Pharmacology for Rehabilitation Professionals 2nd Edition by Gladson – Test Bank
To Purchase this Complete Test Bank with Answers Click the link Below
If face any problem or
Further information contact us At tbzuiqe@gmail.com
Sample
Questions
Gladson: Pharmacology for Rehabilitation Professionals, 2nd
Edition
Chapter 04: Adverse Drug Reactions
Test Bank
MULTIPLE CHOICE
1) An adverse drug event or ADE refers to __________.
1. toxic
reactions of a drug
2. prescription
errors
3. administration
errors
4. All
of the above
ANS: D
Toxic reactions or adverse drug reaction (ADR) are a part of
ADE; however, both terms are often used interchangeably.
2) A drug should only be prescribed if the __________.
1. benefit
outweighs the risk
2. drug
has no serious adverse reactions
3. drug
is affordable by the patient
4. patient
is not pregnant
ANS: A
Serious diseases often require drugs with major adverse
reactions (see cancer drugs). Cost might be a consideration during chronic
dosing and drugs should be avoided during pregnancy unless the life of the
mother is at risk. In all cases, however, benefit versus risk decision is
always the most decisive one.
3) Adverse drug reactions (ADRs) __________.
1. are
caused solely by the drug
2. can
be predicted if a drug has been used for a long period of time
3. occur
less in the elderly
4. none
of the above
ANS: D
They are caused by a combination of a particular drug and those
patients who are particularly sensitive to the drug; not all individuals will
show ADRs to a drug, only some will. While some types of ADRs can be predicted
(sometimes referred to as side effects) others cannot (sometimes referred to as
idiosyncratic reactions). ADRs occur mostly in the elderly who suffer usually
from more serious diseases, take multiple drugs and have bodies that are less
resistant.
4) A patient takes a drug and experiences nausea and vomiting.
This could be due to __________.
1. the
drug
2. spoiled
food which was consumed simultaneously
3. a
stomach virus picked up just before consuming the drug
4. All
of the above
ANS: D
It is sometimes difficult to assign an ADR to a particular drug.
5) A food-drug interaction can be caused by __________.
1. acidic
foods and weak basic drugs
2. milk
3. grapefruit
juice
4. All
of the above
ANS: D
Drugs must be taken exactly as prescribed. Acidic foods charge
weak bases (base-H+) which are hydrophilic and are slower absorbed (while weak acids
would be absorbed faster). Calcium in milk can bind to some drugs like
tetracyclines and the combination will not be absorbed. Grapefruit juice in
large quantities can inhibit P450 enzymes, slow the metabolism of some drugs
and increase their tissue levels causing increased toxicity.
6) A type I allergic drug reaction __________.
1. starts
after about 10-20 hrs after drug ingestion
2. involves
the action of serotonin
3. can
be life-threatening
4. is
quite resistant to treatment
ANS: C
A normal allergic reaction involves redness, swelling, itching
and hives, as well as runny nose and watery eyes. If the reaction becomes
excessive it develops into an anaphylactic reaction with severe breathing
difficulties and severe hypotension and, if not treated with epinephrine, can
result in death. It starts usually minutes after drug exposure. It involves
histamine being released from mast cells; histamines dilate blood vessels
(redness, swelling), stimulate sensory nerves (itching) and cause
bronchoconstriction. Allergic reactions type I can be readily prevented and
treated with steroids or antihistamines.
7) A type IV allergic drug reaction __________.
1. responds
well to antihistamines and steroids
2. shows
drug specific toxic reactions
3. is
more severe as the dose of the drug is increased
4. involves
T-lymphocytes
ANS: D
This reaction occurs 1-2 days after drug exposure and responds
only to steroids (often called delayed allergy). Allergic reactions regardless
of the drug show a similar clinical picture (this is in contrast to ordinary
side reaction of a drug which will be drug specific and vary from drug to
drug). Allergic reactions are dose independent in that already minuscule
amounts can already cause this reaction (in both types).
8) Which of the following groups are least likely to experience
the adverse effects of drugs?
1. Persons
with renal disease
2. Elderly
people
3. Persons
with liver disease
4. Persons
ANS: D
Every drug has a risk/benefit ratio and this ratio increases
with age or disease.
