Pharmacology For The Boards And Wards

Front 1

Question

Back 1

Correct Answer

Hint 1

My Incorrect Answer

Front 2

A drug like that illustrated above is administered orally to a patient. Which of the following statements is correct? (R-CH2-NH2 --> <-- R-CH2-NH3+, Pka = 9.4)

Back 2

over 50% of the drug will accumulate in the stomach

Hint 2

about 50% of the drug will be ionized in the plasma (false)

Front 3

Some drugs can be classified as "partial agonists." A partial agonist differs from a "full agonist" in that:

Back 3

partial agonists act as antagonists in addition to acting as agonists for the same receptor type.

Hint 3

the partial agonist is usually less potent than the full agonist (false)

Front 4

Which of the following drugs is the most potent in causing sodium retention?

Back 4

hydrocortisone

Hint 4

betamethasone (false)

Front 5

Which of the following drugs causes the most prolonged hypoglycemic state?

Back 5

chlorpropamide

Hint 5

pioglitazone (false)

Front 6

With which drug is the following case scenario most associated? A diabetic newly started on this drug is admitted to the hospital three weeks later in severe congestive heart failure:

Back 6

rosiglitazone

Hint 6

glipizide (false)

Front 7

With which drug is the following case scenario most associated? A patient complains of 15-pound weight gain.

Back 7

glipizide

Hint 7

rosiglitazone (false)

Front 8

Digoxin can cause all of the following adverse effects EXCEPT: A. arrhythmias B. sinus bradycardia C. vomiting D. visual problems E. rapid response atrial fibrillation

Back 8

rapid response atrial fibrillation is NOT an adverse effect of digoxin.

Hint 8

sinus bradycardia IS an adverse effect of digoxin (true, but incorrect answer)

Front 9

Which of the following antimicrobial drugs is effective against infections caused by Bacteroides fragilis?

Back 9

cefotetan

Hint 9

n/a

Front 10

Which of the following drugs is the most effective for treating infections caused by Toxoplasma gondii?

Back 10

pyrimethamine and sulfadiazine

Hint 10

pentamidine (false)

Front 11

Which of the following aminoglycosides is often effective against organisms resistant to gentamicin?

Back 11

amikacin

Hint 11

tobramycin (false)

Front 12

A 50-year-old male with a 30-pack-year history of smoking and alcohol abuse presnts with a softball-sized mass protruding up from his lower mandible and a fever of 101 Fahrenheit (38.3 Celsius). Purulent-looking material is draining from the surface of the mass. Suspecting a squamous cell head and neck cancer, you admit the patient for IV antibiotics and nutrition. You start the patient on clindamycin for the superinfection and he defervesces. Three days later, he suddenly spikes to 102 degrees Fahrenheit (38.8 Celsius) and develops fulminant, severe diarrhea and abdominal pain. There is no rebound on exam and the patient has hyperactive bowel sounds. What antibiotic is most appropriate to treat this process?

Back 12

metronidazole IV or PO

Hint 12

vancomycin IV (false)

Front 13

Which of the following drugs does NOT cause a peripheral neuropathy? A. Didanosine (ddI) B. Zalcitabine (ddC) C. Vincristine D. Vinblastine E. Isoniazid

Back 13

vinblastine does NOT cause peripheral neuropathy

Hint 13

didanosine DOES cause peripheral neuropathy (ddI)

Front 14

Which of the following drugs is NOT nephrotoxic? A. Gentamicin B. Vancomycin C. Amphotericin B D. Clarithromycin E. Cisplatin

Back 14

clarithromycin is NOT nephrotoxic

Hint 14

amphotericin B IS nephrotoxic

Front 15

Which of the following is useful to eradicate hepatic stages of malaria infection?

Back 15

primaquine

Hint 15

chloroquine

Front 16

Which drug acts MOST rapidly to inhibit T4 release from the thyroid?

Back 16

sodium iodide

Hint 16

propylthiouracil

Front 17

Which of the above drugs is useful to treat constipation?

Back 17

magnesium hydroxide

Hint 17

kaolin

Front 18

Which of the above drugs produces unconsciousness, analgesia, and amnesia at doses that do NOT cause cardiovascular depression?

Back 18

ketamine

Hint 18

halothane

Front 19

Which of the above drugs produces neuroleptanalgesia when administered together with antipsychotic agents?

Back 19

fentanyl

Hint 19

n/a

Front 20

Which of the above drugs, when used in combination with lovastatin, often causes skeletal muscle pain?

