TEST BANK for Focus On Pharmacology Essentials For Health Professionals 3rd Edition by Jahangir Moin by welldoneassistant

Focus On Pharmacology Essentials For Health Professionals 3rd Edition Moini Test Bank Focus on Pharmacology: Essentials for Health Professionals, 3e (Moini) Chapter 1 Introduction to Pharmacology 1) The study of drugs derived from herbal sources is known as: A) pharmacotherapeutics B) pharmacognosy C) pharmacokinetics D) pharmacodynamics Answer: B Explanation: B) Pharmacognosy is the study of drugs derived from herbal sources, and other natural sources. By studying the compositions of natural substances and how the body reacts to them, one gains better knowledge for developing purified versions. 2) Which of the following organizations is a part of the United States Department of Health and Human Services? A) DEA B) CDC C) FDA D) TJC Answer: C Explanation: C) The Food and Drug Administration (FDA) is part of the United States Department of Health and Human Services. The determination of the correct use of prescription and OTC agents is controlled by the branch of the FDA known as the Center for Drug Evaluation and Research (CDER). 3) Animal pharmacology and toxicology data are obtained during which of the following phases of drug approval? A) Phase I B) Phase II C) Phase III D) Phase IV Answer: A Explanation: A) Phase I of drug approval is when animal pharmacology and toxicology data are obtained. This phase is known as Preclinical Investigation. It involves extensive research on human and microbial cells in a laboratory. Cultured cells and animal studies are used to determine dosages, effectiveness, and adverse effects. 4) Which of the following drug approval phases consists of three trials? A) Phase I B) Phase II C) Phase III D) Phase IV Answer: B Explanation: B) Phase II of drug approval consists of three trials. It is also known as Clinical Investigation, and is the longest, occurring over 2 to 10 years, 5 years being the average. Clinical Phase 1 trials occur over several months. Clinical Phase 2 trials occur over several months to 2 years. Clinical Phase 3 trials occur over 1 to 4 years.

5) Which of the following is NOT an example of a drug withdrawn from the U.S. market as a result of postmarketing surveillance? A) aprotinin B) morphine sulfate C) gatifloxacin D) lumiracoxib Answer: B Explanation: B) Morphine sulfate is not an example of a drug withdrawn from the U.S. market as a result of postmarketing surveillance. Examples of drugs withdrawn from the U.S. market since 2005, as a result of postmarketing surveillance, include aprotinin, propoxyphene, gatifloxacin, lumiracoxib, ozogamicin, pergolide, and sibutramine. 6) Which of the following is the most famous examples of a drug that was withdrawn after postmarketing surveillance? A) celecoxib B) furosemide C) atenolol D) penbutolol Answer: A Explanation: A) Celecoxib is the most famous example of a drug that was withdrawn after postmarketing surveillance. It was withdrawn along with valdecoxib and rofecoxib. All three were linked to safety concerns of stroke and heart attack. Celecoxib remains on the market, but carries a black box warning. 7) Which of the following is NOT an example of a biologic drug? A) vaccine B) interferon C) antibody D) toothpaste Answer: D Explanation: D) Toothpaste is not an example of a biologic drug. A drug is any agent that produces biologic responses within the body. Drugs differ from other products such as cosmetics, foods, and household chemicals, such as toothpaste, shampoo, and others. 8) How many people are injured annually by medication errors in the United States? A) 99,000 B) 450,000 C) 840,000 D) 1,300,000 Answer: D Explanation: D) 1,300,000 people are injured annually by medication errors in the United States, according to the Centers for Disease Control and Prevention. Medication errors cause at least one death every day.

9) Which of the following four phases of drug approval includes review of the New Drug Application (NDA)? A) Phase I B) Phase II C) Phase III D) Phase IV Answer: C Explanation: C) Phase III of drug approval involves review of the New Drug Application (NDA). During this phase, the trade name is finalized. Based on the preclinical testing, clinical trials and further animal testing may continue. For a new drug, it usually takes about 24 months for the full NDA review.

10) Manufacturers start developing their trade names for a new drug during which of the following drug approval phases? A) Clinical phase 1 trials B) Clinical phase 2 trials C) Clinical phase 3 trials D) Phase IV Answer: A Explanation: A) In Clinical Phase 1 trials, manufacturers start developing their trade name for a new drug. Dosages and adverse effects are assessed on approximately 20-100 human volunteers initially, who have the disease or condition that the drug is being tested to treat. Doses are often subtherapeutic, but ascending (increasingN)UdRoSsIeNsGaTrBe.C usOeM d. 11) Complementary and alternative medicine (CAM) therapies are controlled by which of the following organizations? A) CDC B) EPA C) NCCAM D) CFSAN Answer: C Explanation: C) The National Center for Complementary and Alternative Medicine (NCCAM) is the organization that controls complementary and alternative medicine (CAM) therapies. This agency studies the usefulness and safety of these therapies in improving health care. 12) How long does preclinical investigation usually take? A) Between one and six months B) Between three and nine months C) Between one and three years D) Between three and nine years Answer: C Explanation: C) Preclinical investigation usually takes between one and three years. It is the first stage of new drug testing, and involves extensive research on human and microbial cells in a laboratory. The average time for preclinical investigation is 18 months. This phase is always inconclusive since results may be insufficient or excessive in comparison to how human subjects

will actually react to a new product.

