MODULE1
1.Gener
al
Phar
macol
ogy
1.I
ndi
cat
et
het
y
peofact
i
onofadr
ug,whi
chi
s
i
nt
r
oduced or
al
l
y
,i
s absor
bed i
nt
ot
he bl
ood i
n
i
nt
est
i
neandact
sont
hecer
t
ai
nor
gansort
i
ssues:
A.Gener
al
(
Resor
pt
i
v
e)
*
B.Ref
l
ex
C.Mai
n
D.Local
(
Topi
cal
)
E.I
ndi
r
ect
2.
Thef
or
mat
i
onofas
ec
ondar
ymedi
at
ori
sobl
i
gat
or
yi
n
membr
anei
nt
r
ac
el
l
ul
armec
hani
s
m ofhor
moneac
t
i
on.
Poi
ntoutt
hes
ubs
t
anc
et
hati
sunabl
et
obeas
ec
ondar
y
medi
at
or
:
A.Di
acy
l
gl
y
cer
ol
B.Gl
y
cer
ol
*
C.cAMP
D.Ca2+
E.I
nosi
t
ol
3.
4.
5t
r
i
phosphat
e
3.Whi
ch f
r
om t
he speci
f
i
ed par
amet
er
si
s an
obl
i
gat
or
y condi
t
i
on of f
ast per
meat
i
on of t
he
medi
ci
nal
agent
st
hr
oughabl
oodbr
ai
nbar
r
i
er
?
A.Shor
thal
f
l
i
f
e
B.Wat
ersol
ubi
l
i
t
y
C.Li
pi
dsol
ubi
l
i
t
y*
D.St
r
ongbi
ndi
ngt
opr
ot
ei
ns
E.I
oni
zedst
at
e
C.Wi
l
l
decr
ease
D.Wi
l
l
notchange
E.Wi
l
l
di
sappear
8.Thebi
oav
ai
l
abi
l
i
t
yi
sdef
i
nedasanav
er
agel
ev
eli
f
onei
sequal
:
A.020%
B.4070%
C.100%
D.>70%
E.<40%*
9.Forpr
ev
ent
i
onr
emot
er
el
apsesof4day
smal
ar
i
aa
42y
.
o.pat
i
entwasgi
v
enpr
i
maqui
ne.Ont
he3dday
oft
het
r
eat
mentwi
t
ht
her
apeut
i
cdosesoft
hedr
ug
pat
i
entexper
i
enced abdomi
nalpai
n,car
di
ac pai
n,
dy
spepsi
a,gener
al
i
zedcy
anosi
s.Whati
st
her
eason
oft
heseadv
er
seef
f
ect
soft
hedr
ug?
A.
Pot
ent
i
at
i
onoft
hedr
ug’
sac
t
i
onbyot
hert
her
apeut
i
c
agent
B.Sl
owi
ngdownofdr
ug’
ssecr
et
i
onwi
t
hur
i
ne
C.Decr
easi
ngofact
i
v
i
t
yofl
i
v
ermi
cr
osomal
enzy
mes
D.Genet
i
cdef
i
ci
encyofGl
ucose6phosphat
e
dehydr
ogenase*
E.Cumul
at
i
onoft
het
her
apeut
i
cagent
10.Whi
choneoft
hef
ol
l
owi
ngi
sTRUEf
oradr
ug
whose el
i
mi
nat
i
on f
r
om pl
asma shows 1stor
der
ki
net
i
cs?
A.Thehal
f
l
i
f
eoft
hedr
ugi
spr
opor
t
i
onalt
ot
hedr
ug
concent
r
at
i
oni
npl
asma
B.Theamountel
i
mi
nat
edperuni
tt
i
mei
sconst
ant
C.The r
at
e ofel
i
mi
nat
i
on i
s pr
opor
t
i
onalt
ot
he
pl
asmaconcent
r
at
i
on
D.El
i
mi
nat
i
on i
nv
ol
v
es a r
at
el
i
mi
t
i
ng enzy
mat
i
c
r
eact
i
onoper
at
i
ngati
t
smaxi
mal
v
el
oci
t
y(
Vm)
E.Apl
otofdr
ugc
onc
ent
r
at
i
onv
er
s
ust
i
mei
sas
t
r
ai
ght
l
i
ne
4.Whi
choft
hedr
ugsr
eadi
l
ypenet
r
at
ei
nt
ot
heCNS?
A. Hy
dr
ophi
l
i
c dr
ugs wi
t
h a nonuni
f
or
m
di
st
r
i
but
i
onofel
ect
r
ons
B.Pol
ardr
ugs
C.Li
pi
dsol
ubl
e*
D.Bi
ndi
ngdr
ugst
opl
asmapr
ot
ei
ns
E.I
oni
zeddr
ugs
5. A 37 y
.
o. pat
i
ent
,suf
f
er
i
ng an obl
i
t
er
at
i
ng
endar
t
er
i
t
i
soft
hel
egs,
r
ecei
v
espheny
l
i
ni
nadoseof
60mg/
kg.Becauseofconv
ul
si
ondev
el
opment(
br
ai
n
t
r
auma i
si
n anamnesi
s)
,phenobar
bi
t
alhad been
gi
v
en,af
t
ert
he cancel
l
at
i
on ofwhi
ch t
he nasal
bl
eedi
ng occur
r
ed at t
he pat
i
ent
. The gi
v
en
compl
i
cat
i
oni
sconnect
edwi
t
h:
A.Conj
ugat
i
onofpheny
l
i
nwi
t
hagl
ucur
oni
caci
d
B. I
nhi
bi
t
i
on by phenobar
bi
t
al of enzy
mes
mi
cr
osomal
oxi
dat
i
onsi
nal
i
v
er
C. I
nduct
i
on by phenobar
bi
t
al of enzy
mes
mi
cr
osomal
oxi
dat
i
onsi
nal
i
v
er
*
D.Oxi
dat
i
v
edeami
nat
i
onofpheny
l
i
n
E.Al
i
phat
i
chy
dr
oxy
l
at
i
onofphenobar
bi
t
al
11.Whi
choneoft
hef
ol
l
owi
ngi
sTRUEf
oradr
ug
whose el
i
mi
nat
i
on f
r
om pl
asma shows zer
oor
der
ki
net
i
cs?
A.Thehal
f
l
i
f
eoft
hedr
ugi
spr
opor
t
i
onalt
ot
hedr
ug
concent
r
at
i
oni
npl
asma
B.Theamountel
i
mi
nat
edperuni
tt
i
mei
sconst
ant*
C.Ther
at
eofel
i
mi
nat
i
ondoesnotdependont
he
pl
asmaconcent
r
at
i
on
D.El
i
mi
nat
i
on i
nv
ol
v
es a r
at
el
i
mi
t
i
ng enzy
mat
i
c
r
eact
i
onoper
at
i
ngati
t
smaxi
mal
v
el
oci
t
y
E.Apl
otofdr
ugc
onc
ent
r
at
i
onv
er
s
ust
i
mei
sas
t
r
ai
ght
6.Phar
macoki
net
i
cs i
ncl
udes al
loft
he f
ol
l
owi
ng
pr
ocessesEXCEPT:
A.Absor
pt
i
on
B.Di
st
r
i
but
i
on
C.Bi
ot
r
ansf
or
mat
i
on
D.El
i
mi
nat
i
on
E.Cl
i
ni
cal
use*
l
i
ne.
12.Whi
choft
hef
ol
l
owi
ngt
i
meper
i
odsmostcl
osel
y
descr
i
best
hecl
ear
ancer
at
eofadr
ugt
hati
si
nf
used
atar
at
eof4mg/
mi
nandpr
oducesast
eady
st
at
e
concent
r
at
i
onof6mg/
Li
nt
hepl
asma?
A.27ml
/
mi
n
B.40ml
/
mi
n
C.24ml
/
mi
n
D.667ml
/
mi
n*
E.1.
200ml
/
mi
n
7.How phar
mac
ol
ogi
c
alac
t
i
v
i
t
yofadr
ugwi
t
hhi
gh
af
f
i
ni
t
y t
o pl
as
ma pr
ot
ei
n wi
l
l be al
t
er
ed at
hy
poal
bumi
nemi
a?
A.Wi
l
l
sl
i
ght
l
ydecr
ease
B.Wi
l
l
i
ncr
ease
1
13.Chooset
hecor
r
ectst
at
ement
:
A.Weakbasesar
eabsor
bedef
f
i
ci
ent
l
yacr
osst
he
epi
t
hel
i
al
cel
l
soft
hest
omach
B. Coadmi
ni
st
r
at
i
on of at
r
opi
ne speeds t
he
absor
pt
i
onofaseconddr
ug
C.Dr
ugsshowi
ngl
ar
geVdcanbeef
f
i
ci
ent
l
yr
emov
ed
bydi
al
y
si
soft
hepl
asma
D.St
r
essemot
i
onscanl
eadt
oasl
owi
ngofdr
ug
absor
pt
i
on*
E.I
ft
heVdf
oradr
ugi
ssmal
l
,mostoft
hedr
ugi
si
n
t
heext
r
apl
asmi
cspace
14.Adr
ug,
gi
v
eni
na100mgsi
ngl
edose,
r
esul
t
si
na
peak pl
asma concent
r
at
i
on of 20 μg/
ml
. The
appar
entv
ol
ume di
st
r
i
but
i
on i
s(
assume a r
api
d
di
st
r
i
but
i
on and negl
i
gi
bl
e el
i
mi
nat
i
on pr
i
or t
o
measur
i
ngt
hepeakpl
asmal
ev
el
)
:
A.0.
5L
B.1L
C.2L
D.5L*
E.10L.
15.Whati
st
hemai
nmechani
sm ofdr
ugabsor
pt
i
on
i
nt
heGI
T?
A.Fi
l
t
r
at
i
on
B.Passi
v
edi
f
f
usi
on*
C.Act
i
v
et
r
anspor
t
D.Pi
nocy
t
osi
s
E.Al
l
abov
e
16.Pr
oser
i
nei
ncr
easest
het
oneofskel
et
almuscl
es
af
t
ersy
st
emi
cadmi
ni
st
r
at
i
on.Ft
or
ot
an (
hal
ot
hane)
i
nduces skel
et
almuscl
er
el
axat
i
on and r
educes
pr
oser
i
neef
f
ect
s.I
ndi
cat
et
hechar
act
erofpr
oser
i
ne
andf
t
or
ot
ani
nt
er
act
i
on.
A.Compet
i
t
i
v
eant
agoni
sm
B.Di
r
ectf
unct
i
onal
ant
agoni
sm
C.I
ndi
r
ectf
unct
i
onal
ant
agoni
sm *
D.I
ndependentant
agoni
sm
E.Uni
l
at
er
al
ant
agoni
sm
17.How dowecal
lt
hedr
ugact
i
on,whi
chcauses
congeni
t
al
mal
f
or
mat
i
ons?
A.Mut
agenousact
i
on
B.Embr
y
ot
oxi
cact
i
on
C.Ter
at
ogeni
c*
D.Fet
ot
oxi
c
E.Al
l
abov
e
18.How t
o expl
ai
nt
he r
educt
i
on ofef
f
ect
s of
sal
i
cy
l
at
esi
nt
hei
nt
er
act
i
onwi
t
hphenobar
bi
t
al
?
A.I
nhi
bi
t
i
onofenzy
mesoft
hel
i
v
er
B.Ant
agoni
stef
f
ect
C.Tachy
phy
l
axi
s
D.Tol
er
ance
E.Act
i
v
at
i
onofl
i
v
erenzy
mes*
19.Thebr
eadt
hoft
her
apeut
i
cact
i
oni
sar
angeof
doses:
A.Fr
om av
er
aget
her
apeut
i
cdoset
omi
ni
mum t
oxi
c
dose
B.Fr
om si
ngl
edoset
ocour
sedose
C.Fr
om mi
ni
malt
her
apeut
i
cdos
et
omi
ni
mum t
ox
i
c
dos
e*
D.Fr
om si
ngl
edoset
odai
l
ydose
E.Fr
om mi
ni
mum ef
f
ect
i
v
edoset
o av
er
aget
oxi
c
20. Gi
v
et
he cor
r
ect expl
anat
i
on f
or t
he t
er
m
“
t
ol
er
ance”
:
A.Aconst
antov
er
mast
er
i
ngcr
av
i
ngf
ort
aki
ngadr
ug
B. Ampl
i
f
i
cat
i
on of dr
ug act
i
on i
n r
epeat
ed
i
nt
r
oduct
i
on
C.Lower
i
ngofdr
ugact
i
oni
nr
epeat
edi
nt
r
oduct
i
on*
D.I
ncr
easedsensi
bi
l
i
t
yt
ot
hedr
ug
E.Lower
i
ngofdr
ugabsor
pt
i
on
21.Whati
st
heacet
y
l
at
i
onofdr
ugs?К
A.Conj
ugat
i
onwi
t
hgl
ucur
oni
caci
d
B.Oxi
dat
i
onwi
t
hpar
t
i
ci
pat
i
onofCYP450
C.Bi
ndi
ngt
oacet
i
caci
d*
D.Hy
dr
ol
y
si
sofdr
ugs
E.Bi
ndi
ngt
ogl
ucur
oni
caci
d
22.Whati
st
hegl
ucur
oni
dat
i
onofdr
ugs?К
A.Conj
ugat
i
onwi
t
hgl
ucur
oni
caci
d*
B.Oxi
dat
i
onwi
t
hpar
t
i
ci
pat
i
onofCYP450
C.Bi
ndi
ngt
oacet
i
caci
d
D.Hy
dr
ol
y
si
sofdr
ugs
E.Cy
cl
i
zat
i
onofdr
ugs
23.Whatdoest
het
er
m«
t
achyphyl
axi
s»mean?
A.St
r
ongwi
shoft
aki
ngt
hedr
ug
B. Ampl
i
f
i
cat
i
on of dr
ug act
i
on i
n r
epeat
ed
i
nt
r
oduct
i
on
C.Lower
i
ngofdr
ugact
i
oni
nr
epeat
edi
nt
r
oduct
i
on
D. Rapi
d decr
ease of t
he ef
f
ect i
n r
epeat
ed
i
nt
r
oduct
i
on oft
hedr
ug wi
t
hi
n shor
tper
i
od of
t
i
me*
E.I
ncr
easedsensi
bi
l
i
t
yt
ot
hedr
ug
24.Thecumul
at
i
onofdr
ugsi
spossi
bl
e:
A.I
ndecr
easedr
eabsor
pt
i
oni
nki
dney
B.I
ni
ncr
easedsecr
et
i
oni
nr
enal
t
ubul
es
C.I
nl
ower
i
ngoft
hegl
omer
ul
arf
i
l
t
r
at
i
on*
D.I
nact
i
v
at
i
onofmi
cr
osomalenzy
mesoft
he
l
i
v
er
E.I
ni
ncr
easeofbi
ot
r
ansf
or
mat
i
on
25.A pat
i
entt
ook PO a hal
foft
he gl
ass of
chl
or
ophos
(
st
r
ong
i
nhi
bi
t
or
of
t
he
acet
y
l
chol
i
nest
er
ase) wi
t
h t
he ai
m of sui
ci
de.
Besi
desofgast
r
i
cl
av
age,cl
eansi
ngenema,i
nf
usi
on
t
her
apy
,t
hei
nj
ect
i
onofat
r
opi
newasmade.Asa
r
esul
toft
hesi
gnsoft
hei
nt
oxi
cat
i
ondi
sappear
ed.
Det
er
mi
net
het
y
peofi
nt
er
act
i
onbet
weenat
r
opi
ne
andchl
or
ophos:
A.I
nhi
bi
t
i
onofenzy
mesoft
hel
i
v
er
B.Ant
agoni
stef
f
ect
*
C.Tachy
phy
l
axi
s
D.Tol
er
ance
E.Act
i
v
at
i
onofenzy
mesoft
hel
i
v
er
26. A pat
i
ent t
ook t
he l
ongl
ast
i
ng cour
se of
ant
i
bi
ot
i
ct
her
apy i
n connect
i
on wi
t
h i
nf
ect
i
ous
di
sease.Dur
i
ngt
r
eat
menthebegant
ocompl
ai
nof
ski
nr
ash,i
t
chi
ng,r
hi
ni
t
i
s.Af
t
ert
henexti
nj
ect
i
onof
t
heant
i
bi
ot
i
casphy
xi
a,edemaofl
i
ps,i
ncr
easeof
o
bodyt
wer
e obser
v
ed.The doct
orabol
i
shed t
he
ant
i
bi
ot
i
ct
her
apy and i
ndi
cat
ed necessar
y dr
ugs.
Det
er
mi
net
het
y
peoft
hi
spat
hol
ogi
cal
condi
t
i
on:
A.I
nhi
bi
t
i
onofenzy
mesoft
hel
i
v
er
B.Sensi
bi
l
i
zat
i
on*
C.Tachy
phy
l
axi
s
dose
2
D.Tol
er
ance
E.Ant
agoni
stef
f
ect
27.Al
ongcour
seoft
r
eat
mentwi
t
hcy
ancobal
ami
n
was admi
ni
st
er
ed I
M t
o t
he pat
i
ent wi
t
h
megal
obl
ast
i
canemi
adevel
opedaf
t
ergast
r
oect
omy
.
What adv
ant
age does a par
ent
er
al way of
admi
ni
st
r
at
i
onhav
eov
eror
al
?
A.Thedr
ugi
squi
ckl
ydeduced
B.Thedr
ugi
squi
ckl
yabsor
bed
C.Thedr
ugci
r
cul
at
esi
nbl
oodf
oral
ongert
i
me
D.Thedr
ugdoesnotdi
si
nt
egr
at
ei
nt
hel
i
v
er
E. Thi
s way i
s ef
f
ect
i
v
e i
n absence of
gast
r
omucopr
ot
ei
n*
D.Phar
macol
ogi
c*
E.Compet
i
t
i
v
e
33.Whi
choft
hef
ol
l
owi
ngphar
macoki
net
i
cv
al
ues
mostr
el
i
abl
yr
ef
l
ect
st
he t
ot
alamountofdr
ug
r
eachi
ngt
het
ar
gett
i
ssueaf
t
eror
al
admi
ni
st
r
at
i
on?
A.Vol
umeofdi
st
r
i
but
i
on
B.El
i
mi
nat
i
onr
at
econst
ant
C.Peakbl
oodconcent
r
at
i
on
D.Ar
eaundert
hebl
oodconcent
r
at
i
ont
i
mecur
v
e*
E.Cl
ear
ance
34.I
ndi
cat
echemi
calr
eact
i
onofdr
ugmet
abol
i
sm
whi
chbel
ongst
ot
hephaseofsy
nt
het
i
cr
eact
i
ons
(
conj
ugat
i
on)
:
A.Deami
nat
i
on
B.Deal
ky
l
at
i
on
C.Oxi
dat
i
on
D.Gl
ucur
oni
dat
i
on*
E.Reduct
i
on
28.Whi
choft
hef
ol
l
owi
ngst
at
ement
sr
esul
ti
na
doubl
i
ngoft
hest
eady
st
at
econcent
r
at
i
onofadr
ug?
A.Doubl
i
ngt
her
at
eofi
nf
usi
on*
B.Mai
nt
ai
ni
ng t
he i
nf
usi
on r
at
e,butdoubl
i
ng t
he
l
oadi
ngdose
C.Doubl
i
ng t
her
at
eofi
nf
usi
onand doubl
i
ng t
he
concent
r
at
i
onoft
hei
nf
useddr
ug
D.Tr
i
pl
i
ngt
her
at
eofi
nf
usi
on
E.Quadr
upl
i
ngt
her
at
eofi
nf
usi
on
35.An agentwi
t
h mar
ked l
i
pophi
l
i
c pr
oper
t
i
es i
s
admi
ni
st
er
ed t
o a pat
i
ent
. What i
s t
he mai
n
mechani
sm ofi
t
sabsor
pt
i
on?
A.Act
i
v
et
r
anspor
t
B.Passi
v
edi
f
f
usi
on*
C.Fi
l
t
r
at
i
on
D.Pi
nocy
t
osi
s
E.Bi
ndi
ngt
ot
r
anspor
tpr
ot
ei
ns
29.Azi
t
hr
omyci
n,an ant
i
bi
ot
i
c,has an appar
ent
v
ol
umeofdi
st
r
i
but
i
on(
Vd)ofappr
oxi
mat
el
y30L/
kg.
Thecor
r
ecti
nt
er
pr
et
at
i
onoft
hi
si
nf
or
mat
i
oni
st
hat
Azi
t
hr
omyci
ni
swhi
choft
hef
ol
l
owi
ng?
A.Ef
f
ect
i
v
eonl
ywhengi
v
eni
nt
r
av
enousl
y
B. Ext
ensi
v
el
y di
st
r
i
but
ed t
o si
t
es out
si
de t
he
v
ascul
arandi
nt
er
st
i
t
i
al
spaces*
C.El
i
mi
nat
edmai
nl
ybyr
enalexcr
et
i
on,wi
t
houtpr
i
or
met
abol
i
sm
D.Unabl
et
o cr
oss t
he bl
oodbr
ai
n orpl
acent
al
bar
r
i
er
s
E.Notext
ensi
v
el
yboundt
opl
asmapr
ot
ei
ns
36.Excr
et
i
onofdr
ugsort
hei
rmet
abol
i
t
esacr
osst
he
cel
lmembr
aneoccur
sbyt
hef
ol
l
owi
ngmechani
sm
onl
y
:
A.Passi
v
edi
f
f
usi
on
B.Act
i
v
et
r
anspor
t
C.Fi
l
t
r
at
i
on*
D.Pi
nocy
t
osi
s
E.Si
mpl
i
f
i
eddi
f
f
usi
on
30.Whi
ch oft
he f
ol
l
owi
ng admi
ni
st
r
at
i
on r
out
es
mostl
i
kel
ysubj
ectadr
ugt
oa“
f
i
r
st
pass”ef
f
ecti
n
t
hel
i
v
er
?
A.I
nhal
at
i
on
B.I
nt
r
amuscul
ar
C.I
nt
r
av
enous
D.Or
al
*
E.Subl
i
ngual
37.I
ft
hedr
ugsubst
anceort
oxi
ni
nhi
bi
t
ssy
nt
hesi
s
ofATP,whatmechani
sm ofpenet
r
at
i
ont
hr
ought
he
cel
l
membr
anei
sbl
ocked?
A.Passi
v
edi
f
f
usi
on
B.Act
i
v
et
r
anspor
t*
C.Fi
l
t
r
at
i
on
D.Pi
nocy
t
osi
s
E.Si
mpl
i
f
i
eddi
f
f
usi
on
31.Youar
epl
anni
ngt
oi
nf
useadr
ugI
Vataconst
ant
amountperuni
tt
i
me (
r
at
e)
.I
thas a f
i
r
stor
der
el
i
mi
nat
i
onr
at
econst
ant(
kel)of0.
35/
h.Nol
oadi
ng
dose wi
l
l be gi
v
en. How l
ong wi
l
li
tt
ake
appr
oxi
mat
el
yf
orbl
oodl
ev
el
st
or
eachst
eadyst
at
e
af
t
ert
hei
nf
usi
onbegi
ns?
A.0.
7hour
s
B.1.
2hour
s
C.9hour
s*
D.24hour
s
E.36hour
s
38.Whatphar
macoki
net
i
cpr
oper
t
yi
schar
act
er
i
st
i
c
f
orl
i
pophi
l
i
cdr
ugsubst
ance?
A.I
ti
smet
abol
i
zedi
nl
i
v
er
*
B.Lowbi
oav
ai
l
abi
l
i
t
yi
nor
al
i
nt
r
oduct
i
on
C.Qui
ckr
enal
el
i
mi
nat
i
on
D.Lowper
meabi
l
i
t
yacr
osst
i
ssuebar
r
i
er
s
E.Lowr
enal
r
eabsor
pt
i
on
39.Phar
macol
ogi
cali
ncompat
i
bi
l
i
t
y ofmedi
ci
nes,
whi
chi
sf
oundoutatal
ev
elofspeci
f
i
cef
f
ect(
f
or
exampl
e,admi
ni
st
r
at
i
on of adr
enomi
met
i
cs and
adr
enobl
ocker
s)
,
i
sknownas:
A.Phy
si
cal
B.Phar
macoki
net
i
c
C.Chemi
cal
D.Phar
macody
nami
c*
E.Phar
maceut
i
cal
32.Twodr
ugsactont
hesamet
i
ssueoror
ganv
i
a
act
i
v
at
i
onofdi
f
f
er
entr
ecept
or
s,r
esul
t
i
ngi
nef
f
ect
s
t
hatar
equal
i
t
at
i
v
el
yt
heopposi
t
eofoneanot
her
.
Whati
st
het
y
peofdr
ugant
agoni
sm?
A.Chemi
cal
B.Phy
si
ol
ogi
c
C.Di
sposi
t
i
onal
40.I
nf
l
uence of cer
t
ai
n unf
av
or
abl
ef
act
or
s,i
n
3
par
t
i
cul
ar some medi
calagent
s,whi
ch pr
ecede
pr
egnancy
,enl
ar
ger
i
skofabi
r
t
hoft
hechi
l
dwi
t
h
genet
i
cdef
ect
s.Howt
hi
sact
i
oni
scal
l
ed?
A.Embr
y
ot
oxi
cef
f
ect
B.Mut
ageni
cef
f
ect
*
C.Ter
at
ogeni
cef
f
ect
D.Fet
ot
oxi
cef
f
ect
E.Bl
ast
omogeni
cef
f
ect
E.Mat
er
i
al
cumul
at
i
on*
46.Apat
i
entwhohasbeent
r
eat
edwi
t
hdi
azepam on
accountofneur
osi
scompl
ai
nsoft
oot
hache.Doct
or
admi
ni
st
er
ed hi
m an anal
get
i
c,buti
t
s dose was
l
ower t
han av
er
age t
her
apeut
i
c dose. What
phenomenondi
dt
hedoct
ort
akei
nt
oaccountwhi
l
e
pr
escr
i
bi
ngt
hepat
i
entanunder
dose?
A.Tol
er
ance
B.Cumul
at
i
on
C.Summat
i
on
D.Pot
ent
i
at
i
on*
E.Dr
ugdependence
41.I
ti
s known t
hati
ndi
v
i
dual
s wi
t
h genet
i
cal
l
y
caused def
i
ci
ency of gl
ucose6phosphat
e
dehy
dr
ogenase may dev
el
op RBC hemol
y
si
si
n
r
esponset
ot
headmi
ni
st
r
at
i
onofsomeant
i
mal
ar
i
al
dr
ugs.Mani
f
est
at
i
onofadv
er
ser
eact
i
onst
ot
hese
2013
dr
ugsi
scal
l
ed:
A.I
di
osy
ncr
asy*
B.Sensi
bi
l
i
zat
i
on
C.Al
l
er
gi
cr
eact
i
on
D.Tachy
phy
l
axi
s
E.Tol
er
ance
47.Dur
i
ngsur
gi
caloper
at
i
onwi
t
hadmi
ni
st
r
at
i
onofa
my
or
el
axant(
neur
omuscul
arbl
ocker
)
,adi
st
ur
bance
ofbr
eat
hi
ngdev
el
oped.Admi
ni
st
r
at
i
onofpr
oser
i
ne
(
neost
i
gmi
ne)hasi
mpr
ov
edpat
i
ent
’
scondi
t
i
on.What
i
st
henameoft
hi
st
y
peofdr
ugi
nt
er
act
i
on?
A.I
ncompat
i
bi
l
i
t
y
B.Ant
agoni
sm *
C.Tachy
phy
l
axi
s
D.Sy
ner
gi
sm
E.Cumul
at
i
on
42.I
napat
i
ent
’
sl
i
v
ert
hepr
ocessesofdet
oxi
f
i
cat
i
on
ofnat
ur
almet
abol
i
t
es and xenobi
ot
i
cs i
s br
oken.
Act
i
v
i
t
yofwhatcy
t
ochr
omecanber
educed?
A.Cy
t
ochr
omeB
B.Cy
t
ochr
omeB1
C.Hemogl
obi
n
D.Cy
t
ochr
omeoxi
dase
E.Cy
t
ochr
omeP450*
48.Doct
orpr
escr
i
bed5%ephedr
i
nenasaldr
opst
oa
pat
i
entsuf
f
er
i
ng f
r
om acut
er
hi
ni
t
i
s.The pat
i
ent
st
ar
t
edt
oputt
hedr
opsev
er
y30mi
n.Asar
esul
t
t
her
e was shar
p weakeni
ng oft
he ef
f
ectoft
he
pr
epar
at
i
on.I
ndi
cat
et
her
eason ofappear
anceof
t
achyphyl
axi
s:
A.Exhaust
i
onofsubst
r
at
et
hr
oughwhi
ch
ephedr
i
neact
s*
B.Adapt
at
i
onofcel
l
r
ecept
or
s
C.I
ncr
easeofact
i
v
i
t
yofhepat
i
cenzy
mes
D.I
ncr
easeofexcr
et
i
onofephedr
i
ne
E.Bl
ockadeofr
ecept
or
s
43.Thepat
i
entwasgi
v
enadr
ug“
A”
.Af
t
eraf
ewday
s
t
heef
f
ectoft
hedr
ugsi
gni
f
i
cant
l
ydr
oppedandf
or
r
est
or
i
ng oft
he i
ni
t
i
alef
f
ecti
twas necessar
yt
o
i
ncr
easet
hedr
ug’
sdose.Whati
st
henameoft
hi
s
phenomenon?
A.Cumul
at
i
on
B.Tachy
phy
l
axi
s
C.Dependence
D.Tol
er
ance*
E.I
di
osy
ncr
asy
49.I
ndi
cat
et
henumberofi
nt
r
oduct
i
onofadr
ugper
dayi
fi
t
shal
f
l
i
f
eper
i
od(
T1/2)i
s20hour
s:
A.2t
i
mesaday
B.3t
i
mesaday
C.4t
i
mesaday
D.Oncedai
l
y
*
E.Ev
er
y12hour
s
44.Dur
i
ng t
he embr
y
oni
c per
i
od met
abol
i
sm of
medi
cat
i
onsi
sconsi
der
abl
ysl
owedt
hani
nanadul
t
or
gani
sm.The speci
f
i
ed f
eat
ur
e of an embr
y
o
phar
macoki
net
i
cs i
s caused,f
i
r
stof al
l
,by t
he
f
ol
l
owi
ng:
A.The f
unct
i
onali
mper
f
ect
i
on of enzy
mes,
pr
edomi
nant
l
ybyt
hei
rabsence*
B.The bi
g per
meabi
l
i
t
y of hi
st
ohemat
ol
ogi
c
bar
r
i
er
s
C.Essent
i
al
v
ol
umeofext
r
acel
l
ul
arl
i
qui
d
D.Abi
l
i
t
yf
orabsor
pt
i
onandal
l
ocat
i
onofwat
er
sol
ubl
edr
ugsbyt
heski
n
E.Mat
ur
i
ng”ofr
ecept
or
si
nor
gansi
ndi
f
f
er
ent
t
er
ms
50.Whati
shal
f
l
i
f
eper
i
od(
T1/2)ofadr
ug?
A.Bl
oodpl
asmav
ol
ume,whi
chi
scl
ear
edf
r
om t
he
dr
ugi
naper
i
odoft
i
me
B.Per
i
oddur
i
ngwhi
chconcent
r
at
i
onofadr
ugi
n
bl
oodpl
asmai
sdecr
easedby50%*
C.Per
i
odofcompl
et
eexcr
et
i
onofadr
ugf
r
om t
he
or
gani
sm
D.Speedofexcr
et
i
onoft
hedr
ugv
i
aki
dney
s
E.Rat
i
o bet
ween speed ofexcr
et
i
on and bl
ood
pl
asmaconcent
r
at
i
onofadr
ug
45.Apat
i
entwi
t
hchr
oni
ccar
di
aci
nsuf
f
i
ci
encyhad
been t
aki
ng f
oxgl
ov
e(
Di
gi
t
al
i
s)pr
epar
at
i
onsf
ora
l
ongt
i
me.Duet
ot
hev
i
ol
at
i
onofi
nt
akeschedul
et
he
woman got sy
mpt
oms of i
nt
oxi
cat
i
on. These
sy
mpt
omsr
esul
tf
r
om:
A.Tachy
phy
l
axi
s
B.Sensi
bi
l
i
zat
i
on
C.Funct
i
onal
cumul
at
i
on
D.I
di
osy
ncr
asy
51.Benzy
l
peni
ci
l
l
i
n nat
r
i
um sal
ti
si
nj
ect
ed t
ot
he
pat
i
entwi
t
hpneumoni
ai
nadoze500,
000U6t
i
mes
perday
.Justaf
t
erani
nj
ect
i
ont
hepat
i
entdev
el
oped
f
ev
er
,spasms,l
oss ofconsci
ousness.Whathas
happenedt
ot
hepat
i
ent
?
A.Anaphy
l
act
i
cshock*
B.I
di
osy
ncr
asy
C.Tachy
phy
l
axi
s
D.Cumul
at
i
on
4
E.Tol
er
ance
58.Dur
i
ng t
he v
i
si
tt
o a dent
i
st
,an at
t
ack of
br
onchospasm hasdev
el
opedi
nt
hepat
i
entwhohas
been t
r
eat
ed wi
t
h 5 % ephedr
i
ne hydr
ochl
or
i
de
sol
ut
i
oni
nj
ect
i
on.I
n20mi
nt
heat
t
ackr
eoccur
r
ed.
Theaddi
t
i
onali
nj
ect
i
onofephedr
i
nehadnoef
f
ect
duet
ot
achy
phy
l
axi
s.Whatmechani
sm under
l
i
est
hi
s
phenomenon?
A. Exhaust
i
on of t
he nor
adr
enal
i
ne depot i
n
pr
esy
napt
i
cendi
ngs*
B.I
nhi
bi
t
i
onofadr
enal
r
ecept
or
s
C.Act
i
v
at
i
onofadr
enal
r
ecept
or
s
D.Mat
er
i
al
cumul
at
i
onoft
hedr
ug
E.I
nduct
i
onofmi
cr
osomalenzy
mesy
st
em byt
he
52.The pat
i
entsuf
f
er
i
ng f
r
om epi
l
epsyhasbeen
r
ecei
v
i
ngdai
l
y0,
2gofphenobar
bi
t
alcont
i
nuousl
y
.
