pharmacologymcq

7/25/2019 PharmacologyMCQ

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1. An AIDS patient, who is being treated with multiple drugs, develops breast hypertrophy, central adiposity, hyperlipidemia, insulin resistance

and nephrolithiasis. If these changes are related to his drug treatment, this drug belongs to which group of anti-retroviral drugs?

a !ucleoside "everse #ranscriptase Inhibitors $NRTIS

b !on-nucleoside "everse #ranscriptase Inhibitors $!!"#IS

cFusion Inhibitors

dProtease Inhibitors

e Integrase Inhibitors

1. A %& year old 'I( positive male patient comes to the )*D with complaint of anore+ia, nausea and vomiting and abdominal pain. 'is

abdomen is tender in the epigastric area. aboratory results reveal a raised serum amylase activity and a preliminary diagnosis is made of acute

pancreatitis. hich of the following anti-retroviral drugs has the patient most liely been taing?

a Sa/uinavir

b 0idovudine

c Didanosine

d faviren2

e nfuvirtide

3. A 45 year old 'I( positive patient is receiving 'AA"# regimen $'ighly active anti-retroviral therapy. 6our wees after initiating therapy, he

comes to the emergency department complaining of severe pain in the flan, nausea and fre/uent urination. hich one of the following drugs is

most liely the cause of his symptoms?

a 0idovudine

b Indinavir

c faviren2

d !evirapine

e !elfinavir

%. A %5 year old man is recently diagnosed with 'I( and therapy is started. After the first wee of therapy, the patient complains of headaches,

irritability, and nightmares. hich one of the following anti-retroviral drugs is most liely to be causing these symptoms?

a faviren2

b Indinavir

c amivudine

d !evirapine

e Stavudine

4. A %& year old woman is diagnosed with chronic hepatitis 7 infection and therapy is initiated. 8ust after a few hours she comes to the

emergency department complaining of fever, chills and muscle aches. hich one of the following drugs most liely caused these symptoms?

a amivudine

b Adefovir

c ntecavir

d Interferon alfa

e "ibavirin

9. A 95 year old man with nown history of *arinson:s disease is to receive prophyla+is against Influen2a A virus. 'e is given a drug that is

useful against *arinson:s disease as well for prophyla+is against influen2a. #he drug with which of the following mechanisms of action is most

liely to have been given?

a It prevents entry and penetration of the virus

b It prevents uncoating of the virus

c It prevents replication of the virus

d It prevents assembly of newly synthesi2ed virus particles

e It prevents release of the newly synthesi2ed virus

;efuro+ime sodium

b Amo+icillinclavulanate potassium

c *enicillin (

d Ampicillin sodiumSalbactam sodium

e #icarcillin disodiumclavulanate potassium

;@. An antibiotic is distributed in total body water and has an eliminationhalf life of 4& minutes. hich one of the following statements is

consistant with that observation?

a #he drug is stored in high concentration in fat

b #he rapid rate of disappearance rules out metabolism of the drug by the liver

c #he drug is actively transported into tubular urine
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d #he drug cannot be bound to plasma proteins

e #he drug is eliminated only by glomerular filtration

;. hich one of the following is indicated for treatment of chlamydial urethritis during pregnancy?

a Amo+icillin $Amo+il

b *enicillin (

c rythromycin base

d Do+ycycline $Bonodo+

eTetracycline

;15. A 3&-year-old male has a dental infection associated with facial swelling and lymphadenopathy. hich one of the following is the most

appropriate antibiotic?

a >ephale+in

b #etracycline

c *enicillin $note= watch an animation onpenicillin mechanism of action

d rythromycin

e Centamicin

;11. A 19-year-old se+ually active nulliparous white female complains of pelvic pain and vaginal discharge. )n e+amination she is found to have

a temperature of %.@ > $153.5 6, pain with movement of the cervi+, and tenderness and a mass in the right adne+a. hich one of the

following treatment would be appropriate?

a )utpatient treatment with penicillin C procaine ,intramuscularlyE probenecid orallyE plus do+ycycline $(ibramycin orally for 14 days and

ree+amination in % days

b )utpatient treatment with ceftria+one intramuscularlyE probenecid orallyE plus do+ycycline twice a day for 14 days and ree+amination in 1

wee

c )utpatient treatment with cefo+itin intramuscularlyE plus do+ycycline twice a day for 14 days and ree+amination in 15 days

d 'ospitali2ation for treatment with cefo+itin intravenously and do+ycycline orally or intravenously, then do+ycycline orally twice a day to

complete 14 days of treatment

e rythromycin 3 grams orally as a single dose

;13. A drug that may cause nephroto+icity, is=

a *enicillin C

b rythrocin

c Centamycin

d >efuro+ime

e *enicillin (

;1%. hich one of the following is a common early side effect of *enicillin?

a >onstipation

b oss of appetite

c )rthostatic hypotension

d Atrioventricular bloc

e Sin rash

;14. hich of the following might be seen in patient of #7, who has regularly been inFecting intramuscular inFection of streptomycin=

a Depression

b Sialorrhea

c Increased serum alanine aminotransferase

d *riapism

e Deafness

;1&. Significant negative interaction has been nown to occur between the following drugs if given concurrently=

a *enicillin C GampE *enicillin (

b *enicillin GampE tetracycline

c *enicillin GampE Centamycin

d *enicillin GampE >lavulanic acid

e #icarcillin GampE >lavulanic acid

;19. hich of the following is !)# a recogni2ed complication of ampicillin to+icity=

a 'emolytic anemia

b Diarrhea

c !ausea

d )vergrowth of gram-positive organisms

e (entricular fibrillation

;1


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c !eomycin by oral route

d *enicillin ( by oral route

e >efepime by I( route

;1@. #elithromycin=

a Is structurally related to tetracycline

b Is structurally related to beta lactam antibiotics

c Is structurally related to aminoglycosides $note= see an animation onaminoglycosides mechanism of action

d 7inds more tightly to ribosomes and so it is a poor substrate for bacterial efflu+ pumps that mediateantibiotic resistance

e Is used for H#I

;1. Do+ycycline is used=

a for *neumonia as drug of 1st choice

b for the prevention of #7

c for the prevention of malaria

d for the prevention of leprosy

e for the treatment of se+ually transmitted diseases

;35. >lindamycin=

a is chemically related to macrolides

b binds to %5S ribosomal subunit

c is not recommended for oral route

d cross-resistance may be observed between macrolides and >lindamycin

e is e+creted in breast mil

;31. hich of the following statement is true=

a nafcillin is beta-lactamase resistant antibiotic

b cefa2olin is second generation cephalosporin

c ta2obactam is used in gonorrhea mainly

d penicillin C is contraindicated in infections caused by spirochetes

e thrombocytosis is main side effect ofLinezolid

;33. All of the following statement is true, e+cept=

a chloramphenicol is broad spectrum protein synthesis inhibitor

b line2olid and streptogramins are narrow spectrum protein synthesis inhibitors

c mechanism of resistance to chloramphenicol is plasmid mediated and occurs through the formation of acetyltransferases that inactivate the

drug

d tetracyclines are narrow spectrum protein synthesis inhibitors

e susceptible organisms accumulatetetracyclinesintracellularly via energy dependant transport systems in their cell membranes

;3%. in a patient with culture-positive enterococcal endocarditis who has failed to respond tovancomycinbecause of resistance, the treatment

most liely to be effective is=

a clarithromicin

b erythromycin

c line2olid

d minocycline

e #icarcillin

;34. A 34 year old male patient is suffering from peptic ulcer. 'e was advised anti-peptic ulcer drugs including do+ycycline. hich one of the

following statements about do+ycycline is false?

a it is bacteriostatic

b it is e+creted mainly in the feces

c it is used in yme disease

d it has a long elimination half-life

e it is more active than tetracycline against '. *ylori

;3&. A 13 years old female patient came to pediatrician suffering from headache, high grade fever, moderate chest pain, Foint pain and drowsy.

hen doctor got history, he was told to tae dia2epam 3.& mg by patient 1& hours ago. Actually it was already a diagnosed case of pneumonia

and she was on drug treatment including streptogramin. >oncerning streptogramins, which one of the following statements is false=

a they are active against methicillin-resistant staphylococci

b they may cause a syndrome of arthralgia and myalgia

c they are used in the management of infections caused by vancomycin-resistant enterococci

d they are associated with post antibiotic effect

e they induce formation of hepatic drug-metaboli2ing en2ymes
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;39. #elithromycin=

a is cell wall synthesis inhibitor

b is a etolide structurally related to macrolides

c it binds very loosely to ribosomes so it is good substrate for bacterial efflu+ pumps that mediate resistance

d is used in yme disease mainly

e is used in pneumonia as drug of 1st choice

;3lindamycin

e resistant organisms are illed when tetracycline is used in large doses

;3@. A %% years old male patient has been diagnosed mycoplsma pneumoniae infection. 'e was treated by one of the broad spectrum

antibacterial drug group tetracycline 3 gram #ID for 31 days. hat may be most appropriate to+icity?

