Module 1. Clinical Pharmacology of Drugs Affecting the Cardiovascular System and the Respiratory

Module 1. Clinical pharmacology of drugs affecting the cardiovascular system and the respiratory system. Clinical pharmacology of analgesics and antibacterials. Clinical pharmacology of antiseptics, enzymes and drugs that affect the hard tissues of the tooth

Тext test tasks

Alternative antimicrobial drug(s) for treating penicillin-resistant S. aureus:
vancomycin (Vancocin)
* nafcillin (Nafcil, Unipen)
methicillin (Staphcillin)
All of the above
None of the above
Aminoglycosides antibacterial
hetacillin
aztreonam
* gentamicin (Garamycin)
vancomycin (Vancocin)
Clarithromicin
Antibacterials regarded as generally safe to prescribe in pregnancy.
* erythromycin
cephalosporins
tetracyclines
All of the above
None of the above
Antibiotic: Newborn toxicity due to impaired glucuronidation in infants
* chloramphenicol (Chloromycetin)
tetracycline (Achromycin)
ampicillin
all
neither
Antibiotic's clearance from the body most likely influenced by severe hepatic disease:
penicillins
clindamycin (Cleocin)
rifampin (Rimactane)
* clindamycin & rifampin
None of the above
Bacterial cell wall synthesis inhibitor--like penicillins:
bacitracin
lincomycin (Lincocin)
* cephalosporin
streptomycin
none of the above
Beta-lactamase inhibitor:
vancomycin (Vancocin)
sulbactam
clavulanate
* vancomycin & clavulanate
none of the above
Cephalosporin effective against pseudomonas infections:
cefoxitin (Mefoxin)
moxalactam
* ceftazidime (Fortax, Taxidime, Tazicef)
cefoxitin & ceftazidime
neither
Cephalosporin: orally effective
cephalothin (Keflin)
Cephalexin
* cefaclor (Ceclor)
cephalothin & cefaclor
none of the above
Combination of metronidazole (Flagyl) and penicillin in treating an abscess caused by beta-lactamase producing Bacteriodes and anaerobic streptococci is an example of:
synergistic drug treatment
antagonistic drug effects
additive drug effects
* none of the above
all of the above
Drug(s) effective in treating typhoid fever:
ampicillin (Principen, Omnipen)
ciprofloxacin (Cipro)
trimethoprim-sulfamethoxazole (Bactrim)
* all of the above
none of the above
Effective in treating infections due to B. fragilis
cefamandole (Mandol)
* cefoxitin (Mefoxin)
cefadroxil (Duricef, Ultracef)
all of the above
none of the above
FALSE statement about penicillin G
treatment of choice for viridans group streptococcal endocarditis.
* Pen G and Pen V are the two natural penicillins.
Pen G can be combined with procaine, extending drug half-life
Pen G most effective when given orally
None of the above
First generation cephalosporin:
cefamandole (Mandol)
cefaclor (Ceclor) and
cefoxitin (Mefoxin)
* cephalexin (Keflex)
none of the above
Fluoroquinone;effective in treating urinary tract infections (UTI) caused by multidrug resistant strains.
isoniazid (INH)
sulfasalazine (Azulfidine)
* ciprofloxacin (Cipro)
streptomycin
none of the above
Inhibits bacterial cell wall synthesis:
streptomycin
vancomycin (Vancocin)
doxycycline (Vibramycin, Doryx)
* gentamicin (Garamycin)
all of the above
Mechanism of action: Chloramphenicol (Chloromycetin)
* protein synthesis inhibitor
bacterial cell wall synthesis inhibitor
DNA synthesis inhibition
none of the above
all of the above
Mechanism of action: vancomycin (Vancocin):
protein synthesis inhibitor
* cell wall synthesis inhibitor
inhibits folic acid synthesis
none of the above
all of the above
More likely to cause polyneuritis in patients who are"slow acelators"; this antibiotic is inactivated by the liver.
clindamycin (Cleocin)
* isoniazid (INH)
nafcillin (Nafcil, Unipen)
vancomycin (Vancocin)
Flagyl
Properties of tetracycline (Achromycin):
inhibitor of bacterial cell wall synthesis
drug of choice in treating typhus
cleared primarily by the liver
* inhibitor of bacterial cell wall synthesis & drug of choice in treating typhus
none of the above
Safely administered at full doses to patients with renal insufficiency; has antimicrobial activity against gram-positive bacteria.