Recent
l
yat
t
acksbecamemor
ef
r
equent
,suppr
essed
moodi
sobser
v
ed.Whi
chpr
ocessbecamet
hecause
ofdet
er
i
or
at
i
onoft
hepat
i
ent
’
sst
at
e?
A.Li
v
ermonooxy
genaseenzy
messy
st
em i
nduct
i
on*
B.Li
v
ermonooxy
genaseenzy
messy
st
em i
nhi
bi
t
i
on
C.Li
pol
y
si
sact
i
v
at
i
on
D.Gl
uconeogenesi
sact
i
v
at
i
on
E.Gl
y
col
y
si
si
nhi
bi
t
i
on
53.Adoct
orhaspr
escr
i
bedt
oa48y
.
o.manwi
t
ha
st
enocar
di
aat
t
ackapi
l
l
ofni
t
r
ogl
y
cer
i
nesubl
i
ngual
l
y
.
Whyhast
hedoct
orchosenasubl
i
ngualmet
hodof
t
hemedi
ci
neadmi
ni
st
r
at
i
on?
A.Badi
nt
est
i
nal
absor
pt
i
on
B.Dr
ugel
i
mi
nat
i
onbygast
r
i
cj
ui
ce
C.Ef
f
ectdev
el
opsf
ast
er*
D.I
ti
sact
i
v
at
edbysal
i
v
a
E.Onl
ybecausei
tdamagest
hel
i
v
er
l
i
v
er
59.Wer
epeat
edl
yadmi
ni
st
era dr
ug or
al
l
y
.Ev
er
y
dosei
s100mg;t
hei
nt
er
v
albet
weendosesi
s8h,
whi
chi
si
dent
i
calt
ot
hedr
ugpl
asmahal
f
l
i
f
e.The
bi
oav
ai
l
abi
l
i
t
yi
s0.
5.Forasl
ongasweconductt
he
exper
i
ment no i
nt
er
act
i
ng dr
ugs ar
e added or
st
opped,and t
her
e ar
e no pat
i
ent
r
el
at
ed f
act
or
s
(
excr
et
i
on,
met
abol
i
sm)t
hatmi
ghtchanget
hedr
ug’
s
phar
macoki
net
i
cs.
Howl
ongwi
l
li
tt
akef
ort
hedr
ugt
or
eachst
eady
st
at
eser
um concent
r
at
i
on(
Css)
?
A.(
0.
693xVd)/Cl
B.0.
693/ke
C.T1/2xke
D.D/(
FxT1/2)
E.4.
5xT1/2
Abbr
evi
at
i
ons:F=bi
oav
ai
l
abi
l
i
t
y
:
ke=el
i
mi
nat
i
onr
at
econst
ant
;
D=dose(
mg)
;
Сl
=cl
ear
ance;
T1/2=hal
f
l
i
f
e(
h)
Vd=Vol
umeofdi
st
r
i
but
i
on.
54.Phenobar
bi
t
alwaspr
escr
i
bedt
oa54y
.
o.man,
suf
f
er
i
ngf
r
om i
nsomni
a.Thesl
eepr
hy
t
hm hasbeen
nor
mal
i
zed.Butgr
adual
l
y
,
dur
i
ng2mont
hs,
t
heef
f
ect
of a medi
ci
ne has decr
eased and i
nsomni
a
r
eoccur
r
ed.Whatf
act
orcauses t
he r
educt
i
on of
somni
f
aci
entmedi
cat
i
onef
f
ect
?
A.Badsol
ubi
l
i
t
y
B.Tol
er
ance*
C.Badabsor
pt
i
oni
nt
hest
omach
D.Accumul
at
i
oni
nl
i
pi
ds
E.Tachy
phy
l
axi
s
55.I
ti
sknown,
t
hati
npeopl
ewi
t
hgenet
i
cal
l
ycaused
i
nsuf
f
i
ci
encyofgl
ucose6phosphat
edehy
dr
ogenase
enzy
meofr
edbl
oodcel
l
s,l
y
si
sofst
at
edcel
l
smay
dev
el
op as a r
eact
i
on t
o some ant
i
mal
ar
i
al
medi
cat
i
onsi
nj
ect
i
on.Howi
ssuchunt
y
pi
calr
eact
i
on
t
omedi
cat
i
onsdesi
gnat
ed?
A.Sensi
t
i
zat
i
on
B.I
di
osy
ncr
asy*
C.Al
l
er
gi
cr
eact
i
on
D.Tachy
phy
l
axi
s
E.Tol
er
ance
56.Anal
cohol
i
cwomanhasbor
nagi
r
lwi
t
hment
al
andphy
si
caldev
el
opment
all
ag.Doct
or
sdi
agnosed
t
hegi
r
lwi
t
hf
et
alal
coholsy
ndr
ome.Whatef
f
ecti
s
t
hecauseoft
hegi
r
l
’
sst
at
e?
A.Mal
i
gni
zat
i
on
B.Car
ci
nogeni
c
C.Mechani
c
D.Ter
at
ogeni
c
E.Mut
ageni
c
57.Thepat
i
entwi
t
hhy
per
t
ensi
onhasbeent
aki
ngan
ant
i
hy
per
t
ensi
v
edr
ugf
oral
ongt
i
me,
butsuddenl
yhe
st
oppeddoi
ngi
t
.Af
t
ert
hatpat
i
ent
’
scondi
t
i
onhas
wor
sened,hy
per
t
ensi
v
ecr
i
si
shasdev
el
oped.What
ki
ndofasi
deact
i
oni
si
t
?
A.Cumul
at
i
on
B.Wi
t
hdr
awal
sy
ndr
ome*
C.Tol
er
ance
D.Sensi
t
i
zat
i
on
E.Addi
ct
i
on
60.Apat
i
entwhohasbeent
aki
ngadr
ugf
oral
ong
t
i
mecannotabr
upt
l
yst
opi
t
susebecauset
hi
smay
l
eadt
opsy
chi
candsomat
i
cdy
sf
unct
i
ons.Namet
he
sy
ndr
omeofdi
f
f
er
entdi
sor
der
scausedbyadr
ug
wi
t
hdr
awal
:
A.Tachy
phy
l
axi
s
B.Cumul
at
i
on
C.I
di
osy
ncr
asy
D.Sensi
bi
l
i
zat
i
on
E.Abst
i
nence*
61.Achi
l
dsuf
f
er
sf
r
om dr
ugi
di
osy
ncr
asy
.Whati
s
2012
t
hecauseofsuchr
eact
i
on?
A.Her
edi
t
ar
yenzy
mopat
hy*
B.Exhaust
i
onofsubst
r
at
ei
nt
er
act
i
ngwi
t
h
phar
maceut
i
cal
subst
ance
C.Accumul
at
i
onofphar
maceut
i
cal
subst
ance
D.I
nhi
bi
t
i
onofmi
cr
osomal
l
i
v
erenzy
mes
E.Associ
at
eddi
seasesoft
ar
getor
gan
62.A50y
.
o.pat
i
entwi
t
hf
oodpoi
soni
ngi
sonadr
i
p
of10%gl
ucosesol
ut
i
on.I
tnotonl
ypr
ov
i
dest
hebody
wi
t
hnecessar
yener
gy
,
butal
soper
f
or
mst
he
f
unct
i
onofdet
oxi
f
i
cat
i
onbyt
hepr
oduct
i
onofa
met
abol
i
t
et
hatpar
t
i
ci
pat
esi
nt
hef
ol
l
owi
ng
2013
conj
ugat
i
onr
eact
i
on:
A.Met
hy
l
at
i
on
B.Hy
dr
oxy
l
at
i
on
C.Gl
y
cosy
l
at
i
on*
D.Gl
ucur
oni
dat
i
on
5
E.Sul
f
at
i
on
E.Bi
smut
hsubni
t
r
at
e
2.Agent
saf
f
ect
i
ngt
heAf
f
er
entNS
7.Bi
smut
hsal
t
sar
et
houghtt
obeef
f
ect
i
v
eadj
unct
s
i
nmanagi
ng,i
fnotheal
i
ng,r
ef
r
act
or
ygast
r
i
cul
cer
becauset
heyhav
ebact
er
i
ci
dal
pr
oper
t
i
esagai
nst
:
A.St
aphy
l
ococcusaur
eus
B.Cl
ost
r
i
di
um di
f
f
i
ci
l
e
C.E.col
i
D.Hel
i
cobact
erpy
l
or
i
*
E.Bact
er
i
ci
desf
r
agi
l
i
s
1.Whi
choft
hef
ol
l
owi
ngcondi
t
i
onsi
sNOT
char
act
er
i
st
i
cofcocai
neoverdosage?
A.Di
l
at
i
onoft
hepupi
l
B.Euphor
i
a
C.Tachy
car
di
a
D.Per
i
pher
al
v
asodi
l
at
i
on*
E.Hal
l
uci
nat
i
ons
8.I
ndi
cat
et
hemechani
sm ofact
i
onofl
ocal
anest
het
i
cs:
A.For
mat
i
onofal
bumi
nat
eswi
t
ht
i
ssue’
spr
ot
ei
ns
B.Bl
ockadeofsodi
um channel
s*
C.Bl
ockadeofMchol
i
nor
ecept
or
s
D.I
nhi
bi
t
i
onofnonspeci
f
i
cexci
t
at
or
ysy
st
emsof
CNS
E.Bl
ockadeofal
phaadr
enor
ecept
or
s
2.Apat
i
entwasdel
i
v
er
edt
ot
hesur
gi
caldepar
t
ment
i
n connect
i
on wi
t
h acut
e appendi
ci
t
i
s.He was
pr
oposed t
o make appendect
omyundert
he l
ocal
anest
hesi
a.Butf
r
om hi
smedi
calhi
st
or
ywasknown
t
hathe had sev
er
e al
l
er
gi
cr
eact
i
ons t
o dr
ugs.
Choose t
he dr
ug t
he most pr
ef
er
abl
ef
or t
he
i
nf
i
l
t
r
at
i
onanest
hesi
ai
nt
hi
ssi
t
uat
i
on:
A.Nov
ocai
ne
B.Li
docai
ne*
C.Anest
hesi
ne
D.Di
cai
ne
E.Anyf
r
om i
ndi
cat
edabov
e
10.Adr
i
v
erf
el
tshar
ppai
ni
nt
heey
e.Hewas
admi
t
t
edt
ot
hehospi
t
al
.Whi
chl
ocal
anest
het
i
cmay
beappl
i
edf
orr
emov
al
ofaf
or
ei
gnbodyf
r
om t
heey
e?
A.Anaest
hesi
ne(
Benzocai
ne)
B.Nov
ocai
n
C.Li
docai
ne*
D.Tr
i
mecai
ne
E.Sov
cai
num
3.Apat
i
entwasadmi
t
t
edt
oahospi
t
alwi
t
ht
r
auma
oft
heey
easar
esul
tofhi
t
t
i
ngwi
t
hmet
al
l
i
cshav
i
ng.
Edemaandhy
per
emi
aoft
heey
e,hy
per
l
acr
i
mat
i
on,
pai
nar
eobser
v
ed.Chooset
hel
ocal
anest
het
i
ct
ouse
f
orr
emov
al
oft
hef
or
ei
gnbody
:
A.Pr
ocai
ne(
Nov
ocai
ne)
B.Tr
i
mecai
ne
C.Anest
hesi
ne
D.Di
cai
ne*
E.Anyf
r
om i
ndi
cat
edabov
e
11Whatmor
phol
ogi
cal
el
ement
sofski
nandmucous
membr
anesar
ei
nv
ol
v
edi
ni
nt
er
act
i
onwi
t
ht
hedr
ug
i
nt
er
mi
nal
anest
hesi
a?
A.Sensi
t
i
v
ener
v
ousendi
ngs*
B.Epi
der
mi
s
C.
Fat
t
yt
i
ssue
D.
Capi
l
l
ar
ywal
l
E.
Der
ma
4.Nat
ur
al
l
yoccur
r
i
ngl
ocal
anest
het
i
ci
s:
A.Nov
ocai
ne(
Pr
ocai
ne)
B.Anest
hesi
ne
C.Li
docai
ne
D.Cocai
ne*
E.Tr
i
mecai
ne
12.I
ndi
cat
et
hepr
i
nci
pl
eofact
i
onofcov
er
i
ngdr
ugs:
A.For
mat
i
onofpr
ot
ect
i
v
el
ay
eront
hemucous
membr
anes*
B.Bl
ockadeofmucousmembr
anesr
ecept
or
s
C.Coagul
at
i
onofpr
ot
ei
nsofsuper
f
i
ci
al
l
ay
erof
mucousmembr
ane
D.For
mat
i
onofcompl
exeswi
t
ht
oxi
cagent
s
E.Bl
ockadeofNa+channel
s
5.A23y
.
o.womanwi
t
hr
edandi
t
chyeczemat
ous
der
mat
i
t
i
sv
i
si
t
sadoct
orof
f
i
ce.Shehadadent
al
pr
ocedur
eonedayear
l
i
erwi
t
hadmi
ni
st
r
at
i
onofa
l
ocalanaest
het
i
c.Ther
e wer
e no ot
herf
i
ndi
ngs,
al
t
hough she i
ndi
cat
ed t
hatshe had a hi
st
or
yof
al
l
er
gi
cr
eact
i
ons.Whi
choft
hef
ol
l
owi
ngdr
ugsi
s
mostl
i
kel
yi
nv
ol
v
ed?
A.Li
docai
ne
B.Ul
t
r
acai
ne
C.Bupi
v
acai
ne
D.Nov
ocai
ne(
Pr
ocai
ne)
*
E.Tr
i
mecai
ne
13.Foranest
hesi
adur
i
ngt
oot
hext
r
act
i
onsol
ut
i
onof
novocai
n(
pr
ocai
ne)hasbeenused.Whyi
twasnot
i
nt
r
oducedi
nt
ogi
ngi
v
al
t
i
ssue,
buti
nt
hepr
oj
ect
i
on
ofner
v
ef
i
berpat
h?Becauseof
:
A.Tr
ansmi
ssi
onofpai
ni
mpul
sesi
sbl
ocked*
B.Al
t
er
at
i
onoft
i
ssuepHi
nanest
hesi
aar
ea
C.Depr
essi
onofaxonal
t
r
anspor
t
D.Di
st
ur
banceofact
i
onpot
ent
i
al
f
or
mat
i
onof
t
hepai
nr
ecept
or
s
E.I
ncr
easi
ngofexci
t
abi
l
i
t
yoft
hepai
nr
ecept
or
s
6.Apat
i
entwi
t
hr
enalf
ai
l
ur
eunder
goesaper
i
odi
c
hemodi
al
y
si
swhi
l
eawai
t
i
ngat
r
anspl
ant
.Bet
ween
di
al
y
si
s sessi
ons we wantt
or
educe t
he body
’
s
phosphat
e l
oad by r
educi
ng di
et
ar
y phosphat
e
absor
pt
i
onandr
emov
i
ngsomephosphat
eal
r
eadyi
n
t
he bl
ood.Whi
ch compound shal
lwe admi
ni
st
er
or
al
l
y
?
A.Al
umi
num hy
dr
oxi
de*
B.Magnesi
um hy
dr
oxi
de
C.Sodi
um bi
car
bonat
e
D.Tanni
n
14.Whynov
ocai
ne(
pr
ocai
ne)i
snotusedf
ort
er
mi
nal
anaest
hesi
a?
AI
spoor
l
yabsor
bedt
hr
oughnor
mal
ski
nsur
f
ace
andmucousmembr
ane*
B.Doesn’
tcausecov
er
i
ngact
i
on
CI
ti
seasi
l
yabsor
bedandi
nhi
bi
t
st
heCNS
D.I
r
r
i
t
at
esmucousmembr
ane
E.Act
i
v
at
esMchol
i
nor
ecept
or
s
6
15.I
ndi
cat
et
hemai
nef
f
ectoft
hel
ocal
anest
het
i
cs:
A.El
i
mi
nat
eal
lki
ndsofsensi
bi
l
i
t
yduet
obl
ockadeof
act
i
onpot
ent
i
al
*
B.El
i
mi
nat
eal
lki
ndsofsensi
bi
l
i
t
yduet
opar
al
y
si
sof
t
heCNS
C.Decr
easeofexci
t
abi
l
i
t
yofner
v
eendi
ngs
D.Decr
easeofexci
t
abi
l
i
t
yandconduct
i
v
i
t
yoft
he
af
f
er
entner
v
oussy
st
em
E.Sel
ect
i
v
er
el
i
ev
eofpai
nsensi
bi
l
i
t
yi
nl
ocal
act
i
on
D.Tr
i
mecai
ne
E.Anaest
hesi
ne(
Benzocai
ne)*
23.Whi
chdr
ughast
obeaddedt
ol
i
docai
nesol
ut
i
on
t
opr
ol
ongi
t
sact
i
on?
A.Nospa
B.Caf
f
ei
ne
C.Adr
enal
i
ne*
D.At
r
opi
ne
E.Anapr
i
l
i
ne(
Pr
opr
anol
ol
)
16.Whatar
et
heai
msoft
her
apybyi
r
r
i
t
at
i
v
edr
ugs?
A.Ref
l
exst
i
mul
at
i
on
B.Sl
i
m anal
gesi
cef
f
ectasar
esul
tofdi
st
r
act
i
ng
act
i
on
C.Di
l
at
i
onofski
nv
essel
s
D.I
mpr
ov
ementofi
nneror
gant
r
ophi
ci
t
y
E.Al
l
abov
e*
24.Whati
st
hemai
ni
ndi
cat
i
onf
oradsor
bi
ngdr
ugs
use?
A.Di
ar
r
hea
B.Hy
poaci
di
cgast
r
i
t
i
s
C.Decr
easei
nt
r
y
psi
nact
i
v
i
t
y
D.Decr
easei
nbi
l
esecr
et
i
on
E.I
nt
oxi
cat
i
on*
17.I
ndi
cat
et
hemai
nef
f
ectofast
r
i
ngentdr
ugs.
A.Decr
easeofner
v
eendi
ngsensi
bi
l
i
t
y*
B.Reduct
i
onofhy
per
emi
aofmucous
membr
anesduet
ov
asoconst
r
i
ct
i
on
C.Rel
i
efofpai
n
D.Decr
easeofsy
nt
hesi
sofhi
st
ami
ne
E.Decr
easeofgl
andsecr
et
i
on
25.Anur
seusedmust
ar
dpl
ast
erwi
t
hwat
erofmor
e
o
t
han600Ct
andappl
i
edi
tonpat
i
ent
’
sback.I
n30
mi
nshef
oundt
hatpat
i
ent
’
sski
nundert
hemust
ar
d
pl
ast
erdi
d notgetr
ed.Whati
st
he r
eason f
or
absenceofmust
ar
dpl
ast
eref
f
ect
?
A.I
nact
i
v
at
i
onofmi
r
osi
n*
B.I
nact
i
v
at
i
onofchol
i
neest
er
ase
C.Act
i
v
at
i
onofmi
r
osi
n
D.I
nact
i
v
at
i
onofmonoami
neoxi
dase
E.Act
i
v
at
i
onofmet
hy
l
t
r
anspher
ase
18.Whi
chdr
ugf
r
om t
hegr
oupofl
ocalanaest
het
i
cs
i
snotusedt
oget
herwi
t
hsul
f
onami
des?
A.Nov
ocai
n(
pr
ocai
ne)*
B.Sov
cai
ne
C.Li
docai
ne
D.Tr
i
mecai
ne
E.Ul
t
r
acai
ne
26.I
ti
snecessar
yt
ocar
r
youtl
ocalanest
hesi
aby
l
i
docai
neatext
r
act
i
onofaf
or
ei
gnbodyf
r
om aney
e.
Whati
st
heact
i
onmechani
sm oft
hi
sdr
ug?
A.Bl
ocksNa+channel
s*
B.Br
eakst
r
ansi
tofK+t
hr
ought
hemembr
ane
C.Decr
easesdehy
dr
ogenaseact
i
v
i
t
y
D.Act
i
v
at
eK+channel
s
+
E.Act
i
v
at
eNa channel
s
19.Det
er
mi
net
hedr
ug,whi
chi
susedf
oral
lt
y
pesof
anaest
hesi
a.
A.Nov
ocai
n(
pr
ocai
ne)
B.Anaest
hesi
ne(
Benzocai
ne)
C.Li
docai
ne*
D.Tr
i
mecai
ne
E.Di
cai
ne(
t
et
r
acai
ne)
27.I
ti
snecessar
yt
opr
ov
i
del
ocalanest
hesi
at
oa
pat
i
entwi
t
hski
nbur
nswhi
chr
ecei
v
edasul
f
onami
de
agentsul
f
acyl
sodi
um (
sul
f
acet
ami
de sodi
um)f
or
t
he pr
ev
ent
i
on ofcont
ami
nat
i
on oft
he wounds.
Whi
chl
ocalanest
het
i
ci
sundesi
r
abl
et
oadmi
ni
st
er
si
mul
t
aneousl
ywi
t
hsul
f
onami
des?
A.Nov
ocai
ne(
Pr
ocai
ne)
*
B.Li
docai
ne
C.Tr
i
mecai
ne
D.Ul
t
r
acai
ne
E.Py
r
omecai
ne
20. A pat
i
ent wi
t
h i
ncr
eased sensi
t
i
v
i
t
y t
o
sul
f
onami
de needs t
oot
h ext
r
act
i
on.Whi
ch l
ocal
anest
het
i
chast
obeused?
A.Anaest
hesi
ne(
Benzocai
ne)
B.Di
cai
ne(
Tet
r
acai
ne)
C.Li
docai
ne*
D.Cocai
ne
E.Nov
ocai
ne(
Pr
ocai
ne)
21.I
nj
ect
i
onofal
ocalanest
het
i
chast
obegi
v
ent
oa
pat
i
entf
ort
oot
hext
r
act
i
on.Whi
chdr
ugshoul
dbe
used?
A.Cocai
ne
B.Di
cai
ne(
Tet
r
acai
ne)
C.Anest
hesi
ne(
Benzocai
ne)
D.Ul
t
r
acai
ne*
E.Ket
ami
ne
28.A f
ar
merhasbeenadmi
t
t
edt
ohospi
t
alwi
t
ha
shar
ppai
ni
nhi
sey
e.Whatl
ocal
anest
het
i
cwi
l
l
cause
t
hest
r
ongestanest
hesi
aatt
er
mi
nal
anest
hesi
a?
A.Nov
ocai
ne(
Pr
ocai
ne)
B.Li
docai
ne
C.Tr
i
mecai
ne
D.Di
cai
ne(
Tet
r
acai
ne)*
E.Anaest
hesi
ne(
Benzocai
ne)
22.Thi
sagenti
spoor
l
ysol
ubl
ei
nwat
er
,
soi
ti
sused
f
or super
f
i
ci
alanest
hesi
a onl
yi
nt
he f
or
m of
oi
nt
ment
,
past
eandpowder
.Whati
st
hi
sdr
ug?
A.Sov
cai
ne
B.Nov
ocai
ne(
Pr
ocai
ne)
C.Py
r
omecai
ne
29.A26y
.
o.pat
i
entwi
t
hnumer
ousbur
nsoft
heski
n
has been car
r
i
ed outsuper
f
i
ci
alanest
hesi
a wi
t
h
aer
osol«
Ampr
ovi
zol
»t
hatcont
ai
ns anaest
hesi
ne
(
benzocai
ne)
. What el
ement
s of t
he ski
n and
mucosalmembr
anesar
eaf
f
ect
edbyanest
het
i
cat
t
er
mi
nal
anest
hesi
a?
7
A.Epi
der
mi
s
B.Wal
l
sofcapi
l
l
ar
i
es
C.Sensi
t
i
v
ener
v
eendi
ngs*
D.Der
ma
E.Subcut
aneousf
at
t
yt
i
ssue
chol
i
ner
gi
cagoni
stwi
t
haphar
macol
ogi
cact
i
on?
A.Pr
oser
i
ne:
st
i
mul
at
esat
oni
cbl
adder
B.Car
bachol
:
i
nducesr
el
easeofepi
nephr
i
nef
r
om t
he
adr
enal
medul
l
a
C.Acet
y
l
chol
i
ne:decr
easeshear
tr
at
eandcar
di
ac
out
put
D.Pi
l
ocar
pi
ne:
r
educesi
nt
r
aocul
arpr
essur
e
E.Phy
sost
i
gmi
ne:
decr
easesi
nt
est
i
nal
mot
i
l
i
t
y
*
30.I
ti
snecessar
yf
orpat
i
entt
ocar
r
youtpar
anephr
al
bl
ockadeaf
t
erA.
V.
Vi
shnev
sky
.Whatconcent
r
at
i
on
ofnov
ocai
ne(
pr
ocai
ne)i
sr
equi
r
edf
ori
nt
r
oduct
i
on
f
ort
hi
spur
pose?
A.0.
1250.
5%*
B.0.
51%
C.12%
D.23%
E.5%
4.Pr
oser
pi
ne(
Neost
i
gmi
ne)
:
A.I
scont
r
ai
ndi
cat
edi
ngl
aucomaandmy
ast
heni
a
B.Mayi
nduceobst
i
pat
i
on
C.Decr
easest
heacet
y
l
chol
i
neconcent
r
at
i
onatt
he
neur
omuscul
arj
unct
i
on
D.Mayr
esul
ti
nbowelhy
per
mot
i
l
i
t
y
,sal
i
v
at
i
on,and
sweat
i
ng*
E.Exacer
bat
est
ubocur
ar
i
nepoi
soni
ng
31.A pat
i
entsuf
f
er
i
ng f
r
om chr
oni
c hy
per
aci
di
c
gast
r
i
t
i
s t
akes an ant
aci
d dr
ug f
or hear
t
bur
n
el
i
mi
nat
i
on.Af
t
eri
t
si
ngest
i
ont
hepat
i
entf
eel
sbet
t
er
butatt
hesamet
i
mehehasasensat
i
onofst
omach
swel
l
i
ng.Whi
chdr
ugmi
ghtbet
hecauseofsuchsi
de
ef
f
ect
?2012
A.Sodi
um hy
dr
ocar
bonat
e*
B.Pepsi
n
C.Al
umi
ni
um hy
dr
oxi
de
D.Magnesi
um oxi
de
E.Magnesi
um t
r
i
si
l
i
cat
e
5.Whi
choft
hef
ol
l
owi
ngsi
gnsi
sNOTanexpect
ed
sy
mpt
om ofpoi
soni
ngwi
t
hneost
i
gmi
ne(
pr
oser
i
ne)
?
A.I
ncr
easei
nskel
et
al
muscl
et
onus
B.I
ncr
easedbr
onchi
al
secr
et
i
ons
C.Mi
osi
s
D.Tachy
car
di
a*
E.Conv
ul
si
ons
6.Whi
ch of t
he f
ol
l
owi
ng dr
ugs I
NCORRECTLY
mat
ches a chol
i
ner
gi
c agoni
st wi
t
h a
phar
macol
ogi
cal
act
i
on?
A.Pr
oser
i
ne:
st
i
mul
at
esat
oni
cbl
adder
B.Car
bachol
:
i
nducesr
el
easeofepi
nephr
i
nef
r
om t
he
adr
enal
medul
l
a
C.Acet
y
l
chol
i
ne:decr
easeshear
tr
at
eandcar
di
ac
out
put
D.Pi
l
ocar
pi
ne:
r
educesi
nt
r
aocul
arpr
essur
e
E.Gal
ant
ami
ne:
decr
easesi
nt
est
i
nal
mot
i
l
i
t
y
*
32.Whi
chdr
ugf
r
om t
hegr
oupofl
ocalanest
het
i
csi
s
notusedt
oget
herwi
t
hsul
f
onami
des?
A.Nov
ocai
ne(
pr
ocai
ne)*
B.Bupi
v
acai
ne
C.Li
docai
ne
D.Tr
i
mecai
ne
E.Ul
t
r
acai
ne
3.Agent
sAf
f
ect
i
ngt
heEf
f
er
entNS
3.
1.Chol
i
ner
gi
cAgent
s
3.
1.
1.M,
NChol
i
ner
gi
cAgent
s.Ant
i
chol
i
nest
er
ases.
7.Whi
chONEoft
hef
ol
l
owi
ngdr
ugswoul
dbeusef
ul
i
nt
hel
ongt
er
mt
r
eat
mentofmy
ast
heni
agr
av
i
s?
A.Ar
duan
B.At
r
opi
ne
C.Pr
oser
i
ne(
Neost
i
gmi
ne)
*
D.Scopol
ami
ne
E.Lobel
i
ne
1.Det
er
mi
ne t
he phar
macol
ogi
calgr
oup ofdr
ugs
accor
di
ng t
o t
hei
r pr
oper
t
i
es: t
hey i
nhi
bi
t
acet
y
l
chol
i
nest
er
ase, del
ay t
he hy
dr
ol
y
si
s of
acet
y
l
chol
i
ne, f
aci
l
i
t
at
e t
he neur
omuscul
ar
conduct
i
on, cause mi
osi
s and spasm of
accommodat
i
on,i
ncr
easet
het
oni
ci
t
yoft
hesmoot
h
muscl
esoft
hei
nneror
gansandskel
et
al
muscl
es
A.Ant
i
chol
i
nest
er
ases*
B.al
phaadr
enobl
ocker
s
C.bet
aadr
enobl
ocker
s
D.Mchol
i
nobl
ocker
s
E.Nchol
i
nobl
ocker
s
8. Det
er
mi
ne t
he dr
ug. I
t i
s t
he r
ev
er
si
bl
e
acet
y
l
chol
i
nest
er
asei
nhi
bi
t
orandcausest
heef
f
ect
s
associ
at
ed wi
t
ht
he ex
ci
t
at
i
on of par
asy
mpat
het
i
c
ner
v
oussy
st
em:i
tnar
r
owst
hepupi
l
s,decr
easest
he
i
nt
r
aocul
arpr
essur
e,causes br
ady
car
di
a,spasm of
accommodat
i
on;st
i
mul
at
es smoot
h muscl
es and
gl
andsoft
hegast
r
oi
nt
est
i
nal
,
r
espi
r
at
or
y
,
ur
i
nar
yt
r
act
s
and i
n t
he ey
e; f
aci
l
i
t
at
es t
he neur
omuscul
ar
t
r
ansmi
ssi
on.Chemi
cal
l
yi
ti
squat
er
nar
yammoni
um
compound,
hencei
spoor
l
yabsor
bedor
al
l
y(
or
al
dosei
s
2030t
i
meshi
ghert
henpar
ent
er
aldose)andpoor
l
y
penet
r
at
esi
nt
ot
heCNS.
A.Pheny
l
ephr
i
ne
B.Neost
i
gmi
ne(
Pr
oser
i
ne)
*
C.Gal
ant
ami
ne
D.Pi
l
ocar
pi
ne
E.At
r
opi
nesul
f
at
e
2.I
nexper
i
menthet
er
ozy
gousmi
ceamut
at
i
onoft
he
gene codi
ng pr
ot
ei
n ofend pl
at
e oft
he skel
et
al
muscl
es, whi
ch f
i
xes acet
y
l
chol
i
nest
er
ase i
n a
sy
napse, has been r
ecei
v
ed. Whi
ch way wi
l
l
neost
i
gmi
ne (
pr
oser
i
n)i
nf
l
uenceonneur
omuscul
ar
t
r
ansmi
ssi
onbechanged?
A.Wi
l
l
besl
i
ght
l
yampl
i
f
i
ed
B.Wi
l
l
besi
gni
f
i
cant
l
yampl
i
f
i
ed
C.Wi
l
l
benotchanged
D.Wi
l
l
bedecr
eased*
E.–
9.Pr
oser
i
n has been admi
ni
st
er
ed t
o a pat
i
ent
suf
f
er
i
ngf
r
om my
ast
heni
a.Af
t
eri
t
sadmi
ni
st
r
at
i
on
t
hepat
i
enthasgotnausea,
di
ar
r
hea,
t
wi
t
choft
ongue
3.Whi
choft
hef
ol
l
owi
ngdr
ugsi
ncor
r
ect
l
ymat
chesa
8
andskel
et
almuscl
es.Whi
chdr
ugwi
l
lel
i
mi
nat
et
he
i
nt
oxi
cat
i
on?
A.At
r
opi
nesul
f
at
e*
B.Py
r
i
dost
i
gmi
nebr
omi
de
C.I
sadr
i
ne
D.Mesat
on
E.Phy
sost
i
gmi
ne
B.Phy
sost
i
gmi
ne*
C.Pi
l
ocar
pi
ne
D.Di
pi
r
oxi
m
E.At
r
opi
ne
17.Af
t
eruse ofneost
i
gmi
ne i
nt
he pat
i
entwi
t
h
my
ast
heni
a,such sy
mpt
oms as nausea,di
ar
r
hea,
t
wi
t
chi
ngofmuscl
esoft
ongueandskel
et
almuscl
es
hav
e appear
ed. Whi
ch agent can abor
t t
he
i
nt
oxi
cat
i
on?
A.Phy
sost
i
gmi
ne
B.Met
haci
n*
C.Mesat
one(
Phenyl
ephr
i
ne)
D.Tubocur
ar
i
ne
E.Py
r
i
dost
i
gmi
nebr
omi
de
10.A54y
.
o.mal
ei
sadmi
t
t
edt
ot
heemer
gencyr
oom.
Hecompl
ai
nsdr
ymout
h,
phot
ophobi
a,
bl
ur
r
edv
i
si
on.
Hehashy
per
emi
aanddr
y
nessofski
n,my
dr
i
asi
s,
i
ncr
easedi
nt
r
aoc
ul
arpr
es
s
ur
e.
Thehear
tr
at
ei
s140per
mi
nut
eandBPi
s100/
70mm Hg.Whi
c
hofdr
ugs
houl
d
beadmi
ni
s
t
er
ed?
