A 3-year-old is brought to the emergency department having just ingested a large overdose of chlorpropamide, an oral antidiabetic drug. Chlorpropamide is a weak acid with a pKa of 5.0. It is capable of entering most tissues. On physical examination, the heart rate is 110/min, blood pressure 90/50 mm Hg, and respiratory rate 30/min. Which of the following statements about this case of chlorpropamide overdose is most correct?

Botulinum toxin is a large protein molecule. Its action on cholinergic transmission depends on an intracellular action within nerve endings. Which one of the following processes is best suited for permeation of very large protein molecules into cells?

A 12-year-old child has bacterial pharyngitis and is to receive an oral antibiotic. She complains of a sore throat and pain on swallowing. The tympanic membranes are slightly reddened bilaterally, but she does not complain of earache. Blood pressure is 105/70 mm Hg, heart rate 100/min, temperature 37.8°C (100.1°F). Ampicillin is a weak organic acid with a pKa of 2.5. What percentage of a given dose will be in the lipidsoluble form in the duodenum at a pH of 4.5?

Ampicillin is eliminated by first-order kinetics. Which of the following statements best describes the process by which the plasma concentration of this drug declines?

The pharmacokinetics of a new drug are under study in a phase 1 clinical trial. Which statement about the distribution of drugs to specific tissues is most correct?

The pharmacokinetic process or property that distinguishes the elimination of ethanol and high doses of phenytoin and aspirin from the elimination of most other drugs is called

Which of the following statements about animal testing of potential new therapeutic agents is most correct

The “dominant lethal” test involves the treatment of a male adult animal with a chemical before mating; the pregnant female is later examined for fetal death and abnormalities. The dominant lethal test therefore is a test of

In a phase 1 clinical trial, “Novexum,” a new drug, was administered intravenously to 25 volunteers, and blood samples were taken for several hours. Several inactive metabolites were found as well as declining concentrations of Novexum. A graph was prepared as shown below, with the Novexum plasma levels plotted on a logarithmic ordinate and time on a linear abscissa. It was concluded that the drug has first-order kinetics. From this graph, what is the best estimate of the elimination half-life of Novexum?

A large pharmaceutical company has conducted extensive animal testing of a new drug for the treatment of advanced prostate cancer. The chief of research and development recommends that the company now submit an IND application in order to start clinical trials. Which of the following statements is most correct regarding clinical trials of new drug

. Which of the following would probably not be included in an optimal phase 3 clinical trial of a new analgesic drug for mild pain?

The Ames test is frequently carried out before clinical trials are begun. The Ames test is a method that detects

Which of the following statements about new drug development is most correct?

Which statement about the development of new drugs is most correct?

A 55-year-old man is seen in the clinic with hypertension of 150/95 mm Hg (millimeters of mercury). His personal medical history and physical examination are otherwise unremarkable but his family history is positive for early deaths due to cardiovascular disease. A decision is made to treat his hypertension, starting with a calcium channel blocker. Blocker A in a dose of 5 mg produces the same decrease in blood pressure as 500 mg of blocker B. Which of the following predictions is most accurate?

Graded and quantal dose-response curves are being used for evaluation of a new analgesic drug in the animal laboratory and in clinical trials. Which of the following statements best describes graded dose-response curves?

Prior to clinical trials in patients with heart failure, an animal study was carried out to compare two new positive inotropic drugs (A and B) to a current standard agent (C). The results of cardiac output measurements are shown in the graph belowWhich of the following statements is correct

A study was carried out in isolated intestinal smooth muscle preparations to determine the action of a new drug “novamine,” which in separate studies bound to the same receptors as acetylcholine, an agonist. In the absence of other drugs, acetylcholine caused contraction of the muscle. Novamine alone caused relaxation of the preparation. In the presence of a low concentration of novamine, the EC50 of acetylcholine was unchanged, but the Emax was reduced. In the presence of a high concentration of novamine, extremely high concentrations of acetylcholine had no effect. Which of the following expressions best describes novamine?

Beta adrenoceptors in the heart regulate cardiac rate and contractile strength. Several studies have indicated that in humans and experimental animals, about 90% of β adrenoceptors in the heart are spare receptors. Which of the following statements about spare receptors is most corr

Two cholesterol-lowering drugs, X and Y, were studied in a large group of patients, and the percentages of the group showing a specific therapeutic effect (35% reduction in lowdensity lipoprotein [LDL] cholesterol) were determined. The results are shown in the following table.Which of the following statements about these results is correct?