13) The percentage of drugs in clinical phase 2 trials that move on to the next phase of clinical testing is: A) 25% B) 33% C) 46% D) 78% Answer: B Explanation: B) About 33% of drugs in clinical phase 2 trials move on to the next phase of clinical testing. These trials use between several dozen and 300 volunteers that have the disease or condition that the drug is being tested to treat. The drug is assumed not to have a therapeutic effect until further testing occurs. 14) Which of the following drugs carries a black box warning? A) celecoxib B) valdecoxib C) rofecoxib D) rifampin Answer: A Explanation: A) Celecoxib carries a black box warning, but remains on the market. Its warning is about potentially fatal cardiovascular disease, serious gastrointestinal problems, and bleeding ulcerations. 15) Pharmacology deals with all the drugNsUuRsSeIdNG inTsBo.CciOeM ty today, including prescription, legal, OTC, and drugs. A) generic B) legend C) illegal D) experimental Answer: C Explanation: C) Illegal drugs, as well as prescription, legal, and OTC drugs, are dealt with by today's pharmacology. To administer a drug safely, one must know its usual dose, frequency, route of administration, indications, contraindications, significant adverse reactions, and major drug interactions. 16) Any substance intended to be used to improve a physiologic or pathologic condition is known as a: A) drug B) dose C) solution D) compound Answer: A Explanation: A) A drug is any substance intended to be used to improve a physiologic or pathologic condition. It produces biologic responses within the body. When a drug response is desired, it is referred to as therapeutic. When the response is undesired, it is referred to as adverse.

17) A "medicine" refers to a drug mixed with other ingredients that may improve its taste, physical form, or: A) effectiveness B) stability C) odor D) color Answer: B Explanation: B) A "medicine" is a drug mixed with other ingredients that may improve its stability, taste, or physical form. A medicine is also known as a "medication". 18) A sugar pill (which may be thought to be a drug by the patient) is also known as a(n): A) diet pill B) energy pill C) placebo D) antihyperglycemic agent Answer: C Explanation: C) A placebo is a sugar pill, which may be thought to be a drug by the patient. 19) Once a drug has been administered to a patient, it is called: A) biological B) therapeutic C) an alternative drug D) a medication Answer: D Explanation: D) A medication is a drug that has been administered to a patient. Both drugs and medications are thought of as components of normal physiological activities. 20) Herbal products and dietary supplements are controlled by: A) The Center for Biologics Evaluation and Research B) The Center for Food Safety and Applied Nutrition C) The Center for Drug Evaluation and Research D) The Center for Disease Control and Prevention Answer: B Explanation: B) The Center for Food Safety and Applied Nutrition (CFSAN) controls herbal products and dietary supplements. It is a branch of the FDA. Herbal products and dietary supplements are also regulated by the Dietary Supplement Health and Education Act of 1994. Herbal and dietary supplements can still be marketed without FDA approval.

Focus on Pharmacology: Essentials for Health Professionals, 3e (Moini) Chapter 2 Pharmacodynamics 1) The pharmacologic actions of a drug that determine its therapeutic effects are called: A) pharmacology B) pharmacokinetics C) pharmacognosy D) pharmacodynamics Answer: D Explanation: D) The pharmacologic actions of a drug that determine its therapeutic effects are called pharmacodynamics, which can also determine the drug's adverse effects. The term pharmacodynamics describes how a medication causes changes in the body. It studies the biochemical as well as the physiologic effects of drugs, along with the molecular mechanisms used to produce these effects. 2) Which of the following body fluids is the most commonly used to characterize pharmacologic drug actions? A) Urine B) Cerebrospinal fluid C) Blood D) Sputum Answer: C Explanation: C) Blood is the body fluid most commonly used to characterize pharmacologic drug actions. Usually, there are correlatioNnUsRbSeIN twGeTeBn.CpOhM armacokinetics and pharmacodynamics that demonstrate the relationship between drug dose and blood or other biological fluid concentrations. 3) Which of the following can determine the dose-effect relationship? A) Pharmacokinetics B) Pharmacodynamics C) Both D) Neither Answer: C Explanation: C) Both pharmacokinetics and pharmacodynamics can determine the dose-effect relationship, which is also called the dose-response relationship. It is the relationship between the dose of a drug (or other agent) that produces therapeutic effects and the potency of the effects on an individual person.

4) Which of the following represents the number of patients that respond to the actions of a drug? A) Frequency distribution curve B) Median effective dose C) Dose-effect relationship D) Median lethal dose Answer: A Explanation: A) The frequency distribution curve represents the number of patients that respond to the actions of a drug. It represents the number of patients that respond to the actions of a drug at different doses. A few patients are shown to have responded to a medication at very low doses, whereas increasing numbers of patients responded as the dosage was increased. 5) Where are intracellular receptors located? A) in the mitochondrion B) in the cytoplasm C) in the nucleus D) in the ribosomes Answer: B Explanation: B) The intracellular receptors are located in the cytoplasm. Some drugs act on these receptors, including corticosteroids and thyroid hormone. 6) Drugs must before being absorbed. A) be diluted B) circulate C) be compounded D) dissolve Answer: D Explanation: D) Drugs must dissolve before being absorbed. Then, they are able to pass through the small intestine and enter the blood circulation. Some of these drugs are absorbed and metabolized before reaching the site of action. The factors that may influence the onset, duration, and intensity of drug effects include absorption, metabolism, reabsorption, excretion, site of action, and observed response. 7) A drug's potency does NOT indicate anything about which of the following? A) tolerance B) target molecules C) affinity D) maximal efficacy Answer: D Explanation: D) A drug's potency does not indicate anything about its maximal efficacy. This term describes the largest effect that a drug can produce.

