please note the following for fill in the blanks - FH4 is not considered a correct answer - it is the activated

folic acid produced in the body -

however the compound given as a drug is leucovorin or folinic acid is N5-formyl FH4, so they are not exactly the same –

I had tolerance this time for spelling mistakes but please monitor spellings next time... (Please not that PPI stands for Proton pump inhibitor not
protein pump inhibitor) –

o proton means positive charge –

o while protein means proteins!!

 another thing - for the two questions with Tick all possible answers - there were two correct answers per question - for students who have
ticked more than 3 choices (4 or more), there was a deduction of 0.5 marks as it indicates they are not aware of the correct responses...
Hope this clarifies a few issues, Good luck to all...

Quiz 1
The antiplatelet aggregant effects of aspirin are attributed to Fever of severe aspirin toxicity happens due to:
blockage of:
 COX-1 only  Increased loss of heat due to vasodilation and sweating
 COX-2 only  Uncoupling of oxidative phosphorylation
 COX-1 and COX-2 general MOA  Increased metabolism and exothermic reactions
 COX-3 only  Increased muscle contractions with heat generation
Which of the following describes the MOA of aspirin? 2020 Quiz: Naproxen acts by:
 Acetylates arginine residue position 120  Hydrogen bond arginine residue in the position 120
 Acetylates arginine residue position 530  Serine 120
 Acetylates serine residue position 120  530
 Acetylates serine residue position 530
The main adverse effect associated with NSAID use is: All the following are NSAID adverse effects except:
 GIT disturbances  Antagonizing anti-hypertensive effects of drug
 Dizziness  Predisposing patients to stroke and MI.
 Hepatotoxicity  Worsening heart failure
 Postural hypotension  Worsening hepatic function
All the following solutions can be implemented to reduce the GIT aspirin we can achieve all the following except:
effects of aspirin except:  Antiplatelet aggregant effects 81mg
 Taking aspirin after food  Analgesic action
 Taking aspirin with a PPI  Antipyretic action
 Taking aspirin with misoprostol  Anti-inflammatory action 70mg
 Taking aspirin an antiacid
At the dose of 650 mg of aspirin we can achieve all the following Salicylism:
except:  Is managed by urine alkalinization.
 Antiplatelet aggregant effects 80-160 mg  Is characterized by severe hepatic necrosis.
 Analgesic action 650-975mg (2-3tablets325mg)  Occurs in all patients with overdoses of celecoxib.
 Antipyretic action 650-975mg (2-3tablets325mg) Is a fatal fulminating hepatitis with cerebral edema.
 Anti-inflammatory action 3-6g
2020 Quiz: With Which of the following doses of aspirin may a “At a dose of 6 g, which of the following effects of aspirin start
patient experience salicylism ? appearing”?
 1 tablet of 61mg  Antiplatelet aggregant effects 80-160mg
 2 tablets of 100mg  Analgesic action 650-975mg (2-3tablets325mg)
 2 tablets of 325mg  Salicylism Mild toxicity
 20 tablets of 325mg 6500  Severe aspirin toxicity 20-30tablets
 26 tablets of 325mg 19500mg severe toxicity
 severe aspirin toxicity is associated with: 
 Hyperventilation / respiratory alkalosis
 Hyperventilation / respiratory acidosis
 Respiratory depression / metabolic acidosis
Respiratory depression / metabolic alkalosis
Which of the following contraindication to aspirin use and their reason is correct?
 Children/ increased possibility of infection Reyes syndrome occurs when: A child with a viral infection receives aspirin.
 Gout patients/ increased absorption of uric acid from the GIT aspirin antagonist probenecid
 Heparin/ Increased possibility of thrombus formation
 Alcoholic patients/ increased possibility of GI
In which of the following conditions is the use of aspirin Reyes syndrome occurs when:
contraindication:  An infant with patient ductus arteriosus receives aspirin.
 Inflammatory bowel disease  A child with a viral infection receives aspirin.
 Gout  An adult on warfarin therapy receives aspirin.
 Angina An elderly patient with rheumatoid arthritis receives aspirin.
 Hepatitis
All the following drug interact with aspirin except: Written
 Omeprazole PPI  Aspirin is contraindicated in children with viral infection as
 Sulfinpyrazone Gout medicine - aspirin antagonist there is a risk of Reyes syndrome (fatal fulminating
 Methotrexate MTX toxicity hepatitis with cerebral edema)
 Heparin interact and cause bleeding
Quiz 2020 MTX Aspirin interacts with phenytoin because:
Aspirin decreases renal clearance and PPB of MTX leading to MTX  Aspirin interferes with the hepatic metabolism of phenytoin.
toxicity  Aspirin decreases the renal excretion of phenytoin.
 Aspirin inhibits binding of phenytoin to its target site.
Aspirin displaces phenytoin from plasma protein binding sites.
Tick all the following statements regarding aspirin:
1. Aspirin interacts with the arginine residues of COX aspirin interacts with serine residue position 530-this the other NSAIDS
2. Aspirin binds to COX enzyme through covalent bonds
3. Aspirin mainly acts by creating a steric hindrance in the substrate channel of COX.
4. Aspirin action is time dependent and reversible. aspirin irreversible -this the other NSAIDS Selective COX-2 Inhibitors
5. Aspirin has analgesic and antipyretic but no ant-inflammatory properties also inflammatory
6. Salicylism is associated with respiratory alkalosis.
7. Severe aspirin toxicity is managed by urine alkalinization.
2020 Quiz: Diclofenac is available in Bahrain in all the following 2020 Quiz: What to use for Patent ductus arteriosus PDA
dosages forms except:  Indomethacin only IV
 Powder for inhalation ‫ فولترين شيبسوي بالرئة ؟؟وهو اساسا يسوي‬AIA ‫نفس‬  Cele
‫االسبرين‬
 Indo and Cele
 Powder for reconstitution
 Suppositories
 Tablets
Which of the following is a problem associated with the use of 2020 Quiz: Asthma and having toothache
the NO-NSAIDs?  Patient with hepatic insufficiency we can give etoricoxib? ‫شي‬
 Short duration of action with frequent dosing ‫مزمن‬
 Reduced sensitivity with repeated use  Pencilllin
 Poor oral absorption  Osteoarthritis
 Increased adverse effects  Hepatitis
 Selective COX-2 Inhibitors
Drug MOA (written )
Etoricoxib Selective COX-2 Inhibitors
In which of the following cases would Celecoxib be Celecoxib can be used in managing all the following conditions
recommended? except:
 A patient with dental pain  Rheumatoid arthritis
 A patient with osteoarthritis  Osteoarthritis
 A patient with chicken pox  Ankylosing spondylitis
 A patient with fever  Dysmenorrhea
A patient who is allergic to sulfonamides is also allergic to: A patient with a history of peptic ulcer disease is currently
 Aspirin suffering from osteoarthritis. Which of the following may be
 celecoxib suitable to manage his current complaint?
 Paracetamol  NSAIDS only
 Ibuprofen  PPI only
 COXII inhibitors OR NSAIDS
 COXII inhibitors OR NSAIDS + PPI
The main adverse effect associated with the use of COX II A patient with a history of peptic ulcer disease is currently
inhibitors is: suffering from osteoarthritis. Which of the following may be
 Aplastic anemia suitable to manage his current complaint? Written test1 2020
 Cardiovascular complications
 Hepatitis with cerebral edema
 Constipation
Final written
Statement Reason
Selective COX-2 inhibitors are associated Selective COX-2 Inhibitors Celecoxib Etoricoxib Rofecoxib
with increased cardiovascular ADR (2) Does not inhibit platelet aggregation or increase bleeding time (COX-1 actions)

Thrombotic events are more common with selective COX-2 inhibitor because of:
 Blockage of COX-1 dependent PGI2-synthsis without concurrent blockage of COX-2 dependent PGE2 sy
 Blockage of COX-1 dependent PGE2-synthsis without concurrent blockage of COX-2 dependent TXA2 sy
 Blockage of COX-2 dependent PGI2-synthsis without concurrent blockage of COX-1 dependent PGE2 sy
 Blockage of COX-2 dependent PGI2-synthsis without concurrent blockage of COX-1 dependent TXA2 sy??? Mariam

coxibs inhibit cox-2 PGI2: vasodilation= Inhibit platelet aggregation TXA2: Increase platelet aggregation vasoconstrictor

Fill in the blanks:

1. Aspirin is contraindicated in children with viral infection as there is a risk of Reyes syndrome (fatal fulminating hepatitis with
cerebral edema.)
2. Aspirin cause GIT irritation that could be managed by taking aspirin after food or using it concurrently with PPI. Proton pump
inhibitor
 Paracetamol
Patient with a history of Gout is currently on allopurinol and probenecid. He appears with inflamed joints and a preliminary diagnosis
of osteoarthritis is made. which of the following is the most suitable to relieve his painful, inflamed joints?
Aspirin Celecoxib Paracetamol Infliximab
Which of the following is an appropriate dose of paracetamol for The maximum daily dose of paracetamol in healthy adults is:
a 3 year old child?  1g
 60mg  2g
 120mg  4g
 300mg  8g
 500mg
Paracetamol is an inhibitor of: Which of the following may be a serious toxicity associated
 COX-1 COX I with paracetamol overdose?
 COX-2 only COX II  Cardiac arrest and death
 COX-3 only COX III  Internal hemorrhage and shock
 COX-1 and COX-2 Both COX I and COX II  Respiratory depression and respiratory paralysis NSIADs
 Hepatotoxicity and renal necrosis
A Patient with a history of IM currently on warfarin is A Patient suffering from a headache was found to have a
experiencing fever. Which of the following is a good choice to history of MI and diabetes. He is currently on oral
relieve his fever? hyperglycemia agents and warfarin. What relieve his
 Aspirin headache?
 Paracetamol  Aspirin
 Ibuprofen  Paracetamol
 Etoricoxib  Ibuprofen
 Etoricoxib
A Patient with a history of IM currently on warfarin is As a pharmacist you would approve the use of Etoricoxib in
experiencing fever. Which of the following is a good choice to which of the following patients ?
relieve his fever? Written test 1 2020  A patient with a hepatic insufficiency who is currently
experiencing osteoarthritis
 A patient with a history of penicillin allergy who is currently
experiencing joint flare ups
2020 Quiz: Corona Quiz1 2020 Quiz Which of the following is an antidote for paracetamol
 Paracetamol N-acetyl cysteine overdoses?
 Brufin  Naloxone
 ‫حمى خفيفة وصداع‬  Ranitidine
Low fever and headache  Loperamide
 N-acetyl cysteine
Which of the following is a suitable antidote for paracetamol A Patient presents to the hospital 10 hours after ingesting 100
poisoning? tablets of paracetamol 500mg.
 N-acetyl cysteine which of the following can be used to manage h
 N-acetyl p-benzoquinonone imine  Glucuronic acid
 Mefenamic acid  N-acetyl cysteine
 Glutathione  Glutathione
 The patient has exceeded the timeframe for antidote use
test 1 2020
 No toxicity so no antidote
 Paracetamol toxicity AND N-acetyl cysteine
 The duration time is exceed
 The antidote is allopurinol
 I wanted to update you regarding the discussion blog…