Sugammadex is a drug that reverses the action of rocuronium and certain other skeletal muscle-relaxing agents (nondepolarizing neuromuscular blocking agents). It appears to interact directly with the rocuronium molecule and not at all with the rocuronium receptor. Which of the following terms best describes sugammadex?

Mr Jones has zero kidney function and is undergoing hemodialysis 3 days per week while awaiting a kidney transplant. He takes metformin for type 2 diabetes mellitus and was previously stabilized (while his kidney function was adequate) at a dosage of 500 mg twice daily, given orally. The plasma concentration at this dosage with normal kidney function was found to be 1.4 mg/L. He has had 6 dialysis procedures and metformin toxicity is suspected. A blood sample now shows a metformin concentration of 4.2 mg/L. What was Mr Jones’ clearance of metformin while his kidney function was normal?

Ms Smith, a 65-year-old woman with pneumonia, was given tobramycin, 150 mg, intravenously. After 20 minutes, the plasma concentration was measured and was found to be 3 mg/L. Assuming no elimination of the drug in 20 minutes, what is the apparent volume of distribution of tobramycin in Ms Smith?

St. John’s Wort, a popular botanical remedy, is a potent inducer of hepatic phase I CYP3A4 enzymes. Verapamil and phenytoin are both eliminated from the body by metabolism in the liver. Verapamil has a clearance of 1.5 L/min, approximately equal to liver blood flow, whereas phenytoin has a clearance of 0.1 L/min. Based on this fact, which of the following is most correct?

A 45-year-old woman with small cell lung cancer has elected to participate in the trial of a new chemotherapeutic agent. It is given by constant intravenous infusion of 10 mg/h. Plasma concentrations (Cp) are measured with the results shown in the following tableWhat conclusion can be drawn from these data?

You are the only physician in a clinic that is cut off from the outside world by violent storms, flooding, and landslides. A 15-year-old girl is brought to the clinic with severe asthmatic wheezing. Because of the lack of other drugs, you decide to use intravenous theophylline for treatment. The pharmacokinetics of theophylline include the following average parameters: Vd 35 L; CL 48 mL/min; half-life 8 h. If an intravenous infusion of theophylline is started at a rate of 0.48 mg/min, how long would it take to reach 93.75% of the final steadystate concentration?

A 74-year-old retired mechanic is admitted with a myocardial infarction and a severe acute cardiac arrhythmia. You decide to give lidocaine to correct the arrhythmia. A continuous intravenous infusion of lidocaine, 1.92 mg/min, is started at 8 AM. The average pharmacokinetic parameters of lidocaine are: Vd 77 L; clearance 640 mL/min; half-life 1.4 h. What is the expected steady-state plasma concentration?

A new drug is under study in phase 1 trials. It is found that this molecule is avidly taken up by extravascular tissues so that the final total amount in the extravascular compartment at steady state is 100 times the amount remaining in the blood plasma. What is the probable volume of distribution in a hypothetical person with 8 L of blood and 4 L of plasma?

A 63-year-old woman in the intensive care unit requires an infusion of procainamide. Its half-life is 2 h. The infusion is begun at 9 am. At 1 pm on the same day, a blood sample is taken; the drug concentration is found to be 3 mg/L. What is the probable steady-state drug concentration after 16 or more hours of infusion?

A 30-year-old man is brought to the emergency department in a deep coma. Respiration is severely depressed and he has pinpoint pupils. His friends state that he self-administered a large dose of morphine 6 h earlier. An immediate blood analysis shows a morphine blood level of 0.25 mg/L. Assuming that the Vd of morphine in this patient is 200 L and the half-life is 3 h, how much morphine did the patient inject 6 h earlier?

Gentamicin, an aminoglycoside antibiotic, is sometimes given as a single large intravenous bolus dose of once a day to achieve a highly active peak plasma concentration. Gentamicin’s volume of distribution is about 20 L in a 70 kg patient and, in your patient, the half-life is 4 h. If your patient is given an IV bolus dose of 360 mg, what will the trough concentration of gentamicin be 24 hours later just before the next intravenous bolus?

You are planning to treat chronic major depression in a 35-year-old patient with recurrent suicidal thoughts. She has several comorbid conditions that require drug therapy, including rifampin for tuberculosis and amiodarone for arrhythmia. You are concerned about drug interactions caused by changes in drug metabolism in this patient. 1. Drug metabolism in humans usually results in a product that is

2. If therapy with multiple drugs causes induction of drug metabolism in your depressed patient, it will

Which of the following factors is likely to increase the duration of action of a drug that is metabolized by CYP3A4 in the liver?

Reports of cardiac arrhythmias caused by unusually high blood levels of 2 antihistamines, terfenadine, and astemizole, led to their removal from the market. Which of the following best explains these effects?