A.Pr
oser
i
ne(
Neost
i
gmi
ne)*
B.Pi
l
ocar
pi
ne
C.Di
pi
r
oxi
m
D.Dopami
ne
E.Adr
enal
i
ne
11.Al
loft
hef
ol
l
owi
ngdr
ugsdonotcr
osst
hebl
ood
br
ai
nbar
r
i
erexcept
:
A.Pl
at
y
phy
l
l
i
n
B.Gast
r
osepi
ne
C.Gal
ant
ami
ne*
D.Neost
i
gmi
ne(
Pr
oser
i
ne)
E.Pi
r
enzepi
ne
12.Thesubt
y
peofcar
di
acmuscar
i
ni
cr
ecept
ori
s
pr
edomi
nant
l
y
:
A.M1
B.M2*
C.M3
D.M1andM3
E.M1,
M2andM3
13.Phy
sost
i
gmi
ne(
Eser
i
nisul
f
as)usedmai
nl
yf
ori
t
s
par
asy
mpat
homi
met
i
cef
f
ect
s,
i
nhi
bi
t
s:
A.Phosphodi
est
er
ase
B.Acet
y
l
chol
i
nest
er
ase*
C.Cat
echol
Omet
hy
l
t
r
ansf
er
ase(
COMT)
D.Monoami
neoxi
dase(
MAO)
E.DOPAdecar
boxy
l
ase
14.Dur
i
ngsur
gi
caloper
at
i
onwi
t
hadmi
ni
st
r
at
i
onofa
my
or
el
axant(
neur
omuscul
arbl
ocker
)
,adi
st
ur
bance
ofbr
eat
hi
ngdev
el
oped.Admi
ni
st
r
at
i
onofpr
oser
i
ne
(
neost
i
gmi
ne)hasi
mpr
ov
edpat
i
ent
’
scondi
t
i
on.What
i
st
henameoft
hi
st
y
peofdr
ugi
nt
er
act
i
on?
A.I
ncompat
i
bi
l
i
t
y
B.Ant
agoni
sm *
C.Tachy
phy
l
axi
s
D.Sy
ner
gi
sm
E.Cumul
at
i
on
15.Adoct
orhaspr
escr
i
bedcy
cl
odolf
orPar
ki
nson
di
sease. What i
s t
he mechani
sm of i
t
s
ant
i
par
ki
nsoni
anact
i
on?
A.M chol
i
nomi
met
i
cact
i
on
B.M,
Nchol
i
nobl
ocki
ngact
i
on*
C.St
i
mul
at
i
onofdopami
ner
ecept
or
s
D.Bl
ockadeofdopami
ner
ecept
or
s
E.bet
aadr
enobl
ockeract
i
on
18.Toapat
i
entwi
t
hgl
aucomai
ti
snecessar
yt
o
pr
escr
i
be a medi
ci
ne. What ant
i
chol
i
nest
er
ase
(
t
er
t
i
ar
yami
ne)i
snotusedi
nopht
hal
mi
cpr
act
i
ce
becauseofsi
gni
f
i
canti
r
r
i
t
antact
i
ononey
e?
A.Ar
mi
ne
B.Py
r
i
dost
i
gmi
nebr
omi
de
C.Pr
oser
i
ne(
Neost
i
gmi
ne)
D.Gal
ant
ami
ne*
E.Phy
sost
i
gmi
ne
19.Apat
i
entwi
t
hcompl
ai
nt
sondr
y
nessi
nmout
h,
phot
ophobi
aandv
i
sualdi
st
ur
bancesi
sadmi
t
t
edt
o
an admi
ssi
on depar
t
ment
.He has r
edness and
dr
y
nessofski
n,pupi
l
s’di
l
at
i
onandt
achy
car
di
adue
t
opoi
soni
ngwi
t
hBel
l
adonnaal
kal
oi
ds.Whatagent
shoul
dbeused?
A.Ar
mi
ne
B.Pi
l
ocar
pi
ne
C.Pr
oser
i
ne(
Neost
i
gmi
ne)
*
D.Di
pi
r
oxi
m
E.Di
azepam
20. At compl
ex nar
cosi
s (
gener
al anest
hesi
a)
pr
ot
ocoldur
i
ngst
omachr
esect
i
on,apat
i
enthasgot
an i
nj
ect
i
on of t
ubocur
ar
i
ne chl
or
i
de as a
my
or
el
axant(
neur
omuscul
arbl
ocker
)
.Whatagent–
ant
agoni
stshoul
dbeadmi
ni
st
er
edt
ot
hepat
i
entf
or
r
est
or
at
i
onofhi
ssel
f
dr
i
v
enr
espi
r
at
i
on?
A.Pr
oser
i
ne(
Neost
i
gmi
ne)
*
B.Di
t
hy
l
i
n(
Succi
nyl
chol
i
ne)
C.At
r
opi
ne
D.Et
i
mi
zol
E.Benzohexoni
um
21.Whatt
he mostappr
opr
i
at
e ant
i
chol
i
nest
er
ase
agent shoul
d be gi
v
en t
o combat t
r
aces of
pol
i
omy
el
i
t
i
s?
A.Pr
oser
i
ne
B.Gal
ant
ami
ne*
C.Phy
sost
i
gmi
ne
D.Ar
mi
ne
E.Pl
at
y
phy
l
l
i
n
22.Whi
choft
hef
ol
l
owi
ngdr
ugsi
ncor
r
ect
l
ymat
ches
achol
i
ner
gi
cagoni
stwi
t
haphar
macol
ogi
cact
i
on?
A.Pr
oser
i
ne:
st
i
mul
at
esat
oni
cbl
adder
B.Car
bachol
:
i
nducesr
el
easeofepi
nephr
i
nef
r
om t
he
adr
enal
medul
l
a
C.Acet
y
l
chol
i
ne:decr
easeshear
tr
at
eandcar
di
ac
out
put
D.Pi
l
ocar
pi
ne:
r
educesi
nt
r
aocul
arpr
essur
e
E.Phy
sost
i
gmi
ne:
decr
easesi
nt
est
i
nal
mot
i
l
i
t
y
*
16.Thegl
aucomai
sdi
agnosedi
n43y
.
o.pat
i
entf
or
t
he f
i
r
st t
i
me. For t
he t
r
eat
ment doct
or has
pr
escr
i
bedanant
i
chol
i
nest
er
aseagenti
ney
edr
ops.
I
ndi
cat
et
hi
sagent
:
A.Сar
bachol
i
ne
9
23.Ther
ec
ept
or
son t
hes
k
el
et
almus
c
l
eend pl
at
e
r
es
pondt
o:
A.Acet
y
l
chol
i
neandni
cot
i
ne*
B.Acet
y
l
chol
i
ne,
muscar
i
neandni
cot
i
ne
C.Ni
cot
i
ne
D.Muscar
i
ne
E.Acet
y
l
chol
i
ne
24.A82y
.
o.mani
si
ncr
easi
ngl
yf
or
get
f
ul
,andhi
s
wi
f
ei
saf
r
ai
dofhei
sdev
el
opi
ngAl
zhei
mer
’
sdi
sease.
Youconsi
derpr
escr
i
bi
nganant
i
chol
i
nest
er
asedr
ug
t
o see i
ft
hi
sdecr
easeshi
sf
or
get
f
ul
ness.Bef
or
e
wr
i
t
i
ngt
hi
spr
escr
i
pt
i
on,y
ouwantt
obesur
et
hat
t
hesedr
ugsar
esui
t
abl
e.Oft
hepossi
bl
epr
eexi
st
i
ng
condi
t
i
ons l
i
st
ed bel
ow,y
ou shoul
d be t
he l
east
concer
nedabout
:
A.At
r
i
ov
ent
r
i
cul
arbl
ockade
B.Br
ady
car
di
a
C.Ast
hma
D.Obst
r
uct
i
onoft
heGI
T
E.Gl
aucoma*
29.
3.
1.
2.MChol
i
ner
gi
cAgent
s
1.Whi
choft
hef
ol
l
owi
ngcondi
t
i
onsi
schar
act
er
i
st
i
c
ofpar
asy
mpat
het
i
cst
i
mul
at
i
on?
A.Decr
easei
ni
nt
est
i
nal
mot
i
l
i
t
y
B.I
nhi
bi
t
i
onofbr
onchi
al
secr
et
i
on
C.Cont
r
act
i
onofsphi
nct
ermuscl
ei
nt
hei
r
i
soft
he
ey
e(
my
osi
s)*
D.Cont
r
act
i
onofsphi
nct
erofur
i
nar
ybl
adder
E.I
ncr
easei
nhear
tr
at
e
2.Sel
ect t
he most appr
opr
i
at
e dr
ug t
o act at
per
i
pher
al and cent
r
al muscar
i
ni
c chol
i
ner
gi
c
r
ecept
or
s:
A.Pi
r
enzepi
ne
B.Neost
i
gmi
ne
C.Pl
at
y
phy
l
l
i
n
D.Scopol
ami
ne*
E.I
pr
at
r
opi
um br
omi
de
3.Sel
ectt
he mostappr
opr
i
at
e ant
i
chol
i
ner
gi
cf
or
ast
hma:
A.Pl
at
y
phy
l
l
i
n
B.Pi
r
enzepi
ne
C.Pi
pecur
oni
um br
omi
de(
Ar
duan)
D.At
r
opi
ne
E.I
pr
at
r
opi
um br
omi
de*
4.A20y
.
o.pat
i
entwasadmi
t
t
edt
oahospi
t
alwi
t
ha
shar
p pai
ni
nt
he abdomen,v
omi
t
i
ng,i
mpeded
br
eat
hi
ng,and dy
spnoea.He has t
he moi
stski
n,
hy
per
sal
i
v
at
i
on, mi
osi
s, br
ady
car
di
a, muscul
ar
t
wi
t
chi
ng.I
ti
sknownf
r
om t
heanamnesi
st
hatt
he
pat
i
enti
sat
oxoman,hebr
eat
hedi
nt
heaer
osolf
or
ext
er
mi
nat
i
onofi
nsect
s.Whatmechani
sm ofact
i
on
hast
heagent
,
whi
chhascausedpoi
soni
ng?
A.Mchol
i
nobl
ocki
ng
B.Nchol
i
nobl
ocki
ng
C.Mchol
i
nomi
met
i
c
D.Nchol
i
nomi
met
i
c
E.M,
Nchol
i
nomi
met
i
c*
7.Thepat
i
entwi
t
hcompl
ai
nt
sofconst
antdr
ymout
h
addr
essedadent
i
st
.Thedoct
ormadet
hedi
agnosi
s
«
xer
ost
omi
a»
.Tonor
mal
i
zet
hesecr
et
i
onofsal
i
v
ahe
admi
ni
st
er
edPi
l
ocar
pi
ne56dr
ops3t
i
mesaday
.But
t
hepat
i
entv
i
ol
at
edt
hei
nst
r
uct
i
onsandt
ookt
hedr
ug
wi
t
houtf
ol
l
owi
ngt
hei
ndi
cat
eddosage.Soonbesi
des
t
hedi
sappear
anceofmout
hdr
y
nesshef
el
tcr
amps,
di
ar
r
hea,i
ncr
eased br
onchi
alsecr
et
i
on,sweat
i
ng,
t
ear
i
ng, br
ady
car
di
a, const
r
i
ct
i
on i
n t
he chest
,
i
nv
ol
unt
ar
yur
i
nat
i
on,hy
pot
ensi
on.Wi
t
ht
hehel
pof
whatdr
ugcant
hesi
deef
f
ect
sbeeasi
l
yel
i
mi
nat
ed?
A.Acecl
i
di
ne
B.Cy
t
i
t
on
C.Lobel
i
ne
D.At
r
opi
ne*
E.Pr
oser
i
ne
8.Det
er
mi
net
hedr
ug.I
ti
st
heal
kal
oi
doft
hesame
pl
ant
sasat
r
opi
nei
s.I
texer
t
ssi
gni
f
i
canti
nhi
bi
t
i
ng
25.A 40y
.
o.mal
ef
ar
m wor
keri
sbr
oughtt
ot
he
emer
gencyr
oom.He was f
ound conf
used i
nt
he
or
char
dandsi
ncet
henhasl
ostconsci
ousness.Hi
s
HRi
s45/
mi
n;BPi
s80/
40mm Hg.Hei
ssweat
i
ng
and sal
i
v
at
i
ng pr
of
usel
y
.Whi
ch dr
ug shoul
d be
admi
ni
st
er
ed?
A.Gal
ant
ami
ne
B.Nor
adr
enal
i
ne
C.Pr
oser
i
ne
D.At
r
opi
ne*
E.Pr
ocai
ne
26.A pat
i
entsuf
f
er
i
ngf
r
om my
ast
heni
ahasbeen
admi
ni
st
er
ed pr
oser
i
n.Af
t
eri
t
sadmi
ni
st
r
at
i
on t
he
pat
i
enthasgotnausea,di
ar
r
hea,t
wi
t
choft
ongue
and skel
et
almuscl
es.Whatdr
ug woul
d hel
pt
o
el
i
mi
nat
et
hei
nt
oxi
cat
i
on?
A.Py
r
i
dost
i
gmi
nebr
omi
de
B.I
sadr
i
ne
C.Phy
sost
i
gmi
ne
D.Mesat
on
E.At
r
opi
nesul
f
at
e*
27.A pat
i
entwas admi
t
t
ed t
o a hospi
t
alwi
t
h
compl
ai
nt
s aboutqui
ckf
at
i
gabi
l
i
t
yand si
gni
f
i
cant
muscl
e weakness. Exami
nat
i
on r
ev
eal
ed an
aut
oi
mmunedi
seaset
hatcausesf
unct
i
onaldi
sor
der
ofr
ecept
or
si
nt
heneur
omuscul
arsy
napses.Thi
swi
l
l
r
esul
ti
nt
he di
st
ur
bed act
i
v
i
t
y of t
he f
ol
l
owi
ng
2012
medi
at
or
:
A.Acet
y
l
chol
i
ne*
B.Dopami
ne
C.Gl
y
ci
ne
D.Ser
ot
oni
n
E.Nor
adr
enal
i
ne
28.Apat
i
entaf
t
erdi
sr
upt
edcer
ebr
alci
r
cul
at
i
onhas
dev
el
opedpar
al
y
si
s.Chooset
heant
i
chol
i
nest
er
ase
dr
ugt
obepr
escr
i
bedi
nt
hi
scase:
A.Met
haci
n
B.Hexamet
honi
um (
Benzohexoni
um)
C.Pr
oser
i
ne*
D.Cor
di
ami
n
E.Acecl
i
di
ne
10
i
nf
l
uenceupont
heCNS.I
nt
hecl
i
ni
calpr
act
i
cei
t
s
i
nhi
bi
t
i
ngact
i
onupont
hecent
er
sconnect
edwi
t
ht
he
v
est
i
bul
aranal
y
zeri
s used f
ort
he t
r
eat
mentof
mot
i
onsi
ckness.
A.Met
haci
n
B.Scopol
ami
ne*
C.Pi
r
enzepi
ne
D.Gal
ant
ami
ne
E.Pl
at
y
phy
l
l
i
n
9.Al
lof f
ol
l
owi
ng si
de ef
f
ect
s ar
e seen wi
t
h
I
pr
at
r
opi
um br
omi
deexcept
:
A.Ur
i
nar
yr
et
ent
i
on
B.Dr
y
nessofmout
h
C.Scr
at
chi
ngi
nt
r
achea
D.Mi
osi
s*
E.Gl
aucoma
12.Apat
i
entwi
t
hr
enal
col
i
chasbeenadmi
ni
st
er
eda
spasmol
y
t
i
c agent f
r
om t
he gr
oup of Mchol
i
nobl
ocker
s.Speci
f
yt
hi
sdr
ug.
A.Met
haci
n*
B.Ephedr
i
ne
C.Pi
r
enzepi
ne
D.Gal
ant
ami
ne
E.Nospa
13.A pat
i
entr
ecei
v
es Acecl
i
di
ne af
t
erabdomi
nal
sur
ger
y
. Hi
s hear
tr
at
e f
al
l
s sl
i
ght
l
y and she
exper
i
encessomewheezi
ng.Thesepul
monar
yand
car
di
acr
esponsesr
epr
esentorr
ef
l
ect
:
A.Expect
edsi
deef
f
ect*
B.I
di
osy
ncr
asy
C.Par
asy
mpat
het
i
cgangl
i
onact
i
v
at
i
on
D.Ref
l
ex(
bar
or
ecept
or
)suppr
essi
onofcar
di
ac
r
at
e
E.Undi
agnosedast
hma
14.Wegi
v
ean‘
ef
f
ect
i
v
edose’
ofat
r
opi
net
oaper
son
who i
s poi
soned wi
t
h an acet
y
l
chol
i
nest
er
ase
i
nhi
bi
t
or
. Whi
ch st
r
uct
ur
e wi
l
l cont
i
nue t
o be
ov
er
act
edbyt
heexcessacet
y
l
chol
i
neaf
t
ert
hi
sdr
ug
i
sgi
v
en?
A.Ai
r
waysmoot
hmuscl
e
B.SAnodeoft
hehear
t
C.Sal
i
v
ar
yandl
acr
i
mal
gl
ands
D.Skel
et
al
muscl
e*
E.Vascul
arsmoot
hmuscl
e
15.Whi
chi
samuscar
i
ner
ecept
or
bl
ocki
ngdr
ugt
hat
i
s admi
ni
st
er
ed by i
nhal
at
i
on t
o cause
br
onchodi
l
at
i
on f
orpat
i
ent
s wi
t
h emphy
sema and
ast
hma?
A.Pl
at
y
phy
l
l
i
n
B.I
pr
at
r
opi
um br
omi
de*
C.Pancur
oni
um
D.Pi
l
ocar
pi
ne
E.Sal
but
amol
16. A dent
i
st pr
escr
i
bed an agent st
i
mul
at
i
ng
sal
i
v
at
i
ont
oapat
i
entwi
t
hxer
ost
omi
a.I
ndi
cat
et
he
dr
ug:
A.Pi
l
ocar
pi
ne*
B.Di
t
hy
l
i
n
C.Ar
mi
ne
D.Scopol
ami
ne
E.At
r
opi
ne
17.Adoct
orpr
escr
i
bedacecl
i
di
net
oamansuf
f
er
i
ng
f
r
om dr
y
ness oft
he mout
ht
hatappear
ed af
t
er
r
emov
aloft
onsi
l
s.Whi
chef
f
ecti
snotchar
act
er
i
st
i
c
f
ort
hi
sagent
?
A.I
ncr
ease t
he br
onchismoot
h muscl
es
t
oni
ci
t
y
B.My
dr
i
asi
s*
CSpasm ofaccommodat
i
on
D.Br
ady
car
di
a
E.Hy
per
sal
i
v
at
i
on
18.I
nt
r
oduct
i
onofaphar
maceut
i
calsubst
ancet
oan
exper
i
ment
al ani
mal r
esul
t
ed i
n r
educt
i
on of
sal
i
v
at
i
on, pupi
l my
dr
i
asi
s. Next i
nt
r
av
enous
i
nt
r
oduct
i
on of acet
y
l
chol
i
ne di
dn’
tl
ead t
o any
si
gni
f
i
cant changes of hear
tr
at
e. Name t
hi
s
subst
ance:
A.Pr
oser
i
ne
B.Adr
enal
i
ne
C.Pr
opr
anol
ol
D.At
r
opi
ne*
E.Sal
but
amol
19. Mchol
i
nobl
ocker
s ar
e wi
del
y used. Whi
ch
condi
t
i
oni
scont
r
ai
ndi
cat
edf
ort
hei
radmi
ni
st
r
at
i
on?
A.At
r
i
ov
ent
r
i
cul
arbl
ockade
B.At
onyofi
nt
est
i
ne*
C.Br
onchi
al
ast
hma
D.Li
v
erandr
enal
col
i
c
E.Gast
r
i
cul
cer
20.Apat
i
enthasbeengi
v
enat
r
opi
nesul
f
at
ef
orr
api
d
r
el
i
efofspast
i
ccol
onsy
mpt
oms.Theuseoft
hi
s
dr
ugi
scont
r
ai
ndi
cat
eddur
i
ngt
hef
ol
l
owi
ngdi
sease:
2016
A.Hy
pot
ensi
on
B.Gl
aucoma*
C.Br
ady
car
di
a
D.Br
onchi
al
ast
hma
E.Gast
r
i
cul
cer
21.AM1chol
i
nobl
ockerhasbeenadmi
ni
st
er
edt
oa
pat
i
entf
ort
he t
r
eat
mentofgast
r
i
c pept
i
c ul
cer
.
I
ndi
cat
et
hi
sagent
:
A.Pi
r
enzepi
ne*
B.Scopol
ami
ne
C.I
pr
at
r
opi
um br
omi
de
D.Met
haci
n
E.Pl
at
y
phy
l
l
i
n
22.Awomanaskedt
oadr
ugst
or
emant
osel
lan
ey
edr
opsAt
r
opi
ne,butt
hel
astoner
ef
usedbecause
At
r
opi
nei
scont
r
ai
ndi
cat
edatgl
aucoma.Why
?
A.Di
l
at
espupi
l
s
B.I
ncr
easesi
nt
r
aocul
arpr
essur
e*
C.Causespar
al
y
si
sofaccommodat
i
on(
cycl
opl
egi
a)
D.Nar
r
owsv
i
ewf
i
el
d
E.Causesmy
opi
a
23.Af
t
erut
i
l
i
z
at
i
onofopht
hal
mi
cdr
opspat
i
entwi
t
h
gl
aucomahasmi
osi
s,my
opi
a,anddr
opofi
nt
r
aocul
ar
pr
essur
e.Whi
chphar
macol
ogi
cgr
oupcancausesuch
ef
f
ect
s?
A.Mchol
i
nomi
met
i
cs*
B.Mchol
i
nobl
ocker
s
C.Nchol
i
nomi
met
i
cs
D.Gangl
i
obl
ocker
s
E.al
phaadr
enobl
ocker
s
25.At
r
opi
nei
susedasanant
i
dot
et
ot
r
eatpoi
soni
ng
11
wi
t
h f
l
y agar
i
c. Whi
ch mechani
sm i
nher
ent t
o
at
r
opi
ne l
eads t
o mushr
oom t
oxi
n muscar
i
ne
neut
r
al
i
zat
i
on?
A.Enzy
mat
i
c
B.Phy
si
cal
chemi
cal
C.Ant
i
enzy
mat
i
c
D.Met
abol
i
c
E.Recept
or
*
26.Choose t
he agentused i
n opht
hal
mol
ogy t
o
exami
net
hef
undusofey
e:
A.At
r
opi
nesul
phat
e*
B.Pr
oser
i
ne
C.Met
haci
n
D.Pi
l
ocar
pi
ne
E.I
pr
at
r
opi
um br
omi
de
28.A pat
i
entwi
t
hdr
ugi
nt
oxi
cat
i
onpr
esent
edwi
t
h
t
hedr
y
nessofor
almucousmembr
aneandmy
dr
i
at
i
c
pupi
l
s.Suchact
i
onoft
hi
sdr
ugi
sassoci
at
edwi
t
ht
he
f
ol
l
owi
ngef
f
ect
:
A.Adr
enor
ecept
orbl
ock
B.Muscar
i
ni
cchol
i
nor
ecept
orst
i
mul
at
i
on
C.Adr
enor
ecept
orst
i
mul
at
i
on
D.Muscar
i
ni
cchol
i
nor
ecept
orbl
ock*
E.Ni
cot
i
ni
cchol
i
nor
ecept
orst
i
mul
at
i
on
r
es
t
or
ed.Whi
c
henz
y
medef
i
c
i
tpr
ol
ongst
heac
t
i
onof
t
hi
smy
or
el
ax
ant
?
A.Succi
nat
edehy
dr
ogenase
+
+
B.KNaadenosi
net
r
i
phosphat
ase
C.Car
boni
canhy
dr
ase
D.Pseudochol
i
nest
er
ase*
E.Nacet
y
l
t
r
ansf
er
ase
5.Apat
i
entwi
t
hf
r
act
ur
eofl
owerj
aw wasadmi
t
t
ed
t
oamaxi
l
l
of
aci
aldepar
t
ment
.Af
t
erI
Vi
nt
r
oduct
i
onof
my
or
el
axantt
her
ear
osef
i
br
i
l
l
arcont
r
act
i
onsoft
he
pat
i
ent
’
sf
aci
almuscl
es. Whi
ch my
or
el
axant was
admi
ni
st
er
ed?
A.Di
azepam
B.Tubocur
ar
i
nchl
or
i
de
C.Pi
pecur
oni
um br
omi
de
D.Di
t
hy
l
i
n*
E.Mel
l
i
ct
i
n
6.Dur
i
ngsur
gi
caloper
at
i
onwi
t
hadmi
ni
st
r
at
i
onofa
my
or
el
axant(
neur
omuscul
arbl
ocker
)
,adi
st
ur
bance
ofbr
eat
hi
ngdev
el
oped.Admi
ni
st
r
at
i
onofpr
oser
i
ne
(
neost
i
gmi
ne)hasi
mpr
ov
edpat
i
ent
’
scondi
t
i
on.What
i
st
henameoft
hi
st
y
peofdr
ugi
nt
er
act
i
on?
A.I
ncompat
i
bi
l
i
t
y
B.Ant
agoni
sm *
C.Tachy
phy
l
axi
s
D.Sy
ner
gi
sm
E.Cumul
at
i
on
7.Dur
i
ng an oper
at
i
on a pat
i
entgoti
nj
ect
i
on of
muscl
e r
el
axant di
t
hyl
i
num (
succi
nyl
chol
i
ne)
.
Rel
axat
i
on ofskel
et
almuscl
es and i
nhi
bi
t
i
on of
r
espi
r
at
i
onl
ast
ed2hour
s.Thi
scondi
t
i
onwascaused
byabsenceoft
hef
ol
l
owi
ngenzy
mei
nbl
oodpl
asma
2012
:
A.But
y
r
y
l
chol
i
neest
er
ase*
B.Acet
y
l
chol
i
neest
er
ase
C.Gl
ucose6phosphat
ase
D.Cat
al
ase
E.Gl
ut
at
hi
oneper
oxi
de
8.Dur
i
ngsur
gi
caloper
at
i
onapat
i
enthasdev
el
oped
sy
mpt
omsofdi
t
hyl
i
n(
succi
nyl
chol
i
ne)over
dosage.
Whatt
r
eat
menti
snecessar
yt
opr
ov
i
det
ot
hepat
i
ent
?
A.Admi
ni
st
r
at
i
onofant
i
chol
i
nest
er
ases
B.Admi
ni
st
r
at
i
onofMchol
i
nobl
ocker
s
C.Admi
ni
st
r
at
i
onofgangl
i
obl
ocker
s
D.Bl
oodt
r
ansf
usi
on*
E.Admi
ni
st
r
at
i
onofNchol
i
nobl
ocker
s
9.A63y
.
o.pat
i
enthasgotani
nj
ect
i
onofpent
ami
ne
f
orhy
per
t
ensi
v
ecr
i
si
s.Whati
si
t
sact
i
onmechani
sm?
A.St
i
mul
at
i
onofMchol
i
nor
ecept
or
s
B.I
nhi
bi
t
i
onofMchol
i
nor
ecept
or
s
C.I
nhi
bi
t
i
onofM,
Nchol
i
nor
ecept
or
s
D.St
i
mul
at
i
onofNchol
i
nor
ecept
or
s
E.I
nhi
bi
t
i
onofNchol
i
nor
ecept
or
s*
10. The gangl
i
obl
oc
k
er Benz
ohexoni
um has been
admi
ni
s
t
er
edt
oapat
i
entwi
t
hhy
per
t
ens
i
v
ec
r
i
s
es
.
Whi
c
h
ef
f
ec
t
s shoul
d doct
orbe wor
r
i
ed aboutaf
t
ert
he
dr
ug’
si
nj
ect
i
on?
A.Suppr
essi
onofr
espi
r
at
i
on
B.Di
ar
r
hea
C.Reboundsy
ndr
ome
D.I
nf
r
i
ngementoft
ast
esensat
i
on
E.Or
t
host
at
i
c(
post
ur
al
)hy
pot
ensi
on*
29.A manwasi
nt
oxi
cat
edwi
t
hmushr
ooms.They
cont
ai
n muscar
i
ne t
hat st
i
mul
at
es muscar
i
ni
c
chol
i
nor
ecept
or
s. What sy
mpt
oms si
gnal
i
ze
i
nt
oxi
cat
i
onwi
t
hi
nedi
bl
emushr
ooms?2012
A.Ri
seofar
t
er
i
al
pr
essur
e
B.Br
onchi
di
l
at
i
on
C.I
ncr
easedhear
tr
at
e
D.My
dr
i
at
i
cpupi
l
s*
E.My
ot
i
cpupi
l
s*
3.
1.
3.NChol
i
ner
gi
cAgent
s
1.Sel
ectt
hemostappr
opr
i
at
edr
ugt
ot
r
eatt
he
poi
soni
ngwi
t
hdepol
ar
i
zi
ngmyor
el
axant
:
A.Di
t
hy
l
i
n
B.Neost
i
gmi
ne
CFr
eshbl
oodt
r
ansf
usi
on*
DScopol
ami
ne
E.I
pr
at
r
opi
um br
omi
de
2.Ni
cot
i
ni
cr
ecept
or
sar
eseeni
n:
A.Skel
et
al
muscl
e*
B.Vi
scer
al
smoot
hmuscl
e
C.Car
di
acmuscl
e
D.Sal
i
v
ar
ygl
ands
E.Adi
posecel
l
3.A pat
i
entwi
t
h a hi
s
t
or
y ofas
t
hma ex
per
i
enc
es
s
i
gni
f
i
c
antbr
onc
hos
pas
m andur
t
i
c
ar
i
a,
andhi
s
t
ami
nei
s
amai
nmedi
at
ori
nt
hes
er
es
pons
es
.Whi
c
hdr
ugmay
pos
eex
t
r
ar
i
s
kf
ort
hi
spat
i
ent–notbec
aus
ei
thasany
br
onc
hoc
ons
t
r
i
c
t
oref
f
ec
t
si
ni
t
sownr
i
ght
,
butbec
aus
ei
t
r
el
eas
eshi
s
t
ami
nef
r
ommas
tc
el
l
s
?
A.At
r
opi
ne
B.Neost
i
gmi
nesul
f
at
e
C.Pr
opr
anol
ol
D.Pancur
oni
um
E.dTubocur
ar
i
ne*
4.Di
t
hy
l
i
n(
Li
st
enone)hasbeeni
nt
r
oduc
edt
oapat
i
ent
bef
or
eanoper
at
i
on.Af
t
ert
heendofoper
at
i
onand
c
es
s
at
i
onofanaes
t
hes
i
at
hei
ndi
v
i
dual
r
es
pi
r
at
i
onwas
n’
t
12
11.
Cur
ar
el
i
k
emy
or
el
ax
ant
sar
eus
edf
ordec
r
eas
i
ngand
c
es
s
at
i
onofi
mpul
s
et
r
ans
mi
s
s
i
onf
r
om ner
v
eendi
ngt
o
mus
c
ul
arf
i
ber
.Whati
st
hemec
hani
s
m ofac
t
i
onoft
hi
s
gr
oup?
A. Bl
ockade Nchol
i
nor
ecept
or
s of post
sy
napt
i
c
membr
aneofneur
omuscul
arj
unct
i
on
B.I
nhi
bi
t
i
onofacet
y
l
chol
i
nest
er
ase
C.I
nhi
bi
t
i
onofNa+/K+pump
D. Reduct
i
on of neur
ot
r
ansmi
t
t
er r
el
ease i
nt
o
sy
napt
i
ccl
ef
t
E.Bl
ockade ofCa2+ i
nwar
dt
hr
ough pr
esy
napt
i
c
car
di
omy
ocy
t
es
D.Di
r
ecti
nf
l
uenceupont
hecel
l
wal
l
E,
St
i
mul
at
i
onofsy
mpat
het
i
cgangl
i
ons*
18.I
ndi
cat
et
hemai
nf
eat
ur
eofl
obel
i
neact
i
on:
A.I
tst
i
mul
at
esdi
r
ect
l
yt
her
espi
r
at
or
ycent
er
B.I
tcausest
her
el
axat
i
onofbr
onchi
alsmoot
h
muscl
es
C.I
ti
sef
f
ect
i
v
eaf
t
erper
or
al
i
nt
r
oduct
i
on
D.I
tact
sbyr
ef
l
exwayst
i
mul
at
i
ngt
her
ecept
or
s
ofcar
ot
i
dzone*
E.I
tst
i
mul
at
est
her
espi
r
at
or
ymuscl
es
19.I
ndi
cat
et
hedr
ugwhi
chexci
t
esbot
hM-andNchol
i
nor
ecept
or
s:
A.Acet
y
l
chol
i
ne*
B.Pent
ami
ne
C.Di
t
hy
l
i
n
D.Lobel
i
ne
E.Tubocur
ar
i
ne
20.I
ndi
cat
et
hecl
i
ni
cal
usesf
orbenzohexoni
um:
A.I
nt
est
i
nal
at
ony
B.Vascul
arhy
pot
ensi
on
C.My
ast
heni
agr
av
i
s
D.Hy
per
t
ensi
v
ecr
i
si
s*
E.Respi
r
at
or
yar
r
est
membr
ane
12.A y
oung man hasbr
oken hi
sl
eg i
n a ski
i
ng
acci
dent
,causi
ng sev
er
e muscul
ar spasm t
hat
necessi
t
at
ed r
el
axat
i
on of t
he muscl
e wi
t
h a
compet
i
t
i
v
eNr
ecept
orant
agoni
stbef
or
et
hef
r
act
ur
e
coul
dbeset
.Att
heendoft
heor
t
hopedi
cpr
ocedur
e,
t
hedoct
orr
est
or
edneur
omuscul
art
r
ansmi
ssi
onby
admi
ni
st
er
i
ng:
A.Phy
sost
i
gmi
ne(
Eser
i
ne)
B.Neost
i
gmi
ne(
Pr
oser
i
ne)
*
C.Gal
ant
ami
ne
D.Car
bachol
i
ne(
Car
bachol
)
E.Ar
mi
ne
13. A pat
i
ent wi
t
h a l
i
mb f
r
act
ur
e must be
admi
ni
st
er
edadepol
ar
i
zi
ngdr
ugf
r
om t
hegr
oupof
myor
el
axant
sf
ort
hepur
poseofashor
t
t
i
mesur
ger
y
.