I have discussed at the department - we are not authorized to give our bonus marks… but please be informed that a
question or two in assessments will arise from the discussion blog so please make sure you participate… 👌🏻

DMARD therapy
Methotrexate acts by all the following mechanism except:
 Blocking the TNF-a receptors with neutralization of its activity.
 Decreased leukocyte accumulation and neutrophil adhesion in inflammation
 Inhibiting the dihydrofolate reductase enzyme with reduce activation of immune T-cells
 Inhibiting the AICAR transformylase enzyme with adenosine accumulation
Methotrexate acts by the following mechanism except:
 Inhibiting the dihydrofolate reductase enzyme
c. adenosine accumulation
A&C
A women on MTX, 20mg once weekly, informs her rheumatologist that she is intending to have a baby in the near future. Which
of the following changes to her regimen do you expect?
 Discontinue MTX and avoid pregnancy for the following 12 months. Pregnancy (6-12 months after stopping)
 Reduce MTX dose to 7.5 mg once weekly and avoid pregnancy for 6 weeks following the dose reduction.
 Continue on MTX 20 once daily as is it necessary to control RA progression and continue with the pregnancy pain.
 Discontinue MTX, start high dose NSAIDs and continue with the pregnancy plan
A women on MTX, 20mg once weekly, informs her rheumatologist that she is intending to have a baby in the near future. Which
of the following changes to her regimen do you expect? Written test 1 2020
Use birth control while taking MTX and at least 6 months after stopping it.

Suggest a suitable medication to manage the following patients for their current complains, considering their medical and drug
history (Maximum time 14 minutes)
Medical/Drug history Current complaint Drug therapy
A patient with on MTX therapy for RA. Latest blood test reveals low RBCs and WBC count Folinic acid FH4)
(Leukovorin)
Fill in the blanks:
A patient on MTX therapy was found to develop bone marrow suppression. What should the doctor prescribe? Folinic acid FH4
Which of the following tests are required for monitoring of MTX Which of the following Drug-Follow up tests pair is correct?
therapy (tick all the correct tests)  Methotrexate- liver function tests and renal function tests
1. Complete blood count another name FBC full blood count  Chloroquine- Renal function tests and opthalmic
2. Renal function tests MTX is renally excreted examinations
3. Total plasma cholesterol, LDL and HDL  Allopurinol- liver function tests and plasma uric acid
4. Ophthalmological examinations  Cyclizine- Full blood count and renal function tests
5. Thyroid function tests
6. Male sex hormones
7. Fasting blood glucose levels
There’s addition test: LFT : Liver function test
the following tests are required for monitoring of MTX except Side effect of hydroxychloroquine:
 Complete blood count another name FBC full blood count Vascular
 Renal function tests MTX is renally excreted
 There’s addition test: LFT : Liver function test
 Blood glucose
A newly diagnosed RA patients has started DMARD therapy, however, the doctor requests an additional bridging therapy. Which
of the following drug is useful for this purpose? IM Paracetamol IM N-acetyl cysteine Oral Prednisolone Oral Methotrexate
Which of the following best describes etanercept? Which of the following drug / target pair is correct?
  An immunomodulator  Etanercept/ B-cells TNF-a inhibitor
 An antagonist to IL-6 receptors  Rituximab / IL-1
 A monoclonal antibody to neutralize IL-1  Tociluzumab / IL-6
 A fusion protein used to neutralize TNF-a  Anakinra / TNF-a Interleukin-1 Receptor antagonist
Enbrel MOA: Written test 1 2020

Drug Target site

Anakinra Interleukin-1 Receptor antagonist 1. A is MTX
(blocks the IL-1 activity by binding to the IL-1 receptor) 2.A is luflonamide
3. B is antibody monocional antibody
4. B is a etanercept
Which of the following drug / side effect pair is correct? Biological agent are recommended to be introduced into
 Methotrexate / corneal deposits and retinopathy chloroquine  Within 3-6 days of diagnosis
 Etanercept / hepatotoxicity Local inflammation at the site of injection  Within 3-6 weeks of diagnosis
 Adalimumab / increased risk of infections  Within 3-6 months of diagnosis
Leflunomide / mucosal ulceration alopecia
 Within 3-6 years of diagnosis
A patient is currently using the following drugs for management of his aritritis:
 Aspirin 650mg six times daily
 Hydroxychloroquine 500mg once daily
 Paracetamol 1000mg three times daily
He returns to the pharmacy complaining of a ringing in his ears, headache and nausea. What is happeneing to this patient and
how could it be manage
 Severe salicylate Toxicity – Peritoneal dialysis
 Salicylism – Urine alkalinization ‫فاطمة السيد‬
Paracetamol toxicity- Admininster N-acetyl cysteine The maximum daily dose of paracetamol in healthy adults is 4
 Hydroxychloroquine toxicity – Admininster Folic acid MTX
 Gout
1. Colchicine: (0.6- 1.2mg) (1-2 hours) (12 hours effective) 4-6mg in week
2. Allopurinol : prophylaxis but not for the treatment ( Zyloric® tablets 100mg and 300mg_
3. Uricosurics: inhibiting uric acid reabsorption at the PCT (proximal convoluted tubule) (K citrate) potassium citrate and lot water
a. Probenecid
b. Sulfinpyrazone (200–800 mg/day)
c. Benzbromarone:(50–200 mg/day) mild renal impairment
Maximum weekly dose of colchicine therapy is: Drug Target site
1.2mg 4mg (24hours) 6mg 10mg Allopurinol analog of hypoxanthine
Written
Match each drug to it is mechanism of action. Some answer will
not be used at all: MCQ All the following drug- contraindication pairs are true expect:
Colchicine Binds to tubulin to reduce migration of  Allopurinol- Hepatic insufficiency
granulocytes to the site of inflammation.  Sumatriptan- MI
a. Increases renal excretion of uric acid.  Ergotamine- Pregnancy
 Pseudoephedrine- Severe Hypertension

Complete the following statements using not more than 3 words

in each space:
Drug Target site
. The main side effects of colchicine that would warrant the
Sulfinpyrazone
discontinuation of therapy is severe diarrhea
2. Although allopurinol has a short half life
Nauseas - GI disturbance it is given once daily because it is active metabolite called
Alopecia – agranulocytosis ( A plastic anemia) oxypurinol or alloxanthine has a long half life
Complete the following statements using not more than 3 words in each space:
. In educating patients in allopurinol, we should instruct them to:
a. Avoid OTC preparations containing vitamin C which acidifies urine to reduce the risk of crystallization of urate “
b. Potassium citrate ( k citrate) May be used to alkalinize urine
Test 1 2020 WrittenL Patients with gout recurrent stone formers.:
 should be encouraged to drink >2 L of water daily and avoid dehydration.
 Alkalinization of the urine with potassium citrate (60 mEq/day) should be considered in
Which of the following statements about initiating allopurinol therapy is true?
allopurinol should be promptly started regardless of whether the patient is experiencing an acute attack or not.
 Allopurinol should be introduced with NSAID cover, 1-2 weeks after inflammation from the acute attack subsides.
 NSAIDs should be discontinued as soon as allopurinol therapy begins as they interact with each other.
 Allopurinol should used for one year then gradually tapered with introduction of NSAID therapy.
A.R. is a 47-year old male who presented to the clinic with swelling and inflammation in the joint of the large toe. On assessing
A.R.s case, this gouty attack seems to be his months. His plasma uric acid was 12mg% and the uric acid excreted in a 24-hour
urine sample was 800mg. Is Mr. A.R. a candidate for prophylactic therapy?
 Yes, the patient fulfils the criteria.
 No, patient does not fulfil the criteria.
 The data is not enough to determine enough to determine if the patient has fulfilld the criteria or not.
 Migraine
All the following are actions of the triptans except:
 Binding to 5HT 1D/1B receptors leading to vasoconstriction of dural and pial blood vessels (decrease vasodaliation & inflammation)
 Activating receptors in the brainstem to inhibit trigeminal neuron activation.
 Blocking presynaptic receptors to inhibit peptide release and inhibit peptide trigeminal neuron activation
 Activating presynaptic receptors to inhibit peptide release and inhibit peptide trigeminal neuron activation
Sumatriptan is: Which of the following drugs- class pair is correct for long term
 A serotonin receptor agonists prophylaxis of migration:
 A serotonin receptor antagonists  Propranolol- a1 receptor antagonist
 A dopamine receptor agonist  Pizotifen- serotonin receptor antagonist
 A dopamine receptor antagonists  Metoclopramide - serotonin receptor agonist
Sulfinpyrazone- xanthine oxidase inhibitor
Pizotifen acts by:
Drug Target site  Blocking dopamine and serotonin receptors
Sumatriptan  Blocking histamine and serotonin receptors
 Activating histamine and dopamine receptors.
 Activating dopamine serotonin and receptors
Which of the following drugs is an agonist at the 5HT 1D/1B Match each drug to it is mechanism of action. Some answer will
receptor? not be used at all: (5)
 Ergotamine Ergotamine Agonist at the 5HT 1D/1B receptor.
 Pizotifen Antihistamine and serotonin antagonist  Antagonist at the 5HT1D/1B receptor.
 Amitryptilline Antidepressants
 Sodium valproate
When is the best time for administration of sumatriotan? Complete the following statements using not more than 3 words
 At least two hours after the onset of migraine headaches in each space
 Daily in the morning to prevent migraine headaches. Caffeine is added to ergotamine tartarate because caffeine is a
 In the prodromal phase of migraine headaches crainal vasoconstrictor which allows the use of less of ergotamine
 In the post-dromal phase of migraine headaches to reduce it is side effects
Sumatriptan should be used: Caffeine MOA:
 As early as possible as migraine headaches develop.  Systemic vasodilation
 Several hours after the onset of acute migraine pain to relieve pain.  Systemic vasoconstrictor
 As a daily drug for long term prophylaxis of migraine therapy  Cranial vasoconstrictor
 After relief a migraine attack to prevent further attacks  Cranial vasodilation