gentamicin (Garamycin)
* erythromycin
neomycin
penicillin
all of the above
Suitable for treatment of bacterial meningitis caused by H. influenzae:
cefotaxime (Claforan)
cephalexin (Keflex)
cephalothin (Keflin)
* cefadroxil (Duricef, Ultracef)
none of the above
Synergistic antimicrobial combination:
amoxicillin-clavulanate
ampicillin -streptomycin
* sulbactam-ampicillin
All of the above
None of the above
Topical use only:
penicillin
* bacitracin
clindamycin (Cleocin)
ampicillin
none of the above
Unstable at low pH, this antibiotic is structurally similar to penicillin:
streptomycin
* erythromycin
trimethoprim (generic)
rifampin (Rimactane)
all of the above
Which of the following is a short acting leukotriene synthesis (5-lipoxygenase) inhibitor?
* Zileuton
Zafirlukast
Montelukast
Omalizumab
Theophyline
Generation of specific immunity requires antigen-presenting cells, APCs, including:
B lymphocytes
macrophages
Langerhans cells
B lymphocytes & macrophages
* B lymphocytes , macrophages & Langerhans cells
A client is taking famotidine (Pepcid) asks the doctor what would be the best medication to take for a headache. The doctor tells the client that it would be best to take:
* aspirin (acetylsalicylic acid, ASA)
ibuprofen (Motrin)
acetaminophen (Tylenol)
naproxen (Naprosyn)
A doctor is caring for a client with a diagnosis of rheumatoid arthritis who is receiving sulindac (Clinoril) 150 mg po twice daily. Which finding would indicate to the doctor that the client is experiencing a side effect related to the medication?
* nausea
photophobia
fever
tingling in the extremities
All of the above
Anti-inflammatory drugs are:
prednisone (Deltasone)
aspirin
naproxen
prednisone & aspirin
* prednisone, aspirin & naproxen
Activated cytotoxic T cells induce target cell death (virus-infected cells) by:
Fas-Fas ligand apotosis pathway
lytic granule enzymes
perforin
* all of the above
None of the above
Adaptive Immune Response(s):
antibody production
lymphocyte activation
destroys proliferating lymphoid cells
* antibody production lymphocyte activation
neither
Agent acts directly to diminish tissue injury:
tacrolimus
cyclosporine (Sandimmune, Neoral)
* prednisone (Deltasone)
dactinomycin (Cosmegen)
All of the above
Alkylating agent; destroys proliferating lymphoid cells; in low doses -- for effective against autoimmune disorders including systemic lupus erythematosus
azathioprine (Imuran)
methotrexate
* cyclophosphamide (Cytoxan)
antilymphocyte globulin (ALG)
all the above
Analgesic effects of aspirin:
peripheral action (inflammation)
subcortical site of action
decreasing PGE2 synthesis
* all the above
neither
Antilymphocyte antibodies:
binds to the surface of T cells
acts mainly on small, long-lived peripheral lymphocytes
may be used in induction of immunosuppression
may be obtained by hybridoma technique for monoclonal antibody generation
* all of the above
Approximate prevalence of rheumatoid arthritis:
* 1%
5%
7%
10%
15%
Aspirin and antipyresis:
elevation of body temperature is typically a useful defense mechanism
* aspirin -- best available drug for reducing fever (in the absence of contraindications to its use recurrent
aspirin -- more effective in lowering elevated temperature than normal body temperature
aspirin-induced temperature reduction is caused by vasodilation
fever associated with infection: caused by actions of prostaglandins and interleukin 1 at the periphery
Aspirin may be fatal in taken in sufficient quantity. The syndrome of fatal salicyate overdose in children is characterized by
marked hypotermia secondary to an antipyretic effect
* fever, tinnitus
peripheral oedema
disturbance in acid - base and electrolyte balance
* all of the above
Associated with elevated levels of antigen-antibody complexes, which cause tissue damage; complement activation results in anaphylatoxic and chemotactic activities:
* Immediate Hypersensitivity Type III
Immediate Hypersensitivity Type II
Delayed Hypersensitivity
Immediate Hypersensitivity Type I
At low doses required to inhibition of thymidylate synthase, an enhanced adenosine release
chloroquine
gold
* methotrexate
cyclophosphamide
ketorolac
Autoimmune disorder: associated with antibodies made against self DNA, red blood cells, histones, platelets
rheumatoid arthritis
* systemic lupus erythematosus
insulin dependent diabetes
all of the above
neither
Clinical uses of immunosuppressive drugs:
organ transplantation
hemolytic disease of the newborn
autoimmune disorders
*all of the above
neither
Common adverse reactions of corticosteroidal therapy are:
bradycardia, mental dullness
anorexia, polyuria
tachycardia, insomnia
* “moon face”, obese trunk
