Absorption and distribution of drugs.............................................................................................2Amino acid neurotransmitters.......................................................................................................3Analgesic drugs.............................................................................................................................4Antibacterial drugs........................................................................................................................6Antidepressant drugs....................................................................................................................8Antiepileptic drugs........................................................................................................................9Antifungal drugs..........................................................................................................................10Anthelminthic drugs....................................................................................................................11Antipsychotic drugs.....................................................................................................................12Antiviral drugs.............................................................................................................................13Anxiolytic and hypnotic drugs.....................................................................................................14Atherosclerosis and lipoprotein metabolism................................................................................15Bone metabolism........................................................................................................................16Cancer chemotherapy.................................................................................................................16Cannabinoids...............................................................................................................................18Cell proliferation and apoptosis...................................................................................................19Chemical mediators and the autonomic nervous system............................................................20Chemical transmission and drug action in the central nervous system.......................................21Cholinergic transmission.............................................................................................................22CNS stimulants and psychotomimetic drugs...............................................................................24Drug addiction, dependence and abuse......................................................................................25Drug elimination and pharmacokinetics......................................................................................27Drugs used in the treatment of infections and cancer.................................................................28General anesthetic agents..........................................................................................................29Haemostasis and thrombosis......................................................................................................30How drugs act cellular aspects-excitation, contraction and secretion.........................................32How drugs act general principles................................................................................................33Local anaesthetics and other drugs affecting sodium channels..................................................34Local hormones, inflammation, and immune reactions...............................................................35Method and measurement in pharmacology...............................................................................37Molecular aspects of drug action.................................................................................................38Neurodegenerative diseases.......................................................................................................41Nitric oxide..................................................................................................................................42Noradrenergic transmission........................................................................................................43Obesity........................................................................................................................................ 45Other peripheral mediators, 5-hydroxytryptamine and purines..................................................46Other transmitters and modulators.............................................................................................47Peptides and proteins as mediators............................................................................................48The endocrine pancreas and the control of blood glucose..........................................................49The gastrointestinal tract............................................................................................................50The haemopoietic system...........................................................................................................51The heart..................................................................................................................................... 52The kidney..................................................................................................................................54The pituitary and the adrenal cortex...........................................................................................55The reproductive system.............................................................................................................57The respiratory system...............................................................................................................58The thyroid..................................................................................................................................59The vascular system...................................................................................................................60

Absorption and distribution of drugs

1. Concerning the effect of pH on the urinary excretion of drugs, it can be correctly stated thatA) urinary acidification accelerates excretion of weak acids and basesB) urinary alkalinization accelerates excretion of weak acids and basesC) urinary acidification accelerates excretion of weak acidsD) urinary alkalinization accelerates excretion of weak acidsE) urinary alkalinization has no effect on excretion of weak bases

2. Bioavailability is defined as the proportion of ingested drug thatA) is absorbed from the gastrointestinal tractB) reaches the systemic circulation in an active formC) crosses the blood-brain barrierD) is unbound to plasma proteinsE) is distributed to the target tissue

3. The rectal route of administrationA) provides nearly 100 percent bioavailabilityB) is only used for localized effectsC) is suitable for persons with nausea and vomitingD) is subject to a high degree of first-pass metabolismE) is used for administration of nitroglycerin

4. The passage of drugs across the blood-brain barrierA) is facilitated by a high degree of drug ionizationB) is most rapid for drugs with low lipid solubilityC) occurs more readily in the chemoreceptor trigger zoneD) is reduced by inflammation of the meningesE) is rapid with aminoglycoside antibiotics

5. A calculated volume of distribution greater than total body water is most likely to occur with drugs that areA) highly ionizedB) highly lipid solubleC) subject to a high degree of first-pass inactivationD) highly bound to plasma proteinsE) very large molecules

6. Drugs are most readily absorbed across cells of theA) gastrointestinal tractB) renal tubulesC) vascular endotheliumD) lung parenchymaE) liver

7. The binding of drugs to plasma albuminA) is usually irreversibleB) is saturableC) is most important for basic drugsD) accelerates drug metabolismE) accelerates drug excretion

8. Most drugs are absorbed across cell membranes of the gut by the process ofA) diffusing through lipidB) pinocytosisC) diffusing through aqueous poresD) carrier-mediated transportE) ion trapping

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9. Which drug is absorbed by a membrane carrier that transports phenylalanine?A) insulinB) propranololC) levodopaD) aspirinE) penicillin

10. Transdermal drug administrationA) is most suitable for highly polar drugsB) is not subject to first-pass hepatic metabolismC) provides rapid and complete absorptionD) is only used for localized effectsE) is most suitable for unconscious persons

Key: 1D, 2B, 3C, 4C, 5B, 6C, 7B, 8C, 9C, 10B

Amino acid neurotransmitters

1. The N-methyl-D-aspartate receptor for excitatory amino acids is positively modulated byA) γ-amino butyric acidB) tyrosineC) glycineD) phenylalanineE) alanine

2. The pathway leading to long-term potentiation of neuronal activity includesA) inhibition of nitric oxide synthaseB) sustained blockade of N-methyl-D-aspartate receptorsC) feedback inhibition by nitric oxideD) activation of protein kinase C by calciumE) inhibition of metabotropic receptors

3. Baclofen is a selective agonist for theA) kainite receptor for excitatory amino acidsB) N-methyl-D-aspartate receptor for excitatory amino acidsC) metabotropic receptor for excitatory amino acidsD) γ-amino butyric acid-A (GABAA) receptorE) γ-amino butyric acid-B (GABAB) receptor

4. Activation of AMPA (α-amino-5-hydroxy-3-methyl-4-isoxazole propionic acid) receptors for excitatory amino acids leads toA) fast inhibitory neurotransmissionB) fast excitatory neurotransmissionC) modulation of postsynaptic excitatory neurotransmission0) slow excitatory neurotransmissionE) slow inhibitory neurotransmission

5. The glycine receptor blocked by strychnine is aA) ligand-gated chloride channelB) ligand-gated calcium channelC) voltage-gated calcium channelD) G-protein-coupled receptorE) protein kinase receptor

6. The binding of γ-amino butyric acid (GABA) to the GABA receptor is increased byA) flumazenilB) picrotoxin

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C) diazepamD) baclofenE) gabapentin

7. Which substance blocks ion channels of N-methy1-D-aspartate receptors for excitatory aminoacids?A) ketamineB) cycloserineC) kynurenic acidD) cyclothiazideE) kainite

8. Activation of metabotropic excitatory amino acid receptors leads toA) opening of chloride ion channelsB) opening of cation channelsC) formation of inositol triphosphateD) formation of cyclic AMPE) activation of protein kinase A

Key: 1C, 2D, 3E, 4B, 5A, 6C, 7A, 8E

Analgesic drugs

1. Opioids activate descending pathways that inhibit pain transmission by acting on neurons in theA) dorsal hornB) thalamusC) periaqueductal grey matterD) nucleus raphe magnusE) locus coeruleus

2. The vaniioid receptor activated by capsaicin is aA) ligand gated cation channel8) ligand-gated chloride ion channelC) ATP-sensitive potassium channelD) G-protein-coupled receptorE) protein kinase receptor

3. The analgesic effect of morphine is mostly due to activation ofA) delta opioid receptorsB) kappa opioid receptorsC) mu opioid receptorsD) sigma opioid receptorsE) tau receptors

4. Simulation of opioid receptors leads toA) increased guanylate cyclase activityB) decreased guanylate cyclase activityC) increased adenylate cyclase activityD) decreased adenylate cyclase activityE) dosing of potassium channels

5. Opioid drugs that exhibit partial agonist or mixed agonist-antagonist properties includeA) naloxone and naltrexoneB) methadone and meperidineC) fentanyl and sufentanilD) dynorphin and endorphin

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F) nalbuphine and pentazocine

6. The best example of a partial agonist at mu opioid receptors isA) pentazocineB) bupienorphineC) cyclazocineD) nalbuphineE) codeine

7. Which short-acting opioid agonist is administered as a transdermal skin patch?A) fentanylB) methadoneC) meperidineD) codeineE) propoxyphene

8. Activation of Kappa opioid receptors is primarily responsive for causingA) supraspinal analgesiaB) euphoriaC) dysphoriaD) respiratory depressionE) physical dependence

9. Which finding typically occurs in opioid poisoning but not in central nervous system depression due to other causes?A) comaB) hallucinationsC) hypertensionD) respiratory depressionE) pinpoint pupils

10. The pharmacologic properties of morphine areA) well absorbed from the gutB) high oral bioavailabilityC) rapidly metabolized in neonatesD) converted to active morphine-6-glucuronideE) excreted unchanged in the urine

11. Descending inhibition of dorsal horn pain transmission is mediated by neurons that releaseA) acetylcholine and dopamineB) enkephalins, 5-hydroxytryptamine, and noradrenalineC) glutamate and substance PD) bradykinin and prostanoidsE) neuropeptides

12. Opioid drugs inhibit neurotransmitter release partly byA) opening potassium and calcium channelsB) dosing potassium and calcium channelsC) opening potassium channels and closing calcium channelsD) opening calcium channels and closing potassium channelsE) depolarizing pre-synaptic neuronal membranes

13. Which transmitter is released at the first synapse in the dorsal horn ascending nociceptiveA) glutamateB) enkephalinC) substance PD) γ-amino-butyric acidE) noradrenaline

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14. Actions of opioids that are not related to activation of mu, delta, or kappa opioid receptors includeA) euphoriaB) respiratory depressionC) pupillary constrictionD) constipationE) bronchospasm

Key: 1C, 2A, 3C, 4D, 5E, 6B, 7A, 8C, 9E, 10D, 11B, 12C, 13A, 14E

Antibacterial drugs

1. Benzylpenicillin is the first drug of choice for treatment of infections due toA) Pseudomonas aeruginosaB) Legionella pneumophilaC) Haemophilus influenzaeD) Treponema pallidumE) Pasteurelia multocida

2. Red-green color blindness is a dose-related adverse effect ofA) cycloserineB) ethambutolC) rifampicinD) isoniazidE) streptomycin

3. Resistance to cephalosporin antibiotics is most likely to result fromA) phosphorylation by bacterial kinasesB) inactivation by bacterial β-lactamaseC) decreased affinity of dihydrofolate reductaseD) increased efflux by bacterial transport proteinsE) decreased ribosomal affinity for the drugs

4. Penicillins that are active against strains of Pseudomonas aeruginosa includeA) piperacillinB) ampicillinC) benzylpenicillinD) amoxicillinE) phenoxymethylpenicillin

5. Respiratory tract infections caused by Nocardia or Pneumocystis are often treated withA) co-trimoxazoleB) gentamicinC) azithromycinD) tetracyclineE) chloramphenicol

6. Cilastatin inhibits the degradation imipenem byA) hepatic enzymesB) gut wall enzymesC) renal enzymesD) pulmonary enzymesE) plasma enzymes

7. Chloramphenicol is not used for trivial infections because it may rarely causeA) liver failureB) pancytopenia

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C) heart failureD) pulmonary fibrosisE) convulsive seizures

8. Infections due to penicillinase-producing strains of Neisseria gonorrhoeae may be most effectively treated withA) tetracyclineB) gentamicinC) erythromycinD) vancomycinE) ofloxacin

9. A genetically determined variation of hepatic acetyltransferase activity accounts for differences in the elimination half-life ofA) rifampicinB) isoniazidC) pyrazinamideD) ethambutolE) cycloserine

10. Tetracycline should not be given to pregnant women or young children because of the risk ofA) retarded bone developmentB) ototoxicityC) bone marrow depressionD) myositis and rhabdomyolysisE) hypoplasia and staining of the teeth

11. Arthropathy manifested as painful joints is most likely to occur in younger individuals treated withA) ciprofloxacinB) tetracyclineC) azithromycinD) trimethoprimE) vancomycin

12. Quinupristin-dalfopristin is active against some strains ofA) Pseudomonas aeruginosaB) Enterococcus faeciumC) Escherichia coliD) Proteus mirabilisE) Legionella pneumophila

Key: 1D, 2C, 3B, 4A, 5A, 6C, 7B, 8E, 9B, 10E, 11A, 12B

Antidepressant drugs

1. The mechanisms that contribute to the development of mood depression include increasedA) cortisolB) noradrenalineC) brain-derived neurotrophic factorD) 5-hydroxytryptamineE) γ-amino-butyric acid

2. Alternatives to lithium for the prevention and treatment of manic episodes includeA) fluoxetineB) sertralineC) carbamazepine