Sumatriptan nasal spray is useful for all the following Caffeine is added to ergotamine preparations:
patients except:  To reduce doses of ergotamine needed
 patients in whom rapid effect is needed. (15 min)  To enhance the oral absorption of ergotamine
 patients suffering from Nausea and vomiting with migraine.  To enhance alertness during the migraine attack
 patients with particularly severe attacks (unpredictable)  To delay the renal excretion of ergotamine
 patients who are allergic to sumatriptan
Test 1 2020 Written : sever attack of migraine – nauseas and Maximum dose of ergotamine is:
vomiting ?  2 tablets daily
 Sumatriptan nasal spray  4 tablets daily in 24 hours
 8 tablets daily max 8 tablets per week.
 No restriction on use
The onset of action of intranasal Sumatriptan is: Maximum dose of ergotamine is:
 1-2 minutes  0.5mg OD
 15 minutes  1mg OD
 At least 30 minutes Parenterally  1.5 mg OD
 1-2 hours Oral  3mg OD
 Complete the following statements using not more than 3 Ergotamine and Sumatriptan are contraindication in:
words in each space(9):  Angina patients vasoconstriction
Sumatriptan has been formulated as a nasal spray and Scat  Sickle cell anemia patients
injection for patients with nausea and vomiting  Renal failure patients
 Patients with hepatotoxicity
All of the following drug/disease Which of the following is a side effects of ergotamine therapy?
 Paracetamol/ Asthma  Nausea and vomiting
 Methotrexate / Hepatic dysfunction  Hepatotoxicity
 Ergotamine /Angina pectoris  Hemolytic anemia
 Morphine/ BPH  Sexual dysfunction
 myocardial ischemia ((vasoconstriction
 Oxytocic (CI in pregnancy category X)
 gangrene and paraesthesias in hand and feet.
 can reverse with vasodilate
Metoclopramide can be administered to the patient if he also Which of the following is a side effects common to both
suffering from: Ergotamine and Sumatriptan:
 Dizziness  Myocardial ischemia
 Photophobia  Nausea and vomiting Ergotamine tartarate-
 Severe abdominal pain  Peripheral paraesthesias and gangrene Ergotamine tartarate-
 Nausea and vomiting antiementic  Nose and throat irritation Ergotamine
During an ongoing attack of migraine, pain can be relieved Which of the following is a medication used for long term
by the use of: prophylaxis of migration?
 Sumatriptan  Ergotamine
 Ergotamine Agonist at the 5HT 1D/1B receptor.  Propranolol
 Pizotifen Antihistamine and serotonin antagonist  Codeine
 Naproxen (NSAIDs)  ibuprofen
 All the following drug- side effects pairs are correct expect:
 Colchicine – Alopecia
 Phenylephrine- Tremors
 allopurinol- GIT adverse effects
 Sumatriptan- Nausea and vomiting only ergotamine cause nausea
Final 2019 Which of the following drug is prescribed
 Sumatriptan- D2 receptor antagonist 5-HT1D/1B receptor agonists
 Propranolol – Selective 𝐵1 antagonist prophylaxis non-selective beta receptor antagonist
 Pizotifen -5-HT1 receptor agonist Antihistamine and serotonin antagonist
 Amitryptiline -TCA . Antidepressants
 Antihistamine
 Allergic and Inflammatory Conditions
 Motion Sickness and Nausea
 Somnifacients
All of the following drugs are useful for motion sickness except Final 2018 All the following are indicated in the management of
 meclizine motion sickness except
 Cetrizine
 Cinnarizine
 Cyclizine
 Promethazine (also to control N and V following surgical anesthesia)
Which of the following antihistamines is used in managing Final 2018 Which of the following instruction regarding times of
nausea and vomiting in pregnancy? administration of medication:
 Cetirizine  Diclofenac – in the morning on an empty stomach
 Meclizine Navidoxine  Diphenhydramine- Before bedtime (Amydramine®) H1-blocker
 Promethazine motion sickness nausea and vomitingnot for pregnancy  Lansoprazole- At bedtime after dinner
 Chlorpheniramine  Calcium carbonate -Half an hour before Food
Which of the following instruction regarding times of
administration of medications is true:
a) Diclofenac- In the morning on an empty stomach
b) Chlorpheneramine - before bedtime
c) Calcium carbonate - half an hour before food
d) Lansoprazole - fifteen minutes after food
Written A pilot, having a trip at night, is to be prescribed an antihistamine
A pilot having trip after 6 hours , having a nasal congestantion for an allergic reaction. What of the following would you
recommend?:
 chlorpheneramine because it has a fast onset (H1 blocker)
 Diphenhydramine because it is long acting re
 Promethazine because it is non-sedating highly sedative before
surgery
 Fexofenadine because it is non-sedating Second generation less sedative
 Allergic rhinitis (hay fever)
Which of the following is a topical long-acting nasal Match each drug to it is mechanism of action. Some answer will
decongestant? not be used at all:
 Oxymetazoline (Nasivin / Afrin) (12hr) Xylometazoline Constricts blood vessels supplying the nasal
 Pseudoephedrine mucosa.
 Phenylephrine
 Xylometazoline
Which of the following is not pseudoephedrine side effect: A patient is suffering from a blocked nose. Which of the following
 anoroxia drugs can be administered?
 gastric irritation a) Guaifenesin expectorant
 anexiety b) Nabilone nausea and vomiting
 nausea c) Xylometazoline
‫سوال تاليف مو سابق‬ d) Dextromethorphan
Why has Pseudoephedrine Recently been replaced by phenylephrine in many OTC preparations?
 Pseudoephedrine can be used to form methamphetamine by addicts, so it was replaced by Phenylephrine
 Pseudoephedrine is found to be more expensive, so phenylephrine is now used to enhance profits of pharmaceuticals
companies.
 phenylephrine was found to be more potent than Pseudoephedrine at the same dose.
 phenylephrine has a faster onset of action than Pseudoephedrine, so it is better when quick relief is needed.
 Cough Dry ( antitussive)
A patient comes to the pharmacy suffering from a productive cough and a nose that is sometimes blocked and sometimes runny,
You suggests tablets with the following comination:
 Oxymetazoline + Dextromethorphan(dry) + chlorpheneramine
 Butamirate (dry)+ Guaifenesin +Pseudoephedrine
 Bromohexine + chlorpheneramine +Phenylephrine(decong)
Guaifenesin(expectorant) + Diphenhydramine (antihistamine) + Bromohexine
A patient is suffering from a sever productive cough due to a A patient presents with a productive cough due to an infection.
respiratory bacterial infection. Which of the following drugs is Which of the following should be prescribed for his cough?
best for his condition :  a) Xylometazoline nasal decongestant
 Oxymetazoline nasal decongestant  b) Dextromethorphan dry cough : antitussive
 Dextromethorphan dry cough : antitussive  c) Ambroxol
 Codeine dry cough : antitussive  d) Castor Oil
 Ambroxol
All of the following drug / disease Interactions are correct
except:
a) Paracetamol / Peptic ulcers
b) Ergotamine / Angina pectoris
c) Methotrexate / Hepatic dysfunction
d) Pseudoephedrine / Severe hypertension
Which of the following is an expectorant? advil Pm blue: ibuprofen and diphenhydramine Hcl
 Butamirate dry coughanti-tussive advil green allergy: Ibuprofen 200mg, chlorpheniramine
 Bromhexine wet coughMucolytic Medications: maleate 2mg, pseudoephedrine HCl
 Guaifenesin yellow : Ibuprofen chlorpheniramine maleate 4mg
 Pseudoephedrine nasal decongestant (antihistamine) Phenyhephrine (decongestant)
advil cold and sinus: ibuprofen and pseudoephedrine HCL
Guaifenesin acts by? which of the following is an antitussive?
 Stimulating the a1 receptors in mucous membranes causing a) Codeine
vasoconstriction b) Ambroxol
 Drawing water into the bronchial tract to thin mucous c) Nabilone
 Stimulating the serotonin receptors to cause vasoconstriction d) Ondansetron
 Inhibition of the H+/ K+ proton pump to reduce gastric acidity
Final 2018 Which of the following describes the mechanism of action of butamirate?
 Constricts bold vessels the nasal mucosa nasal congestion
 Decreases sensitivity of the cough centers in the brain to stimuli dry cough antitussive
 Decreases the cross linking of mucous its formative stages productive cough Mucolytic Medications:
 Draws water into the bronchi to make mucou-+*9/8s less viscous productive cough Expectorant Medications: Guaifenesin

Match each drug to it is mechanism of action. Some answer will not be used at all: (5)

Decreases sensitivity of the cough centers in the brain to stimuli.

Bromhexine Decreases the cross linking of mucous in it is formative stages.
Guaifenesin Draws water into bronchi to make mucous less viscous.
 Respiratory
Medications for asthma are preferably administered in the Which of the following statements in the inhaler is wrong?
inhaled dosage form because of all the following reasons  Shake the canister thoroughly and remove the cap.
except:  Seal the mouth around the inhaler mouthpiece.
 Faster onset of action  After pressing the canister, hold your breath and count to ten
 Lower effective dose then exhale.
 Less systemic side effects  If two puffs are prescribed, press the canister twice and inhale
 Enhanced systemic absorption. slowly and deeply.
All of the following Instructions should be given to a patient on proper inhaler technique except:
a) Exhale completely before administering your dose
b) Mouth should be sealed around mouthpiece before inhalation
c) Press the canister and inhale slowly and deeply at the same time
d) After drug administration hold your breath for 7 minutes then exhale
Technique. Write the missing steps in the given list below. (Maximum time 2 minute)(2 marks)
Step 1 Shake the canister thoroughly and remove the cap
Step 2 Exhale completely
Step 3 Seal mouth around the mouthpiece
Step 4 Press the canister once to deliver the medication while inhaling slowly and deeply
Step 5 Hold your breath and count to ten before
When using an inhaler form more than one breath, repeat procedure after 1-2 minutes