Whatdr
ugi
si
t
?
A.At
r
opi
nesul
f
at
e
B.Di
t
hy
l
i
n*
C.Tubocur
ar
i
nechl
or
i
de
D.Cy
t
i
t
on
E.Pent
ami
ne
14.Theef
f
ect
soft
ubocur
ar
i
necanbeant
agoni
zed
by
:
A.Pi
l
ocar
pi
ne
B.Acecl
i
di
ne
C.Cy
t
i
t
on
D.Neost
i
gmi
ne(
Pr
oser
i
ne)
*
E.Lobel
i
ne
15.A woman has t
o pr
oduce t
r
achea i
nt
ubat
i
on.
Whi
chdr
ugshoul
dbeadmi
ni
st
er
ed?
A.At
r
opi
nesul
f
at
e
B.Di
t
hy
l
i
n*
C.Pr
oser
i
ne
D.Cy
t
i
t
on
E.Pent
ami
ne
16.I
famanhasanat
t
ackofbr
onchospasm i
ti
s
necessar
yt
or
educet
heef
f
ectofv
agusonsmoot
h
muscl
esofbr
onchi
.Whatmembr
anecy
t
or
ecept
or
s
2011
shoul
dbebl
ockedf
ort
hi
spur
pose?
A.αadr
enor
ecept
or
s
B.Mchol
i
nor
ecept
or
s*
C.α-andβ-adr
enor
ecept
or
s
D.Nchol
i
nor
ecept
or
s
E.β-adr
enor
ecept
or
s
21. Whi
ch dr
ug bel
ongs t
o t
he compet
i
t
i
v
e
ant
agoni
st
sofchol
i
nor
ecept
or
s?
A.Di
t
hy
l
i
n
B.Tubocur
ar
i
ne*
C.Lobel
i
ne
D.Cy
t
i
t
on
E.Ni
cot
i
ne
22.I
ndi
cat
et
hemechani
sm ofdi
t
hyl
i
nact
i
on
A.I
tbr
eaksneur
omuscul
art
r
ansmi
ssi
onduet
o
st
abl
e depol
ar
i
zat
i
on of post
sy
napt
i
c
membr
anesoft
heskel
et
al
muscl
es*
B.I
tst
i
mul
at
esMchol
i
nor
ecept
or
s
C.I
tbl
ocksMchol
i
nor
ecept
or
s
D.I
tcompet
i
t
i
v
el
ybl
ockst
heN-chol
i
nor
ecept
or
s
E.I
tdi
r
ect
l
yact
suponmy
of
i
br
i
l
s
23.I
ndi
cat
et
hesi
deef
f
ectofgangl
i
onbl
ocker
s:
A.I
ncr
easeofbl
oodpr
essur
e
B.I
nt
est
i
nal
at
onyandconst
i
pat
i
on*
C.Sal
i
v
at
i
on
D.I
r
r
i
t
at
i
ng i
nf
l
uence on t
he gast
r
i
c mucous
membr
ane
E.Di
ar
r
hea
24.Cur
ar
i
f
or
m subst
ancesi
nt
r
oducedi
nt
oahuman
bodycauset
her
el
axat
i
onofal
lskel
et
almuscl
es.
Whatchangesi
nt
heneur
omuscul
arsy
napsedoes
t
hi
sef
f
ectcause?2013
A.Depol
ar
i
zat
i
onoft
hepost
sy
napt
i
cmembr
ane
B.I
mpai
r
edacet
y
l
chol
i
ner
el
ease
C.Bl
ockade ofCa2+ channel
s oft
he pr
esy
napt
i
c
membr
ane
D. Bl
ockade of Nchol
i
ner
gi
c r
ecept
or
s of t
he
sy
napt
i
cmembr
ane*
E.I
mpai
r
edchol
i
nest
er
asesy
nt
hesi
s
25.Whi
ch dr
ug can be used t
o decr
ease bl
ood
pr
essur
e?
A.Cy
t
i
t
on
17.Whati
st
hemechani
sm oft
hei
ncr
easeofar
t
er
i
al
pr
essur
ebyni
cot
i
ne?
A.Di
r
ectst
i
mul
at
i
onofv
ascul
aradr
enor
ecept
or
s
B.St
i
mul
at
i
onofpar
asy
mpat
het
i
cgangl
i
ons
C.St
i
mul
at
i
onofmembr
aner
ecept
or
sof
13
B.Tubocur
ar
i
ne
C.Lobel
i
ne
D.At
r
opi
ne
E.Pent
ami
ne*
C.St
r
ophant
hi
n
D.Adr
enal
i
ne*
E.Nor
adr
enal
i
ne
6.Anaphy
l
act
i
cshockhasdev
el
oped i
n a pat
i
ent
af
t
er nov
ocai
n(
pr
ocai
ne) i
nj
ect
i
on. What agent
suppr
esseshi
st
ami
ner
el
easef
r
om mustcel
l
sand
el
i
mi
nat
esmai
nsy
mpt
omsofanaphy
l
act
i
cshock?
A.Ket
ot
i
f
en
B.Cr
omol
i
nnat
r
i
um
C.Adr
enal
i
ne*
D.Mesat
on
E.Nor
adr
enal
i
ne
7.A 26y
.
o.pat
i
enthasbr
onchi
alast
hmaat
t
acks
appear
i
ng usual
l
y at ni
ght accompany
i
ng wi
t
h
br
ady
car
di
a,spast
i
ci
nt
est
i
ne pai
n,and di
ar
r
hea.
Whatki
ndofagent
si
st
hemostappr
opr
i
at
ef
ort
hi
s
pat
i
ent
?
A.Mchol
i
nobl
ocker
s*
B.N-chol
i
nobl
ocker
s
C.Bet
aadr
enomi
met
i
cs
D.Sy
mpat
homi
met
i
cs
E.Met
hy
l
xant
hi
nes
8.Whi
choft
hef
ol
l
owi
ngdr
ugsst
i
mul
at
escent
r
al
pr
esy
napt
i
cal
pha2r
ecept
or
s?
A.Adr
enal
i
nehy
dr
ochl
or
i
de
B.Nor
adr
enal
i
nehy
dr
ot
ar
t
r
at
e
C.Mesat
one(
Pheny
l
ephr
i
ne)
D.Cl
ophel
i
ne*
E.Doxazosi
n
26.A 63y
.
o.mal
epat
i
entwi
t
hbl
adderat
onyhad
beenadmi
ni
st
er
edamedi
cat
i
onwhi
chhehadbeen
ar
bi
t
r
ar
i
l
yt
aki
ng at a hi
gher dose.The pat
i
ent
dev
el
oped hy
per
hy
dr
at
i
on, sal
i
v
at
i
on, di
ar
r
hea,
muscl
espasms.
Theadmi
ni
st
er
eddr
ugr
el
at
est
ot
hef
ol
l
owi
nggr
oup:
2016
A.Adr
ener
gi
cbl
ocker
s
B.Chol
i
nest
er
aser
eact
i
v
at
or
s
C.Gangl
i
oni
cbl
ocker
s
D.Tocol
y
t
i
cs
E.Chol
i
nomi
met
i
cs
3.
2.Adr
ener
gi
cAgent
s
3.
2.
1.Adr
enomi
met
i
cs
1. Di
ast
ol
i
c pr
essur
e i
s i
ncr
eased af
t
er t
he
admi
ni
st
r
at
i
onofwhi
choneoft
hef
ol
l
owi
ngdr
ugs?
A.Nor
adr
enal
i
ne
B.Sal
but
amol
C.I
sadr
i
ne
D.Or
ci
pr
enal
i
ne(
Al
upent
)
E.Ter
but
al
i
ne
2.Sy
st
ol
i
cpr
essur
ei
si
ncr
easedaf
t
ert
hei
nj
ect
i
onof
whi
choff
ol
l
owi
ngdr
ugs?
A.Nadol
ol
B.Dopami
ne*
C.Reser
pi
ne
D.Or
ni
d
E.Met
opr
ol
ol
3.Dopami
ne causes al
lbutone oft
he f
ol
l
owi
ng
act
i
ons?
A.I
nhi
bi
t
i
ngi
nf
l
uenceont
hemot
oneur
onsof
t
hespi
nal
chor
d
B.Di
l
at
esr
enal
v
ascul
at
ur
e
C.I
ncr
easesBP
D.I
ncr
easespr
oduct
i
onofur
i
ne
E.Decr
easescar
di
acout
put
*
4.Al
l
oft
hef
ol
l
owi
ngst
at
ement
sar
et
r
ueEXCEPT:
A.Amongt
hephy
si
ol
ogi
cr
esponsescausedbyal
pha
r
ecept
or st
i
mul
at
i
on ar
e v
asoconst
r
i
ct
i
on,
my
dr
i
asi
s,
anddecr
easedgast
r
oi
nt
est
i
nal
mot
i
l
i
t
y
.
B.Amongt
hephy
si
ol
ogi
cr
esponsescausedbybet
ar
ecept
or st
i
mul
at
i
on ar
ev
asodi
l
at
i
on,car
di
ac
st
i
mul
at
i
on,
andbr
onchi
al
r
el
axat
i
on.
C.Nor
adr
enal
i
nehasast
r
ongeraf
f
i
ni
t
yf
oral
phar
ecept
or
scompar
edt
obet
ar
ecept
or
s.
D.Admi
ni
st
r
at
i
onofat
r
opi
nepr
i
ort
onor
adr
enal
i
ne
l
eads t
o an i
ncr
ease i
n hear
tr
at
e af
t
er
nor
adr
enal
i
neadmi
ni
st
r
at
i
on.
E.Dobut
ami
nei
sapot
entv
asoconst
r
i
ct
or
*
5.A doct
ordi
agnosed hy
pogl
ycemi
c coma i
na
pat
i
ent wi
t
h di
abet
es mel
l
i
t
us and admi
ni
st
er
ed
gl
ucose sol
ut
i
on I
V.Pat
i
ent
’
s condi
t
i
on i
mpr
ov
ed.
Whi
chdr
ugcanbeusedaddi
t
i
onal
l
yasachemi
cal
ant
agoni
stofi
nsul
i
n?
A.Dopami
ne
B.Mesat
on
14
9.Thepat
i
enthasabr
upthy
pot
ensi
on.Whi
chdr
ug
t
hat st
i
mul
at
es adr
ener
gi
cr
ecept
or
s shoul
d be
i
nt
r
oducedt
onor
mal
i
zebl
oodpr
essur
e?
A.Met
opr
ol
ol
B.Mesat
on(
Pheny
l
ephr
i
ne)
*
C.Xy
l
omet
hazol
i
ne
D.Cl
ophel
i
ne
E.Doxazosi
n
10. A pat
i
ent has dev
el
oped br
onchospasmi
c
sy
ndr
ome.St
i
mul
at
or
s ofwhi
ch r
ecept
or
s wi
l
lbe
phy
si
ol
ogi
cal
l
yr
easonabl
ef
oremer
gencyt
r
eat
ment
?
A.al
pha1adr
enor
ecept
or
s
B.Dr
ecept
or
s
C.M1chol
i
nocept
or
s
D.al
phaandbet
aadr
enor
ecept
or
s
E.bet
a2adr
enor
ecept
or
s*
11 A 24 y
.
o.pat
i
enthasbr
onc
hi
alas
t
hma.Fort
he
t
r
eat
mentofas
t
hmaat
t
ac
kadoc
t
orhaspr
es
c
r
i
bed
sal
but
amol
.
Whati
st
hemec
hani
s
m ofc
ur
at
i
v
eac
t
i
onof
t
heagent
?
A.al
pha-andbet
ar
ecept
or
sst
i
mul
at
i
on
B.bet
a2adr
enor
ecept
or
sbl
ockade
C.bet
a2adr
enor
ecept
or
sst
i
mul
at
i
on*
D.bet
a1adr
enor
ecept
or
sbl
ockade
E.bet
a1adr
enor
ecept
or
sbl
ockade
R
12.Al
pha1r
ecept
oract
i
onsar
emedi
at
edt
hr
ough:
A.сAMP
B.сGMP
C.Ca2+ i
ons*
D.ADP
E.K+Channel
s
13.Wi
t
h exci
t
at
i
on of whi
ch r
ecept
or
s ar
et
he
f
ol
l
owi
ng ef
f
ect
s associ
at
ed – st
i
mul
at
i
on oft
he
hear
twor
k,i
ncr
easei
ncar
di
acout
putandHR,AV
conduct
i
on accel
er
at
i
on, i
ncr
ease i
n hear
t
aut
omat
i
sm?
A.M1-chol
i
nor
ecept
or
s
B.M2-chol
i
nor
ecept
or
s
C.bet
a1--adr
enor
ecept
or
s*
D.bet
a2-adr
enor
ecept
or
s
E.al
pha1--adr
enor
ecept
or
s
14.Wi
t
h exci
t
at
i
on of whi
ch r
ecept
or
s ar
et
he
f
ol
l
owi
ng ef
f
ect
s associ
at
ed – di
l
at
i
on ofbl
ood
v
essel
s,
decr
easeoft
oni
ci
t
yoft
hebr
onchi
al
muscl
es
andmy
omet
r
i
um,
st
i
mul
at
i
onofgl
y
cogenol
y
si
s?
A.al
pha1-adr
enor
ecept
or
s
B.al
pha2-adr
enor
ecept
or
s
C.bet
a1-adr
enor
ecept
or
s
D.bet
a2-adr
enor
ecept
or
s*
E.bet
a3-adr
enor
ecept
or
s
15.Anambul
ancewascal
l
edf
ora22y
.
o.pat
i
ent
wi
t
h st
at
us ast
hmat
i
cs.Whatr
out
e ofadr
enal
i
ne
admi
ni
st
r
at
i
onwi
l
lbet
hemostappr
opr
i
at
ei
nt
hi
s
case?R
A.I
nt
r
av
enous*
B.I
nhal
at
i
on
C.Subcut
aneous
D.Subl
i
ngual
E.I
nt
r
amuscul
ar
16.I
ndi
cat
et
he br
onchol
y
t
i
c agentwhi
ch act
i
on
mechani
sm i
ssel
ect
i
v
est
i
mul
at
i
onofbr
onchi
al2adr
enor
ecept
or
s:
A.At
r
opi
ne
B.Fenot
er
ol
*
C.Ami
nophy
l
l
i
ne(
Euphyl
l
i
ne)
D.I
sadr
i
ne
E.Adr
enal
i
ne
17.A 63 y
.
o.man wi
t
h col
l
apse sy
mpt
oms was
admi
t
t
edt
ot
heemer
gencyhospi
t
al
.Aphy
si
ci
anhas
chosennor
adr
enal
i
nagai
nsthy
pot
ensi
on.Whati
si
t
s
mechani
sm ofact
i
on?2012
A.Act
i
v
at
i
onofal
pha1adr
enor
ecept
or
s*
B.Act
i
v
at
i
onofser
ot
oni
nr
ecept
or
s
C.Act
i
v
at
i
onofdopami
ner
ecept
or
s
D.Bl
ockofMchol
i
nor
ecept
or
s
E.Act
i
v
at
i
onofbet
aadr
enor
ecept
or
s
18.Apat
i
enti
l
lwi
t
hbr
onchi
alast
hmadi
dn’
ti
nf
or
m
hi
sdoct
ort
hathehadat
t
acksofst
enocar
di
a.Doct
or
admi
ni
st
er
edhi
m amedi
cat
i
on,
whi
cht
aki
ngr
esul
t
ed
i
nl
ess f
r
equentat
t
acks ofbr
onchi
alast
hma,but
st
enocar
di
a at
t
acks became mor
ef
r
equent
.What
medi
cat
i
onwasadmi
ni
st
er
ed?
A.Sal
but
amol
B.Ami
nophy
l
l
i
ne
C.I
sadr
i
n*
D.Cr
omol
i
nsodi
um
E.Phenot
her
ol
19.Apat
i
entwi
t
hbr
onchi
alast
hmahasbeengi
v
en
0.
5%
sol
ut
i
on of i
sadr
i
n (
i
sopr
ot
er
enol
)
.
Br
onchospasm wasr
emov
ed,butt
hepat
i
entst
ar
t
ed
t
ocompl
ai
nofapai
ni
ncar
di
acar
ea.I
ti
sl
i
nkedt
o
st
i
mul
at
i
onof
:
A.Acet
y
l
chol
i
nesy
nt
hesi
s
B.al
pha1adr
enor
ecept
or
s
C.bet
a1-adr
enor
ecept
or
s
D.bet
a2-adr
enor
ecept
or
s
E.Mchol
i
nor
ecept
or
s
20.A 42 y
.
o.pat
i
enthas been suf
f
er
i
ng f
r
om
br
onchi
alast
hmaandt
achy
car
di
af
oral
ongt
i
me.
Admi
ni
st
er t
he opt
i
mal dr
ug f
or r
emov
i
ng of
br
onchospasm:
A.Adr
enal
i
ne
B.Ephedr
i
ne
C.Or
ci
pr
enal
i
ne
D.I
sadr
i
n
E.Sal
but
amol
*
21.Apat
i
enthasanaphy
l
ac
t
i
cs
hoc
k
.Nameadr
ugof
c
hoi
c
e.
A.Mesat
one(
Pheny
l
ephr
i
ne)
B.Adr
enal
i
ne
C.Ephedr
i
ne
D.Nor
adr
enal
i
ne
E.Fenot
er
ol
22.Tot
hepat
i
entwi
t
hanacut
er
hi
ni
t
i
s5% sol
ut
i
on
of ephedr
i
ne has been pr
escr
i
bed.Howev
er
,t
he
pat
i
enti
nst
i
l
l
edt
hedr
ugi
nt
henoseeach2030mi
n.
Becauseofdev
el
opmentt
achyphyl
axi
s,ef
f
ectoft
he
dr
ug shar
pl
y decr
eased. What mechani
sm of
under
l
i
esdev
el
opmentoft
hi
sphenomenon?
A. Depl
et
i
on of medi
at
or depot i
n pr
esy
napt
i
c
endi
ngs*
B.Act
i
v
at
i
onofadr
enor
ecept
or
s
C.Bl
ockadeofadr
enor
ecept
or
s
D.Mat
er
i
al
cumul
at
i
on
E.I
nduct
i
onofmi
cr
osomal
enzy
mesbyl
i
v
er
23.An opht
hal
mol
ogi
stwi
t
h di
agnost
i
c pur
pose
(
di
l
at
i
onoft
hepupi
lf
orey
ebot
t
om obser
v
at
i
on)has
used1% Mesat
on (
Phenyl
ephr
ene)sol
ut
i
on.Whi
ch
mechani
sm under
l
i
esmy
dr
i
asi
scausedbyt
heagent
?
A.Act
i
v
at
i
onofal
pha1adr
enor
ecept
or
s*
B.Act
i
v
at
i
onofal
pha2adr
enor
ecept
or
s
C.Bl
ockadeofbet
a1-adr
enor
ecept
or
s
D.Bl
ockadeofal
pha1-adr
enor
ecept
or
s
E.Act
i
v
at
i
onofMchol
i
nor
ecept
or
s
24.Chooset
hedr
ugwi
t
hf
ol
l
owi
ngchar
act
er
i
st
i
cs:a
sy
nt
het
i
ccat
echol
ami
ne,st
i
mul
at
esbot
h1-and2adr
enor
ecept
or
s,i
ncr
easescar
di
accont
r
act
i
l
i
t
yand
hear
tr
at
e,decr
easesdi
ast
ol
i
cAPandi
nhi
bi
tl
abor
act
i
v
i
t
y
. I
t i
s phar
macol
ogi
cal ant
agoni
st of
pr
opr
anol
ol
.
A.Sal
but
amol
B.Pi
l
ocar
pi
ne
C.I
pr
at
r
opi
um br
omi
de
D.Acecl
i
di
ne
E.I
sadr
i
ne*
25.Apat
i
enthasmar
keddr
oppi
ngofbl
oodpr
essur
e
dur
i
ng sur
gi
cal oper
at
i
on wi
t
h hy
gr
oni
um
admi
ni
st
r
at
i
on. Repr
esent
at
i
v
es
of whi
ch
phar
macol
ogi
calgr
oupcoul
dnor
mal
i
zeBPi
ngi
v
en
si
t
uat
i
on?
A.Nchol
i
nomi
met
i
cs
B.al
phaadr
enomi
met
i
cs*
C.bet
a1-adr
enobl
ocker
s
D.bet
a2-adr
enomi
met
i
cs
E.Mchol
i
nomi
met
i
cs
26.Af
t
ert
oot
hext
r
act
i
onpat
i
enthasdev
el
opedl
ocal
bl
eedi
ng.Adent
i
stappl
i
edspongewi
t
hamedi
ci
ne
15
andbl
eedi
ngsubsi
ded.Whatmedi
ci
nedi
dt
hedent
i
st
use?
A.I
sadr
i
ne
B.Sal
but
amol
C.Adr
enal
i
ne*
D.Pr
azosi
n
E.Ti
mol
ol
27.Acut
ear
t
er
i
alhy
pot
ensi
onhasdev
el
opedi
na
pat
i
entdue t
o oct
adi
ne (
guanet
hi
di
ne)over
dose.
Whi
chagentshoul
dbeusedt
onor
mal
i
zeAP?
A.Ephedr
i
ne
B.Nor
adr
enal
i
ne*
C.Caf
f
ei
ne
D.Cor
di
ami
n(
Ni
ket
hami
de)
E.Dopami
ne
28.Apat
i
entwi
t
hchr
oni
cbr
onchi
t
i
shasbeent
aki
ng
wi
t
hephedr
i
nef
oral
ongt
i
me.Whati
st
hedr
ug’
s
act
i
onmechani
sm?
A.St
i
mul
at
i
on ofnor
adr
enal
i
ner
el
eas
ei
nt
os
y
napt
i
c
c
l
ef
t
*
B.Bl
ockadeofnor
adr
enal
i
ner
el
easei
nt
osy
napt
i
c
cl
ef
t
C.St
i
mul
at
i
onofal
phaadr
enor
ecept
or
s
D.Bl
ockadeofbet
aadr
enor
ecept
or
s
E.Di
r
ectspasmol
y
t
i
cact
i
on
31.Mesat
on (
Phenyl
ephr
i
ne)was i
nt
r
oduced t
oa
pat
i
entwi
t
hcol
l
apsef
orBPcor
r
ect
i
on.Whati
st
he
mechani
sm ofact
i
onoft
hedr
ug?
A.Act
i
v
at
i
onofMchol
i
nor
ecept
or
s
B.Act
i
v
at
i
onofal
pha2adr
enor
ecept
or
s
C.Bl
ockadeofbet
a1-adr
enor
ecept
or
s
D.Bl
ockadeofal
pha1-adr
enor
ecept
or
s
E.Act
i
v
at
i
onofal
pha1adr
enor
ecept
or
s*
B.Act
i
v
at
i
onofal
pha2adr
enor
ecept
or
s
C.Bl
ockadeofal
pha1-adr
enor
ecept
or
s
D.Bl
ockadeofbet
a1-adr
enor
ecept
or
s
E.Act
i
v
at
i
onofbet
a2adr
enor
ecept
or
s*
34.A12y
.
o.chi
l
dhasav
i
r
al
i
nf
ect
i
oncompl
i
cat
edby
obst
r
uct
i
v
e br
onchi
t
i
s. Br
onchospasm can be
el
i
mi
nat
edbyi
nhal
at
i
onofadr
ugf
r
om t
hef
ol
l
owi
ng
2013
phar
macol
ogi
cal
gr
oup:
A.Anal
ept
i
cs
B.Mant
i
chol
i
ner
gi
cs
C.Nchol
i
nomi
met
i
cs
D.bet
a1-adr
ener
gi
cbl
ocker
s
E.bet
a2-agoni
st
s*
35.Apat
i
entwi
t
hbr
onchi
alast
hmahadbeent
aki
ng
or
al
l
yanagent
,whi
chcausedi
nsomni
a,headache,
i
ncr
eased AP. What medi
ci
ne can cause such
compl
i
cat
i
on?
A.Ephedr
i
ne*
B.I
sadr
i
n
C.Pr
az
osi
n
D.Adr
enal
i
ne
E.Dopami
ne
36.Apat
i
entwi
t
hbr
onchi
alast
hmahasbeengi
v
en
0.
5% sol
ut
i
on of i
sadr
i
num (
i
sopr
ot
er
enol
)
.
Br
onchospasm wasr
emov
ed,butt
hepat
i
entst
ar
t
ed
t
ocompl
ai
nonapai
ni
ncar
di
acar
ea.Whati
st
he
r
eason?
A.I
nhi
bi
t
i
onofacet
y
l
chol
i
nesy
nt
hesi
s
B.Act
i
v
at
i
onofal
pha1adr
enor
ecept
or
s
C.St
i
mul
at
i
onofbet
a1-adr
enor
ecept
or
s
D.St
i
mul
at
i
onbet
a2-adr
enor
ecept
or
s
E.Act
i
v
at
i
onofMchol
i
nor
ecept
or
s
37.Ambul
ancehasbeen cal
l
ed t
o a 22y
.
o.man
becauseofbr
onchi
alast
hmaat
t
ack.Whatwayof
adr
enal
i
neadmi
ni
st
r
at
i
oni
st
hemostappr
opr
i
at
ei
n
t
hi
scase?
A.I
nt
r
av
enous*
B.I
nt
r
amuscul
ar
C.I
nhal
at
i
on
D.Subcut
aneous
E.Subl
i
ngual
38.A 63y
.
o.pat
i
entwi
t
hcol
l
apsesy
mpt
omswas
admi
t
t
edt
ot
heemer
gencyhospi
t
al
.Aphy
si
ci
anhas
chosen nor
adr
enal
i
nf
orhy
pot
ensi
on.Whati
si
t
s
mechani
sm ofact
i
on?
A.Act
i
v
at
i
onofal
pha1-adr
enor
ecept
or
s*
B.Act
i
v
at
i
onofser
ot
oni
nr
ecept
or
s
C.Act
i
v
at
i
onofdopami
ner
ecept
or
s
D.Bl
ockofMchol
i
nor
ecept
or
s
E.Act
i
v
at
i
onofbet
a–adr
enor
ecept
or
s
32.Col
l
aps
ehasdev
el
opedi
napat
i
entduet
odec
r
eas
e
i
n per
i
pher
alv
es
s
el
st
one.Whi
c
h agents
houl
d be
admi
ni
s
t
er
ed?
A.Met
opr
ol
ol
B.Mesat
on(
Pheny
l
ephr
i
ne)*
C.Xy
l
omet
hazol
i
ne
D.Pr
oser
i
ne(
Neost
i
gmi
ne)
E.Pr
azosi
n
39.Dur
i
ngl
ocalanest
het
i
zat
i
ont
hepat
i
enthasgone
i
nt
o anaphy
l
act
i
c shock. What dr
ug must be
admi
ni
st
er
edt
ot
hepat
i
ent
?
A.Pr
opr
anol
ol
B.At
r
opi
nesul
f
at
e
C.Ni
t
r
ogl
y
cer
i
ne
D.Epi
nephr
i
nehy
dr
ochl
or
i
de*
E.Di
az
epam
33.Fenot
er
olwasi
nt
r
oducedt
oa32y
.
o.pr
egnant
woman wi
t
h t
hr
eat
ened abor
t
i
on. I
ndi
cat
e i
t
s
mechani
smofact
i
on:
A.Act
i
v
at
i
onofMchol
i
nor
ecept
or
s
40.
29.I
ndi
cat
et
he st
at
e whi
ch r
equi
r
es ephedr
i
ne
i
nt
r
oduct
i
on:
A.Tachy
car
di
a
B.I
nsomni
a
C.Caf
f
ei
nepoi
soni
ng
D.Ar
t
er
i
al
hy
pot
ensi
on*
E.Ar
t
er
i
al
hy
per
t
ensi
on
30.A pat
i
entwi
t
hobst
r
uct
i
v
ebr
onchi
t
i
shasbeen
t
aki
ng ephedr
i
ne f
ora l
ong t
i
me wi
t
houtdoct
or
’
s
cont
r
ol
.Whatsi
de ef
f
ectcan be obser
v
ed i
nt
he
pat
i
ent
?
A.Apat
hy
B.Sl
eepi
ness
C.Exci
t
at
i
onoft
heCNS*
D.Br
ady
car
di
a
E.Hy
pot
ensi
on
A.
B.
16
C.
D.*
E.
hav
emedi
at
ort
y
peofact
i
on,decr
easet
hest
r
engt
h
ofhear
tcont
r
act
i
onsandHR,i
nhi
bi
taut
omat
i
sm of
my
ocar
di
um,
i
ncr
easeper
i
pher
alv
ascul
arr
esi
st
ance.
Thedr
ugsar
eusedt
ot
r
eatangi
napect
or
i
s,car
di
ac
ar
r
hy
t
hmi
as,ar
t
er
i
alhy
per
t
ensi
on.Thei
rmai
n si
de
ef
f
ect
s ar
e br
onchospasm, di
sor
der
s of AV
conduct
i
on,i
nhi
bi
t
i
onofcont
r
act
i
l
ef
unct
i
onoft
he
my
ocar
di
um.
A.al
phaadr
enomi
met
i
cks
B.al
phaadr
enobl
ocker
s
C.det
a1adr
enomi
met
i
cks
D.bet
a2adr
enomi
met
i
cks
E.bet
aadr
enobl
ocker
s*
40.
3.
2.
2.Adr
enobl
ocker
s
1.A pat
i
ent 50 y
.
o.wi
t
h compl
ai
nt
s of hear
t
pal
pi
t
at
i
on,pai
ni
nt
hehear
tar
ea,headache,v
er
t
i
go
wasdel
i
v
er
edt
oahospi
t
al
.Dur
i
ngt
heexami
nat
i
on
angi
na pect
or
i
s,car
di
ac ar
r
hy
t
hmi
a(
par
oxy
smal
t
achy
car
di
a, at
r
i
um f
i
br
i
l
l
at
i
on) and ar
t
er
i
al
hy
per
t
ensi
on(
180/
90mm Hg)wer
er
ev
eal
ed.Make
t
her
at
i
onal
choi
ceoft
hedr
ugi
nt
hi
ssi
t
uat
i
on.
A.Pr
opr
anol
ol
(
Anapr
i
l
i
ne)*
B.Epi
nephr
i
ne
C.Ephedr
i
ne
D.Neost
i
gmi
ne
E.Reser
pi
ne
2.A 60 y
.
o.ast
hmat
i
c man compl
ai
ns ofsome
di
f
f
i
cul
t
yi
n«
st
ar
t
i
ngt
our
i
nat
e»
.Hehasasl
i
ght
l
y
enl
ar
gedpr
ost
at
e.BP160/
100mm Hg.
.Whi
choft
he
f
ol
l
owi
ngagent
sshoul
dbeadmi
ni
st
er
ed?
A.Phent
ol
ami
ne
B.Reser
pi
ne
C.Ephedr
i
ne
D.Doxazosi
n*
E.Pr
opr
anol
ol
8.Amal
epat
i
entwhohasbeen‘
sur
f
i
ngt
heWeb’i
n
sear
ch ofan aphr
odi
si
ac orsome ot
heragentt
o
enhance’
sex
ualper
f
or
mance’
di
scov
er
sy
ohi
mbi
ne.He
consumest
hedr
ugi
nex
cessanddev
el
opssy
mpt
oms
oft
ox
i
ci
t
yt
hatr
equi
r
ey
ouri
nt
er
v
ent
i
on.Youconsul
t
y
ourdr
ug r
ef
er
ence and l
ear
nt
haty
ohi
mbi
ne i
sa
sel
ect
i
v
e α2adr
ener
gi
c ant
agoni
st
.Whatwoul
dy
ou
ex
pectasar
es
ponset
ot
hi
sdr
ug?
A.Tachy
car
di
a
B.Br
ady
car
di
a
C.Reducedcar
di
acout
putf
r
om r
educedl
ef
t
v
ent
r
i
cul
arcont
r
act
i
l
i
t
y
D.Hy
per
t
ensi
on*
E.Br
onchoconst
r
i
ct
i
on
9.Al
lt
hef
ol
l
owi
ngdr
ugsar
eusedt
opi
cal
l
yi
nt
he
t
r
eat
mentofchr
oni
c wi
deangl
e gl
aucoma.Whi
ch
oner
educesi
nt
r
aocul
arpr
essur
ebydecr
easi
ngt
he
f
or
mat
i
onoft
heaqueoushumor
?
A.Ti
mol
ol
*
B.Pi
l
ocar
pi
ne
C.Phy
sost
i
gmi
ne
D.Neost
i
gmi
ne
E.Acecl
i
di
ne
10. A 40 y
.
o. pat
i
ent compl
ai
nt
s of i
nt
ensi
v
e
hear
t
beat
s,
sweat
i
ng,
nausea,
v
i
si
oni
mpai
r
ment
,
ar
m
t
r
emor
,hy
per
t
ensi
on.Fr
om hi
sanamnesi
s:2y
ear
s
ago he was di
agnosed wi
t
h pheochr
omocyt
oma.
Whathy
pot
ensi
v
eagentshoul
dbeadmi
ni
st
er
ed?
A.Capt
opr
i
l
B.Pr
azosi
n*
C.Dr
ot
av
er
i
ne
D.Ni
f
edi
pi
ne
E.Pl
at
y
phy
l
l
i
n
12.Thedr
ugf
r
om t
hegr
oupofbet
aadr
enobl
ocker
s
has been admi
ni
st
er
ed t
o 47 y
.
o.pat
i
entf
ort
he
t
r
eat
mentofi
schemi
chear
tdi
sease.Whenar
eβadr
enobl
ocker
sabsol
ut
el
ycont
r
ai
ndi
cat
ed?
