1. MUSCLE RELAXANTS: True or false: guaifenesin selectively depresses transmission at internuncial neurons in the spinal cord, brainstem, and subcortical areas
Which is not an effect of guaifenesin?
Depresses CNS giving sedation and muscle relaxation
Decrease BP which then returns to normal
High doses can cause respiratory depression
Analgesia
Which of the following is false regarding guaifenesin?
It has hepatic metabolism to a glucuronide and is excreted in urine
You should avoid using it with physostigmine
It lasts longer in female ponies than males
It can cause hemolysis in cows
Which muscle relaxant requires artificial ventilation with use?
Guaifenesin
Neuromuscular blockers
That’s it…
Which type of neuromuscular block are agonists at the ACh receptor?
Depolarizing
Non-depolarizing
Which non-depolarizing neuromuscular blockers are incorrectly matched with their duration
Mivacurium—short
Tubocurarine, doxacurium, pancuronium, pipecuronium—long
Atracurium, rocurium, vecuronium—intermediate
All of the above are correct!
Which of the following causes initial muscle fasciculation?
Depolarizing neuromuscular blockers
Non-depolarizing neuromuscular blockers
Which of the following are competitive antagonists at the ACh nicotinic receptor?
Which of the following is not a depolarizing neuromuscular blocker?
Decamethonium
Suxamethonium
Mivacurium
On which of the following can you use anticholinesterase drugs to remove the effect?
True or false: the amount of fasciculation correlates with the post-operative muscle pain
Which of the following is not an effect of suxamethonium?
Decreased intraocular pressure
Potassium release
Bradycardia
Prolonged paralysis
Sometimes malignant hyperthermia
Which of the following does not influence the effect of muscle relaxants?
Other neuromuscular agents
Cholinesterase inhibitors
Aminoglycoside antibiotics
None of the above
Which of the following is the most sensitive to neuromuscular blockers?
Dogs
Cats
Cattle
Sheep
In which species do you most commonly use neuromuscular blockers?
Pigs and cats
Dogs and horses
Cattle and sheep
Horses and cats
HEMOSTATIC AND ANTICOAGULANTS: Which of the following hemostatics can cause extensive intravascular clotting when administered intravenously?
Fibrinogen
Thromboplastin
Thrombin
Fibrin
What’s a good characteristic of a topical hemostatic?
Minimal tissue reactivity
Easy to sterilize and handle
Consist of either thrombin or collagen
All of the above
Which is used in measurement of prothrombin time during anticoagulant therapy?
Which topical hemostatic converts endogenous fibrinogen to fibrin for clot formation?
Which topical hemostatic can be used for bleeding from denuded mucous membranes, as an adhesive in skin grafts, and for massive blood loss?
Which topical hemostatic is used for bleeding from parenchymatous tissue, cancellous bone, dental sockets, laryngeal/nasal surgery, reconstructive surgery, and as an adhesive agent for fixation of skin grafts?
Is fibrin foam soluble?
Yes
No
What do you use absorbable gelatin sponge/gelfoam for?
Oozing from the surface area
Massive blood loss
Capillary/venous bleeding
Surgery of the liver and spleen
Which of the following should only be used temporarily because otherwise you’d get fractures and cysts?
Oxidized cellulose
Gelatin sponge
Microcrystalline collagen
Styptics
Which are clinical uses of microcrystalline collagen?
Clotting factor deficiencies
Thrombocytopenia
Clotting factor deficiencies and Thrombocytopenia
Clotting factor deficiencies and Surgery of the liver and spleen
Thrombocytopenia and Surgery of the liver and spleen
Which topical hemostatic produces immediate vasoconstriction and controls bleeding from small vessels?
Epinephrine
What’s the problem with high concentrations of styptics?
Cyst formation
Fractures
Sloughing of tissues and hemorrhage
Reduced effectiveness
Which systemic hemostatic is used for emergency treatment of acute hemorrhagic syndromes with deficiency of clotting factors/platelets?
Vitamin K
Blood
Desmopressin acetate
Protamine sulfate
Which systemic hemostatic releases stored vWf from endothelial cell and macrophages and controls capillary bleeding from wounds?
Which systemic hemostatic is made from fish sperm?
Which systemic hemostatic is used to antagonize heparin-induced hemorrhagic action (since it’s basic and combines with the acidic heparin to prevent it from acting as an anticoagulant)?
Which systemic hemostatic aids in the production of clotting factors II, VII, IX, and X and should not be given IM or IV?
