Answers and Explanations

occur in 7 to 22% of patients using the drug over a 3- to 12-month period. The drug may be used in combination with other glaucoma drugs. (5:1475)

5. (A) Ticlopidine (Ticlid) is an inhibitor of platelet aggregation that is administered orally with food, in doses of 250 mg twice daily. Patients using this drug should have a complete blood count (CBC) with differential performed every two weeks for three months to detect neutropenia (decreased number of white blood cells). The drug's antiplatelet effects are not maximal until at least 8 to 11 days of therapy have been completed. (5:342)

6. (C) Nicardipine (Cardene) is a calcium channel-blocking agent employed in the treatment of angina pectoris and hypertension. It is also indicated for the treatment of congestive heart failure. (3)

1. (E) Zafirlukast (Accolate), zileuton (Zyflo), and montelukast sodium (Singulair) are examples of leukotriene receptor antagonists. Leukotriene production in the body has been associated with the development of asthma symptoms such as airway edema. By interfering with leukotriene receptors, these drugs can be used for prophylaxis and long-term treatment of asthma. They are not useful for the treatment of acute asthmatic attacks. (3)

2. (D) Milrinone lactate (Primacor) and am-rinone lactate (Inocor) are classified as inotropic agents. They are used only par-enterally for the short-term treatment of congestive heart failure (CHF). They produce a positive inotropic effect (ie, they increase the force of cardiac contraction) and they produce vasodilation. (3)

3. (E) Finasteride (Proscar, Propecia) is an agent that is administered orally for the treatment of benign prostatic hyperplasia (BPH). It is also used in the treatment of alopecia (hair loss) in men, particularly in male patients who have male-pattern hair loss. Finasteride acts to inhibit the formation of 5a-dihy-drotestosterone, a potent androgen. It is classified as a pregnancy category X drug. Women who are or may become pregnant should avoid contact with crushed finasteride tablets and with semen from patients using the drug. (3)

4. (E) Latanoprost (Xalatan) is a prostaglandin F2o analog that is used as an ophthalmic solution to reduce intraocular pressure by increasing the outflow of aqueous humor from the eye. Altered pigmentation of the iris may

7. (B) Alteplase (Activase) and reteplase (Reta-vase) are tissue plasminogen activators prepared by recombinant DNA technology. They are administered intravenously in order to lyse thrombi in patients with acute myocardial infarction. (3)

8. (A) Gold compounds such as aurothioglu-cose (Solganal), auranofin (Ridaura), and gold sodium thiomalate (Myochrysine) are used to suppress or prevent, but not cure, arthritis and synovitis. Aurothioglucose and gold sodium thiomalate are administered intra muscularly while auranofin is only administered orally. All gold compounds may cause serious adverse effects, including dermatitis, renal damage, and blood dyscrasias. (5:1436)

9. (E) Tocainide (Tonocard) is most similar to mexiletine (Mexitil). Both are classified as Group IB antiarrhythmic drugs. These are agents that slightly depress phase 0 and may shorten the duration of the action potential. (3)

10. (C) Quinidine is an antiarrhythmic agent that derived from the bark of the cinchona tree. As does quinine, quinidine may cause an array of adverse effects collectively referred to as cinchonism. (3)

11. (C) Budesonide (Rhinocort) and fluticasone propionate (Flonase) are corticosteroids that are employed clinically for the treatment of seasonal and perennial allergic rhinitis. Ne-docromil (Tilade) is an inhalational product that is used for maintenance therapy in the management of bronchial asthma. (3)

12. (E) Sibutramine (Meridia), mazindol (San-orex, Mazanor), and benzphetamine (Didrex) are central nervous system stimulants used as anorexiants, ie, they are used to reduce appetite. (3)

13. (E) Colestipol (Colestid) is an anion exchange resin that binds bile acids in the intestine, causing them to be removed in the feces. This causes further breakdown of cholesterol to bile acids, as well as a decrease in low-density lipoproteins (LDL) and serum cholesterol levels. (5:361)

14. (C) Simvastatin (Zocor) is an HMG-CoA reductase inhibitor. It is employed as an adjunct to diet in treating hypercholesterolemia. It is classified in pregnancy category X. (3)

15. (B) Benzodiazepines are believed to act by potentiating the effects of gamma-aminobu-tyric acid (GABA), an inhibitory amino acid.

