NMS

Chapter 3: Agents Acting on the Central Nervous System

1. Granulocytopenia, gastrointestinal irritation, gingival hyperplasia, and facial hirsutism are all
possible side effects of which one of the following anticonvulsant drugs?
a. Phenobarbital
b. Carbamazepine
c. Dantrolene
d. Phenytoin
e. Valproate

2. Which of the following drugs could be prescribed for a child who suffers from night terrors
a. Meprobamate
b. Clonazepam
c. Droperidol
d. Lithium
e. Ampethamine

3. Type A monoamine oxidase (MAO) inhibitors and tricyclic antidepressants have which one of the
following features in common?
a. Both are useful for the manic phase bipolar disorder
b. Both are useful for enuresis
c. Both can precipitate hypotensive crises if certain foods are ingested
d. Both act postsynaptically to produce their effect
e. Both drugs increase levels of biogenic amines

4. A patient has returned from a skiing holiday with a painful sprained ankle as well as bad cough.
Which of the following agents would relieve both the pain and the cough?
a. Meperidine
b. Naloxone
c. Dextromethropan
d. Codeine
e. Buspirone

5. Barbiturates are being replaced by benzodiazepines for use as sedative-hypnotic agents because
of the shortcomings of barbiturate therapy, which include all of the following EXCEPT
a. A narrow therapeutic index
b. Suppression of rapid eye movement (REM) sleep
c. Induction of seizures
d. High potential for physical dependence.

6. The antianxiety agents, such as diazepam and lorazepam, differ from antipsychotic agents, such
as triflupromazine, in all of the following ways EXCEPT
a. They do not cause parkinsonian tremor
b. They are better skeletal muscle relaxants
c. They are good anticonvulsant agents
d. They are ineffective in treating psychotic symptoms
e. Their adverse effects are not dose and age-dependent

7. A physician prescribes buspirone for short term treatment for a patient with generalized
anxiety. All of the following statements about this therapy are true EXCEPT
a. It is chemically related to the benzodiazepines
b. It is rapidly absorbed from the gastrointestinal tract
c. It undergoes extensive first-pass metabolism
d. It has a little abuse potential
e. Dysphoria has been reported with high doses
8. All of the following opiate receptors are correctly matched with their physiologic effect EXCEPT
a. u1 – analgesia
b. u2 – respiratory stimulation
c. K – spinal analgesia
d. d – dysphoria
e. K - miosis

9. A 27-year old woman is diagnosed with chronic mild endogenous depression. Her psychiatrist
suggests a combination of psychotherapy and pharmacologic therapy. Which of the following
drugs is LEAST likely to be prescribed?
a. Fluoxetine
b. Amitriptyline
c. Sertaline
d. Paroxetine
e. Bupropion

10. An otherwise healthy 37-year-old dentist is diagnosed with chronic migraine. These headaches
occur at least twice per month. All of the following statements are true EXCEPT
a. An ergot preparation would be effective in this patient approximately
b. Sumatriptan would be contraindicated in this patient
c. Sumatriptan should be prescribed prophylactically
d. B-adrenergic antagonists are the agent of choice for prevention of migraine
e. Oral sumatriptan would relieve the headache, but the rate of recurrence within 48 hours is
high

11. At effective antiepileptic agent at low doses

a. Thiopental
b. Pentobarbital
c. Phenobarbital
d. Amobarbital
e. Barbital

12. Used as an intravenous adjunct to anesthesia

a. Thiopental
b. Pentobarbital
c. Phenobarbital
d. Ambarbital
e. Barbital

13. Has “hangover” liability when used as a hypnotic

a. Thiopental
b. Pentobarbital
c. Phenobarbital
d. Ambarbital
e. Barbital

14. Effective for the treatment of Lennox-Gastaut syndrome

a. Phenytoin
b. Ethosuximide
c. Carbamazepine
d. Dantrolene
e. Felbamate
 15. Drug of choice for a 9-year-old boy diagnosed with petit mal epilepsy
a. Phenytoin
b. Ethosuximide
c. Carbamazepine
d. Dantrolene
e. Felbamate

