CHOOSE THE SINGLE BEST ANSWER

Matching. Match each of the agents listed below to one of the following toxicities. Each
toxicity may be used once, more than once, or not at all.

A. Oxalate kidney stones

B. Asphyxia
C. Blindness
D. Chloracne

1._____ Methanol

2. _____ Ethylene Glycol

3. Which heavy metal antagonist listed below is known to interfere with the action of zinc-
insulin preparations by chelating zinc.
A. Dimercaprol
B. Deferoxamine
C. Trientine
D. Succimer
E. EDTA

4. Phenytoin exhibits mixed-order elimination in the therapeutic dose range. Which

parameter(s) is required to calculate a loading dose of phenytoin?
A. the volume of distribution
B. Vmax
C. Km
D. Vmax and Km
E. the volume of distribution and Vmax

5. All of the following are examples of organophosphate type chemical weapon nerve
agents EXCEPT
A. Sarin
B. Soman
C. Sulfur mustard
D. VX

6. Significant CNS drug penetration is seen in patients treated with

A. Paclitaxel
B. Mechlorethamine
C. Daunorubicin
D. Lomustine
E. Teniposide

7. Which part of a prescription includes the name, strength and dosage form of the
medication to be dispensed?
A. Superscription.
B. Inscription
C. Subscription
D. Signa
E. Signature

1
Matching. Match each of the drugs listed below to one of the following treatments for
their toxicity (A-D). Each treatment may be used once, more than once, or not at all.

A. pyridoxine
B. glucagon
C. n-acetylcysteine
D. calcium

8. _____ isoniazid

9. _____ verapamil

10._____ propanolol

11. If the oral dosing rate of a drug is held constant, what will be the effect of increasing the
bioavailability of the preparation?
A. increase the half-life for first-order elimination
B. decrease the first-order elimination rate constant
C. increase the steady-state plasma concentration
D. decrease the total body clearance
E. increase the volume of distribution

12. Which heavy metal listed below can produce toxic effects resulting in elevated urine
levels of coproporphyrinogen III?
A. Mercury
B. Lead
C. Cadmium
D. Calcium
E. Iron

Matching. Match each of the agents listed below to one of the following toxicities. Each
toxicity may be used once, more than once, or not at all.
Each may be used once, more than once, or not at all.

A. Pulmonary fibrosis
B. Kepone shakes
C. Acidosis
D. Lipid peroxidation
E. Chloracne

13. _____ Tetrachlorodibenzodioxin (TCDD)

14._____ Carbon Tetrachloride

15. Leukovorin enhances the efficacy of

A. Busulfan
B. Fluorouracil
C. Thioguanine
D. Methotrexate
E. Mercaptopurine

2
16. Thus far, computer linked database programs can do all of the following EXCEPT
A. Check drug class against diagnosed condition
B. Check spelling of drug names
C. Check if prescribed drug entity exists
D. Write a correct signa for each drug
E. Check for drug interactions with patient history

17. The orally administered heavy metal antagonist recommended by the FDA for treating
children with lead poisoning is
A. succimer
B. dimercaprol
C. trientine
D. polythiol resin
E. none of the above

Matching. Match each of the following drugs with its mechanism of action below.

A. Cisplatin
B. Vinblastine
C. Methotrexate
D. Fluorouracil
E. Etoposide

18. ______ Inhibits thymidylate synthetase

19. ______ Crosslinks DNA

20. ______Inhibits topoisomerase II

21. ______Inhibits microtubule formation

22. ______ Inhibits dihydrofolate reductase (dhfr)

23. Mesna is used to prevent bladder toxicity associated with the use of
A. Cisplatin
B. Cytosine arabinoside
C. Methotrexate
D. Busulfan
E. Cyclophosphamide

