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Pharmacology 350
Section 001
Exam I, 20 February 2007
- Use only a number 2 pencil to mark the machine scored answer sheet.
- Remember to enter your name and ID# on the answer sheet and accurately encode machine read spaces with this information. Sign your name in the box provided.
- There are 65 questions: 10 of these questions are “extra credit”. Make sure that you have all the pages of the exam. Answer all questions: there are no deductions for incorrect answers. Each correct answer is worth one point. Total points available from this exam: 65.
- When you are finished, turn in your answer sheet, delete your name from the attendance sheet and leave the room quietly. You may keep the question paper.
- Concerns regarding individual questions should be e-mailed to Dr Cobbett by 3.00pm Wednesday 21 February 2007. Make it clear to which exam you are referring: A, or B, or C, or D.
This is exam A
For each of the following multiple choice questions, choose the single most appropriate answer.
D1. To reduce the tachycardia characteristic of paroxysmal atrial tachycardia, which of the following drugs would bring your heart rate back to “normal” through its actions outside of the heart:
A. Atenolol B. Atropine C. Propranolol D. Methoxamine E. A and C above.
C2. You are salivating excessively and your pupils are constricted; however, you do not have skeletal muscle weakness. From these symptoms you conclude that you have received an overdose of:
A. Neostigmine B. Succinylcholine C. Pilocarpine D. Atropine E. A and C, above.
A3. Dobutamine (DOBUTREX):
A. Activates β 1 adrenoreceptors but not β 2 adrenoreceptors B. Induces release of norepinephrine from axon terminals of postganglionic sympathetic neurons C. Decreases heart rate and contractility of cardiac muscle D. Can be used to induce mydriasis E. A and C, above
A4. Bethanechol (URECHOLINE):
A. Mimics the effects of acetylcholine at muscarinic receptors in the gastrointestinal tract B. Mimics the effects of acetylcholine at nicotinic receptors at the neuromuscular junction (of skeletal muscle) C. Mimics the effects of acetylcholine at muscarinic receptors at the neuromuscular junction (of skeletal muscle) D. Is used as a muscle relaxant E. A and C above.
For each of the following multiple choice questions, choose the single most appropriate answer.
C9. The therapeutic threshold concentration (aka minimal effective concentration) of a drug:
A. Determines the efficacy of the drug B. Must be known to measure the Therapeutic Index for this drug C. Is the minimum plasma concentration of the drug which is required to induce the desired therapeutic response D. Is affected by the ability of the body to eliminate (metabolize and/or excrete) the drug E. A and C above.
B10. After release from an axon terminal of an acetylcholine-synthesizing neuron, acetylcholine is:
A. Taken up into and destroyed in the postsynaptic cell B. Broken down by acetylcholinesterase in the synaptic gap C. Taken back up into the axon terminal from which it is released D. Broken down by monoamine oxidase E. A and C, above
E11. Uses of anticholinesterases in therapy include administration by appropriate routes to:
A. Increase intestinal contractile activity in individuals with intestinal atony B. Increase pupillary diameter to permit retinal examination C. Lower intraocular pressure in the eyes of individuals diagnosed with glaucoma D. Reduce spastic (i.e. uncontrolled and continuous) skeletal muscle contraction which is the key feature of myasthenia gravis E. A and C, above.
C12. Glycopyrrolate is administered with a general anesthetic in many instances because glycopyrrolate will:
A. Activate non-innervated muscarinic receptors in some blood vessels and thus causes vasoconstriction and increased blood pressure B. Increase bronchosecretion C. Reverse general anesthesia induced bradycardia D. Decrease heart rate E. A and C, above.
For each of the following multiple choice questions, choose the single most appropriate answer.