All the following are bronchodilator expect: Formoterol (B2 agonist LABA) Theophyllin Montelukast Flunisolide
Bronchodilator: SABA – LABA
Salbutamol is available in all the following dosage form expect MDI Nebulizer solution Syrup2mg/5mL Sublingual tablets
Which of the following is a reported side Which of the following is a side effect of All the following are ADRs associated
effect of salbutamol? inhaled salbutamol? with the uses of SABA and LABA expect:
Diarrhea a) Fine Tremors Tremors
Tachycardia b) Oropharyngeal thrush Tachycardia
Nausea and Vomiting c) Hemorrhage Glaucoma
Hepatotoxicity d) Hepatotoxicity sleep disturbances
The only drug that can rescue a patient from a domestic asthmatic Which of the following combination of drug/duration of action is true?
attack is:  Salbutamol / 5 hours SABA 3-5 hours
 Salbutamol 1-2 puff prn: as needed SABA 3-5 hours  Formoterol/ 30 minutes LABA 8-12 hours
 Salmeterol LABA 8-12 hours  Salmeterol/ 3hours
 Theophylline  Montelukast/ 5hours
 Omalizumab
On assessment of an asthmatic patient, it was found that he needs SABA 4 times weekly over the past 2 months. Which of the following
actions would you expect the doctor to take? If SABA is needed more often than twice weekly, prophylactic treatment should be considered
 Maintain the current therapy as his asthma is controlled.
 Discontinue using SABA as he seems to be allergic to the medication.
 Step down his therapy as his asthma is controlled for the required duration.
 Step up his therapy as his asthma in uncontrolled.
Bronchodilator: Antimuscarinic
Ipratropium is An antagonist on M3 receptors Ipratropium is
Less powerful than salbutamol as a bronchodilator
Xanthines
Theophylline has been largely replaced by adrenergic Ethylene diamine is added to aminophylline injections:
agonists because: Xanthines  To make aminophylline more soluble in solution
 It has a narrow therapeutic index.  To make aminophylline more stable in solution
 It cannot be taken orally.  To assist aminophylline action by activating B2 receptor
 It has poor systemic absorption.  To antagonize aminophylline ADRSs
 It is rapidly metabolized by the hepatic microsomal
enzymes Ethylene diamine is added to aminophylline injections because it:
 Makes aminophylline more stable in solution.
 Makes aminophylline more soluble in solution.
 Antagonizes aminophylline ADRs.
 Assists aminophylline action by activating B2 receptors.
Bronchodilator: leukotriene
Which of the following is an Montelukast is: Which of the following drug class pair is correct?
inhibitor of FLAP?  A cystinyl leukotriene  Formoterol – leukotriene receptor blocker B2 agonist LABA
5-lipoxagens activating protein receptor blocker  Ipratropium- M3 receptor agonist antagonist
 Zileuton  A selective B2 agonist  Zileuton- FLAP inhibitor
 Zafirlukast  A muscarinic antagonist
 Omalizumab- B2 blocker agonist
 Omalizuma  An inhibitor of the 5-
 Budesonide lipooxygenase activation
protein
Antiinflammation
corticosteroid
Final 2019 Corticosteroids act by all of the following mechanisms except?
All the following part of the MOA of glucocorticoids expect a) Up - regulation of B2 receptors
 Up-regulation of B2 receptors b) Inhibition of COX - 2 enzymes
 Decreased activation eosinophils c) Blocking muscarinic receptors
 Inhibiting COXII enzyme with decreased PG production d) Decreased expression of IgE receptors
 Increased expression of IgE receptors decrease
Systemic corticosteroids should be given as:
 “Lowest possible dose, shortest possible time”
 “Lowest possible dose, longest possible time”
 “Highest possible dose, shortest possible time”
“Highest possible dose, longest possible time”
Which of the following statements about corticosteroids An asthmatic patient is being managed by medium dose inhaled
therapy is true? corticosteroids and long-acting beta agonist. His doctor decides to
 Corticosteroids are direct bronchodilators. Not direct step down his therapy. His new regimen may be:
 Corticosteroids act mainly by blocking B2 receptors in the lungs  Long-acting beta agonist only
 Corticosteroids reduce the hyperresponsiveness of airways  Low dose corticosteroids only
to irritants.  Low dose corticosteroids and long-acting beta agonist
 Inhaled corticosteroids are associated with the High dose corticosteroids and long-acting beta agonist
development of glaucoma. Systemic
Which of the following a systemic corticosteroid? Fluticasone Budesonide Prednisolone Omalizumab
All the following are advantages of a spacer fitted on All the following are ADRs associated with the use of systemic
corticosteroids inhalers expect: corticosteroids except:
 Reduced onset of action of the drug with faster patient  Decreased growth in children
response.  Prolonged healing time
 Reduced oral candidiasis.  Edema and hypotension hypertension
 Reduced adrenal gland suppression.  Increased risk of infections
 Reduced need to coordinate between actuation and
inhalation for patients with poor inhaler technique.
An asthmatic patient presents to the pharmacy and shows U his mouth (figure X) . He is Which of the following is a
concerned since this only appeared 3 weeks. drug therapy for asthma side effect of using inhaled
corticosteroids?
 Fine tremors
 Insomnia
 GI disturbances
  Oral candidiasis.
a. What is the patient suffering from (1)? Oral Candidiasis
b. Which class of medication in his regimen has caused this
problem(1)? Inhaled Corticosteroids
c. State 1 instruction/ recommendation would U give your
patient to avoid this side effect(1). Use a spacer

Spacers increases deposition of the drug in the lung by:

 allowing more space for droplets to fall and decrease oral thrush.
 allowing more space for drops to fall and decrease their systemic absorption.
 allowing more time for the atomiser to release the droplets.
allowing time for the propellant to evaporate and heavy droplets become finer.
One advantage of using a spacer is:
 It allows patients to skip the routine inhaler technique,
 It reduces the doses a patient needs to inhaled drugs.
 It reduces the need to coordinate between actuation and inhalation.
It enhances the absorption of drugs into the systemic circulation
An asthmatic patient on corticosteroids therapy has gone on a camping trip and has forgotten his spacer.
What can he do to avoid oral thrush?
 Avoid his doses of corticosteroids till he can get access to the spacer.
 Use a topical antifungal agent to avoid candida infection.
 Rinse his mouth with water after using the inhaler.
Using half the prescribed dose to avoid deposition of large doses of corticosteroids in the oral cavity.
An asthmatic patient is currently prescribed salbutamol prn, low dose inhaled fluticasone and formoterol. On follow-up visit, the
patient was found to be compliant with his regimen, with no additional environmental or emotional triggers of asthma over the
past 5 month. He reported he had to use salbutamol at least 4-5 weekly for breakthrough asthmatic attacks during this time.
Which of the following courses of action would the Physician recommended?
 Discontinue all drug and keep salbutamol prn.
 Discontinue formoterol and maintain low dose inhaled fluticasone.
 Continue with low dose fluticasone and increase doses of formoterol. (LABA)
 Continue with formoterol and increase to medium dose inhaled fluticasone.
Omalizumab is: Which of the following is an anti - IgE antibody used in asthma? a)
 A COX-2 inhibitor Infliximab
 An Anti IgE antibody b) Omalizumab
 A mast cell stabilizer Cromolyn (Intal) c) Dextromethorphan
 A leukotriene receptor blocker d) Montelukast
status asthmaticus
All the following are part of management of status IV salbutamol is essentially applied in:
asthmaticus except:  Patient who requires more than 4 daily puffs of salbutamol
 Oxygen therapy  Patient with severe status asthmaticus
 IV salbutamol SABA Ventolin albuterol  Patient who are unable to tolerate inhaled steroids.
 IV aminophylline  Patient who cannot manage the inhaled route
 Inhaled Budesonide
All asthmatic patient who is not responding to inhaled rescue medications during an acute attack can be managed in the hospital
by which of the following agent:
 Salbutamol syrup
 Methylprednisolone - IV corticosteroids
 Oxymetazoline-IM
 Montelukast-SL tablet
An asthmatic patients is on low dose flunisolide + formoterol
Expect his new regimen to be?
 low dose flunisolide + formoterol – disontinue salbutamol
 Medium dose flunisolide + formoterol– disontinue salbutamol
 Medium dose flunisolide + formoterol + salbutamol prn
 High dose flunisolide + salbutamol prn – disontinue fo
An asthmatic patient is on low dose flunisolide + formoterol. On a follow - up visit to his step - up of therapy was recommended.
What do you expect his new regimen to be?
a) Low dose flunisolide only
b) Formoterol only
c) Medium dose flunisolide only
d) Medium dose flunisolide + formoterol
With regards to corticosteroids therapy in status asthmaticus. Which of the following statements is true?
 Patients should be given IV methylprednisolone every 12 hours till their asthmatic attack is controlled.
 Patients should be given IV methylprednisolone every 24 hours till their asthmatic attack is controlled.
 Patients who are controlled on IV methylprednisolone should be moved to oral prednisolone.
 Patient who are controlled on IV methylprednisolone could be moved to high dose inhaled ICS.
 PUD- GERD- Zollinger

Which of the following shows the regimen for H. Pylori triple H2 blockers should be administered:
therapy?  One hour before food
 Amoxycillin 1000mg BID + Clarithromycin 500mg BID + Omeprazole 20mg  Half an hour before food .30minutes
 Amoxycillin 1000mg BID + Cimetidine 40mg QID + Omeprazole 20mg
 With the first spoon of food
 Tetracycline 500mg BID + Metronidazole 250mg BID + Cimetidine 40mg QID
Omeprazole 20mg + Cimetidine 40mg BID + Tetracycline 500mg BID  15minutes after food
H2 receptor blockers should not be administered at the same time with antacids because:
 Antacids enhance the hepatic metabolism of H2 blockers.
 Antacids enhance the renal excretion of H2 blockers.
 Antacids alkalinize the stomach which reduces the absorption of H2 blockers.
Antacids bind to H2 blockers to form an inactive complex in GIT.
The triple therapy for managing H.pylori Infections is composed Which of the following regimen is proper for triple therapy for
of: H. Pylori?
Bismuth subsalicylate + Amoxycillin + Ranitidine .  Amoxicillin + Cimetidine + Metronidazole
Omeprazole + Amoxycillin + Metronidazole  Bismuth subsalicylate + Tetracycline+ Ranitidine
Clarithromycin + Amoxicillin + Omeprazole  Clarithromycin + Amoxicillin + lansoprazole
Tetracycline + Omeprazole + Ranitidine Clarithromycin +Tetracycline + Omeprazole
Triple therapy is preferred over quadruple therapy for all the The eradication rate of Pylori with the triple therapy is:
following reasons expect:  20% 60% 90% 95%
 Less expensive
 Less medications and Side effects
 Higher eradications rates
 Shorter duration of using the drug combination.
A hypertensive patient presents at the pharmacy complaining of heartburn and asks for a medication over the counter. Which of
the following would you prescribe? Low dose of H2 receptor blockers are available as OTC for heartburn. Ranitidine 75mg and 150 are the low doses
Omeprazole 40mg Sodium bicarbonate (antiacids) Ranitidine 75mg Misoprostol 200mg
All the following are problems associated with cimetidine therapy expect: A 70 year old patient on chronic NSAID therapy is
 Interfering with the metabolism of other drugs at high risk of PUD. Which of the following is the
 Causing anti-androgenic side effects best drug to reduce his risk?
 Causing hepatic problems as a side effect  Metronidazole
Lack of compliance due to short duration of action and multiple dosing  Misoprostol
 Calcium carbonate
 Cimetidine
+ +
Inhibitors of the H / K ATPase Proton Pump
Omeprazole (Omizac® Losec®) Esomeprazole (Nexium®) Lansoprazole (Lanzor®) Rabeprazole (Pariet®)
H+/ K+ Which of the following pharmacological class / drug name pair is
H+/ Na+ correct?
H2 receptor blocker /Chlorpheniramine
D2 receptor blockers / Ranitidine
H+/K+ ATPase pump inhibitor / Omeprazole
5 – HT3, receptor blockers / Ranitidine
Proton pump inhibitors need to be administered one hour before food because time is need for:
 Absorption from the intestine and activation in the liver
 Absorption from the stomach and activation in the liver
 Absorption from the intestine and activation in the parietal cell
 Absorption from the stomach and activation in the parietal cell
Which of the following is a side effect of omeprazole? Which of the following is a side effect of omeprazole?
 Throbbing headache Intermittent throbbing headache
 Increased risk of fractures Increased risk of hip fractures
 Gynecomastia Hemolytic anemia
increased colonization of H.Pylori in the stomach Endocrine disturbances due to antiandrogenic effects
Losec MUPS is useful in management of PUD in patients A patient is having trouble swallowing Omeprazole tablets. The
who: doctor prescribes him Losec MUPS. Which of the following
 Are non-compliant with their therapy. statements is true about Losec MUPS?
 Have concommitant renal problems. a) It is a dispersible tablet
 Have impaired renal function. b) It is a solution stable in gastric acid
 Have difficulties in swallowing tablets. It is a capsule with enteric coated granules
• It is an enema for rectal administration
Written For patients who cannot swallow:
• Losec MUPS tablets can disperse the tablets in 10 ml of non-carbonated water and then gently mix this in a small amount of
apple, orange or pineapple juice, or in apple sauce or yogurt.
• Milk or carbonated water should not be used.
• The dispersion should be taken immediately or within 30 minutes. The dispersion should be stirred just before drinking and
rinse it down with half a glass of water.

