Pharm U3 Review
kribsr@upstate.edu
Which is a NDRI used to treat
depression?
Fluoxetine
Bupropion
Aripiprazole
Venlafaxine
Mirtazapine
59%
25%
13%
M
ir t
az
ap
e
fa
xin
Ve
nl
a
e
zo
l
ip
ra
Ar
ip
Bu
pr
op
i
on
e
ox
et
in
in
e
3%
0%
Flu
A.
B.
C.
D.
E.
Bupropion
Which inhibits NE reuptake in the
mesolimbic system?
Methylphenidate
Bupropion
Atomoxetine
More than one of the above
None
45%
18% 18%
12%
No
ne
on
At
o
th
m
an
ox
on
et
in
e
e
of
th
ea
bo
ve
or
e
pr
op
i
M
Bu
at
e
6%
ph
en
id
hy
l
M
et
A.
B.
C.
D.
E.
Methylphenidate
Bupropion, atomoxetine only inhibit NE
reuptake in cerebral cortex and are not
considered addictive
Bupropion is contraindicated in
patients with eating disorders because
it causes
Hypertension
Seizures
Decreased appetite
Hypokalemia
Hyponatremia
33%
30%
21%
9%
ia
re
m
ia
Hy
po
na
t
ale
m
Hy
po
k
ea
se
d
ap
pe
t it
e
re
s
Se
izu
De
cr
en
sio
n
6%
Hy
pe
rt
A.
B.
C.
D.
E.
Seizures
Bupropion causing seizures is a classic
association, you don’t necessarily have to
know the eating disorder part
Which is least likely to cause sexual
side effects?
Paroxetine
Fluoxetine
Venlafaxine
Bupropion
Sertraline
74%
16%
e
ali
n
Se
rtr
on
pr
op
i
Bu
fa
xin
e
3%
Ve
nl
a
e
3%
ox
et
in
Flu
xe
t in
e
3%
Pa
ro
A.
B.
C.
D.
E.
Bupropion
Which is a first line tx for absence
seizures?
Levetiracetam
Carbamazepine
Ethosuxemide
Vigabatran
Phenytoin
Valproate
Ativan
Phenobarbital
71%
9%
3%
3%
3%
9%
3%
0%
Le
ve
t ir
ac
Ca
et
rb
am
am
az
ep
Et
in
ho
e
su
xe
m
id
Vi
e
ga
ba
tr
an
Ph
en
yt
oi
n
Va
lp
ro
at
e
At
Ph
iv
an
en
ob
ar
bi
ta
l
A.
B.
C.
D.
E.
F.
G.
H.
ethosuximide
Which causes gingival hyperplasia?
61%
26%
6%
6%
id
e
Et
ho
su
xim
ne
igi
ot
r
m
La
Ca
r
ba
m
rb
i
ze
pi
n
to
l
e
0%
Ph
en
ob
a
Phenytoin
Phenobarbitol
Carbamzepine
Lamotrigine
Ethosuximide
Ph
en
yt
oi
n
A.
B.
C.
D.
E.
Phenytoin
Which is not a SE of topiramate?
Cognitive Impairment
Angle closure glaucoma
Kidney stones
Weight gain
42%
32%
16%
W
ei
gh
tg
ai
n
ne
s
dn
ey
st
o
Ki
gl
su
re
lo
ec
An
gl
ni
ti
ve
Im
pa
au
c
irm
om
a
en
t
10%
Co
g
A.
B.
C.
D.
Weight gain
• Topiramate causes weight loss
Which is an effective tx for acute
cluster HA?
High flow oxygen
Verapamil
Both
Neither
65%
26%
9%
h
er
Ne
ith
th
Bo
am
il
Ve
ra
p
flo
w
ox
yg
en
0%
Hi
g
A.
B.
C.
D.
A
• For HA make sure you can carefully note
which are prophylactic and which are acute
treatments
Which increases VMAT2 activity?
Methylphenidate
Dextroamphetamine
Both
Neither
58%
24%
er
th
Bo
Ne
ith
ph
et
a
m
at
e
De
xt
ro
am
ph
en
id
hy
l
9%
in
e
9%
M
et
A.
B.
C.
D.
dextroamphetamine
Which would decrease the
effectivenes of OCP?
Dexamphetamine
Bupropion
Fluoxetine
Modafinil
59%
38%
il
od
af
in
M
ox
et
in
Flu
Bu
pr
op
i
on
e
in
et
am
ph
e
3%
0%
De
xa
m
A.
B.
C.
D.
modafanil
Fluoxetine shouldn’t affect OCP based on what I
can find, see eg.
http://www.ncbi.nlm.nih.gov/pubmed/1223762
6
Which would be useful to determine
whether a pt was faking an aneurysm by
taking drops to dilate the pupil?