16. Works peripherally in the muscle by decreasing Ca 2+ release from the sarcoplasmic reticulum
a. Phenytoin
b. Ethosuximide
c. Carbamazepine
d. Dantrolene
e. Felbamate

17. Effective in relieving the pain of recurring trigeminal neuralgia

a. Phenytoin
b. Ethosuximide
c. Carbamazepine
d. Dantrolene
e. Felbamate

Chapter 4: Anesthetic Agents

1. A patient who has untreatable hepatic carcinoma must undergo foot surgery. All of the
following local anesthesia agents may be deleterious to this patient based on his history EXCEPT
a. Lidocaine
b. Prilocaine
c. Mepivacaine
d. Procaine
e. Etidocaine

2. Lidocaine has all of the following properties EXCEPT

a. It is a therapeutically useful local anesthetic
b. It has a rapid onset of activity
c. It has an esteratic linkage
d. It is metabolized in the liver
e. Epinephrine is not required when lidocaine is administered
3. Correct statements concerning procaine include all of the following EXCEPT
a. It has an ester linkage
b. It interferes with sodium influx during depolarization
c. It is relatively short acting
d. It can produce a lupus like syndrome
e. Its metabolic product can inhibit the action of sulfonamides

4. A 72-year-old man is schedule to undergo a transurethral prostatic resection. He refuses general

anesthesia, so spinal anesthesia is selected. All of the following statements are correct EXCEPT
a. Procaine and epinephrine should not be used topically to numb the skin surface for spinal
anesthetic administration
b. Tetracaine combined with 10% dextrose to increase the specific gravity would be a very
effective spinal anesthetic in this patient
c. Dibucaine should not be given as a spinal anesthetic because it has a high systemic toxicity
d. If the spinal anesthetic produces a C-4 block causing the patient to experience respiratory
difficulty, the spinal should be converted to a general anesthetic
e. Dissociative anesthesia is the anesthesia of choice for this procedure
5. A patient with a pseudochilinesterase deficiency requires minor surgery. A local anesthetic will
be used. All of the following statements regarding the choice of an anesthetic agent for this
patient are true EXCEPT
a. Procaine should not be used in this patient because a pseudocholinesterase deficiency
would lengthen its duration of action
b. Tetracaine should not be used because it is most commonly used for spinal anesthesia
c. The chemical structure of lidocaine would most likely explain its therapeutic usefulness in
this case
d. Dibucaine would not be contraindicated because it is a surface anesthetic
e. Although cocaine has abuse potential, because it is metabolized in the liver, it would be
therapeutic value in this case

6. Isoflurance has largely replaced halothane and enflurance as the most frequently as the most
frequently used inhalation anesthetic in adults for all of the following reasons EXCEPT
a. It offers rapid induction
b. It offers rapid emergence
c. It is a better muscle relaxant
d. In maintains arterial blood pressure by increasing peripheral vascular resistance
e. It has little post-anesthetic organ toxicity

7. A toxic dose of lidocaine is inadvertently administered locally into the dorsalis pedis artery of a
patient. All of the following effects may occur EXCEPT
a. Convulsion
b. Respiratory depression
c. Hypotension
d. Increased inotropic effect
e. Reduced oxygen tension

8. A patient is given an inhalational anesthetic, an inert gas that supports combustion. Although it
is not effective as a single agent, when combined with more potent inhalational agents, it
provides significant analgesia. Because of its high partial pressure in blood, this agent could
result in all of the following EXCEPT
a. Distention of the bowel
b. Leukocytosis  (should be Leukopenia)
c. Pneumocephalus
d. Rupture of a pulmonary cyst
e. Rupture of a tympanic membrane in an occluded ear

9. Neuroleptanalgesia has all of the following properties EXCEPT

a. It is used chiefly for diagnostic and minor surgical procedures
b. Droperidol and fentanyl are commonly used agents
c. Hypertension is a common consequence
d. It can be used with nitrous oxide
e. Confusion can occur as an adverse effect

10. Dissociative anesthesia

a. Ketamine
b. Halothane
c. Droperidol, fentanyl, nitrous oxide and oxygen
d. Thiopental