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D) phenelzineE) bupropion

3. Mirtazapme is believed to produce its antidepressant effect byA) activating 5-hydroxytryptamine 5-HT2 receptorsB) activating 5-hydroxytryptamine 5-HT3 receptorsC) activating presynaptic α2 adrenoceptorsD) blocking presynaptic α2 adrenoceptorsE) blocking neuronal reuptake of noradrenaline

4. Which antidepressant drug is used as an adjunct to smoking cessation?A) fluoxetineB) bupropionC) sertralineD) mirtazapineE) paroxetine

5. Ingestion of foods containing tyramine may lead to a hypertensive crisis in persons takingA) A tricyclic antidepressantB) mirtazapineC) a selective serotonin reuptake inhibitorD) lithiumE) a nonselective monoamine oxidase inhibitor

6. Selective serotonin uptake inhibitors causeA) immediate inhibition of serotonin reuptake and mood improvementB) delayed inhibition of serotonin reuptake and mood improvementC) immediate inhibition of serotonin reuptake and delayed mood improvementD) immediate mood improvement and delayed inhibition of serotonin reuptakeE) mood depression followed by mood improvement

7. Severe cardiac arrhythmias are most likely to result from an overdose ofA) fluoxetineB) phenelzineC) mirtazapineD) sertralineE) nortriptyline

8. Serum lithium levels are increased by the concurrent administration ofA) thiazide diureticsB) desipramineC) trazodoneD) phenelzineE) propranolol

9. The concurrent administration of a selective serotonin reuptake inhibitor and a monoamine oxidase inhibitor is most likely to causeA) bradycardiaB) suicidal thoughtsC) postural hypotensionD) dry mouth and blurred visionE) hyperthermia and muscle rigidity

10.Desipramine blocks the neuronal reuptake ofA) only noradrenalineB) only serotoninC) noradrenaline and serotonin equallyD) noradrenaline more than serotonin

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E) serotonin more than noradrenaline

11. Sexual dysfunction is most likely to occur in persons takingA) amitriptylineB) fluoxetineC) mirtazapineD) desipramineE) nortriptyline

12. The adverse effects of amitriptyline caused by muscarinic receptor blockade includeA) urinary retentionB) insomniaC) hypotensionD) diarrheaE) salivation

Key: 1A, 2C, 3D, 4B, 5E, 6C, 7E, 8A, 9E, 10D, 11B, 12A

Antiepileptic drugs

1. Gabapentin is believed to exert its antiepileptic effect byA) increasing the synthesis of γ-aminobutyric acid (GABA)B) increasing the release of γ-aminobutyric acid (GABA)C) activating γ-aminobutyric acid (GABA)-gated chloride ion channelsD) blocking γ-aminobutyric acid (GABA)-gated chloride ion channelsE) inhibiting the release of several neurotransmitters

2. The efficacy of ethosuximide in the treatment of absence seizures is based on its ability toA) block voltageB) activate voltageC) block T (transient)D) activate T (transient)E) activated γ

3. Which antiepileptic agent inhibits γ-aminobutyric acid (GABA) transaminase and thereby increases the brain content of GABA?A) vigabatrinB) carbamazepineC) tiagabineD) lamotrigineE) topiramate

4. Carbamazepine is used in treating all of the following conditions exceptA) bipolar disorderB) neuropathic painC) absence seizuresD) partial seizuresE) generalized tonic-clonic seizures

5. The antiepileptic effect of zonisamide is due to its ability toA) block T (transient)-type calcium channelsB) block voltage-gated sodium channelsC) Inhibit γ-aminobutyric acid (GABA) degradationD) inhibit glutamate releaseE) block glutamate receptors

6. Hirsutism, megaloblastic anemia, and gum hypertrophy are potential adverse effects of

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A) carbamazepineB) ethosuximideC) lamotrigineD) phenobarbitalE) phenytoin

7. Gabapentin, tiagabine, and zonisamide are primarily used in treatingA) partial seizuresB) generalized tonic-clonic seizuresC) absence seizuresD) myoclonic seizuresE) status epilepticus

8. Mood depression and psychotic reactions may occur in some patients receivingA) gabapentinB) tiagabineC) lamotrigineD) vigabatrinE) zonisamide

Key: 1E, 2C, 3A, 4C, 5B, 6E, 7A, 8D

Antifungal drugs

1. The conversion of squalene to lanosterol in fungi is inhibited byA) flucytosineB) itraconazoleC) griseofulvinD) amphotericin BE) terbinafine

2. The synthesis of a component of the fungal cell wall is inhibited byA) ketoconazoleB) caspofurginC) amphotericin BD) griseofulvinE) flucytosine

3. Dermatophyte infections of the nailbed can be effectively treated by oral administration ofA) nystatinB) amphotericin BC) flucytosineD} itraconazoleE) caspofungin

4. Fever, chills, nausea, and vomiting occur frequently in persons administeredA) amphotericin BB) caspofunginC) fluconazoleD) terbinafineE) griseofulvin

5. Cases of invasive aspergillosis that are refractory to amphotericin B have been successfully treatedA) nystatinB) itraconazoleC) caspofungin

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D) fluconazoleE) terbinafine

Key: 1E, 2B, 3D, 4A, 5C

Anthelminthic drugs

1. Praziquantel is effective in treating blood fluke infections because of its ability toA) block voltage-gated calcium channelsB) induce muscle contracture and paralysisC) open chloride ion channelsD) inhibit tubulin polymerizationE) prevent glucose uptake

2. A single dose of niclosamide is effective in treating infections ofA) Enterobius vermicuiarisB) Schistosoma japonicumC) Trichuris trichiuraD) Trichinella spirailisE) Taenia solium

3. Ivermectin is believed to kill filarial roundworm parasites partly byA) blocking glutamate-gated chloride channelsB) opening glutamate-gated chloride channelsC) blocking voltage-gated calcium charnelsD) opening voltage-gated calcium channelsE) inhibiting oxidative phosphorylation

4. Which anthelminthic drug interferes with microtubule-dependent functions such as glucoseA) albendazoleB) diethylcarbamazineC) piperazineD) niclosamideE) levamisole

Key: 1B, 2E, 3B, 4A

Antipsychotic drugs

1. The glutamate hypothesis of schizophrenia is based in part on theA) increased glutamate receptor densities found in schizophrenic brainsB) decreased glutamate receptor densities found in schizophrenic brainsC) reduction of schizophrenic symptoms by glutamate antagonistsD) reduction of schizophrenic symptoms by glutamate agonistsE) occurrence of psychotic symptoms in persons given glutamate agonists

2. Because of the risk of agranulocytosis, periodic blood counts are required in persons receivingA) haloperidolB) quetiapineC) risperidoneD) clozapineE) sulpinde

3. The dopamine hypothesis of schizophrenia is primarily supported by theA) decreased dopamine synthesis found in schizophrenic patients

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B) increased excretion of dopamine metabolites in schizophrenic patientsC) increased dopamine D2 receptor density found in schizophrenic patientsD) decreased dopamine D2 receptor density found in schizophrenic patientsE) correlation between dopamine D2 receptor binding and clinical potency of antipsychotic drugs

4. The primary endocrine effect of most antipsychotic drugs isA) increased secretion of prolactinB) decreased secretion of prolactinC) increased secretion of growth hormoneD) decreased secretion of growth hormoneE) increased secretion of thyrotropin

5. When antipsychotic drugs are administered chronically, the activity of dopaminergic neuronsA) decreases throughout therapy8) increases throughout therapyC) decreases transiently then increasesD) increases transiently then decreasesE) fluctuates randomly throughout therapy

6. The adverse effects of antipsychotic drugs attributed to blockade of muscarinic receptors includeA) hypotensionB) tardive dyskinesiaC) obstructive (cholestatic) jaundiceD) weight gainE) increased intraocular pressure

7. The antipsychotic malignant syndrome is characterized byA) muscle paralysis and hypothermiaB) muscle rigidity and hyperthermiaC) muscle atrophyD) myositis and rhabdomyolysisE) leukopenia and agranulocytosis

Key: 1B, 2D, 3E, 4A, 5D, 6E, 7B

Antiviral drugs

1. Which reverse transcriptase inhibitor achieves the highest percentage of plasma drug concentrations in the cerebrospinal fluid?A) lamivudineB) abacavirC) stavudineD) zidovudineE) efavirenz

2. The mortality due to Lassa fever is significantly reduced in persons treated withA) tribavirin (ribavirin)B) foscarnetC) ganciclovirD) interferon alphaE) oseltamivir

3. Efavirenz inhibits human immunodeficiency virus reverse transcriptase byA) competing with nucleotides for the active site of the enzymeB) binding near the catalytic site and denaturing it

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C) incorporation into nascent DNA, causing chain terminationD) inhibiting formation of nucleotide triphosphatesE) inhibiting maturation of viral poiyproteins

4. The preferred drug for treating active infections of cytomegalovirus isA) acyclovirB) foscametC) lamivudineD) nevirapineE) ganciclovir

5. Which virus is most susceptible to acyclovir?A) cytomegalovirusB) Herpes simplex virusC) Herpes zoster virusD) respiratory syncytial virusE) Epstein-Barr virus

6. Which agent has been used to reduce mother-to-baby transmission of human immunodeficiencyA) abacavirB) ritonavirC) nevirapineD) enfuvirtideE) lamivudine

7. The use of foscarnet is restricted because of its propensity to causeA) nephrotoxicityB) hepatotoxicityC) cardiotoxicityD) pulmonary toxicityE) ototoxicity

8. Oseltamivir effectively prevents influenza because of its ability to inhibitA) viral attachmentB) viral disassemblyC) replication of viral nucleic acidD) assembly of new virionsE) budding of new virions

Key: 1D, 2A, 3B, 4E, 5B, 6C, 7A, 8E

Anxiolytic and hypnotic drugs

1. Benzodiazepines enhance the effect of γ-amino-butyric acid (GABA) on chloride ion channels by increasingA) the chloride conductance of each channelB) the frequency of channel openingC) the amount of time each channel remains openD) the affinity of chloride for the channelE) the recovery time of each channel

2. When used to induce sleep in persons with insomnia, benzodiazepines act to increaseA) subjective ratings of sleep qualityB) the proportion time spent in slow-wave sleepC) the amount of time taken to get to sleepD) the amount of rapid eye movement sleep

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E) the secretion of growth hormone during sleep

3. The atributes of zolpidem includeA) a benzodiazepine structureB) being useful in treating anxietyC) an ultrashort duration of actionD) a significant hangover effectE) a high risk of drug dependence

4. Flumazenil interacts with the γ-amino-butyric add (GABA) receptor so as to competitively inhibit the binding ofA) only GABAB) only benzodiazepine drugsC) only β-carboline drugsD) both GABA and benzodiazepine drugsE) both benzodiazepine and β-carboline drugs

5. The use of buspirone in the treatment of anxiety disorders is characterized byA) a rapid onset of actionB) a risk of drug dependenceC) sedation and motor incoordinationD) a lack of withdrawal effectsE) blockade of 5-hydroxytryptamine 5-HT1A receptors

6. Midazolam is most commonly used asA) a hypnoticB) an anxiolyticC) an intravenous anestheticD) an anticonvulsantE) a muscle relaxant

7. The short-acting benzodiazepines that are converted to inactive glucuronide metabolites includeA) diazepamB) lorazepamC) chlordiazepoxideD) triazolamE) alprazolam

Key: 1B, 2A, 3C, 4E, 5D, 6C, 7B

Atherosclerosis and lipoprotein metabolism

1. Activation of the peroxisome proliferator-activated receptor-alpha is produced by administration ofA) ezetimibeB) fenofibrateC) simvastatinD) niacinE) colesevelam

2. Ezetimibe reduces serum LDL-cholesterol levels byA) inhibiting cholesterol synthesisB) increasing HDL-cholesterol levelsC) inhibiting cholesterol absorptionD) inhibiting bile acid reabsorptionE) stimulate lipoprotein lipase

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3. Myositis leading to rhabdomyolysis is a potentially severe adverse effect ofA) atorvastatinB) niacinC) colestipolD) ezetimibeE) cholestyramine

4. Increased expression of apoproteins A-I and A-II occurs in persons receivingA) colestipolB) niacinC) simvastatinD) ezetimibeE) gemfibrozil

5. Simvastatin and related drugs have been shown to reduce mortality in persons withA) hypertriglyceridemiaB) low HDL-cholesterol levelsC) an inability to make LDL receptorsD) symptomatic coronary artery diseaseE) myositis

6. Which drug inhibits hepatic triglyceride synthesis and VLDL secretion?A) fenofibrateB) colestipolC) niacinD) ezetimibeE) atorvastatin

