HISTAMINE PHARMACOLOGY - RX WRITING AND DRUG COSTS (DR. TERLECKY, DR. WAKADE, DR. TODI, DR. WU AND D

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HISTAMINE PHARMACOLOGY - RX WRITING AND DRUG COSTS (DR. TERLECKY, DR. WAKADE, DR. TODI, DR. WU AND D
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2012-10-13 20:49:37
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PHARM EXAM I
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  1. What is histamine?
    hydrophilic molecule formed by the decarboxylation of L-histidine
  2. Which of the following is required for histamine synthesis:

    A. biotin
    B. glutathione
    C. pyridoxal phosphate
    D. coenzyme A
    e. none of the above
    C. pyridoxal phosphate
    (this multiple choice question has been scrambled)
  3. All of the following are true of histamine degradation except:

    A. histamie is immediately stored or degraded quickly
    B. N-methylimidazole acetic acid is the major excreted metabolote
    C. very little histamine is excreted unchanged
    D. histamine is mostly degraded in the liver
    E. histamine (or imidazole) N-methyltransferase catalyzes  histamine breakdown
    d. all of the above are true
    D. all of the above are true
    (this multiple choice question has been scrambled)
  4. All of the following are true of the causes of histamine release except:

    A. sodium and ATP are modulators
    B. exposure to extreme hot or cold, scratches, crushes and/or sunlight
    C. sensitization of mast cells by IgE antibodies
    D. asthma, hay fever, skin rashes and anaphylaxis are symptoms of histamine release
    e. all of the above are true
    A. sodium and ATP are modulators (calcium and ATP are modulators)
    (this multiple choice question has been scrambled)
  5. All of the following are true of the modulation of histamine release except:

    A. morphine and turbocurarine stimulate histamine release
    B. cromolyn sodium blocks the influx of calcium and inhibit the release of histamine
    C. nedocramil is used in the prophylactic treatment of asthma
    D. compound 48/80 and penicillin act as ionophores and result in clacium influx and release of histamine
    e. all of the above of true
    D. compound 48/80 and penicillin act as ionophores and result in clacium influx and release of histamine (compound 48/80 and polymixin B act as ionophores and result in clacium influx and release of histamine)
    (this multiple choice question has been scrambled)
  6. All of the following are true of the effects of histamine as mediated by its receptors except:

    A. sensory nerve ending stimulation via H1 receptor resulting in severe itching
    B. smooth muscle contraction of the GI tract via H1 receptors
    C. the lungs, uterus, ureters and urinary bladder all contract via H1 receptors
    D. bronchospasms via H1 receptors
    E. gastric secretion via H2 receptors
    F. increases heart rate and blood pressure via H2 receptors
    F. increases heart rate and blood pressure via H2 receptors (histamine increases heart rate via H2 receptors and decreases blood pressure via H1 receptors)
    (this multiple choice question has been scrambled)
  7. Which of the following are true of drugs that block histamine actions:

    A. Allegra and Claritin  cause sedative effects due to their high central nervous system distribution
    B. epinephrine is a physiological histamine blocker
    C. Benadryl and Chlor-Trimethon are 2nd generation H1 blockers that help to reduce the symptoms of allergy, allergic rhinitis and urticaria
    D. Zantac is a H1 receptor blocker and is useful in the treatment of duodenal ulcers, gastritis and reflux esophagitis
    E. Dramamine is an H2 receptor blocker and aids in the treatment of motion sickness
    f. none of the above are true
    g. more than one of the above are true
    B. epinephrine is a physiological histamine blocker
    (this multiple choice question has been scrambled)
  8. Match the following.

    1. first generation antihistamines
    2. second generation antihistamines

    a. Zyrtec
    b. Clarinex
    c. Dramamine
    d. Allegra
    e. Benadryl
    f. Chlor-Trimethon
    g. Claritin
    • 1. first generation antihistamines - c. Dramamine, e. Benadryl, f. Chlor-Trimethon
    • 2. second generation antihistamines - a. Zyrtec, b. Clarinex, d. Allegra, g. Claritin
  9. All of the following are ways to treat ulcerative and inflammatory GI diseases except:

    A. neutralize acid
    B. reduce gastric acid secretion
    C. enhance mucosal defenses through cytoprotective or antimicrobial intervention
    D. administer a proton pump stimulator
    e. all of the above are true
    D. administer a proton pump stimulator
    (this multiple choice question has been scrambled)
  10. All of the following are true of antacids except:

    a. they are weak bases that inactivate HCL production
    b. they confer mucosal protection via prostagladin production
    c. system alkalosis, constipation, hypercalcemia and diarrhea may be side effects of antacid use
    d. Tums, Amphogel, Milk of Magnesia and Alk Seltzer are common antacids used
    e. all of the above are true
    e. all of the above are true
  11. Which of the following are true of gastric secretion reduction:

    A. cholinergic receptor antagonist can be used to depress smooth muscle motility and parasympathetic mediated release of HCL
    B. Prilosec reversibly inhibits the gastric parietal cell proton pump
    C. its under the control of 3 agonists: histamine, epinephrine, and gastrin
    D. it increases gastric acidity
    A. cholinergic receptor antagonist can be used to depress smooth muscle motility and parasympathetic mediated release of HCL
    (this multiple choice question has been scrambled)
  12. All of the following are true of the enhancement of mucosal defenses except:

    A. misoprostol is the drug of choice for treating ulcers caused by the use of NSAIDS
    B. mechanism of action is to form protective coating on ulcer crater that will remain for several hours
    C. Carafate directly inhibits pepsin and bile action without changing the pH of the stomach
    D. prostaglandins increase gastric acid secretion by stimulating histamine-stimulated cAMP production
    D. prostaglandins increase gastric acid secretion by stimulating histamine-stimulated cAMP production (prostaglandins prevent gastric acid secretion by blocking histamine-stimulated cAMP production)
    (this multiple choice question has been scrambled)
  13. Reglan exhibits _____ activity and _____ the motility of the upper GI tract without increasing gastric, biliary, or pancreatic secretions.
    muscarinic; stimulate
  14. What condition is associated with chronic use of too much Reglan (metoclopramide)?
    tardive dyskinesia
  15. What antibitoics are most commonly used to eradicate Helicobacter pylori colonization?
    • Amoxil (amoxicillin)
    • Biaxin (clarithromycin)
  16. What are the 3 basic steps involved in emesis that are controlled by the emetic center in the medulla?
    • excitation of sensors: psychic vomiting, anticipatory vomiting, motion sickness, gagging, thoracic pain and irritation of stomach (intestinal lining) and peritoneum
    • stimulation of vomiting center: received from chemoreceptor trigger zone that are composed of dopamine receptors
    • effector response: increase in pulse rate, salivation, dilation of pupils and pallor, contraction of pylorus and relaxation of gastric smooth muscle, tensing of abdominal and intercostal muscles (increase in abdominal pressure), reverse peristalsis ->> after effects: slowing of heart, drop in blood pressure, faintness and pallor
  17. All of the following are emetic agents except:

    A. apomorphine
    B. Zofran (ondansteron)
    C. Ipecac syrup
    d. all of the above are true
    B. Zofran (ondansteron) (antiemetic)
    (this multiple choice question has been scrambled)
  18. All of the following are true of antiemetic agents except:

    A. Compazine, Tigan and Reglan are all antiemetics
    B. Zofran is a neurokinin receptor antagonist
    C. Granisol (granisetron) is a 5-HT3 antagonist
    D. most are 5-HT3 antagonists or are neurokinin receptor antagonists at the CTZ
    B. Zofran is a neurokinin receptor antagonist (Zofran is a 5-HT3 antagonist)
    (this multiple choice question has been scrambled)
  19. All of the following are true of laxatives except:

    A. stool softners, like mineral oil, promote laxation by coating and lubricating fecal matter, and preventing normal absorption of water
    B. Metamucil and Konsyl promote the "most natural physiological laxation"
    C. daily repeated use can result in atonic hypomotility states of the colon
    D. castor oil, senna, and Exlax are osmotic laxatives
    D. castor oil, senna, and Exlax are osmotic laxatives (these are irritant/stimulant laxatives)
    (this multiple choice question has been scrambled)
  20. What are the 6 most common therapeutic uses of laxatives?
    • treatment of constipation
    • poisoning
    • antihelmenthics
    • evacuation for radiological or proctological exam
    • bowel surgery
    • anorectal diseases to prevent straining
  21. All of the following are true of anti-diarrhea agents except:

    A. Lomotril is an absorbent powder that absorbs water and toxins as well as provides a protective coating to the inflammed intestine
    B. Immodium is an anti-diarrhea agent that decreases the motility of the GI tract
    C. opiates promote sustained contraction of the intestine and interrupt the normal organized sequence of peristalic contractions
    d. all of the above are true
    A. Lomotril is an absorbent powder that absorbs water and toxins as well as provides a protective coating to the inflammed intestine (Lomotril is a motility agent that interferes with peristaltic contractions)
    (this multiple choice question has been scrambled)
  22. What is the rate-limiting step in the entire biosynthetic pathway of catecholamines?
    tyrosine hydroxylase
  23. True or false. phenylethanolamine-N-methyl-transferase (PNMT) is present mainly in the adrenal gland.
    true
  24. All of the following are true of voltage sensitive calcium channels except:

    A. T-type calcium channels are located in cardiac SA and AV nodes and are activated at > -70 mV
    B. L-type calcium channels are located in smooth muscle and endo-, exocrine glands, and their pharmacological antagonist are DHP, nifedipine and verapamil
    C. N-type calcium channels are located in neurons and their pharmacological antagonists are omega-conatoxin GVIA and dilthiazam
    D. P-type are located in cerebellar Purkinje neurons and are activated at -10 mV
    C. N-type calcium channels are located in neurons and their pharmacological antagonists are omega-conatoxin GVIA and dilthiazam (pharmacological antagonists are omega-conatoxin GVIA and Cadmium)
    (this multiple choice question has been scrambled)
  25. All of the following are true of the locations of alpha-1-adrenergic receptors except:

    A. pancreas
    B. blood vessels
    C. internal sex organs
    D. salivary glands
    E. blood platelets
    E. blood platelets (location of alpha-2-receptors)
    (this multiple choice question has been scrambled)
  26. All of the following are true of the locations of alpha-2-adrenergic receptors except:

    A. CNS
    B. sympathetic nerve terminals
    C. blood vessels
    D. blood platelets
    C. blood vessels (location of alpha-1-receptors)
    (this multiple choice question has been scrambled)
  27. All of the following are true of alpha agonists except:

    A. alpha-methyl-NE binds to alpha-2-adrenergic receptors
    B. clonidine is more potent than oxymetazoline
    C. naphazoline, epinephrine and norepinephrine are all equally potent
    D. methoxamine is more potent than phenylephrine
    D. methoxamine is more potent than phenylephrine
    (this multiple choice question has been scrambled)
  28. Which of the following is true of beta-adrenergic receptors:

    a. beta-1-receptors are located in vascular and bronchial smooth muscle cells
    b. phenylephrine is less potent than isoproterenol
    c. beta-2-receptors are located in the heart, kidney and adipose cells
    d. isoproterenol, epinephrine, norepinephrine and phenylephrine bind to both beta-1 and beta-2 receptors
    e. more than one of the above
    e. more than one of the above (b and d)
  29. All of the following is true of adrenergic response on the heart except:

    A. cardiac force of contraction is increased by catecholamines
    B. the rate of decrease of the "potassium leak" from the SA node pacemaker cells during diastolic interval is slowed down leading to shortened time for depolarization to threshold
    C. beta-1-receptors mediate all actions
    D. activation of beta-1-receptors leads to increase in heart rate due to action of catecholamines on pacemaker cells
    E. activation of beta-1-receptors of SA node leads to more rapid diastolic depolarization and increase in action potential frequency
    B. the rate of decrease of the "potassium leak" from the SA node pacemaker cells during diastolic interval is slowed down leading to shortened time for depolarization to threshold (...diastolic interval is accelerated...)
    (this multiple choice question has been scrambled)
  30. Which of the following is true of adrenergic response on the heart:

    A. decrease in calcium influx leads to greater force of contraction
    B. catecholamines induce arrhythmias by activation of beta-2 receptors
    C. cardiac efficiency is decreased by catecholamines
    D. velocity of impulse transfer from SA node and AV nodes is increased and refractory period of AV node is decreased
    E. activation of beta-1 receptors of myocardial cells decreases calcium influx
    D. velocity of impulse transfer from SA node and AV nodes is increased and refractory period of AV node is decreased
    (this multiple choice question has been scrambled)
  31. All of the following are true of adrenergic receptors and their affect on vascular beds except:

    A. skeletal muscle is mediated by alpha-1 and alpha-2 receptors and activation leads to vasoconstriction and vasodilation depending on the sympathomimetic amine and its concentration
    B. the liver and splanchnic area are mostly mediated by alpha-1 receptors and activation leads to vasodilation at low [EPI] and vasoconstriction at high [EPI] and [NE]
    C. kidney is predominately mediated by alpha-2 receptors and activation leads to vasoconstriction in response to epinephrine and norepinephrine and slight vasodilation with ISO
    D. EPI has higher affinity for beta receptors than for alpha receptors
    E. coronary arteries are mediated by beta-2 receptors and activation leads to vasodilation
    C. kidney is predominately mediated by alpha-2 receptors and activation leads to vasoconstriction in response to epinephrine and norepinephrine and slight vasodilation with ISO (predominately alpha-1-receptors, remember we're talking about the vascular beds in the kidney!)
    (this multiple choice question has been scrambled)
  32. Which of the following is true of adrenergic receptors and their affect on vascular beds:

    A. pulmonary circulation is mediated by alpha- and beta-receptors and activation leads to vasodilation with EPI and NE
    B. alpha cells of the pancreas contain beta-receptors that when stimulated, secrete glucagon
    C. beta cells of the pancreas contain beta-receptors that when stimulated, inhibit insulin secretion
    d. none of the above 
    e. more than one of the above
    B. alpha cells of the pancreas contain beta-receptors that when stimulated, secrete glucagon
    (this multiple choice question has been scrambled)
  33. All of the following are true of the cardiovascular system and adrenergic stimulation except:

    A. ISO produces an increase in systolic pressure, a large decrease in diastolic pressure, a decrease in mean BP, a possible decrease of CO and a decrease in TPR
    B. NE and low[EPI] produces an increase in both systolic and diastolic pressure, an increase in BP, an increase in CO and an increase in TPR
    C. low [EPI ] produces an increase in systolic pressure, a decrease in diastolic pressure, a small/no change in mean BP, increase in CO and decrease in TPR
    d. all of the above are true
    B. NE and low[EPI] produces an increase in both systolic and diastolic pressure, an increase in BP, an increase in CO and an increase in TPR (...a decrease in CO...)
    (this multiple choice question has been scrambled)
  34. All of the following are true of smooth muscles and adrenergic stimulation except:

    a. bronchial smooth muscle contain beta-2-receptors that when stimulated cause bronchoconstriction
    b. the iris radial muscle contain alpha-1-receptors that when stimulated result in contraction (dilation of pupil)
    c. the GI tract contain both alpha- and beta-receptors that relax upon stimulation
    d. the bladder smooth muscle contain alpha-1 receptors that mediate contraction of the trigone region and beta-2-receptors that mediate relaxation of the detrussor muscle
    e. the uterus contain both alpha-1 and beta-2-receptors that mediate contraction upon stimulation by NE and biphasic effects by EPI
    • a. bronchial smooth muscle contain beta-2-receptors that when stimulated cause bronchoconstriction (...bronchodilation)
  35. Which of the following is true of smooth muscles and adrenergic stimulation:

    A. spleen smooth muscle contain alpha-1-receptors that result in contraction and blood expulsion when stimulated
    B. the vas deferens smooth muscle is alpha-1-receptor dominant and dilate when stimulated
    C. the seminal vesicles are alpha-2-receptor dominant and contract when stimulated
    d. none of the above
    e. more than one of the above
    A. spleen smooth muscle contain alpha-1-receptors that result in contraction and blood expulsion when stimulated
    (this multiple choice question has been scrambled)
  36. True or false. When EPI is given systemically, it may cause some respiratory stimulatin, restlessness and anxiety.
    true
  37. Indirect-acting adrenergic drugs include _____, _____ and _____, all of which are _____.
    ; tyramine; amphetamine; ephedrine; phenylethylamines
  38. Why are tyramine, amphetamine and ephedrine called indirect-acting adrenergic drugs?
    they do not directly stimulate adrenergic receptors but cause release of NE from sympathetic neurons that then act on alpha or beta-receptors
  39. What are the responses of tyramine injection and what are its possible drug-drug interaction?
    • increase in BP and heart rate
    • MAO inhibitors (effects of tyramine are potentiated because MAO oxidizes tyramine into its inactive form)
  40. All of the following are true of amphetamine and ephedrine except:

    a. mechanism of action is similar to tyramine
    b. can penetrate the blood-brain-barrier and produce CNS arousal by releasing NE and/or DA
    c. CNS effects include restlessness, tremor, reduction of fatigue, and loss of appetite
    d. tachyphylaxis refers to the chronic development of amphetamine tolerance to autonomic effects
    e. all of the above are true
    e. all of the above are true
  41. True or false. Ephedrine is used in the US therapeutically for the management of bronchial asthma.
    False, ephedrine is not used in the US, but pseudoephedrine is used therapeutically for the management of bronchial asthma.
  42. All of the following are true of the antihypertensive agent, Serpasil (reserpine), except:

    a. the mechanism of action is the blocking of the NE carrier of synaptic vesicles (VMAT) and inhibition of NE transport and accumulation of NE in cytosol which allows for degradation by MAO
    b. impairs the transport of DA by synaptic vesicles thereby impairing synthesis of NE in the ANS and depleting DA from the brain
    c. depletion of serotonin from serotonergic neurons and histamine from mast cells
    d. may cause miosis, excessive salivation, gastric hypersecretion, peptic ulceration, hyperperistalsis, diarrhea, bradycardia and hypotension
    e. all of the above are true
    e. all of the above are true
  43. All of the following are true of the antihypertensive agent, Ismalin (guanethidine), except:

    A. mechanism of action is blockage of exocytosis via interference with calcium entry
    B. lowers heart rate and renin secretion
    C. chronic use can reduce NE storage and produce a faster and long-lasting reduction in NE release
    d. all of the above are true
    A. mechanism of action is blockage of exocytosis via interference with calcium entry (does not interfere with with calcium entry, but somehow exocytosis is blocked!)
    (this multiple choice question has been scrambled)
  44. How does Catapress (clonidine) lower BP and what are some possible side effects?
    activation of alpha-2-receptors of CNS and reducing sympathetic outflow to blood vessels; dizzness, nausea, impotence and dry mouth
  45. True or false. Sudden withdrawal from clonidine after long-term  use can result in hypertensive crisis caused by over activity of sympathetic nervous system.
    true
  46. What are the symptoms of hypertensive crisis?
    • nervousness
    • headache
    • tachycardia
    • hypertension
    • sweating
  47. The effect of alpha-Me-NE is to _____ sympathetic nerve impulse activity originating in the _____ of the medulla by activation of _____ receptors.
    reduce; nucleus tractus solitarus; alpha-2
  48. All of the following are true of tricyclic antidepressants except:

    A. mechanism of action is the blockage of NET and enhancement of NE actions
    B. side effects include tremor, insomnia, blurred vision and orthostatic hypotension
    C. amitryptyline is the most potent inhibitor of NET
    d. all of the above are true
    C. amitryptyline is the most potent inhibitor of NET (desipramine is the most potent inhibitor of NET)
    (this multiple choice question has been scrambled)
  49. All of the following are true of cocaine abuse and its affect on adrenergic response except:

    A. irreversibly binds to NET and blocks uptake of NE and EPI in CNS
    B. enhancement of NE, EPI and DA response
    C. blocks conduction of nerve terminals (local anesthetic)
    d. all of the above are true
    A. irreversibly binds to NET and blocks uptake of NE and EPI in CNS (reversibly binds to NET and blocks uptake of NE and EPI in CNS)
    (this multiple choice question has been scrambled)
  50. All of the following are true of amphetamine and its affect on adrenergic response except:

    a. used to control narcolepsy and ADHD in children
    b. causes CNS arousal and suppresses appetite and sleep
    c. chronic overdose can produce psychotic behavior
    d. restlessness, tremor, reduction of fatigue and loss of appetite are typical side effects of chronic overdose
    e. acute overdose can produce severe confusion, anxiety, increase BP, angina and cardiac arrhythmias
    f. all of the above are true
    f. all of the above are true
  51. What 3 drugs should be given in the event of an anaphylactic shock (cardiovascular emergency)?
    • EPI
    • NE
    • PE
  52. What drug should be given in the event of a circulatory shock (cardiovascular emergency)?
    NE
  53. Match the following.

    Local anesthetics for:

    1. urticaria
    2. nasal decongestant
    3. mydriatic agent
    4. CNS stimulant

    a. amphetamine (oral)
    b. PE
    c. naphazoline
    d. methamphetamine
    e. EPI (parenteral)
    f. ephedrine (topical)
    • 1. urticaria - e. EPI (parenteral)
    • 2. nasal decongestant - b. PE, c. naphazoline
    • 3. mydriatic agent - b. PE, f. ephedrine (topical)
    • 4. CNS stimulant - a. amphetamine (oral), d. methamphetamine
  54. Dobutamine is an _____ _____ and comes as a racemic mixture of (L) and (D) isomers. The _____ isomer acts on both receptors as an alpha-agonist and weak beta-1-agonist. The _____ isomer acts as an alpha-1-antagonist and a potent beta-1-agonist. Dobutamine is commonly used in the acute management of _____ _____ to improve _____ _____.
    adrenergic agonist; L; D; heart failure; cardiac output
  55. All of the following are true of alpha adrenergic blocking agents except:

    A. prazosin is a selective antagonist of alpha-1 and alpha-2 receptors and is used to treat hypertension, lowers preload and increases afterload, and treats congestive heart failure
    B. phenoxybenzamine is a noncomeptitive irreversible alpha-adrenergic antagonist and is used for the treatment of pheochromocytoma and severe hypertension
    C. phentolamine is a competitive reversible antagonist and it is also used to treat pheochromocytoma, hypertension and hypertensive crisis
    d. all of the above are true
    A. prazosin is a selective antagonist of alpha-1 and alpha-2 receptors and is used to treat hypertension, lowers preload and increases afterload, and treats congestive heart failure (prazosin is a selective antagonist for alpha-1-receptors only!)
    (this multiple choice question has been scrambled)
  56. All of the following are true of propanolol except:

    a. it is a selective noncompetitive beta-receptor antagonist
    b. can exert profound effects when sympathetic control is elevated (exercise)
    c. causes decrease in heart rate, cardiac output, sinus rate and conduction
    d. causes decrease in peripheral resistance
    e. more than one of the above
    e. more than one of the above (a and d; propanolol is a selective competitive beta-receptor antagonist and causes an increase in peripheral resistance)
  57. All of the following are true of beta-blockers except:

    a. propanolol blocks the release of renin from juxtaglomerular apparatus which accounts for antihypertensive effect
    b. increase peripheral manifestations of hyperthyroidism
    c. increase intraocular pressure
    d. can be used in the treatment of anxiety and migraine headaches
    e. more than one of the above
    e. more than one of the above (b and c;  decrease peripheral manifestations of hyperthyroidism and intraocular pressure)
  58. What are some important situations to consider before prescribing a beta-blocker?
    • should not be used in asthmatic patients
    • can worsen congestive heart failure, Raynaud's syndrome and diabetes
    • should never be used concomitantlywith calcium channel blockers ->> can result in AV block
    • withdraw gradually to avoid withdrawal symptoms and myocardial infarction
  59. True or false. Selectivity of beta-blockers decreases with higher concentrations.
    true
  60. What is Bystolic and what are its effects?
    more specific blocker for beta-1 receptors than beta-2 receptors; reduces force of contraction and heart rate, vasodilation and reduction in peripheral resistance.
  61. What drug is most commonly known for blocking both alpha AND beta receptors?
    labetalol
  62. All of the following are true of glucocorticoids except:

    a. steroid-receptor dimer binds to glucose response elements (GRE) in promoter or enhancer regions of response genes and modulates their transcription
    b. net result is anti-growth, anti-inflammation and immunosuppression
    c. used to treat rheumatoid arthritis, asthma, inflammatory bowel disease, allergic reactions, and graft vs. host disease
    d. complications of chronic use are thinning of skin, cataracts, atherosclerosis, hypertension, gastritis, peptic ulcers, osteoporosis, psychosis, increased risk for infection, diabetes, weight gain and amenorrhea
    e. all of the above are true
    e. all of the above are true
  63. All of the following are true of glucocorticoid actions except:

    a. stimulate production of IL-1, IL-2, IL-4, and TNF-alpha
    b. inhibit T-lymphocyte proliferation response to antigen
    c. inhibit monocyte and macrophage activation and chemotaxis
    d. inhibit neutrophil chemotaxis and adhesion to endothelium
    e. stimulate phospholipase A2 and COX-2
    f. none of the above
    g. more than one of the above
    g. more than one of the above (a and e; inhibit production of IL-1, IL-2, IL-4, and TNF-alpha and inhibit phospholipase A2 and COX-2)
  64. All of the following are true of immunophilins except:

    A. they selectively block the production of IL-2 in helper T-cells
    B. primarily act on cytotoxic T-cells and inhibit cytokine release
    C. cyclosporin A and tacrolimus are the most common agent used
    D. used in the treatment of rheumatoid arthritis, psoriasis, atopic dermatitis, eczema and chronic dry eye
    e. more than one of the above
    B. primarily act on cytotoxic T-cells and inhibit cytokine release (act on helper T-cells)
    (this multiple choice question has been scrambled)
  65. All of the following are true of calcineurin inhibitors except:

    A. amphotericin B and aminoglycosides potentiate the nephrotoxic effects of cyclosporin and tacrolimus
    B. NSAIDS and acyclovir decrease cyclosporin and tacrolimus levels
    C. Ketoconazole and grapefruit juice increase cyclosporin and tacrolimus levels
    d. none of the above
    e. more than one of the above
    B. NSAIDS and acyclovir decrease cyclosporin and tacrolimus levels (NSAID and acyclovir potentiate the nephrotoxic effects of cyclosporin and tacrolimus, while agents like phenytoin, phenobarbital and rifampin decrease cyclosporin and tacrolimus levels)
    (this multiple choice question has been scrambled)
  66. All of the following are possible side effects of calcineurin-inhibiting agents except:

    A. non-Hodgkin's lyphoma
    B. hypotension
    C. osteoporosis
    D. nephrotoxicity
    E. neurotoxicity
    f. all of the above are true
    B. hypotension (hypertension)
    (this multiple choice question has been scrambled)
  67. Which of the following is true of sirolimus:

    a. mechanism is similar to that of cyclosporin and tacrolimus
    b. limits growth factor-induced cell proliferation
    c. compromised wound healing, dyslipidemia and thrombocytopenia are all major side effects
    d. drug interactions include ketoconazole, grapefruit juice, phenytoin, rifampin, NSAIDs and ACE inhibitors
    e. none of the above
    f. more than one of the above
    f. more than one of the above (b, c and d)
  68. All of the following are true of azathioprine except:

    A. mechanism of action is decreased RNA production caused by production of thioinosinic and thioguanylic acid via breakdown of 6-MP by hypoxanthine guanine phosphoribosyltransferase
    B. it is an alkylating agent that decreases B and T lymphocyte numbers, and decreases immunoglobulin and IL-2 production
    C. used as an immunosuppressive agent for organ transplant and autoimmune disorders
    D. adverse drug effects include bone marrow suppression, anemia and alopecia
    E. allopurinol is the major drug interaction
    B. it is an alkylating agent that decreases B and T lymphocyte numbers, and decreases immunoglobulin and IL-2 production (azathioprine is an anti-metabolite agent)
    (this multiple choice question has been scrambled)
  69. All of the following are true of methotrexate except:

    A. it is a structural analog of folic acid that can competitively and reversibly bind to DHFR that reduces dihydrofolic acidto its active form
    B. it is excreted renally
    C. TMP/SMX is a possible drug interaction
    D. it is an anti-metabolite designed for the treat of rheumatoid arthritis, psoriasis and graft vs. host disease
    E. GI upset,  stomatitis, alopecia, fatigue and headaches are all possible side effects
    f. all of the above are true
    A. it is a structural analog of folic acid that can competitively and reversibly bind to DHFR that reduces dihydrofolic acidto its active form (...irreversibly binds to DHFR...)
    (this multiple choice question has been scrambled)
  70. True or false. Methotrexate toxicity can be severe and even fatal.
    true
  71. All of the following are true of mycophenolate mofetil except:

    A. it is a lympthocyte specific agent used to treat refractory renal or organ transplant rejection
    B. its mechanism of action is inhibition of inosine monophosphate dehydronase (IMPD) that leads to decreased production of guanosine nucleotides and excess adenosine nucleotides
    C. decreased production of IL-1 and IL-2
    D. depresses lymphocyte proliferation and response to antigen
    e. more than one of the above
    C. decreased production of IL-1 and IL-2 (no effect on IL-1 and IL-2)
    (this multiple choice question has been scrambled)
  72. True or false. Leflunomide is a prodrug inhibitor of purine synthesis.
    False, leflunomide is a prodrug inhibitor of pyrimidine synthesis.
  73. Which of the following is true of cyclophosphamide:

    A. corticosteroids, antimalarials, tricyclic antidepressants and allopurinol increase its toxicity
    B. possible side effects are weight gain, constipation, and hirsutism
    C. it is metabolized by the kidney
    D. barbituates, alcohol, phenytoin and rifampin decrease its toxicity
    E. it is an alkylating agent used in the treatment of severe, life threatening autoimmune and inflammatory diseases
    f. all of the above
    E. it is an alkylating agent used in the treatment of severe, life threatening autoimmune and inflammatory diseases
    (this multiple choice question has been scrambled)
  74. Antithymocyte globulin is used largely to _____ immunosuppression and its side effects are _____, _____, _____, and _____.
    induce; infection; fever; headache; lymphoma
  75. Muromonab-CD3 _____, _____, and _____ T-cells. Its side effects are _____, _____, and _____.
    inactivates; depletes; destroys; fever; headache; hypertension
  76. Humira (adalimumab), Remicade (infliximab) and Enbrel (entanercept) are all examples of what types of agents?
    anti-TNF-alpha agents
  77. What are the 2 anti-cytokine monoclonal antibodies that we discussed in class?
    • Zenapax(daclizumab)
    • Simulect (basiliximab)
  78. All of the following are true of the COX enzymes except:

    A. COX-2 is inducible in inflammatory tissues, but is constitutive in the kidney and vascular endothelium
    B. COX-1 is inducible and is found mostly in the stomach and platelets
    C. COX-1 and COX-2 catalyze an oxygenation and peroxidation two-step reaction to yield the prostaglandin, PGH2
    D. Eicosanoids have a very short half-life and are first inactivated by specific enzymes followed by fatty acid oxidation
    E. COX products are released by facilitated transport and act via GPCRs
    B. COX-1 is inducible and is found mostly in the stomach and platelets (COX-1 is constitutive)
    (this multiple choice question has been scrambled)
  79. All of the following are true of COX products and their affect on the kidney except:

    A. PGE2 and PGI2 are syntehsized and act locally in the kidney
    B. TXA2 causes vasoconstriction and decline in renal function
    C. PGE2 and PGI2 are vasoconstrictors and decrease GFR
    D. PGE2 and PGI2 reduce the effects of ADH resulting in increased sodium and water clearance
    E. PGE2 and PGI2 directly increase release of renin from the JG apparatus
    f. more than one of the above
    C. PGE2 and PGI2 are vasoconstrictors and decrease GFR (PGE2 and PGI2 are vasodilators and increase GFR)
    (this multiple choice question has been scrambled)
  80. All of the following are true of COX products and their affect on blood vessels except:

    A. IV injection of PGI2 can cause hypertension and reflex tachycardia
    B. In microcirculation, PGE2 is produced by endothelial cells
    C. PGI2 and PGE2 both cause vasodilation
    D. PGI2 is primarily synthesized in vascular endothelium
    e. more than one of the above
    A. IV injection of PGI2 can cause hypertension and reflex tachycardia (IV injection of PGI2 can cause hypotension and reflex tachycardia)
    (this multiple choice question has been scrambled)
  81. All of the following are true of COX products and their affect on the GI tract except:

    A. most prostaglandins and thromboxanes cause GI smooth muscle contraction
    B. PGF2 and PGD2  are synthesized by COX1 in the stomach where they are cytoprotective by maintaining the secretion of mucins and limiting pepsin and acid secretion
    C. COX2 plays a role in healing gastric ulcers
    D. Inhibition of COX1 can cause GI distress
    e. more than one of the above
    B. PGF2 and PGD2  are synthesized by COX1 in the stomach where they are cytoprotective by maintaining the (PGE2 and PGI2  are synthesized by COX1 in the stomach where they are cytoprotective by maintaining the secretion of mucins and limiting pepsin and acid secretion)
    (this multiple choice question has been scrambled)
  82. All of the following are true of COX products and their affect on platelets except:

    A. TXA2 increases the effects of thrombin
    B. TXA2 effects are countered by PGI2 and PGD2
    C. TXA2 is a vasodilator and potent platelet aggregator
    D. TXA2 synthesized by COX1 is the major eicosanoid produced in platelets
    e. more than one of the above
    C. TXA2 is a vasodilator and potent platelet aggregator (TXA2 is a vasoconstrictor and potent platelet aggregator)
    (this multiple choice question has been scrambled)
  83. Which of the following is true of COX products and their affect on the lung:

    a. TXA2 relaxes bronchiolar and tracheal muscle
    b. PGI2 and PGE2 constrict bronchiolar and tracheal muscle
    c. none of the above
    d. all of the above
    c. none of the above (TXA2 constricts bronchiolar and tracheal muscleb; PGI2 and PGE2 relax bronchiolar and tracheal muscle)
  84. Which of the following is true of COX products and their affect on the nervous system:

    a. IL-2 induces the synthesis of PGE2 which causes fever
    b. PGE2 increases transmission in pain fibers in the spinal cord
    c. In the periphery, PGE2 and PGI2 sensitize nerve endings of pain fibers
    d. none of the above
    e. more than one of the above
    e. more than one of the above (b and c are true)
  85. True or false. TXA2, PGF2-alpha, and low doses of PGE2 cause uterine contraction.
    true
  86. Which of the following is true of COX products and their affect on inflammation:

    A. PGE2 stimulates mitogen induced proliferation and lymphokine release from T-lymphocytes
    B. PGE2 inhibit differentiation of B-lymphocytes into plasma cells
    C. the stimulation of COX1 and COX2 produces paliative relief from inflammation
    D. TXA2 inhibits clonal expansion of T-lymphocytes and inhibits interleukin and interleukin receptor synthesis
    e. all of the above
    B. PGE2 inhibit differentiation of B-lymphocytes into plasma cells
    (this multiple choice question has been scrambled)
  87. What is the most likely explanation for the anti-inflammatory effect of COX-inhibitors?
    diminished eicosanoid effects on vasodilation and sensitization of nociceptive nerves
  88. All of the following are descriptive of prostaglandins that are used as pharmacological agents except:

    A. misoprostol is a PGE1 derivative and is used in conjunction with mifepristone to terminate pregnancies and to protect against peptic ulcers
    B. PGE2 and PGF2-alpha are used with oxytocin to induce labor
    C. alprostadil is a PGF2 that is used for its vasodilating effect of impotence and maintenance of the patent ductus arteriosus prior to cardiac surgery
    D. prostacyclin (PGI2) is used to treat pulmonary and portopulmonary hypertension
    C. alprostadil is a PGF2 that is used for its vasodilating effect of impotence and maintenance of the patent ductus arteriosus prior to cardiac surgery (it is a PGE1)
    (this multiple choice question has been scrambled)
  89. All of the following are true of LOX enzymes except:

    A. can catalyze the oxygenation of arachadonic acid to hydroperoxides
    B. arachidonate is oxygenated and dehydrated by 5-LOX to produce LTA4
    C. PMNs, basophils, mast cells,eosinophils and macrophages contain the 12-LOX isoform
    D. LTA4 is either hydrated to LTB4 or conjugated by a thiol bond to form glutathione
    C. PMNs, basophils, mast cells,eosinophils and macrophages contain the 12-LOX isoform (PMNs, basophils, mast cells,eosinophils and macrophages contain the 5-LOX isoform)
    (this multiple choice question has been scrambled)
  90. Which of the following is true of LOX enzymes:

    a. Platelets contain 12-LOX which can convert arachidonic acid to 12S-HETE and 12R-HETE
    b. LTA4 is converted to lipoxin by 12-LOX
    c. Leukotrienes and HETEs interact with GPCRs
    d. LTB4 and LTC4 are actively transported out of the cell and have short half-lives
    e. LTB4 is inactivated by CYP enzymes in leukocytes
    f. all of the above
    f. all of the above
  91. Which of the following is true of LOX products and their affect on airways:

    a. LTC4 and LTD4 are secreted in anaphylaxis asthma and are powerful broncoconstrictors
    b. LTC4 and LTD4 increase permeability of microvessels leading to mucus secretion and plasma exudation
    c. none of the above
    e. all of the above
    e. all of the above
  92. True or false. LTC4 is secreted by colonic epithelial cells and levels of this leukotriene are high in inflammatory bowel disease.
    False, LTB4 is secreted by colonic epithelial cells and levels of this leukotriene are high in inflammatory bowel disease.
  93. _____ and _____ are leukotrienes that depress myocardium and coronary blood flow.
    LTC4; LTD4
  94. Inhibitors of _____ and _____ antagonists are effective in asthma but are not useful in generalized inflammation like rheumatoid arthritis.
    5-LOX; LT-receptor
  95. True or false. Aspirin inhibits COX1 and COX2, but has a higher affinity for COX2.
    False, aspirin inhibits COX1 and COX2, but has a higher affinity for COX1.
  96. All of the following are true of aspirin and its pharmacological effects except:

    a. acts peripherally and centrally to relieve mild to moderate pain
    b. blocks pyrogen induced prostaglandin synthesis in the hypothalamus to lower febrile body temperature as well as basal body temperature
    c. reduces heat, pain and swelling
    d. low doses can reversibly inhibit platelet COX1 without affecting endothelial COX2
    e. more than one of the above
    e. more than one of the above (b and d; blocks pyrogen induced prostaglandin synthesis in the hypothalamus and only lowers febrile body temperature not basal body temperature, aspirin irreversibly inhibits platelet COX1 without affecting endothelial COX2)
  97. All of the following are true of aspirin and its possible side effects except:

    A. can exacerbate existing renal disease
    B. bronchospasms caused by hypersensitivities
    C. can precipitate gouty attacks
    D. linked to Reye's Syndrome in children
    E. gastric irritation, bleeding and peptic ulcers are due to inhibition of gastric COX2
    E. gastric irritation, bleeding and peptic ulcers are due to inhibition of gastric COX2 (...gastric COX1)
    (this multiple choice question has been scrambled)
  98. All of the following are true of acetaminophen except:

    A. it is a non-specific COX inhibitor
    B. lacks antiinflammatory and anticoagulant effects
    C. has analgesic and antipyretic effects
    D. hepatotoxicity and nephrotoxicity are major concerns
    E. causes gastric irritation
    E. causes gastric irritation
    (this multiple choice question has been scrambled)
  99. All of the following are true of ibuprofen and naproxen except:

    a. they are non-selective reversible inhibitors of COX
    b. have antiinflammatory, analgesic and antipyretic effects
    c. are less useful as anticoagulants
    d. have milder GI effects
    e. may cause agranulocytosis, aplastic anemia, and renal failure
    f. all of the above are true
    f. all of the above are true
  100. Which of the following is true of indomethacin:

    a. it is a selective COX inhibitor
    b. has severe gastric, headache, thrombocytopenia, aplastic anemia, coronary artery constriction and hyperkalemia effects
    c. can be used long-term
    d. should not be used in children
    e. more than one of the above
    e. more than one of the above (b and d)
  101. Which of the following is true of Celebrax (celecoxib):

    A. has anticoagulant effects
    B. it is a non-selective reversible COX inhibitor
    C. higher incidence of gastric irritation than aspirin
    D. linked to high incidence of myocardial infarction and sudden cardiac death
    e. more than one of the above
    D. linked to high incidence of myocardial infarction and sudden cardiac death
    (this multiple choice question has been scrambled)
  102. All of the following are true of misoprostol except:

    A. it is a synthetic prostaglandin
    B. can prevent gastric ulcers when used concurrently with a selective COX inhibitor
    C. can cause diarrhea and should not be used during pregnancy
    d. all of the above are true
    B. can prevent gastric ulcers when used concurrently with a selective COX inhibitor (...non-selective COX inhibitors, like NSAIDS)
    (this multiple choice question has been scrambled)
  103. All of the following are true of methotrexate except:

    A. has GI, hematological and hepatic effects
    B. reduce inflammation and joint destruction
    C. can cause thymidine deficiency
    D. it stimulates dihydrofolate reductase (DHFR)
    E. is teratogenic
    D. it stimulates dihydrofolate reductase (DHFR) (...inhibits DHFR)
    (this multiple choice question has been scrambled)
  104. All of the following are true of hydroxychloroquine except:

    A. side effects are rare, but vision should be monitored regularly for retinal damage
    B. should be avoided in pregnancy
    C. used in the treatment of malaria and ameba infestation
    D. reduces inflammation and joint destruction
    E. it is a basic drug that partition into the acidic vacuoles of microbes
    B. should be avoided in pregnancy (safe to use in pregnancy)
    (this multiple choice question has been scrambled)
  105. Which of the following is true of sulfasalazine:

    a. used to treat pain and fever
    b. lacks antirheumatic effect
    c. prefered over methotrexate in treatment of mild rheumatoid arthritis
    d. common side effects are rash, GI upset and photosensitivity
    e. more than one of the above
    e. more than one of the above (c and d)
  106. All of the following are true of leflunomide except:

    A. stimulates p450 enzyme in liver
    B. possible side effects are diarrhea, hairloss and hepatic damage 
    C. inhibits dihydroorotate dehydrogenase
    D. drug interaction with NSAIDS
    e. all of the above are true
    A. stimulates p450 enzyme in liver (inhibits CYP2C9)
    (this multiple choice question has been scrambled)
  107. Azathioprine is an inhibitor of several steps in _____ _____ that inhibit _____ synthesis.
    purine interconversions; DNA
  108. True or false. Azathioprine and methotrexate have similar effects.
    true
  109. Match the following.

    1. Enbrel (etanercept)
    2. Remicade (imfliximab)
    3. Humira (adalimumab)

    a. human antibody
    b. administered subQ
    c. human TNF receptor and Fc fragment of IgG
    d. produces effects similar to that of methotrexate
    e. chimeric human-mouse monoclonal anti-TNF
    f. administered IV
    • 1. Enbrel (etanercept) - b. administered subQ, c. human TNF receptor and Fc fragment of IgG, d. produces effects similar to that of methotrexate
    • 2. Remicade (imfliximab) - e. chimeric human-mouse monoclonal anti-TNF, f. administered IV
    • 3. Humira (adalimumab) - a. human antibody, b. administered subQ
  110. All of the following are true of Orencia (abatacept) except:

    A. inhibits T-lymphocyte activation by binding to CD80 and CD86 on APCs to prevent binding of T-cells CD28
    B. fusion protein composed of T-lymphocyte-associated-antigen-4 and a modified human Fc fragment
    C. may be used to treat RA
    D. principle untoward effect is renal failure
    e. all of the above are true
    D. principle untoward effect is renal failure (principle untoward effect is infection)
    (this multiple choice question has been scrambled)
  111. All of the following are true of Rituxan (rituximab) except:

    A. adminstered IV
    B. it is a chimeric monoclonal antibody that targets T-cell antigen CD28
    C. some possible side effects include infusion reactions and activation of hepatitis B
    D. recently used for treatment of autoimmune diseases that are resistent to anti-TNF agents
    e. all of the above are true
    B. it is a chimeric monoclonal antibody that targets T-cell antigen CD28 (...targets B-cell antigen CD20)
    (this multiple choice question has been scrambled)
  112. All of the following are true of colchicine except:

    A. can be used for acute and chronic gout attacks
    B. side effects include hair loss, bone marrow suppresion, peripheral neuropathy and myopathy
    C. causes GI disturbances, mainly diarrhea
    D. binds to tubulin in leukocytes and reduces their mobility and ability to undergo phagocytosis
    E. administered orally
    f. none of the above
    A. can be used for acute and chronic gout attacks (only used for acute gout attacks)
    (this multiple choice question has been scrambled)
  113. All of the following are true of allopurinol except:

    a. it is an inhibitor of xanthine oxidase
    b. inhibitor the synthesis of urate
    c. used to treat chronic gout
    d. rare side effects include skin reactions, GI disturbances, bone marrow suppression and peripheral neuritis
    e. none of the above
    e. none of the above (all of the above are true)
  114. All of the following are true of probenicid except:

    A. used to treat acute gout
    B. inhibits the active excretion and reaccumulation of urate
    C. inhibits proximal tubular secretion of penicillins
    D. side effects are rare and may include allergic dermatitis and aplastic anemia
    e. none of the above
    A. used to treat acute gout (used to treat chronic gout)
    (this multiple choice question has been scrambled)
  115. All of the following are true of glucocorticoids except:

    A. usually administered orally
    B. once bound to its receptor a signaling cascade is initiated and tyrosine kinases are activated
    C. can be used to treat inflammation due to an insect bite, bronchial asthma, rheumatoid arthritis, acute leukemia and some breast cancers
    D. prednisone and dexamethasone are 5-30 times more potent than cortisol
    E. cause metabolic, anti-inflammatory and sodium retentive effects
    F. the untoward effects of cortisol include cataracts, hyperglycemia, thinning of the skin, edema and peptic ulcers
    B. once bound to its receptor a signaling cascade is initiated and tyrosine kinases are activated (once bound to its receptor, the activated receptor enters the nucleus and binds to GREs which leads to activation or inhibition of mRNA transcription)
    (this multiple choice question has been scrambled)
  116. All of the following are drugs that are currently used to treat bronchial asthma and COPD except:

    A. ephedrine
    B. prednisone
    C. ipratropium
    D. Singulair (montelukast)
    E. albuterol
    F. fluticasone
    g. none of the above
    A. ephedrine (not used anymore because of its undesirable cardiac stimulation and CNS effects (tremors))
    (this multiple choice question has been scrambled)
  117. Match the following.