11. Neurolepanesthesia
a. Ketamine
b. Halothane
c. Droperidol, fentanyl, nitrous oxide and oxygen
d. Thiopental
12. Inhalational anesthesia
a. Ketamine
b. Halothane
c. Droperidol, fentanyl, nitrous oxide and oxygen
d. Thiopental

13. Intravenous induction anesthesia

a. Ketamine
b. Halothane
c. Droperidol, fentanyl, nitrous oxide and oxygen
d. Thiopental

14. Commonly used spinal anesthesia that is ten times more potent than procaine
a. Cocaine
b. Lidocaine
c. Procaine
d. Dibucaine
e. Tetracaine

15. Provides good topical anesthesia of nose, pharynx, and tracheobronchial tube
a. Cocaine
b. Lidocaine
c. Procaine
d. Dibucaine
e. Tetracaine

16. Its metabolic product inhibits the action of sulfonamides

a. Cocaine
b. Lidocaine
c. Procaine
d. Dibucaine
e. Tetracaine

17. Widely used as an antiarrhythmic agent as well

a. Cocaine
b. Lidocaine
c. Procaine
d. Dibucaine
e. Tetracaine

18. Produces the most rapid induction and has the lowest blood:gas partition coefficient
a. Nitrous oxide
b. Isoflurance
c. Halothane
d. Desflurance
e. Enflurance

19. Nonirritating to the larynx and produces bronchiolar dilation

a. Nitrous oxide
b. Isoflurance
c. Halothane
d. Desflurance
e. Enflurance
 20. Powerful analgesic used to supplement more potent anesthetic agents
a. Nitrous oxide
b. Isoflurance
c. Halothane
d. Desflurance
e. Enflurance

Katzung
Chapter 24: Antiseizure Drugs

1. A 9-year-old child is having learning difficulties at school. He has brief lapses of awareness with
eyelid fluttering that occur every 5–10 min. Electroencephalogram (EEG) studies reveal brief 3-
Hz spike and wave discharges appearing synchronously in all leads. Which drug would be
effective in this child without the disadvantages of excessive sedation or tolerance
development?
a. Clonazepam
b. Ethosuximide
c. Gabapentin
d. Felbamate
e. Phenobarbital

2. Which statement concerning the proposed mechanisms of action of anticonvulsant drugs is

inaccurate?
a. Diazepam facilitates GABA-mediated inhibitory actions
b. Ethosuximide selectively blocks potassium ion (K+) channels in thalamic neurons
c. Phenobarbital has multiple actions, including enhancement of the effects of GABA,
antagonism of glutamate receptors, and blockade of sodium ion (Na+) channels
d. Phenytoin prolongs the inactivated state of the Na+ channel
e. Zonisamide blocks voltage-gated Na+ channels

3. Which drug used in management of seizure disorders is most likely to elevate the plasma
concentration of other drugs administered concomitantly?
a. Carbamazepine
b. Clonazepam
c. Gabapentin
d. Valproic acid
e. Vigabatrin

4. A young female patient suffers from absence seizures. Which of the following statements about
her proposed drug management is NOT accurate?
a. Ethosuximide and valproic acid are preferred drugs
b. Gastrointestinal side effects are common with ethosuximide
c. She should be examined every 2 or 3 mo for deep tendon reflex activity
d. The use of valproic acid in pregnancy may cause congenital malformations
e. Weight gain is common in patients on valproic acid

5. Which statement concerning the pharmacokinetics of antiseizure drugs is accurate?

a. Administration of phenytoin to patients in methadone maintenance programs has led to
symptoms of opioid overdose, including respiratory depression
b. Although ethosuximide has a half-life of approximately 40 h, the drug is usually taken
twice a day
c. At high doses, phenytoin elimination follows first-order kinetics
d. Valproic acid may increase the synthesis of porphyrins
e. Treatment with vigabatrin reduces the effectiveness of oral contraceptives
6. With chronic use in seizure states, the adverse effects of this drug include coarsening of facial
features, hirsutism, and gingival hyperplasia.
a. Carbamazepine
b. Felbamate
c. Phenytoin
d. Phenobarbital
e. Valproic acid

