Med –Term Exam/ Second semester

Pharmacology I/ Third year

2022/2001

Q) Choose the most appropriate answer form the following questions 50 Marks

1- A neuron that release Ach acting on nicotinic receptor could be:

A. Sympathetic neuron innervates the adrenal gland
B. Postganglionic parasympathetic neuron innervates the heart
C. Postganglionic sympathetic neuron innervates the sweat gland
D. All of the above

2- If the drug is extensively bound to albumin and has high molecular weight, this mean it has high
volume of distribution (Vd).
A. True
B. False

3- Regarding the distribution process, which of the following statement is correct?

A. Distribution to an organ is independent of blood flow.

B. Distribution is independent of the solubility of the drug in that tissue.
C. Distribution into a tissue depends on the unbound drug concentration gradient between blood and
the tissue.
D. Distribution is increased for drugs that are strongly bound to plasma proteins
E. Distribution has no effect on the half-life of the drug

4- Partial agonist:

A. Has higher affinity to the receptors with no intrinsic activity

B. Has no affinity but intrinsic activity
C. Has no affinity and no efficacy
D. Has affinity and less efficacy compared to full agonist

5- Which of the following type of the receptor families has fastest response?

A. Ligand-gated ion channels

B. Enzyme-linked receptors
C. G-protein-coupled receptors
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 D. Intracellular receptor
6- Effects on stimulation of adrenergic beta receptors include all the following except:

A. Bronchodilation
B. Decreased peripheral vascular resistance
C. Increased myocardia contractility
D. Increased platelet aggregation

7- When the TD50 of a drug is 20000 mg and its ED50 is 20 mg, thus the drug is considering to be:

A. Toxic
B. Extremely toxic
C. Has higher margin of safety
D. Has lower margin of safety

8- Which of the following steps is most critical to achieve a therapeutic drug concentration in plasma?
A. Metabolism
B. Distribution
C. Elimination
D. Absorption
9- The correct answer about efficacy and potency is

A. potency is usually more important than efficacy

B. The greater the efficacy, the great the affinity of a drug
C. If 10 mg of drug A produces the same response as 100 mg of drug B, drug A is more efficacious than
drug B
D. If 10 mg of drug A produces the same response as 100 mg of drug B, drug A is more potent than
drug B.

10- Prior to clinical trials in patients with heart failure, an animal study was carried out to compare
two new positive inotropic drugs (A and B) to a current standard agent (C). The results of cardiac
output measurements are shown in the graph below.

A. Drug A is most effective

A. Drug B is least potent
B. Drug C is most potent
C. Drug B is more potent than drug C and more effective than drug A
D. Drug A is more potent than drug B and more effective than drug C

11- Which physiological change occurs when the parasympathetic system is activated?
A. Increase in heart rate
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 B. Increase in gastric motility
C. Inhibition of lacrimation (tears)
D. Dilation of the pupil (mydriasis)

12- Sugammadex is a new drug that reverses the action of Pancuronium and certain other skeletal
muscle-relaxing agents (nondepolarizing neuromuscular blocking agents). It appears to interact
directly with the Pancuronium molecule and not at all with the Pancuronium receptor. Which of the
following terms best describes sugammadex?
A. Chemical antagonist
B. Noncompetitive antagonist
C. Partial agonist
D. Pharmacologic antagonist
E. Physiologic antagonist
13- Which of the following drugs can improve asthma symptoms?
A. Ipratropium
B. Bethanechol
C. Pilocarpine
D. Pyridostigmine
14- An 18-year-old female patient is brought to the emergency department due to drug overdose.
Which of the following routes of administration is the most desirable for administering the antidote
for the drug overdose?

A. Intramuscular
B. Intravenous
C. Oral
D. Subcutaneous

15- Which strategy is useful in treating symptoms of Alzheimer disease?

A. Inhibiting cholinergic receptors in the brain
B. Inhibiting the release of acetylcholine in the brain
C. Inhibiting the acetylcholinesterase enzyme in the brain
D. Activating the acetylcholinesterase enzyme in the brain
16- Which of the following up-regulates postsynaptic α1-adrenergic receptors?
A. Daily use of amphetamine that causes release of norepinephrine
B. A disease that causes an increase in the activity of norepinephrine neurons
C. Daily use of phenylephrine, an α1 receptor agonist
D. Daily use of prazosin, an α1 receptor antagonist

17- Which of the following reactions represents Phase II of drug metabolism?