Which of the following agents, when used in combination with other anti-HIV drugs, permits dose reductions?

Hich of the following drugs may inhibit the hepatic microsomal P450 responsible for warfarin metabolism

Which of the following drugs, if used chronically, is most likely to increase the toxicity of acetaminophen?

Which of the following drugs has higher first-pass metabolism in men than in women?

Which of the following drugs is an established inhibitor of P-glycoprotein (P-gp) drug transporters?

Which of the following cytochrome isoforms is responsible for metabolizing the largest number of drugs?

A 59-year-old man with acute coronary syndrome is admitted to the hospital for emergency percutaneous insertion of a coronary stent. Which of the following drugs might cause unexpected results based on the patient’s CYP2C19 genotype?

A 62-year-old woman with advanced colon cancer is treated with intravenous 5-fluorouracil. Within a few days, she develops severe diarrhea, and within a week, she shows severe neutropenia. Which of the following polymorphisms is most likely to be responsible?

A 38-year-old man is being treated for HIV-induced acquired immunodeficiency syndrome (AIDS). When abacavir therapy is begun, he develops a severe skin rash. Which of the following pharmacogenomic diagnoses might explain this skin rash?

A college student volunteers to have his genome decoded as part of a population-wide study of polymorphisms. He receives a call from the principal investigator informing him that his genome unexpectedly contains an important single nucleotide polymorphism. Which of the following polymorphisms is associated with risk of hemolysis and increased resistance to malaria?

A 7-year-old child is brought to the emergency department in coma with cyanosis. Her mother states that the girl was given codeine with acetaminophen because of severe bruising after a fall. Shortly after the first dose, the child became unresponsive and “turned blue.” Which of the following alleles might be responsible for this presentation?

A 3-year-old child has been admitted to the emergency department having swallowed the contents of 2 bottles of a nasal decongestant. The active ingredient of the medication is phenylephrine, a potent, selective α-adrenoceptor agonist drug. Which of the following is a sign of α-receptor activation that may occur in this child

Mr Green is a 60-year-old man with atherosclerosis and poorly controlled hypertension of 170/110 mm Hg. He has been taking several antihypertensive drugs, including minoxidil. Minoxidil is a powerful arteriolar vasodilator that does not act on autonomic receptors. Which of the following effects will be observed if no other drugs are used?

Full activation of the parasympathetic nerves is likely to produce which of the following effects

Questions 4–5. For these questions, use the accompanying diagram. Assume that the diagram can represent either the sympathetic or the parasympathetic system.4. Assuming the structure is part of the sympathetic system, norepinephrine acts at which of the following sites in the diagram?

5. If the effector cell in the diagram is a pupillary constrictor smooth muscle cell, which of the following receptor types is denoted by structure 6?

A 40-year-old man with a history of major depression is admitted to the emergency department following a suicide attempt with a drug overdose. Which of the following signs or symptoms would be consistent with an overdose of a ganglion-blocking drug?

Several children at a summer camp were hospitalized with symptoms thought to be due to ingestion of food containing botulinum toxin. Which one of the following signs or symptoms is consistent with the diagnosis of botulinum poisoning?

Which one of the following is the primary neurotransmitter agent normally released in the sinoatrial node of the heart in response to a blood pressure increase?

Questions 9–10. Assume that the diagram below represents a sympathetic noradrenergic postganglionic nerve ending.9. Which of the following blocks the carrier represented by “z” in the diagram?

10. Which of the following inhibits the carrier denoted “y” in the diagram?

A 30-year-old woman undergoes abdominal surgery. In spite of minimal tissue damage, complete ileus (absence of bowel motility) follows, and she complains of severe bloating. She also finds it difficult to urinate. Mild cholinomimetic stimulation with bethanechol or neostigmine is often effective in relieving these complications of surgery. Neostigmine and bethanechol in moderate doses have significantly different effects on which one of the following?

JR, a 35-year-old farm worker, is admitted to the emergency department suffering from insecticide poisoning. Parathion has which one of the following characteristics?

Ms Brown, a 28-year-old accountant, has been treated for myasthenia gravis for several years. She reports to the emergency department complaining of recent onset of weakness of her hands, diplopia, and difficulty swallowing. She may be suffering from a change in response to her myasthenia therapy, that is, a cholinergic or a myasthenic crisis. Which of the following is the best drug for distinguishing between myasthenic crisis (insufficient therapy) and cholinergic crisis (excessive therapy)?

