Pharmacodynamics and pharmacokinetics

1. Regarding drug receptors:

a) A drug usually binds to only one receptor type;

b) Cellular responses to receptors that are ion channels are usually slow;

c) Cellular responses are fast if the mode of action involves modification of DNA transcription

d) G-proteins amplify the effect of receptor stimulation.

2. Choose a correct answer:

a) Receptors are continually being synthesised and destroyed by the cell;

b) Antagonists do not themselves bind to receptors but interfere with the binding of agonists;

c) Antagonists bind to receptors and stimulate them;

d) Competitive antagonists usually bind to receptors for very long periods.

3. Choose a correct answer:

a) Competitive antagonists can be overcome by increasing the agonist concentration;

b) All drugs act by binding to cell macromolecules;

c) Drug “A” is said to be more potent than drug “B” if drug “A” ’s maximal effect is greater than
tham of drug “B”;

d) A partial agonist is a drug that binds to a receptor without stimulating it.

4. Choose a correct answer:

a) Therapeutic index refers to the difference between the concentration of a drug required to
produce its effects and that required to produce toxicity;

b) Drug “A” is said to be more efficacious than drug “B” if drug “A” produces its maximum
effect at a lower concentration than drug “B”;

c) Partial agonists can elicit the same maximum response as full agonists if they have the same
affinity fo the receptor;

d) Intrinsic efficacy is the chemical property of competitive antagonist.

1
5. Choose a correct answer:

a) The affinity constant (Ka) is reciprocal of dissociation constant (KD) and in the absence of
receptor reserve is the concentration of drug that produces less than 50% of the maximum
response;

b) Antagonist are drugs that bind to receptors and activite them;

c) Non-competitive antagonists do not bind to the receptor site but act downstream to prevent the
response to an agonist;

d) Physiological antagonists simply bind to the active drug and intactivate it.

6. Choose a correct answer:

a) When acting alone at receptor, partial agonists stimulate a physiological response, but they can
antagonize the effects of a full agonist;

b) Partial agonist-receptor complex has the same affinity for the transducer as the full agonist-
receptor complex;

c) Intrinsic efficacy is a measure of how avidly a drug binds to its receptor;

d) A drug that is a partial agonist in a tissue with no receptor reserve can not be a full agonist in a
tissue possessing many “spare” receptors.

7. Inverse agonists:

a) Have a much higher affinity for the Ra conformation (constitutive activity) of receptor;

b) Increase constitutive activity of receptor;

c) May produce a contrasting physiologic result;

d) Have equal affinity for both receptor forms (Ra and Ri) and maintain the same level of
constitutive activity.

8. Pharmacodynamic processes include drugs:

a) Absorption;

b) Distribution;

c) Metabolism;

2
d) Pharmacologic effect.

9. Which one of the following statements is correct?

a) Pharmacodynamics describes the way the body affects the drug with time;

b) Pharmacokinetics describes the effects of the drug on the body;

c) Special carriers using for the active transport of drugs are selective, saturable and inhibitable;

d) P-glycoprotein or multidrug-resistance type1 (MDR 1) transporter are particularly important

in the uptake of neurotransmitters across nerve-ending membranes

10. The following statements describe pharmacokinetic concepts:

a) Only the unbound (free) drug fraction has pharmacological effects;

b) All drugs metabolism takes place in the liver;

c) All drugs must first be metabolised before they can be excreted;

d) Drug metabolites have a less pharmacological effects.

11. Which one of the following statements is correct?

a) Weak bases are absorbed efficiently across the epithelial cells of the stomach;

b) Coadministration of atropine speeds the absorption of a second drug;

c) Drugs showing a large Vd can be efficiently removed by dialysis from the plasma;

d) Stressful emotions can lead to a slowing of drug absorption.

12. Which one of the following is true for a drug whose elimination from plasma shows first-
order kinetics?

a) The half-life of the drug is proportional to the drug concentration in plasma;

b) The amount eliminated per unit of time is constant;

c) The rate of elimination is proportional to the plasma concentration;

d) Elimination involves a rate-limiting enzymic reaction operating at its maximal velocity (Vm).

3
13. A patient is treated with drug “A”, which has a high affinity for albumin and is administered
in amounts that do not exceed the binding capacity of albumin. A second drug, “B”, is added to
the treatment regimen. Drug “B” also has a high affinity for albumin but is administered in
amounts that are 100 times the binding capacity of albumin. Which of the following occurs after
administration of drug “B”.

a) An increase in the tissue concentrations of drug “A”;

b) A decrease in the tissue concentrations of drug “A”;

c) A decrease in the volume of distribution of drug “A”;

d) A decrease in the half-life of drug “A”.

14. The addition of glucuronic acid to a drug:

a) Decreases its water solubility;

b) Usually leads to inactivation of the drug;

c) Is an example of a Phase I reaction;

d) Occurs at the same rate in adults and newborns.

15. Drugs showing zero-order kinetics of elimination:

a) Are more common than those showing first-order kinetics;

b) Decrease in concentration exponentially with time;

c) Have a half-life independent of dose;

d) Show a plot of drug concentration versus time that is linear.

16. A drug, given as a 100mg single dose, results in a peak plasma concentration of 20mcg/ml.
The apparent volume of distribution is (assume a rapid distribution and negligible elimination
prior to measuring the peak plasma level):

a) 0,5L;

b) 1L;

c) 2 L;

4
d) 5 L.

17. A drug with a half-life of12 hours is administered by continuous intravenous infusion. How
long will it take for the drug to reach ninety percent of its final steady-state level?

a) 18 hours;

b) 24 hours;

c) 30 hours;

d) 40 hours.

18.Which of the following results in a doubling of the steady-state concentration of a drug?

a) Doubling the rate of infusion;

b) Maintaining the rate of infusion but doubling the loading dose;

c) Doubling the rate of infusion and doubling the concentration of the infused drug;

d) Tripling the rate of infusion.

19. Choose a correct answer:

a) If the Vd for a drug is small, most of the drug is in the extraplasmic space;

b) For a drug whose elimination from plasma shows first-order kinetics a plot of drug
concentration versus time is a straight line;

c) The addition of glucuronic acid to a drug involves cytochrome P-450;

d) If the drug shows zero-order kinetics of elimination a constant amount of drug is eliminated
per unit of time.

20. Choose a correct answer:

a) Most drugs produce their effects by acting on specific protein molecules, usually located in the
cell membrane;

b) A few drugs act by virtue of their physicochemical properties and this is called specific drug
action;

c) Many drugs exert their effects by binding to plasma proteins;

5
d) Receptors are not responsible for selectivity of drug action.

21. Which one of the following statements is correct?

a) Receptors mediate the actions only of pharmacologic agonists;

b) Noncompetitive antagonists actions are reversible if they do not bind covalently;

c) Once the irreversible antagonist has occupied the receptor, it need be present in unbound form
to inhibit agonist responses;

d) The duration of action of irreversible antagonist is more dependent of its own rate of
elimination and relatively independent on the rate of turnover of receptor molecules.

22. Choose a wrong answer:

a) Active transport processes are mainly used to transfer lipid soluble drugs against their
concentration gradients;

b) The absorption of unionized molecules is favoured because they are far more lipid soluble
than those that are ionized;

c) Drug that is bound to plasma proteins is confined to the vascular system and is not able to
exert its pharmacological actions;

d) Some drugs are destroyed by the acid or enzymes in the gut and must be given parenterally.

23. Which routs of drug administration does not avoid the portal circulation?

a) Rectal;

b) Sublingual;

c) Itramuscular;

d) Oral.

24. Choose a wrong answer:

a) G-protein coupled receptors form a family of receptors with seven membrane-spanning

helices;

6
b) G-protein coupled receptors are linked usually to physiological responses by second
messengers;

c) Nuclear receptors are kinase-linked receptors that possess (usually) intrinsic tyrosine kinase
activity and include receptors for insulin, cytokines and growth factors;

d) Nuclear receptors for steroid hormones regulate transcription and protein synthesis.

25. Gs protein activation usually increases the intracellular concentration of:

a) IP3;

b) cAMP;

c) DAG;

d) cGMP.

26. Gq protein activation usually increases the activity of:

a) Adenylyl cyclase;

b) Phospholipase “C”;

c) cCMP phosphodiesterase;

d) Guanylyl cyclase.

27. The activation of Gi protein includes:

a) Increase of cAMP concentration;

b) Opening of cardiac K+ channels and slowing of heart rate;

c) Increase of phospholipase “C” activity;

d) Decrease of cCMP concentration.

28. Which one of the receptors are associated with tyrosine kinase molecules (JAK) and
activation of transcription (STAT) molecules?

a) G-protein coupled receptors;

b) Agonist (ligand)-gated channels;

7
c) Kinase-linked receptors for isnulin;

d) Cytokine receptors.

29. B-arrestin binding accelerates endocytosis for:

a) Serpentine receptors;

b) Kinase-linked receptors;

c) Steroid receptors;

d) Cytokine receptors.

30. Steroid receptors activation:

a) Modulate gene expression in the cell nucleus;

b) Activates a membrane “G” protein that modulates an enzyme or channel;

c) Phosphorylates cytoplasmic proteins;

d) Activates a cytoplasmic protein kinase (STAT).

31. Location of steroid receptors:

a)Cell membrane;

b) Cell membrane and cytoplasm;

c) Cytoplasm or nucleus;

d) Cytoplasm

32. Location of G-protein-coupled receptors:

a) Cytoplasm;

b) Cell membrane;

c) Nucleus;

d) Cytoplasm and nucleus.

8
33. Location of jak-STAT receptors:

a) Cell membrane and cytoplasm;

b) Only cell membrane;

c) Cytoplasm or nucleus;

d) Nucleus.

34. Which receptors are located in cell membrane and cytoplasm?

a) G-protein-coupled;

b) Transmembrane tyrosine kinase;

c) Jak-STAT;

d) Steroid.

35. Ion channel receptors are located in:

a) Cytoplasm or nucleus;

b) Cell membrane;

c) Nucleus;

d) Cell membrane and cytoplasm

36. Receptor type for insulin:

a) Steroid;

b) G-protein-coupled;

c) Transmembrane tyrosine kinase;

d) Ion channel.

37. Receptor type for cytokines:

a) Jak-STAT;

9
b) G-rpotein;

c) Steroid;

d) Transmembrane tyrosine kinase.

38. Substances examples for ion channel receptors:

a) Corticosteroids;

b) Acetylcholine (nicotinic acetylcholine receptor);

c) Cytokines;

d) Acetylcholine (muscarinic receptor).

39. Substances examples for jak-STAT receptors:

a) Cytokines;

b) Insulin;

c) Acetylcholine (muscarinic receptor);

d) Steroids.

40. Choose a correct answer:

a) Most agonist and antagonist drugs bind to their receptors with strong, covalent bonds,
resulting in irreversible action;

b) The EC50 (the concentration of drug that produces 50% of maximal effet) is a measure of the
potency of the drug and its affinity for its receptor;

c) Binding of an agonist drug to a receptor that produces effects opposite to the effects of another
drug acting at the same receptor is called physiologic antagonism;

d) Comparison of the maximal dose to produce a toxic effect versus the median dose to produce
a therapeutic effect may be carried out to determine a therapeutic index (TI).

41. Choose a wrong answer:

a) The idiosyncratic responses are usually caused by genetic differences in metabolism of the
drug, or by immunologic mechanisms, including allergic reactions.
10
b) When responsiveness diminishes rapidly after administration of a drug, the response is said to
be subject to tachyphylaxis;

c) The therapeutic index is usually defined as the ratio of the TD 50 to ED50 for some
therapeutically relevant effect;

d) Tolerance to the drug’s effect is the state when the intensity of effect of a given dose of drug is
increased compared with the effect seen in most individuals.

