Finals- Scotts Flashcards
1
Q
- Histamine can be found in different compartments in the
human body, and are released in varying conditions. Which of
the following is INCORRECT with regards to histamine?
A. Histamine can be released by allergens and physico-chemical
insults
B. Histamine has not been linked with neurotransmission in the
brain
C. Enterochromaffin-like cells in the stomach release histamine
to activate mucosa cells
D. Histamine is found in high concentrations at sites of potential
injury
A
Answer: B
Endogenous histamine functions as brain neurotransmitter.
[Autacoids: Anti-histamines and Anti-leukotrienes Trans]
2
Q
- The triple response of Lewis classically describes the effect if
intradermal injection of histamine. Which of the following is not
consistent with the triple response?
A. Localized red spot
B. Swelling or production of edema
C. Bright red halo
D. Patchy orange induration
A
Answer: D
Triple response of Lewis includes: (1) localized red spot or
“flush” (2) swelling or edema or “wheal” and (3) brighter red
halo or “flare”. Choice D is not included. [Autacoids: Anti-
histamines and Anti-leukotrienes Trans]
3
Q
- Which of the following is INCORRECT with regards to the pharmacodynamics effect of anti-histamine? A. Decrease extrapyramidal signs for acute dystonia associated with antipsychotics
B. Sedative effect is associated with second generation H1 blockers
C. Urinary retention and blurring of vision may be seen with ethanolamine use
D. Cetirizine inhibits mast cell release of histamine and some other mediators of inflammation
A
Answer: B
Sedative effect is common in 1st generation H1 blockers. Newer or 2nd generation H1 blockers such as loratadine are non-
sedating. [Autacoids: Anti-histamines and Anti-leukotrienes Trans]
4
Q
- Immunologic processes account for the most important pathophysiologic mechanism of histamine release. Which of the following is TRUE with regards to the storage and release of histamine?
A. Involves neutrophil histamine release
B. Cells sensitized by IgE antibodies attached to their surface membranes
C. Histamine is also a mediator in Type-II hypersensitivity reactions
D. Histamine decreases chemotaxis of monocytes and lymphocytes
A
Answer: B
The most important pathophysiologic mechanism of mast cell and basophilhistamine release is immunologic. These cells, if sensitized by IgE antibodies attached to their membranes, degranulate when exposed to the appropriate antigen.
5
Q
- Which of the following is FALSE with regards to the leukotrienes?
A
A. Leukotrienes are products of arachidonic acid metabolism through 5-Lipoxygenase pathway
B. Synthesized by airway inflammatory cells
C. Cys-Leukotrienes dominate during allergic constriction of the airway
D. Leukotrienes are only involved with increase airway mucosal secretion
6
Q
- Which of the following is FALSE with regards to the leukotrienes?
A. Leukotrienes are products of arachidonic acid metabolism through 5-Lipoxygenase pathway
B. Synthesized by airway inflammatory cells
C. Cys-Leukotrienes dominate during allergic constriction of the airway
D. Leukotrienes are only involved with increase airway mucosal secretion
A
Answer: D
Choices A, B and C are true. Other functions of leukotrienes include bronchoconstriction, neutrophil chemoaattractant and mucosal edema.[Autacoids: Anti-histamines and Anti-leukotrienes Trans]
7
Q
- The leukotriene which has the highest potency as a chemotactic agent for neutrophils
A. Leukotriene B4
B. Leukotriene C4
C. Leukotriene D4
D. Leukotriene E4
A
Answer: A
LTB4 – potent neutrophil chemoattractant
LTC4 and LTD4 (also LTE4) – bronchoconstriction, bronchial
reactivity, mucosal edema, mucosal hypersecretion [Autacoids:
Anti-histamines and Anti-leukotrienes Trans]
8
Q
- Leukotriene pathway inhibitors are clinically effective for asthma. Which of the following is FALSE with regards to the effects of leukotrienes in asthma?
A. The anti-inflammatory effects may be less than
corticosteroids but nearly equal in reducing the frequency of exacerbations
B. Shown to reduce the asthmatic response to aspirin
C. Taken per orem
D. Zileuton is approved for children 6 years and above
A
Answer: D
Choices A, B and C are true. Zileuton causes occasional liver toxicity thus is least prescribed. MONTELUKAST is approved for children 6 years and above. [Autacoids: Anti-histamines and Anti-leukotrienes Trans]
9
Q
- Which of the following is FALSE with regards to the
pharmacodynamics effects of leukotrienes?
A. Hypotension
B. Chemotaxis
C. Gastric acid production
D. Mucosal edema
A
Answer: C
LTC4 and LTD4 cause hypotension in humans (Brink, 2003). Mucosal edema is one of the functions of LTC4 and LTD4 (see explanation on number
6). LTB4 is a potent chemotactic agent.
LTs act principally on bronchial mucosa, not on gastric mucosa.
[Autacoids: Anti-histamines and Anti-leukotrienes Trans]
10
Q
- Which of the following drugs / agents would reduce release of mediators from mast cells and basophils and produce brochodilation?
A. Prednisone
B. Isoproterenol
C. Montelukast
D. Antihistamines
A
Answer: D
H1 blockers (anti-histamines) involves inhibition of mast cells and basophil histamine release and some other mediators of inflammation. [Autacoids: Anti-histamines and Anti-leukotrienes Trans]
11
Q
- Which of the following routes would probably be the best method to give epinephrine to a patient with anaphylactic shock?
A. Subcutaneous
B. Intramuscular
C. Intravenous
D. Sublingual
A
Answer: C
Management of patient in anaphylactic shock: Epinephrine IV (1:100,000) = 0.01mg/kg [Autacoids: Anti-histamines and Anti-leukotrienes Trans]
12
Q
- Which of the following regarding the use of adrenergic agents in allergic rhinitis is true?
A. Use with caution in patients with hypertension.
B. Topical decongestants are less prone to abuse.
C. Oral decongestants are more prone to produce rebound congestion.
D. They can be safely taken by patients who are on MAO inhibitors.
A
Answer: A
A is correct. Phenylpropanolamine has already been withdrawn
for increased cardiac events in the US. B is wrong since topical
decongestants are more prone to abuse. C is also wrong since
oral decongestants decrease rebound congestion. D is also
wrong since adrenergic agents have an addictive effect with MAO inhibitors.
