Absorption and distribution of drugs .................................................................................. 2
Amino acid neurotransmitters ........................................................................................... 3
Analgesic drugs ............................................................................................................... 4
Antibacterial drugs .......................................................................................................... 6
Antidepressant drugs ....................................................................................................... 7
Antiepileptic drugs ........................................................................................................... 9
Antifungal drugs ............................................................................................................ 10
Anthelminthic drugs ....................................................................................................... 11
Antipsychotic drugs ....................................................................................................... 11
Antiviral drugs .............................................................................................................. 12
Anxiolytic and hypnotic drugs ......................................................................................... 13
Atherosclerosis and lipoprotein metabolism ....................................................................... 14
Bone metabolism ........................................................................................................... 15
Cancer chemotherapy .................................................................................................... 16
Cannabinoids ................................................................................................................ 18
Cell proliferation and apoptosis ....................................................................................... 18
Chemical mediators and the autonomic nervous system ..................................................... 20
Chemical transmission and drug action in the central nervous system .................................. 21
Cholinergic transmission ................................................................................................. 21
CNS stimulants and psychotomimetic drugs ...................................................................... 23
Drug addiction, dependence and abuse ............................................................................ 24
Drug elimination and pharmacokinetics ............................................................................ 26
Drugs used in the treatment of infections and cancer ......................................................... 27
General anesthetic agents .............................................................................................. 28
Haemostasis and thrombosis........................................................................................... 29
How drugs act cellular aspects-excitation, contraction and secretion .................................... 31
How drugs act general principles ..................................................................................... 32
Local anaesthetics and other drugs affecting sodium channels ............................................. 33
Local hormones, inflammation, and immune reactions ....................................................... 34
Method and measurement in pharmacology ...................................................................... 36
Molecular aspects of drug action ...................................................................................... 37
Neurodegenerative diseases ........................................................................................... 39
Nitric oxide ................................................................................................................... 41
Noradrenergic transmission ............................................................................................ 42
Obesity ........................................................................................................................ 43
Other peripheral mediators, 5-hydroxytryptamine and purines ............................................ 44
Other transmitters and modulators .................................................................................. 45
Peptides and proteins as mediators .................................................................................. 47
The endocrine pancreas and the control of blood glucose .................................................... 47
The gastrointestinal tract ................................................................................................ 48
The haemopoietic system ............................................................................................... 50
The heart ..................................................................................................................... 50
The kidney ................................................................................................................... 52
The pituitary and the adrenal cortex ................................................................................ 54
The reproductive system ................................................................................................ 55
The respiratory system .................................................................................................. 56
The thyroid ................................................................................................................... 57
The vascular system ...................................................................................................... 58
1. Absorption and distribution of drugs
1. Concerning the effect of pH on the urinary excretion of drugs, it can be correctly stated that
A) urinary acidification accelerates excretion of weak acids and bases
B) urinary alkalinization accelerates excretion of weak acids and bases
C) urinary acidification accelerates excretion of weak acids
D) urinary alkalinization accelerates excretion of weak acids
E) urinary alkalinization has no effect on excretion of weak bases
2. Bioavailability is defined as the proportion of ingested drug that
A) is absorbed from the gastrointestinal tract
B) reaches the systemic circulation in an active form
C) crosses the blood-brain barrier
D) is unbound to plasma proteins
E) is distributed to the target tissue
3. The rectal route of administration
A) provides nearly 100 percent bioavailability
B) is only used for localized effects
C) is suitable for persons with nausea and vomiting
D) is subject to a high degree of first-pass metabolism
E) is used for administration of nitroglycerin
4. The passage of drugs across the blood-brain barrier
A) is facilitated by a high degree of drug ionization
B) is most rapid for drugs with low lipid solubility
C) occurs more readily in the chemoreceptor trigger zone
D) is reduced by inflammation of the meninges
E) is rapid with aminoglycoside antibiotics
5. A calculated volume of distribution greater than total body water is most likely to occur with
drugs that are
A) highly ionized
B) highly lipid soluble
C) subject to a high degree of first-pass inactivation
D) highly bound to plasma proteins
E) very large molecules
6. Drugs are most readily absorbed across cells of the
A) gastrointestinal tract
B) renal tubules
C) vascular endothelium
D) lung parenchyma
E) liver
7. The binding of drugs to plasma albumin
A) is usually irreversible
B) is saturable
C) is most important for basic drugs
D) accelerates drug metabolism
E) accelerates drug excretion
8. Most drugs are absorbed across cell membranes of the gut by the process of
A) diffusing through lipid
B) pinocytosis
C) diffusing through aqueous pores
D) carrier-mediated transport
E) ion trapping
2
9. Which drug is absorbed by a membrane carrier that transports phenylalanine?
A) insulin
B) propranolol
C) levodopa
D) aspirin
E) penicillin
10. Transdermal drug administration
A) is most suitable for highly polar drugs
B) is not subject to first-pass hepatic metabolism
C) provides rapid and complete absorption
D) is only used for localized effects
E) is most suitable for unconscious persons
Key: 1D, 2B, 3C, 4C, 5B, 6C, 7B, 8C, 9C, 10B
2. Amino acid neurotransmitters
1. The N-methyl-D-aspartate receptor for excitatory amino acids is positively modulated by
A) γ-amino butyric acid
B) tyrosine
C) glycine
D) phenylalanine
E) alanine
2. The pathway leading to long-term potentiation of neuronal activity includes
A) inhibition of nitric oxide synthase
B) sustained blockade of N-methyl-D-aspartate receptors
C) feedback inhibition by nitric oxide
D) activation of protein kinase C by calcium
E) inhibition of metabotropic receptors
3. Baclofen is a selective agonist for the
A) kainite receptor for excitatory amino acids
B) N-methyl-D-aspartate receptor for excitatory amino acids
C) metabotropic receptor for excitatory amino acids
D) γ-amino butyric acid-A (GABAA) receptor
E) γ-amino butyric acid-B (GABAB) receptor
4. Activation of AMPA (α-amino-5-hydroxy-3-methyl-4-isoxazole propionic acid) receptors for
excitatory amino acids leads to
A) fast inhibitory neurotransmission
B) fast excitatory neurotransmission
C) modulation of postsynaptic excitatory neurotransmission
0) slow excitatory neurotransmission
E) slow inhibitory neurotransmission
5. The glycine receptor blocked by strychnine is a
A) ligand-gated chloride channel
B) ligand-gated calcium channel
C) voltage-gated calcium channel
D) G-protein-coupled receptor
E) protein kinase receptor
6. The binding of γ-amino butyric acid (GABA) to the GABA receptor is increased by
A) flumazenil
B) picrotoxin
3
C) diazepam
D) baclofen
E) gabapentin
7. Which substance blocks ion channels of N-methy1-D-aspartate receptors for excitatory
amino
acids?
A) ketamine
B) cycloserine
C) kynurenic acid
D) cyclothiazide
E) kainite
8. Activation of metabotropic excitatory amino acid receptors leads to
A) opening of chloride ion channels
B) opening of cation channels
C) formation of inositol triphosphate
D) formation of cyclic AMP
E) activation of protein kinase A
Key: 1C, 2D, 3E, 4B, 5A, 6C, 7A, 8E
3. Analgesic drugs
1. Opioids activate descending pathways that inhibit pain transmission by acting on neurons in
the
A) dorsal horn
B) thalamus
C) periaqueductal grey matter
D) nucleus raphe magnus
E) locus coeruleus
2. The vaniloid receptor activated by capsaicin is a
A) ligand gated cation channel
8) ligand-gated chloride ion channel
C) ATP-sensitive potassium channel
D) G-protein-coupled receptor
E) protein kinase receptor
3. The analgesic effect of morphine is mostly due to activation of
A) delta opioid receptors
B) kappa opioid receptors
C) mu opioid receptors
D) sigma opioid receptors
E) tau receptors
4. Simulation of opioid receptors leads to
A) increased guanylate cyclase activity
B) decreased guanylate cyclase activity
C) increased adenylate cyclase activity
D) decreased adenylate cyclase activity
E) dosing of potassium channels
5. Opioid drugs that exhibit partial agonist or mixed agonist-antagonist properties include
A) naloxone and naltrexone
B) methadone and meperidine
C) fentanyl and sufentanil
4
D) dynorphin and endorphin
F) nalbuphine and pentazocine
6. The best example of a partial agonist at mu opioid receptors is
A) pentazocine
B) bupienorphine
C) cyclazocine
D) nalbuphine
E) codeine
7. Which short-acting opioid agonist is administered as a transdermal skin patch?
A) fentanyl
B) methadone
C) meperidine
D) codeine
E) propoxyphene
8. Activation of Kappa opioid receptors is primarily responsive for causing
A) supraspinal analgesia
B) euphoria
C) dysphoria
D) respiratory depression
E) physical dependence
9. Which finding typically occurs in opioid poisoning but not in central nervous system
depression due to other causes?
A) coma
B) hallucinations
C) hypertension
D) respiratory depression
E) pinpoint pupils
10. The pharmacologic properties of morphine are
A) well absorbed from the gut
B) high oral bioavailability
C) rapidly metabolized in neonates
D) converted to active morphine-6-glucuronide
E) excreted unchanged in the urine
11. Descending inhibition of dorsal horn pain transmission is mediated by neurons that release
A) acetylcholine and dopamine
B) enkephalins, 5-hydroxytryptamine, and noradrenaline
C) glutamate and substance P
D) bradykinin and prostanoids
E) neuropeptides
12. Opioid drugs inhibit neurotransmitter release partly by
A) opening potassium and calcium channels
B) dosing potassium and calcium channels
C) opening potassium channels and closing calcium channels
D) opening calcium channels and closing potassium channels
E) depolarizing pre-synaptic neuronal membranes
13. Which transmitter is released at the first synapse in the dorsal horn ascending nociceptive
A) glutamate
B) enkephalin
C) substance P
D) γ-amino-butyric acid
E) noradrenaline
5
14. Actions of opioids that are not related to activation of mu, delta, or kappa opioid receptors
include
A) euphoria
B) respiratory depression
C) pupillary constriction
D) constipation
E) bronchospasm
Key: 1C, 2A, 3C, 4D, 5E, 6B, 7A, 8C, 9E, 10D, 11B, 12C, 13A, 14E
4. Antibacterial drugs
1. Benzylpenicillin is the first drug of choice for treatment of infections due to
A) Pseudomonas aeruginosa
B) Legionella pneumophila
C) Haemophilus influenzae
D) Treponema pallidum
E) Pasteurelia multocida
2. Red-green color blindness is a dose-related adverse effect of
A) cycloserine
B) ethambutol
C) rifampicin
D) isoniazid
E) streptomycin
3. Resistance to cephalosporin antibiotics is most likely to result from
A) phosphorylation by bacterial kinases
B) inactivation by bacterial β-lactamase
C) decreased affinity of dihydrofolate reductase
D) increased efflux by bacterial transport proteins
E) decreased ribosomal affinity for the drugs
4. Penicillins that are active against strains of Pseudomonas aeruginosa include
A) piperacillin
B) ampicillin
C) benzylpenicillin
D) amoxicillin
E) phenoxymethylpenicillin
5. Respiratory tract infections caused by Nocardia or Pneumocystis are often treated with
A) co-trimoxazole
B) gentamicin
C) azithromycin
D) tetracycline
E) chloramphenicol
6. Cilastatin inhibits the degradation imipenem by
A) hepatic enzymes
B) gut wall enzymes
C) renal enzymes
D) pulmonary enzymes
E) plasma enzymes
7. Chloramphenicol is not used for trivial infections because it may rarely cause
A) liver failure
6
B) pancytopenia
C) heart failure
D) pulmonary fibrosis
E) convulsive seizures
8. Infections due to penicillinase-producing strains of Neisseria gonorrhoeae may be most
effectively treated with
A) tetracycline
B) gentamicin
C) erythromycin
D) vancomycin
E) ofloxacin
9. A genetically determined variation of hepatic acetyltransferase activity accounts for
differences in the elimination half-life of
A) rifampicin
B) isoniazid
C) pyrazinamide
D) ethambutol
E) cycloserine
10. Tetracycline should not be given to pregnant women or young children because of the risk
of
A) retarded bone development
B) ototoxicity
C) bone marrow depression
D) myositis and rhabdomyolysis
E) hypoplasia and staining of the teeth
11. Arthropathy manifested as painful joints is most likely to occur in younger individuals
treated with
A) ciprofloxacin
B) tetracycline
C) azithromycin
D) trimethoprim
E) vancomycin
12. Quinupristin-dalfopristin is active against some strains of
A) Pseudomonas aeruginosa
B) Enterococcus faecium
C) Escherichia coli
D) Proteus mirabilis
E) Legionella pneumophila
Key: 1D, 2C, 3B, 4A, 5A, 6C, 7B, 8E, 9B, 10E, 11A, 12B
5. Antidepressant drugs
1. The mechanisms that contribute to the development of mood depression include increased
A) cortisol
B) noradrenaline
C) brain-derived neurotrophic factor
D) 5-hydroxytryptamine
E) γ-amino-butyric acid
2. Alternatives to lithium for the prevention and treatment of manic episodes include
A) fluoxetine
7
B) sertraline
C) carbamazepine
D) phenelzine
E) bupropion
3. Mirtazapme is believed to produce its antidepressant effect by
A) activating 5-hydroxytryptamine 5-HT2 receptors
B) activating 5-hydroxytryptamine 5-HT3 receptors
C) activating presynaptic α2 adrenoceptors
D) blocking presynaptic α2 adrenoceptors
E) blocking neuronal reuptake of noradrenaline
4. Which antidepressant drug is used as an adjunct to smoking cessation?
A) fluoxetine
B) bupropion
C) sertraline
D) mirtazapine
E) paroxetine
5. Ingestion of foods containing tyramine may lead to a hypertensive crisis in persons taking
A) A tricyclic antidepressant
B) mirtazapine
C) a selective serotonin reuptake inhibitor
D) lithium
E) a nonselective monoamine oxidase inhibitor
6. Selective serotonin uptake inhibitors cause
A) immediate inhibition of serotonin reuptake and mood improvement
B) delayed inhibition of serotonin reuptake and mood improvement
C) immediate inhibition of serotonin reuptake and delayed mood improvement
D) immediate mood improvement and delayed inhibition of serotonin reuptake
E) mood depression followed by mood improvement
7. Severe cardiac arrhythmias are most likely to result from an overdose of
A) fluoxetine
B) phenelzine
C) mirtazapine
D) sertraline
E) nortriptyline
8. Serum lithium levels are increased by the concurrent administration of
A) thiazide diuretics
B) desipramine
C) trazodone
D) phenelzine
E) propranolol
9. The concurrent administration of a selective serotonin reuptake inhibitor and a monoamine
oxidase inhibitor is most likely to cause
A) bradycardia
B) suicidal thoughts
C) postural hypotension
D) dry mouth and blurred vision
E) hyperthermia and muscle rigidity
10.