a anemia

b hepatic necrosis

c thrombocytosis

d alopecia

e sleeplessness

;3. an elderly debilitated patient has a fever believed to be due to an infection. 'e has e+tensive sin lesions, scrapings of which reveal the

presence of large numbers of gram-positive cocci. #he most appropriate drug to use for treatment of this patient is=

a amo+icillin

b salbactam

c cefo+itin

d nafcillin

e penicillin C

;%5. A 31 year old man was seen in a clinic with a complaint of dysuria and urethral discharge of yellow pus. 'e has a painless clean-base ulcer

on the penis and nontender enlargement of the regional lymph nodes. Cram stain of the urethral e+udates showed gram negative diplococci

within polymorphonucleocytes. #he patient informed the clinic staff that he was unemployed and had not eaten a meal for two days. #he mostappropriate treatment of gonorrhea in this patient is=

a amo+icillin orally for < days

b vancomycinintramuscularly as a single dose

c ceftria+one intramuscularly as a single dose

d tetracycline orally for < days

e procaine penicillin C intramuscularly as a single dose plus one gram of probenecid

;%1. ighty years old male patient having


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c Isonia2id and "ifampicin

d "ifampicin and Streptomycin

e thambutol and *yra2inamide

;%4. A young man 39 years old is started treated for pulmonary tuberculosis. 'e comes to the medical )*D after 1 wee with complaint of

orange red colored urine and sweat and tears. hich of the following drugs is most liely causing these symptoms?

a Streptomycin

b "ifampicin

c thambutol

d *yra2inamide

e #hiaceta2one

;%&. A %5 year old male with nown #7 infection and taing medication since 1 month comes to the ye )*D with complaint of visual

disturbances including decreased visibility and slight color blindness. If these symptoms are due to his drug treatment, which one of the

following drugs is most liely the cause of his symptoms?

a Streptomycin

b >iproflo+acin

c thambutol

d "ifampicin

e Isonia2id

;%9. A %& year old male recently diagnosed with tuberculosis and is started on medication. After a few days he comes to the emergency

department a few hours after taing a meal at BcDonald:s with severe pain in the big toe. 7lood tests show a very high uric acid level. hich of

the following drugs most liely caused these symptoms?

a Streptomycin

b "ifampicin

c Isonia2id

d Amiacin

e *yra2inamide

;%


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;41. A %5 year old male presents with history of fever occurring in a step-ladder fashion for the last 15 days. 'e also feels abdominal pain after

taing meals. ab tests show decreased #> count and a positive idal test. #he drug which is most liely to be given acts by which one of the

following mechanisms?

a >iproflo+acin

b Ampicillin

c >otrimo+a2ole

d >efi+ime

e A2ithromycin

;43. A %& year old pregnant woman presents to the gynecology department with complaint of pain with rising fever since the last & days. ab

tests show gram negative bacilli and widal test comes out positive. hich one of the following drugs will most liely be administered?

a >iproflo+acin

b evoflo+acin

c )flo+acin

d !orflo+acin

e Ampicillin

;4%. A 3< year old male football player gets inFured in a match. 'e comes to the emergency department with pain and swelling near the anle.

)n e+amination, there is small wound with a tender swelling near the anle Foint. 6urther tests reveal tendon rupture with tendonitis setting in.

hich one of the following antibiotics, if re/uired, will most probably not be given to this patient?

a >eftria+one

b >larithromycin

c Aminoglycoside

d >iproflo+acin

e Amo+icillin

;44. A 45 year old male comes to the medical )*D with symptoms of cough GampE fever for the last few days. Sputum culture shows presence

of gram positive cocci. hich one of the following 6luoro/uinolones is most liely to be administered to this patient?

a >iproflo+acin

b !orflo+acin

c )flo+acin

d Catiflo+acin

e evoflo+acin

;4&. A &5 year old patient comes to the emergency department, a day after he has been administered an antibiotic for an on-going infection,

with complaint of palpitations. >C reveals prolonged ;# interval. hich one of the following 6luoro/uinolones most liely caused this adverse

effect?

a >iproflo+acin

b !orflo+acin

c evoflo+acin

d )flo+acin

e Catiflo+acin

;49. Disinfectants are=

a Strong chemical agents that inhibit or ill micro-organisms

b Agents with sufficient to+icity for host cells

c #hey ill both vegetative cells and spores

d A process intended to ill or remove all types of micro-organisms including spores and include viruses

e A process that ills non-sporulating microorganisms by hot water or steam at 9&-155 >

;4


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dCram negative bacilli

eAnaerobes lie 7. fragilis

;4. *atient comes to emergency with the complaints of mared visual and auditory abnormities, vomiting diarrhea abdominal pain GampE sin

rashes. 6rom the history of the patient it was revealed that he too some drug for the treatment of fever. hat could be probable diagnosis?

a>inchonism

bAcute gastro enteritis

c>holera

d#yphoid fever

eAcid peptic disease

;&5. A %< year old male is having repeated episodes of fever with chills with blood smear positive for malaria since last one year. 'e was given

chloro/uine each time GampE the fever subsided. hich of the following drugs would you add with chloro/uine this time?

aArtemether

bBeflo/uine

cBalarone

d*rima/uine

e'alofantrine

1 J Introduction to *harmacology= 7asic *rinciples

1 hich of the following is !)# part of the etymology of the word pharmacology?

a Bedicine

b Drug

c 'erb

d *oison

e Study

3.1 hich of the following describes anagonist?

a Any substance that brings about a change in biologic function through its

chemical action

b A specific regulatory molecule in the biologic system where a drug interacts

c A drug that binds to a receptor and stimulates cellular activity

d A drug that binds to a receptor and inhibits or opposes cellular activity

e A drug directed at parasites infecting the patient

3.3 Kenobiotics are considered=

a ndogenous

b +ogenous

c Inorganic poisons

d #o+ins

e igands

3.% hich of the following would be a to+in $poison of biological origin?

a *b

b As

c 'g

d Atropine

3.4 #he vast maFority of drugs have molecular weights $B between 155 and 1,555.

arge drugs, such as alteplase $t-*A, must be administered=

a Into the compartment where they have their effect

b )rally so they do not absorb too /uicly

c "ectally to prevent irritation to the stomach lining and vessels

d (ia the intraosseous $I) route

e #itrated with buffering agents to prevents cell lysis

3.& hich of the following occurs with drugs that are e+tremely small, such asLithium?

a "eceptor mediated endocytosis

b Binor drug movement within the body

c (asodilation when inFected intravenously $I(

d Specific receptor binding

e !onspecific binding

3.9 Drugs fit receptors using the loc and ey model. >ovalent bonds are the LLLL and

the LLLL specific.

a StrongestE Bost
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b StrongestE east

c eaestE Bost

d eaestE east

3.oumadin is given as a racemic mi+ture with the S enantiomer being four

times more active than the " enantiomer. If the mi+ture of arfarin given is &5M S and

&5M ", what is the potency compared with a 155M " enantiomer solution?

a 4 N " O 1 N S P 1

b 4 N " O 1 N S P 1.&

c 4 N " O 1 N S P 3

d 4 N " O 1 N S P 3.&

e 4 N " O 1 N S P 4

3.@ hat determines the degree of movement of a drug between body compartments?

a *artition constant

b Degree of ioni2ation

c p'

d Si2e

e All of the above

%.1 hich of the following is !)# a protein target for drug binding?

a Side of action $transport

b n2ymes

c >arrier molecules

d "eceptors

e Ion channels

%.3 hich of the following is an e+ample of a drug acting directly through receptors?

a *rotamine binds stoichiometrically to heparin anticoagulants

b Adrenergic beta blocers for thyroid hormone-induced tachycardia

cEpinephrinefor increasing heart rate and blood pressure

d >ancer chemotherapeutic agents

e Bannitol for subarachnoid hemmorhage

4.1 hat is added with drug subclassification, such as an antitubercular drug versus an

antibacterial drug?

a >ost

b Si2e

c Ioni2ation

d *recision

e Speed

4.3 hat type of drug is propranolol $Inderal?

anticonvulsive

b Antihypertensive

c Antinauseant

d Antihistamine

e Antipyretic

&.1 hich of the following is considered the brand name?

a *ropranolol

b Inderal

c Adrenergic Q-blocer

d Roff label use

e 7locs Q-receptors in heart myocardium

&.3 hich of the following is considered the class?

a *ropranolol

b Inderal

c Adrenergic Q-blocer

d Roff label use

e 7locs Q-receptors in heart myocardium

&.% hich of the following cases would be contraindicated for propranolol $Inderal?