Key: 1B, 2C, 3A, 4E, 5D, 6C, 7B

Bone metabolism

1. Substances that stimulate osteoblasts to express the Receptor Activator of Nuclear factor Kappa B (RANK) ligand includeA) alendronateB) raloxifeneC) fluorideD) calcitriolE) osteoprotegerin

2. Which type of vitamin D is formed in the skin by the action of ultraviolet radiation?A) calcitriolB) calcifediolC) ergocalciferolD) alfacalcidolE) cholecalciferol

3. Alendronate is useful in treating osteoporosis because of its ability toA) stimulate bone formation by osteoblastsB) inhibit bone resorption by osteoclastsC) block receptor activator of nuclear factor kappa BD) cause apoptosis of osteoclastsE) cause differentiation of osteoblast precursor cells

4. Activation of calcium-sensing receptors by cinacalcet causesA) a rise in plasma calcium concentration

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B) increased secretion of parathyroid hormoneC) decreased secretion of parathyroid hormoneD) decreased secretion of calcitoninE) increased formation of calcitriol

5. Teriparatide is useful in the treatment of osteoporosis because of its ability toA) increase plasma calcium concentrationsB) decrease plasma calcium concentrationsC) recruit osteoclast precursor cellsD) inhibit osteoclast activityE) increase osteoblast activity

6. Which agent is used to prevent excessive bone turnover and relieve bone pain in Pagers disease of bone?A) calcitoninB) ergocalciferolC) calcium gluconateD) parathyroid hormoneE) prednisone

Key: 1D, 2E, 3B, 4C, 5E, 6A

Cancer chemotherapy

1. A cytoplasmic kinase (Bcr/Abl) involved in the pathogenesis of chronic myeloid leukemia is inhibited byA) crisantaspaseB) anastrozoleC) imatinibD) rituximabE) aldesleukin

2. Cumulative dose-related cardiac toxicity typically results from administration ofA) doxorubicinB) bleomycinC) vincristineD) imatinibE) irinotecan

3. Goserelin is used in treating advanced prostate cancer because of its ability toA) increase gonadotrophin secretionB) reduce gonadotrophin secretionC) block testosterone receptorsD) activate estrogen receptorsE) inhibit estrogen synthesis

4. Vincristine inhibits mitosis of cancer cells at metaphase byA) inhibiting telomeraseB) increasing tubulin degradationC) inhibiting synthesis of tubulinD) inhibiting polymerization of tubulinE) stabilizing microtubules

5. Cytarabine is converted to an active triphosphate metabolite that inhibitsA) DMA polymeraseB) adenine deaminaseC) dihydrofolate reductase

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D) telomeraseE) thymidylate synthetase

6. Folinic acid can be administered to counteract the toxic effects ofA) fludarabineB) gemcitabineC) cytarabineD) fluorouracilE} methotrexate

7. Reactive carbonium ions that attack guanine bases of DNA and lead to crosslinking of DNA strands are formed in the body from drugs such asA) cisplatinB) bleomycinC) doxorubicinD) etoposideE) cyclophosphamide

8. Which anticancer drug is most effective in the G2 phase of the cell cycle?A) paclitaxelB) methotrexateC) bleomycinD) iriinotecanE) cytarabine

9. Thymidylate synthetase is inhibited by the active metabolite ofA) pentostatinB) fluorouracilC) doxorubicinD) gemcitabineE) fludarabine

10. Anastrozole is used in treating advanced breast cancer because of its ability toA) inactivate tumor growth factorsB) block estrogen receptorsC) inhibit aromataseD) decrease gonadotropin secretionE) cross-link strainds of DNA

11. Sulfhydryl donors such as mesna are useful in reducing ifosfamide-inducedA) bone marrow depressionB) nausea and vomitingC) cardiac toxicityD) hemorrhagic cystitisE) gastrointestinal ulceration

12. Trastuzumab is useful in treating breast cancer because of its ability to bindA) telomeraseB) human epidermal growth factor receptor 2C) DNA transcription factorsD) insulin-like growth factorE) calcium channel forming proteins

Key: 1C, 2A, 3B, 4D, 5A, 6E, 7E, 8C, 9B, 10C, 11D, 12B

Cannabinoids

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1. Activation of the cannabinoid CB1 receptor in nerve endings leads toA) activation of neurotransmitter releaseB) inhibition of potassium channelsC) inhibition of calcium channelsD) activation of adenylate cyclaseE) inhibition of Map (mitogen-activated protein) kinase

2. Cannabinoids have been used therapeutically for the purpose ofA) increasing appetiteB) treating obesityC) improving memoryD) treating drug dependenceE) treating anxiety

3. Anandamide is correctly described as a substance thatA) is synthesized from amino acid precursorsB) is stored in synaptic vesiclesC) is a cannabinoid receptor antagonistD) inhibits retrograde neuronal transmissionE) exerts endocannabinoid activity

4. The effects produced by cannabinoid administration includeA) increased intraocular pressureB) decreased intraocular pressureC) VasoconstrictionD) BronchoconstrictionE) emesis

5. Rimonabant is a new drug for the treatment ofA) obesityB) nausea and vomitingC) asthmaD) neuropathic painE) Parkinson’s disease

Key: 1C, 2A, 3E, 4B, 5A

Cell proliferation and apoptosis

1. In the death receptor pathway, activation of tumor necrosis factor receptors causes the receptors to trimerize and complex an adapter protein, thereby leading to activation ofA) mitochondrial pathwaysB) caspase-8C) pro-apoptotic factor Bcl-2D) a p53 proteinE) DNA transcription factors

2. The activation of primitive stem cells so as to replace a damaged tissue is calledA) HealingB) RepairC) RestorationD) RegenerationE) Rejuvenation

3. Defective apoptosis may contribute to the development ofA) CancerB) Alzheimer’s disease

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C) myocardial infarctionD) aplastic anemiaE) stroke

4. The activation of caspase-3 leads toA) activation of transcription factorsB) inhibition of transcription factorsC) activation of the anti-apoptotic pathwayD) fragmentation of genomic DNAE) stabilization of cell membranes

5. Bortemozib causes accumulation of an apoptotic-promoter protein by inhibitingA) mitochondrial DNAB) SuvivinC) matrix metalolproteinasesD) pro-apoptotic Bcl-2E) the proteasome

6. Matrix metalloproteinases are responsible forA) inhibition of neoplastic cell growthB) adjusting the cell cytoskeletonC) degradation of extracellular matrixD) initiating angiogenesisE) activation of the cell cycle

7. Antisense compounds active against antiapoptotic factors are potentially useful for treatingA) myocardial infarctionB) LeukemiaC) Parkinson's diseaseD) multiple sclerosisE) impaired wound healing

8. Bevacizumab is a monoclonal antibody that targetsA) caspase-3B) MetalollproteinaseC) CyclinD) vascular endothelial growth factorE) promoters of apoptosis

9. Mitochondria participate in apoptosis by releasingA) apoptotic protease activating factorB) caspase-9C) cytochrome cD) p53 proteinE) inhibitors of apoptosis

10. Progress through the cell cycle is stimulated byA) cyclin-dependent kinasesB) phosphorylated Rb proteinC) check point factorsD) p53 proteinE) inhibitors of kinases

Key: 1B, 2D, 3A, 4D, 5E, 6C, 7B, 8D, 9C, 10A

Chemical mediators and the autonomic nervous system

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1. The release of acetylcholine from cholinergic nerve terminals is stimulated byA) nitric oxideB) NorepinephnneC) acetylcholineD) prostaglandinsE) endothelin

2. Co-transmitters released from postganglionic sympathetic neurons includeA) AcetylcholineB) vasoactive intestinal peptideC) nitric oxideD) adenosine triphosphateE) gamma-aminobutync acid

3. Constriction of bronchi is typically produced by activation ofA) adrenergic beta-1 receptorsB) adrenergic beta-2 receptorsC) muscarinic M1 receptorsD) muscarinic M2 receptorsE) muscarinic M3 receptors

4. Activation of adrenergic beta-2 receptors producesA) contraction of the iris sphincter muscleB) relaxation of the iris sphincter muscleC) relaxation of the ciliary muscleD) contraction of the ciliary muscleE) lacnmal gland secretion

5. The enteric nervous system is primarily concerned with the regulation ofA) the urinary tractB) gastrointestinal motilityC) male sex organsD) RespirationE) vascular smooth muscle

6. The co-transmitter known as neuropeptide γ enhances theA) vasodilative effect of acetylcholineB) vasodilative effect of nitric oxideC) vasodilative effect of dopamineD) vasoconstrictive effect of norepinephrineE) vasoconstrictive effect of endothelin

7. The final step in the release of norepinephrine from sympathetic neurons isA) dockingB) loadingC) diffusionD) synthesisE) exocytosis

8. In the parasympathetic nervous system, neurotransmitter action is terminated byA) diffusion from the synapseB) active reuptake into presynaptic nervesC) inactivation by inhibitorsD) enzymatic degradationE) endocytosis

9. The enteric nervous systemA) receives input only from the sympathetic neivous systemB) receives input only from the parasympathetic nervous system

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C) releases several peptide neurotransmitters and nitric oxideD) cannot function without the central nervous systemE) has cell bodies lying in plexuses outside the intestinal wall

Key: 1A, 2D, 3E, 4C, 5B, 6D, 7E, 8D, 9C

Chemical transmission and drug action in the central nervous system

1. Fast neurotransmitters in the central nervous system includeA) glutamateB) dopamineC) substance PD) prostanoidsE) nerve growth factor

2. Slow neurotransmitters and neuromodulators act mainly throughA) ligand-gated ion channelsB) G-protein-coupled receptorsC) enzymesD) transcription factorsE) release of nitnc oxide

3. Drugs that are transported out of vascular endothelial cells in the central nervous system by P-glycoprotein includeA) most non polar compoundsB) amino acid derivatives such as levodopaC) highly ionized compoundsD) many anticancer and antibacterial drugsE) most mood-altering drugs

4. The relationship between the biochemical and cellular effects of a drug and its behavioral and therapeutic effects are best understood for drugs used in treatingA) mood depressionB) epilepsyC) Parkinson's diseaseD) schizophreniaE) mania

Key: 1A, 2B, 3D, 4C

Cholinergic transmission

1. Activation of muscarinic M2 receptorsA) increases calcium conductanceB) increases potassium conductanceC) increases cardiac rate and forceD) causes central nervous system excitationE) produces vascular smooth muscle relaxation

2. Succinylcholine is characteristically an agonist atA) muscarinic M1 receptorsB) muscarinic M2 receptorsC) muscarinic M3 receptorsD) nicotinic receptors in skeletal muscleE) nicotinic receptors in autonomic ganglia

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3. The second messengers formed by activation of muscarinic acetylcholine receptors includeA) inositol triphosphateB) cyclic AMPC) cyclic GMPD) EicosanoidsE) guanosine triphosphate

4. Pilocarpine lowers intraocular pressure byA) decreasing aqueous humor formationB) contracting the iris sphincter muscleC) contracting the ciliary muscleD) relaxing the iris sphincter muscleE) relaxing the ciliary muscle

5. The increased release of potassium from denervated musdes by succinylcholine is due toA) inhibition of CholinesteraseB) desensitization of nicotinic receptorsC) nicotinic receptor up-regulationD) denervation supersensitivityE) destruction of the motor end plate

6. Edrophonium produces reversible inhibition of cholinesterase byA) binding the anionic siteB) binding the esteratic siteC) binding both anionic and esteratic sitesD) reversibly binding an allosteric siteE) forming a complex with acetylcholine

7. Pyridostigmine enhances neuromuscular transmission in myasthenia gravis patients byA) increasing release of acetylcholineB) inhibiting degradation of acetylcholineC) causing up-regulation of nicotinic receptorsD) reactivating choiinesteraseE) blocking autoantibodies

8. Activation of muscarinic M3 receptors leads toA) smooth muscle relaxationB) cardiac slowingC) central nervous system stimulationD) VasoconstrictionE) exocrine gland secretion

9. The effects produced by topical ocular administration of atropine includeA) MiosisB) MydriasisC) LacrimationD) decreased intraocular pressureE) conjunctivitis

10. If a test dose of edrophonium increases muscle weakness in a myasthenia gravis patient being treated with pyridostigmine, it means thatA) the patient does not actually have myasthenia gravisB) the dose of pyridostigmine is too lowC) the dose of pyridostigmine is too highD) atropine should be administeredE) none of the above is correct

11. Atropine poisoning in children typically causes

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A) respiratory depressionB) muscle paralysisC) SweatingD) HyperthermiaE) sedation

