Free Printable CNS Pharmacology Part 2

1.

What is the greatest risk factor for Alzheimer’s disease?

a)

Gender

b)

Genetics

c)

Ethnicity

d)

Increased age

2.

Which of the following is the most common limiting adverse effect of L-dopa?

a)

Depression

b)

Dyskinisea

c)

Nausea

d)

Orthostatic hypotension

3.

Which one of the following combinations of antiparkinson drugs is an appropriate therapy?

a)

Amantadine, cerbidopa and entacapone.

b)

Levodopa, carbidopa and entacapone.

c)

Pramipexole, carbidopa and entacapone.

d)

Ropinirole, selegiline and entacapone.

4.

Entacapone inhibits

a)

dopamine D2 receptors.

b)

COMT

c)

monoamine oxidase B.

d)

muscarinic cholinoreceptors.

5.

Beta-amyloid plaques

a)

can be present in the brain of Alzheimer’s disease patient up to 10 years before diagnosis.

b)

are twisted protein fibers that build up within the neuron.

c)

mainly observed in the region of hippocampus.

d)

are soluble and may spread throughout the brain.

6.

Which one of the following is TRUE of familial Alzheimer’s disease?

a)

Describe as late onset Alzheimer’s disease.

b)

It is comprises of 95% of total Alzheimer’s disease cases.

c)

Arises from the mutations of amyloid percursor protein (APP), presinilin 1 and 2.

d)

Both genetic predisposition and environmental factors contribute to the genesis of the disease.

7.

NMDA antagonist includes

a)

Donepezil

b)

Memantine

c)

Rivastigmine

d)

Galantamine

8.

Donepezil

a)

binds irreversibly to acetylcholinesterase and inhibits the hydrolysis of acetylcholine.

b)

is available as an orally disintegrating tablet or an oral film-coated tablet.

c)

absorbs not really well with a relative oral bioavailability of 40%.

d)

has a short half-life.

9.

The classic feature of Parkinson’s disease includes

a)

akinesia.

b)

tremor at rest.

c)

rigidity.

d)

All of the above

10.

The most prominent neuropathological feature of Parkinson’s disease is

a)

Loss of the serotonergic pathway to the frontal lobe.

b)

Loss of the striatal dopamine pathway to neostriatum and globus pallidus.

c)

Loss of the basal ganglia.

d)

Loss of cholinergic pathway to the neostriatum and globus pallidus.

11.

Acetylcholinesterase inhibitor includes

I. Donepezil

II. Rivastigmine

III. Galantamine

IV. Memantine

a)

I, II and III Ö

b)

I, II and IV

c)

I, III and IV

d)

II, III and IV

12.

Beta-amyloid plaques

I. mainly observed in the region of hippocampus.

II. are twisted protein fibers that build up within the neuron.

III. are encompasses a group of peptides ranging in size from 37-49 residues.

IV. can be present in the brain of Alzheimer’s disease patient up to 20 years before diagnosis.

a)

I, II and III

b)

I, II and IV

c)

I, III and IV

d)

II, III and IV

13.

Levodopa

I. acts as a acetylcholine precursor.

II. is able to cross blood brain barrier.

III. has higher affinity for the D2 receptors.

IV. usage in Parkinson’s disease has been associated with the development of ‘ON-OFF’ fluctuation after 2-5 years administration.

a)

I, II and III

b)

I, II and IV

c)

I, III and IV

d)

II, III and IV

14.

The following statement is TRUE of Alzheimer’s disease:

I. It is a progressive disease.

II. Apolipoprotein-E4 (APO-E4) is the strongest risk factor for late-onset Alzheimer’s disease.

III. Beta-, gamma- and alpha-secretase are involved in amyloid precursor protein (APP) cleavage.

IV. The hallmarks of Alzheimer’s disease are intracellular beta-amyloid deposit and extracellular neurofibrillary tangles.

a)

I, II and III

b)

I, II and IV

c)

I, III and IV

d)

II, III and IV

15.

Benzodiazepine

a)

binds to serotonin 5-HT₁ receptors.

b)

binds to GABA_A receptors.

c)

is an antagonist at α-adrenoceptors.

d)

is an antagonist at dopamine D₂ receptors.

16.

A 22-year-old woman is diagnosed with a generalized anxiety disorder. Which of the following is a contraindication for the use of benzodiazepine to treat this patient?

a)

Cigarette smoking

b)

Seizure disorder

c)

Diabetes mellitus

d)

Alcohol

17.

GABA_A receptor containing ______________ is involved in sleep.

a)

alpha 1 subunit

b)

alpha 2 subunit

c)

alpha 3 subunit

d)

beta 1 subunit

18.

Barbiturates enhance _______ neurotransmission.

a)

dopaminergic

b)

cholinergic

c)

GABAergic

d)

Glutamatergic

19.

