Download PHARMACOLOGY : FIRST LONG EXAM Coverage: Principles of

PHARMACOLOGY : FIRST LONG EXAM
Coverage: Principles of Pharmacology
1. Which of the following is a branch of Pharmacology that deals with the undesirable effects of
chemicals on living systems?
A. Pharmacogenomics
B. Pharmacogenetics
C. Toxicology
D. Biotechnology
2. The study of the action of a drug on the body is:
A. Pharmacodynamics
B. Pharmacokinetics
C. Pharmacoeconomics
D. Pharmacogenetics
3. In the process of studying the properties of a new drug, randomized controlled trials involving a
large population falls under what phase of study?
A. Phase I
B. Phase II
C. Phase III
D. Phase IV
4. A placebo is included in most studies of drugs to minimize:
A. Observer bias
B. Subject bias
C. The toxicity of the drug
D. The dose of a drug
5. An example of a drug that binds selectively to a particular type of receptor thereby inhibiting the
binding and action of another drug that acts on that receptor is
A. Acetylcholine on nicotinic receptors
B. Norepinephrine on alpha adrenergic receptors
C. Atopine on muscarinic receptors
D. Dopamine on dopaminergic receptors
6. Which of the following has an astringent property and is commonly used in the treatment of
burns, diarrhea and hemorrhoids?
A. Balsam
B. Resin
C. Tannins
D. Oils
7. It is composed of two immiscible liquids where one liquid id dispersed in the form of small
droplets throughout another liquid:
A. Suspension
B. Emulsion
C. Decoction
D. Tincture
8. Which of the following drugs was originally derived from animal sources?
A. Belladonna alkaloids
B. Penicillin antibiotic
C. Insulin
D. Aluminum hydroxide
9. A semi-solid preparation, similar to an ointment tht is applied with a cloth is best called:
A. Cream
B. Paste
C. Poultice
D. Gel
10. Is it a solution or mixture of substances in oil, alcoholic solution, or emulsion which is intended
for external application
A. Liniment
B. Gel
C. Lotion
D. Cream
11. Tylenol and Alaxan are examples of:
A. Chemical names
B. Brand names
C. Generic names
D. International non-proprietary names
12. A solution injected into the rectum for the purpose of cleansing and evacuation of its contents:
A. Douche
B. Gargle
C. Enema
D. Suppository
13. What is the chemical component responsible for the claimed therapeutic effect of a
pharmaceutical product?
A. Excipient
B. Adjuvant
C. Active ingredient
D. Generic name
14. People empowerment in the Philippine National Drug Policy aims to:
A. Encourage mass actions against fake, irrational, and overpriced drugs
B. Shift the choice of drugs to the consumer
C. Assist patients in making informed choice for cost-effective drugs
D. Encourage patients to debate with their physician on the efficacy of drugs
15. Also called “allopathic” medicine, this modality of treatment advocates therapy and remedies
which produce effects differing from those of the disease treated:
A. Biomedicine
B. Traditional medicine
C. Reflexology
D. Alternative health care
16. Which of the following statements is TRUE of the Essential Drug Concept?
A. The WHO mandates essential drugs to be available at all times in adequate amounts and
in the appropriate dosage forms
B. All countries require the same essential drugs
C. It encourages the free trade of new drugs in the market
D. It is the main basis for the enactment of the Comprehensive Dangerous Drugs Act
17. The following drugs require S2 (opium) license number using ordinary prescription form,
EXCEPT:
A. clonazepam
B. nalbuphine
C. morphine
D. midazolam
18. Prohibited drugs include the following EXCEPT:
A. diazepam
B. LSD
C. codeine
D. marijuana
19. The correct form of prescription writing requires the following EXCEPT:
A. The use of official and generic names of drugs
B. Correct grammar and proper spacing in writing the different parts of the prescription
C. Clarity of handwriting though the use of printed or block letters only
D. The correct dosage form and usual dose of the drug
20. How many grains are there in 60 mg?
A. 1 grain
B. 60 grains
C. 2 grams
D. 15 grains
21. What is the meaning of the Latin word ‘gutta’ or ‘gtt’?
A. Drams
B. Drops
C. Grams
D. Grains
22. A patient was advised to take an antitussive drug one tablespoonful t.i.d for a duration of 5 days.
If his measuring instrument has fluid ounces as units, how many fluid ounces must this patient
take per dose?
A. 1/6th of a fluid ounce
B. 0.5 fluid ounce
C. 2 fluid ounces
D. 4 fluid ounces
23. Clarithromycin is an antibiotic given on b.i.d dosing schedule to patients with pneumonia. This
means that clarithromycin is to be given:
A. As needed
B. 2x a day
C. 3x a day
D. 4x a day
24. A 2-year old child was brought in the emergency room by her father because of indigestion of
half a glassful of an isoniazid syrup. How many ml of the syrup was ingested?
