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Pharm II Exam III practice quiz
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Questions in this quiz (144)
1Which of the following is NOT a cardinal sign of inflammation?
- ARubor
- BTumor
- CFunctio Laesa
- DCrepitus
2Inflammation ends with permanent destruction of tissue or with complete healing after removal of injurious stimulus
- ATrue
- BFalse
3Chronic inflammation is beneficial
- ATrue
- BFalse
4Cell damage results in the release of
- AProstaglandins
- BProstacyclines
- CEiocosanoids
- DAll of the above
5A fundamental feature of inflammation is
- AIncrease permeability of the microvasculature
- BSuppression of leukocytes
- CRelief of symptoms
- DImpaired quality of life
6Which of the following is NOT a goal of treatment of inflammation?
- ARelief of symptoms
- BMaintenance of function
- CSlowing tissue damage
- DShort term control
7Which of the following is NOT considered a drug treatment of arthritis?
- ANSAIDS
- BCorticosteroids
- CDMARDS
- DNaltrexone
8Which of the following is true about NSAIDS?
- AIncreases the inflammatory pain response
- BCOX-2 inhibitors can decrease the chance of cardiovascular effects
- CCOX-2 inhibitors are found to cause Upper GI complications as well as lower GI complications
- DCOX-2 selective drugs inhibit PG synthesis through selective inhibition of COX-2 isoenzyme
9Which of the following is best against release of arachidonic acid?
- AASA
- BIndomethacin
- CCorticosteroids
- DAcetominophen
10Which of the following is NOT a physiologic effect of COX-1?
- AProduction of TXA2
- BRegulate renal blood flow
- CMaintain mucosal integrity
- DInduce inflammation and pain
11Choose ALL of the following that can be seen in OA
- ABone loss
- BThickened synovial membrane
- CEroded cartilage
- DBone spurs
- ESynovial changes
- FDegenerated cartilage
12Which best describes Osteoarthritis?
- ACauses systemic symptoms
- BRadiographic findings of narrowed joint space and lipping of marginal bone
- CThe least common form of joint disease
- DCan be diagnosed with laboratory findings
13Prevalence of OA increased due to aging population and obesity
- ATrue
- BFalse
14Which of the following is NOT a radiographic finding of OA?
- AHeberden nodes
- BBouchard nodes
- CThinning subchondral bone
- DHypertrophy of bone at articular margins
15OA is overtreated
- ATrue
- BFalse
16Which of the following would NOT be effective to treat nociceptive and inflammatory pain syndromes?
- ANSAIDS
- BCOX-2 selective inhibitors
- CAcetominophen
- DSNRIs
17Which of the following would NOT be effective in treating neuropathic and functional pain syndromes?
- AGabapentin
- BAmytriptyline
- CVenlafaxine (SNRI)
- DOpioids
18Nociceptive and inflammatory pain are both adaptive (protective)
- ATrue
- BFalse
19OA pain mechanisms are unknown
- ATrue
- BFalse
20Which of the following is NOT a method of pain management in OA?
- AIntraarticular injections
- BTopical agents
- CPatient education
- DDMARDS
21Which of the following is TRUE regarding acetominophen?
- AIt has potenet anti-inflammatory activity
- BIt acts as a prodrug, activating CB1 receptors in the CNS
- CThe recommended daily max dose for alcoholics is 4g
- DIt decreases risk of bleeding
2295% of Acetaminophen is conjugated into NAPQ1, a toxic metabolite
- ATrue
- BFalse
23Why does chronic ingestion of ethanol increase risk of hepatotoxicity?
- ABecause ethanol induces the CYP2E1 enzymes
- BBecause ethanol decreases the amount of glutathione, therefore there isn't enough to convert NAPQ1 into an inactive mtabolite
- CBecause ethanol inhibits the CYP2E1enzyme
- DBecause it inhibits conjugation of acetominophen
24Why is acetylcysteine used as an antidote for acetaminophen toxicity?
- AIt acts as a precursor for glutathione
- BIt is an expectorant, thus it expectorates acetominophen from the body
- CIt inhibits the CYP2E1 enzymes
- DIt induces the CYP2E1 enzyme
25How do NSAIDs block the COX protein?
