3.2 Which of the following is correct regarding somatic motor neurons?

3.3 Which of the following physiological changes could happen when a person is attacked by a grizzly bear?

3.4 Which of the following changes could theoretically happen in a person when the parasympathetic system is inhibited using a pharmacological agent?

3.5 Which of the following statements is correct regarding the sympathetic and parasympathetic systems?

3.6 Which of the following statements concerning the parasympathetic nervous system is correct?

3.7 Which of the following is correct regarding neurotrans-mitters and neurotransmission?

3.8 An elderly man was brought to the emergency room after he ingested a large quantity of carvedilol tablets, a drug that blocks α1, β1, and β2 adrenergic receptors, which mainly mediate the cardiovascular effects of epinephrine and norepinephrine in the body. Which of the following symptoms would you expect in this patient?

3.9 All of the following statements regarding central control of autonomic functions are correct except:

3.10 Which of the following is correct regarding membrane receptors and signal transduction?

4.1 Botulinum toxin blocks the release of acetylcholine from cholinergic nerve terminals. Which of the following is a possible effect of botulinum toxin?

4.2 A dentist would like to reduce salivation in a patient in preparation for an oral surgical procedure. Which of the following strategies will be useful in reducing salivation?

4.3 Which of the following is a systemic effect of a muscarinic agonist?

4.4 If an ophthalmologist wants to dilate the pupils for an eye examination, which of the following drugs/classes of drugs could be theoretically useful?

4.5 In Alzheimer’s disease, there is a deficiency of cholinergic neuronal function in the brain. Theoretically, which of the following strategies will be useful in treating the symptoms of Alzheimer’s disease?

4.6 An elderly female who lives in a farm house was brought to the emergency room in serious condition after ingesting a liquid from an unlabeled bottle found near her bed, apparently in a suicide attempt. She presented with diarrhea, frequent urination, convulsions, breathing difficulties, constricted pupils (miosis), and excessive salivation. Which of the following is correct regarding this patient?

4.7 Sarin is a volatile nerve agent that inhibits cholinesterase enzymes. Which of the following symptoms would you expect to see in a patient exposed to sarin?

4.8 Head and neck irradiation in cancer patients can decrease salivary secretion and cause dry mouth. All of the following drugs or classes of drugs are theoretically useful in improving secretion of saliva in these patients except:

4.9 Which of the following drugs or classes of drugs will be useful in treating the symptoms of myasthenia gravis?

4.10 Atropa belladonna is a plant that contains atropine (a muscarinic antagonist). Which of the following drugs or classes of drugs will be useful in treating poisoning with belladonna?

5.1 During an ophthalmic surgical procedure, the surgeon wanted to constrict the pupil of the patient using a miotic drug. However, he accidentally used another drug that caused dilation of the pupil (mydriasis) instead. Most likely, which of the following drugs did he use?

5.2 Sarin is a nerve gas that is an organophosphate cholinesterase inhibitor. Which of the following could be used as an antidote to sarin poisoning?

5.3 Atropine is one of the ingredients in the antidiarrheal combination diphenoxylate/atropine available in the United States. Which of the following effects is produced by atropine that contributes to its antidiarrheal effect?

5.4 A patient with chronic obstructive pulmonary disease (COPD) was prescribed a β2 agonist for the relief of bronchospasm. However, the patient did not respond to this treatment. Which of the following drugs or classes of drugs would you suggest for this patient as the next option?

5.5 Which of the following drugs would be the most effective anti–motion sickness drug for a person planning to go on a cruise?

5.6 Which of the following is correct regarding ganglion-blocking drugs?

5.7 Which of the following is correct regarding the neuromuscular blockers (NMBs)?

5.8 Which of the following is correct regarding drug interactions with nondepolarizing neuromuscular blockers (NMBs)?

5.9 A patient was administered a neuromuscular blocker (NMB) prior to a surgical procedure to produce skeletal muscle paralysis. This NMB drug affected small, rapidly contracting muscles of the face and eyes first and diaphragm muscles last. The effect of this drug was easily reversed with neostigmine. Which of the following neuromuscular blockers was most likely administered to this patient?

5.10 A patient was administered a neuromuscular blocker (NMB) prior to a surgical procedure to produce skeletal muscle paralysis. This NMB drug caused initial skeletal muscle fasciculations before the onset of paralysis. The effect of this drug could not be reversed with neostigmine. Which of the following neuromuscular blockers was most likely administered to this patient?