13
Q
- Which of the following adrenergic agents exerts direct action on the alpha 2 adrenergic receptors?
a. phenylephrine
b. pseudoephedrine
c. oxymetazoline
d. epinephrine
A
Answer: C. Oxymetazoline
Oxymetazoline / Xyclometazoline exerrt clonidine like effects
and stimulate alpha 2 adrenergic receptors and promote constriction of nasal arterioles.
14
Q
- Which of the following agents used topically for nasal decongestion would more likely cause mucosal damage?
A. epinephrine
B. phenylephrine
C. ephedrine
D. xylometazoline
A
Answer: A. Epinephrine
B, C, and D are all used as topical decongestants. Chronic use of A can cause structural damage of the mucosa.
15
Q
- Which of the following decongestants releases stored catecholamines, has some direct effects on receptors, has good oral bioavailability and causes significant CNS stimulation?
A. Phenylephrine
B. Ephedrine
C. Oxymetazoline
D. Pseudoephedrine
A
Answer: B. Ephedrine
Ephedrine can be taken orally (does not resist oxidation by MAO), has direct action on receptors, MOA – releases stored catecholamines, and compared to pseudoephedrine- causes more CNS stimulation.
16
Q
- True or False? The standard diluent for epinephrine is D5W.
A
Answer: False
A solution of 5%dextrosein water, sometimes called D5W, is often used instead if the patient is at risk for having lowblood sugar or highsodium. D5W is especially used in mixing and infusing medications due to its hypotonic properties –
Wikipedia. I read in a journal that epinephrine is diluted in endotracheal or endobronchial administration to increase its effectiveness, the usual diluents of epinephrine are normal saline (NS) and distilled water and according to the authors of the journal distilled water is a better diluents.
the journal distilled water is a better diluents.
17
Q
- True or False? Bicarbonates are compatible with
epinephrine.
A
Answer: False
Epinephrine is incompatible withaminophilline, sodium bicarbonate or other alkaline solutions (Trans on Adrenergic Agents in Allergy p.2).
18
Q
- True or False? Bicarbonates are compatible with epinephrine.
A
Answer: False
Epinephrine is incompatible withaminophilline, sodium bicarbonate or other alkaline solutions (Trans on Adrenergic Agents in Allergy p.2).
19
Q
- The following are considered to be glucocorticoids:
A. Testosterone
B. Aldosterone
C. Cortisol
D. Dehydroepiandosterone
A
Answer: C.Testosterone
Testosterone, Aldosterone, Dehydroepiandosterone are all
mineralocorticoids.
20
Q
- The following glucocorticoid has the highest mineralocorticoid potency:
A. dexamethasone
B. prednisone
C. betamethasone
D. hydroxycortisone
A
Answer: D. hydrocortisone
Cortisone and hydrocortisone have the highest mineralocorticoid potency with 2. Prednisone and prednisolone have 1. The rest have none.
21
Q
19.A patient with allergic rhinitis was assessed to require steroids. This drug should be given
A. Systemically by intravenous route
B. By intramuscular route
C. By oral route (e.g. prednisone)
D. Inhaled/intranasal
A
Answer: D. Inhaled / intranasal
Intranasal corticosteroids are the first line of treatment for moderate to severe persistent rhinitis.
22
Q
- The following are expected effects of steroids except:
A. Decrease calcium absorption in the gut
B. Increase glucose uptake by muscles
C. Blocks the synthesis of prostaglandins and leukotrienes
D. Protein catabolism
A
Answer: B. Increase glucose uptake by muscles
Steroids function by increasing glucose levels in the bloodstream during times of stress, thus there is decreased glucose uptake by muscles.
23
Q
- The following practice decreases the likelihood of adverse effects with the use of glucocorticoids:
A. Give a higher dose at night than in the morning.
B. For contact dermatitis, steroids should be administered
systematically for faster absorption.
C. Use at the highest doses for optimal effect.
D. Give prednisone rather than dexamethasone whenever
possible.
A
Answer: D
Use short acting and/or topical drugs whenever possible to
minimize adverse effects. (prednisone has shorter half life than dexamethasone). Higher dose should be given in the morning otherwise ACTH will be suppressed if given at night. Use the lowest dose possible.
24
Q
- The following adverse effect of glucocorticoids is attributed to its interaction and activation of the mineralocorticoid receptor:
A. Hyperglycemia or high blood sugar
B. Osteoporosis
C. Early bruising and thinning of the skin
D. Hypertension
A
Answer: D
Mineralocorticoid receptor activation produces sodium and water retention, eventually leading to hypertension.
25
23. The following are normal physiologic processes concerning steroid secretion which we attempt to mimic whenever exogenous steroids are given:
A. The peak of ACTH secretion is early in the morning at around 8 am
B. The peak of cortisol secretion is at 8 pm
C. Mineralocorticoid secretion peaks at 8 am.
D. Cortisol secretion is lowest at around midnight.
Answer: D
ACTH peaks at midnight. Cortisol peaks early in the morning and is lowest at midnight. Mineralocorticoids have no peak.
26
24. The only mineralocorticoid that has pharmacologic use:
A. Hydrocortisone
B. Prednisone
C. Fludrocortisone
D. Dexamethasone
Answer: C
A, B, and D are all glucocorticoids. Only C is a mineralocorticoid.
27
95. Which of the following is the mechanism of action of
octreotide for the treatment of GH-secreting tumors?
a. competitive inhibition for the growth hormone (GH)
receptor
b. dopaminergic agonist inhibiting GH secretion
c. somatostatin-like effect inhibiting the release of GH
d. competes for the OGF-1 receptor
Answer: C. somatostatin-like effect inhibiting the release of GH
Explanation: Octreotide acetate is an eight-amino-acid synthetic somatostatin analogue. Somatostatin analogues
exert their therapeutic effects through SSTR2 and -5 receptors, both of which are invariably expressed by GH-secreting tumors. In contrast to native somatostatin, the analogue is relatively resistant to plasma degradation. It has a 2-h serum half-life and possesses fortyfold greater potency than native somatostatin to suppress or inhibit GH
release. (Harrison’s)
28
96. All of the following drugs/chemical are inhibitors of prolactin secretion EXCEPT:
a. dopamine
b. bromocriptine
c. carbegoline
d. pegvisomant
Answer: D. pegvisomant
Explanation: Pegvisomant is a GH receptor antagonist.
