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LEVEL II > PHARMA 2 > Flashcards

PHARMA 2 Flashcards

1
Q

Alkalization of urine by giving bicarbonate is used to treat patients presenting with acetylsalicylic acid (aspirin) overdose. Which of the following best describes the rationale for alkalization of urine in this setting?

A. To increase tubular reabsorption
B. To increase ionization
C. To decrease glomerular filtration
D. To decrease proximal tubular secretion

A

B. To increase ionization

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2
Q

The incidence and seriousness of the toxicity is proportionately related to the concentration of the drug in the body and to the duration of the exposure. Which of the following cases corresponds to its pharmacologic toxicity?

A. DM, 54/M, had phenobarbital overdose, presented at the ER for unilateral weakness
B. JJ, 40/F, had Nifedipine overdose, came in at the ER for dizziness and bradycardia but with normal BP
C. KJ, 18/M, had tardive dyskinesia after taking haloperidol for 4 weeks
D. All of the above

A

C. KJ, 18/M, had tardive dyskinesia after taking haloperidol for 4 weeks

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3
Q

Patient AR, 15/F, brought by her parents at the ER for deliberate ingestion of efficascent oil, approximately 15 mL mixed in ½ glass of milk. Patient is complaining of vomiting, nausea, dizziness, and tinnitus. Physical examination revealed RR of 26 cpm, BP 90/60 mmHg, HR 110 bpm. Arterial blood gas revealed mixed respiratory alkalosis with metabolic acidosis. Which of the following interventions must be initiated?

A. Give multiple dose activated charcoal
B. Do urine alkalinization by giving sodium bicarbonate drip
C. Get serum salicylate level and refer to nephrology service
D. All of the above

A

D. All of the above

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4
Q

The pathological toxicity (centrilobular hepatic necrosis) of paracetamol overdose is most likely caused by

A. NAPQI
B. Glutathione
C. N-acetylcysteine
D. All of the above

A

A. NAPQI

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5
Q

The following is/are TRUE about Idiosyncratic Reactions and Pharmacogenetic Contributions, EXCEPT

A. presentation of foreign hapten > immunotoxicological response
B. administration of a drug that is a CYP substrate in combination with a drug that is an inhibitor of the same CYP can lead to drug overdose toxicity
C. single nucleotide polymorphic variants in CYP3A4 and CYP2D6 alter drug half-life
D. isoniazid dosing for TB treatment should be lowered because Filipinos are slow acetylators

A

D. isoniazid dosing for TB treatment should be lowered because Filipinos are slow acetylators

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6
Q

Which of the following is TRUE about quantal dose response relationship?
A. There is a greater magnitude of response as the dose increases
B. The effect of the dose is judged to be either present or absent
C. It is not used to determine the LD50 of drugs
D. All of the above

A

B. The effect of the dose is judged to be either present or absent

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7
Q

Which of the following statement/s best describes the U-shaped dose-response curve?

A. It is a dose-response curve observed for chemotherapeutic drugs
B. At low dose, adverse effects is not observed
C. Surpassing the dose required to maintain homeostasis, overdose toxicity can ensue
D. All of the above

A

C. Surpassing the dose required to maintain homeostasis, overdose toxicity can ensue

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8
Q

Which of the following is a measure of drug safety?

A. TD50/ED50
B. ED50
C. Emax
D. EC50

A

A. TD50/ED50

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9
Q

Which of the following is TRUE about therapeutic index?

A. There is no difference between the slopes of the dose response curves for the therapeutic and lethal effects
B. The margin of safety is large if the ratio of median lethal dose and effective dose is < 1
C. The higher the ratio between the LD50 and ED50, the safer the drug
D. Cardiac glycosides and cancer chemotherapeutic agents have large therapeutic index

A

C. The higher the ratio between the LD50 and ED50, the safer the drug

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10
Q

In the subset of pediatric exposures (age < 5 years), cosmetic/personal care products and household cleaning products accounted for 25% of cases. Which of the following must be prioritized as a home remedy?

A. Give sugar and milk
B. Always induce vomiting
C. Do external decontamination
D. Always administer activated charcoal

A

C. Do external decontamination

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11
Q

Patient RR, 34/M, brought at the ER for deliberate ingestion of unknown medications. On physical examination, the patient was lethargic, BP of 80/40 mmHg, 139 beats per minute, cold clammy skin. Patient was given inotropes and vasotropes after fluid hydration but the BP is still 80/60 mmHg. Patient was then given calcium gluconate 6 grams and the BP becomes 110/70 mmHg. What is the most possible toxicant?

