Pharmacy Study Questions by Mari-Alina Timoshchuk

Pharmacy study questions designed for medical school and preparation for USMLE Step 1

1. 2016 Pharm Block I

2. What is the threshold value of the drug shown in this dose-response curve? 3 30 300 1 ,000 10,000 Dose Effect

3. What is the approximate ED 50 of the drug shown in this dose response curve? 3 30 300 1 ,000 10,000 Dose Effect

4. What is the ceiling dose of the drug shown in this dose response curve? 3 30 300 1 ,000 1 0,000 Dose Effect

5. Which of the following is the more potent drug based on the dose response curves? Drug A Drug B Drug C None, they all have the same potency This cannot be determined from this graph Drug A Drug B Drug C Dose Effect

6. Which of the following drugs on this has the lowest efficacy? Drug A Drug B Drug C Drug A Drug B Drug C None, they all have the same potency This cannot be determined from this graph Dose Effect

7. Competitive antagonist Full agonist Inverse antagonist Non-competitive antagonist Partial agonist Dose Effect In order to determine the behavior of Drug B (an antagonist), we record the dose response of Drug A (a known agonist) under three different [Drug B]. The dose response curves of Drug A are shown at three different Drug B concentrations. In this example Drug B is acting as a(n)

8. Competitive antagonist Full agonist Inverse antagonist Non-competitive antagonist Partial agonist Dose Effect In order to determine the behavior of Drug B (an antagonist), we record the dose response of Drug A (a known agonist) under three different [Drug B]. The dose response curves of Drug A are shown at three different Drug B concentrations. In this example Drug B is acting as a(n)

9. Which of the following receptor subtypes does not respond to NE? α 1 α 2 β 1 β 2 β 3

10. β 2 adrenergic receptor mediates vasodilation via what mechanism? dephosphorylation of MLCK phosphorylation of MLC phosphorylation of MLCK phosphorylation of troponin I stimulation and release of NO

11. α 1 adrenergic receptors stimulate vasoconstriction through what downstream mechanism? Ca 2+ - Calmodulin stimulation of MLCK dephosphorylation of MLC phosphorylation of MLCK phosphorylation of troponin I production of NO

12. A patient presents to the ER in anaphylactic shock. Your attending physician asks you why an IV bolus of epinephrine produces vasoconstriction in the presence of both α 1 and β 2 receptors, which have opposing actions. You respond by saying that Epi activates both α 1 and β 2 receptors, but the effects of α 1 overcome the effects of β 2 leading to vasoconstriction Epi decreases the concentration of Ca 2+ - Calmodulin complex leading to vasoconstriction Epi increases the concentration of NO produced by the endothelial cell resulting in vasoconstriction Epi leads to the phosphorylation of troponin I resulting in vasoconstriction Epi primarily stimulates β 2 receptors resulting in vasoconstriction

13. M 2 receptor mediates which of the following actions? Decreased cAMP and Ca 2+ which results in a decreased heart rate and decreased contractility Increased intracellular concentration of Ca 2+ - Calmodulin complex resulting in vasoconstriction Increased cAMP and Ca 2+ which results in an increase in heart rate and increased contractility Phosphorylation of MLCK which results in dephosphorylation of MLC resulting in vasodilation Phosphorylation of troponin I which results in an increased contractility of the heart

14. A man is held up at gun point at a gas station, and he starts profusely sweating. The mechanism that caused his perspiration is: A cholinergic sympathetic pathway in which the pre- ganglionic cells release ACh , which binds muscarinic receptors A cholinergic sympathetic pathway in which the post- ganglionic cells release ACh , which binds muscarinic receptors A cholinergic sympathetic pathway in which the post- ganglionic cells release NE, which binds muscarinic receptors A cholinergic sympathetic pathway in which the post- ganglionic cells release ACh , which binds α2 adrenergic receptors A cholinergic sympathetic pathway in which the post- ganglionic cells release NE, which binds α2 adrenergic receptors