A. 60 ml
B. 125 ml
C. 250 ml
D. 500 ml
25. When a raid response is required, particularly when the drug is either rapidly metabolized by the
liver or unstable at gastric pH, its best route of administration is:
A. Sublingual
B. Oral
C. Transdermal
D. Rectal
26. The main factor that determines the extent of a drug’s penetration into the brain and other tissues
is:
A. It’s lipid solubility
B. The severity of the patient’s illness
C. It’s molecular weight
D. The quality of its excipients
27. The effect of this recycling process of reabsorption from the intestines is to prolong drug action.
What is this specific process?
A. Hepatic metabolism
B. Biliary excretion
C. Enterohepatic circulation
D. Continuous plasma protein binding
28. If the hepatic extraction ratio, E, of paracetamol is 0.3, what is it’s bioavailability in percent?
A. 0.3
B. 30
C. 0.7
D. 70
29. Atropine affects the absorption of aspirin from the gastrointestinal tract by:
A. Slowing the gastric emptying
B. Increasing gastrointestinal motility
C. Increasing gastric acidity
D. Binding to aspirin
30. The rate of passive diffusion of a drug across membranes is mainly determined by:
A. Carrier protein transport
B. Drug protein binding
C. The drug’s lipid solubility
D. The molecular weight of the drug
31. The following are characteristics of renal drug excretion EXCEPT:
A. Almost all drugs for excretion are filtered by the glomerulus
B. Drugs which are weak acids are excreted faster in acidic urinary pH
C. Drugs which are weak bases are excreted faster in alkaline urinary pH
D. The kidneys remain as the sole organs for drug excretion
32. The clinical consequence of increased binding of a drug to plasma proteins is that it:
A. Achieves rapid drug excretion
B. Hastens the onset of drug action
C. May require a higher drug dose
D. Will have a shorter duration of action
33. When two drugs yield very similar clinical effectiveness and safety among patients, they are:
A. Therapeutically equivalent
B. Bioequivalent
C. Equipotent
D. Pharmaceutically equivalent
34. Which of the following refers to the passage of a drug from its site of administration into the
plasma?
A. Bioequivalence
B. Bioavailability
C. Absorption
D. Diffusion
35. Which of the following may decrease the bioavailability of a drug that is better absorbed in an
acidic (gastric) environment?
A. Taking the drug immediately upon waking up
B. Delayed gastric emptying
C. Taking antacids together with the drug
D. Adequate gastric perfusion
36. Which of the following phrases is TRUE regarding parenteral drug administration?
A. Less predictable compared to oral administration route
B. Not acceptable for unconscious patients
C. Rate of drug systemic drug absorption insensitive to drug solubility in interstitial fluid
D. Rate of systemic drug absorption depends on absorbing capillary membrane surface area
37. Drugs are highly diffusible into cells when they are:
A. Water soluble
B. Acid soluble
C. Lipid soluble
D. Non-ionized
38. In which organ is a drug NOT rapidly distributed?
A. Brain
B. Heart
C. Liver
D. Skeletal muscle
39. If a drug has a large volume of distribution, it indicated that the drug is:
A. Distributed to plasma
B. Concentrated intracellularly
C. Concentrated extracellularly
D. Distributed both to plasma and cells
40. Which of the following molecules is the most restricted from penetrating the blood brain barrier?
A. Lipid soluble
B. Non-polar
C. Polar
D. None of the above
41. The final distribution of a drug in the body is governed by its:
A. Molecular size
B. Rate of blood flow
C. Binding to plasma proteins
D. Affinity for tissue sites
42. First-pass metabolism may occur in which of the following organ/s?
A. Liver
B. Lungs
C. Intestine
D. All of the above
43. The anti-ulcer agent, omeprazole, has to be converted to omeprazole sulfonamide to be
pharmacologically useful. This is an example of drug metabolism that converts an:
A. Active drug to an inactive metabolite
B. Active drug to an active metabolite
C. Inactive drug to an active metabolite
D. Active drug to a toxic metabolite
44. Which of the following statements about Phase I metabolic reactions is TRUE?
A. The reactions take place in the mitochondria
B. There is a notable increase in their pharmacological action
C. They produce products that are usually more chemically reactive
D. They are primarily conjugated reactions
45. The following isoform of cytochrome P450 enzymes is often involved in human metabolism of
drugs and also in drug-drug interactions:
A. CYP1A2
B. CYP2C9
C. CYP2D6
D. CYP3A4
46. Which of the following agents interact with other drugs by acting as hepatic microsomal enzyme
inhibitor?
