Hebron University

Faculty of Pharmacy and Medical Sciences

Pharmacology III (84443) Final Exam (40%) 29.12. 2020 9:00-10:25 AM on line
Student Name & ID #: Dr. Muamar Shaheen, lect.

I. Encircle the only one correct answer in the following MCQs: 1 point each unless
otherwise listed beside the question:

1. Patients who are using antipsychotics might suffer of these side effects that might be
resolved upon discontinuation of the drug, EXCEPT: a. High lipids and blood sugar
b. Dry mouth, urinary retention, constipation
c. Weight gain
d. Tardive dyskinesea
e. Blood dyscrasis

2. Bipolar depression and other schiztoaffective symptoms which has psychotic

component in addition to other manic states or temporary induced psychosis could get
benefit from the wide range calming effect of antipsychotics. Match the following
agents with their therapeutic use:
a. Quetiapine: bipolar depression
b. Lurasidone: illicit drug induced psychosis
c. Paliperdione: depression associated with mania
d. Aripiprazole: refractory depression
e. All match
f. All match except C
3. In addition to their use as antipsychotics, they find a wide range of use in the clinical
practice, neuroleptics could be used for:
a. Chemotherapy-induced nausea and vomiting
b. Sleep aid
c. Intractable hiccups
d. Motor and phonic tics
e. Disruptive behaviour of autism
f. Appetite stimulation
g. All are correct
h. All are correct except B

4. A 16-year-old, 35-kg, female, high school student had her first “convulsion” ever when
at school. She was behaving strangely before the seizure, said one teacher. She got up
suddenly from her desk and began to walk quickly to the door. She hit several desks in
her way and did not respond to the teacher’s attempts to redirect her back to her seat.
One minute after, she fell to the floor and experienced an overall body shaking and
seizures that lasted approximately 90 seconds. During the episode, she was incontinent
of urine and was described as “turning kind of blue.” An EEG showed diffuse slowing
with focal epileptiform discharges in the left temporal area. She had a similar second
seizure in the hospital where she was diagnosed with epilepsy. The drug of choice for
her case that can be used as monotherapy without affecting her intellectual capabilities
and academic achievement is/are:
a. Felbamate
b. Carbamazepine
c. Levetiracetam
d. Ethosuximide
e. Gabapentine
f. Triacetam

5. MDMA get control over the synaptic neuron and illicit its activity of capturing the whole
synapse so the patient will become so addicted that most efforts to free the synapse
from and to return to normal function will end with failure because of EXCEPT,
a. It replaces serotonin at the postsynaptic receptor
b. It stimulates the release of serotonin
c. It prevents the negative feed-back inhibition
 d. It becomes integral part of the synapse
e. Inhibits synthesis of serotonin so the cell loses control on its own pathway

6. Bath salts are illicit drugs that were not so famous until they have been extracted and
synthesized, they:
a. They inhibit the reuptake of serotonin and increase its synthesis
b. Similar in their actions to cocaine
c. Cathinone is the psychoactive ingredient in these products
d. Their intoxication is treated by IV BNZs and propranolol
e. All are correct
f. All are correct except A

7. A newly introduced agent that is non-stimulant and can be used for ADHD that is a non-
habit forming and might be useful according to it`s mechanism of action to treat the
hyperkinetic (motor activity) component of the ADHD in children less than 12 years of
age and adults is:

a. Lisdexamphatamine
b. Canabindiol
c. Modafinil
d. Atomoxetine
e. Guanfacine

8. Respiratory suppression and sudden coma then death could happen while using opioids
in these cases:
a. Using normal starter dose of an opioid in an opioid-naïve patient
b. Tittering up dose of opioids quickly in any patient
c. Using morphine milligram equivalent(MME) tables to change from one opioid to
another-at the same patient- while starting the new opioid on the full dose
d. Missing 2 doses of methadone in patient who is on narcotic withdrawal program
while staring the 3rd dose on full
e. Changing from an opioid to another with incomplete cross-tolerance between the 2
opioids
f. All are correct
 g. All are correct except B

9. Methadone is a very unique opioid that can be used for pain management as well for
withdrawal symptom management in narcotic abusers (addicts). However special
training and knowledge should be done before dealing with it, in a sense if the clinicians
are not fully aware of methadone use, these events might happen EXCEPT:

a. The drug is accumulated in the body and might lead to overdose

b. Start the patient on full MME dose of methadone to quit narcotics
c. The drug doesn`t have complete cross tolerance with original drug of abuse which
might lead to respiratory suppression and death if started on full dose
d. Missing ≥ 2 doses of methadone lead to supersensitivity state of opioid receptors
which lead to death when reissuing methadone at the same dose before missing
e. The drug has a long half-life and protracted withdrawal profile which takes long time
for waning the patient off methadone itself thereafter.