all of the above
Correct drug-drug interactions:
aspirin -- acetazolamide: enhanced salicylate intoxication
aspirin -- spironolactone: reduced spironolactone activity
*all of the above
aspirin -- phenytoin: increased free phenytoin serum levels
aspirin-alcohol: increased gastrointestinal bleeding
Cytotoxic agents with immunosuppressive properties:
cyclophosphamide (Cytoxan)
vincristine (Oncovin)
methotrexate
cytarabine (ARA-C)
* all the above
Drug associated with the hepatic/renal toxic metabolite: N-acetyl-p-benzoquinone
diclofenac
meclofenamate
indomethacin
* acetaminophen
aspirin
Drug of choice in treating autoimmune hemolytic anemia:
cyclophosphamide plus factor XIII
Rho(D) immune globulin
* prednisone
OKT3 monoclonal antibody
cyclosporine
Effective in lowering incidents of rejection in infectious complications in transplant patients:
azathioprine (Imuran)
prednisone (Deltasone)
antilymphocyte antibodies
cyclosporine (Sandimmune, Neoral)
* all the above
Effective in managing acute gouty arthritisand ankylosing spondylitis; also accelerates closure of patent ductus arteriosus in premature infants:
gold
ketorolac
phenylbutazone
methotrexate
* indomethacin
Example of first-class of hormonal agents noted to have lipolytic properties:
cyclosporine
* prednisone (Deltasone)
tacrolimus
IFN-alpha
thalidomide
Example of immunostimulatory cytokine that may be useful in cancer immunotherapy
levamisole
BCG
IFN-alpha
* IL-2
none of the above
Examples of autoimmune diseases
rheumatoid arthritis
insulin-dependent diabetes mellitus
systemic lupus erythematosis
none of the above
* all of the above
For a 6-year-old child with fever, what NSAIDs would be preferred?
aspirin
* acetaminophen
indomethacin
ibuprofen
Glucocorticoid effects:
inhibition of leukotriene production
inhibition of prostaglandins
increased chemotaxis
* inhibition of leukotriene production & inhibition of prostaglandins
all of the above
In rheumatoid arthritis: primary effect of this mediator is on prostaglandin production:
PDGF (platelet-derived growth factor)
GM-CSF
* TNF alpha
all of the above
none of the above
Inhibits antigen recognition of B-cell
prednisone
azathioprine
methotrexate
* Rho(D) immune globulin
tacrolimus
Interferes with cell cycle of activated lymphoid cells;example of the first class of hormonal agents recognized have lympholytic properties:
cyclosporine
tacrolimus
IFN-alpha
* dexamethasone
15-desoxyspergualin
Isozyme primarily responsible for prostaglandin production by cells involve an inflammation:
COX-I
* COX-II
COX-III
all of the above
none of the above
Mechanism of action: aspirin-platelet effects:
promotes platelet aggregation
activates thromboxane synthesis
decreasing PGE2 synthesis
all of the above
* neither
Mediator most likely to promote pain:
histamine
serotonin
* bradykinin
prostaglandins
leukotrienes
Mediator promoting greatest increase in vascular permeability, associated with acute inflammation:
serotonin
prostaglandins
bradykinin
* leukotrienes
NSAID primarily promoted as an analgesic, not as an anti-inflammatory agent:
piroxicam
ibuprofen
naproxen
* ketorolac
sulindac
Reduces uric acid synthesis: for management of gout
colchicine
probenecid (Benemid)
sulfinpyrazone (Anturane)
* allopurinol (Zyloprim, Purinol)
oxaprozin (Daypro)
Structural analog/antimetabolite: cytotoxic immunosuppressive drug:
vincristine
cyclophosphamide
* azathioprine
All of the above
none of the above
T helper lymphocytes -- regulate each other; this substance produced by TH1cells inhibits TH2 cellular proliferation:
interleukin-2
tumor necrosis factor beta
* interferon-gamma
IL-4
IL-6
The chemotherapeutic agent also used orally for severe forms of arthritis is
5-fluorouracil (5-FU)
* methotrexate (Mexate)
cyclophosphamide (Cytoxan)
cisplatin (Platinol)
All of the above
The following is not true about corticosteroids:
have anti-inflammatory activity
highly lipophillic
decrease the quantity and viscosity of mucus secretions
* decrease the synthesis of adrenergic mediators
decrease the transcription of genes coding for pro-inflammatory cytokines
The following is not true about corticosteroids:
have anti-inflammatory activity
highly lipophillic
decrease the quantity and viscosity of mucus secretions
* decrease the synthesis of adrenergic mediators
decrease the transcription of genes coding for pro-inflammatory cytokines
The major role in chronic management of arthritis:
* glucocorticoids
nonsteroidal antiinflammatory drugs
interferon-gamma
All of the above
None of the above
To the patient with gout the doctor prescribed allopurinol. What pharmacological

property of allopurinol is important in this situation?