Desipramine blocks the neuronal reuptake of
A) only noradrenaline
B) only serotonin
8
C) noradrenaline and serotonin equally
D) noradrenaline more than serotonin
E) serotonin more than noradrenaline
11. Sexual dysfunction is most likely to occur in persons taking
A) amitriptyline
B) fluoxetine
C) mirtazapine
D) desipramine
E) nortriptyline
12. The adverse effects of amitriptyline caused by muscarinic receptor blockade include
A) urinary retention
B) insomnia
C) hypotension
D) diarrhea
E) salivation
Key: 1A, 2C, 3D, 4B, 5E, 6C, 7E, 8A, 9E, 10D, 11B, 12A
6. Antiepileptic drugs
1. Gabapentin is believed to exert its antiepileptic effect by
A) increasing the synthesis of γ-aminobutyric acid (GABA)
B) increasing the release of γ-aminobutyric acid (GABA)
C) activating γ-aminobutyric acid (GABA)-gated chloride ion channels
D) blocking γ-aminobutyric acid (GABA)-gated chloride ion channels
E) inhibiting the release of several neurotransmitters
2. The efficacy of ethosuximide in the treatment of absence seizures is based on its ability to
A) block voltage
B) activate voltage
C) block T (transient)
D) activate T (transient)
E) activated γ
3. Which antiepileptic agent inhibits γ-aminobutyric acid (GABA) transaminase and thereby
increases the brain content of GABA?
A) vigabatrin
B) carbamazepine
C) tiagabine
D) lamotrigine
E) topiramate
4. Carbamazepine is used in treating all of the following conditions except
A) bipolar disorder
B) neuropathic pain
C) absence seizures
D) partial seizures
E) generalized tonic-clonic seizures
5. The antiepileptic effect of zonisamide is due to its ability to
A) block T (transient)-type calcium channels
B) block voltage-gated sodium channels
C) Inhibit γ-aminobutyric acid (GABA) degradation
D) inhibit glutamate release
E) block glutamate receptors
9
6. Hirsutism, megaloblastic anemia, and gum hypertrophy are potential adverse effects of
A) carbamazepine
B) ethosuximide
C) lamotrigine
D) phenobarbital
E) phenytoin
7. Gabapentin, tiagabine, and zonisamide are primarily used in treating
A) partial seizures
B) generalized tonic-clonic seizures
C) absence seizures
D) myoclonic seizures
E) status epilepticus
8. Mood depression and psychotic reactions may occur in some patients receiving
A) gabapentin
B) tiagabine
C) lamotrigine
D) vigabatrin
E) zonisamide
Key: 1E, 2C, 3A, 4C, 5B, 6E, 7A, 8D
7. Antifungal drugs
1. The conversion of squalene to lanosterol in fungi is inhibited by
A) flucytosine
B) itraconazole
C) griseofulvin
D) amphotericin B
E) terbinafine
2. The synthesis of a component of the fungal cell wall is inhibited by
A) ketoconazole
B) caspofurgin
C) amphotericin B
D) griseofulvin
E) flucytosine
3. Dermatophyte infections of the nailbed can be effectively treated by oral administration of
A) nystatin
B) amphotericin B
C) flucytosine
D} itraconazole
E) caspofungin
4. Fever, chills, nausea, and vomiting occur frequently in persons administered
A) amphotericin B
B) caspofungin
C) fluconazole
D) terbinafine
E) griseofulvin
5. Cases of invasive aspergillosis that are refractory to amphotericin B have been successfully
treated
A) nystatin
10
B) itraconazole
C) caspofungin
D) fluconazole
E) terbinafine
Key: 1E, 2B, 3D, 4A, 5C
8. Anthelminthic drugs
1. Praziquantel is effective in treating blood fluke infections because of its ability to
A) block voltage-gated calcium channels
B) induce muscle contracture and paralysis
C) open chloride ion channels
D) inhibit tubulin polymerization
E) prevent glucose uptake
2. A single dose of niclosamide is effective in treating infections of
A) Enterobius vermicuiaris
B) Schistosoma japonicum
C) Trichuris trichiura
D) Trichinella spirailis
E) Taenia solium
3. Ivermectin is believed to kill filarial roundworm parasites partly by
A) blocking glutamate-gated chloride channels
B) opening glutamate-gated chloride channels
C) blocking voltage-gated calcium charnels
D) opening voltage-gated calcium channels
E) inhibiting oxidative phosphorylation
4. Which anthelminthic drug interferes with microtubule-dependent functions such as glucose
A) albendazole
B) diethylcarbamazine
C) piperazine
D) niclosamide
E) levamisole
Key: 1B, 2E, 3B, 4A
9. Antipsychotic drugs
1. The glutamate hypothesis of schizophrenia is based in part on the
A) increased glutamate receptor densities found in schizophrenic brains
B) decreased glutamate receptor densities found in schizophrenic brains
C) reduction of schizophrenic symptoms by glutamate antagonists
D) reduction of schizophrenic symptoms by glutamate agonists
E) occurrence of psychotic symptoms in persons given glutamate agonists
2. Because of the risk of agranulocytosis, periodic blood counts are required in persons
receiving
A) haloperidol
B) quetiapine
C) risperidone
D) clozapine
E) sulpinde
11
3. The dopamine hypothesis of schizophrenia is primarily supported by the
A) decreased dopamine synthesis found in schizophrenic patients
B) increased excretion of dopamine metabolites in schizophrenic patients
C) increased dopamine D2 receptor density found in schizophrenic patients
D) decreased dopamine D2 receptor density found in schizophrenic patients
E) correlation between dopamine D2 receptor binding and clinical potency of antipsychotic
drugs
4. The primary endocrine effect of most antipsychotic drugs is
A) increased secretion of prolactin
B) decreased secretion of prolactin
C) increased secretion of growth hormone
D) decreased secretion of growth hormone
E) increased secretion of thyrotropin
5. When antipsychotic drugs are administered chronically, the activity of dopaminergic neurons
A) decreases throughout therapy
8) increases throughout therapy
C) decreases transiently then increases
D) increases transiently then decreases
E) fluctuates randomly throughout therapy
6. The adverse effects of antipsychotic drugs attributed to blockade of muscarinic receptors
include
A) hypotension
B) tardive dyskinesia
C) obstructive (cholestatic) jaundice
D) weight gain
E) increased intraocular pressure
7. The antipsychotic malignant syndrome is characterized by
A) muscle paralysis and hypothermia
B) muscle rigidity and hyperthermia
C) muscle atrophy
D) myositis and rhabdomyolysis
E) leukopenia and agranulocytosis
Key: 1B, 2D, 3E, 4A, 5D, 6E, 7B
10.Antiviral drugs
1. Which reverse transcriptase inhibitor achieves the highest percentage of plasma drug
concentrations in the cerebrospinal fluid?
A) lamivudine
B) abacavir
C) stavudine
D) zidovudine
E) efavirenz
2. The mortality due to Lassa fever is significantly reduced in persons treated with
A) tribavirin (ribavirin)
B) foscarnet
C) ganciclovir
D) interferon alpha
E) oseltamivir
12
3. Efavirenz inhibits human immunodeficiency virus reverse transcriptase by
A) competing with nucleotides for the active site of the enzyme
B) binding near the catalytic site and denaturing it
C) incorporation into nascent DNA, causing chain termination
D) inhibiting formation of nucleotide triphosphates
E) inhibiting maturation of viral poiyproteins
4. The preferred drug for treating active infections of cytomegalovirus is
A) acyclovir
B) foscamet
C) lamivudine
D) nevirapine
E) ganciclovir
5. Which virus is most susceptible to acyclovir?
A) cytomegalovirus
B) Herpes simplex virus
C) Herpes zoster virus
D) respiratory syncytial virus
E) Epstein-Barr virus
6. Which agent has been used to reduce mother-to-baby transmission of human
immunodeficiency
A) abacavir
B) ritonavir
C) nevirapine
D) enfuvirtide
E) lamivudine
7. The use of foscarnet is restricted because of its propensity to cause
A) nephrotoxicity
B) hepatotoxicity
C) cardiotoxicity
D) pulmonary toxicity
E) ototoxicity
8. Oseltamivir effectively prevents influenza because of its ability to inhibit
A) viral attachment
B) viral disassembly
C) replication of viral nucleic acid
D) assembly of new virions
E) budding of new virions
Key: 1D, 2A, 3B, 4E, 5B, 6C, 7A, 8E
11.Anxiolytic and hypnotic drugs
1. Benzodiazepines enhance the effect of γ-amino-butyric acid (GABA) on chloride ion channels
by increasing
A) the chloride conductance of each channel
B) the frequency of channel opening
C) the amount of time each channel remains open
D) the affinity of chloride for the channel
E) the recovery time of each channel
2. When used to induce sleep in persons with insomnia, benzodiazepines act to increase
A) subjective ratings of sleep quality
13
B) the proportion time spent in slow-wave sleep
C) the amount of time taken to get to sleep
D) the amount of rapid eye movement sleep
E) the secretion of growth hormone during sleep
3. The atributes of zolpidem include
A) a benzodiazepine structure
B) being useful in treating anxiety
C) an ultrashort duration of action
D) a significant hangover effect
E) a high risk of drug dependence
4. Flumazenil interacts with the γ-amino-butyric add (GABA) receptor so as to competitively
inhibit the binding of
A) only GABA
B) only benzodiazepine drugs
C) only β-carboline drugs
D) both GABA and benzodiazepine drugs
E) both benzodiazepine and β-carboline drugs
5. The use of buspirone in the treatment of anxiety disorders is characterized by
A) a rapid onset of action
B) a risk of drug dependence
C) sedation and motor incoordination
D) a lack of withdrawal effects
E) blockade of 5-hydroxytryptamine 5-HT1A receptors
6. Midazolam is most commonly used as
A) a hypnotic
B) an anxiolytic
C) an intravenous anesthetic
D) an anticonvulsant
E) a muscle relaxant
7. The short-acting benzodiazepines that are converted to inactive glucuronide metabolites
include
A) diazepam
B) lorazepam
C) chlordiazepoxide
D) triazolam
E) alprazolam
Key: 1B, 2A, 3C, 4E, 5D, 6C, 7B
12.Atherosclerosis and lipoprotein metabolism
1. Activation of the peroxisome proliferator-activated receptor-alpha is produced by
administration of
A) ezetimibe
B) fenofibrate
C) simvastatin
D) niacin
E) colesevelam
2. Ezetimibe reduces serum LDL-cholesterol levels by
A) inhibiting cholesterol synthesis
B) increasing HDL-cholesterol levels
14
C) inhibiting cholesterol absorption
D) inhibiting bile acid reabsorption
E) stimulate lipoprotein lipase
3. Myositis leading to rhabdomyolysis is a potentially severe adverse effect of
A) atorvastatin
B) niacin
C) colestipol
D) ezetimibe
E) cholestyramine
4. Increased expression of apoproteins A-I and A-II occurs in persons receiving
A) colestipol
B) niacin
C) simvastatin
D) ezetimibe
E) gemfibrozil
5. Simvastatin and related drugs have been shown to reduce mortality in persons with
A) hypertriglyceridemia
B) low HDL-cholesterol levels
C) an inability to make LDL receptors
D) symptomatic coronary artery disease
E) myositis
6. Which drug inhibits hepatic triglyceride synthesis and VLDL secretion?
A) fenofibrate
B) colestipol
C) niacin
D) ezetimibe
E) atorvastatin
Key: 1B, 2C, 3A, 4E, 5D, 6C, 7B
13.Bone metabolism
1. Substances that stimulate osteoblasts to express the Receptor Activator of Nuclear factor
Kappa B (RANK) ligand include
A) alendronate
B) raloxifene
C) fluoride
D) calcitriol
E) osteoprotegerin
2. Which type of vitamin D is formed in the skin by the action of ultraviolet radiation?
A) calcitriol
B) calcifediol
C) ergocalciferol
D) alfacalcidol
E) cholecalciferol
3. Alendronate is useful in treating osteoporosis because of its ability to
A) stimulate bone formation by osteoblasts
B) inhibit bone resorption by osteoclasts
C) block receptor activator of nuclear factor kappa B
D) cause apoptosis of osteoclasts
E) cause differentiation of osteoblast precursor cells
15
4. Activation of calcium-sensing receptors by cinacalcet causes
A) a rise in plasma calcium concentration
B) increased secretion of parathyroid hormone
C) decreased secretion of parathyroid hormone
D) decreased secretion of calcitonin
E) increased formation of calcitriol
5. Teriparatide is useful in the treatment of osteoporosis because of its ability to
A) increase plasma calcium concentrations
B) decrease plasma calcium concentrations
C) recruit osteoclast precursor cells
D) inhibit osteoclast activity
E) increase osteoblast activity
6. Which agent is used to prevent excessive bone turnover and relieve bone pain in Pagers
disease of bone?
