Clinical Pharmacology final

Question 1

An example of polypragmasy (NOTE: MULTIPLE CHOICE):

A. simultaneous use of at least 5 drugs
B. improvement of the therapeutic effect through the use of an appropriate combination of drugs adapted to the patient’s health condition and its comorbidities
C. patient takes at least one drug for which there is no indication
D. use of more drugs than is clinically indicated
E. simulates use of up to 4 drugs

Answer 1

A. simultaneous use of at least 5 drugs
B. improvement of the therapeutic effect through the use of an appropriate combination of drugs adapted to the patient’s health condition and its comorbidities

Question 2

Individuals can be classified as extensive Imetabolizers, poor metabolizers or ultrarapid metabolizers. Both codeing
and nortripty line are metabolized by CYP2D6. Codeine is metabolized into an active agent (morphine), conversely,
nortriptyline is the active therapeutic agent and is metabolized to an inactive form. Subjects who are poor
metabolizes based upon CYP2D6 genotype:

A. may require increased dosing both of codeine and nortriptyline for a given therapeutic effect
B. may require increased dosing of codeine for a given therapeutic effect, while dosage of nortripty line should
be reduced as there is concern of side effects
C. may require increased dosing of nortriptyline for a given therapeutic effect, while dosage of codeine should
be reduced as there is concern of side effects
D. dosage both of codeine and nortripty line should be reduced as there is concern of side effects
E. no answer is correct

Answer 2

B. may require increased dosing of codeine for a given therapeutic effect, while dosage of nortripty line should
be reduced as there is concern of side effects

Question 3

Therapies A, B, C iD have different cost and effectiveness. Indicate therapy which dominates:

A. cost: 15 000 PLN, effectiveness: 25
B. cost: 39 000 PLN, effectiveness: 28
C. cost: 41 000 PLN, effectiveness: 22
D. cost: 40 000 PLN, effectiveness: 19
E. cost: 42 000 PLN, effectiveness: 23

Answer 3

A. cost: 15 000 PLN, effectiveness: 25

Question 4

A patient with diagnosed persistent atrial fibrillation takes warfarin 5 mg once daily. What effect on INR will have
the addition of neomycine and what mechanism of interaction is most likely?

A. INR increase, pharmacodynamic antagonism
B. INR decrease, pharmacodynamic antagonism
C. INR increase, pharmacodynamic synergism
D. INR decrease, pharmacodynamic synergism
E. INR increae, displacement from plasma protein bindings

Answer 4

C. INR increase, pharmacodynamic synergism

Question 5

TPMT is responsible for the metabolism of:

A. methotrexate
B. azathioprine
C. tacrolimus
D. all answers are correct
E. leflunomide

Answer 5

B. azathioprine

–> (Thiopurine methyltransferase metabolises thiopurines)

Question 6

What is „trough” drug concentration?

A. the lowest concentration reached by a drug before the next dose is administered, as determined ed by therapeutic drug monitoring
B. toxic blood concentration
C. concentration in the steady-state
D. lethal drug concentration
E. the highest concentration in the therapeutic range

Answer 6

A. the lowest concentration reached by a drug before the next dose is administered, as determined ed by therapeutic drug monitoring

Question 7

Gene responsible for prolonged respiratory muscular paralysis after receiving standard dose of succinyl cholinesterase

A. NAT2
B. TPMT
C. ABCB1
D. BCHE
E. YP2D6

Answer 7

D. BCHE

Question 8

A patient with diagnosed persistent atrial fibrillation takes warfarin 5 mg once daily. What effect on INR will
have the addition of cimetidine and what mechanism of interaction is most likely?

