MCEM MCQ Pharmacology

MCEM Pharmacology MCQ 1. Sedation (a) Midazolam has a short half life

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(c) Pethidine has no active metabolites

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(d) The Ramsay score is a useful index of sedative level

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(b) Diastolic BP drops slightly.

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(c) pCO2 rises

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90min (b) Morphine is metabolised by the liver

1-6 from agitated to comatose (e) Fentanyl is a water soluble analgesic Far more lipid soluble than morphine which accounts for its rapid uptake and distribution 2. Of physiological changes in pregnancy (a) Cardiac output increases by around 30%.

pCO2 falls slightly (d) HCO3- rises. HCO3- falls slightly 3. With regard to soft tissue infection: (a) Cellulitis is frequently caused by B-haemolytic streptococci. Cellulitis is frequently caused by B-haemolytic streptococci. (b) The commonest organism causing myositis is staphylococcus aureus. (c) The commonest organism causing myositis is clostridium perfringes. The commonest organism causing myositis is clostridium perfringes. (d) Cellulitis is frequently caused by staphylococcus aureus. Cellulitis is frequently caused by staphylococcus aureus. (e) Clostridium perfinges is a gram positive , anaerobic spore forming rod. Clostridium perfinges is a gram positive , anaerobic spore forming rod. 4. Induction Drugs in Adults (a) The normal dose of thiopentol is 2-7mg/kg. The normal dose of thiopentol is 2-7mg/kg. (b) The normal dose of etomidate is 0.3mg/kg The normal dose of etomidate is 0.3mg/kg (c) The normal dose of propofol is 1.5-2.5 mg/kg The normal dose of propofol is 1.5-2.5 mg/kg (d) The normal dose of ketamine is 1-2 mg/kg

MCEM Pharmacology MCQ e

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(d) Phenylephrine has poor affinity for beta 2 receptors

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(e) Isoprenaline has affinity for beta 2

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The normal dose of ketamine is 1-2 mg/kg (e) Recovery time is generally longer after propofol than after ketamine Recovery time for ketamine is 15-30 minutes while recovery time for propofol is 510 minutes. 5. Adrenoreceptor affinity of sympathomimetics (a) Dobutamine has more affinity for alpha receptors than adrenaline Adrenaline has more affinity for alpha receptors than dobutamine. alphaadrenoceptors exist on peripheral sympathetic nerve terminals and are divided into two subtypes alpha-1, and alpha-2. alpha-1 peripherally are responsible for contraction and are situated on vascular and on non-vascular smooth muscle.On the heart they mediate a positive inotropic effect alpha-2 receptors are located on liver cells, platelets, and the smooth muscle of blood vessels. Activation of these receptors causes platelet aggregation, and blood vessel constriction. (b) Noradrenaline has more affinity for alpha receptors than adrenaline Noradrenaline has more affinity for alpha receptors than adrenaline. (c) Phenylephrine has more affinity for beta 1 receptors than adrenaline

b1-receptors are largely postsynaptic and are located mainly in the heart but are also found in platelets, the salivary glands and the non-sphincter part of the gastrointestinal tract (GIT). They can however be found presynaptically. Activation causes an increase in the rate and contractile force of the heart, relaxation of the non-sphincter part of the GIT, aggregation of platelets and amylase secretion from the salivary glands. Presynaptically, their activation causes an increase in noradrenaline release. b2-receptors are also mainly postsynaptic and are located on a number of tissues including blood vessels, bronchi, GIT, skeletal muscle, liver and mast cell. Activation results in vasodilatation, bronchodilation, relaxation of the GIT, glycogenolysis in the liver, tremor in skeletal muscle and inhibition of histamine release from mast cells. b3-receptors are expressed predominately in adipose tissue activation is proposed to be involved with noradrenaline induced changes in energy metabolism via lipolysis and thermogenesis. b4-receptors are localised in cardiac tissue with activation causing an increase in heart rate and force. 6. The following are true: (a) The clearance of gabapentin is dependent on renal function. The recommended dose of gabapentin in patients with creatinine clearance >60 ml/min is 1200 mg/day, but it is suggested that patients on haemodialysis start with a loading dose of 300?400 mg and then take 200?300 mg following each session of haemodialysis. (b) Gabapentin converts into a gamma-aminobutyric acid (GABA) agonist. Gabapentin structurally resembles the neurotransmitter gamma-aminobutyric acid (GABA) but does not convert into GABA or a GABA agonist. (c) The average elimination half life of gabapentin in uraemic patients without haemodialysis is 4 hours. The average elimination half life of gabapentin in uraemic patients without haemodialysis is >100 hours. The average elimination half life of gabapentin in uraemic patients with haemodialysis is 4 hours. (d) Gabapentin can cause severe myoclonus