A.Ar
t
er
i
al
hy
per
t
ensi
on
B.Br
onchi
al
ast
hma*
C.Hy
per
t
r
ophi
ccar
di
omy
opat
hy
D.Thy
r
ot
oxi
cosi
s
E.Hi
st
or
yofmy
ocar
di
al
i
nf
ar
ct
i
on
3.A35y
.
o.mal
ewor
keri
sbr
oughtt
ot
heemer
gency
r
oom.HR150/
mi
n,BP180/
100mm Hg.Whi
chdr
ug
shoul
dbeadmi
ni
st
er
ed?
A.Neost
i
gmi
ne
B.Phent
ol
ami
ne
C.At
r
opi
ne
D.Pr
opr
anol
ol
*
E.Pr
azosi
n
4.A 38 y
.
o.f
emal
e has t
aken unknown dr
ug t
o
decr
easehi
ghBP.Af
t
eri
t
sadmi
ni
st
r
at
i
onsy
st
ol
i
c
pr
essur
edecr
easedbutt
achy
car
di
aappear
ed.What
dr
ughadbeenadmi
ni
st
er
ed?
A.At
enol
ol
B.Reser
pi
ne
C.Phent
ol
ami
ne*
D.Pr
opr
anol
ol
E.Pr
azosi
n
5.A pat
i
ent wi
t
h hy
per
t
ensi
on i
sr
egi
st
er
ed at
pr
ophy
l
act
i
c cent
er
.He has concomi
t
antdi
sease
br
onchi
alast
hma.Hei
st
oadmi
ni
st
erabet
abl
ocker
.
Whatdr
ugwi
l
l
y
ouchoose?
A.Ti
mol
ol
B.Met
opr
ol
ol
*
C.Sal
but
amol
D.Reser
pi
ne
E.Pr
opr
anol
ol
(
Anapr
i
l
i
ne)
6.Bet
abl
oc
k
erwi
t
ht
hel
eas
tent
r
yc
r
os
sbl
oodbr
ai
n
bar
r
i
er
:
A.Pr
opr
anol
ol
(
Anapr
i
l
i
ne)
B.Car
v
edi
ol
C.Nadol
ol
*
D.Ti
mol
ol
E.Oxpr
enol
ol
13.A 64y
.
o.womanwi
t
ht
ox
i
cgoi
t
erc
ompl
ai
nsof
per
manent pal
pi
t
at
i
on. Whi
c
h agent s
houl
d be
admi
ni
s
t
er
ed?
A.I
sadr
i
n
B.Sal
but
amol
C.Pent
ami
ne
D.Pr
opr
anol
ol
(
Anapr
i
l
i
ne)
*
7.Det
er
mi
net
hephar
macol
ogi
cgr
oupofdr
ugs.They
17
E.Fenot
er
ol
adr
enobl
ocker
s:
A.Gl
aucoma
B.I
nt
est
i
nal
at
ony
C.Ar
t
er
i
al
hy
per
t
ensi
on*
D.I
nt
est
i
nal
at
ony
E.Br
onchi
al
ast
hma
14. The pat
i
ent suf
f
er
i
ng f
r
om i
di
opat
hi
c
hy
per
t
ensi
on had been admi
ni
st
er
ed t
he compl
ex
t
r
eat
ment
.Lat
erhebegant
ocompl
ai
nofpai
nsi
nt
he
epi
gast
r
i
cr
egi
on,di
ar
r
hea,hear
t
bur
n.Whi
chagent
coul
dpr
ov
oket
hel
i
st
edadv
er
seef
f
ect
si
nt
hepat
i
ent
?
A.bet
aAdr
enobl
ocker
s(
Anapr
i
l
i
ne)
B.Gangl
i
obl
ocker
s(
Pent
ami
ne)
C.Sy
mpat
hol
y
t
i
cs(
Reser
pi
ne)
*
)
D.aal
pha1-adr
enobl
ocker
s(
Pr
azosi
n)
E.Spasmol
y
t
i
cs(
Papaver
i
ne)
21.I
ndi
cat
et
hemechani
sm ofact
i
onofpr
azosi
n:
A. Bl
ockade of al
pha- and bet
aadr
enor
ecept
or
s
B.Bl
ockadeofal
phaadr
enor
ecept
or
s
C.Bl
ockadeofal
pha1adr
enor
ecept
or
s*
D. Bl
ockade of al
pha1- and al
pha2adr
enor
ecept
or
s
E.Bl
ockadeofbet
a1adr
enor
ecept
or
s
15.A pat
i
entsuf
f
er
i
ngf
r
om hy
per
t
ensi
onhadt
he
accompany
i
ng di
seases:cor
onar
y hear
t di
sease,
at
r
i
um f
i
br
i
l
l
at
i
on,chr
oni
cbr
onchi
t
i
s.Thephy
si
ci
an
hasdeci
dest
ouseanagentf
r
om t
hegr
oupofadr
enobl
ocker
s.Whi
chagentshoul
dbeused?
A.Ti
mol
ol
B.Anapr
i
l
i
ne
C.Met
opr
ol
ol
*
D.Reser
pi
ne
E.Cl
ophel
i
ne(
Cl
oni
di
ne)
22.I
ndi
cat
et
hemechani
sm ofact
i
onofanapr
i
l
i
ne:
A.Bl
ockadeofal
pha1adr
enor
ecept
or
s
B.Bl
ockadeofbet
a1adr
enor
ecept
or
s
C.Bl
ockadeofbet
a1-andbet
a2adr
enor
ecept
or
s*
D.Bl
ockadeofal
pha-andbet
aadr
enor
ecept
or
s
E.Bl
ockadeofbet
a2adr
enor
ecept
or
s
23.I
ndi
cat
et
hemechani
sm ofact
i
onofmet
opr
ol
ol
:
A.Bl
ockadeofal
pha1adr
enor
ecept
or
s
B.Bl
ockadeofbet
a1adr
enor
ecept
or
s*
C. Bl
ockade of bet
a1- and bet
a2adr
enor
ecept
or
s
D. Bl
ockade of al
pha- and bet
aadr
enor
ecept
or
s
E.Bl
ockadeofbet
a2adr
enor
ecept
or
s
16.A pat
i
entwhohadbeensuf
f
er
i
ngf
r
om ar
t
er
i
al
hy
per
t
ensi
on was t
r
eat
ed wi
t
h an agent whi
ch
mechani
sm ofact
i
oni
sconnect
edwi
t
hexhaust
i
onof
nor
epi
nephr
i
necont
enti
nsy
mpat
het
i
cner
v
eendi
ng.
I
ndi
cat
et
hi
sagent
:
A.Cl
ophel
i
ne(
Cl
oni
di
ne)
B.Anapr
i
l
i
ne
C.Pr
azosi
n
D.Met
opr
ol
ol
E.Reser
pi
ne*
24.I
ndi
cat
et
hecl
i
ni
cal
usef
orbet
aadr
enobl
ocker
s:
A.Ar
t
er
i
al
hy
pot
ensi
on
B.Ar
t
er
i
al
hy
per
t
ensi
on*
C.Br
onchi
al
ast
hma
D.At
r
i
ov
ent
r
i
cul
arbl
ockade
E.Obl
i
t
er
at
i
ngendar
t
er
i
t
i
s
17.El
ongat
i
onofPQi
nt
er
v
alwasr
ev
eal
edonECG.
I
ndi
cat
et
hedr
ug,
whi
chcancauset
hi
sef
f
ect
:
A.Pr
azosi
n
B.At
enol
ol
*
C.Reser
pi
ne
D.Oct
adi
ne(
Guanet
hi
di
ne)
E.Phent
ol
ami
ne
25.I
ndi
cat
et
he pr
i
nci
pl
e oft
he sy
mpat
hol
y
t
i
cs’
act
i
on:
A.Bl
ockadeofal
phaadr
enor
ecept
or
s
B.Bl
ockadeofexci
t
at
i
ont
r
ansmi
ssi
onont
hel
ev
elof
t
headr
ener
gi
cner
v
eendi
ngs*
C.Act
i
v
at
i
on of exci
t
at
i
on on t
he l
ev
elof t
he
adr
ener
gi
cner
v
eendi
ngs
D.Bl
ockadeofal
pha-andbet
aadr
enor
ecept
or
s
E.I
nhi
bi
t
i
onoft
heenzy
meswhi
chdest
r
oyadr
enal
i
ne
18.A pat
i
entsuf
f
er
i
ngf
r
om hy
per
t
ensi
onhadt
he
accompany
i
ng di
seases:cor
onar
y hear
t di
sease,
at
r
i
um f
i
br
i
l
l
at
i
on,chr
oni
cbr
onchi
t
i
s.Thephy
si
ci
an
hasdeci
dest
ouseanagentf
r
om t
hegr
oupofadr
enobl
ocker
s.Whi
chagentshoul
dbeused?
A.Ti
mol
ol
B.Anapr
i
l
i
ne
C.Met
opr
ol
ol
*
D.Reser
pi
ne
E.Cl
ophel
i
ne(
Cl
oni
di
ne)
26.I
ndi
cat
et
hephar
macol
ogi
cal
ef
f
ect
sofr
eser
pi
ne:
A.Reduct
i
oni
nt
hegast
r
i
cj
ui
cesecr
et
i
on
B.Exci
t
at
i
onoft
heCNS
C.Di
ar
r
hea
D.I
ncr
easei
nt
hegast
r
oi
nt
est
i
nal
mot
i
l
i
t
y
E.Decr
easeoft
hear
t
er
i
al
pr
essur
eand
br
ady
car
di
a*
27.A 60y
.
o.mal
epat
i
enthasa9y
earhi
st
or
yof
di
abet
es and t
akes i
nsul
i
n Semi
l
ent
e f
or t
he
cor
r
ect
i
onofhy
per
gl
y
cemi
a.10day
sagohebegan
t
aki
ng anapr
i
l
i
ne f
orhy
per
t
ensi
on.One houraf
t
er
admi
ni
st
r
at
i
on of t
he ant
i
hy
per
t
ensi
v
e dr
ug t
he
pat
i
entdev
el
opedhy
pogl
y
cemi
ccoma.Whati
st
he
mechani
sm ofhy
pogl
y
cemi
ai
n caseofanapr
i
l
i
ne
use?2013
A.Decr
easei
ngl
ucoseabsor
pt
i
on
B.I
ncr
easei
nbi
oav
ai
l
abi
l
i
t
yofi
nsul
i
n
19.A pat
i
entwhohasbeensuf
f
er
i
ngf
r
om sev
er
e
f
or
m ofar
t
er
i
alhy
per
t
ensi
on was di
agnosed wi
t
h
pheochr
omocy
t
oma(
t
umorofadr
enalmedul
l
awhi
ch
i
s accompani
ed by i
ncr
eased sy
nt
hesi
s of
epi
nephr
i
ne)
.I
ndi
cat
et
he dr
ug gr
oup t
ot
r
eatt
he
pat
i
entbef
or
esur
gi
cal
t
r
eat
ment
:
A.al
phaadr
enobl
ocker
s*
B.Al
phaadr
enomi
met
i
cks
C.Gangl
i
obl
ocker
s
D.Sy
mpat
homi
met
i
cs
E.bet
aadr
enobl
ocker
s
20.I
ndi
cat
et
hecl
i
ni
calappl
i
cat
i
onf
oruseofal
pha18
Semi
l
ent
e
C.I
ncr
easei
ni
nsul
i
nSemi
l
ent
ehal
f
l
i
f
e
D.I
nhi
bi
t
i
onofgl
y
cogenol
y
si
s*
E.Reduct
i
onofgl
ucagonhal
f
l
i
f
e
28.Apat
i
entwi
t
har
t
er
i
al
hy
per
t
ens
i
onhasbeent
r
e
at
i
ng
wi
t
hr
es
er
pi
nef
oral
ongper
i
odoft
i
me.
23week
sagohe
dev
el
opeds
t
omac
hac
he,
hear
t
bur
n,
naus
ea.I
ndi
c
at
et
he
gr
oup ofdr
ugs whi
c
hi
s abl
et
o ant
agoni
z
et
hes
e
s
y
mpt
oms
?
A.Mchol
i
nobl
ocker
s*
B.
Ast
r
i
ngentdr
ugs
C.Ant
aci
ds
D.Pr
ot
onpumpi
nhi
bi
t
or
s
E.H2hi
st
ami
nobl
ocker
s
B.Act
i
v
at
i
ngant
i
t
hr
ombi
nI
I
I
,
i
nhi
bi
t
i
ngt
hr
ombi
n
C.Bl
oc
k
i
ngpl
a
t
e
l
e
taggr
e
gat
i
onbypr
e
v
e
nt
i
ngbr
i
dgi
ng
be
t
we
e
n gl
y
copr
ot
ei
n I
I
b/
I
I
I
a r
ecept
or
s on
nei
ghbour
i
ngpl
at
el
et
s
D.I
nhi
bi
t
i
ng hepat
i
cv
i
t
ami
n Kdependentcl
ot
t
i
ng
f
act
orsy
nt
hesi
s
E.Pr
ev
ent
i
ngpl
at
el
etaggr
egat
i
onbyi
nhi
bi
t
i
ng
t
hr
omboxaneA2sy
nt
hesi
s*
5.Aspi
r
i
n causes si
gni
f
i
cantbr
onchospasm and
br
onchospasm i
n pat
i
ent
s who ar
e subsequent
l
y
descr
i
bedas‘
aspi
r
i
nsensi
t
i
v
e’
.Whi
chmechani
sm i
s
i
nv
ol
v
ed?
A.Bl
ockedepi
nephr
i
nebi
ndi
ngt
obet
a2r
ecept
or
son
ai
r
waysmoot
hmuscl
ecel
l
s
B.Dr
ugmedi
at
edhy
per
sensi
t
i
v
i
t
yofH1 r
ecept
or
son
ai
r
waysmoot
hmuscl
es
C.I
nhi
bi
t
edsy
nt
hesi
sofendogenousPGst
hathav
e
br
onchodi
l
at
oract
i
v
i
t
y*
D. Dr
ugmedi
at
ed hy
per
sensi
t
i
v
i
t
y of muscar
i
ni
c
r
ecept
or
sonai
r
waysmoot
hmuscl
ecel
l
s
E.Enhancedf
or
mat
i
onofant
i
bodi
esdi
r
ect
edagai
nst
t
hesal
i
cy
l
at
eonai
r
waymastcel
l
s
29.Whi
c
h dr
ug i
nt
er
f
er
es wi
t
ht
he c
y
c
l
oox
y
genas
e
pat
hwayofpr
os
t
agl
andi
nss
y
nt
hes
i
sbynons
el
ec
t
i
v
el
y
i
nhi
bi
t
i
ngbot
hCOX1andCOX2?
A.Mel
oxi
cam
B.Cel
ecoxi
b
C.Par
acet
amol
e
D.I
ndomet
haci
n*
E.Nal
t
r
exone
3
6Whi
chsy
mpt
om woul
dbesuggest
i
v
et
hatpl
asma
l
ev
el
s ofaspi
r
i
n ar
e get
t
i
ng t
oo hi
gh – supr
at
her
apeut
i
c?
A.Const
i
pat
i
on
B.Cough
C.Ti
nni
t
us*
D.My
opi
a
E.Hy
per
t
ensi
on
7.A pat
i
entt
akesanacut
e,massi
v
eov
er
doseof
aspi
r
i
n, whi
ch may be f
at
al wi
t
hout pr
oper
i
nt
er
v
ent
i
on.Whi
choft
hef
ol
l
owi
ngcondi
t
i
onswoul
d
y
ouexpecti
nt
headv
anced(
l
at
e)st
agesofaspi
r
i
n?
A.Met
abol
i
cal
kal
osi
s
B.Respi
r
at
or
yal
kal
osi
s
C.Respi
r
at
or
yal
kal
osi
s+met
abol
i
caci
dosi
s*
D.Hy
pot
her
mi
a
E.Vent
i
l
at
or
yst
i
mul
at
i
on
8.I
naddi
t
i
ont
opr
ov
i
di
ngsy
mpt
omat
i
c,suppor
t
i
v
e
car
e,whi
choft
hef
ol
l
owi
ngdr
ugswoul
dbeahel
pf
ul
adj
unctt
omanagesev
er
easpi
r
i
npoi
soni
ng?
A.Acet
ami
nophen
B.Acet
y
l
cy
st
ei
ne
C.Di
azepam
D.Sodi
um bi
car
bonat
e*
E.Uni
t
hi
ol
9.I
naddi
t
i
ont
opr
ov
i
di
ngsy
mpt
omat
i
c,suppor
t
i
v
e
car
e,whi
choft
hef
ol
l
owi
ngdr
ugswoul
dbeahel
pf
ul
adj
unct t
o manage sev
er
e Par
acet
amol
(
Acet
ami
nophen)poi
soni
ng?
A.Nal
oxone
B.Acet
y
l
cy
st
ei
ne*
C.Di
azepam
D.Sodi
um bi
car
bonat
e
E.Uni
t
hi
ol
10.Whi
choft
hef
ol
l
owi
ngcondi
t
i
onsi
st
hepr
i
mar
y
cause of deat
h f
r
om massi
v
e Par
acet
amol
(
Acet
ami
nophen)over
doses?
A.Acut
enephr
opat
hy
B.St
at
usepi
l
ept
i
cus
4.TheAgent
sAf
f
ect
i
ngt
heCNS
4.
1Nonopi
oi
dAnal
gesi
cs
1.A58y
.
o.pat
i
entwi
t
har
t
hr
i
t
i
scompl
ai
nsofnausea,
di
st
r
essi
nepi
gast
r
i
um dur
i
ngt
r
eat
mentwi
t
haspi
r
i
n.
Thedoct
orhascancel
l
edi
tandpr
escr
i
bedaNSAI
D
f
r
om t
he gr
oup of sel
ect
i
v
e cy
cl
ooxy
genase2
i
nhi
bi
t
or
s.I
ndi
cat
ei
t
:
A.Anal
gi
n(
Met
ami
zol
e)
B.But
adi
on(
Phenyl
but
azone)
C.Tr
amadol
e
D.I
ndomet
haci
n
E.Mel
oxi
cam*
2.Whi
c
h dr
ug i
nt
er
f
er
es wi
t
ht
he c
y
c
l
oox
y
ge
nas
e
pat
hwayofpr
os
t
agl
andi
nss
y
nt
hes
i
sbynons
el
ec
t
i
v
el
y
i
nhi
bi
t
i
ngbot
hCOX1andCOX2?
A.Mel
oxi
cam
B.Cel
ecoxi
b
C.Nal
oxone
D.Di
cl
of
enacnat
r
i
um *
E.Nal
t
r
exone
3.Whi
choft
hef
ol
l
owi
ngaspi
r
i
nef
f
ect
si
sexpect
ed
i
nusual
t
her
apeut
i
cdoses?
A.I
nhi
bi
t
edgr
owt
hofbact
er
i
at
hatcausef
ev
er
asasy
mpt
om ofi
nf
ect
i
on
B.I
nhi
bi
t
i
onofur
i
caci
dsy
nt
hesi
s
C. Pr
ot
ect
i
on agai
nst br
onchospasm i
n
ast
hmat
i
cs
D.Ef
f
i
cacygr
eat
ert
hanpar
acet
amol
easant
i
i
nf
l
ammat
or
yagent*
E.Ef
f
i
cacyl
esst
hanacet
ami
nophenf
orr
el
i
ev
i
ng
si
mpl
eheadache
4.Whi
ch of t
he f
ol
l
owi
ng aspi
r
i
n desi
r
ed (
and
somet
i
mesunwant
ed)ef
f
ect
sonbl
oodcl
ot
t
i
ngi
s
i
nv
ol
v
ed?
A.Bl
ocki
ngpl
at
el
etr
ecept
or
sf
orADP
19
C.St
at
usast
hmat
i
cus
D.AVconduct
i
ondi
st
ur
bances
E.Li
v
erf
ai
l
ur
e*
*
17.Pai
ni
nt
hebackdev
el
opedaf
t
ert
hel
i
f
t
i
ngof
heav
y l
oads, and l
umbosacr
al r
adi
cul
i
t
i
s was
di
agnosed.I
ti
sknownf
r
om t
heanamnesi
st
hata
pat
i
entwassuf
f
er
i
ngf
r
om ul
ceroft
heduodenum f
or
al
ongper
i
odoft
i
me.Maket
her
at
i
onalchoi
ceof
NSAI
D:
A.But
adi
on
B.Di
cl
of
enacsodi
um
C.I
ndomet
haci
n
D.Mel
oxi
cam *
E.Aspi
r
i
n
How
do Met
hot
r
exat
e, gol
d sal
t
s,
Hydr
oxychl
or
oqui
ne (
Pl
aqueni
l
)
, or Peni
ci
l
l
ami
ne
di
f
f
erf
r
om ‘
t
r
adi
t
i
onal
’
NSAI
DsasDi
cl
of
enacnat
r
i
um
orI
ndomet
haci
ni
nt
hecont
extofmanagi
ngar
t
hr
i
t
i
c
11.
i
nf
l
ammat
or
ydi
sease?
A.Act
i
v
at
et
hei
mmunesy
st
em r
esponses
B.Ar
er
emar
kabl
yf
r
eef
r
om ser
i
oust
oxi
ci
t
i
es
C.Ar
e pr
i
mar
yt
her
api
es f
orhy
per
ur
i
cemi
a,gout
,
gout
yar
t
hr
i
t
i
s
D.Pr
ov
i
demuchqui
ckerr
el
i
efofar
t
hr
i
t
i
ssy
mpt
oms
E.Sl
ow st
op,possi
bl
yr
ev
er
se j
oi
ntpat
hol
ogy i
n
r
heumat
oi
dar
t
hr
i
t
i
s*
18.Gum bl
eedi
ngar
osei
nt
hepat
i
entaf
t
erext
r
act
i
on
oft
het
oot
h.I
twasr
ev
eal
edf
r
om anamnesi
st
hatt
he
pat
i
enti
ssuf
f
er
i
ng f
r
om r
heumat
oi
d ar
t
hr
i
t
i
s,and
wast
r
eat
edwi
t
haspi
r
i
n.I
ndi
cat
et
her
easonofar
i
sen
bl
eedi
ng:
A.Suppr
essi
onofsy
nt
hesi
sofur
i
caci
d
B.Pr
omot
i
onoft
hr
ombol
y
si
s
C.I
nhi
bi
t
i
onofhaemopoi
esi
s
D.Decr
easi
ngofbl
oodcoagul
at
i
on
E.Suppr
essi
onoft
hr
omboxanesy
nt
hesi
s*
12.Themai
nr
easonf
orusi
ngcel
ecoxi
b(
sel
ect
i
v
e
COX2i
nhi
bi
t
or
)r
at
hert
han a nonsel
ect
i
v
e COX
i
nhi
bi
t
or(
aspi
r
i
n)i
st
hatcel
ecoxi
b:
A.Cur
esar
t
hr
i
t
i
s,
r
at
hert
hanj
ustgi
v
esy
mpt
om r
el
i
ef
B.Ef
f
ect
i
v
el
yi
nhi
bi
t
sur
i
caci
dsy
nt
hesi
s
C.Hasal
owr
i
skofcar
di
ot
oxi
ci
t
y
D.I
s associ
at
ed wi
t
hal
owerr
i
sk ofgast
r
i
c or
duodenal
ul
cer
at
i
on*
E.Hassi
gni
f
i
cantf
ast
eronsetofact
i
on
19.Ut
i
l
i
zat
i
onofar
achi
doni
caci
dv
i
acy
cl
ooxygenase
pat
hway r
esul
t
si
nf
or
mat
i
on ofsome bi
oact
i
v
e
subst
ances.Namet
hem:
A.Bi
ogeni
cami
nes
B.I
nsul
i
nl
i
kegr
owt
hf
act
or
s
C.Thy
r
oxi
ne
D.Pr
ost
agl
andi
ns*
E.Somat
omedi
ns
13.A 46 y
.
o.pat
i
enthas been di
agnosed wi
t
h
r
heumat
oi
dpol
y
ar
t
hr
i
t
i
s.Whi
chagenti
sappr
opr
i
at
e
f
ort
hi
spat
i
ent
?
A.Di
cl
of
enac(
Vol
t
ar
en)
B.Aspi
r
i
n*
C.But
adi
on(
Pheny
l
but
az
one)
D.Par
acet
amol
E.Tr
amadol
e
20.Fort
het
r
eat
mentofchr
oni
cr
heumat
oi
dar
t
hr
i
t
i
s,
t
hepat
i
enthast
akenamedi
ci
nef
oral
ongt
i
me.
Lat
eron,weakness,mal
ai
se and necr
ot
i
c angi
na
hav
edev
el
oped.Ther
ei
sadecr
easeofgr
anul
ocy
t
es
i
nbl
oodanal
y
si
s.
Whatdr
ugcoul
dcausesuchcompl
i
cat
i
on?
A.Par
acet
amol
B.Aspi
r
i
n
C.Pi
r
oxi
cam
D.Anal
gi
n(
Met
ami
zol
e)*
E.Mel
oxi
cam
14.A60y
.
o.pat
i
entwi
t
hr
heumat
oi
dpol
y
ar
t
hr
i
t
i
shas
beent
aki
ngi
ndomet
haci
nf
oral
ongt
i
me.Whati
st
he
mechani
sm ofact
i
onoft
hi
sdr
ug?
A.Bl
ockadeofl
i
poxy
genase
B.Bl
ockadeofacet
y
l
chol
i
nest
er
ase
C.Bl
ockadeofcy
cl
ooxy
genase*
D.Bl
ockadephosphodi
est
er
ase
E.Bl
ockadeofphosphol
i
pase
15.Achi
l
dwi
t
hf
ev
erwasgi
v
enadr
ugwi
t
hst
r
ong
ant
i
py
r
et
i
c act
i
on and no i
nf
l
ammat
or
yact
i
v
i
t
y
.I
t
under
goes i
nact
i
v
at
i
on t
hr
ough conj
unct
i
on wi
t
h
gl
ut
at
hi
one. At t
oxi
c doses i
t can damage
hepat
ocy
t
es. Dur
i
ng poi
soni
ng ant
i
dot
es ar
e
Acet
yl
cyst
ei
neandMet
hi
oni
ne.Def
i
net
hi
sagent
:
A.Par
acet
amol
*
B.Aspi
r
i
n
C.Ni
mesul
i
de
D.Cel
ecoxi
b
E.Mel
oxi
cam
21.A pat
i
entwi
t
h gouthas t
aken a dr
ug,whi
ch
decr
eased a j
oi
ntpai
n.I
naf
ew day
s,nausea,
v
omi
t
i
ng,di
ar
r
hea,abdomi
nalpai
n,andedemahav
e
dev
el
oped.
Whi
chdr
ughasbeent
akenbyt
hepat
i
ent
?
A.Par
acet
amol
B.Mel
oxi
cam
C.Cel
ecoxi
b
D.But
adi
on(
Phenyl
but
azone)*
E.Nal
t
r
exone
16.Ataspi
r
i
nover
dose,met
hodofur
i
neal
kal
i
zat
i
on
i
sused.Thi
smet
hodi
sdi
r
ect
edt
o:
A.St
i
mul
at
e a secr
et
i
on oft
he aci
di
n pr
oxi
mal
t
ubul
es
B.Neut
r
al
i
zeaci
di
nbl
ood
C.St
i
mul
at
er
eabsor
pt
i
onoft
heaci
di
nt
ubul
es
D.Suppr
ess a secr
et
i
on oft
he aci
di
n pr
oxi
mal
t
ubul
es
E.Suppr
essr
eabsor
pt
i
onoft
heaci
di
nr
enalt
ubul
es
22. A pat
i
ent wi
t
h r
heumat
oi
d ar
t
hr
i
t
i
s was
pr
escr
i
bed aNSAI
D – Di
cl
of
enacsodi
um.Af
t
era
per
i
odoft
i
met
hepat
i
entexper
i
encedaggr
av
at
i
onof
aconcomi
t
antdi
seaset
hatf
or
cedt
owi
t
hdr
aw t
he
dr
ug.Whatconcomi
t
antdi
seasecoul
dl
eadt
ot
he
dr
ug’
swi
t
hdr
awal
?
A.Di
abet
esmel
l
i
t
us
B.I
schaemi
chear
tdi
sease
С.Pept
i
cul
cerofast
omach*
20
D.Br
onchi
al
ast
hma
E.Hy
per
t
ensi
v
edi
sease
r
espi
r
at
or
ydi
seaseandt
emper
at
ur
er
i
seupt
o39oC
hascal
l
edi
nadoct
or
.Thedoct
ori
nsi
st
edonher
av
oi
di
ngt
aki
ngpar
acet
amol
,becausei
nt
hi
sper
i
od
2016
ofpr
egnancyt
her
ei
sar
i
skofi
t
s:
A.Fet
ot
oxi
ci
t
y
B.Embr
y
ot
oxi
ci
t
y
C.Ter
at
ogeni
ci
t
y*
D.Hepat
ot
oxi
ci
t
y
E.Al
l
er
geni
ci
t
y
23.Aspi
r
i
ncausesant
i
i
nf
l
ammat
or
yact
i
oni
nr
esul
t
ofdepr
essi
onoft
hecy
cl
ooxy
genaseact
i
v
i
t
y
.Lev
elof
whatbi
ol
ogi
cal
l
yact
i
v
esubst
ancewi
l
l
dr
op?
A.Bi
ogeni
cami
nes
B.Pr
ost
agl
andi
ns*
C.I
odt
hy
r
oni
nes
D.Leukot
r
i
enes
E.Cat
echol
ami
nes
30.Apat
i
entwhohadbeent
aki
ngdi
cl
of
enacsodi
um
f
orar
t
hr
i
t
i
sofmandi
bul
arj
oi
ntdev
el
opedanacut
e
condi
t
i
onofgast
r
i
cul
cer
.Suchsi
deef
f
ectoft
hi
s
medi
ci
ne i
s caused byi
nhi
bi
t
i
on oft
he f
ol
l
owi
ng
2016
enzy
me:
A.Phosphodi
est
er
ase
B.Li
poxy
genase
C.Cy
cl
ooxy
genase1(
COX1)
*
D.Cy
cl
ooxy
genase2(
COX2)
E.Monoami
neoxi
dase
24.A f
emal
e consul
t
ed a doct
oraboutpai
n and
l
i
mi
t
edmov
ement
si
nt
hekneej
oi
nt
s.Whi
choft
he
f
ol
l
owi
ngNSAI
Dsshoul
dbeadmi
ni
st
er
edt
aki
ngi
nt
o
consi
der
at
i
ont
hatt
hepat
i
enthasahi
st
or
yofchr
oni
c
gast
r
oduodeni
t
i
s?2011
A.Pr
omedol
B.But
adi
on
C.Acet
y
l
sal
i
cy
l
i
caci
d
D.Di
cl
of
enacsodi
um
E.Cel
ecoxi
b*
4.
2Opi
oi
dAnal
gesi
csandAnt
agoni
st
s
25.Apat
i
enthasbeendi
agnosedwi
t
hi
nf
l
uenza.Hi
s
condi
t
i
on became dr
ast
i
cal
l
y wor
se af
t
er t
aki
ng
ant
i
py
r
et
i
cdr
ugs.Hi
sconsci
ousnessi
sconf
used,
AP
i
s80/
50mm Hg,psi
s140/
mi
n.Bodyt
emper
at
ur
e
dr
opped down t
o 35.
8°
C. What compl
i
cat
i
on
dev
el
opedi
nt
hi
spat
i
ent
?2012
A.Hy
per
t
her
mi
a
B.Hy
pov
ol
emi
a
C.Al
kal
osi
s
D.Aci
dosi
s
E.Col
l
apse*
1.I
ndi
cat
e a sy
nt
het
i
c opi
oi
d anal
gesi
c,whi
ch
i
ncr
easesmy
omet
r
i
um cont
r
act
i
onandr
el
axest
he
neckofut
er
usandi
sadmi
ni
st
er
edi
nl
abour
:
A.Omnopon
B.Pr
omedol
(
Tr
i
meper
i
di
ne)*
C.Mor
phi
ne
D.Fent
any
l
E.Fenot
er
ol
2.Aper
sonwhowasphy
si
cal
l
ydependentonher
oi
n
buy
sadr
ugi
nt
hest
r
eet
.Het
akesi
tandr
api
dl
ygoes
i
nt
owi
t
hdr
awal
.Whi
choft
hef
ol
l
owi
ngdr
ugsdi
dhe
t
ake?
A.Her
oi
n
B.Pent
azoci
ne*
C.Mor
phi
ne
D.Pr
omedol
(
Tr
i
meper
i
di
ne)
E.Omnopon
26.Apat
i
entwi
t
har
t
hr
i
t
i
sandv
ar
i
cosev
ei
nshas
beent
ak
i
ngaNSAI
Df
oral
ongt
i
me,
whi
chcaused
t
hr
ombosi
sofski
nv
ei
ns.Whi
choft
hef
ol
l
owi
ng
dr
ugsmi
ghthav
ecausedt
hi
scompl
i
cat
i
on?
A.I
ndomet
haci
n
B.I
bupr
of
en
C.Cel
ecoxi
b*
D.Pheny
l
but
azone
E.Aspi
r
i
n
3.Apat
i
entwi
t
hsev
er
e,acut
et
r
aumapai
nr
equi
r
es
anal
gesi
a.Thephy
si
ci
anpr
escr
i
besmor
phi
ne.Whi
ch
oft
hef
ol
l
owi
ngconcomi
t
antcondi
t
i
onswoul
dpose
t
hegr
eat
estr
i
skf
r
om mor
phi
ne’
suse?