Gladson: Pharmacology for Rehabilitation Professionals, 2nd
Edition
Chapter 07: Drug Therapy of Coronary Atherosclerosis and Its
Repercussions
Test Bank
MULTIPLE CHOICE
1) The major determinants of myocardial oxygen demand are all of
the following except _________.
1. heart
rate
2. contractility
3. coronary
blood flow
4. wall
stress
ANS: C
Coronary vessels supply oxygen to the heart and their narrowing
causes ischemic diseases. All the others are correct with wall stress including
intraventricular pressure, ventricular volume and wall thickness.
2) Nitrates _________.
1. should
be used 24 hrs for at least 2 weeks at the beginning of therapy
2. may
have their anti-anginal effect hastened by the patient if he/she leans back and
takes short breaths
3. might
be used 4-6 times before an attack is terminated
4. taken
sublingually should produce a tingling or burning sensation
ANS: D
If the drug does not cause this sensation then the drug is old
or has deteriorated and is not active anymore. Nitrates cause tolerance and
should be used only intermittently like at the beginning of an attack or in
preparation for some strenuous activity – the patch can be worn during the day
but should be removed during the night. Anti-anginal effects can be hastened if
the patient leans forward and inhales deeply. If a third dose does not
terminate the attack then this usually signals the occurrence of a myocardial
infarction and it becomes an emergency.
3) Beta–blockers _________.
1. act
by reducing heart rate and contractility
2. are
beneficial in all types of angina
3. should
not reduce heart rate below 80 beats/min
4. All
of the above
ANS: A
Reduction of heart rate and contractility reduces oxygen demand.
They should not be used in the vasospastic variant angina since blockade of
beta receptors in blood vessels can cause further vasoconstriction. They can
reduce heart rate down to 55-60 beats/min.
4) Which one of the following combinations is false?
1. Nitrates
can cause a throbbing headache.
2. Beta–blockers
can cause dyspnea during exercise.
3. Calcium
channel blockers can cause a severe cough.
4. All
of the above
ANS: C
Calcium channel blockers are associated with dysrhythmias and
fatigue while a severe cough is associated with ACE inhibitors. All the others
are correct.
5) Which of the following statements concerning thrombosis is
false?
1. Platelet
aggregator inhibitors are used prophylactically.
2. Anticoagulants
are used to prevent formation or extension of a clot.
3. Thrombolytics
are used to dissolve a clot.
4. All
of the above
ANS: D
6) Which of the following statements is false?
1. Thromboxane
A2 causes platelet aggregation.
2. Leukotrienes
cause vasoconstriction.
3. Leukotrienes
and thromboxane are formed by cyclooxygenase.
4. Thrombin
converts fibrinogen to fibrin.
ANS: C
Thromboxane A2 is formed from arachadonic acid by cyclooxygenase
while leukotrienes are formed by lipoxygenase.
7) Aspirin _________.
1. inhibits
platelet aggregation
2. inhibits
the enzyme cyclooxygenase reversibly
3. is
given as 80 mg per day for its anti-platelet effect
4. allows
normal platelet function about 32 hours after cessation of therapy
ANS: B
It inhibits the enzyme irreversibly, explaining the long
duration of action. Recently, some physicians recommend a higher dose of 160 mg
– for its antiinflammatory action a dose of 650 mg is used.
8) Patients using aspirin _________.
1. should
be watched for bruising and joint swelling
2. and
NSAIDs simultaneously experience reduced aspirin effects
3. can
expect adverse GI-effects
4. and
experiencing the first signs of a MI or stroke should take one 325 mg aspirin
ANS: D
Aspirin has been shown to be beneficial when taken at the first
signs of a MI but should not be taken in case of a stroke since some strokes
are hemorrhagic and aspirin increases the risk of bleeding. Bruising, joint
swelling, and blood in urine or stool might indicate a reduction in dose.
Simultaneous use decreases the effectiveness of aspirin unless aspirin is given
2 hrs before the NSAIDs. Even this low dose can cause gastritis in sensitive
individuals and some physicians believe that the low dose is responsible for
the increased number of patients with gastritis, anemia and renal failure and
recommend that it should only be used by individuals at risk.
9) Which of the following statements concerning clopidogrel and
ticlopidine is false?
1. They
block prostaglandin induced platelet aggregation.