42. Partial agonists are the:

a) Drugs that may bind to the receptor and produce the maximum effect;

b) Drugs that produce less than the full effect observed for receptor system even when given in
doses that fully saturate the receptors;

c) Drugs that bind to a receptor site without activating it;

d) Drugs that produce a stronger response, at full receptor occupance than do full agonist.

43. A35- kg child with heart disease requires immediate treatment with the antiarrhythmic drug
procainamides. The texbook lists the following pharmacokinetic values for procainamide in a 70-
kg person: Vd-130L, Cl-36L/h and therapeutic concentration 5mg/L.

What intravenous loading dose should be administered?

a) 180mg;

b) 225mg;

c) 270mg;

d) 325mg.

44.A35- kg child with heart disease requires immediate treatment with the antiarrhythmic drug
procainamides. The texbook lists the following pharmacokinetic values for procainamide in a 70-
kg person: Vd-130L, Cl-36L/h and therapeutic concentration 5mg/L.

What constant intravenous infusion rate should be used to maintain the therapeutic concentration
of 5mg/L?

a) 90mg/h;

b) 108mg/h;
11
c) 180mg/h;

d) 217mg/h.

45. A35- kg child with heart disease requires immediate treatment with the antiarrhythmic drug
procainamides. The texbook lists the following pharmacokinetic values for procainamide in a 70-
kg person: Vd-130L, Cl-36L/h and therapeutic concentration 5mg/L.

What is the predicted half-life of procainamide in this child?

a) 2,1h;

b) 2,5h;

c) 3,6h;

d) 5,0h.

Autonomic nervous system pharmacology

46. Choose a correct answer:

a) In the sympathetic system, the ganglia are located close to the spinal column, so that
preganglionic neurons are short and postganglionic neurons are long;

b) The somatic (voluntary) motor system differs from the autonomic nervous system in having a
ganglionic synapse in the efferent path;

c) The sympathetic preganglionic fibers leave the CNS through the cranial nerves and the third
and fourth sacral spinal roots;

d) The parasympathetic preganglionic fibers leave the CNS through the thoracic and lumbar
spinal nerves.

47. Acetylholine is the transmitter substance released by the following, except:

a) All preganglionic autonomic nerves (both sympathetic and parasympathetic);

b) Postganglionic parasympathetic nerves;

c) Some postganglionic sympathetic nerves (thermoregulatory sweat glands and skeletal muscle
vasodilator fibers);

d) Adrenal medulla

12
48. Effects of parasympathetic stimulation include:

a) Bronchodilation;

b) Reduce in motilily and tone;

c) Increase broncho and tear secretion;

d) Decrease in exocrine and endocrine secretion (pancreas).

49. Parasympathetic stimulation causes:

a) Increase in gut sphincters tone;

b) Accomodation for near vision;

c) Dilation of pupil;

d) Glucogenolysis

50. Effects of sympahetic stimulation include:

a) Vasoconstriction in skin and viscera and vasodilation in skeletal muscles;

b) Vasodilation in skin and viscera and vasoconstriction in skeletal muscles.

c) Decrease in glucose level;

d) Increase in motility and tone and decrease in gut sphincters tone.

13
51. The following statements are correct, except:

a) Acetylcholine is the primary neurotransmitter in the motor limb of the parasympathetic system
at both the ganglionic and postganglionic effector cell synapses.

b) Acetylcholine is synthesized from choline, which is transported from the extracellular space
into the neuron, and acetyl-coenzyme A (AcCoA), which is synthesized in mitochondria in the
nerve ending.

c) The acetylcholine is then pumped into storage vesicles by a carrier and remains in the vesicle
until released by interaction of specific vesicle-associated membrane proteins (VAMPS) with
cell membrane nerve ending proteins, known as synaptosomal-associated proteins (SNAPs).

d) Transmitter release occurs when potassium enters nerve ending and triggers an interaction
between VAMPs and SNAPs, resulting in formation of a pore from the vesicle to the
extracellular synaptic cleft.

52. The following statements are correct:

a) The transmitter at sympathetic ganglia is norepinephrine.

b) For thermoregulatory sweat glands and some vasodilator fibers going to skeletal muscle blood
vessels, acetylcholine is the transmitter released from the postganglionic fiber.

c) For most tissues, norepinephrine is the transmitter released from parasympathetic

postganglionic fibers.

d) Tyrosine is pumped into the nerve ending cytoplasm by a carrier and hydroxylated to
dopamine.

53. The following statements are correct:

a) The dopamine is pumped into transmitter vesicles, where it is converted to epinephrine.

b) Norepinephrine is released from the nerve ending by an interaction of calcium with VAMPs
(vesicle-associated membrane proteins) and SNAPS (synaptosomal-associated proteins), which
is not similar to that in cholinergic neurons.

c) Norepinephrine is not metabolized in the synapse. Instead, its action is terminated by being
taken back up into the nerve ending (reuptake) or diffusing out of the synapse.

d) The dopamine is pumped into transmitter vesicles, where it is converted to epinephrine.

14
54. The following statements are correct:

a) Muscarinic and norepinephrine receptors ar coupled to effector enzymes and channels by “G”
proteins, which transfer the receptor activation into an enzyme effect apropriate for the particular
cell type involved.

b) Acetylcholine nicotinic receptor is associated with “G” protein.

c) The activation of muscarinic receptor via “Gs” protein increases the amount of second
mesenger cAMP.

d) The activation of muscarinic (M2) receptor in cardiac muscle increases cAMP and opens Ca2+
channels.

55. α1-adrenoceptor stimulation causes:

a) Vascular smooth muscle relaxation;

b) Increases second messengers IP3 and DAG.

c) Decreases of Gq protein activity.

d) Reduce of blood pressure.

56. Which adrenoceptor stimulation does not cause the increase of second messenger cAMP?

a) B1

b) B2

c) B3

d) α2

57. The following statements are correct:

a) Clonidine by stimulating of presynaptic α2-adrenoceptor causes the inhibition of transmitter

release

b) Isoproterenol is selective β-adrenoceptor agonist

c) Phenyleprine activates B1, B2 adrenoceptors.

d) Epinephrine stimulates only β1-adrenoceptors

15
58. Stimulaton of B2 adrenoceptors is not associated with:

a) Smooth muscle relaxation.

b) Glycogenolysis;

c) Tremor;

d) Bronchospasm

59. B2 -adrenoceptor agonists include:

a) Salbutamol;

b) Clonidine;

c) Phenylephrine;

d) Norepinephrine;

60. α1,2-adrenoceptor agonists include:

a) Dobutamine;

b) Phenylephrine;

c) Albuterol;

d) Salbutamol

61. Which adrenoceptors are involved in lipolysis?

a) B1;

b) B2;

c) B3;

d) α1

62. Which drug by acting on B1 adrenoceptors causes the cardiac stimulation and renin release?

a) Dopamine;

b) Dobutamine;

16
c) Salbutamol;

d) Clonidine

63. Norepinephrine stimulates the following adrenoceptors, except:

a) α1;

b) α2;

c) B1;

d) B2

64. Albuterol activates the following adrenoceptors:

a) α1;

b) α2;

c) B1;

d) B2

65. choose a correct answer:

a) Epinephrine activates - α1, α2, B1, B2 adrenoceptors;

b) Norepinephrine stimulates only α1, α2 adrenoceptors;

c) Phenylephrine activates α1, B1 adrenoceptors;

d) Dopamine activates α-adrenoceptors in low concentration

66. The following statements are correct:

a) Epinephrine causes cardiac stimulation by activating of “Gs” protein and increasing of cAMP
level;

b) Norepinephrine produces bronchodilation;

c) Phenylephrine causes hypotension;

d) Norepinephrine can cause reflex tachycardia

17
67. Indirect acting sympathomimetics include:

a) Midodrine;

b) Dobutamine;

c) Tyramine;

d) Norepinephrine

68. Displacement of stored catecholamines from the adrenergic nerve ending is the property of:

a) Cocaine;

b) Tyramine;

c) Phenylephrine;

d) Albuterol

69. Inhibition of reuptake of catecholamines already released is the mechanism of action of:

a) Tyramine;

b) Ephedrine;

c) Cocaine;

d) Dopamine

70. The α1-adrenoceptor selective blockers include:

a) Prazosin;

b) Phentolamine;

c) Propranolol;

d) Phenoxybenzamine

71. Adrenoceptor irreversible blocker:

a) Phentholamine;

b) Phenoxybenzamine;

18
c) Prazosin;

d) Tamsulosin

72. α1, α2-adrenoceptors blockers:

a) Doxazosin;

b) Terazosin;

c) Tamsulosin;

d) Phentholamine

73. Which drug is most effective in benign prostatic hyperplasia?

a) Terazosin;

b) Doxazosin;

c) Tamsulosin;

d) Phentholamine

74. Which drug is preferred in management of pheochromocytoma?

a) Phenoxybenzamine;

b) Tamsulosin;

c) Terazosin;

d) Doxazosin

75. The following statements are correct:

a) α1-adrenoceptor blockers cause an actual reversal of the blood pressure respone to

epinephrine;

b) α1-adrenoceptor blockers increase urinary obstruction;

c) α1-adrenoceptor blockers action very often can accompanied by reflex bradycardia

d) α1-adrenoceptor blockers increased peripheral resistance

19
76. Drug which causes relatively little tachycardia:

a) Prazosin;

b) Phentolamine;

c) Phenoxybenzamine;

d) Dobutamine

77. Cardioselective β-adrenoblockers include:

a) Propranolol;

b) Nadolol;

c) Pindolol;

d) Metoprolol

78. B-adrenoceptor agent with partial agonist activity:

a) Atenolol;

b) Metoprolol;

c) Timolol;

d) Pindolol

79. Choose a very short-acting B-adrenoblocker:

a) Acebutolol;

b) Atenolol;

c) Carvedilol;

d) Esmolol

80. Which drug has both α and β-adrenoblocking action?

a) Propranol;

20
b) Labetalol;

c) Nadolol;

d) Metoprolol

81. Choose nonselective β-adrenoblocking drug:

a) Propanolol;

b) Metoprolol;

c) Atenolol;

d) Acebutolol

82. β-adrenoblockers cause:

a) Increase secretion of aqueous humor;

b) Sedation or lethargy and reduction of anxiety;

c) The significant effect on the pupil or focus;

d) Marked bronchodilation in patients with airway disease, especially asthma

83. β-adrenoblockers produce the following effects:

a) Slow the heart rate and AV conduction;

b) Increase myocardial contractility;

c) Increase skeletal muscle tremor;

d) increase renin release from the kidney

84. The following statements are correct releated to β-adrenoblockers, except:

a) Reduce glucose release from the liver;

b)Reduce thyroid hormone effects;

c) Reduction in blood pressure in hypertensive patients;

d) Increase in intraocular pressure

21
85. β-adrenoblockers can cause:

a) Symptoms of hypoglycemia (eg, from insulin overdose) are masked;

b) Skeletal muscle tremor;

c) Pupil dilation;

d) Increase of renin release

86. Nonselective β-adrenoblockers do not produce:

a) Peripheral vasoconstriction (cold hands and feet);

b) Cardiac depression (bradicardia, AV blockade, diminished cardiac output);

c) Severe bronchospasm (in patinets with asthma);

d) Stimulation of thyroid hormone effects;

87. Which of the following drugs would be most suitable for oral use in patients who faint
frequently when standing up?

a) Epinephrine;

b) Isoproterenol;

c) Alropine;

d) Ephedrine

88. The following statements are true:

a) Salbutamol given i.v. causes bradycardia;

b) Dobutamine i.v. is indicated for shock secondary to gastrointestinal haemorrhage;

c) Terbutaline causes bronchodilation;

d) Norepinephrine i.v. causes bronchodilation.