a 'ypertension

b ssential tremor

c Angina

d #achycardia

e Asthma
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&.4 hich of the following adverse effects $side-effects is !)# commonly seen with

cholinergic antagonists?

a 7lurred vision

b >onfusion

c Biosis

d >onstipation

e Hrinary retention

9.1 #he drug chloramphenicol $>hloromycetin is risy for which of the following?

a !eonates

b Ceriatric patients

c Adult males

d )bese patients

e >ongestive heart failure patients

9.3 'ow does the glomerular filtration rate $C6" change after the age of 45?

a Increase 1M each year

b Increases 3M each year

c Decreases 1M each year

d Decreases 3M each year

e Does not depend on age

9.% A decrease in renal and liver function, as seen in the elderly, would prolong drug

half-life, LLLL plasma protein binding, and LLLLvolume of distribution.

a IncreaseE Increase

b DecreaseE Decrease

c IncreaseE Decrease

d DecreaseE Increase

9.4 hen prescribing isonia2id $"imifon, pharmacogenetics must be considered as

T5M of Asians and certain other groups are LLLL acetylators, and thus have a LLLL

blood concentration of a given dose and a decreased ris of to+icity.

a SlowE Increased

b SlowE Decreased

c 6astE Increased

d 6astE Decrease

9.& hich of the following are the two modifying factors that contribute to why women

have higher blood pea concentrations of alcohol than men when consuming e/uivalent

amounts?

a ower blood volume G increased hormones

b ower fat content G more gastric alcohol dehydrogenase $AD'

c 'igher fat content G more gastric alcohol dehydrogenase $AD'

d ower fat content G less gastric alcohol dehydrogenase $AD'

e 'igher fat content G less gastric alcohol dehydrogenase $AD'

3 J *harmacoinetic *rinciples= Drug Bovement

1 *harmacoinetics is the effect of the LLLL and pharmacodynamics is the effect of the LLLL.

a Drug on a drugE 7ody on the drug

b 7ody on the drugE Drug on a drug

c Drug on the bodyE 7ody on the drug

d 7ody on the drugE Drug on the body

e Drug on a drugE Drug on a drug

3.1 hich of the following is !)# an action of the body on a drug?

a Absorption

b Distribution

c Betabolism

d +cretion

e Side effects

% If a drug is @5M bound to blood elements or plasma proteins, what part is considered the free form?

a 35M

b 45M

c &5M

d @5M
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e 155M

4.1 hich of the following describes minimal effective concentration $B>?

a #he minimal drug plasma concentration that can be detected

b #he minimal drug plasma concentration to enter tissues

c #he minimal drug plasma concentration to interact with receptors

d #he minimal drug plasma concentration to produce effect

e #he minimal drug plasma concentration to reach therapeutic levels

4.3 If a patient misses three doses of their daily drug, which of the following $in general is the best solution?

a #ae a 4+ dose at the ne+t dose time

b ait % more days $wee total then return to normal regimen

c Do nothing and continue normal regimen

d Setup an appointment to have the patient evaluated

e *rescribe a higher dosage pill so missed doses will have less effect

4.% 7lood levels of a drug correlate to the effectiveness of that drug, such as with

penta2ocine $#alwin or phenobarbitol $uminal.

a #rue

b 6alse

&.1 hich of the following drug permeation mechanisms involves polar substances too large to enter cells by other means, such as iron or

vitamin 713?

a A/ueous diffusion

b ipid diffusion

c >arrier molecules

d ndocytosis and e+ocytosis

&.3 hich of the following drug permeation mechanisms occurs across epithelial tight

Functions and is driven by a concentration gradient?

a A/ueous diffusion

b ipid diffusion

c >arrier molecules


&.% hich of the following drug permeation mechanisms uses the 'enderson-

'asselbalch e/uation for the ratio of solubility for the wea acid or wea base?

a A/ueous diffusion

b ipid diffusion

c >arrier molecules


&.4 hich of the following drug permeation mechanisms is used for peptides, amino

acids, glucose, and other large or insoluble molecules?

a A/ueous diffusion

b ipid diffusion

c >arrier molecules


&.& hich of the following drug permeation mechanisms uses caveolae?

a A/ueous diffusion

b ipid diffusion

c >arrier molecules


9.1 Hsing the 6ic aw of Diffusion, how will flu+ change if membrane thicness is

doubled?

a It will double

b It will /uadruple

c It will halve

d It will /uarter

e It will not change

9.3 Hsing the 6ic aw of Diffusion, how will flu+ change if the permeability

coefficient is /uadrupled?

a It will double

b It will /uadruple

c It will halve

d It will /uarter


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e It will not change

ontin is well-absorbed when

administeredorally #P$%,how much of the drug is metaboli2ed on its first pass through

the liver?

a 5M

b


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13/46

d 15

e 1

4.& If p' T pa, the drug is LLLL and if p' U pa, the drug is LLLL. An unprotonated

acid is LLLL and a protonated base is LLLL.

a *rotonatedE HnprotonatedE >hargedE >harged

b *rotonatedE HnprotonatedE !eutralE !eutral

c HnprotonatedE *rotonatedE >hargedE >harged

d HnprotonatedE *rotonatedE !eutralE >harged

e HnprotonatedE *rotonatedE >hargedE !eutral

&.1 ea acids are e+creted faster in LLLL urine and wea bases are e+creted faster in

LLLL urine.

a AcidicE Alaline

b AlalineE Acidic

c AcidicE !eutral

d !eutralE Alaline

e AlalineE !eutral

&.3 A patient presents with an overdose of acidic Aspirin. #he drug LLLL can be given to

LLLL the p' of the urine and trap the Aspirin, preventing further metabolism.

a !a'>)%E Increase

b !a'>)%E Decrease

c !'4>lE Increase

d !'4>lE Decrease *harmacology J *art 1 ;ui2

(ersion= 19)ct355@ *age of 43

&.% A patient presents with an overdose of alaline >odeine. #he drug LLLL can be given

to LLLL the p' of the urine and trap the >odeine, preventing further metabolism.

a !a'>)%E Increase

b !a'>)%E Decrease

c !'4>lE Increase

d !'4>lE Decrease

9.1 #he principle of drug manipulation for e+cretion of a drug out of the renal tubule can

be accomplished by=

a Acidifying the urinary p'

b AdFusting the urinary p' to protonate wealy acidic drugs

c AdFusting the urinary p' to unprotonate wealy basic drugs

d AdFusting the urinary p' to ioni2e the drug

e 7y neutrali2ing the urinary p'

9.3 Aspirin is a wea organic acid with a pa of %.&. hat percentage of a given dose

will be in the lipid-soluble form at a stomach p' of 1.&?

a About 1M

b About 15M

c About &5M

d About 5M

e About M

9.% 6or which of the following drugs is e+cretion most significantly accelerated by

acidification of the urine?

a ea acid with pa of &.&

b ea acid with pa of %.&

c ea base with pa of


14/46

systemic circulation via a given route as compared to what route?

a )ral

b I( $intravenous

c I) $intraosseous

d >S6 $cerebrospinal fluid

e hatever route attains the target drug concentration in plasma $>#

3 hat organ is responsible for metabolism in the Rfirst pass effect?

a 7rain

b 'eart

c idney

d iver

e Spleen

%.1 A patient is in the hospital and is stable ondigo&in5.1


15/46

e I) $intraosseous

4.9 hich of the following is !)# an advantage of prolonged release medications?

a ess fre/uent administration

b #herapeutic effect overnight

c ower incidence of side effects

d *atient compliance

e Bore fluctuation in plasma concentration

4.hest

c )ver the deltoid muscle

d 7ehind the ear

e )n the bac of the nec

& J *harmacoinetic Distribution= 7asics

1.1 hich of the following would receive drug slowly?

a iver

b 7rain

c 6at

d Buscle

e idney

1.3 hich of the following is the least important for passage through capillary walls but

the most important for passage through the cell wall?

a Bolecular si2e

b ipid solubility

c Diffusion constant

d p'

e pa

1.% hich of the following is the most important for movement through capillary walls?

a Bolecular si2e

b ipid solubility

c Diffusion constant

d p'

e pa

1.4 hich of the following locations would most trap a lipid soluble drug?

a 7lood

b Intestines

c 7rain

d Stomach

1.& hat type of drugs can cross the blood-brain barrier $777?

a arge and lipid-soluble

b arge and lipid-insoluble

c Small and lipid-soluble

d Small and lipid-insoluble

3.1 Acidic drugs, such as phenytoin, bind primarily to which of the following plasma

proteins?

a Y1-fetoprotein $A6*

b C> Clobulin

c Albumin

d Y1-acid glycoprotein $AAC

e #ranscortin

3.3 7asic drugs, such as lidocaine, bind primarily to which of the following plasma

proteins?

