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Central Nervous System Pharmacology- Part 2
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1.A patient i s transported to the emergency A friend who accompanies the patient says “he was experimenting with ‘angel dust’”. What best describes the actions or other characteristics of this recreational drug, more properly know as phencyclidine?
- Causes i ts peripheral and central effects via antimuscarinic properties
- Causes s ignificant withdrawal symptoms
- Has strong opioid receptor-activating activity
- Has amphetamine-like properties and i s an hallucinogen
- Overdoses should be treated with flumazenil
2. Package inserts for a drug caution against administering i t concurrent with any other drug that can raise or lower sodium The ri sks are inadequate or excessive effects of the drug, depending on the direction in which sodium concentrations change. This, of course, requires cautious use or avoidance (i f possible) of the common diuretics. To which of the following drugs does this caution or warning apply?
- Li thium (eg, l i thium carbonate)
- Statin-type cholesterol-lowering drugs
3. A 31-year-old woman has been treated with fluoxetine for 5 She i s diagnosed with another medical problem and receives one or more drugs that, otherwise, would be suitable and probably problem-free. She i s rushed to the ED with unstable vi tal s igns, muscle rigidity, myoclonus, CNS i rri tability and altered consciousness, and shivering. What add-on drug(s) most l ikely caused these responses?
- Codeine for cough
- Loratadine for seasonal allergies
- Midazolam and fentanyl, used to ease discomfort from endoscopy
- Sumatriptan for migraine
- Zolpidem for short-term insomnia
4. A 72-year-old woman with a long history of anxiety that has been treated with diazepam decides to triple her daily dose because of increasing fearfulness about “environmental ” Two days after her attempt at self-prescribing, she i s found extremely lethargic and nonresponsive, with markedly obtunded reflexes and reactions to painful stimuli. Respirations are 8/min and shallow. What drug should be given to reverse these s igns and symptoms?
5. A patient who has been treated for Parkinson disease for about a year presents with purplish, mottled changes to her What drug i s the most l ikely cause of this cutaneous response?
- Levodopa (alone)
- Levodopa combined with carbidopa
6. A young boy who has been treated for epilepsy for a year i s referred to a periodontist for evaluation and probable treatment of massive overgrowth of his gingival ti Some teeth are almost completely covered with hyperplastic ti ssue. Which drug was the most l ikely cause of the oral pathology?
- Valproic acid
7. A patient with undiagnosed coronary artery disease i s given a Shortly thereafter she develops intense tightness and “crushing discomfort” of her chest. An ECG reveals ST-segment changes indicative of acute myocardial i schemia. Which drug most l ikely caused this reaction?
8. Nitrous oxide i s a common component in the technique of balanced It i s used in conjunction with such other drugs as a halogenated hydrocarbon volatile l iquid anesthetic, and usually included as 80% of the total inspired gas mixture. Which phrase best summarizes why nitrous oxide cannot be used alone for general anesthesia?
- Almost total lack of analgesic activity, regardless of concentration
- Inspired concentrations >10% tend to profound cardiac negative inotropic effects
- MAC (minimum alveolar concentration) i s >100%
- Methemoglobinemia occurs even with low inspired concentrations
- Such great solubility in blood that i ts effects take an extraordinarily long time to develop
- Very high frequency of bronchospasm
9. A patient develops a severe and rapidly worsening adverse response to a The physician orders prompt administration of antipyretics, IV hydration, and bromocriptine or dantrolene to manage symptoms and hopefully to prevent a fatal outcome. Which drug or drug group most l ikely caused these adverse responses?
- Benzodiazepines, especially those used as hypnotics
10. Ropinirole i s a relatively new drug that recently was approved to treat what’s commonly called restless leg syndrome (also known as Ekbom syndrome). The drug works as a dopamine receptor agonist in certain parts of the Given this mechanism of action, what other disorder i s , most l ikely, another indication for this drug?
- Daytime anxiety
- Hypersomnia (excessive s leepiness)
- Parkinson disease
- Status epilepticus
- Treatment of severe pain
11. A patient in the neurology unit at your hospital develops status epilepticus, and at the time there i s no good information about the What drug should be given fi rst for the fastest suppression of the seizures?
- Valproic acid
12. A patient has had a documented severe allergic reaction to ester-type local What other drug i s a member of the ester class, and so would be the most l ikely to provoke an allergic or anaphylactic reaction i f this patient received i t?
- Pri locaine
13. A 66-year-old woman i s diagnosed with Alzheimer disease, with symptoms being described as mild-to-moderate. What pharmacologic approach i s generally considered the most fruitful in terms of alleviating symptoms of early Alzheimer and probably s lowing the course of the underlying brain pathology?
- Activate a population of serotonin receptors
- Block dopamine release or receptor activation
- Inhibit acetylcholinesterase
- Inhibit MAO
- Dissolve cerebral vascular thrombi
14. Trihexyphenidyl i s prescribed as an adjunct to other drugs being used to manage a patient with Parkinson What i s the most l ikely purpose or action of this drug as part of the overall drug treatment plan?
- To counteract sedation that i s l ikely to be caused by the other medications
- To help correct further the dopamine-ACh imbalance that accounts for parkinsonian s igns and symptoms
- To manage cutaneous allergic responses that are so common with “typical” anti-parkinson drugs
- To prevent the development of manic/hypomanic responses to other antiparkinson drugs
- To reverse tardive dyskinesias i f the parkinsonism was induced by an antipsychotic drug
15. A few years ago the FDA granted approval to market a new prescription drug (“drug X”) that will be administered in the form of a dermal patch (apply the patch to intact skin, the drug i s absorbed from there).
Drug X belongs to a very old class of drugs that, when given by i ts usual route, orally, can interact with foods such as cheese and processed meats (and certain breads, other foods, and alcoholic beverages) leading to an interaction that can elevate blood pressure to severe and sometimes fatal levels. After more than a decade of testing, the FDA approved i ts use for adults. In i ts lowest dose, no dietary restriction(s) are required.
Based on this information, how i s drug X most l ikely classified and what i s i ts most l ikely cl inical use?
- Amphetamine-like agent for ADD/ADHD
- Barbiturates used for daytime anxiety
- Benzodiazepine for anxiety and s leep
- MAO inhibitor for depression
- Morphine-like analgesic for severe/chronic pain
16. The pediatrician writes a prescription for a combination (of several drugs) product that contains dextromethorphan, which i s an i somer of a codeine The patient i s a 12-year-old boy. What i s the most l ikely purpose for which the drug was prescribed?
- Control mild-moderate pain after the lad broke his wrist playing soccer
- Manage diarrhea caused by food-borne bacteria
- Provide sedation because the child has ADD/ADHD
- Suppress severe cough associated with a bout of influenza
- Treat nocturnal bed-wetting
17. Many legal jurisdictions have imposed various restrictions on over-the-counter sale of products, mainly oral decongestants, that contain That i s because pseudoephedrine can be rather easily used to synthesize which highly psychoactive and abuse-prone drug?
- Phencyclidine (PCP)
18. The anesthesiologist prepares to administer several drugs to a patient as part of normal pre- and intraoperative What drug lacks, as i ts normal spectrum of action, the ability to cause generalized CNS depression or the patient’s level of consciousness, or lacks any intrinsic analgesic effects?