Pharmacology and toxicology

Question 1

RACP 2022a 1.
Which AED needs to be weaned slowly to avoid withdrawal complication?
a. Barbiturate
b. Benzodiazepine
c. Gabapentin
d. Sodium valproate

Question 2

RACP 2022a 23.
29 yo Female has bipolar disorder and is trying is get pregnant. What
medication or medication class should she take to prevent manic relapses
and teratogenicity?
a. Anti-psychotics
b. Benzodiazepines
c. Lithium
d. Mood stabilisers

Question 3

RACP 2022a 26.Woman with infection, receiving novel antibiotic with dose-related toxicity.
Effect measured by time above MIC. eGFR was 90mL/min on admission, and she had an AKI with drop to 30mL/min. The drug is normally 40% excreted unchanged in bile and 60% excreted unchanged renally. The drug was given
100mg/24h but what dose should you now adjust to?
a. 33mg 24hrly
b. 40mg 24hrly
c. 60mg 24hrly
d. 100mg 48hrly

Question 4

RACP 2022 41.What happens to azathioprine metabolites if a patient also takes allopurinol?
a. 6MMT increases, 6-TGN increases
b. 6-MMT increases, 6-TGN decreases
c. 6-MMT decreases, 6-TGN increases
d. 6-MMT decreases, 6-TGN decreases

Question 5

RACP 2022b 7. What is the receptor for midodrine?
A. Alpha 1
B. Alpha 2
C. Alpha 1 and 2
D. Beta 1 and 2

Question 6

RACP 2022a 11. How does probenecid affect the clearance of cephazolin
A. Increased renal tubular reabsoprtion
B. Increased glomerular filtration
C. decreased tubular secretion

Question 7

RACP 2022b 19. What is the mechanism of dexmedetomidine?
A. Alpha 2 receptor
B. NMDA
C. 5HT3
D. Beta receptor

Question 8

RACP 2022b 21. (Past question) Where does CDK4/6 work in the cell cycle?
A) G1 to S
B) S to G2
C) G2 to M
D) M to G1

Question 9

RACP 2022b 26. What is the most psychoactive component of cannabis?
A. Cannabidiol
B. Tetrahydrocannabinol

Question 10

RACP 2022b 46. Which of these drugs has the most anticholinergic effect?
A. Solifenacin
B. Prochlorperazine

Question 11

RACP 2022b 47. Abnormalities of which receptor is implicated in alcohol withdrawal seizures?
A. NMDA
B. GABA
C. Noradrenaline

Question 12

RACP 2022b 54. What serum marker is increased with commencent of angiotensin receptor-
neprilysin inhibitors (ARNI)?

A. BNP
B. NT-proBNP
C. ADH

Question 13

RACP 2022b 66. EMQ: What receptor does this antiemetic act on? Ondansetron
A. 5-HT3
B. Dopamine
C. NK-1
D. Histamine
E. Acetylcholine

Question 14

RACP 2022b 67. EMQ: What receptor does this antiemetic act on? Aprepitant
A. 5-HT3
B. Dopamine
C. NK-1
D. Histamine
E. Acetylcholine

Question 15

RACP 2021a Q6. A 70 year old male with a history of Parkinson’s disease presents with nausea and vomiting. Which of the
following medications would most likely cause an exacerbation of the patient’s Parkinson’s disease?
A. Cyclizine
B. Metoclopramide
C. Domperidone
D. Ondanestron

Question 16

RACP 2021a Q35. A 24yo male presents with dystonia after being administered haloperidol. What medication should be given
to reverse the dystonia?
A. Diazepam
B. Benztropine
C. Propranolol
D. Phenytoin

Question 17

RACP 2021a Q53. A patient “Mr X” is given digoxin 1000 μg in 3 divided doses at 12 pm, 4 pm and 8 pm on day 1. From day 2,
he is given 250 μg daily. The half life of digoxin is approximately 24 hours.
What day will his digoxin level reach its steady state at the earliest?
A. Day 2
B. Day 7
C. Day 10
D. Day 12