8) An example of a toxic agent in which a small dose causes drowsiness, but a large dose can be fatal is: A) carbon monoxide B) sulfuric acid C) hydrochloric acid D) carbon dioxide Answer: A Explanation: A) Carbon monoxide is a toxic agent in which a small dose causes drowsiness, but a large dose can be fatal. None of the answer choices have these effects. 9) A drug that blocks the effects of another substance is called which of the following? A) stimulant B) depressant C) antagonist D) potentiator Answer: C Explanation: C) An antagonism is a drug that blocks the effects of another substance. It can also be another agent, and can also block functions. Antagonists are often used when treating overdoses. 10) The amount of medication needed to produce a specific response in 50% of patients is called the: A) frequency distribution curve B) median effective dose C) maximal efficacy drug D) dose-effect relationship Answer: B Explanation: B) The amount of medication needed to produce a specific response in 50% of patients is called the median effective dose. It appears at the top of the frequency distribution curve of a drug, which indicates if a measurable response occurred in the test group of patients. The median effective dose is abbreviated as "ED50". 11) The therapeutic index of a drug is used to predict whether a certain: A) drug has any side effects B) dosage is toxic for pregnant women C) dosage is safe for a specific patient D) dosage is lethal for a specific patient Answer: C Explanation: C) The therapeutic index of a drug is used to predict whether a certain dosage is safe for a specific patient. Like the median effective dose, frequency distribution curves are also used to determine the median lethal dose (LD50) of a drug during preclinical trials. The therapeutic index is calculated by dividing the LD50 by the median effective dose (ED50).

12) The higher the value of the therapeutic index, A) the safer the medication is to use B) the cheaper the drug may be, and still be effective C) means that the safety of the medication is uncertain D) the less effective a generic drug will be compared to a trade name drug Answer: A Explanation: A) The higher the value of the therapeutic index, the safer the medication is to use. A larger therapeutic index means that the difference between the median lethal dose and median effective dose is larger. 13) The affinity for a target receptor is its: A) transcription factor B) enzyme activation C) target molecule D) attractive force Answer: D Explanation: D) The affinity for a target receptor is its attractive force. The cell recipient is known as a receptor — usually a specific protein — situated in cell membranes on cell surfaces. Intracellular receptors are located within the cellular cytoplasm. 14) Which of the following are NOT triggers of second-messenger events? A) B-complex vitamins B) Retinoids C) Steroid agents D) Hormones Answer: A Explanation: A) B-complex vitamins are not triggers of second-messenger events. Once bound to a receptor, a drug may trigger these events inside cells. Examples include release of intracellular calcium, activation of enzymes and specific G proteins, and conversion of adenosine triphosphate (ATP) to cyclic adenosine monophosphate (cyclic AMP). The agents that bind intracellular components include hormones, steroid medications, retinoids, and vitamin D. 15) Which of the following are NOT included in the four primary drug-receptor families? A) Ligand-gated ion channels B) G protein-coupled receptor systems C) Antagonists D) Transcription factors Answer: C Explanation: C) Antagonists are NOT included in the four primary drug-receptor families. They are drugs or other agents that block or antagonize the effects of other substances or functions. The four primary drug-receptor families include: enzymes embedded in cell membranes, ligandgated ion channels, G protein-coupled receptor systems, and transcription factors.

16) Which of the following are examples of agonist-antagonists? A) dobutamine and insulin B) pentazocine and meperidine C) norethindrone and dobutamine D) antihistamine and naloxone Answer: B Explanation: B) Pentazocine and meperidine are examples of agonist-antagonists, which are agonists that produce weaker or less effective responses than endogenous chemicals. They are also known as partial agonists, and have only slight intrinsic activity. Pentazocine has much lower pain-relieving actions than a full agonist such as meperidine. 17) Transcription factors are located in the: A) cell nucleus B) cell membrane C) mitochondria D) cytoplasm Answer: A Explanation: A) Transcription factors are located in the cell nucleus, on deoxyribonucleic acid (DNA). They regulate protein synthesis with delayed responses. Activation required highly lipidsoluble cell membrane ligands. Examples include thyroid hormone and all steroid hormones. 18) Which of the following is NOT a substance that utilizes a G protein-coupled receptor system? A) serotonin B) histamine C) testosterone D) norepinephrine Answer: C Explanation: C) Testosterone is NOT a substance that utilizes a G protein-coupled receptor system. Instead, it utilizes transcription factors for its actions. Examples of substances that do use G protein-coupled receptor systems include norepinephrine, histamine, serotonin, and many peptide hormones. 19) Which of the following in an enzyme embedded in cell membranes? A) insulin B) acetylcholine C) gamma-aminobutyric acid D) serotonin Answer: A Explanation: A) Insulin is an enzyme embedded in cell membranes. The ligand-binding domain is where drug and endogenous regulatory molecule binding occurs. It is on the cell surface, and catalytic sites of the enzymes are inside.

20) Which of the following is NOT true regarding a median toxicity dose? A) It produces a given toxicity in 50% of patients. B) It is determined from animal testing data. C) It cannot be tested in humans. D) It determines adverse effects occurring during patient clinical trials. Answer: C Explanation: C) A median toxicity dose can be tested in humans, so answer choice "C" is NOT true. The median toxicity dose is the dose that produces a given toxicity in 50% of patients, and can be determined from animal testing data or because of adverse effects occurring during patient clinical trials. 21) Which of the following is a component of nonspecific cellular responses? A) osmotic diuretic B) insulin C) acetylcholine D) progesterone Answer: A Explanation: A) An osmotic diuretic is a component of nonspecific cellular responses. Other agents that work via these responses include general anesthetics and ethyl alcohol. All of these agents act independently of cellular receptors by either changing cellular membrane permeability, by changing how cellular pumps work, or by depressing membrane excitability. 22) A drug that binds to a receptor, and produces a stimulatory response that is similar to what an endogenous substance would have done NifUiRt SwIN erGeTbBo.C unOdMto the receptor is known as a(n): A) receptor B) agonist C) antagonist D) agonist-antagonist Answer: B Explanation: B) An agonist is a drug that binds to a receptor, and produces a stimulatory response that is similar to what an endogenous substance would have done if it were bound to the receptor. For example, adrenaline is an agonist at beta-adrenoceptors. When adrenaline binds to beta-adrenoceptors in the heart, the heart rate increases. Agonists drugs have affinity, which allows them to bind to receptors, as well as high intrinsic activity, which allows them to activate the functions of receptors. 23) Which of the following is a true statement regarding antagonists? A) Combining two antibiotics may increase each drug's effects. B) All antagonists produce a stimulatory response that is similar to what an endogenous substances produces. C) They have affinity and high intrinsic activity. D) All antagonists are associated with receptors. Answer: D Explanation: D) It is true that all antagonists are associated with receptors. They often compete with agonists for their receptor binding sites. However, they have almost no effects upon receptor function on their own. If no agonist is present, an administered antagonist will have no observable effect. 6