6.1 Which of the following is correct regarding adrenergic neurotransmission?

6.2 All of the following are correct regarding adrenergic receptors, except:

6.3 A hypertensive patient was accidentally given an α2agonist instead of an α1 blocker. Which of the following is correct in this situation?

6.4 Which of the following is correct regarding responses mediated by adrenergic receptors?

6.5 An asthma patient was given a nonselective β agonist to relieve bronchoconstriction. Which of the following adverse effects would you expect to see in this patient?

6.6 Which of the following adrenergic agonists is most likely to cause CNS side effects when administered systemically?

6.7 A 12-year-old boy who is allergic to peanuts was brought to the emergency room after accidentally consuming peanuts contained in fast food. He is in anaphylactic shock. Which of the following drugs would be most appropriate to treat this patient?

6.8 A 70-year-old patient was brought to the emergency room with a blood pressure of 76/60 mm Hg, tachycardia, and low cardiac output. He was diagnosed with acute heart failure. Which of the following drugs would be the most appropriate to improve his cardiac function?

6.9 Which of the following adrenergic agonists is commonly present in nasal sprays available overthe-counter (OTC) to treat nasal congestion? A. Clonidine. B. Albuterol. C. Oxymetazoline. D. Dobutamine. 6.9 Which of the following adrenergic agonists is commonly present in nasal sprays available overthe-counter (OTC) to treat nasal congestion?

6.10 One of your patients who is hypertensive and gets mild asthma attacks occasionally bought an herbal remedy online to help with his asthma. He is not on any asthma medications currently but is receiving a β1-selective blocker for his hypertension. The herbal remedy seems to relieve his asthma attacks, but his blood pressure seems to increase despite the β-blocker therapy. Which of the following drugs is most likely present in the herbal remedy he is taking?

7.1 A 60-year-old female patient started on a new antihypertensive medication recently. Her blood pressure seems to be under control, but she complains of fatigue, drowsiness, and fainting when she gets up from the bed (orthostatic hypotension). Which of the following drugs is she most likely taking?

7.2 A 30-year-old male patient was brought to the ER with amphetamine overdose. He presented with high blood pressure and arrhythmia. Which of the following is correct regarding this patient?

7.3 A new antihypertensive drug was tested in an animal model of hypertension. The drug when given alone reduces blood pressure in the animal. Norepinephrine when given in the presence of this drug did not cause any significant change in blood pressure or heart rate in the animal. The new drug is similar to which of the following drugs in terms of its pharmacological mechanism of action?

7.4 A β-blocker was prescribed for hypertension in a female asthma patient. After about a week of treatment, the asthma attacks got worse, and the patient was asked to stop taking the β-blocker. Which of the following β-blockers would you suggest as an alternative in this patient that is less likely to worsen her asthma?

7.5 A 70-year-old male needs to be treated with an α-blocker for overflow incontinence due to his enlarged prostate. Which of the following drugs would you suggest in this patent that will not affect his blood pressure significantly?

7.6 A 50-year-old male was brought to the emergency room after being stung by a hornet. The patient was found to be in anaphylactic shock, and the medical team tried to reverse the bronchoconstriction and hypotension using epinephrine. However, the patient did not fully respond to the epinephrine treatment. The patient’s wife mentioned that he is taking a prescription medication for his blood pressure, the name of which she does not remember. Which of the following medications is he most likely taking that could have prevented the effects of epinephrine?

7.7 Which of the following is correct regarding α-adrenergic blockers? .

7.8 Which of the following is correct regarding β-blockers?

7.9 Which of the following drugs is commonly used topically in the treatment of glaucoma?

7.10 Which of the following is correct regarding carvedilol?

8.1 Which one of the following combinations of antiparkin-sonian drugs is an appropriate treatment plan?

8.2 Peripheral adverse effects of levodopa, including nausea, hypotension, and cardiac arrhythmias, can be diminished by including which of the following drugs in the therapy?

8.3 Which of the following antiparkinsonian drugs may cause vasospasm?

8.4 Modest improvement in the memory of patients with Alzheimer’s disease may occur with drugs that increase transmission at which of the following receptors?

8.5 Which medication is a glutamate receptor antagonist that can be used in combination with an acetylcholinesterase inhibitor to manage the symptoms of Alzheimer’s disease?

8.6 Which of the following agents is available as a patch for once-daily use and is likely to provide steady drug levels to treat Alzheimer’s disease?