7. Abrupt withdrawal of antiseizure drugs can result in increases in seizure frequency and severity.
Withdrawal is most easily accomplished if the patient is being treated with
a. Carbamazepine
b. Diazepam
c. Ethosuximide
d. Phenobarbital
e. Phenytoin

8. The mechanism of antiseizure activity of carbamazepine is

a. Block of sodium ion channels
b. Block of calcium ion channels
c. Facilitation of GABA actions on chloride ion channels
d. Glutamate receptor antagonism
e. Inhibition of GABA transaminase

9. Which statement about phenytoin is accurate?

a. Displaces sulfonamides from plasma proteins
b. Drug of choice in myoclonic seizures
c. Half-life is increased if used with phenobarbital
d. Isoniazid (INH) decreases steady-state blood levels of phenytoin
e. Toxic effects may occur with only small increments in dose

10. A young male patient suffers from a seizure disorder characterized by tonic rigidity of the
extremities followed in 15–30 s of tremor progressing to massive jerking of the body. This clonic
phase lasts for 1 or 2 min, leaving the patient in a stuporous state. Of the following drugs, which
is most suitable for longterm management of this patient?
a. Carbamazepine
b. Clonazepam
c. Ethosuximide
d. Felbamate
e. Tiagabine
Chapter 29: Antipsychotic Agents and Lithium

1. Concerning hypotheses for the pathophysiologic basis of schizophrenia, which statement is

accurate?
a. All clinically effective antipsychotic drugs have high affinity for dopamine D2 receptors
b. Dopamine receptor-blocking drugs are used to alleviate psychotic symptoms in
parkinsonism
c. Drug-induced psychosis can occur without activation of brain dopamine receptors
d. Serotonin receptors are present at lower than normal levels in the brains of untreated
schizophrenics
e. The clinical potency of clozapine correlates well with its dopamine receptor-blocking activity

2. Trifluoperazine was prescribed for a young male patient diagnosed as suffering from
schizophrenia. He complains about the side effects of his medication. Which of the following is
not likely to be on his list?
a. Constipation
b. Disinterest in sexual activity
c. Dizziness if he stands up too quickly
d. Excessive salivation
e. Small print in the newspaper is hard to see

3. Which statement concerning the adverse effects of antipsychotic drugs is accurate?

a. Acute dystonic reactions occur very infrequently with olanzapine
b. Akathisias due to antipsychotic drugs are managed by increasing the drug dose
c. Blurring of vision and urinary retention are common adverse effects of haloperidol
d. Retinal pigmentation is a dose-dependent toxic effect of clozapine
e. The late-occurring choreoathetoid movements caused by conventional antipsychotic drugs
are alleviated by atropine

4. Haloperidol is not an appropriate drug for management of

a. Acute mania
b. The amenorrhea-galactorrhea syndrome
c. Phencyclidine intoxication
d. Schizoaffective disorders
e. Tourette’s syndrome

5. Which statement concerning the use of lithium in the treatment of bipolar affective disorder is
accurate?
a. Excessive intake of sodium chloride enhances the toxicity of lithium
b. Lithium alleviates the manic phase of bipolar disorder within 12 h
c. Lithium dosage may need to be decreased in patients taking thiazides
d. Since lithium does not cross the placental barrier, it is quite safe in pregnancy
e. The elimination rate of lithium is equivalent to that of Creatinine

6. A 30-year-old male patient is on drug therapy for a psychiatric problem. He complains that he
feels “flat” and that he gets confused at times. He has been gaining weight and has lost his sex
drive. As he moves his hands, you notice a slight tremor. He tells you that since he has been on
medication he is always thirsty and frequently has to urinate. The drug he is most likely to be
taking is
a. Carbamazepine
b. Clozapine
c. Fluphenazine
d. Lithium
e. Valproic acid
 7. A young male patient recently diagnosed as schizophrenic develops severe muscle cramps with
torticollis a short time after drug therapy is initiated with haloperidol. The best course of action
would be to
a. Add risperidone to the drug regimen
b. Discontinue haloperidol and observe the patient
c. Give oral diphenhydramine
d. Inject benztropine
e. Switch the patient to fluphenazine

8. Which of the following drugs is established to be both effective and safe to use in a pregnant
patient suffering from bipolar disorder?
a. Carbamazepine
b. Chlorpromazine
c. Lithium
d. Quetiapine
e. Valproic acid