24) Competitive antagonists are also referred to as: A) surmountable antagonists B) insurmountable antagonists C) agonist-antagonists D) partial agonists Answer: A Explanation: A) Competitive antagonists are also referred to as surmountable antagonists. The majority of antagonists are classified as competitive antagonists. They bind reversible to receptors, producing receptor blockade because they compete with agonists for receptor binding. 25) The amount of drug required to cause an effect is referred to as: A) maximal efficacy B) dose-effect relationship C) relative potency D) adverse effect Answer: C Explanation: C) The amount of drug required to cause an effect is referred to as relative potency. Note that potency is rarely important overall. A drug with a higher potency requires smaller doses to produce the same effect as a drug with lower potency. The largest effect that a drug can produce is also known as its maximal efficacy, but its potency does not indicate anything about its maximal efficacy.

Focus on Pharmacology: Essentials for Health Professionals, 3e (Moini) Chapter 3 Pharmacokinetics 1) Simple diffusion involves: A) drugs crossing membranes against their gradient from areas of low concentration to high concentration B) movement of molecules from areas of higher concentration to areas of lower concentration C) a certain carrier protein D) unevenly distributed electrical charges Answer: B Explanation: B) Simple diffusion involves movement of molecules from areas of higher concentration to areas of lower concentration. Over time, drug molecules are inactivated (metabolized) by tissues, and additional doses may be administered to create a continual concentration gradient, from blood to tissue. 2) Which of the following is false regarding plasma membranes? A) They contain two layers of phospholipids. B) They contain cholesterol, carbohydrates, and proteins. C) Their phospholipids have a round head and one tail. D) Cholesterol and phospholipids are essential. Answer: C Explanation: C) Regarding plasma membranes, their phospholipids do NOT have a round head and one tail. While their heads are round and contain the phosphate, they have two tails, which are long-chain hydrocarbons. Other subsNtaUnRcSeIsNeGmTbBe.CdO deMd in the membrane include cholesterol, carbohydrates, and proteins. 3) An example of a polar molecule is the: A) water molecule B) hydrogen molecule C) sugar molecule D) alcohol molecule Answer: A Explanation: A) A water molecule is an example of a polar molecule, which has unevenly distributed electrical charges. In the water molecule, the negative electrons remain closer, most of the time, near the oxygen atom in comparison to the two hydrogen atoms. Therefore, the area near the oxygen atom is usually negatively charged, whereas the area near the hydrogen atoms is usually positively charged.

4) The primary site of gastrointestinal (GI) absorption of a drug is the: A) esophagus B) stomach C) small intestine D) large intestine Answer: C Explanation: C) The small intestine is the primary site of GI absorption of a drug, because of its very large surface area, across which drugs may diffuse. Acids are normally absorbed more extensively in the intestines that in the stomach even though the intestines have a higher pH. The higher the pH, the more alkaline; the lower the pH, the more acidic. 5) The speed of systemic availability depends on pharmaceutical factors and: A) bloodstream absorption B) gastrointestinal absorption C) rate of excretion D) cellular absorption Answer: B Explanation: B) The speed of systemic availability (or bioavailability) depends on pharmaceutical factors and gastrointestinal absorption. Pharmaceutical factors include the rate at which a tablet or capsule dissolves, or the use of binding products in formulating the medication. Factors that affect drug absorption include food in the stomach, other drugs taken concurrently, intestinal motility, or certain disease states. 6) Which of the following is false regardNinUgRtShIN e GGTIBt.rCaO ctMand drug absorption? A) pH partitioning influences absorption. B) The presence of food in the stomach or intestine influences absorption. C) Protein solubility influences absorption. D) Blood flow influences absorption. Answer: C Explanation: C) Regarding the GI tract and drug absorption, protein solubility does NOT influence absorption. However, absorption is influenced by pH partitioning, the presence of food in the stomach or intestine, and blood flow. The term pH partitioning refers to a drug's molecules being more likely to be ionized in the plasma, because of differences between plasma pH and the pH at the site of administration. 7) Many drugs are bound to circulating proteins; the most common of which is usually: A) interferon B) enzymes C) glycoproteins D) albumin Answer: D Explanation: D) The most common circulating protein to which drugs are bound is usually albumin. Many drugs are also bound to lipoproteins or glycoproteins. Only the fraction of drugs not bound to protein can bind to cellular receptors, pass across tissue membranes, and gain access to cellular enzymes, thus being distributed to body tissue.

8) During pregnancy, the placenta may transfer drugs that are: A) ionized B) lipid-soluble C) water-soluble D) metabolized Answer: B Explanation: B) During pregnancy, the placenta may transfer drugs that are lipid-soluble from the mother to the fetus. The substances most likely to pass through the placenta are those that are lipid-soluble and nonionized. These agents are linked to birth defects, drug dependency, and respiratory depression. 9) Most drug metabolism occurs in the: A) liver B) kidneys C) bloodstream D) lungs Answer: A Explanation: A) Most drug metabolism (or biotransformation) occurs in the liver, through the same biochemical pathways and reactions that affect nutrients, vitamins, and minerals. The majority of metabolism in the liver occurs through the hepatic microsomal enzyme system (P450 system). Its key component is cytochrome P450, which is actually a group of 12 enzyme families. 10) An important mechanism that affectsNvUaRrSyIiNnG g TdBru.CgOaMction and metabolism is the: A) GI tract effect B) intestinal effect C) first-pass effect D) toxic drug action Answer: C Explanation: C) An important mechanism that affects varying drug action and metabolism is the first-pass effect. When oral drugs are absorbed from the GI tract, they move to the liver through the hepatic portal vein. Metabolism accomplishes the conversion of molecules as well as biodegradation of foreign substances. 11) The initial rate of distribution of a drug is heavily dependent on the to various organs. A) blood flow B) hepatic portal circulation C) oxygen distribution D) reactions Answer: A Explanation: A) The initial rate of distribution of a drug is heavily dependent on the blood flow to various organs. Lipid-soluble drugs enter the CNS rapidly. Because of the blood-brain barrier, certain drugs are poorly distributed to the CNS because they pass through the barrier. The three major influencing factors related to drug distribution are: blood flow to the body tissues, how drugs are able to exit the vascular system, and how drugs are able to enter body cells. 3