2. It
takes about a week for normal platelet functions to recover after therapy has
stopped.
3. They
can cause increased bleeding episodes.
4. They
can increase the risk of hemorrhagic strokes.
ANS: A
They block ADP-activated platelet aggregation. They are long
acting and increase the risk of external or internal injuries including the
risk of hemorrhagic strokes.
10) Which one of the following statements concerning heparin is
false?
1. It
can be administered at different molecular weights.
2. It
prevents the conversion of prothrombin to thrombin.
3. It is
used to treat deep vein thrombosis, pulmonary embolism, and selected cases of
MIs.
4. It
can cause excessive bleeding, which cannot be easily stopped.
ANS: D
The drug protamine can combine with heparin and inactivate it,
which stops the action of heparin.
11) Which one of the following statements concerning warfarin is
false?
1. It
interferes with the synthesis of vitamin K dependent clotting factors.
2. Ingestion
of large amounts of broccoli and cauliflower enhance its activity.
3. It
should not be used during pregnancy.
4. It
takes as many as 5 days to reach therapeutic levels.
ANS: B
Broccoli and cauliflower contain vitamin K and decrease
warfarin’s effectiveness; excessive bleeding can be counteracted by
administration of vitamin K. It is highly teratogenic, while heparin can be
given since heparin does not cross the placental barrier.
12) Thrombolytic agents _________.
1. facilitate
the action of warfarin
2. must
be given within 12 hrs of an MI
3. are
given by infusion
4. can
save all or some of the myocardium from the damaging effects of ischemia
ANS: B
Time is of the essence and after 6 hours only minimal reversal
can be expected.
13) Which one of the following interventions is contraindicated
in patients receiving anticoagulant therapy?
1. Rigorous
manual techniques
2. Chest
percussions
3. Deep
tissue massages
4. All
of the above
ANS: D
All procedures can cause bleeding episodes. Wound dressings must
be done carefully to prevent bleeding.
14) Which of the following statements about statin drugs is
false?
1. They
inhibit endogenous formation of cholesterol.
2. They
vary greatly in efficacy.
3. They
carry the risk of liver and muscle damage.
4. Cost
can be a factor in choosing the right drug.
ANS: B
Statins vary greatly in potency but vary less in efficacy. For
this reason a less costly statindrug can be chosen if it achieves its goal in a
particular patient. Although muscle pain is more frequent, actual muscle damage
(fatal myopathy, rhabdomyolisis) is rare; tendon ruptures have been reported
but up to this date there are no recommendations to withhold strengthening
exercises. To detect and prevent liver damage, frequent blood tests are
recommended.
15) Which one of the following statements is false?
1. Bile
acid binding drugs will remain in the intestines but can interfere with the
action of other drugs.
2. Fibrates
act to decrease lipoprotein lipase and increase the risk of kidney stones.
3. Niacin
reduces free fatty acid mobilization and causes flushing and GI-upset.
4. A
dark urine can be indicative of drug-induced muscle damage.
ANS: B
Fibrates increase lipoprotein lipase and remove triglycerides
from lipoproteins – they are associated with an increased risk of gall stones.
Niacin-induced flushing has been reduced by newer formulations or by ingestion
of an aspirin. Myalgias, muscle weakness and a dark urine can be the first sign
of muscle damage. During muscle damage, myoglobin is released which is excreted
but mostly precipitates in the kidney causing eventual renal tubular
obstruction, direct nephrotoxicity (ischemia and tubular injury), intrarenal
vasoconstriction, and acute renal failure.
16) Thrombolytic agents are useful after a myocardial infarction
to ______________.
1. act
as an anticoagulant
2. lyse
the blood clot
3. dilate
the coronary arteries
4. constrict
the coronary arteries
ANS: B
Thrombolytics lyse clots whereas anticoagulants prevent
extension of the clot.
17) The role of nitrates in the treatment of angina is to do
which of the following?
1. Reduce
cardiac contractility
2. Enhance
sodium excretion
3. Reduce
preload and afterload
4. Increase
the heart rate
ANS: C
While tachycardia may occur secondary to a drop in BP, nitrates
are designed to reduce oxygen demands by reducing the workload of the heart.
18) Which one of the following is true regarding the
administration of nitroglycerin?