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(d) Combinations of bacteriostatic drugs are generally only additive.

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(e) In septicaemic shock combination therapy should be avoided.

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Gabapentin can cause severe myoclonus, myopathy, neutropaenia,lethargy, dizziness and altered consciousness. 7. Naloxone: (a) Is a specific u opioid receptor antagonist. Naloxone is an antagonist at all opioid receptors. (b) Reverses respiratory depression caused by pethidine. (c) Both hypotension and hypertension may be caused by naloxone. Both hypotension and hypertension may be caused by naloxone. Other side effects include ventricular tachycardia and fibrillation,cardiac arrest;hyperventilation, dyspnoea, pulmonary oedema. (d) Can cause pulmonary oedema Through an unknown mechanism naloxone can cause pulmonary oedema. (e) May cause an increase in heart rate. Naloxone may cause an increase in heart rate. 8. The following statements about combination antibiotic therapy are correct. (a) Combinations of bacteriostatic and bacteriocidal drugs may impair their therapeutic efficacy. (b) Combinations of bactericidal drugs are additive. Penicillins, cepahlosporins and aminoglycosides are examples of bactericidal drugs. (c) Combinations of bactericidal drugs may be synergistic.

9. Nitrous Oxide (a) Onset of action is 3 to 5 minutes (b) It must be delivered with 21% oxygen It should be delivered with 30% oxygen to avoid hypoxia (c) Is contraindicated in patients with COPD Also in patients with altered mental status, head injury or suspected pneumothorax (d) Should routinely be combined with IV opiates It is an opiate agonist and the combination proposed may cause deep sedation (e) It's duration is 1 to 2 hours Its duration is 3 to 5 minutes after withdrawal 10. Beta-Blockers (a) The Beta receptor is coupled to a second messenger called cAMP

MCEM Pharmacology MCQ The Beta receptor(glycoprotein within the cell membrane ) is coupled to cAMP. (b) Stimulation of the beta receptor allows calcium entry into cells. Stimulation of the beta receptor allows calcium entry into cells. (c) Stimulation of the beta2-receptors causes smooth muscle relaxation, which results in vasodilatation and brochodilation Stimulation of the beta2-receptors causes smooth muscle relaxation, which results in vasodilatation, and brochodilation. (d) Beta 1 activation promotes a faster and more forceful heart beat. Beta 1 activation promotes a faster and more forceful heart beat ( inotropy and chronotropy ) (e) The beta 1 subunit is located in the kidney and the eye. The beta 1 subunit is located in the myocardium, the kidney and the eye. 11. Co-Amoxiclav(Augmentin) (a) Absorption is affected by food Unaffected. Peak serum levels one hour after oral administration. (b) Blocks bacterial beta lactamase enzymes And stops bacterial degradation (c) Is active against anaerobes Advantage in treating pelvic infections (d) Recognised side effects include reversible cholestatic jaundice Thought to be due to clavulinic acid (e) Is the anti-biotic of choice in treating animal bite wound infections 12. The following are true: (a) Warfarin is procoagulant in the first days of therapy. Warfarin is procoagulant in the first days of therapy. (b) Tamsulsoin relaxes the muscle of the prostate. Tamsulosin relaxes the muscle of the prostate. (c) The ulnar nerve is blocked at the wrist between the ulnar artery and the tendon of flexor carpi radialis The ulnar nerve is blocked at the wrist between the ulnar artery and the tendon of flexor carpi ulnaris. (d) The median nerve is blocked between the tendons of palmaris longus and fleor carpi radialis. The median nerve is blocked between the tendons of palmaris longus and fleor carpi radialis. (e) Omeprazole is a histamine receptor antagonist.