9. In comparing the characteristics of thioridazine with other older antipsychotic drugs, which of
the following statements is accurate?
a. Most likely to cause extrapyramidal dysfunction
b. Least likely to cause urinary retention
c. Most likely to be safe in patients with history of cardiac arrhythmias
d. Most likely to cause ocular dysfunction
e. The safest antipsychotic drug in overdose

10. Which of the following drugs has a high affinity for 5-HT2 receptors in the brain, does not cause
extrapyramidal dysfunction or hematotoxicity, and is reported to increase the risk of significant
QT prolongation?
a. Clozapine
b. Haloperidol
c. Molindone
d. Olanzapine
e. Ziprasidone

Chapter 31: Opioids Analgesics and Antagonists

Questions 1 and 2. A 63-year-old man is undergoing radiation treatment as an outpatient for metastatic
bone cancer. His pain has been managed with a fixed combination of oxycodone plus acetaminophen
taken orally. Despite increasing doses of the analgesic combination, the pain is getting worse.

1. The most appropriate oral medication for his increasing pain is

a. Buprenorphine
b. Codeine plus aspirin
c. Levorphanol
d. Pentazocine
e. Propoxyphene

2. It is possible that this patient will have to increase the dose of the analgesic as his condition
progresses as a result of developing tolerance. However, tolerance will not develop to a
significant extent with respect to
a. Biliary smooth muscle
b. Constipation
c. Nausea and vomiting
d. Sedation
e. Urinary retention
 3. You are on your way to take an examination and you suddenly get an attack of diarrhea. If you
stop at a nearby drugstore for an over-the-counter opioid with antidiarrheal action, you will be
asking for
a. Codeine
b. Dextromethorphan
c. Diphenoxylate
d. Loperamide
e. Tramadol

4. An emergency department patient with severe pain thought to be of gastrointestinal origin

received 80 mg of meperidine. He subsequently developed a severe reaction characterized by
tachycardia, hypertension, hyperpyrexia, and seizures. Questioning revealed that the patient
had been taking a drug for a psychiatric condition. Which drug is most likely to be responsible
for this untoward interaction with meperidine?
a. Alprazolam
b. Bupropion
c. Isocarboxazid
d. Lithium
e. Mirtazapine

5. Genetic polymorphisms in certain hepatic enzymes involved in drug metabolism are established
to be responsible for variations in analgesic response to
a. Codeine
b. Fentanyl
c. Meperidine
d. Methadone
e. Tramadol

Questions 6 and 7. A young male patient is brought to the emergency department in an anxious and
agitated state. He informs the attending physician that he uses “street drugs” and that he gave himself
an intravenous “fix” approximately 12 h ago. He now has chills and muscle aches and has also been
vomiting. His symptoms include hyperventilation and hyperthermia. The attending physician notes that
his pupil size is larger than normal.

6. What is the most likely cause of these signs and symptoms?

a. The patient had injected methamphetamine
b. The patient has hepatitis B
c. The patient has overdosed with an opioid
d. The signs and symptoms are those of the opioid abstinence syndrome
e. These are early signs of toxicity due to contaminants in “street heroin”

7. Which drug will be most effective in alleviating the symptoms experienced by this patient?
a. Acetaminophen
b. Codeine
c. Diazepam
d. Methadone
e. Naltrexone

8. Which statement about butorphanol is accurate?

a. Activates μ receptors
b. Does not cause respiratory depression
c. Is a nonsedating opioid
d. Pain-relieving action is not superior to that of codeine
e. Response to naloxone in overdose may be unreliable
9. Which drug does not activate opioid receptors, has been proposed as a maintenance drug in
treatment programs for opioid addicts, and with a single oral dose, will block the effects of
injected heroin for up to 48 h?
a. Amphetamine
b. Buprenorphine
c. Naloxone
d. Naltrexone
e. Propoxyphene

10. Which statement about dextromethorphan is accurate?

a. Activates κ receptors
b. Analgesia equivalent to pentazocine
c. Highly effective antiemetic
d. Less constipation than codeine
e. No abuse potential