Which of the following is the most effective at inhibiting Which of the following drug is useful in Zollinger Ellison syndrome:
acid release?  Lansoprazole
 Lansoprazole  Misoprostol
 Misoprostol  Sodium alginate
 Calcium carbonate  Aluminum hydroxide + Magnesium hydroxide
 Ranitidine
Which of the following drug class- time of administration combination is correct?
 Rantidine - Antiacid – fifteen minutes after food
 Ondanserton- D2 receptor blocker- one hour after food
 Calcium carbonate H2 receptor blocker- half an hour before food
Lansorprazole- Proton pump inhibitor- One hour before food
 antacids
A patient with hypophosphatemia should avoid which of the Which of the following antacids should not be recommended for
following antacids? a hypertensive patient?
 Aluminum hydroxide  Aluminum hydroxide
 Magnesium Hydroxide  Magnesium Hydroxide
 Sodium bicarbonate  Sodium bicarbonate
 Calcium carbonate  Calcium carbonate
 Aluminum hydroxide usually is combined with:
 Sodium bicarbonate to enhance the antacid action.
 Sodium bicarbonate to balance others side effects
 Magnesium hydroxide to balance each other’s side effects
Magnesium Hydroxide to enhance the antiacid action.
Antiacids should administered : Diarrhea
15minutes after meals Constipation
Dose

Suggest a suitable medication to manage the following patients for their current complains, considering their medical
and drug history (Maximum time 14 minutes)

Medical/Drug history Current complaint Drug

therapy
A patient with a history of hypertension, angina and Needs an antacid of heartburn experienced after meals Al no
electrolyte disturbances, hyperkalemia and
hypophosphatemia Rennie

2. In the box given below complete the equation summarizing the mechanism of action of antacids.

State one result this may lead to (in the lines provided below).

Antacid + Gastric Acid= salt + water.

Resulting in: decrease peptic activity since pepsin is inactivate, stimulation of PG synthesis, help in reduction H.pylori
colonization
 Prostaglandins Misoprostol (Cytotec®)
Which of the following pharmacological classes could reduce gastric acid secretion?
Gastrin receptor agonist Histamine receptor agonists Prostaglandin receptor agonist muscarinic receptor agonists
Sucralfate acts by: Which of the following is a mucosal protective
 Creating a physical barrier against HCl to allow the ulcers to heal. agent?
 Neutralizing HCl after it is released to form salt and water. a) Ranitidine
 Reducing HCl release by gastric parietal cell through blockage if H2 receptors b) Sucralfate
 Blocking D2 receptors at the CRTZ to reduce stimulation of the vomiting center. c) Omeprazole
d) Calcium carbonate
 Activation All of the following are useful in GERD expect:
 Sucralfate reduce the absorption of the antiacids  Ranitidine
 antiacids reduce the absorption of the Sucralfate  Lansoprazole
 excretion  Sodium alginate
 Sucralfate

Which of the following is an action of bismuth? Sodium alginate acts by:

 Increased mucous secretion  Forming a floating raft on the stomach contents.
 Increased pepsin activity  Binding to and blocking H2 receptor.
 Decreased acid release  Increasing mucous and reducing acid.
 Neutralization of gastric acid  Binding to the ulcer crater to protect it from acid.

Sucralfate- bezoar Which of the following drug acts by forming a complex gel with the
stomach mucosa and necrotic tissue creating a physical barrier
against stomach acid?
 Sucralfate
 Calcium carbonate
 Sodium bicarbonate
 Sodium alginate
 antiemetic GIT
All of the following classes of drugs can relleve nausea and vomiting All of the following drugs could function as antiemetics except?
except: NK1 receptor agonist antagonist
 CB1 receptor agonist
 D2 receptor antagonists domperidone
 5 – HT3 receptor agonist antagonist blocker ondansetron
 NK1 receptor antagonists
Which of the following drug- therapeutic class combinations given Which of the following statements about antiemetic doses/route of
below is correct? administration is true
 Ondansetron-5- HT3 receptor blocker - ondasetron - IV injection _ immediately before chemotherapy
 Domperidone-H2 receptor blocker D2 receptor blockers
 Meclizine- NK1 receptor blocker histamine blocker
 Aprepitant- CB1 receptor blocker
Nabilone is: to which class of drugs does domperidone belong to?
 A COX Il Inhibitor  D2 receptor blockers
 A Dopamine receptor antagonist  H1 receptor blockers
 A Cannabinoid receptor agonist  B2 receptor agonists
 A Histamine receptor blocker  CB1 receptor agonists
 Which of the following drug therapeutic use combinations given below is
correct?
 - ondansetron - post operative emesis
All of the following are used to manage nausea and vomiting of All the following drugs are indicated in nausea and vomiting associated
cancer chemotherapy except: with cancer chemotherapy expect:
 Scopolamine  Cinnarizine
 Nabilone  Nabilone
 Aprepitant  Aprepitant
 Ondansetron  Ondansetron
Which of the following antiemetics is used in managing Which of the following antiemetics is used to relieve morning
nausea and vomiting in pregnancy? sickness of pregnancy?
 Meclizine Histamine H1 Receptor Antagonists  Nabilone
 Nabilone Cimetidine
 Cinnarizine  Meclizine
 Cimetidine  Cinnarizine

Meclizine is combined with Pyridoxine (Vitamin B6) to give

Navidoxine which is indicated for pregnancy induces N & V.
Metoclopramide: Dystonic reactions are a side effect associated with the use of which
 Is a H, receptor blocker of the following drugs?
 Cannot cross the blood brain barrier can cross BBB  - metoclopramide
 May cause extrapyramidal side effects with long term use
 Is used in management of pregnancy induced emesis
A patient is to be prescribed an antiemetic for 2 months due to chronic nausea. The physician approaches U for assistance in
choosing between domperidone and metoclopramide.
a. Which drug would U choose? domperidone
Complete the following statement to justify this choice:” Since therapy will last for 2 months, the drug selected is better because it
does not cross the bbb so it won’t lead to Central effect= sedation and dystonictea
Extrapyrimdial side effect
 Constipation
Which of the following can be used in the management of Stimulant laxatives act by:
chronic constipation? a) Swelling in the gut to provide bulk against which gut wall
a) Loperamide Antimotility Agents (Constipating Agents) contracts 2
b) Isphagula husk Bulk Laxatives: b) Direct irritation of the wall of the gut to stimulate peristalsis
c) Milk of Magnesia Saline Cathartics: c) Incorporating water into the stool structure to make it softer
d) Polyethylene glycol d) Forming a layer that lines the wall of the gut
Which of the following is a problem associated with the use Senna should not be used as a laxative for chronic constipation
of bulk laxatives? Prolonged used may lead to diarrhea and hypokalemia and cathartic
a) Cathartic colon colon
b) Increased risk of infections
c) Gl disturbances
d) Esophageal or intestinal obstruction

Type of laxative: Bulk Laxatives:

And the specific Side effect:
 Flatulence
Type of laxative: Irritant/Stimulant Laxatives:
 Abdominal distention
And the specific Side effect:
 Decreased absorption of other drugs Prolonged used may lead to diarrhea and hypokalemia, melanosis
coli and cathartic colon
 Intestinal or esophageal obstruction or impaction (dry bulk)

A patient with hemorrhoids is given a stool softener to Glycerin acts by:

minimize passing hard stools. Which of the following drugs is  Swellingg in the gut to provide bulk against which gut wall con
a stool softener? Bulk laxatives
 Glycerin  Direct irritation of the wall of the gut to stimulate peristalsis
 Castor oil Irritant/Stimulant Laxatives: senna irratant-stimulant
 C. Sterculia  Incorporating water into the stool structure to make it softer
 Bismuth subsalicylate  A and C
 B and C

Type of laxative: Saline Cathartics:

Side effect
 excessive fluid and electrolyte loss
 Interfere with the absorption of other drugs therefore 2-3 hr
drug spacing is needed
 Diarrhea
All of the following instruction are except Which of the following is a proper instruction on the use of ORS?
 Discard the solution 24 hours after rec contents of the sachet are to be emptied and dissolved in 1 glass of
 Keep the solution refrigerated water
 Dissolve the contents in 1 liter of water
 Boil the solution once before use
Glucose is included in the ORS ingredients to :
- enhance the absorption of sodium
promotes sodium absorption gives energy to the patient
Inflammatory Bowel Disease (IBD)
Which of the following drug-indcation pair is correct? A patient is prescribed sulfasalazine. Which of the following
 Dextromethorphan – Productive cough dry cough conditions is he suffering from?
 Sucralfate – Zollinger Ellison PPI inhibitors  Crohn's disease
 Sulfasalazine – Chrons disease  Rheumatoid arthritis
Methylphenidate – Bipolar disorder CNS stimulant A dopamine transport inhibitor  Productive cough
 Bipolar disorder
A hypertensive patient with hyperacidity and dyspepsia All the following patients are prescribed NSADs for underlying c
comes to the pharmacy. U may dispense all the following to  A 20 year old patient with Zollinger Ellison syndrome
him expect:  A 30 year old patient with nausea and vomiting
 Omeprazole 20mg tablet BID  A 40 year old patient with rheumatoid arthritis
 Ranitidine 75mg tablet BID  A 60 year old patient with an active peptic ulcer
 Al(OH)3 + Mg(OH)2 one teaspoon after meals prn
 NaHCO3 one teaspoon in a half a glass of water after meals prn
 This quiz involves material on Antiparkinsonian Drugs, Neuroleptics and Opioids