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Omeprazole is a proton pump inhibitor. 13. Warfarin (a) Inhibits gamma carboxylation of glutamyl residues of factor VII And factor II, IX, X (b) Onset of action is almost immediate Delayed until previously formed coagulation factors are used or metabolised (c) Has a prothrombotic effect on initiation And all patients should be heparinised on initiation

MCEM Pharmacology MCQ (d) Has immunomodulatory effects on T Cells

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(e) Half life is 6 hours

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(b) Is poorly absorbed from the gut

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(c) Has an elimination half life of 12 hours if renal function is normal

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(d) CSF penetration is poor

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(e) Causes irreversible VIII nerve damage

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36 hours 14. Gentamicin (a) Is effective in pneumococcal pneumonia

15. Which of the following are true: (a) Chlorpromazine(Largactil) has a lesser hypotensive effect than haloperidol. Haloperidol has a lesser effect on BP. (b) Calcium gluconate should not be given to patients on digoxin. Calcium gluconate should be used with caution in digitalized patients; hypercalcemia may precipitate cardiac arrhythmias. (c) 1mg of bumetanide is equal to 40 mg of furosemide. 1mg of bumetanide is equal to 40 mg of furosemide. (d) IM administration of diazepam is well absorbed. IM injections of diazepam have unpredictable absorption. (e) Digoxin slows AV nodal conduction. It is used for SVT and CHF. It slows AV conduction an acts as a Na,K,-ATPase inhibitor. 16. Amiodarone (a) Use with diltiazem may cause severe bradycardia. Amiodarone potentiates the effects of other medications which slow down the heart rate such as beta blockers and calcium channel blockers. Diltiazem and amiodarone may be a particularly bad combination (b) Amiodarone decreases digoxin levels Amiodarone increases digoxin levels (markedly reduce the digoxin dose and watch levels; or stop it) (c) Amiodarone may increase phenytoin levels Amiodarone may increase phenytoin levels (d) If sub-optimal arrhythmia control occurs the next step is to add a class I (Vaughan-Williams) agent such as disopyramide. If amiodarone is combined with Vaughan Williams class I agents then proarrhythmic effects (even polymorphic ventricular tachycardia) may be potentiated. This has been seen with propafenone, disopyramide and mexiletine. Marked QT prolongation may indicate high risk! Quinine and procainamide levels

MCEM Pharmacology MCQ may also be increased on amiodarone therapy. Try and avoid using amiodarone with any class I agent. (e) Rifampicin increases amiodarone levels

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(d) Use with particular caution in alcohol dependence.

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(e) Caution use per rectum in children aged 1- 5 years.

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Rifampicin increases amiodarone levels [ Pharmacotherapy 1999 Feb;19(2):249-51 ] 17. Paracetamol: (a) Side effects are rare. (b) Hypotension is a known side effect. Hypotension is associated with intravenous infusions of paracetamol. (c) Recent evidence suggests paracetamol can be a drug of abuse.

18. Local Anaesthesia (a) The inguinal ligament runs from the pubic tubercle to the anterior superior iliac spine (b) For a femoral nerve block the local anaesthetic agent should be injected medial to the femoral artery The local anaesthetic should be injected laterally as the nerve is lateral to the artery (c) Lignocaine 1% contains 1mg of lignocine per ml of solution 10mg/ml of solution (d) Lignocaine has a half life of 10 hours Lignocaine has a half life of 2 hours (e) Biers block is used as anaesthesia for colles fractures 19. Medications in Pregnancy: (a) Antithyroid drugs such as carbimazole are not associated with neonatal hypothyroidism. Antithyroid drugs such as carbimazole may cause neonatal hypothyroidism (b) Glucocorticoids do not cross the placenta in normal pregnancy. Glucocorticoids may cause neonatal adrenal suppression in high doses. (c) Warfarin is associated with vestibular nerve impairment. Warfarin is associated with bone abnormalities and neonatal haemorrhage (d) Beta blockers are safe in pregnant women with hypertension. Beta blockers may cause growth retardation (e) Carbamazepine is associated with neonatal goitre. Carbamazepine is associated with neural tube defects 20. Cardiac Glycosides: (a) Digoxin is positively inotropic and is renally excreted. Digoxin is positively inotropic and is renally excreted.

