5.

Inflammation is a complex tissue reaction that includes the release of

cytokines, leukotrienes, prostaglandins, and peptides. Prostaglandins
involved in inflammatory processes are typically produced from
arachidonic acid by which of the following enzymes?

(A) Cyclooxygenase-1
(B) Cyclooxygenase-2
(C) Glutathione-S-transferase
(D) Lipoxygenase
(E) Phospholipase A2

7. A patient with a bleeding tendency presents in the hematology 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?

(A) Alprostadil
(B) Aspirin
(C) Ibuprofen
(D) Leukotriene LTC
(E) Misoprostol
(F) Prednisone
(G) Prostacyclin
(H) Zafirlukast
(I) Zileuton

8. 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

(A) Atenolol
(B) Captopril
(C) Carvedilol
(D) Digoxin
(E) Diltiazem
(F) Dobutamine
(G) Enalapril
(H) Furosemide
(I) Metoprolol(J) Spironolactone
7. 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?

(A) Cromolyn
(B) Epinephrine
(C) Ipratropium
(D) Metaproterenol
(E) Metoprolol
(F) Prednisone
(G) Salmeterol
(H) Theophylline
(I) Zileuton

6. 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?

(A) Angiotensin I
(B) Angiotensin II
(C) Atrial natriuretic peptide
(D) Bradykinin
(E) Calcitonin gene-related peptide
(F) Endothelin
(G) Neuropeptide Y
(H) Renin
(I) Substance P
(J) Vasoactive intestinal peptide

1. A 50-year-old woman, a known asthmatic for the past 30 years,

presented to the emergency department with a 2-d history of worsening
breathlessness and cough. Chest auscultation revealed bilateral polyphonic
inspiratory and expiratory wheeze. Supplemental oxygen, nebulized
albuterol (salbutamol) (5 mg) and ipratropium (250g), as well as
intravenous methyl prednisolone (40 mg) were administered. Which of the
following is a pharmacologic effect of exogenous glucocorticoids?

(A) Increased muscle mass

(B) Hypoglycemia
(C) Inhibition of leukotriene synthesis
(D) Improved wound healing
(E) Increased excretion of salt and water

10. Which of the following is a drug that, in high doses, blocks the
glucocorticoid receptor?

(A) Aminoglutethimide
(B) Beclomethasone
(C) Ketoconazole
(D) Mifepristone
(E) Spironolactone

4. A patient with parkinsonism is being treated with levodopa. He suffers

from irregular, involuntary muscle jerks that affect the proximal muscles
of the limbs. Which of the following statements about these symptoms is
accurate?

(A) Coadministration of muscarinic blockers prevents the occurrence of

dyskinesias during treatment with levodopa
(B) Drugs that activate dopamine receptors can exacerbate dyskinesias in a
patient taking levodopa
(C) Dyskinesias are less likely to occur if levodopa is administered with
carbidopa
(D) Symptoms are likely to be alleviated by continued treatment with levodopa
(E) The symptoms are usually reduced if the dose of levodopa is increased

6. Concerning the drugs used in parkinsonism, which statement is

accurate?

(A) Dopamine receptor agonists should never be used in Parkinson’s disease

before a trial of levodopa
(B) Levodopa causes mydriasis and may precipitate an acute attack of
glaucoma
(C) Selegiline is a selective inhibitor of COMT
(D) The primary benefit of antimuscarinic drugs in parkin- sonism is their
ability to relieve bradykinesia
(E) Therapeutic effects of amantadine continue for several years

10. Whichofthefollowingdrugsismostsuitableformanagement of essential

tremor in a patient who has pulmonary disease?

(A) Diazepam (B) Levodopa (C) Metoprolol (D) Propranolol (E) Terbutaline

5. Genetic polymorphisms in certain hepatic enzymes involved in drug

metabolism are established to be responsible for varia- tions in analgesic
response to

(A) Buprenorphine (B) Codeine (C) Fentanyl (D) Methadone (E) Tramadol

Questions 1 and 2. A 63-year-old man is undergoing radiation treatment as an

outpatient for metastatic bone cancer. His pain has been treated with a fixed
combination of oxycodone plus acet- aminophen 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) Hydromorphone
(D) Pentazocine
(E) Tramadol

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) Emesis
(C) Pupillary constriction
(D) Sedation
(E) Urinary retention
3.You are on your way to take an examination and you sud- denly 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) Nalbuphine

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) Fentanyl
(B) Nalbuphine
(C) Naloxone
(D) Naltrexone
(E) Propoxyphene

4.Which of the following drugs is the most effective in the emergency

management of malignant hyperthermia?

(A) Atropine
(B) Dantrolene
(C) Haloperidol
(D) Succinylcholine
(E) Vecuronium

9.Which drug has spasmolytic activity and could also be used in the
management of seizures caused by overdose of a local anesthetic?

(A) Baclofen
(B) Cyclobenzaprine
(C) Diazepam
(D) Gabapentin
(E) Tizanidine

8. SSRIs are much less effective than tricyclic antidepressants in the

management of
(A) Bulimia
(B) Chronic pain of neuropathic origin
(C) Generalized anxiety disorder
(D) Obsessive-compulsive disorder
(E) Premenstrual dysphoric disorder

4. The primary mechanism of resistance of gram-positive organisms to

macrolide antibiotics including erythromycin is

(A) Changes in the 30S ribosomal subunit

(B) Decreased drug permeability of the cytoplasmic membrane
(C) Formation of drug-inactivating acetyltransferases
(D) Formation of esterases that hydrolyze the lactone ring
(E) Methylation of binding sites on the 50S ribosomal subunit

4. Which statement is accurate regarding the antibacterial action of the

aminoglycoside amikacin?

(A) Antibacterial activity is often reduced by the presence of an inhibitor of cell

wall synthesis
(B) Antibacterial action is not concentration-dependent
(C) Antibacterial action is time-dependent
(D) Efficacy is directly proportional to the duration of time that the plasma
level is greater than the minimal inhibitory concentration
(E) The drug continues to exert antibacterial effects even after plasma levels
decrease below detectable levels