pharm last quizzes

Which of the following descriptions does NOT align with considerations associated with the use of Brexanolone?

Option A

Refractory Postpartum Depression

Option B

Intravenous administration inside hospital / facility setting only

Option C

Risk Evaluation Mitigation Strategy  

Option D

Dopamine agonist which is associated with compulsive behaviors

Option D

Dopamine agonist which is associated with compulsive behaviors

Which of the following SSRI / SNRI agents does not typically require dosage adjustment in neither renal nor hepatic disease?

Option A

venlafaxine

Option B

vilazodone

Option C

desvenlafaxine

Option D

fluoxetine

Option B

vilazodone

Which of the following SSRIs possesses the greatest anticholinergic effect?

Option A

Paroxetine

Option B

Escitalopram

Option C

Citalopram

Option D

Sertraline

Option A

Paroxetine

Which class of Antidepressants are considered a last resort therapy due to the Contraindications restricting their use (such as Pheochromocytoma, Use with general Anesthesia, and end stage renal and liver function) as well as their participation in numerous Drug and Food interactions?

Option A

SSRIs

Option B

SNRIs

Option C

TCADs

Option D

MAOIs

Option D

MAOIs

Which class of Antidepressants are notorious for their capacity to cause the following side effects (Sedation, Orthostatic Hypotension and Anticholinergic effects) as well as their ability to cause life-threatening arrythmias in overdose scenarios?

Option A

SSRIs

Option B

SNRIs

Option C

TCADs

Option D

MAOIs

Option C

TCADs

The primary difference between the 1st generation and 2nd generation antipsychotics relates to the 1st generation’s apparently exclusive blockade of which neurotransmitter?

Option A

Serotonin

Option B

Norepinephrine

Option C

GABA

Option D

Dopamine

Option E

Acetylcholine

D Dopamine

The main reason behind the use of the REMS system for the antipsychotic Clozapine is to enforce routine monitoring (and therefore prevention) of what side effect of Clozapine?

Option A

Arrhythmias

Option B

Movement Disorders

Option C

Fatal Hepatitis

Option D

Agranulocytosis

Option D

Agranulocytosis

Which class of drugs listed below, well known for indications in other disease states are also commonly employed as mood stabilizers?

Option A

Type 1A Antiarrhythmics

Option B

Calcium channel blockers   

Option C

Diuretics 

Option D

Anticonvulsants

Option D

Anticonvulsants

Which of the following benzodiazepines lacks an active metabolite?

Option A

Diazepam

Option B

Chlordiazepoxide

Option C

Temazepam

Option D

Lorazepam

Option D

Lorazepam

Which agent is specifically used to reverse the effects of benzodiazepines?

Option A

Flumazenil

Option B

Naltrexone

Option C

Hydroxyzine

Option D

Phentolamine

Option A

Flumazenil

Which of the following drugs is both structurally and pharmacologically similar to the antihypertensive clonidine?

Option A

Propofol

Option B

Dexmedetomidine

Option C

Hydroxyzine

Option D

Droperidol

Option B

Dexmedetomidine

Which of the following agents are anticonvulsants commonly employed as analgesic agents to combat Neuropathic Pain?

Option A

Gabapentin & Pregabalin   

Option B

Amitriptyline & Nortriptyline   

Option C

Pentobarbital & Phenobarbital

Option A

Gabapentin & Pregabalin   

Which agent is considered a non-addictive alternative to a benzodiazepine for the treatment of anxiety? 

Option A

Chlorpromazine

Option B

Hydroxyzine

Option C

Prochlorperazine

Option D

Flumazenil

Option B

Hydroxyzine

Which of the following food groups is a potential problem in patients taking MAO inhibitors?

Option A

Fresh fish and other fresh seafood

Option B

Starches such as pasta, breads and poatatoes

Option C

Foods containing spices such as chili pepper and cayenne pepper

Option D

Fermented foods such as sauerkraut, yogurt and pickled beets.

D. Fermented foods such as sauerkraut, yogurt and pickled beets.

Which of the following psychotropic agents demonstrates a significant dose-related change in its pharmacological profile as the dose is increased from low to high?

Option A

Vortioxetine

Option B

Mirtazapine

Option C

Clozapine

Option D

Bupropion

Option B

Mirtazapine

Which of the following is NOT characteristic of Pimavanserin ?

