NeuroPharm Questions

7/30/2019 NeuroPharm Questions

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Dr. Coffin Jan 2013NEUROPHARMACOLOGY LAB 1 4S.113

1. A 14-year-old girl presents at the hospital, drowsy and confused. She had beenobserved at school to have walked aimlessly and didn’t respond when talked to.She fell to the floor and appeared to have a tonic-clonic seizure. An EEG showedabnormal discharges in the left temporal area. She remembers having this mixed

up feeling before and she has another seizure in the hospital. Is it best to starttherapy right away? Features are consistent with what kind of seizure? Whatnarrow spectrum pharmacotherapy could be given?

A. Valproic acidB. EthosuximideC. PhenobarbitalD. PhenytoinE. Carbamazepine

A) Broad spectrum antiepileptic drug (AED) B) Narrow spectrum AED used inabsence C) Narrow spectrum AED with a narrow therapeutic window, effectscognition and has teratogenic cognitive effects on a fetus D) Narrow spectrumAED, effects cognition and has teratogenic cognitive effects on a fetus E) *Narrow spectrum AED, good efficacy for partial seizures and partial seizuresthat progress to tonic-clonic seizures, better benefit to risk ratio than other narrow spectrum AEDs

2. Given the proposed treatment, what is the most important test prior to starting thedrug?

A. Hepatic and renal function testB. Weight and lipidsC. Liver biopsyD. Eye sightE. Urine analysis

A) *checking the routes of metabolism of the drug is essential, a CBC and aliver function test should be given every two weeks for 2 months and thenonce every 3 months High levels of drug can have toxic effects and thereforeis the best answer B) Valproate has weight issues and this should bemonitored C) not needed to start using the drug D) blurred vision is a sideeffect of a number of antiseptic drugs, this usually resides after a week, if notlower the dose

3. Her dose of drug was slowly increased weekly and she stabilized to ‘no’ seizuresfor 4 weeks. Then she started to experience one seizure per week. Whilecompliance issues could be the reason there is another one as well. What couldreasonable account for a loss of seizure control?



A. Liver failure has caused a build-up of the drug in her bloodB. Another drug is enhancing its absorptionC. Increased drug loss through kidney eliminationD. The drug stimulates its own metabolismE. The drug is an inhibitor of P450 enzymes

A) This would cause an overdose not a loss of efficacy B) This would cause anoverdose not a loss of efficacy C) not the best answer, carbamazepine doesnot increase kidney elimination of itself D) *carbamazepine induces P450’sand increases its own metabolism and this would lead to low plasma levelsand break through seizures E) would increase plasma levels of a drug

4. Doses are increased and now she is experiencing nausea shortly following her medicine and she has not achieved the plasma levels the doctor was expecting.Her pharmacist had begun substituting a generic for the name brand. What role,if any, could this play?

A. Plasma levels should be increased with a genericB. May explain change in plasma levels and inability to reach proper plasma levelsC. Wouldn’t have any effect

A) plasma levels could be increased by a generic but this would not fit that thepatient is seeing breakthrough seizures B) *A change in plasma levels, suchthat first a high does is observed and then lower plasma levels are achievedbelow that needed to prevent seizures. One can see up to 45% differenced in

plasma levels from one generic drug to another generic drug. C) generics canshow different distribution of drug over time and either lower or higher plasmalevels, they can vary 23% from the brand name, generics for antiepilepticdrugs is illegal in some states

5. What could be done to help eliminate nausea at the high dose given and stillcontrol her seizures?

A. One can change the formulation to a longer acting one, extended releaseformulation

B. Induce liver enzymesC. One can change the formulation to a shorter acting one, rapid release

formulationD. No, nothing can be done, wait for it to tolerate out

A) *Changing the formulation to an extended release formulation will even out

the release properties and avoid high and low troughs B) This would lower

plasma levels and reduce efficacy too C) rapid release could worsen the



nausea D) she has been on the drug for some time, the effects of nausea

become tolerant in the first couple of weeks of using the drug, it is likely to be

too high a dose

6. A 7-year-old boy presents to a specialist with constant motion, he can remain inhis chair no longer than 2 minutes. A history reveals he is disruptive andimpulsive at school and can not stay on task. At home he has shown disruptive

behavior since 7 months. In the office he couldn't put a puzzle together and hereversed letters when writing. He was diagnosed and likely started on whatpharmacotherapy?