12. Persons with a genetic variant conferring abnormal plasma cholinesterase activity may exhibitprolonged musde paralysis following administration ofA) tubocurarineB) pilocarpineC) pancuroniumD) atracuriumE) succinylcholine

13. The release of acetylcholine from cholinergic nerve terminals is blocked byA) atropineB) bungarotoxmC) botulinum toxinD) batrachotoxinE) tetrodotoxin

14. Scopolamine is employed clinically in the prevention or treatment ofA) motion sicknessB) asthmaC) peptic ulcerD) glaucomaE) constipation

15. The neuromuscular blockade produced by atracurium can be reversed by administration ofA) atropineB) neostigmineC) succinylcholineD) pilocarpineE) nicotine

16. Transient muscle fasciculations followed by paralysis typically occur after administration ofA) succinylcholineB) TubocurarineC) vecuroniumD) gallamineE) atropine

Key: 1B, 2D, 3A, 4C, 5D, 6A, 7B, 8E, 9B, 10C, 11D, 12E, 13C, 14A, 15B, 16A

CNS stimulants and psychotomimetic drugs

1. Phencyclidine is believed to cause psychotomimetic effects byA) activating receptors for γ-aminobutyric acidB) blocking receptors for γ-aminobutyric acidC) activating N-methyl-D-aspartate-operated ion channelsD) blocking N-methyl-D-aspartate receptor-operated ion channelsE) increasing neuronal release of 5-hydroxytryptamine

2. Both lysergic acid diethylamine (LSD) and phencyclidine may causeA) acute hyperthermia and muscle damageB) physical dependence

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C) schizophrenic symptomsD) analgesiaE) inhibition of monoamine transporters

3. The psychotomimetic activity of lysergic acid diethylamide (LSD) is believed to result from its ability toA) activate 5-hydroxytryptamine 5-HT2 receptorsB) block 5-hydroxytryptamine 5-HT2 receptorsC) inhibit neuronal reuptake of noradrenaline and dopamineD) release 5-hydroxytryptamine and block its neuronal reuptakeE) block receptors for γ-aminobutyric acid

4. Progressive myocardial damage leading to heart failure is most likely to occur in persons whoA) lysergic acid diethylamide (LSD)B) phencyclidineC) mescalineD) psilocybinE) cocaine

5. Methylphenidate is primarily used in the treatment ofA) narcolepsyB) mood depressionC) attention deficit-hyperactivity disorderD) obesityE) asthma

6. The adverse effects of methylenedioxymethamphetamine (MDMA) typically includeA) drug addictionB) skeletal muscle damageC) hypothermiaD) liver failureE) bone marrow depression

Key: 1D, 2C, 3A, 4E, 5C, 6B

Drug addiction, dependence and abuse

1. All dependence-producing drugs act via different pathways to causeA) depletion of norepinephrine in the locus coeruleusB) depletion of dopamine in nigrostriatal pathwaysC) depletion of glutamate in meso-limbic pathwaysD) the release of glutamate in the frontal cortexE) the release of dopamine in the nucleus accumbens

2. Chronic administration of morphine is believed to cause tolerance byA) increasing expression of adenylate cyclaseB) decreasing expression of adenylate cyclaseC) increasing expression of guanylate cyclaseD) decreasing expression of guanylate cyclaseE) increasing expression of α-adrenoceptors

3. Nicotine use often leads to drug dependence by activation of nicotinic receptors in theA) nucleus accumbensB) hippocampusC) ventral tegmental areaD) cerebral cortexE) striatum

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4. Disulfiram has been used to facilitate abstinence from ethanol based on its ability to inhibitA) the mesollimbic dopaminergic pathwayB) ethanol withdrawal symptomsC) alcolhol dehydrogenaseD) aldehyde dehydrogenaseE) aldehyde oxidase

5. The effects that result from smoking marijuana includeA) improved motor coordinationB) improved memoryC) increased creativityD) loss of appetiteE) conjunctival vasodilatation

6. Which drug is used in the treatment of drug dependence because of its ability to reduce withdrawal symptoms?A) clonidineB) methadoneC) bupropionD) naltrexoneE) acamprosate

7. The fetal alcohol syndrome is associated with malformations that typically includeA) increased cranial circumferenceB) abnormal limb developmentC) abnormal facial developmentD) neural tube birth defectsE) cleft palate

8. A sustained-release formulation of bupropion is used to facilitate abstinence in persons who are addicted toA) ethanolB) cocaineC) nicotineD) heroinE) marijuana

9. Metabolism of the amount of ethanol contained in substantial quantities of alcoholic beverages may lead to a depletion ofA) essential amino acidsB) acetaldehydeC) reduced nicotinamide adenine dinucleotide (NADH)D) nicotinamide adenine dinucleotide (NAD+)E) lactate

10. Moderate ingestion of ethanol reduces mortality associated withA) lung cancerB) liver diseaseC) coronary heart diseaseD) hypertensionE) renal disease

11. In this decade, the incidence of cigarette smoking isA) increasing in developing countriesB) decreasing in developing countriesC) increasing in the UK but decreasing in developing countriesD) decreasing in the UK but increasing in developing countriesE) increasing in all countries studied

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12. Ingestion of ethanol typically increases the secretion ofA) testosteroneB) antidiuretic hormoneC) adrenocorticotrophic hormoneD) growth hormoneE) glucagon

Key: 1E, 2A, 3C, 4D, 5E, 6A, 7C, 8C, 9D, 10C, 11D, 12C

Drug elimination and pharmacokinetics

1. Hepatic cytochrome P450 drug-metabolizing enzymes are primarily found inA) cell nucleiB) plasma membranesC) the cytoplasmD) the smooth endoplasmic reticulumE) mitochondria

2. Phase II drug metabolismA) includes hydrolytic reactionsB) produces low molecular weight productsC) usually forms inactive metabolitesD) takes place mainly in the kidneysE) requires NADPH as a cofactor

3. Ketoconazole produces non-competitive inhibition of cytochrome P450 byA) binding to the ferric form of heme ironB) binding to the active site of the enzymeC) causing enzyme autolysisD) oxidizing NADPHE) binding covalently to the P450 protein

4. In first-order drug eliminationA) drug half-life is directly proportional to drug concentrationB) the rate of elimination is directly proportional to drug concentrationC) drug clearance is directly proportional to plasma drug concentrationD) the rate of elimination is constantE) the rate of elimination is unpredictable

5. If a drug is administered repeatedly at the same dose and dosage interval, the time required to reach the steady-state plasma drug concentration is proportional to theA) DoseB) route of administrationC) dosage intervalD) bioavailabilityE) elimination half-life

6. If a drug exhibits saturation (zero-order) kinetics, thenA) the rate of drug elimination is constantB) drug half-life is constantC) drug clearance is constantD) plasma drug concentration is constantE) plasma drug concentration falls exponentially

7. In the two-compartment pharmacokinetic model, orally administered drugs areA) absorbed into the peripheral compartment

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B) distributed from the central to the peripheral compartmentC) metabolized in the central compartmentD) excreted in the peripheral compartmentE) none of the above

8. Which of the following will be increased if the rate of drug absorption from the gut is reduced?A) oral bioavailabilityB) volume of distributionC) peak plasma drug concentrationD) elimination half-lifeE) duration of action

9. The volume of plasma from which a drug is eliminated in a unit of time is known as theA) volume of eliminationB) volume of distributionC) clearanceD) elimination rate constantE) kinetic volume

10. inactive prodrugs have been developed toA) reduce drug toxicityB) increase drug half-lifeC) decrease hepatic drug metabolismD) increase drug absorptionE) slow drug excretion

Key: 1D, 2C, 3A, 4B, 5E, 6A, 7B, 8E, 9C, 10D

Drugs used in the treatment of infections and cancer

1. Which drug selectively inhibits bacterial RNA polymerase?A) cytarabineB) zidovudineC) dactinomiydnD) rifampinE) acyclovir

2. Conjugation is an important mechanism for transfer of drug resistance genes betweenA) coliform bacteriaB) staphylococciC) enterococciD) streptococciE) spirochetes

3. Cycloserine prevents the addition of terminal ________ residues to the peptide side chain on N-acetylmuramic acidA) glycineB) leucineC) methionineD) alanineE) tyrosine

4. Induction of bacterial proteins that enable energy-dependent efflux of drug molecules is an important mechanism of resistance to theA) penicillinsB) aminoglycoside antibioticsC) tetracycline antibiotics

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D) macrolide antibioticsE) folate reduction inhibitors

5. Which drug is correctly paired with the type of organism in which it selectively inhibits dihydrofolate reductase?A) trimethoprimB) pyrimethamineC) methotrexate

6. Ciprofloxacin selectively binds and inhibitsA) bacterial RNA polymeraseB) bacterial topoisomerase IIC) bacterial DNA polymeraseD) mammalian DNA polymeraseE) mammalian topoisomerase II

7. Which antibiotic inhibits translocation of the bacterial peptide chain from the A (acceptor) to the P (peptide) site of the 50S ribosomal subunit?A) erythromycinB) puromycinC) streptomycinD) tetracyclineE) chloramphenicol

8. Inhibition of bacterial transpeptidase and carboxypeptidase is the mechanism of action ofA) bacitracinB) vancomycinC) β-lactam antibioticsD) cycloserineE) fusidic acid

9. Bacterial drug resistance may occur due to expression of a dihydropteroate synthetase that has decreased affinity forA) penicillinB) chloramphenicolC) trimethoprimD) sulfonamidesE) erythhromycin

Key: 1D, 2A, 3D, 4C, 5C, 6E, 7A, 8C, 9D

General anesthetic agents

1. Bone marrow depression may occur following prolonged administration ofA) halothaneB) nitrous oxideC) etomidateD) enfluraneE) thiopental

2. The minimum alveolar concentration (MAC) is an expression of an inhalational anesthetic'sA) margin of safetyB) rate of inductionC) potencyD) water solubilityE) duration of action

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3. The main disadvantage of ketamine as an anesthetic is its tendency to causeA) hypotensionB) respiratory depressionC) bradycardiaD) delirium and hallucinationsE) liver toxicity

4. Metabolites of halothane are believed to be responsible for infrequent episodes ofA) renal toxicityB) hepatic toxicityC) peripheral neuritisD) hemolytic anemiaE) pulmonary fibrosis

5. The attributes of propofol as an intravenous anesthetic include:A) rapid metabolism and recoveryB) slow metabolism and recoveryC) risk of adrenocortical suppressionD) raises intracranial pressureE) considerable hangover effect

6. Coughing and laryngospasm are most likely to occur during administration ofA) sevofluraneB) nitrous oxideC) halothaneD) desfluraneE) isoflurane

7. The primary factor determining the rate of induction and recovery of an inhalational anesthetic is itsA) molecular weightB) rate of metabolic inactivationC) anesthetic potencyD) oil:gas partition coefficientE) blood:gas partition coefficient

Key: 1B, 2C, 3D, 4B, 5A, 6D, 7E

Haemostasis and thrombosis

1. Warfarin inhibits coagulation byA) inactivating prothrombinB) inhibiting active factor XaC) inhibiting vitamin K oxidaseD) inhibiting vitamin K reductaseE) activating antithrombm III

2. Which drug competes with ADP (adenosine diphosphate) for its platelet receptor?A) clopidogrelB) epoprostenolC) hirudinD) aspirinE) tirofiban

3. Abciximab is a monoclonal antibody to receptors forA) thrombinB) thromboxane

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C) glycoprotein IIb/IIIaD) adenosine diphosphateE) von Willebrand factor

4. Dipyridamole and aspirin are used together primarily for the prevention ofA) pulmonary embolismB) ischemic strokeC) myocardial infarctionD) deep vein thrombosisE) unstable coronary syndromes

5. Acute thrombotic stroke may be effectively treated within 3 hours of onset withA) warfarinB) tranexamic acidC) eptifibatideD) aspirinE) tenecteplase

6. Clinical trials of adding clopidogrel to aspirin for preventing thromboembolic disease found that combined therapy isA) less effective than aspirin aloneB) less effective than clopidogrel aloneC) equally effective as clopidogrel aloneD) equally effective as aspirin aloneE) more effective than aspirin alone

7. Enoxaparin increases the activity of antithrombin III againstA) primarily thrombinB) primarily factor XaC) thrombin and factor Xa equallyD) neither thrombin nor factor XaE) fibrin stabilizing factor

8. One of the adverse effects of high-dose or long-term therapy with heparin isA) hyponatremiaB) hypernatremiaC) hypokalemiaD) hyperkalemiaE) hypophosphatemia