Option A

Inverse agonist

Option B

Not for psychosis in an individual without a diagnosis of Parkinson's disease

Option C

Participates in drug interactions involving drugs sharing the CYP3A4 hepatic metabolic pathway

Option D

Reserved for patients at a higher-than-normal risk of suicide

Option D

Reserved for patients at a higher-than-normal risk of suicide

Your patient is taking Clozapine for a schizoaffective disorder which has been difficult to control with other medications.

Their recent CBC returns from the lab with a rather low WBC count. In fact, you calculate their Absolute Neutrophil Count and determine it is 750 /microliter. This makes you suspicious for a drug-induced cause from either Clozapine or the Carbamazepine she is taking. Your best plan of action includes which of the following?

Option A

Reduce dose of Clozapine by 50%. Obtain daily CBC. Consult Hematology.

Option B

Stop Clozapine. Begin Haloperidol or Trifluoperazine. Consult Hematology regarding potential             Aplastic Anemia associated with Carbamazepine.

Option C

Stop Clozapine. Begin Risperidone or Olanzapine. Consult Neurology regarding switch from              Carbamazepine to Valproic Acid

Option D

Hold Clozapine and obtain daily CBC. Consult hematology.

Option D

Hold Clozapine and obtain daily CBC. Consult hematology.

Lithium is a narrow therapeutic index drug, requiring therapeutic drug monitoring and is affected by several other commonly used medications. Its therapeutic range is cited at 0.6 - 1.2 meq/L. Your patient is receiving Lithium carbonate at a dose of 300 mg po Q12hrs (9am/9pm) and the nurse now asks you when she should draw the lithium level you just ordered? You reply . . .

Option A

I have no idea. CALL THE LAB.

Option B

Right before the 9am dose

Option C

1 - 2 hours after the bedtime dose

Option D

At the midpoint between the doses (essentially as close as possible to 3pm)

Option B

Right before the 9am dose

Advantages of the use of a topical lidocaine patch for pain include which of the following:

Option A

Reduced systemic exposure (and therefore side effects) to drug while still possibly providing

analgesia for some minor to moderate pain syndromes (ie; back pain, knee pain and some

neuropathies, etc.)

Option B

Continued delivery of drug for 24 hours or longer from the once daily patch

Option C

Patch is almost invisible once applied to the skin, providing a good disguise in case you need to  wear it to work or to the gym or some other public outing

Option D

Less need to carry around a pillbox or pill bottle if it takes the place of your 3 ibuprofen a day

Option A

Reduced systemic exposure (and therefore side effects) to drug while still possibly providing

analgesia for some minor to moderate pain syndromes (ie; back pain, knee pain and some

neuropathies, etc.)

Which of the following sedatives does not absolutely warrant use of a continuous monitoring scenario (ie; vitals, pulse ox, EKG such as in an ICU setting) for its use?

Option A

Propofol

Option B

Pentobarbital

Option C

Droperidol

Option D

Dexmedetomidine

Option C

Droperidol

What percentage of all lung cancer deaths are attributed to smoking ?

Option A

100%

Option B

95%

Option C

91%

Option D

87%

Option D

87%

Relative to non-smokers, on average how many years earlier do smokers die?

Option A

2 years

Option B

5 years

Option C

10 years

Option D

15 years

Option C

10 years

What percentage of smokers die of tobacco-related disease?

Option A

40%

Option B

50%

Option C

65%

Option D

68%

Option B

50%

The receptor that is thought to be the principal mediator of nicotine dependence is the . . .

Option A

H-1 receptor

Option B

α4β2 nicotinic cholinergic receptor

Option C

5-HT2 receptor

Option D

Dopamine 2 receptor

Question 5

5

Option B

α4β2 nicotinic cholinergic receptor

Cigarette Smoke is a clinically significant inducer of which of the following CYP450 isoenzymes?

Option A

CYP1A2

Option B

CYP3A4

Option C

CYP2D6

Option D

CYP2C9

Option A

CYP1A2

For smokers who drink caffeinated beverages, assuming that caffeine intake does not change, caffeine concentrations after quitting smoking would be expected to . . .

Option A

Increase

Option B

Decrease

Option C

Not change

Option D

Increase in some smokers but decrease in others

Option A

Increase

Which dosage form of nicotine replacement therapy (NRT) is associated with the largest percentage of users experiencing side effects?

Option A

Patch

Option B

Gum

Option C

Lozenge

Option D

Nasal Spray

Option D

Nasal Spray

Which of the following statements regarding the use of bupropion is true?

