PACOP 2 -- Pharmacology, Toxicology, Pharmacokinetics

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PACOP 2 -- Pharmacology, Toxicology, Pharmacokinetics
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  1. REFER TO THE BOOK
  2. REFER TO THE BOOK
  3. REFER TO THE BOOK
  4. When administration of one drug leads to a shift in log dosage- response curve of another drug to the left without a change in the maximal efficacy, is called:
    potentiation
  5. The action of this drug is dependent on colligative property:
    mannitol
  6. Which of the ff. drug groups have mechanism of actions that involve binding to enzymes as target proteins
    nonsteroidal anti-inflammatory agents
  7. Voltage-gated ion channels serve as it site of actions for drugs such as:
    1. Diltiazem & Nifedipine
    2. Lidocaine & Procaine
    3. Captopril & Losartan
    1 & 2
  8. Drugs with mechanism of action that involves Tubulin-binding leading to loss of function of the structural protein include:
    1. cyclosporine
    2. neostigmine
    3. colchicine
    4. glibenclamide
    5. metformin
    3
  9. What type of protein primarily targeted by digitalis glycosides when they exert their effect on the heart:
    Transporters
  10. Which of the following features characterize Nicotinic, GABA-A, & glutamate receptors:
    1. they control the movement of ions into & out of the cell
    2. their actions are mediated by secondary messengers
    3. they all have excitatory efffect on the cell membrane
    4. effects occur several hours after a stimulus
    5. they are located in the cytoplasm
    1
  11. Which of the following drugs bind to receptors located at the cell membrane:
    1. thyroid hormone
    2. prednisone
    3. estrogen
    4. insulin
    5. vitamin D
    4
  12. cAMP is generated as a secondary messenger by the action of the enzyme Adenyl Cyclase. The substrate for the synthesis of cAMP is:
    ATP
  13. Stimulation of Beta-adrenoreceptor, a G-protein-linked receptor involves generation of a secondary messenger known as:
    cAMP
  14. What is the mechanism of action of Sildenafil a drug popularly known as Viagra
    inhibits PDE leading to increase cAMP
  15. Drugs that activate the phospholipase C-inositol phosphate system such as alpha-adrenergic agonists like phenylephrin primarily cause an increase in the intracellular levels of which ion:
    1. calcium
    2, magnesium
    3. sodium
    4. potassium
    5. choride
    1
  16. Which of the following statements characterizes competitive antagonism:
    1. there is a shift of the agonist log concentration-effect curve to the right & downwards
    2. there is a shift of the agonist log concentration-effect curve to the right without a change in the slope or amplitude
    3. there is an exponential relationship between dose ration& antagonist concentration
    4. there is no competition for the binding sites
    5, there is a shift of the agonist log-concentration without a change in the slope or amplitude
    2
  17. The minimum dose that produces the mximum achievable response is known as:
    Ceiling dose
  18. The median dose, or the dose of the drug the produces half of the maximum achievable response is called
    potency
  19. What is described by the equation given as follows:
    Response=f ( ENtotal . Xa/ (Xa + Ka)
    1.Relationship between the occupancy of receptor & the dose of the drug
    2. Relationship between the occupancy of receptor & the response of the drug
    3. Relationship between the dose of drug & the response to the drug
    4. Relationship between the number of receptor & the dose of the drug
    5. Relationship between the response of the drug & the transducer function of tissues
    2
  20. Competitive antagonists of the receptor of Dopamine & Benzodiazepine are expected to produce which effect:
    1. reversal of the intrinsic activity of the receptors
    2. maintain the constitutive aactivity of the receptors
    3. stimulate the constitutive aactivity of the receptors
    4. stimulate the constitutive aactivity of the receptors in the absence of any ligand
    5. produce a negative efficacy
    2
  21. The PT-INR of a patient on Warfarin has been maintained at 2.5 for the last 3 months. 1 week earlier, the patient was given Phenobarbital. What can be expected with the PT-INR of the patient?
    Decreased PT-INR
  22. Phenobarbital when given to a patient on chronic warfarin is classified as
    pharmacokinetic antagonist
  23. Digibind which effectively terminates the action of digitalis glycosides is classified as what type of antagonist?
    chemical antagonist
  24. Omeprazole can inhibit gastric acid secretion induced by Histamine & acetylcholine. It is thus classified as what type of antagonist?
    Physiologic antagonist
  25. Which of the following mechanisms may explain the development of tolerance of drugs:
    1. increase in the quantity of the mediators
    2. decreased metabolic degradation of the active drug
    3. decreased excretion or extrusion of drugs from cells
    4. downregulating of receptors
    5. inactivation of counterregulatory physiologic response
    4
  26. The prerequisite that the drugs must be present in aqueous solutionn for them to be absorbed is true if the drugs are absorbed by which mechanism:
    1. passive transport
    2, carrier mediated transport
    3. pinocytosis
    1 & 2
  27. According to the Fick's diffusion equation, the rate of transport of drug by passive difusion is:
    inversely proportional to the membrane thickness
  28. Which of the following is a feature common to all carrier-mediated transport processes:
    1. movement is along a concentration gradient
    2. involves nonspecific binding to carriers
    3. can be characterized by allosteric inhibition
    4, displays a Michaelis-Menten kinetics
    5. non energy requiring
    4
  29. Which of the following substances may be absorbed significantly by pinocytosis:
    1. vitamin K
    2. cyanocobalamin
    3. cardiac glycoside
    4. quartenary ammonium compounds
    5. inorganic & organisc electrolytes
    1
  30. 100mL of an aqueous solution of a given drug has a concentration of 25% 50mL of Octanol was added & after equilibration, the concentration of the drug in the aqueous layer was 5%. What is the apparent lipid-water partition coefficient of the drug:
    8
  31. For drugs that are given at constant rate, the time to reach steady state concentration is dependent on:
    biologic half life
  32. A given drug has a biologic half life of 4 hours. How much of the drug will remain in the body12 hours after a single dose?
    12.5%
  33. In compartmental analysis of serum drug concentration versus in time plots, which of the following findings confirm a one compartment model of drug behavior:
    1. an AUC above the extrapolated line that is less than 10% of the total AUC
    2. an AUC above the extrapolated line that is less than 5% of the total AUC
    3. slope at last 3 terminal points differing by more than 10% from the slope of the first 3 terminal points
    4. slope at last 3 terminal points differing by more than 20% from the slope of the first 3 terminal points
    5. Cmax that is above the line extrapolated from the terminal points
    2
  34. What should be the rate of infusion of theophylline if the desired plasma concentration is 10ug/ml in a 70kilogram patient? Theophylline has a clearance of 0.6ml/minute/kg body weight.
    420ug/min
  35. A given drug with a half life of 8 hours is being administered at 100 mg IV every 8 hours. What is the amount remaining in the body after the 32nd hour, just before administering the next dose?
    93.75mg
  36. What is the concentration at steady state of Phenobarbital if a drug is given to a 60 kilogram patient as a 65 mg tablet once daily with the bioavailability of 90%? The drug has a volume of distribution of 0.5 liters/KBW & t1/2 of 100 hours.
    11.70 mg/L
  37. A 47 year old female diabetic is maintained on tolbutamide for control of her hyperglycemia. Her fasting blood sugar is maintained at 102 mg% . Three days prior to admission, she slef medicated with indomethacin due to a joint pain. She was admitted at the emergency room unconscious & difficult to arrouse. What laboratory finding may be consistent with history of the patient?
    capillary blood glucose of 20mg/dl
  38. A drug molecule that does not possess biologic activity by itself but is converted in the body to an active metabolite is called a/an:
    prodrug
  39. Astemizole & terfenadine have withdrawn from the market because of their intrinsic cardiotoxicity. The risk of cardiotoxicity is increased with concomitant intake of grapefruit juice or erythromycin. The explanation for this interaction is:
    inhibtion of CYP3A4 enzyme by grapefruit juice or erythromycin
  40. Patients who are poor Debrisoquin metabolizers have decreased activity of which enzyme system:
    1. CYP1A2
    2. CYP2C9
    3. CYP2D6
    4. CYP2C19
    5. CYP 3A4
    3
  41. A patients has been associated to have poor Debrisoquin metabolizing capabilit. Which of the following drugs wil have an increased likelihood of causing toxicity in this patient:
    1. thioridazine
    2. amiodarone
    3. acetaminophen
    4. warfarin
    5. theophylline
    1
  42. What is considered as the dominant phase 1 metabolic reaction:
    oxidation
  43. Chloramphenicol when given to a neonate or premature baby causes cardiovascular collapse manifesting as the so-called "Gray baby syndrome". This toxicity such subsets of patient is due to what age-related biologic feature?
    deficiency of glucoronosyl acyl transferase
  44. Cimetidine, Ketoconazole, & Allopurinol share a common pharmacokinetic property that predispose patients taking other drugs concomitantly with any of these agents to toxicity. What is this property?
    enzyme inhibition
  45. Biotransformation of orally administered drugs occuring primarily in the liver that reduces the amount of drug finally entering the systemic circulation is often referred to as___:
    first pass effect
  46. Charcoal-broiled foods, cruciferous vegetables & omeprazole induce the metabolism of drugs like tamoxifen, acetaminophen, theophylline, & warfarin. This effect is due to induction of which CYP isoform:
    1. CYP1A2
    2. CYP2A6
    3. CYP2C9
    4. CYP2D6
    5. CYP4A4
    1
  47. In a patient with hepatic encephalopathy, which of the following agents may lead to severe drug toxicity even when given to usual doses:
    1. diazepam
    2. oral neomycin
    3. lactulose
    4. propranolol
    5. IV gentamicin
    1
  48. Which of the following features characterizes the autonomis nervous system:
    1. single neuron transmission
    2. presence of ganglia
    3. effects are under volitional control
    4. conveys outputs from the CNS to the skeletal muscle
    5. terminal neurotransmitteris mainly serotonin
    2
  49. The preganglionic fibers of the sympathetic nervous system originate from which roots:
    1. cranial nerves III, VII, IX, X
    2. sacral roots S1-S4
    3. cervical roots C1-C7
    4. throracolumbar roots
    4
  50. What neurotransmitter is released by the preganglionic fibers as a response to sympathetic stimulation:
    acetylcholine
  51. What is the dominant ganglionic receptor found in most sympathetic fibers?
    nicotinic
  52. What is the nuerotransmitter mainly released by postganglionic parasympathetic fibers?
    acetylcholine
  53. Which of the following non-adrenergic, non-cholinergic neurotransmitters is invovled in the action of the enteric nervous system?
    1. ATP
    2. dopamine
    3. GABA
    4. glutamate
    5. glycine
    1
  54. In synaptic nuerotransmission, which of the following ions plays a significant role in neurotransmitter release:
    calcium
  55. The primary mechanism of neurotransmitter release is accomplished by what process?
    exocytosis
  56. What is the aminoacid precursor in the synthesis of catecholamines?
    tyrosine
  57. In the bionsynthesis of Noipinephrine, what step is considered as rate-limiting?
    conversion of tyrosine to dihydroxyphenylalanine
  58. Which of the following substances exert a negative feedback control on tyrosine hydroxylase which serves as the mechansim for moment-to-moment regulation of the rate of catecholamine synthesis:
    1. Dopamine
    2. Acetylcholine
    3. DOPA
    4. Epinephrine
    5. Norepinephrine
    5
  59. Reserpine, an alkaloid from Rauwolfia, can lower the blood pressure & depress the CNS. What enzyme or part of the bionsynthetic pathway is inhibited by Reserpine to bring about these effects?
    1. DOPA decarboxylase
    2. storage of catecholamines in the presynaptic vesicles
    3. Release of Norepinephrine from presynaptic terminals
    4. MAO enzyme
    5. Uptake 1-mechanism
    2
  60. What is the most important mechanism of termination of effects of released Norepinephrine which is the target of action of tricyclic antidepressants & cocaine?
    reuptake into the presynaptic terminal
  61. What is the main final metabolic of Norepinephrine & Epinephrine which when abnormally evaluated is often used as a marker for the disease Pheochromocytoma:
    1. Dihydroxymandelic acid
    2. 3-Methoxy-4-hydroxymandelic acid
    3. 3-Methoxy-4-hydroxyphenylglycol
    4. 3,4-hydroxyphenylglycol
    2
  62. Which of the following is an expected response to alpha-1 adrenoreceptor stimulation:
    1. uterine smooth muscle relaxation
    2. gastrointestinal sphincter constriction
    3. ciliary muscle relaxation
    4. gastrointestinal wall smooth muscle contraction
    5. platelet aggregation
    2
  63. A male patient wishes to purchase an over-the-counter tablet for colds. Which of the following data you gathered during an initial interview of the patient shoud prevent you form dispensing the medication:
    1. the patient is currently taking Nifedipine GITTS
    2. the patient is currently on Tranylcypromine
    3. the patient is an elderly with history of urinary hesitancy, intermittency, & frequency
    all
  64. Stimulation of the alpha-1 receptors leads to the formation of important secondary messenger that promote calcium release & activation of protein kinase C. These secondary messengers responsible for the effects of alpha-1 stimulation include which of the following ?