* Competitive inhibition of ksantinoxydase
Increasing of evacuation of nitrogen substances
Acceleration of catabolism of pirimidinic nucleotides
Decreasing of reutilization of pirimidinic nucleotides
Increasing of synthesis of nucleic acids

Type 1 immediate hypersensitivity:
due to elevated levels of antigen-antibody complexes
* stems from cross-linking of membrane-bound IgE on blood basophils or tissue mast cells by antigen
follows from formation of antigen- antibody complexes between foreign antigen and IgM or IgG immunoglobulins
tissue damage due to influx of antigen-nonspecific inflammatory cells (macrophages and neutrophils)
All above
Typically associated with B cell proliferation and differentiation into antibody-secreting plasma cells
tumor necrosis factor beta
interferon-gamma
* IL-4 (interleukin 4)
IL-2 (interleukin 2)
all of the above
Useful in management of idiopathic thrombocytopenic purpura refractory to prednisone
dactinomycin
* vincristine
cyclophosphamide
azathioprine
all of the above
What adverse effects are associated with chronic use of systemic corticosteroids?
Candidosis
* Gastrointestinal complications
Hypotension
Hypoglycemia
all of the above
Which of the following combinations is false?
Rifampin Light-chain proteinurea
Ethambutol M.avium complex
Linezolide MDR mycobacteria
Streptomycine Brucellosis
* Para-amino Salicylic acid (PAS) Optic neuropathy
A child has ingested an unknown substance and has evidence of respiratory depression. This symptom is usually found with poisoning due to:
amphetamines
atropine
mushrooms
kerosene
* opioids
A drug which could help you confirm the patient's ingestion is:
phenylephrine
naloxone
* physostigmine
edrophonium
neostigmine
A good analgesic at subanesthetic doses Anesthetic Partition Minimum Alveolar Coefficient Concentration (MAC)
halothane 2.30 0.75
enflurane 1.80 1.68
* nitrous oxide 0.47 105.00
isoflurane 1.40 1.15
methoxyflurane 12.00 0.16
A man is receiving oral hydromorphone (Dilaudid) 10 mg every 4 hours. He needs to be NPO. What would be the best equivalent Intravenous dose of Dilaudid, administered as a continuous infusion?
0.1 mg per hour
* 0.5 mg per hour
1.0 mg per hour
1.5 mg per hour
2.5 mg per hour
A patient you follow in clinic has a well-known heroin abuse problem. Drugs which could potentially prevent an abstinence withdrawal syndrome during hospitalization include: methadone, nalbuphine, butorphanol
morphine, nalbuphine, methadone
methadone, nalbuphine
nalbuphine, butorphanol
butorphanol only
* All of the above
A pharmacologic agent which has the potential to cause increased biliary tree pressure is:
* morphine
warfarin
phenytoin
acetazolamide
carbon tetrachloride
Acetaminophen has been used as a safe and effective analgesic/ antipyretic agent for over 80 years. Since it may be purchase without a prescription, it is readily available and as such the recommended dose may be exceeded. The primary toxicity leading to death from an acetaminophen overdose is:
papillary necrosis and chronic interstitial nephritis
pancytopenia
* hepatocellular necrosis
myocarditis
hemolytic anemia
Agents used to counter motion sickness which are more effective than cyclizine and meclizine include: dimenhydramine, promethazine, scopolamine, bethanechol
* dimenhydramine,promethazine, scopolamine
dimenhydramine, scopolamine
promethazine, bethanechol
bethanechol only
All of the above
All of the following are common signs of approaching death except:
Decreasing interest in eating
Decreasing recognition of family members
Decreasing urine output
Increasing confusion
* Increasing number of bowel movements
All of the following classes of drugs can demonstrate anticholinergic side effects EXCEPT:
* tricyclic antidepressants
antihistamines
phenothiazines
anticonvulsants
All of the above
All of the following drugs are classified as indirect or mixed acting agents EXCEPT: ephedrine, dopamine, amphetamine, dobutamine
ephedrine,dopamine,amphetamine
ephedrine, amphetamine
dopamine, dobutamine
* amphetamine only
all are correct
All of the following drugs are examples of direct acting beta agonists EXCEPT:
* phenylephrine
metaproterenol
isoetharine
albuterol
terbutaline
All of the following factors influence the rate of induction of anesthesia with an inhaled anesthetic EXCEPT:
aqueous solubility of the anesthetic
* patient history of malignant hyperthermia
ventilation rate
tension of gas administration
pulmonary blood flow rate
All of the following statements are true concerning effects of intravenous infusion of norepinephrine at 10 UG/Min EXCEPT:
* an increase in pulse rate
an increase in pulse pressure
a marked increase in peripheral resistance
an increase in systolic blood pressure
an increase in diastolic blood pressure
All of the following statements concerning catecholamine biosynthesisare true EXCEPT:
* all of the enzymes involved with catecholamine biosynthesis are highly specific for each substance
tyrosine hydroxylase is the rate-limiting enzyme in catecholamine biosynthesis
the level of glucocorticoid influences the concentration of phenyl-n-methyltransferase and hence the conversion of norepinephrine to epinephrine
the conversion of tyrosine to dopa and dopa to dopamine occurs in the cytoplasm of the adrenergic nerve terminal
the conversion of dopamine to norepinephrine via dopamine beta-hydroxylase tales place within the granule of the adrenergic nerve terminal
All of the following statements concerning physostigmine and neostigmine are true EXCEPT:
physostigmine and neostigmine are classified as reversible cholinesterase inhibitors
neostigmine stimulates nicotinic receptors at ganglia and neuromuscular junctions unlike physostigmine
physostigmine is well absorbed orally
* a major problem encountered with neostigmine is the unpleasant central nervous system effects which result from its administration
physostigmine is a tertiary amine and is able to penetrate the central nervous system
All of the following statements concerning the effects of anticholinesterase agents are true EXCEPT:
when applied topically to the anti-cholinesterase agents cause conjunctival hyperemia, miosis, and constriction of the ciliary muscle
enhancement of gastric contractions and increased secretion of gastric acid from parietal cells
augmentation of secretory function in bronchial, lacrimal, sweat, salivary, gastric, and intestinal glands
* increase the effective refractory period of cardiac muscle and decrease the conduction time in conducting tissue
stimulation followed by depression or paralysis, of all autonomic ganglia and skeletal muscle (nicotinic action)
All of the following statements concerning the structure-activity relationships of sympathomimetic amines are true EXCEPT:
the presence of a hydroxyl group in the 3 and 4 positions on the benzene ring is characteristic of the "catechol" nucleus
resistance to monamine oxidase is conferred by alkyl substitution on the alpha carbon of the phenylethylamine structure
* the presence of hydroxyl groups in the 3 and 5 positions of a benzene ring increases the specificity for beta-1 receptors in the lung
a large alkyl substitution on the amino group of a direct-acting sympathomimetic increases the specificity for beta receptors
the absence of hydroxyl groups of the benzene ring of indirect-acting sympathomimetic amines increases oral effectiveness
All of the following statements regarding acetaminophen toxicity are true EXCEPT:
acetaminophen is the principal metabolic product of phenacetin
an overdose of 10 grams or more may produce hepatic necrosis in adults
acetaminophen overdose may produce transient azotemia or renal failure
* forced diuresis may be a useful form of therapy for acetaminophen overdose
liver pathology is centrilobular and midzonal necrosis
All of the following statements regarding cholinergic blockage are true EXCEPT:
muscarinic actions of all parasympathomimetic drugs are blocked selectively by atropine, through competitive occupation of cholinergic receptors
epinephrine and other sympathomimetic amines antagonize most muscarinic effects at sites where adrenergic and cholinergic impulses produce opposing effects
nicotinic effects of acetylcholine and its derivatives at autonomic ganglia are blocked by hexamethonium
* nicotinic effects of acetylcholine and its derivatives at the neuromuscular junction of skeletal muscle are antagonized by D-tubocurarine
muscarinic effects of acetylcholine and its derivatives at autonomi ganglia are blocked by hexamethonium
Anesthetic associated with the highest incidence of hepatitis.