10. A 78- year old woman who is living independent in her house has difficulty sleeping,
start being worried about cleaning the dishes every night and had a low back pain from
an old accident seeking one medication to deal with her symptoms. The drug class of
choice from which you might chose an agent that can be self-tittered is:
a. TCA
b. SSRI ‫مش معنا‬
c. SNRI
d. MAO-I

11. Serotonin syndrome could happen in the following cases:

a. Overdose of SSRI, SNRI, or TCAs
b. Combination of tramadol and paroxetine
c. Starting a new antidepressant one week after stopping fluoxetine
d. Starting MAO-Is 5 weeks after stopping fluoxetine
e. Starting any antidepressant within 2 weeks of stopping MAO-Is
f. All of the above , ‫مش معنا بس اعرفوا أنه تاني خيار صح‬
12. A 64-year-old woman with symptoms of major depression, anxiety, OCD and low back
pain who has angle-closure glaucoma. Which antidepressant should be avoided in this
patient? ‫مش معنا‬

a. Bupropion
b. Mirtazapine
c. Nortriptyline
d. Fluvoxamine
e. All of the above

13. Xanthine derivatives (caffeine)work in Asthma and COPD as bronchodilators where

short acting adrenergic agonists such as Aalbuterol (ventolin) fails, because they:

a. Stimulate the adrenergic receptor at an allosteric site different from that of

adrenaline
b. Stimulate phosphodiesterase enzyme
c. Increase directly the synthesis and inhibit breakdown of cAMP
d. Lead to direst calcium translocation inside cells without ligand-receptor binding e. B
and C only
f. Non of the above

14. Nicotine or tobacco smoking at higher doses leads to drop in blood pressure, because of;
a. Stimulation of sympathetic ganglia as well as the adrenal medulla
b. Induction of vasoconstriction via alpha receptor
c. Stimulation of parasympathetic ganglia
d. Muscarinic M2 receptor stimulation at the level of ganglia
e. Nicotine-induced block of parasympathetic ganglia

15. Tobacco smoking addiction is one of the hardest habits to quit. Euphoric effects and reward
from nicotine smoking in addition to hand to mouth ritual reward are among the most habit
forming in this context. One agent that can work on most of the previous habits and used for
people who relapse after smoking cessation is:

a. Nicotine patch
b. Bupropion
 c. Scoplolamine patches
d. Benztropine
e. Varenicline
f. Nicotine gum

16. AHDH could come with hyperkinetic or without. Hyperactivity and no- stop ongoing non settling
movement by the kid to the degree he/she can`t focus on any mission more than few minutes
and can`t finish any work is the most prevailing type of ADHD. Despite that we give them highly
stimulating sympathomimetic agents, why?

a. There are overstimulation of the motor zone in the cerebellum so when we give these
agents, they will, by negative feedback inhibition, calm down this zone
b. There is over activity of certain areas in medulla oblongata and brain stem that when we
use these agents, they will activate other areas in the brain that will shut off brain stem
c. There is under activity in the inhibitory area in the medulla oblongata that once
stimulated by these agents, it will cause less excitatory stimuli
d. Non of the above.

17. Name one drug or more from the following that are examples of these agents mentioned in the
previous question?

a. Lysergic acid
b. MDMA
c. Drobirinol
d. Cocaine
e. Lisdexamphetamine
f. B and E ‫من أجوبة البنت‬

18. Hallucinogenic agents and sympathomimetic agents share one mechanism for tolerance to their
psychedelic /hallucinogenic and excitatory effects:

a. Inhibition of NE and Dopamine reuptake

b. Stimulation of postsynaptic serotonin receptors
c. Blocking presynaptic serotonin receptors
d. Down regulation of postsynaptic serotonin receptors
e. Down regulation of presynaptic serotonin receptors
19. Smoking marijuana or ingestion of specific dose of it is widely legalized now a days in many
countries. The medical uses and benefits of marijuana is/ are:

a. Help in refractory epilepsy in children by using the refined form(cannabindiol)

b. Improve mobility and reduce rigidity and muscle spasm in Parkinson`s patients
c. Improve memory in Alzheimer’s patients
d. Reduce pain in end stage patients or chronic pain patients
e. Help in Migraine headaches
f. All are correct