a Y1-fetoprotein $A6*

b Cc-Clobulin $CcC

c Albumin

d Y1-acid glycoprotein $AAC

e #ranscortin

%.1 A decrease in drug-protein binding will lead to which of the following?

a Decrease in the unbound drug concentration


16/46

b Increase in free drug

c Increase in rate of drug elimination

d Decrease in volume of distribution

%.3 A patient presents with acute-onset cirrhosis of the liver. #hey are found to have

hypoalbuminemia. In severe cirrhosis it is e+pected that AAC will be decreased, but the

patient presents with increased AAC due to the inflammatory response. hich of the

following is the most liely?

a Increased acidic drug binding and increased basic drug binding

b Increased acidic drug binding and decreased basic drug binding

c Decreased acidic drug binding and increased basic drug binding

d Decreased acidic drug binding and decreased basic drug binding

%.% hich of the following is !)# a site of loss $where drug is not used?

a 6at

b CI tract

c Buscle

d Site lacing receptors

4.1 hich of the following locations can accumulate lipid-soluble drugs, has little or no

receptors, and can hold distributed drugs liebarbiturates?

a iver

b idney

c 7rain

d 6at

e 6etus

4.3 hich of the following locations has high blood flow and is a site of e+cretion?

a iver

b idney

c 7rain

d 6at

e 6etus

4.% Anything affecting renal perfusion will affect drug delivery to the idney, drug

e+cretion, and drug levels in the blood.

a #rue

b 6alse

4.4 hich of the following can be treated with drugs due to a leay area in the blood-

brain barrier near the medulla?

a Sei2ures

b Shivers

c Diarrhea

d !ausea

e (omitting

4.& hat is the appro+imate lag time for e/uilibration between maternal blood and fetal

tissues?

a 35 mins

b 45 mins

c 1 hour

d 3 hours

e 9 hours

Batch the body compartment with the volume, assuming a


17/46

b 5.4

c 4

d 45

e 455

&.@ lderly patients often have LLLL muscle mass and thus a$n LLLL (d.

a BoreE Increased

b BoreE Decreased

c essE Increased

d essE Decreased

&. *atients with ascites or edema would have LLLL (d for hydrophilic drugs, such as

gentamicin.

a Increased

b Decreased

c Hnchanged

9 J *harmacoinetics= Drug Betabolism

1.1 hich of the following locations is the most liely for finding a free, unaltered drug?

a Hrine

b 6eces

c 7reast mil

d 6at

e Sweat

1.3 Bost drugs are active in their LLLL form and inactive in their LLLL form.

a !on-polarE *olar

b *olarE !on-polar

c ater-solubleE ipid-soluble

d ipid-insolubleE ater-insoluble

e !eutralE !eutral

3.1 Drugbiotransformationphase I maes drugs LLLL polar for metabolism and phase II

maes drugs LLLL polar for e+cretion.

a BoreE Bore

b BoreE ess

c essE Bore

d essE ess

3.3 hich of the following is !)# a phase II substrate?

a Clucuronic acid

b Sulfuric acid

c Acetic acid

d Amino acids

e Alcohol

% hich of the following reactions is phase II and !)# phase I?

a )+idations

b "eductions

c >onFugations

d Deaminations

e 'ydrolyses

4 hich of the following metabolically active tissues is the principle organ for drug

metabolism?

a Sin

b idneys

c ungs

d iver

e CI #ract

&.1 Damage at which of the following locations would most affect the goals of phase II

biotransformation?

a Sin

b idneys

c ungs

d iver

e CI #ract
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18/46

Batch the biotransformation reaction with the drug=

&.3 'ydro+ylation of aromatic ring to increase polarity a >odeine

&.% !-dealylation b Borphine

&.4 Sulfo+idation c #hiorida2ine

&.& )-dealylation d !icotine

&.9 !-o+idation e *henobarbitol

&.imetidine, erythromycin, G grapefruit FuiceE #heophyline G warfarin

d >imetidine G erythromycinE >yclosporine

9.9 hich of the following groups of people is the least liely to have biotransformation

effects due to altered hepatic function?

a Infants

b Adults

c lderly

d >hronic alcoholics

e Acetaminophen overdoses

9.ytosol

c Bitochondria

9.@ here does acetylation conFugation $e.g. isonia2id and sulfate conFugation $e.g.
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19/46

acetaminophen tae place?

a Bicrosomal

b >ytosol

c Bitochondria

9. here does glucuronide conFucation $e.g. digo+in, bilirubin tae place?

a Bicrosomal

b >ytosol

c Bitochondria

9.15 hat is a result of conFugation of isonia2id via !-acetylation?

a Deto+ification of liver

b Deto+ification of idneys

c Deto+ification of blood

d Deto+ification of urine

e 'epatoto+icity

< J *harmacoinetics= *rinciples of liminations

1.1 )ne liter contains 1,555 mg of a drug. After one hour, 55 mg of the drug remains.

hat is the clearance?

a 155 m

b 155 mhr

c 1 mgml

d 155 mg

e 1 mgsec

1.3 #o maintain a drug concentration atsteady state,the dosing rate should e/ual the

elimination rate. hich of the following is true? $> P Drug >learancea Dosing rate P > O target concentration

b Dosing rate P > J target concentration

c Dosing rate P > N target concentration

d Dosing rate P > target concentration

1.% hich of the following is most useful in determining the rate of elimination of a

drug, in general?

a Drug concentration in urine $renal elimination

b Drug concentration in stool $bilary elimination

c Drug concentration in blood

d Drug concentration in brain

e Drug o+idation rate

3.1 6or first-order drug elimination, half lifet$13 is LLLL at two places on the curve

and a constant LLLL is lost per unit time.a /ualE Amount

b /ualE *ercentage

c !ot e/ualE Amount

d !ot e/ualE *ercentage

3.3 6or first-order drug elimination, given the half-life e/uation of t$13 P $5.9% N (d

>, how many half-lives would be necessary to reach steady state $V&M without a

loading dose?

a 1 to 3

b 3 to %

c % to 4

d 4 to &

e & to 9

3.% hich of the following is !)# a drug e+hibiting 2ero-order elimination inetics?

a Aspirin

b Borphine
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20/46

c *henytoin

d #)'

3.4 6or 2ero-order drug elimination, half-life t$13 is LLLL at two places on the curve

and a constant LLLL is lost per unit time.

a /ualE Amount

b /ualE *ercentage

c !ot e/ualE Amount

d !ot e/ualE *ercentage

3.& If a drug with a 3-hour half life is given with an initial dose of @ mcgml, assuming

first-order inetics, how much drug will be left at 9 hours?

a @ mcgml

b 4 mcgml

c 3 mcgml

d 1 mcgml

e 5.& mcgml

%.1 hat are the units for steady-state concentration $>ss, or infusion rate over

clearance?

a mgmin

b mlmin

c mgml

d mlmg

e minmg

%.3 hat percentage of the steady-state drug concentration is achieved at %.% N t$13?

a 15M

b 3&M

c &5M

d


21/46

divisions of which of the following?

a Somatic nervous system division of peripheral nervous system

b Somatic nervous system division of central nervous system

c Autonomic nervous system division of peripheral nervous system

d Autonomic nervous system division of central nervous system

1.3 *reganglionic sympathetic and parasympathetic fibers release LLLL, postganglionic

parasympathetic fibers release LLLL $formuscarinic receptors, and

postganglionic sympathetic fibers release LLLL $foradrenergic receptors.

a A>hE A>hE !

b A>hE !E A>h

c !E A>hE !

d !E !E A>h

1.% hich of the following adrenergic receptors is most commonly found pre-synaptic?

a Alpha 1 receptors

b Alpha 3 receptors

c!eta ( receptors

d!eta ) receptors

e!eta * receptors

1.4 hich of the following describes the result of adrenal medulla stimulation?

a Bass parasympathetic discharge, @&=1& ratio of epi=norepi

b Bass parasympathetic discharge, 1&=@& ratio of epi=norepi

c Bass sympathetic discharge, @&=1& ratio of epi=norepi

d Bass sympathetic discharge, 1&=@& ratio of epi=norepi

Batch the sympathetic response with the receptor=

1.& Increased lipid breadown a Y1

1.9 *eripheral vasoconstriction b Z1

1.aOO influ+ and e+ocytosis?

a *resynaptic sympathetic

b *resynaptic parasympathetic

c *ostsynaptic sympathetic

d *ostsynaptic parasympathetic

3.1 hich of the following methods of terminating a+on response is !)# a target for

drug action?

a "euptae via ! transporter $!#= Hptae 1

b Betabolism of ! of inactive metabolite

c ! diffusion away from synaptic cleft

3.3 !# is a symporter of what ion?

a O

b >aOO

c >l-

d !aO
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22/46

e BgOO

3.% hich of the following is recycled via (BA# into vesicles after response

termination?