- AThey block the hydrophobic channel of the COX protein where arachidonic acid binds
- BThey block the production of arachidonic acid
- CThey bind to Phospholipid A2
- DThey bind to the COX protein, which causes inactivation of the enzyme
26Which of the following is NOT possible from the use of NSAIDs?
- ADyspepsia
- BGastropathology
- CDecrease renal blood flow resulting in renal ischemia
- DThrombosis
27Which of the following is true regarding -oxicam like drugs
- AIt is a selective COX inhibitor
- BThey inhibit collagenase and proteoglycanase
- CIt has a short half-life and therefore requires multiple doses daily
- DLow percentage of patients report adverse effects
28Which of the following is a possible side effect of -oxicam like drugs when taken for a long period of time?
- ATinnitus
- BThrombosis
- CCNS effects
- DBlurred vision
29Fenamate derivatves are used for severe dysmenorrhea
- ATrue
- BFalse
30Which of the following is NOT true regarding Indomethicin?
- AUsed for spondylitis
- BIt is an acetic acid derivative
- CPromotes closure of PDA
- DUsed when ibuprofen is ineffective or not tolerated
31Which of the following best describes the mechanism of Indomethacin?
- APromotes the incorporation of arachidonic acid into triglycerides, thus reducing its availability for COX
- BInhibits collagenase and proteoglycanase
- CBlock the COX-2 enzyme ONLY
- DIt is a folic acid analogue
32Which of the following is true regarding ASA?
- ADecreases the duration of pregnancy
- BUsed in treat fetal PDA
- CReversibly binds to platelets so prolongs bleeding for one day
- DCan cause bronchoconstriction in ASA-sensitive asthmatics
33Reye's syndrome develops in children who suffer a bacterial infection
- ATrue
- BFalse
34Mr. Smith is a 70 year old male with history of inflammatory GI and gastric ulcers. You would like to prescribe NSAIDs to treat his OA. Which of the following drugs could you also co-prescribe to avoid worsening his other pre-existing conditions?
- ACytotec
- BASA
- CSulindac
- DNaproxen
35What advantage does Sulindac have over any other NSAID?
- AIt causes less renal toxicity
- BIt is a synthetic prostaglandin E1 analogue
- CIt has no significant effect on bleeding time because it is a Cox-2 inhibitor
- DIt decreases gastric irritation
36Long-term NSAID analgesic medication is perfectly acceptable in patients with history of CV disease
- ATrue
- BFalse
37Which of the following drugs is MOST appropriate for a nursing mother?
- AASA
- BIbuprofen
- CCelecoxib
- DKetorolac
38Why does ASA interact with antihypertensives?
- ABecause antihypertensives depend on renal PG to work
- BBecause it can cause prolonged bleeding
- CBecause ASA prevents excretion of antihypertensives
- DBecause antihypertensives increase plasma levels of ASA
39Why should you not use SSRIs in combination with NSAIDs?
- ABecause they can increase the risk of upper GI bleed
- BBecause they cause more CNS effects
- CBecause together can cause increase in hypersensitivity reactions
- DBecause together they can worsen bronchoconstrition
40The use of anticoagulants and ________ has caused reported fatal hemorrhages
- AASA
- BNSAIDS
- CAcetominophen
- DBoth A and B
41Choose ALL of the following drugs whose renal clearance is reduced due to use of ASAs and NSAIDS
- ADigoxin
- BMethotrexate
- CAnticoagulants
- DEthanol
42High ASA dose can inhibit the metabolism of which drug?
- AValproic acid
- BMethotrexate
- CDigoxin
- DCyclosporine
43Which of the following drugs should be avoided in patients with sulfa allergy (according to Foong, not Chand)?
- ACelecoxib
- BSulfasalazine
- CSulfinpyrazone
- DCyclosporine
44Celecoxib is metabolized by CYP 2D6
- ATrue
- BFalse
45Which of the following drugs does NOT interact with COX-2 inhibitors?
