Pharmacology Practice Questions

The correct answer is E. Protease inhibitors
such as lopinavir/ritonavir (Kaletra), amprenavir,
nelfi navir, indinavir, and saquinavir can
cause gastrointestinal intolerance and fat redistribution.
Lopinavir/ritonavir is one of the
main combinations forming the basis of highly
active antiretroviral therapy. Two nucleotide
reverse transcriptase inhibitors are added to
form the backbone.

The correct answer is D. β-Blockers decrease
contractility and heart rate (resulting in decreased
oxygen consumption) by inhibiting β-receptors in
the heart. A decrease in heart rate will then allow
more time for diastolic fi lling (increasing EDV)
and systolic ejection (increasing ejection time). In
addition, β-blockers will decrease the secretion of
renin, thus diminishing the renin-angiotensin cascade.

The correct answer is B. This patient presents
with gastroparesis, specifi cally esophageal dysmotility,
secondary to her diabetes. Other
causes of esophageal dysmotility include diabetic
gastroparesis, Chagas’ disease, lupus, and
other collagen vascular diseases. Initial treatment
consists of promotility agents, with metoclopramide
being fi rst-line therapy.

The correct answer is E. This patient is presenting
with a medical emergency: an extreme
form of thyrotoxicosis known as “thyroid
storm.” The symptoms of this syndrome are
due primarily to increased β-adrenergic outfl
ow stimulated by thyroid hormones. After primary
stabilization (airway, breathing, and circulation),
propylthiouracil or methimazole is

The correct answer is C. This patient suffers
from generalized anxiety disorder (GAD),
which is marked by symptoms of excessive
worry and anxiety about every aspect of one’s
life. The Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition, Text Revision
(DSM-IV-TR) criteria for generalized anxiety
disorder include: (1) At least 6 months in
which the person experiences a majority of the
days feeling anxious and apprehensive; (2) the
anxiety and apprehension impair functioning
in areas such as work and social life; (3) there
are ≥3 associated symptoms including restlessness,
diffi culty concentrating, irritability, decreased
energy, muscle tension, and/or sleep
disturbance; and (4) the anxiety and apprehension
are not associated with another medical or
psychiatric disorder. Benzodiazepines are fi rstline
agents in the treatment of GAD due to
their sedative properties. However, patients
with polydrug or alcohol use, chronic pain disorders,
and severe personality disorders probably
should not be prescribed benzodiazepines
in light of the high potential in such patients
for benzodiazepine dependence.

The correct answer is A. The photomicrograph
shows Kimmelstiel-Wilson nodules,
which are pathognomonic for diabetic nephropathy.
Even without recognizing this specifi c
histopathology, however, one should be reminded
of diabetes due to the combination of
renal and visual fi ndings (diabetic nephropathy
and retinopathy). Angiotensin-converting enzyme
(ACE) inhibitors are the drugs of choice
in the control of diabetes-induced renal disease
because they reduce systemic blood pressure,
reduce the effects of angiotensin II (AT II) on
efferent arterioles, and attenuate the stimulatory
effect of AT II on glomerular cell growth
and matrix production. ACE inhibitors have
been conclusively shown to delay the time to
end-stage renal disease by 50% in type 1 diabetics
and to signifi cantly delay progression of renal
disease in type 2 diabetics. All diabetics
should begin ACE inhibitor therapy at the onset
of microalbuminuria, even in the absence
of hypertension.

The correct answer is C. This is the classic presentation
of a child with cystic fi brosis, an autosomal
recessive defect in the cystic fi brosis transmembrane
conductance regulator (CFTR) gene
on chromosome 7. This results in a defective
chloride channel, leading to the secretion of abnormally
thick mucus in the lungs, pancreas,
and liver.

The correct answer is B. Renal failure is a very
dangerous adverse event associated with nonsteroidal
anti-infl ammatory drugs (NSAIDs).
The patient was in congestive heart failure
when he fi rst presented. His cardiologist consequently
treated him with a diuretic, intending
to reduce his total body fl uids. When the
amount of fl uids in the body contracts, the
body attempts to compensate by releasing angiotensin
II, a potent vasoconstrictor. In order
to protect the kidney from losing its perfusion
due to this vasoconstriction, the kidney simultaneously
releases prostaglandins at both the
afferent and efferent arterioles, where they act
as vasodilators. By taking an NSAID like ibuprofen
and inhibiting the cyclooxygenase
(COX)-1 and COX-2 enzymes, this patient
blocked the pathway producing the prostaglandins
that were keeping the afferent arterioles

The correct answer is E. This man has the
symptoms of benign prostatic hypertrophy,
which include diffi culty starting and maintaining
a urine stream, feeling as though the bladder
is never emptied, having the urge to urinate
again soon after voiding, and pain on
urination or dysuria. Finasteride is most commonly
used to treat this condition. Finasteride
acts by inhibiting the conversion of testosterone
to dihydrotestosterone by inhibiting
5α-reductase. This leads to a reduction in the
size of the prostate, providing symptomatic
relief.