a !

b -D)*A

c !#

d *I

e D)*CA

3.4 hich of the following is broen down by BA)-7 $monoamine o+idase more than

the others?

a Serotonin $&-'#

b !orepinepherine $!

c Dopamine $DA

3.& here is the cytosolic catecholamine metaboli2ing en2yme catechol-)-methyl

transferase $>)B# primarily found?

a iver

b CI tract

c *lacenta

d 7lood platelets%.1 hich of the following receptor subtypes rela+es smooth muscle and causes liver

glycogenolysis and gluconeogenesis?

a Y1 $C/CiCo

b Y3 $CiCo

c Z1 $Cs

d Z3 $Cs

e Z% $Cs

%.3 hich of the following receptor subtypes causes vascular smooth muscle contraction

and genitourinary smooth muscle contraction?

a Y1 $C/CiCo

b Y3 $CiCo

c Z1 $Cs

d Z3 $Cs

e Z% $Cs

%.% hich of the following receptor subtypes increases cardiac chronotropy $rate and

inotropy $contractility, increases A(-node conduction velocity, and increases rennin

secretion in renal Fu+taglomerular cells?

a Y1 $C/CiCo

b Y3 $CiCo

c Z1 $Cs

d Z3 $Cs

e Z% $Cs

%.4 hich of the following receptor subtypes decreases insulin secretion from pancreatic

Z-cells, decreases nerve cell norepinephrine release, and contracts vascular smooth

muscle?

a Y1 $C/CiCo

b Y3 $CiCo

c Z1 $Cs

d Z3 $Cs

e Z% $Cs

4.1 hat type$s ofsecond messenger$s interact with adenylyl cyclase?

a Y1

b Y3

c Z

d Z G Y1

e Z G Y3

4.3 hat type$s of second messenger$s are associated with phospholipase > $*>?

a Y1

b Y3

c Z
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23/46

d Z G Y1

e Z G Y3

4.% hich of the following adrenergic receptor activation mechanisms is involved with

ephedrine, amphetamine, and tyramine?

a Direct binding to the receptor

b *romoting release of norepinephrine

c Inhibiting reuptae of norepinephrine

d Inhibiting inactivation of norepinephrine

4.4 hich of the following adrenergic receptor activation mechanisms is involved with

BA) inhibitors?





4.& hich of the following adrenergic receptor activation mechanisms is involved with

tricyclic antidepressants and cocaine?





4.9 hich of the following is !)# true of catecholamines?

a !on-polar

b >annot cross the blood-brain barrier

c >annot be used as an oral drug

d 'ave brief duration

e BA) and >)B# act rapidly

Batch the catecholamine with the receptor$s=

4.lonidine a Y1-agonist

4.14 Betaproterenol, terbutaline, ritodine b Y3-agonist

4.1& *henylephrine c Z3-agonist

&.1 hich of the following is a long-acting $oral Y1-agonist and not a short-acting

$nasal spray, ophthalmic drops Y1-agonist?

a *henylephrine

b )+ymeta2oline

c #etrahydra2aline

d *seudoephedrine

&.3 hich of the following would !)# be used as a topical vasoconstrictor for a patient

with epista+is $nasal pac soaed in drug?

a *henylephrine

b pinepherine

c )ymeta2oline

d Isoproterenol

&.% Y1 drugs can be given with local anesthetics to vasoconstrictor and decrease blood

flow to the side of administration. hich of the following should not be given above theweb space?

a *henylephrine


24/46

b pinephrine

c Betho+amine

&.4 hich of the following is the Y1 drug of choice $D)> for retinal e+ams and

surgery, giving mydiasis $dilation of iris?

a phedrine

b pinepherine

c )ymeta2oline

d Isoproterenol

e *henylephrine

&.& Y3-agonists are only approved for hypertension and wor by decreasing sympathetic

tone and increasing vagal tone. hich of the following is !)# a Y3-agonist?

a >lonidine

b Bethyldopa

c Cuanaben2

d Cuanfacine

e pinephrine

&.9 At the adrenergic synapse, what does Y3 do?

a Stimulates ! release

b Inhibits ! release

c Stimulates A>h release

d Inhibits A>h release

&.


25/46

c *hosphorylation

&.1% hich of the following is the action of the indirect-acting sympathomimetic drug

cocaine?

a Stimulator of !# $uptae 1

b Inhibitor of !# $uptae 1

c Stimulator of (BA# $uptae 3

d Inhibitor of (BA# $uptae 3

&.14 #ricyclic antidepressants $#>As have a great deal of side effects. hich of the

following is the action of #>As?

a Stimulator of !# $uptae 1

b Inhibitor of !# $uptae 1

c Stimulator of (BA# $uptae 3

d Inhibitor of (BA# $uptae 3

&.1& hich of the following is !)# a mi+ed sympathomimetic?

a Amphetamine

b-ethamphetamine

c phedrine

d *henylepherine

e *seudoephedrine

&.19 *rior to an operation to remove a pheochromocytoma $neuroendocrine tumor of the

medulla of the adrenal glands, which of the following should be given to the patient?

a Y-agonist

b Y-blocer

c Z-agonist

d Z-blocer

&.1


26/46

e ipolysis

9.3 hich of the following agonists can have dose-related withdrawal syndrome if the

drug is withdrawn too /uicly, leading to rebound hypertension?

a Y1-agonist

b Y3-agonist

c Z1-agonist

d Z3-agonist

e Z%-agonist

9.% hich of the following agonists can have sedation and +erostomia $dry mouth in

&5M of patients starting therapy, se+ual dysfunction in males, nauseas, di22iness, and

sleep disturbances?

a Y1-agonist

b Y3-agonist

c Z1-agonist

d Z3-agonist

e Z%-agonist

9.4 hich of the following agonists can cause hyperglycemia in diabetics?

a Y3-agonist

b Y1-agonistc Z%-agonist

d Z3-agonist

e Z1-agonist

9.& Angina pectoris, tachycardia, and arrhythmias are possible adverse effects of which

of the following agonists?

a Y3-agonist

b Y1-agonist

c Z%-agonist

d Z3-agonist

e Z1-agonist

9.9 If a patient is taing BA) inhibitors and ingests tyramine $red wine, aged cheese,

which of the following acute responses is most liely? $sympathomimetic

a Stimulation of ! release

b Inhibition of ! release

c Stimulation of A>h release

d Inhibition of A>h release

e !o response due to BA) inhibitor

9.h release

d Inhibition of A>h release

9.@ BaFor adverse affects of the Y1 blocade include refle+ tachycardia and which of the

following?

a )rthostatic tachycardia

b )rthostatic bradycardia

c )rthostatic hypertension

d )rthostatic hypotension

e Increased cardiac output

9. hich of the following effects would be intensified with the Y3 blocade?

a "efle+ tachycardia

b "efle+ bradycardia

c )rthostatic hypertension

d )rthostatic hypotension

e *latelet clotting

9.15 hich of the following is !)# an adverse affect of the Z1 blocade?

a 7radycardiab Decreased cardiac output

c A( node bloc


27/46

d Increased arrhythmias

e 'eart failure

9.11 hich of the following is the most severe adverse effect that has been associated

with sudden termination of Z1-blocers?

a Atrial fibrillation

b "efle+ bradycardia

c Syncope $fainting

d Angina

e Sudden death

9.13 hich of the following groups of patients is most at ris for adverse effect seen in

Z3-blocers?

a Asthmatics

b >ongestive heart failure patients

c #rauma patients

d Diabetics

e *atients with deep vein thromboses $D(#s

9.1% hich of the following can be detrimental in diabetics and also can lead to masing

of tachycardia, which is indicative of hypoglycemia?

