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Pharmacology 2 Exam 3

Total questions: 100

Worksheet time: 50mins

Name
Class
Date
1.

Which of the following is not a physiologic function of the endocrine system

a)

Travels in the blood stream

b)

Utilizes hormones

c)

Fast onset

d)

Duration is long

2.

Which is an example of positive feedback system at work

a)

Uterus contraction with Oxytocin during pregnancy

b)

Insulin release from the pancreas after eating a meal

c)

Luteinizing hormone releasing hormone during menstruation

d)

Thyrotropin releasing hormone stimulating the thyroid

3.

Select all the hormones that have the appropriate response associated with them

a)

Luteinizing hormone- testosterone production in males

b)

Thyroid stimulating hormone- Thyroid hormone release

c)

Antidiuretic hormone- Water retention

d)

Adrenocorticotropic hormone- Water retention

e)

Follicle -stimulating hormone- Ovulation in females

4.

Which medication is associated with the treatment of Diabetes Insipidus

a)

DDAVP or vasopressin

b)

Fluid Restriction

c)

Regular Insulin IV

d)

Clonidine

5.

Which is the 1st SCIP

a)

Prophylactic antibiotic received within one hour prior to surgical incision

b)

Appropriate prophylactic antibiotic selected for surgical patients consistent with current guidelines

c)

Surgery patients with appropriate hair removal

d)

colorectal surgery patients with appropriate hair removal

6.

What is SCIP 4?

a)

Cardiac surgery patients with controlled 6 AM postoperative blood glucose < 200mg/dL on Post op Day 1 and Post op Day 2

b)

Surgery patients with appropriate hair removal

c)

Prophylactic antibiotic discontinued within 24 hours after the end of surgery

d)

Prophylactic antibiotic received within one hour prior to surgical incision

7.

Which of the following is not a hormone that is excreted by the anterior pituitary

a)

Human Growth Hormone

b)

Adrenocorticotrophic Hormone

c)

Thyroid Stimulating Hormone

d)

Oxytocin

e)

Luteinizing Hormone

8.

Which tissue does thyroid hormone not increase oxygen consumption in

a)

Brain

b)

Heart

c)

Kidneys

d)

Intestinal tract

9.

What is the precursor of all corticosteroids

a)

Mineralocorticoids

b)

Glucocorticoids

c)

Adrogens

d)

Cholesterol

10.

Select all the normal endocrine functions with appropriate tissue

a)

Zona fasciculata- Glucocorticoids

b)

Zona Reticularis- Androgens and Estrogens

c)

Zona Glomerulosa- Androgens and Estrogens

d)

Parathyroid- Parathyroid hormone

e)

Anterior Pituitary- Arginine Vasopressin

11.

What is the onset of Regular insulin? Why does insulin last so long?

a)

30 minutes; It is tightly bound to tissue receptors

b)

1 hour; It has a slow release within the body

c)

30 minutes; It has a slow release within the body

d)

2 hours; It is tightly bound to tissue receptors

12.

What is the intra-operative glucose control level needed to be maintained? Does general anesthesia mask Hypoglycemia?

a)

140-150 mg/dl; No

b)

180-200 mg/dl; No

c)

180-200 mg/dl; Yes

d)

150- 160 mg/dl; Yes

13.

Which of the following is a common side effect of SGLT2 inhibitors

a)

Decrease in blood glucose

b)

UTI risk

c)

Liver failure

d)

Pancreatic necrosis

14.

Which of the following oral hypoglycemic agents does not cause hypoglycemia

a)

Glyburide

b)

Metformin

c)

Repaglinide

d)

Exenatide

15.

Which is an associated complication with Type 1 diabetes more than type 2 diabetes

a)

Ketoacidosis

b)

Hyperglycemic hyperosmolar syndrome

c)

Obesity

d)

High, resistant to suppression of glucagon

16.