20. Regard morphine actions,

a. Analgesia: alter brain’s perception of pain
b. Respiration: suppress respiratory center
c. Cough suppression: codeine
d. Euphoria: frontal mesolimbic system
e. Labor: prolong 2nd stage of labor
f. All are correct
g. All are correct except D

21. A 66- year old patient with end-stage kidney disease, stomach ulcer and diabetes who is
suffering from chronic back pain and neuralgia is seeking an analgesic drug. The most
suitable agent is:

a. Oxycodone
b. Morphine
c. Codeine
d. Methadone
e. Meperidine
f. Hydromorphone

22. A narcotic drug that is highly accumulating in body and has short duration of action
despite long half-life in the body:
a. Oxycodone
b. Nabilone
c. Methadone
d. Mepeiridine
e. Pentazocine
f. Morphine
23. Methadone has evolved lately as one of the most important and extensively used
agents for dealing with narcotics addiction. It ensures safe and smooth withdrawal from
most opioids. Special Methadone pharmacies now are preparing solution dosage forms
to be given taken by their patients under witness of a health professional. It is mainly
used for this purpose because of:

a. It causes less pain suppression than morphine

b. It is partial agonist at µ Receptor
c. It has a less severe withdrawal symptoms
d. Can`t lead to respiratory depression and death when the patient skips more than 3
doses then take the full dose he was on before skipping
e. All of the above

24. Incomplete tolerance between different opioids is a serious problem when stopping or
initiating a new agent or when combining 2 or more agents together to control pain.
Such as Morphine SR twice daily for ongoing control of cancer pain along with codeine
elixir as needed for break through pain. Incomplete tolerance between opioids means:

a. If the patient develops tolerance to respiratory depression for Narc 1 after long use,
that mean he will develop it for drug 2 once given to patient
b. Accumulation of previous drug in patient`s body must be taken into consideration
c. Patient might be well tolerated to drug 1 but he is unable to metabolize drug 2 or
incomplete metabolism might occur due to genetic polymorphism
d. You have to calculate the overall dose of all opioids in the patient body before you
issue new equivalent dose from the new opioid
e. All of the above
f. Al except A

25. Partial agonists on opioid receptors are gaining wide use in dealing with withdrawal
symptoms during abstinence from opioids. Their use for this purpose came by the
virtue of:

a. Their strong intrinsic activity and long duration of action

b. Their strong binding capacity to opioid receptor and competence on the receptor
comparing with full agonists
c. Their pharmacologic effect keeps increasing with dose and that’s why they have
more control on withdrawal symptoms
 d. They compete with full agonists, displace them from binding sites on opioid receptor
and once they occupy the receptor they never give full agonistic action

26. Buprenorphine plus naloxone (Suboxone) combination is used sublingual in selected

patients to help them get rid of addiction on opioids or narcotic abuse. It actually help
with withdrawal symptoms. Naloxone was added in order to or because:
a. It is absorbed easily from buccal cavity which can directly reverse addiction
b. Increase buprenorphine activity and decrease withdrawal symptoms
c. Protect form respiratory depression when skipping doses of Suboxone or changing
of the abused agent, due to prevention of incomplete tolerance
d. It leads to severe withdrawal symptoms if the drug is injected by the abuser as IV
e. Non of the above ‫تم وضعه لمنع االستخدام السيء للجرعه ك حقن‬
27. An opioid analgesic that works well for chronic musculoskeletal pain and other
orthopedic conditions. It has less physical dependence potential comparing to opioids. It
might cause habituation due mainly to positive reward effects to the patient, is:

a. Buterphanol
b. Pentazocine
c. Buprenorphine
d. Sufentanyl
e. Tapendalol

28. An opioid agent that is used extensively to treat chronic severe pain in patients who
developed tolerance to oral opioids. It is also used in gynecological surgeries because it
doesn`t interfere with labor. It can accumulate in body leading to death:

a. Fentanyl patch
b. Nalbuphine IV
c. Intranasal buprenorphine
d. SL Suboxone
e. Oxycodone SR high dose

29. Simple partial seizures or focal seizures does not spread to large parts of the brain and
hence their motor effects on the different body organs will be confined and limited to
certain organs or group of organs that is manipulated by that part of the brain. What is
true about it?
 a. It starts basically by firing of certain sodium channels
b. Patient doesn`t lose consciousness during it
c. It distorts vision or smell or hearing
d. It may spread or convert to generalized seizure if not stopped
e. All of the above
f. All except B.