A. rifampicin
B. grapefruit juice
C. phenobarbital
D. phenytoin
47. The following statements are TRUE of CYP450 enzyme induction EXCEPT:
A. It may be due to the binding of a substance to the heme iron of CYP450
B. It may be due to a decrease in the rate of enzyme degredation
C. It may exacerbate tissue toxicity
D. It may be due to an increase in enzyme
48. A patient was brought to the ER because of slight overdose of salbutamol which has a pKa of 9.3
To ensure renal clearance of this drug, it would be most rational to give:
A. ascorbic acid
B. sodium chloride
C. sodium bicarbonate
D. potassium citrate
49. What is the only limiting factor in the process of glomerular filtration for the elimination of
drugs?
A. Amount of filtrate
B. Glomerular basement membrane
C. Size of molecule
D. Blood flow
50. In what form does a drug have to be in order to be excreted?
A. Uncharged
B. Charged
C. Protein-bound
D. Non-lipid soluble
51. The highly acidic metabolites of the drug are mainly excreted from the body by which process?
A. Filtration
B. Tubular secretion
C. Passive diffusion
D. Exocytosis
52. In what part of the tubular system are drugs actively secreted?
A. Proximal tubule
B. Distal tubule
C. Loop of Henle
D. Collecting ducts
For numbers 53 and 54, please refer to Drug X:
Drug X is eliminated by first order process.
53. This statement means that:
A. A constant amount of drug X is eliminated per unit time
B. The process is saturable
C. Elimination of drug X increases with increasing drug dose
D. The relationship between the concentration of drug X and time is nonlinear
54. The elimination half-life of Drug X is 6 hours. If 100 mg of drug X is initially administered,
approximately how much of the drug will remain after 18 hours?
A.
B.
C.
D.
None
12.5 mg
25 mg
33.3 mg
55. Which of the following statements is TRUE regarding the loading dose for a drug?
A. It is proportional to the drug’s volume of distribution
B. It is mainly determined by the drug’s clearance
C. It is inversely proportional to the target concentration
D. It is usually lower than the maintenance dose
56. Which of the following events is likely to occur if the dosing interval used in giving a certain
drug is much longer than its half-life?
A. The fluctuations between peak and trough levels of the drug will be lesser
B. Drug toxicity is likely to occur
C. The trough levels of the drug are likely to be below the therapeutic range
D. The peak levels of the drug are likely to be above the therapeutic range
57. Which of the following drugs is eliminated by zero-order kinetics?
A. amoxicillin
B. diazepam
C. gentamycin
D. phenytoin
58. Which of the following mechanisms occurs when two drugs act on the same tissue or organ
through independent receptors, resulting in effects in opposite direction?
A. Physiologic antagonism
B. Chemical antagonism
C. Competitive antagonism
D. Irreversible antagonism
59. Which of the following statements is/are TRUE concerning competitive inhibition?
A. It is based on reversible drug/antagonist binding at receptor site
B. The dose-effects curve shifted to the left
C. Maximal drug effect cannot be obtained, even at high agonist concentrations
D. All of the above
60. The type of transmembrane signaling mechanism for GABA is:
A. Gene active nuclear receptors
B. Transmembrane linked receptors
C. Ion channel receptors
D. G protein linked receptors
61. The following statements are TRUE of drug potency EXCEPT:
A. It is often expressed as the dose of the drug required to achieve 50% of the desired
therapeutic effect
B. It is the maximal response a drug can produce
C. Its absolute and relative values can be determined
D. It is a measure of the dose that is required to produce a response
62. Which of the following ratios accurately describes the Therapeutic Index?
A. ED50/LD50
B. Potency/selectivity
C. EC50/LC50
D. TD50/ED50
63. Terbutaline, a bronchodilator drug, is a selective beta-2 agonist. Which of the following
statements is NOT TRUE of this full agonist?
A. The magnitude of response is proportional to the number of drug receptor complexes
B. It cannot produce 100% of the biological response even at very high doses
C. Maximal response can occur without occupancy of all receptors
D. It binds to beta-2 receptors and produces the corresponding biological response
64. Which of the following statements is TRUE regarding competitive inhibition?
A. At high concentrations of agonist, a maximal physiological response is not possible even
in the presence of the agonist
B. With competitive inhibition, the dose effect curve is shifted to the right
C. Competitive inhibition is often irreversible
D. It is produced by antagonists that have the ability to activate receptors
65. What branch of pharmacology deals with the study of influence of heredity on the
pharmacokinetic and pharmacodynamic responses to the drug?