A) calcitonin
B) ergocalciferol
C) calcium gluconate
D) parathyroid hormone
E) prednisone
Key: 1D, 2E, 3B, 4C, 5E, 6A
14.Cancer chemotherapy
1. A cytoplasmic kinase (Bcr/Abl) involved in the pathogenesis of chronic myeloid leukemia is
inhibited by
A) crisantaspase
B) anastrozole
C) imatinib
D) rituximab
E) aldesleukin
2. Cumulative dose-related cardiac toxicity typically results from administration of
A) doxorubicin
B) bleomycin
C) vincristine
D) imatinib
E) irinotecan
3. Goserelin is used in treating advanced prostate cancer because of its ability to
A) increase gonadotrophin secretion
B) reduce gonadotrophin secretion
C) block testosterone receptors
D) activate estrogen receptors
E) inhibit estrogen synthesis
4. Vincristine inhibits mitosis of cancer cells at metaphase by
A) inhibiting telomerase
B) increasing tubulin degradation
C) inhibiting synthesis of tubulin
D) inhibiting polymerization of tubulin
E) stabilizing microtubules
5. Cytarabine is converted to an active triphosphate metabolite that inhibits
16
A) DMA polymerase
B) adenine deaminase
C) dihydrofolate reductase
D) telomerase
E) thymidylate synthetase
6. Folinic acid can be administered to counteract the toxic effects of
A) fludarabine
B) gemcitabine
C) cytarabine
D) fluorouracil
E} methotrexate
7. Reactive carbonium ions that attack guanine bases of DNA and lead to crosslinking of DNA
strands are formed in the body from drugs such as
A) cisplatin
B) bleomycin
C) doxorubicin
D) etoposide
E) cyclophosphamide
8. Which anticancer drug is most effective in the G2 phase of the cell cycle?
A) paclitaxel
B) methotrexate
C) bleomycin
D) iriinotecan
E) cytarabine
9. Thymidylate synthetase is inhibited by the active metabolite of
A) pentostatin
B) fluorouracil
C) doxorubicin
D) gemcitabine
E) fludarabine
10. Anastrozole is used in treating advanced breast cancer because of its ability to
A) inactivate tumor growth factors
B) block estrogen receptors
C) inhibit aromatase
D) decrease gonadotropin secretion
E) cross-link strainds of DNA
11. Sulfhydryl donors such as mesna are useful in reducing ifosfamide-induced
A) bone marrow depression
B) nausea and vomiting
C) cardiac toxicity
D) hemorrhagic cystitis
E) gastrointestinal ulceration
12. Trastuzumab is useful in treating breast cancer because of its ability to bind
A) telomerase
B) human epidermal growth factor receptor 2
C) DNA transcription factors
D) insulin-like growth factor
E) calcium channel forming proteins
Key: 1C, 2A, 3B, 4D, 5A, 6E, 7E, 8C, 9B, 10C, 11D, 12B
17
15.Cannabinoids
1. Activation of the cannabinoid CB1 receptor in nerve endings leads to
A) activation of neurotransmitter release
B) inhibition of potassium channels
C) inhibition of calcium channels
D) activation of adenylate cyclase
E) inhibition of Map (mitogen-activated protein) kinase
2. Cannabinoids have been used therapeutically for the purpose of
A) increasing appetite
B) treating obesity
C) improving memory
D) treating drug dependence
E) treating anxiety
3. Anandamide is correctly described as a substance that
A) is synthesized from amino acid precursors
B) is stored in synaptic vesicles
C) is a cannabinoid receptor antagonist
D) inhibits retrograde neuronal transmission
E) exerts endocannabinoid activity
4. The effects produced by cannabinoid administration include
A) increased intraocular pressure
B) decreased intraocular pressure
C) Vasoconstriction
D) Bronchoconstriction
E) emesis
5. Rimonabant is a new drug for the treatment of
A) obesity
B) nausea and vomiting
C) asthma
D) neuropathic pain
E) Parkinson’s disease
Key: 1C, 2A, 3E, 4B, 5A
16.Cell proliferation and apoptosis
1. In the death receptor pathway, activation of tumor necrosis factor receptors causes the
receptors to trimerize and complex an adapter protein, thereby leading to activation of
A) mitochondrial pathways
B) caspase-8
C) pro-apoptotic factor Bcl-2
D) a p53 protein
E) DNA transcription factors
2. The activation of primitive stem cells so as to replace a damaged tissue is called
A) Healing
B) Repair
C) Restoration
D) Regeneration
E) Rejuvenation
3. Defective apoptosis may contribute to the development of
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A) Cancer
B) Alzheimer’s disease
C) myocardial infarction
D) aplastic anemia
E) stroke
4. The activation of caspase-3 leads to
A) activation of transcription factors
B) inhibition of transcription factors
C) activation of the anti-apoptotic pathway
D) fragmentation of genomic DNA
E) stabilization of cell membranes
5. Bortemozib causes accumulation of an apoptotic-promoter protein by inhibiting
A) mitochondrial DNA
B) Suvivin
C) matrix metalolproteinases
D) pro-apoptotic Bcl-2
E) the proteasome
6. Matrix metalloproteinases are responsible for
A) inhibition of neoplastic cell growth
B) adjusting the cell cytoskeleton
C) degradation of extracellular matrix
D) initiating angiogenesis
E) activation of the cell cycle
7. Antisense compounds active against antiapoptotic factors are potentially useful for treating
A) myocardial infarction
B) Leukemia
C) Parkinson's disease
D) multiple sclerosis
E) impaired wound healing
8. Bevacizumab is a monoclonal antibody that targets
A) caspase-3
B) Metalollproteinase
C) Cyclin
D) vascular endothelial growth factor
E) promoters of apoptosis
9. Mitochondria participate in apoptosis by releasing
A) apoptotic protease activating factor
B) caspase-9
C) cytochrome c
D) p53 protein
E) inhibitors of apoptosis
10. Progress through the cell cycle is stimulated by
A) cyclin-dependent kinases
B) phosphorylated Rb protein
C) check point factors
D) p53 protein
E) inhibitors of kinases
Key: 1B, 2D, 3A, 4D, 5E, 6C, 7B, 8D, 9C, 10A
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17.Chemical mediators and the autonomic nervous system
1. The release of acetylcholine from cholinergic nerve terminals is stimulated by
A) nitric oxide
B) Norepinephnne
C) acetylcholine
D) prostaglandins
E) endothelin
2. Co-transmitters released from postganglionic sympathetic neurons include
A) Acetylcholine
B) vasoactive intestinal peptide
C) nitric oxide
D) adenosine triphosphate
E) gamma-aminobutync acid
3. Constriction of bronchi is typically produced by activation of
A) adrenergic beta-1 receptors
B) adrenergic beta-2 receptors
C) muscarinic M1 receptors
D) muscarinic M2 receptors
E) muscarinic M3 receptors
4. Activation of adrenergic beta-2 receptors produces
A) contraction of the iris sphincter muscle
B) relaxation of the iris sphincter muscle
C) relaxation of the ciliary muscle
D) contraction of the ciliary muscle
E) lacnmal gland secretion
5. The enteric nervous system is primarily concerned with the regulation of
A) the urinary tract
B) gastrointestinal motility
C) male sex organs
D) Respiration
E) vascular smooth muscle
6. The co-transmitter known as neuropeptide γ enhances the
A) vasodilative effect of acetylcholine
B) vasodilative effect of nitric oxide
C) vasodilative effect of dopamine
D) vasoconstrictive effect of norepinephrine
E) vasoconstrictive effect of endothelin
7. The final step in the release of norepinephrine from sympathetic neurons is
A) docking
B) loading
C) diffusion
D) synthesis
E) exocytosis
8. In the parasympathetic nervous system, neurotransmitter action is terminated by
A) diffusion from the synapse
B) active reuptake into presynaptic nerves
C) inactivation by inhibitors
D) enzymatic degradation
E) endocytosis
9. The enteric nervous system
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A) receives input only from the sympathetic neivous system
B) receives input only from the parasympathetic nervous system
C) releases several peptide neurotransmitters and nitric oxide
D) cannot function without the central nervous system
E) has cell bodies lying in plexuses outside the intestinal wall
Key: 1A, 2D, 3E, 4C, 5B, 6D, 7E, 8D, 9C
18.Chemical transmission and drug action in the central nervous system
1. Fast neurotransmitters in the central nervous system include
A) glutamate
B) dopamine
C) substance P
D) prostanoids
E) nerve growth factor
2. Slow neurotransmitters and neuromodulators act mainly through
A) ligand-gated ion channels
B) G-protein-coupled receptors
C) enzymes
D) transcription factors
E) release of nitnc oxide
3. Drugs that are transported out of vascular endothelial cells in the central nervous system by
P-glycoprotein include
A) most non polar compounds
B) amino acid derivatives such as levodopa
C) highly ionized compounds
D) many anticancer and antibacterial drugs
E) most mood-altering drugs
4. The relationship between the biochemical and cellular effects of a drug and its behavioral
and therapeutic effects are best understood for drugs used in treating
A) mood depression
B) epilepsy
C) Parkinson's disease
D) schizophrenia
E) mania
Key: 1A, 2B, 3D, 4C
19.Cholinergic transmission
1. Activation of muscarinic M2 receptors
A) increases calcium conductance
B) increases potassium conductance
C) increases cardiac rate and force
D) causes central nervous system excitation
E) produces vascular smooth muscle relaxation
2. Succinylcholine is characteristically an agonist at
A) muscarinic M1 receptors
B) muscarinic M2 receptors
C) muscarinic M3 receptors
21
D) nicotinic receptors in skeletal muscle
E) nicotinic receptors in autonomic ganglia
3. The second messengers formed by activation of muscarinic acetylcholine receptors include
A) inositol triphosphate
B) cyclic AMP
C) cyclic GMP
D) Eicosanoids
E) guanosine triphosphate
4. Pilocarpine lowers intraocular pressure by
A) decreasing aqueous humor formation
B) contracting the iris sphincter muscle
C) contracting the ciliary muscle
D) relaxing the iris sphincter muscle
E) relaxing the ciliary muscle
5. The increased release of potassium from denervated musdes by succinylcholine is due to
A) inhibition of Cholinesterase
B) desensitization of nicotinic receptors
C) nicotinic receptor up-regulation
D) denervation supersensitivity
E) destruction of the motor end plate
6. Edrophonium produces reversible inhibition of cholinesterase by
A) binding the anionic site
B) binding the esteratic site
C) binding both anionic and esteratic sites
D) reversibly binding an allosteric site
E) forming a complex with acetylcholine
7. Pyridostigmine enhances neuromuscular transmission in myasthenia gravis patients by