Mrs. Smith is 82 year old, that has been living with Diabetes type 2 for 20 years; she is insulin dependent and requires Lantus and Novolog injection. She also has neuropathy bilaterally in the lower extremities. What time should she be scheduled for a Cholecystectomy? What type of Anesthetic would you perform

a)

Any time is good; General Anesthesia with an ETT

b)

First case in the morning; LMA general Anesthesia

c)

Afternoon case; Regional Anesthesia with General ETT

d)

First case in the Morning; General anesthesia ETT

17.

How far in advance should Metformin be stopped prior to surgery?

a)

24 hours prior

b)

Day of surgery prior

c)

48 hours prior

d)

7 days prior

18.

Select all the true statements regarding hyperparathyroidism and Anesthesia requirements

a)

Lower the MAC requirements

b)

Administer Lasix 40 to 80mg IV Q 2-4 hours

c)

Administer Thiazide diuretics 10 mg to 15 mg Q 8 hours

d)

Administer isotonic fluids

e)

Prepare for hypotension

19.

Increase in thyroid hormone all of the following occur with in the body except

a)

Basal Metabolic Rate

b)

Increase Oxygen consumption

c)

Increase Carbon Dioxide production

d)

Decrease Carbon Dioxide production

20.

How much hydrocortisone is given for exogenous steroids stress dose? When do you re-dose?

a)

100 mg IM; Q 5 hours

b)

100 mg IV; Q 8 hours

c)

50 mg IV; Q 8 hours

d)

100 mg IM; Q 5 hours

21.

What is important to monitor in patients with Cushing Syndrome select all that apply

a)

Body position

b)

Tears and tissue breakdown

c)

A stress response intra-operatively

d)

Monitor metabolic acidosis

22.

Select all that apply as management of thyroid storm

a)

Administration of Fluids

b)

Propranolol 10 to 40 mg

c)

Esmolol infusion

d)

Meperidine (25mg-50mg)

e)

Levothyroxine 200 to 300 mcgs IV over 5 to

23.

Major complication of myxedema coma are all of the following except

a)

Hypoventilation

b)

Hypothermia

c)

Hypotension

d)

Hypernatremia

24.

Which of the following medications is the equivalent dose of 100 mg Hydrocortisone

a)

Cortisone 50 mg

b)

Prednisone 75 mg

c)

Methylprednisolone 40 mg

d)

Dexamethasone 4 mg

25.

Mr. Williams has been in the ICU for 3 weeks and has developed SIADH; he is heading to the OR for an IND of a lower extremity. His sodium level is 130 meQ/L and his potassium is 4.8 meQ/L. Which is NOT an appropriate treatment?

a)

Loop Diuretics

b)

Demeclocycline

c)

Loop Diuretics

d)

IV hypertonic fluid administered over 20 minutes

26.

What is the definition of a seizure

a)

Finite episode of brain dysfunction resulting from abnormal discharge of cerebral neurons

b)

Single or multiple myoclonic muscle jerks

c)

A series of tonic-clonic without recovery of consciousness between attacks

d)

Impaired consciousness, sometimes with automatisms, loss of postural tone

27.

What is the percentage of patients that will be free of seizures on one medication therapy

a)

70%

b)

60%

c)

50%

d)

40%

28.

A majority of the antiepileptic's are enzyme inducers except which medication

a)

Valproic Acid

b)

Gabapentin

c)

Phenytoin

d)

Carbamazepine

29.

Which of the following medications follows zero order kinetics, and has ADH secretion as a side effect

a)

Phenytoin

b)

Carbamazepine

c)

Valproic acid

d)

Lamotrigine

30.

True or False: Valproic acid is a enzyme inhibitor-metabolism of phenytoin is slowed, causes Phenobarbital plasma concentration increase by 50%

a)

True

b)

False

31.

Mr. Rodriguez has been on phenytoin for 13 years following a car accident that has left with increase partial seizures. What does the SRNA expect with anesthetic medications requirements?

a)

Increase requirement because phenytoin is a potent enzyme inducer

b)

Decrease requirements because phenytoin is a potent enzyme inhibitor

c)

No change in medication requirements

d)

Increase in non-depolarizing medication only because they have CYP enzymatic properties

32.

