increased risk for malignant hypertension
d. Relaxation of smooth muscle in the uterus
e. Relaxation of smooth muscle in the blood vessels
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39. All of the following statements are correct regarding the anesthetic etomidate,
except:
a. It does not decrease the blood pressure significantly
b. It blocks steroid synthesis in the adrenal
c. The duration of action of etomidate is short
d. It can be used to induce anesthesia in hemodynamically unstable
patient
e. Etomidate can be used in prolonged use for several days
40. What is the correct reason for the short duration of action of the anesthetic
thiopental?
a. Quick metabolism in the liver
b. Quick excretion by the kidneys
c. Redistribution of the drug from the nervous system to peripheral
tissues, such as skeletal muscle
d. Absorption into nerve cells by active pump in the membrane
e. Blockage of sodium channels in the post-synaptic membrane
41. What is the correct statement regarding the toxicity of local anesthetics?
a. CNS symptoms appear after cardiovascular symptoms
b. The dosage causing toxicity effects is fixed for a given anesthetic
c. The dosage causing toxicity is dependent upon the location of the
injection
d. Addition of vasoconstrictors to the local anesthetic solution does not
affect the rate of the drug absorption following sub-cutaneous injection
e. Toxicity symptoms are not affected by benzodiazepine pretreatment
42. What is correct regarding the mechanism of action of local anesthetics?
a. Blockade of sodium channels is the main mechanism of action
b. Part of the anesthetics are able to block nervous conduction by
dissolving in the lipid layer and changing the conformation of channels
c. In order to block conduction in a nerve, a fragment including several
Ranvier nodes should be blocked
d. Local anesthetic must enter the nerve in order to take action
e. All of the above are correct
43. What is the correct statement regarding the chemical structure of local
anesthetics?
a. The part of the molecule that binds the polarized end to the aromatic
end of the molecule is significant in determination of the speed of
nerve blockade
b. The part binding the two ends is significant in determination of the
metabolic pathway through which the molecule is degraded
c. The degradation product of an anesthetic from the amide family is
PABA
d. Anesthetics from the amide family cause more allergic side effects
than other local anesthetics
e. All of the above are correct
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Correct answers:
1. b
2. b
3. a
4. c
5. b
6. b
7. d
8. e
9. c or d
10. c
11. d
12. d
13. c
14. d
15. b
16. c
17. a
18. a
19. c
20. d
21. b
22. b
23. e
24. d
25. b
26. b
27. b
28. e
29. a
30. d
31. c
32. b
33. c
34. a
35. a
36. d
37. e
38. a
39. e
40. c
41. c
42. e
43. b
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