A crop duster pilot has been accidentally exposed to a high concentration of a highly toxic agricultural organophosphate insecticide. If untreated, the cause of death from such exposure would probably be

Mr Green has just been diagnosed with dysautonomia (chronic idiopathic autonomic insufficiency). You are considering different therapies for his disease. Pyridostigmine and neostigmine may cause which one of the following in this patient?

Parasympathetic nerve stimulation and a slow infusion of bethanechol will each

Actions and clinical uses of muscarinic cholinoceptor agonists include which one of the following?

Which of the following is a direct-acting cholinomimetic that is lipid-soluble and is used to facilitate smoking cessation?

A 3-year-old child is admitted to the emergency department after taking a drug from her parents’ medicine cabinet and swallowing multiple tablets. The signs suggest that the drug is a cholinomimetic with little or no vascular effect, little or no CNS effect, and a duration of action of about 2–4 h. Which of the following is the most likely cause of these effects?

Which of the following is the primary second-messenger process in the contraction of the ciliary muscle when focusing on near objects?

A 27-year old compulsive drug user injected a drug he thought was methamphetamine, but he has not developed any signs of methamphetamine action. He has been admitted to the emergency department and antimuscarinic drug overdose is suspected. Probable signs of atropine overdose include which one of the following?

Which of the following is the most dangerous effect of belladonna alkaloids in infants and toddler

Which one of the following can be blocked by atropine?

Questions 4–5. Two new synthetic drugs (X and Y) are to be studied for their cardiovascular effects. The drugs are given to three anesthetized animals while the blood pressure is recorded. The first animal has received no pretreatment (control), the second has received an effective dose of a long-acting ganglion blocker, and the third has received an effective dose of a long-acting muscarinic antagonist. 4. Drug X caused a 50 mm Hg rise in mean blood pressure in the control animal, no blood pressure change in the ganglionblocked animal, and a 75 mm mean blood pressure rise in the atropine-pretreated animal. Drug X is probably a drug similar to

5. The net changes in heart rate induced by drug Y in these experiments are shown in the following graph.Drug Y is probably a drug similar to

A 30-year-old man has been treated with several autonomic drugs for 4 weeks. He is now admitted to the emergency department showing signs of drug toxicity. Which of the following signs would distinguish between an overdose of a ganglion blocker versus a muscarinic blocker?

Which of the following is an accepted therapeutic indication for the use of antimuscarinic drugs?

Which of the following is an expected effect of a therapeutic dose of an antimuscarinic drug?

Which one of the following drugs causes vasodilation that can be blocked by atropine?

Which one of the following drugs has a very high affinity for the phosphorus atom in parathion and is often used to treat life-threatening insecticide toxicity?

Questions 1 and 2. While playing in the garden, a 7-year-old boy is stung by 3 bees. Because he has a previous history of bee sting allergy, he is brought to the emergency department by his mother who is very concerned about a possible anaphylactic reaction. 1. Which of the following are probable signs of an anaphylactic reaction to bee stings?

2. If this child has signs of anaphylaxis, what is the treatment of choice?

A 65-year-old woman with impaired renal function and a necrotic ulcer in the sole of her right foot is admitted to the ward from the emergency department. She has longstanding type 2 diabetes mellitus and you wish to examine her retinas for possible vascular changes. Which of the following drugs is a good choice when pupillary dilation—but not cycloplegia—is desired?

A 60-year-old woman was told she had hypertension and should be taking antihypertensive medication. She decides to take an herbal medication from an online “holistic pharmacy.” One week after starting the medication, she is found unconscious in her apartment. In the emergency department, her blood pressure is 50/0 mm Hg and heart rate is 40 bpm. Respirations are 20/min; pupils are slightly constricted. Bowel sounds are present. Which of the following would be the most effective cardiovascular stimulant?

A group of volunteers are involved in a phase 1 clinical trial of a new autonomic drug. When administered by intravenous bolus, the blood pressure increases. When given orally for 1 week, the blood pressure decreases. Which of the following standard agents does the new drug most resemble?

Your 30-year-old patient has moderately severe new onset asthma, and you prescribe a highly selective β2 agonist inhaler to be used when needed. In considering the possible drug effects in this patient, you would note that β2 stimulants frequently cause

Mr Green, a 54-year-old banker, had a cardiac transplant 6 months ago. His current blood pressure is 120/70 mm Hg and heart rate is 100 bpm. Which of the following drugs would have the least effect on Mr Green’s heart rate?

A patient presents at the emergency department with threatened anaphylaxis. Respiratory obstruction appears likely if she is not treated immediately. Her past medical history includes hypertension, for which she is receiving an adrenoceptor blocker. The emergency physician plans to use epinephrine to treat her anaphylactic reaction. Which of the following effects of epinephrine would be blocked by prazosin but not by metoprolol?