9. Eptifibatide is used to prevent thrombosis in persons undergoingA) coronary angioplastyB) fibrinolysisC) blood transfusionD) abdominal surgeryE) hip-replacement surgery

10. Fondaparinux is correctly described as aA) hirudin derivativeB) cyclic peptide from snake venomC) low-molecular-weight heparinD) warfarin analogueE) synthetic pentasaccharide

Key: 1D, 2A, 3C, 4B, 5E, 6E, 7B, 8D, 9A, 10E

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How drugs act cellular aspects-excitation, contraction and secretion

1. L(long-lasting)-type calcium channels are correctly described as havingA) low activation threshold and slow inactivationB) high activation threshold and slow inactivationC) low activation threshold and fast inactivationD) high activation threshold and fast inactivationE) none of the above as correct

2. The extrusion of calcium from the cell cytoplasm primarily depends onA) ligand-gated calcium channelsB) voltage-gated calcium channelsC) the sodium-calcium exchange transporterD) the ATP-driven calcium pumpE) nuclear sequestration

3. The mechanism by which monamine neurotransmitters are released from nerve terminalsA) calcium-mediated exocytosisB) carrier-mediated releaseC) ATP-dependent active transportD) diffusion through aqueous poresE) diffusion through membrane lipid

4. Batrachotoxin binds sodium channels and therebyA) opens channelsB) prevents channel openingC) prevents channel inactivationD) closes channelsE) causes channels to remain closed

5. Closure of potassium channels in excitable membranes causes membraneA) RepolarizationB) DepolarizationC) HyperpolarizationD) DisintegrationE) Inactivation

6. In smooth muscle, inositol triphosphate releases calcium from theA) Golgi bodyB) MitochondriaC) Cell nucleusD) T-tubuleE) Sarcoplasmic reticulum

7. Calcium facilitates the release of nitric oxide byA) causing exocytosisB) causing membrane depolanzationC) activating nitric oxide synthaseD) activating transport carriersE) activating G-protein-coupled receptors

8. Amiloride affects epithelial ion transport by blockingA) the Na+/K+ exchange pumpB) the Na+/K+ co-transporterC) sodium channelsD) potassium channelsE) calcium channels

9. In the colon, chloride transport is important in

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A) potassium secretionB) potassium reabsorptionC) fluid secretionD) fluid reabsorptionE) sodium bicarbonate reabsorption

10. A key step in causing smooth muscle contraction is the phosphorylation ofA) ActinB) myosin light chainC) myosin heavy chainD) guanylate cyclaseE) myosin phosphatase

11. Adrenergic beta-receptor agonists cause smooth muscle relaxation byA) increasing cyclic AMP formationB) decreasing cyclic AMP formationC) increasing cyclic GMP formationD) decreasing cyclic GMP formationE) inhibiting protein kinase A

Key: 1B, 2D, 3A, 4C, 5B, 6E, 7C, 8C, 9D, 10B, 11A

How drugs act general principles

1. The concentration of a drug required to occupy 50 percent of its receptor sites isA) the concentration required to produce the maximum physiological effectB) directly proportional to the drug's affinity for its receptorC) inversely proportional to the drug's affinity for its receptorD) directly proportional to the drug's intrinsic efficacyE) usually determined with the Schild equation

2. In the presence of a competitive antagonist the agonist log-concentration effect curve isA) shifted to the right without a change in slope or maximum effectB) shifted to the left without a change in slope or maximum effectC) shifted to the right with a decreased slope and maximum effectD) shifted to the left with a decreased slope and maximum effectE) not shifted right or left but shows a decreased maximum effect

3. The magnitude of the response to a drug is related to theA) total number of receptors for the drugB) number of receptors occupied by the drugC) number of vacant receptors in the tissueD) number of spare receptors in the tissueE) number of phosphorylated receptors in the tissue

4. The Schild equation shows that the concentration ratio of an agonist required to occupy the same number of receptors in the absence and presence of a competitive antagonist is determined by theA) equilibrium constant of the agonistB) affinity of the agonist for its receptorC) equilibrium constant of the antagonistD) total number of available receptorsE) number of spare receptors in the tissue

5. A partial agonist is typically a drug thatA) has low affinity for its receptorB) can only occupy a small fraction of its receptors

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C) can only produce a submaximal responseD) requires high doses to produce a maximal responseE) increases the number of spare receptors

6. A type of drug that reduces the slope and maximum response of an agonist isA) a non-competitive antagonistB) a competitive antagonistC) a physiologic antagonistD) an inverse agonistE) a partial agonist

7. Drugs that form covalent bonds with their receptors are usuallyA) reversible competitive antagonistsB) irreversible competitive antagonistsC) partial agonistsD) inverse agonistsE) inverse antagonists

8. A gradual decrease in the number of drug receptors is most likely to result from exposure toA) a competitive antagonistB) a non-competitrve antagonistC) an agonistD) an inverse agonistE) an antimetabolite

9. The total number of receptor binding sites in a preparation and the binding equilibnum constant can be determined from aA) total binding versus drug concentration curveB) dose-response curveC) Hill-Langmuir equationD) Scatchard plotE) Schild plot

10. Receptor desensitization typically results fromA) endocytosis of receptorsB) exposure to an inverse agonistC) irreversible agonist bindingD) spare receptorsE) phosphorylation of receptor protein

Key: 1C, 2A, 3B, 4C, 5C, 6A, 7B, 8C, 9D, 10E

Local anaesthetics and other drugs affecting sodium channels

1. Intravenous regional anesthesia with lidocaine is used to provide anesthesia forA) childbirthB) removal of superficial foreign bodiesC) neurosurgeryD) limb surgeryE) abdominal surgery

2. Local anesthetics have greater affinity for sodium channels in theA) resting stateB) open and inactivated statesC) open and resting statesD) inactivated and resting statesE) closed state

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3. Which local anesthetic is characterized by rapid onset, medium duration of action, and good tissue penetration?A) procaineB) cocaineC) lidocaineD) bupivacaineE) prilocaine

4. Use-dependent blockade of nerve conduction results from sodium channel binding by localA) in the cationic form on the inner membrane surfaceB) in the uncharged form on the inner membrane surfaceC) in the cationic form on the outer membrane surfaceD) in the uncharged form on the outer membrane surfaceE) in the anionic form on the inner membrane surface

Key: 1D, 2B, 3C, 4A

Local hormones, inflammation, and immune reactions

1. The conversion of fibrinogen to fibrin is accelerated byA) PlasminB) PlasminogenC) KallikreinD) ComplementE) thrombin

2. The release of histamine from mast cells is activated byA) complement component C3aB) complement component C4bC) opsoninD) chemotaxinE) plasmin

3. Type I hypersensitivity reactions results from the production ofA) natural killer cellsB) interleukin-2C) immunoglobulin ED) leukotriene D4

E) thromboxane

4. Prostanoids and leukotrienes are both formed fromA) cyclic endoperoxidesB) arachidonic acidC) linolenic acidD) LipoxinsE) 5-hydroperoxyeicosatetraenoic acid

5. Vasodilation and inhibition of platelet aggregation are the primary effects ofA) ProstacyclinB) prostaglandin E2C) ThromboxaneD) prostaglandin F1α

E) prostaglandin F2α

6. The formation of 5-hydroperoxyeicosatetraenoic acid is inhibited byA) Montelukast

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B) nonsteroidal anti-inflammatory drugsC) ProstaglandinsD) ZileutonE) platelet-activating factor

7. Leukotriene B4 causesA) coronary vasoconstrictionB) vasodilation in most vascular bedC) bronchoconstrictionD) BronchodilationE) chemotaxis and activation of leukocytes

8. The structure of bradykinin is that ofA) a prostanoidB) a nonapeptideC) a leukotrieneD) a monoamineE) a glycopeptide

9. It is postulated that bradykinin plays a role inA) peptic ulcerB) gastroesophageal reflux diseaseC) DiarrheaD) inflammatory bowel diseaseE) gallstones

10. Substance P, neurokinin A, and calcitonin gene-related peptide are partly responsible forA) neurogenic inflammationB) acute anaphylactic reactionsC) septic shockD) rheumatoid arthritisE) coronary vasoconstnction

11. Latanoprost is used clinically toA) dilate the pupilB) constrict the pupilC) correct strabismusD) lower intraocular pressureE) treat uveitis

12. The treatment of primary pulmonary hypertension may include administration ofA) prostaglandin F2α

B) prostaglandin I2C) thromboxaneD) misoprostolE) dinoprostone

13. The release of arachidonate from cell membrane phospholipids is inhibited byA) non-steroidal anti-inflammatory drugsB) ZileutonC) GlucocorticoidsD) histamine H1 receptor antagonistsE) zafirlukast

14. Activation of prostaglandin EP3 receptors leads toA) contraction of bronchial smooth muscleB) inhibition of platelet aggregationC) relaxation of gastrointestinal smooth muscleD) increased gastric mucus secretion

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E) contraction of uterine smooth muscle

15. Intradermal injection of histamine produces a “triple response” in which the wheal is caused byA) dilation of small arterioles and precapillary sphinctersB) increased permeability of postcapillary venulesC) increased capillary permeabilityD) an axon reflexE) release of calcitonin gene-related peptide

16. A bradyldnin antagonist would be expected toA) cause vasodilationB) increase vascular permeabilityC) increase gastrointestinal fluid secretionD) contract intestinal smooth muscleE) decrease stimulation of nociceptive neurons

17. During the induction of lymphocytes by antigen, the proliferation of T-helper-1 cells is increased byA) interleukin-2B) interleukin-4C) interferon-gammaD) tumor necrosis factor-betaE) Glucocorticoids

Key: 1E, 2A, 3C, 4B, 5A, 6D, 7E, 8B, 9C, 10A, 11D, 12B, 13C, 14D, 15B, 16E, 17A

Method and measurement in pharmacology

1. A statistical technique used to pool data from several independent but related studies is calledA) double-blind techniqueB) RandomizationC) sequential studiesD) meta-analysisE) high-powered trial

2. The main problem with all types of bioassay isA) human errorB) inadequate instrumentationC) biological variationD) high cost compared to other techniquesE) inability to determine potency

3. If the dose-response curves of two drugs are parallel in a bioassay, it usually indicates that the two drugsA) have the same potencyB) act on the same type of receptorsC) are identicalD) are clinically effectiveE) produce a quantal response

4. Quantal dose-response curves are obtained when studyingA) all-or-nothing responsesB) submaximal responsesC) bimodal responsesD) partial agonists

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E) pain intensity

5. Transgenic mice that overexpress mutated forms of amyloid precursor protein provide a useful model for studyingA) facilitate meta-analysisB) confuse regulatory agenciesC) avoid bias in assigning subjects to treatment groupsD) avoid bias of patients and investigatorsE) obviate the need for a control groupF) Alzheimer's disease

6. Transgenic animal models referred to as "knock-outs"A) result from insertion of new genesB) result from substitution of one gene for anotherC) result from inactivation of an existing geneD) result from mutation of an existing geneE) typically cause overexpression of proteins

Key: 1D, 2C, 3B, 4A, 5F, 6C

Molecular aspects of drug action

1. The Jak/Stat pathway of signal transduction responds to activation byA) AcetylcholineB) steroid hormonesC) human growth hormoneD) CytokinesE) epinephrine

2. In the growth factor Kinase cascade, Map (mitogen-activated protein) kinase acts to phosphorylateA) DNAB) transcription factorsC) cyclic AMPD) ion channelsE) transport proteins

3. Which second messenger in a G-protein coupled receptor signal transduction cascade typically increases intracellular calcium?A) cyclic GMPB) cyclic AMPC) DiacylglycerolD) arachidonic acidE) inositol triphosphate

4. Which signal transduction pathway is most important in cell division, growth, and differentiation?A) beta-adrenoceptor signal pathwaysB) phospholipase C pathwaysC) Ras/Raf/Map kinaseD) eicosanoid signal pathwaysE) guanylate cyclic signal pathways

5. Coupling of a G-protein alpha subunit to an agonist-occupied receptor initially leads toA) activation of the beta-gamma complexB) hydrolysis of GTPC) activation of adenylate cyclase

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D) exchange of bound GDP with GTPE) dissociation of the alpha-subunit from the receptor

6. The nicotinic receptor is an example of aA) G-protein coupled receptorB) ligand-gated ion channelC) tyrosine-kinase linked receptorD) cytokine receptorE) transport protein

7. In G-protein coupled receptor signal transduction, protein kinase A is typically activated byA) inositol triphosphateB) ATPC) cyclic AMPD) cyclic GMPE) Diacylglycerol