a Y1-blocer

b Y3-blocer

c Z1-blocer

d Z3-blocer

e Z%-blocer

Item !umber= 19@4 correct answer= & category= Analgesics

1. A child has ingested an unnown substance and has evidence of

respiratory depression. #his symptom is usually found with poisoning

due to=

1. amphetamines

3. atropine

%. mushrooms

4. erosene

&. opioids

Item !umber= 3&%4 correct answer= % category= Analgesics

3. #he use of methadone in the treatment of heroin addiction continues

to be controversial. It would therefore be advantageous to find a substance

with the beneficial effects of methadone, but without its undesirable

characteristics. #he correct statement is that=

1. methadone is not physically addicting and therefore very useful in

treating heroin addicts

3. the withdrawal syndrome of methadone is of shorter duration than that of

heroin

%. propo+yphene may successfully suppress the withdrawal syndrome in

heroin-addicted individuals

4. although propo+yphene does bloc heroin withdrawal, it itself is not

physically addicting

&. propo+yphene may be successfully substituted for heroin in the addicted

individual and abruptly discontinued after three to four wees without

signs of an abstinence syndrome

Item !umber= 3hronic renal damage resulting from the ingestion of analgesics has

been suggested. #he 6AS statement is=

1. phenacetin has been implicated

3. salicylates have been implicated

%. meperidine has been implicated

4. acetaminophen is a metabolite of phenacetin

&. combinations may be more harmful

Item !umber= %495 correct answer= 4 category= Analgesics

4. A 35-month old infant is brought to the emergency room with fever,


28/46

vomiting, stupor, and hyperpnea of 13 hours: duration. 'is leuocyte count

is 9,555cu mm. #he chest roentgenogram is clear. Hrinalysis shows albuminuria,

a positive test for reducing substance, and acetonuria. 6erric chloride added

to the boiled acidified urine shows a persistent purple color. #he most liely

diagnosis is=

1. acute glomerulonephritis

3. diabetic acidosis

%. acute bacterial meningitis

4. salicylate poisoning

&. phenothia2ine poisoning

Item !umber= %@


29/46

life in serum

%. bac diffusion of hydrogen ions across the gastric mucosa

4. 1,%

&. !one of the above

Item !umber= 49% correct answer= % category= Analgesics

15. Bany stimuli may cause vomiting. #he chemoreceptor trigger 2one of the

central nervous system is=

1. located in the cerebral corte+

3. stimulated in all forms of vomiting

%. stimulated by morphine and its congeners

4. All of the above

&. 1,%

Item !umber= &3

%. 7,D


30/46

4. D only

&. All of the above

Item !umber= 9. aspirin e+erts its actions primarily by inhibition of

cycloo+ygenaseD. aspirin overdose causes significant hepatic to+icity if ingested

in sufficient /uantities

1. A,7,>

3. A,>

%. 7,D

4. D only

&. All of the above

Item !umber= 9


31/46

4. morphine

&. codeine

Item !umber= 9. methadone

D. butorphanol

1. A,7,>

3. A,>

%. 7,D

4. D only

&. All of the above

Item !umber= 9


32/46

Item !umber= . peripheral edema

D. disturbance in acid-base and electrolyte balance

1. A,7,>

3. A,>

%. 7,D

4. D only

&. All of the above

Item !umber= 1131< correct answer= % category= Analgesics

3*#=

1. behavioral changes

3. miosis

%. respiratory depression

4. diarrhea

&. postural hypotension

Item !umber= correct answer= 3 category=nesthetics

1. All of the following factors influence the rate of induction of anesthesia

with an inhaled anesthetic K>*#=

1. a/ueous solubility of the anesthetic

3. patient history of malignant hyperthermia

%. ventilation rate

4. tension of gas administration

&. pulmonary blood flow rate

6or /uestions 3 J , choose the correct answer from the following list. ach

answer may be used once, more than once, or not at all.

Anesthetic *artition Binimum Alveolar

>oefficient >oncentration $BA>

1. halothane 3.%5 5. is the concentration of anesthetic at

1 atmosphere of pressure that produces immobility in &5M of patients e+posed

to a no+ious stimulus. hich anesthetic is most potent by this measure?
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Item !umber= correct answer= % category= Anesthetics

4. A good analgesic at subanesthetic doses


&. #he anesthetic that may be most safely used in a patient with a history of

malignant hyperthermia?

Item !umber= correct answer= 1 category= Anesthetics

9. Anesthetic associated with the highest incidence of hepatitis.


an be minimi2ed

by decreasing dose.
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4. safe alternative for patients predisposed to malignant hyperthermia

&. high lipophilicity provides rapid and smooth onset, dose titratability,

and rapid recovery from anesthesia


19. 6AS statement regarding etamine as an anesthetic=

1. contraindicated in a patient with asthma because it may cause

bronchoconstriction

3. recovery from anesthesia associated with emergence phenomenon of

hallucinations and vivid dreams

%. produces dissociative anesthetic state, whereby patient appears awae

but is unconscious

4. produces analgesia


1orrect statements regarding etomidate include all K>*#=

1. inhibits adrenocortical function

3. no adverse effects from adrenocortical inhibition during short-term use

%. produces minimal cardiovascular effects

4. potent hypnotic with e+cellent analgesic properties

&. safe alternative for a patient with unstable cardiovascular status


1@. #"H statement regarding mida2olam as an adFunct to anesthesia=

1. provides analgesia

3. provides ade/uate seletal muscle rela+ation alone

%. useful for ameliorating sei2ure activity

4. produces cardiovascular stimulation

&. contraindicated in patients with asthma or >)*D


1. 6AS statement regarding bupivacaine, a local anesthetic with a molecular

structure that includes an amide linage.

1. undergoes hepatic metabolism

3. rapidly hydroly2ed by plasma esterase en2ymes

%. contraindicated in a patient with a history of allergy to lidocaine

4. higher dose necessary to induce epidural anesthesia than spinal

anesthesia

&. higher ris of systemic side effects when used for epidural anesthesia

compared to spinal anesthesia


35. 6AS statement regarding local anesthetics=

1. produce effects by inhibiting voltage gated sodium channels

3. inhibition of sodium channels enhanced by repetitive depolari2ations

%. small nerve fibers more susceptible than large nerve fibers

4. all sensory functions of a nerve affected e/ually at onset of anesthesia

&. vasoconstriction prolongs duration of action

Item !umber= correct answer= & category= Anesthetics

31. #reatment of malignant hyperthermia includes all of the following K>*#=

1. cessation of anesthetic and changing of rubber tubing to anesthesia

machine

3. administration of dantrolene sodium 1mgg by rapid intravenous infusion

until symptoms subside

%. hyperventilation of patient with 155M o+ygen

4. administration of fluids and diuretics to control myoglobinemia and

hyperalemia

&. lidocaine is indicated for arrhythmias

Item Number/ 01)* correct ans2er/ 3 category/ Inotropes4'asodilators

(5 6igitalis glycosides slo2s the heart rate in patients 2ith systolic

dysfunction as a result of all of the follo2ing E78EPT/


35/46

(5 direct action of digitalis on the ' node to slo2 conduction

)5 indirect e9ect of enhanced vagal tone on ' node

*5 enhanced parasympathetic out:o2 from the 8NS through an indirect

mechanism

;5 diminished sympathetic tone 2hich is high as a compensatory mechanism in

heart failure

35 enhanced responsiveness of the S and ' node to norepinephrine through

an indirect mechanism

Item Number/ ((*31 correct ans2er/ ( category/ Inotropes4'asodilators

)5 inhibits Na? > @? TPase pump

)5 dobutamine > inhibits troponin I

*5 amrinone > inhibits troponin I

;5 dopamine > inhibits troponin I

35 isoproterenol > inhibits ( and ) receptors

Item Number/ ((1( correct ans2er/ ) category/ Inotropes4'asodilators

*5 The rapid heart rate sometimes seen after nitroglycerin administration is best

e&plained by/

(5 a direct positive chronotropic e9ect on the myocardium)5 re:e& sympathetic discharge due to a fall in systemic blood pressure

*5 the ability of nitroglycerin to release norepinephrine from sympathetic

nerve endings

;5 a decrease in intracranial pressure

Item Number/ ((3A correct ans2er/ * category/ Inotropes4'asodilators

;5 The e9ectiveness of digitalis in the treatment of atrial :utter is primarily

due to its ability to/

(5 slo2 the rate of Bring of the S, node

)5 e&ert an atropine,li.e e9ect on the ,' node

*5 slo2 conduction through the ,' node

;5 decrease the refractory period through the ,' node

35 decrease the rate of conduction through atrial muscle

Item Number/ *A)A correct ans2er/ 3 category/ Inotropes4'asodilators

35


36/46

;5 "uinidine

35 ll are correct

Item Number/ ((*30 correct ans2er/ ) category/ Inotropes4'asodilators

A5 The correct statement regarding digitalis is/

(5 in normal individualsC digitalis increases cardiac output

)5 in normal individualsC digitalis increases myocardial o&ygen consumption

*5 in normal individualsC digitalis reduced total peripheral resistance in

response to enhanced myocardial contractility

;5 in normal individualsC digitalis depresses myocardial contractility

35 in normal individualsC digitalis increases heart rate

Item Number/ *(A correct ans2er/ ( category/ Inotropes4'asodilators

05 routine electrocardiogram reveals a borderline delay in PR intervalC sagging

left ventricular ST segments and a shortened RT interval5 The most li.ely

e&planation 2ould be/

(5 digitalis e9ect

)5 acute sub,endocardial ischemia

*5 hypo.alemia

;5 hypocalcemia

35 my&edema

Item Number/ ((*1 correct ans2er/ ; category/ Inotropes4'asodilators

(5 n uncommon cardiac manifestation of digitalis to&icity is/

(5 premature ventricular contractions

)5 second and third degree heart bloc.