15. What is the effect of hemicholinium on the nerve terminal? Blocks uptake of ACh into vesicle Blocks uptake of tyrosine by the sympathetic terminal Blocks uptake of choline by the parasympathetic terminal Blocks uptake of dopamine into vesicle Prevents release of ACh from vesicle

16. A 65 yo man shows up at the ED with a headache and blurred vision. His blood pressure is 210/115. When asked if he was on any medication for his HTN, he said he was but he hasn’t taken anything in 2 weeks because he ran out and hasn’t gotten his prescription refilled yet. The attending physician says this is called a “hypertension crisis”. The mechanism that causes this medical emergency is: Denervation supersensitivity Dual innervation Due to the baroreflex Post-synaptic receptor recycling Unregulated reuptake

17. You are a 4 th year medical student suturing a 10 inch laceration on a woman’s back. The resident supervising you suggests you use a licodaine that also contains epinephrine. The reason epinephrine is used is it prolongs the effects of lidocaine by: Binding to a1 adrenergic receptors and causing vasodilation Binding to a1 and a2 adrenergic receptors and causing vasoconstriction Binding to B1 adrenergic receptors to decrease contractile force Binding to B2 adrenergic receptors and causing vasodilation Binding to muscarinic receptors to decrease sweating

18. An unknown drug is given and the mean BP increases, while the heart rate decreases, and the total peripheral resistance increases. The drug that was most likely administered is: Acetylcholine Beta-Blocker Dopamine Epinephrine Norepinephrine

19. A patient comes into your office with a previous history of Myasthenia Gravis (MG) and looks like they are in acute respiratory distress. The patient stated that she took too much of her MG medication by mistake and now is experiencing a life threatening condition. The most effective treatment is: A: Trimethaphan B: Tubocurare C: Propanolol D: Atropine E: Carbechol

20. You are in the ER on an overnight shift, when an ambulance rushes in the door with a GSW patient who is barely conscious, has impaired alveolar ventilation measured by PaCO 2 , and whose PaO 2 is declining by the second, the drug most likely administered to induce sedation for intubation is: A: Pyridostigmine B: Tubocurare C: Succynyl choline D: Pilocarpine E: Ipratropium

21. The drug responsible for blocking the rate limiting step of Ach synthesis is: A: Carbechol B: Hemocholinium C: Vesamichol D: Hexamethonium E: Mivacuronium

22. The drug responsible for the effects shown in this tracining is: A: High Dose Ach B: Low Dose Epi C: High Dose Sopolamine D: Low Dose ACH E: High Dose Epi Drug administration

23. A patient comes into your office with chronic open angle glaucoma, the drug of choice to ciliary body production of aqueous humor is: A: Pilocarpine B: Ipratropium C: Furosemide D: Chlorothalidone E : Timolol

24. A patient presents to the emergency room with a bloody laceration to the tip of the nose. Before suturing, you administer lidocaine+NE as a local anesthetic to stem the flow of blood. Since you are experiencing trouble controling the bleed, you decide to double the amount of drug being administered. Your attending kindly reminds you the tip of the nose can be considered an end organ and you must attempt to revascularize the area. You would use which drug to do so? Phenylephrine Dopamine Dobutamine Bethanechol Phentolamine

25. After administration of phentolamine you notice that the patient’s heart rate increases greatly. The mechanism for this increase can be blocked with: Atropine Carbachol Cocaine Physostigmine Phenylephrine

26. A child is brought to the emergency room after being found unresponsive. It is determined she took some of her grandfather’s medication. Her BP is 200/100, HR 40bpm, and her pupils are dilated. She took: Atropine Carvedilol Prazosin Acebutol Phenylephrine

27. Patient X is being treated for hypertension. His chief complaint since beginning his medicine is an inability to ejaculate. You explain that Clonidine has this effect because it is: An alpha 1 agonist An alpha 2 agonist An unselective beta agonist An alpha 1 antagonist An alpha 2 antagonist

