Pharmboardsreview2009 (Answers Higlighted)[1]

UPCM 2009 BOARDS ORIENTATION AND REVIEW COURSE PHARMACOLOGY 1. The process by which the amount of orally-administered drug is reduced before it reaches the systemic circulation A. First-order kinetics B. First-pass effect C. Pharmacokinetics D. Excretion E. Metabolism 2. A drug repeatedly administered at dosing intervals equal to its elimination half-life will reach steady state after how many doses A. 2 to 3 B. 4 to 5 C. 6 to 7 D. 8 to 9 E. 10 or more 3. A drug that counters the effects of another by binding the drug and preventing its action A. Physiologic antagonist B. Partial antagonist C. Competitive antagonist D. Irreversible antagonist E. Chemical antagonist 4. The dose or concentration required to bring about 50% of a drug’s maximal effect A. Potency B. ED50 C. Efficacy D. Kd E. Therapeutic index 5. The concentration of drug that results in binding to 50% of the receptors A. Potency B. ED50 C. Efficacy D. Kd E. Therapeutic index 6. The maximum effect of the drug may be produced even if not all receptors are bound in the presence of which of the following: A. Full agonist B. Partial agonist C. Spare receptors D. Inert binding site

E. Effector 7. The pharmacokinetic value that most reliably reflects the amount of drug reaching the target tissue after oral administration is the A. Peak blood concentration B. Time to peak blood concentration C. Product of the volume of distribution and the first-order rate constant D. Volume of distribution E. Area under the blood concentration-time curve 8. Which of the following terms is best described as a rapid reduction in the effect of a given dose of a drug after only one or two doses A. Supersensitivity B. Tachyphylaxis C. Tolerance D. Anaphylaxis E. Synergism 9. FALSE of plasma protein binding A. Acidic drugs generally bind to plasma albumin and basic drugs to alpha-1 glycoprotein B. It reduces the availability of a drug for diffusion or transport to drug’s target organ C. Inhibition of clearance of the unbound drug is the relevant mechanism explaining drug interaction of highly-protein bound drugs D. A highly-protein drug has a relatively higher volume of distribution E. Many drugs bind with albumin through both hydrophobic and electrostatic forces 10. Aspirin is a weak organic acid with a pKa of 3.5. What percentage of a given dose will be in

the lipid soluble form at a stomach pH of 2.5? A. About 1% B. About 10% C. About 50% D. About 90% E. About 99% 11. Which of the following is TRUE in Promethazine overdose given that its a weak base with a

pKa of 9.1 A. Urinary excretion would be accelerated by administration of an acidifying agent B. Urinary excretion would be accelerated by giving an alkalinizing agent C. More of the blood will be ionized at blood than at stomach pH D. Absorption will be faster from the stomach than the small intestine E. Peritoneal dialysis is the only effective therapy 12. Given a drug with a volume of distribution of 80 L and clearance of 1.386 L/h, the half-life is approximately A. 0.02 h

B. C. D. E.

40 h 58 h 80 h 111 h

13. Which of the following is NOT a Phase II reaction of drug metabolism A. Deamination B. Acetylation C. Glucuronidation D. Methylation E. Sulfate conjugation 14. The plasma concentration of a drug rendered inactive by Cytochrome P450 enzymes will increase when given concomitantly with which of the following drugs A. Phenobarbital B. Phenytoin C. Rifampicin D. Carbamazepine E. Fluconazole 15. An important modulator of intestinal drug transport and usually functions to expel drugs from the intestinal mucosa to the lumen A. UDP-glucuronic acid B. P-glycoprotein C. Microsomal mixed function oxidase system D. NADPH-cytochrome P450 reductase E. Glutathione 16. Phase of drug development and testing process involving evaluation of drug in a moderate number of patients (100-300) with the target disease A. Phase I B. Phase II C. Phase III D. Phase IV E. Phase V 17. Which of the following factors commonly decrease half-life A. Aging B. Obesity C. Cytochrome P450 inhibition D. Hepatic failure E. Cardiac failure 18. The kinetics characteristic of elimination of ethanol and high doses of phenytoin and aspirin is known as A. Distribution