Repeated administration of which drug reduces its effectiveness?
Which anticoagulant should you not use for laboratory diagnostic purposes?
Sodium oxalate
Acid citrate dextrose
Sodium citrate
Edetate disodium
Which is not part of the mechanism of heparin?
Binds reversibly to antithrombin III to produce conformational changes to it, thereby inhibiting thrombin and activated factor Xa
Binds to endothelial walls, imparts negative charge, inhibits platelet adhesion and aggregation
Inhibits hepatic synthesis of prothrombin and factors II, VII, IX, and X
Increases plasminogen activator and tissue factor inhibitor
Which of these describes the action of heparin?
Antithrombotic
Anticoagulatory
Neither
Both
Which of the following statements is false regarding heparin?
It’s used to prevent venous thrombosis and pulmonary embolism, and to treat thromboemboli, as well as to treat DIC and to decrease risk factors in heartworm
adulticide treatment
It prevents serosal post-operative adhesions
It’s metabolized by the liver and reticulo endothelial system
Its antidotes are protamine and fresh blood
Which of the following is false regarding vitamin K antagonists?
It is stored in adipose tissue
Undergoes metabolism in the liver and is excreted in urine
It’s used for prophylaxis and treatment of venous thrombosis
Its side effect is hemorrhage
Which of the following is false regarding fibrinolytic agents?
Streptokinase can cause systemic fibrinolysis
Tissue plasminogen activator is used for lysis of aortic thromboemboli in cats
Fibrinolysin is an activator of plasminogen
Urokinase is isolated from pee and prevents serosal post-operative adhesions in dogs
Which of the following irreversibly binds COX in order to inhibit thromboxane A2 and prostaglandins?
Aspirin
Clopidogrel
Dipyrimadole
Ticlopridine
Which of the following inhibits phosphodiesterase, increasing cAMP levels in platelets, which inhibits aggregation?
Ticlopidine
Which of the following is a P2Y12 receptor inhibitor, resulting in more cAMP and less aggregation of platelets?
ANTICONVULSANTS: True or false: seizures are associated with episodic high frequency discharge of impulses by a group of neurons
Which of the following neurotransmitters is not involved in epileptogenesis?
Glutamate
Aspartate
Glycine
GABA
Which of the following is a problem associated with seizures?
Brain edema
Hyperthermia
Aspiration pneumonia
Disseminated intravascular coagulation
Permanent brain injury
Which is not a drug used in emergency treatment of seizures that stimulates GABA?
Phenytoin
Barbiturates
Benzodiazepines
Valproate
Which of the following drugs is mismatched with its mechanism of action?
Carbamazepine—inhibition of Na channels
Zonisamide—inhibition of Ca channels
Propofol—inhibition of Ca channels
Phenytoin—inhibition of Na channels
Which of the following drugs is a GABA agonist?
Zonisamide
Carbemazepine
Lamotrigrine
Etomidate
True or false: benzodiazepines decrease frequency of opening of GABA receptors.
Which route should you not use for lorazepam or midazolam?
IV
IM
Intranasal
Intrarectal
Which benzodiazepine inhibits T-type calcium channels?
Diazepam
Clonazepam
Midazolam
Lorazepam
What is not a side effect of barbiturates?
Hepatotoxicity
Autoinduction of CYP450
Sedation
Anorexia
True or false: barbiturates enhance GABA A by increasing the frequency of opening of the chloride channel.
Which of the following drugs works by competing with chloride, hyperpolarizing the neuronal membranes?
Gabapentin
Potassium bromide
Phenobarbital
Which of the following can potassium bromide be used for?
Only emergencies
Only add on
Which is not a mechanism of action of felbamate?
Blocking NMDA-mediated neuronal excitation
Potentiation of GABA-mediated neuronal inhibition
Inhibition of voltage sensitive neuronal Cl channels
Protects neurons from hypoxic or ischemic damage
True or false: felbamate is well absorbed from oral administration and has a wide safety margin
Which of the following drugs has absorption depending on an L-amino acid carrier, making the process saturable?
Levetiracetam
Felbamate
True or false: pregabalin has a long half life
Which of the following drugs works by binding to SV2A?
Which of the following drugs is partially excreted unchanged and partly glucuronidated?
Which of the following drugs weakly inhibits GABA transaminase and has some effect on sodium and T-type calcium channels?
Vigabatrin
Carbamazepine
Which of the following drugs is metabolized by mixed function oxidases and is well absorbed orally?