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 A. Amidation
B. Hydrolysis
C. Oxidation
D. Reduction
E. Sulfation
18- Urinary retention after an abdominal surgery ( if it is not due to urinary obstruction) can be
treated by a drug that act by following mechanism:
A. Blocking muscarinic receptors
B. Activating nicotinic receptors
C. Inhibiting the release of acetylcholine
D. Inhibiting cholinesterase enzyme
19- Which is correct concerning the safety of using warfarin (with a small therapeutic index) versus
penicillin (with a large therapeutic index)?
A. Warfarin is a safer drug because it has a low therapeutic index.
B. Warfarin treatment has a high chance of resulting in dangerous adverse effects if bioavailability is
altered.
C. The high therapeutic index makes penicillin a safe drug for all patients.
D. Penicillin treatment has a high chance of causing dangerous adverse effects if bioavailability is
altered
20- Which agent could be used to diagnose myasthenia gravis in this patient?
A. Atropine
B. Pralidoxime
C. Edrophonium
D. Echothiophate
21- If 1 mg of lorazepam produces the same anxiolytic response as 10 mg of diazepam, which is correct?
A. Lorazepam is more efficacious than is diazepam.
B. Lorazepam is a full agonist, and diazepam is a partial agonist.
C. Lorazepam is a better drug to take for anxiety than is diazepam.

D. Lorazepam is more potent than is diazepam.

22- Which physiological change is expected when the sympathetic system is inhibited using a
pharmacological agent?
A. Reduction in heart rate
B. Increase in blood pressure
C. Decrease in fluid secretions
D. Constriction of blood vessels

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23- Which is correct regarding activation of receptors on the effector organs in the ANS?
A. Acetylcholine activeates adrenergic receptors.
B. Acetylcholine activates muscarinic receptors.
C. Epinephrine activates nicotinic receptors.
D. Norepinephrine activates muscarinic receptors.
24- A patient who received a nondepolarizing neuromuscular blocker (NMB) for skeletal muscle
relaxation during surgery is experiencing mild skeletal muscle paralysis after the surgery. Which drug
could reverse this effect of NMBs?
A. Pilocarpine
B. Bethanechol
C. Neostigmine
D. Atropine
25- Which of the following cholinomimetics activates both muscarinic and nicotinic receptors?

A. Lobeline
B. Pilocarpine
C. Nicotine
D. carbechol

26- Which of the following direct-acting cholinomimetics is mainly muscarinic in action?

A. Bethanechol
B. Carbachol
C. Aceylcholine
D. None of the above
27- Pharmacokinetics is:

A. The study of biological and therapeutic effects of drugs

B. The study of absorption, distribution, metabolism and excretion of drugs
C. The study of mechanisms of drug action
D. The study of methods of new drug development
28- Muscarinic receptors are located in:

A. Autonomic ganglia
B. Skeletal muscle neuromuscular junctions
C. Autonomic effectors cells
D. Sensory carotid sinus baroreceptor zone
29- What term is used to describe a decrease in responsiveness to a drug repeated or continuous
administration of an agonist or antagonist?

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 A. Refractoriness
B. Cumulative effect
C. Tolerance
D. Tachyphylaxis

30- Pharmacodynamics involves the study of following?

A. Mechanism of drug action

B. Biotransformation of drugs in the organism
C. Distribution of drugs in the organism
D. Excretion of drug from organism
31- The mechanism of action of indirect-acting cholinomimetic agents is:

A. Binding to and activation of muscarinic or nicotinic receptors

B. Inhibiting of the hydrolysis of endogenous acetylcholine
C. Stimulation of the action of acetylcholinesterase
D. Releasing acetylcholine from storage sites

32- Which route of drug administration is more likely to lead to the first-pass effect?

A. Sublingual
B. Intravenous
C. Oral
D. Intramuscular

33- Which of the followings is the second messenger of G-protein coupled (metabotropic) receptor:

A. Adenylyl cyclase
B. Sodium ions
C. Phospholipase C
D. cAMP
34-A neuron that release Ach acting on nicotinic receptor could be:
A. Sympathetic neuron innervates the adrenal gland
B. Postganglionic parasympathetic neuron innervates the heart
C. Postganglionic sympathetic neuron innervates the sweat gland
D. All of the above

35- Which of the following reactions represents Phase II of drug metabolism?

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 a.Amidation b.Sulfation c.Hydrolysis d.Oxidation e. Reduction
36- Regarding the distribution process, which of the following statement is correct?