12) Which of the following carries blood directly to the liver? A) A biochemical pathway B) Renal portal circulation C) Hepatic portal circulation D) Lymphatic portal circulation Answer: C Explanation: C) The hepatic portal circulation carries blood directly to the liver. If the liver has a high metabolic capacity, the drug is totally inactivated on its first pass, and no therapeutic effects occur. A drug may be given parenterally in order to avoid the first-pass effect. The liver is temporarily bypassed, and the drug reaches therapeutic levels in the systemic blood. 13) Orally administered drugs are usually absorbed in the: A) lower GI tract B) esophagus C) pharynx D) upper GI tract Answer: D Explanation: D) Orally administered drugs are usually absorbed in the upper GI tract (the stomach and the small intestine). From the small intestine, drugs are absorbed and immediately move to the liver for metabolism, involving various enzymes, to reach the systemic circulation. This process is called the first-pass effect. 14) The stomach has a(n) environment. A) basic B) acidic C) alkaline D) physiochemical Answer: B Explanation: B) The stomach has an acidic environment. Lipid-soluble drugs and weak acids may be absorbed directly from the stomach. Weak bases are not normally absorbed from the site. Aspirin and other drugs that have an acidic pH are easily absorbed in the stomach's acidic environment. 15) Most drug metabolism is also referred to as: A) glucuronidation B) oxidation C) biotransformation D) conjugation Answer: C Explanation: C) Most drug metabolism is also referred to as biotransformation. It is the process of conversion of drugs via enzymatic actions, and may be divided into four main stages: oxidation, reduction, hydrolysis, and conjugation. Oxidation is combination with oxygen. Reduction involves the gaining of electrons. Hydrolysis is the cleaving of a compound into simpler compounds, with uptake of hydrogen and hydroxide from water molecules. Conjugation is the combination of substances with glucuronic or sulfuric acid.

16) Which of the following medications temporarily bypasses the liver? A) Vitamin D B) Penicillin C) Vitamin A D) Nitroglycerin Answer: D Explanation: D) Nitroglycerin temporarily bypasses the liver. It may avoid the first-pass effect via sublingual administration, since this method allows it to be absorbed directly into the systemic circulation. The drug moves to its sites of action prior to being exposed to liver enzymes. 17) For which of the following drugs may toxicity occur when blood levels of potassium are lower than normal? A) digoxin B) cortisol C) tetracycline D) morphine Answer: A Explanation: A) For digoxin, toxicity may occur when blood levels of potassium are lower than normal. This is a highly significant example of altered drug response due to electrolyte imbalance. Lower than normal levels of potassium may result in digoxin toxicity, and potentially fatal dysrhythmias. 18) Which of the following is NOT one N ofUtRhSeIN thGreTeB.cCaOteMgories of tolerance? A) pharmacodynamic B) hydrophilic C) metabolic D) tachyphylaxis Answer: B Explanation: B) The term "hydrophilic" is NOT one of the three categories of tolerance. It refers to a substance that is water-soluble. The three categories of tolerance include: pharmacodynamic tolerance, metabolic tolerance, and tachyphylaxis. 19) Which of the following chemical substances in the blood normally cannot pass during glomerular filtration? A) simple sugars B) electrolytes C) proteins D) uric acids Answer: C Explanation: C) Proteins in the blood normally cannot pass during glomerular filtration. This process occurs at the glomerulus of the kidney tubule. Drugs are forced through pores of capillary walls, then into the tubular urine. However, blood cells and large molecules such as proteins cannot undergo this process due to their size. Therefore, drugs bound to albumin remain in the blood.

20) Manipulation of urinary pH results in decreased passive reabsorption and increased: A) excretion B) glomerular filtration C) recirculation of urea D) elimination of iron Answer: A Explanation: A) Manipulation of urinary pH results in decreased passive reabsorption and increased excretion. Regarding competition for active tubular transport, if two drugs are administered concurrently that both use the same transport system, excretion of each drug is delayed by the other's presence. 21) Certain drugs are poorly distributed to the CNS because they: A) must be approved by the FDA B) are fat soluble C) pass through the blood-brain barrier D) are hepatotoxic Answer: C Explanation: C) Certain drugs are poorly distributed to the CNS because they pass through the blood-brain barrier. This is the highly-selective permeable barrier separating the blood from the brain extracellular fluid in the CNS. It prevents entry of many undesirable chemicals. 22) The lowest amount of blood flow in solid tumors occurs because: A) they are infected B) they have metastasized to other organNsURSINGTB.COM C) they are benign D) there is a limitation of blood supply Answer: D Explanation: D) The lowest amount of blood flow in solid tumors occurs because there is a limitation of blood supply. Low regional blood flow affects drug therapy in tumors and abscesses. When a tumor is sold, the lowest amount of blood flow is in the tumor's core. High drug levels, therefore, cannot reach the deeper parts of a tumor, making solid tumors highly resistance to drug therapy. 23) Faster drug excretion via the kidneys occurs by converting: A) lipid-soluble drugs into more water-soluble forms B) water-soluble drugs into more lipid-soluble forms C) the color of urine D) urea to amino acids Answer: A Explanation: A) Faster drug excretion via the kidneys occurs by converting lipid-soluble drugs into more water-soluble forms. This speeds up excretion of many drugs. Methods of conversion include the structural addition of a hydroxyl group, or by glucuronidation, which is the addition of glucuronic acid to a substrate. This process is often involved in metabolism of drugs and other substances. It is also called glucuronosylation.