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Antiparkinsonian
2019Management of Parkinson’s disease involves the following Management of Parkinson’s disease involves the following
criteria: criteria:
 Blocking DA transmission in the mesocortical pathway  Blocking DA transmission in the mesocortical pathway
 Blocking Ach transmission in the neostriatum  Blocking Ach transmission in the neostriatum
 enhancing NE transmission in the basal ganglia  Blocking NE transmission in the basal ganglia
 enhancing 5-HT transmission in the nigrostriatal pathway  Blocking DA transmission in the nigrostriatal pathway
All of the following are advantages of formulating L-dope with Which of the following drug-class pair is correct?
carbidopa except  Carbidopa - MAO B inhibitor Dopa decarboxylase inhibitor
 To increase the availability of L-dopa to the CNS  Benserazide - Dopa decarboxylase inhibitor
 To reduce the doses of L-dopa in the formulation  Entacapone - MAO B inhibitor COMT inhibitor
 To enhance the systemic absorption of L-dopa  Selegiline - Anticholinergic agent MAO B inhibitor
 To reduce the systemic side effects of L-dopa 
Why is carbidopa formulated with L-dopa? Why is benserazide formulated with L-dopa?
• It increases availability of L-dopa to the CNS.
• It enhances the oral absorption of L-dopa.
• It increases the doses needed of L-dopa by 4-5 fold. Reduce
• It controls the on-off phenomenon associated with L-dopa therapy. Sustained Release )SR (preparation of levodopa or COMT inhibitors (Entacapone – Tolcapone)
Which of the following statements is true regarding administration Therapeutic efficacy of L-dopa declines after 3-5 years because
of L-dope: of:
 2 hours after food -avoid fried fate foods. • Lack of patient monitoring
 45 min before food -avoid protein rich food. • Patients discontinue the drug because of its side effects
 2 hours before food -avoid dairy products. • Tolerance to the effects of L-dopa
45 min after food - avoid fiber rich food. • Further degeneration of dopaminergic neurons
All of the following are side effects of L-dopa therapy except: L - dopa causes patients' urine to turn________due to melanin
 Hypotension from catecholamine oxidation
 Vomiting  Red
 Visual hallucination  Green
 Extrapyramidal side effects  Orange
  Brown

Which of the following ADR-reason pairs for L-dopa is true? Patients on L-dopa should be instructed that:
 Nausea and Vomiting - stimulation of S-HT3 receptors in the • L-dopa is sedating so they should take it before they sleep.
CRTZ • L-dopa may cause tachycardia and arrhythmias on sudden
 Brown urine - melanin pigment from CA oxidation discontinuation.
 Visual hallucinations - blockage of DA receptors in the basal • L-dopa may change the color of urine to brown.
ganglia • L-dopa may cause tardive dyskinesias on long term use.
Neuroleptic longterm use :Upregulation of D2 receptors in the extrapyramidal system
 Mydriasis – blockage of cholinergic innervation to the radial
muscles
Which of the following drugs Interact with L-dope? Which of the following interact with L-dopa therapy?
 Pramipexole D agonists  Risperidone antipsychotic drugs
 Amantadine antivirals  Vitamin B
 Entacapone COMT inhibitors  Cabergoline
 Haloperidol antipsychotic drugs  A and B
 B and C
A parkinsonian patient on L-dopa is suffering from on-off A parkinsonian patient on L-dopa is suffering from on-off
phenomenon. Which of the following drugs could be added to the phenomenon. Which of the following drugs could be added to
regimen to ameliorate the problem? the regimen to ameliorate the problem?
• Entacapone - COMT Inhibitors  Entacapone - COMT Inhibitors
• Benztropine -Anticholinergic agent  Prochlorperazine- H2 receptor blocker
• Naloxone- D2 receptor blocker  Benztropine- Anticholinergics
• Hydrocodone- S-HT2A receptor blocker  Benserazide – D2 receptor blocker
Bromocriptine acts by: On-off phenomenon associated with long term use of L-dopa
 Blacking dopaminergic transmission in the neostriatum can be managed
 Enhancing dopaminergic transmission in the basal ganglia  Carbidopa
 Enhancing cholinergic transmission in the substantia ganglia  Entacapone
 Blacking cholinergic transmission in the neostriatum  Pyridoxine ‫تعارض‬
 Benztropine
Antiviral drug found to have anti - Parkinson's properties: a)
Lidocaine b) Benztropine c) Amantadine d) Levodopa
From the given list choose 6 conditions, drugs and/ or foods that interact with L-dopa
• Fatty food
• Spicy food
• Diary food
• Protein rich food
• Patients on multivitamins containing vitamins B2, B6 , B12
• Patients on multivitamins containing vitamins A, B2 , D
• patient with sickle cell disease
• Patients with fungal infections
• Patients with renal dysfunction
• Patients with hepatotoxicity
• Patients on chlorpromazine therapy
• patient with positive schizophrenia
• Patients with angina pectoris
• Patients with arrhythmia
Suggest a suitable medication to manage the following patients for their current complains, considering their medical and drug
history
 Medical/Drug history Current complaint Drug therapy
Parkinson’s disease for Low efficacy of L-dopa therapy *Sustained Release )SR (preparation of levodopa
the past 8 years with appearance of “on-off” phenomenon or COMT inhibitors (Entacapone – Tolcapone)

MAO B inhibitor Selegiline and rasagiline therapy

Dopamine Agonists e.g. Pramipexole, Ropinirole, Apomorphine

NO. Drug Target site

1. Carbidopa They are dopa decarboxylase inhibitors that decrease metabolism of L-dopa in the GIT and peripheral
tissues thus:
Benserazide
N.B. Carbidopa/Benserazide do not cross the BBB therefore cannot inhibit dopa decarboxylase enzyme
in the CNS (effective metabolism of Dopa into Dopamine in the brain)

2. Selegiline MAO B Inhibitors: Inhibits DA degradation to increase actions of DA in the CNS.

• Block metabolism of dopamine in the brain.
Rasagiline
 Neuroleptics
Fluphenazine is a blocker of the following: Which of the following drug class pair is correct?
 D2 receptors  Aprepitant- NK1 receptor agonist
 H2 receptors  Chlorpromazine – D2 receptor blocker
 5-H𝑇2𝐴 receptors  Domperidone- CB1 receptor blocker
 Both a and b  Ondansetron- 5-HT3 receptor agonist
 Both a and c
Which of the following drug-mechanism of action is correct?
 Chlorpromazine- D2 receptor agonist antagonist
 Prochlorperazine- D2 and 5-HT2A receptor antagonist

 Olanzapine- 5-HT2A receptor agonist antagonist
 Risperidone- D2 and 5-HT2A receptor antagonist

A patient is suffering from negative symptoms of negative A patient is suffering from negative symptoms of schizophrenia.
schizophrenia. Which of the following is a better drug choice Which of the following is the best drug choice for his
for his management? management?
 Bromocriptine – 5H and receptor agonist  Bromocriptine- 5-HT2A receptor blocker
 Chlorpromazine – 5H and receptor blocker  Chlorpromazine- D2 receptor blocker
 Risperidone – 5H and receptor blocker  Risperidone- D2 and 5-HT2A receptor blocker
Haloperidol – 5-H and receptor agonist  Haloperidol- H2 receptor blocker
A patient is suffering from negative symptoms of schizophrenia. Which of the following would be more effective in the
Which of the following is the best drug choice for his management of negative psychosis?
management?  Chlorpromazine
• Risperidone- D2 and 5-HT2A receptor blocker ‫السيد فاطمة‬  Haloperidol
• Bromocriptine- 5-HT2A receptor blocker  Trifluperazine
• Haloperidol- H2 receptor blocker  Olanzapine 2nd Generation Atypical
• Chlorpromazine- D2 receptor blocker

Extrapyramidal symptoms occur due to: To reduce extrapyramidal side effects of first generation
 Blockage of D2 receptors in the nigrostriatal pathway neuroleptics the following drug may be added to therapy:
 Blockage of D2 receptors in the mesolimbic pathway  Carbidopa dopa decarboxylase inhibitors
 Blockage of 5-HT2A receptors in the nigrostriatal pathway  Bromocriptine DA agonist
Blockage of 5-HT2A receptors in the mesolimbic pathway  Selegiline MAO B inhibitor
 benztropine. Antichlonergic used for parkinsonian

Management of negative schizophrenia involves the following Extrapyramidal symptoms occur due to:
criteria: • Blockage of D2 receptors in the nigrostriatal pathway
• Enhancing ACh transmission in mesolimbic system • Blockage of D2 receptors in the mesolimbic pathway
• Enhancing DA transmission in mesocortical system • Blockage of 5-HT2A receptors in the nigrostriatal pathway
• Enhancing 5-HT transmission in nigrostriatal system • Blockage of 5-HT2A receptors in the mesolimbic pathway
Enhancing NE transmission in basal ganglia
Tardive dyskinesias are associated with: Tardive dyskinesias associated with neuroleptic therapy are
• Dopamine receptor up-regulation caused by:
• Dopamine receptor down-regulation  Blockage of D2 receptor in the mesolimbic system
• Serotonin receptor up-regulation  Blockage of D2 receptors in the extrapyramidal system
• Serotonin receptor down-regulation  Upregulation of D2 receptors in the mesocortical pathway
 Upregulation of D2 receptors in the extrapyramidal system
All of the following statements regarding neuroleptics are true except:
 Almost all patients on typical neuroleptics will experience extrapyramidal side effects.
 We can relieve extrapyramidal side effects using Benztropine anticholinergic
  Atypical neuroleptics have a stronger affinity to D2 receptors than typical agents.
 All antiepileptics can lower seizure threshold.
Involuntary motor movements such as tongue protrusion, occurring on long term therapy with chlorpromazine are called:
 The "on-off phenomenon" Due to L-dopa’s short half life
Extrapyramidal side effects pseudoparkinsonism
 Tardive Dyskinesias
 Anticholinergic side effects

A patient has been diagnosed positive schizophrenia and is prescribed Haloperidol. He is expected to experience short term and long
term a .
THREE correct statements from this list about his side effects- CHOOSING MORE THAN THREE BE PENALIZED. (3).

