IVMS Comprehensive -USMLE-type- Pharmacology-#1-2012 Examination


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IVMS Comprehensive -USMLE-type- Pharmacology-#1-2012 Examination

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IVMS Comprehensive -USMLE-type- Pharmacology-#1-2012 Examination

  1. 1. 3/30/2011 Comprehensive Pharmacology Examination (75 Questions, 90 minutes to Complete)Directions: Each of the numbered items or incomplete statements in this section is followed byanswers or by completions of the statement. Select the ONE lettered answer or completion that isBEST in each case.1. A 17-year-old male was placed on carbamazepine therapy by his neurologist to control newlydeveloped seizures of unknown etiology. The patient was also recently given a macrolideantibiotic by his family physician for a presumed “walking pneumonia.” Halfway through hisantibiotic course, the patient again developed seizures. What could account for this new seizureactivity?A. Inhibition of the cytochrome P-450 monooxygenase systemB. Induction of the cytochrome P-450 monooxygenase systemC. Impairment of renal excretion of the antiseizure medicationD. Induction of glucuronyl transferase activity in the liverE. Reduction in the amount of nicotinamide adenine dinucleotide phosphate (NADPH)2. A 21-year-old male sustains multiple blunt traumas after being beaten with a baseball bat by agang. Aside from his fractures, a serum creatine kinase measurement is dramatically elevatedand the trauma team is worried as the myoglobinuria caused by the trauma can cause kidneyfailure. They immediately begin to administer bicarbonate to alkalinize the urine. How does thisserve to decrease myoglobin levels?A. Increasing glomerular filtrationB. Promoting renal tubular secretionC. Inhibiting renal tubular reabsorptionD. Increasing hepatic first-pass metabolismE. Inducing the P-450 system3. Which of the following correctly describes the formula for a loading dose?A. Loading dose = (Desired plasma concentration of drug) × (clearance)B. Loading dose = (Clearance) × (Plasma drug concentration)C. Loading dose = (0.693) × (Volume of distribution)/(Clearance)D. Loading dose = (Amount of drug administered)/(Initial plasma concentration)E. Loading dose = (Desired plasma concentration of the drug) × (Volume of distribution) Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D. Page 1
  2. 2. 3/30/20114. A 32-year-old HIV-positive male follows up with an infectious disease (ID) specialist in theclinic. The results of his recent blood work suggest that the virus has become resistant tomultiple nucleoside reverse transcriptase inhibitors. The ID specialist decides to include in thetreatment a nonnucleoside inhibitor (nevirapine), which works by binding to a site near the activesite on the reverse transcriptase. Nevirapine is an example of what?A. Full agonistB. Reversible competitive antagonistC. Partial agonistD. Noncompetitive antagonistE. Irreversible competitive antagonist5. Which of the following drugs is a selective α-adrenergic receptor agonist that is availableover-the-counter?A. EpinephrineB. PhenylephrineC. IsoproterenolD. NorepinephrineE. Phentolamine6. Pilocarpine is what type of pharmacologic agent?A. Indirect muscarinic agonistB. α2-Adrenergic agonistC. Carbonic anhydrase inhibitorD. β-Adrenergic antagonistE. Direct-acting muscarinic agonist7. Which of the following is a short-acting acetylcholinesterase inhibitor?A. PyridostigmineB. BethanecholC. EdrophoniumD. ScopolamineE. Methantheline8. DantroleneA. Inhibits calcium release from the sarcoplasmic reticulumB. Functions as a GABAB receptor agonistC. Facilitates GABA activity in the CNSD. Reactivates acetylcholinesteraseE. Competitively inhibits the effects of acetylcholine Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D. Page 2