A. INR increase, pharmacodynamic synergism
B. INR decrease, pharmacodynamic antagonism
C. INR increase, displacement from plasma protein bindings
D. INR decrease, induction of CYP450 activity
E. INR increase, inhibition of CYP450 activity

Answer 8

E. INR increase, inhibition of CYP450 activity

Question 9

What type of adverse drug reactions is adrenal suppression with corticosteroids?
A. A
B. B
C. C
D. D
E. E

Answer 9

A. A

Question 10

16.In cost-utility analysis QALY is a common measure of outcome. Based on cost utility ratios, ie.cost/QALY that
are given for 3 therapies, choose the most favourable therapy:

A. implementation of an artificial cardiac pacemaker in a patient with bradyarrhytmia-100 000 PLN/QALY
B. use of infliximab in treatment of severe flare of Crohn’s disease -250 000/QALY
C. specialistic program of neonatology care 50 000 PLN/QALY
D. breast cancer screening 120 000 PLN/QALY
E. mentioned therapies concern different populations and therefore cannot be compared

Answer 10

C. specialistic program of neonatology care 50 000 PLN/QALY

Question 11

Drugs may differ in extent of plasma protein binding (EPB). The dosage of which drug should be reduced the most
in nephrotic syndrome?

A. phenobarbital, EPB = 4%
B. digoxin, EPB = 20%
C. methotrexate, EPB = 50%
D. chlorpropamide, EPB = 80%
E. warfarin, EPB = 99%

Answer 11

E. warfarin, EPB = 99%

Question 12

Digoxin is bound to plasma proteins in 20%. In a patient with liver failure and associating hypoalbuminemia there
is the reduction of protein binding by 10%. How much would the unbound fraction of the drug increase in this
case?

A. by 10%
B. by 12.5%
C. by 50%
D. by 75%
E. by 80%

Answer 12

A. by 10%

Question 13

Probenecid is a week acid, while diazepam is a week base. In which disease state the absorption of probenecid
would increase?

A. Zollinger-Ellisona syndrome 
B. Addison-Biermer disease
C. state after gastrectomy
D. chronic use of proton pump inhibitors
E. absorption of weak acids does not depend on Gl pH

Answer 13

A. Zollinger-Ellisona syndrome

Question 14

The standard dose of sertraline is 50 mg. Creatinine clearance in the patient was assessed to be 20 ml/min. What is
the required dose of sertraline in this patient, assuming that normal creatinine clearance is 100 ml/min.

A. 10 mg
B. 20 mg
C. 40 mg
D. 50 mg
E. 100 mg

Answer 14

A. 10 mg

Question 15

General indicative therapeutic guidelines for changing dosing of drugs in elderly patients include (NOTE
MULTIPLE CHOICE):

A. A. over 85 years of age - drug doses should be reduced by 30%
B. B. from 76 to 85 years of age - drug doses should be reduced by 20%
C. C. from 65 to 75 cars of age - drug doses should be reduced by 30%
D. D. from 70 to 82 years - doses should be increased by 10%
E. E. from 60 to 70 years of age - doses should be increased by 5%

Answer 15

A. A. over 85 years of age - drug doses should be reduced by 30%
B. B. from 76 to 85 years of age - drug doses should be reduced by 20%

Question 16

Indicate the true statement regarding the treatment of affective disorders and depression in pregnancy:

1. if mother’s current illess is severe and threatening to her and the baby to the point that the risk of not taking treatment outweighs the risk of potential foetal harm
2. in the first trimester of pregnancy the treatment of choice for depression is psychotherapy and phototherapy together with attempts to discontinue antidepressants, if any
3. the pharmacotherapy of schizophrenia during pregnancy, if necessary, should consist of drugs well known in polypharmacy in order to increase the chance of obtaining synergistic optimal effect and choosing the safest during pregnancy preparations of depot form administered intramuscularly
4. In the first trimester of pregnancy, sertaline or fluoxetine should be given in the lowest doses if absolutely necessary in depressed patients
5. the drugs of choice for the treatment of psychotic disorders in pregnant patients are A typical neuroleptics such as triflucoperidol or zuclopenthixol given together with lithium carbonate and valproate as mood stabilisers to maintain remission of schizophrenia symptoms

A. 2,3,4
B.2,5
C. 1,3,5
D. 1,2,4
E. 3,4

Answer 16

D. 1,2,4

Question 17

Indicate the correct combination of the product in question being marketed and the institution responsible for monitoring its safety on the market (multiple choice)