24) Which of the following is NOT a stage of biotransformation? A) hydrolysis B) fluoridation C) oxidation D) conjugation Answer: B Explanation: B) Fluoridation is NOT a stage of biotransformation. The stages of biotransformation include oxidation, reduction, hydrolysis, and conjugation. Fluoridation is defined as the addition of fluorides to the public water supply, to reduce the incidence of tooth decay. 25) End-products of a drug occur in the: A) small intestine B) pancreas C) kidneys D) liver Answer: D Explanation: D) End-products of a drug occur in the liver, after the drug was previously moved from the liver, through the bile duct, to the duodenum, and then moved back to the liver via the portal blood. Since the liver is the major site of drug metabolism, liver disease may result in drugs accumulating in the body. 26) Total clearance of a drug is directly affected by the: A) dosage of the drug B) amount of blood flow to the organs of elimination C) age, sex, and race of the patient D) drug plasma concentration Answer: B Explanation: B) Total clearance of a drug is directly affected by the amount of blood flow to the organs of elimination. The rate of drug clearance can also be significantly affected by cardiac disease, as well as drugs that alter blood flow. Also, for some drugs, clearance is not constant. 27) Peak concentration of a drug is the: A) plasma level at which toxic effects begin to occur B) plasma drug levels below which therapeutic effects do not occur C) highest level at which a drug is present in the body D) minimum effective concentration and the toxic concentration Answer: C Explanation: C) Peak concentration of a drug is the highest level at which it is present in the body, whereas the trough concentration is the lowest level at which a drug is present in the body.

28) A comparatively large dose given at the beginning of treatment to quickly obtain therapeutic effects is called a: A) loading dose B) maintenance dose C) plateau D) half-life Answer: A Explanation: A) A loading dose is a comparatively large dose given at the beginning of treatment to quickly obtain therapeutic effects. A maintenance dose keeps the plasma concentration of the drug continuously in the therapeutic range. However, the more a drug is taken, the more chance that drug accumulation will occur. 29) When patients are taking monoamine oxidase inhibitors (MAOIs), they may eat: A) beef liver B) ripe cheese C) fish D) yeast products Answer: C Explanation: C) When patients are taking monoamine oxidase inhibitors (MAOIs) — used for depression - they may eat fish but not products such as beef liver, ripe cheese, or yeast products. This is because these foods, as well as Chianti wine, may trigger serious malignant hypertension. 30) Which of the following defines the "half-life" of a drug? A) the time taken for it to metabolize in N thUeRlSivIN erGTB.COM B) the time taken for its concentration to increase from one-half to full, after the last dose C) the time taken for it to be excreted by the kidneys D) the time taken for its concentration to decrease from full to one-half, after the last dose Answer: D Explanation: D) A drug's half-life is the time taken for its concentration to decrease from full to one-half, after the last dose. This is the major determinant of the duration of drug action. The half-life of each may be different.

Focus on Pharmacology: Essentials for Health Professionals, 3e (Moini) Chapter 4 Drug Toxicity and Pharmacogenomics 1) Side effects are generally predictable, and their intensity is: A) dose dependent B) based on the patient's age C) based on preexisting conditions D) based on gender Answer: A Explanation: A) Side effects are generally predictable, and their intensity is dose dependent. They are peripheral or secondary effects caused by drugs and other agents. Some side effects develop soon after drug use begins, whereas others may not appear until a drug has been taken for weeks or months. 2) Programmed cell death that allows cells to self-destruct is called: A) necrosis B) ascites C) toxicosis D) apoptosis Answer: D Explanation: D) Programmed cell death that allows cells to self-destruct is called apoptosis. This process involves the activation of specific proteins. It is helpful when the process kills damaged cells but does not harm surrounding tissue. In cancer cells, apoptosis is often inhibited. 3) Unknown mechanisms of action of an adverse effect of a drug are referred to as: A) overdose B) idiosyncratic C) prophylaxis D) polymorphism Answer: B Explanation: B) Unknown mechanisms of action of an adverse effect of a drug are referred to as idiosyncratic. These responses are unpredictable reactions to a drug, and occur rarely. 4) The FDA requires serious or unexpected events to be reported within how many days? A) 3 B) 7 C) 15 D) 30 Answer: C Explanation: C) The FDA requires serious or unexpected events to be reported within 15 days of occurrence. During new drug application studies, all adverse events must be reported, regardless of their severity. Additionally, once the drug reaches the market, adverse events of all types must still be reported.

5) Any components inside the body to which drugs bind are called: A) drug targets B) pathogens C) genomes D) autosomes Answer: A Explanation: A) Any components inside the body to which drugs bind are called drug targets. They are also influenced by genetic variations. Also called biological targets, they are often proteins within the body that may be modified by drugs, altering their activities. In most cases, common drug targets are either proteins or nucleic acids. More than 50% of drug targets are G protein-coupled receptors. 6) The interferon lambda-3 enzyme is encoded by the IFNL3 gene, which is linked to which of the following infections? A) meningitis B) hepatitis A C) hepatitis C D) pancreatitis Answer: C Explanation: C) The interferon lambda-3 enzyme is encoded by the INFL3 gene, which is linked to hepatitis C infection. In patients with the favorable genotype, these enzymes have resulted in about double the success rate in curing the condition with proper treatment. This involves pegylated interferon with ribavirin, with our without a protease inhibitor. 7) Which of the following is NOT a sign or symptom of anaphylactic shock? A) paralysis of the diaphragm B) hypertension C) urticaria D) swelling of the oropharynx Answer: B Explanation: B) Hypertension is not a sign or symptom of anaphylactic shock, but hypotension is, along with urticaria, paralysis of the diaphragm, and swelling of the oropharynx. The end result may be cardiac collapse. Anaphylactic shock is a true medical emergency, occurring so swiftly and severely that controlled clinical studies of treatment have never been possible. 8) Which of the following drugs are most commonly linked to physical dependence? A) immunosuppressants B) antibiotics C) antihistamines D) narcotics Answer: D Explanation: D) Narcotics are most commonly linked to physical dependence. Narcotics include prescribed opioids as well as illegal drugs such as heroin. Many other drugs produce physical dependence, including amphetamines, barbiturates, and ethanol. Some drugs cause specific type of physical dependence even though their effects are outside of the CNS.

