Study Guide for NR 293 Exam 1
Pharmacology
Contents
Principles of Pharmacology ……………………………………………… 2
Principles of Neuropharmacology ………………………………………. 13
Cardiovascular Pharmacology ………………………………………….. 25
Endocrine Pharmacology ………………………………………………. 38
Drugs Affecting Other Systems (Including GI and Pulmonary) ………. 51
, 2
Principles of Pharmacology
Select the single best answer.
1. A 28-year-old man with seborrheic dermatitis is prescribed a topical corticosteroid
crème by his dermatologist in hopes of alleviating the chronic rash and erythema on
the cheeks. Which of the following steps is most critical to achieve a therapeutic drug
concentration in plasma?
a) Absorption
b) Distribution
c) Elimination
d) Glycosylation
e) Metabolism
Answer: a) Absorption.
Drug absorption from the site of administration, in this case via the topical route,
allows the medication to enter into the skin and then into the plasma. Following
this step, the medication can distribute into tissues and also be metabolized in
tissues.
2. Drug A and Drug B are of equal magnitude. If Drug A and Drug B are combined
together, this would be an example of which of the following?
a) Additive effects
b) Neutralization
c) Potentiation
d) Synergism
Answer: a) Additive effects
The additive effects of drugs occur when two drugs with the same effect are
added together and produce an effect that is equal in magnitude to the sum of
the effects when the two drugs are given individually.
3. A 28-year-old man is an unrestrained driver in a motor vehicle accident. He suffers a
compound fracture of the right femur and is currently undergoing fixation in the
, 3
operating room. The surgery is not completed and anesthesia is not being administered
at this time. Recovery from IV induction agents is caused by
a) Ionization
b) Liver metabolism
c) Plasma clearance
d) Protein binding
e) Redistribution from sites in the CNS
Answer: e) Redistribution from sites in the CNS
Following initial flooding of the CNS with nonionized molecules, the drug
diffuses into other tissues. With secondary tissue uptake, plasma concentration
falls, allowing the drug to diffuse out of the CNS. This initial redistribution of
drug into other tissues leads to the rapid recovery seen after a single dose of an
IV induction drug.
4. A 29-year-old woman cuts her arm when her steak knife slips while cutting a steak at a
barbeque dinner. She sustains a 4-cm laceration of the lateral aspect of her left arm
that will require sutures. A 2% lidocaine is infiltrated prior to suture placement. Which
of the following will have an effect on the onset and duration of action of this
medication?
a) Blood pH
b) Lidocaine pH
c) Lipid solubility of the tissue
d) Nerve diameter
e) pKa of the drug
Answer: e) pKa of the drug.
Onset and duration of action of local anesthetics are influenced by several
factors. These include tissue pH, pKa of the drug, nerve morphology,
concentration, and lipid solubility of the drug. Of these, the most important are
pH of the tissue and pKa of the drug. At physiologic pH, these compounds are
charged. The ionized form interacts with the protein receptor of the sodium
channel to inhibit its function and, thereby, achieve local anesthesia. The pH
may drop in sites of infection, which causes onset to be delayed or even
prevented.
5. A 37-year-old man is in the intensive care unit with sepsis. He is receiving intravenous
(IV) vasopressors to maintain his blood pressure. During morning
rounds, you notice his IV has extravasated and the skin around the IV site is cool and
pale. What should be done?
a) Atropine should be injected
, 4
b) Dopamine should be injected
c) Nothing
d) Phentolamine should be injected
e) Topical prednisone should be given
Answer: d) Phentolamine should be injected.
Extravasation of a-adrenergic agonists into surrounding tissue is a serious
problem. The paleness and coolness of the skin around his IV site is caused by
constriction of the vasculature in his skin. The vasoconstriction caused by
vasopressors can lead to tissue necrosis. An a-antagonist should be injected
into the affected tissue as soon as possible to counteract the vasopressor that
has extravasated. Phentolamine can be used to restore blood flow to the
affected area.
6. A 44-year-old man with a sacral spinal cord injury has atonia of the sigmoid colon and
rectum. Despite sacral nerve root stimulation, no normal colorectal function is able to
be achieved. Which of the following is true concerning the postganglionic receptors at
the distal colon and rectum?
a) Exogenous ligand formation is taking place
b) The active and inactive receptor states are in irreversible equilibrium
c) The receptors are likely in a transient state
d) The drugs occupying the receptor are producing conformational change in the
receptor
Answer: d) The drugs occupying the receptor are producing
conformational change in the receptor.
More recent information suggests that receptors exist in at least two states:
inactive (R) and active (R*) states that are in reversible equilibrium with one
another. In the absence of an agonist, R* typically represents a small fraction
of the total receptor population (i.e., the equilibrium favors the inactive state).
Drugs occupying the receptor can stabilize the receptor in a given
conformational state.
