Ms. Smith, a 65-year-old woman with pneumonia, was given tobramycin, 150 mg, intravenously.

After 20 minutes, the plasma concentration was measured and was found to be 3 mg/L. Assuming
no elimination of the drug in 20 minutes, what is the apparent volume of distribution of tobramycin
in Ms. Smith?
(A) 3 L/min (B) 3 L (C) 50 L (D) 7 L (E) 0.1 mg/min
A 74-year-old retired mechanic is admitted with a myocardial infarction and a severe acute cardiac
arrhythmia. You decide to give lidocaine to correct the arrhythmia. A continuous intravenous
infusion of lidocaine, 1.92 mg/min, is started at 8 AM. The average pharmacokinetic parameters of
lidocaine are: Vd 77 L; clearance 640 mL/min; half-life 1.4 h. What is the expected steady-state
plasma concentration?
(A) 40 mg/L (B) 3.0 mg/L (C) 0.025 mg/L (D) 7.2 mg/L (E) 3.46 mg/
A new drug is under study in phase 1 trials. It is found that this molecule is avidly taken up by
extravascular tissues so that the final total amount in the extravascular compartment at steady
state is 100 times the amount remaining in the blood plasma. What is the probable volume of
distribution in a hypothetical person with 8 L of blood and 4 L of plasma?
(A) Insufficient data to calculate (B) 8 L (C) 14.14 L (D) 100 L (E) 404 L
Which of the following factors is likely to increase the duration of action of a drug that is
metabolized by CYP3A4 in the liver?
(A) Chronic administration of rifampin during therapy with the drug in question
(B) Chronic therapy with Amiodarone
(C) Displacement from tissue-binding sites by another drug
(D) Increased cardiac output
(E) Chronic administration of carbamazepine
A 12-year-old child has bacterial pharyngitis and is to receive an oral antibiotic. She complains of a
sore throat and pain on swallowing. The tympanic membranes are slightly reddened bilaterally, but
she does not complain of earache. Blood pressure is 105/70 mm Hg, heart rate 100/min,
temperature 37.8°C (100.1°F). Ampicillin is a weak organic acid with a pKa of 2.5. What
percentage of a given dose will be in the lipid-soluble form in the duodenum at a pH of 4.5?
(A) About 1% (B) About 10% (C) About 50% (D) About 90% (E) About 99%
An 18-year-old female patient is brought to the Emergency department due to drug overdose.
Which of the following routes of administration is the most desirable for administering the antidote
For the drug overdose?
A. Intramuscular B. Intravenous C. Oral D. Subcutaneous E. Transdermal
The pharmacokinetics of a new drug are under study in a phase 1 clinical trial. Which statement
about the distribution of drugs to specific tissues is most, correct?
(A) Distribution to an organ is independent of blood flow
(B) Distribution of a lipid-soluble drug will be too adipose tissue initially
(C) Distribution into a tissue depends on the unbound drug concentration gradient between blood
and the tissue
(D) Distribution is increased for drugs that are strongly bound to plasma proteins
(E) Distribution has no effect on the half-life of the drug
Prior to clinical trials in patients with heart failure, an animal study was carried out to compare
two new positive inotropic drugs (A and B) to a current standard agent (C). The results of cardiac
output measurements are shown in the graph below. Which of the following statements is correct.
(A) Drug A is most effective (B) Drug B is least potent (C) Drug C is most potent
(D) Drug B is more potent than drug C and more effective than drug A
(E) Drug A is more potent than drug B and more effective than drug C
A 55-year-old woman with type 1 diabetes of 40 years’ duration complains of severe bloating and
abdominal distress, especially after meals. Evaluation is consistent with diabetic gastro paresis.
Which of the following is a prokinetic drug that could be used in this situation?
(A) Aldosterone (B) Cimetidine (C) Loperamide (D) Metoclopramide
(E) Sucralfate
A 40-year-old male CEO came to the emergency department with severe burning chest pain
radiating into his neck. His electrocardiogram was normal and test for troponin was negative. A
diagnosis of GERD was made and he was sent home with a prescription for a drug that inhibits
stomach acid. Which of the following is a drug that irreversibly inhibits the H+ /K+ ATPase in the
parietal cells?