30. There is a debate about treating epilepsy with ongoing medication to a patient that
might or might not have a seizure. The only way to prove that he becomes seizure- free,
is to stop the medication and challenge that. People who support the idea of ongoing
medication depends in their argument on:

a. We have to stop early in time the partial seizure in order not to spread as GCTS
b. If patient has GS from the beginning then we could prevent it, reduce time of the
seizure, its complications or further spreading
c. Some of these drugs are selective in a way that they bind only to the overactive
channels so won`t affect the normal functions of the brain
d. All of the above

31. When initiating, tapering or stopping any antiepileptic agent, the clinician might do all of
the following, EXCEPT:

a. Start with slow dose then tapper up to the effective dose that controls seizures
b. When adding new agent you must not stop the original one until you control the
seizure with the newly added agent
c. Start carbamazepine with large dose to control the seizure then tapper down to
maintenance dose later
d. If toxicity ensues, then stop the drug right away and add the new agent in full dose
e. In newly diagnosed patient mono-therapy is started first
32. Numerous mechanisms of action were proposed for antiepileptic agents, it might
include but not limited to:
a. Block T- type calcium channels
b. Block voltage dependent sodium channels
c. Enhance chloride channels conductance
d. Block sodium- dependent calcium channels
e. Binds to collapsin response mediator protein-2
f. All except E
g. All are correct

33. A 6-year old boy just diagnosed with Lennox-Gastaut syndrome. The drug(s) of choice
for his case is:
a. Rufinamide
b. Lacosomide
c. Tegretol 400 mg
d. Valproate 125 mg BID

34. Antiepileptic agent that can be added to any regimen of epilepsy treatment or any
agent can be added to it without leading to interaction is: a. Tegretol
b. Levitiracetam
c. Phenytoin
d. Valproic acid
e. Zonisamide

35. 27-year-old woman with myoclonic seizures is well controlled on valproate. She
indicates that she is interested in becoming pregnant in the next year. What will be you
advice to her in regard to her antiepileptic medication?

a. Leave her on valproate

b. Change to valproic acid
c. Switch her to lamotrigine
d. Add topiramate
e. Decrease her valproate dose

36. A 45-year-old man undergoes a neurologic evaluation because of episodes of apparent

confusion. Over the past year, the man has experienced episodes of blank look on his
 face and fails to respond to questions. Moreover, it appears it takes several minutes
before the man recovers from the episodes. Which type of seizure he has?

a. Tonic- clonic seizure

b. Clonic seizure
c. Myoclonic seizure
d. Complex partial
e. Absence seizure

37. A 60-year-old woman had a stroke approximately 1 month ago. She still have small focal
seizures where she fails to respond appropriately while talking. Which of the following is
the most appropriate treatment for this individual? a. Phenytoin.
b. Oxcarbazepine.
c. Phenobarbital.
d. Tegretol
e. Levetiracetam.

38. For short duration cleansing of opioids, we use :

a. Methadone
b. Lorazepam
c. Naloxone
d. Flurazepam
e. Buphrenorphine

39. Despite the fact that tolerance to respiratory depressant effects of opioids can develop
with time, still the addicts can die of over dose of opioids, why?
a. On higher dose the opioid suppresses new receptors of the respiratory system
b. Involvement of spinal cord mu and kappa receptors that lead to difficulty in
swallowing and choking
c. Sudden up regulation of opioid receptors in the respiratory center
d. Suppressing of higher centres of brain cortex that control respiration ‫من أجوبة البنت‬
e. High Oxygen levels in the blood and respiratory centre that inhibit repository reflex
f. Cardiac arrhythmia and cardiovascular collapse
g. Non of the above
 40. If an addict who comes regularly to your pharmacy to take his liquid dose of methadone
under your witness who is enrolled in withdrawal program missed 2 doses, would you
give him the third dose at the same level he was on before missing? Justify your answer
in very short sentences. ( 2 points)

Hebron University
Faculty of Pharmacy and Medical Sciences
Pharma III (84443) Final Exam (40%) 19.12. 2020 9-10:20 AM On line Exam
Student Name & ID #: Dr. Muamar Shaheen, lect.

The Answer sheet for all forms, please download, type in, write your name and ID use capital
letters for the answers, then attach as document not as image:
Question 1 2 3 4 5 6 7 8 9 10
#
Answer

Q. # 11 12 13 14 15 16 17 18 19 20
A.
Q. # 21 22 23 24 25 26 27 28 29 30
A.
Q. # 31 32 33 34 35 36 37 38 39 40
A.