Clinical studies have shown that adrenoceptor blockers have many useful effects in patients. However, a number of drug toxicities have been documented. Adverse effects that limit the use of adrenoceptor blockers include which one of the following?

When given to a patient, phentolamine blocks which one of the following?

Your 75-year-old patient with multiple comorbidities is to receive a β-blocking drug. For which of the following conditions are β-blocking drugs NOT indicat

A 56-year-old man has hypertension and an enlarged prostate, which biopsy shows to be benign prostatic hyperplasia. He complains of urinary retention. Which of the following drugs would be the most appropriate initial therapy

A 32-year-old woman with hypertension wishes to become pregnant. Her physician informs her that she will have to switch to another antihypertensive drug. Which of the following drugs is absolutely contraindicated in pregnancy?

A patient is admitted to the emergency department with severe tachycardia after a drug overdose. His family reports that he has been depressed about his hypertension. Which one of the following drugs increases the heart rate in a dosedependent manner?

Which one of the following is characteristic of nifedipine treatment in patients with essential hypertension?

A 73-year-old man with a history of a recent change in his treatment for moderately severe hypertension is brought to the emergency department because of a fall at home. Which of the following drug groups is most likely to cause postural hypotension and thus an increased risk of falls?

A significant number of patients started on ACE inhibitor therapy for hypertension are intolerant and must be switched to a different class of drug. What is the most common manifestation of this intolerance?

Which one of the following is a significant unwanted effect of the drug named?

Comparison of prazosin with atenolol shows that

A patient with hypertension and angina is referred for treatment. Metoprolol and verapamil are among the drugs considered. Both metoprolol and verapamil are associated with which one of the following?

A 45-year-old man is brought to the emergency department with mental obtundation. He is found to have a blood pressure of 220/160 and retinal hemorrhages. Which one of the following is used in severe hypertensive emergencies, is shortacting, acts on a G-protein-coupled receptor, and must be given by intravenous infusion?

Which of the following is very short acting and acts by releasing nitric oxide

Questions 1–4. A 57-year-old woman presents to her primary care physician with a complaint of severe chest pain when she walks uphill in cold weather. The pain disappears when she rests. She has a 40-pack-year history of smoking but her plasma lipids are within the normal range. After evaluation and discussion of treatment options, a decision is made to treat her with nitroglycerin. 1. Which of the following is a common direct or reflex effect of nitroglycerin

2. In advising the patient about the adverse effects she may notice, you point out that nitroglycerin in moderate doses often produces certain symptoms. Which of the following effects might occur due to the mechanism listed?

3. One year later, the patient returns complaining that her nitroglycerin works well when she takes it for an acute attack but that she is now having more frequent attacks and would like something to prevent them. Useful drugs for the prophylaxis of angina of effort includ

4. If a β blocker were to be used for prophylaxis in this patient, what is the most probable mechanism of action in angina?

A new 60-year-old patient presents to the medical clinic with hypertension and angina. He is 1.8 meters tall with a waist measurement of 1.1 m. Weight is 97 kg, blood pressure is 150/95, and pulse is 85. In considering adverse effects of possible drugs for these conditions, you note that an adverse effect that nitroglycerin and prazosin have in common is

A 25-year-old man is admitted to the emergency department with a brownish cyanotic appearance, marked shortness of breath, and hypotension. He has needle marks in both arms. Which of the following is most likely to cause methemoglobinemia?

Another patient is admitted to the emergency department after a drug overdose. He is noted to have hypotension and severe bradycardia. He has been receiving therapy for hypertension and angina. Which of the following drugs in high doses causes bradycardia?

A 45-year-old woman with hyperlipidemia and frequent migraine headaches develops angina of effort. Which of the following is relatively contraindicated because of her migraines?

When nitrates are used in combination with other drugs for the treatment of angina, which one of the following combinations results in additive effects on the variable specified?

Certain drugs can cause severe hypotension when combined with nitrates. Which of the following interacts with nitroglycerin by inhibiting the metabolism of cGMP?

Questions 1–2. A 73-year-old man with an inadequate response to other drugs is to receive digoxin for chronic heart failure. He is in normal sinus rhythm with a heart rate of 88 and blood pressure of 135/85 mm Hg1. Which of the following is the best-documented mechanism of beneficial action of cardiac glycosides?

2. After your patient has been receiving digoxin for 3 weeks, he presents to the emergency department with an arrhythmia. Which one of the following is most likely to contribute to the arrhythmogenic effect of digoxin?