41%
28%
16%
13%
3%
op
i
ca
m
id
ph
e
en
yle
ph
r in
e
e
pi
n
Tr
At
ro
ne
rp
i
ca
ta
n
La
Pi
lo
ap
ro
st
ol
ol
0%
m
Timolol
Latanaprost
Pilocarpine
Atropine
Tropicamide
phenylephrine
Ti
A.
B.
C.
D.
E.
F.
Pilocarpine (1%)
Which glaucoma treatment is
contraindicated in a patient with CHF?
Latanoprost
Timolol
Brimonidine
Dorzolamide
10%
e
6%
id
m
on
i
im
Br
Do
rz
ol
a
di
n
e
ol
ol
m
Ti
ta
n
op
r
os
t
6%
La
A.
B.
C.
D.
77%
Timolol
Which has a ceiling effect on CNS
depression?
Benzos
Barbs
Both
Neither
82%
er
6%
Ne
ith
th
3%
Bo
rb
s
Ba
nz
os
9%
Be
A.
B.
C.
D.
benzos
Which is often used for EtOH detox
because of its long effective half-life
(secondary to active metabolites)?
27%
27%
12%
12%
9%
6%
3%
3%
az
ol
am
Al
pr
Ch
az
lo
ol
rd
am
ia
ze
po
xi
de
Zo
lp
id
em
Tr
iaz
ol
Flu am
m
az
en
Th
il
io
p
Ph
en
en
t
ob al
ar
bi
ta
l
Midazolam
Alprazolam
Chlordiazepoxide
Zolpidem
Triazolam
Flumazenil
Thiopental
Phenobarbital
M
id
A.
B.
C.
D.
E.
F.
G.
H.
chlordiazepoxide
Which is a BDZ1 selective agonist?
69%
10%
10%
3%
0%
3%
3%
0%
az
ol
am
Al
pr
Ch
az
lo
ol
rd
am
ia
ze
po
xi
de
Zo
lp
id
em
Tr
iaz
ol
Flu am
m
az
en
Th
il
io
p
Ph
en
en
t
ob al
ar
bi
ta
l
Midazolam
Alprazolam
Chlordiazepoxide
Zolpidem
Triazolam
Flumazenil
Thiopental
Phenobarbital
M
id
A.
B.
C.
D.
E.
F.
G.
H.
zolpidem
Which is a benzo antagonist used in
some cases of benzo OD?
87%
3%
7%
0%
0%
0%
0%
3%
az
ol
am
Al
pr
Ch
az
lo
ol
rd
am
ia
ze
po
xi
de
Zo
lp
id
em
Tr
iaz
ol
Flu am
m
az
en
Th
il
io
p
Ph
en
en
t
ob al
ar
bi
ta
l
Midazolam
Alprazolam
Chlordiazepoxide
Zolpidem
Triazolam
Flumazenil
Thiopental
Phenobarbital
M
id
A.
B.
C.
D.
E.
F.
G.
H.
flumazenil
Which is a highly lipid soluble barbiturate used
for anesthesia induction because of its rapid
onset/offset of sedation?
59%
31%
7%
3%
0%
0%
0%
0%
az
ol
am
Al
pr
Ch
az
lo
ol
rd
am
ia
ze
po
xi
de
Zo
lp
id
em
Tr
iaz
ol
Flu am
m
az
en
Th
il
io
p
Ph
en
en
t
ob al
ar
bi
ta
l
Midazolam
Alprazolam
Chlordiazepoxide
Zolpidem
Triazolam
Flumazenil
Thiopental
Phenobarbital
M
id
A.
B.
C.
D.
E.
F.
G.
H.
thiopental
Which is used to treat acute MS
attacks?
Interferons
Natalizumab
Dimethyl fumarate
Corticosteroids
Teriflunomide
Fingolimod
Glatiramer
93%
3%
0%
3%
0%
0%
0%
In
te
rfe
ro
Na
ns
t
a
Di
liz
m
um
et
hy
ab
lf
um
ar
Co
at
rti
e
co
st
er
oi
Te
ds
r if
lu
no
m
id
e
Fin
go
lim
od
Gl
at
ira
m
er
A.
B.
C.
D.
E.
F.
G.
corticosteroids
Interferons
Natalizumab
Dimethyl fumarate
Corticosteroids
Teriflunomide
Fingolimod
Glatiramer
29%
21%
14%
14%
11%
11%
0%
In
te
rfe
ro
Na
ns
t
a
Di
liz
m
um
et
hy
ab
lf
um
ar
Co
at
rti
e
co
st
er
oi
Te
ds
r if
lu
no
m
id
e
Fin
go
lim
od
Gl
at
ira
m
er
A.
B.
C.
D.
E.
F.
G.
Which is an imunologically active
mixture of 4 amino acids that is an
analog of MBP?
glatiramer
Which binds to the VLA-4 subunit of
integrins on leukocytes, inhibiting their
migration across the BBB?