A. Medical devices - Department of Therapeutic Information of the Ministry of Health
B. Medicinal products - National Institute of Medicines in Warsaw
C. Dietary supplements - Chief Sanitary Inspector
D. Vaccines - Institute of Biotechnology of Serums and Vaccines
E. Dermocosmetics - the Institute of Occupational Medicine named after prof. dr. Jerzy Nofer in Łódź

Answer 17

B. Medicinal products - National Institute of Medicines in Warsaw
C. Dietary supplements - Chief Sanitary Inspector

Question 18

Indicate the correct statements (NOTE: MULTIPLE CHOICE):

A. Detailed, currently valid information on the individualization of the dosage of the drug in a patient with renal insufficiency can be found in hospital prescriptions and the clinical trial brochure.
B. Formats CKD-EPI and Childe-Pugh scale allow estimation of creatinine clearance and constant rate of drug elimination in patients with acute kidney injury
C. The RUCAM classification and the R-value are used to assess polyphic hepatic injury
D. based on the assessment of stehen alkaline phosphatar and alanine aminotransferase in the blood.In a patient with nephrotic syndrome, an increase in the free fraction of acidic drugs should be expected and, consequently, the risk of an increase in their pharmacodynamic effects
E. Patients with advanced cirrhosis, treated with beta-blockers and calcium channel blockers administered per as, require increasing the doses of these drugs due to the expected reduction in their bioavailability with this route of administration

Answer 18

B. Formats CKD-EPI and Childe-Pugh scale allow estimation of creatinine clearance and constant rate of drug elimination in patients with acute kidney injury
C. The RUCAM classification and the R-value are used to assess polyphic hepatic injury

Question 19

A positive (beneficial) drug interaction used in practice is combined use (NOTE: MULTIPLE-CHOICE)

A. Metamizole and musculotropic spasmolytic in patients with symptoms of kidney or gallstone disease
B. Ibuprofen and aspirin, which increases the anti-aggregating effect in patients with coronary atherosclerosis
C. Digoxin and rifampicin in a patient with chronic heart failure coexisting with extrapulmonary tuberculosis, which increases the concentration of both drugs in the blood and allows to shorten the treatment time
D. Paroxetine and preparations containing St. John’s wort extracts, which enhances the antidepressant effect and promotes consolidation the timoleptic effect of
E. Ketoprofen administered orally and diclofenac applied externally in the form of a gel in a patient with symptoms of osteoarthritis

Answer 19

A. Metamizole and musculotropic spasmolytic in patients with symptoms of kidney or gallstone disease

E. Ketoprofen administered orally and diclofenac applied externally in the form of a gel in a patient with symptoms of osteoarthritis

Question 20

The patient with endoscopically diagnosed oesophageal candidiasis was started on oral itraconazole in a dose of 100 mg once daily for 4 weeks.
The control esophagoscopy revealed more intense and disseminated fungal lesions compared to the previous image, therefore the daily dose of the drug was increased to 200 mg p.o. for the next 4 weeks. The patient also developed a prolonged attack of migraine while on treatment, which prompted him to take 1.5 ml of dihydroergotamine 3 times a day (a total of 9 mg of dihydroergotamine methylsulfonate). On the next day, the patient experienced nausea and vomiting, paresthesia of peripheral parts of the body, weakness of the limbs, disorientation, arrhythmias, manifestation of side effects of the dihydroergonotamine used. What could have been their cause? (Note: Multiple Choice):

A The occurrence of a pharmacokinetic interaction during the metabolism of both drugs
B Effect of itraconazole on the increase in the volume of distribution of dihydroergotamine resulting in an increase in its concentration in the blood
C. The occurrence of a pharmacodynamic interaction in the form of competitive antagonism of both drugs with respect to effects on vascular alpha and adrenergic receptors
D something with CYP3A4
E are both not readable