28. A pregnant woman presents in the ER going into labor 10 weeks early. In an attempt to lessen the contractions and relax the uterus you administer: Albuterol Atropine Dobutamine Propanolol Ritodrine

29. A patient is pretreated with atropine, phenoxybenzamine and practolol before receiving a IV bolus of epinephrine. What receptor can still be activated by epinephrine and what effects will it have? Alpha 1, increase in blood pressure, increase in heart rate Alpha 2, increase in blood pressure, decrease in heart rate Beta 1, increase in blood pressure, no change in heart rate Beta 2, decrease in blood pressure, no change in heart rate Beta 2, decrease in blood pressure, decrease in heart rate

30. When NE activates a ___ receptor the heart rate increases. When ACh activates a ___ receptor heart rate decreases. When ACh activates a ___ receptor blood vessels vasodilate . α1, β 1, M3 β 1, M2, M3 β 1, M1, M3 β 1, M2, M1 β 1, M1, M2

31. A patient is given a drug that increases blood pressure and total peripheral resistance while leading to a reflexive decrease in heart rate. This drug could be a α1/α2 antagonist α1/α2 agonist β 1 antagonist β 2 antagonist β 1/ β 2 agonist

32. A patient is given a LOW DOSE infusion of epinephrine which selectively binds to ___ receptor(s) in the blood vessels and ___ receptor in the heart. This leads to a ____ total peripheral resistance, ____ in heart rate, ____ in contractile force. α1, β 1, ↓,↑,↑ β 1, β 2, ↓,↑,↓ β 2, β 1, ↑,↓,↑ β 2, β 1, ↑,↑,↑ β 2, β 1, ↓ ,↑,↑ β 2, β 1, ↓ ,↑,↓

33. What drug(s) could cause the changes seen in the graph? norepinephrine atropine acetylcholine Isoproterenol phenoxybenzamine HR TPR

34. What drug could cause the changes seen in the graph? norepinephrine epinephrine acetyl choline isoproterenol atropine

35. Most diuretics enter the urine via Glomerular filtration Organic acid and base secretory system of PCT Passive diffusion in the descending loop of Henle Blocking the Na/K ATPase Paracellular transport

36. Mannitol is contraindicated in CHF and pulmonary edema because It readily crosses the blood brain barrier and inhibits the α -2’s of the lateral medulla Further activates the juxtaglomerular cells to increase renin production Decreases blood flow to the afferent arteriole Sets up an osmotic gradient that moves water from the vasculature into the interstitium

37. Acetazolamide is often given as a treatment for glaucoma via inhibition of A. Aldosterone interaction at intracellular receptor sites B. Methyltransferase C. Decreasing calcium in the distal nephron D. N/K/CCl2 cotransporter E. carbonic anhydrase in the ciliary body

38. Acetazolamide is not used to treat chronic hypertension because It causes excessive excretion of carbonic acid that results in metabolic alkalosis It blocks the Na/H antiporter and results in acidic urine It causes excessive excretion of bicarbonate that results in metabolic acidosis It causes retention of bicarbonate that results in metabolic alkalosis

39. Betty White has osteoporoesis as well as peripheral edema. He doctor opts not to give her furosemide because Furosemide will compete with parathyroid hormone Blocking Enac will increase calcium secretion Blocking the organic acid system will decrease absorption of calcium in the PCT Furosemide will irreversibly bind calcitonin Blocking NKCC transporter will disrupt the electrochemical gradient and prevent calcium reabsorption

40. The most significant adverse effect of both chlorothiazide and furosemide is A. Hyperkalemia B. Hypokalemia C. Hypercalcemia D. Hypocalcemia E. hypomagnesemia

41. Spironolactone has no effect on which condition? Primary aldosteronism Hypokalemia Heart failure Hypertension Primary adrenal insufficiency

42. A patient has polydipsia and polyuria , but no hyperglycemia. She improves with desmopressin , so you know she has Central diabetes insipidus nephrogenic diabetes insipidus Hyponatremia Secondary hyperaldosteronism Primary adrenal insufficiency