Dopamine inhibits prolactin secretion while Bromocriptine and Cabergoline are ergot alkaloids used to treat hyperprolactinemia. (Harrison’s)
29
97. All of the following are correct therapeutic targets in the treatment of prolactinomas EXCEPT:
a. resumption of regular monthly menses
b. pregnancy
c. shrinkage of the pituitary tumor
d. weight loss
Answer: D. weight loss
Explanation: Treatment of prolactinoma will address the amenorrhea and infertility associated with the said disorder.
30
98. The following conditions will be amenable to growth
hormone injections EXCEPT:
a. Short stature due to Turner’s syndrome
b. Growth hormone deficiency in an 11 year old child
developing after surgery of craniopharyngioma in the sellar
area
c. Dwarfism due to congenital hypothyroidism
d. Growth restriction of a 13 year old due to chronic kidney disease
Answer: C. Dwarfism due to congenital hypothyroidism
Explanation: Growth hormone injections can be used to treat
growth failure in pediatric patient with GH deficiency, chronic renal failure, Noonan’s syndrome, Prader-Willi syndrome, Turner syndrome, small for gestational age with failure to catch up by age 2, and idiopathic short stature
31
99. Gold standard or first line treatment of acromegaly:
a. Bromocriptine
b. Surgery (TSE)
c. Pegvisomant
d. Octreotide
Answer: B. surgery (TSE)
Explanation: The 1st line treatment for acromegaly is transphenoidal surgery. 2nd line is the use of somatostatin analogs. 3rd line is the use of dopamine agonist. The last resort will be radiation therapy.
32
100. The following drugs can potentially decrease the cortisol
levels in Cushing’s syndrome EXCEPT:
a. Ketoconazole
b. Metyrapone
c. Octreotide
d. Aminogluthetimide
Answer: C. Octreotide
Explanation: Octreotide is a somatostatin analog used in the treatment of acromegaly.
33
88. True about the management of patients with Type 1 diabetes mellitus:
a. the best treatment is insulin given once a day as a basal regimen in order to improve compliance.
b. the best treatment is combination of insulin given in a basal and prandial regimen
c. Type 1 diabetics using inhaled insulin will not require any more subcutaneous injection
d. Chronic or long term use is given as intramuscular injections
B
34
89. The oral antidiabetic agent that is most notorious for hypoglycemia
a. Glimepiride
b. Metformin
c. Thiazolidinedione
d. Glibenclamide
e. Repaglinide
D
35
90. The following drugs can be given specifically to control
postprandial blood sugar in Type 2 DM EXCEPT
a. Insulin aspart
b. Megletinides/glinides
c. alpha-glucosidase inhibitors
d. Insulin lispro
e. NPH insulin
E
36
90. The following drugs can be given specifically to control postprandial blood sugar in Type 2 DM EXCEPT
a. Insulin aspart
b. Megletinides/glinides
c. alpha-glucosidase inhibitors
d. Insulin lispro
e. NPH insulin
A
37
92. The most potent in terms of the amoung of lowering of both the FBS and HbA1c among the following oral agents:
a. Megletinides
b. Thiazolidinediones
c. Alpha glucosidase inhibitors
d. Sulfonylureas
D
38
93. The most feared side effect of metformin use
a. bone marrow toxicity
b. hepatotoxicity
c. acute interstitial nephritis
d. lactic acidosis
e. hypoglycemia
D
39
94. The mechanism of action of the following drugs involve a
glucose independent increase in insulin secretion EXCEPT for:
a. first generation sulfonylureas
b. megletinides
c. GLP-1
d. second generation sulfonylureas
C
40
95. Your patient was injected with a mixture of two kinds of
insulin before breaskfast at 7am and was apparently well until
this referral. As the intern on duty, he is being referred to you
now at 930 am for cold sweats, blank stares and tremulousness.
You suspect hypoglycemia. The insulin that caused the
hypoglycemia is most probably:
a. insulin glargine
b. regular insulin
c. insulin detemir
d. NPH insulin
e. Lente insulin
no answer given
41
96. Bolus insulin injected through this route has the shortest
halflife or is eliminated most quickly
a. intramuscular
b. subcutaneous
c. intravenous
d. intradermal
NAG
42
97. This oral agent is approved for use by children with Type 2
diabetes:
a. metformin
b. sulfonylureas
c. alpha glucosidase inhibitors
d. thiazolidinediones
e. DPP-4 inhibitors
A
43
98: This drug is contraindicated among diabetic patients with
acute infection and sepsis
a. Regular insulin
b. NPH insulin
c. Megletinides
d. Metformin
D
44
99. A patient is consulting you in the OPD for second opinion. He
was recently diagnosed to be diabetic and was given two
different drugs. Two weeks after starting these medications, he
developed bipedal edema. Unfortunately, he did not bring both
his prescription and the actual tablets, and just described his
medications as one large round tablet and one triangular tablet.