Answer 20

B Effect of itraconazole on the increase in the volume of distribution of dihydroergotamine resulting in an increase in its concentration in the blood

D something with CYP3A4

Question 21

Please indicate the statement that is false about non-commercial clinical trials:

A. A non-commercial trial may change its qualification to a commercial one upon the request of the sponsor and a positive opinion of the Bioethics Committee and the approval of the President of URPL
B. The sponsor may be supported by the responsible entity by e.g. transferring the investigational medicinal product free of charge or at a reduced cost
C. Data may be used to obtain marketing authorisation for the medicinal product
D. Participant enrolment is subject to the participant’s written consent to inform the National Health Fund of their pesel number
E. Academic research differs in purpose from commercial research

Answer 21

C. Data may be used to obtain marketing authorisation for the medicinal product

Question 22

Patient AW takes digoxine 250 mcg since 5 years … was within the therapeutic range. … find out about the symptoms of colds in the pharmacy bought ibuprofen. After a few days of use …
What could have been the cause of the described ailments of the patient?

A. The described complication is due to allergic reaction to ibuprofen
B. The described complication is due to allergic reaction to digoxin
C. Patient … unexplained eye disease
D. Digoxin was increased due to interaction with ibuprofen
E. Neither answer is correct

Answer 22

D. Digoxin was increased due to interaction with ibuprofen

Question 23

Patient KP is a mother who breastfeeds her 3-month-old baby. K.P. suffers from postpartum depression.
Her doctor advised her to use Fluoxetine at a dose of 20 mg a day. Can Fluoxetine be used while breastfeeding?

A. Yes, because it can also be used by pregnant women
B. No, as fluoxetine is metabolized to an active metabolite with a long biological half-life
C. No, because Fluoxetine has a high biological half-life
D. Correct answers are B, C

Answer 23

D. Correct answers are B, C

Question 24

A Patient of the university of Warsaw is after a kidney transplant. He uses cyclosporine as a immunosuppressive therapy. One day he felt bad. The doctor diagnosed bronchitis and prescribed him clarithromycine 500g twice a day and flucanzole 50mg once a day. After 3 days of treatment the patient developed symptoms that may indicate deterioration of kidney function. What could be the cause of the symptoms?

A. Acute Transplant rejection
B. Interaction between clarithromycine and cyclosporines, resulting in a decrease in cyclosporine levels
C. interaction between clarithromycine and cyclosporine, resulting in increased levels of cyclosporine
D interaction between clarithromycine and fluconazole, resulting in increased levels of antibiotic
E. C&D are correct

Answer 24

E. C&D are correct

Question 25

Patient WJ. was admitted to hospital for knee surgery. After the procedure, the patient was administered tramadol by continuous infusion. During the infusion, the patient complained of several nausea. The doctor on duty ordered the application metoclopramide. Is the combined use of metoclopramide and tramadol safe? A. Yes, metoclopramide is effective in reducing the patients nausea B. No, as you may develop seizures C. No, because you may develop serotonin syndrome D. B&C are correct ?? E. No, as the patient may lose the analgesic effect of tramadol

Answer 25

B. No, as you may develop seizures

Question 26

Patient A.K was treated with ciprofloxacin due to bacteriuria. At the same time, the patient was taking escitalopram for depression. It was also decided to prescribe omeprazole as a shielding drug. Symptoms of torsade de pointes have been observed after some time of treatment. What could be the cause of this complication? a. an interaction between ciprofloxacin and escitalopram leading to QT prolongation b. interaction between ciprofloxacin and omeprazole leading to increased levels of ciprofloxacin c. an interaction between escitalopram and omeprazole leading to QT prolongation d. interaction between escitalopram and omeprazole leading to increased omeprazole levels e. no correct answer.