Which one of the following is TRUE of benzodiazepine antagonist?

a)

Diazepam

b)

Natrexone

c)

Flumazenil

d)

Propanolol

20.

Which one of the following benzodiazepines is classifies as an intermediate-acting drug?

a)

Lorazepam

b)

Diazepam

c)

Midazolam

d)

Clorazepate

21.

Alcohol is likely to have cross-reaction with

a)

opioid.

b)

cocaine.

c)

naloxone.

d)

benzodiazepines.

22.

Alcohol

a)

inhibits NMDA receptors.

b)

inhibits kappa opioid receptor.

c)

inhibits GABA_A receptor mediated synaptic inhibition.

d)

decreases dopamine release in the mesocorticolimbic system.

23.

Delirium Tremens (DTs)

a)

occurs 6 to 24 h after the last drink.

b)

occurs 48 to 96 h after the last drink.

c)

is the mildest alcohol withdrawal syndrome.

d)

is the most common alcohol withdrawal syndrome.

24.

Disulfiram

a)

blocks opioid receptors.

b)

blocks NMDA receptors.

c)

inhibits alcohol dehydrogenase.

d)

inhibits degradation of acetaldehyde.

25.

Blood alcohol concentration will quickly spike if the alcohol

a)

is consumed sip by sip.

b)

consumed is non-sparkling.

c)

consumed is very concentrated.

d)

is consumed with a full stomach.

26.

The following enzyme degrades acetaldehyde to acetate:

a)

CYP2E1

b)

Catalase

c)

Alcohol dehydrogenase

d)

Aldehyde dehydrogenase

27.

Individuals with heterozygous ALDH2*2 allele

a)

are mostly Caucasian.

b)

are at low risk for oesophageal cancer.

c)

gradually develop tolerance to adverse response of alcohol consumption.

d)

are highly likely to experience severe side effects of alcohol consumption.

28.

Amphetamine

a)

antagonises the effect of endocannabinoid in the body.

b)

reduces inhibitory effects of GABA on dopaminergic neurons.

c)

competitively antagonises the binding of adenosine to its receptor.

d)

induces a reverse transporter exchange to release more dopamine into the synapse.

29.

Cocaine

a)

antagonises the effect of endocannabinoid in the body.

b)

imitates the action of acetylcholine at the nicotinic receptor.

c)

inhibits reuptake of dopamine into the presynaptic neurons.

d)

competitively antagonises the binding of adenosine to its receptor.

30.

Marijuana

a)

antagonises the effect of endocannabinoid in the body.

b)

reduces the release of dopamine in the reward pathway.

c)

imitates the action of acetylcholine at the nicotinic receptor.

d)

reduces inhibitory effects of GABA on dopaminergic neurons.

31.

Nicotine

a)

antagonises the effect of endocannabinoid in the body.

b)

reduces the release of dopamine in the reward pathway.

c)

imitates the action of acetylcholine at the nicotinic receptor.

d)

reduces inhibitory effects of GABA on dopaminergic neurons.

32.

Opioid

a)

reduces the release of dopamine in the reward pathway.

b)

antagonises the effect of endogenous opioids in the body.

c)

imitates the action of acetylcholine at the nicotinic receptor.

d)

reduces inhibitory effects of GABA on dopaminergic neurons.

33.

Tolerance

a)

is masked when drug taking is ceased.

b)

is characterised by the symptoms of withdrawal.

c)

is a compulsive drug use despite harmful consequence.

d)

results in reduced effects of the drugs after repeated administration of the same dose.

34.

The following is TRUE of agoraphobia:

a)

Worry about everyday life events.

b)

Having intense fear of being in open spaces.

c)

Having intense fear of being judged or embarrassed by others.

d)

Having intense anxiety when exposed to a specific object or situation.

35.

Buspirone

a)

fully agonises the presynaptic 5HT1A receptors.

b)

fully agonises the postsynaptic 5HT1A receptors.

c)

increases the duration of chloride ion channel opening.

d)

increases the frequency of chloride ion channel opening.

36.

Benzodiazepine

a)

fully agonises the presynaptic 5HT1A

receptors.

b)

fully agonises the postsynaptic 5HT1A receptors.

c)

increases the duration of chloride ion channel opening.

d)

increases the frequency of chloride ion channel opening.

37.

Addiction

a)

is masked when drug taking is ceased.

b)

is characterised by the symptoms of withdrawal.

c)

is a compulsive drug use despite harmful consequence.

d)

results in reduced effects of the drugs after repeated administration of the same dose.

38.

Dependence

a)

is masked when drug taking is ceased.

b)

is characterised by the symptoms of withdrawal.

c)

is a compulsive drug use despite harmful consequence.

d)

results in reduced effects of the drugs after repeated administration of the same dose.

39.