A.Acut
epul
monar
yedema
B.Hy
per
t
ensi
on
C.Cl
osedheadi
nj
ur
y*
D.Opi
oi
dabuse
E.Recentmy
ocar
di
al
i
nf
ar
ct
i
on
27.Apat
i
enthasbeenadmi
ni
st
er
edanant
i
i
nf
l
ammat
or
ydr
ugt
hatbl
ockst
heact
i
v
i
t
yof
cy
cl
ooxy
genase.Speci
f
yt
hi
sant
i
i
nf
l
ammat
or
yagent
:
2013
A.Anal
gi
n
B.Al
l
opur
i
nol
C.Thi
ami
ne
D.Cr
eat
i
ne
E.Aspi
r
i
n*
4.Al
loft
hef
ol
l
owi
ngst
at
ement
sconcer
ni
ngf
ent
anyl
ar
ecor
r
ectexcept
:
A.I
thasl
esspot
entanal
gesi
cact
i
v
i
t
yt
hant
hat
ofmor
phi
ne*
B.I
thasshor
t
erdur
at
i
onofact
i
ont
hant
hatof
mor
phi
ne.
C.I
ti
sef
f
ect
i
v
epar
ent
er
al
l
y
D.I
tcausesami
l
derwi
t
hdr
awal
sy
ndr
omet
han
mor
phi
ne.
E.I
thast
hegr
eat
estact
i
ononμr
ecept
or
s
28.Apat
i
entwi
t
har
t
hr
i
t
i
sandv
ar
i
cosev
ei
nshas
beent
aki
nganonst
er
oi
dal
ant
i
i
nf
l
ammat
or
ydr
ug
f
oral
ongt
i
me,
whi
chcausedt
hr
ombosi
sofski
n
v
ei
ns.Whi
choft
hef
ol
l
owi
ngdr
ugsmi
ghthav
e
causedt
hi
scompl
i
cat
i
on?2013
A.I
ndomet
haci
n
B.I
bupr
of
en
C.Aspi
r
i
n
D.Cel
ecoxi
b*
E.Pheny
l
but
azone
5.Whi
chst
at
ementaboutpent
azoci
nei
si
ncor
r
ect
?
A.I
ti
sami
xedagoni
st
ant
agoni
st
B.I
tmaybeadmi
ni
st
er
edPOorpar
ent
er
al
l
y
29. An 8week pr
egnant woman wi
t
h acut
e
21
C.I
tpr
oducesl
esseuphor
i
at
hanmor
phi
ne
D.I
ti
sof
t
encombi
nedwi
t
hmor
phi
nef
ormaxi
mal
anal
gesi
cef
f
ect
s*
E.Hi
ghdosesofpent
azoci
nei
ncr
easeAP
D.I
nhi
bi
t
i
onofcy
cl
ooxy
genase
E.I
nhi
bi
t
i
onofpr
ost
agl
andi
nsy
nt
hesi
s
13.A dr
ugabuserwi
t
hsy
mpt
omsofov
erdosage
wi
t
hnar
cot
i
canal
gesi
cshasar
r
i
v
edatr
esusci
t
at
i
on
uni
t
. Compl
et
ed emer
gency act
i
ons appear
ed
i
nef
f
i
ci
ent
.Whatwast
hemostl
i
kel
ycauseofdeat
h?
A.Renal
f
ai
l
ur
e
B.Li
v
erf
ai
l
ur
e
C.Col
l
apse
D.I
nhi
bi
t
i
onofr
espi
r
at
or
ycent
er*
E.Br
onchospasm
14.Mor
phi
neunder
goesgl
ucur
oni
dat
i
oni
nt
hel
i
v
er
.
Bi
ndi
ngoft
hedr
ugwi
t
hgl
ucur
oni
caci
ddur
i
ngi
t
s
bi
ot
r
ansf
or
mat
i
onwi
l
l
:
A.I
ncr
easei
t
sphar
macody
nami
cact
i
v
i
t
y
B.I
ncr
easei
t
swat
ersol
ubi
l
i
t
y*
C.Reducei
t
swat
ersol
ubi
l
i
t
y
D.Notchangei
t
sphar
macody
nami
cact
i
v
i
t
y
E.I
nduceCYP450sy
st
em
15. The pat
i
ent was admi
ni
st
er
ed a nar
cot
i
c
anal
gesi
c,
agoni
st
ant
agoni
stofopi
oi
dr
ecept
or
st
hat
i
sweakert
hanmor
phi
ne.Whati
st
heagent
?
A.Nal
t
r
exone
B.Fent
any
l
C.Pent
azoci
ne*
D.Codei
nephosphat
e
E.Nal
oxone
6. I
n t
he post
oper
at
i
v
e per
i
od pr
omedol was
admi
ni
st
er
edcont
i
nuousl
yt
oapat
i
ent
.Cancel
l
at
i
on
oft
hemedi
cat
i
oncausedheav
yment
alandsomat
i
c
di
sor
der
s.Whati
st
hi
sphenomenondesi
gnat
ed?
A.Cancel
l
at
i
onsy
ndr
ome
B.I
di
osy
ncr
asy
C.Tachy
phy
l
axi
s.
D.St
eal
i
ngsy
ndr
ome
E.Abst
i
nentsy
ndr
ome*
7.
Mor
phi
nehy
dr
ochl
or
i
dehasbeengi
v
ent
or
educ
epai
n
att
r
aumat
i
cs
hoc
k
.I
ndi
c
at
et
hemec
hani
s
m ofac
t
i
onof
t
hedr
ug:
ABl
ockofper
i
pher
al
sensat
i
onr
ecept
or
s
B.I
nhi
bi
t
i
onofpr
ost
agl
andi
nssy
nt
hesi
s
C.Bl
ockadeofopi
oi
dr
ecept
or
s
D.St
i
mul
at
i
onofopi
oi
dr
ecept
or
s*
E.Bl
ockadeofadr
enor
ecept
or
s
8.I
ndi
c
at
et
hedr
ugs
t
i
mul
at
i
ngt
heopi
oi
dr
ec
ept
or
si
n
t
heCNS,
whi
c
hl
eadst
oi
nhi
bi
t
i
onoft
het
r
ans
mi
s
s
i
onof
pai
ni
mpul
s
es
.
A.I
ndomet
haci
n
B.Bupr
enor
phi
ne*
C.Acet
y
l
sal
i
cy
l
i
caci
d
D.Anal
gi
n
E.Nal
oxone
9.
Nal
t
r
exonewasadmi
ni
st
er
edt
oa23y
.
o.
mant
ot
r
eat
her
oi
nmani
a.I
ndi
cat
et
hemechani
sm ofact
i
onoft
he
dr
ug:
A.St
i
mul
at
i
onofopi
oi
dr
ecept
or
s
B.Bl
ockadeofbenzodi
azepi
ner
ecept
or
s
C.Bl
ockadeofadeny
l
cy
cl
ase
D.Bl
ockadeofGABAr
ecept
or
s
E.Bl
ockadeofopi
oi
dr
ecept
or
s*
10.
Apat
i
enthass
i
gnsofac
ut
epoi
s
oni
ngwi
t
hmor
phi
ne:
mi
os
i
s
,l
os
s ofc
ons
c
i
ous
nes
s
,dec
r
eas
ed BP and
Chey
neSt
ok
es
r
es
pi
r
at
i
on.
Admi
ni
s
t
er
t
he
phar
mac
ol
ogi
c
al
ant
agoni
s
t
:
A.Nal
or
phi
ne
B.Pr
omedol
C.Pent
azoci
ne
D.Nal
oxone *
E.Tr
amadol
e
11.A dr
ug addi
c
twas admi
t
t
ed t
ot
he emer
genc
y
depar
t
menti
nc
omawi
t
hs
i
gnsofpoi
s
oni
ngwi
t
hopi
oi
ds
.
Whatadv
er
s
eef
f
ec
tofmor
phi
ne cont
r
i
but
ed t
ot
he
poi
s
oni
ng?
A.Const
i
pat
i
on
B.Euphor
i
a
C.Reduct
i
onofdi
ur
esi
s
D.Tachy
phy
l
axi
s
E.Tol
er
ance*
12.Fent
anylhasbeenadmi
ni
st
er
edt
or
educet
he
pai
n atcar
di
ogeni
c shock.Whati
st
he anal
gesi
c
act
i
onmechani
sm oft
hedr
ug?
A.Bl
ockadeofNa+channel
s
B.St
i
mul
at
i
onofGABAr
ecept
or
s
C.St
i
mul
at
i
onofopi
oi
dr
ecept
or
s*
16.A 4y
.
o.chi
l
dwasadmi
t
t
edt
ot
heor
t
hopedi
c
depar
t
ment wi
t
h shi
n f
r
act
ur
e t
oget
her wi
t
h
di
spl
acement
.Bone f
r
agment
sr
eposi
t
i
on r
equi
r
es
pr
el
i
mi
nar
y anal
gesi
a. What dr
ug shoul
d be
admi
ni
st
er
ed?2010
A.Mor
phi
nehy
dr
ochl
or
i
de
B.Pr
omedol
*
C.Panadol
D.Anal
gi
n
E.Nal
oxone
17.Whyi
si
tundesi
r
abl
et
ousemor
phi
nei
npat
i
ent
s
wi
t
hheadi
nj
ur
y
?
A.I
tpr
ov
okescar
di
acar
r
hy
t
hmi
as
B.I
tr
educesbl
oodpr
essur
e
C.I
ncr
easesi
nt
r
acr
ani
al
pr
essur
e
D.I
tcausesphy
si
ol
ogi
cal
dependence
E.I
tsuppr
essesr
espi
r
at
i
on *
18.A30y
.
o.manhasbeenadmi
t
t
edt
ot
hehospi
t
al
r
ecept
i
onaf
t
ercaracci
dentwi
t
hhi
pf
r
act
ur
e.Hehas
decr
easedBP,t
hr
eadl
i
kepul
se,l
ocalt
ender
nessof
t
hebr
okenhi
p.Whati
snecessar
yt
oadmi
ni
st
erf
or
t
r
aumat
i
cshockpr
ev
ent
i
on?
A.Pr
omedol
B.Nal
t
r
exone
C.Fent
any
l*
D.Nal
oxone
E.Aspi
r
i
n
19.A 65 woman wi
t
h br
eas
tc
anc
erhas r
ec
ei
v
ed
mor
phi
nef
oral
ongt
i
me.Whatdoesnotbel
ongt
ot
he
phar
mac
ol
ogi
c
al
ef
f
ec
t
sofmor
phi
ne?
A.Const
i
pat
i
on
B.I
nhi
bi
t
i
onofr
espi
r
at
or
ycent
er
C.Spasm ofOddi
sphi
nct
er
D.Decr
easeofr
at
eofr
espi
r
at
i
on
22
E.My
dr
i
asi
s*
C.Mor
phi
ne *
D.Ni
mesul
i
de
E.Di
cl
of
enacsodi
um
20.Whi
chst
at
ementaboutPent
azoci
nei
si
ncor
r
ect
?
A.I
ti
sami
xedagoni
st
ant
agoni
st
B.I
ti
sadmi
ni
st
er
edor
al
l
yorpar
ent
er
al
l
y
C.I
tpr
oducesl
esseuphor
i
at
hanmor
phi
ne
D.I
ti
sof
t
encombi
nedwi
t
hmor
phi
nef
ormaxi
mal
anal
gesi
cef
f
ect
s*
E.Hi
ghdosesofpent
azoci
nei
ncr
easeBP
4.
3Neur
ol
ept
i
cs,
Tr
anqui
l
i
zer
s,
Sedat
i
v
es
1.A 42 y
.
o.man who hasbeen i
nj
ur
ed i
n a car
acci
denti
s br
oughtt
ot
he emer
gency r
oom.Hi
s
bl
ood al
coholl
ev
elon admi
ssi
on i
s 250 mg/
dL.
Hospi
t
alr
ecor
ds show a pr
i
orhospi
t
al
i
zat
i
on f
or
al
coholr
el
at
edsei
zur
es.Hi
swi
f
econf
i
r
mst
hathe
hasbeendr
i
nki
ngheav
i
l
yf
or3weeks.
Whatt
r
eat
mentshoul
dbepr
ov
i
dedt
ot
hepat
i
ent
i
fhegoesi
nt
owi
t
hdr
awal
?
A. Di
azepam *
B. Phenobar
bi
t
al
C. Pent
obar
bi
t
al
D. Di
pheni
n(
Pheny
t
oi
n)
E. None
21.Exami
nat
i
on ofa pat
i
entr
ev
eal
ed ext
r
emel
y
my
ot
i
c pupi
l
s,l
abour
ed Chai
nSt
ock’
sr
espi
r
at
i
on,
ur
i
nar
yr
et
ent
i
on,sl
owi
ngdownofHR,l
ow BP and
enhanced spi
nalr
ef
l
exes.Whatagentcaused t
he
poi
soni
ng?
A.Nar
cot
i
canal
gesi
cs*
B.Nonnar
cot
i
canal
gesi
cs
C.Muscur
i
ni
cr
ecept
orbl
ocker
s
D.Local
anaet
het
i
cs
E.Bet
aadr
enobl
ocker
s
22.A pat
i
enthasbeendi
agnosedwi
t
ht
r
ansmur
al
my
ocar
di
ali
nf
ar
ct
i
on.Whatdr
ugshoul
dbegi
v
ent
o
pr
ev
entcar
di
ogeni
cshock?2012
A.Phent
ol
ami
ne
B.Anal
gi
n
C.Pr
omedol
*
D.Oct
adi
ne
E.Reser
pi
ne
23.Apat
i
entdi
agnosedwi
t
hmor
phi
ni
sm hasbeen
admi
t
t
edt
ot
henar
col
ogi
caldepar
t
ment
.A doct
or
not
ed a decr
ease i
n phar
macol
ogi
calact
i
v
i
t
y of
mor
phi
ne.Repet
i
t
i
v
euseoft
hedr
ugmayr
esul
ti
n
t
ol
er
ancet
oi
t
sef
f
ect
,
andt
hi
sphenomenoni
scal
l
ed:
2.A17y
.
o.pat
i
entc
ons
ul
t
edadoc
t
orabouti
ns
omni
a
mani
f
es
t
edi
nhar
df
al
l
i
ngas
l
eept
hatl
edt
of
at
i
gue,
weak
nes
s
,and di
f
f
i
c
ul
t
y of l
ear
ni
ng. The c
l
i
ni
c
al
ex
ami
nat
i
on r
e
v
eal
ed i
r
r
i
t
abi
l
i
t
y
,emot
i
onali
ns
t
abi
l
i
t
y
,
pul
s
eandBP al
t
er
at
i
on.Thedoc
t
ordet
er
mi
nedt
hat
i
nsomni
awasassoci
at
edwi
t
hneur
osi
sl
i
kest
at
eand
v
eget
ov
ascul
ardi
st
oni
a.Choose t
he mostr
at
i
onal
agentf
orcor
r
ect
i
onoft
hi
scondi
t
i
on.
A.Dr
oper
i
dol
B.Ni
t
r
azepam *
C.Ami
nazi
ne(
Chl
or
pr
omazi
ne)
D.Phenobar
bi
t
al
E.Hal
oper
i
dol
2012
A.Cumul
at
i
on
B.Al
l
er
gy
C.Ant
agoni
sm
D.Addi
ct
i
on*
E.Tachy
phy
l
axi
s
3. A pat
i
ent has been t
aki
ng a mi
xt
ur
e f
or
neur
ast
heni
a f
or a week. He f
el
t bet
t
er
, but
conj
unct
i
v
i
t
i
s,r
ash,i
ner
t
i
a,decr
ease of memor
y
appear
ed.He has been di
agnosed wi
t
h br
omi
sm.
Whatshoul
dbeadmi
ni
st
er
ed?
A.Nal
oxone
B.At
r
opi
ne
C.Panangi
n
D.Sodi
um chl
or
i
de*
E.Pi
l
ocar
pi
ne
24. A pat
i
ent wi
t
h ur
ol
i
t
hi
asi
s has unbear
abl
e
spasmodi
cpai
n.Topr
ev
entpai
nshock,hehasbeen
gi
v
enani
nj
ect
i
onofat
r
opi
neal
ongwi
t
hanar
cot
i
c
anal
gesi
chav
i
ngant
i
spasmodi
cef
f
ect
s.Whatdr
ug
wasi
t
?2013
A.Tr
amadol
e
B.Pr
omedol
(
Tr
i
meper
i
di
ne)*
C.Mor
phi
nehy
dr
ochl
or
i
de
D.Et
hy
l
mor
phi
nehy
dr
ochl
or
i
de
E.Nal
or
phi
ne
4. Choose dr
ug combi
nat
i
on pr
oduci
ng
neur
ol
ept
anal
gesi
a.
A.Hal
oper
i
dol
+Par
acet
amol
B.Dr
oper
i
dol
+Nal
oxone
C.Di
cl
of
enacnat
r
i
um +Hal
oper
i
dol
D.Dr
oper
i
dol
+Fent
any
l
(
I
nnovar
)*
E.Ami
nazi
ne+Ni
mesul
i
de
25.A pat
i
enti
s di
agnosed wi
t
h acut
e mor
phi
ne
hy
dr
ochl
or
i
de i
nt
oxi
cat
i
on.Admi
ni
st
eran oxi
di
zi
ng
2016
agentf
orgast
r
i
cl
av
age:
A.Pot
assi
um per
manganat
e*
B.Sul
f
ocamphocai
ne(
Pr
ocai
ne+
Sul
f
ocamphor
i
caci
d)
C.Chl
or
ami
ne
D.Cer
i
gel
E.Chl
or
hexi
di
ne(
bi
)
gl
uconat
e
5.A 45 y
.
o.pat
i
entdev
el
oped t
he s
y
mpt
oms of
par
k
i
ns
oni
s
m dur
i
ng ps
y
c
hos
i
s t
r
eat
ment
. Whi
c
h
ant
i
ps
y
c
hot
i
cdr
ughaspr
obabl
ybeenused?
A.Sul
pi
r
i
de(
Egl
oni
l
)
B.Ti
apr
i
de
C.Cl
ozapi
ne
D.Ami
nazi
ne(
Chl
or
pr
omazi
ne)*
E.Di
azepam
26.Due t
o sev
er
e pai
n sy
ndr
ome a pat
i
entwas
pr
escr
i
bedanar
cot
i
canal
gesi
c.Namet
hedr
ug:
A.Met
ami
zol
e(
Anal
gi
n)
B.I
ndomet
haci
n
6.A40y
.
o.pat
i
entwasadmi
t
t
edt
ot
hepsy
chi
at
r
i
c
cl
i
ni
ci
nast
at
eofexci
t
at
i
on,aggr
essi
on,del
i
r
i
um.
Whatdr
ugshoul
dbeadmi
ni
st
er
edt
ot
hepat
i
ent
?
23
A.Reser
pi
ne
B.Ami
nazi
ne(
Chl
or
pr
omazi
ne)
*
C.Di
azepam
D.Di
cl
of
enacsodi
um
E.Sodi
um oxy
but
y
r
at
e
D.Fl
umazeni
l
*
E.Al
l
oxi
m
13.Whi
chgr
oupofdr
ugsi
susedasmoodst
abi
l
i
zer
s
i
nmani
cdepr
essi
v
epsy
chosi
s?
A.Ant
i
depr
essant
s
B.Sedat
i
v
es
C.Neur
ol
ept
i
cs
D.Tr
anqui
l
i
zer
s
E.Li
t
hi
um sal
t
s*
14.Whi
chdr
ugshoul
dbeadmi
ni
st
er
edt
oapat
i
enti
n
t
hecaseofpoi
soni
ngwi
t
hdr
oper
i
dolt
ost
abi
l
i
zeBP?
A.Pl
at
y
phy
l
l
i
n
B.St
r
ophant
hi
n*
C.Adr
enal
i
ne
D.Mesat
on
E.Met
opr
ol
ol
15.The maj
or
i
t
yofdr
ugsf
r
om t
hi
sgr
oup pr
oduc
e
ex
pr
es
s
eds
edat
i
v
ehy
pnot
i
candmy
or
el
ax
antac
t
i
ont
hat
i
swhyt
heydec
r
eas
ec
onc
ent
r
at
i
onandr
eac
t
i
ont
i
meof
t
hec
ur
edpat
i
ent
s
.
Det
er
mi
net
hi
sgr
oup:
A.Tr
anqui
l
i
zer
s*
B.Bet
aadr
enomi
met
i
cs
C.Sy
mpat
homi
met
i
cs
D.Sal
i
cy
l
at
es
E.Monoami
nooxi
dasei
nhi
bi
t
or
s
16. Ther
e i
s a necessi
t
y t
o admi
ni
st
er an
ant
i
psy
chot
i
cdr
ugt
oapat
i
entwi
t
hpar
ki
nsoni
sm.
Whi
chneur
ol
ept
i
chast
hel
eastr
i
skf
ort
hepat
i
ent
?
A.Ami
nazi
ne(
Chl
or
pr
omazi
ne)
B.Dr
oper
i
dol
C.Tr
i
f
t
azi
ne
D.Cl
ozapi
ne(
Leponex)
*
E.Hal
oper
i
dol
17.Ami
naz
i
ne was admi
ni
s
t
er
ed t
o a pat
i
entwi
t
h
s
c
hi
z
ophr
eni
a. Whi
c
h phar
mac
ody
nami
c ef
f
ec
t of
ami
naz
i
nei
st
hebas
i
cf
ort
hi
spat
i
ent
?
A.Anxi
ol
y
t
i
c
B.Ant
i
psy
chot
i
c*
C.My
or
el
axant
D.Hy
pot
ensi
v
e
E.Hy
pot
her
mi
c
18. A 45 y
.
o. pat
i
ent suf
f
er
s f
r
om neur
osi
s
char
act
er
i
zed by i
r
r
i
t
abi
l
i
t
y
, sl
eepl
essness, and
mot
i
v
el
essanxi
et
y
.Whatdr
ugwoul
del
i
mi
nat
eal
lt
he
sy
mpt
oms?
A.Lev
odopa
B.Py
r
acet
am
C.Val
er
i
anext
r
act
D.Di
azepam *
E.Caf
f
ei
nesodi
um benzoat
e
19.Amet
hodofgener
alhy
pot
her
mi
ai
snecessar
yt
o
use f
orper
f
or
mi
ng an oper
at
i
v
e measur
e.Whi
ch
agent i
n combi
nat
i
on wi
t
h phy
si
calcool
i
ng wi
l
l
pr
ov
i
det
heexpr
essedhy
pot
her
mi
a?
A.Sul
pi
r
i
de(
Egl
oni
l
)
B.Ti
apr
i
de
C.Chl
or
di
azepoxi
de(
Chl
ozepi
de)
D.Li
t
hi
um car
bonat
e
E.Ami
nazi
ne*
20.I
ndi
cat
e a dr
ug wi
t
h st
r
ong,qui
ck butshor
t
neur
ol
ept
i
cact
i
on.I
tpot
ent
at
esact
i
onofanal
gesi
cs,
hy
pnot
i
cs,and al
cohol
,possesses ant
i
shock and
7.A pat
i
ent
,get
t
i
ng t
r
eat
mentf
orneur
osi
s wi
t
h
Di
azepam compl
ai
ns of a t
oot
hache.A doct
or
pr
escr
i
bedananal
gesi
ci
nal
es
sdos
et
hanav
er
age
t
her
apeut
i
c
.Whatphenomenon di
d doc
t
ort
ak
ei
nt
o
c
ons
i
de
r
at
i
onwhi
l
edec
r
eas
i
ngt
hedos
e?
A.Summat
i
on
B.Cumul
at
i
on
C.Tol
er
ance
D.Addi
t
i
v
eef
f
ect
E.Pot
ent
i
at
i
on*
8 A woman wi
t
h an act
i
v
el
i
f
est
y
l
e consul
t
ed a
doct
orcompl
ai
ni
ngofbadmood,
mi
gr
ai
ne,
emot
i
onal
l
i
abi
l
i
t
y
,and chestpai
n.Whi
ch dr
ug shoul
d be
admi
ni
st
er
ed t
aki
ng i
nt
o accountt
hatt
he woman
spendsal
otoft
i
meatwor
k?
A.Gi
dazepam *
B.Phenazepam
C.Tr
i
f
t
azi
ne
D.Phenobar
bi
t
al
E.Ami
nazi
ne(
Chl
or
pr
omazi
ne)
9Apat
i
entv
i
si
t
edadoct
orcompl
ai
ni
ngofemot
i
onal
i
nst
abi
l
i
t
y
,f
eel
i
ngofpsy
choemot
i
onalt
ensi
onand
f
ear on meet
i
ng hi
s chi
ef accompani
ed by
t
achy
car
di
a,hy
per
emi
a oft
he f
ace,hand t
r
emor
,
sweat
i
ng.Thedoct
ordi
agnosedv
eget
at
i
v
eneur
osi
s.
Whi
chdr
ugshoul
dbeadmi
ni
st
er
ed?
A.Sul
pi
r
i
de(
Egl
oni
l
)
B.Ti
apr
i
de
C.Lor
azepam *
D.Sodi
um br
omi
de
E.Li
t
hi
um car
bonat
e
10.
Ane
ur
ol
ept
i
cwi
t
hex
pr
es
s
edhy
pot
ens
i
v
eac
t
i
v
i
t
yhas
been admi
ni
s
t
er
ed t
o a pat
i
ent s
uf
f
er
i
ng f
r
om
s
c
hi
z
ophr
eni
a ac
c
ompani
ed by ar
t
er
i
alhy
per
t
e
ns
i
on.
I
ndi
c
at
et
hi
sdr
ug:
A.Hal
oper
i
dol
B.Ri
sper
i
done
C.Ami
nazi
ne(
Chl
or
pr
omazi
ne)*
D.Di
azepam
E.Tr
i
f
t
azi
ne
11.At
r
uckdr
i
v
erconsul
t
edadoct
oraboutemot
i
onal
t
ensi
on,anxi
et
y
.Thedoct
ordi
agnosedneur
ast
heni
a.
Chooset
hedayt
i
met
r
anqui
l
i
zerf
ort
hi
spat
i
ent
:
A.Phenazepam
B.Mezapam *
C.Chl
ozepi
de(
chl
or
di
azepoxi
de)
D.Di
azepam
E.Lor
azepam
12.A26y
.
o.f
emal
ehast
akennozepam f
orneur
osi
s
f
oral
ongt
i
me.Onedayshedev
el
opedweakness,
nausea,sl
ur
r
ed speech,di
scoor
di
nat
i
on,unst
eady
gai
t
.Sheconsul
t
ed adoct
orand headmi
ni
st
er
ed
benzodi
azepi
neant
agoni
st
.Det
er
mi
net
hi
sant
i
dot
e:
A.I
soni
t
r
ozi
ne
B.Nal
t
r
exone
C.Nal
oxone
24
ant
i
emet
i
cact
i
on,
bel
ongst
obut
y
r
ophenones:
A.Cl
ozapi
ne
B.Dr
oper
i
dol
*
C.Sul
pi
r
i
de
D.Ami
nazi
ne(
Chl
or
pr
omazi
ne)
E.Lor
azepam
21.Apat
i
entaskedadoct
orf
orhel
pt
oov
er
comehi
s
f
earbef
or
edent
almani
pul
at
i
on.Whi
chdr
ugdi
dt
he
doct
orr
ecommend?
A.Sul
pi
r
i
de
B.Ami
nazi
ne(
Chl
or
pr
omazi
ne)
C.Dr
oper
i
dol
D.Di
azepam *
E.Li
t
hi
um car
bonat
e
27.I
mpai
r
mentofmov
ementcoor
di
nat
i
on,shi
v
er
i
ng
oft
hehandsandsl
eepi
nessdev
el
opedi
napat
i
ent
suf
f
er
i
ngf
r
om schi
zophr
eni
aandt
aki
ngpsy
chot
r
opi
c
dr
ugs.I
ndi
cat
et
hi
sgr
oupofdr
ugs.
A.Neur
ol
ept
i
cs*
B.Anal
gesi
cs
C.Tr
anqui
l
i
zer
s
D.Ant
i
depr
essant
s
E.Psy
cost
i
mul
ant
s
28.I
nt
r
oduct
i
onofami
nazi
net
oapat
i
entsuf
f
er
i
ng
f
r
om chr
oni
c al
cohol
i
sm f
or el
i
mi
nat
i
on of
aggr
essi
on and del
i
r
i
um, caused l
oss of
consci
ousness.I
ndi
cat
et
hepr
obabl
er
easonoft
hi
s
compl
i
cat
i
on.
A.Or
t
host
at
i
ccol
l
apse*
B.I
nhi
bi
t
i
onoft
her
et
i
cul
arf
or
mat
i
on
C.Suppr
essi
onoft
hel
i
mbi
csy
st
em
D.I
mpai
r
mentofoxi
dat
i
v
epr
ocessesi
nt
hebr
ai
n
t
i
ssue
E.I
mpai
r
mentofcor
onar
yci
r
cul
at
i
on
22.Gl
ut
amat
edecar
boxy
l
at
i
onr
esul
t
si
nf
or
mat
i
onof
i
nhi
bi
t
or
yt
r
ansmi
t
t
eri
nCNS.Namei
t
:
A.Ser
ot
oni
n
B.GABA*
C.Gl
ut
at
hi
one
D.Hi
st
ami
ne
E.Aspar
agi
nes
29.I
ndi
cat
et
hedr
ug f
orel
i
mi
nat
i
on oft
heacut
e
psy
chosi
s f
r
om t
he gr
oup of der
i
v
at
i
v
es of
phenot
hi
azi
ne:
A.Ami
nazi
ne(
Chl
or
pr
omazi
ne)
*
B.Dr
oper
i
dol
C.Cl
ozapi
ne
D.Sul
pi
r
i
de
E.Ti
apr
i
de
23.Adoc
t
orhasadmi
ni
s
t
er
edanagentI
Vt
ot
hepat
i
ent
wi
t
hac
ut
eps
y
c
hos
i
s
,whi
c
hac
c
ompani
edbydel
i
r
i
um
andhal
l
uc
i
nat
i
ons
.Sy
mpt
omsofps
y
c
hos
i
shav
ebeen
el
i
mi
nat
ed,
butwhent
hepat
i
enthasr
i
s
enf
r
om abed,
he
bec
ame pal
e and l
os
tc
ons
c
i
ous
nes
s
.The doc
t
or
di
agnos
edor
t
hos
t
at
i
c(
post
ur
al
)c
ol
l
aps
e.
Whi
c
hagenti
s
mos
tl
i
k
el
yt
oi
nv
ol
v
e?
A.Reser
pi
ne
B.Ami
nazi
ne*
C.Di
azepam
D.Dr
oper
i
dol
E.Cl
ozapi
ne
24.A35y
.
o.pat
i
entwi
t
hschi
z
ophr
eni
acompl
ai
nsof
di
scoor
di
nat
i
on of mov
ement
,t
r
emor of hands,
dr
owsi
ness.
Thepat
i
enthasbeent
ak
i
ngapsy
chot
r
opi
c
agentf
oral
ongt
i
me.Whi
chgr
oupi
smostl
i
k
el
yt
o
i
nv
ol
v
e?
A.Tr
anqui
l
i
zer
s
B.At
y
pi
cal
neur
ol
ept
i
cs
C.Ty
pi
cal
neur
ol
ept
i
cs*
D.Ant
i
depr
essant
s
E.Psy
chost
i
mul
ant
s
25.Lor
azepam hasbeenadmi
ni
st
er
edt
oapat
i
ent
wi
t
h hy
per
exci
t
abi
l
i
t
y
, i
r
r
i
t
abi
l
i
t
y
, t
ear
f
ul
ness,
sl
eepl
essness.Whati
st
hemechani
sm i
t
sact
i
on?
A.Bl
ockadeofGABAr
ecept
or
s
B.Bl
ockadeofbenzodi
azepi
ner
ecept
or
s
C.St
i
mul
at
i
onofbenzodi
azepi
ner
ecept
or
s*
D.St
i
mul
at
i
onofGABAr
ecept
or
s
E.Bl
ockadedopami
ner
ecept
or
s
30.Det
er
mi
ne t
he gr
oup ofdr
ugs,whi
ch doesn’
t
causedr
ugdependence.
A.Neur
ol
ept
i
cs*
B.Tr
anqui
l
i
zer
s
C.Bar
bi
t
ur
at
es
D.Opi
oi
danal
gesi
cs
E.Pheny
l
al
ky
l
ami
nes
31.A doct
oradmi
ni
st
er
ed ami
nazi
ne t
o apat
i
ent
suf
f
er
i
ngf
r
om schi
zophr
eni
at
oel
i
mi
nat
edel
i
r
i
um,
hal
l
uci
nat
i
ons, t
o decr
ease aggr
essi
on and
psy
chomot
orexci
t
ement
.Whati
st
hemechani
sm of
ant
i
psy
chot
i
cact
i
onofami
nazi
ne?
A.St
i
mul
at
i
onofMchol
i
nor
ecept
or
si
nt
heCNS
B.St
i
mul
at
i
onofopi
oi
dr
ecept
or
s
C.Bl
ockadeofD2r
ecept
or
si
nt
heCNS*
D.St
i
mul
at
i
onofadr
ener
gi
canddopami
ner
ecept
or
s
i
nt
heCNS
E.I
nhi
bi
t
i
onofMAO
32.Aneur
ol
ept
i
cf
r
om t
hegr
oupofbut
y
r
ophenones
wasadmi
ni
st
er
edt
oapat
i
entwi
t
hal
cohol
psy
chosi
s.
Det
er
mi
net
hedr
ug:
A.Ti
apr
i
de
B.Chl
ozepi
de(
Chl
or
di
azepoxi
de)
C.Sul
pi
r
i
de
D.Hal
oper
i
dol
*
E.Ami
nazi
ne(
Chl
or
pr
omazi
ne)
33.A 32 y
.
o.woman wi
t
h compl
ai
nt
soft
emper
,
t
i
r
edness,i
nsomni
a,i
nt
er
nalt
ensi
onhasdi
agnosed
wi
t
h neur
osi
s and admi
ni
st
er
ed a t
r
anqui
l
i
zer
(
di
azepam)
.Whi
ch ef
f
ect of t
he dr
ug i
s mor
e
i
mpor
t
anti
nt
hi
ssi
t
uat
i
on?