Answer 26

a. an interaction between ciprofloxacin and escitalopram leading to QT prolongation

Question 27

Unwanted effects of medical products should be reported to: a. Chief Pharmaceutical Inspector b. Board for Registration of Medicinal, Medical and Bacteriocide Products c. The hygiene institute d. National institute of medications e. National institute of public health

Answer 27

b.Board for Registration of Medicinal, Medical and Bacteriocide Products

Question 28

There is no clinical indication for concentration monitored therapy: 1. no clinical effect 2. non-linear drug kinetics 3. existence of inter-individual differences (age, genotype) 4. diseases of organs responsible for particular stages of drug travel in the body 5. narrow therapeutic index of a drug ``` The correct answer is: A. 1,3 B. 1,4 C. 1,5 D. only 5 E. 2,5 ```

Answer 28

D. only 5

Question 29

Acute kidney injury was diagnosed in a 65-year-old woman admitted to the hospital in the emergency room (creatinine clearance below 15 ml / min). Which drug will be contraindicated because of the risk of lactic acidosis? ``` A. metamizole B. metformin C. klopidogrel D. pantoprazol E. amlodipine ```

Answer 29

B. metformin

Question 30

In a 79-year-old patient hospitalized in the cardiology department, community acquired pneumonia was diagnosed, which was the cause of decompensation of heart failure. The use of ceftriaxone and clarithromycin was ordered. The regulations on the medications taken by the patient before admission to the hospital include, among others digoxin and bisoprolol. What should I do to pay attention when analyzing pharmacotherapies? A. the possibility of reducing the clinical effect of digoxin by bisoprolol B. possible impairment of the action of bisprolol by clarithromyne C. possible symptoms of digoxin toxicity associated with the use of clarithromycin D. for the lack of therapeutic roots regarding the use of ceftriaxone and clarithromycin E. the possibility of increasing the effect of bisoprolol by ceftriaxone

Answer 30

C. possible symptoms of digoxin toxicity associated with the use of clarithromycin

Question 31

A patient hospitalized in a standardized chemotherapy unit is taking sertraline for depression and ondansetron for nausea. It became necessary to treat the infection and, based on the antibiogram, it was decided to include linezolid in the doctor's prescription card. What may be the consequences of using the drugs mentioned in the description? ``` A. serotonin syndrome B. decaying neuroleptic syndrome C. NSEMI infarction D. torsades de pointes polymorphic ventricular tachycardia E. ketoacidosis ```

Answer 31

A. serotonin syndrome

Question 32

Indicate the correct answer - pregnant women at increased risk of developing pre- eclampsia should take A. Acetylsalicylic acid in a prophylactic dose B. ramipril 5 mg C Valpruic acid 900 mg in the 3rd prophylactic dose D. Warfarin as indicated by the INR E Vitamine B6 in high doses

Answer 32

A. Acetylsalicylic acid in a prophylactic dose

Question 33

Select the correct antibiotic-characteristic adverse reaction 1. penicillin - joint pain and swelling, increased risk of Achilles tendon rupture 2. Macrolides- Increased risk of cardiac arrhythmias, digestive tract disorders, rashes 3. Aminoglycosides - hepatotoxicity 4. Glycopeptides - grey baby syndrome I 5. Tetracyclin - enamel damage, caries ``` • a) 1,2,3 • b)3,4 • c) 1,3,5 • d)2,5 - e) None of the above ```

Answer 33

• d)2,5

Question 34

A tripartite agreement for clinical conduct is concluded below * a) researcher, sponsor, bioethics committee * b) Hospital, bioethics committee, sponsor * c) Sponsor, researcher, hospital * d) Researcher, bioethics committee, hospital * e) Researcher, the president of the registration office PLWMiPB, sponsor

Answer 34

• c) Sponsor, researcher, hospital

Question 35

A patient who wants to be treated in breast cancer innovative therapy as part of a phase III clinical trial, after meeting the "inclusion criteria", signs relevant documents in accordance with the GCP principles, of which the most important are: * a) Informed consent * b) Clinical trial protocol * c) Researchers brochure * d) eCRF * e) Consent to perform laboratory tests