A. Beta blockers
B. Losartan
C. Verapamil
D. Amlodipine

A

D. Amlodipine

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12
Q

Potential candidates for whole-bowel irrigation include the following, EXCEPT

A. patients with deliberate ingestion of toxic enteric coated tablets
B. patients who have ingested household cleaners
C. patients with iron overdose
D. “body packers” with intestinal packets of illicit drugs

A

B. patients who have ingested household cleaners

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13
Q

Patient DD, 28/M, was brought at the ER because of anxiety, restlessness, and palpitation after bar hopping. On physical exam, he had a BP of 140/90 mmHg, sweating, and dilated pupils. What toxicant is most possibly involved?

A. Diphenhydramine
B. Marijuana
C. Heroin
D. Methamphetamine

A

D. Methamphetamine

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14
Q

Patient BB, 28/F. rushed to the ER for hallucination, restlessness and palpitation 4 hours after the break-up with her boyfriend. On the physical exam, she had a BP of 140/90 mmHg, flushed skin and dilated pupils. What toxicant is most possibly involved?

A. Heroin
B. Diphenhydramine
C. Ethanol
D. Marijuana

A

B. Diphenhydramine

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15
Q

Select the corresponding antidote:
Cyanide poisoning

A. Sodium nitrate and thiosulfate
B. Deferoxamine
C. Dantrolene
D. High dose insulin
E. Flumazenil
A

A. Sodium nitrate and thiosulfate

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16
Q

Select the corresponding antidote:
Iron toxicity

A. Sodium nitrate and thiosulfate
B. Deferoxamine
C. Dantrolene
D. High dose insulin
E. Flumazenil
A

B. Deferoxamine

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17
Q

Select the corresponding antidote:
Malignant hyperthermia

A. Sodium nitrate and thiosulfate
B. Deferoxamine
C. Dantrolene
D. High dose insulin
E. Flumazenil
A

C. Dantrolene

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18
Q

Select the corresponding antidote:
Severe amlodipine overdose

A. Sodium nitrate and thiosulfate
B. Deferoxamine
C. Dantrolene
D. High dose insulin
E. Flumazenil
A

D. High dose insulin

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19
Q

Select the corresponding antidote:
Diazepam toxicity

A. Sodium nitrate and thiosulfate
B. Deferoxamine
C. Dantrolene
D. High dose insulin
E. Flumazenil
A

E. Flumazenil

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20
Q

Patient JS, 23/female, 45 kg, brought at the ER for the deliberate ingestion of 50 tablets of aspirin and 20 tablets of paracetamol (500 mg/tablet) 2 hours prior to admission. If you are the ER physician, the plan would be (MULTIPLE ANSWERS)

A. do gastric lavage with activated charcoal since the ingestion causes spasm in the pyloric valve
B. give multiple dose activated charcoal
C. give cathartics for severe electrolyte imbalance
D. none of the above

A

A. do gastric lavage with activated charcoal since the ingestion causes spasm in the pyloric valve
B. give multiple dose activated charcoal

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21
Q

Upon doing descriptive toxicity testing in animals, which of the following must be considered?

A. Human beings generally are more vulnerable than experimental animals
B. Effects of chemicals produced in laboratory animals is always equal to human toxicity
C. Exposure of experimental animals to toxic agents in high doses is not necessary
D. All of the above

A

B. Effects of chemicals produced in laboratory animals is always equal to human toxicity

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22
Q

Which of the following types of dose-response curves is observed with synthetic estrogen?

A. Hockey stick-shaped
B. Conventional
C. U-shape
D. Inverted U-shaped

A

D. Inverted U-shaped

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23
Q

A 30-year-old farmer was brought to the emergency room due to abdominal pain and vomiting. He recalled that the symptoms occurred minutes after he drank the contents of a bottle of fluid on top of their dinner table. He recounted that it had a weird taste but still continued drinking due to excessive thirst. Pertinent examination findings include normal vital signs except for an increase in respiratory rate. He was in stupor, had miotic pupils and excessive drooling of saliva and had wet pants. This is a case of which type of toxicity?