8.7 Which of the following is the only medication that is approved for the management of amyotrophic lateral sclerosis?

8.8 Which of the following medications reduces immune system–mediated inflammation via inhibition of pyrimidine synthesis to reduce the number of activated lymphocytes in the CNS?

8.9 Which of the following agents may cause tremors as a side effect and, thus, should be used with caution in patients with Parkinson’s disease, even though it is also indicated for the treatment of dementia associated with Parkinson’s disease?

8.10 Which of the following agents exerts its therapeutic effect in multiple sclerosis via potassium channel blockade?

9.1 Which one of the following statements is correct regarding benzodiazepines?

9.2 Which one of the following is a short-acting hypnotic?

9.3 Which one of the following statements is correct regarding the anxiolytic and hypnotic agents?

9.4 A 45-year-old man who has been injured in a car accident is brought into the emergency room. His blood alcohol level on admission is 275 mg/dL. Hospital records show a prior hospitalization for alcoholrelated seizures. His wife confirms that he has been drinking heavily for 3 weeks. What treatment should be provided to the patient if he goes into withdrawal?

9.5 Which one of the following is a short-acting hypnotic and better for sleep induction compared to sleep maintenance?

9.6 Which of the following agents has a rapid anxiolytic effect and would be best for the acute management of anxiety?

9.7 Which of the following sedative–hypnotic agents utilizes melatonin receptor agonism as the mechanism of action to induce sleep?

9.8 All of the following agents for the management of insomnia are controlled substances and may have a risk for addiction or dependence except:

9.9 All of the following agents may cause cognitive impairment, including memory problems when used at recommended doses except:

9.10 Which agent is best used in the Emergency Room setting for patients who are believed to have received too much of a benzodiazepine drug or taken an overdose of benzodiazepines?

10.1 A 55-year-old teacher began to experience changes in mood. He was losing interest in his work and lacked the desire to play his daily tennis match. He was preoccupied with feelings of guilt, worthlessness, and hopelessness. In addition to the psychiatric symptoms, the patient complained of muscle aches throughout his body. Physical and laboratory tests were unremarkable. After 6 weeks of therapy with fluoxetine, his symptoms resolved. However, the patient complains of sexual dysfunction. Which of the following drugs might be useful in this patient?

10.2 A 25-year-old woman has a long history of depressive symptoms accompanied by body aches and pain secondary to a car accident 2 years earlier. Physical and laboratory tests are unremarkable. Which of the following drugs might be useful in this patient?

10.3 A 51-year-old woman with symptoms of major depression also has angle-closure glaucoma. Which of the following antidepressants should be avoided in this patient?

10.4 A 36-year-old man presents with symptoms of compulsive behavior. If anything is out of order, he feels that “work will not be accomplished effectively or efficiently.” He realizes that his behavior is interfering with his ability to accomplish his daily tasks but cannot seem to stop himself. Which of the following drugs would be most helpful to this patient?

10.5 Which antidepressant has, as its two proposed principle mechanisms of action, 5-HT1a receptor partial agonism and 5-HT reuptake inhibition?

10.6 Which antidepressant is the most sedating?

10.7 Which mood stabilizer is completely renally eliminated and may be beneficial for patients with hepatic impairment?

10.8 Which antidepressant has, as its two principle mechanisms of action, 5-HT2A receptor antagonism and α2 receptor antagonism?

10.9 Which agent is best known to have the side effect of decreasing the thyroid function of the patient being chronically treated with this agent?

10.10 Which agent would be a poor choice in a 70-year-old elderly female with depressive symptoms due to the drug having significant α1 receptor antagonism and thus a higher risk for falls due to orthostatic hypotension?

11.1 An adolescent male is newly diagnosed with schizo-phrenia. Which of the following antipsychotic agents may have the best chance to improve his apathy and blunted affect?

11.2 Which one of the following antipsychotics has been shown to be a partial agonist at the dopamine D2receptor?

11.3 A 21-year-old male has recently begun pimozide therapy for Tourette disorder. His parents bring him to the emergency department. They describe that he has been having “different-appearing tics” than before, such as prolonged contraction of the facial muscles. While being examined, he experiences opisthotonos (type of extrapyramidal spasm of the body in which the head and heels are bent backward and the body is bowed forward). Which of the following drugs would be beneficial in reducing these symptoms?

11.4 A 28-year-old woman with schizoaffective disorder (combination of mood and psychotic symptoms) reports difficulty falling asleep. Which of the following would be most beneficial in this patient?

11.5 Which of the following antipsychotic agents is con-sidered to be the most potent and, thus, have the highest risk of extrapyramidal symptoms?