24. A kidney transplant recipient should be switched from cyclosporine to tacrolimus to

avoid
A. neurotoxicity
B. hirsutism
C. diabetogenicity
D. nephrotoxicity

3
25. In normal individuals, an antibiotic is eliminated 25% by hepatic metabolism, 50% by
renal filtration, and 25% by biliary excretion. If the normal maintenance dose rate = 10
mg/hour, what dose rate will you administer to a patient with a creatinine clearance that
is'/2 normal? (Assume that hepatic and biliary clearances are normal.)
A. 2.5 mg/hour
B. 5.0 mg/hour
C. 6.0 mg/hour
D. 7.5 mg/hour
E. 20 mg/hour

26. Metabolic activation is required for the action of

A. Hydroxyurea
B. Bleomycin
C. Cyclophosphamide
D. Dactinomycin
E. Asparaginase

Use the following pharmacokinetic parameters for theophylline to answer

Questions 27 and 28 : oral bioavailability = 96%; fraction bound in plasma =
56%; clearance = 2.88 liters/hour; volume of distribution = 35 liters; and elimination half-
life = 8.1 hours.

27. What loading dose of theophilline (in mg) would you administer i.v. to reach an initial
plasma concentration of 10 mg/liter?
A. 2
B. 24.3
C. 202
D. 350
E. 625

28. What oral maintenance dose (in mg/hour) would you administer to maintain the average
steady-state plasma concentration at 10 mg/liter?
A. 0.2
B. 2.4
C. 20
D. 30
E. 62.5

Matching. Match each of the following drugs with one of the organs listed below that is
associated with that drug's dose limiting toxicity.

A. Bleomycin
B. Vincristine
C. Doxorubicin
D. Cytosine arabinoside
E. Cisplatin

29. ______ Heart

30. ______ Lungs

31. ______ Kidney

32. ______ Peripheral nervous system

4
33. ______ Bone marrow

CHOOSE THE SINGLE BEST ANSWER

34. A disease causes a 4-fold increase in the half-life of a drug. What is the effect of the
disease on the clearance and volume of distribution (Vd) of the drug?
A. the clearance is doubled and the Vd is reduced by 1/2
B. the clearance and Vd are both doubled
C. the clearance is reduced by 1/2 and the Vd is doubled
D. the clearance and Vd are both reduced by 1/2

35. Reactive oxygen species can cause toxicity by all of the following mechanisrps EXCEPT
A. lipid peroxidation
B. oxidation of glutathione
C. covalent modification of proteins
D. single-strand DNA breaks
E. hapten formation

36. A combination of drugs frequently used to treat childhood acute lymphocytic leukemia
includes all of the following EXCEPT
A. Methotrexate
B. Vincristine
C. Chlorambucil
D. Mercaptopurine
E. Prednisone

37. The best therapy for a transplant recipient who receives a kidney that has been
preserved for an extended period of time is
A. simultaneous treatment with regular doses of mycophenolate mofetil and
cyclosporine
B. simultaneous treatment with ATGAM and regular dose of tacrolimus
C. an initial treatment with ATGAM alone followed by addition of low dose of
cyclosporine
D. an initial treatment with regular doses tacrolimus followed by addition of
high dose of steroids

38. You administer an oral maintenance dose of drug calculated to achieve a steady-state
plasma concentration of 5 mcg/liter in a normal patient. After dosing a patient for a
time sufficient to reach steady state, the average plasma concentration of drug is 10
mcg/liter. A decrease in which of the following parameters explains this higher than
anticipated plasma drug concentration in this patient?
A. bioavailability
B. volume of distribution
C. clearance
D. half-life

5
39. Hydrogen peroxide when applied to ulcerated areas in certain patients with progressive
oral gangrene did not froth in the usual manner (i.e. hydrogen peroxide was not broken
down). Which of the following enzymes would you suspect to be defective in these
patients?
A. P-450 reductase
B. cytochrome oxidase
C. Catalase
D. Superoxide Dismutase
E. Alcohol Dehydrogenase

40. P-glycoprotein mediated multidrug resistance (mdr) inhibits the intracellular

accumulation of all of the following drugs EXCEPT
A. Actinomycin D
B. Bleomycin
C. Vinblastine
D. Doxorubicin
E. Etoposide