9) The generic name of "Lipitor" is: A) niacin B) atorvastatin C) valproic acid D) rifampin Answer: B Explanation: B) The generic name of Lipitor is atorvastatin. It is an example of a "statin", used to lower lipid levels. Other examples of statins and lipid-lowering drugs include fenofibrate, fluvastatin, gemfibrozil, lovastatin, niacin, pravastatin, and simvastatin. 10) Anaphylaxis is an example of type allergic drug reactions. A) I B) II C) III D) IV Answer: A Explanation: A) Anaphylaxis is an example of type I allergic drug reactions. It is also referred to as "immediate hypersensitivity". Examples of drugs or classes of drugs linked to anaphylaxis include penicillins, streptomycin, local anesthetics, neuromuscular-blocking drugs, and radiologic contrast media. 11) Type II allergic drug reactions are described as: A) immediate hypersensitivity B) immune complex-mediated hypersensNiU tiR viStIyNGTB.COM C) antibody-dependent cytotoxic hypersensitivity D) delayed-type hypersensitivity Answer: C Explanation: C) Type II allergic drug reactions are described as antibody-dependent, cytotoxic hypersensitivity. Examples of drugs or classes of drugs linked to these reactions include quinine, quinidine, rifampicin, and metronidazole. When such a reaction occurs, the drug binds to (usually) red blood cells, and is recognized by the antibody (primarily, IgG). 12) Epinephrine is frequently injected to combat anaphylactic shock, but must be administered: A) after 8 hours B) after 24 hours C) within the intensive care unit only D) soon after shock begins Answer: D Explanation: D) Epinephrine is frequently injected to combat anaphylactic shock, but must be administered soon after shock begins. Epinephrine is also known as adrenaline. Patients who are predisposed to allergic reactions should wear an alerting bracelet or necklace such as Medic Alert®.

13) Before administering a drug, knowledge of a patient's is essential. A) allergies B) Rh factor C) blood type D) family history Answer: A Explanation: A) Before administering a drug, knowledge of a patient's allergies is essential. Ask all patients if they have a history of allergies, such as hay fever, rashes, or asthma; or have had unusual reactions to any drugs taken orally or by injection in the past. 14) When a drug to which a person has become physically dependent is discontinued, what will occur? A) anaphylactic shock B) toxicity C) tolerance D) abstinence syndrome Answer: D Explanation: D) Abstinence syndrome will occur when a drug is discontinued to which the user has become physically dependent. Each drug's abstinence syndrome is unique. 15) How many adverse drug events occur annually in hospitals? A) more than 770,000 B) more than 320,000 C) less than 120,000 D) less than 25,000 Answer: A Explanation: A) More than 770,000 adverse drug events occur annually in hospitals. This is often because of unclear or missing drug information. 16) An interaction between two drugs that causes an effect greater than that which would have been expected from the additive properties of the drugs involved is called: A) physical dependence B) polymorphism C) potentiation D) overdose Answer: C Explanation: C) Potentiation is the term that describes an interaction between two drugs causing an effect greater than that which would have been expected from the additive properties of the drugs involved. For example, alcohol potentiates the sedating effects of the tranquilizer diazepam (Valium®) when the two drugs are ingested at the same time.

17) A drug reaction that is noxious, unintended, and occurs at doses normally used in humans for the prophylaxis, diagnosis, or treatment of disease is known as: A) an idiosyncratic drug reaction B) an adverse drug reaction C) a toxicity reaction D) a hepatotoxic effect Answer: B Explanation: B) An adverse drug reaction is one that is noxious, unintended, and occurs at doses normally used in humans for the prophylaxis, diagnosis, or treatment (therapy) of disease. Examples include severe nausea, vomiting, and diarrhea. Adverse drug reactions may range in intensity from mildly annoying to life-threatening. 18) A drug's adverse effects are based on its: A) margin of safety B) manufacturing process C) date of expiration D) frequency of use Answer: A Explanation: A) A drug's adverse effects are based on its margin of safety, between the effective dose and the toxic dose. An overdose is usually linked to a drug with a large margin of safety, whereas adverse effects can occur from therapeutic doses when the margin of safety is small or nonexistent. Margin of safety applies to all drugs — prescription or nonprescription. 19) Pharmacogenomics is focused on geN neUsReSnIN coGdTiBn.gCO mM etabolic enzymes that alter . A) drug distribution B) drug solubility C) drug activity D) adverse effects Answer: C Explanation: C) Pharmacogenomics is focused on genes encoding metabolic enzymes that alter drug activity. It was formerly known as pharmacogenetics. It is the study of genetic factors that influence variations in drug responses. More than one genetic variant may play a part in varied drug responses. 20) Which of the following is the fourth major drug-related cause of death, especially among elderly patients in the USA? A) polymorphism B) hypersensitivity C) autoimmunity D) adverse drug reaction Answer: D Explanation: D) Adverse drug reaction(s) are the fourth major drug-related cause of death, especially among elderly patients in the USA. They do occur in patients of all ages, however. More than 770,000 adverse drug events occur annually in hospitals, often because of unclear or missing drug information.