Which of the following oral anti-diabetic agents probably caused
the edema?
a. Metformin
b. Sulfonylurea
c. Thiazolidinedione
d. alpha glucosidase inhibitor
e. megletinide
C
45
100. The drug of choice for a newly diagnosed overweight Type
2 diabetic with mild to moderate hyperglycemia
a. alpha glucosidase inhibitor
b. metformin
c. thiazolidinedione
d. megletinide
e. sulfonylurea
NAG
46
101. The drug of choice for Type 2 diabetic patients with renal
failure:
a. alpha glucosidase inhibitor
b. metformin
c. insulin
d. sulfonylurea
e. GLP-1
NAG
47
102. Insulin for long term use is given
a. subcutaneously
b. intramuscular
c. intradermal
d. intravenous
NAG
48
103. Your patient who is on insulin could not buy insulin syringes
due to the floods. You have however an abundance of tuberculin
syringes in your medical mission that you use to administer
tetanus toxoid. If the patient is injecting 30 units of unsulin
glargine, how much in mL should he inject using the tuberculin
syringe?
a. 30mL
b. 3.0mL
c. 0.3mL
d. 0.03mL
NAG
49
104. You are the intern on duty when around midnight, the
nurse referred a patient with cold clammy sweating,
tremulousness and decreased sensorium. You suspect hypoglycemia. After giving glucose solution, the patient improves and asks you which of his medications caused the hypoglycemia. The following is the least likely to have caused the hypoglycemic episode:
a. NPH insulin injected at dinnertime
b. GLP-a (exenatide)
c. Glimepiride
d. Regular insulin infected at 9pm
NAG
50
104. You are the intern on duty when around midnight, the nurse referred a patient with cold clammy sweating, tremulousness and decreased sensorium. You suspect hypoglycemia. After giving glucose solution, the patient improves and asks you which of his medications caused the hypoglycemia. The following is the least likely to have caused the hypoglycemic episode:
a. NPH insulin injected at dinnertime
b. GLP-a (exenatide)
c. Glimepiride
d. Regular insulin infected at 9pm
NAG
51
105. A patient with Type 2 diabetes was admitted to the wards due to high risk pneumonia and congestive heart failure. The resident on duty was busy and told you to finish making the admitting orders in the emergency room, after he had written his orders for antibiotics. He tells you to continue all of the patient’s previous medications in the outpatient for the
meantime. You will write the following medical in the orders:
a. Glibenclimide
b. insulin glargine
c. thiazolidinediones
d. metformin
NAG
52
106. The following are logical combinations of drugs for patients with markedly elevated blood sugar
a. glibenclamide and gliclazide
b. regular insulin and insulin glargine given together in
one syringe
c. insulin glargine and NPH insulin given in one syringe
d. glipizide and metformin
D
53
107. Drug of choice for a patient with diabetes and hepatic
failure:
a. metformin
b. thiazolidinediones
c. glipizide
d. insulin
NAG
54
1. The following medication for treatment of hyperthyroidism interfere with the peripheral conversion of T4 to T3:
A. Methimazole
B. Lithium
C. Organic iodides
D. Glucocorticoids
Peripheral conversion of T4 to T3 is impaired during low T3 syndrome or with the intake of drugs including PTUs, -blockers (uncertain), iodinated contrast media, and corticosteroids (glucocorticoids). Organic iodides inhibit hormone release by reducing thyroglobulin proteolysis.
Lithium (a monocovalent anion) blocks thyroid hormone synthesis by inhibiting active iodine uptake. Methimazole blocks the organification process.
55
The drug of choice for the OPD medical treatment of
patients with hyperthyroidism due to better compliance:
A. Propylthiouracil
B. High dose iodides
C. Beta-blockers
D. Methimazole
D
Once-daily dosing of methimazole is possible after euthyroidism is restored, making it a better drug in an out-patient setting due to better compliance. Propylthiouracil is
given at a dose of 100–200 mg every 6–8 h, and divided
doses are usually given throughout the course, making PTU
a hard choice for patients with problems in compliance.
Beta-blockers are only indicated in patients with
sympathetic effects such as palpitations due to hyperthyroidism. Effects of iodides take longer (2-7 days) making it a less priority in an out-patient setting.
56
Dose of levothyroxine in a 55kg person for treatment of post-surgical hypothyroidism (round off please to the nearest exact dose):
A. 50 mcg OD
B. 25 mcg tablet OD
C. 100 mcg OD
D. 140 mcg BID
CDose for replacement: 1.6-1.7 mcg/kg
55kg x 1.6 mcg/kg = 88mcg
Rounding off 88mcg = 100mcg
57
The most common side-effect of thionamide drugs:
A. Jaundice
B. Joint pains
C. Agranulocytosis
D. Pruritus
D
The most common side effect of thionamide drugs is the presence of a maculopapular pruritic rash.
58
5. Which of the following drugs is used in thyroid storm because it interferes with the release of preformed thyroid hormones?
A. Hydrocortisone
B. Propylthiouracil
C. Propanolol
D. Saturated solution of potassium iodide
Answer: D
Iodides inhibit preformed thyroid hormone release by inhibiting or reducing thyroglobulin proteolysis. Hydrocortisone and PTUs inhibit peripheral conversion of
T4 to T3. In addition, PTU inhibits the organification
process. Propanolol acts in controlling sympathetic effects.
59
The following are advantages of RAI ablation therapy over
surgery in Graves’ disease EXCEPT:
A. Lesser cost (cheaper)
B. Done on an out-patient basis
C. Rapid effects expected within days
D. More effective
C.
Advantages of Radioactive Iodine (RAI) Ablation therapy include easy administration (which make it easily done on an out-patient basis), effectiveness, low expense, and
absence of pain. Destruction of thyroid parenchyma is evident within weeks.
60
The following is true about the treatment of Graves’
disease
A. Overall long-term remission rate for medical
B. The majority of patients with diffuse toxic goiter
C. Anti-thyroid drugs can be discontinued as soon as
D. Use of thionamide drugs will lead to regression of
therapy with thionamide drugs in Graves’ disease
is high making it the most popular form of
definitive treatment.
from Graves’ disease should receive some form of
definitive treatment, i.e. radioactive iodine
ablation therapy of surgery.
the patients are euthyroid since cure has been
achieved.
the goiter.
B.
The starting dose of anti-thyroid drugs can be gradually
reduced (titration regimen) as thyrotoxicosis improves and
should not be stopped instantaneously. Initial reports
suggesting superior remission rates with the block-replace
regimen have not been reproduced in several other trials.
Maximum remission rates (up to 30–50% in some
populations) are achieved by 18–24 months for the titration regimen and by 6 months for the block-replace regimen.