Interferons
Natalizumab
Dimethyl fumarate
Corticosteroids
Teriflunomide
Fingolimod
Glatiramer
54%
18%
11%
11%
7%
0%
0%
In
te
rfe
ro
Na
ns
t
a
Di
liz
m
um
et
hy
ab
lf
um
ar
Co
at
rti
e
co
st
er
oi
Te
ds
r if
lu
no
m
id
e
Fin
go
lim
od
Gl
at
ira
m
er
A.
B.
C.
D.
E.
F.
G.
natalizumab
Which is associated with a risk of PML?
Interferons
Natalizumab
Dimethyl fumarate
Corticosteroids
Teriflunomide
Fingolimod
Glatiramer
35%
19%
19%
15%
8%
4%
0%
In
te
rfe
ro
Na
ns
t
a
Di
liz
m
um
et
hy
ab
lf
um
ar
Co
at
rti
e
co
st
er
oi
Te
ds
r if
lu
no
m
id
e
Fin
go
lim
od
Gl
at
ira
m
er
A.
B.
C.
D.
E.
F.
G.
natalizumab
Which works by sequestration of
leukocytes in secondary lymphoid
organs?
45%
Interferons
Natalizumab
Dimethyl fumarate
Corticosteroids
Teriflunomide
Fingolimod
Glatiramer
28%
14%
10%
3%
0%
0%
In
te
rfe
ro
Na
ns
ta
Di
liz
m
um
et
hy
ab
lf
um
ar
Co
at
rti
e
co
st
er
oi
Te
ds
r if
lu
no
m
id
e
Fin
go
lim
od
Gl
at
ira
m
er
A.
B.
C.
D.
E.
F.
G.
fingolimod
• S1P analog
Which inhibits dihydroorotate
dehydrogenase?
Interferons
Natalizumab
Dimethyl fumarate
Corticosteroids
Teriflunomide
Fingolimod
Glatiramer
50%
38%
6%
0%
6%
0%
0%
In
te
rfe
ro
Na
ns
t
a
Di
liz
m
um
et
hy
ab
lf
um
ar
Co
at
rti
e
co
st
er
oi
Te
ds
r if
lu
no
m
id
e
Fin
go
lim
od
Gl
at
ira
m
er
A.
B.
C.
D.
E.
F.
G.
Teriflunomide
Which activates the Nrf2 pathway?
Interferons
Natalizumab
Dimethyl fumarate
Corticosteroids
Teriflunomide
Fingolimod
Glatiramer
75%
25%
0%
0%
0%
0%
0%
In
te
rfe
ro
Na
ns
t
a
Di
liz
m
um
et
hy
ab
lf
um
ar
Co
at
rti
e
co
st
er
oi
Te
ds
r if
lu
no
m
id
e
Fin
go
lim
od
Gl
at
ira
m
er
A.
B.
C.
D.
E.
F.
G.
Dimethyl fumarate
Mitoxantrone is associated with?
Irreversible CHF
Acute leukemia
Both
neither
59%
26%
15%
er
ne
ith
th
Bo
eu
ke
m
ia
el
Ac
ut
ev
er
sib
le
CH
F
0%
Irr
A.
B.
C.
D.
C
Which is a D3 partial agonist?
Clozapine
Aripiprazole
Olanzapine
Haloperidol
Trihexyphenidyl
Fluphenazine
Pramipexole
Tetrabenazine
Reserpine
Carbidopa-levadopa
82%
7%
4%
0%
4%
4%
0%
0%
0%
0%
Cl
o
Ar zap
ip
i
irp ne
Ol azo
a n le
z
Ha api
n
Tr
l
ih ope e
ex
yp rido
h
Flu en l
ph idy
l
e
Pr naz
a m in
T e ip e
tra ex
b e o le
na
Ca
z in
rb
R
id
e
s
op e e
a- rpi
le
va ne
do
pa
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
aripiprazole
• D3 = static dopamine
Which antagonizes D4?
48%
16%
12%
12%
8%
4%
0%
0%
0%
0%
Ar zap
ip
i
irp ne
Ol azo
a n le
z
Ha api
n
Tr
l
ih ope e
ex
yp rido
h
Flu en l
ph idy
l
e
Pr naz
a m in
T e ip e
tra ex
b e o le
na
Ca
z in
rb
R
id
e
op se e
a- rpi
le
va ne
do
pa
Clozapine
Aripirpazole
Olanzapine
Haloperidol
Trihexyphenidyl
Fluphenazine
Pramipexole
Tetrabenazine
Reserpine
Carbidopa-levadopa
Cl
o
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
clozapine
• Also: treats refractory SZ, causes
agranulocytosis, very little EPS risk, decreases
suicide risk
Associated with greatest risk of
gambling addiction?