    1. Inositol triphosphate
    2. Cyclic adenosine monophosphate
    3. Adenosine triphosphate
    4. Cyclic guanosine monophsphate
    5. adenosine diphosphate
    1
  65. In which of the following clinical conditions are the agonists of the alpha-1 adrenorecepetors found to be useful:
    1. nasal congestion
    2. hypotension
    3. symptomatic bradycardia
    1 & 2
  66. Which of the following effects can be attributed to alpha-2 receptor stimulation:
    1. vasolidation
    2. inhibition of catecholamine released
    3. vasoconstriction
    all
  67. A given adrenergic agent induces uterine relaxation & bronchial smooth muscle relaxation. These effects can be attributed to:
    Beta-2 stimulation
  68. What is the dominant adrenergic receptor in the heart?
    Beta-1
  69. Which of the following effects is/are consistent with the systemic use of the drug Clonidine:
    1. initial trnasient increase in the blood pressure
    2. "first-dose" phenomenon
    3. Lowering of the blood pressure
    1 & 3
  70. In terms of mechanism of action, which of the following drugs most closely resembles that of Clonidine:
    1. Phenylephrine
    2. Reserpine
    3. Guanethidine
    4. Methyldopa
    5. Amlodipine
    4
  71. Epinephrine is considered as the first line drug for the treatment of anaphylaxis & anaphylactic shock. Which of the following explain/s the mechanism of action of Epinephrine in anaphylaxis & anaphylactic shock:
    1. inhibition of Histamine release by beta-2 receptor activation
    2. Alpha-1 activation leading to vasoconstriction
    3. Beta-2 activation leading to broncholidation
    all
  72. The activity of this drug is attributed to its metabolism which is a false neurotransmitter at the CNS:
    Methyldopa
  73. Which of the following inotropic agents most useful for patients with actute heart failure complicated by acute reduction in creatine clearance:
    1. Epinephrine
    2. Norepinephrine
    3. Dopamine
    4. Dobutamine
    5. Digitalis
    3
  74. In the adrenal medulla, Norepinephrine is converted to Epinephrine by the action of which enzyme:
    1. DOPA decarboxylase
    2. Tyrosine hydroxylase
    3. Catechol-O-methyl transferase
    4. Monoamine oxidase
    5. Phenylethylamine N-methyl transferase
    5
  75. As an inotropic agent, Norepinephrine (Levophed) has been shown small clinical trials to be most useful in which of the following conditions:
    1. Cardiogenic shock
    2. Septic shock
    3. Acute renal failure
    4. Acute myocarditis
    5. Dilated cardiomyopathy
    2
  76. Which of the following statement/s is/are true rgarding the Methyldopa:
    1. its current clinical use is in the management of hypertension in pregnancy
    2. it is associated with warm antibody type of immunohemolytic anemia
    3. toxic doses are associated with hepatoxicity
    all
  77. What are known clinical uses of beta-2 antagonist:
    1. In the management of premature labor
    2. as part of the interventions employed for hyperkalemia
    3. management of bronchial asthma
    all
  78. Which of the following agents is classified as selective direct-acting beta-2 agonist:
    1. propranolol
    2. methoxamine
    3. Isoxsuphrine
    4. Prazosin
    5. Ephedrine
    3
  79. During the conduct of ACLS, whart is the recommended dosing for epinephrine in adults?
    1 mg every 3-5 minutes
  80. Which of the following isan accepted indication for Epinephrine:
    1. bronchodilator intermittent bronchial asthma
    2. local vasocinstrictor
    3. tocolytic agent for premature labor
    4. inotropic for cardiogenic shock
    2
  81. A dominant alpha-1 agonist affect is expected when epinephrine is given as an IV infusion at what doses?
    at least 120 ng/kg/min
  82. What is the clinical use of the Dopamine-1 agonist Fenoldopam?
    acute treatment of hypertension
  83. Which of the following adrenergic agent is/are most useful for hypodynamic septic shock with hypotension:
    1. dopamine
    2. dobutamine
    3. norepinephrine
    1 & 3
  84. At what dose should dopamine be given as IV infusion to produce a predominantly dopaminergic effect?
    0.5 - 5 ug/kg/min
  85. Guanfacine & Guanabenz are primarily agonists at what receptors?
    Presynaptic alpha-2
  86. Which of the following is/are correct clinical indications for the drug Terbutaline:
    1. subcutaneously given as management of recalcitrant acute exacerbations of bronchial asthma
    2. to increase heart rate insymptomatic bradycardia
    3. adjunct treatment of malignant hypertension
    1 & 2
  87. Which of the following drugs primarily stimulates beta-1 recpetors:
    1. Dobutamine
    2. Ritodrine
    3. Yohimbine
    4. Phenoxybenzamine
    5. Oxymetazoline
    1
  88. A drug is currently being developed, whose maechanism of actionn is stimulation of the beta-3 receptors. In which condition will this drug have most likely usefulness:
    1. obesity
    2. bronchial asthma
    3. hypertension
    4. shock
    5. acute renal failure
    1
  89. A patient complains of muscle weakness after several doses of Salbutamol nebulization. This weakness can be attributed to ___
    hypokalemia induced by Salbutamol therapy
  90. Which of the following beta-blockers also has peripheral vasolidating effect similar to Prazosin:
    1. propranolol
    2. betazolol
    3. nadolol
    4. bisoprolol
    5. labetalol
    5
  91. Which of the following beta-blockers is considered as cardioselective:
    1. Labetalol
    2. propranolol
    3. pindolol
    4. esmolol
    5. timolol
    4
  92. Rebound tachycardia & hypertension are expected complications of abrupt withdrawal of beta-blocker therapy. Which of the following agents has the least likelihood of casuing rebound effects when withdrawn?
    1. acebutolol
    2. propranolol
    3. bisoprolol
    4.metroprolol
    5. atenolol
    1
  93. Which of the following beta-blockers has the shortest duration of action (half-life = 10 minutes) making its useful for administration as continuous IV infusion with rapid achievement of a steady state conentration:
    1. metoprolol
    2. esmolol
    3. atenolol
    4. propranolol
    5. pindolol
    2
  94. Which of the following beta-blockers has/have been proven in clinical trials to be useful in the management of stable congestive heart failure:
    1. carvedilol
    2. bisoprolol
    3. metoprolol
    all
  95. In which conditions are beta-blockers found to be useful:
    1. hyperthyroidism
    2. Raynaud's Phenomenon
    3. Initial therapy in Pheochromocytoma
    1
  96. Among diabetic patients using insulin or OHAs, why are beta-blockers used with special caution if not totally avoided ?
    beta-blockers can mask hypoglycemic symptoms
  97. In which subset/s of patients are beta-blockers used with caution if not avoided:
    1. patients with bronchospastic diseases like COPD & bronchial asthma
    2. Patients with peripheral vascular disease especially vasospastic type
    3. patients with recent myocardial infarction
    1 & 2
  98. A 44 y/o female patient i started a weel ago on the following medications: Metoprolol 100 mg BID, Diltiazem 30 mg tablet BID, & Indapamide 1.5 mg OD for poorly controlled hypertension & chronic stable angina pectoris. She is now admitted at the ICU for dizziness & two episodes of syncope. Her heart was 45beats/min. What course of action would you suggest?
    stop Metropolol & Diltiazem & request for a 12-lead ECG
  99. Methylphenidate & dextroamphetamine are centrally acting sympathomimetics which have found use in which of the following conditions:
    1, manic-depression
    2. alcohol withdrawal
    3. attention deficit hyperactivity dosorder
    4. generalized anxiety disorder
    5. hypotensive epidoses
    3
  100. Which of the following effects is/are consistent with direct stimulation of the muscarinic receptors:
    1. peripheral vasodilation
    2. relaxation of the ciliary muscles
    3. negative dromotropic effect
    1 & 3
  101. The effects of muscarinic receptor activation in tissues like the exocrine glands & the extravascular smooth muscles have been linked with the generation of which second messenger molecule ?
    IP3
  102. What is the physiologic event that follows stimulation of the Nm type cholinergic receptors?
    opening of inward sodium channels
  103. Bethanecol is clinically used for which of the following conditions:
    1. urinary retention in neurogenic bladder
    2. intestinal obstruction
    3. chronic glaucoma
    4. supraventicular tachycardia
    5. congestive heart failure
    1
  104. What is/are the clinical use/s of Edrophonium (Tensilon)?
    1. reverse the effect of neuromuscular blockers after surgery
    2. treatment of overdose of atropine
    3. management of organophosphate poisoning
    1
  105. Ambenonium, Neostigmine & Pyridostigmine are most commonly used for which of the following conditions:
    1. atropine overdose
    2. myasthenia gravis
    3. bronchial asthma
    4. COPD
    5. ADHD
    2
  106. Tacrine, Donepezil, Rivastigmine & Galantamine are indicated for which of the following conditions:
    1. supraventicular tachycardia
    2. Curare-induced muscle paralysis
    3. Accomodative esotropia
    4, Alzheimer's disease
    5. Glaucoma
    4
  107. Which of the following agents used for the management of glaucoma:
    1. pilocarpine-physostigmine
    2. Ecothiophate
    .3 Demecarium
    all
  108. Which of the following findings may be consistent to overdose of or accidental exposure to an organiphosphate:
    1. constipation
    2. mydriasis
    3. peripheral vasodilation
    4. emesis
    5. decreased sweating
    4
  109. Which of the following effects can be attributed to Atropine:
    1. ciliary muscle contraction
    2. contraction of the papillary constrictor muscle
    3. blockade of vagal slowing of the heart
    3
  110. In comparison to other muscarinic agents, Scopolamine is expected to exert significant CNS effects due to :
    its being tertiary amine
  111. Ipratropium, Oxytropium & Tiotropium are antimuscarinic agents that are most useful as:
    relaxants of bronchial smooth muscles
  112. Oxybutunin, Dicyclomine & Glycopyrrolate are clinically useful for which of the following conditions:
    1. Cholinomimetic agent overdose
    2. Gastrointestinal hypermotility & urinary incontinence
    3. Angina due to coronary artery vasospasm
    4. motion sickness & Parkinsonism
    5. COPD & bronchial asthma
    2
  113. In most patients admitted to Atropine overdose, most poison control experts recommended which of the following measures as primary management:
    1. temperature control with cooling blankets
    2. Physostigmine as intial therapy
    3. Diazepam for seizure control
    1 & 3
  114. Poisoning resulting from ingestion of high dose quarternary antimuscarinic agents can be managed with which of the following agents:
    1. physostigmine
    2. neostigmine
    3. pilocarpine
    4. atropine
    5. scopolamine
    2
  115. Which of the following is/are important contraindications to the use of antimuscarinic agents or drugs with atropine-like properties:
    1. history of prostatic hyperlplasia
    2. glaucoma
    3. hypertension
    1 & 2
  116. Trimethapan is expected to produce which of the following effects:
    1. excessive sweating
    2. pupillary constriction
    3. diarrhea
    4. urinary incontinence
    5. hypotension
    5
  117. What is the mechanism of skeletal muscle paralysis produced by Succinylcholine?
    1. compettively inhibtits binding of acetylcholine to the Nm receptors
    2. increased inward chloride conductance leading to hyperpolarization of the neuromuscular endplate membrane
    3. sustained depolarization of the motor end plate making it unresponsive to other impulses & upon repolarization cannot easily be depolarized
    4. repeated short depolarizations of the motor end plate leading to a prolonged state of sodium channel inactivation
    5. irreversible & non competitive inhibition of the Nn receptors in both the ganglia & motor end plate with attenuation of depolarizing impulses
    3
  118. Which of the following findings is consistent with the skeletal muscle relaxant effect of Pancuronium & Racuronium?
    1. effect is enhanced with administration of succinycholine
    2. effect is reduced with co-administration of tubocurarine
    3. initially cause depolarization of the motor end plate leading to fasciculations
    4. sustained response to tetanic stimulation
    4
  119. Which of the following inhalational anesthetics produces the greatest augmentation of the effect of neuromusscular blockers:
    1. Isoflurane
    2. Sevoflurane
    3. Halothane
    4. Desflurane
    5. Nitrous oxide
    1
  120. Anaphylactoid reaction may be seen as a side effect with which of the following neuromusscular blockers:
    1. Pancuronium
    2. Vecucuronium
    3. Gallamine
    4. Tubocurarine
    5. Rucoronium
    4
  121. Which of the following statements correctly describe/s the side effects of succinylcholine:
    1. negative chonotropic & inotropic effects which can be attenuated by atropine
    2. increased risk of emesis among diabetic & obese patients
    3, hyperkalemia when given to burn or trauma patients or patients with closed head injury
    all
  122. Which of the following mechanisms may explain the ability of beta-blockers to reduce blood pressure in hypertension;
    1. increased compliance of the capacitance vessels
    2. relaxation of the primary resistance vessels
    3. inhibition of renin release
    4. direct inhibition of Angiostensin II receptors
    5. decreased in total body stores of sodium
    3
  123. Which of the following equations describes the factors that contribute to blood pressure:
    1. BP = SV/SVR
    2. BP = CO x SVR
    3. BP = SV x SR
    4. BP = CO/SVR
    5. BP = SV x SVR
    2
  124. Which of the following mechanisms explains the blood pressure-lowering effect of thiazide diuretics:
    1. reduction in blood volume & cardiac output
    2. increased vascular compliance
    3. decreased proximal tubular reabsorption of water & sodium
    1 & 2
  125. Which of the following drugs inhibit the enzyme carbonic anhydrase:
    1. Dichlorphenamide
    2. Tolazamide
    3. Astemizole
    4. Selegaline
    5. Donepezil
    1
  126. What is the primary mechanism of action of the drug Indapamide?
    1. inhibition of the 2Cl-Na-K cotransporters in the distal convulated tubule
    2. inhibition of the Na-Cl cotransporters at the distal convulated tubule
    3. inhibition of the Na-Cl cotransporters at the collecting duct
    4. Competitive inhibition of Aldosterone binding to its receptors
    5. Competitive inhibition of Vasopressin binding to V2 receptors
    2
  127. Which side effect of Chlorthalidone is prominent especally among the elderly when Chlorthalidone is given at a dose of at least 50mg/day & signoficantly reduced when doses are maintained below 50mg/day:
    1. hyperuricemia
    2. hyperglycemia
    3. increased in serum LDL
    4. allergic reactions
    5. hyponatremia
    5
  128. What is the rationale behind the combination of Amiloride & hydrochlorothiazide (HCZ)?
    minimizehypokalemia due to HCTZ
  129. The action of the drug Eplerenone most closely resembles which of the following agents:
    1. spirinolactone
    2. amiloride
    3. triamterene
    4. metolazone
    5. quinethazone
    1
  130. Which of the agents exhibits pharmacodynamics interaction with the thiazide diuretics leading to a reduced diuretic effect:
    1. furosemide
    2. indomethacin
    3. enalapril
    4. hydralazine
    5. digoxin
    3
  131. Which of the following mechanisms explains the effects of the drugs Torsemide & Bumetanide:
    1. inhibition of carbonic anhydrase at the proximal convulated tubule
    2. inhibition of the Na-K-2Cl cotransporter at the thick ascending limb of the Loop of Henle
    3. inhibition of the Na-Cl cotransporter at the thin ascending limb of the Loop of Henle
    4. inhibition of the Na-Cl cotransporter at the distal convulated tubule
    5. inhibition of the Na-Cl cotransporter at the distal convulated tubule & collecting duct
    2
  132. Which of the following is/are accepted indication/s for the drug spirinolactone:
    1. adjunct in the management of Congestive Heart failure
    2. Conn's syndrome
    3. Nephrogenic Diabetes Insipidus
    1 & 2
  133. Which of the following is/are accepted indication/s for the drug Furosemide:
    1. Infusion-Diuresis in hypercalcemia
    2. Oliguric acute renal failure
    3. acute pulmonary edema
    all
  134. Which of the following agents is primarily indicated for the management of increased intracranial pressure:
    1. mannitol
    2. acetazolamide
    3. furosemide
    4. chlorthalidone
    5. bumetanide
    1
  135. Which of the following agents mosr useful for the management of nephrolithiasis due to idiopathic hypercalciuria:
    1. ethacrynic acid
    2. hydrochlorthiazide
    3. dorzolamide
    4. vasopressin
    5. triamterene
    2
  136. Which of the following statements correctly describes the characteristics of Indapamide as a drug for hypertension:
    1. its diuretic effect is self limiting, & may not account for its hypertensive effect after about 2-4 weeks of therapy
    2. long-term use leads to impropved blood vessel compliance
    3. has modest vasodilating property
    all
  137. Which of the following agents may be associated with ototoxicity which may have increased risk of occuring when patients also receive aminoglycoside antibiotic:
    1. furosemide
    2. chlorthalidone
    3. dorzolamide
    4. amiloride
    5. spirinolactone
    1
  138. Which of the following mechanisms explains best action of the drug methyldopa?
    1. the molecule replaces norepinephrine in the presynaptic vesicles & is released by nerve stimulation to interact with postsynaptic adrenergic receptors
    2. the molecule is converted first to alpha-methyldopamine & alpha-methylnorepinephrine which replace norepinephrine in the presynaptic vesicles & are released by nerve stimulation to interact with postsynaptic adrenergic receptors
    3. the molecule is converted first to alpha-methyldopamine & alpha-methylnorepinephrine which stimulate central alpha receptors
    4. the molecule is converted first to alpha-methyldopamine & alpha-methylnorepinephrine which inhibit alpha & beta receptors
    5. the molecule directly inhibits the peripheral alpha & beta receptors
    3
  139. What is the most frequent side effect of methyldopa which can be seen particularly at the onset of treatment?
    sedation
  140. A 45 y/o female on clonidine 1.0 mg/day for the last four weeks was brought to the hospital for 1 day history of nervousness, tachycardia & abrupt increase in her blood pressure to 180/130 mmHg. Her last intake of clonidine was 2 days prior to admission. Which of the following is/are appropriate interventions that you can suggest for the patient:
    1. start patient on Propranolol 50mg twice a day
    2. Re-institue Clonidine 1.0mg/day
    3. start labetolol at 200mg/day
    2 & 3
  141. Which of the following side effects is/are common to the three drugs: Hydralazine, Diazoxide, & Minoxidil
    1. hypertrichosis
    2. glucose intolerance
    3. reflex tachycardia
    4. Lupus-like side effect
    5. Dyslipidemia
    4
  142. In which subset of patients should Hydralazine be avoided or used with caution:
    1. patients with arrythmias
    2. patients with hypertension
    3. patients with diabetes mellitus
    4. patients with ischemic heart disease
    5. patients with congestive heart failure
    4
  143. Which of the following drugs if combined with Minoxidil may minimize latters drug's side effects:
    1. hydralazine + Hydrochlorothiazide
    2. Guanethidine + Reserpine
    3. Metoprolol + Chlorthalidone
    4. Amlodipine
    5. Amlodipine + Prazosin
    3
  144. In the management of paroxysmal hypertension in Pheochromocytoma, which of the following drugs is the most appropriate initial therapy:
    1. phentolamine
    2. metropolol
    3. guanfacine
    4. reserpine
    5. clonidine
    1
  145. Orthostatic hypotension & syncope are manifestations of a phenomenon associated with the first dose of which agent :
    1. labetalol
    2. methyldopa
    3. fenoldopam
    4. Irbesartan
    5. Doxazosin
    5
  146. The mechanism of action of the drug Clonidine most closely resembles that of___
    methyldopa
  147. Constipation, urinary retention, tachycardia, mydriasis & anhidriosis are expected effects based on the mechanism of action of which of the drugs:
    1. clonidine
    2. trimethapan
    3. reserpine
    4. sodium nitroprusside
    5. nicardipine
    2
  148. Which of the following drugs may be used safely for the control of hypertension in pregnant patients with pre-ecclampsia:
    1. magnesium sulfate
    2. methyldopa
    3. hydralazine
    2 & 3
  149. Which of the following mechanisms explains the action of the drug Sodium Nitroprusside:
    1. activation of guanylyl cyclase with increase in cGMP
    2. release of N20 with subsequent increase in cAMP
    3. inhibition of the secretion of renin
    4. stimulaion of the A 1 recpetors
    5. increase conductance of outward potassium channels
    1
  150. Which of the following agents is a pure arteriolar vasolidator:
    1. prazosin
    2. sodium nitroprusside
    3. diazoxide
    4. phentolamine
    5. pindolol
    3
  151. Which of the following agents can be used for hypertensive emergencies:
    1. Enelaprilat
    2. Diazoxide
    3. Sodium Nitroprusside
    all
  152. The decrease in arterial tone due to the vasorelaxant action of sodium nitroprusside is associated with:
    a local anesthetic effect on smooth muscle cells
  153. Which of the following effects can be attirubuted to Angiotensin II:
    1. stimulation of release on nitric acid
    2, stimulation of synthesis & release of Aldosterone
    3. stimulaition of release of Norepinephrine
    1
  154. What is the primary advantage of Angiotnesin II recpetor blockers over the ACE inhibitors?
    lesser incidence of coughs
  155. Which of the following ACE inhibitors require hydrolysis to the active metabolite/s in the body to produce effects:
    1. Enalapril
    2. Ramipril
    3. Perindopril
    all
  156. In which of the following conditions are ACE inhibitors found to be clinically useful as first-line treatment :
    1. angina pectoris
    2. congestive heart failure
    3. siabetic nephropathy
    2 & 3
  157. The efficacy of ACE inhibitors in the management of hypertension may be reduced in the presence of certain drugs such as :
    ibuprofen
  158. In which subset of patients are ACE inhibitors avoided as treatment option:
    1. patients with bilateral renal artery stenosis
    2. patients with hyperkalemia
    3. pregnant patients in their 2nd & 3rd trimesters of pregnancy
    all
  159. Which of the following channel blockers has greater activity on calcium channels in myocardial tissues than calcium channels in the vasculas smooth muscles:
    1. diltiazem
    2. verapamil
    3. nifedipine
    4. amlodipine
    5. felodipine
    2
  160. What is the mechanism of action of the Diydropyridine calcium channel blockers?
    inhibit the L-type calcium channel in the arteriolar smooth muscles
  161. In the long term management of hypertension, which of the following agents is/are considered as appropriate maintenace therapy:
    1. regular nifedipine capsules
    2. Enalapril tablets
    3. Indapamide tablets
    2 & 3
  162. What is the most common side effect of Enalapril?
    coughs
  163. Which of the following anti-hypertensive agents is most appropriate for elderly male patients with benign prostatic hyperplasia:
    1. prazosin
    2. amlodipine
    3. metoprolol
    4. hydrochlorothiazide
    5. enalapril
    3
  164. Which of the following anti-hypertensive agents may be more appropriate to use for diabetic patients with evidence of renal disease:
    1. prazosin
    2. amlodipine
    3. metoprolol
    4. hydrochlorothiazide
    5. enalapril
    5
  165. Chinese patients are most likley to be more sensitive to the effects of which of the following for hypertension that lower doses may have to be used?
    1. prazosin
    2. amlodipine
    3. metoprolol
    4. hydrochlorothiazide
    5. enalapril
    3
  166. In the management of hypertensive emergencies, which of the following goals or interventions is/are correct:
    1. rapid normalization of the blood pressure within 24 hours
    2. lowering of the mean arterial pressure by about 25%
    3. initiation of oral antihypertensives as soon adequate blood pressure lowering has been achieved
    2 & 3
  167. Which of the following are important consideration regarding the proper handling of nitroglycerin tablets:
    1. formulations used in the medicine are explosive
    2. sublingual tablets lose their potency when stored in plastic containers
    3. these are sensitve to lights
    2
  168. Which of the available nitrovasolidators has a bioavailability of about 100%:
    1. isosorbide mononitrate
    2. isosorbide dinitrate
    3. amyl nitrite
    4. glyceryl trinitrate
    1
  169. Which of the following statements most closely describes the primary mechanism of action of the nitrovasolidator :
    1. denitrification by glutathione S-transferase leads to release of nitrite ion which is then converted to nitrite oxide, a molecule that activates adenylyl cyclase leading to increase cAMP
    2. denitrification by glutathione S-transferase leads to release of nitrite ion which is then converted to nitrite oxide, a molecule that activates adenylyl cyclase leading to increase cGMP
    3. nitrate ion released upon denitrification directly stimulates outward K-channels leading to hyperpolarization of the vascular smooth muscles
    4. nitrate ion released upon denitrification stimulates the production of prostacyclin leading to vasodilation
    2
  170. Which of the following tissues exhibits the greatest sensitivity to nitrovasolidator at the lowest effective doses:
    1. arteries
    2. arterioles
    3. capillaries
    4. veins
    5. mypcardial tissues
    4
  171. Which of the following statements correctly explains the primary mechanism of relief of angina pectoris with the use of nitrovasolidator when given at usual dose:
    1. peripheral dilation of the veins leading to reduciton in cardiac preload & myocardial oxygen demand
    2. vasodilation of epicardial coronary arteries leading to improved oxygen delivery to myocardial tissues
    3. increase in diastolic perfusion time leading to improved perfusion to ischemic myocradium
    4. decreased total peripheral resistance with arteriolar vasolidation
    5. decreased in myocardial contractility leading to reduction in myocardial oxygen demand
    1
  172. Which of the following agents classified as nitrovasolidators is useful in the management of cyanide poisoning:
    1. sodium nitrite
    2. amyl nitrite
    3. sodium thiosulfate
    4. nitroglycerin
    5. isosorbide mononitrate
    2
  173. Which of the following vasolidators may be induce conversion of hemoglobin to methemoglobin (methemoglobinemia) which can lead to cyanosis:
    1. nitroglycerin
    2.
    isosorbide mononitrate
    3.
    isosorbide dinitrite
    4. Tetraethyl trinitrate
    5.
    amyl nitrite
    5
  174. This side effect of nitrovasolidators is explained in part by the depletion of sulfhydryl moieties in vascular smooth muscles with continuous use of the drugs, & may be partly reversed by sulfhydryl-regenerating compounds
    tolerance
  175. Which of the following agents is/are considered useful as single agent in the acute treatment of vasospastic angina pectoris:
    1. nitrovasolidators
    2. beta-blockers
    3. calcium channel blockers
    1 & 3
  176. What is the primary limitation with the use of Dihydropyridine calcium channel blockers in the management angina pectoris:
    1. tendency to reduce cardiac preload
    2. tendency to cause reflex tachycardia
    3. tendency to induce reflex vasospasm stopped
    4. tendency to cause peripheral edema
    5. tendency to reduce cardiac end-diastolic pressure
    2
  177. What is the most important role of beta-blockers in the management of angina pectoris?
    1. causes coronary artery vasodilation thus useful in the management of angina pectoris
    2. dilates the epicardial coronary vessels thus useful patients with ongoing Prinzmetal angina
    3. Reduces myocardial oxygen demand by reducing the total peripheral resistance making it useful for chronic stable angina
    4. Reduces myocardial oxygen demand by reducing myocardial contractility making it useful for chronic stable angina
    5. Reduces myocardial oxygen demand by decreasing myocardial perfusion time making it useful for all types of angina pectoris
    4
  178. Which of the following drugs or drug combinations is/are useful chronic stable angina pectoris:
    1. regular release Nifedipine capsule
    2. metoprolol tablet
    3. metoprolol + diltiazem tablet
    2
  179. What is the principal mechanism of action of Cardiac Glycoside?
    1. stimulate the release of calcium from the sarcoplasmic reticulum leading to an increase in intracellular calcium
    2. inhibition of the cell membrane outward calcium transporter preventing calcium extrusion
    3. stimulation of inward calcium transporter leading to an increase in intracellular calcium
    4. inhibition of the Na-K-ATPase leading to an increase in intracellular sodium preventing calcium extrusion
    5. inhibition of the Na-Ca exchanger in the sarcoplasmic reticulum leading to an increase in intracellular calcium
    2
  180. Which of the following statements on pharmacokinetic parameters must be considered for patients taking digoxin:
    1. in about 10% of patients, use of antibiotics can lead to increase oral bioavailbility
    2, renal clearance of the drug is inversely proportional to the creatinine clearance
    3. half-life is long, at about 160 hours due in part to extensive enterohepatic recirculation
    4. hepatic metabolism acounts for more than 80% of the elimination of the drug
    5. it is primarily distributed within the intravascular space due to its high protein binding
    1
  181. Which of the following is/are mechanical effect/s of digitoxin on myocardial tissues:
    1. increased in contractility of myocardial tissues
    2. increase in conduction velocity in the AV node
    3. a postive inotropic effect
    1 & 2
  182. Which of the following is/ar expected electrical effect/s of digitoxin on myocardial tissues:
    1. decreased in the refractory pperiod of the atrial muscles
    2. increased in the refractory pperiod of the AV node
    3. increased in the automaticity of atrial tissues & AV node
    all
  183. Which of the following conditions may augment the effect of digitalis gylcosides in myocardial tissues:
    1. concurrent use of Captopril
    2. reduced oxygenation of myocardial tissues
    3. concurrent administration calcium gluconate
    2 & 3
  184. Which of the following is/are the primary indication/s of digitalis glycosides:
    1. first line drug for the initial management of congestive heart failure
    2. useful in controling the rate of ventricular response in atrial fibrillation
    3. useful in pregnant patients with congestive heart failure
    2 & 3
  185. What is the major mechanism of interaction between digoxin & quinidine?
    decreased renal clearance of digoxin
  186. A 50 y/o male patient with congestive heart failure was started on the following medications: Digoxin 0.25mg OD, Hydralazine 10mg BID, Furosemide 20mg OD, & ISMN 60mg OD. 1 week after initiating therapy, the patient was admitted for blurring of vision & palpitations. He feels nauseated & has problems discriminating colors. Which of the following coursesof action is appropriate:
    1. suggest discontinuing Hydrlazine & starting patient on Amlodipine
    2. suggest giving metoclopromide for the nausea & examining for probable eye problem
    3. suggest starting patient on beta-blocker therapy
    4. suggest discontinuing Digoxin & Furosemide & checking for serum potasiium levels for necessary correction
    5. suggest discontinuing all medicaitons & starting patient instead on an ACE inhibitor, vasodilator & a thiazide
    4
  187. Whcih of the following interventions may be appropriate in the management of severe cases of digitalis intoxication such as in children & suicidal overdose:
    1. administration of digoxin immune fab
    2. administration of poatssium chloride
    3. administration of magnesium sulfate
    1
  188. What is considered as the toxic plasma concentration of Digoxin?
    > 2 ng/mL
  189. What is the primary use of drugs like Inamrinone& Milrinone?
    1. alternative to digoxin in patients with chronic congestive heart failure
    2. management of acute heart failure
    3. management of exacerbations of chronic congestive heart failure
    2 & 3
  190. What is the mechanism of action of Inamrinone & Milrinone in the management of heart failure?
    1. increase the levels of cAMP by activating the enzyme adenylyl cyclase
    2. increase the levels of cAMP by activating the enzyme phosphodiesterase III
    3. increase the levels of cGMP by activating the enzyme guanylyl cyclase
    4. inhibit the outward calcium flux leading to increaseintracellular calcium
    5. primarily cause peripheral vasolidation leading to reduce cardiac preload
    2
  191. Inotropic activity of the heart in congestive heart failure can be increased by which of the following agents:
    1. Bipyridines
    2. ACE inhibitors
    3. Beta-1 agonists
    1 & 3
  192. Which of the following agents for heart failure may be associated with arrythmia, thrombocytopenia, & hepatotoxicity which limit their use in patients with chronic congestive heart failure:
    1. Bipyridines
    2. digitalis glycosides
    3. Beta-1 agonists
    4. ACE inihibitors
    5. angiotensin II antagonists
    1
  193. Which of the following statements correctly describe/s the appropriate use of drugs for congestive heart failure:
    1. beta-blockers when used for patients with stable CHF can be given at doses similar to the dose used for hypertension
    2. ACE inhibitor dose must be carefully titrated to the maximum allowable or tolerated dose
    3. spirinolactone has been found to be most useful as initial drug therapy for CHF even prior to the use of ACE inhibitors or vasolidators
    2
  194. Which of the following drugs or drug combination can reduce both the cardiac preload & afterload in CHF?
    1. Hydrazaline + Nitrovasolidators
    2. Beta-blockers + Loop diuretics
    3. Loop diuretics + Digitalis
    1
  195. Which of the following interventions may be beneficial in the management of CHF?
    1. replacement of chronic digoxin dose with ACE inhibitors
    2. Add on therapy with an aldosterone antagonist on patients already on Digoxin or ACE inhibitors
    3. use of calcium channel blockers in patients who cannot receive beta blockers
    2
  196. Which of the following drugs is a sodium channel blocker that can prolong the duration of the action potential & dissociates from the channel with intermediate kinetics :
    1. lidocaine
    2. Flecainide
    3. Quinidine
    4. Bretylium
    5. Sotalol
    2
  197. Which of the following drugs is a sodium channel blocker which has no significant effect on the duration of the action potential & dissociates from the channel with slow kinetics :
    1. lidocaine
    2. Flecainide
    3. Quinidine
    4. Bretylium
    5. Sotalol
    2
  198. Which of the following beta-blockers have found to be most useful as arrythmic agent/s:
    1. Esmolol
    2. Metropolol
    3. Propranolol
    1 & 3
  199. Which of the following antiarrythmic agents has been associated with lupus-like side effects:
    1. Quinidine
    2. lidocaine
    3. propafenone
    4. amiodarone
    5. procainamide
    5
  200. What is the drug of choice for the management of sustained ventricular arrythmia associated with acute myocardial infarction
    lidocaine
  201. What is the preferred drug for the management of ventricular arrythmia associated with digitalis intoxication?
    Lidocaine
  202. What is the preferred drug for the management of acute episodes of supraventricular tachycardia?
    Adenosine
  203. What is the preferred drug for the management of chronic paroxysmal supraventricular tachycardia?
    Verapamil
  204. What is the primary mechanism of action of the drug Amiodarone?
    1. prolong the action potential with block of sodium channels
    2. shorten the action potential with block of sodium channels
    3. prolong the action potential with block of potassium channels
    4. shorten the action potential with block of potassium channels
    3
  205. What side effect/s may be expected with the use of Amiodarone?
    1. hypothyroidism or hyperthyroidism
    2. fatal pulmonary fibriosis
    3. symptomatic bradycardia & heart block particularly in patients with atrioventricular nodal disease
    all
  206. Measurement of the serum ALP prior to & during therapy of arrythmia is indicated when which of the following drugs for arrythmia is /are used:
    1. propafenone
    2. moricizine
    3. amiodarone
    4. flecainide
    5. diltiazem
    3
  207. Which of the following calcium channel blocker is most useful in arrythmia therapy:
    1. verapamil
    2. diltiazem
    3. nifedipine
    4. lidocaine
    5. propafenone
    1
  208. Which of the following effects can be attributed to histamine binding to its H1 receptor:
    1. extravascular smooth muscle contraction
    2. vascular smooth muscle contraction
    3. gastric acid secretion
    1
  209. The triple response of Lewis following intradermal injection of histamine includes which of the following:
    1. sensory nerve ending stimulation producing flare
    2. erythem caused by contraction of vascular smooth muscles
    3. endothelial cells contraction leading to exudation of fluids
    1 & 3
  210. Which of the following effects may be expected as a direct consequence of blockade of the H1 recpetors:
    1. sedation
    2. resolution of initial allergic response
    3. Anti-nausea & anti-emetic effect (anti-motion sickness)
    2
  211. Dimenhydrinate & Diphenhydramine are H1-antihistamines that belong to what chemical class of agents?
    Ethanolamine
  212. Which of the following agents is used primarily for its sedating property as the active ingredient of an OTC agents:
    1. alkylamines
    2. Phenothiazine
    3. Piperazine
    4. Ethanolamine
    5. Ethyla minediamine
    4
  213. What chemical class of H1 antihistamines include drugs that are used as components of OTC "cold" medications?
    Alkylamines
  214. What is the active metabolite of Hydroxyzine which is also available as an H1- antihistamine without significant sedating side effect?
    Cetrizine
  215. Which of the following H1-anthistamine chemical groups possess significant Atropine-like effects:
    1. Alkylamines
    2. Phenothiazine
    3. Piperazine
    4. Ethanolamine
    5. Piperadines
    4
  216. Which of the following H1-anthistamine has significant blocking effects on 5-HT receptors:
    1. Promethazine
    2. Cyproheptadine
    3. Pyrilamine
    4. Carbinoamine
    5. Cetirizine
    2
  217. Which of the following H1-anthistamine has significant anticholinergic effect to be useful for the management of dystonia & pseudoparkinsonism associated with the use of Neuroleptic agents:
    1. Diphenhydramine
    2. Brompheniramine
    3. Promethazine
    4. Cypropheptadine
    5. Cyclizine
    1
  218. Which of the following H1-anthistamine can block sodium channels in excitable membranes bringing about a local anesthetic effect:
    1. Diphenhydramine
    2. Meclizine
    3. Doxylamine
    4. Pyrilamine
    5. Cypropheptadine
    1
  219. What is the primary mechanism of action of the drugs Ondansetron & Granisetron?
    Antagonist effect at the 5-HT3 receptor
  220. What is the clinical use of drugs Ondansetron & Granisetron?
    Anti-emetic
  221. What is the clinical use of drugs that primarily stimulate the 5-HT1B & 5-HT1D recpetors?
    treatment of acute migraine attacks
  222. Sumatripan is contraindicated in which subset of patients :
    1. patients with bronshospastic disease
    2. pateints with acute attacks of migraine
    3. patients with ischemic heart disease
    4. patients with hypertension
    5. patients with Wolf-Parkinson-White syndrome
    3
  223. Which of the following statements is/are correct regarding Arachidonic acid:
    1. it is a 20-carbon known as eicosapentaenoic acid
    2. it is a mobilized from phospholipids by the enzyme phospholipase A2
    3. It is released from the phospholipids by the action of the enzymes Phospholipase C & diglyceride lipase
    2 & 3
  224. Which of the following eicosanoids is the product of the metabolism of Arachidonic acid by the cyclooxygenase enzyme:
    1. Leokotrienes
    2. isoprostanes
    3. Epoxides
    4. Lipoxins
    5. Prostaglandins
    5
  225. Which of the following correctly differentiate/s COX-1 from COX-2 isozymes:
    1. COX-1 is widely distributed & constitutively expressed
    2. COX-1 is expressed upon stimulation by cytokines & growth factor
    3. COX-2 is expressed by inflammatory & immune cells
    1 & 3
  226. Epoprestenol, a drug that is being used in the management of primary pulmonaryhypertension is an analogue of which eicosanoid:
    1. PGD2
    2. PGI2
    3. PGE1
    4. PGE2
    5. PGF2-alpha
    2
  227. Which of the following eiconsanoids has an analogue that is primary indicated as cytoprotectant in peptic ulcer disease:
    1. PGD2
    2. PGI2
    3. PGE1
    4. PGE2
    5. PGF2-alpha
    3
  228. Which of the following effects is caused by Prostacylcin:
    1. Bronchoconstriction
    2. vasodilation of the blood vessels
    3. inhibition of gastric acid secretion
    4. contraction of the uterus
    5. inhibition of renin secretion
    2
  229. What is the primary indication for the prostaglandin analogue latanoprost?
    magnesium of glaucoma
  230. Which of the following statements correctly describes the effect of glucocorticosteroid in eicosanoid synthesis:
    1. Dexamethasone inhibits the expression of the COX-2 gene
    2. glucocorticosteroids inhibit the synthesis of annexins leading to decreased activity of Phospholipase C
    3. glucocorticosteroids stimulate the synthesis of lipocortins which inhibit the activity of phospholipase A2
    1 & 3
  231. Which of the following drugs classified as NSAIDs inhibits the COX-1 more than the COX-2 isozymes:
    1. Indomethacin
    2. Ibuprofen
    3. mefenamic acid
    4. Naproxen
    5. Celexocib
    1
  232. Which of the following drugs classified as NSAIDs inhibits the COX-2 more than the COX-1 isozymes:
    1. Indomethacin
    2. Ibuprofen
    3. mefenamic acid
    4. Naproxen
    5
  233. Which of the following statements correctly describe/s the pharmacokinetics of Aspirin:
    1. aspirin can be absorbed in the stomach & the small intestines in the hydrolyzed form
    2. elimination of aspirin can be best describes as following a Michaelis-Menten kinetics
    3. acidification of the urine facilitates renal elimination of salicylates
  234. Which of the following mechanisms mat play a role in the anti-inflammatory effect of asprin:
    1. decreased synthesis of prostaglandins
    2. inhibition of neutrophil migration & adherence
    3. stabilize lysosomes of neutrophil
  235. At what usual adult dose of aspirin is its anti-inflammatory effect observed?
    3.2-4 g/day
  236. What is the principal mechanisms which can explain the anti-pyretic effect of aspirin?
    1. peripheral reduction in the levels of prostaglandins
    2. peripheral vasodilation
    3. inhibition of prostaglandin synthesis in subcortical sites
    4. inhibition of CNS response to interleukin-1
    5. activation of the thermoragulatory sweat glands
  237. Which of the following statements is/are correct regarding the anti-platelet aggregation effect of aspirin:
    1. discontinuation of aspirin immediately restores platelet aggregation in a matter of 1-2 days
    2. the mechanism involves irreversible acetylation of the cyclooxygenase eynzyme in platelets
    3, the effect is clinically significant in all dose ranges for aspirin
  238. Which of the following statements must be considered with regards to the effect of aspirin & other NSAIDs on the gastric mucosa:
    1. the risk of GI intolerance can be reduced if aspirin or any other NSAIDs is taken with meals
    2. with aspirin, the risk of erososive gastritis is observed only when aspirin is gvien at doses > 0.325 g/day
    3. gastrinc irritation is most prominent among NSAIDs that inhibit the COX-1 more than COX-2
  239. Which of the following drugs is currently considered as the preferred drug to prevent erosive gastritis in patients at risk of developing this side effect when NSAIDs have to be given to the patient:
    1. Omeprazole
    2. Ranitidine
    3. Sucralfate
    4. Telenzipine
    5. Misoprostol
  240. In salicylate poisoning, serum salicylate levels of 50-80 mg/dL can present with which of the following clinical findings :
    1. hyperthermia
    2. respiratpry alkalosis
    3. tinnitus & vertigo
  241. A 25 year old male patient ingested an unidentified number of aspirin tablets. He presents with the following findings: responsive to verbal stimulation, BP = 110/60mmHg, body temperature = 39.5oC; ABGs : pH= 6.9, HOC3 = 7meq/L, pCO2= 29 mmHg; dry oral mucosa, absent axillary sweating. What serum salicylate level is consistent with these findings?
  242. A number of the NSAIDs cannot be given to patients with gouty arthritis as these may precipitate an acute attack of gout or induce uric acid stone formation. Which of the following NSAIDs should not be given to patients with gout?
    1. Tolmetin
    2. Ibuprofen
    3. Indomethacin
    4. Diclofenac
    5. Mefenamic acid
  243. Which of the following NSAIDs with minimal anti-inflammatory activity is/are primarily indicated as analgesic especially in the management of post-operative pain:
    1. diclofenac
    2. ketorolac
    3. etodolac
    2 & 3
  244. All the known NSAIDs are weak acids. Which of the following drugs is the only exception?
    1. piroxicam
    2. sulindac
    3. nebumetone
    4. ketorolac
    5. tolmetin
    3
  245. Which of the following statements is/are correct regarding Mefenamic acid, a popular NSAID?
    1. it is mroe toxic than aspirin
    2. the drug should not be used for more than 1 week
    3. it should not be given to children
    all
  246. What is the most important toxicity associated with Pyrazolone derivatives like phenylbutazone which necessitated the withdrawal of a number of these drugs from the market?