Which of the following drugs inhibits GABA transaminase by forming an irreversible covalent bond, resulting in increased GABA?
Which of the following is a tricyclic antidepressant with hepatic metabolism that is a strong inducer of hepatic enzymes?
BEHAVIOR MODIFIERS: Which of the following is not an indication of psychotropic drugs in vetmed?
Sedation and major tranquillizers
Behavioral disorders
Central analgesia
Peripheral anesthesia
Epilepsy
Which of the following is false regarding MAOIs?
MAOIs inhibit the breakdown of serotonin, norepinephrine, and dopamine
MAO-A has only central effects
MAO-B has only central effects
MAO-B’s substrates are norepinephrine and dopamine
MAO-A’s substrates are serotonin, norepinephrine, and epinephrine
Which of the following is not associated with serotonin syndrome?
Hypertension
Metabolic alkalosis
Rhabdomyolysis
Which of the following is an example of an MAOI?
Selegiline
Amitriptyline
Clomipramine
Fluoxetine
Alprazolam
Which of the following is not an adverse effect of selegiline?
Hyperactivity
Stereotypic behavior
Phobias
Which of the following drugs is incorrectly matched with its indication?
Selegiline—dementia in dogs
Clomipramine—separation anxiety
Fluoxetine—aggression in male dogs
FFP—urine spraying in cats
7. True or false: SNRIs are metabolized via CYP450
What isn’t an adverse effect of SNRIs?
Tachycardia
Arrhythmia
Salivation
Constipation
Which of the following is true about SNRIs according to slide 11 (e.g. generally)?
They have antihistamine effects
They have anticholinergic effects
They’re alpha-1 antagonists
These are all true!
Which of the following is not an indication for SNRI use in dogs?
Excessive arousal (mild aggression)
Inappropriate urination
Compulsive disorders
Anxiety
Which SNRI has analgesic properties?
Imipramine
Which SNRI has equal effects on serotonin and norepinephrine?
Which SNRI is used for separation anxiety and canine compulsive disorders?
Which is an indication for SSRIs in cats?
Separation anxiety
Impulse aggression
Compulsive behavior
Dominance
Which is not an adverse effect of fluoxetine?
GI effects
Lethargy
Depression
Polyphagia
True or false: the metabolites of benzodiazepines are not active.
True or false: in a dopaminergic synapse the enzyme beta-dopamine hydroxyls is missing
Neuroleptics block which of the following?
ACH-M receptors
Alpha-adenoreceptors
Histamine receptors
Serotonin receptors
Which of the following is an incorrect example of receptor cross talk?
Adrenergic a2-receptor stimulation increases the release of dopamine and serotonin
Adrenergic B-receptor stimulation inhibits release of serotonin
Dopamine down-regulates serotonin auto-receptors
All of the above are true!
True or false: progestins and estrogen suppress the excitatory effects of glutamate.
True or false: it’s totally fine to combine MAOIs and TCAs.
SEDATIVES AND TRANQUILLIZERS: Which is not a therapeutic target for these?
GABA agonists
NMDA antagonists
D2 receptor
Alpha 1 receptor agonists
Which is not a mechanism of action of phenothiazines?
Block D2 receptors in the CNS
Block alpha adrenoceptors in the CNS
Block D receptors in the periphery
Block alpha receptors in the periphery
What is not an effect of phenothiazines?
CNS depression
Peripheral vasodilation
Good muscle relaxation
True or false: phenothiazines have extensive hepatic metabolism and metabolites are excreted in bile
Which of the following is false?
You should use chlorpromazine in horses
Some boxers have an exaggerated reaction to acepromazine
Acepromazine prevents occurrence of halothane induced malignant hyperthermia in pigs
Phenothiazines can be used to treat feline lower urinary tract disease
Which is false about the mechanism of action of benzodiazepines?
They bind to and activate the benzodiazepine binding site on the GABA-A receptor
They decrease the opening frequency of the Cl channel
They hyperpolarize the post-synaptic membrane
All of the above are true
Which GABA receptor subunit, when mutated, prevents binding of volatile and injectable agents?
Alpha
Beta
Which of the following is not an effect of benzodiazepines?
Dose dependent muscle relaxation
Biphasic cardiovascular response
Mild respiratory repression
Dose dependent CNS depression
True or false: benzodiazepines are reduced or glucuronidated and either excreted via the kidneys (diazepam) or both in the kidney and bile (lorazepam)
Which benzodiazepine has active metabolites?