• On off phenomenon happens due to 5-HT receptor upregulation

• On off phenomenon occurs on the short term with haloperidol therapy Due to L-dopa’s short half life
• On off phenomenon can be managed by risperidone (managed by SR preparations or COMT inhibitors!)

 Extrapyramidal side effects happen as the Dopaminergic neurons degenerate in the course of the disease.
 Extrapyramidal side effects happen due to blockage of DA receptors in the CRTZ.
 Extrapyramidal adverse effects appear after several months of use of haloperidol. Tardive dyskinesias
 Extrapyramidal side effects may be managed by benztropine. Anticholinergic

• Tardive dyskinesias happen due to DA receptor upregulation.

• Tardive dyskinesias are associated with muscle abnormal involuntary muscle movement like lip smacking and tongue protrusion.
Suggest a suitable medication to manage the following patients for their current complains, considering their medical and drug
history

Medical/Drug history Current complaint Drug therapy

Positive psychosis using chlorpromazine for the past 5 weeks Dystonic muscle reactions benztropine.
 Opioid ((Narcotic Analgesics & Antagonists))
All of these are part of the mechanism of action of morphine except:
 Decreased calcium influx in the presynaptic neuron with reduce of P substance
 Decreased calcium Influx in presynaptic neuron with decreased glutamate release
 Increased potassium efflux in postsynaptic neuron bath cell hyperpolarization
 Inhibiting GABA release in the dorsal horn with decreased release of NE and 5-HT increase

Final 2019 written

In Act by
“In Presynaptic Morphine act by
“In Postsynaptic Morphine act by
Choose FOUR statement that describe the correct mechanisms by which morphine brings about analgesic effects. Choosing more
than 4 will be penalized (4)
 activating the opioid receptors with increased ca ++ influx decrease ca++ influx
 decreased released of substance P
 increased glutamate release decrease glutamate release
 activating the opioid receptors with increased K+ efflux
 activating the opioid receptors with decrease K+ efflux

 inhibiting GABA release descending pathway

 increased released of serotonin from the pain inhibiting neuron
 decreased release of norepinephrine from pain inhibiting neuron increased release of norepinephrine from pain inhibiting neuron
11. Euphoria of opioids occurs due to:
 Decreased release of GABA and therefore a Increased release of Dopamine
 Decreased release of GABA and therefore a decreased release of Dopamine
 Increased release of GABA and therefore a Increased release of Dopamine
 Increased release of GABA and therefore a decreased release of Dopamine
constipation SE/ morphine Morphine causes respiratory depression by? depression of
morphine cause? Constipation respiratory center in brain
‫الهالل بتولة‬
All of these patients should be prescribed opioids with caution The major cause of death in opioid overdose is:
expect:  Respiratory depression
 Asthmatic patients respiratory depression  Cerebral ischemia
 Patients with BPH urinary retention  Metabolic acidosis
 Patients with previous head injuries  Renal failure
 Patients with sickle cell disease
Which of the following is an action of morphine? All the following are actions of morphine EXCEPT :
 increased cough reflex decreased • Antitussive
 increased bowel motility • Diarrhea
 Pupillary dilation miosis • Pupillary constriction
 Increased feelings of nausea and vomiting • Emesis
The duration of action of morphine for naive individuals is
Statement Reason usually:
Morphine is not prolongs labor by decreasing strength,  1-2 hours per dose for a total duration of 4 weeks
used as an analgesic duration, and frequency of uterine  4-6 hours per dose for a total duration of 8 weeks
in labor (2) contractions  8-12 hours per dose for a total duration of 12 weeks
12- 18 hours per dose for a total duration of 20 weeks
In the table given below, state the reason
 16. Which of the following is preferred in the controlled withdrawal of addicts from opioid addiction?
 Morphine - milder but longer duration of withdrawal symptoms
 Fentanyl - milder and shorter duration of withdrawal symptoms
 Buprenorphine - milder and shorter duration of withdrawal symptoms
 Naloxone - more severe but shorter duration of withdrawal symptoms
Final 2019 In the contolled withdrawal of addicts from heroin addiction. Which of the following statements is true?
 Buprenorphine has longer and milder withdrawal symptoms
 Buprenorphine has shorter and milder severe withdrawal symptoms
 Methadone has shorter and milder withdrawal symptoms compairing with methadone
 Methadone has longer and more severe withdrawal symptoms

Which of the following medications is applied in the controlled Which of the following drugs is the best in the controlled
withdrawal of addicts from heroin addiction? withdrawal of addicts from heroin addiction in terms of severity
 Morphine of side effects and duration of withdrawal symptoms?
 Methadone  Methadone
 Codeine  Buprenorphine
 Naloxone  Codeine antitussive reoplced by dextromethorphan
 Naloxone
Which of the following has replaced codeine as an antitussive Which of the following drug-indication is correct:
with less addictive potential?  Tramadol- antitussive for drug cough
 Tramadol  Meperidine – analgesic in labor
 Dextromethorphan  Fentanyl – controlled withdrawal of addicts from heroin
 Fentanyl dependence
 Methadone  Codeine- anesthetic in short surgeries
Which of the following is a mixed agonist antagonists’ opioid?
 Naloxone
 Methadone
 Meperidine
 Pentazosine
A patient with an overdose of heroin is comatsed. Which of the Respiratory depression effect of Morphine is antagonized by:
following drugs can reverse this?  Diazepam epilepsy
Flumazenil A GABA receptor antagonist  Chlorpromazine
 Naloxone  Paroxetine
 Buprenorphine  Naloxone
 Pentazosine mixed agonist antagonists’ opioid

Patient Medical/Drug history Current complaint Drug therapy

Patient A Drug addict with a history of recurrent use of Comatosed - with respiratory depression and
heroin and phenobarbital pupillary constriction
 Anxiolytic and Hypnotic Drugs
Quiz Short acting Benzodiazepines like Oxazepam have the advantage of:
 Lower hangover effect when used in insomnia.
 Tolerance occurring only over extended periods of consumption. Within days
 Being effective in managing all types of sleep disturbances
 Less severe withdrawal symptoms on discontinuation of the drug

Flumazenil is: Benzodiazepines have replaced barbiturates because of all the

 A GABA receptor antagonist following reasons expect:
 A glutamate receptor agonist  Lower potential for addiction
 A serotonin receptor antagonist  Less drug interactions
 A M receptor antagonist  Faster rates of absorption
 Lower chances of death with overdoses
Benzodiazepines have replaced barbiturates as sedative Which of the following is a therapeutic effect of Benzodiazepines?
hypnotics  Antiemetic effect
 Lower potential for tolerance and addiction  Antipsychotic effect
 Less severe withdrawal symptoms on drug  Muscle relaxation
discontinuation  CNS stimulation
 Less Drug Interactions: Do not induce drug metabolizing
enzymes Overdose is seldom lethal
Diazepam acts by: long acting benzodiazepine
 Blocking the NMDA glutamate receptors
 Blocking the Na+/K+ ATPase proton pump on the gastric parietal cells
 Enhancing binding of GABA to its receptor with increased opening chloride of channels
 Blocking Na channels with decreased influx necessary for generating an action potential

diazepam act by long acting benzodiazepine

 Inhibiting the dopa decarboxylase enzyme bensersizde + carbidopa
 Inhibiting reuptake of Norepinephrine and dopamine from the synaptic cleft antidepressant Noradrenaline Reuptake Inhibitors Bupropion
 Enhancing binding of GABA to its receptor with increased opening of CL- channels
 Decreasing calcium influx with decreased glutamate release from presynaptic neuron
Final 2019 written Diazepam acts by

CNS stimulant
All the following are CNS stimulants except: A patient is prescribed Methylphenidate. What condition is he suffering from?
 Amphetamine  Narcolepsy
 Cocaine  Petit mal seizures
 Buspirone  Peptic ulcer disease
 Tetrahydrocannabinol  Atypical schizophrenia

Methylphenidate is: Which of the following is an effect of administration of low dose nicotine?
 A dopamine transport inhibitor  Respiratory paralysis CNS high dose
 Generally applied as an anesthetic  Increased motor activity of the bowel
 A CNS depressant drug  Decreased blood pressure high dose
 Used in the management of bipolar disorder  Severe hypotension
 Antidepressant
Escitalopram is: TCAs act by blocking the following:
 AD, receptor blocker  MT1 receptors
 A GABA receptor agonist  MAO-A and MAO-B enzymes
 C. ACB, receptor agonist  Serotonin and NE re-uptake pumps
 A selective serotonin reuptake inhibitor due to melanin from  5-HT1A somatodendritic receptor
catecholamine oxidation
Anti - depressants actions generally appear after 2-12 weeks of treatment because:
 Time is needed to inhibit release of serotonin from nerve endings
 Time is needed for desensitization of the 5 – HTA1 somatodendritic receptors
 Time is needed for blockage of the serotonin reuptake pumps at the nerve endings
 Time is needed for the serotonin synthesis in the synaptic vesicles

Statement Reason
It takes 2-12 weeks to observe the therapeutic antidepressant effects of SSRIs (3) 2- long term adaptive changes
A patient is prescribed lithium. Which of the following Which of the following is a major side effect of Paroxetine:
conditions is he suffering from?  Sexual dysfunction SSRI
 Parkinson's disease  Weight loss weight gain
 Schizophrenia  Tardive dyskinesia
 Bipolar disorder  Megaloblastic anemia
 Absence seizures
Serotonin syndrome occurs by concomitant use of: Mirtazepine:
 MAOIs and SSRIs  Is a blocker of the MAO enzyme
 MAOIs and Opioids  Is a serotonin - norepinephrine reuptake inhibitor
 SNRIs and COX III inhibitors  is used in the management of bipolar disorder
 SSRIs and Typical Neuroleptics  Has an advantage of causing less agitation and impotence
than SSRIs
Mirtazepine is a modulator of several receptors . Which of the Mirtazepine has the following advantages over fluoxetine
following recept: expect:
 Blocking 5-HT3 receptors- Antidepressant effect 1  Faster onset of antidepressant action
 Blocking 5-HT2c receptors - Improved sleep  Less insomnia and violent behavior
 Blocking 5-HT1𝑎 - Reduced GIT irritation 3  Less sexual impotence
 Blocking 𝐻1 receptor- Reduced sexual dysfunction  Reduced GIT adverse effects