    Hematologic Toxicities
  247. Which of the following NSAIDs is most useful as an analgesic & has been used succesfully to replace morphine in some situations involving mild to moderate post surgucal pain? When used with an opioid, it may decrease the opioid requirement by as much as 25-50%
    ketorolac
  248. What is the primary advantage of drugs like celoxocib & etericoxib?
    less incidence of gastric irritation or ulceration
  249. A number of drugs classified as specific COX-2 inhibitors like Rofecoxib (Vioxx) have been withdrawn from the market or are marketed with "Black box" warning. What is the primary reason for such actions to be taken against these drugs ?
    they increase the risk of thrombosis & cardiac deaths
  250. Which of the following agents is currently used as the first line DMARDs in the management of Rheumatoid Arthritis:
    1. Hydroxychloroquine
    2. Auranofin
    3. Penicillamine
    4. Azathioprine
    5. Methotrexate
    5
  251. When the methotrexate is used for the management of Rheumatoid Arthritis, what is the usual maintenance dosing regimen given to patients?
    15mg once daily
  252. Which of the following statements is/are correct regarding the drug Methotrexate when used for Rheumatoid Arthritis?
    1. the primary mechanism of action involves inhibition of AICAR transfomylase & thymidylate synthase
    2. toxicity of the drug may be minimized with the use of Leucovorin
    3. the drug is contraindicated in pregnancy
  253. Which of the following statements is/are correct regarding the drug Acetaminophen?
    1. it is a weak inhibitor of COX-1 & COX-2 isozymes in peripheral tissues
    2. it has significance anti-inflammatory activity
    3. it is equivalent to aspirin as an analgesic & antipyretic
  254. Which of the following agents is most useful in the management of Acetaminohen poisoning:
    1. N-acetylcysteine
    2. S-carboxymethylcysteine
    3. Dantrolene
    4. Atropine
    5. Sodium bicarbonate
    1
  255. Which of the following conditions when present mayincrease the risk of formation of toxic intermediate N-acetyl-p-imminobenzoquinone with regular doses of Acetaminophen:
    1. patient with acute viral hepatitis
    2. patients on warfarin therapy
    3. chronic alcoholics
    1 & 3
  256. Which of the following drugs used for gout produces its effect by inhibiting the enzyme xanthine oxidase:
    1. allopurinol
    2. colchicine
    3 indomethacin
    4. prebenecid
    5. sulfinpyrazone
    1
  257. Which of the following drugs used for gout produces its effect by inhibiting the synthesis of microtubules :
    1. allopurinol
    2. colchicine
    3 indomethacin
    4. prebenecid
    5
    2
  258. Which of the following is/are appropriate indications of Allopurinol:
    1. in the management of chronic tophaceous gout
    2. in preventing massive uricosuria in patients to be given chemotherapeutic agents for acute leukemia
    3. in patients with recurrnet renal urate stones
    all
  259. In the management of acute gouty attack, which of the following statements is/are correct:
    1. uricosuric agents are given at the onset of an acute attack due to reduce the duration of the episode
    2. indomethacin is preferred for the management of the pain of an acute attack
    3. colchicine relieves the pain & inflammation of acute attack in 12-24 hours
    2 & 3
  260. Which of the following drug groups can relax the bronchial smooth muscles & are primarily used as bronchodilators in bronchial asthma:
    1. methylxanthines
    2. Beta-agonists
    3. Anticholinergic agents
    all
  261. In the management of bronchial asthma, which of the following medications is/are considered as controller medications:
    1. low-dose inhaled glucocorticosteroids
    2. short-acting beta-2 agonists
    3. long-acting inhaled beta-2 agonists
    1 & 3
  262. Which of the following advice should you give to a patient with bronchial asthma regarding the use of medications for his condition based on current recommendations:
    1. oral bambutorol must be taken on a prn basis for acute exacerbations of bronchial asthma
    2. Inhalations of salbutamol for acute relief of attack must be used for not more than 3x a day
    3. he must adequately gargle about 5x after each of use of Fluticasone inhaler
    2 & 3
  263. Which of the following drugs for bronchial asthma can be given subcutaneously during acute episodes of bronchospasm:
    1. Salbutamol
    2. Isoproterenol
    3. Terbutaline
    4. Budesonide
    5. Theophylline
    3
  264. Which of the following mechanisms may explain the action of Methylxanthines in bronchial asthma:
    1. may inhibit the late phase allergic reaction occuring about 2-8 hours after an acute attack
    2. may inhibit the enzyme phosphodiesterase leading to ab increase in the levels of cAMP
    3. may inhibit the action of adenosine
    all
  265. Which of the following statements describe/s the clinical use of Theophylline
    1. may reduce the nocturnal attack of bronchial asthma when given as sustained-release preparation
    2. may improve response to high dose inhaled beta-agonists when given intravenously concurrently with beta-2 agonists during acute exacerbations of asthma
    3. may improve contractility of the diaphragm imrpoving ventilatory response to hypoxia
    1 & 3
  266. Which of the following statements is an important consideration regarding the toxicities & side effects of Theophylline:
    1. toxicities & side effects do not occur as long as the serum levels of theophylline do not exceeds 20mg/L
    2, adults, neonates, & young infants have faster clearance of theophylline than children
    3. clearance may be decreased by inhibition of hepatic enzymes among chronic smokers
    4. seizures & arrythmias are more common when serum levels exceed 40 mg/L
    5. hepatic dysfucntion does not alter significantly the clearance of theophylline & can thus safely used for patients with liver diseases
    4
  267. Which of the following statements describes the use of anticholinergic agents in COPD & bronchial asthma?
    1. they can safely given at high doses by inhalations to saturate the muscarinic receptors
    2. available agents are tertiary ammonium compounds
    3. they are more effective than beta-2 agonists in bronchial asthma but less effective in COPD
    1
  268. What is the mechanism of action Nedocromil?
    1. increased outward potassium conductance leading to hyperpolarization of mast cell membrane
    2. increased inward chloride conductance leading to hyperpolarization of mast cell membrane
    3. increased inward sodium conductance leading to depolarization of mast cell membrane
    4. increased outward calcium conductance leading to repolarization of mast cell membrane
    5. increased inward potassium conductance leading to depolarization of mast cell membrane
    2
  269. What is the mechanism of action Zafirlukast & Montelukast?
    1. pharmacologic antagonism of Leukotriene D4 action
    2. pharmacologic antagonism of Leukotriene C4 action
    3. inhibition of the enzyme 5-lipoxygenase
    4. inhibition of cytokline release by macrohages
    5. inhibition of histamine-1 receptors
    1
  270. Which of the following agents has/have experimental effect of broncholidator:
    1. Omalizumab
    2. Nifedipine
    3. Nitric oxide
    2 & 3
  271. Which of the following correctly describes the action of cromolyn sodium:
    1. induces relaxation of bronchial smooth muscles
    2. blocks the degranulation of mast cells
    3. inhibits release of cytokines by inflammatory cells
    4. inhibits binding of IgE to mast cell membrane
    5. inhibits degradation of cGMP
    2
  272. Which of the following effects observed with acute or chronic use of opioids like morphine can be attributed to stimulation of the mu-receptors:
    1. respiratory depression
    2. psychosis
    3. miosis
    1 & 3
  273. Which of the following statements correctly describe the mechanism of action of opiod:
    1. they mimic the action of endogenous opiod peptides
    2. they stimulate the release of endogenous opiod peptides
    3. they the bind the receptors like the mu, kappa & delta
    all
  274. Which of the following is an opiod receptor that is responsible for inducing analgesia most especially among women:
    1. kappa
    2. delta
    3. alpha
    4. epsilon
    5. mu
    1
  275. Tolerance is an expected consequence with chronic use of most of the available Opiods. Which of the following effects of opiod is tolerance not observed:
    1. respiratory depression
    2. analgesia
    3. euphoria
    4. constipation
    5. sedation
    4
  276. Which of the following statements regarding the development of tolerance of opiods is/are correct:
    1. develops in 2-3 weeks of continuous use especially when large doses are used over short intervals
    2. cross tolerance develops among predominantly kappa-receptor full agonists
    3. partial agonist induce cross-tolerance with strong agonist & antagonist
    1
  277. A 45 male admitted for severe chest pain was diagnosed with acute myocardial infarction. He was being morphine 2mg IV for relief of chest pain. Which of the following is/are important findings that must be observed as expected consequence/s of the use of morphine:
    1. tachycardia
    2. hypotension
    3, vasopasm
    2
  278. Which of the following opiods is not associated with biliary colic & can thus be used for severe pain associated with this condition:
    1. morphine
    2. pantazocine
    3. fentanyl
    4. meperidine
    5. codeine
    4
  279. Abstinence symdrome is a rebound effect characterized by rhinorrhea, lacrimation, yawning, chills, gooseflesh, hyperventilation & hostility observed in which in which of the following situations?
    1.Abrupt widrawal of an opoid agonist ina patient taking drug chronically.
    2. In a newborn of mother illicity taking heroin during her pregnancy.
    3. Administration of Nalbuphine on a patient chronically on Morphine.
    All
  280. Which of the following oral doses of morphine is equivalent to 10 mg of an intravenous dose?
    1. 200 mg
    2. 180 mg
    3. 100 mg
    4. 40 mg
    5. 10 mg
    4
  281. Diacetylmorphine is the chemical name of which of the following opoids?
    1. Apomorphine
    2. Morphine
    3. Heroin
    4. Codeine
    5. Meperidine
    3
  282. Tramadol is a weak mu-receptor agonist that does not require an S2 license for dispensing.It is a synthetic analogue of which of the following opiates/opiods?
    1. Codeine
    2. Thebaine
    3. Morphine
    4.Meperidine
    5. Diphenoxylate
    1
  283. Which of the listed opiod below is among the recommended drugs of the management of acute pumonary edema?
    1. Nalbuphine
    2. Codeine
    3. Morphine
    4. Meperidine
    5. Apomorphine
    3
  284. What is the primary mechanism involved in the utility of Opoids in the management of acute pulmonary edema?
    1. Induction of Osmotic diuresis of edema fluids
    2. Peripheral vasodilation reducing venous return
    3. Decreased cardiac inotropism
    4. Improved mobilization of edema fluid by osmosis.
    5. Increased glomerular filtration rate
    2
  285. Which of the following is/are possible therapeutic classification/s for available opiods and opiates
    1. Cough suppressants
    2. Emetics
    3. Analgesics
    All
  286. What is the main reason why Atropine is always given with Diphenoxylate(Lomotil)?
    1. The anticholinergic after-effects with Atropine discourages abuse of Diphenoxylate
    2. The anti-motility effect of Atropine augments the constipating effect of Diphenoxylate
    3. Atropine minimizes the respiratory depression expected with Diphenoxylate
    4. Atropine reduces the absorption and systemic toxicity of Diphenoxylate.
    5. Atrophine inhibits the hepatic metabolism of Diphenoxylate effectively reducing the dose requires for diarrhea.
    1
  287. What is the primary indication for the drug Methadone?
    1. Analgesic substitute for Morphine
    2. Antitussive substitute for Codeine
    3. Weaning off the patients addicted to Heroin or Morphine.
    4.Management of biliary Colic
    5. Anesthetic premedication
    3
  288. Which of the following agents is classified as a full
    agonist of Opoid receptors
    1. Hydromorphone
    2. Hydrocodone
    3. Codeine
    4. Propoxyphene
    5. Pentazocine
  289. 1
  290. Which of the following agents is classified as a partial agonist of opoid receptors
    1. Meperidine
    2. Methadone
    3. Levallorphan
    4. Fentanyl
    5. Nalbuphine
    5
  291. Which of the following agents is/are classified as opoid antagonist/s?
    1. Nalorphine
    2. Naloxone
    3.Naltrexone
    All
  292. Which of the following is an anticoagulant is produced by recombinant DNA technology from the gene that encodes the natural anticoagulant derive from the medicinal Leeches?
    1. Dicumarol
    2. Hirudin
    3. Lepirudin
    4. Heparin
    5. Dalteparin
    3
  293. What is the primary indication of the anticoagulant derived from the medicinal leeches or its recombinant form?
    1. Anticoagulant when necessary during pregnancy
    2. When initiating anticoagulantion theraphy in patients requiring chronic anticoagulation
    3. Treatment of and prophylaxis against pulmonary thromboembolism
    4. Management of Thrombosis associated with heparin-induced thrombocytopenia
    5. In patients with acute myocardial infarction or unstable angina pectoris.
    5
  294. What is the mechanism of action of regular heparin?
    1. Activated antithrombin III which in turn inactivated a number of activated clotting factors.
    2. Activation of plasminogen to plasmin leading to destruction of fibrin and fibrinogen
    3. Inhibits the reductive activation of Vitamin K epoxide to the hyrdoquinone form
    4. Inhibits activation of Prothrombin to Thrombin
    5. Mimics the action of epsilon-aminocaproic acid
    1
  295. The activity of regulat heparin when given intravenously is best monitored at least every 6 hours for the first 24 hours of therapy using the parameter?
    1. Protime
    2. Platelet Count
    3. Clot retraction time
    4. Activated partial thromboplastin time
    5. Bledding time
    4
  296. When regular heparin is used SubQ,which of the following statements is correct?
    1. The is no need to monitor activity in most cases
    2. Monitoring of activity must be done on a weekly instead of daily basis
    3. Monitoring of activity must be done using PTT
    4. Monitoring of Activity must be done regularly using the PT value.
    5. Monitoring of activity must be done using the platelet count.
    1
  297. Which of the following agents is classified as a low molecular wieght heparin?
    1. Enoxaparin
    2. Regular Heparin
    3. Hirudin
    4. Phenindione
    1
  298. Which of the following parameters must be measured when a patient on low molecular wt. heparin develops bledding that may be associated with therapy?
    1. aPTT
    2. Prothombin Time
    3. Factor X assay
    4. Factor IX assay
    5. Bledding Time
    3
  299. Blessing associated with the use of regular heparin is best managed with which of the following interventions?
    1. Immediate stopping of Therapy
    2. Administration of Tranexamic Acid
    3. Administration of Vitamin K
    4. Administration of Protamine Sulfate and stopping therapy
    5. Lowewrng of the current dose withour stoppine therapy
    4
  300. What is the primary drawback with Phenprocoumon that limits its clinical use in the management of Thrombosis?
    1. Its metabolism to a hepatotoxic metabolite
    2. Its long half-life
    3. Its high degree of protein binding
    4. The long delay in its onset of action
    2
  301. Warfarin exerts its effect primarily by inhibiting the gamma-carboxylation of the glutamate residues of which of the following clotting factiors?