  3. 3. 3/30/20119. A 63-year-old male, with a history of multiple myocardial infarctions is admitted for shortnessof breath. A diagnosis of congestive heart failure is made on clinical grounds, and a cardiologistorders a positive inotropic agent for his heart failure. He is also concerned about maintainingperfusion to the kidneys, so an agent that increases renal blood flow is also desirable. Which ofthe following agents produces both of these desired effects?A. EpinephrineB. DopamineC. IsoproterenolD. Terbutaline10. Clonidine works byA. Activating β1-adrenergic receptorsB. Activating α1-adrenergic receptorsC. Activating β2-adrenergic receptorsD. Activating α2-adrenergic receptorsE. Blocking β-adrenergic receptors11. A 23-year-old female presents with hypertension, anxiety, and palpitations. Her thyroid-stimulating hormone levels are normal, but she has increased levels of urinary catecholamines.She is referred to a endocrine surgeon after a CT scan shows a unilateral pheochromocytoma.The surgeon should start therapy with which of the following agents prior to removing thelesion?A. DopamineB. PhentolamineC. PancuroniumD. PseudoephedrineE. Isoproterenol12. A 45-year-old male with a history remarkable for both asthma and angina now has a kidneystone stuck in his right ureter. The urologist needs to perform cystoscopy, but theanesthesiologist is concerned about using a β-blocker during surgery to control the patientsblood pressure in light of his history of asthma. Ultimately, it is decide to use an ultra-short-acting β-blocker and closely monitor both his blood pressure and respiratory status. Which of thefollowing is best to use in this situation?A. AtenololB. NorepinephrineC. AlbuterolD. PseudoephedrineE. Esmolol Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D. Page 3
  4. 4. 3/30/201113. A neurosurgeon decides to start a patient on a diuretic that works by altering the diffusion ofwater relative to sodium (an osmotic diuretic) that is helpful in reducing cerebral edema. Whichagent did the physician likely prescribe?A. FurosemideB. HydrochlorothiazideC. SpironolactoneD. AcetazolamideE. Mannitol14. Which of the following would be useful in treating nocturnal enuresis?A. MannitolB. IndomethacinC. FurosemideD. VasopressinE. Probenecid15. VasopressinA. Reduces ADH levelsB. Increases permeability of the collecting ductC. Inserts aquaporins into the plasma membrane of collecting duct cellsD. Increases diffusion of sodiumE. Reduces production of prostaglandins16. A 45-year-old male with a 60-pack/year history of smoking presents to his primary careprovider with loss of appetite, nausea, vomiting, and muscle weakness. His chest CT revealsenlarged hilar lymph nodes and a suspicious mass in the left hilar region. A presumptivediagnosis of lung cancer is made. Laboratory results reveal low levels of sodium, which in thissetting has likely contributed to the syndrome of inappropriate ADH secretion. Whichmedication might be helpful for this patients symptoms?A. ClofibrateB. DemeclocyclineC. AllopurinolD. AcetazolamideE. Furosemide17. Which of the following drugs inhibits xanthine oxidase?A. ColchicineB. IndomethacinC. ProbenecidD. ClofibrateE. Allopurinol Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D. Page 4
  5. 5. 3/30/201118. Which of the following is a common adverse effect of quinidine?A. CinchonismB. Lupuslike syndromeC. SeizuresD. ConstipationE. Pulmonary fibrosis19. What is the mechanism of action of β-blockers in heart disease?A. Prolongation of AV conductionB. Activation of the sympathetic systemC. Promotion of automaticityD. Increase in heart rateE. Arteriolar vasodilation20. Which of the following would be useful in the management of arrhythmia due to Wolf-Parkinson-White syndrome?A. DigoxinB. LidocaineC. AmiodaroneD. AdenosineE. Atropine21. Which of the following inhibit HMG-CoA reductase?A. Nicotinic acidB. RosuvastatinC. EzetimibeD. CholestyramineE. Gemfibrozil22. Which of the following would be a good option to help a patient fall asleep with minimal“hangover”?A. SecobarbitalB. ZolpidemC. ChlordiazepoxideD. FlumazenilE. Buspirone23. Which of the following is a good choice to treat newly diagnosed generalized anxietydisorder (GAD) in a patient who is a truck driver?A. AlprazolamB. TriazolamC. BuspironeD. TrazodoneE. Thiopental Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D. Page 5