B. C. D. E.

Excretion First-pass effect First-order elimination Zero-order elimination

19. Which of the following drug combinations is known to lead to a pharmacokinetic drug interaction A. Furosemide and hydrochlorthiazide B. Cimetidine and warfarin C. Metoprolol and Dobutamine D. Digoxin and Propranolol E. ACE inhibitor and spironolactone 20. Which of the following drugs has the highest probability of toxicity or loss of efficacy with changes in plasma concentration A. Amoxicillin B. Furosemide C. Atenolol D. Digoxin E. Enalapril 21. Which of the following CNS receptors is an Ionotropic receptor A. Nicotinic B. Muscarinic C. Dopamine receptor D. Beta-adrenergic receptor E. Alpha-adrenergic receptor 22. Which of the following drugs inhibits cyclooxygenase irreversibly A. Aspirin B. Ibuprofen C. Prednisone D. Indomethacin E. Zileuton 23. Prostaglandins involved in inflammatory processes are produced from arachidonic acid by A. Phospholipase A2 B. Lipoxygenase C. Glutathione-S-transferase D. Cyclooxygenase-1 E. Cyclooxygenase- 2 24. Corticosteroids are usually indicated in the following conditions EXCEPT: A. Herpes simplex of the eye B. Status asthmaticus C. Severe allergic rhinitis

D. Nephrotic syndrome E. Adrenal insufficiency 25. Which of the following drugs is most often associated with hypotension caused by histamine release? A. Diazepam B. Pancuronium C. Vecuronium D. Tubocurarine E. Succinylcholine 26. Which of the following characterizes local anesthetics A. They generally block myelinated before unmyelinated fibers B. They are generally administered along with epinephrine to prolong its action C. The primary action is on calcium permeability D. Do not readily cross the blood-brain barrier 27. Which of the following is commonly used to treat both absence and generalized tonic-clonic seizures A. Phenytoin B. Valproate C. Carbamazepine D. Clonazepam E. Phenobarbital 28. Which of the following is the mechanism of action of effective anti-psychotic agents A. Decreases acetylcholine in the CNS B. Blocks dopamine receptor sites in the CNS C. Makes acetylcholine more available in the CNS D. Facilitates the use of norepinephrine in the CNS E. Makes dopamine more available in the CNS 29. Which of the following drugs can cause Stevens-Johnson syndrome, ataxia, and gingival hyperplasia A. Phenobarbital B. Disulfiram C. Phenytoin D. Valproic acid E. Carbamazepine 30. A pure opioid antagonist with a greater affinity for μ receptors and used for acute opioid

overdose A. Morphine B. Naloxone C. Codeine D. Dextromethorpan

E. Diphenoxylate 31. A patient with overdose toxicity of MDMA or “ecstasy” is UNLIKELY to manifest which of the following symptoms A. Agitation B. Hyperthermia C. Hyperreflexia D. Bradycardia E. Seizures 32. A patient who underwent percutaneous coronary angioplasty with placement of a stent in a coronary vessel was started on clopidogrel. This drug exerts its antithrombotic effect through which of the following mechanisms A. Irreversible inhibition of ADP receptor B. Inhibition of thromboxane synthesis C. Reversible blockade of glycoprotein IIb/IIIa D. Conversion of plasminogen to plasmin E. Posttranslational modification of vitamin K-dependent clotting factors 33. The effect of heparin in a patient who suddenly presented with gastrointestinal hemorrhage may be promptly reversed with which of the following: A. Vitamin K B. Ascorbic acid C. EDTA D. Protamine E. Folic Acid 34. Which of the following is most useful for patients with red cell deficiency caused by renal disease or depression of the bone marrow A. Erythropoietin B. Hemosiderin C. Transferrin D. Folic acid E. Vitamin B 12 35. Which of the following is FALSE about Vitamin B 12 A. It can be synthesized by multicellular organisms B. It is stored in the liver in large amounts which can last up to 5 years C. Used in the treatment of anemia caused by gastric resection D. Deficiency of Vitamin B12 can cause neurologic defects E. It is essential in the conversion of methylmalonyl CoA to succinyl-CoA 36. A bactericidal glycoprotein with a narrow spectrum of activity and is used for serious

infections caused by methicillin resistant staphylococci (MRSA), penicillin-resistant pneumococci, and Clostridium difficile A. Aztreonam

B. C. D. E.

Clavulanic acid Imipinem Cefepime Vancomycin

37. Which of the following cephalosporins is highly effective against pseudomonas A. Cefazolin B. Cefuroxime C. Ceftazidime D. Cefaclor E. Ceftriaxone 38. Which of the following antibiotics inhibit microbial protein synthesis by binding to the 30S ribosomal subunit A. Clindamycin B. Erythromycin C. Chloramphenicol D. Tetracycline E. Linezolid 39. A selective inhibitor of bacterial dihydrofolate reductase A. Sulfonamide B. Trimethoprim C. Ciprofloxacin D. Nalidixic acid E. Linezolid 40. Aminoglycoside toxicity includes the following EXCEPT: A. Auditory or vestibular damage B. Acute tubular necrosis C. Respiratory paralysis in high doses D. Contact dermatitis E. Encephalopathy 41. The following are drugs used in the treatment of Tuberculosis, EXCEPT: A. Ethambutol B. Rifampicin C. Streptomycine D. Dapsone E. Ciprofloxacin 42. Urinary tract infection due to Chlamydia trachomatis will NOT reapond to which of the following drug? A. Tetracycline B. Erythromycin C. Nitrofurantoin