11.6 Which antipsychotic has the most sedative potential and is sometimes questionably used as a hypnotic agent in certain clinical settings?

11.7 A 30-year-old male patient who is treated with halo-peridol for his diagnosis of schizophrenia is considered to be well-managed symptomatically for his psychotic symptoms. However, he is reporting restlessness, the inability to sit still at the dinner table, and his family notices that he is pacing up and down the hallway frequently. Of the following, which is the best medication to treat this antipsychotic-induced akathisia?

11.8 Which of the following antipsychotic agents is available in a LAI formulation that may be useful for patients with difficulty adhering to therapy?

11.9 Which of the following antipsychotic agents is most associated with the possibility of a hematological dyscrasia such as agranulocytosis in a patient being treated for schizophrenia?

11.10 Which antipsychotic agent has been most associated with significant QT interval prolongation and should be used with caution in patients with preexisting arrhythmias or patients taking other drugs associated with QT prolongation?

12.1 A 9-year-old boy is sent for neurologic evaluation because of episodes of apparent inattention. Over the past year, the child has experienced episodes during which he develops a blank look on his face and his eyes blink for 15 seconds. He immediately resumes his previous activity. Which one the following best describes this patient’s seizures?

12.2 A child is experiencing absence seizures that interrupt his ability to pay attention during school and activities. Which of the following therapies would be most appropriate for this patient?

12.3 Which of the following drugs is most useful for the treatment of absence seizures?

12.4 A 25-year-old woman with myoclonic seizures is well controlled on valproate. She indicates that she is interested in becoming pregnant in the next year. With respect to her antiepilepsy medication, which of the following should be considered?

12.5 A woman with myoclonic seizures is well controlled with lamotrigine. She becomes pregnant and begins to have breakthrough seizures. What is most likely happening?

12.6 A 42-year-old man undergoes a neurologic evaluation because of episodes of apparent confusion. Over the past year, the man has experienced episodes during which he develops a blank look on his face and fails to respond to questions. Moreover, it appears to take several minutes before the man recovers from the episodes. Which one of the following best describes this type of seizure?

12.7 A 52-year-old man has had several focal complex partial seizures over the last year. Which one of the following therapies would be the most appropriate initial therapy for this patient?

12.8 A patient with focal complex partial seizures has been treated for 6 months with carbamazepine but, recently, has been experiencing breakthrough seizures on a more frequent basis. You are considering adding a second drug to the antiseizure regimen. Which of the following drugs is least likely to have a pharmacokinetic interaction with carbamazepine?

12.9 Which of the following is a first-line medication for generalized tonic–clonic seizures?

12.10 A 75-year-old woman had a stroke approximately 1 month ago. She is continuing to have small focal seizures where she fails to respond appropriately while talking. Which of the following is the most appropriate treatment for this individual?

13.1 Which of the following is a potent analgesic but a weak anesthetic?

13.2 The potency of inhaled anesthetics is defined quantitatively as:

13.3 Which of the following determines the speed of recovery from intravenous anesthetics used for induction?

13.4 Which one of the following is a potent intravenous anesthetic but a weak analgesic?

13.5 Which of the following is correct regarding local anesthetics?

13.6 Which of the following is correct regarding malignant hyperthermia?

13.7 A patient with heart failure and significantly reduced cardiac output requires surgical anesthesia. Which of the following would you expect to see in this patient?

13.8 An 80-year-old patient with asthma and low blood pressure requires anesthesia for an emergency surgical procedure. Which of the following agents would be most appropriate for inducing anesthesia in this patient?

13.9 A 52-year-old woman will be undergoing sedation with propofol for a brief diagnostic procedure. Which of the following is an advantage of propofol for this patient?

13.10 A 32-year-old woman requests an epidural to ease labor pains. She reports that she had an allergic reaction to Novocain (procaine) at the dentist’s office. Which of the following local anesthetics would be appropriate for use in an epidural for this patient?

14.1 A young woman is brought into the emergency room. She is unconscious, and she has pupillary constriction and depressed respiration. Based on reports, an opioid overdose is almost certain. Which of the listed phenanthrene opioids will exhibit a full and immediate response to treatment with naloxone?

14.2 A 76-year-old female with renal insufficiency pres-ents to the clinic with severe pain secondary to a compression fracture in the lumbar spine. She reports that the pain has been uncontrolled with tramadol, and it is decided to start treatment with an opioid. Which of the following is the best opioid for this patient?