MCEM Pharmacology MCQ (b) Digoxin increases vagal tone and decreases conduction through the AV node

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(c) NSAIDs inhibit the conversion of membrane phospholipids to arachidonic acid

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(d) Cyclooxygenase converts arachidonic acid to thromboxanes, prostacyclins and prostaglandins

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Digoxin increases vagal tone and decreases conduction through the AV node (c) The half life of therapeutic dose digoxin is about 12 hours The half life of therapeutic dose digoxin is about 48 hours. (d) Digoxin activates the Na/K/ATPase pump. Digoxin inactivates the Na/K/ATPase pump (e) Hypokalaemia but not hypomagnesemia increases the likelihood of digoxin toxicity. Both hypokalaemia and hypomagnesemia increase the likelihood of digoxin toxicity. 21. Opioid analgesics (a) 3mg oral morphine is about equivalent to 10mg oral codeine 3mg oral morphine is about equivalent to 20mg oral codeine (b) 3mg oral morphine is about equivalent to 5mg oral oxycodone 3mg oral morphine is about equivalent to 1.5mg oral oxycodone (c) 1mg IV morphine is about equivalent to 3mg po morphine 1mg IV morphine is about equivalent to 3mg po morphine (d) True allergic reactions are common True allergic reactions are extremely rare (e) The classes of opioids include the phenanthrene derivatives, the phenylpiperidine derivatives, and the diphenylheptane derivatives 22. Digoxin: (a) The half life of therapeutic dose digoxin is about 48 hours. The half life of therapeutic dose digoxin is about 48 hours. (b) Digoxin inactivates the Na/K/ATPase pump. Digoxin inactivates the Na/K/ATPase pump (c) Digoxin is negatively inotropic and is renally excreted. Digoxin is positively inotropic and is renally excreted. (d) Digoxin decreases vagal tone and decreases conduction through the AV node. Digoxin increases vagal tone and decreases conduction through the AV node (e) Both hypokalaemia and hypomagnesemia increase the likelihood of digoxin toxicity. Both hypokalaemia and hypomagnesemia increase the likelihood of digoxin toxicity. 23. The following are true: (a) NSAIDS augment the conversion of arachidonic acid to thromboxanes, prostacyclins and prostaglandins NSAIDS inhibit the conversion of arachidonic acid to thromboxanes, prostacyclins and prostaglandins (b) NSAIDs inhibit the conversion of arachidonic acid to leukotrienes

MCEM Pharmacology MCQ Cyclooxygenase converts arachidonic acid to thromboxanes, prostacyclins and prostaglandins (e) Lipoxygenase inhibits the conversion of arachidonic acid to leukotrienes Lipoxygenase converts arachidonic acid to leukotrienes Membrane phospholipids are converted to arachidonic acid by phospholipase A2. Arachidonic Acid is converted to thromboxanes, prostacyclins and prostaglandins by cyclooxygenase.Lipoxygenase converts Arachidonic acid to leukotrienes www.medscape.com 24. Amiodarone (a) Lung toxicity may occur in up to 2% of patients on long term therapy. This is be significant in 3 to 9% of patients (possibly even up to 17%), and may kill the patient if missed. There may be: Interstitial pneumonitis Lung fibrosis Hypersensitivity pneumonitis Bronchiolitis obliterans organising pneumonia (BOOP) has been reported. [ Neth J Med 1998 Sep;53(3):109-12 ] (b) Onset of lung toxicity may be delayed for 3 years after starting amiodarone Onset of toxicity may be delayed for 3 years after starting amiodarone (c) Neurotoxicity may manifest as proximal myopathy,distal sensory disturbance or peripheral neuropathy. Neurotoxicity has been reported in up to 40%, manifesting mainly as peripheral neuropathy with proximal motor weakness or distal sensory disturbance. Sleep disturbance, ataxia, vivid dreams and fine resting tremor are said to be common, and worse in the elderly. (d) Phototoxicity is a rare adverse effect. Phototoxicity is common and is a response to UVA. Blue-Grey skin discoloration may occur, as well as itch, petechiae and erythema nodosum. (e) Hyperthyroidism may occur but not hypothyroidism. Both hypo and hyperthyroidism may occur. 25. Lactulose (a) Is an osmotic laxative It is a non absorbed disaccharide (b) May be used by diabetics Despite very sweet taste 15ml contains 14 kcals (c) Recognised side effects include increased flatus So increase dose slowly (d) Is a useful drug in the treatment of hepatic encephalopathy Discourages the proliferation of ammonia producing organisms (e) May take up to 48 hours before side effects are obtained Also has a carry over effect