Question 18

RACP 2021 Q69. A patient is on a vancomycin infusion for MSSA bacteremia. You are given some data:
Target concentration 20mg/L
Half life is 6 hours
Vd is 0.5L/kg
Bioavailability <5
Protein binding 30%
Patient weight 60kg
+ other information about insensible clearance
What is the maintenance dose?
A. 2mg/hr
B. 5mg/hr
C. 85mg/hr
D. 120mg/hr

Question 19

RACP 2021b Q102. A new drug (drug B) is being manufactured and marketed by a pharmaceutical company which they say will
increase compliance when compared to the current drug (drug A) on the market. The drug company says this is
because the new drug will be “metabolised slower”. They provide this pharmacokinetic information:

The dosing interval was proportional to the elimination half-life for both drugs. Drug A is dosed three times daily.
Based on the following properties, what should drug B be dosed at?
A. Once a day
B. Twice a day
C. Three times a day
D. Four times a day

Question 20

RACP 2021b Q110. What is the predominant metabolic pathway in the metabolism of isoniazid?
A. Acetylation
B. CYP450
C. Glycine conjugation
D. Sulfination

Question 21

RACP 2021b Q111. In a patient with nephrogenic diabetes insipidus due to lithium, adjunctive treatment with amiloride will
help by blocking transport of which ion?
A. Calcium
B. Chloride
C. Potassium
D. Sodium

Question 22

RACP 2021b Q115. What is the site of action of sulfonylurea drugs on pancreatic beta cells?
A. AMP kinase enzyme
B. ATP sensitive potassium channels
C. Glucokinase enzyme
D. Insulin storage vesicles

Question 23

RACP 2021b Q120. A concentration-time curve is shown for Drug A and Drug B with identical bioavailability and AUC in a person with normal renal function.
What is the reason for Drug B having a different curve to Drug A?
A. Increase in clearance
B. Decrease in clearance
C. Increase in volume of distribution
D. Decrease in volume of distribution.

Question 24

RACP 2021b Q125. What is the most important pharmacological determinant for penicillin in terms of its bacterial eradication
and clinical response?
A. AUC:MIC ratio
B. Time above MIC
C. Peak concentration
D. Trough level

Question 25

RACP 2021b Q147. What is the mechanism of action of omalizumab?
A. Blocks IgE from binding to mast cells and eosinophils
B. Blocks IgE production
C. (Rhubarb)
D. (Rhubarb)

Question 26

RACP 2021b Q148. Acute opioid withdrawal has been reported in patients with end stage liver disease when administered
oxycodone-naloxone combination. This is best explained by:
A. Augmentation of endogenous partial agonists
B. Increased absorption due to gastric hyperaemia and gut oedema
C. Increased volume of distribution
D. Shunting of portal circulation to systemic circulation

Question 27

RACP 2021b Q158. Which neurotransmitter activates NMDA receptors?
A. Acetylcholine
B. GABA
C. Glutamate
D. Glycine

Question 28

RACP 2021b Q161. Which antidepressant has longest half-life?
A. Citalopram
B. Paroxetine
C. Fluoxetine
D. Sertraline

Question 29

RACP 2021b Q164. A patient is started in Rifampicin, Isoniazid, Pyrazinamide and Ethambutol for confirmed active TB. Which
complication of ethambutol would warrant stopping treatment with this agent?
A. Hepatitis
B. Optic neuritis
C. Adrenal failure
D. Seizures

Question 30

RACP 2021o 25. What is the most common side effect of ticagrelor that leads to it needing to
be ceased?
a. Diarrhea
b. Nausea
c. Dyspnea
d. Dizziness

Question 31

RACP 2021o 27. Question on the two tenofovir types. TDF is used less due to its effect on the
renal function. What is the other reason why TDF is less preferred over TAF?
a. Hepatotoxicity
b. Cardiomyopathy
c. Stomach upsets
d. Osteoporosis

Question 32

RACP 2021o 38. Why is lamotrigine effectiveness reduced in pregnancy?