A. Carbamazepine; extended releaseB. Ethosuximide; immediate releaseC. Ethosuximide; extended releaseD. Methylphenidate; extended releaseE. Methylphenidate; immediate releaseF. Dextroamphetamine; immediate release

A) antiepileptic or used in bipolar disorder or neuropathic pain B) C) for

absence seizures, characterized by staring D) *extended release allows one to

dose once before going to school and it lasts all day, least disruptive for the

child E) F) immediate release would have to be dosed more then once for a

school age child

7. The mother of the 7-year-old boy wanted to save money and requested a genericat the pharmacy. He was given an intermediate acting psychostimulant. When hewas in junior high, he had a supply at school and at home. The supply wasrunning out early. It was discovered the boy was selling the drug to friends. What

is an alternative treatment?

A. Methylphenidate; immediate releaseB. AtomoxetineC. Triple-bead mixed amphetamine saltsD. Methylphenidate patch

A) Immediate release stimulant, high abuse liability B) *non-stimulant, no

abuse liability C) The beads can be crushed and cause high amounts of drug

to be released and abused D) drug can be pulled out of a patch and injected

and abused

8. A six-year-old boy, presented to a specialist, with tics, blinking, grimacing, throatclearing and grunts. He had previously been diagnosed with ADHD and was onmethylphenidate, extended release. What therapy can be added that mightcontinue to support treatment for ADHD and help with the tics?

A. Bupropion



B. LisdexamfetamineC. Guanfacine XRD. Atomoxetine

A) D) used as a nonstimulant treatment for ADHD, good for attention

symptoms B) a prodrug stimulant, good for attention and other symptoms of

uncomplicated ADHD C) *a nonstimulant, useful for ADHD that is complicatedwith tics, can be added or used alone, also useful for impulsive behavior

9. ADHD is characterized by low CNS dopamine and behavior includinghyperactivity to compensate for this. The inability to attend to low stimulationactivities interferes with school performance. The pharmacotherapy used to treat

ADHD enhances dopamine levels in the synapse and then dopamine works atwhat kind of receptors?

A. EnzymeB. Nucleus

C. MetabotropicD. IonotropicE. Transport

A) B) D) These are mechanism of action for other classes of drugs C)

*dopamine works directly as an agonist at dopamine receptors which are g

protein linked receptor and are called metabotropic E) some of the drugs are

transport inhibitors, but not the question

10. How does pharmacotherapy used in Alzheimer’s disease increase theneurotransmitter acetylcholine?

A. Direct acting agonistB. Reuptake inhibitor C. Autoreceptor inhibitor D. Neurotransmitter releaseE. Enzyme inhibitor

A) B) C) D) none of these are the mechanism of action of donepezil E)

*donepezil is an acetylcholine esterase inhibitor and thus neuronal synapticlevels of acetylcholine increase

11. A 23-year-old woman presents to her physician pregnant. She was takingphenytoin and valproic acid for complex partial and secondary generalized tonic-clonic seizures. Despite taking norgestrel and estradiol, she became pregnant.Is there a relationship from her contraceptive failure and antiepileptic drugtherapy?



A. The anticonvulsants do not change estradiol and progesterone levelsB. Phenyotin can increase metabolism of estradiol and progesteroneC. Valproic acid can increase levels of estradiol and progesterone

A) A number of anticonvulsants reduce plasma levels of contraceptive drugs

(phenytoin, carbamazepine, oxcarbazepine, barbiturates, primidone,topiramate) B) *Phenytoin is an enzyme inducer and can increase the

metabolism of contraceptive drugs C) Valproic acid can inhibit P450’s and

decrease the metabolism of contraceptives but this will not result in less

efficacy but possible side effects (Lamotrigine and levetiracetam have no

effect)

The following vignette is for the next 4 questions

12. A 70 year-old man presents to his primary care physician with slowingmovements, cogwheel rigidity, dampened facial expressions, very small

handwriting and a resting tremor. The physician suggests that they start him onwhich pharmacotherapy?

A. Benztropine

B. Ropinerole

C. L-DOPA/ carbidopa

D. L-DOPA

E. A benzodiazepine drug

A) blocks cholinergic sites, an antagonist, can reduce tremors but causescognitive issues B)dopamine agoinst, can be used as first line in peopleaged 65 and younger C) *this is first line for slowed movements inparkinson’s disease for 65 and older D) can’t give L-DOPA alone, it will bemetabolized to dopamine in the peripheral blood and cause nausea and notbe effective in the CNS E) this subclass causes ataxia and falls in theelderly and in people with Parkinson’s disease

13. Upon further questioning, he also presented with a lack of interest in his hobbies,sleep disturbances, muscle aches and sadness. What pharmacotherapy could

be prescribed to address these symptoms?