E13. You are given the same dose of drug X every four hours. After two days, you are also given drug Y (at the same time as drug X). If drug Y is a substrate for the enzyme that metabolizes drug X (i.e., the same enzyme degrades X and Y), then:
A. Drug Y will effectively increase the effect of drug X (i.e., the response induced by drug X, applied at the same dose whether drug Y is absent or present, is increased when drug Y is co-administered) B. Drug Y will not affect the half life of drug X C. Drug Y will effectively increase the half life of drug X D. Drug Y will effectively decrease the half life of drug X E. A and C, above.
C14. Drug X is an agonist at the P receptor. Drug Y does not compete with Drug X to bind the P receptor but increases the affinity of the P receptor for Drug X. Drug Y is:
A. A partial agonist B. A full agonist C. An allosteric modulator D. A competitive antagonist E. A and C, above.
D15. Activation of the sympathetic nervous system:
A. Decreases heart rate B. Increases the motility of the gastrointestinal tract C. Relaxes the sphincter of the urinary bladder D. Increases bronchiole diameter E. A and C, above.
A16. You are given the same oral dose of a drug every 24 hours. By the sixth day, the drug seems to have a reduced effectiveness (compared to its effect on the first couple of days). This reduced effectiveness could be the result of:
A. Increased rate of elimination B. Decreased rate of elimination C. Receptor supersensitivity D. Increased absorption of drug from the gastrointestinal tract E. A and C, above.
For each of the following multiple choice questions, choose the single most appropriate answer.
E19 Trimethaphan (ARFONAD):
A. Is used to induce hypotension during surgery B. Is an antagonist at nicotinic receptors at the skeletal neuromuscular junction C. Is used to treat hypertensive crisis D. Is used as a (skeletal) muscle relaxant E. A and C, above.
E20. Gallamine:
A. Binds to nicotinic cholinergic receptors on skeletal muscle B. Binds to nicotinic cholinergic receptors in the gastrointestinal tract C. Causes muscle weakness through a different mechanism of action as succinylcholine (SUCOSTRIN) produces this effect D. Is a non competitive antagonist at nicotinic receptors at the skeletal neuromuscular junction E. A and C, above.
D21. A drug which has a high affinity for β 1 adrenoreceptors and β 2 adrenoreceptors but low affinity for all other receptors:
A. Dobutamine (DOBUTREX) B. Epinephrine (ADRENALIN) C. Terbutaline (BRETHINE) D. Isoproterenol (ISUPREL) E. Phentolamine (REGITINE).
B22. All of the following routes of administration are classified as parenteral except:
A. Transdermal B. Oral C. Subcutaneous D. Intravenous E. Intramuscular.
For the following questions, select the most appropriate answer
Select (A) if 1, 2 and 3 (but not 4) are correct Select (B) if 1 and 3 (but not 2 and 4) are correct Select (C) if 2 and 4 (but not 1 and 3) are correct Select (D) if only 4 is correct Select (E) if 1, 2, 3 and 4 are correct
C23. Which factors determine the number of receptors (of a particular type, at a particular site) that are bound by a drug?
- The potency of the drug
- The affinity of the drug for the receptor
- The duration of action of the drug
- The concentration of the drug
C24. Epinephrine (ADRENALIN) is co-administered with a local anesthetic:
- To reduce the irritant effect of the local anesthetic
- To reduce blood flow to the site where the local anesthetic is injected
- To increase blood flow to the site where the local anesthetic is injected
- To effectively prolong the duration of action of the local anesthetic at the injection site.
B25. When a drug is dissolved in an aqueous (water-based) solution, the ratio of the concentration of ionized drug to the concentration of the unionized drug is dependent on:
- The pKa of the drug
- The amount of drug dissolved in the solution
- The acidity (pH) of the aqueous solution
- The lipid solubility of the drug.
B26. After equilibrium has been reached, for a drug with a pkA of 4.4 present in two compartments which are filled with aqueous (water-based) solutions of different pH and which are separated by a lipid membrane:
- The concentration of non-ionized drug in each compartment is the same
- There is more total (ionized and non-ionized) drug in the acidic environment
- There is more total (ionized and non-ionized) drug in the basic environment
- The concentration of non-ionized drug in the two compartments is not the same.