A. Estrogen increases the clearance of lamotrigine by inducing the liver
enzymes involved in its metabolism.
B. Pregnant women are more tired due to lack of sleep secondary to
abdominal pain
C. Increased plasma volume leading to increased excretion of lamotrigine
from kidneys
D. Interaction with rhubarb

Question 33

RACP 2021o 41. Dabigatran affects testing of which lupus antibody procoagulant
a. lupus anticoagulant
b. beta 2 microglobulin
c. anti cardiolipin
d. anti thrombin

Question 34

RACP 20210 76. Which antipsychotic medication has the highest risk of seizures among
the elderly?
a. Clozapine
b. Quetiapine
c. Risperidone
c. Olanzapine

Question 35

RACP 2021o 77. Low dose Adrenaline (0.1mcg/kg) works on which receptors?
a. Alpha 1
b . Alpha-1, Beta-1 and Beta-2 receptors equally
b. Beta-1 d. Beta-2

Question 36

RACP 2021o 78. What pharmacokinetic/pharmacodynamic properties determine the
efficacy of Vancomycin?
a. AUC: MIC Ratio
b. Peak level:MIC ratio
c. Time above MIC
d. Trough level: MIC ratio

Question 37

RACP 2021o 79. What pharmacokinetic/pharmacodynamic parameters determine efficacy
of penicillin drugs in treatment of staph?
a. AUC:MIC ratio
b. Time above MIC.
c. Peak Level

Question 38

RACP 2021o 80. Antihypertensive medication exerting effects after medicine has stopped.
What is this effect called?
a. Hawthorne
b. Legacy

Question 39

RACP 2021o 99. Where does Lignocaine work
a. Voltage gated sodium channels
b. Voltage gated calcium channels
c. Potassium channels
d. Calcium channel

Question 40

RACP 2021o 101. What is the mechanism of action of Ethanol in Methanol poisoning?
a. increasing the clearance of Methanol
b. eliminating toxic products
c. reducing the metabolism of methanol
d. decreasing absorption of methanol

Question 41

RACP 2021o 113. Where is the target of action of romosumumab in osteoporosis
a. RANK
b. sclerostin
c. osteoblasts
d. rhubarb

Question 42

RACP 2021o
Commonest side effects of CTLA inhibitors
-dermatitis
-colitis
-hepatitis
-thyroiditis

Question 43

RACP 2020a 6. In acute seizures, certain medications are used including diazepam, lorazepam, phenytoin and
phenobarbital. Which of the following cannot be used to control seizures due to lidocaine
(lignocaine) toxicity?
A) Diazepam
B) Oxazepam
C) Phenobarbital
D) Phenytoin

Question 44

RACP 2020a 15. What is the most common side effect of osteltamivir?
A) Hepatitis
B) Rash
C) Nausea and vomiting
D) Confusion

Question 45

RACP 2020a 25. What is the dose of thiamine for Wernicke's encephalopathy?
A) 100mg oral three times a day
B) 300mg oral three times a day
C) 300mg IV daily
D) 300mg IV three times a day

Question 46

RACP 2020a 34. Analgesics, antibiotics, antidepressants and antithrombotics represent 50% of the
presentations to Australian EDs involving adverse drug reactions. Which of them represents the
largest proportion?
A) Analgesics
B) Antibiotics
C) Antidepressants
D) Antithrombotics

Question 47

RACP 2020a 36. What is the most common presentation of gentamicin induced ototoxicity?
A) High frequency hearing loss
B) Low frequency hearing loss
C) Oscillopsia + vertigo
D) Ataxia + vertigo