43. ADH/AVP functions to Activate the V1 receptor for vasculature to decrease preload Activate the V2 receptor for the collecting duct to decrease water absorption Increase Na/Cl transporters in the early distal convoluted tubule Increase ENaC production in the collecting duct Make aquaporins insert on the lumenal membrane

44. Spironolactone may be added to a thiazide or furosemide to prevent Hyperlipidemia Hyperuricemia Hypokalemia Hypocalcemia hypoglycemia

45. A lipid soluble drug is administered intravenously into a patient in the ICU. The drug will diffuse rapidly via passive diffusion to a. adipose b. heart c. muscle d. skin

46. A Patient in the ICU is administered an IV bolus of a drug with a large k el . The rate of elimination of the drug will be a. slower than the rate of elimination of a drug with a small k el and decreasing as the concentration of drug decreases b. slower than the rate of elimination of a drug with a small k el and increasing as the concentration of drug decreases c. faster than the rate of elimination of a drug with a small k el and decreasing as the concentration of the drug decreases d. slower than the rate of elimination of a drug with a small k el and increasing as the concentration of the drug decreases

47. You would like to increase the time between dosages of an intravenously administered drug for one of your patients. One way to accomplish this is to select a drug with a different elimination rate constant, elimination rate, and half-life. These properties in the new drug should be a. decreased kel, decreased Vel, and decreased half-life b. decreased kel, decreased Vel, and increased half-life c. increased kel, increased Vel, and decreased half-life d. increased kel, increased Vel, and increased half life e. increased kel, decreased Vel, and decreased half-life

48. A drug that undergoes receptor-mediated transport in the body is administered to a patient in the ICU. As the concentration of drug increases, the rate of reaction a. increases continuously because the two properties are directly proportional b. increases slowly at low drug concentration and then then increases rapidly at higher drug concentrations c. increases until the drug reaches therapeutic concentrations and then remains constant d. remains constant despite changes in the concentration of the drug e. remains constant until receptors are saturated then increases rapidly

49. The graph that best represents the extravascular administration of a drug is A. B. C. D.

50. Passive diffusion is At the same rate for drugs with the same pK value Increased with a drug with a low Kp More likely with a weakly acidic drug whose pK is lower than the pH More likely with a weakly basic drug where the pK is lower than its pH

51. Drug A is introduced into the A compartment and is able to enter compartment B through passive diffusion. On which side would the weakly acidic drug be more likely to accumulate given the conditions seen below:

52. A weakly basic drug is introduced into the A compartment and is able to enter compartment B through passive diffusion. Determine the amount of drug that will be present on each side of the membrane: With click the answer for compartment A will show With second click, the answer for compartment B will show 0.01 100

53. A weakly acidic drug is introduced into the A compartment and is able to enter compartment B through passive diffusion. Determine the amount of drug that will be present on each side of the membrane: With click the answer for compartment A will show With second click, the answer for compartment B will show 0.01 100

54. A weakly acidic drug is introduced into the A compartment and is able to enter compartment B through passive diffusion. Determine the amount of drug that will be present on each side of the membrane: With click the answer for compartment A will show With second click, the answer for compartment B will show 0.001 10

55. Advantages to IV administration of a drug include: Bypassing the first-pass effect of the kidneys Can be used with drugs that burn or cause pain to the tissue. Ease of reversal of an overdose Rapid absorption process The drug will work faster than with parenteral administration

56. The most important factor determining the rate of absorption of a drug give IM into circulation is Size of the drug compound Dissolving the drug into oil Fat content of the area of injection Injection into different muscle groups

57. Match the following category of drug with the appropriate carrier protein: (When you click, the answer for A will be shown – second click shows the answer for B --- so on ) Acidic drugs α 1-acid glycoprotein Basic drugs Albumin Lipophilic drugs VLDL