D. Ciprofloxacin 43. Which of the following statements about fluconazole is most accurate: A. It is highly effective in the treatment of aspergillosis B. Its oral bioavailability is less than that of ketoconazole C. It does not penetrate the blood brain barrier D. It inhibits demethylation of lanosterol E. It is a potent inducer of Cytochrome P450 enzymes 44. Which of the following drugs is a reverse transcriptase inhibitor that is useful in the treatment of Hepatitis B infection A. Amantadine B. Ganciclovir C. Lamivudine D. Interferon-alpha E. Acyclovir 45. The use of chloroquine in Plasmodium vivax infection is primarily targeted on the

elimination of which of the following forms of the parasite A. Secondary tissue schizonts B. Exoerythrocytic schizonts C. Erythrocytic stage D. Asexual forms E. Liver stages 46. Which of the following is the drug of choice for Schistosoma haematobium A. Praziquantel B. Mebendazole C. Metronidazole D. Diethlcarbamazine E. Albendazole 47. Drug of choice for the relief of acute exacerbations of asthma A. Terbutaline B. Ipatropium bromide C. Cromolyn sodium D. Montelukast E. Prednisone 48. Which of the following drugs is used to decrease uric acid production in gout A. Allopurinol B. Aspirin C. Colchicine D. Probenecid E. Hydroxychloroquine

49. Treatment for thyrotoxicosis does not include which of the following drugs A. Radioactive iodine B. Thyroglobulin C. Propylthiouracil D. Potassium iodide E. Methimazole 50. A patient with chronic overdose of exogenous T4 will have which of the following

manifestations: A. Dry, puffy skin B. Large tongue and drooping eyelids C. Weight loss D. Lethargy, sleepiness E. Bradycardia 51. Action of Sulfonylurea hypoglycemic agents does NOT include A. Stimulate release of endogenous insulin B. Reduce glucagon release C. Increase functional insulin receptors in peripheral tissues D. Increase target tissue sensitivity to insulin E. Closing of potassium channels in the pancreatic B cell membrane 52. Which of the following is most likely to cause hypoglycemia when used as a monotherapy for Type II diabetes A. Acarbose B. Glimepiride C. Metformin D. Rosiglitazone E. Miglitol 53. The hypoglycemic agent of choice in pregnant women A. Biguanides B. Sulfonylurea C. Insulin D. Rosiglitazone E. Acarbose 54. Which of the following is NOT an effect of muscarinic blocking drugs A. Miosis B. Constipation C. Reduced salivation and gastric secretion D. Urinary retention E. Bronchodilation 55. Which of the following is NOT a direct-acting cholinergic agonist A. Bethanechol

B. C. D. E.

Carbachol Pilocarpine Neostigmine Nicotine

56. Cause of death from exposure to a high concentration of organophosphate insecticide will most likely be A. Cardiac arrhythmia B. Respiratory failure C. Hypertension D. Renal failure E. Gastrointestinal hemorrhage 57. A patient with “warm” septic shock presents with hypotension and generalized vasodilation. High dose Dopamine intravenous infusion was started. Which adrenoceptor does dopamine act to constrict the vessels? A. Beta-1 B. Alpha-1 C. Alpha-2 D. D1 E. D2 58. A patient rushed to the emergency room for anaphylactic shock was given intramuscular epinephrine. Which of the following are expected effects of the drug A. Bronchodilation B. Vasodilation C. Decreased cardiac contractility D. Pupillary constriction E. Uterine contraction 59. Which of the following is the drug of choice for a hypertensive patient with benign prostatic hypertrophy and urinary obstruction: A. Metoprolol B. Clonidine C. Prazosin D. Ephedrine E. Methlydopa 60. A patient diagnosed to have pheochromocytoma, a tumor of the adrenal medulla causing excessive release of epinephrine and norepinephrine, was started on a non-selective alphaantagonist, an example of which is A. Yohimbine B. Methyldopa C. Terazosin D. Phenoxybenzamine E. Clonidine