A. Distribution to an organ is independent of blood flow.

B. Distribution is independent of the solubility of the drug in that tissue.
C. Distribution into a tissue depends on the unbound drug concentration gradient between blood and
the tissue.
D. Distribution is increased for drugs that are strongly bound to plasma proteins
E. Distribution has no effect on the half-life of the drug

37- Which of the following up-regulates postsynaptic α1-adrenergic receptors?

A. Daily use of amphetamine that causes release of norepinephrine
B. A disease that causes an increase in the activity of norepinephrine neurons
C. Daily use of phenylephrine, an α1 receptor agonist
D. Daily use of prazosin, an α1 receptor antagonist
38- If 1 mg of lorazepam produces the same anxiolytic response as 10 mg of diazepam, which is correct?
A. Lorazepam is more potent than is diazepam.
B. Lorazepam is more efficacious than is diazepam.
C. Lorazepam is a full agonist, and diazepam is a partial agonist.
D. Lorazepam is a better drug to take for anxiety than is diazepam.

39- Which is correct concerning the safety of using warfarin (with a small therapeutic index) versus
penicillin (with a large therapeutic index)?
A. Warfarin is a safer drug because it has a low therapeutic index.
B. Warfarin treatment has a high chance of resulting in dangerous adverse effects if bioavailability is
altered.
C. The high therapeutic index makes penicillin a safe drug for all patients.
D. Penicillin treatment has a high chance of causing dangerous adverse effects if bioavailability is
altered
40- When the TD50 of a drug is 20000 mg and its ED50 is 20 mg, thus the drug is consider to be:

A. Toxic
B. Extremely toxic
C. Has higher margin of safety
D. Has lower margin of safety

41- Effects on stimulation of adrenergic beta receptors include all the following except:

A. Bronchodilation

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 B. Increased myocardia contractility
C. Increased platelet aggregation
D. Decreased peripheral vascular resistance

42- A 60-year-old female who had a cancerous growth in the neck region underwent radiation
therapy. Her salivary secretion was reduced due to radiation and she suffers from dry mouth
(xerostomia). Which drug would be most useful in treating xerostomia in this patient?
A. Acetylcholine
B. Pilocarpine
C. Echothiophate
D. Atropine
43- A patient who received a nondepolarizing neuromuscular blocker (NMB) for skeletal muscle
relaxation during surgery is experiencing mild skeletal muscle paralysis after the surgery. Which drug
could reverse this effect of NMBs?
A. Pilocarpine
B. Bethanechol
C. Neostigmine
D. Atropine

44- Which of the following statement describe the mechanism of action of non-depolarizing
neuromuscular blocking agent?
A. Prevent access of the transmitter to its receptor and depolarization
B. Block acetylcholine reuptake
C. Block transmission by an excess of a depolarizing agonist
D. Block the nicotinic receptor
E. All of the above
45- If the drug is extensively bound to albumin and has high molecular weight, this mean it has high
volume of distribution (Vd).
C. True
D. False
46- A study was carried out in isolated intestinal smooth muscle preparations to determine the action
of a new drug “novamine,” which in separate studies bound to the same receptors as acetylcholine. In
the absence of other drugs, acetylcholine caused contraction of the muscle. Novamine alone caused
relaxation of the preparation. In the presence of a low concentration of novamine, the EC50 of
acetylcholine was unchanged, but the Emax was reduced. In the presence of a high concentration of
novamine, extremely high concentrations of acetylcholine had no effect. Which of the following
expressions best describes novamine?

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 A. A chemical antagonist
B. A partial agonist
C. A physiologic antagonist
D. An irreversible antagonist
E. A spare receptor agonist

47-Full activation of the parasympathetic nervous system is likely to produce which of the following
effects?
A. Bronchodilation
B. Decreased intestinal motility
C. Increased thermoregulatory sweating
D. miosis
tachycardia
48- Which of the following steps is most critical to achieve a therapeutic drug concentration in plasma?
a) Metabolism b) Distribution c) Elimination d) Absorption

49- - Sugammadex is a new drug that reverses the action of Pancuronium and certain other skeletal
muscle-relaxing agents (nondepolarizing neuromuscular blocking agents). It appears to interact
directly with the Pancuronium molecule and not at all with the Pancuronium receptor. Which of the
following terms best describes sugammadex?
A. Chemical antagonist
B. Noncompetitive antagonist
C. Partial agonist
D. Pharmacologic antagonist
E. Physiologic antagonist

50-Which of the following type of the receptor families has fastest response?

A. Ligand-gated ion channels

B. Enzyme-linked receptors
C. G-protein-coupled receptors
D. Intracellular receptor