58. The best enteral route of administration for a weakly acidic drug with a pK of 5 is Sublingual (pH of 6) Oral (pH of 1) Intramuscular Intravenous

59. Drug absorption can be increased by: Delaying gastric emptying Decreasing intestinal motility Intestinal microorganisms/enzymes that begin the metabolism Taking your medicine with food

60. The blood-brain barrier Allows the transfer of unionized drugs by passive diffusion Allows drugs with a molecular weight less than 1000 to pass Is formed through gap junctions in endothelial and glial cells Provides active transport of lipid soluble drugs

61. The process of decreasing the pH of urine via administration of ascorbic acid in order to aid in the excretion of weakly basic drugs is known as: First pass effect Forced acid diuresis Forced alkaline diuresis Passive acid diuresis Passive alkaline diuresis

62. The mechanism of excretion of drugs into sweat, saliva and milk is: Active transport Filtration Ion pair transport Passive diffusion Receptor-mediated transport

63. Based on the cytochrome nomeclature system, CYP2E1 and CYP2E2 have at least what percentage sequence homology? 40% 60% 80% 95% 99%

64. Through which of the following reaction types can a cytochrome P450 enzyme cause mutations by the production of reactive intermediates? Aliphatic hydroxylation Aromatic hydroxylation Epoxidation Dealkylation Methylation

65. P450’s can metabolize a wide variety of different endogenous and exogenous compounds. This is due to all of the following reasons except: Broad active site selectivity Enzyme induction Gene polymorphisms Gene rearrangement Multiple enzyme forms

66. CYP1A1 and CYP1A2 are both constitutively expressed in extra-hepatic tissue are both found in the liver Are both inducible Are both inducible by Heat Shock Protein 90

67. Succinylcholine apnea syndrome is due to Polymorphisms in drug metabolizing enzymes that cause rapid metabolism of succinylcholine Polymorphism in drug metabolizing enzymes that cause slow metabolism of succinylcholine An epoxide reaction of succinylcholine causing formation of reactive compounds An autosomal recessive disease resulting in an aberrant succinylcholine

68. The cytochrome P450 that plays a role in acetaminophen toxicity after drinking is CYP2B1 CYP2b6 CYP2C9 CYP2E1

69. An in vivo assay used to determine how much CYP1A2 a patient has is Caffeine metabolism S mephenytoin metabolism Debrisoquine dextromethorphan

70. Antidepressants are inhibitors of which cytochrome P450? CYP1A2 CYP1B1 CYP2D6 CYP2E1

71. A 27 year old female complains of chest pain at rest, she is diagnosed with variant angina ( Prinzmental’s Angina). Which of the following medications would be contraindicated? Aspirin D iltiazem Isosorbide Dinitrate Nadalol Nifedipine

72. A 27 year old female complains of chest pain at rest, she is diagnosed with variant angina ( Prinzmental’s Angina). The patient is treated with a calcium channel blocker and a nitrate. Which of the following adverse effects is likely? Anemia Bronchospasm Severe Hypotension Severe Hypertension Impotence

73. A 68 year old male with long standing heart disease recently retired and moved to southern Florida where you are a cardiologist. The best combination of medications to prescribe him would be: A. Nitroglycerine and Dilitazem B. Nitroglycerine and Nifedipine C. Propranolol and Nifedipine D . Propranolol and Dilitazem E . Propranolol and Verapimil

74. All of the following are limitations to the use of Nitroglycerine except : A. Rapid Tolerance B. Contraindicated in Diabetes C. Potential to cause reflex tachycardia D. May worsen Ischemia E. Metabolized fully by first pass metabolism

75. Correctly order the effectiveness of the following calcium channel blockers as vasodilatory agents: A. Nifedipine >> Diltiazem ~ Verapamil B. Diltiazem >> Nifedipine ~ Verapimil C. Verapimil >> Nifedipine ~ Diltiazem D. Metropol >> Nifedipine ~ Diltiazem E. Diltiazem >> Metropolol ~ Nifedipine