Clozapine
Aripirpazole
Olanzapine
Haloperidol
Trihexyphenidyl
Fluphenazine
Pramipexole
Tetrabenazine
Reserpine
Carbidopa-levadopa
52%
16%
8%
4%
4%
4%
4%
4%
4%
0%
Cl
o
Ar zap
ip
i
irp ne
Ol azo
a n le
z
Ha api
n
Tr
l
ih ope e
ex
yp rido
h
Flu en l
ph idy
l
e
Pr naz
a m in
T e ip e
tra ex
b e o le
na
Ca
z in
rb
R
id
e
s
op e e
a- rpi
le
va ne
do
pa
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Pramipexole, (ropinirole)
This was an unfair question, as carbidopalevodopa is also associated with impulse
control disorders. I think the pramipexole
association is more likely to be tested.
http://archinte.jamanetwork.com/article.aspx?a
rticleid=1916909
Initial tx for mild PD in a 45 yo F?
Clozapine
Aripirpazole
Olanzapine
Haloperidol
Trihexyphenidyl
Fluphenazine
Pramipexole
Tetrabenazine
Reserpine
Carbidopa-levadopa
43%
18%
18%
7%
4%
0%
0%
7%
4%
0%
Cl
o
Ar zap
ip
i
irp ne
Ol azo
a n le
z
Ha api
n
Tr
l
ih ope e
ex
yp rido
h
Flu en l
ph idy
l
e
Pr naz
a m in
T e ip e
tra ex
b e o le
na
Ca
z in
rb
R
id
e
s
op e e
a- rpi
le
va ne
do
pa
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
pramipexole
• Trihexyphenidyl also an acceptable answer,
especially if tremor is the predominant sx, but
pramipexole is what I would expect to be
tested based on the class lecture
VMAT inhibitor to tx Huntington’s
chorea?
Clozapine
Aripirpazole
Olanzapine
Haloperidol
Trihexyphenidyl
Fluphenazine
Pramipexole
Tetrabenazine
Reserpine
Carbidopa-levadopa
50%
42%
4%
0%
4%
0%
0%
0%
0%
0%
Cl
o
Ar zap
ip
i
irp ne
Ol azo
a n le
z
Ha api
n
Tr
l
ih ope e
ex
yp rido
h
Flu en l
ph idy
l
e
Pr naz
a m in
T e ip e
tra ex
b e o le
na
Ca
z in
rb
R
id
e
s
op e e
a- rpi
le
va ne
do
pa
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
tetrabenazine
Used to tx dystonia induced by FGA?
27%
23%
15%
12%
8%
8%
4%
4%
0%
0%
Ar zap
ip
i
irp ne
Ol azo
a n le
z
Ha api
n
Tr
l
ih ope e
ex
yp rido
h
Flu en l
ph idy
l
e
Pr naz
a m in
T e ip e
tra ex
b e o le
na
Ca
z in
rb
R
id
e
op se e
a- rpi
le
va ne
do
pa
Clozapine
Aripirpazole
Olanzapine
Haloperidol
Trihexyphenidyl
Fluphenazine
Pramipexole
Tetrabenazine
Reserpine
Carbidopa-levadopa
Cl
o
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Trihexyphenidyl
• Benztropine, diphenhydramine
Blurred vision associated with
antagonism of?
A. H1
B. M
C. alpha1
61%
32%
1
ph
a
al
M
H1
7%
M
Weight gain associated with
antagonism of?
94%
ph
a
1
0%
al
M
6%
H1
A. H1
B. M
C. alpha1
H1
Orhtostasis associated with
antagonism of?
A. H1
B. M
C. alpha1
89%
al
ph
a
1
7%
M
H1
4%
alpha1
A 75-year-old male with chronic lower back pain has been on
hydrocodone for pain relief for the past 5 years. He states that
his pain is adequately controlled. He states that at the beginning
of opioid therapy, he had multiple side effects, but now only one
continues to bother him. What is the most likely side effect
100%
affecting this patient?
0%
et
en
t io
n
ar
yr
Ur
in
ng
it i
vo
m
0%
re
s
0%
es
Hi
v
Na
us
ea
/
st
ip
at
io
n
0%
Se
izu
Constipation
Hives
Nausea/vomiting
Seizures
Urinary retention
Co
n
A.
B.
C.
D.
E.
constipation
On exam, you notice a physical exam finding that the patient has
not developed tolerance to over the 5-year period of
hydrocodone therapy. What is the most likely finding?
Delirium
Hives
Miosis
Sedation
Respiratory
depression
63%
22%
7%
7%
n
de
pr
es
sio
io
n
to
ry
Se
da
t
ra
Re
sp
i
M
io
sis
es
Hi
v
iu
m
0%
De
lir
A.
B.
C.
D.
E.
miosis