Back 20

gemfibrozil

Hint 20

n/a

Front 21

Which of the above drugs increases 7-hydroxylase-mediated breakdown of cholesterol?

Back 21

cholestyramine

Hint 21

clofibrate

Front 22

Which of the above drugs should NOT be taken while the patient is eating cheeses and drinking wine?

Back 22

phenelzine

Hint 22

L-dopa

Front 23

Which of the above drugs works as an anti-emetic by blocking dopamine receptors?

Back 23

metoclopramide

Hint 23

ondansetron

Front 24

Which of the above drugs works as an anti-emetic by blocking 5-HT3 receptors?

Back 24

ondansetron

Hint 24

sumatriptan

Front 25

Which of the above drugs most effectively DECREASES airway inflammation in chronic, recurrent asthmatics?

Back 25

triamcinolone

Hint 25

albuterol

Front 26

Which of the above drugs is the most effective bronchodilator for asthmatics?

Back 26

albuterol

Hint 26

triamcinolone

Front 27

Which of the above drugs is a 1st-line anti-hypertensive agent?

Back 27

hydrochlorothiazide

Hint 27

n/a

Front 28

1st-line drug for essential hypertension?

Back 28

beta-blockers or thiazide diuretics

Hint 28

alpha-blockers

Front 29

1st-line drug for diabetic hypertensive patient?

Back 29

ACE inhibitors

Hint 29

thiazide diuretics (false)

Front 30

1st-line drug for post-myocardial infarction patient?

Back 30

beta-blockers + ACE inhibitors + HMG-CoA reductase inhibitors

Hint 30

beta-blockers only (false)

Front 31

1st-line drug for hypertensive patient with BPH?

Back 31

alpha-blockers

Hint 31

ACE inhibitors

Front 32

1st-line drug for hypertensive patient with osteoporosis?

Back 32

thiazide diuretic

Hint 32

spirinolactone (false)

Front 33

1st-line drug for heart failure?

Back 33

beta-blockers + ACE inhibitors + spirinolactone

Hint 33

beta-blockers only (false)

Front 34

Which of the above drugs promotes DNA interstrand cross-linking, and causes bone marrow suppression and alopecia but no renal or bladder toxicity?

Back 34

melphalan

Hint 34

n/a

Front 35

Which of the above drugs is designed to treat nosocomial gram-negative rod infections, especially Pseudomonas?

Back 35

ceftazidime

Hint 35

n/a

Front 36

Which of the above drugs is only active against aerobic gram-negative rods?

Back 36

aztreonam

Hint 36

n/a

Front 37

Which of the above drugs has essentially NO oral bioavailability?

Back 37

vancomycin

Hint 37

levofloxacin

Front 38

Which of the above drugs achieves essentially identical serum levels whether dosed IV or orally?

Back 38

levofloxacin

Hint 38

vancomycin

Front 39

Which of the above drugs has no gram-positive activity by itself, but synergizes with cell-wall inhibitors to provide extra killing of gram-positive organisms?

Back 39

gentamicin

Hint 39

erythromycin

Front 40

Which of the above drugs can cause marked GI intolerance?

Back 40

erythromycin

Hint 40

gentamicin

Front 41

Which of the above drugs can cause idiosyncratic aplastic anemia?

Back 41

chloramphenicol

Hint 41

n/a

Front 42

Which of the above drugs can cause drug-induced lupus?

Back 42

isoniazid

Hint 42

pyrazinamide

Front 43

Which of the above drugs can cause optic neuritis?

Back 43

ethambutol

Hint 43

isoniazid

Front 44

Which of the above drugs causes nephrolithiasis?

Back 44

indinavir

Hint 44

n/a

Front 45

Which of the above drugs is active against both hepatitis B and HIV?

Back 45

lamivudine (3TC)

Hint 45

n/a

Front 46

Which of the above drugs antagonizes AZT therapy?

Back 46

stavudine (d4T)

Hint 46

nevirapine

Front 47

Which of the above drugs causes severe heptatitis?

Back 47

nevirapine

Hint 47

stavudine (d4T)

Front 48

The efficacy of which of the above drugs is markedly INCREASED in the presence of hydroxyurea?