61. The following is NOT a clinical use of beta-adrenoceptor antagonists: A. Portal hypertension B. Glaucoma C. Hypothyroidism D. Chronic heart failure E. Angina 62. Postsynaptic activation of Alpha-1 receptors will lead to the following cellular effects A. Decreased intracellular calcium B. Increased cAMP C. Increased IP3 and DAG D. Inhibition of phospholipase activity E. Inhibition of Phosphodiesterase III 63. In an experiment by Arinze and Kawai in 1983, glycogenolysis in hepatocytes isolated from

fed guinea pigs was stimulated by catecholamines with the following order of potency: Isoproterenol>Epinephrine>>Norepinephrine. This order of potency is characteristic of which adrenoceptor: A. Alpha-1 B. Alpha-2 C. Beta-1 D. Beta-2 E. Beta-3 64. Increased cardiac contractility, decreased peripheral vascular resistance, increased pacemaker activity are actions of A. Dopamine B. Norepinephrine C. Isoproterenol D. High-dose epinephrine E. Atenolol 65. Which of the following drugs will decrease heart rate in a normal heart but has little or no effect in a denervated heart A. Phenylephrine B. Isoproterenol C. Dobutamine D. Epinephrine E. Prazosin 66. Beta-receptor activation will produce which of the following metabolic effects A. Increased fat stores B. Increased extracellular potassium C. Increased glycogen stores D. Increased renin secretion E. Insulin release inhibition

67. Which among the following is the most potent diuretic A. Furosemide B. Hydrochlorothiazide C. Spironolactone D. Acetazolamide E. Eplerenone 68. Which of the following is a direct centrally-acting sympatholytic agent A. Methyldopa B. Guanethedine C. Reserpine D. Propranolol E. Prazosin 69. The expected frequency of occurrence of a particular toxic effect in response to a particular agent is known as A. Bioaccumulation B. Biomagnification C. Threshold limit value D. Risk E. Toxic threshold 70. Chemical compounds known to contribute to environmental pollution does NOT include which of the following A. Dioxins B. Polychlorinated biphenyls C. Malathion D. DDT 71. A major air pollutant which can cause headache, tachycardia, and syncope A. Carbon monoxide B. Nicotine C. Nitrogen dioxide D. Ozone E. Sulfur dioxide 72. A patient manifesting with wrist-drop, anorexia, anemia, tremor, weight loss and gastrointestinal symptoms is most likely suffering from which of the following A. Acute mercury poisoning B. Chronic mercury poisoning C. Iron poisoning D. Chronic lead poisoning E. Chronic arsenic poisoning 73. A child with diagnosed to have acute lead poisoning with signs and symptoms of encephalopathy should be given

A. B. C. D. E.

Acetylcysteine Deferoxamine EDTA Penicillamine Succimer

74. A patient who suddenly deteriorated due to respiratory depression after being given diazepam may benefit from this antidote A. Flumazenil B. Acetylcysteine C. Atropine D. Oxygen E. Pralidoxime 75. Which of the following will confer passive immunity A. Diphtheria toxoid B. Measles vaccine C. Tetanus antitoxin D. Oral polio vaccine E. Purified protein derivative 76. Drug that blocks estrogen receptors in the pituitary gland increasing FSH and LH output A. Clomiphene B. Diethylstilbesterol C. Danazol D. Tamoxifen E. Raloxifene 77. Estrogen used in most combined hormonal contraceptives A. Clomiphene B. Ethinyl estradiol C. Estrone D. DES E. Norgestrel 78. Which of the phases of the cell cycle is most resistant to most chemotherapeutic agents and requires increased drug dose to obtain response A. S phase B. G0 phase C. G1 phase D. G2 phase 79. By which of the following mechanisms do vinca alkaloids work in cancer chemotherapy A. Inhibition of function of microtubules B. Damage and prevention of repair of DNA C. Inhibition of purine synthesis

D. Inhibition of DNA gyrase E. Inhibition of protein synthesis 80. Which of the following is an alkylating chemotherapeutic agent A. Mercaptopurine B. Methotrexate C. Cyclophosphamide D. Fluorouracil E. Cytarabine 81. Doxorubicin, a drug used in the treatment of Hodgkin’s disease belongs to which group of antineoplastic drugs A. Alkylating agents B. Antimetabolites C. Plant alkaloids D. Antibiotics E. Hormones 82. A monoclonal antibody targeted against TNF-alpha which is used in Crohn’s disease and rheumatoid arthritis A. Infliximab B. Abciximab C. Etanercept D. Thalidomide E. Cyclosporine 83. A patient in heart failure was given a diuretic which inhibits Na reabsorption and potassium secretion by acting as a competitive antagonist of a receptor located at the blood side of the tubule. The drug is most likely A. Spironolactone B. Hydrochlorothiazide C. Amiloride D. Furosemide E. Mannitol 84. Hydrochlorothiazide was prescribed when lifestyle modification failed to lower the blood pressure of a patient with Stage I hypertension. Adverse effects of this drug include which of the following: A. Hypokalemic metabolic acidosis B. Hyperuricemia C. Hypoglycemia D. Hypocalcemia E. Decrease in serum cholesterol and LDL