    1. IXa,Xa,XIa,XIIIa
    2. IIa,VIIa,IXa,Xa
    3. II,VII,IX,X
    4. IX,X,XI,XII
    5. I,II,V,VII
    3
  302. When warfarin is used as anticoagulant,the achievement of a maximal hypothrombinemic effect is expected to be delayed. What is the primary reason for this delay in warfarin effect?
    1. The presence of preformed clotting factors in the plasma which have biologic half-lives of 6 to 60 hours.
    2. The high degree of protein binding which delays entry of the drug into its biologic site of action.
    3. The delay in the actvation of precursor clotting factors due to high levels of activation-inhibitors.
    4. The ability of Warfarin to induce its own metabolism which delays achievement of the therapeutic levels by days.
    5. The ability of Warfarin to interfere with the assay done to measure its activity.
    3
  303. Cutaneous necrosis which can develop during the first few weeks of therapy is expected with Warfarin due to whic of the following mechanism?
    1. Idiosyncratic and paradoxical increase in the rate of synthesis of a number of clotting factors
    2. Earlier decline in the circulation levels of natural anticoagulants causing predominance of procoagulant clotting factors.
    3. Intrinsic thrombogenic property of Warfarin molecules.
    4. Direct reduction in tissue perfusion as a cosequences of the allegenic property of Warfarin
    5. Hypotensive effect of Warfarin which redistributes blood flow to critical sites in the body.
    1
  304. What is the recommended target protime INR for patients who need Warfarin and have prosthetic heart valves?
    1. 1-3
    2. 2-3
    3. 3-4
    4. 4-5
    5. 5-6
    3
  305. A pt. on Warfarin for the last 4 weeks for DVT has a PT INR of 4 but without evidence of blessing.What is the most appropriate intervention?
    1. No intervention as within target INR range
    2. Reduction of the dose by at least half
    3. Administration of Vit. K
    4. Administration of protamin sulfate
    5. Administration of Tranexamic Acid
    2
  306. Which of the ff. drugs or conditions can increase the activity of Warfarin by affection the drug's absorption,distribution and elimination?
    1. Cimetidine
    2. Rifampicin
    3. Change to vegetarian diet
    4. The presence of hepatice dse.
    5. Concurrent use of heparin
    1
  307. What interaction is present with concominant use of
    Warfarin and Pyrazolone NSAIDS?
    1. Inhibition of urinary excretion of Warfarin
    2. Inhibition of the oxidative metebolism of S- Warfarin
    3. Displacement of Warfarin from its protein binding
    2 and 3
  308. Which of the ff. correctly describes the mechanism of action of fibrinolytic agents?
    1. directly catalyze the proteolysis of fibrin and fibrinogen
    2. Inhibit the action of thrombin by preventing its binding to fibrin and fibrinogen
    3. Activate Plasminogen to Plasmin,a serine protease that catalyzes breakdown of fibrin and fibrinogen
    4. Inhibit activation of fibrinogen by proteolysis of thrombin
    5. Activate the endogenous anticoagulants Protein C and Protein S.
    3
  309. Which of the following is classified as a thrombolytic Agent?
    1.Retaplase
    2. Warfarin
    3. Argatroban
    4. Bivalirudin
    5. Lepirudin
    1
  310. Which of the following statements is/are corect regarding the use of thrombolytic agents in myocardial infarction?
    1. Best response is seen if the drug is given within 24 hours from onset of symptoms
    2. Generally given to patients with ST segment elevation
    3. Absolute contraindication is a history of stroke of less than 1 year
    2 and 3
  311. Which of the following agents is associated with the formation of antibodies that can cause development of allergic reaction with subsequent exposure to the drug?
    1. Urokinase
    2. Streptokinase
    3. Alteplase
    4. Tissue Plasminogen Activator
    5. Tenecteplase
    2
  312. Which of the following mechanisms may lead to inhibition of platelet aggregation?
    1. Activation of antithrombin III
    2. Thromboxane synthesis inhibition
    3. Guanylyl cyclase inhibition
    2
  313. Which of the ff. mechanisms correctly describes the mechanism of action of Aspirin as an inhibitor of platelet aggregation?
    1. Irreversible inhibition of platelet and endothelial cell cyclooxygenase
    2. Irreversible inhibition of endothelial cell cyclooxygenase
    3. Irreversible inhibition of platelet cyclooxegenase
    4. Reversible Inhibition of platelet and endothelial cell cyclooxygenase
    5. Reversible inhibition of endothelial cell cyclooxegynase
    3
  314. Which of the following agents requires weekly WBC monitoring within the first 3 months of treatment due to a risk of causing leukopenia?
    1. Cilostazol
    2. Dipyridamole
    3. Abciximab
    4. Clopidogrel
    5. Ticlopidine
    5
  315. Which of the ff. agents is assoc. with the devt. of thrombotic thrombocytopenic purpura?
    1. Aspirin
    2. Ticlopidine
    3. Tirofiban
    4. Eptifibatide
    5. Cilostazol
    2
  316. Wc of the ff. agents is classified as an inhibitor of glycoprotein IIb/IIIa and is useful in patients with acute coronary syndrome and those undergoing coronary intervention
    1. Clopidogrel
    2.Ticlopidine
    3. Abciximab
    4. Cilostazol
    5. Urokinase
    3
  317. What is the most important adverse effect of Dipyridamole when given to pts. with ischemic heart dse?
    1. Significant thrombocytopenia
    2. Vasospasm of coronary vessels
    3. Coronary steal phenomenon
    4. Severe Diarrhea
    5. Intemittent claudication
    3
  318. What is the mech. of action of the Tranexamic Acid?
    1. ADP inhibition
    2. Serine protease inhibition
    3. Inhibits plasminogen activation
    4. Inhibits reductive hydrolysis of Vit. K epoxide
    5. Increase factor VIII activity.
    3
  319. Which of the ff, agents primarily cause lowering of the VLDL and is thus useful for hypertriglyceridemia?
    1. Niacimide
    2. Fenofibrate
    3. Simvastatin
    4. Probucol
    5. Cholestyramine
    2
  320. Which of the ff. findings is consistent with the action of the drug Colestipol?
    1. Prevents reabsorption of bile acids in intestines
    2. Increase uptake of LDL and IDL with the up-regulation od LDL receptors in the liver
    3. Causes an increase in conversion of cholesterol to bile acids.
    ALL
  321. What is the mech. of action of Atorvastatin?
    1. Inhibits the first committed step in the biosynthesis of cholesterol
    2. Serves as ligand for the nuclear transcription receptor call peroxisome proliferators-activated receptor alpha
    3. Stimulates the activity of lipoprotein lipase leading to lyposis of lipoprotein triglyceride
    4. Inhibits re-uptake of bile acids leading to loss of negative feedback on the alpha- hydroxylase enzyme
    5. Prevents oxidation of Ldl cholesterol
    1
  322. Which of the ff. is/are importante monitoring consideration/s is a pt. receiving Simvastatin?
    1. Baseline and ff. up measurements of serum creatinine
    2. Baseline and ff. up measurements of serum aminotransferase activity
    3. Baseline and ff. up measurements of creatinine kinase activity
    2 and 3
  323. Patients on statins are generally advised to take the meds at night, what is the basis for this?
    1. Maximal absorption occurs at night
    2. Maximal cholesterol de-novo synthesis occurs at night
    3. Minimize postural hypotension expected with statins
    4. Minimize syncopal attacks with the first dose of statins
    5. LDL release occurs at nights
    2
  324. Statins are generally best taken at night. Which of the ff. Statins is night dosing is necessary?
    1. Lovastatin
    2. Simsvastatin
    3. Atorvastatin
    4. Pravastatin
    5. Fluvastatin
    3
  325. Which of the ff. drug combi is generally avoided?
    1.Simvastatin + Niacin
    2. Niacin + Colestipol
    3. Simvastatin + Gemfibozil
    4. Gemfibozil + Colestipol
    5. Simsvastatin +Colestipol
    3
  326. Therapy with HMGCoA reductase inhibitors is assoc. with rhabdomyolosis and myositis.These Complications which can least to tubular necrosis and renal failure have been reported to augmented with co-administration of which drugs.
    1. Fenofibrated and other fibrates
    2. Cholestyramine and othe bile-acid binding resins
    3. Captopril and other ACE inhibitors
    4. Tranylcypromine and other MAO inhibitors
    5. Methamphetamine and other norepinephrine relaeasers.
    1
  327. Which of the ff drugs associated with cutaneous vasodilation and sensation of warmth after an initital dose which may be reduced with the use of 300 mg dose Aspirin taken an hour before the dose
    1. Niacin
    2. Fenofibrate
    3. Atorvastatin
    4. Cholestyramine
    5. Probucol
    1
  328. Which of the ff. drugs can be bind to molecular components of the macromoleculat complex of GABA-A receptor-chlorise channel present in neuronal memoranes in the CNS?
    1. Diazepam
    2. Zolpidem
    3. Phenobarbital
    ALL
  329. Which of the following statements correctly describes the mechanism of action of the anxiolytic drug Buspirone?
    1. Selective binding to the BZ-1 receptor int the brain
    2. Antagonist of alpha receptor in the brain
    3. Partial agonists of 5-HT-1A receptor in the CNS
    4. Inhibitor of MAO enzyme
    5. Antagonist of the BZ-1 receptor in the brain
    3
  330. Which of the following benzodiazepines is a prodrug that is hydrolyzed to the active metabolite Nodiazepam in the stomach?
    1. Alprazolam
    2. Chlordiazepoxide
    3. Chlorazepate
    4. Diazepam
    5. Lorazepam
    3
  331. What is the primary use of the drug Flumazenil?
    1. Antagonizes the action of benzodiazepines
    2. Stimulate BZ-1 receptor similar to Benzodiazepines
    3. Antagonizes the action barbiturates
    4. Inhibits the 5-HT-1A receptor
    5. Stimulate the GABA-A receptor
    1
  332. Which of the following benzodiazepines has the shortest half-life and a rapid onset of action?
    1. Lorazepam
    2. Triazolam
    3. Oxazepam
    4. Diazepam
    5. Prazepam
    2
  333. Which of the ff. agents is absolutely contraindicated in pts. with D/Os associated with Porphyrin such as acute intermittent porphyxia, Variegate porphyria and symptomatic porphyria?
    1. Chlordiazepoxide
    2. Diazepam
    3. Zolpidem
    4. Phenobarbital
    5. Buspirone
    4
  334. Which of the ff. agents is assoc. with sig. anterograde amnestic effect which is adventageous in a number of medical and surgical procedures that may give discomfort to the patient?
    1. Midazolam
    2.Zolpidem
    3. Buspirone
    4, Phenobarbital
    5. Thiophental
    4
  335. What is the rationale behind the use of long-acting benzodiazepines like chlordiazepoxide and diazepam in the mgt. of alcohol widrawal?
    1. The benzodiazepines produce paradoxical reaction amont the chronic alcoholics
    2. Cross- Dependence develops among sedative-hypnotics
    3. Increase in the renal clearance of alcohol
    4. Increase in the non-CYP mediated metabolism of alcohol
    5. Competition develops with the transport of alcohol across the blood-brain barrier
    2
  336. Which of the following agents may be expected to have an additive CNS depressants effect with sedative hypnotics like benzodiazepine when taken simultaneously?
    1. Opiod analgesics
    2. Phenothiazines
    3. Alcoholic beverages
    ALL
  337. Which of the following pts. may be expected to have increased in sensitivity to sedative-hypnotics leading to higher incidence of adverse effects or toxicity?
    1. Young women
    2. Pts. with Cardiovascular dse
    3. Pts. with Respiratory dse
    2 and 3
  338. Which of the following statements correctly describes the pharmcokinetics of Phenytoin?
    1. Absorption of Phenytioin is constant regardless of the formulation
    2. Phenytoin is well absorbed after IM injection
    3. Elimination of Phenytoin follows a first order kinetics at very low blood level
    4. A first order kinetics of metabolism is observed with Phenytoin at low with high blood levels
    5. Phenytoin is not significantly protein bound so drug displacement interaction is not a major concern
    3
  339. Which of the following findings in a patient taking phenytoin would warrant reduction in the dose:
    1. gingival hyperplasia
    2. nystagmus
    3. osteomalacia
    4. ataxia
    4
  340. Autoinduction of metabolism is a phenomenon that leads to a decrease in half life of a given drug that dosage adjustments must be made within the first month of therapy to ensure therapeutic drug levels are reached, & reduction of dosage musr be made once metabolims stbilized. Suc is seen with which of the following drugs:
    1. carbamazepine
    2. phenytoin
    3. phenobarbital
    4. valproic aacid
    1
  341. Which of the following drugs for seizure is metabolized by yield phenobarbital:
    1. lamotrigine
    2. vigabatrin
    3. primidone
    4. topiramate
    3
  342. When phenytoin is given intravenously, what is the maximum rate by which the drug can be administered:
    50 mg/min
  343. Which of the ff statements is/are correct regarding intravenous phenytoin:
    1. cardiotoxicity is partly due to propylene glycol which is used as a solubilizing agent
    2, it is compatible with dextrose containing IV fluids
    3. fosphenytoin is more soluble & requires no solubilizing agent
    1 & 3
  344. Which of the ff statements is/are correct regarding the toxicity profiel & management of overdose of most drug used for treatment of seizures:
    1. the most dangerous effect is cardiotoxicity
    2. alaklinization of the urine to hasten elimination is usually ineffective
    3. stimulants are useful antodotes
    2
  345. What is the common side effect seen with the use of carbamazepine which requires adjstment in the dose of the drug?
    diplopia
  346. What is the preferred drug for the management of pure absence seizures?
    Ethosuximide
  347. Which of the ff agents is associated with idiosyncratic hepatotoxicity when given to the treatment of seizure in children less than 2 yrs of age & in patients on multiple medication:
    1. gabapebtin
    2. valproic acid
    3. phenytoin
    4. primidone
    2
  348. Which of the ff agents is currently the preferred drug for the initial management of status epilepticus:
    1. Lorazepam
    2. Diazepam
    3. Phenobarbital
    4. Phenytoin
    1
  349. Which of the ff drugs used for seizrue disorders is most commonly associated with cosmetic changes making the drug less desirable to use among adolescents, school-age children & women:
    1. gabapentin
    2. phenobarbital
    3, phenytoin
    4, valproic acid
    3
  350. A 50 year old male with generalized tonic clonic for seizure was initially given carbamazepine as maintenance therapy. He however developed adverse response to the drug in the form of Steven-Johnson syndrome. Which of the ff agents may be safe to use as an alternative treatment for the seizure:
    1. valproic acid
    2. phenytoin
    3. phenobarbital
    1
  351. Which of the ff drugs classified as diuretics may be useful in epileptic woman who have seizures exaserbations at the time of menses:
    1. hydrochlorothiazide
    2. metolazone
    3. acetazolamide
    4. chlorthalidone
    3
  352. Which of the ff correctly describes the clinical use of carbidopa in the therapy of Parkinsonsim :
    1. increase the CNS bioavailability of levodopa
    2. imrpove a symptoms of bradykinesia
    3. minimize nausea & vomiting associated with levodopa
    1 & 3
  353. What is the mechansim of action of bromocriptine in the management of Parkinsonism?
    direct agonist of D2 receptor
  354. Female patients with pituitary tumor & manifesting with amenorrhea & galactorrhea are initially managed with bromocriptine. What is the mechanism of bromocriptine in these conditions?