Zolazepam
In which patients should you not use benzodiazepines?
Those with fear-induced aggression
Those with hypersensitivity to benzodiazepines
Those with hepatic dysfunction
True or false: flumazenil is a benzodiazepine antagonist that has a high affinity for the BZ-binding sites.
Which of the following is false regarding a2 agonists?
They target GPCRs Gi and Go
Their target has 7 transmembrane domains
A2B is the most important type of receptor for analgesia and anesthesia
They’re used for sedation, chemical restraint, and analgesia, as well as for emesis
in cats
Which of the following is not an effect of a2 agonists?
Depressive on the CNS, reduces blood flow and O2 consumption
Mild, dose dependent respiratory depression
Poor muscle relaxation
It can be administered parenterally, orally, or epidurally
It’s synergistic with opioids, local anesthetics, and NMDA antagonists
Medetomidine has a strong correlation between the effect and plasma concentration
Bioavailability of medetomidine is 100% in dogs and cats
In which animal can a2 agonists cause hypercapnia?
Horse
Cat
In which animal does xylazine cause activation of pulmonary intravascular macrophages, resulting in acute lung injury?
Which animal has an a2D receptor, making them more susceptible to the effects of sedatives?
In whom can you use a2 agonists?
Patients with diabetes mellitus
Patients with epilepsy
Patients with compromised cardiac function
Agitated animals
Which of the following regarding a2 antagonists is true?
They’re competitive antagonists at the a1 receptor
They have varying effects on the a2 receptor
They have varying effects at the a1 receptor
All of the above are false
Which of the following is a non-selective a-adrenergic antagonist?
Tolazoline
Yohimbine
Atipamezole
Romifidine
True or false: the answer to the previous question also has histaminergic and cholinergic effects
Butyrophenone derivatives work via all of the following except:
Antagonism of the D2 receptor
Antagonism of the a2 receptor
Some antihistaminergic properties
Which of the following is not an effect of butyrophenones?
CNS depressive
Cardiovascular depressive
Reduced muscle tone
ANESTHESIA & ANALGESIA: Which is not a post-synaptic target for these drugs?
AMPA receptors
Synaptic vesicle proteins
NMDA receptors
EAAT
Which receptor type is incorrectly matched with its number of subunits?
NMDA—7
AMPA—4
Kainite—5
Which ion blocks NMDA receptors?
Ca
Na
Mg
K
Activation of glutamate receptors requires the binding of which of the following?
Where do almost all anesthetics potentiate the action of GABA?
GABA-A
GABA-B
GABA-C
Somewhere else entirely
Which ion passes through the channel in the GABA receptors?
Cl
Generally how many subunits are present in GABA receptors?
3
4
5
6
True or false: tyrosine hydroxylase (TH) is the rate limiting step in dopamine neurotransmission
Which of the following dopamine receptors increase adenylate cyclase activity (thereby increasing cAMP)?
D1
D2
D3
D4
True or false: presynaptic receptors are the clinically relevant ones in the a2 adrenergic synapse (on the slide from the review…)
HISTAMINE & SEROTONIN: Which is false regarding autacoids?
They’re local hormones
They’re long-lived
They include histamine, serotonin, nitric oxide
They include angiotensin and eicosanoids
Which of the following is not mediated by H1?
Inflammation
Allergies
Gastric acid secretion
Anaphylaxis
Which of the following is an H3 effect?
Smooth muscle contraction
Relaxing small arterioles
Modulating neurotransmitter release in the CNS
Where do you not have H4 receptors?
Dendritic cells
Mast cells
Basophils
Eosinophils
Which of the following is false regarding the production of histamine?
You start with histidine
Histidine decarboxylase is the enzyme
The group removed to form histamine is CO2
Which of the following is true regarding histamine stores?
The mast cell pool synthesizes histamine more quickly than the non-mast cell pool
The non-mast cell pool occurs in basophils
The mast cell pool continuously synthesizes and releases histamine
The mast cell pool plays a key role in drug reactions
In order to release histamine from mast cells, the cells must become more permeable to which ion?
Which of the following is not a role of histamine?
Stimulate sensory nerve endings
Relax arterioles
Decrease capillary permeability
All of the above are roles of histamine!
Which is not an effect of histamine on the cardiovascular system?
Dilation of terminal arterioles
Decrease in blood pressure briefly
Dilation of large arteries and veins
Edema from increased capillary permeability
Which of the following is true regarding histamine-mediated vasodilation?
