Exercise 4

1. Mrs C is a 62-year-old woman with a history of hypertension, atrial

fibrillation and type 2 diabetes. She is a non-smoker and obese. Her
current medication comprises flecainide 100 mg twice a day, aspirin 75 mg
daily, simvastatin 40 mg and diltiazem 180 mg daily. Mrs C is suffering
from a respiratory tract infection and her primary care doctor has
prescribed a 5-day course of clarithromycin. Are there likely to be any
clinically significant drug interactions?
a) Simvastatin and Diltiazem
b) Simvastatin and Clarithromycin
c) Diltiazem and Clarithromycin
d) Diltiazem and Aspirin
e) A and B

2. In the presence of propranolol, a higher concentration of epinephrine is

required to elicit full anti asthmatic activity. Propranolol has no effect on
asthma symptoms. Which is correct regarding these medications?
a. Epinephrine is less efficacious than propranolol
b. Epinephrine is a full agonist, and propranolol is a partial
agonist.
c. Epinephrine is an agonist, and propranolol is a competitive
antagonist.
d. Epinephrine is an agonist, and propranolol is a
noncompetitive antagonist.

3. Which of the following up-regulates postsynaptic α1 adrenergic

receptors?
a) Daily use of amphetamine that causes release of norepinephrine.
b) A disease that causes an increase in the activity of norepinephrine
neurons.
c) Daily use of phenylephrine, an α1 receptor agonist.
d) Daily use of prazosin, an α1 receptor antagonist.
4. Methylphenidate helps patients with attention defi cit hyperactivity
disorder (ADHD) maintain attention and perform better at school or
work, with an ED50 of 10 mg. However, methylphenidate can also cause
significant nausea at higher doses (TD50 = 30 mg). Which is correct
regarding methylphenidate?
a) The therapeutic index of methylphenidate is 3.
b) The therapeutic index of methylphenidate is 0.3.
c) Methylphenidate is more potent at causing nausea than treating
ADHD.
d) Methylphenidate is more efficacious at causing nausea than
treating ADHD.

5. Which is correct concerning the safety of using warfarin (with a small

therapeutic index) versus penicillin (with a large therapeutic index)?
a) Warfarin is a safer drug because it has a low therapeutic index.
b) Warfarin treatment has a high chance of resulting in dangerous
adverse effects if bioavailability is altered.
c) The high therapeutic index makes penicillin a safe drug for all
patients.
d) Penicillin treatment has a high chance of causing dangerous
adverse effects if bioavailability is altered.

6. Which type of adverse drug reactions are serious?

a) Type A: Augmented reactions such as hypotension with
antihypertensives
b) Type B: Bizarre reactions such as hypersensitivity
c) Type C: Chronic reactions such as renal toxicity and ototoxicity
d) Type D: Delayed reactions such as cancer and teratogenicity
e) All of the above

7. A patient develops urinary retention after an abdominal surgery.

Urinary obstruction was ruled out in this patient. Which strategy would
be helpful in promoting urination?
a) Activating nicotinic receptors
 b) Inhibiting the release of acetylcholine
c) Inhibiting cholinesterase enzyme
d) Blocking muscarinic receptor

8. In Alzheimer disease, there is a deficiency of cholinergic neuronal

function in the brain. Theoretically, which strategy is useful in treating
symptoms of Alzheimer disease?
a) Inhibiting cholinergic receptors in the brain
b) Inhibiting the release of acetylcholine in the brain
c) Inhibiting the acetylcholinesterase enzyme in the brain
d) Activating the acetylcholinesterase enzyme in the brain