89. The action of norepinephrine:

a) Is terminated by its uptake from the synapse;

22
b) Is potentiated by inhibitors of monoamine oxidaze “B”;

c) Includes vasodilation in some arteriolar beds;

d) Includes bronchodilation

90. Atropine:

a) Is a direct agonist at autonomic acetylcholine receptors;

b) Slows the heart rate;

c) Causes a dry mouth;

d) Causes a bronchospasm

91. Which agent is centrally acting antimuscarinic drug?

a) Dicyclomine;

b) Tropicamide;

c) Ipratropium;

d) Benztopine

92. Choose quaternary amine for use in asthma:

a) Pirenzepine;

b) Glycopyrrolate;

c) Propantheline;

d) Ipratropium

93. Choose tertiary amines using in opthalmology that have mydriatic and cycloplegic actions:

a) Benztropine;

b) Ipratropium;

c) Tropicamide;

23
d) Dicyclomine

94. Choose a correct answer:

a) The parasympathetic division is involved in accommodation of near vision, movement of food

and urination;

b) The postganglionic fibers of the parasympathetic division are long compared to those of the
sympathetic nervous system;

c) The parasympathetic system controls the secretion of the adrenal medulla;

d) The parasympathetic system often discharges as a single, functional system

95. Which one of the following is characteristic of parasympathetic stimulation?

a) Decrease in intestinal motility;

b) Inhibition of bronchial secretion;

c) Contraction of sphincter muscle in the iris of the eye (miosis);

d) Contraction of sphincter of urinary bladder.

96. Which of the following is characteristic of the sympathetic nervous system?

a) Actions mediated by muscarinic and nicotinic receptor;

b) Effects only mediated by norepinephrine;

c) Responses predominate during physical activity or when one is frightened;

d) A discreate response to activation

97. A patient being diagnosed for myasthenia gravis would be expected to have improved
neuromuscular function after being treated with:

a) Tropicamide;

b) Atropine;

c) Echothiophate;

d) Neostigmine
24
98. The drug of choice for treating glaucoma:

a) Scopolamine;

b) Carbochol;

c) Acetylcholine;

d) Pilocarpine

99.The prolong apnea sometimes seen in patients who have undergone an operation in which
succinylcholine was employed as a muscle relaxant has been shown to be due to:

a) Urinary atony;

b) Depressed level of plasma cholinesterase;

c) A mutation in acetylcholinesterase;

d) A mutation in the nicotinic receptor at the neuromuscular junction.

100. A 50-year-old male farm worker is brought to the emergency room. He was found confused
in the orchard and since then has lost consciousness. His heart rate is 45, and his blood pressure
is 80/40 mm Hg. He is sweating and salivating profusely. Which of the following treatment is
indicated?

a) Physostigmine;

b) Norepinephrine;

c) Trimetaphan;

d) Atropin

101. Which one of the following drugs, when administered intravenously, can decrease blood
flow to the skin, increase blood flow to skeletal muscle, and increase the force and rate of cardiac
contraction?

a) Epinephrine;

b) Isoproterenol;

c) Norepinephrine;

d) Phenylephrine

25
102. Remedies for nasal stuffness which often contain one of the following drugs?

a) Atropine;

b) Epinephrine;

c) Norepinephrine;

d) Phenylephrine

103. Which of the following medicationes would be useful in treating of high blood pressure and
a slightly enlarged prostate (prostate hyperlasia):

a) Doxazosin;

b) Labetalol;

c) Propranol;

d) Isoproterenol

26
 HIstamine, serotonin and the ergot alkaloids

104. Histamine (H1) receptors are located in:

a) Smooth muscle, endothelium and brain;

b) Gastric musoca, cardiac muscle, mast cells;

c) Myenteric plexus;

d) CD4 T cells.

105. Which histamine receptors have presynaptic localization?

a) H1;

b) H2;

c) H3;

d) H4

106. Eosinophils and neutrophils contain the following histamine receptors:

a) H1;

b) H2;

c) H3;

d) H4

107. The postreceptor mechanism of H1-histamine receptor stimulation includes:

a) Gq protein activation and increasing of IP3, DAG;

b) Cs protein activation and increasing of cAMP;

c) Gi protein activation and decreasing of cAMP;

d) Gq protein activation and increasing of cAMP

108. Which of the following drugs have a lower sedative potential?

27
a) Cyclizine;

b) Hydroxyzine;

c) Fexofenadine;

d) Doxylamin

109. A 53 year-old ship’s captain complains of seasonal allergies. Which one of the following
would be indicated?

a) Promethazine;

b) Dimenhydrinate;

c) Fexofenadine;

d) Hydroxyzine

110. Which of the following statements concerning H1 antihistamines is correct?

a) Second generation H1 antihistamines are relatively free of advers effects

b) The motor coordination involved in driving an automobile is not affected by the use of first
generation H1 antihistamines;

c) Both first- and second generation H1 antihistamines readily penetrate the blood-brain barrier;

d) Because of the established long-term safety of first-generation H1 antihistamines, they are the
first choice for initial therapy.

111. Which one of the following drugs could significantly impair the ability to drive an
automobile?

a) Diphenhydramine;

b) Fexofenadine;

c) Cetirizine;

d) Loratadine

112. Second generation H1 antihistamines are:

28
a) Diphenhydramine;

b) Hydroxyzine;

c) Cyclizine;

d) Loratadine.

113. First-generation H1 antihistamines includes:

a) Fexofenadine;

b) Cetirizine;

c) Dimenhydrinate;

d) Loratadine

114. Which one of the following antihistamines are produced α-adrenoceptor blocking effects?

a) Loratadine;

b) Cetirizine;

c) Promethazine;

d) Cyclizine

115. Which one of the following antihistamines are produced anticholinergic activity?

a) Diphenhydramine;

b) Fexofenadine;

c) Loratadine;

d) Cetirizine

116. Second generation antihistamines are using in:

a) Sleep aid;

b) Motion sickness;

29
c) Nausea of chemotherapy;

d) Allergy

117. First generation (older) antihistamines are used in the treatment of following condition,
except:

a) Allergy;

b) Sleep aid;

c) Motion sickness;

d) Arterial hypertension

118. Histamine is synthesized from:

a) L-histidine;

b) L-tryptophan;

c) Melatonin;

d) Tyrosine

119. Strong blocking effects at serotonin receptors have been demonstrated for the following
antihistamines:

a) Loratadine;

b) Cetirizine;

c) Fexofenadine;

d) Cyproheptadine

120. Which H1-antihistamine drug can be used in “serotonin syndrome” therapy:

a) Cyproheptadine;

b) Loratadine;

c) Cyclizine;

30
d) Cetirizine

121. Which antihistamine drugs have negligible CNS and ANS effects?

a) Diphenhydramine;

b) Promethazine;

c) Dimenhydrinate;

d) Cetirizine

122. Which serotonin receptors mediate nausea and vomiting?

a) 5-HT1D;

b) 5-HT2;

c) 5-HT3;

d) 5-HT4

123. The following serotonin receptors are located in chemoreceptors:

a) 5-HT1D;

b) 5-HT2;

c) 5-HT3;

d) 5-HT4

124. Which serotonin receptor mediates increased gastrointestinal motility?

a) 5-HT1D;

b) 5-HT2;

c) 5-HT3;

d) 5-HT4

31
125. Which serotonin receptor is coupled with ion channel?

a) 5-HT1D;

b) 5-HT2;

c) 5-HT3;

d) 5-HT4

126. Stimulation of 5-HT2 (A, B, C) serotonin receptors mediate:

a) Increased IP3;

b) Increased cAMP;

c) Decreased cAMP;

d) Open of Na+-K+ ion channel

127. Stimulation of 5-HT4 serotonin receptor mediates:

a) Increase cAMP;

b) Decrease cAMP;

c) Activation of Gi protein;

d) Increase IP3

128. Serotonin 5-HT1D/1B receptor agonist are used in the treatment of:

a) Migraine;

b) Serotonin syndrome;

c) Smooth muscle manifestation of carcinoid tumor;

d) Cold-induced urticaria

129. Antimigraine drugs include the following agents, except:

a) Sumatriptan;

32
b) Eletriptan;

c) Zolmitriptan;

d) Cyproheptadine

130. Serotonin 5-HT2 receptor blocking agents include:

a) Cyproheptadine;

b) Ondansetron;

c) Sumatriptan;

d) Granisetron

131. Which drug is the prototypical 5-HT3 serotonin receptor antagonist?

a) Cyproheptadine;

b) Ondansetron;

c) Phenoxybenzamine;

d) Ketanserin

132. The 5-HT3 serotonin receptor antagonists are used in the prevention of:

a) Migraine attacks;

b) Nausea and vomiting associated with cancer chemotherapy;

c) Serotonin syndrome;

d) Malignant hyperthermia

133. Which irreversible α-adrenoceptor blocking agent has a long-lasting blocking action at 5-
HT2 receptors?

a) Ondansetron;

b) Phenoxybenzamine;

c) Sumatriptan;
33
d) Ritanserin

134. The following statements are correct:

a) The ergot alkaloids are irreversible antagonists at 5-HT2, α-adrenoceptors and dopamine
receptors;

b) Naturally occuring ergot alkaloids include ergotamine and ergonovine, which are used to treat
migraine headache and as an oxytocic respectively;

c) Semisynthetic ergots include bromocriptine, with powerful hallucinogenic effects;

d) Lysergic acid diethylamide (LSD) is a semisynthetic ergot derivative used in

hyperprolactinemia

135. Dihydroergotamine:

a) Causes vasodilation;

b) Exerts its actions by binding to specific ergotamine receptors;

c) Is useful in treating acute migraine headaches;

d) Is useful for maintaining uterine muscle tone during pregnancy

136. The powerful hallucinogenic effects are produced by following ergot alkalois:

a) Ergonovine;

b) Lysergic acid diethylamide (LSD);

c) Bromocriptine;

d) Cabergoline

137. The following ergot alkaloids exert the high affinity for dopamine receptors:

a) Bromocriptine;

b) Ergonovine;

c) Ergotamine;

34
d) Dihydroergotamine

138. Which ergot derivates are highly specific for migraine pain?

a) Cabergoline;

b) Ergotamine;

c) Pergolide;

d) Bromocriptine

139. The following statements are correct:

a) In most patients the ergot alkaloids have significant effect on bronchiolar or urinary smooth
muscle;

b) The ergot alkaloids can induced nausea, vomiting, and diarrhea even in low doses in some
patients:

c) The gastrointestinal tract is less sensitive to ergot alkaloids;

d) The ergot alkaloids should be given before delivery

140. Choose a correct answer:

a) The ergot derivatives should be used only for control of late uterine bleeding (postpartum
hemorrhage);

b) Ergotamine and ergonovine caused prolonged vasodilation;

c) Semisynthetic ergots bromocriptine and pergolide are contraindicated in parkinsonism;

d) Dihydroergotamine is contraindicated for treatment of intractable migraine.

141. Choose a correct answer:

a) Using of ergot alkaloids may result in gangrene and require amputation;

b) The most rare toxic effects of the ergot derivatives are gastrointestinal disturbances;

c) The peripheral vascular vasodpasm caused by ergot is always refractory to nitroprusside or

nitroglycerin;
35
d) Ergonovine given intravenously produces prompt vasodilation during coronary angiography

The Eicosanoids, Prostaglandins, Thromboxanes, Leukotrienes and related drugs

142. The following statements are correct:

a) The prostaglandins, thromboxane and prostacyclin, collectively termed the prostanoids;

b) Prostaglandins are produced by the enzyme 5-Lipoxygenase;

c) PGF2α causes bronchodilation and myometrial relaxation;

d) PGD2 increases platelet aggregation

143. Choose a correct answer:

a) COX-2 (Cyclooxygenase)is present in tissues in which prostaglandins are useful (eg, the
stomach, where prostaglandins protect the mucosa against acid.

b) COX-1 appears to be more important in mediating pathophysiologic processes, especially

joint inflammation;

c) The metabolism of arachidonic acid by the 5-12, and 15-lipoxygenases results in the
production of hydroperoxyeicosatetraenoic acids (HPETEs), which rapidly convert to hydroxy
derivatives (HETEs) and leukotrienes;

d) Prostaglandin D2 (PGD2) is vasoconstrictor agent

144. The following agents are chemotaxins, except:

a) LTB4 (leukotriene-B4);

b) PAF (Platelet-activating factor);

c) 12-HETE(Hydroxyeicosatetraenoic acid);

d) LTC4 (Leukotriene-C4).