Which statement regarding Parkinson's treatment is true

a)

All medications are palliative

b)

Dopamine medication crosses the blood brain barrier

c)

Dopamine acts as the principal excitation neurotransmitter

d)

Parkinson's medication have very little neurological side effects

33.

Which is not a side effect of Levodopa

a)

Nausea/ Vomiting

b)

Dyskinesia

c)

Urinary Metabolites

d)

Hypertension

34.

Which enzymes are responsible for breaking down Levodopa

a)

Catechol-O-methyltransferase (COMT)

b)

Peripheral Decarboxylase

c)

CYP 3A4

d)

Ester Hydrolysis

35.

Select all that apply utilized to treat status epilepticus

a)

IV glucose

b)

Lorazepam IV

c)

Continuous infusion of Levetiracetam

d)

Propofol Infusion if severe

e)

Phyentoin infusion if severe

36.

Which of the following is not a side effect of doxapram

a)

Hypertension

b)

Tachycarida

c)

Cardiac dysrhythmia

d)

Decrease in body temperature

37.

What is the dose of Caffeine for a Post dural puncture headache?

a)

75-300 mg

b)

25 mg/kg

c)

2.5-5.0 mg/kg IV

d)

200-450 mg

38.

Which statement regarding Amphetamine is false

a)

Amphetamine is a powerful CNS stimulant

b)

It acts as sympathomimetic peripherally

c)

Indirect acting agent similar to ephedrine

d)

Increase the release of dopamine and increase stimulatory neurotransmitters via inducing re-uptake via MAO.

39.

Cocaine has which cellular property

a)

Hell of a drug

b)

Inhibition of Serotonin re-uptake

c)

Inhibition of NE re-uptake

d)

Inhibition of Dopamine re-uptake

40.

Select all that apply regarding Ethanol

a)

Aspirin inhibits gastric ADH increasing levels of ethanol in blood

b)

Ethanol follows zero order kinetics about 120 mg/hour

c)

Ethanol follows zero order kinetics about 60 mg/hour

d)

Acute ingestion decreases MAC requirements

e)

Chronic ingestion causes enzyme induction

41.

Baclofen is an agonist of what receptor? What should not be used in conjunction with Baclofen?

a)

GABA-B; Neuromuscular blocking agents

b)

GABA-B; There is not limitation, less Neuromuscular blocking agent should be used

c)

NMDA; Neuromuscular blocking agents

d)

NMDA; There is not limitation, less Neuromuscular blocking agent should be used

42.

Cyclobenzaprine is similar to what class of medication

a)

Tricyclic acids

b)

SSRI's

c)

Anti Parkinson's medication

d)

Benzodiazepines

43.

What is the elimination half time of Dantrolene

a)

5-8 hours

b)

4-7 hours

c)

8 to 10 hours

d)

2 hours

44.

Which statement regarding Statins is false

a)

Liver toxicity in a dose related fashion

b)

Several factors can inhibit statin catabolism: age, hepatic dysfunction

c)

Increase HDL by 10 %

d)

Statins are major function is within the liver, but are not metabolized in the liver

45.

Which class of medication has the highest incidences of orthostatic hypotension

a)

Selective serotonin re-uptake inhibitors

b)

Monoamine oxidase inhibitors

c)

Tricyclic Antidepressants

d)

Norepinephrine re-uptake inhibitors

46.

Which enzyme that naturally occurs is required to breakdown free norepinephrine and serotonin

a)

Monoamine Oxidase (MAO)

b)

COMT

c)

CYP 3A5

d)

Transferase COMT

47.

Which of the following Serotonin receptors is a ligand-gated Na and K cation channel? What is the major secondary cellular messenger of serotonin receptors

a)

5-HT1; cAMP

b)

5-HT3; cAMP

c)

5-HT5; DAG, IP3

d)

5-HT6; DAG, IP3

48.

Which two serotonin receptors are inhibitory

a)

5-HT1

b)

5-HT2

c)

5-HT6

d)

5-HT5

49.