1. Nitroglycerin
patches should be worn for 24 hours at a time
2. Up to
three sublingual doses may be administered within 15 minutes
3. Nitroglycerin
is stable up to an unspecified time
4. Nitroglycerin
can be exposed to light
ANS: B
Nitroglycerin is very unstable with a short shelf life. Nitro
patches should be only worn for approx 12 hours to avoid tolerance.
19) Which one of the following adverse effects is associated
with nitroglycerin?
1. Hypertension
2. Throbbing
headache
3. Bradycardia
4. Abdominal
bloating
ANS: B
Nitro reduces BP but may cause a reflex tachycardia.
20) You are treating a patient who is wearing a nitroglycerin
transdermal patch. Which of the following interventions would be most
contraindicated?
1. Dexterity
training
2. Hand
exercises with the aid of a biofeedback device
3. Ultrasound
to the knee
4. Hot
pack application to the left shoulder
ANS: D
Heat application near a transdermal patch will increase the rate
of absorption and can cause a dangerous drop in BP.
21) Transdermal nitroglycerin patches are indicated for which of
the following conditions?
1. To
end angina
2. For
use with ventricular fibrillation
3. To
prevent angina
4. For
use with type II heart block
ANS: C
Transdermal patches are worn during the day to prevent angina.
Sublingual nitro would be used to end an angina attack. Nitro does not alter
the electrical capabilities of the heart.
22) Your patient asks about the best way to store sublingual
nitrates during travel to your clinic for therapy. The correct answer is which
of the following?
1. Put
one in a plastic bag and bring it to the clinic in your pocket.
2. Protect
it from heat by transporting it in an ice chest.
3. Lock
it in the glove compartment in your car.
4. Store
it in the original container to keep it away from heat and light.
ANS: D
Nitro degrades very rapidly and must be maintained in the original
brown vial.
23) A patient who is taking sublingual nitrates reports
dizziness after dosing. What should your response to the patient be?
1. Sit
or lie down to prevent dizziness.
2. Drink
water to wash any remaining nitrates out of the mouth.
3. Perform
isometric fisting exercises.
4. Take
a second nitrate.
ANS: A
Dizziness may occur secondary to a drop in BP. Have the patient
sit or lie down.
24) The rehab therapist would monitor which of the following
laboratory values to determine the effectiveness of oral anticoagulants
(warfarin)?
1. Blood
urea nitrogen
2. Activated
partial thromboplastin time (APTT)
3. INR
4. Complete
blood count (CBC)
ANS: C
INR is used to guide warfarin dosing. APTT can be used to guide
the heparin dose.
25) A patient who has been taking oral anticoagulants (warfarin)
for stroke prevention is admitted to the emergency room with GI bleeding. The
therapist should anticipate the patient receiving which of the following?
1. Vitamin
K
2. Vitamin
E
3. A
plasmin supplement
4. Vitamin
C
ANS: A
Warfarin inhibits production of a reduced form of vitamin K that
is a necessary cofactor for several clotting factors. Increasing vitamin K
levels will allow the formation of clotting factors.
26) Which of the following represents a therapeutic dose of
warfarin (oral anticoagulant)? An INR = _____________.
1. 1 to
2
2. 1.5
to 2.0
3. 2.0
to 3.0
4. 3.0
to 4.0
ANS: C
Acceptable INR on warfarin to prevent DVT is between 2-3.
Slightly higher is allowed for a valve transplant patient.
27) A patient in ambulation training is on warfarin after a
stroke. He is developing some tendonitis and is asking your opinion on which
aspirin-type drug is better for pain, Aleve or Motrin. Your best response
should be which of the following?
1. Inform
the patient of the potential drug interactions with anticoagulants.
2. Inform
the patient to administer a 650-mg dose of aspirin.
3. Explain
that tendonitis is an expected outcome of therapy and it will improve shortly
with more therapy.
4. Suggest
that the patient take ibuprofen instead.
ANS: A
Aspirin is an anti-thrombotic agent and when paired with
warfarin may significantly increase bleeding.
28) When working with patients on statins, you should ask the
patient to report which of the following side effects?
1. Muscle
pain
2. Headache
3. Fatigue
4. Bruising
ANS: A
While statins are relatively safe, some individuals may suffer
from muscle pain ranging from mild discomfort to tenditis to rupture and even
full blown rhabdomyolysis.
