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USMLE Step 1/Pharmacology Review Lippincott’s Illustrated Q&A Review of Pharmacology offers up-to-date, clinically relevant board-style questions —perfect for course review and board prep! Features: n 1,000 board-style review questions covering major topics in pharmacology n Questions related to clinical topics and divided by body system n Detailed explanations addressing incorrect answers n Full-color illustrations n Online access to the questions and answers Try other titles in this series: Lippincott’s Illustrated Q&A Review of Anatomy & Embryology Lippincott’s Illustrated Q&A Review of Biochemistry Lippincott’s Illustrated Q&A Review of Microbiology & Immunology Lippincott’s Illustrated Q&A Review of Neuroscience Lippincott’s Illustrated Q&A Review of Rubin’s Pathology, Second Edition ISBN-13: 978-1-4511-8286-6 ISBN-10: 1-4511-8286-4 9 7 8 1 4 5 1 1 8 2 8 6 6 9 0 0 0 0 LWW.com/medstudent Pharmacology Stanley Zaslau, MD Professor and Chief, Division of Urology Urology Residency Program Director Course Director, Urology Rotation West Virginia University Morgantown, West Virginia Lippincott’s Illustrated Review of Zaslau_FM.indd 1 12/08/12 12:20 AM Acquisitions Editor: Susan Rhyner Product Manager: Catherine Noonan Marketing Manager: Joy Fisher-Williams Designer: Doug Smock Compositor: Absolute Service, Inc. First Edition Copyright © 2014 Lippincott Williams & Wilkins, a Wolters Kluwer business 351 West Camden Street Two Commerce Square Baltimore, MD 21201 2001 Market Street Philadelphia, PA 19103 Printed in China All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at permissions@lww.com, or via website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Zaslau, Stanley. Lippincottt’s illustrated Q&A review of pharmacology / Stanley Zaslau.—1st ed. p. ; cm. Illustrated Q&A review of pharmacology Includes index. ISBN 978-1-4511-8286-6 I. Title. II. Title: Illustrated Q&A review of pharmacology. [DNLM: 1. Pharmacology—Examination Questions. 2. Pharmaceutical Preparations—Examination Questions. QV 18.2] 615.1076—dc23 2012046819 DISCLAIMER Care has been taken to confirm the accuracy of the information present and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner; the clini- cal treatments described and recommended may not be considered absolute and universal recommendations. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is par- ticularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320. International customers should call (301) 223-2300. Visit Lippincott Williams & Wilkins on the Internet: http://www.lww.com. Lippincott Williams & Wilkins customer service representa- tives are available from 8:30 am to 6:00 pm, EST. Zaslau_FM.indd 2 12/08/12 12:20 AM iii This compendium of pharmacology questions was created for the medical students to be able to test their knowledge of the subject. Questions are clinically based and divided by body system. Explanations are provided for correct and incorrect answers. This will allow the students to use the question guide to prepare for medical school course examinations as well as more comprehensive end-year exams and for licensure examinations. Furthermore, students will find the clinical nature of the questions useful for review in their third- and fourth-year rotations as well. Significant contributions to this text were made by medical students who are very familiar with the important concepts in pharmacology that are necessary to master for success on examinations. I am grateful for their contributions to this book. Preface Zaslau_FM.indd 3 12/08/12 12:20 AM Zaslau_FM.indd 4 12/08/12 12:20 AM v The author would like to acknowledge the outstanding efforts of the following contributing authors: Chad Morley, MD and Jared Manwaring, BA. Dr. Morley completed his medical education at West Virginia University and is currently enrolled in the Urology Residency at West Virginia University Hospitals. He has contributed a significant number of questions for this publication. Jared Manwaring, BA, is a fourth-year medical student at West Virginia University. He, with his tireless work ethic, also contributed a significant number of questions for this publication. Medical students make great teachers. The efforts of the aforementioned students during their medical education have taught their teacher, me, a great deal about how students think and process when faced with examination questions. The product of our efforts is reflected in this publication, which we sincerely hope is beneficial to the study of pharmacology. Acknowledgments Zaslau_FM.indd 5 12/08/12 12:20 AM Zaslau_FM.indd 6 12/08/12 12:20 AM vii Contents Preface iii Acknowledgments v Chapter 1 Principles of Pharmacology 1 Chapter 2 Principles of Neuropharmacology 35 Chapter 3 Cardiovascular Pharmacology 81 Chapter 4 Endocrine Pharmacology 123 Chapter 5 Drugs Affecting Other Systems (Including GI and Pulmonary) 159 Chapter 6 Chemotherapeutic Drugs 201 Chapter 7 Inflammation, Immune Pharmacology, and Toxicology 247 Index 294 Zaslau_FM.indd 7 12/08/12 12:20 AM Zaslau_FM.indd 8 12/08/12 12:20 AM [...]