For unclear reasons, remission rates appear to vary in different geographic regions. Patients with severe
hyperthyroidism and large goiters are most likely to relapse when treatment stops, but outcome is difficult to predict.
All patients should be followed closely for relapse during the first year after treatment and at least annually thereafter. Patients with diffuse toxic goiter still require definitive treatment including surgery and radioiodine ablation therapy. (HPIM, 17th ed.)
61
For items 50-54: Choose from the items below which anti-thyroid drug is being described by the numbered statements.
A. Methimazole
B. Carbimazole
C. Propylthiouracil
D. All of the above
8. Thionamide drug that inhibits peripheral conversion of T4 to T3.
9. Attenuate(s) or induce(s) serum concentrations of thyrotropin-receptor antibodies.
10. Preferred agent in thyroid storm.
11. Inhibit(s) organification of iodides and coupling of
iodothyroxines
12. Used to prepare patient for definitive treatment such as RAI
ablation
50. C
51. D
52. C
53. D
54. D
62
For 21-25:
Write A if the statement applies in general to currently used antiepileptic drugs.
Write B if the statement does not apply in general to currently
used antiepileptic drugs.
21. Absorption occurs in several minutes
22. Elimination can be modeled by first order kinetics in its therapeutic range
23. Most have active metabolites
24. They are distributed widely in the body
25. >90% of the drug is absorbed when taken orally
21. B - Absorption is rapid, but occurs in several hours.
22. A – Elimination can be modeled by first order kinetics (except
for Phenytoin, which follows zero order kinetics)
23. B – most have inactive metabolites (except Benzodiazepines)
24. A – verbatim; Distributed widely in the body
25. A – verbatim; >90% is absorbed
63
Select ONE mode of action for the following drugs.
Mode of action:
A. It blocks sodium channels
B. It is an irreversible inhibitor of GABA aminotransferase
C. It alters GABA metabolism or its nonsynaptic release
D. It blocks calcium currents.
E. Inhibits fusion of the vesicle to the cell membrane
wall.
26. Lamotrigine
27. Gabapentin
28. Ethosuximide
29. Vigabantrin
30. Levetiracetam
26. A – Lamotrigine acts on the sodium channel
27. C – Gabapentin is a GABA analogue that alters GABA metabolism
28. D – Ethosuximide is a cyclic ureide that inhibits low threshold calcium (T-type) currents.
29. B – Vigabantin is a a GABA analogue that irreversibly binds to GABA aminotransferase
30. E – Levetiracetam, although mechanism unknown, inhibits fusion of the vesicle to the cell membrane wall Levetiracetam
64
Choose A if the statement applies in general to currently used
antiepileptic drugs or B if it does not apply in general to
currently used antiepileptic drugs
92. Absorption occurs in several minutes
93. Elimination can be modeled by first order kinetics in its
therapeutic range
94. Most have active metabolites
95. They are widely distributed in the body
92 – B, absorpotion occurs in several hours
93 – A, first order kinetics for most except phenytoin
94 – B, most have inactive metabolites except benzodiazepenes
95 – A
65
91. False statement about streptomycin:
A. It inhibits protein synthesis
B. It has excellent activity against intracellular
mycobacteria
C. It must be admistered parenterally
D. It may be used for the treatment of streptococcal
endocarditis in combination with other beta-
lactams
Answer: B?
Streptomycin is a protein synthesis inhibitor, binding to 30s
subunit of the bacterial ribosome. It is bactericidal, and must
not be given orally (rather, given intramuscularly or in a lesser frequency, intravenously). It is used in treating TB (in combination with other anti-TB drugs, not the first-line drug), plague, and infective endocarditis caused by Enterococcus
when the organism is not sensitive to Gentamycin.
66
92. Which is a TRUE statement about Isoniazid?
A. It inhibits RNA polymerase
B. Once weekly treatment is acceptable
C. It is bactericidal against growing mycobacteria
D. It causes ototoxicity
Answer: C
It is bactericidal against actively growing M. tuberculosis but bacteriostatic against dormant organisms. It inhibits synthesis of mycolic acid. Streptomycin causes ototoxicity (distinguishing feature).
The standard dose of INH in adults is 5mg/kg/day or for children 8-12mg/kg/day. Once weekly is
useless dosing! (Diba sa TB-DOTS, may scheduled drug intake everyday?)
67
93. Which is a FALSE statement about pyrazinamide?
A. It is bactericidal against intracellular mycobacteria
B. It is given during the maintenance or continuation
phase of treatment
C. Adverse effects include hepatotoxicity and
hyperuricemia
D. It inhibits mycolic acid synthesis
Answer: B
The drug is largely bacteriostatic, but can be bactericidal on actively replicating tuberculosis bacteria. Pyrazinamide is used in the first two months of treatment to reduce the duration of treatment required. Adverse effects include hepatotoxicity and hyperuricemia above others. The target of pyrazinamide is the mycobacterial fatty acid synthase I gene involved in mycolic acid biosynthesis
68
94. Combination therapy is necessary for TB treatment because:
A. Natural resistance to first-line drugs exist in
patients
B. There are different populations with different metabolic activity
C. All of the above
D. None of the above
Answer: C
TB drugs are given in combination to avoid resistance, to cover up the “weakness” of a certain drug, and to consider the different populations with different metabolic activity (ex. Slow and fast acetylators).
69
95. The following Quinolones have good anti-mycobacterial activity EXCEPT:
A. Ciprofloxacin
B. Levofloxacin
C. Nalidixic acid
D. Moxifloxacin
C
Nalidixic acid is not for respiratory tract infections. It is for urinary tract pathogens and Shigella (gram negatives).
70
46. the mainstay for treatment of symptomatic asthma is
a. oral corticosteroids and inhaled LABA
b. inhaled LABA alone
c. inhaled LABA and inhaled glucocorticoid
d. inhaled glucocorticoid alonev
Answer: C. Inhaled corticosteroid + inhaled LABA,
controller + reliever
71
47. the drug of choice for treatment of an acute
exacerbation of asthma for rapid termination of the attack is
a. inhaled LABA
b. inihaled SABA
c. inhaled glucocorticoid
d. systemic glucocorticoid
Answer: B. Inhaled SABA for acute attacks.