For each of the following multiple choice questions, choose the single most appropriate answer.
E31. A drug which increases heart rate and binds with high affinity to muscarinic receptors.
A. Norepinephrine B. Nicotine C. Pilocarpine D. Succinylcholine E. Atropine
D32. A drug that activates receptors and initiates a series of cellular reactions that results in a maximal (100%) response by the cell/tissue/organ is:
A. A partial agonist B. A competitive antagonist C. A modulator D. A full agonist E. A non-competitive antagonist.
E33. Drug X is metabolized by enzyme Z in the liver. Drug Y is metabolized in the liver by enzyme W; drug Y also induces enzyme Z. In an individual being administered drug Y and drug X:
A. Drug X has a greater plasma half life (than when only drug X is administered) B. Drug X has a lesser plasma half life (than when only drug X is administered) C. The dose of drug X might need to be decreased to avoid any potential toxic effects of drug X D. The half life of drug X is not affected E. A and C above.
E34. A drug which is a (somewhat resistant) substrate for cholinesterases, and although it does not affect salivary secretion, it does activate cholinergic receptors at the (skeletal) neuromuscular junction:
A. Pilocarpine B. Physostigmine C. Curare D. Atropine E. Succinylcholine.
For each of the following multiple choice questions, choose the single most appropriate answer.
C35. From the dose-response relationship (below) for drugs X and Y, you can determine that:
A. Both drugs are pharmacological agonists B. Both drugs are pharmacological antagonists C. Drug Y is less potent than drug X (at least for the response being measured) D. Drug X is less potent than drug Y (at least for the response being measured) E. A and C, above.
For questions 36-38 select the letter of the word or phrase from the list of five below which best matches the item stem. Each letter may be used once, more than once, or not at all.
A36. A drug which is used as a nasal decongestant
A37. A drug which induces mydriasis when applied to the eye but does not have the same mechanism of action as atropine
B38. A drug which might be expected to reduce blood pressure through effects on receptors on blood vessels but which has no direct effect on cardiac output:
A. Phenylephrine (NEO-SYNEPHRINE) B. Prazosin (MINIPRESS) C. Atenolol (TENORMIN) D. Propranolol (INDERAL) E. Isoproterenol (ISUPREL)
For each of the following multiple choice questions, choose the single most appropriate answer.
A41. From the two dose-response relationships shown below, the therapeutic index for each drug (Drug X and Drug Y) was determined.
A. The therapeutic index for drug Y is greater than for drug X B. The therapeutic index for drug X is greater than for drug Y C. The therapeutic index is indicative of the potency of each drug D. The therapeutic index can not be determined from the information given E. A and C above.
D42. The direct, chronotropic actions of isoproterenol on the heart:
A. Are mediated through a reflex and are dependent on α 1 adrenoreceptor mediatedvasoconstriction B. Are mediated through β 2 adrenoreceptors C. Include decreased heart rate D. Are mediated through β 1 adrenoreceptors E. A and C above.
E43. A drug which when administered intravenously will enter the central nervous system rapidly, will decrease salivary secretion and will not affect skeletal muscle strength:
A. Norepinephrine B. Nicotine C. Pilocarpine D. Succinylcholine E. Atropine
For the following questions, select the most appropriate answer
Select (A) if 1, 2 and 3 (but not 4) are correct Select (B) if 1 and 3 (but not 2 and 4) are correct Select (C) if 2 and 4 (but not 1 and 3) are correct Select (D) if only 4 is correct Select (E) if 1, 2, 3 and 4 are correct
B44. Pralidoxime (PROTOPAM) is useful to treat overdose by:
- Malathion
- Neostigmine
- Echothiophate
- Atropine
C45. Activation of α 2 adrenoreceptors:
- Causes constriction of arterioles in the skin and mesentery
- Is the mechanism of action of clonidine
- Causes relaxation of sphincter of the urinary bladder
- Reduces release of norepinephrine from axon terminals.