(A) Cimetidine (B) Diphenoxylate (C) Esomeprazole (D) Metoclopramide
(E) Sulfasalazine
A 34-year-old woman has irritable bowel syndrome with diarrhea that is not responsive to
conventional therapies. Despite the small risk of severe constipation and ischemic colitis, the patient
decides to begin therapy with aldosterone. Aldosterone has which of the following receptor actions?
(A) 5-HT3 receptor antagonist (B) 5-HT4 receptor agonist (C) D2 receptor antagonist
(D) NK1 receptor antagonist (E) Muscarinic receptor antagonist
A 45-year-old man with a duodenal ulcer was treated with a combination of drugs intended to heal
the mucosal damage and to eradicate Helicobacter pylori. Which of the following antibacterial
drugs is used commonly to eradicate intestinal H pylori?
(A) Cefazolin (B) Ciprofloxacin (C) Clarithromycin (D) Clindamycin
(E) Vancomycin
Unit 4 drugs affecting hematology
Which of the following drugs accelerates the conversion of plasminogen to plasmin?
(A) Aminocaproic acid (B) Heparin (C) Argatroban (D) Reteplase (E) Warfarin
 If this patient undergoes a percutaneous coronary angiography procedure and placement of a stent
in a coronary blood vessel, he will need to be on dual antiplatelet therapy, eg, aspirin and
clopidogrel for at least a year. Which of the following most accurately describes the mechanism of
action of clopidogrel?
(A) Clopidogrel directly binds to the platelet ADP receptors
(B) Clopidogrel irreversibly inhibits cyclooxygenase
(C) Clopidogrel facilitates the action of antithrmobin III
(D) The active metabolite of clopidogrel binds to and inhibits the platelet ADP receptors
(E) The active metabolite of clopidogrel binds to and inhibits the platelet glycoprotein IIb/IIIa receptors
You are discussing the risks and benefits of anticoagulation therapy with her, including the option
of using direct thrombin inhibitors. Which of the following anticoagulants is a direct inhibitor of
thrombin?
(A) Abciximab (B) Dabigatran (C) Rivaroxaban (D) Warfarin (E) Heparin
She is excited about not having to come in for blood tests but wonders if there is a test, just in case
the doctors need to know. Which of the following tests would provide accurate information about
the coagulation status of a patient taking apixaban?
(A) APTT (B) Factor X test (C) INR (D) PT test (E) HB.
Which of the following best describes the mechanism of anticancer action of cellular metabolites of
fluorouracil?
(A) Cross-linking of double-stranded DNA (B) Inhibition of DNA-dependent RNA synthesis
(C) Interference with the activity of topoisomerases I
(D) Irreversible inhibition of thymidylate synthase (E) Selective inhibition of DNA polymerases
After several cycles of chemotherapy, the patient was found to have a high resting pulse rate. A
noninvasive radionuclide scan revealed evidence of cardiomyopathy. The drug that is most likely
responsible for the cardiac toxicity is?
(A) Cyclophosphamide (B) Doxorubicin (C) Fluorouracil
(D) Methotrexate (E) Tamoxifen
An adult patient is being treated for acute leukemia with a combination of anticancer drugs that
includes cyclophosphamide, mercaptopurine, methotrexate, vincristine, and prednisone. He is also
using Ondansetron for emesis, a chlorhexidine mouthwash to reduce microsites, and laxatives. The
patient complains of “pins and needle” sensations in the extremities and muscle weakness. He is not
able to execute a deep knee bend or get up out of a chair without using his arm muscles. He is also
very constipated. If these problems are related to the chemotherapy, which of the following is the
most likely causative agent?
(A) Cyclophosphamide (B) Mercaptopurine (C) Methotrexate (D) Prednisone
(E) Vincristine
A cancer cell that is resistant to the effects of both vincristine and methotrexate probably has
developed the resistance as a result of which of the following mechanisms?
(A) Changes in the properties of a target enzyme
(B) Decreased activity of an activating enzyme
(C) Increased expression of a P-glycoprotein transporter
(D) Increased production of drug-trapping molecules
(E) Increase in proteins that are involved in DNA repair
Unit 1 drugs used endocrine system
Which of the following statements is correct regarding insulin glargine?
A. It is primarily used to control postprandial hyperglycemia.
B. It is a “peakless” insulin.
C. The prolonged duration of activity is due to slow dissociation from albumin.
D. It should not be used in a regimen with insulin lispro or glulisine.
Morning injection of NPH insulin and evening injection of regular insulin
Which one of the following drugs promotes the release of endogenous insulin?