Which of the following drug interaction is correct?
 Mirtazepine AND cheese leads to Tyramine Reaction MAO inhibitors : Phenelzine –Tranylcypromin - Moclobemide
 Imipramine AND wine leads to cheese reaction TCAs
 Tranylcypromine AND amitriptyline leads to serotonin syndrome TCAs
 Phenelzine AND Fluoxetine leads to Serotonin syndrome MAOI + SSRIs
 Epilepsy
Anti - epileptic drugs may act by all of the following mechanisms except:
 Activating GABA receptors with enhanced chloride entry
 Blocking Na+ channels with decreased Influx necessary for generating an action potential
 Inhibition of Ca+ channels or the NMDA receptor
 Blockage of the MAO enzyme with decreased breakdown of NE and DA
 All of the following Drug-ADR combination are correct expect:
 Fluoxetine – Sexual dysfunction SRRI
 Imipramine- Dry mouth TCAs
 Carbamaepine – hypernatremia hypo to blockage of NA
 Valproic acid – alopecia
Which of the following drug-indcation pair is correct?
Which of the following drug-Mechanism of Action pair is correct  Carbamazepine – Insomnia Epilepsy and bipolar
 Felbamate- Blocking AMPA glutamate receptor  Ethosuximide-Generalized ton cloni seizures absence seizures
 Phenytoin-blocking L-type Calcium channels  Lorazepam – Severe pain from ischemic crisis
 Levetiracetam-blocking NMDA glutamate receptor  Fluvoxamine – Obessive compulsive disorder
Ethosuximide- blocking T-type Calcium channels
• Which of the following antiepileptic drugs is useful in petit mal seizures Absence Seizures
 Phenytoin and Carbamazepine (Tegretol®) Not useful in absence seizures!!
 Valproic acid and Ethosuximide (Zarontin®) and clozepain
 Diazepam
 Chlorpromazine
All the following drugs are contraindicated in pregnancy expect:
 Methotrexate: DMARDS: Use birth control while taking MTX and at least 6 months after stopping it.
 Colchicine gout: Colchicine is contraindicated in pregnancy
 Valproic acid
 Phenytoin epilepsy: teratogenic : “FETAL HYDANTOIN SYNDROME” doctor will descrope lowest possible dose
Answer the following questions:
1. An epileptic woman on phenytoin therapy is now married and has become pregnant.
a. What recommendations would you make to her therapeutic regimen? Lowest possible dose of phenytoin in order to control her seizure
What would happen (mention the syndrome) if she continues to use her regimen of phenytoin? Fetal hydantoin syndrome
Which of the following drug interaction
 Warfarin and Aspirin – warfarin inhibits the renal excretion of aspirin Aspirin decreases renal clearance and PPB of MTX leading to MTX toxicity
 NSAIDs and MTX- NSAIDs displace MTX from plasma protein binding sites aspirin effects Warfarin Phenytoin Valproic aciddue to displacement from PPB sites
 Phenytoin and Carbamazepine – Carbamazepine enhances the hepatic metabolism of oral Phenytoin
 Oral contraceptives and Phenytoins – Phenytoin decrease the hepatic metabolism of oral contraceptives increase
Which of the following is an indication of pregabalin? Lyrica
 Obsessive compulsive disorder
 Bipolar disorder lithium Carbamazepine
 Grand mal seizures tonic clonic
 Neuropathic pain
In the management of status epilepticus, which of the following sequences is:
 Start with IV carbamazepine if uncontrolled initiates IV lorazepam
 Start with IV diazepam if uncontrolled initiates IV phenytoin
 Start with IV lorazepam if uncontrolled initiates IV diazepam
 Start with IV phenytoin if uncontrolled initiates IV phenobarbital
Anesthetic
Which of the following medications is an IV anesthetic? An inhalational anesthetic with a low blood: gas coefficient is
 Enflurane expected to have:
 Cocaine  Fast induction and fast recovery from anesthesia
 Propofol  Fast induction and slow recovery from anesthesia
 Nitrous oxide  Slow induction and slow recovery from anesthesia
 Slow induction and fast recovery from anesthesia
Fentanyl is used for:
 Parkinson's disease Drug Target site
 Reactive depression
Aprepitant
 Grand mal seizures
 Anesthesia
. Which of the following regarding anesthetics is true?
 Anesthetics generally act by enhancing NMDA glutamate activity
 Anesthetics generally suppress respiration and cause hypotension
 Recovering from anesthesia occurs when the liver metabolizes the anesthetic agent
 It is recommended to intiate anesthetia with inhalational anesthetics and maintain anesthetia with IV anesthetics
Use the following table to answer this question
Inhalation anesthetic Boold:gas partition coefficient Oil:gas partition coefficient
Halothane 2.3 5
Nitrous oxide 0.4 2

Which of the following statements is true?

 Nitrous oxide is expected to remain in the adpoise tissue longer than halothane
 Nitrous oxide is expected to have a higher potency than halothane
 Halothane is expected to have faster induction than nitrous oxide
 Nitrous oxide is expected to have faster recovery than Halothane
 Final
 Hello Rawan.. these are the instructions for tomorrow's exam

you will need to do an environment check - where you show your working area –
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This is your PHAM 310 Pharmacology II

The exam consists of 47 MCQs - one mark each,
followed by 6 written questions of fill in multiple blanks (23 blanks - 28 marks) fill in multiple blanks (26 blanks).
 You are expected to spend around 1 hour for the MCQ part and one hour for the Written part
 The time allocated for this exam is 120 minutes (2 hours) Total marks - 75 marks

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ANY SUSPICIOUS BEHAVIOUR ON THE EXAM RECORDINGS OR FAILING TO COMPLY WITH THE EXAM RULES WILL LEAD TO
DISQUALIFICATION FROM THE EXAM AND SENDING THE RECORDINGS TO THE STUDENT VIOLATIONS AND MISCONDUCT
COMMITTEE FOR INVESTIGATION.
CHEATING STUDENTS WILL BE AWARDED AN GRADE OF "F" ON THE SUBJECT FOR CHEATING DURING THE FINAL EXAMS
GOOD LUCK!
June 8 2021
 Neuropathic pain except?
Small increase phenytoin ?

NO Drug Target site

1. Anakinra IL-1 Receptor antagonist (Anti-IL-1)
2. Allopurinol analog of hypoxanthine
3. Colchicine Binds to tubulin to reduce migration of granulocytes to the site of inflammation.
4. Sulfinpyrazone
5. Sumatriptan A serotonin receptor agonists
6. Ergotamine agonist at the 5HT 1D/1B receptor
7. Pizotifen Blocking histamine and serotonin receptors
8. Guaifenesin
9. Sulfinpyrazole
10. Carbidopa dopa decarboxylase enzyme blocker
11. Selegiline MAO B Inhibitors: Inhibits DA degradation to increase actions of DA in the CNS.
Block metabolism of dopamine in the brain
12. Aprepitant

Match the following: Write the letter that matches the description in the answer column of the table shown below.

 Indomethacin
 Montelukast

No Description Answer
1. A selective COX II inhibitor Etoricoxib Celecoxib Rofecoxib
2. A uricosuric drug gout Probenecid Sulfinpyrazone Benzbromarone
3. An antitussive dry cough Butamirate Codeine Dextromethorphan
4. An adrenergic agonist used as a rescue agent in asthmatic attacks Salbutamol
5. A drug used in the management of pregnancy induced emesis Meclizine
6. An anti-emetic used for the management of chemotherapy induced vomiting Ondansetron Nabilone Aprepitant
7. A mucosal protective agent Sucralfate Bismuth chelate Sodium Alginate
8. An antidiarrheal Loperamide
Suggest a suitable medication to manage the following patients for their current complains, considering their medical and drug
history (Maximum time 14 minutes)
Current complaint Drug therapy
Patient A PUD Osteoarthritis 1.

2.
Patient b Parkinsons disease for the past years Low efficacy of L-dopa therapy with
appropriate
The “on-off” phenomenon
Patient c Positive psychosis using Dystonic muscle reactions
chlorpromazine for the past 5 weeks
Patient D Drug addict with a history of Comatosed- with respiratory depression and
recurrent use of heroin and pupillary constriction
phenobarbital
Patient E A patient with a history of Need an antiacid for heart burn experience
hypertension angina and electrolyte after meals
disturbances, hyperkalemia and
hypophosphatemia
Patient F A patient on MTX therapy for RA Latest blood test reveals for RBCs and WBS
count

For each of the following medications, fill the table to show their drug interactions and contraindications:

. Interacting drug/food/disease Reason for the interaction

Aspirin Children with viral infections Reye’s syndrome with fatal fulminating hepatitis. Cerebral edema
Levodopa Pyridoxine Increased peripheral breakdown of levodopa
MOAI Tyramine containing food cheese, wine, processed meal Tyramine reaction

The table below gives various problems encountered with drug therapy. Mention the way in which these problems are
overcome, You may need to mention additives or ingredients added to the formulation OR utilizing devices OR
formulation into a particular dosage form to overcome the given problem. Write your answer in the column provided:

Medication Problem Management of the problem

Ergotamine High doses is associated with side effects Add 100mg of caffeine to reduce the SE encountered
with ergotamine
Sumatriptan Some patients have unpredictable attacks of Use nasal spray of the medication
migraine complicated with nausea and vomiting
Corticosteroids Inhaled corticosteroids deposition in the oral cavity Use spacer
causes oral thrush
Levo-dopa Peripheral metabolism leads to many side effects and Add dopa decarboxylase inhibitor
the need to increase doses in each tablet Example carbidopa or benserazide

Fill in the following drug labels to indicate the proper use of each of these medications:

 Aspirin 325 mg 2 tablets to be taken after food tablet

 Zantac 50 mg tablet 1 tablet to be taken before food
 In the table given below, state one reason for each of the following statements

Statement Reason
Aspirin should not be administered to children Reye's syndrome, with: fatal fulminant hepatitis and cerebral infection edem
under 12 years old with viral infection
Caffeine is added to ergotamine tablets Will this will reduce the SE of ergotamine,and enhance the carinal VC of the drug
reduce the dose of ergotamine,
Xylometazoline should not be used for more than Rhinitis medicamentosa – Rebound nasal congestion
5-7 days
Spacers are fitted to corticosteroid therapy removes the need for co-ordination between actuation of a pressurized
metered dose inhaler and inhalation for patients with poor inhaler technique
(e.g. children) to eliminate the SE of candidiasis
SE The triple therapy is better than the quadruple  Lower n.o. of medications and tablets
therapy in the management of H.Pylori  Shorter period
 Higher eradication rate 95% Lower incidence SE

Moxal is formulated as a combination of Al(OH)3 To counter out the SE of both drugs, Aluminum hydroxide causing constipation
and Mg(OH)2 and magnesium hydroxide causing diarrhea > normalize bowel movement

Glucose is included in the ORS formula promotes sodium absorption gives energy to the patient