21) Stevens-Johnson syndrome may cause severe damage of which organ? A) liver B) pancreas C) brain D) heart Answer: A Explanation: A) Stevens-Johnson syndrome may cause severe damage of the liver. It is a severe hypersensitivity reaction that can also cause toxic epidermal necrosis. This syndrome is a lifethreatening skin condition, in which cell death causes separation of the epidermis from the dermis. 22) Any drug that causes harm to an embryo is called a(n): A) carcinogen B) interferon C) teratogen D) allergen Answer: C Explanation: C) Any drug that causes harm to an embryo is called a teratogen. Teratogens can also be illnesses that harm embryos. Examples of teratogens include alcohol, cigarette smoke, medications, illegal drugs, some vaccines, certain viral infections, radiation, some occupational chemicals, and maternal autoimmune disorders. 23) Serum sickness is an example of which type of hypersensitivity? A) I B) II C) III D) IV Answer: C Explanation: C) Serum sickness is an example of type III hypersensitivity. This type requires formation of antibodies, usually IgG or IgM, against soluble antigens. Complexes of antigens and antibodies are then deposited in tissues, primarily the joints, kidneys, and lung vascular endothelium. Serum sickness involves inflammation due to activation of complement and leukocytes inside the tissues. 24) Which of the following drugs may cause "Red man syndrome"? A) penicillin B) vancomycin C) bupropion D) cefaclor Answer: B Explanation: B) Vancomycin may cause Red man syndrome, which is a rare condition involving degranulation of the mast cells that is independent of preformed complement or IgE. Other drugs that cause Red man syndrome include amphotericin B, ciprofloxacin, rifampicin, and teicoplanin. Usually, wheals and urticaria of the skin develop on the neck, arms, and upper trunk.

25) Which of the following is most often linked to cumulative toxicity? A) ethyl alcohol B) methyldopa C) aspirin D) caffeine Answer: A Explanation: A) Ethyl alcohol is most often linked to cumulative toxicity, out of the answer choices. This may occur rapidly. A cumulative effect occurs when the body is not able to metabolize and excrete one dose of a drug completely before the next dose is given. With repeated doses, the drug starts to collect in the blood and body tissues. 26) The combined action of two drugs that produce an effect greater than each of their unique effects is called: A) cumulative B) tolerance C) polypharmacy D) synergism Answer: D Explanation: D) The combined action of two drugs that produce an effect greater than each of their unique effects is called synergism. Some drug interactions exhibit synergism, which, depending on the circumstances, may be beneficial or harmful. An example of harmful synergism is the combination of aspirin with the anticoagulant warfarin (Coumadin®), which can reduce blood clotting to the extent of spontaneous hemorrhage if doses are not carefully monitored. 27) An example of an herbal supplement that interacts with NSAIDs is: A) cranberry B) ginkgo biloba C) chondroitin D) saw palmetto Answer: B Explanation: B) Ginkgo biloba is an example of an herbal supplement that interacts with NSAIDs. Since both agents inhibit platelet aggregation, concurrent use may increase risk of bleeding. 28) The bacterial peptidoglycan cell wall is a drug target for certain drugs. A) antifungal B) antiviral C) antibacterial D) antiprotozoal Answer: C Explanation: C) The bacterial peptidoglycan cell wall is a drug target for certain antibacterial drugs. These drugs interrupt peptidoglycan synthesis. Cell lysis results from abnormal cell wall synthesis. Penicillins can harm these drug targets while causing little toxicity to normal cells.

29) A chemical inside an organism that is NOT normally produced or even expected to be present is called: A) xenobiotic B) a peptidoglycan C) aspartate aminotransferase D) alanine aminotransferase Answer: A Explanation: A) A chemical inside an organism that is not normally produced or even expected to be present is called xenobiotic. Many drug products are xenobiotics. Plasma membrane transporters mediate selective uptake as well as removal of endogenous compounds and xenobiotics. Transporters work with drug-metabolizing enzymes to a great degree. 30) Which of the following is NOT an example of an antifungal? A) itraconazole B) ketoconazole C) terbinafine D) simvastatin Answer: D Explanation: D) Simvastatin is not an example of an antifungal. It is a statin, which helps to lower lipid levels in the body. Examples of antifungals include: itraconazole, ketoconazole, and terbinafine.

Focus on Pharmacology: Essentials for Health Professionals, 3e (Moini) Chapter 5 Law and Ethics of Medications 1) Amphetamines are most commonly classified as which type of scheduled drug? A) Schedule I B) Schedule II C) Schedule III D) Schedule IV Answer: B Explanation: B) Amphetamines and codeine are usually listed as Schedule II drugs, although specific products containing smaller quantities of Schedule II substances–usually combined with noncontrolled substances–are listed as Schedule III or IV. 2) Certificates of registration for pharmacist licensure are granted in most states for a period of: A) 1 to 2 years B) 2 to 3 years C) 3 to 4 years D) 4 to 5 years Answer: A Explanation: A) Most states guarantee licensure for 1 to 2 years. Continuing education must be undertaken so pharmacists and pharmacy technicians remain on the cutting edge of new advancements in their practice. This relatively short period of licensure (before having to become relicensed) helps to ensure better quality of skills, abilities, and continuing growth of knowledge. 3) Medical facilities must comply with the Bloodborne Pathogens Standard and be able to prove their compliance to: A) CDC inspectors B) DEA inspectors C) FDA inspectors D) OSHA inspectors Answer: D Explanation: D) OSHA is the regulatory agency that inspects medical facilities and requires compliance with the Bloodborne Pathogens Standard. The other agencies listed focus on different types of regulatory activities. 4) In the United States, drug legislation began in the: A) 1700s B) 1800s C) 1900s D) 1950s Answer: C Explanation: C) Drug legislation in the United States began in the 1900s. Before that, there was little regulation for the way drugs were manufactured, tested, packaged, or sold. This correct answer rules out the "1950s" as being a possible choice because the first drug legislation occurred early in the century.