A patient who has been taking digoxin for several years for atrial fibrillation and chronic heart failure is about to receive atropine for another condition. A common effect of digoxin (at therapeutic blood levels) that can be almost entirely blocked by atropine is

A 65-year-old woman has been admitted to the coronary care unit with a left ventricular myocardial infarction. She develops acute severe heart failure with marked pulmonary edema, but no evidence of peripheral edema. Which one of the following drugs would be most useful?

A 72-year-old woman has long-standing heart failure. Which one of the following drugs has been shown to reduce mortality in chronic heart failure

Which of the following drugs increases the plasma levels of endogenous BNP and also blocks angiotensin receptors?

Which one of the following drugs is associated with clinically useful or physiologically important positive inotropic effect?

A 68-year-old man with a history of chronic heart failure goes on vacation and abandons his low-salt diet. Three days later, he develops severe shortness of breath and is admitted to the local hospital emergency department with significant pulmonary edema. The first-line drug of choice in most cases of acute decompensation in patients with chronic heart failure is

Which of the following has been shown to prolong life in patients with chronic congestive failure in spite of having a negative inotropic effect on cardiac contractility?Which of the following has been shown to prolong life in patients with chronic congestive failure in spite of having a negative inotropic effect on cardiac contractility?

A 5-year-old child was vomiting and was brought to the emergency department with sinus arrest and a ventricular rate of 35 bpm. An empty bottle of his uncle’s digoxin was found where he was playing. Which of the following is the drug of choice in treating a severe overdose of digoxin?

Questions 1 and 2. A 76-year-old retired postal worker with rheumatoid arthritis and chronic heart disease presents with a cardiac arrhythmia and is being considered for treatment with procainamide. She is already receiving an ACE inhibitor, digoxin, and hydrochlorothiazide for her cardiac condition. 1. In deciding on a treatment regimen with procainamide for this patient, which of the following statements is most correct?

2. If this patient should take an overdose and manifest severe acute procainamide toxicity with markedly prolonged QRS, which of the following should be given immediately?

A 54-year-old airline pilot is admitted to the emergency department with chest pain and a rapid heart rhythm. The ECG shows an inferior myocardial infarction and ventricular tachycardia. Amiodarone is ordered. Amiodarone

A 36-year-old woman with a history of poorly controlled thyrotoxicosis has recurrent episodes of tachycardia with severe shortness of breath. During elective surgery to remove her thyroid, she develops a heart rate of 200 with a slightly decreased blood pressure. Which of the following drugs would be most suitable?

A 16-year-old girl has paroxysmal attacks of rapid heart rate with palpitations and shortness of breath. These episodes occasionally terminate spontaneously but often require a visit to the emergency department of the local hospital. Her ECG during these episodes reveals an AV nodal tachycardia. Which of the following drugs would be most suitable for prophylaxis of future episodes of acute AV nodal tachycardia?

A 55-year-old man is admitted to the emergency department and is found to have an abnormal ECG. Overdose of an antiarrhythmic drug is considered. Which of the following drugs is correctly paired with its ECG effects?

A 60-year-old woman comes to the emergency department with atypical chest pain. Her ECG reveals ventricular tachycardia with rare normal sinus beats, and ST-segment elevation. Troponin C levels are markedly increased, suggesting myocardial damage. A diagnosis of myocardial infarction is made, and the woman is admitted to the cardiac intensive care unit. Her arrhythmia will probably be treated initially with

Which of the following drugs slows conduction through the AV node and has a duration of action of 10–20 seconds?

When working in outlying areas, this 62-year-old rancher is away from his house for 12–14 h at a time. He has an arrhythmia that requires chronic therapy. Which of the following has the longest half-life of all antiarrhythmic drugs

A 70-year-old retired businessman with a history of chronic heart failure has been taking digoxin and furosemide. He is now admitted with a history of vomiting, acute decompensated heart failure, and metabolic derangements. He has marked peripheral edema and metabolic alkalosis (pH, 7.50; pCO2, 45; HCO3, 36; Na+ , 140). Which of the following drugs is most appropriate for the treatment of his edema?

A 50-year-old man has a history of frequent episodes of renal colic with calcium-containing renal stones. A careful workup indicates that he has a defect in proximal tubular calcium reabsorption, which results in high concentrations of calcium salts in the tubular urine. The most useful diuretic agent in the treatment of recurrent calcium stones is

Which of the following is an important effect of chronic therapy with loop diuretics?

Which of the following diuretics would be most useful in the acute treatment of a comatose patient with traumatic brain injury and cerebral edema?