    inhibits the action of prolactin
  355. During the maintenance therapy with levodopa, patients are advised to take the drug on an empty stomach. Why is this advise given?
    large neutral amino acid in food interfere with drug's transport across the blood brain barrier
  356. Which of the ff drugs is most useful on controlling the bradykinesia of Parkinsonism:
    1. levodopa
    2. bromocriptine
    3. amantadine
    4. selegiline
    1
  357. Retroperitoneal fibrosis is an observed complication seen with the drugs that belong to what class of agents?
    amantadine
  358. Livedo reticularis, a vascular cutaneous reaction characterized by a redish-purple, fishnet-patterned mottling of the upper or lower extremities is a side effect associated with whcih of the ff agents
    1. amnatadine
    2. diphenhydramine
    3. levodopa
    4. pramipexole
    1
  359. What is Entacapone?
    a CMOT inhibitor
  360. The so called "wearing off" phenomenon encountered with the use of levodopa-carbidopa combination in parkinsonism is partly due to the formation of which metabolite which can compete with the transport of across the blood-brain barrier
    3-O-methyldopa
  361. Which of the currently available inhalational anesthetic is the msot potent based on the minimum alveolar concentration:
    1. halothane
    2. desflurane
    3. nitrous oxide
    4. sevoflurane
    1
  362. Based in recent studies, what is currently considered as the most probable explanation for the action of the inhalational anesthetic?
    interaction with the molecular compinents of the GABA-A receptor
  363. Which of the ff inhalational anesthetic sensitizes the myocardium catecholamines which can lead to ventricualr arrythmia when sympathomimetics drugs are concurrently administered:
    1. sevoflurane
    2, isoflurane
    3. desflurane
    4. halothane
    4
  364. Which ofthe ff inahalational anesthetics is associated with potentially severe & life threatening hepatitis ?
    1. sevoflurane
    2, isoflurane
    3. desflurane
    4. halothane
    4
  365. Malignant hyperthemia which may develop in susceptible individuals exposed to inahalational anesthetics is appropriately treated with which of the ff agents:
    1. diazepam
    2. baclofen
    3. dantrolene
    4. thiamylal
    3
  366. Which of the following drug combinations provide a state called "neuroleptanesthesia"
    1. haloperidol + thiamylal + halothane
    2. droperidol +fentanyl + nitrous oxide
    3. thioridazine+ succinylcholine + propofol
    4. nitrous oxide + droperidol +fentanyl
    4
  367. Which ofthe ff statements is/are corrrect regarding the use of a combination of the least potent Nitrous oxide with a second inahalational anesthetics
    1, reduction in the risk of myocardial depression at a given depth of anesthesia compared to the more potent anesthetic given alone
    2. facilitation of metabolism of the more potent anethetic which may increase the risk of nephrotoxicity
    3. reduction in the anesthetic requirement for the more potent anesthetic due to a second gas effect
    1 & 3
  368. What is responsible for the very short duration& very rapid onset of effect of the so called "ultra short acting barbiturates" ?
    the increase in the number of polar substituents
  369. Which of the ff intravenous agents can only be used to induce anesthesia but not to anesthesia:
    1. propofol
    2. thiopental
    3. ketamine
    2
  370. Which of the ff aensthetics is associated with dissociative state characterized catatonia, amnesia, & analgesia with or without loss of consciousness
    1. propofol
    2. thiopental
    3. midazolam
    4. ketamine
    5. nitrous oxide
    4
  371. Which of the ff characteristics is/are consistent with the drug propofol:
    1. causes a marked reduction in blood preddure during indction
    2. recovery from amesthesia is rapid
    3. post-operative nausea & vimiting is minimal due to its ant-emetic effect
    all
  372. What is the common mechanism of action of the local anesthetic when given in their usual dose?
    inhibition of the voltage-gated sodium channel
  373. Which of the ff local anesthetic is hydrolyzed to para-amino benzoic acid:
    1. cocaine
    2. isobucaine
    3. lidocaine
    4. bupivacaine
    5. tetracaine
    5
  374. Allergic reaction is most likely to occur with which ofthe ff agents:
    1. isobucaine
    2, prilocaine
    3. procaine
    4. lidocaine
    3
  375. Which of the ff local anesthetic is a substrate for metabolic degradation by the enzyme butyrylcholinesterase
    1. chloroprocaine
    2. etidocaine
    3. ropivacaine
    4. lidocaine
    1
  376. Which of the ff agents is considered to be the most neurotoxic when given as a spinal anesthetic causing a transient radicular irritation:
    1. Procaine
    2. Lidocaine
    3. Bupivacaine
    4. Mepivacaine
    2
  377. Cardiotoxicity manifesting as electromechancal dissociation, cardiovascular & death, is a complication of therapy most commonly seen with which of the ff local anesthetics:
    1. mepivacine
    2. ropivacaine
    3. lidocaine
    4. procaine
    5. bupivacaine
    5
  378. When large doses of a local anesthetic must be administered, the risk of developing seizures can be significantly reduced with the use of which of the ff agents as premedication
    1. midazolam
    2. thiopenthal
    3. succinylcholine
    4. propofol
    1
  379. Which of the ff local anesthetic can predispose to the development of methemoglobin when given in large doses during regional anesthesia:
    1. procaine
    2. lidocaine
    3. cocaine
    4. tetracaine
    5. prilocaine
    5
  380. Which of the ff metabolites of local anesthetics when formed in the body in significant amounts can cause oxidation of iron in hemoglobin to the ferric form
    1. glycine xylidide
    2. ortho-toluidine
    3. para-aminobenzoic acid
    4. benzoi acid
    2
  381. Which of the ff anti-psychotic drug groups primarily inhibit the Dopamie-2 receptors in the brain
    1. Phenothiazipines
    2. Dibenzodiazepines
    3. Butyrophenones
    1 & 3
  382. In terms of potency, which of the drugs listed below is expected to be the most potent
    1. trifluoperazine
    2. thioridazine
    3. piperacetazine
    4. tirfluopromazine
    1
  383. The anti-psychotic drugs Clozapine belongs to what chemical class of agents?
    Dibenzodiazepine
  384. Which of the ff agents is expected to produce the effects & side effects comparable to Haloperidol
    1. mesoridazine
    2. Chlorprothixene
    3. Thiothixene
    4. Promazine
    5. Fluophenazine
    5
  385. Anitcholinergic effect manifesting as loss of accomodation, difficulty in urination, constipation & a toxic-confusional state is more commonly observed with which of the ff drugs:
    1. haloperidol
    2. sertindole
    3. chlorpromazine
    4. Loxapine
    5. chlorprothixene
    3
  386. Dyxtonic reactions such as oculogyric crisis & pseudoparkinsonism such as tremors are side effects most likely to be seen in patients taking which of the ff medications
    1. thioridazine
    2. chlorpromazine
    3. loxapine
    4. trifluphenazine
    5. melindine
    4
  387. Neuroleptic malignant syndrome which resembles malignant hyperthemia is more commonly observed with which of the ff agents:
    1. mesoridazine
    2. promazine
    3. loxapine
    4. haloperidol
    4
  388. Which of the following drugs for pssychosis is most commonly associated with prolongation of the QT interval on ECG which can lead to fatal arrythmias
    1. thioridazine
    2. mesoridazine
    3. haloperidol
    4. clozapine
    1
  389. Which of the ff drugs when given to patients will necessitate weekly WBC monitoring for the first 6 months of therapy & every 3 weeks thereafter due to its propensity to cause agranulocytosis
    1. thioridazine
    2. chlorpromazine
    3. loxapine
    4. clozapine
    4
  390. Which of the ff agents is most likely to cause deposits in the retina which can lead to blindness necessitating a baseline & regular ophthalmogic examinations when administered
    1. thioridazine
    2. chlorpromazine
    3. loxapine
    4. trifluphenazine
    1
  391. Weight gain is expected complication of therapy with all clinically useful antipsychotics. One of the drugs listed below, however does not produce this side effect. What is this drug?
    1. thioridazine
    2. chlorpromazine
    3. loxapine
    4. trifluphenazine
    5. molindone
    5
  392. Tardive dyskinesia is considered as the most important unwanted effect of antipsychtic agents. What is considered as the mechanism of development of this condition?
    1. dopamine receptor blcok
    2. relative cholinergic deficiency
    3. dopamine receptor hypersensitivity
    2 & 3
  393. Which of the ff drugs is most commonly associated with seizures
    1. thioridazine
    2. chlorpromazine
    3. loxapine
    4. trifluphenazine
    5. molindone
    2
  394. Poisonings with antipsychotics are rarely fatal. Which of the ff agents is associated with a higher incidence of fatal poisoning
    1. mesoridazine
    2. chlorpromazine
    3. trifluphenazine
    4. haloperidol
    1
  395. What is the most common side effect associated with the use of tricyclic antidepressant?
    weight gain
  396. Which of the ff agents is classified as tricyclic antidepressant or 1st generation antidepressant
    1. bupropion
    2. trazodone
    3. desipramine
    4. amoxspine
    3
  397. Which of the ff is/are the advatage/s of the SSRIs compared to the rest of the drugs used for depression
    1. lesser lethality with overdose
    2. genrally, no dose tritration is required
    3. minimal antichlolinergic effects
    all
  398. A psychiatric patient on medications develop a tremor, thyroid enlargement, & leukocytosis. The drug is taking most likely
    lithium
  399. Serotonin syrndrome which resembles malignant hyperthemia is symptomatology occurs when SSRIs like fluxetime & sertraline are given concurrently with
    1. TCAs like nortriptyline
    2. MAOIs like phenelzine
    3. heterocyclics like maprotiline
  400. 2
  401. MAO-A is the ammine oxidase primarily responsible for the metabolism of norepinephrine, serotonin & tyramine, while MAO-B is specific for the metabolism of Dopamine. Which of the ff agents is a selective reversible MAO-A inhibitor whose advantage is a lesser risk of causing hypertensive crisis with tyramine-rich foods
    1. selegiline
    2. nefazodone
    3. moclobemide
    4. trazodone
    1
  402. Which of the ff conditions can enhance the toxicity of lithium
    1. use of thiazide diuretics
    2. diarrhea & vomiting
    3. exessive sweating
    all
  403. Imipramine has been found to be useful in the treatment of nocturnal enuresis (bed wetting). This clinical use can be explained by which of the following effects of the drug
    1. inhibition of re-uptake of norepinephrine
    2. inhibition of re-uptake of serotonin
    3. anticholinergic effects
    4. sedating effect
    5. inhibition of re-uptake of dopamine
    3
  404. Which of the ff findings is/are consistent with poisoning with the antipsychotic drugs
    1. hypotension
    2. hypothermia
    3. ventricular arrythmias
    all
  405. Which of the ff interventions is/are appropriate in the management of poisoning with the Phenothiazine antipsychotics
    1. gastric lavage is necessary 1 hour after ingestion of tablets
    2. activated charcoal is given followed by saline cathartics
    3. epineprhine is the preferred pressor agent for persistent hypotension
    2
  406. Which of the ff agents are avoided in patients taking tranylcypromine
    1. Ephedrine
    2. phenylpropanolamine
    3. levodopa
    all
  407. Which of the ff agents can produce the so-called serotonin syndrome when given to a patient already on Phenelzine
    1. venlafaxine
    2. buspirone
    3. fluoxetine
    all
  408. Which of the ff side effects of lithium can be seen even in usual doses thus by itself is not considered a sign of lithium toxicity
    1. coarse hand tremors
    2. polyuria
    3. hyperreflexia
    4. confusion
    5. ataxia
    2
  409. Which of the ff may be considered as mechanism/s of effect of the Beta-lactam antibiotics
    1. inhibition of the activity of the transpepetide enzyme
    2. inhibition of the formation of the 50s ribosomal aubunit
    3. binding to the so-called PBPs & related proteins in the cell membrane
    1 & 3
  410. Which of the ff statements is/are correct regarding Penicillins
    1. penicillins are not metabolzied extensively by liver enzyme
    2. ;probenecid increases penicillin excretion by blocking renal tubular reabsorption
    3. ampicillins undergoes enterohepatic cycling
    1 & 3
  411. Which of the ff statements on Sulfonamides is/are correct
    1. their effect is attributed to their ability to inhibit the enzyme dihydrofolate reductase
    2. as single agents, they are bacteriostatic but are bactericidal when given with trimethoprim
    3. they can cause hemolytic anemia if given to G6PD deficient individuals
    2 & 3
  412. Which of the ff may be an expected complication with the use of aminoglycosides
    1. nueromuscular blockade
    2. thombotic thrombocytopenic purpura
    3. inhibition of the CYP3A4 enzyme
    1
  413. Which of the ff agents is not effective against nosocomial infection with pseudomonas aeruginosa
    1. clarithromycin
    2. ceftrixone
    3. amikacin
    4. imepenem
    4
  414. Which of the ff drugs may be given to orally to treat infections caused by pseudomonas aeruginosa
    1. ciprofloxacin
    2. ceftazidime
    3. piperacillin
    4. clindamycin
    1
  415. Which of the agents can be safely used for a pregnant woman with UTI
    1. cotrimoxazole
    2. ampicillin
    3. norfloxacin
    4. doxycycline
    2
  416. Which of the ff statements correctly describe the preperties of aminoglycosides
    1. they are mainy bacteriostatic
    2. they are mainly effective against gram-negative aerobic bacteria
    3. they inhibit bacterial protein synthesis
    2 & 3
  417. Which of the ff agents can penetrate inflamed meningines in sufficient concentration to be useful for meningitis
    1. maikacin
    2. tobramycin
    3. chloramphenicol
    4. aztreonam
    3
  418. Which of the ff agents has activity against anaerobic organisms & against most protozoan infection
    1. clindamycin
    2. metronidazole
    3. chloramphenicol
    2
  419. Which of the ff drugs attacks plasmodia in exoerythrocytic stages & is an effective prophylactic agents against Plasmodium vivax & plasmodium ovale
    1. quinine
    2. chloroquine
    3. primaquine
    3
  420. Which of the ff agents is primarily bactericidal in its activity
    1. clindamycin
    2. erythromycin
    3. ciprofloxacin
    3
  421. Which of the ff agents exhibit a primary concentration concentration-dependent bactericidal activity wherein the rate & extent of killing increases with increasing concentrations of the drug
    1. amikacin
    2. vancomycin
    3. clindamycin
    1
  422. Among patients with renal impairment, the dose of antibiotics must be adjusted according to the creatinine clearance. Which of the ff drugs does not require such an adjustment in dosing for patients with decreased creatinie clearance
    1. imepenem
    2. penicillin G
    3. nafcillin
    3
  423. Which of the ff agents require dosage adjusment or may even have to be avoided in patients with hepatic impairment
    1. erythromycin
    2. metronidazole
    3. clindamycin
    all
  424. Which of the ff agents is contraindicated in patients less then 18 years of age & among pregnant patients due to its adverse effect on cartilage development
    1. chloramphenicol
    2. doxycycline
    3. ciprofloxacin
    3
  425. Which of the antibiotics is contraindicated in children less than 9 years of age& in pregnant patients due to the rusk of permanent staining of teeth & enamal dysplasia in children
    1. chloramphenicol
    2. doxycycline
    3. ciprofloxacin
    2
  426. Which of the agents may predispose the neonate predispose the babies to kernicterus when given to this subset of patients