16. (D) Tolcapone (Tasmar) is a COMT inhibitor used in the treatment of Parkinson's disease. Its use has been associated with the potential for the development of hepatic failure. It should, therefore, not be used in patients who have any evidence of liver disease. Baseline liver enzyme studies should be performed before therapy is begun and at two-week intervals during the first year of therapy. Such studies should be continued every four weeks during the 12 to 18 months of therapy and every eight weeks thereafter. (3)

17. (A) Epithelial keratitis is an ophthalmic disorder caused by the action of herpes simplex virus. Trifluridine (Viroptic) blocks herpes simplex virus reproduction and thereby helps to control this condition. (3)

18. (B) Terbinafine (Lamisil) is an antifungal agent used in treating onychomycosis of the fingernail or toenail caused by dermatophytes. Mafenide is for the treatment of burns and cycloserine is an antitubercular drug. (3)

19. (A) Isotretinoin (Accutane) is a vitamin A derivative that appears to be useful in the treatment of acne because of its ability to reduce the secretion of sebum. It is classified in pregnancy category X. Female patients should be advised to use an effective contraceptive technique for at least one month prior to starting isotretinoin and for at least one month after discontinuing it. Such patients must also have had a negative serum pregnancy test within two weeks of starting the drug. (5:1495)

20. (E) Sotalol (Betapace) is a nonselective beta-adrenergic blocking agent. Such drugs should be avoided in patients with bron-chospastic disorders because they may cause bronchoconstriction. (3)

21. (D) Dobutamine (Dobutrex) is a parenterally administered agent that is chemically related to dopamine. It acts by stimulating primarily betaj-adrenergic receptors to produce an inotropic effect. It is commonly employed in the treatment of shock syndrome. Unlike dopamine, dobutamine does not cause the endogenous release of norepinephrine. (5:398)

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22. (C) Ropinirole (Requip) and pergolide (Permax) are dopaminergic agents that enhance dopamine activity and provide palliative treatment of Parkinson's disease. Procycli-dine is an anticholinergic drug used to treat Parkinson's disease. (3)

23. (D) Salmeterol (Serevent) is an agonist acting primarily on beta2-adrenergic receptors to produce bronchodilation. It is the longest-acting sympathomimetic bronchodilating agent with a duration of approximately 12 hours. It is available as an aerosol (Serevent) and as a powder for inhalation (Serevent Diskus). Because of its rather slow onset of action it is used only for maintenance and prophylaxis. It is not used for treating acute asthma attacks. (3)

24. (C) Diphenhydramine and hydroxyzine are Hj-receptor antagonists. They antagonize actions of histamine such as vasodilation. Famotidine is an H2-receptor antagonist that is used to reduce gastric acid secretion. (3)

25. (B) Metoclopramide (Reglan) is a prokinetic agent that increases the motility of the upper GI tract without increasing the production of secretions. It appears to act by increasing the sensitivity of GI tissues to the action of acetylcholine. (5:593)

26. (D) Inhalation of the smoke of cannabis generally results in increased pulse rate, perceptual changes, and vascular congestion of the eye. (3)

27. (D) Betamethasone is about 25 times as potent as hydrocortisone, 5 to 6 times as potent as prednisone, 4 to 6 times as potent as triamcinolone, and about 30 times as potent as cortisone. (3)

28. (E) Benzoyl peroxide is an oxidizing agent found in many OTC products that are used in the treatment of acne. It is believed to exert an antibacterial effect, thereby reducing the level of Propionibacterium acnes on the skin surface. (3)

29. (A) Clavulanate potassium is an agent capable of inactivating beta-lactamase enzymes that are often found in microorganisms resistant to penicillins. The addition of clavulanate potassium to ticarcillin disodium extends the spectrum of antimicrobial coverage of this penicillin to include beta-lactamase-producing organisms. (3)