9. Where would you expect to see the first return of function in skeletal
muscles following discontinuation of a nondepolarizing neuromuscular
blocking agent?
a) Arms
b) Diaphragm
c) Fingers
d) Pupils
10. Which of the following adrenergic drugs is used in the treatment of
overactive bladder?
a) Epinephrine
b) Dobutamine
c) Phenylephrine
d) Mirabegron
11.A 22-year-old male is brought to the emergency room with suspected
cocaine overdose. Which of the following symptoms is most likely in this
patient?
a) Hypertension
b) Bronchoconstriction
c) Bradycardia
d) Miosis (constriction of pupil).
12.A 12-year-old boy with a peanut allergy is brought to the emergency
room after accidental consumption of peanuts. He is in anaphylactic
 shock. Which of the following drugs is most appropriate to treat this
patient?
a) Norepinephrine
b) Phenylephrine
c) Dobutamine
d) Epinephrine
13. A patient who has hypertension and mild asthma attacks bought an
herbal remedy for asthma online. He does not take any prescription
medications for asthma, but takes a β1-selective blocker for
hypertension. The herbal remedy relieves the asthma attacks, but his
blood pressure seems to increase despite the β-blocker therapy. Which of
the following drugs is most likely present in the herbal remedy?
a) Phenylephrine
b) Norepinephrine
c) Ephedrine
d) Salmeterol
14.A 30-year-old male patient was brought to the ER with amphetamine
overdose. He presented with high blood pressure and arrhythmias.
Which drug is the most appropriate to treat the cardiovascular
symptoms of amphetamine overdose in this patient?
a) Metoprolol
b) Prazosin
c) Labetalol
d) Nebivolol
A β-blocker was prescribed for hypertension in a patient with asthma. After
a week of treatment, the asthma attacks got worse, and the patient was
asked to stop taking the β-blocker. Which β-blocker would you suggest as an
alternative that is less likely to worsen the asthma?
a) Propranolol
b) Metoprolol
c) Labetalol
d) Carvedilol
15.A 70-year-old male is treated with doxazosin for overflow incontinence
due to his enlarged prostate. He complains of dizzy spells while getting
up from bed at night. Which drug would you suggest as an alternative
that may not cause dizziness?
 a) Propranolol
b) Phentolamine
c) Tamsulosin
d) Terazosin
16.A 50-year-old male was in anaphylactic shock after being stung by a
hornet. The medical team tried to reverse the bronchoconstriction and
hypotension using epinephrine; however, the patient did not fully
respond to the treatment. The patient’s wife mentioned that he is taking
a prescription medication for blood pressure. Which medication is he
most likely taking that contributed to a reduced response to
epinephrine?
a) Doxazosin
b) Propranolol
c) Metoprolol
d) Acebutolol
17. Which of the following drugs has the highest potential to worsen
orthostatic hypotension when given together with prazosin?
a) Propranolol
b) Atenolol
c) Nebivolol
d) Labetalol
18. Which one of the following combinations of antiparkinsonian drugs is
an appropriate treatment plan?
a) Amantadine, carbidopa, and entacapone
b) Levodopa, carbidopa, and entacapone
c) Pramipexole, carbidopa, and entacapone
d) Ropinirole, selegiline, and entacapone
19.Which of the following antiparkinsonian drugs may cause vasospasm?
a) Amantadine
b) Bromocriptine
c) Carbidopa
d) Entacapone
20.Which medication is a glutamate receptor antagonist that can be used in
combination with an acetyl cholinesterase inhibitor to manage the
symptoms of Alzheimer’s disease?
a) Rivastigmine
b) Pramipexole
 c) Memantine
d) Galantamine
21. Which of the following medications reduces immune system–mediated
inflammation via inhibition of pyrimidine synthesis to reduce the
number of activated lymphocytes in the CNS?
a) Riluzole
b) Rotigotine
c) Teriflunomide
d) Dexamethasone
22. Which of the following agents may cause tremors as an adverse effect
and, thus, should be used with caution in patients with Parkinson’s
disease, even though it is also indicated for the treatment of dementia
associated with Parkinson’s disease?
a) Benztropine
b) Rotigotine
c) Rivastigmine
d) Dimethyl fumarate
23. A 19-year-old woman is on long-term treatment with minocycline 100
mg daily for acne. She wishes to start using the combined oral
contraceptive and her doctor has prescribed a low-strength pill
(containing ethinyloestradiol 20 µcg with norethisterone 1 mg). The
doctor contacts the pharmacist for advice on whether the tetracycline
will interfere with the efficacy of the oral contraceptive.