Option A

Bupropion is only effective at increasing cessation rates in smokers who exhibit symptoms of major depressive disorder

Option B

It is the most effective medication at increasing smoking cessation rates

Option C

It should be started on the day the smoker plans on quitting

Option D

It is contraindicated in those with a seizure disorder

Option D

It is contraindicated in those with a seizure disorder

Which of the following statements is true regarding the use of nicotine patch?

Option A

It can be applied on an as needed basis when symptoms of craving or withdrawal are present

Option B

Smokers who experience sleep disturbances while wearing the patch may benefit from

removing the patch at bedtime

Option C

Quit rates when using the patch are lower than when using any other dosage form of nicotine

replacement therapy

Option D

Patients smoking their first cigarette of the day within 30 minutes of waking should start with the 21 mg patch

Option B

Smokers who experience sleep disturbances while wearing the patch may benefit from

removing the patch at bedtime

After stopping smoking, symptoms of nicotine withdrawal generally peak . . .

Option A

Within 24 hours after cessation.

Option B

Within 1 week after cessation

Option C

About 2 to 4 weeks after cessation

Option D

About 1 to 2 months after cessation

Option B

Within 1 week after cessation

Which of the following is true regarding the use of nicotine gum?

Option A

It should be chewed in a manner similar to regular chewing gum

Option B

The 4 mg dose should be used if the first cigarette of the day is smoked within 30 minutes of

waking up

Option C

It should only be used when symptoms of craving or withdrawal are present

Option D

Drinking an acidic beverage before use increases the extent of nicotine absorption

Option B

The 4 mg dose should be used if the first cigarette of the day is smoked within 30 minutes of

waking up

Which of the following is true regarding combination nicotine replacement therapy?

Option A

The most commonly used combination is the nicotine patch with another dosage form of

nicotine replacement therapy

Option B

The nicotine gum is usually combined with the nicotine lozenge

Option C

Combination nicotine replacement therapy is no more effective at increasing cessation rates than using a single dosage form of nicotine replacement therapy

Option D

Combination nicotine replacement therapy should be used with caution due to a high risk of

nicotine overdose

Option A

The most commonly used combination is the nicotine patch with another dosage form of

nicotine replacement therapy

Which of the following is a true statement?

Option A

Pharmacotherapy should only be recommended to smokers who have previously failed to quit

without the assistance of pharmacotherapy.

Option B

Pharmacotherapy should be recommended for all smokers trying to quit except in a few

special circumstances

Option C

Pharmacotherapy, if used correctly, leads to long-term cessation rates of approximately 60%

Option D

The addition of behavioral counseling to pharmacotherapy does not increase quit rates beyond those observed when just using pharmacotherapy

Option B

Pharmacotherapy should be recommended for all smokers trying to quit except in a few

special circumstances

Which of the following is a true statement?

Option A

Nicotine is the primary addictive component of cigarette smoke and is responsible for most of

the negative health effects of smoking

Option B

Nicotine is the primary addictive component of cigarette smoke but is a relatively minor

contributor to the negative health effects of smoking

Option C

Nicotine is a relatively minor contributor to the addictiveness of tobacco products but is

responsible for most of the negative health effects of smoking

Option D

Nicotine contributes to neither the addictiveness of tobacco products nor to the negative health effects of

smoking

Option B

Nicotine is the primary addictive component of cigarette smoke but is a relatively minor

contributor to the negative health effects of smoking

Opioid pseudo-addiction is characterized by all of the following, EXCEPT . . .

Option A

Desire for the mood-altering effects of the drug

Option B

Preoccupation with obtaining opioid medications

Option C

Drug-seeking behavior caused by inadequate pain control

Option D

A crisis of mistrust between the patient and the healthcare team

Option A

Desire for the mood-altering effects of the drug

Which of the following is NOT a characteristic of opioid use disorder?

Option A

Tolerance

Option B

Withdrawal symptoms

Option C

Ability to control the use of opioids

Option D

Continued use despite harmful consequences

Option C

Ability to control the use of opioids

Compared with methadone, buprenorphine has a . . .

Option A

lower risk of overdose

Option B

shorter duration of action

Option C

more severe withdrawal syndrome following cessation

Option D

All of the above

Option D

All of the above

Which of the following agents listed below might be considered a first line treatment for the amelioration of alcohol withdrawal?

Option A

Acamprosate

Option B

Lorazepam

Option C

Phenobarbital

Option D

Propofol

Option B

Lorazepam

Why is buprenorphine typically administered sublingually, as opposed to simply given orally?

