SHLAFER - CENTRAL NERVOUS SYSTEM
PHARMACOLOGY
100. A 42-year-old woman develops akathisias, parkinsonian-like dyskinesias,
galactorrhea, and amenorrhea, during drug therapy. Which of the following drug-
receptor-based mechanisms, occurring in the central nervous
system, most likely caused these responses?
a. Blockade of $-adrenergic receptors
b. Blockade of dopamine receptors
c. Blockade of muscarinic receptors
d. Supersensitivity of dopamine receptors
e. Stimulation of nicotinic receptors
CORRECT ANSWER b
101. A patient on the trauma-burn unit receives a drug to ease the pain of debridement
and dressing changes. The patient experiences good, prompt analgesia, but despite the
absence of pain sensation during the procedure her heart rate and blood pressure rise
considerably, consistent with the concept that the sympathetic nervous system was
activated by the pain and not affected by the analgesic drug. As the effects of the drug
develop, the
patient's skeletal muscle tone progressively increases. The patient appears awake at
times because the eyes periodically open. As drug effects wear off, the patient
hallucinates and behaves in a very agitated fashion. Which of the following drug was
most likely given?
a. Fentanyl
b. Ketamine
c. Midazolam
d. Succinylcholine
e. Thiopental
CORRECT ANSWER b
102. A patient who has been treated with levodopa is switched to a regimen with a
proprietary product that contains both levodopa and carbidopa. Which of the following is
the main action of carbidopa that provides the rationale for using it in this combined
approach?
a. Blocks ACh release in the CNS, thereby facilitating levodopa's ability to restore a
dopamine-ACh balance
,b. Helps activate dietary vitamin B6, a deficiency of which occurs during levodopa
therapy
c. Increases permeability of the blood-brain barrier to levodopa, giving levodopa better
access to the CNS
d. Inhibits metabolic conversion of levodopa to dopamine outside the CNS
e. Reduces levodopa-induced hypotension by blocking vascular dopamine receptors
CORRECT ANSWER d
103. The attending with whom you are working in the emergency department quizzes
you on your basic knowledge of local anesthetics and their uses. She asks you to identify
the drug that is suitable for topical administration (e.g., to mucous membranes), but
cannot be given parenterally because of its physicochemical properties, which render it
very poorly soluble. Which of the following drugs is the best answer to her question?
a. Benzocaine
b. Bupivacaine
c. Etidocaine
d. Mepivacaine
e. Procaine
CORRECT ANSWER a
104. A physician considers placing a patient on long-term (months, years)
phenobarbital for control of a relatively common medical condition. For most of these
indications, newer and arguably more efficacious drugs are available and preferred. For
which of the following, however, is it still considered reasonable and appropriate to use
this barbiturate?
a. Alcohol withdrawal signs/symptoms
b. Anxiety management
c. Certain epilepsies
d. Endogenous depression (adjunct to SSRIs)
e. Sleep disorders such as insomnia
CORRECT ANSWER c
105. One reason for the declining use of tricyclic antidepressants such as imipramine,
and the growing use of newer classes, is the prevalence of
, common tricyclic-induced side effects or adverse responses. Which of the following best
describes the side effects or adverse responses that are most likely to occur with the
administration of a tricyclic?
a. Anticholinergic (antimuscarinic) effects
b. Arrhythmias
c. Hepatotoxicity
d. Nephrotoxicity
e. Seizures
CORRECT ANSWER a
107. We have a patient with Parkinson's disease. Signs and symptoms can be classified as
"moderate" now but progressive and not responding well to current drug therapy. The
physician decides to empirically assess an antiparkinson
drug that is a selective inhibitor of monoamine oxidase type B (MAO-B).
Which of the following drugs would that be?
a. Bromocriptine
b. Carbidopa
c. Phenelzine
d. Selegiline
e. Tranylcypromine
CORRECT ANSWER d
108. Meperidine is similar to morphine in many ways. However, with very high blood
levels or with true overdoses, meperidine can cause significant adverse responses that
simply aren't seen with morphine or most other opioid
analgesics. Which of the following best identifies that rather unique effect of meperidine?
a. Constipation leading to paralytic ileus
b. Heightened response to pain (paradoxical hyperalgesia)
c. Intense biliary tract spasm
d. Psychosis-like state, possibly seizures
e. Respiratory depression, apnea, ventilatory arrest
CORRECT ANSWER d
109. Chlorpromazine and haloperidol can be considered prototypes of two
PHARMACOLOGY
100. A 42-year-old woman develops akathisias, parkinsonian-like dyskinesias,
galactorrhea, and amenorrhea, during drug therapy. Which of the following drug-
receptor-based mechanisms, occurring in the central nervous
system, most likely caused these responses?