A. Pharmacoeconomics
B. Pharmacogenomics
C. Pharmacogenetics
D. Ethnopharmacology
66. The liver enzyme CYP2D6 is influenced by genes. People with low levels of CYP2D6 are
expected to:
A. Metabolize drugs rapidly
B. Metabolize drugs slowly
C. Need larger doses of the drug
D. Have low levels of the drug in the blood
67. With the understanding of how genes determine the way people respond to drugs, the future of
pharmacology promises all of the following EXCEPT:
A. Effective drug therapy
B. Greater safety
C. More harmful effects
D. Fewer treatment failures
68. Gray baby syndrome resulting from chloramphenicol administration to preterm babies is due to:
A. Low water content
B. Immature kidneys
C. A poorly developed blood-brain barrier
D. Enzyme deficiency
69. Up-regulation is likely to occur with prolonged use of:
A. clonidine, an alpha-2 receptor agonist
B. metoprolol, a selective beta-1 receptor blocker
C. phenylephrine, an alpha-1 stimulant
D. dobutamine, a beta-1 agonist
70. Clavulanic acid was very weak bacterial action. When combined with amoxicillin, a bactericidal
agent used against many gram-positive organisms, it increases the latter’s efficacy to include
beta-lactamase-producing bacteria. This type of drug-drug interaction is best termed as:
A. Additive
B. Synergistic
C. Potentiation
D. Competitive
71. The action of antacids, as well as most poison antidotes (e.g. dimercaprol), is by means of:
A. Pharmacologic antagonism
B. Physiologic antagonism
C. Chemical antagonism
D. Dispositional antagonism
72. Which of the following exemplifies rebound phenomenon?
A. Greater blood pressure lowering with subtherapeutic doses of a drug
B. Failure of usual doses of nitroglycerin, a vasodilator, to provide the same degree of BP
lowering
C. Profound hypotension upon clonidine, an antihypertension drug
D. Hypertension upon withdrawal of propranolol, an antihypertension drug
73. Which of the following statements about drug interactions is NOT TRUE?
A. They may occur completely outside the body
B. Drugs with high therapeutic index (TI) are more lethal than those with low TI.
C. They are more likely to occur with polypharmacy
D. A drug’s effect may be enhanced or diminished by another drug
74. A post-myocardial infarction patient is on long-term treatment with aspirin. If her develops depp
vein thrombosis and requires anticoagulation with heparin, you should especially watch out for:
A.
B.
C.
D.
Peptic ulcer
Infection
Hypothermia
Bleeding
75. The following are acceptable fixed dose combinations of drugs EXCEPT:
A. antacids + tetracycline
B. aluminum hydroxide + magnesium hydroxide
C. amoxicillin + clavulanic acid
D. trimethoprim + sulfamethoxazole
76. Which of the following clinical conditions would best satisfy the criteria of an ADR from antiulcer agents?
A. Gynecomastia (enlarged breasts) due to cimetidine in a female actress doing sexy roles
B. Diarrhea due to magnesium hydroxide in a medical student who wishes to skip the day’s
exams that he did not prepare for
C. Constipation due to aluminum hydroxide in a patient who had watery stools for 3 days
D. Headache due to omeprazole in an executive with an important business meeting
77. Which of the following is a type B ADR?
A. Accidental falls due to sedation after benzodiazepine intake
B. Dryness of the mouth due to atropine sulfate
C. Hemolytic anemia due to sulfonamides and aspirin in a patient with G6Pd deficiency
D. Failed efficacy of counterfeit diazepam
78. Which of the following is a metabolite that causes such adverse effects as throbbing headache,
hypotension, and confusion if disulfiram is taken with alcohol?
A. Tetraethylthiuram
B. Acetate
C. Acetaldehyde
D. Alcohol dehydrogenase
79. Which of the following signs and symptoms that occurred a few minutes after intake of an
antibiotic is LEAST LIKELY to be due to anaphylaxis?
A. Bronchospasm
B. Pruritus and urticaria
C. Nausea, vomiting, abdominal cramps
D. Bleeding
80. A four-year old recently adopted boy was brought to your clinic because the adoptive mother
notices that he is not playful and that he rarely responds to outside stimulus. You noticed
microcephaly, and indistinct philtrum, thin upper lip, and a short nose. You must inform the
adoptive mother of the possibility of:
A. Autism
B. Narcotic withdrawal syndrome
C. Acute adrenal insufficiency due to steroids
D. Fetal alcohol syndrome
81. The following drug groups have an increased potential for drug-to-drug interactions EXCEPT:
A. Anticoagulants
B. Oral hypoglycemic
C. Antipyretics
D. Anti-inflammatory drugs
82. Which of the following goals of treatment would best describe the giving of a thyroid hormone
preparation to a newborn patient diagnosed to have congenital hypothyroidism?