7. A novel cholinomimetic agent is being designed to improve salivary glandular
secretions in patients with xerostomia. This agent will increase the uptake of choline
into cells. This will combine with acetyl coenzyme A which is found in which of the
following locations?
a) Cytosol
b) Golgi apparatus
c) Mitochondria
d) Rough endoplasmic reticulum
Pharmacology
Contents
Principles of Pharmacology ……………………………………………… 2
Principles of Neuropharmacology ………………………………………. 13
Cardiovascular Pharmacology ………………………………………….. 25
Endocrine Pharmacology ………………………………………………. 38
Drugs Affecting Other Systems (Including GI and Pulmonary) ………. 51
, 2
Principles of Pharmacology
Select the single best answer.
1. A 28-year-old man with seborrheic dermatitis is prescribed a topical corticosteroid
crème by his dermatologist in hopes of alleviating the chronic rash and erythema on
the cheeks. Which of the following steps is most critical to achieve a therapeutic drug
concentration in plasma?
a) Absorption
b) Distribution
c) Elimination
d) Glycosylation
e) Metabolism
Answer: a) Absorption.
Drug absorption from the site of administration, in this case via the topical route,
allows the medication to enter into the skin and then into the plasma. Following
this step, the medication can distribute into tissues and also be metabolized in
tissues.
2. Drug A and Drug B are of equal magnitude. If Drug A and Drug B are combined
together, this would be an example of which of the following?
a) Additive effects
b) Neutralization
c) Potentiation
d) Synergism
Answer: a) Additive effects
The additive effects of drugs occur when two drugs with the same effect are
added together and produce an effect that is equal in magnitude to the sum of
the effects when the two drugs are given individually.
3. A 28-year-old man is an unrestrained driver in a motor vehicle accident. He suffers a
compound fracture of the right femur and is currently undergoing fixation in the
, 3
operating room. The surgery is not completed and anesthesia is not being administered
at this time. Recovery from IV induction agents is caused by
a) Ionization
b) Liver metabolism
c) Plasma clearance
d) Protein binding
e) Redistribution from sites in the CNS
Answer: e) Redistribution from sites in the CNS
Following initial flooding of the CNS with nonionized molecules, the drug
diffuses into other tissues. With secondary tissue uptake, plasma concentration
falls, allowing the drug to diffuse out of the CNS. This initial redistribution of
drug into other tissues leads to the rapid recovery seen after a single dose of an
IV induction drug.
4. A 29-year-old woman cuts her arm when her steak knife slips while cutting a steak at a
barbeque dinner. She sustains a 4-cm laceration of the lateral aspect of her left arm
that will require sutures. A 2% lidocaine is infiltrated prior to suture placement. Which
of the following will have an effect on the onset and duration of action of this
medication?
a) Blood pH
b) Lidocaine pH
c) Lipid solubility of the tissue
d) Nerve diameter
e) pKa of the drug
Answer: e) pKa of the drug.
Onset and duration of action of local anesthetics are influenced by several
factors. These include tissue pH, pKa of the drug, nerve morphology,
concentration, and lipid solubility of the drug. Of these, the most important are
pH of the tissue and pKa of the drug. At physiologic pH, these compounds are
charged. The ionized form interacts with the protein receptor of the sodium
channel to inhibit its function and, thereby, achieve local anesthesia. The pH
may drop in sites of infection, which causes onset to be delayed or even
prevented.
5. A 37-year-old man is in the intensive care unit with sepsis. He is receiving intravenous
(IV) vasopressors to maintain his blood pressure. During morning
rounds, you notice his IV has extravasated and the skin around the IV site is cool and
pale. What should be done?
a) Atropine should be injected
, 4
b) Dopamine should be injected
c) Nothing
d) Phentolamine should be injected
e) Topical prednisone should be given
Answer: d) Phentolamine should be injected.
Extravasation of a-adrenergic agonists into surrounding tissue is a serious
problem. The paleness and coolness of the skin around his IV site is caused by
constriction of the vasculature in his skin. The vasoconstriction caused by
vasopressors can lead to tissue necrosis. An a-antagonist should be injected
into the affected tissue as soon as possible to counteract the vasopressor that
has extravasated. Phentolamine can be used to restore blood flow to the
affected area.
6. A 44-year-old man with a sacral spinal cord injury has atonia of the sigmoid colon and
rectum. Despite sacral nerve root stimulation, no normal colorectal function is able to
be achieved. Which of the following is true concerning the postganglionic receptors at
the distal colon and rectum?
a) Exogenous ligand formation is taking place
b) The active and inactive receptor states are in irreversible equilibrium
c) The receptors are likely in a transient state
d) The drugs occupying the receptor are producing conformational change in the
receptor
Answer: d) The drugs occupying the receptor are producing
conformational change in the receptor.
More recent information suggests that receptors exist in at least two states:
inactive (R) and active (R*) states that are in reversible equilibrium with one
another. In the absence of an agonist, R* typically represents a small fraction
of the total receptor population (i.e., the equilibrium favors the inactive state).
Drugs occupying the receptor can stabilize the receptor in a given
conformational state.
7. A novel cholinomimetic agent is being designed to improve salivary glandular
secretions in patients with xerostomia. This agent will increase the uptake of choline
into cells. This will combine with acetyl coenzyme A which is found in which of the
following locations?
a) Cytosol
b) Golgi apparatus
c) Mitochondria
d) Rough endoplasmic reticulum