85. A patient diagnosed to have essential hypertension was receiving enalapril, furosemide, metoprolol and clonidine. Good control of hypertension made the doctor decide to discontinue one drug. Gradual withdrawal of which drug will prevent rebound hypertension: A. Enalapril B. Furosemide C. Metoprolol D. Clonidine E. Losartan 86. An anti-hypertensive agent which acts through nitric oxide, dilates arterioles but not veins, and causes a lupus-erythematosus-like syndrome A. Minoxidil B. Nitroprusside C. Fenoldapam D. Hydralazine E. Verapamil 87. A 20-year old male was admitted in moderate cardiorespiratory distress due to heart failure

secondary to Rheumatic Heart Disease. Drugs which were found useful in heart failure include the following EXCEPT: A. Diuretics B. Beta- adrenoceptor agonists C. Calcium channel blockers D. ACE inhibitors E. Digoxin 88. This anti-heart failure drug increases cAMP and cGMP leading to both vasodilation and enhanced myocardial contractility A. Dobutamine B. Digoxin C. Nesiritide D. Milrinone E. Dopamine 89. Which calcium channel blocker/s conduction abnormalities A. Diltiazem B. Verapamil C. Nifedipine D. Bepridil E. All of the above

is/are ideally used in patients with atrioventricular

90. Both an intravenously and orally administered drug useful for both supraventricular and ventricular tachyarrhythmias A. Adenosine B. Verapamil

C. Lidocaine D. Esmolol E. Amiodarone 91. A 37-year old male presenting with pancreatitis, eruptive xanthoma and centripetal obesity had a triglyceride level of 900 mg/dL. The rest of the lipid profile was normal. This patient will most likely benefit from which of the following drugs A. Lovastatin B. Ezetimibe C. Niacin D. Cholestyramine 92. A 35-year old male diagnosed to have familial combined hyperlipoproteinemia with elevated levels of both triglycerides and LDL was started on fenofibrate and a statin. To avoid drug interactions, the best statin of choice is A. Atorvastatin B. Simvastatin C. Lovastatin D. Pravastatin 93. When used as a monotherapy, a major toxicity of gemfibrozil is increased risk of A. Bloating and constipation B. Cholelithiasis C. Myopathy D. Cutaneous flushing E. Hepatic toxicity 94. Most potent H2 blocker with negligible binding with CYP450 enzyme

A. B. C. D.

Cimetidine Famotidine Ranitidine Nizatidine

95. Which is FALSE of proton pump inhibitors A. Reversibly inhibits K+/H+ATPase B. Inactive at neutral pH C. Effectively inhibits meal-stimulated acid secretion D. Inhibit 90-98% of 24-hour acid secretion E. Inhibits Cytochrome P450 enzyme 96. A laxative usually given as suppository and promotes peristaltic action and defecation in 15-30 minutes A. Methylcellulose B. Bisacodyl C. Magnesium sulfate D. Lactulose

97. Which of the following is NOT effective for cytotoxic drug emesis A. Ondansetron B. Metoclopromide C. Cyclizine D. Dronabinol 98. H. pylori associated peptic ulcer can be treated with the following regimen:

A. B. C. D.

PPI, Amoxicillin, Metronidazole for 10-14 days Bismuth, PPI, Amoxicillin, Clarithromycin for 4-6 weeks PPI for 10-14 days; Clarithromycin and Amoxicillin for 4-6 weeks PPI for 4-6 weeks; Clarithromycin and Amoxicillin for 10-14 days

99. A 65-year old man being treated for both pneumonia and gastroesophageal reflux disease was brought to the ER for syncope and pulselessness. The cardiac monitor showed Torsades de pointes. The most likely combination of drug he is taking is: A. Erythromycin/Cisapride B. Ciprofloxacin/Metoclopromide C. Clarithromycin/Domperidone D. Amoxicillin/Cisapride 100.A high incidence of adverse effects including pericarditis, pneumonitis, and interstitial nephritis characterize this drug used to induce remission in ulcerative colitis: A. Prednisone B. Sulfasalazine C. Azathioprine D. 6-mercaptopurine E. Olsalazine