- AACE inhibitors
- BFluconazole
- CRifampin
- DValproic acid
46Which of the following is NOT an adverse effect of COX-2 inhibitors?
- ABleeding time
- BGastric disorder
- CBronchoconstriction
- DCardiovascular toxicity
47Celecoxib and Ibuprofen are overall similar, except for cost, GI effects, and bleeding time effects
- ATrue
- BFalse
48High carb diet can decrease absorption of acetominophen
- ATrue
- BFalse
49SSRIs are more effective than TCAs as adjuvant analgesics
- ATrue
- BFalse
50How can you delay absorption of ASA?
- AIncrease pH
- BFood
- CDecrease pH
- DA and B
51Under normal conditions, which of the following prevents platelet aggregation?
- APG12
- BPGE2
- CTXA2
- DBoth A and B
52Phospholipase A2 is activated by which of the following?
- ACytokines
- BGrowth factors
- CLPS
- DAll of the above
53Which of the following medications can lower the seizure threshold?
- ATramadol
- BMorphine
- CCodeine
- DVicodin
54Which of the following is NOT a substrate of CYP2D6?
- ACodeine
- BTramadol
- COxycodone
- DCelecoxib
55Which of the following is NOT a clinical use of Naltrexone?
- AOpioid overdose
- BTreatment of alcohol dependence
- CPrevent opioid addiction
- DAnalgesia during the induction and maintenance of general anesthesia
56Which of the following is NOT true regarding tramadol?
- AIts active metabolite has a greater affinity for mu receptors than codeine
- BInhibits reuptake of NE and 5HT
- CSuppresses cough reflex
- DHas a quick onset of action
57Which of the following is NOT true regarding opioids with mixed mechanisms?
- ALarge doses can cause anxiety and dysphoria
- BThey may antagonize action of opioids
- CRespiratory depression has a ceiling effect
- DHas full agonist effect at mu receptors, thus increasing addiction liability
58Which of the following is NOT an indication for use of opioids with mixed mechanisms?
- AObstetric analgesia during labor and delivery
- BPre and post operative analgesia
- COrally for mild pain
- DThese are all indications
59OA primarily attacks the joints but also skn, lungs, vessels and muscles
- ATrue
- BFalse
60Rheumatoid arthritis, along with bacterial endocarditis and SLE, is found to have elevated levels of autoantibodies against
- ARheumatoid factor
- BIgG
- CIgA
- DNone of the above
61Rheumatoid can occur at any age
- ATrue
- BFalse
62Which of the following is NOT a goal of treating RA
- AActive patient and family participation
- BPreservation of function
- CPrevent deformity
- DThese are all objectives
63Successful treatment of RA is seen with when ________ are started immediately
- ABiological DMARDs
- BNon-biological DMARDs
- CAcetominophen
- DNSAIDs
64What is the role of glucocorticoids in RA
- ASlow bone erosion and prevent new bone erosion
- BReverse bone erosion
- CPrevent secondary fungal infection
- DIncrease blood sugar
65Newer biologic DMARDs are known to
- AMask serious infections (bacterial or fungal)
- BCause leukopenia
- CCause thrombocytopenia
- DAll of the above
66Which of the following DMARDs is a folic acid analogue that may also increase adenosine levels?
- AMethotrexate
- BLeflunomide
- CHydroxychloroquine
- DPenicillamine
67Which of the following drugs requires monthly monitoring of CBC, liver, and renal function
- AMethotrexate
- BLeflunomide
- CGold
- DMinocycline
68Use of methotrexate increases risk of hepatotoxicity with fibrosis and cirrhosis
- ATrue
- BFalse
69Which of the following DMARDs blocks synthesis of UMP, thus reducing B and T cell populations?
- AMethotrexate
- BLeflunomide
- CMinocycline
- DHydroxychloroquine
70Leflunomide is currently used for
- ARA
- BSLE
- CMyasthenia gravis
- DAll of the above
71Cholestyramine can be given to clear hydroxychloroquine from the system quickly
- ATrue
- BFalse
72How does Hydroxychloroquine work against RA?
