Pharmacology 1

A 54-year-old woman with severe essential hypertension refractory to treatment switched to a new antihypertensive drug 1 month ago. Her blood pressure is currently well controlled. She now comes complaining of excessive hair growth. Which antihypertensive drug is she taking?

• Hydrochlorothiazide

• Isosorbide dinitrate

• Minoxidil

• Nifedipine

Answer explanation

Minoxidil is a direct-acting vasodilator used to treat hypertension. It works by relaxing the smooth muscle in blood vessels, leading to vasodilation and decreased blood pressure. However, one of its side effects is hypertrichosis, which is excessive hair growth.

Hypertrichosis can occur in both men and women taking minoxidil, and it is not related to the location of hair growth. It can occur on the face, arms, legs, back, or chest. The mechanism by which minoxidil causes hypertrichosis is not fully understood, but it is thought to be related to its vasodilatory effect on the hair follicles.

(A) Hydrochlorothiazide is a thiazide diuretic that works on the distal tubule. It also causes resorption of calcium into the blood. It is not known to cause hypertrichosis.

(B) Isosorbide dinitrate is converted to nitric oxide (NO) in the body. NO is a potent vasodilator. It is not associated with hypertrichosis.

(D) Nifedipine is a dihydropyridine calcium channel blocker

A 65-year-old man with non–insulin-dependent diabetes mellitus presents to his primary care physician for follow-up. He is currently managed with glyburide. His weight has increased from a baseline of 195 lb to 230 lb during the past year. He walks approximately 30 min every other day throughout the year and eats three balanced meals per day. What is the most likely explanation for these findings?

• Lack of physical exercise

• Lack of proper diet

• Medication side effect

• Underlying hyperthyroidism

Answer explanation

Glyburide is a medication that belongs to a class of drugs called sulfonylureas, which work by stimulating the pancreas to produce more insulin. This increased insulin production can lead to weight gain in some individuals with diabetes. Insulin is an anabolic hormone that promotes the storage of glucose and fat in the body. Therefore, when the body produces more insulin in response to glyburide, it can lead to an increase in both glucose and fat storage. This can contribute to weight gain, particularly if there is insufficient physical activity or if the diet is not well controlled.

Glyburide is a medication that belongs to a class of drugs called sulfonylureas, which work by stimulating the pancreas to produce more insulin. This increased insulin production can lead to weight gain in some individuals with diabetes.

Insulin is an anabolic hormone that promotes the storage of glucose and fat in the body. Therefore, when the body produces more insulin in response to glyburide, it can lead to an increase in both glucose and fat storage. This can contribute to weight gain, particularly if there is insufficient physical activity or if the diet is not well controlled.

Additionally, glyburide can cause hypoglycemia (low blood sugar), which can lead to increased appetite and overeating, also contributing to weight gain

(A) This patient walks 30 min every other day as stated in the question stem.

(B) This patient eats three balanced meals as stated in the question stem.

(D) This patient does not have signs of hyperthyroidism because weight loss would be expected, not weight gain.

A 20-year-old female with a history of substance abuse has delivered a child whose weight is less than the 10th percentile. Other findings include small head and flat midface. The patient has an atrial septal defect. Which of the following substances may have caused these symptoms?

• Alcohol

• Cocaine

• Marijuana

• Opioids

Answer explanation

Of the substances listed, only alcohol has been consistently associated with a “syndrome” involving intrauterine growth retardation; abnormal facies; and cardiac abnormalities, most commonly atrial septal defects.

(B) Cocaine has been associated with growth restriction, placental abruption, and CNS effects.

(C) Marijuana has not proven to be teratogenic. (D) Opioids are not proven to be teratogenic.

A 19-year-old man who is a known heroin addict is brought to the emergency department because of an apparent overdose. The reason why addicts enjoy heroin is because of its conversion to which of the following substances?

• Dopamine

• Epinephrine

• Morphine

• Norepinephrine

Answer explanation

Heroin does not occur naturally. It is produced by diacetylation of morphine, which leads to a threefold increase in its potency. Its greater lipid solubility allows it to cross the blood– brain barrier more rapidly than morphine, causing a more exaggerated euphoria when the drug is injected. Heroin is converted to morphine in the body, but its effects last about half as long. It has no accepted medical use in the United States but is used therapeu- tically in other countries for the severe pain of cancer. That is delivered to the gastrointestinal system after swallowing.

(A) Heroin is not converted to dopamine.

(B) Heroin is converted to morphine.

(D) Heroin is not converted to a catecholamine.

A 13-year-old boy complains of nausea and vomiting when he takes long road trips with his family. His family is getting ready to leave on another such trip, so he asks if there is anything he can take to lessen his nausea. The physician prescribes an antinausea drug with anticholinergic activity. Which of the following drugs is this?

• Dimenhydrinate

• Droperidol

• Marijuana

• Ondansetron

Answer explanation

his boy’s com- plaint is most consistent with motion sickness. This is a sensation that occurs when visual stimuli do not seem to agree with information from the vestibular system of the inner ear. Dimenhydrinate can be used to interrupt signals from the vestibule in order to pre- vent the disagreement between visual and vestibular messages. Although the mechanism is not completely clear, it has been proposed that the anticholinergic activity possessed by dimenhydrinate blocks signals from the vestibule.

(B) Droperidol is a neuroleptic similar to haloperidol and antagonizes multiple CNS receptors but not cholinergic receptors. Its antinausea activity is likely caused by antagonism at dopaminer- gic receptors.

(C) Medical marijuana is currently indi- cated for nausea only when arising from chemotherapy regimens. Its actions are thought to relate primarily to stimulation of CB receptors, not inhibition of cholinergic receptors. Dimenhydrinate is an antihistamine that is used to prevent and treat nausea, vomiting, and dizziness caused by motion sickness. It works by blocking the action of histamine, a chemical released by the body that can cause these symptoms. Additionally, dimenhydrinate has anticholinergic activity, which means that it can also block the action of acetylcholine, another chemical in the body that can contribute to nausea and vomiting.

(D) Ondansetron works both centrally and peripherally by blocking serotonin receptors in the vagal nerve and in the chemoreceptor trigger zone. It does not have significant anticholinergic activity.

True or false

Zero order elimination means the same amount is eliminated per unit time regardless of it concentration in the blood

• True

• False

A 63-year-old man with glaucoma maintained on a regimen of topical medications with an exacerbation of his symptoms. He complains of difficulty with his vision in both eyes and has headaches. Which of the following drugs is the most appropriate treatment for this patient?

• Bimatoprost

• Latanoprost

• Pilocarpine

• Tetracycline

Which drug is most commonly used to diagnose suspected asthma?

• Albuterol 

• Methacholine 

• Neostigmine

• Nicotine

A 43-year-old caucasian woman complains that her irises have been darkening. She says that she has been taking a drug for years to treat her glaucoma. Which of the following drugs is most likely causing the increased pigmentation of her irises?

• Acetazolamide

• Epinephrine

• Latanoprost

• Pilocarpine

What causes a false positive for amphetamines during a urine drug screen?

• Codeine

• Ephedrine

• Marijuana