8. An agonist for a ligand-gated ion channel typicallyA) increases channel conductanceB) increases the number of open channelsC) increases the rate of channel closingD) alters channel ion selectivityE) alters the open channel conformation

9. Diacylglycerol produces its intracellular effects byA) activating protein kinase CB) activating protein kinase AC) releasing intracellular calciumD) activating adenylate cyclaseE) activating guanylate cyclase

10. Class I nuclear receptors that control gene transcriptionA) contain cysteine residues bound to ironB) interact with nucleolar RNAC) bind to hormone response elements of DNAD) only act to inhibit DNA transcriptionID E) only act to stimulate DNA transcription

11. Myasthenia gravis is a disease in whichA) receptors have an abnormal amino acid sequenceB) G proteins have mutatedC) signal transmission pathways are defectiveD) autoantibodies are directed against receptor proteinsE) nuclear receptors are down-regulated

12. Receptors for insulinA) contain tyrosine kinase in their intracellular domainB) bind and activate intracellular kinasesC) exhibit phosphatase activityD) phosphorylate DNA transcription factorsE) are linked to guanylate cyclase

13. Which ion inhibits an enzyme (inositol-1-phosphatase) in the phosphoinositol cycle?A) CalciumB) FerrousC) SodiumD) PotassiumE) lithium

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14. The opening of chloride ion channels by gamma-amino butyric acid is facilitated byA) tricyclic antidepressant drugsB) benzodiazepine drugsC) local anestheticsD) opioid analgesicsE) central nervous system stimulants

15. The most rapid response is produced by activation ofA) kinase-linked receptorsB) G-protein coupled receptorsC) receptors activating gene transcriptionD) ionotropic receptorsE) insulin receptors

16. Which type of receptors contains seven transmembrane helices?A) nicotinic acetylcholine receptorsB) sodium channelsC) steroid hormone receptorsD) insulin receptorsE) G protein coupled receptors

17. The treatment of chronic myeloid leukemia with imatinib results from the ability of the drug to inhibit a specificA) ligand-gated ion channelB) G-protein-coupled receptorC) tyrosine kinaseD) Map (mitogen-activated protein) kinaseE) nuclear receptor

18. Which receptors are activated by proteolytic cleavage and inactivated by phosphorylation?A) neurotransmitter receptorsB) cytokine receptorsC) growth factor receptorsD) thrombin receptorsE) insulin receptors

19. Which receptors are entirely located intracellularly?A) G-protein-coupled receptorsB) nicotinic receptorsC) thyroid hormone receptorsD) cytokine and growth factor receptorsE) muscarinic receptors

Key: 1D, 2B, 3E, 4C, 5D, 6B, 7C, 8B, 9A, 10C, 11D, 12A, 13E, 14B, 15D, 16E, 17C, 18D, 19C

Neurodegenerative diseases

1. An essential factor in neuronal excitotoxicity isA) depletion of intracellular calciumB) excessive levels of intracellular calciumC) depletion of adenosine triphosphateD) inhibition of intracellular proteasesE) depletion of intracellular glutamate

2. The accumulation of β-amy1oid protein is believed to cause neuronal degeneration inA) Huntington s diseaseB) Parkinson's disease

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C) Creutzfeldt-Jakob diseaseD) amyotrophic lateral sclerosisE) Alzheimer's disease

3. Levodopa is usually administered with a peripheral dopa decarboxylase inhibitor such asA) carbidopaB) selegilineC) entacaponeD) amantadineE) pergolide

4. Factors that contribute to the development of Alzheimer's disease includeA) absence of Aβ40 peptidesB) decreased proportion of Aβ42 peptidesC) mutations in the apoEA geneD) increased expression of α-secretaseE) decreased expression of γ-secretase

5. The use of selegiline in Parkinson's disease is based on its ability toA) selectively inhibit type A monoamine oxidaseB) slow progression of Parkinson's diseaseC) inhibit peripheral degradation of levodopaD) protect dopamine from intra-neuronal degradationE) exert the neuroprotectrve effects shown in clinical trials

6. Memantine may produce a small improvement in cognitive function in persons with Alzheimer's disease because it acts toA) inhibit CholinesteraseB) activate cholinergic nicotinic receptorsC) block N-methyl-D-aspartate receptorsD) activate N-methyl-D-aspartate receptorE) activate dopamine D1 receptors

7. Entacapone reduces “end of dose” motor fluctuations in Parkinson's disease because entacapone inhibits the degradation of levodopa byA) catechol-O-methyltransferaseB) monoamine oxidase-AC) monoamine oxidase-BD) dopa decarboxylaseE) dopamine β-hydroxylase

8. Expansion of CAG (cyotosine-adenine-guanine) trinucleotide repeats in certain genes occurs in persons withA) spongiform encephalopathyB) Parkinson’s diseaseC) Alzheimer’s diseaseD) amyotrophic lateral sclerosisE) Huntington's disease

9. In the treatment of Alzheimer's disease, rivastigmine typically causesA) rapidly irreversible inhibition of acetyl- and butyryl-cholinesteraseB) slowly reversible inhibition of acetyl- and butyryl-cholinesteraseC) allostenc enhancement of nicotinic receptor activationD) allostenc enhancement of muscarinic receptor activationE) cholinergic side effects that increase over time

10. The acute side effects of levodopa in Parkinson's disease patients includeA) involuntary writhing movementsB) rapid fluctuations in clinical state

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C) nausea and anorexiaD) hypertensionE) urinary retention

Key: 1B, 2E, 3A, 4C, 5D, 6C, 7A, 8E, 9B, 10C

Nitric oxide

1. The effects exerted by nitric oxide includeA) stimulation of platelet aggregationB) vasoconstrictionC) inhibition of smooth muscle proliferationD) increased atherogenesisE) inhibition of host defenses

2. The primary action of inhaled nitric oxide isA) VasoconstrictionB) pulmonary vasodilationC) bronchoconstrictionD) cardiac stimulationE) respiratory distress

3. Nitric oxide causes vasodilation byA) decreasing formation of cyclic GMPB) increasing formation of cyclic GMPC) decreasing formation of cyclic AMPD) increasing formation of cyclic AMPE) increasing calcium influx

4. In the gastrointestinal tract nitric oxide serves toA) inhibit gastric emptyingB) stimulate gastric emptyingC) inhibit peristalsisD) inhibit gastric acid formationE) cause constipation

5. Nitroprusside produces its effects by acting asA) a nitric oxide donorB) a substrate for nitric oxide synthaseC) an inducer of nitric oxide synthaseD) an inhibitor of nitric oxide degradationE) an agonist at nitric oxide receptors

6. Glucocorticoids may be beneficial in treating sepsis in part due to their ability toA) inhibit constitutive nitric oxide synthaseB) stimulate constitutive nitric oxide synthaseC) stimulate inducible nitric oxide synthaseD) inhibit inducible nitric oxide synthaseE) inhibit both constitutive and inducible nitric oxide synthase

Key: 1C, 2B, 3B, 4B, 5A, 6D

Noradrenergic transmission

1. An intravenous infusion of norepinephrine typically

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A) increases peripheral resistance and heart rateB) decreases peripheral resistance and heart rateC) increases peripheral resistance and decreases heart rateD) decreases peripheral resistance and increases heart rateE) has no consistent effect on peripheral resistance and heart rate

2. In the liver, epinephrine acts via adrenergic beta-2 receptors toA) stimulate both phosphorylase and glycogen synthaseB) inhibit both phosphorylase and glycogen synthaseC) inhibit phosphorylase and stimulate glycogen synthaseD) stimulate phosphorylase and inhibit glycogen synthaseE) stimulate phosphorylase, glycogen synthase, and lipase

3. Which drug inhibits the transport of norepinephrine into synaptic vesicles, thereby leading to neurotransmitter depletion?A) reserpineB) methyldopaC) bretyliumD) 6-hydroxydopamineE) guanethidine

4. Doxazosin is an example of aA) nonselective alpha-adrenoceptor antagonistB) selective alpha-1 adrenoceptor antagonistC) selective alpha-2 adrenoceptor antagonistD) selective alpha-1 adrenoceptor agonistE) selective alpha-2 adrenoceptor agonist

5. Irreversible blockade of alpha-adrenoceptors results from covalent binding of these receptors byA) phentolamineB) phenylephrineC) prazosinD) phenoxybenzamineE) pseudoephednne

6. The reuptake of norepinephrine by presynaptic nerve terminals (uptake 1) is inhibited byA) guanethidineB) reserpineC) methyldopaD) methyltyrosineE) cocaine

7. The first-line treatment for acute severe type I hypersensitivity reactions isA) dopamineB) epinephrineC) isoproterenolD) norepinephrineE) phenylephrine

8. Which adrenergic receptor antagonist increases heart rate at rest but reduces it during exercise?A) pindololB) propranololC) prazosinD) timololE) phentolamine

9. In the peripheral tissues, the primary end product of norepinephrine metabolism is

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A) 3-methoxy, 4-hydroxyphenylglycolB) normetanephrineC) vanillylmandelic acidD) 3,4-dihydroxymandelic acidE) 3,4-dihydroxyphenyiglycol

10. The adverse effects of beta-adrenoceptor antagonists includeA) hyperglycemiaB) cardiac arrhythmiasC) myocardial ischemiaD) anxietyE) bronchoconstriction

11. Selective beta-3 adrenoceptor agonists are potentially useful in treating obesity because of their ability toA) suppress appetiteB) inhibit digestion of fatsC) uncouple oxidative phosphorylationD) increase thermogenesisE) increase thyroid function

12. Symptoms of urinary retention due to benign prostatic hyperplasia may be improved byA) alpha-1 adrenoceptor antagonistsB) alpha-2 adrenoceptor antagonistsC) alpha-1 adrenoceptor agonistsD) alpha-2 adrenoceptor agonistsE) nonselective adrenoceptor agonists

13. Persons with acute thyrotoxicosis are often treated with propranolol because itA) reduces peripheral vascular resistanceB) increases cardiac outputC) decreases cardiac stimulationD) decreases blood glucose levelsE) inhibits thyroid hormone secretion

14. Persons with pheochromocytoma may benefit from administration of methyltyrosine because of its ability toA) block alpha-1 adrenoceptorsB) block beta-1 adrenoceptorsC) inhibit norepinephrine releaseD) inhibit norepinephrine synthesisE) inhibit norepinephrine storage

Key: 1C, 2D, 3A, 4B, 5D, 6E, 7B, 8A, 9C, 10E, 11D, 12A, 13C, 14D

Obesity

1. Food intake is increased byA) increased neuropeptide γ secretionB) decreased neuropeptide γ secretionC) increased alpha-melanocyte stimulating hormone secretionD) increased leptin secretionE) increased insulin secretion

2. Sibutramine produces weight loss in obese patients primarily byA) decreasing intestinal absorption of carbohydratesB) decreasing intestinal absorption of fats

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C) decreasing intestinal absorption of proteinsD) increasing satietyE) increasing thermogenesis

3. A person with a body mass index of 28 kg/m2 is considered to beA) anorecticB) thinC) normalD) overweight but not obeseE) obese

4. Factors contributing to the development of obesity includeA) increased responsiveness to leptinB) increased thermogenesisC) decreased β3 adrenoceptor toneD) uncoupling of oxidative phosphorylationE) increased secretion of thyroid hormone

5.The incidence of which disease increases most sharply as a function of body mass index?A) coronary heart diseaseB) hypertensionC) asthmaD) cholelithiasisE) type 2 diabetes mellitus

6. Orlistat acts in part by inhibitingA) leptin secretionB) pancreatic lipaseC) neuropeptide γ receptorsD) food intakeE) storage of fat

Key: 1A, 2D, 3D, 4C, 5E, 6B

Other peripheral mediators, 5-hydroxytryptamine and purines

1. Urinary levels of 5-hydroxyindole acetic add provide an indication of the body's production ofA) adenosineB) serotoninC) adenosine triphosphateD) histamineE) endothelin

2. Some of the effects of theophylline are attributed to antagonism ofA) GlutamateB) 5-hydroxytrypamineC) adenosineD) norepinephrineE) histamine

3. The effects of chemical mediators on platelets indudeA) stimulation of platelet aggregation by adenosine diphosphateB) stimulation of platelet aggregation by adenosineC) inhibition of platelet aggregation by adenosine diphosphateD) inhibition of platelet aggregation by histamineE) inhibition of platelet aggregation by serotonin

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4. Cyproheptadine is useful in treating cardnoid syndrome because of its ability toA) activate 5-HT1 receptorsB) block 5-HT1 receptorsC) activate 5-HT2 receptorsD) block 5-HT2 receptorsE) activate 5-HT4 receptors