    1. sulfamethoxazole
    2. chloramphenicol
    3. doxycycline
    4. ciprofloxacin
    1
  427. What is the primarily role of agents such as Tazobactam & sulbactam in antibaterial therapy?
    1. effective against anaerobic bacteria including clostridia
    2. minimize destruction of the penicillins by bacterial beta-lactamases
    3. improve CNS penetrability of most penicillins
    2
  428. Which of the ff antibiotics combinations is associated with clinically significant antimicrobial antagonism which has been reported to cause higher rate of mortality in patients given this combination compared to patients receiving any of the agents singly
    1. erythromycin + aminoglycoside
    2. penicillin _chloramphenicol
    3. erythromycin + doxycycline
    2
  429. Which of the ff is the preferred empiric treatment for patients suspected or prove to have systemic fungal infection of any etiology
    1. itraconazole
    2. amphotericin B
    3. fluconazole
    2
  430. The activity of the penicillin G is defined in units. How many units does each milligram of crystalline sodium Penicillin G contain?
    1600
  431. The absorption of most oral penicllins is impaired by food. An exception to this is?
    Amoxicillin
  432. Which of the ff organisms is/are suceptible to Penicillin G, making the drug of choice in the treatment of infections caused by this/these organism/s
    1. treponema pallidum
    2. pneumococcus
    3. beta-hemolytic streptococci
    all
  433. The so-called isoxazolyl penicillins are prinarily indicated for the treatment of infection caused by what organisms?
    Staphylococcus aureus
  434. Pencillins classified as ureidopenicillins have extended spectrum of activity against gram-negative bacteria compared to the natural & other semisynthetic penicillins. Which of the ff organism are the ureidopenicillins effective against
    1. enterococci
    2. klebsiella pneumoniae
    3. pseudomonas aeruginosa
    2 & 3
  435. Which of the ff antibiotics belong to the ureidopenicillin class of agents
    1. carbenicillin
    2. ticarcillin
    3. piperacillin
    3
  436. Which of the ff agents is a first generation cephalosporin that is given intravenously?
    1. cefazolin
    2. cephalexin
    3. cephradine
    1
  437. The second generation cephalosporins include the cephamycins. What is the distinct advantage of the cephamycins over the rest of the second generation cephalosporins?
    They have coverage for anaerobic bacteria
  438. Which of the ff second generation cephalosporins can be given orally & parenterally
    1. cefotenan
    2. cefprozil
    3. cefoxitin
    2
  439. Which of the ff agents belong to the cephalosporin group called cephamycins
    1. cefamandole
    2. cefprozil
    3. cefoxitin
    3
  440. Which of the ff thrid generation cephalosporins have activity against Pseudomonas aeruginosa
    1. ceftriaxone
    2. ceftazidine
    3. cefoperazone
    2 & 3
  441. Which of the ff agents is considered the fourth generation cephalosporin
    1. cefepime
    2. cefotaxime
    3. cefoperazone
    1
  442. Which of the ff cephalosporins is/are associated with a Disulfiram-like effect when alcohol is taken by patients who are on this/these antibiotic/s
    1. cefotetan
    2. ceftazidime
    3. cefamandole
    1 & 3
  443. Which of the ff cephalosporins is/are associated with hypotrothrombinemia & has incresaed risk of bleeding disorders
    1. cefoperazone
    2. cefoxidin
    3. cefuroxime
    1
  444. Which of the ff agents is considered as first line drug in the managment of Neisseria gonorrhea infection:
    1. ceftriaxone
    2. cefuroxime
    3. Pen G
    1
  445. Which of the ff beta-lactam antibiotic is called a monobactam
    1. moxalactam
    2. azreonam
    3. meropenem
    2
  446. What is the use of Cilstatin?
    1. prevents glomerular filtration of imepenem
    2. inhibits the renal dehydropeptidase which metabolizes imepenem
    3. inhibits liver dehydropeptidase which metabolizes imepenem
    2
  447. Which of the ff antibacterial agents primarily work by inhibiting cell wall synthesis
    1. polymixin B
    2. vancomycin
    3. streptogramins
    2
  448. Which of the ff antibacterial agents primarily work by inhibiting aminoacyl translocation & blocking the formation of initiation complexes
    1. linezolid
    2. tetracyclines
    3. macrolides
    3
  449. Which of the ff drugs reversibly binds to the 50s subunit of the bacterial ribosome & inhibits the peptidyl transferase step of protein synthesis
    1. aminoglycosides
    2. chloramphenicol
    3. linezolid
    2
  450. Which of the agents reversibly binds to the 30s subunit of the bacterial ribosome blocking the binding of aminoacyl-tRNA to the acceptor site on the mRNA-ribosome complex:
    1. linezolid
    2. tetracyclines
    3. macrolides
    2
  451. no question
  452. Which of the ff agents inhibits protein synthesis by binding to the 23s ribosomal RNA & preventing the formation of ribosome complex that initiates protein synthesis
    1. aminoglycosides
    2. chloramphenicol
    3. linezolid
    3
  453. The mechanism of action of Clindamycin is similar to the mechanism of action of which of the following agents
    1. linezolid
    2. tetracyclines
    3. macrolides
    3
  454. Which of the ff statements correctly describe the prperties of the drugs minocycline & doxycycline
    1. they have the longest half lives among the tetracyclines
    2. their absorption is not impaired by divalent cations like calcium or magnesium
    3. their absorption is not imapired by food
    1 & 3
  455. Which of the tetracyclines is the drug of choice when tetracyclines are needed in a patient with renal insufficiency
    1. methacycline
    2. doxycycline
    3. minocycline
    2
  456. Which of the ff macrolides can inhibit cytochrome P450 enzymes & can cause an increase in the serum concentration of drugs like theophylline & warfarin
    1. erythromycin
    2. azithromycin
    3. clarithromycin
    1 & 3
  457. What form of erythromycin has the best oral absorption?
    erythromycin estolate
  458. What is the clinical use of the tetracycline drug Demeclocycline?
    management of SIADH
  459. Which of the following is/are clinical indication/s for the drug clindamycin
    1. treatment of severe gram-negative bacterial infection
    2. treatment of severe anaerobic infections caused by bacteroides
    3. prophylaxis of endocarditis in patients with valvular heart disease undergoing dental procedures
    2 & 3
  460. Which of the ff may be considered as indication for the streotogramin combination of Quinopristin-Dalfopristin
    1. treatment of MRSA
    2. treatment of multi-drug resistant strains of strptococci
    3. treatment of penicllin-resistant strain of streptococcus pneumoniae
    all
  461. Which of the ff statements correctly describe the characteristic of aminoglycosides
    1. exhibit synergistic activity with beta-lactam antibiotic
    2. may be given both orally & parenterally for systemic activity
    3. readily penetrate the blood brain barrier reaching adquate concentrations in the CSF
    1
  462. Which of the ff aminoglycosides is considered as the most ototoxic in terms of its effect on the cochlear apparatus
    1. neomycin
    2. amikacin
    3. streptomycin
    1
  463. Which of the ff aminoglycosides is considered as the most vestibulotoxic
    1. neomycin
    2. amikacin
    3. streptomycin
    3
  464. Which of the ff aminoglycosides is considered as the most nephrotoxic
    1. neomycin
    2. amikacin
    3. streptomycin
    1
  465. In which of the ff disease-causing organism is/are the aminoglycosides most useful either as single agent or in combination
    1. myobacterium tuberculsis
    2. myobacterium avium intracellulare
    3. staphylococcus aureus
    1 & 3
  466. Which of the ff agents is given with sulfonamide for its synergistic effect with the latter inhibiting folic acid synthesis in protozoal cells in mammalian or bacterial cells
    1. pyrimethamine
    2. trimethoprim
    3. silver
    1
  467. What is the mechanism of action of quinolone antiobacterial agents?
    inhibit the bacterial enzyme topoisomerase II
  468. A patient receiving sulfadiazine 4 grams/day may benefit with co-administration of which of the ff agents as preventive therapy or as therapy of sulfadiazine-related complications
    1. sodium bicarbonate
    2. ammonium chloride
    3. folinic acid
    1 & 3
  469. Which of the ff drugs given for tuberculosis is/are bactericidal in activity at usual doses given for TB
    1. ethambutol
    2. rifampicin
    3. isoniazid
    2 & 3
  470. A 3 year old boy is diagnosed with primary tuberculosis infection. The appropriate antiTB regimen for the child may include which of the ff agents
    1. ethambutol
    2. rifampicin
    3. isoniazid
    2 & 3
  471. Which of the ff drugs given for tuberculosis is metabolized by the liver enzyme N-acetyltransferase whose expression is genetically determined & may vary in different populations
    1. ethambutol
    2. rifampicin
    3. isoniazid
    3
  472. Which of the ff drugs for tuberculosis is given only during the intensive phase of therapy
    1. ethambutol
    2. pyrazinamide
    3. streptomycin
    2
  473. What is the acceptable dose for isoniazid in the treatment of TB?
    5mg/k/day
  474. What is the acceptable dose for rifampicin in the treatment of TB?
    10mg/k/day
  475. Which of the ff agents given may be considered as useful second line agents for tuberculosis
    1, kanamycin
    2. amikacin
    3. ciprofloxaxin
    all
  476. Which of the ff agents given for tuberculosis may provoke an attack of acute gouty arthritis
    1. ethambutol
    2. pyrazinamide
    3. streptomycin
    2
  477. Which of the ff drugs has been historically associated with the development of Creutzfeldt-Jakob disease, a fatal neurodegenerative disease caused by prions
    1. pancreas-derived insulin
    2. pituitary-derived growth hormone
    3. thyroid hormone extract
    1
  478. Ocreotide is the drug used for the treatment of such conditions as acromegaly, gastrinoma, & glaucagoma. What hormone is ocreotide an anlog of?
    Somatostatin
  479. Which of the ff correctly describes the normal physiologic hormone release
    1. GnRH is released continuously by the hypothalamus to induce secretion of FSH & LH by the pituitary
    2. ACTH release occurs in pulses that oeak in the early in the morning hours & after meals
    3. the release of cortisol is constant throughout the day maintaining a level that vaires little with meals
    2
  480. Which of the ff is/are appropriate inidcations for oxytocin
    1. control of post-partum uterine bleeding
    2. stimulate initial milk production
    3. induction of labor
    all
  481. What is the primary use of the drug Desmopressin?
    management of Central Diabetes Insipidus
  482. Which of the ff statements correctly describe/s the Thyroid hormones
    1. T3 is better absorbed after oral administration than T4
    2. peripheral deiodination of T3 converts it to the more active T4
    3. hypothyroidism increases the clearance of both hormones leading to an decrease in their half-lives
    1
  483. Which of the ff agents may interfere with the absorption of levothyroxine that patient must be advised on the proper interval of intake with this/these agents
    1. sucralfate
    2. ferrous sulfate
    3. aluminum hydroxide antacids
    all
  484. A 34 year old female who works in a hospital was admitted for tachycardia, palpitations & weight loss. Her T4 was elevated with suppresses TSH but her thyroid scan showed a normal-sized glannd with normal iodine uptake. Which of the ff should be suspected
    1. presence of Grave's disease
    2. presence of solitary toxic nodule
    3. iodine deficiency goiter
    4. illicit intake of levothyroxine
    5. hypothyroidism
    4
  485. A patient receiving 50 mg of Propylthiouracil 3x a day. ..???
  486. In monitoring response to therapy with methimazole, which of the ff findings taken 3 months after initiating therapy best indicates good response to therapy
    1. normal TSH
    2. normal T4
    3 lower than normal T4
    1
  487. Which of the ff describe/s the mechanism of action of the thionamides for the management of hyperthyroidism
    1. block uptake of iodine by follicular cells
    2. block the peroxidase-catalyzed reactions
    3. block coupling of iodotyrosines
    2 & 3
  488. Which of the ff interventions may be appropriate to monitor or treat thionamide-associated agranulocytosis
    1. discontinuing the offending drug usually reverses the side effect
    2. monitoring of the WBC is necessary for the first 3 months of therapy
    3. switching of therapy from thionamide to another may reverse the effect
    1
  489. Which of the ff cautions must be oserved when iodides are given to treat hyperthyroidism
    1. iodides must be initiated before thionamide therapy
    2. iodides must be avoided if treatment with radioactive iodine is likely
    3. iodides are the preferred drugds for chronic therapy during pregnancy
    2
  490. What is the role of beta blockers in the management of thry

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