A.Ant
i
psy
chot
i
c
B.Anxi
ol
y
t
i
c*
26.Hal
oper
i
dolhasbeenadmi
ni
s
t
er
edf
ordel
i
r
i
um and
hal
l
uc
i
nat
i
on.
Whati
st
hemec
hani
s
mofi
t
sant
i
ps
y
c
hot
i
c
ac
t
i
on?
A.Bl
ockadeofr
eupt
akeofcat
echol
ami
nes
B. St
i
mul
at
i
on of adr
ener
gi
c and dopami
ner
gi
c
pr
ocessesi
nt
heCNS
C. I
nhi
bi
t
i
on of adr
ener
gi
c and dopami
ner
gi
c
pr
ocessesi
nt
heCNS*
D.Bl
ockadeofMchol
i
nor
5ecept
or
s
E.St
i
mul
at
i
onofMchol
i
nor
ecept
or
s
25
C.Ant
i
conv
ul
si
v
e
D.My
or
el
axant
E.Ant
i
emet
i
c
34.A dent
i
sti
nt
r
oduced di
azepam t
o a 47 y
.
o.
woman bef
or
e ext
r
act
i
on of t
oot
h.I
ndi
cat
et
he
anxi
ol
y
t
i
cact
i
onmechani
sm oft
hedr
ug:
A.St
i
mul
at
i
onofopi
oi
dr
ecept
or
s
B.I
nhi
bi
t
i
on of dopami
ne r
ecept
or
s and
adr
enor
ecept
or
s
C. St
i
mul
at
i
on dopami
ne r
ecept
or
s and
adr
enor
ecept
or
s
D.Agoni
stofbenzodi
azepi
ner
ecept
or
s*
E.I
nhi
bi
t
i
onofbenzodi
azepi
ner
ecept
or
s
ofbenzodi
azepi
ner
ow hasbeenusedf
oranal
gesi
a.
Whi
ch agenthasbeen admi
ni
st
er
ed f
oranal
gesi
a
2014
pot
ent
i
at
i
on?
A.Car
bamazepi
ne
B.Tr
i
f
t
azi
ne
C.Dr
oper
i
dol
D.Di
azepam *
E.I
mi
zi
ne
35.A pat
i
entv
i
si
t
ed a doct
orwi
t
h compl
ai
nt
sof
i
r
r
i
t
abi
l
i
t
y
,i
nsomni
a,f
at
i
gue.Adoct
oradmi
ni
st
er
eda
sedat
i
v
edr
ugt
ohi
m.I
naweekt
hepat
i
entbegant
o
compl
ai
nofcough,sl
eepi
ness,decr
easeofmemor
y
,
sy
mpt
oms of r
hi
ni
t
i
s, conj
unct
i
v
i
t
i
s, der
mat
i
t
i
s.
Whi
chgr
oupoft
hedr
ugswasadmi
ni
st
er
edbyt
he
doct
or
?
A.Neur
ol
ept
i
cs
B.Tr
anqui
l
i
zer
s
C.Li
t
hi
um
D.Br
omi
des*
E.Nonst
er
oi
dal
ant
i
i
nf
l
ammat
or
yagent
s
3.
4Hy
pnot
i
c,
Ant
i
epi
l
ept
i
cDr
ugandPhar
macol
ogi
c
ManagementofPar
ki
nsoni
sm
1.Whi
choneoft
hef
ol
l
owi
ngst
at
ement
si
scor
r
ect
?
A.Ami
nazi
nei
si
ndi
cat
edi
nt
r
eat
i
ngt
henausea
B.Vi
t
ami
nB6i
ncr
easest
heef
f
ect
i
v
enessofl
ev
odopa
C. Admi
ni
st
r
at
i
on of dopami
ne i
s an ef
f
ect
i
v
e
t
r
eat
mentofPar
ki
nson΄
sdi
sease
D.Lev
odopai
nducednauseai
sr
educedbycar
bi
dopa
E.Nonspeci
f
i
cMAOi
nhi
bi
t
or
s,
suchasni
al
ami
de,ar
e
ausef
ul
adj
unctt
ol
evodopat
her
apy
2. Whi
ch one of t
he f
ol
l
owi
ng st
at
ement
s i
s
I
NCORRECT?
A.Tr
eat
mentwi
t
hsel
egel
i
ne(
depr
enyl
)candel
ayt
he
par
ki
nsoni
ansy
mpt
oms
B.Ov
er
t
r
eat
mentofPar
ki
nson΄
sdi
seasecanr
esul
ti
n
t
hesy
mt
omsofpsy
chosi
s
C.Di
et
sr
i
chi
npr
ot
ei
nmaydecr
easet
heef
f
ect
sof
l
ev
odopa
D. Vi
t
ami
n B6 decr
eases t
he ef
f
ect
i
v
eness of
l
ev
odopa
E.Par
ki
nsoni
an pat
i
ent
s ar
e char
act
er
i
zed by a
i
ncr
eased r
at
i
o of dopami
ner
gi
c/
chol
i
ner
gi
c
act
i
v
i
t
yi
nt
heneost
r
i
at
um.
36.Whi
chef
f
ecti
snotdev
el
opedaf
t
erami
nazi
ne
(
chl
or
pr
omazi
ne)admi
ni
st
r
at
i
on?
A.Ant
i
emet
i
cact
i
on
B.Hy
pot
her
mi
a
C.Ar
t
er
i
al
hy
pot
ensi
on
D.Ant
i
hi
st
ami
neact
i
on
E.St
i
mul
at
i
onoft
hebr
ai
ncor
t
ex*
37.A man dev
el
ops akat
hi
si
a,a Par
ki
nsonl
i
ke
sy
ndr
ome,gal
act
or
r
hea,andamenor
r
headur
i
ngt
he
t
her
apy
.Whi
ch of t
he f
ol
l
owi
ng mechani
sms i
s
i
nv
ol
v
ed?
A.Bl
ockadeofM chol
i
nor
ecept
or
s
B.St
i
mul
at
i
onofdopami
ner
ecept
or
s
C.Bl
ockadeofal
phaadr
ener
gi
cr
ecept
or
s
D.Bl
ockadeofdopami
ner
ecept
or
s*
E.Bl
ockadeofNchol
i
nor
ecept
or
s
3.A v
er
yagi
t
at
edy
oungmal
ewasbr
oughtt
ot
he
emer
gency r
oom by t
he pol
i
ce. Psy
chi
at
r
i
c
exami
nat
i
onr
ev
eal
edt
hathehadsnor
t
edcocai
ne
sev
er
alt
i
mesi
nt
hepastf
ewday
s;t
hel
astt
i
mewas
12hour
sago.Hewasgi
v
enadr
ug,whi
chsedat
ed
hi
m,andhef
el
lasl
eep.Thedr
ugv
er
yl
i
kel
yusedt
o
count
ert
hi
spat
i
ent
’
sappar
entcocai
newi
t
hdr
awal
was:
A.Phenobar
bi
t
al
*
B.Lor
azepam
C.Cocai
ne
D.Di
pr
azi
ne(
Pi
pol
phen)
E.Fl
uoxet
i
ne
38.Apat
i
entwhohasbeent
r
eat
edi
naneur
alcl
i
ni
c
andhasbeent
aki
ngasedat
i
v
ef
oral
ongt
i
megot
t
hef
ol
l
owi
ngcompl
i
cat
i
on:cough,r
hi
ni
t
i
s,epi
phor
a
(
l
acr
i
mat
i
on)
.Whatdr
ugcausedt
hesedi
st
ur
bances?
2011
A.Sodi
um br
omi
de*
B.Phenazepam
C.Reser
pi
ne
D.Di
azepam
E.Val
er
i
an
39.A pat
i
enthas r
ecur
r
entat
t
acks ofepi
l
ept
i
c
sei
zur
esandst
ay
sunconsci
ousbet
weent
hem.I
n
or
dert
ost
opconv
ul
si
onst
hedr
ugsoft
hef
ol
l
owi
ng
2013
gr
oupshoul
dbeusedi
nt
hef
i
r
stpl
ace:
A.Sedat
i
v
es
B.Neur
ol
ept
i
cs
C.Muscl
er
el
axant
s
D.Tr
anqui
l
i
zer
s*
E.Anal
ept
i
cs
40.Anopi
oi
danal
gesi
ci
ncombi
nat
i
onwi
t
hanagent
4.Dr
ugofchoi
cef
orpsy
chomot
orepi
l
epsyi
s:
A.Val
pr
oi
caci
d
B.Car
bamazepi
ne*
C.Et
hosuxi
mi
de
D.Bar
bi
t
ur
at
e
E.Di
pheni
n
5.Whi
ch ant
i
epi
l
ept
i
c act
s by augment
at
i
on of
r
el
easeofi
nhi
bi
t
or
yt
r
ansmi
t
t
erGABAbyi
nhi
bi
t
i
ngi
t
s
degr
adat
i
on (
by GABAt
r
ansami
nase) as wel
las
pr
obabl
ybyi
ncr
easi
ngi
t
ssy
nt
hesi
s?
26
A.Val
pr
oi
caci
d*
B.Car
bamazepi
ne
C.Di
pheni
n(
Pheny
t
oi
n)
D.Et
hosuxi
mi
de
E.Bar
bi
t
ur
at
es
E.Bl
ockscent
r
al
chol
i
nor
ecept
or
s
13.Thedoct
orhaspr
escr
i
bedcy
cl
odolf
orPar
ki
nson
di
seaset
r
eat
ment
.Whati
st
hemechani
sm ofant
i
par
ki
nsoni
anact
i
onoft
hedr
ug?
A.M chol
i
nomi
met
i
cact
i
on
B.M chol
i
nobl
ockeract
i
on*
C.St
i
mul
at
i
onofdopami
ner
ecept
or
s
D.Bl
ockadeofdopami
ner
ecept
or
s
E.bet
aAdr
enobl
ockeract
i
on
6.Whi
chant
i
epi
l
ept
i
cact
sbypr
ol
ongat
i
onofNa+
channel
si
nact
i
v
at
i
onaswel
l
asbyi
nhi
bi
t
i
ngki
ndl
i
ng?
Thedr
ugal
so hasant
i
di
ur
et
i
cact
i
on,pr
obabl
yby
enhanci
ngADHact
i
ononr
enal
t
ubul
es.
A.Car
bamazepi
ne*
B.Phenobar
bi
t
al
C.Dr
oper
i
dol
D.Val
pr
oat
esodi
um
E.Et
hosuxi
mi
de
14.A 56 y
.
o.pat
i
enthas t
aken phenobar
bi
t
ali
n
connect
i
onwi
t
hi
nsomni
a.Af
t
eracancel
l
at
i
onoft
he
dr
ugt
hepat
i
enthasdi
f
f
i
cul
t
yi
nf
al
l
i
ngasl
eepagai
n,
f
r
equent
l
ywakesupatni
ght
;sl
eepi
saccompani
ed
bydr
eadf
uldr
eams.Whati
st
her
easonoft
hegi
v
en
undesi
r
abl
eef
f
ectofphenobar
bi
t
al
?
A.Dependence
B.I
di
osy
ncr
asy
C.Tachy
phy
l
axi
s
D.Reboundsy
ndr
ome*
E.Tol
er
ance
7Whi
chant
i
conv
ul
santi
snotusedi
ngener
al
i
zed
t
oni
ccl
oni
cconv
ul
si
on?
A.Phenobar
bi
t
al
B.Et
hosuxi
mi
de*
C.Di
pheni
n
D.Di
azepam
E.Sodi
um oxy
but
y
r
at
e
15.A pat
i
entdef
i
ed hi
sdoct
or
’
si
nst
r
uct
i
onsand
cont
i
nued t
o use phenobar
bi
t
al over 3 weeks.
Meanwhi
l
e,he was f
or
ced t
oi
ncr
ease t
he dr
ug’
s
dose.Howt
oexpl
ai
nf
al
l
i
ngofphenobar
bi
t
alef
f
i
cacy
?
A.Act
i
v
at
i
onofl
i
pol
y
si
s
B.I
nhi
bi
t
i
onofmonooxy
genasesy
st
emsoft
hel
i
v
er
C.I
nduct
i
onofmonooxy
genasesy
st
emsoft
hel
i
v
er*
D.I
nhi
bi
t
i
onofl
i
pol
y
si
s
E.I
nduct
i
onofgl
y
col
y
si
s
8.Al
l
ar
eusedi
nt
het
r
eat
mentofepi
l
epsyexcept
:
A.Et
hosuxi
mi
de
B.Reser
pi
ne*
C.Lamot
r
i
gi
ne
D.Di
azepam
E.Sodi
um oxy
but
y
r
at
e
9.Dr
ug,whi
chdecr
easesexci
t
i
ngneur
ot
r
ansmi
t
t
er
ami
noaci
ds(
gl
ut
amat
e,
aspar
t
at
e)l
ev
el
i
nbr
ai
n:
A.Di
azepam
B.Phenobar
bi
t
al
C.
Sodi
um v
al
pr
oat
e
D.Car
bamazepi
ne
E.Lamot
r
i
gi
ne*
16. A 56 y
.
o. man wi
t
h i
nsomni
a was gi
v
en
phenobar
bi
t
al
.Thesl
eepwasnor
mal
i
zed.Howev
er
,
af
t
er2weekst
heef
f
ectofPhenobar
bi
t
alf
el
ldown.
Whatr
easoncauseddecr
easi
ngofhy
pnot
i
cact
i
onof
phenobar
bi
t
al
?
A.I
t
spoorsol
ubi
l
i
t
y
B.Tol
er
ancedev
el
opment
*
C.I
t
spoorabsor
pt
i
oni
nt
hest
omach
D.I
t
sf
i
xat
i
oni
nl
i
pi
ds
E.Tachy
phy
l
axi
sdev
el
opment
10.A maj
orpr
obl
em t
hatmustbe f
aced when
admi
ni
st
er
i
ng ant
i
conv
ul
sant
s wi
t
h many ot
her
medi
cat
i
ons (
i
ncl
udi
ng ot
her ant
i
epi
l
ept
i
c dr
ugs)
i
nv
ol
v
esdr
ugi
nt
er
act
i
onsduet
oal
t
er
edmet
abol
i
sm.
Whi
ch oft
he f
ol
l
owi
ng dr
ugs i
sl
i
kel
yt
o cause
excessi
v
eort
oxi
cef
f
ect
sf
r
om someot
herdr
ugsby
i
nhi
bi
t
i
ngmet
abol
i
sm?
A.Et
hosuxi
mi
de
B.Car
bamazepi
ne
C.Phenobar
bi
t
al
D.Pheny
t
oi
n
E.Val
pr
oi
caci
d*
17.A pat
i
entwi
t
h epi
l
epsywas r
ecommended a
medi
ci
neknown asa pr
opy
l
v
al
er
i
caci
d der
i
v
at
i
v
e
t
hati
nhi
bi
t
sGABAt
r
ansf
er
aseandi
ncr
easesGABA
l
ev
eli
nt
he br
ai
n;i
nhi
bi
t
s exci
t
abi
l
i
t
yand sei
zur
e
capabi
l
i
t
yofmot
orzoneoft
heCNS.I
tcanbeused
R
f
oral
l
t
y
pesofepi
l
epsy
.Namet
hi
smedi
ci
ne:
A.Reser
pi
ne
B.Di
azepam (
Seduxen)
C.Di
pheni
n
D.Sodi
um br
omi
de
E.Sodi
um v
al
pr
oat
e*
16.Admi
ni
s
t
ert
oapat
i
entwi
t
hi
ns
omni
aamoder
n
hy
pnot
i
c
.I
ti
sani
mi
daz
opy
r
i
di
neder
i
v
at
i
v
e
;ac
t
i
v
at
es
benz
odi
az
epi
ner
ec
ept
or
si
nt
heCNS;doesnotal
t
er
ei
t
hers
l
eeps
t
r
uc
t
ur
eorac
t
i
v
i
t
yofl
i
v
erenz
y
mes
,does
notc
aus
edependenc
e:
A.Phenobar
bi
t
al
B.Ni
t
r
azepam
C.Zol
pi
dem *
D.Chl
or
al
hy
dr
at
e
E.Fl
umazeni
l
11.Det
er
mi
ne t
he hy
pnot
i
c dr
ug,whi
ch doesn’
t
i
nf
l
uencet
hest
r
uct
ur
eofsl
eep:
A.Bar
bi
t
al
B.Phenobar
bi
t
al
C.Ni
t
r
azepam *
D.Thi
opent
al
sodi
um (
Aet
hami
nal
umnat
r
um)
E.Secobar
bi
t
al
12.A pat
i
enthas been admi
ni
st
er
ed l
evodopa i
n
compl
ex t
her
apy of Par
ki
nson di
sease. What
changest
hi
sdr
ugpr
oducesi
nt
heCNS?
A.Enhancesdopami
nemedi
at
i
on*
B.Decr
easesdopami
nemedi
at
i
on
C.St
i
mul
at
esdopami
ner
ecept
or
s
D.Bl
ocksdopami
ner
ecept
or
s
27
17.Anat
t
ac
kofgener
al
i
z
edt
oni
c
c
l
oni
cc
onv
ul
s
i
ons
ac
c
ompani
ed byl
os
sofc
ons
c
i
ous
nes
sand gener
al
s
uppr
es
s
i
onoft
heCNSdev
el
opedi
napat
i
entaf
t
er
t
r
auma.Whi
c
hagents
houl
dbeadmi
ni
s
t
er
edt
ot
hi
s
pat
i
e
nt
?
A.Et
hosuxemi
de
B.Car
bamazepi
ne
C.Phenobar
bi
t
al
D.Sodi
um oxy
but
y
r
at
e*
E.Tr
i
met
hi
ne(
Tr
i
met
hadi
one)
18. Sy
mpt
oms of poi
soni
ng wi
t
h der
i
v
at
i
v
e of
bar
bi
t
ur
i
caci
dar
er
ev
eal
edi
napat
i
ent
.Whatdr
ug
can i
ncr
ease excr
et
i
on ofbar
bi
t
ur
at
es f
r
om t
he
or
gani
sm?
A.Nat
r
i
um chl
or
i
de
B.Sodi
um hy
dr
ocar
bonat
e*
C.Pot
assi
um chl
or
i
de
D.Magnesi
um oxi
de
E.Magnesi
um sul
f
at
e
19.Whatphenomena may be dev
el
oped i
nl
ong
t
aki
ngofbar
bi
t
ur
at
es?
A.Dr
ugt
ol
er
ance*
B.Dr
ugdependence
C.Ext
r
apy
r
ami
dal
sy
ndr
ome
D.Sensi
bi
l
i
zat
i
on
E.I
nhi
bi
t
i
onofenzy
mesofl
i
v
er
20.A pat
i
ent has consul
t
ed t
he dent
i
st about
hy
per
t
r
ophyandpai
ni
nt
hegumsandhy
perpl
ast
i
c
gi
ngi
v
i
t
i
s was di
agnosed.I
thas been est
abl
i
shed
f
r
om t
heanamnesi
s,t
hatt
hepat
i
enthast
akenan
ant
i
epi
l
ept
i
cagentf
oral
ongt
i
me.Speci
f
yt
hi
sdr
ug:
A.Phenobar
bi
t
al
B.Hexami
di
ne
C.Di
pheni
n(
Phenyt
oi
n)*
D.Car
bamazepi
ne
E.Tr
i
met
hi
ne(
Tr
i
met
hadi
one)
21.Apat
i
entwi
t
hcr
ani
ocer
ebr
ali
nj
ur
yhasgotbr
ai
n
edemaandhy
poxi
ccr
amps.Whatagentshoul
dbe
admi
ni
st
er
ed?
A.Cor
di
ami
n
B.Anapr
i
l
i
ne(
Pr
opr
anol
ol
)
C.Bemegr
i
de
D.Sodi
um oxy
but
i
r
at
e*
E.Pi
r
acet
am
22.A57y
.
o.mani
nacomahasbeendel
i
v
er
edt
o
hospi
t
al
.I
ti
sknown f
r
om hi
sanamnesi
st
hathe
suf
f
er
edf
r
om i
nsomni
a.Ati
nspect
i
ont
hef
ol
l
owi
ng
i
s r
ev
eal
ed: r
espi
r
at
or
y depr
essi
on, f
al
l
en BP,
o
pr
ogr
essi
ngcar
di
acweakness,decr
easeofbodyt
,
i
nhi
bi
t
i
onoft
endonr
ef
l
exes.Whatdr
ugcoul
dcause
poi
soni
ng?
A.Fl
uoxet
i
ne
B.Phenobar
bi
t
al
*
C.Ti
nct
ur
eofVal
er
i
an
D.Lev
odopa
E.Sodi
um br
omi
de
23.A hy
pnot
i
cdr
ug wi
t
ht
r
anqui
l
l
i
zi
ng ef
f
ectwas
pr
escr
i
bedt
oapat
i
entwhosuf
f
er
sf
r
om i
nsomni
a
causedbyemot
i
onaldi
sor
der
.Whathy
pnot
i
cwas
pr
escr
i
bed?2010
A.Thi
opent
al
sodi
um
B.Phenobar
bi
t
al
C.Ni
t
r
azepam*
D.Ami
nazi
ne(
Chl
or
pr
omazi
ne)
E.Sodi
um br
omi
de
24.Di
pheni
n(
Phenyt
oi
n)hasbeenadmi
ni
st
er
edt
oa
pat
i
entf
orepi
l
epsywi
t
ht
oni
ccl
oni
cat
t
acks.Whati
s
t
heact
i
onmechani
sm oft
hedr
ug?
A.Act
i
v
at
i
onofGABAsy
st
em
B.Bl
ockadeofCa2+channel
s
C.St
i
mul
at
i
onofdopami
ner
ecept
or
s
D.Bl
ockadeofdopami
ner
ecept
or
s
E.Bl
ockadeofNa+channel
s*
25. A pat
i
ent s
uf
f
er
s f
r
om Par
ki
nson’
s di
sease
ac
c
ompani
edwi
t
hmus
c
l
er
i
gi
di
t
y
,c
ons
t
r
ai
nedmot
i
ons
,
andc
ons
t
antt
r
emorofar
ms
.Whatdr
ugs
houl
dbe
admi
ni
s
t
er
ed?
A.Phenobar
bi
t
al
B.Lev
odopa*
C.Di
azepam
D.Di
pheni
n
E.Et
hosuxi
mi
de
26.Apat
i
entsuf
f
er
i
ngwi
t
hpar
ki
nsoni
sm hasbeen
t
aki
ng f
or a l
ong t
i
me t
he agent wi
t
h cent
r
al
chol
i
nol
y
t
i
cact
i
onmechani
sm whi
chef
f
i
ci
encyhas
gr
adual
l
ydecr
eased.I
ndi
cat
edr
ugwhi
chshoul
dbe
admi
ni
st
er
edi
nst
eadofusedone?
A.Cy
cl
odol
(
Tr
i
hexypheni
dyl
)
B.Lev
odopa*
C.My
docal
m(
Tol
per
i
zon)
D.Tr
opaci
n(
Di
phenyl
t
r
opi
n)
E.Bel
l
at
ami
nal
27.A76y
.
o.pat
i
enthasappeal
edt
ot
hedoct
orwi
t
h
compl
ai
nt
sofsuper
f
i
ci
alshor
t
t
er
m sl
eepwi
t
hof
t
en
awakeni
ngs caused by sense ofi
nt
er
nalt
ensi
on,
anxi
et
y
,f
ear
.Seni
l
esl
eepl
essnesswasdi
agnosed.
Makear
at
i
onalchoi
ceofahy
pnot
i
ci
nt
hegi
v
en
si
t
uat
i
on:
A.Phenobar
bi
t
al
B.Chl
or
al
hy
dr
at
e
C.Ni
t
r
azepam*
D.Lamot
r
i
gi
ne
E.Car
bamazepi
ne
28.Apat
i
entwi
t
hconv
ul
si
onswasadmi
t
t
edt
ot
he
hospi
t
alwher
e st
at
us epi
l
ept
i
cus was di
agnosed.
I
ndi
cat
et
hef
i
r
stchoi
cedr
ugt
ot
r
eatt
hepat
i
ent
:
A.Car
bamazepi
ne
B.Di
azepam *
C.Phenobar
bi
t
al
D.Lev
odopa
E.Chl
or
al
hy
dr
at
e
29.I
ndi
cat
et
hechar
act
erofchangesi
nt
hest
r
uct
ur
e
ofsl
eepundert
heact
i
onoft
hehy
pnot
i
cagent
sf
r
om
t
hegr
oupofbar
bi
t
ur
at
es:
A.Deepeni
ng ofsuppr
essi
on oft
he CNS dur
i
ng
UNREM sl
eepphase
B.Shor
t
eni
ngoft
hel
at
entper
i
odt
hef
i
r
stepi
sodeof
t
heREMsl
eep
C.Ext
ensi
onofREMsl
eep(
par
adoxi
cal
)phase
D.Shor
t
eni
ngofREMsl
eep(
par
adoxi
cal
)phase*
E.Lengt
heni
ngoft
hedur
at
i
onofepi
s
odesoft
heREMs
l
eep
30.A17y
.
o.gi
r
lt
ookahi
ghdoseofphenobar
bi
t
alt
o
commi
tasui
ci
de.Anambul
ancedoct
orcl
eansedher
28
st
omachandgav
eheranI
Vi
nj
ect
i
onofbemegr
i
de
andsodi
um bi
car
bonat
esol
ut
i
on.Whatwassodi
um
bi
car
bonat
ei
nj
ect
edf
or
?
A.Fori
ncr
easi
ngr
enal
excr
et
i
onofphenobar
bi
t
al
*
B.Forbr
i
ngi
ngt
hepat
i
entt
oconsci
ousness
C.Forbr
eat
hi
ngst
i
mul
at
i
on
D.Forphenobar
bi
t
al
i
nact
i
v
at
i
on
E.Forar
t
er
i
al
pr
essur
enor
mal
i
zat
i
on
31.
Apat
i
entpr
e
s
ent
swi
t
hdy
s
f
unc
t
i
onofc
er
ebr
al
c
or
t
ex
ac
c
ompani
ed by epi
l
ept
i
cs
ei
z
ur
es
.He has been
admi
ni
s
t
er
ed a bi
ogeni
c ami
ne s
y
nt
hes
i
z
ed f
r
om
gl
ut
amat
eandr
es
pons
i
bl
ef
orc
ent
r
ali
nhi
bi
t
i
on.What
s
ubs
t
anc
ei
si
t
?2012
A.Acet
y
l
chol
i
ne
B.Hi
st
ami
ne
C.Gammaami
nobut
y
r
i
caci
d*
D.Ser
ot
oni
n
E.Dopami
ne
32.A66y
.
o.pat
i
ents
uf
f
er
swi
t
hPar
k
i
ns
on’
sdi
s
eas
e
s
hows an i
mpr
ov
ementi
nl
oc
omot
orac
t
i
v
i
t
y af
t
er
pr
ol
onge
dus
eofac
er
t
ai
ndr
ugwhi
c
hi
sc
onv
er
t
edt
o
dopami
nebydec
ar
box
y
l
at
i
on.Whatdr
ughast
hepat
i
ent
t
ak
en?2013
A.Cel
ecoxi
b
B.Lev
odopa*
C.Chl
or
pr
omazi
ne
D.Dr
oper
i
dol
E.Nal
oxone
E.Dr
oper
i
dol
5.A doct
oradmi
ni
st
er
edami
t
r
i
pt
y
l
i
net
oapat
i
ent
wi
t
hendogenousdepr
essi
on.Expl
ai
nt
hemechani
sm
ofact
i
onoft
hi
sdr
ug:
A. I
nhi
bi
t
i
on of t
he neur
onal r
eupt
ake of
nor
adr
enal
i
ne
B.I
nhi
bi
t
i
onoft
heneur
onal
r
eupt
akeofser
ot
oni
n
C.MAOi
nhi
bi
t
or
D.I
ncr
easeofr
el
easeofnor
adr
enal
i
neandser
ot
oni
n
E. I
nhi
bi
t
i
on of t
he neur
onal r
eupt
ake of
nor
adr
enal
i
neandser
ot
oni
n*
6 A man was addr
essed t
ot
he psy
chi
at
r
i
stwi
t
h
compl
ai
nt
s and desper
at
i
on,t
endency t
o sui
ci
de.
Det
er
mi
net
hegr
oupofdr
ugsf
ort
het
r
eat
mentof
t
hi
spat
i
ent
?
A.Ant
i
depr
essant
s*
B.Sedat
i
v
es
C.Neur
ol
ept
i
cs
D.Tr
anqui
l
i
zer
s
E.Li
t
hi
um
6.Thi
sgr
oupofdr
ugi
ncl
udespsy
chot
r
opi
cagent
sof
pl
antor
i
gi
n.Thesedr
ugsar
eusedi
nast
heni
cst
at
es
af
t
er sev
er
ei
nf
ect
i
ous di
seases.They i
ncr
ease
gener
al v
i
t
al t
oni
ci
t
y of t
he or
gani
sm and i
t
s
r
esi
st
ancet
oi
nf
ect
i
ousdi
seases.Thesedr
ugsar
e
used i
nt
he f
or
m oft
i
nct
ur
es orl
i
qui
d ext
r
act
s.
Chooset
hi
sgr
oupofdr
ugs:
A.Sedat
i
v
e
B.Adapt
ogens*
C.Psy
chost
i
mul
ant
s
D.Ant
i
depr
essant
s
E.Noot
r
opi
cagent
s
7.48.A 36y
.
o.manhasacr
ani
ocer
ebr
alt
r
auma.
Obj
ect
i
v
el
y
:di
mi
ni
shedbr
eat
hsounds,t
hr
eadypul
se,
andnor
ef
l
exes.Whatwayofpy
r
acet
am i
nt
r
oduct
i
on
wi
l
l
bet
hemostappr
opr
i
at
ei
nt
hi
scase?
A.I
nhal
at
i
on
B.Subcut
aneous
C.Rect
al
D.I
nt
r
av
enous*
E.Per
or
al
8.Thi
sdr
ughasst
i
mul
at
i
ngact
i
onpr
omot
i
ng
sy
nt
hesi
sofpr
ot
ei
nsandATP,
i
ncr
easest
hecapaci
t
y
f
orphy
si
cal
andment
al
per
f
or
mance.I
ti
susedf
ora
l
ongt
i
meandshoul
dnotbet
akenbef
or
esl
eep.
A.Gi
nsengt
i
nct
ur
e*
B.Val
er
i
ant
i
nct
ur
e
C.Zol
pi
dem
D.Ni
al
ami
de
E.Ami
t
r
i
pt
y
l
i
ne
9.Ananal
ept
i
cofr
ef
l
ect
i
v
et
y
pef
r
om t
hegr
oupofNchol
i
nomi
met
i
cswasgi
v
ent
oapat
i
entf
orbr
eat
hi
ng
r
est
or
at
i
on af
t
erpoi
soni
ng wi
t
h car
bon monoxi
de.
Whatagentwasadmi
ni
st
er
edt
ot
hepat
i
ent
?
A.Adr
enal
i
ne
B.Lobel
i
ne*
C.Mesat
on
D.Nal
oxone
E.
Caf
f
ei
ne
10.I
ndi
cat
et
hemechani
sm ofact
i
onofcaf
f
ei
ne.
A.Bl
ockadeofMonoami
noox
i
dase(
MAO)
4.
5.
CNSSt
i
mul
ant
s
1.MAOi
nhi
bi
t
or
sar
econt
r
ai
ndi
cat
edwi
t
hal
loft
he
f
ol
l
owi
ngEXCEPT:
A.I
ndi
r
ectadr
ener
gi
cagent
s,
suchasephedr
i
ne
B.Tr
i
cy
cl
i
cant
i
depr
essant
C.Par
acet
amol
*
D.Beerandcheese
E.Dopami
ne
2.Av
er
yupsetmot
herbr
i
ngsi
nher12y
.
o.sont
o
askhel
pi
ndeal
i
ngwi
t
hhi
sbedwet
t
i
ng.Whi
choft
he
f
ol
l
owi
ngdr
ugsmi
ghtal
l
ev
i
at
et
hi
spr
obl
em?
A.Fl
uoxet
i
ne
B.I
mi
zi
ne(
I
mi
pr
ami
ne)*
C.Di
azepam
D.Pi
r
acet
am
E.Zol
pi
dem
3.Awomant
r
i
edt
ocommi
tsui
ci
de,herpsy
chi
at
r
i
st
madet
hedi
agnosi
sofendogeni
cdepr
essi
on.What
dr
ugshoul
dbegi
v
enf
orhert
r
eat
ment
?
A.Ami
t
r
i
pt
y
l
i
ne*
B.Noot
r
opi
l
C.Sy
dnocar
b(
Mesocar
be)
D.Et
i
mi
zol
E.Caf
f
ei
ne
4.
Apat
i
entaddr
es
s
edt
oadoc
t
orwi
t
hc
ompl
ai
nt
sabout
badmood,t
hatwasac
c
ompani
edbyex
pr
es
s
edf
eel
i
ng
of f
ear
,anx
i
et
y
.The c
l
i
ni
c
alex
ami
nat
i
on r
ev
eal
ed
ps
y
c
hi
c
al
depr
es
s
i
on.Whatdr
ugs
houl
dbeadmi
ni
s
t
er
ed
t
ot
hi
spat
i
ent
?
A.Caf
f
ei
ne
B.Sul
f
ocamphocai
ne
C.Py
r
acet
am
D.Ami
t
r
i
pt
y
l
i
ne*
29
B.I
nhi
bi
t
i
onoft
heneur
onal
capt
ur
eofnor
adr
enal
i
ne
C.I
nhi
bi
t
i
onofphosphodi
est
er
ase(
PDE)
D.Bl
ockadeofadenosi
ner
ecept
or
s.