145. The cysteinyl-leukotrienes include:

a) LTA4, LTB4, LTD4;

36
b) LTC4, LTD4, LTE4;

c) LTB4, LTD4, LTE4;

d) LTA4, LTC4

146. The bronchoconstrictor agents are:

a) PGI2 (prostaglandin);

b) PGD2;

c) PGE2;

d) LTD4 (leukotriene)

147. Vasodilating agents include:

a) TXA2;

b) PGI2

c) PGF2α

d) Isoprostanes

148. The cysteinyl leukotrienes cause:

a) Vasoconstriction in most vessels, but coronary vasodilation;

b) Decrease vascular permieability;

c) Coronary vasoconstriction;

d) Bronchodilation

149. Choose a correct answer:

a) 5-Lipoxygenase acts on arachidonate to give 12-HPETE (Hydroxyperoxyeicosa tetraenoic

acid), which is converted to leukotriene LTA4;

b) LTA4 can be converted only to cysteinyl-leukotrienes (LTC4, LTD4 and LTE4);

c) LTB4 is can important mediator in all types of inflammation;

37
d) Cysteinyl-leukotrienes are less important in bronchial asthma.

150.Vasodilator prostaglandins – PGI2 and PGE2 promote vasodilation via the:

a) IP and EP4 receptors;

b) EP3 receptors;

c) FP receptors;

d) TP receptors

151. PGF2α causes:

a) Bronchoconstriction;

b) Myometrial relaxation;

c) Vasodilation;

d) Decreased aqueous humor drainage in glaucoma

152. PGD2 via the DP1 receptors causes:

a) Vasoconstriction;

b) Inhibition of platelet aggregation;

c) Hyperalgesia;

d) Increased aqueous humor drainage in glaucoma

153. PGE1 analogs:

a) Increased bicarbonate and mucus secretion in stomach;

b) Cause gastric ulcer;

c) Have analgesic effects;

d) Facilitate platelet aggregation

38
154.Misoprostol is a analog of:

a) PGI2;

b) PGE1;

c) PGF2α;

d) PGD2

155. Latanoprost is a analog of:

a) PGE1;

b) PGE2;

c) PGF2α;

d) PGI2

156. Dinoprostone is a synthetic peparation of:

a) PGF2α;

b) PGE2;

c) PGI2;

d) PGE1

157. Dinoprostone is used:

a) As oxytocic;

b) For prevention of NSAID-induced ulcers;

c) In glaucoma;

d) In severe pulmonary hypertenzion

158. Epoprostenol is used:

a) For severe pulmonary hypertension;

39
b) In chronic glaucoma;

c) For prevention of NSAID-induced ulcers;

d) As oxytocic.

159. Epoprostenol, iloprost and treprostinil are the analogs of:

a) PGF2α;

b) PGI2;

c) PGD2;

d) PGE1

160. Which drugs are used for prevention of NSAID – induced ulcers:

a) Latanoprost;

b) Misoprostol;

c) Carboprost;

d) Alprostadil

161. Which drug is used to induced second-trimester abortions and to control postpartum
hemorrhage that is not responding to conventional methods of management:

a)Carboprost;

b) Alprostadil;

c) Iloprost;

d) Epoprostenol

162. Alprostadil is used:

a) In eretill dysfunction;

b) In chronic glaucoma;

c) For prevention of NSAID-induced ulcers;

40
d) In severe pulmonary hypertesion

163. Which prostanoid receptors stimulation activate adenylyl cyclase via Gs protein?

a) EP3;

b) TP;

c) FP;

d) IP

164. “Contractile” prostanoid receptors which activation leading to the formation of inositol
triphosphate (IP3), with subsequent mobilization of Ca2+ stores and increase of free intracellular
Ca2+:

a) IP, EP2;

b) EP2, EP4;

c) TP, FP, EP1;

d) DP1, IP

165. THe term “prostanoids” encompasses the:

a) Prostaglandins and thromboxanes;

b) Thromboxanes and leukotrienes;

c) Leukotrienes and platelet-activating factor;

d) Prostaglandins and platelet-activating factor

41
 Anti-inflammatory drugs

167. Anti-inflammatory nonsteroidal drugs include the following agents, except:

a) Diclofenac;

b) Naproxen;

c) Piroxicam;

d) Allopurinol

168. The selective cyclooxygenase-2 (COX-2) inhibitors:

a) Cyclosporine;

b) Celecoxib;

c) Azathioprine;

d) Iburprofen

169. Propionic acid derivative NSAIDs:

a) Indomethacin;

b) Iburpofen;

c) Phenylbutazone;

d) Piroxicam

170. Pyrazolone derivative NSAIDs:

a) Phenylbutazone;

b) Indometacin;

c) Meloxicam;

d) Paracetamol

42
171. Indole derivative NSAIDs:

a) Flurbiprofen;

b) Indometacin;

c) Diclofenac;

d) Piroxicam

172. Phenylacetic acid derivative:

a) Diclofenac;

b) Naproxen;

c) Meloxicam;

d) Ibuprofen

173. In which one of the following conditions would aspirin be contraindicated?

a) Myalgia;

b) Fever;

c) Peptic ulcer;

d) Unstable angina

174. Which of the following statements concerning COX-2 nhibitors is correct?

a) The COX-2 (cyclooxygenase-2) inhibitors show greater analgesic activity than traditional
NSAID-s;

b) The COX-2 inhibitors decrease platelet function;

c) The COX-2 inhibitors do not affect the kidney;

d) The COX-2 inhibitors show anti-inflammatory activity similar to that of the traditional
NSAID-s.

175. An 8 year-old girl has a fever and muscle aches from a presumptive viral infection. Which
one of the following drugs would be most appropriate to treat her symptoms?
43
a) Paracetamol;

b) Aspirin;

c) Celecoxib;

d) Indomethacin

176. A 70 year-old man has a history of ulcer disease. He has recently experienced swelling and
pain in the joints of his hads. His physician wants to begin therapy with an NSAID-s. Which one
of the following drugs might also be prescribed along with the NSAID to reduce the risk of
activaing this patient’s ulcer disease?

a) Allopurinol;

b) Colchicine;

c) Misoprostol;

d) Probenecid

177. Which one of the following drugs have the greatest half-life (T1/2)?

a) Diclofenac;

b) Ibuprofen;

c) Indometacin;

d) Piroxicam

178. Which drug irreversibly blocks cyclooxygenase, especially in platelets:

a) Celecoxib;

b) Aspirin;

c) Iburpofen;

d) Diclofenac

179. The following statements are correct:

44
a) The anti-inflammatory and analgesic action of aspirin is longer than its antiplatelet effect;

b) The NSAID-s are well absorbed after oral administration. Most are excreted via the kidney;

c) Paracetamol has greater anti-inflammatory action than other NSAID-s;

d) In overdosage, metabolites of paracetamol can mainly cause kidneys damage

180. The following statements are correct:

a) Paracetamol is a very weak COX (cyclooxygenase) inhibitor and has little or no anti-
inflammatory action;

b) At high doses, aspirin is a very effective antiplatelet agent;

c) Most of NSAID-s are less effective against the pain in dysmenorrhea;

d) NSAID-s are not used for acute joint pain

181. Which of drugs have a lower risk of gastrointestinal bleeding but is associated with an
increased risk of cardiovascular events (myocardial infarction and stroke)?

a) Non-COX-selective NSAIDs;

b) The selective COX-2 inhibitors;

c) Paracetamol;

d) Leukotrienes antagonists

182. Which drug at low doses is a very effective antiplatelet agent and widely used to reduce the
risk of myocardial infarction and stroke:

a) Allopurinol;

b) Aspirin;

c) Paracetamol;

d) Celecoxib

183. Which drug in children with viral infections has been associated with an increased risk of
Reye’s syndrome?
45
a) Iburpofen;

b) Flurbiprofen;

c) Aspirin;

d) Celecoxib

184. Diversion of arachidonic acid metabolism to the leukotriene pathway may rarely present
with the clinical picture of:

a) An allergic response to aspirin, including anaphylaxia;

b) Toxicities of NSAIDs include gastrointestinal upset;

c) Reye’s syndrome;

d) Peptic ulcers with or without bleeding

185. Which of the following enzymes is the main target of glucocorticosteroids:

a) Cyclooxygenases (COX-1 and-2);

b) 5-Lipoxygenase;

c) Phospholipase A2;

d) Xanthine oxidase

186. The precursor of prostaglandins and leukotrienes is:

a) Glutamic acid;

b) Citric acid;

c) Arachidonic acid;

d) Acetylsalycilic acid

187. Choose a side effect which is not caused by aspirin:

a) Increased in blood pH;

b) Gastric ulceration;

46
c) Tinnitus;

d) Hyperventilation

188. Arachidonic acid is metabolized by two main pathways: cyclooxygenase and lipoxygenase.
Which of the following is a main end-product of the lipoxygenase pathway?

a) Prostaglandins;

b) Prostacyclin (PGI2);

c) Leukotrienes;

d) Thromboxanes

189. In an overdose situation, the elimination of aspirin follows zero-order kinetics. This means
that:

a) No drug appears in the urine;

b) The metabolism rate of aspirine is zero;

c) Elimination rate is directly proportional to plasma concentration;

d) Plasma concentrations decrease linearly with time

190. A child takes what comes close to being a lethal dose of paracetamol. Which of the
following is the most likely pathology involved in this drug overdose?

a) Acute nephropathy;

b) A-V conduction disturbances, heart block;

c) Liver failure;

d) Status asthmaticus

191. A patient has been taking doses of aspirin that are too high for several weeks. Low-grade
aspirin toxicity (salicylism) develops. Which of the following signs of symptoms would be most
indicative of the salicylism and the high salicylate levels:

a) Constipation;

47
b) Cough;

c) Hypertension;

d) Tinnitus

192. Which of the following property combinations is peculiar to the majority of NSAIDs?

a) Antihistaminic, antipyretic, Analgesic;

b) Immunodepressive, anti-inflammatory, analgesic;

c) Antipyretic, Analgesic, Anti-inflammatory;

d) Anti-inflammatory, immunodepressive, antihistaminic

193. Side effects of indometacin include the following:

a) Abdominal pain diarrhea, gastrointestinal hemorrhage and pancreatitis;

b) Dizziness, confusin and depression;

c) Trombocytopenia;

d) All of the above

194. Indication for aspirin administration in the following, except:

a) Inflammatory conditions;

b) Decreasing the incidence of transient ischemic attack, unstable angina, coronary arteryd
thrombosis with myocardial infarction and thrombosis after coronary artery bypass grafting;

c) Relieving severe visceral pain, e.g. myocardial infarction, cancer pain condition, renal or
biliary colic;

d) Reducing elevated body temperature

195. NSAIDs are effective in the treatment of pain in:

a) Acute abdomen;

b) Bone cancer;

48
c) Renal colic;

d) Myocardial infarction

196. Disease modifying antirheumatic drugs include the following agents, except:

a) Abatacept;

b) Azathioprine;

c) Cyclophosphamide;

d) Probenecid

197. Which one of the following drugs is monoclonal antiboody?

a) Rituximab;

b) Sulfasalazine;

c) Methotrexate;

d) Allopurinol

198. TNF (tumor necrosis factor)-α blocking agent:

a) Rituximab;

b) Infliximab;

c) Colchicine;

d) Phenylbutazone

199.TNF-α (tumor necrosis factor) blocking agents are used in the treatment of following
diseases, except:

a) Crohn’s disease;

b) Ankylosing spondylitis;

c) Gout;

d) Psoriatic arthritis
49
200. Which drug does not use in the treatment of gout?

a) Indometacin;

b) Colchicine;

c) Naproxen;

d) Paracetamol

201. Which drug inhibits xanthine oxidase activity and is used in patients with recurrent attacks
of gout?

a) Indometacin;

b) Aspirin;

c) Allopurinol;

d) Probenecid

202. Uricosuric drugs are:

a) Sulfinpyrazone;

b) Cochicine;

c) Alloperidol;

d) Aspirin

203. Which drug raises plasma urate levels at low doses by inhibiting uric acid secretion in the
renal tubules and is contraindicated in acute attacks of gout?

a) Indometacin;

b) Naproxen;

c) Aspirin;

d) Diclofenac

50
204. Which drug binds to tubulin in leucocytes and prevents its polymerization into
microtubules?

a) Naproxen;

b) Colchicine;

c) Sylfipyrazone;

d) Indometacin

205. What is a common side effect of colchicine used to treat acute gout, especially when given
orally:

a) Reye’s syndrome;

b) Gi side effects;

c) Anemia;

d) GU side effects

206. The following statements are correct:

a) Prostaglandins produce little pain by themselves, but potentiate the pain caused by other
mediators of inflammation(e.g. histamine, bradykinin).

b) NSAIDs reduce the normal body temperature or the elevated temperatures in heat stroke;

c) During fever, endogenesous pyrogen (interleukin-12) is released from leucocytes and acts
directly on the thermoregulatory center in the hypothalamus to increase body temperature;

d) Paracetamol unlike NSAIDs in overdose may cause interstitial nephritis

207. The following statements are correct:

a) The glucocorticosteroids are examples of gene-active hormones;

b) The glucocorticosteroids are used for their immunostimulatory action;

c) The glucocorticosteroids directly inhibit phospholipase-A2 enzyme;

d) The glucocorticosteroids suppress only the early phase of inflammation

51
208. Inflammation by glucocorticosteroids is suppressed by:

a) Increasing of circulating immunocompetent cells and macrophages;

b) Producing annexines and inhibit phospholipase A2;

c) Increasing of formation of prostaglandins, leukotrienes and platelet activating factor;

d) Stimulating the genes encoding for COX-2, phospholipase-A2 and interleukin-2.

Drugs used in asthma

209. The following statements are correct:

a) Steroids commonly used in asthma include beclomethasone, fluticasone and several others;

b) B2 adrenoceptor selective agonist salmeterol is short acting drug;

c) Mast cell stabilizers include ipratropium;

d) Theophylline is a methylxanthine related to caffeine and theobromine, but is a less effective

bronchodilator than either

210. B2 adrenoceptor selective agonists:

a) Are the drugs of rare choice in acute episodes of asthmatic bronchoconstriction;

b) Salmeterol is a drug of choice in acute episodes of asthmatic bronchoconstriction;

c) Toxicities of β2-adrenoceptor agonists include tremor and tachycardia, but it is important not
to limit the amount of the drug during an acute attack because uncontrolled bronchoconstriction
can be fatal;

d) β2-adrenoceptor selective agonists act as physiologic antagonists against leukotrienes by

increasing IP3 in smooth muscle.

211. Antimuscarinic drugs:

a) Are available in metered-dose inhaler form and are as generally effective as the β2-selective
agonists;

b) Ipratropium is a tertiary amine and has marked central effects;

c) Tiotropium is a most short-acting agent among the atropinelike muscarinic antagonists;

52
d) Impratropium can produce less tachycardia to compare with atropine

212. Leukotriene receptor antagonists include:

a) Zafirlucast;

b) Zileuton;

c) Nedocromil;

d) Cromolin

213. Cysteinyl leukotrienes receptor antagonists:

a) Are orally active, an advantage for treatment of young children and others who cannot use
inhalers;

b) Are as effective as corticosteroids and have a great value in acute bronchospasm;

c) Are acting on LTB4 leukotriene receptors;

d) Are used only in adults

214. The mechanisms of action of theophylline include:

a) Beta-adrenoceptor stimulating activity;

b) Direct effects on intracellular calcium concentration;

c) Antagonism of adenosine receptors;

d) Muscarinic receptor antagonism

215. Zileuton mechanism of action:

a) Stimulates Beta-2 adrenoceptors;

b) Inhibits 5-lypoxygenase;

c) Blocks M3-muscarinic receptors;

d) Inhibits phosphodiesterase

53
216. Theophylline mainly inhibits:

a) Phosphodiesterase-1;

b) Phosphodiesterase-2;

c) Phosphodiesterase-3;

d) Phosphodiesterase-4

217. Which of these groups of drugs is used for management of acute asthma?

a) Leukotriene receptor antagonists;

b) 5-LO inhibitors;

c) Cromolyn;

d) Corticosteroids

218. The standard treatment regimen for asthma is best described by which of the following:

a) Theophylline;

b) Inhaled Beta-2 adrenoceptors agonists only;

c) A combination of inhaled bronchodilators and inhaled corticosteroids;

d) Inhaled corticosteroids only

219. Symptoms typically produced by inhaled beta adrenoceptor agonists are:

a) Tachycardia, dizziness, nervousness;

b) Candidiasis and sore throat;

c) Nausea, agitation and convulsion;

d) Diarrhea, vomiting and nausea

220. Cromolyn is useful in many patients with asthma because it:

a) Inhibits cyclooxygenase-2;

b) Blocks adenosine receptors in bronchiolar smooth muscle;

c) Prevents antigen-induced degranulation of most cells;

54
d) Inhibits phosphodiesterase

221. A 23 year old women with asthma has what is described as “aspirin hypersensitivity” and
experiences severe bronchospasm in response to even small doses of the drug. Which of the
following is the most likely mechanism by which the aspirin provokes her pulmonary problems?

a) Blocks synthesis of endogenous prostaglandins that have bronchodilator activity;

b) Induces hypersensitivity of muscarinic receptors on airway smooth muscles;

c) Induces hypersensitivity of H1-histamine receptors on airway smooth muscles;

d) Prevents or reduces epinephrine binding to B2-adrenergic receptors (airways and elsewhere).

222. A-26 year old patient with asthma is being treated with zafirlucast. Which of the following
in the main mechanism by which this drug works:

a) Blocks the proinflammatory effects of certain arachidonic acid metabolites;

b) Enhances release of epinephrine from the adrenal (suprarenal) medulla;

c) Increases airway β-adrenergic receptor responsiveness to endogenous norepinephrine;

d) Inhibits cAMP breakdown via phosphodiesterase inhibition

223. Corticosteroids in the treatment of asthma:

a) Relax smooth muscle;

b) Inhibit the inflammatory response;

c) Reduce patient responsiveness to beta-agonists;

d) Increase airway obstruction in acute asthma and therefore should only be used for chronic
treatment.

224. Which drug group used to treat asthma causes oral candidiasis?

a) Leukotriene receptor antagonists;

b) Anti IgE antibodies;

c) Corticosteroids;

d) Beta-adrenoceptor agonists
55
225. Anti-IgE monoclonal antibodies used in the treatment of bronchial asthma:

a) Omalizumab;

b) Adalimumab;

c) Infliximab;

d) Etanersept

BASIC PHARMACOLOGY

1. Pharmacokinetics is:
a) The study of biological and therapeutic effects of drugs

b) The study of drug “destiny” in the organism

c) The study of mechanisms of drug action

d) The study of methods of new drug development

1. What does “pharmacokinetics” include?

a) Complications of drug therapy

b) Drug absorption, distribution and elimination

c) Influence of drugs on metabolism processes

d) Influence of drugs on genes

2. What does “pharmacokinetics” include?

a) Pharmacological effects of drugs

b) Unwanted effects of drugs

c) Chemical structure of a medicinal agent

d) Biotransformation of drugs in the organism

3. What does “pharmacokinetics” include?

56
a)Localization of drug action

b) Mechanisms of drug action

c) Distribution of substances

d) Interaction of substances

4. The main mechanism of most drugs absorption in GI tract is:

a) Active transport (carrier-mediated diffusion)

b) Filtration (aqueous diffusion)

c) Endocytosis and exocytosis

d) The drug moves from a region of high concentration to one of lower concentration

5. What kind of substances can’t permeate membranes by passive diffusion?

a) Lipid-soluble

b) Non-ionized substances

c) Hydrophobic substances

d) Insolubale in lipids

6. A hydrophilic medicinal agent has the following property:

\\ May diffuse passively through aqueous channels in the intracellular junction

\\\ Penetrate through membranes by means of endocytosis

\\\ Easy permeation through the blood-brain barrier

\\\ High reabsorption in renal tubules

7. What is implied by «active transport»?

a) Transport of drugs trough a membrane by means of diffusion

b) Transport without energy consumption

c) Engulf of drug by a cell membrane with a new vesicle formation

d) This process is selective, saturable and inhibitable

57
 8. What does the term “bioavailability” mean?
a) Plasma protein binding degree of substance

b) Permeability through the blood-brain barrier

c) The fraction of administered drug that reaches the systemic circulation in a chemically unchanged
form

d) Amount of a substance in urine relative to the initial doze

9. The factors determing bioavailability are:

a) Rheological parameters of blood

b) Amount of a substance obtained orally and quantity of intakes

c) Ingestion of drugs with food, or in combination with other drugs

d) Glomerular filtration rate

10. Which route of drug administration is most likely to lead to the first-pass effect?
a) Sublingual

b) Rectal

c) Intravenous

d) Intramuscular

11. What is characteristic of the oral route?

a) Fast onset of effect

b) First-pass metabolism in the liver

c) Usually produces rapid response

d) The sterilization of medicinal forms is obligatory

12. Pick out the parenteral route of medicinal agent administration:

a) Rectal

b) Oral

c) Sublingual

58
d) Intranasal

13, Parenteral administration:

a) Cannot be used with unconsciousness patients

b) Generally results in a less accurate dosage than oral administration

c) Has the highest bioavalability and is not subject to first-pass metabolism

d) Is too slow for emergency use

14. What is the reason of complicated penetration of some drugs through blood-brain barrier?

A) High lipid solubility of a drug

b) Meningitis

c) P-glycoprotein or multidrug resistance type 1 transporter

d) High endocytosis degree in a brain capillary

15. The volume of distribution (Vd) is:

a) A hypothetical volume of fluid into which a drug is dispersed

b) Concentration of substance in urine

c) Therapeutical window of drug action

d) A daily dose of drug

16. The term “biotransformation” includes the following:

a) Accumulation of substances in a fat tissue

b) Binding of substances with plasma proteins

c) Accumulation of substances in a tissue

d) Process of transforming lipophilic drugs into more polar readily excretable products

17. Biotransformation of the drugs is to render them:

59
a) Less ionized

b) usually More pharmacologically active

c) More lipid soluble

d) more ionized

18. Pick out the right statement:

a) Microsomal oxidation always results in inactivation of a compound

b) Microsomal oxidation results in a decrease of compound toxicity

c) Microsomal oxidation proceeds by the drug binding to the oxidized form of cytochrome P450

d) Microsomal oxidation usually results in an increase of lipid solubility of a drug thus its excretion
from the organism is facilitated

19. Induction of liver microsomal enzymes can:

a) Decreae the pharmacologic action of the inducer and also of coadministered drugs

b) Require the dose decrease of some drugs

c) Prolong the duration of the action of a drug

d) Intensify the unwanted reaction of a drug

20. Metabolic transformation (phase 1) is:

a) Acetylation and methylation of substances

b) Cytochrome P450 dependent oxidation

c) Glucuronide formation

d) Binding to plasma proteins

21. Biotransformation of a medicinal substance results in:

a) Minimize passive reabsorption of lipid soluble drug in distal tubules

b) Slower urinary excretion

c) Easier distribution in organism

60
d) Higher binding to membranes

22. Conjugation is:

a) Process of drug reduction by special enzymes

b) Process of drug oxidation by special oxidases

c) Process of drug glucuronidation, sulfation or methylation

d) Solubilization in lipids

23. Which of the following processes proceeds in the second phase of biotransformation?
a) Glutathione conjucation

b) Reduction

c) Oxidation

d) Hydrolysis

24. Conjugation of a drug includes the following EXCEPT:

a) Glucoronidation

b) Sulfate formation

c) Reduction

d) Methylation

25. Half life (t1/2) doesn’t depend on:

a) Biotransformation

b) First-pass hepatic metabolism

c) Concentration of a drug in plasma

d) Rate of drug elimination

26. Elimination is expressed as follows:

a) Rate of renal tubular reabsorption

b) Clearance speed of some volume of blood from substance

61
c) Time required to decrease the amount of drug in plasma by one-half

d) Metabolic clearance + renal excretion

27. Pharmacodynamics involves the study of following

a) Drug concentration at site of action – pharmacological effect

b) Biotransformation of drugs in the organism

c) Distribution of drugs in the organism

d) Excretion of drug from the organism

28. Pharmacodynamics involves the following

a) Information about main mechanisms of drug absorption

b) Information about effectiveness and toxicity

c) Information about biological barriers

d) Information about excretion of a drug from the organism

29. Pick out the answer which is the most appropriate to the term “receptor”
a) All types of ion channels modulated by a drug

b) Enzymes of oxidizing-reducing reactions activated by a drug

c) Protein molecules that are normally activated by transmitters or hormones

d) Carriers activated by a drug

30. What does “affinity” mean?

a) A measure of how tightly a drug binds to plasma proteins

b) This is a measure of how avidly a drug binds to its receptor

c) A measure of inhibiting potency of a drug

d) A measure of bioavailability of a drug

31. Antagonist is a substance that:

62
a) Binds to receptors, but do not activate them

b) Interacts with the receptor and initiates changes in cell function, producing various effects

c) Increases concentration of another substance to produce effect

d) Interacts with plasma proteins and doesn’t produce any effect

33. An antagonist is a substance that:

a) Binds to the receptors and initiates changes in cell function, producing maximal effect

b) Binds to the receptors and initiates changes in cell function, producing submaximal effect

c) Interacts with plasma proteins and doesn’t produce any effect

d Decreases the action of another drug or endogenous ligand

34. A competitive antagonist is a substance that:

a) Interacts with receptors and produces submaximal effect

b) Binds to the same receptor site has no intrinsic activity

c) Binds to the nonspecific sites of tissue

d) Binds to one receptor subtype as an agonist and to another as an antagonist

35. Irreversible interaction of an antagonist with a receptor is due to:

a) Ionic bonds

b) Hydrogen bonds

c) Covalent bonds

d)Hydrophobic bonds

36. Tick the second messenger of Gq-protein-coupled receptor:

a) Adenylyl cyclase

b) Sodium ions

c) Phospholipase C
63
d) Diacylglycerol

37. Tick the second messenger of Gs protein coupled receptor:

a) cAMP

b) cGMP

c) IP3

D) Calcium ions

38. Pick out the correct definition of a therapeutic dose:

a) The amount of substance to produce the minimal biological effect

b) The amount of substance to produce effects hazardous for an organism

c) The amount of substance to produce the necessary effect in most of patients

d) The amount of substance to fast creation of high concentration of medicine in an organism

39. Which state may lead to allergic reactions when a drug is taken repeatedly?

a). Refractoriness

b). Hypersensitivity

c) Tolerance

d) Tachyphylaxis

40. What term is used to describe a decrease in responsiveness to a drug which develops in a short
period of time?

a) Refractoriness

b) Cumulative effect

c) Tolerance

d) Tachyphylaxis

64
41.The idiosyncratic response is:

a) A drug interaction between two similar types of drugs

b) Very rapidly developing tolerance

c) A decrease in responsiveness to a drug, taking days or weeks to develop

d) Usually caused by genetic differences in metabolism of the drug

42. Drug resistance can be a consequence of:

a) Reducing its rate of degradation

b) Cytochrome P450 enzyme induction

c) Depressed renal drug excretion

d) Activation of a drug after hepatic first-pass

43. Tolerance can be a consequence of:

a) Drug addiction

b) Increased receptor sensitivity

c) Decreased metabolic degradation

d) Decreased renal tubular secretion

44. The situation when failure to continue administering the drug results in serious psychological
disturbances is called?

a) Tachyphylaxis

b) Sensibilization

c) Dependence

d) Idiosyncrasy

45. What phenomenon can occur in case of using a combination of drugs?

a) Tolerance

65
b) Tachyphylaxis

c) Accumulation

d) Synergism

46. If two drugs with the same effect, taken together, produce more effect in magnitude than the
sum of the effects of the drugs given individually is called as:

a) Antagonism

b) Potentiation

c) Additive effect

d) Accumulation

47. The types of antagonism are:

a) Summarized

b) Potentiated

c) Additive

d) Irreversible

48. A mutagenic action is:

a) Toxic action on the liver

b) Negative action on the fetus causing fetal malformation

c) Toxic action on blood system

d) Toxic action on the genetic apparatus

49. Negative action on the fetus causing fetal malformation is called:

a) Hematotoxicity

b) Hypersensitivity

c) Tolerance

d) Teratogenic action
66
 50. Allergic reaction of a drug is:
a) A type of hypersensitivity reaction

b) A type of drug antagonism

c) Unpredictable, inherent, qualitatively abnormal reaction to a drug

d) Quantitatively exaggerated response

51. Which one of the following routes of drug administration produces the less rapid absorption?
a) Inhalation

b) Oral

c) subcutaneous

d) Sublingual

52. Which one of the following is a phase I drug metabolism reaction?

a) Acetylation

b) Glucuronidation

c) Methylation

d) Hydrolysis

AUTONOMIC NERVOUS SYSTEM

53. Acetylcholine is a specific neurotransmitter at:

a) Only Sympathetic ganglia

b) Sympathetic postganglionic nerve endings

c) Only Parasympathetic ganglia

d) Parasympathetic postganglionic nerve endings

67
 54. Muscarinic receptors are located in:

a) Autonomic ganglia

b) Skeletal muscle neuromuscular junctions

c) Effector organ cells inervated by postganglionic parasympathetic fibers

d) Adrenal medulla

55. M3 cholinoreceptor type is not located in:

a) Heart

b) Glands

c) Smooth muscle

d) Endothelium

56. Edrophonium
a) Physostigmine

b) Pilocarpine

c) Isoflurophate

57. Acetylcholine is not used in clinical practice because:

a) It is very toxic

b) The doses required are very high

c) It is very short acting agent

d) It is very costly

58. Parasympathomimetic drugs cause:

a) Bronchodilation

b)Mydriasis

c) Salivation

d) Constipation
68
 59. Which of the following direct-acting cholinomimetics is mainly muscarinic in action?
a) Methacoline

b) Carbachol

c) Acetylcholine

d) None of the above

60. Which of the following direct-acting cholinomimetics has the nicotinic action?
a) Carbachol

b) Methacholine

c) Pilocarpine

d) Bethanechol

61. M-cholinimimetic agent is:

a) Carbachol

b) Bethanechol

c) Acetylcholine

d) Nikotine

62. Which of the following cholinomimetics is indirect-acting?

a) Lobeline

b) Neostigmine

c) Pilocarpine

d) Carbachol

63 . The mechanism of action of indirect-acting cholinomimetic agents is:

a) Binding to and activation of muscarinic or nicotinic receptors

b) Inhibition of cholinesterase

c) Stimulation of the action of acetylcholinesterase

69
d) Releasing acetylcholine from storage sites

64. Indicate a reversible cholinesterase inhibitor:

a) Isoflurophate

b) Carbochol

c) Edrophonium

d) Parathion

65. Which of the following cholinesterase inhibitors is irreversible?

a) Physostigmine

b) Edrophonium

c) Neostigmine

d) Parathion

66. The organophosphate cholinesterase inhibitors are well absorbed except:

a) Ecothiophate

b) Malathion

c) Malaoxan

d) Parathion

67. Isofluorophate increases all of the following effects except:

a) Lacrimation

b) Tachycardia

c) Muscle twitching

d) Salivation

68. Сholinesterase inhibitors do not produce:

a) Bradycardia, no change or modest fall in blood pressure

b) Increased strength of muscle contraction, especially in muscles weakened by myasthenia gravis

70
c) Miosis and reduction of intraocular pressure

d) Bronchodilation

69. Which of the following cholinomimetics is commonly used in the treatment of myasthenia
gravis?
a) Pilocarpine

b) Lobeline

c) Acethylcholine

d) Neostigmine

70. Which of the following cholinomimetics is most widely used for treatment of glaucoma?
a) Lobeline

b) Neostigmine

c) Pilocarpine

d) Echothiophate

71. The symptoms of excessive stimulation of muscarinic receptors include all of the following
EXCEPT:
a) Abdominal cramps, diarrhea

b) Increased salivation, excessive bronchial secretion

c) Miosis, bradycardia

d) Bronchodilation

72. The excessive stimulation of muscarinic receptors by pilocarpine and choline esters is blocked
competitively by:
a) Edrophonium

b) Tropicamide

c) Pralidoxime

d) Echothiophate

71
 73. The dominant initial sights of acute cholinesterase inhibitors intoxication include all of the
following except:
a) Salivation, sweating

b) Respiratory stimulation

c) Bronchial constriction

d) Vomiting and diarrhea

74. M2 receptor subtype is located:

a) In the myocardium

b) In sympathetic postganglionic neurons

c) On effector cell membranes of glandular and smooth muscle cells

d) On the motor end plates

75. Which of the following drugs is ganglion blocker?

a) Atropine

b) Benztropine

c) Hexamethonium

d) Succinylcholine

76. Indicate a muscarinic receptor-blocking drug:

a) Ipratropium

b) Pipecuronium

c) Trimethaphan

d) Pilocarpine

77. The tissues less sensitive to atropine are:

a) The salivary, bronchial and sweat glands

b) The gastric parietal cells

c) Cilliary muscle

d) The heart
72
 78. Atropine causes:
a) Miosis, a reduction in intraocular pressure and cyclospasm

b) Bronchodilation

c) Miosis, a rise in intraocular pressure and cycloplegia

d) Mydriasis, a rise in intraocular pressure and cyclospasm

79. Atropine causes:

a) Tachycardia

b) Intestinal hypermotility

c) Stimulation of contraction in the gut

d) Stimulation of secretory activity

80. Which of the following effects is related to direct beta2-adrenoreceptor stimulation?

a) Bronchodilation

b) Hypoglycemia

c) Bronchoconstriction

d) Bradycardia

81. Distribution of alpha-adrenoreceptor subtypes is associated with all of the following tissues
except those of:
a) Circular muscle of iris

b) Blood vessels

c) Prostate

d) Pupillary dilator muscle

82. Which of the following drugs causes bronchodilation without significant cardiac stimulation?
a) Isoprenaline

b) Albuterol

c) Xylometazoline
73
d) Methoxamine

83. Which of the following effects is associated with beta2 -receptor stimulation?
a) Glycogenolysis

b) Increase in platelet aggregation

c) Bronchoconstriction

d) Bradycardia

84. Indicate the drug, which is a direct-acting alfa-receptor agonist:

a) Terbutaline

b) Methoxamine

c) Isoproterenol

d) Ephedrine

85. Which of the following agents is an alpha1, beta1, beta2 receptor antagonist?
a) Methoxamine

b) Albuterol

c) Epinephrine

d) Labetalol

86. Which of the following agents is an alpha1 -selective agonist?

a) Norepinephrine

b) Phenylephrine

c) Ritodrine

d) Ephedrine

87. Indicate the beta1-selective agonist:

a) Xylometazoline

b) Epinephrine

c) Dobutamine

74
d) Methoxamine

88. Indicate the indirect-acting sympathomimetic agent:

a) Epinephrine

b) Phenylephrine

c) Tyramine

d) Isoproterenol

89. Ephedrine causes:

a) Miosis

b) CNS stimulation

c) Hypotension

d) Bradycardia

90. Which of the following drugs is a selective alfa receptor antagonist?

a) Prazosin

b) Phentolamine

c) Metoprolol

d) Reserpine

91. Which of the following drugs is an nonselective beta receptor antagonist?

a) Metoprolol

b) Atenolol

c) Timolol

d) Acebutolol

92. Indicate the beta1-selective antagonist:

a) Propranolol

b) Atenolol

75
c) Carvedilol

d) Sotalol

93. Indicate the indirect-acting adrenoreceptor blocking drug:

a) Tolazoline

b) Guanethidine

c) Carvedilol

d) Prazosin

94. Indicate an alfa receptor antagonist, which is an efficacious drug in the treatment of mild to
moderate systemic hypertension:
a) Phentolamine

b) Tolazoline

c) Ergotamine

d) Doxasozin

95. Beta-receptor antagonists cause:

a) Stimulation of lipolysis

b) Stimulation of gluconeogenesis

c) Bradycardia

d) Stimulation of insulin secretion

96. Which of the following beta receptor antagonists is preferable in patients with asthma,
diabetes or peripheral vascular diseases?
a) Propranolol

b) Acebutolol

c) Nadolol

d) Timolol

97. Choose the selective blocker of beta-1 adrenoreceptors:

76
a) Labetalol

b) Prazosin

c) Bisoprolol

d) Propranolol

98. This drug activates alpha-2 adrenergic receptors:

a) Labetalol

b) Phentolamine

c) Methyldopa

d) Pilocarpine

99. This drug is contraindicated in patients with bronchial asthma:

a) Nadolol

b) Clonidine

c) Prazosin

d) Phentolamine

100. Oxidable drugs form a complex with and are oxidized by what iron containing pigment
in the microsomal fraction of liver
a) Cytochrome A450

b) Cytochrome B450

c) Cytochrome C450

d) Cytochrome P450

101. An individual in whom a drug produces its usual effect although administered in a very
low dose is
a) Hyperreactive

b) Hypersensitive

c) Hyporeactive

d) Tachyphylactic
77
 102. A drug that combines with a receptor, has an action and initiates a series of effects is
called
a) Partial agonist

b) Agonist

c) Antagonist

d) Competitive antagonist

103. Oral route

a) Yields better absorption than parenteral administration for majority of drugs

B) Should be avoided in the recumbent position

c) Has no demerit

d) Produces quick onset of action

103. All of the following drugs are ganglionic blocking agents EXCEPT
a) Tetraethylammonium

b) Hexamethonium

c) Trimetaphan

d) Isoproterenol

104. The drug of choice for the treatment of anaphylactic shock is

a) Histamine

b) Epinephrine

c) Norepinephrine

d) Isoproterenol

105. In the treatment of migraine headache, ergotamine

a) Has vasoconstrictive properties that account for its efficacy

b) Has adrenergic blocking properties that are responsible for its therapeutic benefits

c) Will successfully terminate a headache already in progress

78
d) Is easily tolerated when taken orally

106. Which of the following drugs produces a selective blockade of beta receptors
a) Guanethidine

B) Propranolol

C) Atenolol

D) Phentolamine

107. Functionally a patient with myasthenia gravis resembles a person who has been treated
with low doses of
A) Atropine

B) Tubocurarine

C) Muscarine

D) Propranolol

108. Which of the following drugs is essentially a pure beta adrenergic agonist
A) Isoproterenol

B) Methoxamine

C) Neostigmine

D) Phentolamine

109. Which of the following neurotransmitter receptor sites is NOT a beta adrenergic
receptor
A) Ciliary muscle

B) Radial muscle, iris

C) Bronchial muscle

D) Sinoatrial node

110. The adrenal medulla secretes epinephrine in response to

A) Atropine

79
B) Succinylcholine

C) Methyldopa

D) Nicotine

111. Phenylethanolamine –N-methyl transferase methylates

A) Epinephrine

B) Norepinephrine

C) Serotonin

D) Histidine

112. The rare person who remains apneic for a long time after succinylcholine administration
probably has a deficiency of
A) Liver transglucosylase

B) Plasma cholinesterase

C) Glucose-6-phosphate dehydrogenase

D) Liver Hydroxymethylase

113. Which of the following drugs acts equally well on alpha and beta adrenergic receptors
A) Epinephrine

B) Norepinpehrine

C) Isoproterenol

D) Phentolamine

114. Which of the following drugs causes the release of the stored catecholamine from
presynaptic membrane
A) Hydralazine

B) Methyldopa

C) Reserpine

D) Tyramine

80
 115. Once norepinephrine has interected with the receptor of the effector cell, it is subject
to inactivation by
A) Aromatic L-amino acid decarboxylase

B) Catechol-O-methyltransferase

C) Phenylethanolamine-N-methyl transferase

D) Dophamine beta-hydroxylase

116. The central nervous system transmitter serotonin is found in the highest concentration
in which area of the brain
A) Thalamus

B) Hypothalamus

C) Cerebral cortex

D) Basal ganglia

117. For the production of short term hypotension during surgery, the preferred ganglionic
blocking agent is
A) Mecamylamine

B) Pentolinium

C) Trimethaphan

D) Tetraethylammonium

118. Which of the following effects would NOT be expected from ganglionic blocking agent
A) Vasodilation

B) Salivation

C) Mydriasis

D) Decreased cardiac output

119. Bronchodilation a beta adrenergic effect, can be produced by all of the following drugs
EXCEPT
A) Theophylline

B) Aminophylline

81
C) Isoproterenol

D) Phenoxybenzamine

120. The parasympathomimetic agents carbachol and bethanecol

A) Cause vasodialation and have a negative chronotropic and inotropic effect

B) Undergo hydrolysis by acetylcholinesterase

C) Exhibit muscarinic activity that is not blocked by atropine

D) Act relatively selectively on the smooth muscle of the gastrointestinal tract and urinary bladder

121. Which of the following physiological changes would occur with the administration of
intravenous epinephrine
A) Decrease in coronary blood flow

B) Decrease of blood pressure

C) Reduction of cutaneous blood flow

D) Increase of GI tract motility

122. A predictably dangerous side effect of propranolol which constitutes a contraindication

of its clinical use in susceptible patients is the induction of
A) Hypertension

B) Hypersensitivity

C) Asthma

D) Arrhythmia

123. The preferred drug for evaluating the presence of pheochromocytoma in a severely
hypertensive patient is
A) Phenylephrine

B) Histamine

C) Phentolamine

D) Methacholine

82
 124. The neuromuscular blocking adent that acts by initial depolarization of postsynaptic
membranes followed by decreased sensitivity to acetylcholine
A) Gallamine

B) Tubocurarine

C) Neostigimine

D) Succinylcholine

125. The mechanism of action of long lasting organic phosphate anticholinesterases is

A) Splitting of polypeptide bonds in cholinesterases

B) Phosphorylation of the anionic site of cholinesterases

C) Phosphorylation of the esteratic site of cholinesterases

D) Acetylation of the anionic site of cholinesterases

126. Patients with myasthenia gravis may exhibit a transient improvement of symptoms
when treated with
A) Neostigmine

B) Pilocarpine

C) Succinylcholine

D) Tubocurarine

127. Atropine effectivley blocks the effect of acetylcholine at all of the following sites EXCEPT
A) Exocrine glands

B) Cardiac muscle

C) Smooth muscle

D) Skeletal muscle

128. Beta adrenergic stimulation plus alpha adrenergic blockade causes all of the following
EXCEPT
A) Tachycardia

B) Bronchodilatation

83
C) Vasodilatation

D) Decreased levels of cyclic AMP

129. Epinephrine is added to local anesthetics in order to

A) Stimulate local wound repair

B) Promote hemostasis

C) Facilitate their dissemination

D) Lessen their absorption

130. Which of the following has antihypertensive effects associated with blockade of alpha
receptors
A) Propranolol

B) Clonidine

C) Prazosin

D) Phenylephrine

131. Which of the following is used only as a diagnostic agent in myasthenia gravis
A) Edrophonium

B) Pyridostigmine

C) Neostigmine

D) Gallamine

132. Therapeutic doses of which of the following are associated with decreased heart rate at
rest
A) Propranolol

B) Pindolol

C) Salbutamol

D) Terbutaline

133. The principle route for succinylcholine inactivation is a:

84
A) Mitochondrial enzyme

B) Microsomal enzyme

C) Plasma enzyme

D) Cytosolic enzyme

134. Abrupt withdrawal of which of the following drugs may be accompanied by severe
blood pressure elevation
a) Phenylephrine

b) Dobutamine

c) Clonidine

d) Ephedrine

135. A patient receiving timolol and epinephrine instillation into the eye for glaucoma
experienced dizziness associated with hypertension. The most likely explanation for this event is
that timolol
a) Increased the release of norepinephrine

b) Unmasked epinephrine`s pressor response

c) Prevented the urinary excretion of epinephrine

d) Increased the activity of the enzymes monoamine oxidase and catechol-o-methyltransferase

136. Which of the following causes muscle paralysis by sustained depolarization of the
postjunctional membrane
a) Pancuronium

b) Succinylcholine

c) Tubocurarine

d) Atracurium

137. Injection of a drug X into an anesthetized dog increased blood pressure and decreased
heart rate. Following bilateral vagotomy drug X elicited a pressor response without changes in
heart rate. Drug X is probably:
a) A ganglionic stimulant

85
b) A sympathomimetic amine acting on alpha and beta adrenoceptors

c) A sympathomimetic amine acting only on alpha adrenoceptors

d) An Indirect acting sympathomimetic amine

138. Diminution or prevention of reflex bradycardia is caused by

a) Ganglionic blocker

b) Beta blocker

c) Alpha blocker

d) Indirect acting sympathomimetics

139. Drugs reaching plasma via which route of administration may first undergo extensive
hepatic degradation
a) Intravenous

b) Intramuscular

c) Sublingual

d) Oral

140. Which of the following acts in the CNS

a) Clonidine

b) Prazosin

c) Tamsulosin

d) Ipratropium

141. \\\\ Which of the following promotes salt and water reabsorption
\\ Clonidine

\\\ Phenylephrine

\\\ Methyldopa

\\\ Midodrine

86
 142. Which of the following inhibits norepinephrine release
a) Clonidine

b) Salbutamol

c) Phenyleprine

d) Yohimbine

143. Which of the following causes orthostatic hypotension

a) Clonidine

b) Prazosin

c) Propranolol

d) Midodrine

144. N-Acetylcysteine would be indicated for treatment of an overdose of which of the

following
a) Aspirin

b) Alcohol

c) Acetaminophen ( Paracetamol)

d) Atropine

145. Which one of the following statements is correct

a) Weak base are absorbed efficiently across the epithelial cells of the stomach

b) Coadministration of atropine speeds the absorption of a second drug

c) Drugs showing a large Vd can be efficiently removed by dialysis of the plasma

d) Stressful emotions can lead to a slowing of drug absorption

145. Which one of the following is true for a drug whose elimination from plasma shows first
order kinetics
a) The half-life of the drug is proportional to the drug concentration in plasma

b) The amount eliminated per unit of time is constant

c) The rate of elimination is proportional to the plasma concentration

87
d) A plot of drug concentration versus time is a straight line

146. A patient is treated with drug A, which has a high affinity for albumin and is
administered in amounts that do not exceed the binding capacity of albumin. A second drug, B,
is added to the treatment regimen. Drug B also has a high affinity for albumin but is
administered in amounts that are 100 times the binding capacity of albumin. Which of the
following occurs after administration of drug B
a) An increase in the tissue concentration of drug A

b) A decrease in the tissue concentration of drug A

c) A decrease in the volume of distribution of drug A

d) A decrease in the half-life of drug A

147. Which of the following drugs exert its principal effects by enzyme inhibition:
a) Pyridostigmine

b) Atropine

c) Salbutamol

d) Cetirizine

148. The following drugs are reversible competitive antagonists:

a) Suxamethonium

b) Loratidine

c) Phentolamine

d) Phenoxybenzamine

149. The following drugs obey non-linear (dose-dependent) elimination pharmacokinetics:

a) Atropine

b) Phenylephrine

c) Phenytoin

D) Atenolol

88
 150. The following are examples of prodrugs:
a) Levodopa

b) Phentolamine

c) Cetirizine

d) Fexofenadine

151. Drug absorption following oral administration:

a) Is most commonly through active transport

b) Occurs predominantly in the colon

c) Is usually complete within 5 minutes

d) Non-polar lipid-soluble drugs are absorbed more readily than polar water-soluble drugs

152. The following inhibit at least one of the hepatic CYP450 isoenzymes:
a) Modafilin

b) Grapefruit juice

c) Phentolamine

d) Atropine

153. Stopping treatment with the following drugs may lead to adverse effects due to drug
withdrawal:
a) Loratadine

b) Prazosin

c) Atropine

d) Metoprolol

154. Atenolol is causing:

a) Prolongation of prothrombin time

b) Reduction in blood glucose

c) Reduction in exercise-induced increase in heart rate

d) Pupil constriction
89
 155. Pilocarpine is causing:
a) Prolongation of prothrombin time

b) Reduction in blood glucose

c) Reduction in exercise-induced increase in heart rate

d) Pupil constriction

156. Allopurinol:
a) Inhibits xanthine oxidase

b) Increases uric acid secretion

c) Is contraindicated in renal failure

d) Should not be prescribed with a non-steroidal anti-inflammatory drug (NSAID)

157. Find an incorrect statement about Doxazosin:

a) Is a selective reversible α1 receptor antagonist

b) Should always be prescribed with a beta blocker to prevent reflex tachycardia

c) Is associated with first-dose hypotension

d) Can cause urinary incontinence in women with pre-existing pelvic pathology

158. Find an incorrect statement about Beta-adrenoceptor antagonists:

a) Increase cardiac tissue cyclic adenosine monophosphate (cAMP)

b) Competitively antagonize the β receptor-mediated effects of adrenaline and noradrenaline

c) Non-competitively antagonize several of the actions of thyroxine

d) Reduce renin secretion

159. Find an incorrect statement about Aspirin:

a) Reduces the risk of stroke in patients with transient ischaemic attacks

b) Predisposes to peptic ulceration

c) Irreversibly inhibits fatty acid cyclo-oxygenase

90
d) Has no effect on bleeding time

160. Find an incorrect statement about Dobutamine:

a) Is a sympathomimetic amine

b) Is predominantly a β1-receptor agonist

c) Increases blood pressure via vasoconstriction

d) Increases myocardial oxygen consumption

161. Beta2 agonists (e.g. salbutamol, terbutaline, salmeterol):

a) Relax bronchial smooth muscle

b) Reduce heart rate

c) Cause pulmonary vasoconstriction

d) Decrease intracellular cyclic adenosine monophosphate (cAMP)

162. Find an incorrect statement about Ipratropium bromide:

a) Is administered intravenously

b) Causes bronchodilatation because of its antagonistic effects at the cholinergic M3 receptors

c) Decreases activation of Phospholipase C

d) May precipitate glaucoma in high doses

163. The addition of glucuronic acid to a drug

a) Decreases its water solubility

b) Usually leads to inactivation of the drug

c) Is an example of a Phase I reaction

d) Occurs at the same rate in adults and newborns

164. Drugs showing zero-order kinetics of elimination

a) Are more common than those showing first-order kinetics

b) Decrease in concentration exponentially with time

91
c) Have a half-life independent of dose

d) Show a plot of drug concentration versus time that is linear

165. A drug given as a 100mg single dose, results in a peak plasma concentration of
20mcg/ml. The apparent volume of distribution is
a) 0.5L

b) 1L

c) 2L

d) 5L

166. A drug with a half-life of 12 hours is administered by continuous Intravenous infusion.

How long will it take for the drug to reach 90% of its final steady-state level
a) 18 hours

b) 24 hours

c) 36 hours

d) 48 hours

167. Which of the following results in a doubling of the steady-state concentration of a drug
a) Doubling of the rate of infusion

b) Maintaining the rate of infusion but doubling the loading dose

c) Doubling the rate of infusion and doubling the loading dose

d) Tripling the rate of infusion

168. Which of the following statements is correct

a) If 10mg of drug A produces the same response as 100mg of drug B, drug A is more efficacious than
drug B

b) The greater the efficacy, the greater the potency of a drug

c) In selecting a drug potency is usually more important than efficacy

d) A competitive antagonist increases the ED50 of an agonist

92
 169. Variation in the sensitivity of a population of individuals to increasing doses of a drug is
best determined by which of the following
a) Efficacy

b) Therapeutic index

c) Graded dose-response curve

d) Quantal dose-response curve

170. Which of the following statements most accurately describes system having spare
receptors
a) The number of spare receptors determines the maximum effect

b) Spare receptors are sequestered in the cytosol

c) A single drug-receptor interaction results in many cellular response elements being activated

d) Spare receptors are active even in the absence of agonist

171. Albuterol
a) Takes about 1 hour to produce

b) Should be stopped if it causes tremor

c) Must be taken regularly

d) May be valuable for acute left ventricular failure

172. A 45 year old man is to undergo chemotherapy for testicular tumor, which of the
following drugs is most likely to be used concomitantly as an antiemetic
a) Bromocriptine

b) Ergotamine

c) Ibuprofen

d) Ondansetron

173. A 63 year old man has glaucoma and requires treatment to lower the intraocular
pressure, which of the following eicosanoids is most likely to be used
a) Alprostadil

b) Dinoprostone

93
c) Latanoprost

d) Misoprostol

174. Which of the following drugs will control rheumatoid arthritis symptoms with the
smallest risk of GI tract ulceration
a) Celecoxib

b) Ibuprofen

c) Ketorolac

d) Naproxen

175. Which of the following is one of the earliest dose related signs or symptoms of aspirin
toxicity in the adult
a) Respiratory depression

b) Reye`s syndrome

c) Metabolic acidosis

d) Tinnitus

176. Ipratropium
a) Is a nicotinic antagonist

b) May cause intraocular pressure to rise

c) Is of no value in the treatment of acute severe asthma

d) Encourages oral candidiasis

177. Which one of the following statements concerning the parasympathetic nervous system
is correct
a) The parasympathetic system uses norepinephrine as a neurotransmitter

b) The parasympathetic system often discharges as a single, functional system

c) The parasympathetic system division is involved in accommodation of near vision, movement of

food and urination

d) The postganglionic fibers of the parasympathetic division are long compared to those of the
sympathetic nervous system
94
 178. Which of the following is characteristic of the sympathetic nervous system
a) A discrete response to activation

b) Actions mediated by muscarinic and nicotinic receptors

c) Responses predominate during physical activity or when one is frightened

d) Subjected to voluntary control

179. Which one of the following is characteristic of parasympathetic stimulation

a) Decrease in intestinal motility

b) Inhibition of bronchial secretion

c) Contraction of sphincter muscle in the iris of the eye

d) Increase in heart rate

180. A patient with an acute attack of glaucoma is treated with pilocarpine. The primary reason
for its effectiveness in this condition is its
a) Action to terminate acetylcholinesterase

b) Selectivity for nicotinic receptors

c) Ability to inhibit secretions, such as tears, saliva and sweat

d) Ability to lower intraocular pressure

180. A soldier’s unit has come under attack with a nerve agent. The symptoms exhibited are
skeletal muscle paralysis, profuse bronchial secretions, miosis, bradycardia and convulsions.
What is the correct treatment
a) Administer anticholinesterase agents

b) Administer atropine and attempt to confirm the nature of the nerve agent

c) Administer atropine and 2-PAM (Pralidoxime)

d) Administer 2-PAM

181. A patient being diagnosed for myasthenia gravis would be expected to have improved
neuromuscular function after being treated with
a) Donepezil

95
b) Edrophonium

c) Atropine

d) Ecothiophate

182. A 75 year old man who was a smoker is diagnosed with chronic obstructive pulmonary
disease and suffers from occasional bronchospasm. Which of the following would be effective in
treating him?
a) Ipratropium aerosol

b) Scopolamine patches

c) Mecamylamine

d) Oxygen

183. Which of the following may precipitate an attack of open angle glaucoma if instilled
into the eye
a) Physostigmine

b) Atropine

c) Pilocarpine

d) Ecothiophate

184. The prolonged apnea sometimes seen in patients who have undergone an operation in
which succinylcholine was employed as a muscle relaxant has been shown to be due to
a) Urinary atony

b) Depressed levels of plasma cholinesterase

c) A mutation in acetylcholinesterase

d) A mutation in the nicotinic receptor at the neuromuscular junction

185. A 68 year old man presents to the emergency department with acute heart failure. You
decide that this patient requires immediate drug therapy to improve his cardiac function. Which
one of the following drugs would be most beneficial
a) Albuterol

b) Dobutamine

96
c) Norepinephrine

d) Phenylephrine

186. Remedies for nasal stuffiness often contain which one of the following drugs
a) Atropine

b) Epinephrine

c) Norepinephrine

d) Phenylephrine

187. Which one of the following drugs, when administered intravenously can decrease blood
flow to the skin, increase blood flow to skeletal muscle and increase the force and rate of
cardiac contraction
a) Epinephrine

b) Isoproterenol

c) Phenylephrine

d) Terbutaline

188. A 60 year old asthmatic man comes in for checkup and complains that he is having
some difficulty in “starting to urinate”. Physical examination indicates that the man has a blood
pressure of 160/100mm Hg and a slightly enlarged prostate. Which of the following medications
would be useful in treating both of these conditions
a) Doxazosin

b) Labetalol

c) Phentolamine

d) Isoproterenol

189. In which of the following conditions would aspirin be contraindicated

a) Myalgia

b) Peptic ulcer

c) Fever

d) Unstable angina

97
 190. Which one of the following statements concerning COX-2 inhibitors is correct
a) The COX-2 inhibitors show greater analgesic activity than traditional NSAIDs

b) The COX-2 inhibitors decrease platelet function

c) The COX-2 inhibitors show anti-inflammatory activity similar to that of the traditional NSAIDs

d) The COX-2 inhibitors are cardioprotective

191. An 8 year old girl has a fever and muscle aches from a presumptive viral infection.
Which one of the following drugs would be most appropriate to treat her symptoms
a) Acetaminophen ( Paracetamol)

b) Aspirin

c) Allopurinol

d) Indomethacin

192. A 70 year old man has a history of ulcer disease. He has recently experienced swelling
and pain in the joints of his hands. His physician wants to begin therapy with NSAID. Which one
of the following drugs might also be prescribed along with the NSAID to reduce the risk of
activating this patient’s ulcer disease
a) Allopurinol

b) Colchicine

c) Misoprostol

d) Probenecid

193. Dihydroergotamine
a) Causes vasodilation

b) Exerts its actions by binding to specific ergotamine receptors

c) Is useful in treating acute migraine headaches

d) Is useful for maintaining uterine muscle tone

194. A 43 year old ship`s captain complains of seasonal allergies. Which one of the following
would be indicated

98
a) Diphenhydramine

b) Doxylamine

c) Hydroxyzine

d) Fexofenadine

195. Which one of the following statements concerning H1 antihistamines is correct

a) Second generation H1 antihistamines are relatively free of adverse effects

b) Because of the established long-term safety of first generation H1 antihistamines, they are the first
choice for initial therapy

c) The motor coordination involved in driving an automobile is not affected by the use of first
generation H1 antihistamines

d) Both first and second generation H1 antihistamines readily penetrate the blood-brain barrier

196. Which one of the following drugs could significantly impair the ability to drive an
automobile
a) Diphenhydramine

b) Fexofenadine

c) Ranitidine

d) Sumatriptan

99