A) increasing release of acetylcholine
B) inhibiting degradation of acetylcholine
C) causing up-regulation of nicotinic receptors
D) reactivating choiinesterase
E) blocking autoantibodies
8. Activation of muscarinic M3 receptors leads to
A) smooth muscle relaxation
B) cardiac slowing
C) central nervous system stimulation
D) Vasoconstriction
E) exocrine gland secretion
9. The effects produced by topical ocular administration of atropine include
A) Miosis
B) Mydriasis
C) Lacrimation
D) decreased intraocular pressure
E) conjunctivitis
10. If a test dose of edrophonium increases muscle weakness in a myasthenia gravis patient
being treated with pyridostigmine, it means that
A) the patient does not actually have myasthenia gravis
B) the dose of pyridostigmine is too low
C) the dose of pyridostigmine is too high
D) atropine should be administered
E) none of the above is correct
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11. Atropine poisoning in children typically causes
A) respiratory depression
B) muscle paralysis
C) Sweating
D) Hyperthermia
E) sedation
12. Persons with a genetic variant conferring abnormal plasma cholinesterase activity may
exhibit
prolonged musde paralysis following administration of
A) tubocurarine
B) pilocarpine
C) pancuronium
D) atracurium
E) succinylcholine
13. The release of acetylcholine from cholinergic nerve terminals is blocked by
A) atropine
B) bungarotoxm
C) botulinum toxin
D) batrachotoxin
E) tetrodotoxin
14. Scopolamine is employed clinically in the prevention or treatment of
A) motion sickness
B) asthma
C) peptic ulcer
D) glaucoma
E) constipation
15. The neuromuscular blockade produced by atracurium can be reversed by administration of
A) atropine
B) neostigmine
C) succinylcholine
D) pilocarpine
E) nicotine
16. Transient muscle fasciculations followed by paralysis typically occur after administration of
A) succinylcholine
B) Tubocurarine
C) vecuronium
D) gallamine
E) atropine
Key: 1B, 2D, 3A, 4C, 5D, 6A, 7B, 8E, 9B, 10C, 11D, 12E, 13C, 14A, 15B, 16A
20.CNS stimulants and psychotomimetic drugs
1. Phencyclidine is believed to cause psychotomimetic effects by
A) activating receptors for γ-aminobutyric acid
B) blocking receptors for γ-aminobutyric acid
C) activating N-methyl-D-aspartate-operated ion channels
D) blocking N-methyl-D-aspartate receptor-operated ion channels
E) increasing neuronal release of 5-hydroxytryptamine
2. Both lysergic acid diethylamine (LSD) and phencyclidine may cause
23
A) acute hyperthermia and muscle damage
B) physical dependence
C) schizophrenic symptoms
D) analgesia
E) inhibition of monoamine transporters
3. The psychotomimetic activity of lysergic acid diethylamide (LSD) is believed to result from
its ability to
A) activate 5-hydroxytryptamine 5-HT2 receptors
B) block 5-hydroxytryptamine 5-HT2 receptors
C) inhibit neuronal reuptake of noradrenaline and dopamine
D) release 5-hydroxytryptamine and block its neuronal reuptake
E) block receptors for γ-aminobutyric acid
4. Progressive myocardial damage leading to heart failure is most likely to occur in persons
who
A) lysergic acid diethylamide (LSD)
B) phencyclidine
C) mescaline
D) psilocybin
E) cocaine
5. Methylphenidate is primarily used in the treatment of
A) narcolepsy
B) mood depression
C) attention deficit-hyperactivity disorder
D) obesity
E) asthma
6. The adverse effects of methylenedioxymethamphetamine (MDMA) typically include
A) drug addiction
B) skeletal muscle damage
C) hypothermia
D) liver failure
E) bone marrow depression
Key: 1D, 2C, 3A, 4E, 5C, 6B
21.Drug addiction, dependence and abuse
1. All dependence-producing drugs act via different pathways to cause
A) depletion of norepinephrine in the locus coeruleus
B) depletion of dopamine in nigrostriatal pathways
C) depletion of glutamate in meso-limbic pathways
D) the release of glutamate in the frontal cortex
E) the release of dopamine in the nucleus accumbens
2. Chronic administration of morphine is believed to cause tolerance by
A) increasing expression of adenylate cyclase
B) decreasing expression of adenylate cyclase
C) increasing expression of guanylate cyclase
D) decreasing expression of guanylate cyclase
E) increasing expression of α-adrenoceptors
3. Nicotine use often leads to drug dependence by activation of nicotinic receptors in the
A) nucleus accumbens
B) hippocampus
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C) ventral tegmental area
D) cerebral cortex
E) striatum
4. Disulfiram has been used to facilitate abstinence from ethanol based on its ability to inhibit
A) the mesollimbic dopaminergic pathway
B) ethanol withdrawal symptoms
C) alcolhol dehydrogenase
D) aldehyde dehydrogenase
E) aldehyde oxidase
5. The effects that result from smoking marijuana include
A) improved motor coordination
B) improved memory
C) increased creativity
D) loss of appetite
E) conjunctival vasodilatation
6. Which drug is used in the treatment of drug dependence because of its ability to reduce
withdrawal symptoms?
A) clonidine
B) methadone
C) bupropion
D) naltrexone
E) acamprosate
7. The fetal alcohol syndrome is associated with malformations that typically include
A) increased cranial circumference
B) abnormal limb development
C) abnormal facial development
D) neural tube birth defects
E) cleft palate
8. A sustained-release formulation of bupropion is used to facilitate abstinence in persons who
are addicted to
A) ethanol
B) cocaine
C) nicotine
D) heroin
E) marijuana
9. Metabolism of the amount of ethanol contained in substantial quantities of alcoholic
beverages may lead to a depletion of
A) essential amino acids
B) acetaldehyde
C) reduced nicotinamide adenine dinucleotide (NADH)
D) nicotinamide adenine dinucleotide (NAD+)
E) lactate
10. Moderate ingestion of ethanol reduces mortality associated with
A) lung cancer
B) liver disease
C) coronary heart disease
D) hypertension
E) renal disease
11. In this decade, the incidence of cigarette smoking is
A) increasing in developing countries
B) decreasing in developing countries
25
C) increasing in the UK but decreasing in developing countries
D) decreasing in the UK but increasing in developing countries
E) increasing in all countries studied
12. Ingestion of ethanol typically increases the secretion of
A) testosterone
B) antidiuretic hormone
C) adrenocorticotrophic hormone
D) growth hormone
E) glucagon
Key: 1E, 2A, 3C, 4D, 5E, 6A, 7C, 8C, 9D, 10C, 11D, 12C
22.Drug elimination and pharmacokinetics
1. Hepatic cytochrome P450 drug-metabolizing enzymes are primarily found in
A) cell nuclei
B) plasma membranes
C) the cytoplasm
D) the smooth endoplasmic reticulum
E) mitochondria
2. Phase II drug metabolism
A) includes hydrolytic reactions
B) produces low molecular weight products
C) usually forms inactive metabolites
D) takes place mainly in the kidneys
E) requires NADPH as a cofactor
3. Ketoconazole produces non-competitive inhibition of cytochrome P450 by
A) binding to the ferric form of heme iron
B) binding to the active site of the enzyme
C) causing enzyme autolysis
D) oxidizing NADPH
E) binding covalently to the P450 protein
4. In first-order drug elimination
A) drug half-life is directly proportional to drug concentration
B) the rate of elimination is directly proportional to drug concentration
C) drug clearance is directly proportional to plasma drug concentration
D) the rate of elimination is constant
E) the rate of elimination is unpredictable
5. If a drug is administered repeatedly at the same dose and dosage interval, the time
required to reach the steady-state plasma drug concentration is proportional to the
A) Dose
B) route of administration
C) dosage interval
D) bioavailability
E) elimination half-life
6. If a drug exhibits saturation (zero-order) kinetics, then
A) the rate of drug elimination is constant
B) drug half-life is constant
C) drug clearance is constant
D) plasma drug concentration is constant
E) plasma drug concentration falls exponentially
26
7. In the two-compartment pharmacokinetic model, orally administered drugs are
A) absorbed into the peripheral compartment
B) distributed from the central to the peripheral compartment
C) metabolized in the central compartment
D) excreted in the peripheral compartment
E) none of the above
8. Which of the following will be increased if the rate of drug absorption from the gut is
reduced?
A) oral bioavailability
B) volume of distribution
C) peak plasma drug concentration
D) elimination half-life
E) duration of action
9. The volume of plasma from which a drug is eliminated in a unit of time is known as the
A) volume of elimination
B) volume of distribution
C) clearance
D) elimination rate constant
E) kinetic volume
10. inactive prodrugs have been developed to
A) reduce drug toxicity
B) increase drug half-life
C) decrease hepatic drug metabolism
D) increase drug absorption
E) slow drug excretion
Key: 1D, 2C, 3A, 4B, 5E, 6A, 7B, 8E, 9C, 10D
23.Drugs used in the treatment of infections and cancer
1. Which drug selectively inhibits bacterial RNA polymerase?
A) cytarabine
B) zidovudine
C) dactinomiydn
D) rifampin
E) acyclovir
2. Conjugation is an important mechanism for transfer of drug resistance genes between
A) coliform bacteria
B) staphylococci
C) enterococci
D) streptococci
E) spirochetes
3. Cycloserine prevents the addition of terminal ________ residues to the peptide side chain
on N-acetylmuramic acid
A) glycine
B) leucine
C) methionine
D) alanine
E) tyrosine
4. Induction of bacterial proteins that enable energy-dependent efflux of drug molecules is an
27
important mechanism of resistance to the
A) penicillins
B) aminoglycoside antibiotics
C) tetracycline antibiotics
D) macrolide antibiotics
E) folate reduction inhibitors
5. Which drug is correctly paired with the type of organism in which it selectively inhibits
dihydrofolate reductase?
A) trimethoprim
B) pyrimethamine
C) methotrexate
6. Ciprofloxacin selectively binds and inhibits
A) bacterial RNA polymerase
B) bacterial topoisomerase II
C) bacterial DNA polymerase
D) mammalian DNA polymerase
E) mammalian topoisomerase II
7. Which antibiotic inhibits translocation of the bacterial peptide chain from the A (acceptor) to
the P (peptide) site of the 50S ribosomal subunit?