30. (B) Oxytocin is an endogenous hormone produced by the posterior pituitary gland. It is a uterine stimulant that promotes uterine contractions, particularly during labor. The other hormones listed are released by the anterior pituitary gland. (3)

31. (C) During the menstrual cycle, levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) vary widely. At the time of ovulation, the concentration of each of these hormones reaches a peak, coinciding with the release of the ovum and the complete development of a mature endometrial wall. (3)

32. (D) Liotrix consists of a uniform mixture of synthetic levothyroxine sodium (T4) and lio-thyronine sodium (T3) in a ratio of 4:1 by weight. It is used in products such as Eu-throid and Thyrolar as a thyroid hormone supplement. (5:1258)

33. (E) Propylthiouracil and methimazole (Tapa-zole) are antithyroid agents that inhibit synthesis of thyroid hormone and thus are useful in the treatment of hyperthyroidism. (3)

34. (D) Most antipsychotic agents are believed to act by antagonizing dopamine receptors. They may also cause some blockade of cholinergic, alphaj-adrenergic, and histamine receptors. (3)

35. (D) Tiagabine (Gabitril) and topiramate (Topamax) are anticonvulsants utilized for the treatment of partial seizures. (3)

36. (B) Buspirone (BuSpar) is an antianxiety agent that, unlike the benzodiazepines, barbiturates, and carbamates, does not produce significant sedative, muscle relaxant, or anticonvulsant effects. (3)

37. (B) Nelfinavir (Viracept) is the only protease inhibitor. Cidofovir is an inhibitor of DNA polymerase that is used for the treatment of CMV retinitis. Acyclovir (Zovirax) also acts by interfering with DNA polymerase and is used for the treatment of herpes simplex and herpes zoster infections. (3)

38. (E) All of these are aminopenicillins. They are easily recognized by the "... am ..." in their name. (3)

39. (C) Cefpodoxime proxetil (Vantin) and dirithromycin (Dynabac) are prodrugs, ie, they are pharmacologically inactive until they are enzymatically converted to their active forms in the body (3)

40. (C) Probenecid is a uricosuric and renal tubular blocking agent. It is capable of inhibiting the tubular secretion of penicillins and cephalosporins, thereby increasing the plasma levels of these drugs and prolonging their action in the body (3)

41. (A) The strength of phenoxymethyl penicillin is usually measured in milligrams or units. Each milligram of the pure drug is equivalent to 1600 units of activity. Thus, 300 mg of phenoxymethyl penicillin is approximately equivalent to 480,000 units of activity. (3)

42. (D) Nafcillin and cloxacillin are both beta-lactamase-resistant penicillins. They are employed primarily in treating infections caused by beta-lactamase-producing staphylococci. (3)

45. (B) LYMErix is a vaccine that is used to prevent Lyme disease, a tick-borne infection. Cyclosporine (Sandimmune) and tacrolimus (Prograf) are immunosuppressive agents employed in preventing rejection of transplanted organs. (3)

(E) Sumatriptan (Imitrex) and other "trip-tans" such as naratriptan (Amerge), rizatriptan (Maxalt), and zolmitriptan (Zomig) are primarily used for the treatment of migraine headaches. (3)

(A) Diacetylmorphine is another name for heroin. Because of its great ability to cause dependence, diacetylmorphine may not be legally prescribed in the United States. (3)

48. (B) Sulfonamides exert their antimicrobial action by competitively antagonizing p-aminobenzoic acid (PABA). Sulfonamide resistance may occur if an organism produces excessive amounts of PABA or if PABA-containing products are used concurrently with a sulfonamide drug. (3)

(E) Dapsone is a sulfone that is bactericidal and bacteriostatic against Mycobacterium leprae, the organism believed to be the cause of leprosy (Hansen's disease). (3)

50. (D) Clonidine is a central alpha-adrenergic stimulant. Its primary action is to stimulate alpha2-adrenergic receptors to reduce sympathetic outflow from the CNS, thereby reducing peripheral vascular resistance and reducing heart rate and blood pressure. (3)

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