- AInhibits chemotaxis of eosinophils and neutrophils
- BIt is a pyrimidine synthesis inhibitor
- CIt inhibits macrophages responsible for inflammation
- DIt inhibits matrix metalloproteinase
73Which drug causes the least toxicity?
- AHydroxychloroquine
- BMethotrexate
- CLeflunomide
- DTNF inhibitors
74Which of the following is NOT an adverse effect of hydroxychloroquine?
- APigmentary retinitis
- BIrreversible myopathies
- CPhotophobia
- DVisual loss
75Which of the following is a mechanism of Minocycline
- AMatrixmetalloproteinase inhibitor
- BInhibits inflammatory cell migration and transformation of lymphocytes
- CBoth A and B
- DNone of the above
76Which of the following is NOT true regarding Chrysotherapy?
- AIt is erratically absorbed orally
- BIt acts by inhibition of macrophages responsible for inflammation
- CIt is excreted through the kidneys
- DThe intravenous route is preferred
77Which of the following is true regarding the use of cyclophosphamide in the use of RA?
- AIncreases bone erosion
- BIt is used to reverse the progression of RA
- CIt s used in patients where other anti-inflammatory drugs have been successful
- DCauses hematuria
78Each of the following is a mechanism of penicillamine except
- AReduces numbers of T-lymphocytes
- BDecreases IL-1 and rheumatoid factor
- CPrevents collagen from cross-linking
- DInhibits inflammatory cell migration
79Monitoring the CBC and liver enzymes is necessary when taking which drug?
- ALeflunomide
- BGold
- CPenicillamine
- DNone of the above
80Which of the following is NOT a common side effect of penicillamine?
- ABone marrow suppression
- BDysgeusia
- CAnorexia
- DDizziness
81Which of the following is NOT a disadvantage when using biological DMARDs?
- AThey are very expensive
- BThey increase risk of bcterial infections
- CDemyelination can occur
- DThese are all disadvantages of biological DMARDs
82Biological DMARDs are not recommended until at least one non-biological DMARD has been administered without sufficient success
- ATrue
- BFalse
83Which of the following is FALSE regarding TNF inhibitors such as Entanercept?
- AThey inhibit cytokines, thus preventing PG production and up-regulation of COX-2
- BThey decrease joint destruction
- CThey are also used for Crohn's disease
- DThey prevent latent infections such as fungal or tuberculoid
84Which of the following is true regarding rituximab?
- ANot used with methotrexate
- BRash occurs in 30% of patients
- CNo cardiovascular effects
- DIt is a T-cell activation inhibitor
85Rituximab depletes B lymphocytes by apoptosis
- ATrue
- BFalse
86Which of the following best describes the mechanism of abatacept?
- APrevents T-cell activation by complexing with 'co-stimulatory' molecules
- BInhibits cytokines such as TNF alpha/IL-1 thus preventing PG production
- CTargets CD20 and depletes T lymphocytes
- DAll of the above
87Abatacept cannot be used as monotherapy but can be used combination with other DMARDS
- ATrue
- BFalse
88Which of the following is best described as "unique" and caused by deposition of urate crystals in joints
- AGout
- BRheumatoid
- COsteoartritis
- DKidney stones
89Which of the following is NOT one of the four stages of gout?
- ATophi
- BAsymptomatic hyperuricemic
- CIntercritical
- DThese are all stages of gout
90Which of the following would not be used for gout
- ANSAIDs
- BColchine
- CAllopurinol
- DRituximab
91Colchicine can be used in low doses as prophylaxis for acute attacks of gout
- ATrue
- BFalse
92Colchicine can be taken continuously at high doses
- ATrue
- BFalse
93Colchicine limits the inflammatory response by which of the following mechanisms?
- ADecreasing motility of neutrophils
- BDeactivating URAT 1 transporter
- CInhibit cytokines such as TNF alpha/IL-1 thus preventing PG production and up-regulation of COX-2
- DAll of the above
94Which drug shares the same mechanism as Allopurinol?