a) Tetracyclines will cause contraceptive toxicity
b) Tetracyclines will cause contraceptive failure
c) These drugs are contraindicated in combination
d) These drugs will provide antagonism
24.A 68-year-old woman is on long-term treatment with lansoprazole for
gastro-oesophageal reflux disease and warfarin for atrial fibrillation. She
is admitted with hematemesis. On direct questioning, she also revealed
that she takes various herbal medicines which contain chamomile, horse
chestnut, garlic, feverfew, ginseng and St John's wort. What is the
possible cause of hematemesis?
a) Warfarin +garlic
b) Warfarin +ppi
c) Warfarin +St john’s
d) Both a and b
25.A 79-year-old man presented to hospital with a 3-day history of
increasing confusion and collapse. He had a history of chronic
lumbosacral pain, treated with oxycodone 10 mg twice daily and
amitriptyline 75 mg daily. Five days before hospital admission he had
been prescribed tramadol 100 mg four times daily for worsening sciatica.
On admission the patient had a Glasgow Coma Scale of 11 and he was
delirious and hallucinating. There were no focal neurological signs. Over
the next 2 days he became increasingly unwell, confused and sweaty with
pyrexia and muscular rigidity. Biochemical tests showed a metabolic
acidosis (base deficit of 10.7) and an elevated creatine kinase level of 380
IU/L. There was no evidence of infection. At this stage a diagnosis of
probable serotonin syndrome was made.
a) Opioid analgesic +SSRI
b) Lambosacral pain +SSRI
c) Oxycodone + Tramadol
d) Oxycodone + SSRI
26.A 39-year-old male taking varenicline for smoking cessation reports that
he has been suffering from vivid dreams and has become increasingly
aggressive towards his family. Last night he had a major argument with
his wife. His wife mentioned he hadn't been the same since he started the
varenicline and he would like to know if this was a possible cause.
a) Nicotine withdrawal
b) Nicotine receptor overstimulation
c) CNS side effects of Vareniciline
d) All of Above
27. Selegeline -- MAO B Inhibitor
a) Epinephrine reversal
b) Serotonine syndrome
c) Hypertensive crisis
d) hypomania
28.A 68-year-old woman is brought to the emergency department for
treatment of a myocardial infarction. She is currently taking clopidogrel
(antiplatelet agent) and aspirin daily, as well as omeprazole (potent CYP
inhibitor) for heartburn. Which of the following is the most likely
contributor to her myocardial infarction today?
a) Reduced antiplatelet activity of clopidogrel due to aspirin
 b) Reduced antiplatelet activity of clopidogrel due to omeprazole
c) Hypersensitivity reaction due to clopidogrel
d) Increased antiplatelet activity of clopidogrel due to omeprazole
e) Increased antiplatelet activity of clopidogrel due to aspirin
29.A pharmacokinetic study of a new antihypertensive drug is being
conducted in healthy human volunteers. The half-life of the drug after
administration by continuous intravenous infusion is 12 hours. Which of
the following best approximates the time for the drug to reach steady
state?
a) 24 hours
b) 48 hours
c) 72 hours
d) 120 hours
e) 240 hours
30.If 10 mg of oxycodone produces a greater analgesic response than aspirin
at any dose, which is correct?
a) Oxycodone is more efficacious than aspirin.
b) Oxycodone is less potent than aspirin.
c) Aspirin is a full agonist, and oxycodone is a partial agonist.
d) Oxycodone and aspirin act on the same drug target.
31.Which drug should be taken on empty stomach
a) Levodopa
b) Penicillin
c) Safinamide
d) Neostigmine
32.Which drug should be taken with food
a) Levodopa
b) Penicillin
c) Safinamide
d) Neostigmine
33.DOC for acute glaucoma
a) Pilocarpine
b) Latanoprost
c) Timolol
d) Ach
34. DOC for emergency intubation
a) Ach
 b) Neostigmine
c) Rocuronium
d) Succinylcholine
35. Most disturbing side effect of levodopa carbidopa treatment
a) Bradykinesia
b) Akinesia and Dyskinesia
c) Peripheral effects
d) CNS depression
36. BCG is type of which vaccinations?
a) Toxoid
b) Ig
c) LAV
d) Full viral genome
37. Passive natural immunity is acquired by which antibodies?
a) IgM
b) IgA
c) IgG
d) IgE
38.Methacholine challenge test is used to diagnose
a) MS
b) MG
c) COPD
d) ALS
39. Epinephrine plus insulin
a) Antagonism
b) Synergism
c) Abnormal Response
d) No effect
40.Clonidine use
a) Treatment of HTN
b) Treatment of Hypotension
c) Treatment of Depression
d) Treatment of Epilepsy
41.DOC for Cardiogenic shock
a) Dopamine
b) Dobutamine
c) Epinephrine
 d) Norepinephrine
42.Half-life of Ecothiophate
a) 10 days
b) 4 days
c) 100 days
d) 2 days