Answer 35

• a) Informed consent

Question 36

Enzyme inducers include: A. carbamazepine, rifampicin, chronic alcohol, griseofulvin B. carbamazepine, rifampicin, single-dose alcohol, griseofulvin C. cimetidine, fluconazole, erythromycin, chronic alcohol consumption D. phenobarbital, ketoconazole, fluconazole, carbamazepine, phenytoin E. phenobarbital, ketoconazole, carbamazepine, rifampicin

Answer 36

A. carbamazepine, rifampicin, chronic alcohol, griseofulvin

Question 37

Which combinations of antidote and drug / drug group (important order!) Are correct? 1. Naloxone - opioids 2. Flumazenil - benzodiazepines. 3. N-acetylcysteine - ibuprofen 4. Methanol- ethanol A) 1, 2 B) 3, 4 C) 1, 3 D) 1,4 E) 2, 4

Answer 37

D) 1,4

Question 38

Please calculate the maintenance dose of theophylline to be administered to a 62- year-old man weighing 65 kg suffering from chronic obstructive pulmonary disease and suffering from cirrhosis, whose serum bilirubin level is 2.6 mg / l, albumin 2.5 mg / l and prothrombin time is 8 seconds longer than normal. There was also a trace amount of fluid in the peritoneal cavity. The patient was not shown to have hepatic encephalopathy, he never suffered from cardiovascular diseases, and he never smoked. Dose due to patient without NW 300 mg / day. ``` A. 200 mg / day B. 150 mg / day C. 450 mg / day D. 50 mg / day E. 45 mg / day ```

Answer 38

B. 150 mg / day

Question 39

What is sequential antibiotic therapy: A. at the initiation of treatment with a broad-spectrum antibiotic and after it is obtained Antibtogram to a narrow-range antibiotic B. at the start of intravenous antibiotic therapy, and after clinical improvement, changes to the treatment preparation administered orally C.at the beginning of the therapy based on the anti-biogram result, and then the concentrations antuhiofvs.e serum D on the correct order of applying individual anti-biota cows E.no answer is valid

Answer 39

B. at the start of intravenous antibiotic therapy, and after clinical improvement, changes to the treatment preparation administered orally

Question 40

According to class II recommendations used in EBM: A. there is scientific evidence or it is widely believed that a particular treatment or procedure is not useful / effective B. there is scientific evidence and / or common belief that a given procedure or treatment is beneficial. useful and effective research data are inconclusive and / or diverging views on suitability / efficacy C. a specific treatment or procedure D. experts agree that data from small-scale studies, retrospective studies or registries are reliable E. C and D are correct

Answer 40

D. experts agree that data from small-scale studies, retrospective studies or registries are reliable

Question 41

Please indicate a false statement A. example of prescribing cascade in the elderly is: digoxin nausea - metoclopramide parkinsonian symptoms anti-Parkinsonian drugs B. polypharmacy is the patient taking at least one drug for which there is no indication or more the number of drugs than is clinically indicated C. the domino effect is a consequence of the ageing process and the inability to adapt in stressful situations, the consequence of damage to one organ is a significant risk of multi- organ changes D. during the ageing process of the organism, the active transport of calcium and iron preparations is increased also increasing their absorption E. an increase in adipose tissue in the elderly causes an increase in the volume of lipophilic drug distribution, such as, for example: amiodarone, verapamil, haloperidol, and consequently increase the risk of their accumulation, concentrations and adverse effects

Answer 41

B. polypharmacy is the patient taking at least one drug for which there is no indication or more the number of drugs than is clinically indicated --> only says multiple drugs, not if they are necessary or not (D. during the ageing process of the organism, the active transport of calcium and iron preparations is increased also increasing their absorption) --> should be a correct answer bc they DO get higher preparations prescribed e.g. iron def. anemia