A) erythromycin
B) puromycin
C) streptomycin
D) tetracycline
E) chloramphenicol
8. Inhibition of bacterial transpeptidase and carboxypeptidase is the mechanism of action of
A) bacitracin
B) vancomycin
C) β-lactam antibiotics
D) cycloserine
E) fusidic acid
9. Bacterial drug resistance may occur due to expression of a dihydropteroate synthetase that
has decreased affinity for
A) penicillin
B) chloramphenicol
C) trimethoprim
D) sulfonamides
E) erythhromycin
Key: 1D, 2A, 3D, 4C, 5C, 6E, 7A, 8C, 9D
24.General anesthetic agents
1. Bone marrow depression may occur following prolonged administration of
A) halothane
B) nitrous oxide
C) etomidate
D) enflurane
E) thiopental
2. The minimum alveolar concentration (MAC) is an expression of an inhalational anesthetic's
A) margin of safety
B) rate of induction
28
C) potency
D) water solubility
E) duration of action
3. The main disadvantage of ketamine as an anesthetic is its tendency to cause
A) hypotension
B) respiratory depression
C) bradycardia
D) delirium and hallucinations
E) liver toxicity
4. Metabolites of halothane are believed to be responsible for infrequent episodes of
A) renal toxicity
B) hepatic toxicity
C) peripheral neuritis
D) hemolytic anemia
E) pulmonary fibrosis
5. The attributes of propofol as an intravenous anesthetic include:
A) rapid metabolism and recovery
B) slow metabolism and recovery
C) risk of adrenocortical suppression
D) raises intracranial pressure
E) considerable hangover effect
6. Coughing and laryngospasm are most likely to occur during administration of
A) sevoflurane
B) nitrous oxide
C) halothane
D) desflurane
E) isoflurane
7. The primary factor determining the rate of induction and recovery of an inhalational
anesthetic is its
A) molecular weight
B) rate of metabolic inactivation
C) anesthetic potency
D) oil:gas partition coefficient
E) blood:gas partition coefficient
Key: 1B, 2C, 3D, 4B, 5A, 6D, 7E
25.Haemostasis and thrombosis
1. Warfarin inhibits coagulation by
A) inactivating prothrombin
B) inhibiting active factor Xa
C) inhibiting vitamin K oxidase
D) inhibiting vitamin K reductase
E) activating antithrombm III
2. Which drug competes with ADP (adenosine diphosphate) for its platelet receptor?
A) clopidogrel
B) epoprostenol
C) hirudin
D) aspirin
E) tirofiban
29
3. Abciximab is a monoclonal antibody to receptors for
A) thrombin
B) thromboxane
C) glycoprotein IIb/IIIa
D) adenosine diphosphate
E) von Willebrand factor
4. Dipyridamole and aspirin are used together primarily for the prevention of
A) pulmonary embolism
B) ischemic stroke
C) myocardial infarction
D) deep vein thrombosis
E) unstable coronary syndromes
5. Acute thrombotic stroke may be effectively treated within 3 hours of onset with
A) warfarin
B) tranexamic acid
C) eptifibatide
D) aspirin
E) tenecteplase
6. Clinical trials of adding clopidogrel to aspirin for preventing thromboembolic disease found
that combined therapy is
A) less effective than aspirin alone
B) less effective than clopidogrel alone
C) equally effective as clopidogrel alone
D) equally effective as aspirin alone
E) more effective than aspirin alone
7. Enoxaparin increases the activity of antithrombin III against
A) primarily thrombin
B) primarily factor Xa
C) thrombin and factor Xa equally
D) neither thrombin nor factor Xa
E) fibrin stabilizing factor
8. One of the adverse effects of high-dose or long-term therapy with heparin is
A) hyponatremia
B) hypernatremia
C) hypokalemia
D) hyperkalemia
E) hypophosphatemia
9. Eptifibatide is used to prevent thrombosis in persons undergoing
A) coronary angioplasty
B) fibrinolysis
C) blood transfusion
D) abdominal surgery
E) hip-replacement surgery
10. Fondaparinux is correctly described as a
A) hirudin derivative
B) cyclic peptide from snake venom
C) low-molecular-weight heparin
D) warfarin analogue
E) synthetic pentasaccharide
30
Key: 1D, 2A, 3C, 4B, 5E, 6E, 7B, 8D, 9A, 10E
26.How drugs act cellular aspects-excitation, contraction and secretion
1. L(long-lasting)-type calcium channels are correctly described as having
A) low activation threshold and slow inactivation
B) high activation threshold and slow inactivation
C) low activation threshold and fast inactivation
D) high activation threshold and fast inactivation
E) none of the above as correct
2. The extrusion of calcium from the cell cytoplasm primarily depends on
A) ligand-gated calcium channels
B) voltage-gated calcium channels
C) the sodium-calcium exchange transporter
D) the ATP-driven calcium pump
E) nuclear sequestration
3. The mechanism by which monamine neurotransmitters are released from nerve terminals
A) calcium-mediated exocytosis
B) carrier-mediated release
C) ATP-dependent active transport
D) diffusion through aqueous pores
E) diffusion through membrane lipid
4. Batrachotoxin binds sodium channels and thereby
A) opens channels
B) prevents channel opening
C) prevents channel inactivation
D) closes channels
E) causes channels to remain closed
5. Closure of potassium channels in excitable membranes causes membrane
A) Repolarization
B) Depolarization
C) Hyperpolarization
D) Disintegration
E) Inactivation
6. In smooth muscle, inositol triphosphate releases calcium from the
A) Golgi body
B) Mitochondria
C) Cell nucleus
D) T-tubule
E) Sarcoplasmic reticulum
7. Calcium facilitates the release of nitric oxide by
A) causing exocytosis
B) causing membrane depolanzation
C) activating nitric oxide synthase
D) activating transport carriers
E) activating G-protein-coupled receptors
8. Amiloride affects epithelial ion transport by blocking
A) the Na+/K+ exchange pump
B) the Na+/K+ co-transporter
C) sodium channels
D) potassium channels
31
E) calcium channels
9. In the colon, chloride transport is important in
A) potassium secretion
B) potassium reabsorption
C) fluid secretion
D) fluid reabsorption
E) sodium bicarbonate reabsorption
10. A key step in causing smooth muscle contraction is the phosphorylation of
A) Actin
B) myosin light chain
C) myosin heavy chain
D) guanylate cyclase
E) myosin phosphatase
11. Adrenergic beta-receptor agonists cause smooth muscle relaxation by
A) increasing cyclic AMP formation
B) decreasing cyclic AMP formation
C) increasing cyclic GMP formation
D) decreasing cyclic GMP formation
E) inhibiting protein kinase A
Key: 1B, 2D, 3A, 4C, 5B, 6E, 7C, 8C, 9D, 10B, 11A
27.How drugs act general principles
1. The concentration of a drug required to occupy 50 percent of its receptor sites is
A) the concentration required to produce the maximum physiological effect
B) directly proportional to the drug's affinity for its receptor
C) inversely proportional to the drug's affinity for its receptor
D) directly proportional to the drug's intrinsic efficacy
E) usually determined with the Schild equation
2. In the presence of a competitive antagonist the agonist log-concentration effect curve is
A) shifted to the right without a change in slope or maximum effect
B) shifted to the left without a change in slope or maximum effect
C) shifted to the right with a decreased slope and maximum effect
D) shifted to the left with a decreased slope and maximum effect
E) not shifted right or left but shows a decreased maximum effect
3. The magnitude of the response to a drug is related to the
A) total number of receptors for the drug
B) number of receptors occupied by the drug
C) number of vacant receptors in the tissue
D) number of spare receptors in the tissue
E) number of phosphorylated receptors in the tissue
4. The Schild equation shows that the concentration ratio of an agonist required to occupy the
same number of receptors in the absence and presence of a competitive antagonist is
determined by the
A) equilibrium constant of the agonist
B) affinity of the agonist for its receptor
C) equilibrium constant of the antagonist
D) total number of available receptors
E) number of spare receptors in the tissue
32
5. A partial agonist is typically a drug that
A) has low affinity for its receptor
B) can only occupy a small fraction of its receptors
C) can only produce a submaximal response
D) requires high doses to produce a maximal response
E) increases the number of spare receptors
6. A type of drug that reduces the slope and maximum response of an agonist is
A) a non-competitive antagonist
B) a competitive antagonist
C) a physiologic antagonist
D) an inverse agonist
E) a partial agonist
7. Drugs that form covalent bonds with their receptors are usually
A) reversible competitive antagonists
B) irreversible competitive antagonists
C) partial agonists
D) inverse agonists
E) inverse antagonists
8. A gradual decrease in the number of drug receptors is most likely to result from exposure to
A) a competitive antagonist
B) a non-competitrve antagonist
C) an agonist
D) an inverse agonist
E) an antimetabolite
9. The total number of receptor binding sites in a preparation and the binding equilibnum
constant can be determined from a
A) total binding versus drug concentration curve
B) dose-response curve
C) Hill-Langmuir equation
D) Scatchard plot
E) Schild plot
10. Receptor desensitization typically results from
A) endocytosis of receptors
B) exposure to an inverse agonist
C) irreversible agonist binding
D) spare receptors
E) phosphorylation of receptor protein
Key: 1C, 2A, 3B, 4C, 5C, 6A, 7B, 8C, 9D, 10E
28.Local anaesthetics and other drugs affecting sodium channels
1. Intravenous regional anesthesia with lidocaine is used to provide anesthesia for
A) childbirth
B) removal of superficial foreign bodies
C) neurosurgery
D) limb surgery
E) abdominal surgery
2. Local anesthetics have greater affinity for sodium channels in the
A) resting state
B) open and inactivated states
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C) open and resting states
D) inactivated and resting states
E) closed state
3. Which local anesthetic is characterized by rapid onset, medium duration of action, and good
tissue penetration?
A) procaine
B) cocaine
C) lidocaine
D) bupivacaine
E) prilocaine
4. Use-dependent blockade of nerve conduction results from sodium channel binding by local
A) in the cationic form on the inner membrane surface
B) in the uncharged form on the inner membrane surface
C) in the cationic form on the outer membrane surface
D) in the uncharged form on the outer membrane surface
E) in the anionic form on the inner membrane surface
Key: 1D, 2B, 3C, 4A
29.Local hormones, inflammation, and immune reactions
1. The conversion of fibrinogen to fibrin is accelerated by
A) Plasmin
B) Plasminogen
C) Kallikrein
D) Complement
E) thrombin
2. The release of histamine from mast cells is activated by
A) complement component C3a
B) complement component C4b
C) opsonin
D) chemotaxin
E) plasmin
3. Type I hypersensitivity reactions results from the production of
A) natural killer cells
B) interleukin-2
C) immunoglobulin E
D) leukotriene D4
E) thromboxane
4. Prostanoids and leukotrienes are both formed from
A) cyclic endoperoxides
B) arachidonic acid
C) linolenic acid
D) Lipoxins
E) 5-hydroperoxyeicosatetraenoic acid
5. Vasodilation and inhibition of platelet aggregation are the primary effects of
A) Prostacyclin
B) prostaglandin E2
C) Thromboxane
D) prostaglandin F1α
E) prostaglandin F2α
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6. The formation of 5-hydroperoxyeicosatetraenoic acid is inhibited by
A) Montelukast
B) nonsteroidal anti-inflammatory drugs
C) Prostaglandins
D) Zileuton
E) platelet-activating factor
7. Leukotriene B4 causes
A) coronary vasoconstriction
B) vasodilation in most vascular bed
C) bronchoconstriction
D) Bronchodilation
E) chemotaxis and activation of leukocytes
8. The structure of bradykinin is that of
A) a prostanoid
B) a nonapeptide
C) a leukotriene
D) a monoamine
E) a glycopeptide
9. It is postulated that bradykinin plays a role in
A) peptic ulcer
B) gastroesophageal reflux disease
C) Diarrhea
D) inflammatory bowel disease
E) gallstones
10. Substance P, neurokinin A, and calcitonin gene-related peptide are partly responsible for
A) neurogenic inflammation
B) acute anaphylactic reactions
C) septic shock
D) rheumatoid arthritis
E) coronary vasoconstnction
11. Latanoprost is used clinically to
A) dilate the pupil
B) constrict the pupil
C) correct strabismus
D) lower intraocular pressure
E) treat uveitis
12. The treatment of primary pulmonary hypertension may include administration of
A) prostaglandin F2α
B) prostaglandin I2
C) thromboxane
D) misoprostol
E) dinoprostone
13. The release of arachidonate from cell membrane phospholipids is inhibited by
A) non-steroidal anti-inflammatory drugs
B) Zileuton
C) Glucocorticoids
D) histamine H1 receptor antagonists
E) zafirlukast
14. Activation of prostaglandin EP3 receptors leads to
A) contraction of bronchial smooth muscle
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B) inhibition of platelet aggregation
C) relaxation of gastrointestinal smooth muscle
D) increased gastric mucus secretion
E) contraction of uterine smooth muscle
15. Intradermal injection of histamine produces a “triple response” in which the wheal is
caused by
A) dilation of small arterioles and precapillary sphincters
B) increased permeability of postcapillary venules
C) increased capillary permeability
D) an axon reflex
E) release of calcitonin gene-related peptide
16. A bradyldnin antagonist would be expected to
A) cause vasodilation
B) increase vascular permeability
C) increase gastrointestinal fluid secretion
D) contract intestinal smooth muscle
E) decrease stimulation of nociceptive neurons
17. During the induction of lymphocytes by antigen, the proliferation of T-helper-1 cells is
increased by
A) interleukin-2
B) interleukin-4
C) interferon-gamma
D) tumor necrosis factor-beta
E) Glucocorticoids
Key: 1E, 2A, 3C, 4B, 5A, 6D, 7E, 8B, 9C, 10A, 11D, 12B, 13C, 14D, 15B, 16E, 17A
30.Method and measurement in pharmacology
1. A statistical technique used to pool data from several independent but related studies is
called
A) double-blind technique
B) Randomization
C) sequential studies
D) meta-analysis
E) high-powered trial
2. The main problem with all types of bioassay is
A) human error
B) inadequate instrumentation
C) biological variation
D) high cost compared to other techniques
E) inability to determine potency
3. If the dose-response curves of two drugs are parallel in a bioassay, it usually indicates that
the two drugs
A) have the same potency
B) act on the same type of receptors
C) are identical
D) are clinically effective
E) produce a quantal response
4. Quantal dose-response curves are obtained when studying
A) all-or-nothing responses
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B) submaximal responses
C) bimodal responses
D) partial agonists
E) pain intensity
5. Transgenic mice that overexpress mutated forms of amyloid precursor protein provide a
useful model for studying
A) facilitate meta-analysis
B) confuse regulatory agencies
C) avoid bias in assigning subjects to treatment groups
D) avoid bias of patients and investigators
E) obviate the need for a control group
F) Alzheimer's disease
6. Transgenic animal models referred to as "knock-outs"
A) result from insertion of new genes
B) result from substitution of one gene for another
C) result from inactivation of an existing gene
D) result from mutation of an existing gene
E) typically cause overexpression of proteins
Key: 1D, 2C, 3B, 4A, 5F, 6C
31.Molecular aspects of drug action
1. The Jak/Stat pathway of signal transduction responds to activation by
A) Acetylcholine
B) steroid hormones
C) human growth hormone
D) Cytokines
E) epinephrine
2. In the growth factor Kinase cascade, Map (mitogen-activated protein) kinase acts to
phosphorylate
A) DNA
B) transcription factors
C) cyclic AMP
D) ion channels
E) transport proteins
3. Which second messenger in a G-protein coupled receptor signal transduction cascade
typically increases intracellular calcium?
A) cyclic GMP
B) cyclic AMP
C) Diacylglycerol
D) arachidonic acid
E) inositol triphosphate
4. Which signal transduction pathway is most important in cell division, growth, and
differentiation?
