ETX 30 FINAL

Quiz #1

Q1: Water is essential for human life; however, water can be toxic if too much is consumed in a short period of time. This concept is an example of what key principle of toxicology and pharmacology:

A: The dose makes the poison

Q2: Which of the following drugs has the safest therapeutic index?

A: Cetirizine (Zyrtec): ED50: 0.2mg/kg; TD50: 55mg/kg

Q3: Toxins are generally safer than toxicants because toxins are naturally produced from plants, bacteria, or animals and toxicants are synthetic.

A: False

Q4: Eating and smoking Tetrahydrocannabinol (THC, the psychoactive chemical in marijuana), will produce different biological responses. Why is this? (select all)

A: THC will get into the bloodstream faster by smoking than by eating; THC will have a more predictable biological response by smoking than by eating

Q5: The difference between the amount of 11-OH-THC when smoking or eating THC is a result of what?

A: First-pass metabolism

Q6: Your friend tells you to take Oscillococcinum to treat your flu-like symptoms.  The recommended dose is 1 tube. How much duck liver is in 1 tube of Oscillococcinum?

A: The duck liver will be diluted so many times that the tube consists of all sugar

Q7: Which drug is the most potent?

A: Drug A because it has the lowest ED50

Q8: Which part of this diagram would cocaine act to block dopamine reuptake?

A: D Connecting Synapses 

Quiz #2

Q1: Which of the following is not an example of a pharmacokinetics study:

A: Determining the mechanism of action of a drug

Q2: What information can you learn from the distribution of THC in the following distribution plot:

A: THC passes through the blood-brain barrier

Q3: Oxycodone (an opioid agonist) is metabolized through the CYP3A4 enzyme into a weaker opioid agonist than oxycodone. Which of the following is true:

A: Grapefruit juice can decrease the half-life of oxycodone

Q4: Ibuprofen (Advil) has a half-life of ~2 hours.  Half an hour after taking a 400mg pill of ibuprofen, the peak plasma concentration is 10 ug/ml. Advil has pain-killing activity at a plasma concentration above 3 mg/ml. Approximately how often would you need to take another pill to maintain the pain relief activity of Ibuprofen?

A: Every 4 hours

Q5: In the following figure, which is true?

A: A is the most potent receptor agonist

Q6: Individual variability in caffeine metabolism may be the result of:

A: Smoking, which will decrease the half-life of caffeine

Q7: Which of the following is true about adenosine:

A: Caffeine is an antagonist of the adenosine receptor

Q8: A large Charged Lemonade from Panera contains ~250mg of caffeine. After drinking 5 large Charged Lemonades:

A: An individual would display signs of toxicity, including increased urinary output, anxiety, tachycardia

Quiz #3

Q1: The majority of college students who have used amphetamine-like stimulants have a prescription.

A: False

Q2: Off-label use of a drug indicates that:

A: The FDA has not conducted a careful evaluation of the benefits and risks for the off-label use

Q3: What is one of the ways Amphetamines lead to increased dopamine levels in the synaptic cleft?

A: By inhibiting dopamine reuptake

Q4: Lisdexamfetamine (Vyvanse) is a prodrug that is converted in red blood cells to dextroamphetamine. Which of the following is true?

A: Lisdexamfetamine has less abuse potential than dextroamphetamine when administered intravenously

Q5: How does propranolol impact performance anxiety?

A: By blocking the fight or flight response

Q6: Propranolol half-life is 3-6 hours and is primarily metabolized by CYP1A2. We also know that smoking cigarettes can increase the activity of the CYP1A2 enzyme. How would smoking affect the metabolism of propranolol?

A: Increase propranolol metabolism, reduce the duration of action/decrease half-life

Q7: The bioavailability of propranolol was assessed by a single-dose (80 mg) study in healthy volunteers who either took the drug 1) on an empty stomach, 2) immediately after a protein-rich breakfast, or 3) together with a carbohydrate-rich, protein-poor breakfast. Which group would have the highest plasma concentration of propranolol?

A: Protein-rich breakfast

Q8: My friend Tommy Bahama has been doing the keto diet, which makes his urine a pH of 4. His doctor also recently put him on Adderall to help with his ADHD, but he didn’t disclose his diet in his appointment. He is noticing that the dose he was prescribed wears off quickly during the day. Why is this?