29) Statins decrease lipid levels by which of the following
mechanisms?
1. They
prevent absorption of cholesterol through the GI tract.
2. They
bind to bile, causing cholesterol to be excreted in the feces.
3. They
block the HMG-CoA reductase enzyme.
4. They
stimulate the excretion of dietary cholesterol.
ANS: C
Statins work by preventing the production of cholesterol in the
liver.
MATCHING
1)
|
Thrombolytics |
Hemorrhage, headache, bloody stools,
stiff joints |
|
α-Blockers |
Orthostatic hypotension, reflex
tachycardia, dizziness |
|
Antiarrhythmic |
Aggravation of cardiac rhythm
disturbances, dizziness, visual disturbances |
|
Oral anticoagulants |
Vitamin K deficiency, bleeding, many
drug interactions |
2)
|
ACE Inhibitor |
Dry cough, hyperkalemia, hypotension |
|
Calcium channel blocker |
Hypotension, constipation, dizziness |
|
HMG-CoA reductase inhibitor |
Gas, stomach cramps, nausea, muscle
pain |
|
β-blocker |
Hyperglycemia, abnormalities in lipid
profile, bradycardia |
|
Thiazide diuretics |
Hypotension, dehydration, hypokalemia |
Gladson: Pharmacology for Rehabilitation Professionals, 2nd
Edition
Chapter 17: Pharmacologic Management of Degenerative Neurologic
Disorders
Test Bank
MULTIPLE CHOICE
1) It is assumed that in the brains of patients with Parkinson’s
disease there exists an imbalance between the _____________.
1. serotonin
and norepinephrine systems
2. acetylcholine
and dopamine systems
3. glutamine
and GABA systems
4. endorphin
and enkephalin systems
ANS: B
It is thought the acetylcholine system is more active than the
dopamine system.
2) It is assumed that part of the pathology of Parkinson’s
disease involves _____________.
1. excessive
growth of cholinergic neurons in the motor cortex
2. death
of cholinergic neurons in the basal ganglia
3. excessive
growth of dopamine neurons in the motor cortex
4. death
of dopamine neurons in the substantia nigra
ANS: D is correct.
3) Drugs used in the treatment of Parkinson’s disease try to
_____________.
1. increase
dopamine and decrease acetylcholine actions
2. block
actions of both dopamine and acetylcholine
3. increase
actions of both dopamine and acetylcholine
4. only
block the action of dopamine without affecting acetylcholine
ANS: A is correct.
4) Oral L-DOPA _____________.
1. is
converted selectively in the brain to dopamine
2. is
somewhat less effective than oral dopamine
3. and
its absorption is enhanced by carbidopa
4. improves
most disease signs except it benefits tremors the least
ANS: D
It is actually extensively metabolized in the periphery and only
a little reaches the brain where it is converted to dopamine. Dopamine is not
used since it does not cross the blood-brain barrier. Carbidopa prevents
peripheral metabolism and since it does not cross into the brain, it does not
affect L-DOPA’s conversion into dopamine in the CNS. This reduces the dose of
L-DOPA and reduces peripheral effects.
5) A patient receiving L-DOPA would not be expected to show
_____________.
1. dry
mouth and skin
2. nightmares
3. hallucinations
4. paranoia
ANS: A
Sweating has been observed.
6) Which one of the long-term adverse reactions has not been or
only rarely been observed?
1. “On-off”
syndrome
2. Dyskinesias
3. Decreased
effectiveness of L-DOPA
4. Allergy
and anaphylactic reactions
ANS: D
The “Off-On” syndrome and dyskinesias are thought to be caused
by the constant effect of exogenous production of dopamine affecting dopamine
receptors adversely – dopamine released from nerve terminals is tonic with
periods of no activity. The dose has to be increased because tolerance develops
or more likely because the disease progresses.
7) Which one the following combinations is mismatched?
1. Bromocriptine
– stimulation of dopamine receptors
2. Selegiline
– inhibition of MAO-B
3. Entacapone
– inhibition of COMT
4. Amantadine
– stimulation of dopamine synthesis
ANS: D
Amantadine might act by releasing dopamine from and preventing
reuptake into nerve terminals.
8) Anticholinergics _____________.