41. An orphan drug is a drug that is

A. no longer a "Rx only" drug
B. developed for a rare disease (>200,000 cases)
C. imported from a small country
D. too toxic for most patients
E. inexpensive

42. Co-administration of allopurinol to a cancer patient necessitates a reduction in the dose

of
A. Mercaptopurine
B. Thioguanine
C. Fluorouracil
D. Cytosine arabinoside
E. Procarbazine

43. Which heavy metal listed below can form a complex with cysteine to structurally mimic
methionine and ultimately traverse capillaries entering the CNS and placenta?
A. Arsenic
B. Lead
C. Cadmium
D. Calcium
E. Mercury

6
 Administration of an i.v. loading dose of drug X yields an initial plasma concentration of
100 mcg/liter, and the table below illustrates the plasma concentration of X as a function
of time after the initial loading dose.

TIME (hours) Plasma Conc. (mcg/liter)

0 100
1 50
5 25
9 12.5

44. What is the half-life (in hours) of drug X?

A. 1
B. 2
C. 4
D. 5
E. 9

45. Physiologically, Vitamin C

A. recycles glutathione to its reduced form
B. acts as an anti-oxidant to breakdown hydrogen peroxide
C. repairs plasma membrane damage caused by lipid peroxidation
D. reduces disulfide bonds in oxidized proteins
E. when mixed with chicken soup cures the common cold

46. A highly successful drug targeted to the fusion protein created by a chromosomal
translocation in chronic myelogenous leukemia is
A. Interferon
B. Herceptin
C. Interleukin 2
D. Imatinib mesylate (Gleevec)
E. Angiostatin

Matching. Match each of the types of insecticides listed below to one of the following
mechanisms of toxicity. Each mechanism may be used once, more than once, or not at
all.

A. Changes the state of iron from the ferric (3+) to the ferrous (2+) state
B. Binds to cytochrome oxidase, thus blocking electron transport
C. Forms an irreversible complex with acetylcholinesterase to inactivate the
enzyme
D. Forms a reversible complex with acetylcholinesterase to inactivate the
enzyme
E. Prolongs the falling phase of the action potential

47. ______ Organochlorine insecticides

48. ______ Organophosphorous insecticides

49. ______ Carbamate insecticides

7
50. Which of the following drugs is the most neurotoxic?
A. Cyclosporine
B. Sirolimus
C. Azathioprine
D. Tacrolimus

51. An emerging strategy for treating cancer is to inhibit the growth of blood vessels into the
tumor using
A. Retinoids
B. Endostatin
C. Tumor necrosis factor
D. GCSF
E. Vitamin E

52. You infuse a drug at constant dose rate until it reaches a steady-state plasma
concentration of 10 mcg/liter. You discontinue administration of the drug for one hour,
at which time the plasma concentration is 5 mcg/liter. If the drug has a volume of
distribution of 40 liters, what is the elimination rate of the drug (in mcg/hour) from the
body?
A. 5
B. 50
C. 100
D. 150
E. 200

53. Which of the following drugs blocks mTOR?

A. cyclosporine
B. sirolimus
C. tacrolimus
D. prednisolone

54. Which of the following drugs is most effective during M-phase (mitosis)?
A. Paclitaxel
B. Melphalan
C. Etoposide
D. Methotrexate
E. Daunorubicin

55. Which heavy metal listed below can form an unstable complex with ADP that effectively
depletes the cell's energy.
A. Arsenic
B. Lead
C. Cadmium
D. Calcium
E. Mercury

8
Answers
1. C 45. C
2. A 46. D
3. E 47. E
4. A 48. C
5. C 49. D
6. D 50. D
7. C 51. B
8. A 52. E
9. B 53. B
10. B 54. A
11. C 55. A
12. B
13. E
14. D
15. B
16. D
17. A
18. D
19. A
20. E
21. B
22. C
23. E
24. A
25. D
26. C
27. D
28. D
29. C
30. A
31. E
32. B
33. D
34. C
35. B
36. C
37. C
38. C
39. C
40. B
41. B
42. A
43. E
44. C