Back 48

didanosine (ddI)

Hint 48

n/a

Front 49

binds 50S ribosome, blocks peptidyltransferase reaction:

Back 49

chloramphenicol

Hint 49

linezolid

Front 50

neuromuscular blocker:

Back 50

praziquantal

Hint 50

n/a

Front 51

binds 50S ribosome, prevents union of 50S and 30S subunits

Back 51

linezolid

Hint 51

clindamycin

Front 52

inhibits beta-1-3 glucan synthesis, blocking cell wall formation

Back 52

caspofungin

Hint 52

n/a

Front 53

blocks DNA gyrase (topoisomerase)

Back 53

ofloxacin

Hint 53

n/a

Front 54

binds to 30S ribosome, causes misreading of mRNA code

Back 54

amikacin

Hint 54

tetracycline

Front 55

inhibits synthesis of ergosterol

Back 55

fluconazole

Hint 55

n/a

Front 56

binds to 30S ribosome, blocks aminoacyl-tRNA acceptor site

Back 56

tetracycline

Hint 56

amikacin

Front 57

binds 50S ribosome, blocks amino acid translocation

Back 57

clarithromycin

Hint 57

chloramphenicol

Front 58

inhibits oxidative phosphorylation

Back 58

niclosamide

Hint 58

n/a

Front 59

binds 50S ribosome, blocks formation of peptide bond

Back 59

clindamycin

Hint 59

clarithromycin

Front 60

Which of the above therapies is an enzyme inhibitor?

Back 60

STI-571

Hint 60

n/a

Front 61

Which of the above therapies induces diferentiation of malignant cells?

Back 61

all-trans retinoic acid (ATRA)

Hint 61

STI-571

Front 62

Which of the above therapies are used to treat hematologic malignant cells (choose as many as apply)?

Back 62

all-trans retinoic acid (ATRA) + rituximab + gemtuzumab + interferon-alpha + STI-571 (BUT NOT TRASTUZUMAB OR G-CSF)

Hint 62

all-trans retinoic acid (ATRA) + interferon-alpha only

Front 63

Which of the above compounds would you use to treat junctional tachycardia in a patient in CHF on several heart failure medicines?

Back 63

Digibind

Hint 63

n/a

Front 64

Which of the above drugs is the standard first-line pressor for most hypotensive patients and can also promote diuresis at low doses?

Back 64

dopamine

Hint 64

vasopressin

Front 65

Which of the above pressors is particularly useful in patients with low systemic vascular resistance (e.g., sepsis), but can promote severe tachycardia?

Back 65

norepinephrine

Hint 65

dobutamine

Front 66

Which of the above pressors is particularly useful in patients who are already tachycardic?

Back 66

phenylephrine

Hint 66

n/a

Front 67

Which of the above pressors is 1st line for cardiogenic shock, but may lower blood pressure and therefore is often combined with a second agent?

Back 67

dobutamine

Hint 67

dopamine

Front 68

Which of the above pressors is now considered a 1st-line option for pulseless ventricular fibrillation or tachycardia during cardiac resuscitation, but is not on the ACLS guidelines for any other type of code?

Back 68

vasopressin

Hint 68

norepinephrine

Front 69

Which is greater? A) Efficacy of BETHANECHOL as a topical preparation for glaucoma B) Efficacy of PILOCARPINE as a topical preparation for glaucoma

Back 69

PILOCARPINE (better CNS/ocular penetration b/c it's non-ionized and non-polar)

Hint 69

n/a

Front 70

Which is greater? A) Magnitude of bronchoconstriction in asthmatic caused by PROPRANOLOL. B) Magnitude of bronchoconstriction in asthmatic caused by METOPROLOL.

Back 70

Magnitude of bronchoconstriction in asthmatic caused by PROPANOLOL (a beta blocker)

Hint 70

n/a

Front 71

Which is greater? A. In vitro anticoagulant activity of HEPARIN. B. In vitro anticoagulant activity of COUMADIN

Back 71

In vitro anticoagulant activity of HEPARIN

Hint 71

In vitro anticoagulant activity of COUMADIN

Front 72

Which is greater? A) Half-life of AMIODARONE B) Half-life of DIGOXIN

Back 72

Half-life of AMIODARONE

Hint 72

Half-life of DIGOXIN

Front 73

Which is greater? A) Incidence of bone marrow suppression in patients taking VINCRISTINE. B) Incidence of bone marrow suppression in patients taking VINBLASTINE

Back 73

VINBLASTINE

Hint 73

n/a

Front 74

A 56-year-old male presents to the ER with worsening dyspnea on exertion, orthopnea, and a thirty-pound weight gain over two months. He has long-standing hypertension, and has been taking hydrochlorothiazide. His vital signs are stable. He has jugular venous distention to fifteen centimeters, an S3, crackles halfway up both lungs posteriorly, and 3+ pitting edema in both extremities. Which initial therapeutic regimen is most appropriate?