- AFebuxostate
- BCochicine
- CMethotrexate
- DProbenecid
95Why can't allopurinol be used for monotherapy?
- ABecause it does not have any anti-inflammatory effects
- BBecause it has no uric acid prevention mechanism
- CBecause allopurinol only works in the presence of colchicine
- DBecause it only works in the presence of NSAIDs
96Which of the following is NOT an adverse effect of Allopurinol?
- ASteven Johnson rash
- BHepatic necrosis
- CVomiting
- DRenal stones
97Which of the following is NOT true regarding Probenecid
- AIt deactivates the URAT 1 transporter, thus preveting reabsorption of urate
- BCan cause renal stones
- CUsed for treatment of chronic hyperuricemia
- DMakes uric acid levels fall which causes more crystal deposition in the synovium
98Febuxostat requires dose adjustment during renal insufficiency
- ATrue
- BFalse
99Which of the following gout medications could also be useful in a patient with hypertension
- ALosartan
- BSulfinpyrazone
- CGlucocorticoids
- DFebuxostate
100Which of the following has a similar mechanism to Probenecid but should be used with caution in patients taking anticoagulants?
- ALosartan
- BSulfinpyrazone
- CGlucocorticoids
- DNone of the above
101Which of the following is NOT true regarding SLE?
- ACan be cause by environmental factors
- BIncreased IgA production
- CFailure to remove immune complexes from circulation can lead to vasculitis and disease
- DThere is impaired T cell regulation
102There is a prevalence of SLE in women. One possible reason for this is because
- ACalcium is a B-cell stimulator
- BIL-10 is a B-cell stimulator
- CEstrogen is a B-cell stimulator
- DProlactin is a B-cell stimulator
103Increased levels of erythrocyte sedimentation rate is specific to SLE
- ATrue
- BFalse
104For treatment of SLE, we should NOT use drugs with
- Athe least side effects
- Bthe lowerst dose to control disease
- Clong term damage prevention
- Dsteroids in mild disease
105Corticosteroids can cause muscle wasting
- ATrue
- BFalse
106What is a concern with abruptly withdrawing corticosteroids?
- APossible adrenal insufficiency
- BInfection
- CRetinitis
- DImmunosuppresion
107Which of the following is NOT true regarding the use of hydroxychloroquine?
- AExact mechanism is unknown
- BMay lead to regression of skin lesions
- CMay improve psoriasis
- DOphthalmologic examinations should be performed prior to administration and periodically after
108What leads to the formation of PGE2 and PGI2?
- AB1
- BB2
- CProtons
- DATP
109Which of the following does NOT use a voltage-gated calcium channel?
- AZiconitide
- BOmega-conotoxin
- CGabapentin
- DGlutamate
110Which of the following is NOT a common mediator in peripheral sensitization?
- AGlutamate
- BBradykinins
- CProtons
- DNGF
111For peripheral sensitization, which of the following is NOT used to target analgesia?
- AASA
- BCOX-2 inhibitors
- CIndomethicin
- DAcetominophen
112Which of the following does NOT contribute to central sensitization?
- ANitric oxide synthase
- BGlutamate
- CSubstance P
- DBradykinins
113L-NAME can be used to inhibit NOS which prevents further retrograde stimulation of glutamate release
- ATrue
- BFalse
114Which ion is usually associated with NMDA in its inactive state ?
- AMagnesium
- BSodium
- CCalcium
- DPotassium
115Which of the following inhibits the dissociation of Mg from the NMDA receptor, thus preventing activation?
- AKetamine
- BDM
- CGABA
- DBoth A and B
- EBoth A and C
116Which of the following is NOT a mechanism of opioids?
- AThey activate descending PAG neurons
- BThey directly activate opioid receptors
- CThey activate descending NMR and LC neurons
- DThey activate presynaptic potassium channels which decreases conductance
117Which of the following opioid receptors does NOT mediate the main pharmacological effects of opiates?
- AMu
- BKappa
- CDelta
- DEpsilon
118Which opioid receptor subunit is responsible for most of the analgesic effects along with some unwanted effects?