A) beta-adrenoceptor signal pathways
B) phospholipase C pathways
C) Ras/Raf/Map kinase
D) eicosanoid signal pathways
E) guanylate cyclic signal pathways
5. Coupling of a G-protein alpha subunit to an agonist-occupied receptor initially leads to
37
A) activation of the beta-gamma complex
B) hydrolysis of GTP
C) activation of adenylate cyclase
D) exchange of bound GDP with GTP
E) dissociation of the alpha-subunit from the receptor
6. The nicotinic receptor is an example of a
A) G-protein coupled receptor
B) ligand-gated ion channel
C) tyrosine-kinase linked receptor
D) cytokine receptor
E) transport protein
7. In G-protein coupled receptor signal transduction, protein kinase A is typically activated by
A) inositol triphosphate
B) ATP
C) cyclic AMP
D) cyclic GMP
E) Diacylglycerol
8. An agonist for a ligand-gated ion channel typically
A) increases channel conductance
B) increases the number of open channels
C) increases the rate of channel closing
D) alters channel ion selectivity
E) alters the open channel conformation
9. Diacylglycerol produces its intracellular effects by
A) activating protein kinase C
B) activating protein kinase A
C) releasing intracellular calcium
D) activating adenylate cyclase
E) activating guanylate cyclase
10. Class I nuclear receptors that control gene transcription
A) contain cysteine residues bound to iron
B) interact with nucleolar RNA
C) bind to hormone response elements of DNA
D) only act to inhibit DNA transcription
ID E) only act to stimulate DNA transcription
11. Myasthenia gravis is a disease in which
A) receptors have an abnormal amino acid sequence
B) G proteins have mutated
C) signal transmission pathways are defective
D) autoantibodies are directed against receptor proteins
E) nuclear receptors are down-regulated
12. Receptors for insulin
A) contain tyrosine kinase in their intracellular domain
B) bind and activate intracellular kinases
C) exhibit phosphatase activity
D) phosphorylate DNA transcription factors
E) are linked to guanylate cyclase
13. Which ion inhibits an enzyme (inositol-1-phosphatase) in the phosphoinositol cycle?
A) Calcium
B) Ferrous
C) Sodium
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D) Potassium
E) lithium
14. The opening of chloride ion channels by gamma-amino butyric acid is facilitated by
A) tricyclic antidepressant drugs
B) benzodiazepine drugs
C) local anesthetics
D) opioid analgesics
E) central nervous system stimulants
15. The most rapid response is produced by activation of
A) kinase-linked receptors
B) G-protein coupled receptors
C) receptors activating gene transcription
D) ionotropic receptors
E) insulin receptors
16. Which type of receptors contains seven transmembrane helices?
A) nicotinic acetylcholine receptors
B) sodium channels
C) steroid hormone receptors
D) insulin receptors
E) G protein coupled receptors
17. The treatment of chronic myeloid leukemia with imatinib results from the ability of the
drug to inhibit a specific
A) ligand-gated ion channel
B) G-protein-coupled receptor
C) tyrosine kinase
D) Map (mitogen-activated protein) kinase
E) nuclear receptor
18. Which receptors are activated by proteolytic cleavage and inactivated by phosphorylation?
A) neurotransmitter receptors
B) cytokine receptors
C) growth factor receptors
D) thrombin receptors
E) insulin receptors
19. Which receptors are entirely located intracellularly?
A) G-protein-coupled receptors
B) nicotinic receptors
C) thyroid hormone receptors
D) cytokine and growth factor receptors
E) muscarinic receptors
Key: 1D, 2B, 3E, 4C, 5D, 6B, 7C, 8B, 9A, 10C, 11D, 12A, 13E, 14B, 15D, 16E, 17C, 18D, 19C
32.Neurodegenerative diseases
1. An essential factor in neuronal excitotoxicity is
A) depletion of intracellular calcium
B) excessive levels of intracellular calcium
C) depletion of adenosine triphosphate
D) inhibition of intracellular proteases
E) depletion of intracellular glutamate
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2. The accumulation of β-amy1oid protein is believed to cause neuronal degeneration in
A) Huntington s disease
B) Parkinson's disease
C) Creutzfeldt-Jakob disease
D) amyotrophic lateral sclerosis
E) Alzheimer's disease
3. Levodopa is usually administered with a peripheral dopa decarboxylase inhibitor such as
A) carbidopa
B) selegiline
C) entacapone
D) amantadine
E) pergolide
4. Factors that contribute to the development of Alzheimer's disease include
A) absence of Aβ40 peptides
B) decreased proportion of Aβ42 peptides
C) mutations in the apoEA gene
D) increased expression of α-secretase
E) decreased expression of γ-secretase
5. The use of selegiline in Parkinson's disease is based on its ability to
A) selectively inhibit type A monoamine oxidase
B) slow progression of Parkinson's disease
C) inhibit peripheral degradation of levodopa
D) protect dopamine from intra-neuronal degradation
E) exert the neuroprotectrve effects shown in clinical trials
6. Memantine may produce a small improvement in cognitive function in persons with
Alzheimer's disease because it acts to
A) inhibit Cholinesterase
B) activate cholinergic nicotinic receptors
C) block N-methyl-D-aspartate receptors
D) activate N-methyl-D-aspartate receptor
E) activate dopamine D1 receptors
7. Entacapone reduces “end of dose” motor fluctuations in Parkinson's disease because
entacapone inhibits the degradation of levodopa by
A) catechol-O-methyltransferase
B) monoamine oxidase-A
C) monoamine oxidase-B
D) dopa decarboxylase
E) dopamine β-hydroxylase
8. Expansion of CAG (cyotosine-adenine-guanine) trinucleotide repeats in certain genes occurs
in persons with
A) spongiform encephalopathy
B) Parkinson’s disease
C) Alzheimer’s disease
D) amyotrophic lateral sclerosis
E) Huntington's disease
9. In the treatment of Alzheimer's disease, rivastigmine typically causes
A) rapidly irreversible inhibition of acetyl- and butyryl-cholinesterase
B) slowly reversible inhibition of acetyl- and butyryl-cholinesterase
C) allostenc enhancement of nicotinic receptor activation
D) allostenc enhancement of muscarinic receptor activation
E) cholinergic side effects that increase over time
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10. The acute side effects of levodopa in Parkinson's disease patients include
A) involuntary writhing movements
B) rapid fluctuations in clinical state
C) nausea and anorexia
D) hypertension
E) urinary retention
Key: 1B, 2E, 3A, 4C, 5D, 6C, 7A, 8E, 9B, 10C
33.Nitric oxide
1. The effects exerted by nitric oxide include
A) stimulation of platelet aggregation
B) vasoconstriction
C) inhibition of smooth muscle proliferation
D) increased atherogenesis
E) inhibition of host defenses
2. The primary action of inhaled nitric oxide is
A) Vasoconstriction
B) pulmonary vasodilation
C) bronchoconstriction
D) cardiac stimulation
E) respiratory distress
3. Nitric oxide causes vasodilation by
A) decreasing formation of cyclic GMP
B) increasing formation of cyclic GMP
C) decreasing formation of cyclic AMP
D) increasing formation of cyclic AMP
E) increasing calcium influx
4. In the gastrointestinal tract nitric oxide serves to
A) inhibit gastric emptying
B) stimulate gastric emptying
C) inhibit peristalsis
D) inhibit gastric acid formation
E) cause constipation
5. Nitroprusside produces its effects by acting as
A) a nitric oxide donor
B) a substrate for nitric oxide synthase
C) an inducer of nitric oxide synthase
D) an inhibitor of nitric oxide degradation
E) an agonist at nitric oxide receptors
6. Glucocorticoids may be beneficial in treating sepsis in part due to their ability to
A) inhibit constitutive nitric oxide synthase
B) stimulate constitutive nitric oxide synthase
C) stimulate inducible nitric oxide synthase
D) inhibit inducible nitric oxide synthase
E) inhibit both constitutive and inducible nitric oxide synthase
Key: 1C, 2B, 3B, 4B, 5A, 6D
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34.Noradrenergic transmission
1. An intravenous infusion of norepinephrine typically
A) increases peripheral resistance and heart rate
B) decreases peripheral resistance and heart rate
C) increases peripheral resistance and decreases heart rate
D) decreases peripheral resistance and increases heart rate
E) has no consistent effect on peripheral resistance and heart rate
2. In the liver, epinephrine acts via adrenergic beta-2 receptors to
A) stimulate both phosphorylase and glycogen synthase
B) inhibit both phosphorylase and glycogen synthase
C) inhibit phosphorylase and stimulate glycogen synthase
D) stimulate phosphorylase and inhibit glycogen synthase
E) stimulate phosphorylase, glycogen synthase, and lipase
3. Which drug inhibits the transport of norepinephrine into synaptic vesicles, thereby leading to
neurotransmitter depletion?
A) reserpine
B) methyldopa
C) bretylium
D) 6-hydroxydopamine
E) guanethidine
4. Doxazosin is an example of a
A) nonselective alpha-adrenoceptor antagonist
B) selective alpha-1 adrenoceptor antagonist
C) selective alpha-2 adrenoceptor antagonist
D) selective alpha-1 adrenoceptor agonist
E) selective alpha-2 adrenoceptor agonist
5. Irreversible blockade of alpha-adrenoceptors results from covalent binding of these
receptors by
A) phentolamine
B) phenylephrine
C) prazosin
D) phenoxybenzamine
E) pseudoephednne
6. The reuptake of norepinephrine by presynaptic nerve terminals (uptake 1) is inhibited by
A) guanethidine
B) reserpine
C) methyldopa
D) methyltyrosine
E) cocaine
7. The first-line treatment for acute severe type I hypersensitivity reactions is
A) dopamine
B) epinephrine
C) isoproterenol
D) norepinephrine
E) phenylephrine
8. Which adrenergic receptor antagonist increases heart rate at rest but reduces it during
exercise?
A) pindolol
B) propranolol
C) prazosin
D) timolol
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E) phentolamine
9. In the peripheral tissues, the primary end product of norepinephrine metabolism is
A) 3-methoxy, 4-hydroxyphenylglycol
B) normetanephrine
C) vanillylmandelic acid
D) 3,4-dihydroxymandelic acid
E) 3,4-dihydroxyphenyiglycol
10. The adverse effects of beta-adrenoceptor antagonists include
A) hyperglycemia
B) cardiac arrhythmias
C) myocardial ischemia
D) anxiety
E) bronchoconstriction
11. Selective beta-3 adrenoceptor agonists are potentially useful in treating obesity because of
their ability to
A) suppress appetite
B) inhibit digestion of fats
C) uncouple oxidative phosphorylation
D) increase thermogenesis
E) increase thyroid function
12. Symptoms of urinary retention due to benign prostatic hyperplasia may be improved by
A) alpha-1 adrenoceptor antagonists
B) alpha-2 adrenoceptor antagonists
C) alpha-1 adrenoceptor agonists
D) alpha-2 adrenoceptor agonists
E) nonselective adrenoceptor agonists
13. Persons with acute thyrotoxicosis are often treated with propranolol because it
A) reduces peripheral vascular resistance
B) increases cardiac output
C) decreases cardiac stimulation
D) decreases blood glucose levels
E) inhibits thyroid hormone secretion
14. Persons with pheochromocytoma may benefit from administration of methyltyrosine
because of its ability to
A) block alpha-1 adrenoceptors
B) block beta-1 adrenoceptors
C) inhibit norepinephrine release
D) inhibit norepinephrine synthesis
E) inhibit norepinephrine storage
Key: 1C, 2D, 3A, 4B, 5D, 6E, 7B, 8A, 9C, 10E, 11D, 12A, 13C, 14D
35.Obesity
1. Food intake is increased by
A) increased neuropeptide γ secretion
B) decreased neuropeptide γ secretion
C) increased alpha-melanocyte stimulating hormone secretion
D) increased leptin secretion
E) increased insulin secretion
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2. Sibutramine produces weight loss in obese patients primarily by
A) decreasing intestinal absorption of carbohydrates
B) decreasing intestinal absorption of fats
C) decreasing intestinal absorption of proteins
D) increasing satiety
E) increasing thermogenesis
3. A person with a body mass index of 28 kg/m2 is considered to be
A) anorectic
B) thin
C) normal
D) overweight but not obese
E) obese
4. Factors contributing to the development of obesity include
A) increased responsiveness to leptin
B) increased thermogenesis
C) decreased β3 adrenoceptor tone
D) uncoupling of oxidative phosphorylation
E) increased secretion of thyroid hormone
5.The incidence of which disease increases most sharply as a function of body mass index?