    1. bronchodilators
    2. non-selective beta-2-agonists
    3. selective beta-2-agonists
    4. anticholinergic agents
    5. anti-inflammatory agents
    6. prostaglandins
    7. leukotriene synthesis inhibitors
    8. leukotriene receptor blocker
    9. IgE antibody
    10. corticosteroid
    11. xanthine

    a. cromolyn sodium
    b. PGE1 and PGE2
    c. epinephrine
    d. prednisone
    e. Genentech (omalizumab)
    f. fluticasone
    g. theophylline
    h. Albuterol
    i. ephedrine
    j. Spiriva (tiotropium)
    k. Atrovent (ipratropium bromide)
    l. Advair
    m. zileuton
    n. Accolate (zafirleukast)
    • 1. bronchodilators - c. epinephrine, i. ephedrine
    • 2. non-selective beta-2-agonists - c. epinephrine, i. ephedrine
    • 3. selective beta-2-agonists - h. Albuterol
    • 4. anticholinergic agents - j. Spiriva (tiotropium), k. Atrovent (ipratropium bromide)
    • 5. anti-inflammatory agents - a. cromolyn sodium, d. prednisone, f. fluticasone, l. Advair
    • 6. prostaglandins - b. PGE1 and PGE2
    • 7. leukotriene synthesis inhibitors - m. zileuton
    • 8. leukotriene receptor blocker - n. Accolate (zafirleukast)
    • 9. IgE antibody - e. Genentech (omalizumab)
    • 10. corticosteroid - d. prednisone, f. fluticasone, l. Advair
    • 11. xanthine - g. theophylline
  118. _____ and _____ are two new therapeutic treatments for asthma and COPD that are still under development.
    IL-5 antibody; bacterial DNA induces TH1 response
  119. All of the following are true of selective beta-2-agonists used to treat asthma and COPD except:

    A. superior to non-selective beta-2-agonists because they produce bronchodilation and fewer cardiac effects
    B. drug contraindications include non-selective beta-blockerslike propanolol or timolol because they decrease the bronchodilating effects of beta-2-agonists
    C. long-acting salmeterol and formoterol can be used as monotherapy
    D. most of them are short-acting
    C. long-acting salmeterol and formoterol can be used as monotherapy (should be used in combination with an inhalation corticosteroid like fluticasone)
    (this multiple choice question has been scrambled)
  120. All of the following are true of anticholinergic agents used to treat asthma and COPD except:

    A. Atrovent and Spiriva are not FDA-approved for the treatment of asthma, but they may be used off-label for treatment of acute asthma
    B. Spiriva (tiotropium bromide) is an inhalation powder that is used for the treatment of bronchospasms associated with COPD
    C. theophylline can be administered orally or IV and its mechanism of action is inhibition of phosphodiesterase which leads to bronchial muscle relaxation and decreased mucosal secretion and edema
    D. Atrovent (ipratropium bromide) is used as a long-acting broncodilator for patients with chronic bronchitis and COPD
    e. none of the above
    D. Atrovent (ipratropium bromide) is used as a long-acting broncodilator for patients with chronic bronchitis and COPD (Atrovent is short-acting)
    (this multiple choice question has been scrambled)
  121. All of the following are true of anticholinergic agents used to treat asthma and COPD except:

    A. theophylline has modest anti-inflammatory effects
    B. may cause N/V
    C. barbituates and caffeine cause drug interactions
    D. anticholinergic agents and beta-2-agonists can be used synergistically in treatments for prolonged asthma and COPD
    E. plasma levels should be monitored during treatment
    F. possible side effects include seizures, arrhythmia, hypertension and cardiac arrest
    F. possible side effects include seizures, arrhythmia, hypertension and cardiac arrest (possible side effects include seizures, arrhythmia, hypotension and cardiac arrest)
    (this multiple choice question has been scrambled)
  122. All of the following are true of corticosteroids except:

    A. inhaled corticosteroids have a direct and immediate effect on airflow obstruction, similar to that of inhaled bronchodilators
    B. they are used as anti-inflammatory agents
    C. Advair should not be used for the treatment of children less than 12 year-old
    D. adverse reactions include Cushing's syndrome and growth retardation
    E. prednisone is given orally or IV for systemic treatment of severe acute asthma
    A. inhaled corticosteroids have a direct and immediate effect on airflow obstruction, similar to that of inhaled bronchodilators
    (this multiple choice question has been scrambled)
  123. All of the following are true of corticosteroids except:

    A. possible side effects are sore throat, dry mouth, skin rashes, headache and dizziness
    B. does not relax smooth muscle directly and should not be used to treat acute bronchospasms
    C. cromolyn sodium stabilizes mast cell membranes and prevent the release of mediators, but does not inhibit binding of IgE to mast cells
    D. acts as a sodium channel blocker and is used exclusively for the prophylatic treatment of mild to moderate asthma
    E. must be given via inhalation because oral absorption is poor
    D. acts as a sodium channel blocker and is used exclusively for the prophylatic treatment of mild to moderate asthma (acts as a calcium channel blocker and is used exclusively for the prophylatic treatment of mild to moderate asthma)
    (this multiple choice question has been scrambled)
  124. Singulair (montelukast) is most commonly used in the treatment of _____ _____ _____.
    seasonal allergic rhinitis
  125. _____ is a humanized monoclonal antibody given subQ that binds to IgE and is used in the treatment of moderate to severe asthma.
    Genentech (omalizumab)
  126. True or false. Oral administration is superior to IV administration if a patient has a functioning gut.
    true
  127. What are the 4 basic prescription laws?
    • max of 4 medications per Rx
    • no refills on C-IIs
    • up to 5 refills in 6 months for C-IIIs to C-Vs
    • DEA # is needed for all controlled substances
  128. What should always be included on a Rx?
    • Date/time
    • your name/pager #
    • height/weight of patient
    • allergies of patient

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