- AMu
- BKappa
- CDelta
- DSigma
119Opioid receptor activation is G-coupled
- ATrue
- BFalse
120Select ALL of the strong opiods
- AMorphine
- BMeperidine
- CMethadone
- DFentanyl
- ECodeine
- FOxycodone
- GPentazocine
- HHydrocodone
121Select ALL of the pure opioid agonists
- AMorphine
- BHydromorphone
- CCodeine
- DOxycodone
- EMeperidine
- FFentanyl
- GPentazocine
- HNaloxone
- INaltrexone
- JBuprenorphine
122Opiod pure agonists have a higher affinity for_________ receptors.
- AMu
- BKappa
- CDelta
- DB and C
123Pentazocine is an antagonist at the ___________ receptor, but a partial agonist at the _____________ receptor.
- AMu; Kappa and delta
- BKappa; Mu and delta
- CDelta; kappa and mu
- DMu; Kappa and sigma
124Most mixed mechanism opioids cause
- ADysphoria
- BEuphoria
- CRespiratory depression
- DPhysical dependence
125Which peripherally acting opioid antagonist can be used to reduce post-op ileus and opioid-induced constipation?
- AAlvimopan
- BMorphine
- CNaltrexone
- DPentazocine
126Opioids have a ceiling effect
- ATrue
- BFalse
127Which of the following does NOT have a 90% first pass effect?
- AMorphine
- BCodeine
- CHydromorphone
- DMeperidine
128Which of the following receptors does codeine activate?
- AKappa
- BDelta
- CMu
- DBoth B and C
129How is morphine excreted?
- ARenally
- BThrough the bile
- CBoth and A and B
- DNone of the above
130How is codeine excreted?
- ARenally
- BThrough breast milk
- CHepatic
- DBoth A and B
- EBoth A and C
131Which of the following is true?
- ACodeine is a more effective analgesia than morphine
- BCodeine provides little euphoria
- CPhysical dependence is common in users of low daily dose
- DNo risk of opiate withdrawal symptoms with sudden stop
132Codeine does not cause tolerance over prolonged use
- ATrue
- BFalse
133Which of the following is an alternative to codeine when a weak opiod is required?
- AMeperidine
- BFentanyl
- CPropoxyphene
- DOxycodone
134Which of the following is an alternative to codeine when a strong opiod is required?
- AMorphine
- BMeperidine
- CPropoxyphene
- DFentanyl
135Which of the following is equipotent to morphine but has greater oral efficacy?
- AMethadone
- BMeperidine
- CCodeine
- DFentanyl
136Which of the following is used to treat opioid addiction?
- AMethadone
- BMeperidine
- CMorphine
- DCodeine
137Which of the following opioids can prolong QT interval
- AMethadone
- BMeperidine
- CMorphine
- DFentanyl
138Methadone has a long duration and therefore can be given has a single dose daily
- ATrue
- BFalse
139It is better to give meperidine orally rather than IV because it decreases risk of anxiety and other CNS side effects
- ATrue
- BFalse
140Which of the following is correct, starting with the least potent to the most potent
- AFentanyl<morphine<codeine
- BFentanyl<codeine<morphine
- CMorphine<codeine<fentanyl
- DCodeine<morphine<fentanyl
141Which of the following is NOT true regarding fentanyl?
- AIt may induce skeletal rigidity at high doses
- BDoes NOT cause histamine release
- CSmaller safety margin than morphine
- DMinimal respiration depression
142There is no ceiling effect of respiratory depression with use of opioids with mixed mechanisms
- ATrue
- BFalse
143Which of the following is an advantage of fentanyl patches?
- AGood if concerned about drug abuse
- BQuick onset
- CResidual activity after patch is removed
- DIt's cheap
144Which of the following is true regarding opioids with mixed mechanisms
- AMay antagonize action of opioid agonists
- BIncreases addiction liability
- CSmall doses can cause hallucinations
- DLarge doses can cause euphoria
Information
- Description
- Exam III practice quiz
- Author
- Diana Flores
- Language
- English
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- History
- Created on 17 Jul 2015 · updated on 22 Dec 2016
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