A) coronary heart disease
B) hypertension
C) asthma
D) cholelithiasis
E) type 2 diabetes mellitus
6. Orlistat acts in part by inhibiting
A) leptin secretion
B) pancreatic lipase
C) neuropeptide γ receptors
D) food intake
E) storage of fat
Key: 1A, 2D, 3D, 4C, 5E, 6B
36.Other peripheral mediators, 5-hydroxytryptamine and purines
1. Urinary levels of 5-hydroxyindole acetic add provide an indication of the body's production
of
A) adenosine
B) serotonin
C) adenosine triphosphate
D) histamine
E) endothelin
2. Some of the effects of theophylline are attributed to antagonism of
A) Glutamate
B) 5-hydroxytrypamine
C) adenosine
D) norepinephrine
E) histamine
3. The effects of chemical mediators on platelets indude
A) stimulation of platelet aggregation by adenosine diphosphate
B) stimulation of platelet aggregation by adenosine
44
C) inhibition of platelet aggregation by adenosine diphosphate
D) inhibition of platelet aggregation by histamine
E) inhibition of platelet aggregation by serotonin
4. Cyproheptadine is useful in treating cardnoid syndrome because of its ability to
A) activate 5-HT1 receptors
B) block 5-HT1 receptors
C) activate 5-HT2 receptors
D) block 5-HT2 receptors
E) activate 5-HT4 receptors
5. In persons with irritable bowel syndrome whose predominant symptom is constipation,
intestinal peristaltic activity may be increased by drugs that
A) activate 5-HT1 receptors
B) block 5-HT1 receptors
C) activate 5-HT2 receptors
D) block 5-HT2 receptors
E) activate 5-HT4 receptors
6. Activation of 5-HT1D receptors is usually beneficial in persons suffering from
A) carcinoid syndrome
B) nausea and vomiting
C) migraine headache
D) Constipation
E) anxiety
7. Retroperitoneal and mediastinal fibrosis is a characteristic adverse effect of
A) methysergide
B) Ergotamine
C) Bromocriptine
D) Sumatriptan
E) tegaserod
8. Blockade of 5-HT3 receptors in vagal afferent neurons is useful in preventing
A) migraine headache
B) serotonin syndrome
C) platelet aggregation
D) nausea and vomiting
E) Constipation
Key: 1B, 2C, 3A, 4D, 5E, 6C, 7A, 8D
37.Other transmitters and modulators
1. The 5-hydroxytryptamine 5-HT2 receptors are
A) primarily inhibitory
B) chiefly found in the area postrema
C) mostly presynaptic
D) abundant in the cortex and limbic system
E) predominantly presynaptic autoreceptors
2. Agonists at 5-hydroxytryptamine 5-HT2A receptors typically cause
A) sleep
B) vigilance
C) hallucinations
D) hyperphagia
E) euphona
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3. The major functions of cholinergic pathways in the central nervous system include
A) learning and memory
B) mood and emotion
C) control of body temperature
D) appetite
E) drug dependence
4. The effects of jet lag can be alleviated by administration of
A) methylxanthine drugs
B) melatonin
C) histamine H2 receptor antagonists
D) 5-hydroxytryptamine 5-HT3 agonists
E) Cholinesterase inhibitors
5. The predominant site containing cell bodies of noradrenergic neurons is the
A) raphe nuclei
B) nigrostnatal pathway
C) locus coeruleus
D) nucleus accumbens
E) nucleus basalis
6. The 5-hydroxytryptamine 5-HT3 receptors are
A) excitatory ligand-gated cation channels
B) inhibitory ligand-gated cation channels
C) G-protein-coupled receptors
D) inhibitory ligand-gated chloride channels
E) presynaptic autoreceptors
7. The dopamine transporter located in presynaptic nerve terminals is inhibited by
A) bromocriptine
B) levodopa
C) ondansetron
D) haloperidol
E) cocaine
8. Degeneration of the nucleus basalis of Meynert is associated with the development of
A) obesity
B) narcolepsy
C) schizophrenia
D) Alzheimer's disease
E) mood depression
9. A deficiency of dopamine in the nigrostriatal pathway contributes to the development of
A) drug dependence
B) Parkinson's disease
C) obesity
D) schizophrenia
E) insomnia
10. Functions associated with noradrenergic pathways in the central nervous system include
A) feeding behavior
B) induction of sleep
C) control of mood
D) pleasure and reward
E) release of hormones
Key: 1D, 2C, 3A, 4B, 5C, 6A, 7E, 8D, 9B, C10
46
38.Peptides and proteins as mediators
1. Peptide and protein mediators typically
A) function as fast neurotransmitters
B) contain intramolecular diphosphate bonds
C) are easily crystallized
D) have highly rigid structures
E) activate cell surface receptors
2. As pharmacologic agents, most peptides are
A) easily absorbed from the gastrointestinal tract
B) rapidly distributed to the brain
C) usually administered by the transdermal route
D) rapidly degraded by plasma and tissue enzymes
E) inexpensive to manufacture
3. Bosentan is an antagonist of
A) opioid receptors
B) angiotensin AT1 receptors
C) endothelin receptors
D) bradykinin receptors
E) platelet fibrinogen receptors
4. Most neural and endocrine peptide mediators
A) act on G-protein-coupled receptors
B) activate ligand-gated ion channels
C) exhibit protein kinase activity
D) cause receptor up-regulation
E) bind to membrane transport proteins
5. Cyclosporine is a fungal polypeptide used clinically to
A) diagnose endocrine disease
B) cause immunosuppression
C) treat cystic fibrosis
D) treat thromboembolism
E) induce labor
6. Which agent blocks substance P (neurokinin NK1) receptors and thereby prevents nausea
and vomiting?
A) granisetron
B) Promethazine
C) Diphenhydramine
D) Aprepitant
E) scopolamine
Key: 1E, 2D, 3C, 4A, 5B, 6D
39.The endocrine pancreas and the control of blood glucose
1. The characteristics of type 2 diabetes mellitus typically include
A) insulin resistance
B) absence of 1st and 2nd phase insulin secretion
C) absence of 2nd phase insulin secretion only
D) excessive insulin secretion
E) impaired glucagon secretion
47
2. The actions of insulin include
A) inhibition of glycogen synthesis
B) inhibition of tnglycende synthesis
C) inhibition of gluconeogenesis
D) inhibition of protein synthesis
E) inhibition of glucose uptake by muscle
3. Which drug binds to the peroxisome proliferator-activated receptor-gamma in adipose
tissue, muscle, and liver?
A) metformin
B) pioglitazone
C) repaglinide
D) glipizide
E) acarbose
4. The effects of metformin include
A) increased appetite
B) increased hepatic glucose output
C) decreased hepatic glucose output
D) hypoglycemia
E) increased low-density lipoproteins
5. The mechanism of action of glipizide is
A) stimulation of glucose transporters
B) stimulation of insulin synthesis
C) blockade of calcium channels
D) activation of ATP-sensitive potassium channels
E) blockade of ATP-sensitive potassium channels
6. Weight gain and fluid retention are most likely to occur in persons receiving
A) metformin
B) insulin lispro
C) nateglinide
D) pioglitazone
E) acarbose
7. The characteristics of insulin glargine include:
A) rapidly and completely absorbed after injection
B) provides a constant basal insulin supply
C) has an intermediate duration of action
D) used in treating diabetic ketoacidosis
E) contains a lysine-proline amino acid transposition
8. The most common adverse effect of glipizide is
A) hypoglycemia
B) weight loss
C) fluid retention
D) liver dysfunction
E) lactic acidosis
Key: 1A, 2C, 3B, 4C, 5E, 6D, 7B, 8A
40.The gastrointestinal tract
1. The symptomatic treatment of diarrhea may include administration of
A) loperamide
48
B) lactulose
C) omeprazole
D) bisacodyl
E) cimetidine
2. Omeprazole reduces gastric add secretion by
A) reversibly inhibiting the H+/Na+ ATPase
B) irreversibly inhibiting the H+/Na+ ATPase
C) reversibly inhibiting the H+/K+ ATPase
D) irreversibly inhibiting the H+/K+ ATPase
E) irreversibly inhibiting the Na+/K+ ATPase
3. According to the two-cell hypothesis of gastric add secretion, the parietal cell has receptors
for
A) only histamine and acetylcholine
B) only histamine and gastrin
C) only gastrin and acetylcholine
D) only gastrin
E) histamine, gastrin, and acetylcholine
4. The use of misoprostol in treating gastric damage caused by nonsteroidal anti-inflammatory
drugs is partly due to its ability to
A) increase secretion of mucus and bicarbonate
B) decrease secretion of mucus and bicarbonate
C) increase gastrointestinal motility
D) decrease mucosal blood flow
E) inhibit release of histamine
5. Nausea and vomiting caused by vestibular stimulation is most effectively prevented by
A) ondansetron
B) metoclopramide
C) nabilone
D) promethazine
E) prochlorperazine
6. Sucralfate is best described as a
A) proton pump inhibitor
B) histamine H1 receptor antagonist
C) substituted benzimidazole
D) prostaglandin E2 analogue
E) complex of aluminum hydroxide and sulfated sucrose
7. Which drug increases electrolyte and water secretion by the intestinal mucosa?
A) sucralfate
B) lactulose
C) bisacodyl
D) docusate sodium
E) methylcellulose
8. The antiemetic effect of ondansetron is primarily based on its ability to block
A) 5-HT3 receptors in vestibular nuclei
B) 5-HT3 receptors in the chemoreceptor trigger zone
C) 5-HT3 receptors in the vomiting center
D) 5-HT4 receptors in visceral afferent neurons
E) histamine and muscarinic receptors in the solitary tract
Key: 1A, 2D, 3C, 4A, 5D, 6E, 7C, 8B
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41.The haemopoietic system
1. Ascorbic acid influences iron absorption from the gastrointestinal tract by
A) forming an insoluble iron-chelate
B) oxidizing iron to the ferric state
C) reducing iron to the ferrous state
D) stimulating the iron transport protein
E) activating haem oxidase
2. Neural tube birth defects can be prevented by the administration to pregnant women of
A) folic acid
B) cyanocobalamin
C) ferrous gluconate
D) epoetin
E) filgrastim
3. Desferrioxamine is administered for the purpose of treating
A) iron deficiency anemia
B) megaloblastic anemia
C) pernicious anemia
D) iron toxicity
E) hemosiderosis
4. Persons with an elevated blood level of methylmalonyl-Coenzyme A may have a deficiency
of
A) erythropoietin
B) iron
C) formyl-tetrahydrofolic acid
D) colony-stimulating factors
5. Filgrastim is conjugated with polyethylene glycol to
A) increase its absorption from the gut
B) increase its elimination half-life
C) reduce its duration of action
D) decrease its adverse effects
E) increase its potency
6. Epoetin is indicated for the treatment of
A) pernicious anemia
B) anemia of renal failure
C) megaloblastic anemia
D) neutropenia
E) platelet deficiency
Key: 1C, 2A, 3D, 4E, 5B, 6B
42.The heart
1. Delayed after-depolarizations in cardiac tissue typically result from an increased influx of
A) sodium
B) potassium
C) calcium
D) chloride
E) sodium and potassium
2. The re-excitation of cardiac tissue prior to the next cardiac impulse occurs in the process
known as
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A) re-entry
B) ectopic automaticity
C) atrioventricular block
D) atrial fibrillation
E) bradycardia
3. In persons with atrial fibrillation, digoxin may slow the ventricular rate by
A) decreasing sinoatrial node automaticity
B) increasing ventricular contractility
C) inhibiting the Na+/K+ pump
D) reducing the calcium transient
E) slowing atrioventricular conduction
4. Sotalol exerts an antiarrhythmic effect primarily by
A) slowing ventricular conduction
B) blocking sodium channels
C) slowing atrioventricular conduction
D) increasing the effective refractory period
E) decreasing action potential duration
5. Verapamil is indicated for the treatment of
A) supraventricular tachycardia
B) ventricular tachycardia
C) atrial fibrillation
D) ventricular fibrillation
E) cardiac asystole
6. In persons who have had a myocardial infarction, flecainide has been shown to
A) decrease the incidence of ventricular fibrillation
B) decrease the incidence of atrial fibrillation
C) decrease the incidence of sudden death
D) increase the frequency of ventricular ectopic beats
E) increase the incidence of sudden death
7. The pharmacokinetic attributes of amiodarone include
A) rapidly metabolized and excreted
B) a very short elimination half-life
C) a very long elimination half-life
D) distributed only to extracellular fluid
E) limited binding to plasma proteins
8. Dobutamine is useful in treating acute heart failure because of its ability to
A) increase heart rate more than contractile force
B) increase contractile force more than heart rate
C) produce a negative dromotropic effect
D) cause cardiac stimulation and vasoconstriction
E) inhibit phosphodiesterase
9. Digoxin slows AV conduction and decreases heart rate by
A) activating cardiac muscarinic receptors
B) blocking cardiac adrenergic beta-1 receptors
C) antagonizing cardiac calcium channels
D) increasing vagal outflow from the CNS
E) increasing cardiac contractile force
10. The half-life of digoxin is considerably longer in persons with
A) renal insufficiency
B) pulmonary edema
C) atrial fibrillation
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D) hypertension
E) endocarditis
11. Which drug has been shown to reduce mortality in persons who have had a myocardial
infarction?