A. Cholinergic toxicity
B. Atropine overdose
C. Opioid overdose
D. Sympathomimetic toxicity

A

A. Cholinergic toxicity

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24
Q

Sulfonamide-induced granulocytopenia is an example of which type of hypersensitivity reaction?

A. III
B. I
C. IV
D. II

A

D. II

25
Q

Match the antidote to its indication.
Naloxone hydrochloride:

A. Methotrexate
B. Acetaminophen
C. Valproic acid
D. Morphine

A

D. Morphine

26
Q

Match the antidote to its indication.
Acetylcysteine::

A. Methotrexate
B. Acetaminophen
C. Valproic acid
D. Morphine

A

B. Acetaminophen

27
Q

Match the antidote to its indication.
Leucovorin calcium:

A. Methotrexate
B. Acetaminophen
C. Valproic acid
D. Morphine

A

A. Methotrexate

28
Q

A drug is ideally removed by hemodialysis when it has low:

  1. Protein-binding
  2. Molecular weight
  3. Volume of distribution
  4. Solubility in water
A
  1. Protein-binding
  2. Molecular weight
  3. Volume of distribution
29
Q

Which of the following poisons is correctly paired to its adsorbent?

  1. Paraquat – Fuller’s earth
  2. Thallium – Sodium polystyrene
  3. Cesium – Prussian blue
  4. Lithium – Actvated charcoal
A
  1. Paraquat – Fuller’s earth

3. Cesium – Prussian blue

30
Q

A 19-year male was brought to the emergency room after allegedly ingesting 20 tablets of paracetamol. He was awake, coherent and had apparently normal vital signs. When the patient’s vital physiological functions were maintained, the emergency physician decided to do gastric lavage with normal saline solution. What is the maximum volume of the lavage fluid that should be administered and withdrawn for this patient? (Assume patient’s weight is ~50kg.)

A. 250
B. 750
C. 50
D. 500

A

A. 250

31
Q

Which among the following substances is most frequently involved in pediatric poisoning exposures?

A. Vitamins
B. Anti-depressants
C. Antihistamines
D. Analgesics

A

D. Analgesics

32
Q

Which of the following substances induces vomiting by acting on the area postrema of the medulla?

  1. Emetine
  2. Polyethylene glycol
  3. Cephaeline
  4. Magnesium citrate
A
  1. Emetine

3. Cephaeline

33
Q

Intake of ethanol leading to increased susceptibility to acetaminophen poisoning after overdose is an example of which type of drug-drug interaction?

A. Interaction of absorption
B. Interaction of metabolism
C. Interaction of protein binding
D. Interaction of receptor binding

A

B. Interaction of metabolism

34
Q

Drug A produces a response quantified as x while drug B produces a response quantified as y. When both drugs are taken and produce a response which is equal to (x + y), then the interaction is:

A. Additive
B. Chemically antagonistic
C. Synergistic
D. Functionally antagonistic

A

A. Additive

35
Q

“How long will it take an intoxicated patient to get better” is a matter of the offending drug’s:

  1. Metabolism
  2. Absorption
  3. Excretion
  4. Distribution
A
  1. Metabolism

3. Excretion

36
Q

A 23-year old male was brought to the emergency by his girlfriend because of restlessness and tremors. Pertinent physical findings include increased blood pressure, tachycardia and excessive sweating. Close examination of the patient’s pupils reveals mydriasis. The patient is most likely suffering from toxicity of which substance?

A. Cocaine
B. Heroin
C. Diazepam
D. Nicotine

A

A. Cocaine

37
Q

What is the most common adverse effects noted with the penicillins?

A. Nephrotoxicity
B. Bleeding
C. Diarrhea
D. Hypersensitivity Reaction

A

D. Hypersensitivity Reaction

38
Q

Which metabolic derangement is significantly associated with urine alkalinization for severe salicylate poisoning?

A. Hypokalemia
B. Hyponatremia
C. Hypercalcemia
D. Hyperchloridia

A

A. Hypokalemia

39
Q

Which of the following is an example of a concentration-dependent agent?

A. Aminoglycosides
B. Monobactams
C. Penicillins
D. Cephalosporins

A

A. Aminoglycosides

40
Q

A patient taking Co-trimoxazole (a sulfonamide) had prolonged exposure to sunlight and developed signs and symptoms of phototoxicity. This is an example of which type of toxicity?

A. Carcinogenic
B. Pharmacological
C. Mutagenic
D. Pathological

A

B. Pharmacological

41
Q

Which of the following types of dose-related curves is compatible with formaldehyde?