  6. 6. 3/30/201124. A 57-year-old male with a strong family history of Parkinsons disease sees a neurologist foran evaluation. On examination, the neurologist notes a slight pill-rolling tremor and subtle gaitabnormalities. He begins treatment with levodopa, along with the addition of carbidopa. Howdoes carbidopa work in this setting?A. Restores dopamine levels in the substantia nigraB. Inhibits monoamine oxidase (MAOI)C. Inhibits catechol-O-methyltransferase (COMT)D. Functions as a dopamine agonistE. Inhibits the metabolism of levodopa outside the CNS25. The patient in the previous question returns to see his neurologist 3 years later. At this timethe patients symptoms have progressed, and he now has marked bradykinesia and a profoundshuffling gait. In an attempt to prevent further deterioration, the neurologist prescribes acatechol-O-methyltransferase (COMT) inhibitor on top of the patients levodopa and carbidopa.Which agent below is likely to have been added?A. EntacaponeB. SelegilineC. RopiniroleD. AmantadineE. Benztropine26. Which of the following is a noncompetitive NMDA receptor inhibitor that can be used totreat Alzheimers disease?A. MemantineB. DonepezilC. TacrineD. TolcaponeE. Pergolide27. A 43-year-old high-profile attorney sees a psychiatrist with expertise in addiction medicine.He explains that he has recently received his third drunk driving citation and fears losing hislicense to practice unless he stops drinking altogether. He says he “just cant stop” once he starts.He tells the physician that he doesnt have time to attend Alcoholic Anonymous and “wants apill.” The physician explains that there is something that might work if the patient is trulyserious. What agent is the physician considering?A. LorazepamB. FlumazenilC. NaloxoneD. DisulfiramE. Carbamazepine Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D. Page 6
  7. 7. 3/30/201128. A nonstimulant agent that can be used to treat attention-deficit/hyperactivity disorder(ADHD) isA. MethylphenidateB. CaffeineC. DextroamphetamineD. AtomoxetineE. Modafinil29. Which of the following can be used to treat a 22-year-old with a recent diagnosis ofschizophrenia?A. BaclofenB. HaloperidolC. Chloral hydrateD. PhenobarbitalE. Imipramine30. Soon after drug administration, the patient in the above question begins making odd faceswith spastic movements of his neck. Which of the following should be administered to treat thesedystonic reactions?A. FluphenazineB. BromocriptineC. DantroleneD. ProlactinE. Benztropine31. Which of the following is a potential side effect of clozapine?A. Cholestatic jaundiceB. QT prolongationC. AgranulocytosisD. PhotosensitivityE. Galactorrhea32. Risperidone works primarily through inhibition of receptors forA. DopamineB. SerotoninC. HistamineD. AcetylcholineE. Norepinephrine33. A 7-year-old boy is brought to the neurologist by his mother. She says that the boys teachersays there are times in class when he stares “out into space” and smacks his lips. In the office theboy has one such episode while having an EEG, which demonstrates a 3-per-second spike andwave tracing. Which drug is the best for this absence seizure?A. Phenytoin Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D. Page 7
  8. 8. 3/30/2011B. CarbamazepineC. PrednisoneD. LorazepamE. Ethosuximide34. Which of the following is a complication of phenytoin use?A. HepatotoxicityB. Gingival hyperplasiaC. ThrombocytopeniaD. Aplastic anemiaE. Stevens-Johnson syndrome35. Tiagabine works byA. Inhibiting GABA uptake by inhibiting the GABA transporterB. Increasing GABA by stimulating its release from neuronsC. Increasing GABA-stimulated chloride channel openingD. Prolonging GABA-induced channel openingE. Blocking T-type calcium channels36. Which of the following agents is approved for treatment of diabetic neuropathy?A. PhenytoinB. CarbamazepineC. AcetazolamideD. Valproic acidE. Gabapentin37. A 5-year-old boy is brought to the emergency room by his parents after they found him withan empty bottle of aspirin. They are not sure how many tablets the boy consumed. Onexamination, the child is hyperpneic and lethargic. While the emergent treatment is started, asample is drawn for an arterial blood determination. What pattern is most likely to be indicatedby the arterial blood gas values?A. Mixed metabolic alkalosis and respiratory alkalosisB. Mixed respiratory alkalosis and metabolic acidosisC. Mixed respiratory acidosis and metabolic acidosisD. Mixed respiratory acidosis and metabolic alkalosisE. Mixed metabolic acidosis and metabolic alkalosis38. Which of the following is an antineoplastic agent that has been shown to help patients withrheumatoid arthritis?A. ValdecoxibB. KetorolacC. MethotrexateD. Entocort Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D. Page 8