*5 atrio,ventricular Dunctional escape beats

;5 atrial Bbrillation 2ith rapid ventricular response

35 ll are correct

Item Number/ ;3( correct ans2er/ ) category/ Inotropes4'asodilators

((5 The most 2idely used digitalis glycosides in the Gnited States are digo&in and

digito&in5 The half,life #t(4)% of digito&in is appro&imately/

(5 ( day)5 days

*5 () days

;5 dependent upon the route of administration

35 dependent upon renal function

Item Number/ ((0 correct ans2er/ ( category/ Inotropes4'asodilators

()5 The maintenance dose of digo&in is primarily dependent upon/

(5 renal function

)5 se&C hepatic function and protein level

*5 pulmonary function

;5 theloading doseand the type of diuretic being used

35 level of serum potassium

Item Number/ ((;A correct ans2er/ ; category/ Inotropes4'asodilators

(*5 Thiocyanate to&icity is a potential adverse e9ect associated 2ith/

5 amrinone

!5 nitroglycerin

85 milrinone

65 nitroprusside

(5 C!C8

)5 C8

*5 !C6

;5 6 only

35 ll are correct

Item Number/ ))) correct ans2er/ ; category/ Inotropes4'asodilators

(;5 ;),year,old 2hite male 2ith rheumatic mitral insuHciency is seen 2ith

symptoms and Bndings of initial left ventricular failure5 ou give him

digitalis and recall that all of the follo2ing are pharmacologic e9ects of
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37/46

digitalis E78EPT/

(5 decreases conduction velocity in the ,' node

)5 increases the e9ects of normal vagal activity of the heart

*5 shortens the e9ective refractory period of the Pur.inDe Bbers

;5 2ea.ens myocardial contractility

35 prolongs the functional refractory period of the ,' node

Item Number/ ((0* correct ans2er/ * category/ Inotropes4'asodilators

(35 $rthostatic hypotension is most li.ely to occur follo2ing the use of/

(5 phenylephrine

)5 reserpine

*5 amyl nitrite

;5 metaraminol

35 tetrahydrozoline

Item Number/ ;1 correct ans2er/ ) category/ Inotropes4'asodilators

(15 The chemical conBguration of a molecule may determine its degree of

absorptionC its distributionC and its route of metabolism5 StructurallyC the

digitalis glycosides resemble/

(5 catecholamines

)5 steroids

*5 salicylates

;5 nitrofurantoin

35 phenothiazines

Item Number/ (*10 correct ans2er/ * category/ Inotropes4'asodilators

(5 ll of the follo2ing are actions of nitrates in angina pectoris E78EPT/

(5 re:e& increase in heart rate

)5 ventricular size decrease

*5 eDection fraction increased

;5 peripheral venous pooling>decrease in preload

35 systolic blood pressure decrease

Item Number/ ((*0A correct ans2er/ ; category/ Inotropes4'asodilators(A5 The sympathomimetic 2hich may promote diuresis by a direct e9ect on the

.idney is/

(5 isoproterenol

)5 dobutamine

*5 norepinephrine

;5 dopamine

35 epinephrine

Item Number/ (*; correct ans2er/ ; category/ Inotropes4'asodilators

(05 Nitroglycerin administered sublingually reduces venous toneC causing pooling

of blood in peripheral veins and lo2ers peripheral arterial resistanceC

resulting in a decline in blood pressure5 !oth end,diastolic and end,systolic

dimensions of the left ventricle are reducedJ therefore myocardial o&ygen

needs are decreased primarily by a reduction of/

(5 blood pressure

)5 heart rate

*5 coronary vascular resistance

;5 intramyocardial tension

35 sulfhydryl bonds

Item Number/ A0 correct ans2er/ * category/ Inotropes4'asodilators

)5 6igitalis must be used 2ith caution in patients 2ith acute myocardial

infarction5


38/46

65 in acute myocardial infarctionC patients are less sensitive to the

development of arrhythmias due to digitalis to&icity

(5 only

)5 C!C8

*5 C8

;5 !C6

35 6 only

Item Number/ ((1 correct ans2er/ * category/ Inotropes4'asodilators

)(5 6igitalis may slo2 the heart rate by/

(5 bloc.ing the activity of the carotid and aortic arch baroreceptors

)5 e&erting an atropine,li.e e9ect on the ,' node

*5 stimulation of vagal center in the medulla to increase e9erent Bring

;5 increasing the rate of conduction through the ,' node

35 None of the above

Item Number/ ((;() correct ans2er/ ; category/ Inotropes4'asodilators

))5 8ompared to digito&inC digo&in is or has/

(5 more highly protein,bound

)5 more e&tensive enterohepatic circulation

*5 prolonged elimination half,life

;5 less completelyabsorbed orally

35 more e&tensively hepatically cleared

Item Number/ ((*0 correct ans2er/ ; category/ Inotropes4'asodilators

)*5 The beneBcial e9ects of digitalis are derived from its e9ect on myocardial

contractility and on myocardial conduction and e&citability5 In therapeutic

dosesC digitalis/

(5 slo2s the atrial rate in atrial Bbrillation

)5 enhances atrioventricular conduction

*5 slo2s the atrial rate in sinus tachycardias

;5 slo2s the ventricular rate in atrial Bbrillation

35 decreases ventricular automaticity

Item Number/ ;101 correct ans2er/ * category/ Inotropes4'asodilators

);5 6igitalis,induced emesis is/

(5 only seen 2hen digo&in is given orally

)5 of no true clinical importance

*5 due to stimulation of the chemoreceptor trigger zone

;5 related to Na? @? TPase inhibition 2ithin the +I tract

35 commonly seen 2ith rapid parenteral administration

Item Number/ ;30* correct ans2er/ ; category/ Inotropes4'asodilators

)35 6igitalis has a beneBcial e9ect on the failing myocardium via its action to

increase the availability of calcium to the contractile machinery5 s 2ith

many drugsC digitalis has also been overused5 The correct statement

concerning the use of digitalis in the ischemic and non,ischemic myocardium

is/(5 there is a net increase in o&ygen consumption in the non,failing

myocardium

)5 there is a net increase in o&ygen consumption in the failing dilated

myocardium

*5 digitalis has proven value in prophyla&is for diastolic dysfunction

;5 digitalis causes vasoconstriction in the normal heart secondary to

enhanced sympathetic out:o2 and bloc.ing the Na?,@? TPase in smooth

muscle

35 digitalis causes an increase in heart rate in the normal heart

Item Number/ ((;)* correct ans2er/ ( category/ ntiarrhythmics

(5 Properties of the class I antiarrhythmics include

5 reduce automaticity of his,Pur.inDe Bbers

!5 decrease the rate of rise and amplitude of phase depolarization

85 prolong P,R and K,T intervals
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65 facilitate in2ard sodium conductance during rapid depolarization

(5 C!C8

)5 C8

*5 !C6

;5 6 only

35 ll are correct

Item Number/ ((;*) correct ans2er/ ; category/ ntiarrhythmics

)5


40/46

5 lidocaine

!5 phenytoin

85 tocainide

65 me&iletine

(5 C!C8

)5 C8

*5 !C6

;5 6 only

35 ll are correct

Item Number/ ((;11 correct ans2er/ ( category/ ntiarrhythmics

5 In treating supraventricular arrhythmiasC 2hich of the follo2ing reduces

ventricular response primarily by increasing the e9ective refractory period

of the ,' node=

5 propranolol

!5 digo&in

85 verapamil

65 tocainide

(5 C!C8

)5 C8*5 !C6

;5 6 only

35 ll are correct

Item Number/ ((;; correct ans2er/ ( category/ ntiarrhythmics

A5 Potential side e9ects associated 2ith amiodarone therapy include/

5 pneumonitis

!5 pseudocyanosis

85 photosensitivity

65 parotiditis

(5 C!C8

)5 C8

*5 !C6

;5 6 only35 ll are correct

Item Number/ ((;3 correct ans2er/ * category/ ntiarrhythmics

05 8lass I8 antiarrhythmics possess 2hich of the follo2ing electrophysiologic

properties=

5 mar.edly prolong repolarization

!5 mar.edly depress phase depolarization

85 inhibit calcium entry during plateau portion of action potential

65 inhibit sodium entry during phase depolarization

(5 C!C8

)5 C8

*5 !C6

;5 6 only

35 ll are correct

Item Number/ ((;1 correct ans2er/ ( category/ ntiarrhythmics

(5 dverse e9ects associated 2ith disopyramide therapy include/

5 urinary retention

!5 constipation

85 blurred vision

65 lupus syndrome

(5 C!C8

)5 C8

*5 !C6

;5 6 only

35 ll are correct

Item Number/ )A0 correct ans2er/ 3 category/ ntiarrhythmics

((5 ntiarrhythmic drugs can be separated into four groupsC types I to I'5 ll of
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the follo2ing are type I antiarrhythmic drugs E78EPT/