1. are
most effective in reducing tremors
2. cause
sweating, diarrhea and bradycardia
3. are
used in severe forms of PD with prominent bradydyskinesia
4. include
rasagiline and tocapone
ANS: A
They cause dry mouth, tachycardia, constipation and urinary
retention. They are used in the mild form with prominent tremors. Rasagiline is
a MAOB and tocapone a COMT inhibitor.
9) The “OFF” phase of the “Off-On” syndrome can be hopefully
avoided if the therapist schedules treatment _____________.
1. just
before the next dose is to be taken
2. 10
min after the drug is taken
3. 1 hr
after the drug is taken
4. 4 hrs
after the drug is taken
ANS: C
Depending on the patient, about 1 hr after drug use is usually
the “On” phase.
10) Which one of the following causes does not seem to be
involved in the pathogenesis of multiple sclerosis?
1. Autoimmune/inflammatory
processes involving T cell activities
2. Selective
destruction of myelin sheet
3. Increased
glutamate release
4. Selective
destruction of axons
ANS: C is correct.
11) Which of the following is designed to bridge the gap between
NSAIDs and DMARDs?
1. Corticosteroid
2. Interferons
3. Glatiramer
4. Methotrexate
ANS: A
Steroids are used in acute relapses.
12) Interferon therapy _____________.
1. causes
flu-like signs and symptoms
2. reduces
autoimmune but not inflammatory processes
3. should
only be started as a last resort therapy
4. includes
interferon delta 1a and delta 1b
ANS: A
They reduce both autoimmune and inflammatory processes. Early
therapy has been shown to slow the disease progress and it is suggested to
start therapy right after a diagnosis has been made. They include interferon
beta 1 and 1b.
13) Glatiramar _____________.
1. is a
mixture of carbohydrates with lipids resembling myelin
2. prevents
the autoimmune response but is not antiinflammatory
3. is
more efficacious but also more toxic than the interferons
4. acts
as a myelin decoy
ANS: D
It is a mixture of proteins resembling myelin basic protein. It
reduces both the autoimmune system and inflammation. It seems to be equally
effective but does not cause the flu-like signs.
14) Mitoxantrone _____________.
1. interferes
with RNA action
2. can
cause renal and pulmonary problems
3. has
been shown to have antimicrobial actions
4. is
approved for use in MS and also as an anti-cancer drug
ANS: D
It is a DNA reactive agent. Significant adverse reactions
include myelosuppression, leukemia, and cardiotoxicity and hepatotoxicity. It
increases the risk of infections.
15) Modafinil _____________.
1. reduces
inflammation by suppression of T cells
2. is
antispastic but causes severe fatigue
3. is
associated with anorexia
4. increases
wakefulness and alertness
ANS: D
All the other statements are wrong.
16) Alzheimer’s disease or AD is characterized by plaques and
tangles as well as a marked loss of _____________.
1. cholinergic
receptors
2. melatonin
receptors
3. enkephalin
receptors
4. norepinephrine
receptors
ANS: A
17) Which of the following drugs is not an acetylcholinesterase
inhibitor?
1. Donepezil
2. Galantamine
3. Rivastigmine
4. Memantine
ANS: D
18) Which of the following adverse reactions might be
experienced by a patient treated with an acetylcholinesterase inhibitor?
1. Diarrhea
2. Tremors
3. Tachycardia
4. Fever
ANS: A
Cholinergic drugs cause bradycardia.
19) Memantine _____________.
1. is a
cholinergic agonist
2. shows
both high efficacy and toxicity
3. is
often combined with acetylcholinesterase inhibitors
4. All
of the above
ANS: C
It is a NMDA (glutamic acid) receptor antagonist and protects
the brain from supposedly excessive and nerve damaging effects of glutamic
acid. It is relatively free of adverse reactions (headache, slight increases in
blood pressure).
20) Parkinsonism has been observed as a side effect for which of
the following drug groups?
1. Selective
serotonin reuptake inhibitors
2. Monoamine
oxidase inhibitors
3. Tricyclic
antidepressants
4. Antipsychotic
medications (major tranquilizers)
ANS: D
Antipsychotic drugs block dopamine receptors but can reduce
dopamine activity enough to cause Parkinson’s symptoms.
Comments
Post a Comment