  9. 9. 3/30/2011E. Auranofin39. Which of the following is true regarding infliximab?A. It is a recombinant antibody to TNF-αB. It is a humanized antibody to TNF-αC. It is a fusion protein that binds to TNF-α receptorD. It is a recombinant protein resembling IL-1E. It is a recombinant protein composed of a portion of LFA-340. Which of the following is useful in an acute gout attack?A. ProbenecidB. SulfinpyrazoneC. AllopurinolD. ColchicineE. Celecoxib41. What is the mechanism of action of tacrolimus?A. It inhibits transport to the nucleus of the transcription factor NF-ATB. It stimulates apoptosis of some lymphoid lineagesC. It decreases the activity of calcineurinD. It inhibits mTOR, which in turn delays the G1—S transitionE. It inhibits proliferation of promyelocytes42. Which of the following is an alkylating agent that may cause hemorrhagic ceptitis andcardiomyopathy?A. AzathioprineB. CyclosporineC. TacrolimusD. CyclophosphamideE. Basiliximab43. Your resident asks you what the mechanism of action of tPA is. What is your answer?A. It inhibits platelet aggregationB. It increases antithrombin activityC. It impairs inhibits fibrin polymerizationD. It blocks GPIIa/IIIbE. It activates plasminogen bound to fibrin44. Which of the following is an antidote for iron overdose?A. ProtamineB. DeferoxamineC. Vitamin KD. Fresh frozen plasmaE. Charcoal Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D. Page 9
  10. 10. 3/30/201145. Which of the following medications would provide the best relief from episodic attacks ofMénìres disease?A. FurosemideB. OndansetronC. DiazepamD. EmetrolE. Phentermine46. A 56-year-old female with severe rheumatoid arthritis returns to see her rheumatologist. Shehad been referred to a gastroenterologist, who had found multiple gastric ulcers onesophogastroduodenoscopy. She is reluctant to give up the use of NSAIDS and afraid of thepotential cardiovascular toxicity of COX-2 inhibitor. At this point, what would be reasonable forthe rheumatologist to prescribe?A. OmeprazoleB. LansoprazoleC. NizatidineD. MetronidazoleE. Misoprostol47. A 29-year-old male who recently immigrated to the United States sees his physician for aburning sensation in his epigastrium. He is referred to a gastroenterologist, who performsesophogastroduodenoscopy with biopsy that demonstrate ulcers with the presence ofHelicobacter pylori. Use of which of the following regimens would provide the most effectiveand shortest treatment?A. Pepto Bismol, metronidazole, tetracycline, and omeprazoleB. Pepto Bismol, metronidazole, tetracycline, and ranitidineC. Clathromycin, metronidazole, and omeprazoleD. Clathromycin, amoxicillin, and omeprazoleE. Pepto Bismol, metronidazole, and amoxicillin48. An 83-year-old male with multiple medical problems develops worsening constipationduring his hospitalization for lower extremity cellulitis. The hospitalist decides to start giving alaxative. Which of the following is an appropriate choice and why?A. Psyllium, because it is a bulk-forming laxative good for chronic constipationB. An osmotic agent, such as senna, which is administered rectallyC. A stool softener such as lactulose administered rectallyD. A stool softener such as methyl cellulose that inhibits water reabsorptionE. A salt-containing osmotic agent such as docusate, useful in preventing constipation49. A 35-year-old intravenous drug abuser in a methadone maintenance program is admitted tothe hospital for a work-up of suspected pulmonary tuberculosis. While in the hospital, hecomplains of diarrhea and cramping. After stool studies return with a negative result, you decideto begin an antidiarrheal. Which of the following is a good choice for this patient?A. KaolinB. CodeineC. Diphenoxylate Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D. Page 10