Question 48

RACP 2020a 47. A table was given with gabapentin euqivalence dosing to pregabalin; gabapentin 300 -
pregabalin 75, gabapentin 600 - pregabalin 150, gabapentin 900 - pregabalin 225, gabapentin
1800 - pregabalin 300, gabapentin 3600 - pregabalin 275 (ie jump in gabpentin dose to double at
900mg, but linear increase for pregabalin). What is the reason for this?
A) Gabapentin has a saturable absorption vs pregabalin does not
B) The is a difference in the volume of distribution (it specified which way)
C) Higher clearance for gabapentin compared to pregabalin
D) ? Difference in protein binding (could have been something else - not remembered well)

Question 49

RACP 2020a 70. What is the half life of levothyroxine (thyroxine)?
A) 1 day
B) 7 days
C) 21 days
D) 42 days

Question 50

RACP 2020a 71. In the treatment of hyperkalaemia the mechanism of action of Calcium chloride is
A) Membrane antagonism
B) Increase urinary excretion of potassium
C) Increased intracellular shift of potassium
D) Reduced potassium absorption

Question 51

RACP 2020a 74. Clozapine therapy may be complicated by myocarditis. What is the predominant cellular
infiltrate seen in clozapine-associated myocarditis?
A) Giant cell
B) Eosinophil
C) Lymphocyte
D) Neutrophil

Question 52

RACP 2020a 75. When therapeutic dose of paracetamol is administered, the blood concentration usually takes 2
hours to peak. If someone is overdosed on paracetamol e.g. taken 50g, it takes more than 6 hours
to peak. What is the reason for this?
A) Given NAC
B) Given charcoal
C) Delayed absorption
D) Delayed elimination

Question 53

RACP 2020a 76. An 80M with T2DM was commenced on Metformin by his GP. Which of the following vitmain is
he at risk of becoming deficient of?
A) B12
B) B6
C) Vit C
D) Vitamin D

Question 54

RACP 2020a 77. Methotrexate used in RA and other inflammatory diseases. Which enzyme does methotrexate
inhibit ?
A) Dihydrofolate reductase
B) Dihyroorotate reductase
C) Inosine monophosphate dehydrogenase
D) Thiopurine methyltransferase

Question 55

RACP 2020a 78. What is the mechanism of action of Terlipressin?
A) Splanchnic vasodilation
B) Splanchnic vasoconstriction
C) Systemic vasodilation
D) Systemic vasoconstriction

Question 56

RACP 2020a 83. What is the main mechanism of action of metaraminol?
A) Alpha 1 agonist
B) Alpha 2 agonist
C) Beta 1 agonist
D) Beta 2 agonist

Question 57

RACP 2020a 13. What pathway does PARP inhibitors act on?
A) Base excision repair
B) Double stranded repair recombinase pathway
C) Nucleotide Excision repair
D) CDK4/6

Question 58

RACP 2020 26. Which antibiotic is most associated with QT prolongation?
A) Ceftriaxone
B) Amoxicillin
C) Gentamicin
D) Ciprofloxacin

Question 59

RACP 2020 27. Which antidepressant is most associated with cholinergic side effects?
A) MAO Inhibitors
B) SNRIs
C) SSRIs
D) Tricyclics

Question 60

RACP 2020 36. Pirfenodine, an anti-fibrotic agent, has been shown to reduce rate of decline in which
condition?
A) Sarcoidosis
B) Silicosis
C) Idiopathic pulmonary fibrosis

Question 61

RACP 2020 40. Pharmacology question - What is the bioavailability of this drug. Table provided of AUC / DOSE
/ Volume of distribution / [something else]: 100mg PO dose -> AUC: 50. 10mg IV dose of -> AUC
5.
A) 20%
B) 33%
C) 50%
D) 100%

Question 62

RACP 2020 43. Proton pump inhibitors are associated with which complication?
A) Hypophopshatemia
B) Hypomagnesemia
C) Hypocalcemia
D) Hypokalemia

Question 63

RACP 2020 48. What does TXA bind to?
A) Fibrin
B) Factor 10
C) Plasminogen
D) Thrombin