A 62-year-old man with advanced prostate cancer is admitted to the emergency department with mental obtundation. An electrolyte panel shows a serum calcium of 16.5 (normal 8.5–10.5 mg/dL). Which of the following therapies would be most useful in the management of severe hypercalcemia?

A 60-year-old patient complains of paresthesias and occasional nausea associated with one of the drugs she is taking. She is found to have hyperchloremic metabolic acidosis. She is probably taking

A 70-year-old woman is admitted to the emergency department because of a “fainting spell” at home. She appears to have suffered no trauma from her fall, but her blood pressure is 120/60 when lying down and 60/20 when she sits up. Neurologic examination and an ECG are within normal limits when she is lying down. Questioning reveals that she has recently started taking “water pills” (diuretics) for a heart condition. Which of the following drugs is the most likely cause of her fainting spell?

A 58-year-old woman with lung cancer has abnormally low serum osmolality and hyponatremia. A drug that increases the formation of dilute urine and is used to treat SIADH is

A graduate student is planning to make a high-altitude climb in South America while on vacation. He will not have time to acclimate slowly to altitude. A drug that is useful in preventing high-altitude sicknes

Your 37-year-old patient has been diagnosed with a rare metastatic carcinoid tumor. This neoplasm is releasing serotonin, bradykinin, and several unknown peptides. The effects of serotonin in this patient are most likely to include

A 23-year-old woman is admitted to the emergency department with difficulty breathing. Examination reveals significant laryngeal edema. Past medical history indicates that she suffers from recurrent episodes of angioneurotic edema with release of histamine and other mediators. Which of the following drugs is the most effective physiologic antagonist of histamine in smooth muscle?

A 20-year-old woman is taking over-the-counter diphenhydramine for severe hay fever. Which of the following adverse effects is she most likely to report?

A laboratory study of new H2 blockers is planned. Which of the following will result from blockade of H2 receptors?

An obese 40-year-old man (BMI 31) is being seen in the cardio-pulmonary clinic for pulmonary hypertension and a cardiac murmur. He took fenfluramine for several years in an attempt to reduce his weight. The mechanism by which fenfluramine affected appetite is:

A 40-year-old patient with breast cancer is about to undergo cancer chemotherapy with a highly emetogenic (nausea- and vomiting-causing) drug combination. The antiemetic drug most likely to be included in her regimen is

The hospital pharmacy committee is preparing a formulary for staff use. Which of the following is a correct application of the drug mentioned?

A 26-year-old woman presents with amenorrhea and galactorrhea. Her prolactin level is grossly elevated (200 ng/mL vs normal 20 ng/mL). Which of the following is most useful in the treatment of hyperprolactinemia?

A 28-year-old office worker suffers from intense migraine headaches. Which of the following is a serotonin 5-HT1D/1B agonist useful for aborting an acute migraine headache?

A 33-year-old woman attempted to induce an abortion using ergotamine. She is admitted to the emergency department with severe pain in both legs. On examination, her legs are cold and pale with absent arterial pulses. Which of the following is the most useful antidote for reversing severe ergotinduced vasospasm

Field workers exposed to a plant toxin develop painful fluidfilled blisters. Analysis of the blister fluid reveals high concentrations of a peptide. Which of the following is a peptide that causes increased capillary permeability and edema?

In a laboratory study of several peptides, one is found that decreases peripheral resistance but constricts veins. Which of the following causes arteriolar vasodilation and venoconstriction?

Which of the following endogenous molecules is elevated in heart failure and when given as a drug is a vasodilator with significant renal toxicity?

A 50-year-old factory worker presents with cardio-respiratory symptoms and careful workup reveals idiopathic pulmonary hypertension. Which of the following binds endothelin receptors and is approved for use in pulmonary hypertension?

A 60-year-old financial consultant presents with severe pain in a neuronal dermatome region of her chest. This area was previously affected by a herpes zoster rash. Which of the following might be of benefit in controlling this postherpetic pain?

In a phase 2 clinical trial in hypertensive patients, an endogenous octapeptide vasoconstrictor was found to increase in the blood of patients treated with large doses of diuretics. Which of the following is the most likely endogenous peptide?

Which of the following is a vasodilator that increases in the blood or tissues of patients treated with captopril?

Which of the following is an antagonist at NK1 receptors and is used to prevent or reduce chemotherapy-induced nausea and vomiting?