H2 has a long duration
H1 mediated is slow onset
H2 is at small doses
H2 induces high levels of tachycardia
In which group of animals does histamine relax bronchial smooth muscle?
Rabbits and dogs
Calves and pigs
Cats and sheep
Humans and guinea pigs
Which other smooth muscles are contracted by histamine?
Intestinal muscle
Uterine smooth muscle
Which of the following is true?
H1 is Gi while H2 is Gq
H1 is Gq while H2 is Gs
H1 is Gs, H2 is Gq
H1 is Gs, H2 is Gi
Which of these other receptors has the same pathway as endothelial H1 receptors?
Alpha 2
M3
Nm
True or false: histamine is poorly absorbed from parenteral administration
Which is NOT part of the the metabolism of histamine:
Methylation and oxidation
Histamine N-methyltransferase enzyme acts on histamine to form methyl histamine (further acted upon by MAO)
Histaminase enzyme cleaves histamine into inactive metabolites
All of them are part of histamine metabolism
Which of the following is false regarding histamine agonists?
Histamine phosphate is used to test for achlorhydria
So is betazole
Betazole is more selective
Histamine phosphate is more selective
Which of the following will give you CNS sedation?
Cetirizine
Trimeprazine
Loratadine
Fexofenadine
Which of the following lacks antimuscarinic effects?
Chlorpheniramine
Clemastine
Dimenhydrinate
Desloratidine
Which of the following is false regarding the pharmacokinetics of antihistamines?
You can use them IV in emergencies (acute anaphylaxis)
You can use them topically
They don’t bind to plasma proteins
They’re excreted in urine and feces
Which is not a pharmacologic effect of antihistamines?
Vasodilation
Relaxation of bronchiolar smooth muscle
Relaxation of intestinal smooth muscle
Local anesthetic action
Anti-inflammatory response
Inhibits arterial hypertension
Anti-motion sickness
What is not a therapeutic use of antihistamines in bovines?
Bloat
Acetonemia
Mastitis
Gut edema
Metritis
Pregnancy toxemia
Pulmonary emphysema
Retained placenta
Which of the following is not a therapeutic use of antihistamines?
Myoglobinuria
Periodic opthalmia
Gastric stasis
Laminitis
Which antihistamine can cause polyphagia, sedation, increased vocalization, and vomiting in cats?
Cyproheptadine
Diphenhydramine
True or false: antihistamines can cause hyperexcitability and convulsions at high doses
Which is false regarding cromolyn sodium?
It inhibits the release of histamine from mast cells
It closes Cl- channels
It’s used for nasal allergies in horses
It’s used for conjunctivitis
True or false: serotonin is derived from tryptophan
Which of the following serotonin receptors is mismatched with their mechanism?
5-HT1—Gi
5-HT3—Gs
5-HT5—Gi
5-HT4--Gs
5-HT2—Gq
5-HT6—Gs
5-HT7—Gs
Which of the following is false regarding the triphasic response to rapid IV injection of serotonin?
The Bezold-Jarisch reflex involves an initial fall in systemic arterial pressure with accompanying reflex tachycardia
The second phase is a short period of a pressor effect
The third phase is a prolonged fall in systemic BP
Which of the following is not caused by serotonin?
Contraction of smooth muscles
Increased GIT motility
Decreased pulmonary pressure
Which of the following is not an SSRI?
Sertraline
Paroxetine
Fluvoxamine
Buspirone
Which of the following serotonin agonists would you use to control postpartum hemorrhage and for uterine involution? (Hint: it’s an agonist of the 5-HT2 receptor!)
Cisapride
Ergometrine
Metoclopramide
Which drug is used for constipation and megacolon in cats? (But let’s be honest here, all I care about is its use for stasis in rabbits.)
Which drug is an agonist of the 5-HT4 receptor and a D2 antagonist that, while being useful for gastric stasis and anti-emesis, can also change your mood/behavior?
Which antagonist of the 5-HT1 receptor (and first gen antihistamine) is used for head shaking in horses and feline asthma?
Ketaserin
Methysergide
Ondansetron
Which of the following is an antagonist of the 5-HT2 receptor and alpha adrenergic receptor, antihistamine, and is used for glaucoma?
Which drug (that sounds like a transformer) is used as an antiemetic during chemotherapy?
Which 5-HT2 antagonist is used for carcinoid syndrome (cancerous tissues producing too much serotonin)?