A. Cure
B. Relief
C. Prevention
D. Modifying a pathophysiologic process
83. The criteria of drug safety considers the following factors EXCEPT:
A. Adverse drug effects
B. Toxicity of the drug
C. Complications from drug treatment
D. None of the above
84. A follow-up in your clinic becomes necessary a few days after prescribing a rational drug
because of the following:
A. To determine if the drug treatment has been effective
B. To determine if the treatment is inconvenient or has many side effects
C. To evaluate whether the goals of therapy have been achieved
D. All of the above
85. In which of the following conditions would the consideration for drug safety be of primary
importance?
A. Intake of paracetamol in a pregnant patient
B. Previous history of allergy to penicillin
C. Possibility of a cure using a new anticancer drug in a terminally ill patient
D. Antibiotic to a wounded soldier in the battlefield with no previous history of allergy
86. In the Integrated Case, “Goldfinger,” the housewife T.C., was given an antimicrobial and a
NSAID by the physician. Which of the following was given to achieve definitive cure for her
condition?
A. The antibiotic
B. The NSAID
C. Both A and B
87. Common clinical indications for NSAIDs include the following EXCEPT:
A. Rheumatoid arthritis
B. Sprains
C. Pain of dental extractions
D. Hemorrhagic strokes
88. Which of the following is NOT a known adverse reaction to NSAIDs?
A. Bronchoconstriction
B. Gastric irritation
C. Retinal damage
D. Renal damage
89. Which of the following antipyretics irreversibly inhibits cyclooxygenase?
A. aspirin
B. ibuprofen
C. mefenamic acid
D. paracetamol
90. In writing a prescription with multiple ingredients, which of the following is written first in the
inscription area?
A. Basis
B. Adjuvant
C. Corrective
D. Vehicle
PRESCRIPTION WRITING:
Case 1
A 5 year old boy weighing 15 kg came in with complaints of low grade fever and productive
cough of 10 days duration. No self-prescribed home medications were taken. Upon consult at the OPD,
there were fine rales noted on the right lower lung. He was diagnosed to have right lower lung
pneumonia. Laboratory examinations done revealed slight leucocytosis with neutrophilia. Patient was
given Cephalexin at a dose of 50 mg//kg/day in three divided doses round the clock for 7 days.
(Cephalexin suspension is available in the pharmacy at 125 mg/5 ml and 250 mg/5 ml preparations in 60
ml bottles.)
Case 2
A 10 year old girl weighing 20 kg was brought in at the emergency room with a 2 days history of
left facial swelling. It started as a nodular lesion in the left maxillary area and gradually progressed to
involve the left facial area. It is associated with fever and tenderness on the involved area. She was
admitted with a diagnosis of hemifacial cellulitis and prescription for Oxacillin IV at a dose of 50
mg/kg/day in four divided doses for 3 days was given to the patient. (The only available preparation of
Oxacillin in the pharmacy is 250 and 500 mg vials.)
Answer Key:
1C
11 B
2A
12 C
3C
13 C
4B
14 C
5C
15 A
6C
16 A
7B
17 C
8C
18 A
9C
19 C
10 A
20 A
21 B
22 B
23 B
24 B
25 A
26 A
27 C
28 D
29 A
30 C
31BONUS
32 C
33 A
34 C
35 C
36 D
37 C
38 A
39 D
40 C
41 D
42 D
43 C
44 C
45 D
46 B
47 A
48 A
49 C
50 B
51 B
52 A
53 C
54 B
55 A
56 C
57 D
58 A
59 A
60 C
61 B
62 D
63 B
64 B
65 C
66 B
67 C
68 D
69 B
70 C
71 C
72 D
73 B
74 D
75 A
76 D
77 C
78 C
79 D
80 D
81 C
82 D
83 D
84 D
85 B
86 A
87 D
88 C
89 D
90 A
91-95. Case 1
Cephalexin Suspension
250mg/5ml
Dispense No. 2 bottles (60ml)
Label: Take 1 teaspoon full every 8 hours round the clock for 7 days.
96-100. Case 2
Oxacillin IV
250mg/vial
Dispense No.12 vials
Label: For injection. Dissolve contents of one vial in 5ml of distilled water and inject
intravenously every 6 hours round the clock for 3 days.
Inject only after negative skin test.
91
92
93
94
95
96
97
98
99
100