Answers

1. E. Quinidine. These are the classic signs of cinchon-ism and are adverse effects of quinidine and quinine, constituents of the cinchona tree. Some of these effects could be seen as toxic effects of phe-nytoin. However, auditory acuity is associated with cinchonism and not with phenytoin toxicity. Nausea but not the other effects could be associated with ciprofloxacin. Excessive drowsiness would be expected if diazepam were involved. These effects would not be expected with the estrogen replacement therapy.

2. B. Anticholinergic agents, such as procainamide and disopyramide, are relatively contraindicated in patients with glaucoma. Procainamide is hypoten-sive rather than hypertensive. The local anesthetic activity of procainamide would have no adverse interaction with the diabetes mellitus.

3. B. Each of these approaches would reduce the tissue calcium concentration and prevent arrhythmias. Agents with a-blocking capacity would have no effect on calcium. Agents with ACE inhibitory activity would likewise have no effect on calcium.

4. A. Class I agents suppress both normal Purkinje fiber and His bundle automaticity in addition to abnormal automaticity resulting from myocardial damage. Class II drugs block p-adrenoceptors; class III drugs prolong the membrane action potential by delaying repolarization; and class IV drugs block the slow inward movement of calcium ions.

5. C. Adenosine is a product of the metabolism of adenosine triphosphate. Phenytoin and lidocaine are totally synthetic, while digoxin occurs naturally in plants and quinine occurs in the cinchona tree.

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