14.3 Which of the following statements about fentanyl is correct?

14.4 A 56-year-old patient who has suffered with severe chronic pain with radiculopathy secondary to spinal stenosis for years presents to the clinic for pain management. Over the years, this patient has failed to receive relief from the neuropathic pain from the radiculopathy with traditional agents such as tricyclics or anticonvulsants. Based on the mechanism of action, which opioid might be beneficial in this patient to treat both nociceptive and neuropathic pain?

14.5 Which of the following statements regarding methadone is correct?

14.6 Which of the following opioids is the LEAST lipophilic?

14.7 A 64-year-old male is preparing for a total knee replacement. He is taking many medications that are metabolized by the CYP450 enzyme system and is worried about drug interactions with the pain medication that will be used following his surgery. Which of the following opioids would have the lowest chance of interacting with his medications that are metabolized by the CYP450 enzyme system?

14.8 Which of the following opioids is the best choice for treating pain associated with diabetic peripheral neuropathy?

14.9 KM is a 64-year-old male who has been hospitalized following a car accident in which he sustained a broken leg and broken arm. He has been converted to oral morphine in anticipation of his discharge. What other medication should he receive with his morphine upon discharge?

14.10 AN is a 57-year-old male who has been treated with oxycodone for chronic nonmalignant pain for over 2 years. He is now reporting increased pain in the afternoon while at work. Which of the following opioids is a short-acting opioid and is the best choice for this patient’s breakthrough pain?

15.1 A 22-year-old HIV patient has been told that marijuana may benefit him should he start using the substance. Which of the following adverse effects has been associated with marijuana usage and may be a reason for this patient to avoid use of marijuana?

15.2 A 21-year-old college student is curious about the effects of LSD. She asks what type of risks may be involved with using the drug for the first time. Which of the following is a correct response to her question?

15.3 A 58-year-old male is brought into the emergency department following an automobile accident. His blood alcohol level on admission is 280 mg/dL. He has been treated in the past for seizures related to alcohol abuse, and he confirms that he has been drinking heavily over the past month since losing his job. What treatment should be given to this patient if he begins to go into withdrawal while hospitalized?

15.4 A 35-year-old man has been abusing cocaine and is agitated, tachycardic, hypertensive, and hyperthermic. Which of the following is correct regarding treatment in this situation?

15.5 A 22-year-old man with a history of substance abuse arrives in the emergency department hypertensive, hyperthermic, and tachycardic, with altered mental status and hyperreflexia. His friends say he has been snorting “bath salts.” Which of the following is correct regarding this patient?

16.1 A young male was brought to the emergency room by the police due to severe agitation. Psychiatric examination revealed that he had injected dextroamphetamine several times in the past few days, the last time being 10 hours previously. He was given a drug that sedated him, and he fell asleep. Which of the following drugs was most likely used to counter this patient’s apparent symptoms of dextroamphetamine withdrawal?

16.2 JM is a 10-year-old male who is sent to a pediatric neurologist for an evaluation due to receiving poor grades in class. JM’s parents have recently received complaints from his teacher that he is performing poorly in school and he is repeatedly caught not paying attention in class. Several times a day during class, JM is noted to be getting out of his chair and socializing with other students. He has also been getting into fights with some children, as he is being singled out by others and teased. JM is given a diagnosis of ADHD with impulsivity and irritability. Which of the following is the most appropriate recommendation for management of the ADHD?

16.3 JM is a 10-year-old male with ADHD. His symptoms are currently controlled with an oral psychostimulant. However, he and his family wish to avoid having to give a second dose of medication at school. They are looking for an alternative treatment option that could be implemented in the morning and last the entire day. Which treatment option would be best for JM’s needs?

16.4 Which of the following treatments for ADHD is a controlled substance (DEA Schedule II)?

16.5 Amphetamines are contraindicated in patients with all of the following conditions except:

16.6 Which of the following agents is considered a first-line treatment for narcolepsy?

16.7 Which of the following is a common adverse effect of amphetamines?

16.8 Which of the following CNS stimulants occurs naturally and can be found in certain candies?

16.9 TT is a 35-year-old male who is interested in quitting smoking. In previous quit attempts, he has tried nicotine gum, the nicotine patch, and the “cold turkey” method. He has been unsuccessful in each of these attempts and usually resumed smoking within 4 to 6 weeks. Which of the following may be useful to assist TT in his attempt to quit smoking?

16.10 All of the following drugs are controlled substances with a risk for drug addiction or dependence except: