Pharmacology 1-200 Flashcards
(200 cards)
1
Q
In the stomach, aspirin will exist predominantly as the \_\_\_\_\_\_\_\_\_\_\_\_\_\_ form. A. Hydrophilic, ionized, polar B. Lipophilic, unionized, non-polar C. Hydrophilic, unionized, non-polar D. Lipophilic, ionized, polar E. Hydrophilic, unionized, polar
A
B
Review the Henderson-Hasselbach equation. Aspirin (acetylsalicyclic acid) is acidic in nature. In an acidic environment like the stomach, it will exist predominantly as the lipid-soluble, unionized, non-polar form
2
Q
In the CHOP regimen for non-Hodgkin's lymphoma, which chemotherapeutic drug acts by inhibiting the mitotic spindle? A. Cyclophosphamide B. Hydroxyurea C. Oncovin D. Prednisone E. Doxorubicin
A
C
Oncovin is vincristine.
3
Q
A patient with leprosy is taking a drug that casts a red color to the skin. He is probably taking: A. Dapsone B. Rifampin C. Clofazimine D. Ethambutol E. Phenylbutazone
A
C
Rifampin causes red discoloration of body fluids but not the skin.
4
Q
What part of the pharmacokinetics of penicillin is affected by the drug probenecid? A. Glomerular filtration B. Tubular reabsorption C. Tubular secretion D. Hepatic uptake E. Protein-binding with albumin
A
C
Probenecid raises plasma concentration of penicillin by inhibiting its tubular secretion in the renal tubules.
5
Q
Hoffman elimination is exhibited by: A. Succinylcholine B. Diazepam C. Phenobarbital D. Phenytoin E. Atracurium
A
E
Hoofman elimination aka exhaustive methylation
6
Q
In a patient suffering from organophosphate poisoning with a cardiac rate of 45, what drug should be given? A. Neostigmine B. Atropine C. Epinephrine D. Pancuronium E. Edrophonium
A
B
Because of its antimuscarinic effect on the heart, atropine (the antidote for organophosphate poisoning) has a positive chronotropic effect.
7
Q
Patients receiving cyclophosphamide should also be given: A. Mesna B. Leucovorin C. Vitamin B6 D. Thiamine E. Amifostine
A
A
Leucovorin for methotrexate. Pyridoxine for isoniazid. Thiamine for alcoholics.
8
Q
Which statement is correct regarding the aminoglycosides?
A. They work in anaerobic conditions.
B. They exhibit concentrationdependent killing.
C. Most drugs of this class are myelosuppresive.
D. They cannot be given to patients allergic to penicillins.
E. They are acidic in nature.
A
B
Aminoglycosides only work in arebic conditions. They do not have crossreactivity with the penicillins. Most drugs are nephrotoxic and ototoxic.
9
Q
What is the second messenger system for the receptors blocked by metoprolol? A. cAMP B. IP3 C. DAG D. cGMP E. PLC
A
A
Beta-2 receptors are coupled to the cAMP second messenger system.
10
Q
In the treatment of Parkinson's disease, what drug is given with levodopa to increase the drug's bioavailability? A. Entacapone B. Selegiline C. Carbidopa D. Fluoxetine E. Pyridoxine
A
C
Carbidopa peripherally inhibits the enzyme DOPA decarboxylase, the enzyme that converts DOPA to dopamine. Dopamine itself is unable to cross the blood-brain barrier but DOPA can. Inhibition of the enzyme results in more DOPA available to enter the CNS. Within the CNS, DOPA is converted to dopamine by the same enzyme. However, it is not inhibited by carbidopa at this location
11
Q
Which drug used in the treatment of depression possess a tricyclic ring? A. Imipramine B. Fluoxetine C. Trazodone D. Venlafaxine E. Bupropion
A
A
Imipramine is a tricyclic antidepressant.
12
Q
Which antiretroviral drug acts through the M2 ion channel? A. Efavirenz B. Nevirapine C. AZT D. Amantadine E. Indinavir
A
D
Amantadine is also effective for influenza.
13
Q
Drug X has greater affinity for albumin than Drug Y. Considering all other parameters are the same, what significant drug-drug interaction is expected to take place when both drugs are administered simultaneously?
A. Drug X will have a higher plasma concentration than Drug Y.
B. Drug Y will not be filtered by the renal glomerulus.
C. Drug Y will not be available to interact with its receptors in the tissues.
D. The free plasma drug concentration of Drug Y will increase.
E. Drug X can exert its full biologic activity.
A
D
Only the free, unbound drug can interact with receptors, exert biologic activity, and be excreted by the kidneys.
14
Q
Dissociative anesthesia is effectively achieved by the combination of:
A. Thiopental, diazepam, ketamine
B. Ketamine, nitrous oxide, fentanyl
C. Succinylcholine, thiopental, diazepam
D. Nitrous oxide, halothane, fentanyl
E. Succinylcholine, halothane, thiopental
A
B
15
Q
Among the inhaled anesthetics, nitrous oxide has the \_\_\_\_\_\_\_ MAC and the \_\_\_\_\_\_ potency. A. Lowest, lowest B. Lowest, highest C. Highest, lowest D. Highest, highest E. Intermediate, intermediate
A
C
The MAC is a measure of an inhaled anesthetic’s potency. The relationship is inverse.
16
Q
Which properties of digoxin make it an effective treatment in cases of heart failure?
A. Positive inotrope, positive chronotrope
B. Positive inotrope, negative chronotrope
C. Negative inotrope, negative chronotrope
D. Negative inotrope, positive chronotrope
E. None of the above
A
B
Digoxin also slows AV conduction (negative dromotrope)
17
Q
In anticoagulation, warfarin therapy is usually overlapped with heparin for the first 1-2 days. Why is this so?
A. To achieve supraoptimal anticoagulation during critical periods of illness as warfarin and heparin have synergistic effects.
B. To prevent bleeding as heparin partially counteracts warfarin’s hemorrhagic property.
C. Warfarin is metabolized slowly thus leading to a delay in anticoagulation if heparin is not also given.
D. To compensate for warfarin’s initial prothrombotic property.
E. Heparin decreases the clearance of warfarin thus achieving greater plasma drug concentration of warfarin.
A
D
Warfarin acts by vitamin K anatagonism. The initial prothrombotic effect of warfarin is because the synthesis of protein S, an anticoagulant, also depends on vitamin K. Thus, protein S levels decline initially and the effect of protein C (for which it serves as a co-factor) is also diminshed.
18
Q
A commercial product for colds contain the following: Phenylephrine, chlorpheniramine, and paracetamol. Which acts as the decongestant?
A. Paracetamol
B. Chlorpheniramine
C. Phenylephrine
D. Both chlorpheniramine and phenylephrine
E. This product does not contain a decongestant.
A
C
Phenylephrine constricts blood vessels through stimulation of adrenergic receptors. This acts as a decongestant
19
Q
Which antimalarial drug should not be given to a patient with glucose-6- phosphate dehydrogenase deficiency? A. Chloroquine B. Quinine C. Atovaquoneproquanil D. Mefloquine E. Primaquine
A
E
20
Q
What drug should be given to an immunocompromised patient with CMV retinitis? A. Acyclovir B. Vidarabine C. Indinavir D. Ganciclovir E. AZT
A
D
Ganciclovir is the drug of choice for CMV. Foscarnet is an alternative.
21
Q
What is the pharmacologic basis of using Timolol in open angle glaucoma?
A. Increaed outflow via dilatation of uveoscleral veins
B. It leads to opening of trabecular meshwork
C. It suppresses the ciliary epithelium from producing aqueous humor
D. lt decrease production of aqueous humor by decreasing levels of bicarbonate through cAMP mediated pathway.
E. none of the above
A
C
MOA: letter A- alpha agonist and epinephrine; B- Cholinomimetics ( physostigmine, pilocarpine) D- there is no such thing cAMP dependent decrease in bicarbonate; however inhibition of Carbonic anhydrase leads to decrease humor production via decreased bicarbonate levels.
22
Q
A 7 yo male was brought to ER secondary to symptoms suggestive of botulinum toxin ingestion, which of the following are likely included in the symptoms of the patient? A. Muscle fasciculation B. Bronchoconstriction C. Increased bowel movement D. blurred near vision E. hypertension
A
D
Botulinum toxin inhibits the release of vesicular contents from all types of cholinergic nerve endings. Since both ganglionic/autonomic and peripheral motor synapse are affected. Patient will present with hypotension and lack of muscular contraction. Blurred near vision is a result of paralysis of ciliary muscle aka cycloplegia
23
Q
Which of the following will increase the arrythmogenic side effect of digoxin? A. Decrease sympathetic discharge B. Increase serum Potassium C. Decrease serum Calcium D. Increase Parasympathetic discharge E. None of the above
A
D
hypokalemia, hypomagnesemia, hypercalcemia, and increase vagal tone increases the risk for digoxin induced arrhytmia
24
Q
Which of the following is correct regarding isosorbide mononitrate?
A. Can be use along with PDE inhibitors compared to other forms of nitroglycerin
B. It has a similar mechanism of action with Nitroprusside by phosphorylation of myosin light chain phosphate
C. It has no direct effect on cardiac muscle
D. the primary mechanism for decrease in BP is due to decrease in afterload
E. B and C are correct
A
C
ISMN is the oral form of nitroglycerin. Its mechanism is by activating guanylyl cyclase causing an increase in cGMP eventually leading dephosphorylation of MLC. Its antihypertensive effect is primarily via venodilation. It has no direct inotropic or chronotropic effect to the heart. all forms of nitroglycerin should not concomitantly use with anyform of PDEI ( sildenafil) since it will cause profound hypotension and hypoperfusion of critical organs
25
```
This drug when given IV and supraphysiologic dose will cause conduction block on AV node via increasing K efflux?
A. Verapamil IV
B. Adenosine
C. Fleicanide
D. Amiodarone
E. None of the above
```
```
B
Verapamil can also decrease AV node conduction however via blocking L type Ca channels and not K channels. Fleicanide is a class IC drug that affects primarily Na channels present in both atria and ventricles. Amiodarone is the most efficacious of all antiarrhythmic drug since it blocks Na, Ca, K and Beta receptors. the question is specific on its action in reference to AV node. the best answer is adenosine.
```
26
```
Which of the following drugs can cause prolonged QT interval leading to Torsade de Pointes arrhytmia?
A. Esmolol
B. Propafenone
C. Procainamide
D. Verapamil
E. None of the above
```
C
antiarrhytmic drugs that affects the K channel at phase 3 causes prolongation of Action Potential leading prolonged QT interval. These drugs are of the Class IA and III. Class IA drugs - procainamide, quinidine, disopyramide. Class IIIIbutilide, sotalol, dofetilide
27
```
Which in the following drugs is classified as 5HT1D agonist?
A. Tegaserod
B. Ketanserin
C. Ondansetron
D. Naratriptan
E. None of the above
```
D
Naratriptan and its prototype Sumatriptan are 5HT 1D agonist use for the treatment of acute migraine and cluster headache. Tegaserod indicated for constipation is a 5HT4 partial agonist.Ondansetron is a 5-HT3 antagonist ise for antiemesis in post operative and postchemotherapy patients. Ketanserin is a 5HT2 antagonist use for controlling the systemic effects of carcinoid syndrome.
28
```
The primary indication of Epoprostenol?
A. Open angle glaucoma - increase outflow of aqueous humor
B. Severe pulmonary hypertension
C. Postpartum bleeding
D. All of the above
E. None of the above
```
B
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE last aug 2014. Epoprostenol is a Prostacyclin analog use for dialysis to prevent platelet aggregation and also for pulmonary hypertension. Latanoprost or PGF2a analog is the one use for glaucoma. Misoprostol or RU 486 (PGE1 analog) has an off label indication for induction of labor. it primarily acts as an abortifacient
29
```
What is the site of action of corticosteroids in terms of its antiinflammatory effect?
A. Cyclooxygenase 1 and 2
B. Phospholipase C
C. Phospholipase A2
D. Thromboxane synthase
E. All of the above
```
C
Corticosteroids exerts its anti inflammatory effect by inhibiting the Phospholipase A2 enzyme which is responsible for generation of arachidonic acid from membrane lipids. Phospholipase C is not connected with corticosteroids and its function is to generate IP3 and DAG. Cyclooxygenase and thromboxane synthase is primarily inhibit by Coxibs and NSAIDS
30
```
the major systemic side effects of systemic corticosteroids are much more likely to occur if at least the duration of treatment is more than_____?
A. 14 days
B. 4 weeks
C. 3 weeks
D. 20 days
E. 2 months
```
A
| Katzung Review of pharmacology 8th ed pp 171. .
31
```
What is the most serious side effect of Methanol ingestion?
A. Retinal damage
B. Hepatotoxicity
C. Blood dyscrasia
D. Nephrotoxicity
E. Neurotoxicitystatus epilepticus
```
A
Methanol or wood alcohol is metabolized by alcohol dehydrogenase to produce a product called Formaldehyde and formic acid. This metabolite causes severe acidosis and prominent retinal damage. Nephrotoxicity is a major side effect of ethylene glycol poisoning via its oxalic acid metabolite. treatment for both alcohol is by administration of Fomepizole ( inhibitor alcohol dehydrogenase) and ethanol ( competitive substrate for alcohol dehydrogenase)
32
```
which of the following antiseizure drugs can inhibit cytochrome isoenzymes leading to increase plasma concentration of other drugs?
A. Phenobarbital
B. Lorazepam
C. Oxcarbazepine
D. Valproic acid
E. None of the above
```
D
Oxcarbazepine, carbamazepine, Barbiturates, Phenytoin are all drug metabolizing inducers. Only Valproic acid in the choice is an inhibitor. Benzodiazepines do not affect the function of the cytochromes.
33
```
Which of the following antiparkinsonian drugs can cause exacerbation of psychosis and produce ergot related effects such as pulmonary fibrosis and erythromelalgia
A. Amantadine
B. Bromocriptine
C. Entacapone
D. Haloperidol
E. None of the above
```
B
Katzung Review of pharmacology 8th ed pp 233. Both Levodopa and bromocriptine can cause exacerbation of schizophrenia by increasing brain dopamine levels. However, only bromocriptine can cause ergot related side effects.
34
```
Prolonged treatment with a PPAR alpha ligand in the treatment of hyperlipidemia will increase the risk for the following condition?
A. Cutaneous flushing
B. Hyperuricemia leading to Gout
C. Intestinal malabsorption
D. Gallstones
E. hepatotoxicit
```
D
PPAR alpha ligands is the MOA of fibric acid derivatives ( Gemfibrozil and fenofibrate). It increases the supersaturation of bile leading cholelithiasis. Risk for hepatotoxicity only significantly increase if gemfibrozil is combined with HMG CoA inhibitor. Cutaneous flushing and hyperuricemia are toxicity profile of Niacin. Intestinal malabsorption is a primary side effect of resins ( cholestyramine, colestipol, colsevelam)
35
Which of the following is not true in the pharmacologic profile of Aminoglycosides?
A. The primary mechanism of resistance is due to plasmid mediated group transferases
B. Bactericidal action continuous even if the plasma drug concentration is below measuring levels
C. It does not have an activity against anaerobic organisms
D. high dose can cause respiratory paralysis
E. none of the above
E
Aminoglycoside exerts concentration dependent killing and post antibiotic effect. It also has curare like action at high dose leading to respiratory paralysis. Aminoglycosides needs Oxygen dependent transport to exerts inhibitory effect 30s ribosome. therefore, it has no activity to anaerobes. acetylation by plasmid mediated group transferase is the major mode of resistance.
36
```
Which of the following is a drug of choice for daily dose prophylaxis in AIDS patient with a CD4 count of 50/UL?
A. Cotrimoxazole
B. Kanamycin
C. Azithromycin
D. Erythromycin
E. Clarithromycin
```
E
AIDS patient with a CD4 count of less than 50/UL are prone to have Mycobacterium Avum Intracellulare infection. The only approved prophylactic treatment are daily dose of clarithromycin with or without rifabutin and once weekly dose of azithromycin
37
```
Which in the following choices can be primarily use for the treatment of hemolymphatic stage of trypanosomiasis and for Pneumocystis jiroveci infection
A. Sodium Stibogluconate
B. Metronidazole
C. Nifurtimox
D. Pentamidine
E. Cotrimoxazole
```
D
Sodium stibogluconate - treatment of all forms of leishmaniasis infection; Metronidazole is not effective in the said infection, it is use for giardia and trichomonas infection. Nifurtimox is for chagas diseae ( T cruzi infection). Cotrimoxazole is used for P jiroveci but not effective in Trypanosomiasis infection
38
```
What is the drug of choice for all forms of schistosomiasis and paragonimiasis?
A. Diethylcarbamazine
B. Praziquantel
C. Ivermectin
D. Albendazole
E. Piperazine
```
B
DEC is the drug of choice for loa loa infection, it is also an alternative drug for elephantiasis. Ivermectin - DOC for onchocerciasis, cutaneous larva migransm and strongyloides. Albendazole- ascariasis, hookworm, pinworm, whipworm, cysticercosis and hydatid disease. Piperazine is an alternative drug for ascariasis.
39
```
In what phase of the cell cycle does vinca alkaloid exerts its effect?
A. G0
B. G1
C. S
D. G2
E. M
```
```
E
Vinca alkaloids ( vinblastine, vincristine, vinorelbine) blocks the formation of mitotic spindle by preventing the assembly of tubin dimers into microtubules. Therefore it acts on the M phase.
```
40
Which of the following drugs/drug regimen is primarily used for Hodgkin's Lymphoma
A. ABVD- adriamycin, bleomycin, vincristine, dacarbazine, prednisone
B. PEB - cisplatin, etoposide, bleomycin
C. Gemcitabine + 5 FU + radiation
D. EMACO- etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine
E. all of the above
A
B- testicular cancer, C- pancreatic cancer, D- choriocarcinoma. Aug 2014 SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE.
41
```
25 year old female came in with chief complaint of cough of 3 weeks duration, this was accompanied by night sweats, weight loss, body malaise. PE revealed slightly pale palpebral conjunctiva, multiple bilateral posterior cervical lymphadenopathies but with no adventitious breath sounds on bilateral lung fields. The rest of the physical examination was unremarkable, which of the following drugs is considered to be the most active for her condition?
A. Rifampicin
B. Isoniazid
C. Pyrazinamide
D. Ethambutol
E. streptomycin
```
B
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE.,Considered as the most active anti-TB drug, in fact the only drug given to treat latent tuberculosis
42
```
A 56 year old patient diagnosed with rheumatic heart disease underwent mitral valve replacement and is placed on oral anticoagulant Warfarin, she comes to your clinic for a follow up check up and complaints of heartburn and epigastric pain, which of the following medications will you avoid prescribing?
A. Cimetidine
B. Aluminum Magnesium Hydroxide
C. lansoprazole
D. ranitidine
E. sucralfate
```
A
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, which asked us directly which of the following is a CYP inhibitor: cimetidine, Warfarin is majorly metabolized by CYP 2C9, cimetidine inhibits this enzyme among others which inhibits warfarin metabolism which increases its toxicity
43
```
Which of the following medications is considered as an inhibitor of glucocorticoid synthesis which could be used in the treatment of cushing's syndrome and some types of cancers?
A. Methylprednisolone
B. anastrozole
C. Danazol
D. Aminogluthetimide
E. Flutamide
```
D
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, I couldnﾒt believe this was actually asked, aminoglutethimide inhibits desmolase blocking conversion of cholesterol to pregnenolone reduces synthesis of all hormonally active steroids, anastrozole inhibits only estrogen synthesis, danazol is an androgen, flutamide is androgen antagonist
44
```
Which of the following drugs can cause cataract formation?
A. allopurinol
B. pyrazinamide
C. propanolol
D. omeprazole
E. ciprofloxacin
```
A
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, one of the hardes pharma questions we encountered, we did not know at that time that allopurinol was associated with cataracts :)
45
```
Which of the following chemotherapeutic regimens could be used for the treatment of advanced hodgkin's disease?
A. FOLFOX
B. MOPP
C. CHOP
D. 7+3
E. BEP
```
B
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE - MOPP nitrogen mustard, oncovin, procarbazine, prednisone, take time to know the common regimens for other cancers as well, ex: folfox colorectal, CHOP nonhodgkins, BEP testicular, 7+3 AML
46
```
Which of the following medications causes mydriasis but without cycloplegia?
A. tropicamide
B. homatropine
C. cylopentolate
D. phenylephrine
E. atropine
```
D
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE also a difficult one, only phenylephrine among the choices causes mydriasis without affecting accomodation
47
```
When a pregnant 18 year old female delivered her child, her baby was noted to have characteristic small palpebral fissures, smooth philtrum and thin upper lip, which of the following substances when ingested by the mother during pregnancy could potentially be the cause of such changes?
A. phenytoin
B. warfarin
C. ethanol
D. captopril
E. isotretinoin
```
C
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, know the common syndromes and teratogen, answer here is fetal alcohol syndrome
48
What is the predominant reason why nitroglycerin is generally preferred not to be given via the oral route?
A. could potentially cause dangerous systemic hypotension
B. is considerably less effective when given through this route
C. is immediately inactivated by exposure to low gastric pH
D. there is high first pass effect
E. food in the stomach significantly retards absorption
D
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, high first pass effect is the best answer, low bioavailability through the oral route due to liver metabolism
49
```
Which of the following is an inhalational anesthetic of choice for asthmatic patient because it causes the least bronchospasm?
A. halothane
B. desflurane
C. sevoflurane
D. thiopental
E. propofol
```
A
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, halothane generally is the inhaled agent of choice, sevoflurane is debatable, desflurane is pungent, the others are IV anesthetics
50
```
Which of the following drugs given contains an effect which suppresses nausea and vomiting ?
A. propanolol
B. procarbazine
C. chlorambucil
D. chlorpromazine
E. chloramphenicol
```
```
D
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, difficult because chlorpromazine usually is used as a antipsychotic but has antiemetic effects belonging to the phenothiazine class along with other drugs used to control nausea vomiting like promethazine
```
51
```
Which of the following medications could be given to high risk or immunocompromised patients with RSV infections?
A. Acyclovir
B. Fosamprenavir
C. Indinavir
D. Ganciclovir
E. Ribavirin
```
E
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, acyclovir and ganciclovir for herpes group, indinavir and fosamprenavir for hiv
52
```
Using drugs to block which of the following chemical mediators could potentially decrease leukocyte chemotaxis?
A. prostaglandin H
B. cyclooxygenase
C. bradykinin
D. leukotrienes
E. serotonin
```
D
| SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, but leukotrienes could also serve as chemotactic factors
53
A patient is taking fenofibrate for elevated trigylceride levels, which of the following laboratory examinations should the doctor request to monitor for potential side effects upon follow up after 3 to 6 months?
A. CBC with differential count
B. urinalysis C. AST, ALT
D. fasting blood glucose levels
E. serum total cholesterol and triglycerides
C
| SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, fibrates can potentially increase liver enzymes
54
```
Which of the following medications can be used as part of a regimen for migraine prophylaxis?
A. ibuprofen
B. acetaminophen
C. sumatriptan
D. propranolol
E. dihydroergotamine
```
D
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, prophylaxis: pizotifen, TCA, anticonvulsants and beta blockers, methysergide, flunarizine
55
```
Which of the following medications can decrease conduction through the AV node?
A. nifedipine
B. verapamil
C. lithium
D. prazosin
E. dypyridamole
```
B
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, verapamil is a non dihydropyridine calcium channel blocker which exerts its actions more on the heart decreasing AV nodal conduction
56
```
A 24 year old female is taking oral contraceptives as family planning method. Which of the following drugs is considered a CYP450 enzyme inducer which can cause rapid metabolism of other drugs such as oral contraceptives which can potentially decrease their effectiveness?
A. isoniazid
B. trimethoprim sulfamethoxazole
C. griseofulvin
D. Amiodarone
E. ketoconazole
```
C
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, what came out as an enzyme inducer in ours was phenobarbital, griseofulvin is an inducer all the others are inhibitors, memorize at least the most common of them inducers and inhibitors, topnotch handouts are good reference
57
```
Which of the following chemotherapeutic agents can produce pulmonary fibrosis as toxicity?
A. bleomycin
B. doxorubicin
C. irinotecan
D. etoposide
E. carmustine
```
A
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, know the characteristic adverse effects and toxicities, the peculiar ones, the ones that make the drugs famous, pulmo fibrosis = bleomycin
58
```
Which among the following cardiac drugs can decrease preload, afterload and contractility?
A. digoxin
B. captopril
C. amlodipine
D. Hydrochlorthiazide
E. propranolol
```
E
know the mechanism understand them, know and master normal physiology, digoxin is a negative chronotropic but positive inotropic inc contractility, captopril inhibits ACE, acts on the RAAS decreases preload by decreasing aldosterone and sodium water retention hence decrease blood volume dec venous return, amlodipine calcium antagonist predominantly on the vessels decrease afterload by dilating resistance vessels, hydrochlorthiazide decreases preload by increasing secretion of both sodium water, propranolol, non selective beta blocker, decreases renin secretion hence RAAS through B1 blockage this includes angiotensin 2 so decreased both preload afterload, decreases contractilitty through B1 blockade,
59
```
Which of the following antibiotics are highly protein bound which can act to displace other substances from albumin binding and increase free drug levels
A. chloramphenicol
B. ciprofloxacin
C. cotrimoxazole
D. tetracycline
E. gentamicin
```
C
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, sulfa drugs are usually highly protein bound drugs which can displace other drugs making the free drug available to easily permeate cell membranes or bind to receptors, it can also displace bilirubin from albumin raising bilirubin levels in neonates
60
```
Which of the following drugs with mechanism of action that inhibits protein synthesis by inhibiting binding of the tRNA to the mRNA ribosome complex
A. tetracycline
B. clindamycin
C. gentamycin
D. erythromycin
E. chloramphenicol
```
A
| SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, please know the mechanism of action of each drug class
61
```
If a single dose of a known drug with first order elimination is given intravenously, how long will it take for 75% of the drug to be eliminated if the half-life is 1.5 hours?
A. 1.5 hours
B. 2 hours
C. 2.5 hours
D. 3 hours
E. 6 hours
```
D
| Review first-order elimination. 50% is one half-life, 75% is 2 X half-life and so on..
62
```
Which of the following teratogenic effects is associated with valproic acid use in pregnancy?
A. Craniofacial anomalies
B. Neural tube defects
C. Ebstein anomaly
D. Fetal hydantoin syndome
E. Microcephaly
```
B
| A is carbamazepine; C is Lithium, D is phenytoin
63
```
You are assigned to go on duty as an intern of the toxicology department of the hospital. You recall that activated charcoal will NOT be effective adsorbing which of the following?
A. Iron
B. Theophylline
C. Phenobarbital
D. Amitryptiline
E. Digoxin
```
A
| Iron, lithium, cyanide, alcohol are poorly adsorbed by activated charcoal
64
```
Which of the following Cholinomimetic drugs are used exclusively in the treatment of Alzheimer's disease?
A. Donepezil
B. Physostigmine
C. Rivastigmine
D. A and B
E. A and C
```
E
| Donepezil, Rivastigmine, Tacrine used exclusively in Alzheimer's
65
```
You prescribe a cancer patient who is undergoing chemotherapy with allopurinol to address hyperuricemia. Upon reviewing his chart, you realize caution is needed because of risk of toxicity. Which of the following chemotherapeutic drus is most likely being given to the patient?
A. Azathioprine
B. Methotrexate
C. Fluorouracil
D. Cytarabine
E. All of the above
```
A
| Azathioprine/Mercaptopurine metabolism is inhibited by allopurinol.
66
```
Adrenoreceptor blockers such as acebutolol and pindolol are unique for having intrinsic sympathetic activity. What is meant by this characteristic?
A. has a membranestabilizing activity
B. has partial agonist activity
C. has receptor selectivity
D. A and B
E. All of the above
```
B
67
```
Which of the following drugs that used in gout has been associated with cataract formation?
A. Colchicine
B. Allopurinol
C. Probenecid
D. Indomethacin
E. Acetaminophen
```
B
| SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE
68
```
You are treating a patient HIV-patient for an opportunistic viral infection affecting the eyes. If you suspect viral strains that are thymidine-kinase deficient, you decide to choose an antiviral drug that is exclusively phosphorylated by host cell kinases but which doesn't require viral kinase phosphorylation. Which of the following will you choose?
A. Acyclovir
B. Ganciclovir
C. Cidofovir
D. Foscarnet
E. Lamivudine
```
C
Cidofovir is phosphorylated by host kinases while Foscarnet doesnﾒt reqauire phosphorylation. Both are used in thymidine-deficient resistant strains of CMV
69
A 63 year old male patient presenting with intermittent complaints of chest pain upon walking several blocks or climbing several flights of stairs is prescribed with nitroglycerin to used on an as needed basis. What will be the expected physiologic changes as a result of this drug?
A. Increased HR and and decreased left ventricular end-systolic volume
B. Decreased HR and decreased left ventricular end-systolic volume
C. Decreased HR and increased left ventricular end-systolic volume
D. Increased HR and increased left ventricular end-systolic volume
E. None of the above
A
Nitroglcerin decreases afterload, thus, decreasing end systolic volume. Compensatory sympathetic activity increases heart rate.
70
Which of the following mechanism indicates high-level resistance in a TB patient being treated with Isoniazid?
A. deletions in inhA gene that encodes target enzyme
B. changes in drug sensitivity to RNA polymerase
C. expression of drug efflux system
D. expression of inactivating enzymes
E. deletion in katG gene involved in the bioactivation of the drug
E
| E is INH high level resistance; A is INH low level resistance; B is rifampicin resistance
71
```
A drug with diuretic activity is being studied based on its effects on electrolyte levels in the urine. It was found to moderately increase urine NaCl and urine K while decreasing urine Ca with associated slight increase in body pH and minimal change in urine HCO3-. This drug has characteristics similar to that of?
A. Loop diuretic
B. Carbonic anhydrase inhibitor
C. K-sparing diuretic
D. Thiazide diuretic
E. Osmotic diuretic
```
D
| Thiazide increases Na and K excretion and causes metabolic alkalosis. It increases Ca reabsorption
72
```
Which of the following steroid antagonists inhibits cytochrome P450 enxymes necessary for all steroids?
A. Ketoconazole
B. Aminogluthetimide
C. Metyrapone
D. Spinorolactone
E. Mifepristone
```
A
Ketoconazole is a potent cytochrome p450 inhibitor. Aminoglutethimide inhibits conversion of cholesterol to pregnenolone. Metyrapone inhibits cortisol synthesis. Spinorolactone inhibits aldosterone. Mifepristone inhibits progesterone
73
```
A patient with warfarin as a maintenance medication is treated for pneumonia. Prothrombin time monitoring during treatment of the respiratory infection reveals elevated INR but it decrease back to baseline levels after treatment with the antibiotic is completed. Which of the following is most likely given?
A. Amoxicillin
B. Ceftriaxone
C. Clindamycin
D. Erythromycin
E. TMP-SMX
```
D
| Erythromycin inhibits metabolism of warfarin causing an increase In INR
74
```
A COPD patient with severe concomitant heart condition is being prescribed a drug that will relieve his dyspnea and shortness of breath. Which of the following bronchodilators will be the primary choice?
A. Salmeterol
B. Salbutamol
C. Terbutaline
D. Atropine
E. Ipratropium
```
E
| Ipratoropium is an anticholinergic used in COPD because of less cardiac effects
75
```
A physician prescribes a diabetic patient with an antidiabetic agent that activates a nuclear receptor that increases transcription of GLUT-4 transporters in adipose tissue. The drug prescribed is most likely:
A. Methotrexate
B. Insulin
C. Pioglitazone
D. Glyburide
E. Sitagliptin
```
C
| Thiozolidinediones - activates PPAR, a nuclear receptor to improve sensitivity to insulin
76
```
A patient presented to your clinic with complaints of dyspnea and chronic cough. He states that he frequently gets short of breath and is unable to take a deep breath. History is significant for prolonged treatment of rheumatoid arthritis. Chest X-ray revealed fine reticulonodular densities. Which drug is most likely responsible?
A. Glucocorticoids
B. Methotrexate
C. Infliximab
D. Cyclosporine
E. Anakinra
```
B
| Methotrexate is known to cause pulmonary fibrosis
77
```
If you need to give a skeletal muscle relaxant to a burn patient, you will AVOID prescribing which of the following drugs?
A. Pancuronium
B. Baclofen
C. Dantrolene
D. Vecuronium
E. Succinylcholine
```
E
| Succinylcholine is contraindicated in patient with rhabdomyolysis, hyperkalemia, burn patients, malignant hyperthermia
78
```
Which of the following medications exert its anticoagulant effect through the inactivation of thrombin?
A. Fondaparinux
B. Unfractionated heparin
C. Low molecular weight heparin
D. Apixaban
E. All of the above
```
B
Fondaparinux and LMW heparin combines with antithrombin and selectively inhibits factor X but NOT thrombin. Apixaban is a direct Xa inhibitor
79
```
One of the following drugs is effective in reducing the risk of ulcers in chronic NSAID users. Diarrhea is a frequent side effect. Which is it?
A. Sucralfate
B. Ranitidine
C. Omeprazole
D. Misoprostol
E. Cimetidine
```
D
80
Knowledge of potency and solubility is important in general anesthetic medications. Which of the following characteristics refers to high potency?
A. Low minimum alveolar concentration
B. High minimum alveolar concentration
C. Low blood:gas partition coefficient
D. High blood:gas partition coefficient
E. None of the above
A
Low MAC - high potency; High MAC - low potency; Low blood:gas coefficient - low solubility; High blood:gas coeeficient - high solubility
81
```
Which of the following anti hypertensive medications when taken during pregnancy can cause hypocalvaria in the fetus?
A. Carvedilol
B. Amlodipine
C. Captopril
D. HCTZ
E. Hydralazine
```
C
Intake of ACE inhibitors can produce teratogenic effect in the fetus which includes renal dysgenesis and hypoplastic skulls (hypocalvaria) thus it is contraindicated during pregnancy
82
```
A 29 year old woman presented with amenorrhea, galactorrhea and loss of sexual libido. On evaluation her serum prolactin was noted to be markedly elevated. Which of the following medications is most useful in the treatment of her condition?
A. Bromocriptine
B. Cimetidine
C. Sumatriptan
D. Ergotamine
E. Ondansetron
```
A
Bromocriptine is an effective dopamine agonist in the CNS with the advantage of oral activity. The drug inhibits prolactin secretion by activating pituitary dopamine receptors
83
```
A 47 year old obese male, who is a heavy alcoholic beverage drinker, was recently diagnosed with diabetes mellitus. He was started on Metformin 500 mg/tab TID. This patient is at risk of developing which of the following complications?
A. Hypoglycemia
B. Disulfiram like reaction
C. Congestive heart failure
D. Lactic acidosis
E. Diarrhea
```
D
Metformin is associated with lactic acidosis. It should be avoided or used with extreme caution in patients who are heavy alcoholics since acute ethanol ingestion increaes the risk of lactic acidosis
84
```
A 65 year old female presented to the ER due to progressive dyspnea. She is a known hypertesive but is poorly compliant with medications. On history, patient claims to experience orthopnea, paroxysmal nocturnal dyspnea and easy fatigability. On PE, her BP is 80/50. There is prominent neck vein distention. S3 gallop, bibasal crackle and a grade 3 bipedal edema were also appreciated. A 2d echo was done which showed a depressed ejection fraction of 32%. Which of the following medications should not be given at this time for this patient ?
A. Furosemide
B. Digoxin
C. Metoprolol
D. Dobutamine
E. None of the above
```
C
This is a case of an acute decompensated heart failure. Due to the marked systolic dysfunction as evident by a depressed ejection fraction, beta blockers are contraindicated at this time as it may further lower the cardiac output.
85
```
A 75 year old male was brought to the ER due to sudden onset of right sided weakness accompanied by a progressive deterioration in sensorium. On PE, BP was elevated at 220/100. Neurologic exam showed a GCS of 11, an MMT of 2/5 on the both right upper and lower extremities and a positive babinski on the right. A CT scan showed a massive intracerebral hemorrhage involving the left basal ganglia. A diuretic was started to decrease the patient's intracranial pressure. Which of the following is an associated adverse effect of this medication ?
A. Ototoxicity
B. Hyperlipidemia
C. Gynecomastia
D. Pulmonary Edema
E. Thrombocytosis
```
D
Mannitol is used to decrease the ICP in patient's with hemorrhagic stroke. It acts as an osmotic diuretic thus removes water from the intracellular compartment. This rapid fluid shifting may cause hyponatremia and pulmonary edema and as the water is excreted, hypernatremia may follow.
86
```
Which of the following is an orally active direct thrombin inhibitor?
A. Apixaban
B. Rivaroxaban
C. Enoxaparin
D. Fondaparinux
E. Dabigatran
```
E
| Apixaban and Rivaroxaban are both oral Factor Xa inhibitors. Enoxaparin and Fondaparinux are both SC factor Xa inhibior.
87
A 48 year old female, a known case of Acute Myelogenous Leukemia (AML), who is on reinduction chemotherapy was started on anti viral prophylaxis with Valacyclovir 500 mg/tab TID. What is the mechanism of action of this anti viral medication?
A. Inhibition of Viral DNA polymerase
B. Blockage of M2 proton channel
C. Inhibition of neuraminidase
D. Inhibition of viral reverse transcriptase
E. Prevents fusion of virus with the host cellular membrane
A
Valaciclovir is a prodrug, an esterified version of aciclovir that has greater oral bioavailability (about 55%) than aciclovir (10ﾖ20%). It is phophorylated three times and this form acts as a competitive substrate for DNA polymerase and it leads to chain termination
88
```
Which of the following drugs of abuse is non addictive?
A. Amphetamine
B. Cocaine
C. Morphine
D. LSD
E. Heroin
```
D
Some drugs of abuse do not lead to addiction. This is the case for substances that alter perception without causing sensation of reward and euphoria. These include LSD, Phencyclidine and ketamine
89
```
A 70 year old male who is diagnosed with Colon Cancer Stage IV with metastasis to the liver who is currently on FOLFOX regimen was started on a monoclonal antibody which binds to the vascular endothelial growth factor (VEGF) receptor. What is the medication that was given to the patient?
A. Imatinib
B. Sorafenib
C. Trastuzumab
D. Bevacizumab
E. Erlotinib
```
D
Imatinib is a tyosine kinase inhibitor used in CML. Sorafenib inhibit multiple tyrosne kinase receptors and are primarily used in HCC. Trastuzumab inhibits cells that overexpress the Her- 2/neu recepto in Breast CA. Erlotinib inhibits epidermal growth factor receptor and is used for non small cell lung CA and pancreatic cancer
90
```
Which of the following medications can be given once a week for prophylaxis against bactermia caused by M. avium complex (MAC) in AIDS patients?
A. Azithromycin
B. Kanamycin
C. Ethambutol
D. Rifampicin
E. Cycloserine
```
A
because of its long elimination half life (3-4 days), weekly administration of azithromycin has proved to be equivalent to daily administration of clarithromycin when used for prophylaxis against MAC in AIDS
91
```
A 37 year old female diagnosed with chronic schizophrenia maintained on an antipsychotic medication was brought to the clinic due to a 3 day history of fever. PE showed presence of tonsillar exudates. A CBC was requested which showed a markedly decreased WBC count. The medication was immediately discontinued by the patient's physician. What is the antipsychotic medication that could have caused this problem?
A. Haloperidol
B. Quetiapine
C. Clozapine
D. Risperidone
E. Olanzapine
```
C
Clozapine can cause agranulocytosis in a small but significant number of patients (1-2%). This serious, potentially fatal effect can develop rapidly usually between the 6th to 18th week of treatment. It appears to be reversible upon discontinuation of treatment. Because of this risk, patient on clozapine must have weekly blood counts for the first 6 months of treatment and every 3 weeks thereafter
92
What is the major advantage of Etomidate over other intravenous anesthetics?
A. Has greater analgesic effects
B. Causes minimal cardiovascular and respiratory depression
C. Relatively longer duration of effect
D. Has a lower incidence of postoperative nausea and vomiting
E. Has a rapid onset of recovery when compared with Propofol
B
Etomidate has no analgesic effects. Distribution is rapid from the brain to highly perfused tissue hence a relatively short duration of its anesthetic effect. It has a high incidence of postoperative nausea and vomiting, pain and myoclonic activity. Initial recovery is less rapid compared with propofol
93
```
A 24 year old female G1P0, 12 weeks AOG, sought consult due to purulent vaginal discharge and dyspareunia. Gram stain of the vaginal discharge showed intracellular gram negative diplococci. The patient disclosed that she had a severe allergic reaction to amoxicillin a year ago. Which of the following is the safest antibiotic for this case ?
A. Doxycyline
B. Ciprofloxacin
C. Ceftriaxone
D. Gentamicin
E. Azithromycin
```
E
Cephalosporins should be avoided in patients with history of severe allergic reaction to penicillin. FQ and doxycycline are avoided in pregnancy since it can cause cartilage and bone damage. Azithromycin, a macrolide antibiotic is the safest drug for this case.
94
```
Which of the following is a major adverse effect associated with use of fenofibrates?
A. Constipation
B. Gallstones
C. Hyperuricemia
D. Cardiac arrythmia
E. Liver damag
```
B
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE. A major toxicity of fenofibrates is increased risk of gallstone which may be due to enhanced biliary excretion
95
```
A 45 year old male presented to the ER due to sudden onset of right eye pain accompanied by blurring of vision. On examination there was note of ciliary injection over the right eye, IOP pressure was noted to be elevated. A diagnosis of acute angle closure glaucoma was made. Which of the following ophthalmic medications should be avoided ?
A. Brinzolamide
B. Timolol
C. Apraclonidine
D. Atropine
E. All of the above
```
D
| Atropine is a mydriatic and cyloplegic and can further increase IOP hence worsen angle closure glaucoma.
96
```
Which of the following beta blockers possess intrinsic sympathomimetic activity?
A. Metoprolol
B. Esmolol
C. Pindolol
D. Acebutolol
E. Both C and D
```
E
| Acebutolol and Pindolol have partial agonist activity (ISA)
97
```
Which of the following drugs is used to induce ovulation in anovulatory women by selectively blocking estrogen receptors in the pituitary, thus increasing FSH and LH output?
A. Raloxifene
B. Clomiphene
C. Fulvestrant
D. Anastrozole
E. Progestins
```
B
| SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE
98
```
A 39 year old female, known case of Graves' disease but poorly compliant with medications, presented to the ER due to palpitations and shortness of breath. She was hooked to a cardiac monitor which showed supraventricular tachycardia. Which of the following drugs would be most suitable for this case ?
A. Esmolol
B. Quinidine
C. Flecainide
D. Disopyramide
E. Lidocaine
```
A
| beta blockers are the most effective agents in acute thyrotixc arrythmias . Esmolo is a rapid parenteral beta blocker
99
```
A 67 year old woman, known diabetic for 20 years and maintained on Gliclazide, complained of severe bloating and post prandial fullness. Evaluation was done and she was assessed to have diabetic gastropathy. Which of the following medications would be most appropriate for this case?
A. Cimetidine
B. Metoclopramide
C. Alosetron
D. Loperamide
E. Bismuth subsalicylate
```
B
| Metoclopramide is DOC for diabetic gastropathy
100
```
Which drug when taken together with Azathioprine has resulted in severe myelosupression by inhibiting the enzyme responsible for its metabolism ?
A. Theophylline
B. Celecoxib
C. Allopurinol
D. Digoxin
E. Rifampicin
```
C
Azathioprine is converted to mercaptopurine which is responsible for its immunosuppressant and hematotoxicity. Allopurinol inhibits xanthine oxidase, the enzyme that metabolizes mercaptopurine.
101
```
During anaphylaxis, administration of IM epinephrine is essential because of its bronchodilatory effect in the lungs. How does epinephrine acts to produce such an effect in this particular condition?
A. Chemical antagonist
B. physiologic antagonist
C. partial agonist
D. noncompetitive antagonist
E. none of the above
```
B
physiologic antagonist binds to a different receptor molecules producing an effect opposite to that produced by the drug it antagoniszes. It differs from a pharmacologic antagonist, which interacts with the same receptors as the drug it is inhibiting. the antagonism of bronchoconstrictor effect of histamine ( through histamine receptors) by epinephrine bronchodilator action ( beta receptors). chemical antagonist - reacts directly with the drug being antagonized to remove it or to prevent it from reaching its target. Katzung review 8th ed p 13.
102
```
which of the following drugs exhibit zero order kinetics ?
A. Ethanol
B. tolbutamide
C. warfarin
D. heparin
E. All of the above
```
E
zero order kinetics refers to a contant rate of elimination of a drug regardless of its concentration. The following drugs exhibit zero order kinetics: aspirin, ethanol, warfarin,heparin, penytoin, tolbutamide, theophyline phenylbutazone, and salicylates.
103
```
The following drugs promote induction of liver CYP enzymes except ?
A. Rifampin
B. Carbamazepine
C. Phenylbutazone
D. Disulfiram
E. Glutethimide
```
D
CYP inducers enhances drug metabolism. Ex. Benzopyrene, carbamazepine, chlorcyclizine, glutethimide, griseofulvin, phenobarbital, phenylbutazone, phenytoim, rifampin, ritonavir ( chronic administration, acute -acts as inhibitor), st johns wort. Katzung 11th ed p 64-65.
104
```
which of the following effects in parathion poisoning will not be antagonized by timely administration of pralidoxime?
pralidoxime?
A. cyclospasm
B. Urinary incontinence
C. convulsion
D. Negative dromotrophy
E. None of the above
```
C
pralidoxime is a chemical antagonist acting as cholinesterase regenerator. It cannot enter the BBB because of its positively charged group and poor lipid solubility. Katzung review pp 69
105
```
Among the beta adrenergic blockers, which of the following will less likely to cause bradycardia and increased VLDL concentration?
A. metoprolol
B. nebivolol
C. carteolol
D. labetalol
E. None of the above
```
C
pindolol, acebutolol, carteolol, bopindolol, penbutolol,celiprolol are the beta blockers having also partial b agonist activity ( intrinsic sympathomimetic activity). The advantage of this property is that it is less likely to cause elevation of plasma lipids without affecting its antihypertensive effect. Katzung 11th ed p 159
106
```
which of the following changes will promote digitalis induced cardiototoxicity?
A. Acute tubular necrosis
B. hypermagnesemia
C. hyperparathyroidism
D. Triamterene administration
E. All of the above
```
C
any condition that can predisposed to hyperkalemia, hypermagnesemia and hypocalcemia will inhibit the binding of digitalis to Na K ATPase resulting to decrease toxicity. Triamterene and ATN can induce hyperkalemia. Katzung 11th ed p 216.
107
```
which of the following drugs is highly selective to ischemic or prolonged depolarized purkinje fibers?
A. Mexiletine
B. Procainamide
C. Propafenone
D. ibutilide
E. None of the above
```
```
A
phenytoin, lidocaine and mexiletine are classified as class IB antiarrhythmics. This group affects primarily ischemic or depolarized ventricular tissue and does not have any use in atrial arrhytmia. Bprocainamide is a class IA drug, Cpropafenone is a Class IB agent, Dibutilide is class III drugs.
```
108
```
which of the following effects of acetazolamide is self limiting?
A. Sodium reabsorption
B. Tubular bicarbonate excretion
C. CSF acidosis
D. Aqueous humor production
E. None of the above
```
B
the major effect of acetazolamide is bicarbonate diuresis resulting to metabolic acidosis. As increased sodium is presented to the cortical collecting tubule, some of the excess sodium is reabsorbed and potassium is secreted resulting to significant potassium wasting. as a result of bicarbonate depletion, sodium bicarbonate excretion slows even with continued administration. Katzung review 8th ed p 135
109
A 39 y/o male went for follow up consult secondary to open angle glaucoma. He was compliant with all the topical medications given to him. Indirect ophthalmoscopy revealed brownish discoloration in his iris. What is the mechanism of action of the drug that
causes such change?.
A. decrease aqueous secretion due to lack of HCO3
B. increase outflow via uveoscleral veins
C. increase aqueous outflow
D. decrease aqueous secretion from the ciliary epithelium
E. none of the above
C
dermanent discoloration of the iris and eyelashes is a well known side effect of latanoprost. Its mechanism of action is to increase aqueous outflow. Abrinzolamide, dorsolamide, Bepinephrine. D- timolol. Katzung review p 87
110
```
which in the following antipsychotic medications has the greatest risk of inducing Torsades de pointes arryhthmia?
A. Fluphenazine
B. Clozapine
C. Thioridazine
D. Ziprasidone
E. Haloperidol
```
D
Olanzapine -weight gain, clozapine - agranulocytosis, haloperidolextrapyramidal symptoms. Thioridazine - retinal deposits. Among the atypical antipsychotics, ziprasidone has the greatest risk of inducing QT prolongation leading to ventricular arrhythmias. Kazung review p 242
111
Which of the following is true about Buspirone?
A. Anxiolytic effect is secondary to direct stimulation of GABAergic neurons
B. It is highly effect in acute panic attacks
C. Less psychomotor retardation
D. Abrupt discontinuation can lead acute withdrawal syndrome
E. all of the above
C
Buspirone is a selective anxiolytic medication that does not cause, sedative, hypnotic, euphoric, and acute withdrawal or rebound effect. It has no effect in psychomotor skills (driving skills). The mechanism of anxiolysis is secondary to partial antagonism to 5HT1A receptors in the brain. it has no direct GABAergic activity. weeks are needed before buspirone takes effect, therefore, it is not effect in treating acute panic attacks. Katzung 11ed p374.
112
```
what is the recommended treatment for a 29 y/o G1PO female diagnosed with Gonnorrhea infection who has severe hypersensitivity to pennicilin?
A. erythromycin
B. Spectinomycin
C. Cetriaxone
D. Doxycycline
E. Clindamycin
```
B
single dose administration of spectinomycin is effective in treating Gonnorhea in a patient who has severe beta lactam hypersensitivity. It has lesser risk of teratogenicity compared to conventional aminglycosides. Clindamycin is active only on gram positive and anaerobic organisms. ceftriaxone is a 3rd generation cephalosporin effective against Gonorrhea infection however it should be avoided since the patient has beta lactam hypersensitivity. Doxycycline should never be given for pregnant patients. erythromycin is not effective treatment for gonorrhea infection. Katzung 11th ed p 813.
113
```
the pungency of this inhaled anesthetics leading breath-holding limits it use in anesthesia induction?
A. desflurane
B. Isoflurane
C. Sevoflurane
D. enflurane
E. Halothane
```
D
| (SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE) Katzung review 8th ed p 211
114
```
what is the drug of choice for restless leg syndrome?
A. haloperidol
B. aripriprazole
C. Citalopram
D. Ropinirole
E. Propanolol
```
D
the pathologic basis for restless leg syndrome is dopamine blockade. Agonist to dopamine receptors such as pramipexole or ropinirole is very effective in treating this condition. Katzung review 8th ed p 235
115
```
Prolonged treatment with a PPAR alpha ligand in the treatment of hyperlipidemia will increase the risk for the following condition?
A. Cutaneous flushing
B. Hyperuricemia leading to Gout
C. Intestinal malabsorption
D. Gallstones
E. hepatotoxicity
```
D
PPAR alpha ligands is the MOA of fibric acid derivatives ( Gemfibrozil and fenofibrate). It increases the supersaturation of bile leading cholelithiasis. Risk for hepatotoxicity only significantly increase if gemfibrozil is combined with HMG CoA inhibitor. Cutaneous flushing and hyperuricemia are toxicity profile of Niacin. Intestinal malabsorption is a primary side effect of resins ( cholestyramine, colestipol, colsevelam)
116
```
oral administration of this antibiotic will yield greater blood levels compared when it is administered intravenously?
A. chlorampenicol
B. Quinipristin - dalfopristin
C. Azithromycin
D. Telithromycin
E. None of the above
```
A
the pharmacokinetics of chlorampenicol is unusual since blood levels are higher when the drug is given at oral form rather than intravenous form. Katzung 11th ed page 802
117
what is the mechanism of action of nystatin?
A. Formation of artificial pore in the fungal membrane
B. Inhibit ergosterol synthesis
C. Inhibit microtubular formation
D. Inhibits squalene epoxidase
E. Inhibit the synthesis of B(1-2) glycan
A
nystatin and ampothericin B are both polyene antifungal antibiotics. It binds to ergosterol and creates an artificial pores in the fungal membrane leading to increase membrane permeability. Katzung review 8th ed p 401
118
the drug of choice for Chagas disease acts through what mechanism of action?
A. Inhibit mitochondrial electron transport
B. Trypanothione reductase inhibition
C. Suicide substrate of ornithine decarboxylase
D. Inhibits enzyyme sulfhydryl groups
E. none of the above
B
the drug of choice for Chagas disease or american trypanosomiasis is nifurtimox. Its anitprotozoan action is due to inhibition of trypanothiane reductase. A- atovaquone MOA ( use for PCP and chloroquine resistant malaria) Ceflornithine ( use in cerebral stage of african trypanosomiasis). D- melarsoprol ( african sleeping sickness). SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE Katzung review p 438-439
119
```
what is the primary drug of treatment for ascariasis, pinworm, whipworm and hydatid disease?
A. albendazole
B. Mebendazole
C. Pyrantel pamoate
D. Diethylcarbamazine
E. All of the above
```
A
| B,C,D has no clinical effectivity in hydatid disease.
120
```
what is the dose limiting toxicity of vincristine ?
A. areflexia
B. Bone marrow suppression
C. Acute tubular necrosis
D. Hepatocyte degeneration
E. None of the above
```
A
vincristine does not cause serious myelosuppresive effect however it induces neurotoxicity such as areflexia, ileus and peripheral neuritis. Katzung review 8th ed p 455.
121
```
Among insulin secretagogues, the risk of hypoglycemia is least in?
A. Meglitinides
B. 1st generation sulfonylureas
C. 2nd generation sulfonylureas
D. Biguanides
```
A
| Biguanides are not insulin secretagogues.
122
```
What is the most important drug in pulmonary tuberculosis?
A. INH
B. Pyrazinamide
C. Rifampin
D. Ethambutol
```
A
123
```
Pupillary construction is a characteristic effet of all opioids, except:
A. Oxycodone
B. Meperidine
C. Morphine
D. Fentanyl
```
B
124
```
This antiplatelet inhibits aggregation by interfering with GpIIb/IIIa binding to fibrinogen and other ligands:
A. Aspirin
B. Clopidogrel
C. Dipyridamole
D. Tirofiban
```
D
Aspirin is a nonselective irreversible COX inhibitor. Clopidogrel irreversibly inhibits platelet ADP receptor. Dipyridamole inhibits adenosine uptake and inhibits phosphodiesterase enzymes that degrade cyclic nucleotides.
125
```
Which tetracycline has the broadest spectrum of microbial coverage?
A. Tetracyline
B. Doxycyline
C. Minocycline
D. Tigecycline
```
D
126
```
The following drugs' efficacy is directly related to time above the minimal inhibitory concentration and becomes independent of concentration once the MIC has been reached, except?
A. Penicillins
B. Cephalosporins
C. A & B
D. none of the above
```
D
What is described is the time-dependent killing property for which penicillins and cephalosporins are known. Aminoglycosides are known for their concentration-dependent killing.
127
```
The following are bactericidal, except:
A. TMP-SXZ
B. Vancomycin
C. Metronidazole
D. Cefalexin
E. none of the above
```
E
| All drugs stated are bactericidal. TMP and SXZ alone are bacteriostatic but are bactericidal when in combination.
128
The following antituberculosis drugs are correctly paired with their mechanisms of action, except:
A. INH - inhibits mycolic acid synthesis
B. Rifampin - inhibits RNA dependent DNA polymerase
C. Ethambutol - inhibits arabinosyl transferase
D. none of the above
B
| Rifampicin inhibits DNA dependent RNA polymerase
129
```
This drug requires phosphorylation by host cell kinases to be active:
A. Efavirenz
B. Delavirdine
C. Nevirapine
D. Tenofovir
```
D
Efavirenz, delaverdine, and nevirapine are non nucleoside reverse transcriptase inhibitors which do not require host cell kinase for activation, unlike tenofovir, a nucleoside reverse transcriptase inhibitor which does
130
```
This antihistamine causes depolarizationinduced paralysis in nematodes:
A. Mebendazole
B. Ivermectin
C. Pyrantel pamoate
D. Piperazine
```
C
Mebendazole selectively inhibits microtubule synthesis and glucose uptake. Ivermectin interferes with GABA mediated neurotransmission. Piperazine is an agonist at GABA receptors.
131
```
Which of the following is uricosuric?
A. Allopurinol
B. Colchicine
C. Sulfinpyrazone
D. Celecoxib
```
C
| Allopurinol is a xanthine oxidase inhibitor. Colchicine inhibits microtubule assembly. Celecoxib is a COX-2 inhibitor.
132
```
Which drug is most effective in raising HDL?
A. Niacin
B. Fibrates
C. Statins
D. Bile acid sequestrants
```
A
133
```
The metabolism of which drug is inhibited by allopurinol and febuxostat?
A. Cytarabine
B. Methotrexate
C. Fluorouracil
D. Mercaptopurine
```
D
Allopurinol inhibits the enzymatic inactivation of 6-MP and its derivative, Azathioprine, by xanthine oxidase. Thus, when allopurinol is used concurrently with oral 6-MP/azathioprine, dosage of the antineoplastic agent must be reduced to 1/2 to 1/3 of usual dose.
134
This regimen is utilized in the treatment of Hodgkin lyphoma:
A. PEB regimen
B. ABVD regimen
C. CHOP regimen
D. GnRH agonist and androgen receptor antagonist
B
ABVD - adriamycin, bleomycin, vincristine, dacarbazine, prednisone. PEB (cisplatin, etoposide, bleomycin) regimen is used in testicular CA. CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) regimen in nonHodgkin lymphoma, and GnRH agonist and androgen receptor antagonist in prostate CA treatment.
135
```
This drug is a monoclonal antibody that binds to VEGF and prevents it from interacting with VEGF receptors:
A. Bevacuzimab
B. Rituximab
C. Trastuzumab
D. Imatinib
```
A
Rituximab is a monoclonal antibody that binds to surface protein in NHL inducing lysis, cytotoxicity and apoptosis. Trastuzumab is a monoclonal antibody that recognizes protein in breast CA cells overexpressing HER-2neu receptor for EGF. Imatinib inhibits tyrosine kinase activity of the product of bcr-abl oncogene expressed in CML.
136
```
This chemotherapeutic agent is known for its association with heart toxicity in cumulative doses:
A. 5-FU
B. 6-MP
C. Methotrexate
D. Doxorubicin
```
D
137
```
The following laxative mechanisms are correctly paired with its representative laxative drug, except:
A. bulk forming - psyllium
B. stool softening - docusate
C. osmotic - lactulose
D. stimulant - polyethylene glycol
```
D
| Polyethylene glycol is an osmotic laxative. Examples of stimulant laxatives include senna, bisacodyl, castor oil.
138
```
Ondansetron, highly effective in preventing chemotherapy-induced nausea and vomiting, is an antagonist at which receptor?
A. muscarinic
B. B2
C. 5-HT3
D. D2
```
C
139
```
This drug stimulates platelet production and decreases the number of platelet transfusions required by patients undergoing bone marrow suppression in treatment for CA:
A. Oprevelkin
B. Filgrastim
C. Erythropoietin
D. Folic acid
```
A
| Filgrastim stimulates the function and production of neutrophils.
140
```
Serum concentration of lithium in mEq/L favored for acutely manic patients is:
A. 0.9-1.1
B. 0.6-0.75
C. 0.5-0.85
D. 0.1-0.5
```
A
The serum concentration favored for long-term use in the prevention of reccurent manic-depressive illness, on the other hand, is 0.6-0.75 mEq/L.
141
```
This direct acting cholinomimetic is used in the treatment of postoperative ileum and neurogenic bladder:
A. Neostigmine
B. Bethanechol
C. Pilocarpine
D. Physostigmine
```
B
142
```
Use of aspirin as an antiplatelet inhibits primarily which prostanoid?
A. Prostacyclin
B. Thromboxane
C. Prostaglandin
D. Epoprosterenol
```
B
143
This is not a characteristic of phase I clinical trials in drug development:
A. Pharmacokinetic measurements are done
B. Determination of drugﾒs efficacy
C. Determination of maximum tolerated dose
D. Subjects are healthy volunteers
B
| Determination of drug efficacy is done during phase II of clinical trials.
144
```
he prime target of addictive drugs in the brain:
A. Thalamocortical system
B. Nigrostriatal dopamine system
C. Mesolimbic dopamine system
D. Mesocortical dopamine system
```
C
| Reference: Katzung. Basic and Clinical Pharmacology, 11th ed. p. 554
145
```
A 30 year old female with bipolar disorder delivered a baby with Ebstein anomaly. The drug that the mother was taking during her pregnancy that caused this congenital anomaly is:
A. Olanzapine
B. Lithium
C. Carbamazepine
D. Risperidone
```
B
146
```
Ketamine exerts its anaesthetic effect by its inhibitory action on these receptors:
A. NMDA
B. GABA-A
C. Glycine
D. Neuronal nictonic
acetylcholine receptors
```
A
147
A 20 year old male develops tachycardia, hypotension, muscle rigidity, and spiking fever immediately after start of surgery. Which of the following are commonly associated with this anaesthetic complication?
A. IV anesthetic and succinylcholine
B. IV anesthetic and midazolam
C. Inhalational anesthetic and succinylcholine
D. Inhalational anesthetic and midazolam
C
This is a case of malignant hyperthermia, which is associated with the combination of inhaled anaesthetics and succinylcholine.
148
```
Nitrates relieve angina by:
A. Decreasing venous return to the heart
B. Increasing intracardiac volume
C. Increasing end diastolic left ventricular volume
D. All of the above
```
A
149
```
The main indication of this agent is hypertension in pregnancy:
A. Reserpine
B. Prazosin
C. Methyldopa
D. Clonidine
```
C
150
```
This antihypertensive drug is absolutely contraindicated in pregnancy because it can cause renal damage in the fetus:
A. Reserpine
B. Hydralazine
C. Propranolol
D. Captopril
```
D
151
```
Which class of antibiotics can be safely given during pregnancy?
A. Tetracycline
B. Aminoglycoside
C. Fluoroquinolones
D. Beta-lactams
```
D
152
```
Vancomycin is administered orally for this condition:
A. Sepsis
B. Endocarditis
C. Antibiotic-associated enterocolitis
D. Meningitis
```
C
153
```
These anti-neoplastic agents are cell-cycle specific, except:
A. 5-fluorouracil
B. Cyclophosphamide
C. Bleomycin
D. Vincristine
```
B
154
```
The preferred antithyroid drug for thyroid storm:
A. Methimazole
B. Carbimazole
C. Propylthiouracil
D. Propranolol
```
C
155
```
Which of the following is a contraindication to the use of thiazolidinediones?
A. Alcohol ingestion
B. Heart failure
C. Cholelithiasis
D. Renal insufficiency
```
B
| Reference: Katzung. Basic and Clinical Pharmacology, 11th ed. p. 743
156
Clomiphene acts to induce ovulation by:
A. Diminishing estrogen mediated negative feedback at the pituitary
B. Increasing the action of estrogen in the hypothalamus
C. Increasing the action of estrogen in the ovary
D. Increasing the amount of estrogen receptors
A
157
Organophosphate toxicity is based on its ability to:
A. Compete with brain pyridoxal phosphate
B. Inhibit acetylcholinesterase
C. Interrupt heme synthesis
D. React with sulfhydryl groups binding to protein and other enzymes
B
158
```
A drug used for treatment of advanced prostatic carcinoma by producing continuous gonadal suppression:
A. Ketoconazole
B. Testosterone undecanoate
C. Leuprolide
D. Cyproterone acetate
```
C
Leuprolide combined with an androgen receptor antagonist such as flutamide is the primary medical therapy for advanced prostate cancer and is as effective as surgical castration.
Reference: Katzung. Basic and Clinical Pharmacology, 11th ed. p. 654
159
```
The following drug/s is/are used to augment labor:
A. Oxytocin
B. Misoprostol
C. Methyl ergonovine
D. All of the above
```
A
160
```
Type II DM with insulin resistance will be best treated with which of the following:
A. Sulfonylureas
B. Gliptins
C. Insulin glargine
D. TZDs
```
D
161
```
A 26/M presented with RUQ pain and fever. Imaging showed an abscess and aspiration biopsy was done. The aspirate resembled anchovy paste in color and in consistency. What is/are the possible drug/s that you can give for this patient?
A. Metronidazole
B. Tinidazole
C. Chloroquine
D. A and B
E. All of the above
```
E
For cases of amebic hepatic abscess you can give either Metronidazole, 750 mg 3 times daily (or 500 mg IV every 6 hours) for 10 days or Tinidazole, 2 g daily for 5 days PLUS a luminal agent. Alternatively you can give Dehydroemetine2 or emetine,2 1 mg/kg SC or IM for 8ﾖ10 days, followed by (liver abscess only) chloroquine, 500 mg twice daily for 2 days, then 500 mg daily for 21 days PLUS a luminal agent Luminal agent (Diloxanide, iodoquinol, paramomycin) Katzung 12th ed pg 928
162
```
Which antifungal drug inhibits ?-glucan synthase causing a disruption in cell wall synthesis
A. Terbinafine
B. Ketoconazole
C. Amphotericin B
D. Fluconazole
E. Caspofungin
```
E
Terbinafine - inhibits squalene oxidase; Ketoconazole - inhibits synthesis of ergosterol; Fluconazole - inhibits thymidylate synthase; Ampho B - polyene causes disruption of fungal cell walls Katzung 12th ed pg 857
163
```
A 65/M hypertensive, diabetic, smoker presents to you with fever, productive cough with an infected non healing wound in the foot. Labs showed anemia and very elevated creatinine.You schedule the patient for dialysis. As the prescribing physician, which of the following drug/s dose/s would you have to modify?
A. Vancomycin
B. Meropenem
C. Metoprolol
D. A and B
E. All of the above
```
D
Vancomycin and meropenem need to be adjusted Katzung 12th ed pg 798 Metoprolol is metabolized in the liver and requires no adjustment pg 179
164
```
A 34/F was diagnosed to have lepromatous leprosy. She was given the appropriate drugs which she took religiously. One day she came back to you complaining that her skin changed to a redbrownish color. Which of the following drug/s most likely have caused her predicament?
A. Dapsone
B. Rifampicin
C. Clofazimine
D. Rifabutin
E. Cycloserine
```
C
Clofazimine is a phenazine dye which causes red-brown to nearly black skin discoloration. SE of dapsone: methemoglobinemia; Rifampicin: red orange discoloration of body fluid Katzung 12th ed pg 846
165
```
Which of the following drug/s can be used for eliminating meningococcal carriage states?
A. Minocycline
B. Pen G
C. Rifampin
D. Demeclocycline
E. A and C
```
E
Minocycline, 200 mg orally daily for 5 days, can eradicate the meningococcal carrier state, but because of side effects and resis- tance of many meningococcal strains, rifampin is preferred. Katzung 12th ed pg 812
166
```
A 3/M was brought to the hospital for decreased sensorium. On further history, the child accidentally ingested a mouthful of antifreeze. You then proceed to give the child which antidote?
A. Disulfiram
B. Fomepizole
C. Famotidine
D. Methanol
E. There is no antidote
```
B
Antidotes for ethylene glycol or methanol poisoning include ethanol and fomepizole. Although ethanol is effective, it is difficult to achieve safe and effective blood levels that is why fomepizole is preferred. Katzung 12th ed pg 1037
167
```
Which antihelminthic drugs rapidly kills adult worms presumably through inhibition of oxidative phosphorylation or stimulation of ATPase activity?
A. Mebendazole
B. Niclosamide
C. Praziquantel
D. Pyrantel pamoate
E. Ivermectin
```
B
MOA of mebendazole: Mebendazole probably acts by inhibiting microtubule synthesis; Praziquantel: increase the permeability of trematode and cestode cell membranes to calcium, resulting in paralysis, dislodgement, and death; Pyrantel pamoate: neuromuscular blocking agent that causes release of acetylcholine and inhibition of cholinesterase which results in paralysis of worms followed by expulsion; Ivermectin: paralyze nematodes and arthropods by intensifying ?- aminobutyric acid (GABA)ﾖmediated transmission of signals in peripheral nerves. Katzung 12th ed pg 941-945
168
```
A 60/M was diagnosed to have refractory follicular B-cell lymphoma. He was prescribed with an agent which binds CD20 on both normal and malignant B lymphocytes. Which of the following is this drug?
A. Rituximab
B. Cetuximab
C. Bevacizumab
D. Omalizumab
E. Natalizumab
```
A
Cetuximab targets EGFR; Bevacizumab targets VEGF; Omalizumab is an anti-IgE useful in asthma therapy; Natalizumab binds to ?4-subunit of ?4?1 and ?4?7 integrins expressed on the surfaces of all leukocytes except neutrophils. Used in MS and Crohn's disease. Katzung 12th ed pg 991-993
169
```
A 34/F asthmatic, scheduled to undergo cholelithiasis, was being induced by the anesthesiologist. After starting the volatile anesthetic, the anesthesiologist noted increased peak air pressure, prolonged expiration with the classic "shark fin" capnograph. Which of the following most likely have caused the above findings?
A. Halothane
B. Sevoflurane
C. Desflurane
D. Nitrous oxide
E. None of the above
```
C
The patient is most likely experiencing bronchospasm and although all volatile anesthetics possess varying degrees of bronchodilating properties airway irritation induced by the pungency of isoflurane and desflurane may induce bronchospasm. These rarely occur with halothane, sevoflurane and nitrous oxide since they are non pungent. Katzung 12th ed pg 436
170
Which of the following regarding anticholesterol drugs is/are TRUE?
A. Simvastatin, a reversible inhibitor of HMG-CoA reductase, is most effective in reducing LDL levels
B. Niacin stimulates PPAR-? causing an increase in HDL and a decrese in triglycerides
C. There is increased risk of gallstone formation when fibrates are combined with bile acid binding resins
D. A and C
E. All of the above
D
Fibrates stimulate PPAR alpha, most effective for decreasing elevated triglyceride levels. Katzung 12th ed pg 626, 628, 631
171
```
A 50/M is about to be given 6-mercaptopurine for his ulcerative colitis as an off-label use. The patient has multiple comorbidities which include hypertension, diabetes, asthma and gout and takes losartan, metformin, salmeterol, allopurinol and diclofenac for these conditions. Which of the above drugs would prompt you to rethink the dose of 6-MP that you are about to administer?
A. Losartan
B. Metformin
C. Salmeterol
D. Allopurinol
E. Diclofenac
```
D
Because allopurinol inhibits xanthine oxidase, simultaneous therapy with allopurinol and 6-MP would result in increased levels of 6-MP, thereby leading to excessive toxicity. In this setting, the dose of mercaptopurine must be reduced by 50ﾖ75%. Katzung 12th ed pg 961-962
172
```
A 18/M previously diagnosed with epilepsy and maintained on phenobarbital seizure free for the past 2 years, presented to you with a 3 month history of cough, recurrent fever and weight loss. AFB was positive on two occasions and CXR show cavitations on the upper lung fields. You conclude that he has PTB and you start him of HRZE. After a few days, you were informed that you patient was in the ER and their working impression is status epilepticus. Which of the following drugs could have caused the breakthrough seizures?
A. Isoniazid
B. Rifampicin
C. Pyrazinamide
D. Ethambutol
E. None of the above
```
B
| Memorize inducers & inhibitors VERY HIGH YIELD
173
```
A 50/M previously diagnosed with BPH develops mild fever, cough and rhinorrhea. Thinking that he just has the common cold, he self medicates with over the counter medication. After 12 hours he rushes to the ER and complains of inability to void. Which of the following OTCs may have caused his condition?
A. Chlorphenamine
B. Phenylephrine
C. Acetaminophen
D. Ibuprofen
E. None of the above
```
B
Sympathomimetic agents may cause or worsen urinary difficulty in patients with prostate enlargement due to smooth muscle contraction in the bladder neck via stimulation of alpha-1 adrenergic receptors. Katzung 12th ed pg 139
174
```
Which of the following have been proven to cause pulmonary fibrosis?
A. Methothrexate
B. Bleomycin
C. Busulfan
D. Amiodarone
E. All of the above
```
E
175
```
A 21/M presented with recurrent fever, night sweats, enlarged abdomen and generalized lymphadenopathy. Biopsy of a lymph node showed Reed-Sternberg cells. Which of the following chemotherapeutic regimen/s can be given to the patient?
A. ABVD
B. CHOP
C. MOPP
D. Rituximab
E. A and C
```
```
A
ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) and MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) have been used to treat Hodgkin's lymphoma. ABVD has supplanted MOPP as the regimen of choice since it is more effective and less toxic. CHOP and Rituximab are used for NHL Katzung 12th ed pg 970
```
176
```
Drug X is currently undergoing clinical trials with it being tested on a small number of volunteers with the goal being to find the maximum tolerated dose. It is now on what phase of clinical testing?
A. Phase 1
B. Phase 2
C. Phase 3
D. Phase 4
E. Phase 5
```
A
Phase 1- tested on small number of healthy volunteers in order to find the maximum tolerated dose and prevent severe toxicity; Phase 2- studied on a modest number of patients with the target disease to test efficacy; Phase 3- evaluated on a large number of patients to further establish efficacy and safety, usually a RCT with blinding and crossover; Phase 4- post marketing surveillance Katzung 12th ed pg 75
177
```
A 65/M was diagnosed to have CAP-HR. You plan to start Piperacillin-Tazobactam with a loading dose of 4.5g IV. Which among the following variables is not involved in the calculation of the loading dose?
A. Volume of distribution
B. Clearance
C. Bioavailability
D. Desired concentration
E. All are needed to calculate the LD
```
B
| Clearance is involved in determining the maintenance dose Topnotch
178
```
Which of the following inhibit/s cortisol synthesis?
A. Aminoglutethimide
B. Ketoconazole
C. Mifepristone
D. A and B
E. All of the above
```
D
Aminoglutethimide blocks the conversion of cholesterol to pregnenolone and causes a reduction in the synthesis of all hormonally active steroids. Ketoconazole is a potent nonselective inhibitor of adrenal and gonadal steroid synthesis through inhibiton of P450 enzymes. Mifepristone is a glucocorticoid receptor antagonist with strong antiprogesterone activity. Katzung 12th ed pg 709-711
179
```
A 34/F came in to the ER complaining of severe eye pain. On PE you notice that the cornea is steamy with accompanying conjunctival injection. You proceed to administer a drug that will cause an increase in the outflow of aqueous humor through the canal of Schlemm resulting in a decrease in IOP. Which drug was administered?
A. Timolol
B. Apraclonidine
C. Latanoprost
D. Pilocarpine
E. Epinephrine
```
C
All of the choices can decrease IOP and are used in the treatment of glaucoma. Beta blockers, osmotic agents, alpha-2 agonists and carbonic anhydrase inhibitors decrease secretion of aqueous humor from the ciliary epithelium. Cholinomimetics cause contraction of the ciliary muscle causing the trabecular meshwork to open, increasing outflow. Prostaglandins increase outflow through the canal of Schlemm. Nonselective alpha agonists increase outflow via the uveoscleral veins. Topnotch
180
Minoxidil causes vasodilation through:
A. Hyperpolarization of smooth muscle membrane through opening of potassium channels
B. Blockade of voltage gated calcium channels causing a reduction in calcium influx
C. Release of nitric oxide from the drug itself
D. Activation of dopamine receptors
E. Blockade of beta receptors
A
| Choice B - calcium channel blockers; Choice C - Nitroprusside, nitrates; Choice D - fenoldepam
181
```
Which of the following drugs is classified as Category X during pregnancy?
A. Valproate
B. Statins
C. Aspirin
D. Captopril
E. Phenytoin
```
B
| The rest of the choices are category D drugs.
182
```
Which of the following is a balanced vasodilator-- meaning, both an arterial and a venous vasodilator--used to treat both congestive heart failure and coronary artery vasospasm?
A. Verapamil
B. Captopril
C. Nifedipine
D. Propranolol
E. Hydralazine
```
B
Balanced vasodilators include ACEIs, ARBs, alpha-adrenergic blockers, alphacentral agonists, nitroprusside and nesiritide
183
```
Which of the following diuretics do not act on the luminal side of the renal tubules?
A. Mannitol
B. Furosemide
C. Spironolactone
D. Acetazolamide
E. Hydrochlorothiazide
```
C
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE. Spironolactone is an aldosterone antagonist that blocks its binding to mineralocorticoid receptors in the basolateral membrane of the cortical collecting tubules. The rest of the choices act on the luminal side. Mannitol is an osmotic diuretic. Furosemide inhibits Na/K/Cl transporters in the luminal side of the loop of Henle. Acetazolamide inhibits carbonic anhydrase activity at the luminal side of the PCT. Hydrochlorothiazide inhibits Na/Cl transporters in the luminal side of the DCT
184
```
Which of the following vasodilators has also been used for the treatment of male pattern baldness due to its side effect of inducing hair growth
A. Verapamil
B. Fenoldopam
C. Nitroprusside
D. Minoxidil
E. Hydralazine
```
D
185
```
Which of the following is the drug of choice for tic disorders?
A. Carbamazepine
B. Lamotrigine
C. Valproic acid
D. Topiramate
E. Phenytoin
```
A
| Carbamazepine is also the drug of choice for trigeminal neuralgia.
186
```
Which of the following drugs used in the treatment of peptic ulcer disease works by forming a protective coating over ulcer beds and has known adverse effects of melena and darkening of the tongue?
A. Sucralfate
B. Bismuth salicylate
C. Psyllium
D. Senna
E. Kaolin
```
B
187
```
Which of the following analgesics would you avoid in a patient with history of epilepsy as it is known to lower the seizure threshold?
A. Ketorolac
B. Aspirin
C. Tramadol
D. Celecoxib
E. Indomethacin
```
C
188
```
In which of the following drugs used for the treatment of gout is cataract an important side effect?
A. Colchicine
B. Probenicid
C. Allopurinol
D. Febuxostate
E. Indomethacin
```
C
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE.
189
```
Which of the following adrenergic receptors in the ciliary body of the eye causes a decrease in aqueous humor production when activated?
A. alpha-1
B. alpha-2
C. beta-1
D. beta-2
E. beta-3
```
B
Activation of alpha-2 receptors decreases aqueous humor production, while activation of either beta-1 or beta-2 receptors increases aqeous humor production. Alpha-1 and beta-3 receptors have no known function in relation to aqueous humor production.
190
```
Tocainide is an antiarrhythmic agent classified under which group?
A. Class IA
B. Class IB
C. Class IC
D. Class II
E. Class III
```
B
191
```
Ondansetron is an antagonist of which serotonin receptor?
A. 5HT1D
B. 5HT1B
C. 5HT2
D. 5HT3
E. 5HT4
```
D
| 5HT3 receptor is also the only ligandgated ion channel among the serotonin receptors.
192
Clomiphene is a selective estrogenreceptor modulator commonly used to induce ovulation in patients undergoing assisted reproduction therapy. Which of the following best describes its mechanism of action?
A. It potentiates the action of FSH and LH on the ovaries.
B. It acts as a partial agonist in the pituitary to block negative feedback from estradiol.
C. It acts as a GnRH analogue that increases the release of FSH and LH from the pituitary.
D. It inhibits the release of inhibin from ovarian follicles, thus facilitating FSH and LH secretion.
E. It is an LH analogue and mimics the physiologic LH surge when given just before ovulation.
B
| C refers to leuprolide when administered in pulsatile fashion.
193
```
Which of the following anti-lipid drugs would you avoid giving to a diabetic patient due to its adverse effect of inducing hyperglycemia?
A. Cholestyramine
B. Egetimibe
C. Niacin
D. Gemfibrozil
E. Colestipol
```
C
194
```
Which of the following traditional antipsychotic agents has now been more widely used for antiemetic treatment of nausea and vertigo?
A. Prochlorperazine
B. Promethazine
C. Haloperidol
D. Chlorpromazine
E. Metoclopramide
```
A
Promethazine is histamine H1- antagonist. Haloperidol and chlorpromazine are typical antipsychotics mainly used for psychotic disorders, not so much as antiemesis. Metoclopramide is a D2-antagonist used as GI prokinetic agent.
195
```
Which of the following is not used for the treatment of alcohol dependence?
A. Chlordiazepoxide
B. Disulfiram
C. Naltrexone
D. Acamprosate
E. None of the above
```
A
Chlordiazepoxide is used for the treatment of alcohol withdrawal, not dependence. Diazepam may also be used for alcohol withdrawal.
196
```
Which of the following antitumor antibiotics is cell-cycle specific?
A. Mitomycin
B. Doxorubicin
C. Bleomycin
D. Actinomycin
E. None of the above
```
C
| Bleomycin is specific for G2 phase of the cell cycle. The rest of the choices are noncell-cycle specific.
197
```
Which of the following antimicrobial agent acts as a dihydrofolate reductase inhibitor?
A. Trimethoprim
B. Sulfamethoxazole
C. Metronidazole
D. Nitrofurantoin
E. Rifampicin
```
A
198
```
In which of the following penicillins is interstitial nephritis a known adverse effect, partly leading to a decline in its popularity?
A. Nafcillin
B. Methicillin
C. Carbenicillin
D. Bacitracin
E. Metampicillin
```
B
| SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE.
199
```
Which of the following antibiotics work by binding to the D-Ala-DAla terminus of bacterial cell wall precursors, thus preventing peptidoglycan polymerization?
A. Imipenem
B. Cycloserine
C. Bacitracin
D. Vancomycin
E. Piperacillin
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D
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE. Piperacillin: inhibits transpeptidase and binds to penicillin-binding proteins in the cell membrane. Cycloserine: blocks incorporation of D-Ala into the pentapeptide side chain of peptidoglycan. Bacitracin: interferes with a late stage in cell wall synthesis
200
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Which of the following ophthalmic agents decreases intraocular pressure by increasing outflow of aqueous humor through the uveoscleral or unconventional pathway?
A. Homatropine
B. Bimatoprost
C. Apraclonidine
D. Mannitol
E. Timolol
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B
Bimatoprost is a prostaglandin analogue that increase outflow via the uveoscleral pathway. Apraclonidine is a alpha-2 receptor agonist that decreases aqueous humor production. Mannitol works via osmosis. Timolol is a beta-receptor antagonist that also decreases aqueous humor production. Homatropine has no effect on IOP.