Option A

Not well absorbed via oral administration

Option B

Circumvents significant first pass metabolism by the liver

Option C

Sublingual dosage forms are constructed in such a way that there is less chance of misuse

or abuse

Option D

Because there are multiple food interactions with buprenorphine that it is most reliable

to administer the drug sublingually

Option B

Circumvents significant first pass metabolism by the liver

Which neurotransmitter plays a dominant role as a reward motivator and is common to

many substance abuse disorders?

Option A

Gamma aminobutyric acid (GABA)

Option B

Serotonin

Option C

Dopamine

Option D

Nicotine

Option C

Dopamine

MAO inhibitors are problematic because they may cause a hypertensive crisis when combined with any of the following EXCEPT:

Option A

Tyramine containing foods

Option B

Norepinephrine

Option C

Dopamine

Option D

Clonidine

Option D

Clonidine

Tetrahydrocannabinol is considered a . . .

Option A

weak partial agonist of the endocannabinoid system

Option B

weak partial antagonist of the endocannabinoid system

Option C

Synthetic CB1/CB2 agonist

Option D

strong antagonist of the endocannabinoid system

Option A

weak partial agonist of the endocannabinoid system

Oral administration of THC & CBD results in poor bioavailability due to the ____________________________ nature of these two cannabinoids. (Fill in the blank)

Option A

high first pass effect

Option B

hydrophilic

Option C

alkaline

Option D

lipophilic

Option D

lipophilic

Approximately how many different Cannabinoids have been identified in the various strains of the Cannabis plant?

Option A

5 - 10

Option B

80 - 100

Option C

20 - 30

Option D

10 - 20

Option B

80 - 100

Pennsylvania has approved more than 20 approved "indications" for which patients may pursue Medicinnal Marijuana.

Which of the following is NOT a Pennsylvania approved indication?

Option A

For recreational use

Option B

Anxiety

Option C

Peripheral Neuropathy

Option D

Sickle Cell Anemia

Option A

For recreational use

The potential for drug interactions with Cannabis is very high because of . . . .

Option A

It's purported effect on appetite and the fact that food significantly affects the absorption of

orally administered Cannabis

Option B

It's heavy reliance on hepatic CYP450 metabolism via enzymes such as 2C9, 2C19 & 3A4

which are shared by many commonly prescribed psychiatric & cardiovascular medications

Option C

The fact that approximately 80% of the cannabinoid is eliminated via

tubular secretion as the unchanged parent compound

Option D

The fact that Cannabis penetrates heavily into fat tissues and subsequently the

psychoactive effects can last for weeks due to redistribution back into the bloodstream

long after the drug has been consumed

Option B

It's heavy reliance on hepatic CYP450 metabolism via enzymes such as 2C9, 2C19 & 3A4

which are shared by many commonly prescribed psychiatric & cardiovascular medications

Traditionally speaking, the strain of Cannabis which had the highest THC content was

Option A

Sativa

Option B

Ruderalis

Option C

Indica

Option D

Hemp

Option C

Indica

Some of the potential problems with edible forms of cannabis include all of the following EXCEPT . . .

Option A

The Gummies stick to your teeth and have been shown to promote tooth decay

Option B

Some forms of edibles are attractive to children and subsequently have caused issues with

pediatric patients necessitating trips to the emergency room

Option C

High potency dosage forms expose cannabis naive patients to potentially dangerous

concentrations of tetrahydrocannabinol

Option D

The significant lag time between oral administration of THC dosage forms and the onset of effect seen from the metabolite (11-hydroxy-THC) promotes consumption of larger than

necessary doses of these edible cannabis dosage forms

Option A

The Gummies stick to your teeth and have been shown to promote tooth decay

Although not approved in the US, SATIVEX (nabiximols), a 1:1 mix of THC and CBD, is approved in 25 countries and the UK for what indication?

Option A

Refractory Epilepsy

Option B

Moderate to severe muscle spasticity in multiple sclerosis (MS)

Option C

Post-traumatic stress disorder (PTSD)

Option D

Appetite stimulant in HIV / AIDS

Option B

Moderate to severe muscle spasticity in multiple sclerosis (MS)

A purified version of which cannabinoid has been shown in placebo-controlled, compassionate use trials to reduce median seizure frequency by over 50% for refractory epileptogenic syndromes such as Lennox-Gastaut and Dravet

Option A

Cannabidiol

Option B

Tetrahydrocannabinol

Option C

Cannabigerol

Option D

Cannabinol

Option A

Cannabidiol

Which of the following conditions are NOT inherent to pharmaceutical dosage forms when dietary supplement and other "manufacturers" attempt to make products for sale and distribution from plants and other natural sources?