  11. 11. 3/30/2011D. LoperamideE. Propantheline50. Which of the following would be an appropriate treatment to begin in a patient with Crohnsdisease?A. GlucocorticoidsB. SulfasalazineC. Bismuth subsalicylateD. OctreotideE. Loperamide51. The above patient returns for follow-up, and she still complains of bloody diarrhea, fever,and weight loss. The gastroenterologist has placed her on a trial of steroids, and yet she stillcomplains of her symptoms. The gastroenterologist could consider using which of the followingagents?A. InfalyteB. Opium tinctureC. MesalamineD. InfliximabE. Diphenoxylate52. Adverse effects seen with high blood levels of theophylline includeA. SeizuresB. ArrhythmiasC. NervousnessD. Nausea and vomitingE. All of the above53. A 62-year-old male alcoholic being treated for non-insulin-dependent diabetes mellituscomes to the emergency department with a 1-hour history of nausea, vomiting, headache,hypotension, and profuse sweating. What is the most likely causative agent?A. ClomipheneB. GlyburideC. ChlorpropamideD. NandroloneE. Vasopressin54. An 81-year-old man with a history of coronary artery disease and a recent diagnosis ofhypothyroidism presents to the emergency department with an acute myocardial infarction (MI).What is the most likely causative agent?A. MedroxyprogesteroneB. LevothyroxineC. ThiocyanateD. Flutamide Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D. Page 11
  12. 12. 3/30/2011E. Diethylstilbestrol (DES)55. A 32-year-old woman being treated for an acute exacerbation of lupus erythematosuscomplains of pain on eating. What is the most likely causative agent?A. OxytocinB. AndroloneC. VasopressinD. PrednisoneE. Clomiphene56. It is likely that the acquisition of antibiotic resistance in gram-negative bacilli such asvancomycin is a result ofA. Spontaneous mutationB. TransformationC. TransductionD. ConjugationE. Transposition57. A 30-year-old patient is undergoing chemotherapy for Hodgkins disease and develops afever, prompting an admission by his oncologist. He is found to have a severely decreased whiteblood cell count and therapy is started with several antibiotics for febrile neutropenia. Assuminghis regimen contains imipenem, which of the following must also be administered?A. ProbenecidB. Clavulanic acidC. SulbactamD. CycloserineE. Cilastatin58. A 17-year-old male presents with right lower quadrant pain with guarding and rebound. ACT scan demonstrates appendicitis, and he is taken to the operating room. What would be a goodantibiotic to administer prophylactically before the surgery?A. CefazolinB. CefoxitinC. CeftriaxoneD. AztreonamE. Oxacillin59. A 23-year-old female, who is 23 weeks pregnant, develops a bladder infection due toPseudomonas sp. As well, she has a documented allergy to penicillin. What might be the bestchoice, given the patients history and condition?A. CefoxitinB. AztreonamC. ImipenemD. PiperacillinE. Ciprofloxacin Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D. Page 12
  13. 13. 3/30/201160. A 37-year-old alcoholic is recovering from pneumonia due to Haemophilus influenzae in thehospital. His treatment included the use of intravenous antibiotics. The nurse calls you toevaluate the patient as he returned from a visit from his “buddy” outside. The nurse tells you hesmells like alcohol and he is flush, warm, and uncomfortable. You suspect a disulfiram-likereaction. What antibiotic was he likely treated with?A. VancomycinB. BacitracinC. ChloramphenicolD. IsoniazidE. Cefamandole61. Which of the following can occur in a patient treated with chloramphenicol?A. Gray baby syndromeB. Bone marrow suppressionC. Disulfiram-like reactionD. NephrotoxicityE. Ototoxicity62. A 32-year-old male complains of persistently dry cough for several days with a mild feverand fatigue. The family physician suspects a diagnosis of “walking pneumonia” on clinicalgrounds, presumably due to Mycoplasma pneumoniae. Which of the following groups ofantibiotics would be effective?A. PenicillinsB. CephalosporinsC. VancomycinD. ChloramphenicolE. Macrolides63. Which of the following is a side effect of clindamycin?A. DizzinessB. BruisingC. Difficulty hearingD. DiarrheaE. Tendon pain64. An 18-year-old African-American army recruit with a history of G-6-PDH deficiency is to bestationed in Somalia. During his tour of duty he develops a cyclic fever, malaise, and weakness.A thin blood smear shows malarial organisms within red blood cells. Which antimalarial is likelyto give him the most hemolysis with use, given his enzyme deficiency?A. ChloroquineB. PyrimethamineC. DoxycyclineD. PrimaquineE. Sulfasalazine Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D. Page 13