The following is TRUE of generalized anxiety disorder (GAD):

a)

Worry about everyday life events.

b)

Having intense fear being in open spaces.

c)

Having intense fear of being judged or embarrassed by others.

d)

Having intense anxiety when exposed to a specific object or situation.

40.

The following is TRUE of social anxiety disorder:

a)

Worry about everyday life events.

b)

Having intense fear being in open spaces.

c)

Having intense fear of being judged or embarrassed by others.

d)

Having intense anxiety when exposed to a specific object or situation.

41.

The following is TRUE of lamotrigine:

I. It is a dopaminergic agonist used in parkinsonism

II. It acts by inhibiting the sodium channels

III. It is a broad-spectrum antiepileptic drug

IV. It suppresses tonic-clonic seizures, but worsens absence seizures

a)

I only

b)

II and III only

c)

I, II and IV only

d)

I, III and IV only

42.

The following is TRUE of the treatment of epilepsy:

I. The choice of drug depends on the cause of epilepsy and not on the seizure type.

II. Treatment should be instituted as early as possible.

III. Treatment is generally started with a single drug and the other drug is added or substituted according to response.

IV. Withdrawal of drug can be attempted if no seizures have occurred for 3-5 years.

a)

I only

b)

I and II only

c)

I, II and IV only

d)

II, III and IV only

43.

An epileptic woman controlled by phenytoin therapy conceives. Which of the following measures are most appropriate?

I. Withdraw the phenytoin therapy immediately.

II. Gradually reduce phenytoin dose to the lowest effective level and supplement with folic acid.

III. The patient may be prescribed with safe alternate drug by slowly tapering the phenytoin dose.

IV. Substitute phenytoin with a combination of carbamazepine and sodium valproate.

a)

I only

b)

II and III only

c)

I, II and IV only

d)

II, III and IV only

44.

A 3-year-old boy gets seizures whenever he develops fever. Which is the most appropriate strategy to avoid the development of febrile convulsions?

a)

Control the fever with paracetamol and don’t administer any anticonvulsant drug.

b)

Intermittent diazepam prophylaxis at the onset of fever.

c)

Can use phenobarbitone as prophylactic and continue for 2 to 3 years.

d)

Continuous diazepam prophylaxis for 3 years.

45.

The following statements is TRUE of sodium valproate:

I. Induces hepatitis in young children.

II. Inhibit degradation of GABA by GABA-transaminase.

III. Does not cause any foetal malformations.

IV. Effective in treating multiple neuropsychiatric disorders.

a)

I only

b)

I and II only

c)

I, II and IV only

d)

II, III and IV only

46.

Recommended antiepileptic drug choices for the treatment of generalised tonic-clonic seizures

I. Sodium valproate treatment except for female of childbearing age and gynaecological issues.

II. Clobazam, levetiracetam and topiramate can be used as adjunctive therapy.

III. Phenobarbitone can be used as an alternative drug.

IV. General anaesthesia may be used as addon therapy.

a)

I only

b)

I and II only

c)

I, II and III only

d)

II, III and IV only

47.

The following statements are TRUE of infantile spasm:

I. Symptoms are symmetric tonic muscle contraction producing flexion/extension of the trunk and extremities.

II. Associated with fever as symptom.

III. Corticosteroids afford symptomatic relief.

IV. Vitamins and co-factors like Vitamin B6, pyridoxal phosphate, biotin and folinic acid are the non-antiepileptic drug treatment choice.

a)

I only

b)

I and II only

c)

I, II and III only

d)

I, III and IV only

48.

The following statements about diazepam is TRUE during its antiepileptic application:

I. Thromboflebitis is common in the injected vein.

II. Does not cause abuse and withdrawal effects.

III. Drug of choice for emergency control of convulsions.

IV. Rectal suppository is preferred for management of convulsions in children.

a)

I and II only

b)

I, II and III only

c)

I, III and IV only

d)

II, II and IV only

49.

A 45-year old male patient reported in emergency department having a tonic-clonic seizures. His medication history includes digoxin for congestive heart failure and his diabetic is controlled with Glimepiride and Metformin combination. The doctor does not prefer phenytoin. The following treatment considerations are TRUE and accounted.

I. Phenytoin is one of the drugs of choice for tonic-clonic seizures.

II. High dose of phenytoin causes arrythmias.

III. Phenytoin induces the microsomal metabolism of digoxin.

IV. Phenytoin does not produce fall in B.P upon i.v. injection.

a)

I and II only

b)

I, II and III only

c)

I, III and IV only

d)

II, II and IV only

50.

A 50-year old patient with partial seizures and is diabetic. He is reported to have diabetic neuropathy and postherpetic neuralgia. The drug effective in this patient is

a)

carbamazepine.

b)

gabapentin.

c)

lamotrigine

d)

primidone

CNS Pharmacology Part 2

Total questions: 50

Worksheet time: 19mins

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