72
48. the following are true statements regarding theophylline
EXCEPT:
a. it is chemically related to caffeine
b. it stimulates phosphodiesterase enzymes leading to
increased breakdown of cAMP
c. this drug is a competitive antagonist of adenosine for its
receptor
d. it has a narrow margin of safety
B. should be inhibits PDE.
73
49. the primary mechanism of action of beta2 adrenergic agonists causing bronchodilation:
a. activation of adenyl cyclase leading to increased production of cAMP and direct relaxation of bronchial
smooth muscles
b. inhibition of release of acetylcholine at the preganglionic fibers of the vagal efferent
c. decreased mast cell degranulation inhibiting bronchospasm
d. decreased leukotriene synthesis leading to decreased bronchoconstriction
Answer: A. Mechanism of beta 2 adrenergic agonists by increasing cAMP.
74
50. drug whose main mechanism of action is inhibition of mast cell degranulation by altering the function of the
delayed chloride ion channels in the cell membrane:
a. cromolyn sodium
b. montelukast
c. zileuton
d. ketotifen
Answer: A. Mechanism of cromolyn sodium is the inhibition of mast cell degranulation.
75
51. The following are true of nasal decongestants:
A. Preferred route is oral
B. are relatively safe and can be given indefinitely for as
long as there is congestion
C. are alpha-adrenergic antagonists
D. Phenlypropanolamine and phenylephrine are examples
Answer: D. They are both decongestants. Therefore the others are incorrect.
A is incorrect because the preferred route is nasal, B is incorrect
because common side-effects include sleeplessness, anxiety,
dizziness, excitability, and nervousness and hypertension. C is
incorrect because they stimulate alpha-adrenergic receptors.
76
52. This drug is an expectorant:
A. Ambroxol
B. Mesna
C. Guaifenesin
D. Carbocysteine
Answer: C. Ambroxol is a secretolytic and secretomotoric drug that restore the physiological clearance mechanisms of the respiratory tract. Carbocysteine is a mucolytic drug.
77
53. The following are correct indications for using antitussives EXCEPT:
A. Hemoptysis (coughing out of blood) in cavitary PTB
B. Irritative cough of bronchogenic carcinoma
C. Cough due to pneumonia
D. Cough due to pleural effusion
Answer: Indications for using antitussives include: dry, painful cough of neoplasia or pleural disease, irritative cough in inflammation of the repiratory tract (epiglottitis) and hemoptytsis (might exsanguate). DO NOT suppress in bacterial lung infections, asthma, bronchiectasis (suppurating bronchial asthma) or chronic
bronchitis where antitussives can cause harmful sputum thickening
and retention.
78
54. True regarding the action of antitussives EXCEPT:
A. are generally opioid dervatives
B. generally all of these agents cause constipation
C. Addiction potential is equivalent for codeine, morphine,
dextromethorphan and butamirate
D. can thicken sputum and inhibit mucociliary clearance
Answer: Addiction potential for the said drugs are never equal to
one another. Morphine has the most potential to addiction.
79
55. True regarding the treatment of COPD
A. considering its pathophysiology, steroids should be a
major treatment among patients with COPD
B. can be cured with a combination drugs
C. The drug of choice for patients with COPD is
anticholinergics like ipatropium
D. Chronic cough in COPD should be managed with
antitussives
Answer: C. Anticholinergic drugs inhibit nagally-mediated airway tone leading to bronchodilatation. The effect is small in normal airways but greater in airways of COPD patients which are structurally narrowed. However, it should be pointed out that the dilatation using antichoinergics will never return to its baseline
diameter.
80
55. True regarding the treatment of COPD
A. considering its pathophysiology, steroids should be a
major treatment among patients with COPD
B. can be cured with a combination drugs
C. The drug of choice for patients with COPD is anticholinergics like ipatropium
D. Chronic cough in COPD should be managed with
antitussives
Answer: C. Anticholinergic drugs inhibit nagally-mediated airway tone leading to bronchodilatation. The effect is small in normal airways but greater in airways of COPD patients which are structurally narrowed. However, it should be pointed out that the dilatation using antichoinergics will never return to its baseline diameter.
81
59. Which of the following quinolones does not have activity against respiratory tract infections?
a. Nalidixic acid
b. Ciprofloxacin
c. Levofloxacin
d. Moxifloxacin
Answer: A
Explanation: Nalidixic acid is not used to treat respiratory tract infections but it has a good activity against urinary pathogens
and Shigella.
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60. True of Streptomycin
| a. difficult to administer to patient
Answer: C
Explanation: The aminoglycosides irreversibly bind to the 30S ribosome and freeze the 30S initiation complex (30S-mRNA-tRNA), so that no further initiation can occur. Optic neuritis and inhibition of arabinoglycan synthesis are due to use of ethambutol. The adverse effects of streptomycin are nephrotoxicity and and ototoxicity and not hepatotoxicity and hyperuricemia.
83
True of rifampin except:
A.. Potent inducer of CYP450 system
B. Increases isoniazid hepatotoxicity
C. May cause withdrawal symptoms in narcotic addicts under methadone
D. Causes peripheral neuropathy
Answer: D.
Explanation: I quote Katzung, “Rifampin strongly induces most cytochrome P450 isoforms (CYPs 1A2, 2C9, 2C19, 2D6, and 3A4),
which increases the elimination of numerous other drugs including methadone, anticoagulants, cyclosporine, some
anticonvulsants, protease inhibitors, some nonnucleoside reverse
transcriptase inhibitors, contraceptives, and a host of others..” A
and D then are true.
I’m not sure about C but according to Katzung, peripheral
neuropathy is observed in 10–20% of patients given dosages of
Isoniazid greater than 5 mg/kg/d. That;s why we give pyridoxine
to prevent this from occurring, especially in slow acetylators.
84
62. Which is TRUE about isoniazid?
a. inhibits RNA polymerase
b. treatment once a week is ok
c. bactericidal against actively growing mycobacterium
d. ototoxic
Answer: C
Explanation: It is bactericidal against actively growing M.
tuberculosis but bacteriostatic against dormant organisms.