Option A

Harvesting of the wrong part of the plant or harvest of the wrong plant altogether

Option B

Variation of phytochemicals of the plant due to variations in rainfall, sunshine, wind and soil

Option C

Contamination of the plant itself from residues of pesticides and/or herbicides

as well as organisms such as fungi and bacteria

Option D

Loss of phytochemical quality and quantity due to handling and storage conditions

Option E

Sufficient oversight and regulation by the FDA and the FTC

Option E

Sufficient oversight and regulation by the FDA and the FTC

If drug A is very lipophilic, which of the following assumptions would be the LEAST likely to be true of drug A?

Option A

Undergoes significant first pass metabolism resulting in poor bioavailability

Option B

Achieves high and sustained (ie; long-lasting) blood concentrations

after a 60-minute intravenous infusion

Option C

High concentrations of the parent drug can be recovered in the urine over time

Option D

The volume of distribution of drug A increases with a subject's increasing body fat

Option C

High concentrations of the parent drug can be recovered in the urine over time

Drug A & Drug B are both predominantly hepatically metabolized via the CYP450 system.

Drug C is now added to a regimen containing both Drug A & Drug B.

Which of the following theoretical ideas can be expressed with greatest certainty?

Option A

Concentrations of both Drug A & B now increase

Therefore, Drug C must be sharing the same metabolic pathway of the CYP450 system and

is an enzyme inducer of both A & B

Option B

Concentrations of both Drug A & B now increase and remain elevated

Therefore, Drug C must have a greater affinity for plasma protein binding sites

Option C

Concentrations of both Drug A & B now increase

Therefore, Drug C must have a shorter half-life than either Drug A or B

Option D

Concentrations of both Drug A & B now increase and remain elevated

Therefore, Drug C must be metabolized via the CYP450 and

is a likely an enzyme inhibitor of both Drug A & B

Option D

Concentrations of both Drug A & B now increase and remain elevated

Therefore, Drug C must be metabolized via the CYP450 and

is a likely an enzyme inhibitor of both Drug A & B

Smoke from combustion (ie; cigarette smoking) induces (primarily and to the greatest extent)

which cytochrome P450 enzyme ?

Option A

3A4

Option B

2D6

Option C

1A2

Option D

2C19

Option C

1A2

With repeated dosing, if we allow for 5 half-lives of a drug to take place, we can rest assured that we are _____________ of the way to steady state blood concentrations of that drug. (Fill in the blank)

Option A

50%

Option B

87.5%

Option C

96.875%

Option D

12.5%

Option C

96.875%

Which of the following is currently NOT a Pennsylvania specific restriction (ie; considered illegal) on the use of

Medicinnal Cannabis?

Option A

Driving under the influence of cannabis

Option B

Home cultivation of cannabis

Option C

Consuming cannabis while on federal property or within 1000 feet of a school

Option D

Use by adults and adolescents diagnosed with Huntingdon's Chorea

Option D

Use by adults and adolescents diagnosed with Huntingdon's Chorea

Anandamide and 2-arachidonoylglycerol are examples of . . . (Choose the one best answer)

Option A

Endogenous biochemicals in the body which affect the same physiologic receptors as cannabis

Option B

Difficult names to pronounce

Option C

Two of the Gods of Greek mythology

Option D

Functionally inactive compounds thought to enhance the effects of THC

Option A

Endogenous biochemicals in the body which affect the same physiologic receptors as cannabis

First Order (Linear)

elimination kinetics

The percent of drug eliminated over time remains constant regardless of the dose. However, the amount of drug eliminated changes over time, relative to the amount delivered / remaining in the body.

Zero Order (Saturable)

elimination kinetics

The amount of drug eliminated over time remains constant, regardless of the dose. However, the percent of drug eliminated over time changes relative to the amount delivered / remaining in the body.

It is usually always reasonable and recommended to taper someone off of a drug which they have been receiving for a long time due to all of the following reasons EXCEPT . . .

Option A

Prevent disease exacerbation

Option B

Prevent withdrawal symptoms

Option C

To be sure to use up all the expensive medication

Option C

To be sure to use up all the expensive medication