A. Cholinergic antagonistsB. Serotonin partial agonistsC. Serotonin norepinephrine reuptake inhibitor D. NMDA antagonistsE. Cholinesterase inhibitors



A) would interfere with cognition, cause dry mouth …. B) usually a part of another mechanism of action of antipyschotic drugs or an atypical sedative C)*A good option to treat depression in Parkinson’s disease (PD) and NE is anti-inflammatory D) antagonists NMDA can be used to either reduce tremors inearly stage PD or alleviate abnormal movements during later stage PD caused

by treatment with L-DOPA and carbidopa E) useful to help with cognition andappears to help prevent falls

14. After 7 years, he is referred to a movement disorder clinic for deteriorating controlof his Parkinson’s disease, dyskinesias and frequent falls due to more and moreoff periods which results in freezing. He is on levodopa/ carbidopa andropinerole. The neurologist decreases levodopa/ carbidopa for what reason?

A. To reduce dyskinesiasB. To prevent disease progressionC. To reduce off periods

D. To prevent tremor E. To reduce cogwheel rigidity

A) *chronic administration of L-DOPA has caused the abnormal movementslike dyskinesisas, so one would lower the dose B) L-DOPA /carbidopa is notinvolved in the progression of the disease C) off periods are due to enhancedslowing of movement, its part of the symptoms of PD, would increase adopamine agonist (ropinerole) to help this D) tremor is not part of hissymptoms E) these symptoms would respond to increased dopamine agonist(rolpinerole), its part of the symptoms of PD but not part of his symptoms

discussed in the vignette

15. The neurologist also prescribed a drug that has to be injected or given intranasalso that it rapidly enters the bloodstream and the nervous system and binds todopamine D2 receptors. This pharmacotherapy is?

A. RotigotineB. BenztropineC. SelegilineD. RopineroleE. Apomorphine

A) a dopamine agonist given as a patch can be given chronically B) acholinergic antagonist C) a monoamine oxidase inhibitor, can be given at lowdoses and it increases DA levels in the CNS, add on to enhance efficacy, butgiven orally and chronically D) a dopamine agonist given orally E) *this is theonly dopamine agonist we can give intranasal or injected and it work quickly



to help with freezing, a symptom seen when one no longer can adequatelytreat PD symptoms with L-DOPA/carbidopa and dopamine agonists

16. A 34-year-old woman presents with symptoms of severe headache pain to theemergency department. She has had throbbing pain on one temple for the past 4hours. She is in so much pain she cannot function and has a history of headache thatdoes not respond to non-steroidal anti-inflammatory drugs. What pharmacotherapy, if

injected sc, would work quickly and with the best efficacy?

A) ErgotamineB) DuloxetineC) PropranololD) SumatriptanE) Valproate

A) only works if given at the very beginning of a headache. B, C, and E, are given

for prevention of migraine headaches D) *a serotonin agonist that works mosteffectively when given sc for migraine headache.

17. A 56-year-old man presents with abnormal movements due to an inherited

progressive neurodegenerative disease characterized with early abnormal movement

symptoms. What is the mechanism of action of a drug used to block these early

abnormal chorea movements?

A) Dopamine agonist

B) Dopamine reuptake inhibitor C) Vesicular dopamine transporter inhibitor D) Norepinephrine agonistE) GABA agonist

A) B) D) E) are not the mechanism of action of tetrabenazine C*) tetrabenazineselectively inhibits dopamine being transported into the presynaptic vesicleswhich helps only with the chorea symptoms of Huntington's which occurs in theearly loss of some GABA neurons in the indirect pathway for movement in thebasal ganglia. This disrupts the indirect pathway, causes an imbalance between

the direct and indirect and one sees abnormal movements. It appears since it isnot the loss dopamine neurons but loss of some GABA neurons, one can restoresome balance by depleting dopamine or blocking d2 receptors. But eventuallyone loses all the GABA neuronal function in both indirect and direct pathwaysand parkinsonism symptoms predominate.

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NeuroPharm Questions