85
63. Which is false?
a. direct observation of drug intake is ideal during initial phase of
treatment of TB smear-positive cases.
b. fourth drug can be omitted during initial phase of treatment
for patient with non-cavitary smear-negative PTB, such as
children with primary TB.
c. contact of patient with culture proven MDR-TB should be
considered for early culture and sensitivity testing.
d. frequency of mutants to any single anti-TB drug is 1:10^20
bacteria, even without previous anti-TB therapy.
Answer: D
Explanation: It should be 1:10^6.`
86
Match the drug with its adverse effect.
64. Streptomycin
a. hyperuricemia and hepatotoxicity
b. optic neuritis
c. red orange urine
d. ototoxicity and nephro toxicity
e. seizure
Answer: D
Explanation: Ototoxicity is one of the main and distinguishing adverse effect of Streptomycin.
87
65. Ethambutol
a. hyperuricemia and hepatotoxicity
b. optic neuritis
c. red orange urine
d. ototoxicity and nephro toxicity
Answer: B.
Explanation: optic neuritis as indicated by trans on Pharma on antibiotics.
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66. Rifampicin
a. hyperuricemia and hepatotoxicity
b. optic neuritis
c. red orange urine
d. ototoxicity and nephro toxicity
e. seizure
Answer: C. red-orange urine.
Explanation: One of the adverse effects of Rifampicin aside from
causing hepatotoxicity, hypersensitivity reactions, and
hematologic abnormalities is causing body fluids to turn
orange/red-orange in color. TB patients should then be
reassured that when they will be taking their TB medications
(including Rifampicin), their urine, saliva, tears, sweat, etc. may
turn orange and that this is but normal.
89
66. Rifampicin
a. hyperuricemia and hepatotoxicity
b. optic neuritis
c. red orange urine
d. ototoxicity and nephro toxicity
e. seizure
Answer: C. red-orange urine.
Explanation: One of the adverse effects of Rifampicin aside from
causing hepatotoxicity, hypersensitivity reactions, and
hematologic abnormalities is causing body fluids to turn
orange/red-orange in color. TB patients should then be
reassured that when they will be taking their TB medications
(including Rifampicin), their urine, saliva, tears, sweat, etc. may
turn orange and that this is but normal.
90
67. Isoniazid
a. hyperuricemia and hepatotoxicity
b. optic neuritis
c. red orange urine
d. ototoxicity and nephro toxicity
d. seizure
Answer: E
Explanation: as indicated in the trans on antibiotics
91
68. Pyrazinamide
a. hyperuricemia and hepatotoxicity
b. optic neuritis
c. red orange urine
d. ototoxicity and nephro toxicity
e. seizure
Answer: A. Hyperuricemia and hepatotoxicity
Explanation: Hyperuricemia and hepatotoxicity are the adverse effects of pyrazinamide
92
66. A patient with severe persistent asthma is expected to have
the following medication for maintenance- daily use for several
weeks or months.
a. Oral Prednisone
b. Inhaled Salmeterol
c. Inhaled Sodium Cromoglycate
d. Ketotifen
Answer: b. inhaled salmeterol
Explanation: Sodium cromoglycate is a cromone and a mast cell
stabilizer; while Ketotifen is an antihistamine drug and prophylaxis
against allergic reactions; both of which are just “additional respiratory
drugs.” Prednisone, a form of systemic corticosteroid, is used for acute exacerbations and persistent asthma but not as maintenance. It is a mainstay in acute asthma but its effects are too systemic that it cannot be used for daily maintenance. Long-Acting Beta Adrenergic (LABA) is the drug of choice as maintenance for persistent asthma and Salmeterol is a LABA. But be wary, LABA should not be taken as a monotherapy. Try it with inhaled corticosteroids! ^__^
93
67. What must be given for acute asthma exacerbation:
A. inhaled LABA
B. inhaled SABA
c. inhaled steroids
d. systemic steroids
Answer B:
Short acting B2 agonists are the drugs of choice for treatment of acute asthma exacerbations and episodes.
94
68. the following are true statements regarding theophylline except:
a. it is chemically related to caffeine
b. it stimulates phosphodiesterase enzymes leading to increased
breakdown of cAMP
c. it is a competitive antagonist of adenosine for its receptor
d. it has a narrow margin of safety
Answer: B
Explanation: B is not true about theophylline. Theophylline is a phosphodiesterase enzyme inhibitor leading to decreased breakdown of cAMP.
95
69. You have a patient who is currently on high dose combination inhaled glucocorticosterois and LABA and has been on this regimen for the last 1 month with no symptoms and stable PEFR. The patient asks what to do next:
a. the inhaled agents can be discontinued
b. shift from the current combination to inhaled
glucocorticosteroids alone
c. maintain the current dose of inhaled glucocorticosteroids and LABA
d. decrease the dose of the combination to once a day
Answer: C
Explanation: Need at least 3 months before you change the dose, since full effect of the drug seen at least 1-3 months.
96
70. Drug whose main mechanism of action is inhibition of mast cell degranulation by altering the function of the delayed chloride ion channel in the cell membrane:
a. cromolyn sodium
b. montekulast
c. zileuton
d. ketotifen
A
97
72. which of the following is an expectorant?
a. ambroxol
b. mesna
c. guaiafenessin
d. carbocysteine
C
Explanation: ambroxol, mesna, and carbocysteine are all mucolytic agents. Only guiaifenessin is an expectorant.
98
73. the following are correct indications for using antitussies
except:
a. hemoptysis (cough out of blood) in cavitary PTB
b. irritative cough of bronchogenic carcinoma
c. cough due to pneumonia
d. cough due to pleural effusion
Answer: C. trans on Pharmacology of Common Respiratory Drugs.
Explanation: Indicators for using antitussives include: Dry painful cough
of neoplasia or pleural disease, Irritative cough in inflammation of the
respiratory tract (epiglottitis) and in hemoptysis (might exsanguinate).