A: Acidic urine promotes elimination leading to a shorter half-life

Quiz #4

Q1:

This figure demonstrates the mechanism of action of steroid hormones. The figure shows that the binding of hormones to hormone receptors induces:

Picture_2.png

A: Gene expression

Q2: True or False: only people with ovaries produce estrogen and progesterone and only people with testes produce testosterone

A: False

Q4: NES/T is currently in Phase II trials for use as a hormonal contraceptive in people who produce sperm.  This hormonal contraceptive combines Nestorone (to inhibit testosterone production) with synthetic testosterone. The addition of synthetic testosterone is included to increase blood testosterone levels, while keeping testicular testosterone levels low.  This addition is important because:

A: Blood levels of testosterone are necessary for libido, sexual function, and muscle growth

Q5: Tricyclic Antidepressants were originally developed as a therapeutic for Tuberculosis, but later were shown to have antidepressant effects as they are antagonists of some serotonin, adrenergic, and histamine, muscarinic targets. Why was the development of SSRI’s such an advanced shift from TCAs used for antidepressants?

A: SSRIs are more selective for serotonin than TCAs and have a higher therapeutic index

Q6: Joe Schmoe was recently prescribed propranolol for his high blood pressure by his primary care physician. As we remember, propranolol is metabolized by primarily by CYP1A6 and also CYP2D6. A few weeks later, he went to the psychiatrist, who prescribed him Fluoxetine (Prozac), an SSRI that inhibits activity of CYP2D6. How would this change the metabolism of both drugs?

A: No change in fluoxetine metabolism, decreased metabolism of propranolol

Q7: What is not one of the differences between different drugs within the SSRI class?

A: Selectivity for the serotonin transporter over other neurotransmitter transporters

Q8: Below is a general diagram of a monoamine synapse. If this monoamine was serotonin, where would SSRI’s have their affect? 

Picture1.png

A: C

Quiz #5 

Q1: True or False: Drugs (including benzodiazepines) are always designed to act through a defined mechanism of action and for a specific disease indication.

A: False

Q2: GABA binds to a binding site on the GABA A receptor that is between the alpha and beta subunits to open the ion gate. Benzodiazepines bind to a binding site between the alpha and gamma subunits to open the ion gate. Therefore, benzodiazepines are:

A: Allosteric agonists

Q3: Different drugs within the benzodiazepine class can have different biological effects. Which is NOT one of the reasons for these differences:

A: Some benzodiazepines predominately act through a receptor that is not the GABA A receptor

Q4: Combining benzodiazepines with other depressants (e.g. alcohol or opioids) can increase overdose risks because:

A: Combination of benzodiazepines and depressants can increase risk of respiratory depression (slowing or stopping breathing)

Q5: Phencyclidine (PCP) and ketamine differ in that:

A: Ketamine is less potent than PCP

Q6: Ketamine acts as an allosteric antagonist to the excitatory NMDA receptor. This means that:

A: Ketamine binds to a different site as glutamate to prevent the activation of the NMDA receptor

Q7: In The CUT article “Leave Your Body at the Door”, NYU professor, Dr. Joseph Palamar, is quoted as saying “[Ketamine] is also extremely potent; the difference between a goofy buzz and total body paralysis is [a small amount].” This statement is an example of ketamine having:

A: A low therapeutic index (here the effective dose is a goofy buzz and the toxic dose leads to total body paralysis]

Q8: The R-ketamine (R-Ket) enantiomer is more efficacious as an anti-depressant than MK 801 and S-ketamine (S-Ket). Below is a graph showing the ability of these three chemicals to bind to NMDAR.  (remember, drugs that bind at lower concentrations are more potent).  Data SPECIFICALLY FROM THIS GRAPH provide evidence that:

NMDAR_image.png

A: R-Ketamine likely has additional mechanisms of action, beyond binding to NMDAR, that are responsible for its anti-depressant activity

Quiz #6

Q1

Fentanyl, propranolol, and ~1/3 of FDA approved drugs target:

A: G-protein coupled receptors

Q2

Heroin has less of a biological effect when delivered orally compared to by i.v. injection because:

A:Heroin undergoes first-pass metabolism when delivered orally

Q3

A subset of the population is considered “ultrarapid metabolizers” that have increased activity of CYP2D6, the enzyme that converts codeine to morphine.  Compared to the rest of the population, when these “ultrarapid metabolizers” are exposed to codeine, they will:

A: Have increased analgesic (pain reducing) effect

Q4

The addition of functional groups to morphine make the chemical more lipophilic. This increased lipophilicity makes codeine and heroin:

A: Better at passing through cell membranes and crossing the blood-brain barrier

Q5

Naloxone (Narcan) is an antagonist of the opioid receptor. Which line represents its opioid receptor activity:

Picture1.png

A: C

Q6

Which of the following is true regarding the regulation of blood glucose levels:

A: After a meal containing glucose, the incretin, GLP-1, is secreted from the intestine in order to increase insulin secretion, which decreases blood glucose levels

Q7

Which is NOT an outcome of the GLP-1 receptor agonist, Semaglutide (Ozempic/Wegovy):

A: Increased hemoglobin A1C

Q8

If orally administered alone, the peptide, semaglutide (Ozempic/Wegovy) is not efficacious  because:

A: It is degraded by the acidic pH and proteolytic enzymes in the stomach

Quiz #7 

Q1

Botulism neurotoxin (BoNT) is

A: Bacteria

Q2

How does Botulism neurotoxin prevent Acetylcholine release?

A: By cutting up SNARE proteins and preventing vesicle exocytosis

Q3

Which of the following is not possibly treated by Botox:

A: Seasonal allergies

Q4:

Amphetamines, Beta Blockers, SSRIs, Benzodiazepines, Ketamine, and Botox influence which neurotransmitters, respectively:

Quiz_Z_image.JPG

A: C, A, D, E, G, F

Q5

True or False, the safest drugs/chemicals come from natural (plant, bacteria, or animal) sources.

A: False

Q6

Which of the following is considered a supplement by the FDA:

A: Vitamin D capsules for oral ingestion

Q7

When does the FDA involvement in supplement regulation begin

A: After market: the FDA takes action against adulterated or misbranded supplements

Q8

Which of the following is NOT an example of an allowed structure/function claim on a supplement label, when accompanied by the statement “This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease”:

A: Berberine can reverse type 2 diabetes

Quiz #8

Q1

Alcohol is not considered a Schedule I drug, because:

1. It is not addictive

2. It has important medical benefits

3. Historical, political, and financial reasons

4. Overdose is not possible

Q2

Alcohol has biological effects by:

1. Specifically GABA receptor signaling

2. Specifically through NMDA receptor signaling

3. Specifically through opioid receptor signaling

4. Nonspecifically through GABA, NMDA, Opioid, as well as additional receptor signaling

Q3

A deficiency in aldehyde dehydrogenase can result in a low alcohol tolerance. Which statement is accurate:

1. This deficiency leads to a build up in acetate, a toxic metabolite

2. This deficiency leads to a build up acetaldehyde, a toxic metabolite that also leads to production of histamine

3. This deficiency can be combatted by taking antihistamines, such as Benadryl

4. his deficiency can be combatted by taking the aldehyde dehydrogenase inhibitor, Disulfiram

Q4

Which statement is NOT true about CYP2E1 induction by alcohol:

1. CYP2E1 induction increases tolerance to alcohol, because it can be metabolized more readily

2. CYP2E1 induction leads to an increase in the hepatotoxic metabolite of acetaminophen (Tylenol), which is why Tylenol and alcohol should not be taken together

3. CYP2E1 induction leads to an increase in the inactive metabolite of acetaminophen (Tylenol), making it less effective. This is why Tylenol and alcohol should not be taken together.

Q5

The estimated blood alcohol concentration of a 70000 gram individual who drank 7 ounces of vodka (40% alcohol) over the course of 2 hours is 0.22%. On average, blood alcohol is reduced 0.015% each additional hour. If the legal driving limit is 0.08%, and the individual ceases alcohol consumption, how many additional hours will the individual need to wait before their blood alcohol concentration should be at where they can legally drive.

1. They are already legally able to drive

2. An additional 1

3. An additional 2 hours

4. An additional 10 hours

5. An additional 24 hours

Q6

Cannabinoid receptors differ from monoamine (e.g. serotonin, dopamine) receptors in that:

1. Cannabinoid receptors are expressed on the presynaptic neuron

2. Cannabinoid receptors are expressed only in the brain

3. Cannabinoid receptors cannot be activated by endogenous (produced by the body) chemicals

4. Cannabinoid receptors impact neurotransmitter signaling

Q7

The only compound in the cannabis plant that has a biological effect is cannabidiol (CBD).

1. True

2. False

Q8

The difference between the amount of the metabolite, 11-OH-THC, when smoking or eating THC is a result of what?

1. First-pass metabolism

2. Therapeutic index

3. Neurotransmitter transporters

4. Frequency of exposure