Back 74

furosemide + captopril + digoxin

Hint 74

furosemide + lisinopril + carvedilol + digoxin

Front 75

Assume you successfully treat the 56-year-old patient with ACUTE CHF, and you see him in your office a month later for a check-up. Which of the following regimens should he be taking when he sees you in your office?

Back 75

furosemide + lisinopril + carvedilol + digoxin + spironolactone

Hint 75

n/a

Front 76

A 47-year-old male with a twenty-year history of alcohol abuse presents to the hospital after being found down at home by a family member. The patient was lying in a pool of vomitus and was unresponsive. According to the paramedics, the vomitus was tinged with blood. During transport to the hospital, the patient suffered from a witnessed tonic-clonic seizure. His family members tell you he was not taking any medications, although he does have a history of bloody vomitus in the past. He has no prior history of seizures. On arrival to the ER, the patient is febrile to 102 F (38.8C), has an HR of 130, a blood pressure of 90/30, and a respiratory rate of 33. He is disheveled and non-responsive. He has scleral icterus, numerous spider angiomata, coarse rales at bilateral lung bases, a distended abdomen with a fluid wave, decreased bowel sounds, palmar erythema, and guaic-positive melenic stool. You place a nasogastric tube in the ER and lavage out clots of bright red blood and coffee-ground material. Laboratories are as follows: WBC count 23,000 with 95% neutrophils, hemoglobin of 8.5, platelets of 100,000, BUN of 96, creatinine of 1.6, AST of 130, ALT of 90. Head CT and lumbar puncture are normal. Ascitic fluid reveals 700 WBC with 90% neutrophils, gram stain positive for gram-positive cocci in pairs. Urinalysis reveals pyuria and gram stain reveals gram-negative rods in the urine. Chest x-ray shows bilateral opacifications in the superior segments of the lower lobes. Since you are a strong Resident, you break down this complex patient into his various problems and address each individually: GI bleed. In addition to blood transfusion, which of the following therapeutic regimens is most appropriately initiated in the ER?

Back 76

octreotide + ranitidine

Hint 76

octreotide + DDAVP + ranitidine

Front 77

A 66-year-old female with a history of hypertension, diabetes, and hypercholesterolemia presents to the ER with shortness of breath and a vague sensation of tingling in her chest. Being an astute clinican, you note her cardiac risk factors and realize that ischemia in females and diabetics is often atypical. Therefore, you order an EKG as part of your evaluation. The EKG reveals 4mm of ST elevation in leads V2 to V4. You immediately diagnose MI and initiate the ER protocol for MI management. The patient's vital signs are: T 99.5 F (37.5 C), HR 110, BP 170/90, RR 23. Which of the following are primary therapies for myocardial infarction accompanied by ST elevation?

Back 77

urokinase + tPA plus heparin + streptokinase

Hint 77

tPA plus heparin

Front 78

A patient becomes neutropenic during the third cycle of CHOP therapy, and presents to clinic complaining of severe abdominal pain, nausea, and vomiting. On exam, the pateient's vitals are as follows: T 101 F (38.3 C), HR 130, BP 80/40, RR 34. He has marked acute distress, with peritoneal signs on abdominal exam, and hypoactive bowel sounds. WBC count is 250 cells/uL with 10% neutrophils (i.e., the patient is neutropenic). Creatinine is normal. The patient is admitted to intensive care and surgery is called to evaluate him. You immediately begin antibiotic and pressor therapy. What antibiotic regimen is most appropriate?

Back 78

ampicillin + gentamicin + metronidazole

Hint 78

clindamycin and azithromycin

Front 79

For the patient with peritoneal signs, which pressor is your agent of first choice?

Back 79

dopamine

Hint 79

epinephrine

Front 80

A 54-year-old female with no past medical history presents to your primary care office for a routine annual exam. In the past, you have twice noted that the patient had borderline elevations in blood pressure, and you have advised the rather portly woman on diet and exercise as a therapy to prevent the need for antihypertensive medications. Alas, the patient did not modify her behavior and now you again note a blood pressure of 150/90. You decide to initiate anti-hypertensive therapy. Which therapy would you use in this patient?

Back 80

hydrochlorothiazide or metoprolol

Hint 80

benazepril

Front 81

For a patient with previous hypertension with comorbid illness: Two years later, you diagnose the patient with Type II diabetes mellitus, and on screening, you detect the presence of microalbuminuria. What medicine would you now use to control the patient's persistent hypertension?

Back 81

benazepril

Hint 81

hydrochlorothiazide