1. A 42-year-old woman has been experiencing severe, unilateral throbbing headaches. The headaches are frequently preceded by flashing shapes of light in her vision. The headaches are accompanied by nausea, vomiting, and sensitivity to light. Which of the following might be suitable for treating this patient's headaches?
A. Selective 5-HT3 receptor antagonists
B. Selective D2 receptor antagonists
C. Selective 5-HT1B/1D receptor agonists
D. Selective calcium channel antagonists
E. Selective H1 receptor antagonists
2. A 62-year-old woman has been experiencing an increased frequency of migraine headaches. She has also been experiencing dyspnea on exertion and mild peripheral edema. Which of the following would be contraindicated for migraine prophylaxis for this patient?
3. Loratadine differs from most older H1 antihistamines in that it
A. inhibits gastric acid secretion.
B. has few central nervous system (CNS) side effects, such as sedation.
C. has a much shorter duration of action.
D. does not have gastrointestinal (GI) side effects.
E. has no tendency to induce impotence and gynecomastia in men.
4. Gynecomastia and impotence in men may occur with prolonged administration of which of the following?
E. Cromolyn sodium
5. A 25-year-old Hispanic woman complains of itchy, watery eyes and an itchy, runny nose. The symptoms occur in the spring and summer and become worse if she mows the lawn. Which of the following might be useful for treatment of this patient's symptoms?
6. A 36-year-old man has epigastric pain he describes as burning. Which of the following drugs would be most useful to relieve the pain this patient is experiencing?
7. A 58-year-old man with rheumatoid arthritis is taking antiinflammatory doses of diclofenac. The drug is available in a combination with an analogue of prostaglandin E1 (PGE1). What is the purpose of adding a PGE1 analogue to diclofenac?
A. To provide a synergistic antiinflammatory effect
B. To prevent the breakdown of diclofenac in the gastrointestinal tract
C. To prolong the duration of action of diclofenac
D. To prevent diclofenac from causing nephritis
E. To protect the stomach lining from potential damage by diclofenac
8. Which of the following promote platelet aggregation?
9. Which of the following inhibits platelet aggregation by acetylating platelet cyclooxygenase?
10. A 5-month-old infant has been crying, has a decreased appetite, and has a fever of 39°C (102°F). Which of the following antipyretics should be used?
11. A 48-year-old man attempts to commit suicide by taking an overdose of acetaminophen after consuming several shots of vodka. He is brought to the emergency room, and acetylcysteine is administered intravenously. What is the purpose of including acetylcysteine in the treatment regimen?
A. To prevent cardiac failure
B. To increase urine flow
C. To block absorption of acetaminophen from the gastrointestinal tract
D. To enhance metabolism of ethanol
E. To prevent liver damage
12. A patient has mild osteoarthritis (i.e., the disease is not progressing rapidly). Her pain is no longer effectively managed with aspirin, except by doses that cause unacceptable tinnitus. Which of the following would be the best course of action for treating this patient?
A. Stop all medications for 4 weeks, then try aspirin again.
B. Treat with acetaminophen.
C. Treat with morphine.
D. Treat with naproxen.
E. Treat with an antiinflammatory steroid.
13. Which of the following increases urinary excretion of uric acid?
14. A 56-year-old man has pain, swelling, and redness in the first metatarsophalangeal joint of his right foot that began 2 days ago. He has a history of previous gout attacks. To treat the patient's symptoms, a drug may be given that does which of the following?
A. Decreases the production of uric acid
B. Increases the excretion of uric acid
C. Lowers the concentration of serum uric acid
D. Inhibits the migration of leukocytes and interrupts the inflammatory response to uric acid by reducing phagocytosis
15. Which of the following drugs is the best choice to treat severe chronic gout in the presence of impaired renal function?
Answers and Explanations
1. C These are migraine symptoms that can be treated with triptans, which are selective 5-HT1B/1D receptor agonists (p. 340).
A Selective 5-HT3 receptor antagonists are used to prevent nausea.
B Selective D2 receptor antagonists are antipsychotics.
D Selective calcium channel antagonists are used to treat hypertension.
E Selective H1 receptor antagonists are used to treat allergies.
2. D Although propranolol is used to treat migraines, it is a β-adrenergic receptor blocking agent that may have adverse effects in a patient with heart failure and/or difficulty breathing (p. 341).
A, C Acetaminophen and aspirin are for acute treatment of pain not for prophylaxis.
B, E Amitriptyline and valproate are used for migraine prophylaxis.