(5 "uinidine

)5 lidocaine

*5 procainamide

;5 phenytoin

35 propranolol

Item Number/ )0( correct ans2er/ 3 category/ ntiarrhythmics

()5 Individual antiarrhythmic agents can alter the surface electrocardiogram5

8haracteristics of "uinidine include/

(5 decreased PR interval

)5 increased KRS duration

*5 increased KT interval

;5 ll of the above

35 )C*

Item Number/ )0) correct ans2er/ 3 category/ ntiarrhythmics

(*5 Kuinidine to&icity includes all of the follo2ing E78EPT/

(5 thrombocytopenia

)5 diarrhea

*5 cinchonism

;5 ventricular Bbrillation

35 hypertension

Item Number/ )0* correct ans2er/ ( category/ ntiarrhythmics

(;5 $f the follo2ing antiarrhythmic agentsC the one 2hich most closely resembles

procainamide 2ith respect to electrophysiologic e9ects and mechanism of

action is/

(5 "uinidine

)5 lidocaine

*5 phenytoin

;5 propranolol

35 bretylium

Item Number/ (*1 correct ans2er/ 3 category/ ntiarrhythmics

(35 !ronchiolar constriction is a rare but potentially dangerous side e9ect of/

(5 "uinidine

)5 lidocaine

*5 procainamide

;5 phenytoin

35 propranolol

Item Number/ (3A correct ans2er/ ; category/ ntiarrhythmics

(15 The e9ect of di9erent antiarrhythmic agents is best understood by .no2ing

their predominant actions on cardiac Bbers5 ll of the follo2ing general

statements are true E78EPT/

(5 "uinidine slo2s the rate of depolarization of cardiac action potentials

and increases the refractory period

)5 lidocaine and phenytoin are class ( ! antiarrhythmic

*5 beta,receptor bloc.ing drugs act by reducing the slope of the pacema.er

potential

;5 procainamide acts as a speciBc calcium antagonist

35 bretylium prolongs the action potential and so prolongs the absolute

refractory period

Item Number/ 03(A correct ans2er/ ; category/ ntiarrhythmics

(5 In the pharmacologic treatment of cardiovascular disordersC "uinidine has all

of the follo2ing e9ects E78EPT/

(5 prolongation of the e9ective refractory period

)5 slo2s conduction velocity

*5 reduces spontaneous fre"uency of discharge of ectopic pacema.er


42/46

;5 has a positive chronotropic e9ect

35 produces peripheral vasodilation in large doses

Item Number/ 0A0* correct ans2er/ * category/ ntiarrhythmics

(A5


43/46

Item Number/ correct ans2er/ 3 category/ ntiarrhythmics

)*5 In 8LS algorithmC Brst antiarrhythmic to be administered in the treatment of

ventricular Bbrillation refractory to deBbrillation and epinephrine5

Item Number/ correct ans2er/ * category/ ntiarrhythmics

);5 6rug of choice for paro&ysmal supraventricular tachycardia unresponsive to

vagal maneuvers5

Item Number/ correct ans2er/ ( category/ ntiarrhythmics

)35 Produces transient increase in blood pressure follo2ed by hypotension due to

an initial release of norepinephrine from neurons follo2ed by bloc.ade of

norepinephrine re,upta.e5

Item Number/ correct ans2er/ ) category/ ntiarrhythmics

)15 8ontains iodine in molecular structureC is similar to thyro&ineC and use is

associated 2ith hyper, or hypothyroidism in ) > 3 of patients5


)5 Pharmaco.inetic properties characterized by very high protein,binding #0050%C

very largevolume of distribution#11 L4.g%C and average elimination half,life

of )3 days5

Item Number/ correct ans2er/ ; category/ ntiarrhythmics

)A5 class I8 antiarrhythmicC characterized by high aHnity for and slo2

dissociation from fast sodium channels


)05 class I! antiarrhythmicC characterized by rapid association > dissociation

from sodium channels


*5 8orrect statements concerning propafenone include all E78EPT/

(5 class I8 antiarrhythmic

)5 slo2s actions potential conduction by bloc.ing sodium channels

*5 possesses 2ea. beta bloc.ing activity

;5 class III antiarrhythmic35 increases duration of KRS comple&


*(5 8orrect statements concerning sotalol include all E78EPT/

(5 prolongs action potential duration and e9ective refractory period by

bloc.ing sodium channels5

)5 prolongs cell repolarization by bloc.ing potassium channels5

*5 produces bradycardia

;5 prolongs K,T interval

35 increases e9ective refractory period

Kuestions *) > *3

8hoose the correct ans2er for the follo2ing "uestions from the list belo25

Each ans2er can be used onceC more than onceC or not at all5

(5 propranolol

)5 acebutolol

*5 sotalol

;5 esmolol

35 butorphanol


*)5 8ardioselective beta bloc.er 2ith a short elimination half,life administered

intravenously only5


**5 Nonselective beta bloc.er 2hich slo2s heart rate and also prolongs action

potential duration by bloc.ing transmembrane potassium currents5
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*;5 8ardioselective beta bloc.er possessing intrinsic sympathetic activity and

given by oral administration only5


*35 Nonselective beta bloc.er possessing "uinidine,li.e membrane stabilizing

e9ects5


*15 FLSE statement concerning use ofcalcium channel bloc.ersas antiarrhythmics/

(5 slo2s in2ard calcium current thereby decreasing the rate of spontaneous

phase ; depolarization in Pur.inDe Bbers

)5 slo2s conduction velocity through the atrio,ventricular node and

increases functional refractory period

*5 useful for slo2ing ventricular rate in atrial Bbrillation

;5 hypotension may be a limiting side e9ect

35 verapamilC diltiazemC and nifedipine all e&ert e"ually e9ective

antiarrhythmic actions


*5 8$RRE8T statement concerning the antiarrhythmic drug adenosine/

(5 undergoes e&tensive hepatic metabolism

)5 produces coronary vasoconstriction

*5 causes fre"uent but transient post,conversion arrhythmias

;5 increases sinus node rate

35 increases atrio,ventricular conduction


*A5 True statement concerning adenosine include all E78EPT/

(5 administered sublingually

)5 negative chronotrope

*5 negative dromotrope

;5 negative inotrope

35 may precipitate bronchospasm


*05 FLSE statement concerning adenosine/

(5 half,life of ( > ( seconds

)5 higher doses necessary in patients ta.ing theophylline

*5 chest pain and shortness of breath are common but short,lived side

e9ects

;5 indicated for treating paro&ysmal supraventricular tachycardia

35 less e9ective than verapamil for treating paro&ysmal supraventricular

tachycardia


;5 8orrect statements about epinephrine administration for ventricular

Bbrillation include all E78EPT/

(5 ( mg I' push every * > 3 minutes

)5 5( mg I' push every * > 3 minutes

*5 5( mg4.g I' push every * > 3 minutes

;5 ( mg I' push follo2ed by * mg I' push follo2ed by 3 mg I' push * minutes

apart

35 )53 mg diluted to a total volume of ( ml in saline solution via an

endotracheal tube 2hen no I' access is available

Buprenorphine is a?

A. Partial mu agonist

B. Full mu agonist

C. Partial kappa agonist

D. Full kappa agonist

Which of the following is an integrase inhibitor currently in use for the treatment of HIV infection?
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A. Indinavir

B. Elvitegravir

C. Saquinavir

D. Raltegravir

Item !umber= 159@ correct answer= 3 category= Anticoagulants

1. A patient diagnosed with a deep venous thrombosis is begun on a heparin

infusion of 1555 H'" after a &555 H 7olus. #he earliest you can draw bloodfor an a*## reflecting steady-state heparin is=

1. 4 hours

3. . the onset of warfarin action may be prolonged due to the long

half-life of factor (II

D. factors II, (II, IK, and K are not activated $carbo+ylated when

warfarin is administered in therapeutic doses

1. A,7,>

3. A,>

%. 7,D

4. D only

&. All of the above

Item !umber= 15@@ correct answer= % category= Anticoagulants

&. Drugs which interact with warfarin to increase its anticoagulant effect

include=

A. ranitidine

7. trimethoprimsulfametho+a2ole

>. rifampin

D. nonsteroidal anti-inflammatory drugs

1. A,7,>

3. A,>

%. 7,D

4. D only

&. All of the above

Item !umber= 1151@ correct answer= 1 category= Anticoagulants

9. #he mechanism of action of mini-dose heparin is correctly described by=

A. factor K is more sensitive to heparin than are other serine

protease factors


46/46

7. mini-dose heparin is useful prophylactically rather than during

active clot formation

>. by inhibiting factor K activation, a relative bloc of the

clotting cascade develops, with les

pharmacologymcq

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