A 35-year-old woman with moderately severe arthritis has been treated with nonsteroidal anti-inflammatory drugs for 6 mo. Her arthritis symptoms have been well controlled. She now complains of heartburn and indigestion. A fecal blood test is positive. You give her a prescription for a drug to be taken along with the anti-inflammatory agent, but 2 d later she calls the office complaining that your last prescription has caused severe diarrhea and cramping that resembles her periods. Which of the following is most likely to be associated with increased gastrointestinal motility and uterine cramping?A 35-year-old woman with moderately severe arthritis has been treated with nonsteroidal anti-inflammatory drugs for 6 mo. Her arthritis symptoms have been well controlled. She now complains of heartburn and indigestion. A fecal blood test is positive. You give her a prescription for a drug to be taken along with the anti-inflammatory agent, but 2 d later she calls the office complaining that your last prescription has caused severe diarrhea and cramping that resembles her periods. Which of the following is most likely to be associated with increased gastrointestinal motility and uterine cramping?

Which mechanism explains aspirin’s inhibition of thromboxane synthesis?

A 57-year-old man has severe pulmonary hypertension and right ventricular hypertrophy. Which of the following agents causes vasodilation and may be useful in pulmonary hypertension?

A 19-year-old woman complains of severe dysmenorrhea. A uterine stimulant derived from membrane lipid in the endometrium

Inflammation is a complex tissue reaction that includes the release of cytokines, leukotrienes, prostaglandins, and peptides. Leukotrienes involved in inflammatory processes are typically produced from arachidonic acid by which of the following enzymes?

A newborn infant is diagnosed with transposition of the great vessels, wherein the aorta exits from the right ventricle and the pulmonary artery from the left ventricle. Which of the following drugs is likely to be used in preparation for surgical correction of this anomaly?

A patient with a positive fecal blood test is referred to the gastroenterology clinic. He is apparently taking large amounts of an unidentified drug that inhibits platelet activity. Which of the following is taken orally and directly and reversibly inhibits platelet cyclooxygenase?

Which of the following is a component of slow-reacting substance of anaphylaxis (SRS-A)?

A 17-year-old patient complains that he develops wheezing and severe shortness of breath whenever he takes aspirin for headache. Increased levels of which of the following may be responsible, in part, for some cases of aspirin hypersensitivity

Which of the following is a leukotriene receptor blocker?

Which one of the following is not a nitric oxide donor but causes it to be synthesized and released from endogenous precursors, resulting in vasodilation?

An NO-containing molecule that releases nitric oxide in the blood is

The inducible isoform of nitric oxide synthase (iNOS, isoform 2) is found primarily in which of the following?

The primary endogenous substrate for the enzyme nitric oxide synthase (NOS) is

Which of the following is a recognized effect of nitric oxide (NO)?

Which of the following is an endogenous inhibitor/inactivator of nitric oxide?

One effect that theophylline, nitroglycerin, isoproterenol, and histamine have in common is

A 23-year-old woman is using an albuterol inhaler for frequent acute episodes of asthma and complains of symptoms that she ascribes to the albuterol. Which of the following is not a recognized action of albuterol?

A 19-year-old college student has well-controlled asthma but on reporting to the college health clinic, complains of a sore throat. On examination, he has typical signs of thrush, a fungal infection with Candida albicans. The asthma controller medication most likely to be associated with Candida infection is:

Questions 4–5. A 16-year-old patient is in the emergency department receiving nasal oxygen. She has a heart rate of 125 bpm, a respiratory rate of 40 breaths/min, and a peak expiratory flow <50% of the predicted value. Wheezing and rales are audible without a stethoscope. 4. Which of the following drugs can be used by nebulizer for a prompt direct bronchodilator effect in severe, acute asthma?

5. After successful treatment of the acute attack, the patient was referred to the outpatient clinic for follow-up treatment for asthma. Which of the following is not an established prophylactic strategy for asthma

Mr Green is a 60-year-old former smoker with cardiac disease and severe chronic obstructive pulmonary disease (COPD) associated with frequent episodes of bronchospasm. Which of the following is a bronchodilator useful in COPD and least likely to cause cardiac arrhythmia?

A 22-year-old man is brought to the emergency department after suffering seizures resulting from an overdose of a drug he has been taking. His friends state that he took the drug orally and sometimes had insomnia after taking it. Which of the following is a direct bronchodilator that is most often used in asthma by the oral route and is capable of causing insomnia and seizures?

Which of the following in its parenteral form is life-saving in severe status asthmaticus and acts, at least in part, by inhibiting phospholipase A2?

Which of the following has a slow onset but long duration of action and is always used in combination with a corticosteroid by inhalation

Oral medications are popular for the treatment of asthma in children because young children may have difficulty with the proper use of aerosol inhalers. Which of the following is an orally active inhibitor of leukotriene receptors?