DO NOT suppress in bacterial lung infections, asthma, bronchiectasis
(suppurating bronchial inflammation) or chronic bronchitis where
antitussives can cause harmful sputum thickening and retention
99
74. true regarding the action of antitussives except:
a. they are generally opioid derivatives
b. generally all of these agents cause constipation
c. addiction potential is equivalent for codeine, morphine,
dextromethorphan and butamirate
d. can thicken sputum and inhibit mucociliary clearance
Answer: C.
Explanation: Addiction potential for the said drugs are never equal to one another. Morphine has the most potential to addiction.
100
75. the following is true regarding the approach to the treatment of asthma
a. use only one drug whenever possible
b. use systemic drugs rather than local acting (inhaled) agents as maintenance therapy
c. avoid systemic administration of steroids during acute
exacerbation to avoid unwanted side effects
d. combination of drugs and chronic use of drugs is the general
rule
Answer: D
Explanation: a combination of drugs is the general rule to complement the weak points of every drug. For example, there are drugs that have fast onset/effect but do not have a long-lasting effect and there are drugs that have slow onset of effect but can be used for maintenance due to its long effect. Chronic use of drugs is also the general rule so that
asthma will not have the chance to recur and cause injury/inflammation
again which can leave scars.
101
61. Which of the following is TRUE about the action and properties of Omeprazole?
a. Reversibly binds to H+/K+ ATPase pump
b. Active in neutral pH
c. Administered as inactive prodrug
d. Cyclically inhibits gastric acid secretion
A
102
62. A potent laxative which increases peristalsis but can cause dependence and colonic atony and dilatation when
used chronically is which of the following:
a. Lactulose
b. Bisacodyl
c. Magnesium sulphate
d. Methylcellulose
B
103
63. A 65 yo man being treated for both pneumonia and gastroesophageal reflux disease was brought to the ER for syncope and pulselessness. The cardiac monitor showed Torsades de pointes. The most likely combination of drug he is taking is:
a. Erythromycin/Cisapride
b. Ciprofloxacin/Metoclopromide
c. Clarythromycin/Domperidone
d. Amoxicillin/Cisapride
A
104
64. Milk of Magnesia should be avoided in small children and patients with poor renal function because of the following adverse effect/s:
a. Heart block
b. Neuromuscular block
c. CNS depression
d. AOTA
D
105
65. Which of the following inhibits gastric acid secretion?
a. Gastrin
b. Acetylcholine
c. Somatostatin
d. Histamine
C
106
their mechanism of action?
a. Glycerin softens stool material allowing water and lipid to penetrate.
b. Bisacodyl increases volume of fluid in the lumen through osmosis.
c. Bulk laxatives promote peristalsis and defecation in 15-30 mins.
d. Lactulose increases water and electrolyte
secretion by the mucosa.
D
107
67. An antacid preparation which efficiently neutralizes acid but can cause diarrhea:
a. Aluminum hydroxide
b. Sodium bicarbonate
c. Calcium carbonate
d. Magnesium hydroxide
D
108
68. Properties which make proton-pump inhibitors ideal
drugs from the pharmacokinetic perspective include which
of the following?
a. Long serum half-life
b. Concentrated near the site of action
c. Short duration of action
d. AOTA
B
109
69. True of Racecadotril:
a. Increases intracellular cAMP
b. Increases level of Enkephalin
c. Increases secretion of water and electrolytes
d. Alters motility or duration of intestinal transit
B
110
70. A serotonin antagonist which prevents and treats
radiation therapy and chemotherapy induces emesis is
which of the following?
a. Cyclizine
b. Hyoscine
c. Ondansetron
d. Promethazine
```
D
Phenothiazines (group of drugs where promethiazine is included) are used for severe episodes of nausea and vomiting associated w/ vertigo, motion sickness, radiation, etc. The answer is doubtful since this group of drugs is under dopamine antagonists. Ondansetron is the drug under serotonin antagonists.
```
111
71. A 45-year old housewife being treated for diabetic gastroparesis and gastroesophageal reflux disease was noted by the class to have involuntary movements. The drug she is MOST LIKELY taking is which of the following?
A. Domperidone
B. Metoclopromide
C. Cisapride
D. Morphine
Answer: B
5-HT4 agonists and 5-HT3 antagonists like Metoclopromide cause extrapyramidal effects such as involuntary movements, dystonias, and parkinsonian-like movements. (GI PharmaPart 1 trans, p.5)
112
72. Which of the following drugs inhibits nocturnal more than meal-stimulated gastric acid secretion?
A. Ranitidine
B. Al(OH)3Mg(OH)2
C. Omeprazole
D. Bismuth subsalicylate
A
H2 blockers such as Ranitidine are excellent for nocturnal acid suppression (GI Pharma Part 1 trans, p.2 col. 1) That is why Ranitidine is usually taken before one sleeps.
113
“Melanosis coli” is a reversible side-effect of which drug?
A. Bismuth subcitrate
B. Senna
C. Bisacodyl
D. Attapulgite
Answer: B
Melanosis coli is the reversible brown pigmentation of the bowel on colonoscopy associated with chronic use of senna, a stimulant laxative.
114
Which of the following is INEFFECTIVE for cytotoxic drug-induced emesis?
A. Ondansetron
B. Dronabinol
C. Metoclopromide
D. Cyclizine
D
115
75. A 62-year old woman known to have Diabetes Mellitus
Type II is suspected to have diabetic gastroparesis for complains of heartburn and occasional vomiting. You decide to give Domperidone, the mechanism of action which includes the following:
A. Dopamine 1 (D1) receptor blockade
B. Decreased esophageal peristaltic amplitude
C. Increased LES pressure
D. Decreased gastric emptying
C
Domperidone is a D2 receptor blocker that increases esophageal peristaltic amplitude, LES pressure, and gastric emptying.
116
52 year old female with cholelithiasis who has not undergone cholestectomy will benefit from which of the following drugs
A. morphine
B. somatostatin
C. ursodeoxycholic acid
D. vasopressin
Answer: C ursodexycholic acid
Ursodexycholic acid or URSA is used to dissolve gallstones.
