Which one of the following CNS receptors is directly coupled to an ion channel so that the effects of its activation do not involve second messenger systems? N (ACh) alpha (NE) D2A mu (beta endorphin) 5HT2 (serotonin) Lorazepam can be safely used as a preanesthetic medication in a patient undergoing liver transplantation without fear of excessive CNS depression because the drug is excreted in unchanged form actively secreted into the GI tract conjugated extrahepatically a selective anxiolytic devoid of CNS depressant actions reversible by naloxone Benzodiazepines are thought to cause sedative and/or anxiolytic effects by increasing functional activity at GABAB receptors enhancing the actions of dopamine blocking the NMDA glutamate receptor subtype acting as a partial agonist at 5HT receptors facilitating GABA-mediated increases in chloride ion conductance Which one of the following is an established clinical use of morphine? Management of generalized anxiety disorders Relief of pain associated with biliary colic Pulmonary congestion Treatment of cough associated with use of ACE inhibitors Suppression of the ethanol withdrawal syndrome Which one of the following is characteristic of phenytoin? Inhibition of hepatic cytochromes P450 First-order elimination at high therapeutic doses Enhances the effects of estrogenic steroids The drug is safe to use in pregnancy Slows the rising phase of the action potential A patient known to be a heroin abuser comes to the ER with a painful stab wound. The ER resident administers nalbuphine for the pain. Why is this not a good idea? The patient is probably tolerant to nalbuphine. The drug may precipitate a withdrawal state. Nalbuphine is a weaker analgesic than codeine. Vasodilating effects of nalbuphine increase blood loss. Nalbuphine is a strong p receptor agonist. Anesthesia protocols for day surgery (outpatient) may include sevoflurane because recovery from this agent is more rapid than that for older inhaled anesthetics. Rapid recovery from anesthesia with sevoflurane is associated with its redistribution from brain to skeletal nluscle low MAC value rapid metabolism by liver enzymes
low blood-gas partition coefficient reversal of anesthesia by naloxone Tricyclic antidepressants increase the antihypertensive effect of guanethidine have anticonvulsant activity should not be used in patients with glaucoma may increase oral absorption of levodopa are sometimes used as antiarrhythmics Which one of the following statements about lithium is accurate? It causes symptoms of mild hyperthyroidism in up to 25% of patients. Plasma levels are increased by a high-Na diet. Adverse effects include acne, polydipsia, and polyuri Spina bifida is major concern in fetal development. Sedative actions calm manic patients within 24 h. Which one of the following do morphine and D-tubocurarine have in common? Increased bladder tone ANS ganglion blockade Malignant hyperthermia Histamine release Uterine muscle relaxation In the management of toxicity caused by ingestion of methanol in wood spirits, which one of the following statements is most accurate? Treatment should involve the administration of disulfiram in the ER. Naltrexone is a suitable antidote in poisoning due to alcohols. Ethanol will prevent formation of formaldehyde in methanol poisoning. Hemodialysis will not remove methanol from the blood. Delirium tremens is characteristic of methanol poisoning. Regarding the management of Parkinson’s disease, which one of the following statements is most accurate? Selegiline is a direct activator of striatal DA receptors. Carbidopa increases levodopa entry into the CNS by inhibiting peripheral COMT. Levodopa causes a rapid development of tardive dyskinesia. Pramipexole is an inhibitor of MA0 type A Bradykinesia is not improved significantly by benztropine. A 29-year-old male patient is being treated with an antidepressant drug, and his mood is improving. However, he complains of feeling "jittery" and agitated at times, and if he takes his medication in the afternoon he finds it difficult to get to sleep at night. He seems to have lost weight during the 6 months that he has been taking the drug. He has been warned not to take other drugs without consultation because severe reactions have occurred with opioid analgesics, and with dextromethorphan (in cough syrup). This patient is probably taking alprazolam chlorpromazine paroxetine amitriptyline trazodone
A patient suffering from bipolar disorder (BD) becomes pregnant. A drug that has been shown to have some clinical value in alleviating symptoms of BD and that is unlikely to cause problems regarding fetal development is carbamazepine clonazepam methylphenidate phenytoin valproic acid A patient suffering from generalized anxiety disorder (GAD) has a history of drug dependence that includes the illicit use of secobarbital ("reds") and a variety of other drugs. Psychotherapy is indicated, but the physician also prescribes a drug that can be helpful in GAD and that has the advantage of no abuse liability. The drug prescribed was most likely to have been bupropion buspirone baclofen buprenorphine butabarbital A patient has been diagnosed has having "long QT syndrome." Which one of the following drugs used in the management of CNS dysfunction is most likely to cause problems in this patient? Diazepam Ethosuximide Fluoxetine Propoxyphene Thioridazine A habitual user of a schedule-controlled drug abruptly stops using it. Within 8 h, she becomes anxious, starts to sweat, and gets severe abdominal pain with diarrhea. These symptoms intensify over the next 12 h, during which time she has a runny nose, is lacrimating, and has uncontrollable yawning and intensification of muscle cramping and jerking. Assuming that these are withdrawal symptoms in the patient due to her physical dependence, the drug most likely to be involved is alprazolam amphetamine ethanol meperidine secobarbital A hospital nurse is taking imipramine for a phobic anxiety disorder, and her patient is being treated with chlorpromazine for a psychotic disorder. Which of the following adverse effect is likely to occur in both of these individuals? Excessive salivation Pupillary constriction Orthostatic hypotension ↑ Seizure threshold Weight loss
A 30-year-old male patient is brought to the ER with the following symptoms attributed to a drug overdose: ↑HR and BP, mydriasis, behavioral excitation, aggressiveness, paranoia, and hallucinations. Of the following drugs, which one is most likely to be responsible for these symptoms? Amphetamine Ethanol Fentanyl Flunitrazepam Marijuana Which one of the following pairs of "drug / mechanism of action" is most accurate? Carbamazepine / facilitation of the actions of GABA Ethosuximide / blocks Na channels in axonal membranes Phenelzine / inhibits dopa decarboxylase Procaine /blocks Ca channels (type T) in thalamic neurons Lithium /inhibits recycling of inositol A 57-year-old patient, living at home, has severe pain due to a metastatic carcinoma that is being managed with fentanyl, delivered transdermally from a patch. He should also be taking, or at least have on hand apomorphine docusate loperamide morphine naloxone