A) amiodarone
B) lidocaine
C) propranolol
D) amiodarone
E) verapamil
12. Hypothyroidism is most likely to occur in persons who are taking
A) sotalol
B) flecamide
C) timolol
D) amiodarone
E) adenosine
13. Nitroglycerin relieves typical angina pectoris in part by
A) increasing cardiac stroke volume
B) dilating coronary arterioles
C) decreasing cardiac oxygen consumption
D) constricting collateral vessels in the heart
E) increasing blood pressure
14. Nitroglycerin and other organic nitrates produce their vasodilator effect by
A) increasing formation of cyclic AMP
B) increasing formation of cyclic GMP
C) blocking calcium channels
D) blocking adrenergic alpha receptors
E) activating potassium channels
Key: 1C, 2A, 3E, 4D, 5A, 6E, 7C, 8B, 9D, 10A, 11C, 12D, 13C, 14B
43.The kidney
1. Excessive doses of hydrochlorothiazide may cause
A) hyperkalemic metabolic acidosis
B) hyperkalemic metabolic alkalosis
C) hyperchloremic metabolic acidosis
D) hypokalemic metabolic alkalosis
E) hypokalemic metabolic acidosis
2. Amiloride exerts its diuretic effect by
A) blocking epithelial sodium channels
B) inhibiting the epithelial sodium pump
C) inhibiting the sodium chloride transporter
D) blocking aldosterone receptors
E) inhibiting chloride channels
3. The Na+/K+/2CI- transporter is inhibited by
A) amiloride
B) furosemide
C) acetazolamide
D) hydrochlorothiazide
E) triamterene
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4. A mild hyperchloremic metabolic acidosis may occur following administration of
A) amiloride
B) hydrochlorothiazide
C) mannitol
D) bumetanide
E) acetazolamide
5. Hydrochlorothiazide decreases the urinary excretion of
A) calcium
B) sodium
C) potassium
D) chloride
E) bicarbonate
6. The usual therapeutic doses of aspirin
A) inhibit uric acid reabsorption
B) stimulate uric acid reabsorption
C) inhibit uric acid secretion
D) stimulate uric acid secretion
E) lower serum uric acid levels
7. Hyperkalemia is most likely to occur following the administration of
A) furosemide and amiloride
B) losartan and amiloride
C) hydrochlorothiazide and amiloride
D) hydrochlorothiazide and losartan
E) losartan and amiloride
8. Testicular atrophy and gynecomastia are most likely to result from the administration of
A) eplerenone
B) spironolactone
C) amiloride
D) acetazolamide
E) bumetanide
9. Before exerting its diuretic effect, furosemide undergoes
A) metabolic activation in the liver
B) passive reabsorption from the nephron
C) glomerular filtration in the kidneys
D) passive diffusion into the nephron
E) active renal tubular secretion
10. The electroneutral sodium and chloride cotransporter in the distal tubule is inhibited by
A) metolazone
B) amiloride
C) acetazolamide
D) bumetanide
E) spironolactone
11. The uricosuric effect of sulfinpyrazone results from inhibition of
A) uric acid formation
B) uric acid transport
C) uric acid secretion
D) uric acid reabsorption
E) uric acid degradation
Key: 1D, 2A, 3B, 4E, 5A, 6C, 7E, 8B, 9E, 10A, 11D
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44.The pituitary and the adrenal cortex
1. The anabolic effects of growth hormone are mediated primarily by
A) somatotropin
B) somatostatin
C) somatomedin
D) somatotrophin
E) somatorelin
2. During breastfeeding, prolactin inhibits the release or response to
A) oxytocin
B) estradiol
C) progesterone
D) gonadotrophins
E) hydrocortisone
3. The effects of fludrocortisone can be antagonized by
A) spironolactone
B) beclomethasone
C) metyrapone
D) aldosterone
E) ammoglutethimide
4. Octreotide is correctly described as a
A) short-acting analogue of somatotrophin
B) long-acting analogue of somatotrophin
C) short-acting analogue of somatostatin
D) long-acting analogue of somatostatin
E) long-acting analogue of somatomedin
5. In the basic transactivation mechanism of glucocorticoid receptor control of gene
expression, the ligand-bound glucocorticoid receptor dimer binds to
A) nuclear factor kappa B sites
B) regulatory sites of Fos/Jun transcription factors
C) negative glucocorticoid response elements
D) positive glucocorticoid response elements
E) negative transcription factors
6. Metyrapone inhibits the biosynthesis of
A) only corticosterone
B) only hydrocortisone
C) only dehydroepiandrosterone
D) both corticosterone and hydrocortisone
E) corticosterone, hydrocortisone, and dehydroepiandrosterone
7. Insulin-like growth factor-1 causes feedback inhibition of the secretion of
A) prolactin
B) melanocyte-stimulating hormone
C) growth hormone
D) corticotropin
E) thyrotropin
8. Polyuria may result from inhibition of antidiuretic hormone by
A) desmopressin
B) oxytocin
C) carbamazepine
D) ibuprofen
E) lithium
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9. The adverse effects of high-dose or chronic administration of prednisone include
A) muscle hypertrophy
B) cataracts
C) decreased abdominal fat
D) thickened skin
E) hypotension
10. Cabergoline inhibits the anterior pituitary secretion of
A) prolactin
B) melanocyte-stimulating hormone
C) thyrotropin
D) somatotrophin
E) corticotrophm
11. The treatment of diabetes insipidus includes nasal administration of
A) vasopressin
B) desmopressin
C) demeclocycline
D) octreotide
E) budesonide
Key: 1C, 2D, 3A, 4D, 5D, 6D, 7C, 8E, 9B, 10A, 11B
45.The reproductive system
1. The expression of estrogen receptors in the mammary gland is increased by
A) oxytocin
B) progesterone
C) prolactin
D) gonadotrophins
E) androgens
2. The secretion of progesterone from the corpus luteum is primarily stimulated by
A) follicle-stimulating hormone
B) luteinizing hormone
C) estrogen
D) prolactin
E) oxytocin
3. Compared to the combination estrogen-progestogen contraceptive, the progestogen-only pill
is more likely to
A) cause hypertension
B) prevent conception
C) cause breast cancer
D) cause myocardial infarction
E) produce irregular bleeding
4. Administration of sildenafil leads to
A) activation of guanylate cyclase
B) inhibition of guanylate cyclase
C) activation of phosphodiesterase V
D) inhibition of phosphodiesterase V
E) release of nitnc oxide
5. In the estrogen-progestogen contraceptive pill, the estrogen component acts primarily by
inhibiting
A) secretion of LH
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B) secretion of FSH
C) ovulation
D) passage of sperm
E) mucus secretion
6. The prevention and treatment of postpartum hemorrhage may include injections of
A) estrogen
B) progestogen
C) oxytocin
D) ritodrine
E) prolactin
7. The benefits of using estrogen-progestogen contraceptive pills include
A) decreased risk of hypertension
B) improved glucose tolerance
C) decreased risk of breast cancer
D) decreased menstrual irregularities
E) decreased risk of stroke
8. The use of atosiban to delay premature labor is based on its ability to
A) block β2-adrenoceptors
B) activate β2-adrenoceptors
C) block progesterone receptors
D) activate progesterone receptors
E) block oxytocin receptors
9. When finasteride is used in treating benign prostatic hypertrophy, it acts by
A) blocking androgen receptors
B) inhibiting gonadotrophin secretion
C) inhibiting 5α-reductase
D) inhibiting testosterone secretion
E) blocking α1 adrenoceptors
10. The interaction between nitroglycerin and sildenafil results from the
A) inhibition of sildenafil metabolism by nitroglycerin
B) inhibition of nitroglycerin metabolism by sildenafil
C) similar effect of the drugs on phosphodiesterase V
D) similar effect of the drugs on cyclic GMP levels
E) antagonistic effect of the drugs on cyclic GMP levels
Key: 1C, 2B, 3E, 4D, 5B, 6C, 7D, 8E, 9C, 10D
46.The respiratory system
1. The clinical uses of formoterol include
A) prevention of nocturnal bronchospasm
B) treatment of acute bronchospasm
C) long-term prevention of airway inflammation
D) prevention and treatment of allergic rhinitis
E) stabilization of mast cells in persons with atopic dermatitis
2. The cysteinyl leukotriene CysLT1 receptor is blocked by
A) tiotropium
B) theophylline
C) nedocromil
D) zafirlukast
E) omalizumab
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3. Persons with aspirin-sensitive asthma
A) can safely use naproxen or ibuprofen
B) seldom have nasal polyps
C) exhibit hyper-responsiveness to inhaled leukotrienes
D) are effectively treated with antihistamines
E) have few cysteinyl leukotriene receptors
4. Which drug inhibits phosphodiesterase and blocks adenosine receptors?
A) salmeterol
B) budesonide
C) zileuton
D) cromoglycate
E) theophylline
5. In the treatment of asthma, glucocorticoids
A) increase secretion of interleukin-4
B) up-regulate adrenergic beta-2 receptors
C) increase microvascular permeability
D) increase formation of vasodilator prostanoids
E) are usually administered orally
6. Tremor and tachycardia are common side effects of
A) theophylline
B) salbutamol
C) montelukast
D) fluticasone
E) cromoglycate
7. Tiotropium is useful in the treatment of chronic obstructive pulmonary disease because of its
ability to
A) reduce airway inflammation
B) improve gas transfer
C) inhibit proteolytic enzymes
D) relax bronchial smooth muscle
E) stimulate respiration
8. Omalizumab is a humanized monoclonal antibody to
A) immunoglobulin G
B) immunoglobulin E
C) cysteinyl leukotriene receptors
D) chemokines
E) interleukin IL-3
Key: 1A, 2D, 3C, 4E, 5B, 6B, 7D, 8B
47.The thyroid
1. The characteristics of triiodothyronine (T3) include
A) a large pool in the body
B) a low turnover rate
C) formed from thyroxine (T4) intracellularly
D) interacts with a cytoplasmic receptor
E) represses transcription
2. Iodination of tyrosine residues of thyroglobulin is inhibited by
A) propranolol
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B) methimazole
C) liothyronine
D) protirelin
E) hydrogen peroxide
3. The characteristics of radioactive iodine (131I) in the treatment of hyperthyroidism include
A) a rapid onset of action
B) a maximum effect in 8 days
C) a cytotoxic effect produced by y rays
D) safe use in children and pregnant women
E) hypothyroidism as a typical later-onset disease
4. The long elimination half-life of thyroxine (T4) is primarily due to
A) slow absorption from the gut
B) slow excretion in the urine
C) strong binding to thyroxine-binding globulin
D) slow hepatic inactivation
E) storage in fat cells
5. An uncommon but serious adverse effect associated with the use of propylthiouracil is
A) granulocytopenia
B) hemolytic anemia
C) a lupus erythematosus-like syndrome
D) cholestatic hepatitis
E) hypoglycemia
Key: 1C, 2B, 3E, 4C, 5A
48.The vascular system
1. Which vasoconstrictor substance is produced by vascular endothelial cells?
A) nitric oxide
B) bradykinin
C) prostacyclin
D) natriuretic peptide
E) endothelin
2. The opening of membrane potassium channels by minoxidil leads to A) increased potassium
influx
B) increased calcium influx
C) inactivation of calcium channels
D) membrane depolarization
E) formation of cyclic GMP
3. Both valsartan and enalapril
A) increase serum potassium levels
B) often cause a dry cough
C) block angiotensin AT1 receptors
D) inhibit formation of angiotensin II
E) increase bradykinin levels
4.Bosentan is an antagonist of
A) endothelin ETA and ETB receptors
B) angiotensin AT1 receptors
C) angiotensin AT2 receptors
D) nitric oxide receptors
E) prostaglandin FP receptors
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5. In persons with heart failure, enalapril typically increases
A) cardiac afterload
B) cardiac preload
C) vascular resistance
D) cardiac output
E) aldosterone secretion
6. Which drug reduces sympathetic outflow from the central nervous system?
A) fosinopril
B) clonidine
C) terazosin
D) felodipine
E) hydralazine
7. Captopril is a structural analog of the terminal dipeptide of
A) renin
B) nitric oxide synthase
C) endothelin
D) angiotensin converting enzyme
E) angiotensin I
8. Effects similar to those of angiotensin converting enzyme inhibitors may be obtained in
heart failure patients by administering
A) furosemide
B) digoxin
C) hydralazine and isosorbide dinitrate
D) dobutamine
E) nitroglycerin
9. The adverse effects of terazosin and related drugs typically include
A) hypokalemia
B) drowsiness and dry mouth
C) urinary retention in older men
D) postural hypotension and edema
E) bradycardia and syncope
10.
In persons with decompensated heart failure, nesintide activates
X A) adrenergic alpha receptors
B) adrenergic beta receptors
C) adenylate cyclase
D) guanylate cyclase
E) myosin phosphatase
11. The preferred drugs for the initial treatment of most patients with mild hypertension
include
A) hydralazine
B) minoxidil
C) hydrochlorothiazide
D) methyldopa
E) prazosin
12. Fenoldopam is useful in treating hypertensive emergencies because of its ability to
A) block adrenergic beta receptors
B) block adrenergic alpha receptors
C) block calcium channels
D) open potassium channels
E) activate dopamine D1 receptors
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13. Beginning therapy with low doses that are gradually increased over several months is
appropriate when treating heart failure with
A) digoxin
B) furosemide
C) dobutamine
D) carvedilol
E) nitroglycerin
14. The progression of diabetic nephropathy may be slowed by
A) propranolol
B) enalapril
C) hydrochlorothiazide
D) amlodipine
E) doxazosin
15. The use of eplerenone in the treatment of heart failure is based on its ability to
A) cause vasodilation
B) inhibit sympathetic nervous system activity
C) antagonize aldosterone
D) inhibit angiotensin II formation
E) increase cardiac contractile force
Key: 1E, 3C, 3A, 4A, 5D, 6B, 7E, 8C, 9D, 10D, 11C, 12E, 13D, 14B, 15C
60