5. In persons with irritable bowel syndrome whose predominant symptom is constipation, intestinal peristaltic activity may be increased by drugs thatA) activate 5-HT1 receptorsB) block 5-HT1 receptorsC) activate 5-HT2 receptorsD) block 5-HT2 receptorsE) activate 5-HT4 receptors

6. Activation of 5-HT1D receptors is usually beneficial in persons suffering fromA) carcinoid syndromeB) nausea and vomitingC) migraine headacheD) ConstipationE) anxiety

7. Retroperitoneal and mediastinal fibrosis is a characteristic adverse effect ofA) methysergideB) ErgotamineC) BromocriptineD) SumatriptanE) tegaserod

8. Blockade of 5-HT3 receptors in vagal afferent neurons is useful in preventingA) migraine headacheB) serotonin syndromeC) platelet aggregationD) nausea and vomitingE) Constipation

Key: 1B, 2C, 3A, 4D, 5E, 6C, 7A, 8D

Other transmitters and modulators

1. The 5-hydroxytryptamine 5-HT2 receptors areA) primarily inhibitoryB) chiefly found in the area postremaC) mostly presynapticD) abundant in the cortex and limbic systemE) predominantly presynaptic autoreceptors

2. Agonists at 5-hydroxytryptamine 5-HT2A receptors typically causeA) sleepB) vigilanceC) hallucinationsD) hyperphagiaE) euphona

3. The major functions of cholinergic pathways in the central nervous system includeA) learning and memoryB) mood and emotion

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C) control of body temperatureD) appetiteE) drug dependence

4. The effects of jet lag can be alleviated by administration ofA) methylxanthine drugsB) melatoninC) histamine H2 receptor antagonistsD) 5-hydroxytryptamine 5-HT3 agonistsE) Cholinesterase inhibitors

5. The predominant site containing cell bodies of noradrenergic neurons is theA) raphe nucleiB) nigrostnatal pathwayC) locus coeruleusD) nucleus accumbensE) nucleus basalis

6. The 5-hydroxytryptamine 5-HT3 receptors areA) excitatory ligand-gated cation channelsB) inhibitory ligand-gated cation channelsC) G-protein-coupled receptorsD) inhibitory ligand-gated chloride channelsE) presynaptic autoreceptors

7. The dopamine transporter located in presynaptic nerve terminals is inhibited byA) bromocriptineB) levodopaC) ondansetronD) haloperidolE) cocaine

8. Degeneration of the nucleus basalis of Meynert is associated with the development ofA) obesityB) narcolepsyC) schizophreniaD) Alzheimer's diseaseE) mood depression

9. A deficiency of dopamine in the nigrostriatal pathway contributes to the development ofA) drug dependenceB) Parkinson's diseaseC) obesityD) schizophreniaE) insomnia

10. Functions associated with noradrenergic pathways in the central nervous system includeA) feeding behaviorB) induction of sleepC) control of moodD) pleasure and rewardE) release of hormones

Key: 1D, 2C, 3A, 4B, 5C, 6A, 7E, 8D, 9B, C10

Peptides and proteins as mediators

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1. Peptide and protein mediators typicallyA) function as fast neurotransmittersB) contain intramolecular diphosphate bondsC) are easily crystallizedD) have highly rigid structuresE) activate cell surface receptors

2. As pharmacologic agents, most peptides areA) easily absorbed from the gastrointestinal tractB) rapidly distributed to the brainC) usually administered by the transdermal routeD) rapidly degraded by plasma and tissue enzymesE) inexpensive to manufacture

3. Bosentan is an antagonist ofA) opioid receptorsB) angiotensin AT1 receptorsC) endothelin receptorsD) bradykinin receptorsE) platelet fibrinogen receptors

4. Most neural and endocrine peptide mediatorsA) act on G-protein-coupled receptorsB) activate ligand-gated ion channelsC) exhibit protein kinase activityD) cause receptor up-regulationE) bind to membrane transport proteins

5. Cyclosporine is a fungal polypeptide used clinically toA) diagnose endocrine diseaseB) cause immunosuppressionC) treat cystic fibrosisD) treat thromboembolismE) induce labor

6. Which agent blocks substance P (neurokinin NK1) receptors and thereby prevents nausea and vomiting?A) granisetronB) PromethazineC) DiphenhydramineD) AprepitantE) scopolamine

Key: 1E, 2D, 3C, 4A, 5B, 6D

The endocrine pancreas and the control of blood glucose

1. The characteristics of type 2 diabetes mellitus typically includeA) insulin resistanceB) absence of 1st and 2nd phase insulin secretionC) absence of 2nd phase insulin secretion onlyD) excessive insulin secretionE) impaired glucagon secretion

2. The actions of insulin includeA) inhibition of glycogen synthesisB) inhibition of tnglycende synthesis

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C) inhibition of gluconeogenesisD) inhibition of protein synthesisE) inhibition of glucose uptake by muscle

3. Which drug binds to the peroxisome proliferator-activated receptor-gamma in adipose tissue, muscle, and liver?A) metforminB) pioglitazoneC) repaglinideD) glipizideE) acarbose

4. The effects of metformin includeA) increased appetiteB) increased hepatic glucose outputC) decreased hepatic glucose outputD) hypoglycemiaE) increased low-density lipoproteins

5. The mechanism of action of glipizide isA) stimulation of glucose transportersB) stimulation of insulin synthesisC) blockade of calcium channelsD) activation of ATP-sensitive potassium channelsE) blockade of ATP-sensitive potassium channels

6. Weight gain and fluid retention are most likely to occur in persons receivingA) metforminB) insulin lisproC) nateglinideD) pioglitazoneE) acarbose

7. The characteristics of insulin glargine include:A) rapidly and completely absorbed after injectionB) provides a constant basal insulin supplyC) has an intermediate duration of actionD) used in treating diabetic ketoacidosisE) contains a lysine-proline amino acid transposition

8. The most common adverse effect of glipizide isA) hypoglycemiaB) weight lossC) fluid retentionD) liver dysfunctionE) lactic acidosis

Key: 1A, 2C, 3B, 4C, 5E, 6D, 7B, 8A

The gastrointestinal tract

1. The symptomatic treatment of diarrhea may include administration ofA) loperamideB) lactuloseC) omeprazoleD) bisacodylE) cimetidine

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2. Omeprazole reduces gastric add secretion byA) reversibly inhibiting the H+/Na+ ATPaseB) irreversibly inhibiting the H+/Na+ ATPaseC) reversibly inhibiting the H+/K+ ATPaseD) irreversibly inhibiting the H+/K+ ATPaseE) irreversibly inhibiting the Na+/K+ ATPase

3. According to the two-cell hypothesis of gastric add secretion, the parietal cell has receptors forA) only histamine and acetylcholineB) only histamine and gastrinC) only gastrin and acetylcholineD) only gastrinE) histamine, gastrin, and acetylcholine

4. The use of misoprostol in treating gastric damage caused by nonsteroidal anti-inflammatory drugs is partly due to its ability toA) increase secretion of mucus and bicarbonateB) decrease secretion of mucus and bicarbonateC) increase gastrointestinal motilityD) decrease mucosal blood flowE) inhibit release of histamine

5. Nausea and vomiting caused by vestibular stimulation is most effectively prevented byA) ondansetronB) metoclopramideC) nabiloneD) promethazineE) prochlorperazine

6. Sucralfate is best described as aA) proton pump inhibitorB) histamine H1 receptor antagonistC) substituted benzimidazoleD) prostaglandin E2 analogueE) complex of aluminum hydroxide and sulfated sucrose

7. Which drug increases electrolyte and water secretion by the intestinal mucosa?A) sucralfateB) lactuloseC) bisacodylD) docusate sodiumE) methylcellulose

8. The antiemetic effect of ondansetron is primarily based on its ability to blockA) 5-HT3 receptors in vestibular nucleiB) 5-HT3 receptors in the chemoreceptor trigger zoneC) 5-HT3 receptors in the vomiting centerD) 5-HT4 receptors in visceral afferent neuronsE) histamine and muscarinic receptors in the solitary tract

Key: 1A, 2D, 3C, 4A, 5D, 6E, 7C, 8B

The haemopoietic system

1. Ascorbic acid influences iron absorption from the gastrointestinal tract by

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A) forming an insoluble iron-chelateB) oxidizing iron to the ferric stateC) reducing iron to the ferrous stateD) stimulating the iron transport proteinE) activating haem oxidase

2. Neural tube birth defects can be prevented by the administration to pregnant women ofA) folic acidB) cyanocobalaminC) ferrous gluconateD) epoetinE) filgrastim

3. Desferrioxamine is administered for the purpose of treatingA) iron deficiency anemiaB) megaloblastic anemiaC) pernicious anemiaD) iron toxicityE) hemosiderosis

4. Persons with an elevated blood level of methylmalonyl-Coenzyme A may have a deficiency ofA) erythropoietinB) ironC) formyl-tetrahydrofolic acidD) colony-stimulating factors

5. Filgrastim is conjugated with polyethylene glycol toA) increase its absorption from the gutB) increase its elimination half-lifeC) reduce its duration of actionD) decrease its adverse effectsE) increase its potency

6. Epoetin is indicated for the treatment ofA) pernicious anemiaB) anemia of renal failureC) megaloblastic anemiaD) neutropeniaE) platelet deficiency

Key: 1C, 2A, 3D, 4E, 5B, 6B

The heart

1. Delayed after-depolarizations in cardiac tissue typically result from an increased influx ofA) sodiumB) potassiumC) calciumD) chlorideE) sodium and potassium

2. The re-excitation of cardiac tissue prior to the next cardiac impulse occurs in the process known asA) re-entryB) ectopic automaticityC) atrioventricular blockD) atrial fibrillation

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E) bradycardia

3. In persons with atrial fibrillation, digoxin may slow the ventricular rate byA) decreasing sinoatrial node automaticityB) increasing ventricular contractilityC) inhibiting the Na+/K+ pumpD) reducing the calcium transientE) slowing atrioventricular conduction

4. Sotalol exerts an antiarrhythmic effect primarily byA) slowing ventricular conductionB) blocking sodium channelsC) slowing atrioventricular conductionD) increasing the effective refractory periodE) decreasing action potential duration

5. Verapamil is indicated for the treatment ofA) supraventricular tachycardiaB) ventricular tachycardiaC) atrial fibrillationD) ventricular fibrillationE) cardiac asystole

6. In persons who have had a myocardial infarction, flecainide has been shown toA) decrease the incidence of ventricular fibrillationB) decrease the incidence of atrial fibrillationC) decrease the incidence of sudden deathD) increase the frequency of ventricular ectopic beatsE) increase the incidence of sudden death

7. The pharmacokinetic attributes of amiodarone includeA) rapidly metabolized and excretedB) a very short elimination half-lifeC) a very long elimination half-lifeD) distributed only to extracellular fluidE) limited binding to plasma proteins

8. Dobutamine is useful in treating acute heart failure because of its ability toA) increase heart rate more than contractile forceB) increase contractile force more than heart rateC) produce a negative dromotropic effectD) cause cardiac stimulation and vasoconstrictionE) inhibit phosphodiesterase

9. Digoxin slows AV conduction and decreases heart rate byA) activating cardiac muscarinic receptorsB) blocking cardiac adrenergic beta-1 receptorsC) antagonizing cardiac calcium channelsD) increasing vagal outflow from the CNSE) increasing cardiac contractile force

10. The half-life of digoxin is considerably longer in persons withA) renal insufficiencyB) pulmonary edemaC) atrial fibrillationD) hypertensionE) endocarditis

11. Which drug has been shown to reduce mortality in persons who have had a myocardial

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infarction?A) amiodaroneB) lidocaineC) propranololD) amiodaroneE) verapamil

12. Hypothyroidism is most likely to occur in persons who are takingA) sotalolB) flecamideC) timololD) amiodaroneE) adenosine

13. Nitroglycerin relieves typical angina pectoris in part byA) increasing cardiac stroke volumeB) dilating coronary arteriolesC) decreasing cardiac oxygen consumptionD) constricting collateral vessels in the heartE) increasing blood pressure

14. Nitroglycerin and other organic nitrates produce their vasodilator effect byA) increasing formation of cyclic AMPB) increasing formation of cyclic GMPC) blocking calcium channelsD) blocking adrenergic alpha receptorsE) activating potassium channels

Key: 1C, 2A, 3E, 4D, 5A, 6E, 7C, 8B, 9D, 10A, 11C, 12D, 13C, 14B

The kidney

1. Excessive doses of hydrochlorothiazide may causeA) hyperkalemic metabolic acidosisB) hyperkalemic metabolic alkalosisC) hyperchloremic metabolic acidosisD) hypokalemic metabolic alkalosisE) hypokalemic metabolic acidosis