a. Blockade of $-adrenergic receptors
b. Blockade of dopamine receptors
c. Blockade of muscarinic receptors
d. Supersensitivity of dopamine receptors
e. Stimulation of nicotinic receptors
CORRECT ANSWER b
101. A patient on the trauma-burn unit receives a drug to ease the pain of debridement
and dressing changes. The patient experiences good, prompt analgesia, but despite the
absence of pain sensation during the procedure her heart rate and blood pressure rise
considerably, consistent with the concept that the sympathetic nervous system was
activated by the pain and not affected by the analgesic drug. As the effects of the drug
develop, the
patient's skeletal muscle tone progressively increases. The patient appears awake at
times because the eyes periodically open. As drug effects wear off, the patient
hallucinates and behaves in a very agitated fashion. Which of the following drug was
most likely given?
a. Fentanyl
b. Ketamine
c. Midazolam
d. Succinylcholine
e. Thiopental
CORRECT ANSWER b
102. A patient who has been treated with levodopa is switched to a regimen with a
proprietary product that contains both levodopa and carbidopa. Which of the following is
the main action of carbidopa that provides the rationale for using it in this combined
approach?
a. Blocks ACh release in the CNS, thereby facilitating levodopa's ability to restore a
dopamine-ACh balance
,b. Helps activate dietary vitamin B6, a deficiency of which occurs during levodopa
therapy
c. Increases permeability of the blood-brain barrier to levodopa, giving levodopa better
access to the CNS
d. Inhibits metabolic conversion of levodopa to dopamine outside the CNS
e. Reduces levodopa-induced hypotension by blocking vascular dopamine receptors
CORRECT ANSWER d
103. The attending with whom you are working in the emergency department quizzes
you on your basic knowledge of local anesthetics and their uses. She asks you to identify
the drug that is suitable for topical administration (e.g., to mucous membranes), but
cannot be given parenterally because of its physicochemical properties, which render it
very poorly soluble. Which of the following drugs is the best answer to her question?
a. Benzocaine
b. Bupivacaine
c. Etidocaine
d. Mepivacaine
e. Procaine
CORRECT ANSWER a
104. A physician considers placing a patient on long-term (months, years)
phenobarbital for control of a relatively common medical condition. For most of these
indications, newer and arguably more efficacious drugs are available and preferred. For
which of the following, however, is it still considered reasonable and appropriate to use
this barbiturate?
a. Alcohol withdrawal signs/symptoms
b. Anxiety management
c. Certain epilepsies
d. Endogenous depression (adjunct to SSRIs)
e. Sleep disorders such as insomnia
CORRECT ANSWER c
105. One reason for the declining use of tricyclic antidepressants such as imipramine,
and the growing use of newer classes, is the prevalence of
, common tricyclic-induced side effects or adverse responses. Which of the following best
describes the side effects or adverse responses that are most likely to occur with the
administration of a tricyclic?
a. Anticholinergic (antimuscarinic) effects
b. Arrhythmias
c. Hepatotoxicity
d. Nephrotoxicity
e. Seizures
CORRECT ANSWER a
107. We have a patient with Parkinson's disease. Signs and symptoms can be classified as
"moderate" now but progressive and not responding well to current drug therapy. The
physician decides to empirically assess an antiparkinson
drug that is a selective inhibitor of monoamine oxidase type B (MAO-B).
Which of the following drugs would that be?
a. Bromocriptine
b. Carbidopa
c. Phenelzine
d. Selegiline
e. Tranylcypromine
CORRECT ANSWER d
108. Meperidine is similar to morphine in many ways. However, with very high blood
levels or with true overdoses, meperidine can cause significant adverse responses that
simply aren't seen with morphine or most other opioid
analgesics. Which of the following best identifies that rather unique effect of meperidine?
a. Constipation leading to paralytic ileus
b. Heightened response to pain (paradoxical hyperalgesia)
c. Intense biliary tract spasm
d. Psychosis-like state, possibly seizures
e. Respiratory depression, apnea, ventilatory arrest
CORRECT ANSWER d
109. Chlorpromazine and haloperidol can be considered prototypes of two