  14. 14. 3/30/201165. A 54-year-old diabetic female was seen in the emergency room 3 weeks ago with complaintsof swelling, warmth, and pain in her foot. She was diagnosed with cellulitis and sent home on a10-day course of an oral first-generation cephalosporin. She returns with severe diarrhea, andClostridium difficile is suspected. What is the initial treatment for this condition?A. ClindamycinB. MetronidazoleC. CiprofloxacinD. NeomycinE. Silver sulfadiazine66. A 37-year-old female recently had a large soft tissue sarcoma surgically resected from herretroperitoneum. She is to receive both radiation and chemotherapy, with cyclophosphamide aspart of her chemotherapy. Which agent should be given in conjunction with this drug?A. MESNAB. AllopurinolC. LeucovorinD. CilastatinE. MOPP67. A 54-year-old female is undergoing an experimental high-dose regimen with adriamycin andcyclophosphamide for breast cancer. As this treatment is particularly myelosuppressive, theoncologist is worried that her white blood cell count will drop dangerously low, making hersusceptible to opportunistic infections. In addition to the chemotherapy, what is the oncologistlikely to administer to prevent neutropenia?A. Epoetin alphaB. FilgrastimC. Interferon-αD. OprelvekinE. Amifostine68. Trastuzumab works byA. Inhibiting the oncoprotein bcr-ablB. Blocking estrogen-mediated gene transcriptionC. Preventing phosphorylation of a receptor tyrosine kinaseD. Targeting cells for destruction by antibody-mediated cellular cytotoxicity (ADCC)E. Reducing circulating levels of tumor necrosis factor (TNF)69. Which of the following might be considered for treatment of acute myelocytic anemia (M3variant)?A. CisplatinB. LomustineC. TretinoinD. FluorouracilE. Streptozocin Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D. Page 14
  15. 15. 3/30/201170. Chromosomal studies in a 56-year-old male indicate a (9:22) translocation, the Philadelphiachromosome, confirming the diagnosis of chronic myelocytic leukemia (CML). Which of thefollowing might be used in his treatment?A. AnastrozoleB. RituximabC. ImatinibD. GefitinibE. Amifostine71. Which agent can be used to treat hairy cell leukemia?A. Interferon-αB. Interleukin-2C. All-trans-retinoic acidD. RituximabE. Daunorubicin72. A 63-year-old female develops metastatic colon cancer. The pathologist confirms that abiopsy specimen retrieved from a recent colonoscopy demonstrates that the tumor overexpressesepidermal growth factor receptor (EGFR). The oncologist decides to add a monoclonal antibodyto EGFR to her treatment. Which of the following would be added?A. RituximabB. ErlotinibC. GefitinibD. CetuximabE. Traztuzamab73. A 62-year-old female complains of severe back pain refractory to NSAID use. An x-ray filmof the lumbar spine demonstrates “punched-out” lytic lesions. Her IgG levels are elevated andshow a monoclonal spike. A bone marrow biopsy specimen showing malignant plasma cellsconfirms the diagnosis of multiple myeloma. In addition to chemotherapy, a bisphosphonate isstarted. Which of the following would be the best choice?A. PlicamycinB. Retinoic acidC. ThalidomideD. Zoledronic acidE. Etidronate74. Which of the following should be considered to treat an acetominophen (APAP) overdose ina 17-year-old female?A. TrientineB. SorbitolC. N-acetylcysteineD. IpecacE. Diazepam75. Organophosphate poisoning is treated with Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D. Page 15
  16. 16. 3/30/2011A. PralidoximeB. ParathionC. Amyl nitrateD. BethanecholE. Nicotine Comprehensive Pharmacology Examination Marc Imhotep Cray, M.D. Page 16