Which of the following SSRI's when combined with another antidepressant with most likely cause serotonin syndrome

a)

Fluoxetine

b)

Sertraline

c)

Paroxetine

d)

Fluvoxamine

50.

Which of the following is not a sign or symptom of Serotonin syndrome

a)

Altered mental status

b)

Clonus

c)

Hypothermia

d)

Hyperthermia

51.

Which statement regarding Tricyclic antidepressants is false

a)

Cardiovascular and CNA side effects limit their use

b)

Narrow therapeutic level

c)

Taper off over 4 weeks to avoid withdrawal symptoms

d)

Takes 4 to 5 weeks to become effective

52.

Select the appropriate symptom of TCA (Tricyclic Antidepressant) overdose with the appropriate treatment

a)

Seizures- Phenytoin

b)

Ventricular cardiac dysrhytmias- Lidocaine

c)

Heart block- Isoproterenol

d)

Hypotension- Sympathomimetics

e)

Anticholinergic syndrome- Physostigmine

53.

Which of the following is NOT a complication of anticholinergic syndrome

a)

Constipation

b)

Mydriasis

c)

Convulsions

d)

Bradycardia

54.

Chronic treatment of Tricyclic antidepressants can lead to all of the following except

a)

Down regulation of Beta adrenergic receptors

b)

Adrenergic receptors may be desensitized

c)

Catecholamine store may be depleted

d)

Utilization of regular dose sympathomimetic will elicit an exaggerated response

55.

Select of the side effects associated with MAOI

a)

Sedation

b)

Insomnia

c)

Impotence

d)

Hepatitis

e)

Hypertension

56.

True or False: While taking Phenelzine [It's a MAOI] the patient has to have a tyramine restriction, because it can cause extreme hypertension.

a)

True

b)

False

57.

Mrs. Smith is coming for a Lap- Cholecystectomy she has a history of Schizophrenia and is taking Chlorpromazine, which has recently been increased in dose within the last 3 days. This is the first time she has anesthesia as well. 20 minutes after induction her ETCO2 is 53 and climbing, her temperature is 40 degrees Celsius; She has normal pupils, pallor, and lead-pipe rigidity. What has happened?

a)

Malignant hyperthermia

b)

Neuroleptic Malignant Syndrome

c)

Anticholinergic syndrome

d)

Serotonin syndrome

58.

Which Anxiolytic is utilized to treat generalized anxiety disorder? Which is the most potent anxiolytic?

a)

Diazepam; Lorazepam

b)

Midazolam; Diazepam

c)

Lorazepam; Midazolam

d)

Diazepam; Midazolam

59.

Which Diuretics can be utilized in conjunction with Lithium

a)

You cannot use diuretics

b)

Thiazide Diuretics

c)

Loop Diuretics

d)

Potassium sparing diuretics

60.

Which of the following is not a side effect of Lithium

a)

Polydipsia

b)

Polyuria

c)

SA node dysfunction

d)

Galactorrhea and gynecomastia

61.

What drug would be prolonged in a patient on a Lithium regiment?

a)

Lisinopril

b)

Rocuronium

c)

Meteoprolol

d)

Aspirin

62.

Select all that apply; MAO-B Inhibitors work best when combined with?

a)

Levodopa

b)

Dopamine

c)

Carbidopa

d)

Benserazide

e)

COMT inhibitors [Tolcapone]

63.

Which of the following is not a side effect of anti-psychotic drugs

a)

Extrapyramidal effects

b)

Sedation

c)

Hypothermia

d)

Increased seizure threshold

64.

Which opioid has higher chance of causing serotonin syndrome

a)

Demerol

b)

Morphine

c)

Fentanyl

d)

Hydromorphone

65.

Which of the following is not an effect of Cannabis

a)

Analgesia

b)

Vomiting

c)

Bronchoconstriction

d)

Inflammation

66.

Which is receptor is associated with long term treatment of pain and N/V

a)

CB1

b)

CB2

c)

D9THC

d)

D1THCb2

67.