D46. Atenolol (TENORMIN) can be used as an antihypertensive agent because atenolol:
- Reduces total peripheral resistance by activation of β 2 adrenoreceptors
- Reduces total peripheral resistance by blockade of β 2 adrenoreceptors
- Reduces total peripheral resistance by blockade of α 1 adrenoreceptors
- Reduces cardiac output through its actions within the heart.
D47. Epinephrine (ADRENALIN) decreases diastolic blood pressure by:
- Blockade of β 2 adrenoreceptors on the blood vessels of skeletal muscle
- Blockade of α 1 adrenoreceptors on blood vessels of the skin and mesentery
- Activation of α 1 adrenoreceptors on blood vessels of the skin and mesentery
- Activation of β 2 adrenoreceptors on the blood vessels of skeletal muscle.
D48. Bronchiole dilation induced by epinephrine (ADRENALIN) can be reversed by administration of:
- Prazosin (MINIPRESS)
- Atenolol (TENORMIN)
- Phentolamine (REGITINE)
- Propranolol (INDERAL).
For each of the following questions, choose the single most appropriate answer:
Select (A) if 1, 2 and 3 are correct Select (B) if 1 and 3 (but not 2 and 4) are correct Select (C) if 2 and 4 (but not 1 and 3) are correct Select (D) if only 4 is correct Select (E) if 1, 2, 3 and 4 are correct
C54. Tropicamide administered topically to the eye:
- Will produce miosis (reduced pupillary diameter)
- Has the opposite effect of physostigmine (ANTILIRIUM) applied topically to the eye
- Has the opposite effect of epinephrine (ADRENALIN) applied topically to the eye
- Will produce mydriasis (increased pupillary diameter).
A55. Bethanechol:
- Induces urine release (i.e., the bladder empties) when administered systemically
- Is a cholinergic muscarinic receptor agonist
- Is a substrate for plasma cholinesterases
- Activates α 1 adrenoreceptors.
D56. Albuterol:
- Is an adrenoreceptor antagonist and will bind to β 2 adrenoreceptors in the heart to increase heart rate
- Is an adrenoreceptor antagonist with low affinity for β 1 adrenoreceptors in the kidney
- Is an adrenoreceptor antagonist and will bind β 1 adrenoreceptors in the heart to reduce heart rate
- Is used as an inhalant by asthmatics because it will produce bronchodilation.
For each of the following questions, choose the single most appropriate answer
A57. Considering that there is ongoing activity in both the parasympathetic nervous system and the sympathetic nervous system, atenolol (TENORMIN) will produce:
A. Decreased heart rate through actions in the heart B. Bronchodilation C. Bronchoconstriction D. Vasoconstriction in skeletal muscle through actions on β 2 adrenoreceptors E. A and C, above.
A58. Dobutamine (DOBUTREX):
A. Mimics the effects of isoproterenol (ISUPREL) to alter heart rate and contractility of heart muscle B. Can be used to induce mydriasis C. Is a selective α 2 adrenoreceptor agonist D. Induces release of norepinephrine from axon terminals of postganglionic sympathetic neurons E. A and C, above.
E59. An undesired side effect of propranolol (INDERAL) being used in the treatment of hypertension is:
A. Coronary artery constriction B. Elevated heart rate C. Bronchiole constriction D. Reduced blood pressure E. A and C, above.
B60. Ephedrine is known as a “mixed sympathomimetic” because it:
A. Has different effects dependent on the level of sympathetic tone or activity B. It not only has high affinity for postsynaptic adrenoreceptors, which it activates, but also induces release of norepinephrine C. It is an antagonist at muscarinic cholinergic receptors D. It has agonist properties at some types of adrenoreceptors but is an antagonist at other types of adrenoreceptor E. It has effects in the brain and in the autonomic nervous system.