... metabolism, which would likely be decreased 28 The answer is E: CYP3A4. Cytochrome P450 3A4 (CYP3A4) accounts for roughly 30% of human liver CYP enzymes CYP1A2 makes up about 15%, CYP2A6 about 4%, CYP2D6 about 5%, and CYP2E1 about 10% Many drugs are metabolized by this enzyme, including cyclosporine, protease inhibitors, and benzodiazepines CYP3A4 activity is also modulated by many substances that it does... the cytochrome P450 system, disrupting levels of certain drugs The cytochrome P450 system includes dozens of enzymes Which is the most abundant CYP enzyme in human livers? (A) CYP1A2 (B) CYP2A6 (C) CYP2D6 (D) CYP2E1 (E) CYP3A4 25 A 27-year-old woman takes phenytoin to control focal seizures Most of the phenytoin in her blood is plasmaprotein bound, and only the free fraction is pharmacologically active... (A) CYP1A2 makes up about 15% of human liver CYP e nzymes (B) CYP2A6 makes up about 4% of human liver CYP enzymes (C) CYP2D6 makes up about 5% of human liver CYP enzymes (D) CYP2E1 makes up about 10% of human liver CYP enzymes 29 The answer is E: Smooth endoplasmic reticulum. The cytochrome enzymes are involved in oxidation and reduction reactions and contain heme groups All cytochrome P450 enzymes... pH for the purpose of ion trapping (D) Weakly acidic medications are not generally inactivated by bases 27 The answer is A: Glucuronidation. Morphine is metabolized by P-glycoprotein on enterocytes, by cytochrome P450 3A4 enzymes (phase I), and by glucuronidation (phase II) Phase I metabolism usually involves oxidation, but may involve reduction or hydrolysis, and r esults in the unmasking or addition... include lipid and steroid synthesis, drug metabolism, and regulation of intracellular calcium concentration The Golgi apparatus, lysosomes, and peroxisomes contain no cytochrome enzymes Mitochondria contain cytochrome C but no cytochrome P450 (A) The Golgi apparatus is involved in protein trafficking and glycosylation It has no cytochrome enzymes (B) Lysosomes contain hydrolytic enzymes, which work at a... neurotransmitters and their excitatory and inhib itory status Which of the following neurotransmitters is likely to be serotonin? (A) Neurotransmitter A; excitatory (B) Neurotransmitter B; excitatory (C) Neurotransmitter C; excitatory and inhibitory (D) Neurotransmitter D; inhibitory (E) Neurotransmitter E; generally inhibitory 44 A 19-year-old G1P0 woman lost her eyeglasses for a day Constant squinting causes... low pH The inside of a lysosome is acidified to activate these enzymes Lysosomes contain no cytochrome enzymes (C) Mitochondria do have cytochrome C (involved in the electron transport chain of oxidative phosphorylation) but do not contain cytochrome P450 enzymes (D) Peroxisomes are involved in the metabolism of very long chain fatty acids (.22 carbons) and have no cytochrome enzymes 30 The answer is... isolate the enzyme of interest from the many other proteins in the cells One of their initial steps is to lyse the cells and isolate the organelle which carries the enzyme they want to study Which organelle will they isolate to find CYP enzymes? (A) Golgi apparatus (B) Lysosomes (C) Mitochondria (D) Peroxisomes (E) Smooth endoplasmic reticulum 26 You receive a call from a frantic mother whose 3-yearold son... b-lactam and an aminoglycoside The rationale behind the use of multiple antibiotics includes which of the following? (A) Hepatotoxicity (B) Nephrotoxicity (C) Synergism (D) Toxicity 59 A 12-year-old male with Type-1 diabetes mellitus takes an insulin preparation before his meals to avoid h yperglycemia Once glucose molecules enter his cells, they are phosphorylated Phosphorylated glucose is unable... Regarding the use of a daily baby aspirin, oral fiber supplements, and a daily “water” pill in an 89-year-old man with hypertension and coronary artery disease, which of the following statements is true regarding pharmacology in the elderly patient? (A) Coexisting disease states are unlikely to produce additive impairment (B) Elderly patients are less sensitive to drug effects (C) Elderly patients are less . abundant CYP enzyme in human livers? (A) CYP1A2 (B) CYP2A6 (C) CYP2D6 (D) CYP2E1 (E) CYP3A4 29 Researchers interested in studying a certain cyto- chrome P450 enzyme wish to isolate the enzyme of. acne. In which FDA Pregnancy Category does this drug belong? (A) Category A (B) Category B (C) Category C (D) Category D (E) Category X 76 A 57-year-old man with a history of knee trauma un- dergoes. Neurotransmitter C; excitatory and inhibitory (D) Neurotransmitter D; inhibitory (E) Neurotransmitter E; generally inhibitory 44 A 19-year-old G1P0 woman lost her eyeglasses for a day. Constant squinting