What does garlic, ginger, ginkgo biloba, ginseng all have in common

a)

Increase platelet aggregation

b)

Decrease Platelet function

c)

Increase anti-coagulation

d)

Increases coagulation

68.

What does Kava-Kava and valerian have in common

a)

Potentiates benzo

b)

Potentiates increase bleeding

c)

Potentiates Warfarin

d)

Potentiates CYP 450

69.

Which herbal medication induces CYP 450

a)

St. John Worts

b)

Ginseng

c)

Ginkgo

d)

Ephedra

70.

What phase does anti-tumor antibiotics work on? Which is a anti-tumor antibiotic?

a)

G1, S, G2, M; Cyclophosphamide

b)

G1, S, G2; Doxorubicin

c)

G1, S, G2; Bleomycin

d)

S only; Dactinomycin

71.

Alkylating agents work on what phase of the cell cycle? Which of the following is an alkylating agent that requires fluid intake?

a)

G1, S, M; Mechlorethamine

b)

G1, S, G2, M; Methotrexate

c)

G1, S, G2, M; Cyclophosphamide

d)

S, G2, M; Bisulfan

72.

What is the most common limiting factor of all chemotherapeutic medications

a)

Myelosuppression

b)

Peripheral neuropathy

c)

Renal Toxicities

d)

Interstitial pulmonary fibrosis

73.

Which medication do give diuretics and fluids with

a)

Cisplatin

b)

Fluorouracil

c)

Doxorubicin

d)

Bleomycin

74.

Which chemotherapy medication has a side effect of heart failure with a non-productive cough in 2% of patients that is fatal after 3 weeks

a)

Doxorubicin

b)

Cisplatin

c)

Methotrexate

d)

Vincritine

75.

Which sub classification of chemotherapeutic medications has a side effect of SIADH and a possibility of laryngeal nerve paralysis with hoarseness

a)

Vinca Alkaloids

b)

Nitrosoureas

c)

Alkyl Sulfonates

d)

Nitrogen Mustards

76.

Which of the following is a operative risk factor for surgical site infection

a)

Age

b)

Nutrition status

c)

Diabetes

d)

Skin antisepsis

77.

What is the correct step for the general approach to antimicrobial therapy

a)

Suspect infection; Culture suspected sites; Gram stain; Identification; Susceptibilities

b)

Culture suspected sites; Gram stain; suspect infection; indetification; susceptibilities

c)

Susceptibilities; Gram stain; Suspect infection; identification; culture suspected sites

d)

Gram stain; Culture suspected sites; identification; suspected infection; susceptibilities

78.

Prophylactic antibiotics should be given to what patients, select all that apply

a)

Cancer Patients

b)

Patients on immunosuppressive therapy

c)

Patient having surgery

d)

Patients coming for surgical check up

79.

Normal Flora within CO2 rich environments are part of the HACEK organisms which of the following are part of that group. Select all that apply

a)

Haemophilus

b)

Actinobacillus

c)

Kingella

d)

Klebsiella

e)

Staphylococcus aureus

80.

Which definition is INCORRECT

a)

Super-infection: infection occurring after or on top of an earlier infection, especially following treatment with broad-spectrum antibiotics.

b)

Resistance: occurs when bacteria change in a way that reduces the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections

c)

Anaphylaxis- Immediate IgE or delayed T cell mediated response with no prior exposure

d)

Anaphylactoid- Immediate IgE or Delayed T cell mediated response with no prior exposure

81.

Which of the following is not a ESKAPE pathogen (Resistant Bacteria)

a)

Enterococcus faecium

b)

Klebsiella pneumoniae

c)

Pseudomonas aeruginosa

d)

Cardiobacterium

82.

Which statement regarding prevention of antibiotic resistance is true

a)

Treat colonization or contamination

b)

Use of broad spectrum agents is most appropirate

c)

Utilization of any dose is appropriate

d)

Use the shortest effective duration of therapy

83.