E.Bl
ockadeofadenosi
ner
ecept
orandi
nhi
bi
t
i
onof
phosphodi
est
er
ase*
B.Sodi
um oxy
but
y
r
at
e
C.Sy
dnocar
b
D.Mer
i
di
l
ECor
di
ami
n(
Ni
ket
hami
de)
19.A pat
i
entwi
t
hpost
t
r
aumat
i
cencephal
opat
hyi
s
admi
t
t
ed t
o t
he neur
ol
ogi
cal depar
t
ment wi
t
h
compl
ai
nt
s of di
sor
der
s of memor
y
,i
nt
el
l
ect
,
headache,v
er
t
i
go.Chooset
hegr
oupofdr
ugsf
ort
he
pat
i
entt
r
eat
ment
:
A.Psy
chost
i
mul
ant
s
B.Anal
ept
i
cs
C.Noot
r
opi
cagent
s*
D.Ant
i
depr
essant
s
E.Adapt
ogens
11.I
ndi
cat
et
hecondi
t
i
onf
ort
heuseofPi
r
acet
am:
A.Angi
napect
or
i
s
B.Ment
al
i
nsuf
f
i
ci
ency*
C.Conv
ul
si
ons
D.Hy
per
t
ensi
v
ecr
i
si
s
E.Congest
i
v
ehear
tf
ai
l
ur
e
12.I
ndi
cat
et
heanal
ept
i
cofmi
xedt
y
peofact
i
on:
A.Cor
di
ami
n(
Ni
ket
hami
de)
*
B.Caf
f
ei
ne
C.Lobel
i
nehy
dr
ochl
or
i
de
D.Bemegr
i
de
E.Et
i
mi
zol
13.I
ndi
cat
et
heanal
ept
i
cofdi
r
ectt
y
peofact
i
on:
A.Cor
di
ami
n(
Ni
ket
hami
de)
B.Cy
t
i
t
on
C.Lobel
i
ne
D.Bemegr
i
de*
E.Sul
f
ocamphocai
ne
14.Apat
i
ent
’
sr
espi
r
at
i
oni
ssi
gni
f
i
cant
l
ydepr
essed
dur
i
ng t
he oper
at
i
on under gener
alanaest
hesi
a.
Whi
ch agentshoul
d be used wi
t
houtpausi
ng t
he
gener
al
anest
hesi
a?
A.Et
i
mi
zol
*
B.Sy
dnocar
b
C.Mer
i
di
l
D.Cy
t
i
t
on
E.Lobel
i
ne
15.I
ndi
cat
et
he dr
ug possessi
ng anal
ept
i
c and
psy
chost
i
mul
at
i
ngact
i
v
i
t
y
:
A.Caf
f
ei
ne*
B.Bemegr
i
de
C.Et
i
mi
zol
D.Cor
di
ami
n(
Ni
ket
hami
de)
E.St
r
y
chni
ne
16.Speci
f
ycl
i
ni
cal
usef
orBemegr
i
de:
A.Par
ki
nsoni
sm
B.Hy
per
t
ensi
v
ecr
i
ses
C.Ov
er
doseofgener
al
anest
het
i
cs*
D.Br
ai
nhy
poxi
a
E.Conv
ul
si
ons
17. The CNS st
i
mul
at
i
on pr
oduced by
met
hy
l
xant
hi
nes,suchascaf
f
ei
ne,i
smostl
i
kel
yt
he
r
esul
toft
heant
agoni
sm wi
t
ht
hef
ol
l
owi
ngr
ecept
or
s:
A.Mchol
i
nor
ecept
or
s
B.Nchol
i
nor
ecept
or
s
C.Al
pha1adr
enor
ecept
or
s
D.Adenosi
ner
ecept
or
s*
E.GABAr
ecept
or
s
18.Apat
i
enti
sadmi
t
t
edt
ot
heneur
ol
ogydepar
t
ment
duet
ocompl
ai
nt
sofdecr
easeofmemor
y
,ment
al
and wor
kcapaci
t
y
,sl
eepl
essnessand v
er
t
i
go.Hi
s
sy
mpt
omsar
econnect
edwi
t
habr
ai
nconcussi
on,
t
aki
ngpl
ace2y
ear
sagoasar
esul
tofanaut
omobi
l
e
acci
dent
.Whi
chdr
ugshoul
dbeadmi
ni
st
er
edt
ot
he
pat
i
ent
?
A.Pi
r
acet
am (
Noot
r
opi
l
)*
20.Speci
f
yt
hemai
nef
f
ectofPy
r
acet
am (
Noot
r
opi
l
)
.
A.St
i
mul
at
i
onofmy
ocar
di
um act
i
v
i
t
y
B.Tr
anqui
l
i
zi
ngef
f
ect
C.I
nhi
bi
t
i
onuponexci
t
at
i
oni
nt
heCNS
D.I
mpr
ov
est
hepr
ocessesofmemor
i
zi
ngand
t
hi
nki
ng*
E.Decr
easest
heneur
onal
st
abi
l
i
t
yt
ohy
poxi
a
21.A28y
.
o.pat
i
enti
sdel
i
v
er
edt
ot
hei
nt
ensi
v
ecar
e
uni
twi
t
ht
hedi
agnosi
sofpoi
soni
ngwi
t
hbar
bi
t
ur
at
es
of moder
at
e degr
ee.Admi
ni
st
er a st
i
mul
ant of
r
espi
r
at
i
onwhi
chwi
l
l
beper
t
i
nenti
nt
hi
scase:
A.Et
i
mi
zol
B.Bemegr
i
de*
C.Sy
dnocar
b
D.Pi
r
acet
am
E.Cor
di
ami
n
22.Thi
opent
alnat
r
i
um wasi
nt
r
oducedt
ot
hepat
i
ent
f
ori
ni
t
i
algener
alanest
hesi
at
hatcausedt
hear
t
er
i
al
hy
pot
ensi
onandr
espi
r
at
or
ydepr
essi
on.Sel
ectt
he
dr
ugt
or
est
or
ebr
eat
hi
ngandbl
oodci
r
cul
at
i
on:
A.Lobel
i
ne
B.Di
pi
r
oxi
m
C.Nal
oxone
D.Cy
t
i
t
on
E.Bemegr
i
de*
23.I
ndi
cat
et
hechar
act
er
i
st
i
csi
deef
f
ectof
bemegr
i
de.
A.Gast
r
i
t
i
s
B.Br
onchi
ospasm
C.Hepat
i
t
i
s
D.Ar
t
er
i
al
hy
pot
ensi
on
E.Conv
ul
si
ons*
24.Achi
l
dwasbor
nasphy
xi
at
ed.Whatdr
ugmustbe
admi
ni
st
er
edt
ot
henewbor
nt
ost
i
mul
at
ebr
eat
hi
ng?
2016
A.Pr
oser
i
ne(
Neost
i
gmi
ne)
B.Nal
oxone
C.Pr
azosi
n
D.At
r
opi
ne
E.Aet
hi
mi
zol
um *
25.A68y
.
o.pat
i
enti
sdel
i
v
er
edt
ot
hei
nt
ensi
v
ecar
e
uni
twi
t
ht
hedi
agnosi
sofpoi
soni
ngwi
t
hbar
bi
t
ur
at
es
ofami
l
ddegr
ee.Speci
f
yast
i
mul
antofr
espi
r
at
i
on,
whi
chwi
l
l
beper
t
i
nenti
nt
hi
scase.
A.I
nst
enon
B.Sy
dnocar
b
30
C.Cor
di
ami
n*
D.Pi
r
acet
am
E.Encephabol
E.Caf
f
ei
nebenzoat
esodi
um
33.Thi
sdr
ugi
susedf
ort
het
r
eat
mentofdi
sor
der
s
ofmemor
y
,cer
ebr
alat
her
oscl
er
osi
s,af
t
ercer
ebr
al
i
nj
ur
i
es,al
coholencephal
opat
hy
,and dement
i
a.I
t
i
mpr
ov
es t
he pr
ocesses of memor
i
zi
ng and
cogni
t
i
v
el
y
.Det
er
mi
net
hegr
oupofdr
ug.
A.Ami
t
r
i
pt
y
l
i
ne
B.Py
r
acet
am *
C.Par
acet
amol
D.Bemegr
i
de
E.Di
azepam
26.A pat
i
entwi
t
hdepr
essi
onhasbeenpr
escr
i
bed
Ni
al
ami
de.Thedoct
orhaswar
nedt
hepat
i
entabout
necessi
t
yt
o excl
ude f
r
om hi
d di
et dur
i
ng t
he
t
r
eat
ment
:
A.Cheese*
B.Appl
es
C.Pot
at
o
D.Cabbages
E.Pear
s
34.Apat
i
entwi
t
ht
r
aumat
i
cencephal
opat
hywas
admi
t
t
edt
ot
heneur
ol
ogi
cal
depar
t
mentwi
t
h
compl
ai
nt
sofdi
sor
der
sofmemor
y
,
i
nt
el
l
ect
,
headache,
v
er
t
i
go.Chooset
hegr
oupoft
he
t
r
eat
mentoft
hepat
i
ent
.
A.Psy
chost
i
mul
ant
s
B.Anal
ept
i
cs
C.Noot
r
opi
cagent(
cogni
t
i
v
eenhancer
s)*
D.Ant
i
depr
essant
s
E.Adapt
ogens
27.I
mpai
r
mentofl
ear
ni
ng,r
et
ar
dat
i
onofi
nt
el
l
ect
ual
dev
el
opmenti
sr
ev
eal
edat9y
.
o.chi
l
d.Whi
chgr
oup
admi
ni
st
r
at
i
oni
sappr
opr
i
at
ei
nt
hi
scase?
A.Neur
ol
ept
i
cs
B.Noot
r
ops*
C.Tr
anqui
l
i
zer
s
D.Ant
i
depr
essant
s
E.Adapt
ogens
28.Thepat
i
entabusesamphet
ami
nes.Dev
el
opment
ofwhatef
f
ecti
sunusual
af
t
eri
nt
akeoft
hi
sagent
?
A.Anor
exi
a
B.Dependence
C.Br
ady
car
di
a*
D.Ri
si
ngofAP
E.Ar
r
hy
t
hmi
as
35.Apat
i
entt
ookaf
ewt
abl
et
sofphenobar
bi
t
alt
o
f
al
l
asl
eepf
ast
er
.Soonhi
sr
espi
r
at
i
onwas
suppr
essedandi
twasdi
f
f
i
cul
tt
owakehi
m up.Hi
s
wi
f
ecal
l
edf
oranambul
ance.Whi
chspeci
f
i
c
ant
agoni
stshoul
dbeused?
A.Bemegr
i
de*
B.Caf
f
ei
ne
C.Lobel
i
ne
D.Cy
t
i
t
on
E.At
r
opi
ne
29. For r
est
or
at
i
on of t
he CNS f
unct
i
on af
t
er
i
schaemi
c st
oke a 63 y
.
o.woman wer
et
aki
ng
pi
r
acet
am.Shei
mpr
ov
edsi
gni
f
i
cant
l
y
.Whati
st
he
mechani
sm ofact
i
onofgi
v
endr
ug?
A.Bl
ockageofmonoami
neoxi
di
ze
B.Bl
ockageofchol
i
nest
er
ase
C.Bl
ockageofcat
echol
–Omet
hy
l
t
r
ansf
er
ase
D.I
mpr
ov
ementofmet
abol
i
sm i
nt
heCNS*
E.Bl
ockageofdopami
nehy
dr
oxy
l
ase
36.Phar
macol
ogi
cal
ef
f
ect
sofant
i
depr
essant
sar
e
baseduponi
nhi
bi
t
i
ngt
heenzy
met
hatact
sasa
cat
al
y
stf
ort
hebr
eakdownofbi
ogeni
cami
nes
nor
adr
enal
i
nandser
ot
oni
ni
nt
hemi
t
ochondr
i
aof
cephal
i
cneur
ons.Whatenzy
mest
akepar
ti
nt
hi
s
pr
ocess?
A.Ly
dase
B.Tr
ansami
nase
C.Pept
i
dase
D.Decar
boxy
l
ase
E.Monoami
neoxi
dase*
30.Anant
i
depr
essant
,whi
chi
scapabl
et
oi
nv
okea
st
at
eofagi
t
at
i
onandsl
eepl
essnessi
nhumans,has
beenpr
escr
i
bedt
ot
he22y
.
o.pat
i
ent
.Namet
hi
s
dr
ug.
A.Fl
uoxet
i
ne
B.Ami
t
r
i
pt
y
l
i
ne
C.Mocl
obemi
de(
Aur
or
i
x)*
D.Hal
oper
i
dol
E.Caf
f
ei
ne
37.Whi
l
eunderbar
bi
t
ur
at
eanaest
hesi
aa65 y
.
o.
mal
e pat
i
ent dev
el
oped r
espi
r
at
or
y i
nhi
bi
t
i
on.
Anaest
hesi
ol
ogi
sti
nt
r
oduced hi
m 10 mlof0.
5%
bemegr
i
de sol
ut
i
onI
V.Thepat
i
ent
’
scondi
t
i
ongot
bet
t
er
,t
hepul
monar
yv
ent
i
l
at
i
onv
ol
umei
ncr
eased.
Whatphenomenonunder
l
i
est
hei
nt
er
act
i
onoft
hese
medi
cat
i
ons?2012
A.Di
r
ectant
agoni
sm
B.Di
r
ectsy
ner
gi
sm
C.I
ndi
r
ectant
agoni
sm *
D.I
ndi
r
ectsy
ner
gi
sm
E.Uni
l
at
er
al
ant
agoni
sm
31.Apat
i
entwi
t
hr
espi
r
at
or
ydepr
essi
onwasami
t
t
ed
t
ot
he hospi
t
al
.Agent
s ofwhi
ch phar
macol
ogi
c
gr
oupshoul
dbeadmi
ni
st
er
ed?
A.Neur
ol
ept
i
cs
B.Tr
anqui
l
i
zer
s
C.Anal
ept
i
cs*
D.Ant
i
depr
essant
s
E.Anal
gesi
cs
32.A pat
i
entneedsadr
ugt
hati
mpr
ov
esmemor
y
and cogni
t
i
v
ef
unct
i
oni
nor
gani
cdamagesoft
he
br
ai
n.Sel
ecti
tout
:
A.Ni
t
r
azepam
B.Py
r
acet
am *
C.Mezapam
D.Di
azepam
38.Apat
i
entwi
t
hepi
l
epsyanddepr
essi
v
er
eact
i
on
hasbeenadmi
ni
st
er
edadr
ugt
hatr
educedepi
l
epsy
mani
f
est
at
i
on and i
mpr
ov
ed t
hatpat
i
ent
’
spsy
chi
c
condi
t
i
on.2012
A.Ami
t
r
i
pt
y
l
i
ne*
B.Pheny
t
oi
n
31
C.Sodi
um v
al
pr
oat
e
D.Et
hosuxemi
de
E.Phenobar
bi
t
al
B.Thi
opent
al
sodi
um
C.Di
et
hy
l
et
her
D.Sombr
ev
i
n
E.Fl
uor
ot
ane(
Hal
ot
hane)
3.
6.Gener
al
Anest
het
i
cs.Et
hy
l
Al
cohol
6.Thi
opent
alsodi
um was I
V admi
ni
st
er
ed t
oa
pat
i
entf
oran i
nt
r
oduct
i
on nar
cosi
s.Wi
t
hi
naf
ew
mi
nut
es l
ar
y
ngospasm and hy
per
sal
i
v
at
i
on hav
e
dev
el
oped.Whi
chdr
ugcoul
dhav
epr
ev
ent
edsuch
ef
f
ect
s?
A.Ni
t
r
azepam
B.Adr
enal
i
ne
C.Al
l
oxi
m
D.At
r
opi
ne*
E.Pr
oser
i
ne(
Neost
i
gmi
ne)
1.Apat
i
entwi
t
hcr
ani
ocer
ebr
ali
nj
ur
ywasadmi
t
t
ed
t
oahospi
t
al
.Pr
ogr
essi
v
ei
ncr
easeofneur
ol
ogi
cal
sy
mpt
omsal
l
owedt
omaket
hedi
agnosi
sofbr
ai
n
cont
usi
on,whi
chbecamet
her
easonofi
ncr
easi
ng
br
ai
nedemaf
ol
l
owedbyhy
poxi
aofi
t
sst
r
uct
ur
es.
Admi
ni
st
era gener
alanaest
het
i
c,whi
ch pr
oduces
benef
i
ci
al
i
nf
l
uencei
nbr
ai
nhy
poxi
a:
A.Ft
or
ot
an(
Hal
ot
hane)
B.I
sof
l
ur
ane
C.Pr
opani
di
de(
Sombr
evi
ne)
D.Ket
ami
ne
E.Sodi
um Oxy
but
y
r
at
e(
GOBA)
*
7.Thecombi
nat
i
onofader
i
v
at
i
v
eoft
hebar
bi
t
ur
i
c
aci
d and i
nhal
ed anaest
het
i
c was used dur
i
ng a
sur
gi
caloper
at
i
onf
ort
hegener
alanaest
hesi
a.What
combi
nat
i
onhasbeenused?
A.Phenobar
bi
t
al
+Ket
al
ar(
Ket
ami
ne)
B.Thi
opent
al
+Ft
or
ot
an(
Hal
ot
hane)*
C.Ket
al
ar(
Ket
ami
ne)+Ft
or
ot
an(
Hal
ot
hane)
D.Hexenal
+Pr
opani
di
de
E.Ft
or
ot
an(
Hal
ot
hane)+Hexenal
2.To anaest
het
i
ze t
he mani
pul
at
i
on r
el
at
ed t
oa
bur
nedsur
f
acet
r
eat
ment
,
apat
i
entwasI
Vi
nj
ect
eda
shor
t
act
i
ng anaest
het
i
c.Wi
t
hi
n 1 mi
nt
he pat
i
ent
bei
ng under anaest
hesi
a had an i
ncr
eased AP,
t
achy
car
di
a,i
ncr
eased t
one ofskel
et
almuscl
es;
r
ef
l
exesr
emai
ned.Af
t
erawakeni
ngt
hepat
i
enthad
di
sor
i
ent
at
i
onandv
i
sualhal
l
uci
nat
i
ons.Whatagent
wasadmi
ni
st
er
ed?
A.Ni
t
r
ousoxi
de
B.Thi
opent
al
sodi
um
C.Di
et
hy
l
et
her
D.Sombr
ev
i
n
E.Ket
ami
ne*
8.Pr
oser
i
ne i
ncr
easesskel
et
almuscl
et
onewhen
gi
v
en sy
st
emi
cal
l
y
. Ft
or
ot
an (
hal
ot
hane) i
nduces
r
el
axat
i
onofskel
et
almuscl
esandr
educespr
oser
i
ne
ef
f
ect
s.Whati
st
henat
ur
eofpr
oser
i
nandhal
ot
hane
i
nt
er
act
i
on?2011
A.Di
r
ectf
unct
i
onal
ant
agoni
sm
B.Noncompet
i
t
i
v
eant
agoni
sm
C.I
ndi
r
ectf
unct
i
onal
ant
agoni
sm *
D.I
ndependentant
agoni
sm
E.Uni
l
at
er
al
ant
agoni
sm
3.A23y
.
o.pat
i
entwi
t
hhumer
usabscesshasbeen
admi
t
t
ed t
o a sur
gi
caldepar
t
ment
.Whatki
nd of
anest
hesi
a and whi
ch agentt
o usear
et
hemost
appr
opr
i
at
ef
ort
hi
spat
i
ent
?
A.Et
hernar
cosi
s
B.Spi
nal
anest
hesi
awi
t
hnov
ocai
ne
C.Hexenal
nar
cosi
s
D.Local
anest
hesi
awi
t
hl
i
docai
ne*
E.Ket
ami
nenar
cosi
s
9.I
n a pat
i
entdur
i
ng f
t
or
ot
an nar
cosi
s BP has
abr
upt
l
ydecr
eased.Whi
chdr
ugshoul
dbeusedf
or
r
est
or
at
i
onofBPl
ev
el
?
A.Adr
enal
i
ne
B.I
sadr
i
ne
C.Mesat
one(
Phenyl
ephr
i
ne)*
D.Nor
adr
enal
i
ne
E.Ephedr
i
ne
4.Det
er
mi
net
hedr
ugf
orI
Vanest
hesi
awi
t
hqui
ck
onset and shor
t dur
at
i
on of act
i
on. Gener
al
anest
hesi
ai
sdev
el
opedi
n2040secandl
ast
s35
mi
n.Thest
ageofexci
t
ementi
sabsent
.Thi
sdr
ug
doesnotcauseaf
t
er
anaest
het
i
csl
eep.I
tpr
act
i
cal
l
y
doesnoti
nhi
bi
tt
hemy
ocar
di
um act
i
v
i
t
y
.I
ti
susedi
n
ambul
antpr
act
i
cef
ori
ni
t
i
alanest
hesi
aandi
nshor
t
oper
at
i
ons. The possi
bl
e compl
i
cat
i
on i
s
hy
per
v
ent
i
l
at
i
onf
ol
l
owedbyr
espi
r
at
i
ondepr
essi
on,
t
achy
car
di
a,hy
per
t
ensi
on,andhy
per
emi
aal
ongt
he
v
ei
n
A.Ni
t
r
ousoxi
de
B.Thi
opent
al
sodi
um
C.Sombr
ev
i
n(
Pr
opani
di
de)
D.Nat
r
i
um oxy
but
y
r
at
e
E.Ket
ami
ne*
10.Gener
al
anaest
het
i
cwi
t
hul
t
r
ashor
tact
i
on(
5mi
n)
wasi
nt
r
oducedt
oapat
i
entI
Vf
oranal
gesi
aofbi
opsy
.
I
tcaused a muscul
art
wi
t
chi
ng,decr
ease ofAP,
r
espi
r
at
or
y ar
r
est f
or a shor
t per
i
od of t
i
me.
Det
er
mi
net
hi
sdr
ug.
A.Ket
ami
ne
B.Nat
r
i
um oxy
but
y
r
at
e
C.Pent
azoci
ne
D.Pr
opani
di
de*
E.Ft
or
ot
an(
Hal
ot
hane)
11.Pr
opani
di
de i
s of
t
en used i
n dent
alpr
act
i
ce.
Det
er
mi
net
hecont
r
ai
ndi
cat
i
onf
oruseoft
hi
sdr
ug.
A.Reposi
t
i
onofj
awbonef
r
agment
s
B.Shock*
C.Reposi
t
i
onofdi
sl
ocat
i
onsofj
aw
D.Taki
ngoutt
hest
i
t
ches
E.Di
ssect
i
onofpul
pcav
i
t
y
5.A25y
.
o.pat
i
entwi
t
hpol
y
t
r
aumai
nunconsci
ous
st
at
ewasadmi
t
t
edt
ot
hehospi
t
al
.AP95/
70mm Hg,
pul
se75/
mi
n,r
espi
r
at
i
onsuper
f
i
ci
alwi
t
hf
r
equency
30/
mi
n.Whatagentshoul
d be used f
orgener
al
anest
hesi
a?
A.Ket
ami
ne*
12.Expr
essedbr
ady
car
di
a,
f
al
l
ofAPappear
eddur
i
ng
f
t
or
ot
ananest
hesi
a.Whatdr
ugi
scont
r
ai
ndi
cat
edt
o
32
st
abi
l
i
zehemody
nami
csdur
i
ngf
t
or
ot
ananest
hesi
a?
A.Pr
edni
sol
one
B.At
r
opi
ne
C.Mesat
on(
Phenyl
ephr
i
ne)
D.Caf
f
ei
ne
E.Adr
enal
i
ne*
B.Ft
or
ot
an(
Hal
ot
hane)
*
C.Sodi
um oxy
but
i
r
at
e
D.Et
herpr
onar
cosi
s
E.Pr
opani
di
de
20.I
nwhatconcent
r
at
i
oni
set
hy
lal
coholusedf
or
ant
i
mi
cr
obi
al
pr
ocessi
ngofski
n:
A.96%
B.70%*
C.40%
D.50%
E.60%
21.A 35y
.
o.pat
i
entwhoof
t
enconsumesal
cohol
wast
r
eat
edwi
t
hdi
ur
et
i
cs.Ther
eappear
edser
i
ous
muscl
eandhear
tweakness,v
omi
t
i
ng,di
ar
r
hea.AP
100/
60mm Hg,depr
essi
on.Thi
scondi
t
i
oni
scaused
byi
nt
ensi
f
i
edexcr
et
i
onof
:
A.Cal
ci
um
B.Pot
assi
um*
C.Chl
or
i
ne
D.Phosphat
es
E.Sodi
um
13.Themostappr
opr
i
at
eanaest
het
i
cusedmai
nl
yi
n
obst
et
r
i
cpr
act
i
ce:
A.Met
hoxy
f
l
ur
ane*
B.Ft
or
ot
an
C.Ket
ami
ne
D.Nat
r
i
um oxy
but
y
r
at
e
E.Et
herpr
onar
cosi
s
14.Thi
opent
alsodi
um was I
V admi
ni
st
er
ed t
oa
pat
i
entf
orani
ni
t
i
alnar
cosi
sandt
henl
ar
y
ngospasm
andhy
per
sal
i
v
at
i
onhav
edev
el
oped.I
nt
r
oduct
i
onof
whatagentcoul
dpr
ev
entundesi
r
abl
eef
f
ect
s?
A.Adr
enal
i
ne
B.Neost
i
gmi
ne(
Pr
oser
i
ne)
C.Pl
at
y
phy
l
l
i
n*
D.Dobut
ami
ne
E.I
sadr
i
ne
22.Wi
t
ht
hepur
poseofwar
mi
ngaf
t
ercool
i
ng,t
he
pat
i
entusedsol
ut
i
onofet
hanol
.How doeset
hanol
i
nf
l
uenceont
her
mor
egul
at
i
on?
A.I
ncr
easesheatr
el
ease*
B.Decr
easesheatr
el
ease
C.I
ncr
easesheatpr
oduct
i
on
D.Decr
easesheatpr
oduct
i
on
E.Decr
easesheatpr
oduct
i
onandheatr
el
ease
15.A pat
i
enthad an acut
el
esi
on oft
he l
i
v
er
(
hepat
i
t
i
s)af
t
err
epeat
edsur
gi
caloper
at
i
ons.What
gener
alanaest
het
i
c mostl
i
kel
yhas caused gi
v
en
pat
hol
ogy
?
A.Ni
t
r
ousoxi
de
B.Ft
or
ot
an(
Hal
ot
hane)
*
C.Ket
ami
ne
D.Sodi
um oxy
but
y
r
at
e
E.Et
herpr
onar
cosi
s
23.A pat
i
entsuf
f
er
sf
r
om chr
oni
cal
cohol
i
sm wi
t
h
t
he f
ol
l
owi
ng sy
mpt
oms:pai
ni
n ar
ms and l
egs,
i
mpai
r
mentofski
n sensi
t
i
v
i
t
y
,muscl
e weakness,
edemas.Whi
chv
i
t
ami
nshoul
dbepr
escr
i
bedt
ot
he
pat
i
ent
?
A.Er
gocal
ci
f
er
ol
B.Thi
ami
ne*
C.Ret
i
nol
D.Rut
i
n
E.Vi
casol
(
Menadi
one)
24.Fl
ushi
ngoccur
swhenal
cohol
i
st
akenal
ongwi
t
h:
A.Uni
t
hi
ol
B.Met
r
oni
dazol
e*
C.Gl
i
bencl
ami
de
D.Dr
ot
av
er
i
ne(
Nospa)
E.I
t
r
aconazol
e
25.I
nsev
er
eal
coholi
nt
oxi
cat
i
on,t
hebl
oodet
hanol
exceeds:
A.0.
5g/
L
B.1g/
L
C.2g/
L
D.3g/
L
E.4g/
L*
26.Thesamedoseofal
coholi
nv
okesadi
f
f
er
ent
degr
eeofal
coholi
nt
oxi
cat
i
oni
ndi
f
f
er
entpeopl
e.I
ti
s
l
i
nkedwi
t
h:
A.Hi
ghpl
asmal
ev
el
ofbet
al
i
popr
ot
ei
ns
B.I
nhi
bi
t
i
onofi
nsul
i
nsy
nt
hesi
s
C.Genet
i
cal
l
ydet
er
mi
ned i
nsuf
f
i
ci
encyofal
cohol
dehydr
ogenasesynt
hesi
s*
D.I
nhi
bi
t
i
onofhepat
i
cmi
cr
osomal
enzy
mes
E. Low
act
i
v
i
t
y of pseudochol
i
nest
er
ase
(
but
yr
yl
chol
i
nest
er
ase)
16.Apat
i
entt
r
eat
edwi
t
hcl
ophel
i
ne(
cl
oni
di
ne)due
t
oar
t
er
i
alhy
per
t
ensi
on,hadt
akenanal
cohol
i
cdr
i
nk
t
hatcausedashar
pi
nhi
bi
t
i
onoft
heCNS.Whati
st
he
nameoft
hi
si
nt
er
act
i
on?
A.Pot
ent
i
at
i
on*
B.Summat
i
on
C.Cumul
at
i
on
D.I
nt
oxi
cat
i
on
E.I
di
osy
ncr
at
i
cr
eact
i
on
17.Asuddenf
al
lofAPar
osei
napat
i
entwhowas
bei
ng oper
at
ed under gener
alanaest
hesi
a.The
doct
ori
nt
r
oducedepi
nephr
i
nef
ol
l
owi
ngbyv
ent
r
i
cl
e
f
i
br
i
l
l
at
i
on.I
ndi
cat
egener
alanaest
het
i
c,whi
chcoul
d
mostl
i
kel
yi
nducet
hi
scompl
i
cat
i
on:
A.Ni
t
r
i
coxi
de
B.Pr
opani
di
de
C.Ft
or
ot
an(
Hal
ot
hane)
*
D.Ket
ami
ne
E.Thi
opent
al
sodi
um
18.I
ndi
cat
et
hegener
alanaest
het
i
c,whi
chcausesa
l
ongandexpr
essedst
ageofexci
t
ement
:
A.Et
herpr
onar
cosi
s*
B.Pr
opani
di
de
C.Ft
or
ot
an(
Hal
ot
hane)
D.Ket
ami
ne
E.Thi
opent
al
sodi
um
19.I
ndi
cat
et
he gener
alanaest
het
i
c dur
i
ng whi
ch
appl
i
cat
i
onadr
enal
i
nemustnotbeused:
A.Ni
t
r
ousoxi
de
33
27.I
ndi
cat
et
heemet
i
cagentexci
t
i
ngv
omi
t
i
ngcent
er
di
r
ect
l
y
,whi
chi
susedi
nav
er
si
ont
her
apyofchr
oni
c
al
cohol
i
sm:
A.I
pecacuanha
B.Apomor
phi
ne*
C.Di
sul
f
i
r
am (
Tet
ur
am)
D.Met
r
oni
dazol
e
E.Nal
t
r
exone
28.Adoct
orhaspr
escr
i
bedTet
ur
am (
Di
sul
f
i
r
am)f
or
al
cohol
i
sm.Whati
st
hemechani
sm ofact
i
onoft
he
dr
ug?
A.Act
i
v
at
i
onofv
omi
t
i
ngcent
er
B.Augment
at
i
onofacet
y
l
chol
i
nest
er
ase
C.I
nhi
bi
t
i
onofacet
y
l
chol
i
nest
er
ase
D. Augment
at
i
on of al
dehy
de dehy
dr
ogenase
act
i
v
i
t
y
E.I
nhi
bi
t
i
onofal
dehy
dedehy
dr
ogenase*
29.Anal
cohol
i
chasal
cohol
i
cpsy
chosi
swi
t
hev
i
dent
psy
chomot
or agi
t
at
i
on. Whi
ch neur
ol
ept
i
c dr
ug
shoul
dbeadmi
ni
st
er
edf
oremer
gencyai
d?2015
A.Sodi
um br
omi
de
B.Di
azepam
C.Hal
ot
hane
D.Ami
nazi
ne
E.Reser
pi
ne
30.Dur
i
nganest
het
i
zat
i
onapat
i
entpr
esent
edwi
t
h
sy
mpt
oms oft
onus i
ncr
ease ofpar
asy
mpat
het
i
c
ner
v
ous sy
st
em such as hy
per
sal
i
v
at
i
on and
l
ar
y
ngospasm.What dr
ug coul
d hav
e pr
ev
ent
ed
t
heseundesi
r
abl
eef
f
ect
s?2011
A.At
r
opi
nesul
phat
e*
B.Py
r
acet
am
C.Anal
gi
n
D.Adr
enal
i
nehy
dr
ochl
or
i
de
E.Neost
i
gmi
ne
31.A 55 y
.
o.man had been admi
t
t
ed t
ot
he
r
esusci
t
at
i
on uni
tunconsci
ous.Rel
at
i
v
es r
epor
t
ed
hi
mt
ohav
emi
st
akenl
ydr
unkanal
cohol
i
csol
ut
i
onof
unknown or
i
gi
n.On exami
nat
i
on t
he pat
i
entwas
di
agnosedwi
t
hmet
hanoli
nt
oxi
cat
i
on.Whatant
i
dot
e
shoul
dbeusedi
nt
hi
scase?2016
A.Pr
ot
ami
nesul
f
at
e
B.Et
hanol
*
C.Di
sul
f
i
r
am (
Tet
ur
am)
D.Acet
y
l
cy
st
ei
n
E.Nal
t
r
exone
32.Sev
er
almi
nut
es af
t
era dent
i
stadmi
ni
st
er
ed
novocai
nef
orl
ocalanaest
hesi
aofapat
i
ent
’
st
oot
h,
t
he f
ol
l
owi
ng sy
mpt
oms shar
pl
ydev
el
oped i
nt
he
pat
i
ent
:f
at
i
gue,ski
ni
t
chi
ng,Obj
ect
i
v
el
yt
hef
ol
l
owi
ng
can be obser
v
ed:ski
n hy
per
emi
a,t
achy
car
di
a,BP
dr
oppeddownt
o70/
40mm Hg.Whatki
ndofal
l
er
gi
c
r
eact
i
oni
st
hi
spat
hol
ogy
?
A.Cy
t
ot
oxi
c
B.Cel
l
medi
at
edi
mmuner
eact
i
on
C.St
i
mul
at
i
ng
D.Anaphy
l
act
i
c*
E.I
mmunecompl
ex
34