A. Conventional
B. Hockey-stick curve
C. U-shaped curve
D. Inverted U curve

A

B. Hockey-stick curve

42
Q

When drug A produces a response designated x and drug B produces a response designated B, when both drugs are taken and produce a response greater than (x+y), the interaction is:

A. Additive
B. Synergistic
C. Allosteric antagonism

A

B. Synergistic

43
Q

Which of the following steps precede the others in selecting a P-drug?

A. Start of Treatment
B. Define diagnosis
C. Specify the therapeutic objective
D. Choosing an effective group according to criteria

A

B. Define diagnosis

44
Q

Which of the following should be considered LEAST when selecting a P-drug?

A. Good scientific evidence
B. National list of essential drugs
C. Existing standard treatment guidelines
D. Endorsements from medical representatives

A

D. Endorsements from medical representatives

45
Q

Which of the following is considered the first selection criterion when choosing an effective group of drugs?

A. Cost of treatment
B. Efficacy
C. Safety
D. Suitability

A

B. Efficacy

46
Q

A 3 year old girl was brought to the clinic because of watery diarrhea for three days. She had no fever and vomiting. She was afebrile, appeared undernourished and had tachycardia and poor skin turgor. Which of the ff is the main therapeutic objective for this case?

A. To give prophylaxis
B. To cure the infection
C. To prevent dehydration

A

C. To prevent dehydration

47
Q

A 19 year old patient was brought to the emergency room after allegedly ingesting 20 tablets of paracetamol. He was awake, coherent and had normal vital signs. Which of the following is necessary for the patients at this time?

A. Naloxone administration
B. Gastric emptying with syrup of Ipecac
C. Maintain oxygenation and ventilation
D. Pharmacological blood pressure support

A

C. Maintain oxygenation and ventilation

48
Q

Which of the following substances is/are responsible for the greatest number of human fatalities?

  1. Sedatives/hypnotics
  2. Antidepressants
  3. Anti-psychotics
  4. Antihistamines
A
  1. Sedatives/hypnotics
  2. Antidepressants
  3. Anti-psychotics
49
Q

Which is/are the following belong to the five rights of safe medication:

  1. right drug
  2. right dose
  3. right route
  4. right brand
A
  1. right drug
  2. right dose
  3. right route
50
Q

Which of the following strategies is are implemented in passive poisoning prevention?

  1. Develop special precaution on high risk drugs
  2. Change product formulation
  3. Develop technological based standards
  4. Prevent access to poison
A
  1. Change product formulation

4. Prevent access to poison

51
Q

Remains therapeutically effective and safe strategies for decontamination of the poisoned patient.

  1. Administration of activated charcoal
  2. Whole-bowel irrigation of sorbitol
  3. Gastric lavage
  4. Gastric emptying
A
  1. Administration of activated charcoal

3. Gastric lavage

52
Q

Penicillin-induced hemolytic anemia

A. type 1
B. type 2
C. type 3
D. type 4

A

B. type 2

53
Q

Allergic Reactions Histamine induced inflammatory response

A I
B II
C III
D IV

A

A I

54
Q

Antibiotic-induced serum-like sickness

A. Type I
B. Type II
C. Type III

A

C. Type III

55
Q

Phenytoin toxicity in hypoalbuminemia

A. Interaction of absorption
B. Interaction of protein binding
C. Interaction of receptor binding
D. Interaction of metabolism
E. Interaction of therapeutic action
A

B. Interaction of protein binding

56
Q

Concomitant use of aspirin and heparin increases the risk for bleeding.

A Interaction of absorption
B Interaction of protein binding
C Interaction of receptor binding
D Interaction of metabolism
E Interaction of therapeutic action
A

E Interaction of therapeutic action

57
Q

Hypersensitivity to Penicillin

A. initiated by hapten
B. mediated by IgE
C. initiated by Th2
D. mediated by IgG and IgM

A

D. mediated by IgG and IgM

58
Q

Match the antidote to its indication.
Naloxone hydrochloride:

A. Methotrexate
B. Acetaminophen
C. Valproic acid
D. Opioids

A

D. Opioids

59
Q

Match the antidote to its indication.
sodium thiosulfate

A. Methotrexate
B. Acetaminophen
C. Valproic acid
D. Opioids
E. Cyanide
A

E. Cyanide

LEVEL II (16 decks)

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