2. Amiloride exerts its diuretic effect byA) blocking epithelial sodium channelsB) inhibiting the epithelial sodium pumpC) inhibiting the sodium chloride transporterD) blocking aldosterone receptorsE) inhibiting chloride channels

3. The Na+/K+/2CI- transporter is inhibited byA) amilorideB) furosemideC) acetazolamideD) hydrochlorothiazideE) triamterene

4. A mild hyperchloremic metabolic acidosis may occur following administration ofA) amilorideB) hydrochlorothiazideC) mannitol

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D) bumetanideE) acetazolamide

5. Hydrochlorothiazide decreases the urinary excretion ofA) calciumB) sodiumC) potassiumD) chlorideE) bicarbonate

6. The usual therapeutic doses of aspirinA) inhibit uric acid reabsorptionB) stimulate uric acid reabsorptionC) inhibit uric acid secretionD) stimulate uric acid secretionE) lower serum uric acid levels

7. Hyperkalemia is most likely to occur following the administration ofA) furosemide and amilorideB) losartan and amilorideC) hydrochlorothiazide and amilorideD) hydrochlorothiazide and losartanE) losartan and amiloride

8. Testicular atrophy and gynecomastia are most likely to result from the administration ofA) eplerenoneB) spironolactoneC) amilorideD) acetazolamideE) bumetanide

9. Before exerting its diuretic effect, furosemide undergoesA) metabolic activation in the liverB) passive reabsorption from the nephronC) glomerular filtration in the kidneysD) passive diffusion into the nephronE) active renal tubular secretion

10. The electroneutral sodium and chloride cotransporter in the distal tubule is inhibited byA) metolazoneB) amilorideC) acetazolamideD) bumetanideE) spironolactone

11. The uricosuric effect of sulfinpyrazone results from inhibition ofA) uric acid formationB) uric acid transportC) uric acid secretionD) uric acid reabsorptionE) uric acid degradation

Key: 1D, 2A, 3B, 4E, 5A, 6C, 7E, 8B, 9E, 10A, 11D

The pituitary and the adrenal cortex

1. The anabolic effects of growth hormone are mediated primarily by

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A) somatotropinB) somatostatinC) somatomedinD) somatotrophinE) somatorelin

2. During breastfeeding, prolactin inhibits the release or response toA) oxytocinB) estradiolC) progesteroneD) gonadotrophinsE) hydrocortisone

3. The effects of fludrocortisone can be antagonized byA) spironolactoneB) beclomethasoneC) metyraponeD) aldosteroneE) ammoglutethimide

4. Octreotide is correctly described as aA) short-acting analogue of somatotrophinB) long-acting analogue of somatotrophinC) short-acting analogue of somatostatinD) long-acting analogue of somatostatinE) long-acting analogue of somatomedin

5. In the basic transactivation mechanism of glucocorticoid receptor control of gene expression, the ligand-bound glucocorticoid receptor dimer binds toA) nuclear factor kappa B sitesB) regulatory sites of Fos/Jun transcription factorsC) negative glucocorticoid response elementsD) positive glucocorticoid response elementsE) negative transcription factors

6. Metyrapone inhibits the biosynthesis ofA) only corticosteroneB) only hydrocortisoneC) only dehydroepiandrosteroneD) both corticosterone and hydrocortisoneE) corticosterone, hydrocortisone, and dehydroepiandrosterone

7. Insulin-like growth factor-1 causes feedback inhibition of the secretion ofA) prolactinB) melanocyte-stimulating hormoneC) growth hormoneD) corticotropinE) thyrotropin

8. Polyuria may result from inhibition of antidiuretic hormone byA) desmopressinB) oxytocinC) carbamazepineD) ibuprofenE) lithium

9. The adverse effects of high-dose or chronic administration of prednisone includeA) muscle hypertrophyB) cataracts

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C) decreased abdominal fatD) thickened skinE) hypotension

10. Cabergoline inhibits the anterior pituitary secretion ofA) prolactinB) melanocyte-stimulating hormoneC) thyrotropinD) somatotrophinE) corticotrophm

11. The treatment of diabetes insipidus includes nasal administration ofA) vasopressinB) desmopressinC) demeclocyclineD) octreotideE) budesonide

Key: 1C, 2D, 3A, 4D, 5D, 6D, 7C, 8E, 9B, 10A, 11B

The reproductive system

1. The expression of estrogen receptors in the mammary gland is increased byA) oxytocinB) progesteroneC) prolactinD) gonadotrophinsE) androgens

2. The secretion of progesterone from the corpus luteum is primarily stimulated byA) follicle-stimulating hormoneB) luteinizing hormoneC) estrogenD) prolactinE) oxytocin

3. Compared to the combination estrogen-progestogen contraceptive, the progestogen-only pill is more likely toA) cause hypertensionB) prevent conceptionC) cause breast cancerD) cause myocardial infarctionE) produce irregular bleeding

4. Administration of sildenafil leads toA) activation of guanylate cyclaseB) inhibition of guanylate cyclaseC) activation of phosphodiesterase VD) inhibition of phosphodiesterase VE) release of nitnc oxide

5. In the estrogen-progestogen contraceptive pill, the estrogen component acts primarily by inhibitingA) secretion of LHB) secretion of FSHC) ovulationD) passage of sperm

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E) mucus secretion

6. The prevention and treatment of postpartum hemorrhage may include injections ofA) estrogenB) progestogenC) oxytocinD) ritodrineE) prolactin

7. The benefits of using estrogen-progestogen contraceptive pills includeA) decreased risk of hypertensionB) improved glucose toleranceC) decreased risk of breast cancerD) decreased menstrual irregularitiesE) decreased risk of stroke

8. The use of atosiban to delay premature labor is based on its ability toA) block β2-adrenoceptorsB) activate β2-adrenoceptorsC) block progesterone receptorsD) activate progesterone receptorsE) block oxytocin receptors

9. When finasteride is used in treating benign prostatic hypertrophy, it acts byA) blocking androgen receptorsB) inhibiting gonadotrophin secretionC) inhibiting 5α-reductaseD) inhibiting testosterone secretionE) blocking α1 adrenoceptors

10. The interaction between nitroglycerin and sildenafil results from theA) inhibition of sildenafil metabolism by nitroglycerinB) inhibition of nitroglycerin metabolism by sildenafilC) similar effect of the drugs on phosphodiesterase VD) similar effect of the drugs on cyclic GMP levelsE) antagonistic effect of the drugs on cyclic GMP levels

Key: 1C, 2B, 3E, 4D, 5B, 6C, 7D, 8E, 9C, 10D

The respiratory system

1. The clinical uses of formoterol includeA) prevention of nocturnal bronchospasmB) treatment of acute bronchospasmC) long-term prevention of airway inflammationD) prevention and treatment of allergic rhinitisE) stabilization of mast cells in persons with atopic dermatitis

2. The cysteinyl leukotriene CysLT1 receptor is blocked byA) tiotropiumB) theophyllineC) nedocromilD) zafirlukastE) omalizumab

3. Persons with aspirin-sensitive asthmaA) can safely use naproxen or ibuprofen

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B) seldom have nasal polypsC) exhibit hyper-responsiveness to inhaled leukotrienesD) are effectively treated with antihistaminesE) have few cysteinyl leukotriene receptors

4. Which drug inhibits phosphodiesterase and blocks adenosine receptors?A) salmeterolB) budesonideC) zileutonD) cromoglycateE) theophylline

5. In the treatment of asthma, glucocorticoidsA) increase secretion of interleukin-4B) up-regulate adrenergic beta-2 receptorsC) increase microvascular permeabilityD) increase formation of vasodilator prostanoidsE) are usually administered orally

6. Tremor and tachycardia are common side effects ofA) theophyllineB) salbutamolC) montelukastD) fluticasoneE) cromoglycate

7. Tiotropium is useful in the treatment of chronic obstructive pulmonary disease because of its ability toA) reduce airway inflammationB) improve gas transferC) inhibit proteolytic enzymesD) relax bronchial smooth muscleE) stimulate respiration

8. Omalizumab is a humanized monoclonal antibody toA) immunoglobulin GB) immunoglobulin EC) cysteinyl leukotriene receptorsD) chemokinesE) interleukin IL-3

Key: 1A, 2D, 3C, 4E, 5B, 6B, 7D, 8B

The thyroid

1. The characteristics of triiodothyronine (T3) includeA) a large pool in the bodyB) a low turnover rateC) formed from thyroxine (T4) intracellularlyD) interacts with a cytoplasmic receptorE) represses transcription

2. Iodination of tyrosine residues of thyroglobulin is inhibited byA) propranololB) methimazoleC) liothyronineD) protirelin

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E) hydrogen peroxide

3. The characteristics of radioactive iodine (131I) in the treatment of hyperthyroidism includeA) a rapid onset of actionB) a maximum effect in 8 daysC) a cytotoxic effect produced by y raysD) safe use in children and pregnant womenE) hypothyroidism as a typical later-onset disease

4. The long elimination half-life of thyroxine (T4) is primarily due toA) slow absorption from the gutB) slow excretion in the urineC) strong binding to thyroxine-binding globulinD) slow hepatic inactivationE) storage in fat cells

5. An uncommon but serious adverse effect associated with the use of propylthiouracil isA) granulocytopeniaB) hemolytic anemiaC) a lupus erythematosus-like syndromeD) cholestatic hepatitisE) hypoglycemia

Key: 1C, 2B, 3E, 4C, 5A

The vascular system

1. Which vasoconstrictor substance is produced by vascular endothelial cells?A) nitric oxideB) bradykininC) prostacyclinD) natriuretic peptideE) endothelin

2. The opening of membrane potassium channels by minoxidil leads to A) increased potassium influxB) increased calcium influxC) inactivation of calcium channelsD) membrane depolarizationE) formation of cyclic GMP

3. Both valsartan and enalaprilA) increase serum potassium levelsB) often cause a dry coughC) block angiotensin AT1 receptorsD) inhibit formation of angiotensin IIE) increase bradykinin levels

4.Bosentan is an antagonist ofA) endothelin ETA and ETB receptorsB) angiotensin AT1 receptorsC) angiotensin AT2 receptorsD) nitric oxide receptorsE) prostaglandin FP receptors

5. In persons with heart failure, enalapril typically increasesA) cardiac afterload

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B) cardiac preloadC) vascular resistanceD) cardiac outputE) aldosterone secretion

6. Which drug reduces sympathetic outflow from the central nervous system?A) fosinoprilB) clonidineC) terazosinD) felodipineE) hydralazine

7. Captopril is a structural analog of the terminal dipeptide ofA) reninB) nitric oxide synthaseC) endothelinD) angiotensin converting enzymeE) angiotensin I

8. Effects similar to those of angiotensin converting enzyme inhibitors may be obtained in heart failure patients by administeringA) furosemideB) digoxinC) hydralazine and isosorbide dinitrateD) dobutamineE) nitroglycerin

9. The adverse effects of terazosin and related drugs typically includeA) hypokalemiaB) drowsiness and dry mouthC) urinary retention in older menD) postural hypotension and edemaE) bradycardia and syncope

10.In persons with decompensated heart failure, nesintide activatesX A) adrenergic alpha receptorsB) adrenergic beta receptorsC) adenylate cyclaseD) guanylate cyclaseE) myosin phosphatase

11. The preferred drugs for the initial treatment of most patients with mild hypertension includeA) hydralazineB) minoxidilC) hydrochlorothiazideD) methyldopaE) prazosin

12. Fenoldopam is useful in treating hypertensive emergencies because of its ability toA) block adrenergic beta receptorsB) block adrenergic alpha receptorsC) block calcium channelsD) open potassium channelsE) activate dopamine D1 receptors

13. Beginning therapy with low doses that are gradually increased over several months is appropriate when treating heart failure withA) digoxin

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B) furosemideC) dobutamineD) carvedilolE) nitroglycerin

14. The progression of diabetic nephropathy may be slowed byA) propranololB) enalaprilC) hydrochlorothiazideD) amlodipineE) doxazosin

15. The use of eplerenone in the treatment of heart failure is based on its ability toA) cause vasodilationB) inhibit sympathetic nervous system activityC) antagonize aldosteroneD) inhibit angiotensin II formationE) increase cardiac contractile force

Key: 1E, 3C, 3A, 4A, 5D, 6B, 7E, 8C, 9D, 10D, 11C, 12E, 13D, 14B, 15C

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