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MCEM Pharmacology MCQ

vancomycin: (a) Is a broad spectrum antibiotic. False ?Gram positives. (b) Is active against MRSA. True ? (c) Commonly produces nephrotoxicity. True ? (d) May cause red man syndrome. True ?Particularly if infused too quickly. (e) Is indicated in the treatment of antibiotic associated colitis. True ?Is indicated in the treatment of antibiotic associated colitis.

MCEM Pharmacology MCQ Emergency treatment of bradycardias: (a) May be treated with atropine. True (b) May be treated with transcutaneous cardiac pacing. True (c) May be treated with internal pacing. True (d) Should be initiated even without evidence of hypoperfusion. False (e) Treatment is not required if the bradydysrhythmia is due to disease of the infranodal conduction system. False

Bradydysrhythmia can be caused by 2 mechanisms. Depression of the SA nodal activity or conduction system blocks.Subsidiary pacemakers take over the pacing of the heart, and provided the pacemaker is located above the bifurcation of the His bundle, the rate is generally adequate to maintain cardiac output. The need for emergent treatment should be guided by 2 considerations,1.evidence of hypoperfusion or 2. the bradydysrhythmia is due to structural disease of the infranodal conductiong system that may degenerate into complete AV block or asystole.

MCEM Pharmacology MCQ Opioid Analgesics (a) The classes of opioids include the phenanthrene derivatives, the phenylpiperidine derivatives, and the diphenylheptane derivatives True ?The classes of opioids include the phenanthrene derivatives, the phenylpiperidine derivatives, and the diphenylheptane derivatives (b) True allergic reactions are extremely rare True ?Opiate hypersensitivity is uncommon and true allergic reactions are extremely rare (c) 1mg IV morphine is about equivalent to 5mg po morphine False ?1mg IV morphine is about equivalent to 3mg po morphine (d) 3mg oral morphine is about equivalent to 1.5mg oral oxycodone True ?3mg oral morphine is about equivalent to 1.5mg oral oxycodone (e) 3mg oral morphine is about equivalent to 20mg oral codeine True ?3mg oral morphine is about equivalent to 20mg oral codeine

MCEM Pharmacology MCQ Salbutamol (a) Produces significant bronchodilatation within 2 to 3 minutes False ?Within 15 minutes (b) Use is contraindicated in patients with co-existing heart disease False ?Very little effect on the heart and regarded as safe (c) Is of no value in preventing exercise induced asthma attacks False ?Two puffs prior to exertion likely to be effective (d) Duration of action is 2 to 3 hours False ?Effects last longer than this (e) Delivers 400 doses per canister False ?200.Terbutaline(Bricanyl) inhaler delivers 400.

MCEM Pharmacology MCQ

MCEM Pharmacology MCQ

MCEM Pharmacology MCQ Regarding muscles of the orbit: (a) Levator palpabrae superioris is supplied by the oculomotor nerve. True Levator palpabrae superioris is supplied by the oculomotor nerve. (b) Lateral rectus is an abductor of the eyeball. True Lateral rectus is an abductor of the eyeball. (c) Superior rectus turns the eye upwards and laterally. False The action of superior rectus is to turn the eye upwards and medially. (d) Superior oblique loops through a fascial sling before attaching to the eyeball. True Superior oblique loops through a fascial sling before attaching to the eyeball.

MCEM Pharmacology MCQ

MCEM Pharmacology MCQ Adenosine (a) Can be given orally False ? (b) Should be given as a 6 mg infusion over 10 min False ?Push (c) Has a plasma half life of 10 mins False ?