(A) Acarbose (B) Canagliflozin (C) GLIPIZIDE (D) Metformin (E) Miglitol
The hospital pharmacy committee is preparing a formulary for staff use. Which of the following is
a correct application of the drug mentioned?
(A) Aldosterone: for obstetric bleeding (B) Cetirizine: for hay fever
(C) Ergonovine: for Alzheimer’s disease (D) Ondansetron: for acute migraine headache
(E) Ranitidine: for Parkinson’s disease
A 28-year-old office worker suffers from intense migraine headaches. Which of the following is a
serotonin 5-HT1D/1B agonist useful for aborting an acute migraine headache?
(A) Bromocriptine (B) Cimetidine (C) Ephedrine (D) Ketanserin (E) Loratadine
Full activation of the parasympathetic nervous system is likely to produce which of the following
effects?
(A) Broncho dilation (B) Decreased intestinal motility (C) Increased thermoregulatory sweating
(D) increased pupillary constrictor tone (miosis) (E) Increased heart rate (tachycardia)
If the effector cell in the diagram is a pupillary constrictor smooth muscle cell, which of the
following receptor types is denoted by structure 6?
(A) Alpha1 adrenoceptor (B) Beta2 adrenoceptor (C) M3 cholinoceptor (D) Ng cholinoceptor.
(E) Mg cholinoceptor
This drug is used in the management of insomnia and facilitates the inhibitory actions of GABA,
but it lacks anticonvulsant or muscle-relaxing properties and has minimal effect on REM sleep. Its
actions are antagonized by flumazenil.
(A) Buspirone (B) Chlordiazepoxide (C) Eszopiclone (D) Ramelteon (E) Phenobarbital
A 40-year-old woman has occasional acute attacks of intense anxiety with marked physical
symptoms, including hyperventilation, tachycardia, and sweating. If she is diagnosed as suffering
from a panic disorder, the most appropriate drug to use is
(A) Alprazolam (B) Eszopiclone (C) Lorazepam (D) Propranolol (E) Ramelteon
A 32-year-old woman with hypertension wishes to become pregnant. Her physician informs her
that she will have to switch to another antihypertensive drug. Which of the following drugs is
absolutely contraindicated in pregnancy?
(A) Atenolol (B) Losartan (C) Methyldopa (D) Nifedipine (E) Propranolol
A significant number of patients started on ACE inhibitor therapy for hypertension are intolerant
and must be switched to a different class of drug. What is the most common manifestation of this
intolerance?
(A) Angioedema (B) Glaucoma (C) Headache (D) Incessant cough
(E) Ventricular arrhythmias
Nicotinic receptor sites do not include which one of the following sites?
(A) Bronchial smooth muscle (B) Adrenal medullary cells (C) Parasympathetic ganglia
(D) Skeletal muscle end plates (E) Sympathetic ganglia.
Which of the following has a slow onset but long duration of action and is always used in
combination with a corticosteroid by inhalation?
(A) Aminophylline (B) Salmeterol (C) Epinephrine (D) Metaproterenol (E) Metoprolol
After successful treatment of the acute attack, the patient was referred to the outpatient clinic for
follow-up treatment for asthma. Which of the following is not an established prophylactic strategy
for asthma?
(A) Avoidance of antigen exposure (B) Blockade of histamine receptors
(C) Blockade of leukotriene receptors (D) IgE antibody blockade
(E) Inhibition of phospholipase A2.
A 45-year-old man is brought to the emergency department with mental obtundation. He is found
to have a blood pressure of 220/160 and retinal hemorrhages. Which one of the following is used in
severe hypertensive emergencies, is short acting, acts on a G protein-coupled receptor, and must be
given by intravenous infusion?
(A) Aliskiren (B) Captopril (C) Fenoldopam. (D) Hydralazine (E) Losartan.
Which statement about the clinical use of sulfonamides is correct?
(A) Cannot be used topically for treatment of chlamydial infections of the eye
(B) Effective as sole agents in the treatment of prostatitis
(C) Effective in Rocky Mountain spotted fever
(D) In some bacterial strains resistance occurs via reduced PABA formation
(E) Reduced intracellular uptake is a mechanism of sulfonamide resistance in some bacterial
strains.