What is the mechanism of action of all beta-lactams

a)

Bind to the bacterial ribosome at 30s subunit leading to misreading of gentic coding.

b)

Inhibition of transpeptidases, inhbiting crossl inking of peptidoglycan in the cell-wall leading to autolysis and cell death

c)

Inhibit DNA topioisomerases leading to break down in DNA and death of the bacterial cell

d)

Bind to the bacterial ribosome (30s subunit) leading to misreading of genetic code which causes incorrect protein formation

84.

Select all the clinical physiologic responses seen in an allergic response

a)

Hypotension

b)

Bronchoconstricition

c)

Decreased ETCO2

d)

Flushing or uticaria

e)

Constipation

85.

Which physiologic structure is responsible for a anaphylaxis

a)

IgE response

b)

T-cell

c)

Histamine

d)

Mast Cell

86.

Select all the antibiotics that potentiate neuromuscular blocking agents?

a)

Ampicillin/Sublactam

b)

Vancomycin

c)

Gentamicin

d)

Clindamycin

e)

Ceftriaxone

87.

Which of the following antibiotics cross the blood brain barrier?

a)

Certriaxone, Cefotaxime

b)

Oxacillin, Dicloxacillin

c)

Cefuroxime

d)

Meropenem, Doripenem

e)

Linezolid, Tedizolid

88.

Which medications below does NOT inhibit CYP450 enzymes

a)

Fluconazole

b)

Azithromycin

c)

Ritanovir

d)

Levofloxacin

89.

What is the first choice for a GU case

a)

Ancef (Cefazolin)

b)

Clindamycin

c)

Vancomycin

d)

Levofloxacin

90.

What is the secondary choice of antibiotics for cardiac surgery. Select all that apply

a)

Ancef (Cefazolin)

b)

Clindamycin

c)

Vancomycin

d)

Ampicillin/ Sublactam

91.

In an orthopedic clean operation of the hand, knee, foot. Not involving implantation of foreign objects should get what type of antibiotics?

a)

None

b)

Ancef (Cefazolin)

c)

Clindamycin

d)

Vancomycin

92.

Which of the following antibiotics prolongs bleeding? Select all that apply

a)

Cefamandole

b)

Cefotetan

c)

Carboxypenicillin

d)

Metronidazole

e)

Tigecycline

93.

Select all the antibiotics that utilize inhibition of transpeptidases leading to inhibiting cross linking of peptidoglycan in the cell wall of bacteria

a)

Oxacillin

b)

Cefazolin

c)

Cefoxotin

d)

Meropenem

e)

Gentamicin

94.

Which of the following antibiotics binds to the bacterial ribosome 30S subunit causing misreading of genetic code. Select all that apply

a)

Gentamicin

b)

Cefazolin

c)

Tetracycline

d)

Linezolid

e)

Trimethoprim/Sulfamethoxazole (Bactrim)

95.

What medication of antivirals inhibit DNA reverse transcriptase enzyme and prevent viral DNA from becoming part of the host cell. Select all that apply

a)

Abacavir

b)

Efavirernze

c)

Raltegravir

d)

Amphotericin

96.

Which topical antiseptic kills 90% of normal flora for 6-8 hours

a)

Alcohol

b)

Chlorahexadine

c)

Iodophors

d)

Ethyl alcohol

97.

Which statement regarding the thyroid is false

a)

Hyperthyroidism there is low TSH, high T3 and T4

b)

Hypothyroidism there is high TSH, low T3 and T4

c)

Hypothyroidism causes increased minute ventilation

d)

Hyperthyroidism causes hypertension

98.

What medication from the antimycobacterial drugs [TB regiment] has the potential to deflorniate Volatile anesthetics

a)

Rifampin

b)

Isoniazid

c)

Pyrazinamide

d)

Ethambutol

99.

What is the most common side effect of prophylactic antibiotic therapy?

a)

Pseudomembranous Colitis

b)

Super-infection

c)

Microbial resistance

d)

Diarrhea

100.

Which antibiotic inhibit topoisomerase

a)

Tetracycline

b)

Gentamicin

c)

Ciprofloxacin

d)

Trimethoprim/ Sulfamethoxazole

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