Question 42

A 81 year old female with Parkinson's disease treated with levodopa/benzerazide 100/25 mg 4x daily, and ropinirole 2 mg. After a fall at home, she was rushed to the ED, where she was diagnosed with impaired copper tensile strength and psychomotor agitation. In a pre-evacuation interview, the patient's son reported additional medications used by the mother: ramipril 5 mg and estazolam 2 mg, but did not know their dosage schedule. In the emergency room, the woman was given 5 mg of haloperidol. After taking x-ray, she was found to have a femoral neck damang, resulting in surgery. She received metoclopramide in the postoperative period because of nausea and vomiting. Please identify the following problems. therapeutic problems and potential cause of fall. A metoclopramide is contraindicated in Parkinson's disease mode of induction of extrapyramidal symptoms, combination with levodopa is contraindicated due to increased risk of exacerbation of parkinsonian symptoms B ropinirole revealed adverse effects of ramipril, including hypotension, dizziness, and subsequent collapse C haloperidol is contraindicated in Parkinson's disease because it increases extrapyramidal symptoms D correct answers a,c E correct answers a,b

Answer 42

D correct answers a,c

Question 43

The drug is safe for the breastfed child A. RID<10%, t0.5 >12-24 h, with cystic mass <150 Da, codeine, tramadol B. binding to proteins at 85-90%, RID<10%, t0.5 <12 h, M/P<1, amoxicillin, heparin, warfarin, ibuprofen C. lipophilic, RID>25%, M/P> I, amiodarone, clozapine - D. M/P

Answer 43

B. binding to proteins at 85-90%, RID<10%, t0.5 <12 h, M/P<1, amoxicillin, heparin, warfarin, ibuprofen

Question 44

Symptoms of malignant hyperthermia do not include (multiple choice): ``` A. Bradycardia B. Fever up to 42°C C. Increase in blood calcium levels (there is an increase in calcium level in the blood) D. Tachycardia E. Increased muscle tension ```

Answer 44

A. Bradycardia (tachycardia would be correct) | B. Fever up to 42°C (43-44 in presentation)

Question 45

``` In accordance with the principles of clinical chronopharmacology 75% of glucocorticoid dose should be administered at: A. 01:00-02:00 B. 07:00-08:00 C. 14:00-15:00 D. 17:00-18:00 E. 22:00-23:00 ```

Answer 45

B. 07:00-08:00 --> the last 25% at 14:00-15:00

Question 46

``` In neonates relative to adults: A) gastric acid production is reduced B) fat content (as a percentage of body weight) is low C) plasma albumin concentration is low D) skin permeability is high E) all answers are correct ```

Answer 46

E) all answers are correct

Question 47

Concomitant ingestion of grapefruit juice and certain (dihydropyridine) calcium channel blockers: A) may lead to hypotension, because grapefruit juice increases the bioavailability of certain calcium channel blockers B) may lead to hypotension, because grapefruit juice decreases the bioavailability of certain calcium channel blockers C) may lead to insufficient control of arterial hypertension, because grapefruit juice increases the bioavailability of certain calcium channel blockers D) may lead to insufficient control of arterial hypertension, because grapefruit juice decreases the bioavailability of certain calcium channel blockers E) you can consume grapefruit juice without worrying about changing the effect of certain calcium channel blockers

Answer 47

A) may lead to hypotension, because grapefruit juice increases the bioavailability of certain calcium channel blockers

Question 48

``` Creatinine clearance is a measure of which of the renal drug excretion processes? A. re-absorption B. glomerular filtration C. active tubular secretion D. all answers are correct E. no answer is correct ```

Answer 48

B. glomerular filtration

Question 49

``` What type of adverse drug reactions is rebound hypertension after stopping clonidine? A. A B. B C. C D. D E. E ```

Answer 49

E. E --> 'end-of-use' reactions --> associated with withdrawal of medicine

Question 50

Fluoroquinolones should be used in elderly people only in exceptional cases because they (NOTE: MULTIPLE CHOICE): A. increase the risk of polymorphic ventricular tachycardia B. decrease confusion C. be responsible for the change of colour vision to blue D. aggravte bleeding E. intensify weakness, tremors and depression

Answer 50

A. increase the risk of polymorphic ventricular tachycardia E. intensify weakness, tremors and depression - -> they actually increase confusion - -> can cause QT interval prolongation