3. B The main difference between loratadine and the first-generation antihistamines, such as diphenhydramine and chlorpheniramine, is that loratadine does not cross the blood-brain barrier. Thus, it has fewer CNS side effects (p. 344).
A Neither first-nor second-generation H1 antihistamines inhibit gastric acid secretion; that is an H2-mediated effect.
C The duration of action of loratadine is longer than that of the H1 agents.
D Loratadine may have GI side effects.
E None of the H1 agents have a tendency to induce impotence and gynecomastia in men. These are rare side effects of cimetidine.
4. B These side effects have been reported with cimetidine, an H2 receptor blocker, but not with the other agents listed (p. 346).
5. A The patient is experiencing symptoms of allergic rhinitis. Diphenhydramine is a first-generation H1 antihistamine useful for alleviating these symptoms (p. 345).
B Ranitidine is an H2 antihistamine used in the treatment of peptic ulcers or gastroesophageal disease.
C Amantadine is an antiviral agent.
D Chlorpromazine is an antipsychotic agent.
6. B The patient is having heartburn from gastroesophageal reflux, which can be treated with an H2 antihistamine such as ranitidine which inhibits gastric acid secretions (p. 346).
A Diphenhydramine is an H1 antihistamine that has no effect on gastric acid production.
C Amantadine is an antiviral agent.
D Chlorpromazine is an antipsychotic agent.
7. E The PGE1 analogue is an inhibitor of gastric acid secretion. It is used for prophylaxis of gastric ulcers induced by nonsteroidal anti-inflammatory agents, such as diclofenac (p. 350).
8. B Thromboxanes stimulate platelet aggregation (p. 349).
A, C, E Prostaglandins, prostacyclins, and bradykinin inhibit platelet aggregation.
D Leukotrienes do not promote platelet aggregation.
9. A Aspirin inhibits the cyclooxygenase enzymes by acetylating a single serine residue. This is an irreversible covalent modification that inactivates both cyclooxygenase-1 and -2 (COX-1 and COX-2). Inhibition of platelet COX-1 prevents thrombosis (p. 351).
B Celecoxib is a COX-2 selective inhibitor
C Acetaminophen is a weak inhibitor of COX.
D, E Indomethacin and ibuprofen are competitive inhibitors of the cyclooxygenases.
10. B Although most of the nonsteroidal antiinflammatory drugs have some antipyretic action, aspirin is usually the antipyretic of choice. In patients younger than 19 years of age, however, aspirin and other salicylates are contraindicated in cases of fever associated with viral illness, due to an association of Reye syndrome with aspirin use in such cases. Acetaminophen is recommended to reduce fever in these cases (p. 356).
11. E Acetylcysteine protects against hepatic injury from the acetaminophen overdose (p. 356).
A-D The other choices are not applicable.
12. D Although aspirin and acetaminophen can be used as initial treatment for osteoarthritis pain, an agent such as naproxen with greater analgesic activity is often required (p. 355).
A, B In general, aspirin and acetaminophen have equal analgesic activity.
C Morphine is for severe pain and has numerous side effects.
E Long-term use of antiinflammatory steroids is not recommended due to side effects.
13. A Probenecid blocks the proximal tubular reabsorption of uric acid, thus increasing its excretion (p. 361).
B Colchicine inhibits mitotic activity, neutrophil migration, and phagocytic activity in inflamed tissue. It does not affect production, excretion, or serum levels of uric acid.
C Acetaminophen is an analgesic and antipyretic.
D Allopurinol reduces the synthesis of uric acid by inhibiting xanthine oxidase.
14. D The therapy of gout involves treatment of the acute attack with nonsteroidal antiinflammatory drugs (NSAIDs) or colchicine. Colchicine inhibits mitotic activity, neutrophil migration, and phagocytic activity in inflamed tissue. NSAIDs inhibit cyclooxygenase to reduce inflammation (p. 359).
A-C Drugs that affect uric acid production, excretion, and/or serum concentration are not effective for acute attacks but are used to treat chronic gout.
15. C Allopurinol is the correct choice because it reduces the synthesis of uric acid (p. 361).
A Naproxen is a nonsteroidal antiinflammatory agent that may be used to treat symptoms of an acute attack of gout.
B, D Sulfinpyrazone and probenecid block the proximal tubular reabsorption of uric acid and would be less effective in cases of impaired renal function.
E Acetaminophen is an analgesic but not an antiinflammatory agent, so it is generally not used in treating chronic gout.