1. 2. 3. 4. 5. 6.

7.

8.

9.

10.

11.

12.

13.

Angiotensin II : 1. is a powerful vasodilating agent 2 .induces vasodilation of the afferent arterioles 3. inhibit ADH ( antidiuretic hormone ) production 4. inhibit renin release 5. all the above are correct The clearance of creatinine is proportional to the 1. glomerular filtration rate ( GFR) 2. tubular secretion rate (TSR) 3. GFR+TSR 4. cyclosporine clearance rate 5. cholic acid clearance rate Serum creatinine levels are: 1. low in pregnancy 2. low in elderly patients 3. low in stage 3 chronic kidney disease 4. directly proportional to the liver function 5. inversely proportional to the white blood cell production What fraction of the bile acid is normally reabsorbed in the intestine? 1. 1% 2. 5% 3. 15% 4. 40% 5. 90% Thoracic duct is a part of the following system: 1. Nervous 2. Urogenital 3. Gastrointestinal 4. Lymphatic 5. Musculo-skeletal Majority of the proteins that are secreted by cells are synthesized in the 1. Nucleus 2. Endoplasmic reticulum 3. Which of the following amino acids is aromatic? 1. Lysine 2. Tyrosine 3. Cysteine 4. Arginine 5. Alanine Hematuria can occur in all of the following except: 1. Acute glomerulonephritis 2. Cancer of urinary tracts 3. Stone in urinary tract 4. Mismatched blood transfusion

14.

15.

16.

17.

18.

19.

20.

21.

22.

5. Benign prostatic hyperplasia Low density lipoproteins (LDL) are rich in: 1. Chylomicrons 2. Cholesterol 3. Mono-glycerides 4. Proteins 5. hormones The P wave of the electrocardiogram (ECG) results from: 1. Hyperpolarization of the atria 2. depolarization of the atria 3. hyperpolarization of the ventricles 4. depolarization of the ventricles contraction of the aorta Which of the following can cause diabetes? 1. Shortage of receptors for extracellular proteins 2. Shortage of G-proteins 3. Excess of glucose receptors 4. Production of antibodies against the glucose receptors 5. None of the above Cellular immune response is mediated by: 1. B-lymphocytes 2. T-lymphocytes 3. . 4. . 5. . Sympathetic nervous system contain: 1. Short postganglionic fibers 2. Long preganglionic fibers 3. Ganglions located close to the spinal cord 4. The vagus nerve 5. All of the above Adrenaline and noradrenaline : 1. Are amino acids 2. Activate alpha-adreno receptors , but not beta-adrenergic receptors 3. Are synthesized from dopamine 4. Are characterized by a half-life of approximately 2-3 hours 5. None of the above answers are correct Increased secretion of human growth hormone in adults causes : 1. Gigantisim 2. Acromegaly 3. Increased skeletal muscle glucose utilization 4. Decreased thyroid function 5. Increased adrenal function Hormones produced by the parathyroid gland (PTH): 1. Regulates the phosphate levels in the blood 2. Leads to release of calcium from the bones 3. Increases the excretion of calcium in urine 4. Reduce the absorption of calcium in the gastrointestinal tract 5. All of the above Substance that is secreted into the blood by a neuron is a :

23.

24.

25.

26.

27.

28.

29.

1. Neurohormone 2. Neuromodulator 3. Neuromediator 4. neurotransmitter 5. neurogene The neurotransmitter that is normally released in the sinoatrial node in response to increased blood pressure is : 1. Acetylcholine 2. Dopamine 3. Epinephrine 4. Glutamate 5. norepinephrine Which pyrimidine base is found only in RNA? 1. Cytosine 2. Thymine 3. Uracil 4. Adenine 5. None of the above Pharmacy A pharmacist prepare a solution by adding 1 g of sodium chloride to 100ml. water what is the percentage of sodium chloride in the prepared solution? 1. 10% 2. 1% 3. 0.1% 4. 0.01% 5. 100% 100 g are equal to: 1. 100,000 ng 2. 0.1 mg 3. 0.001 g 4. 1+3 5. 1+2+3 A tablet of multi-vitamin contains 250 g of (something).(same something) of 6mg - is 1. 10-fold higher 2. 24-fold higher 3. 250-fold higher 4. The same 5. lower Which of the following processes is bypassed by the sublingual rout of administration? 1. Absorption 2. Dissolution 3. First-pass metabolism 4. Plasma protein binding 5. Entero-hepatic cycle A patient weighs 80 kg. A vial with concentrated solution of the drug is labeled 20mg/mL. How many milliliters of the solution should be added to 50mL water if Patient should receive 0.5 mg/kg drug?

30.

31.

32.

33.

1. 0.2 2. 0.5 3. 1 4. 2 5. 4 Vial containing 1,000 units if a drug powder is labeled add 9ml saline water for Injection to obtain 100 units /ml. How many milliliters of diluent should be added if the Required concentration is 120 units /ml? 1. 7.3 2. 8.3 3. 9.0 4. 10 5. 11 A pharmacist adds 200 mL of alcohol USP to the mouthwash solutionMake 1 L of final product. What is the percentage of the ethanol percentage of ethanol present in the original mouthwash contained 12% v/v ethanol? 1. 10 2. 19 3. 23 4. 29 5. 36 The infusion rate of theophylline for an infant is 0.08 mg/kg/h. how many Drug should be added to the 12-hour infusion bottle if the body weight7.3kg? 1. 0.58 2. 14 3. 30 4. 150 5. 7 You were given the following prescription: Cocaine HCL 4% Tetracaine HCL 2% 0.5 mL Epinephrine HCL 1/2,000 Sodium chloride injection q.s. 4mL

34.

How many milligrams of cocaine HCL will be present in the final solution? 1. 4 2. 8 3. 16 4. 40 5. 160 P-gp (p-glycoprotein) pumps are found in all the following cells except: 1. Brain vascular endothelial cells 2. Nerve cells 3. Gut epithelial cells 4. Liver cells

35.

36.

37.

38.

39.

5. Kidney cells Drugs with narrow therapeutic window: 1. Are usually very safe 2. Require administration at high doses 3. Have extremely high clearance rate 4. Require administration at low doses with high frequency 5. Are administered only as iv infusion Therapeutic drugs monitoring is usually performed for all the following drugs except: 1. Phenytoin 2. Insulin 3. Lithium 4. Digoxin 5. Theophylline Therapeutic antibodies are characterized by: 1. Predominantly hepatic and renal excretion 2. Effective penetration into cells in the peripheral tissues and the blood-brain barrier 3. Once-a-day or twice a-day dosing frequency 4. Effective absorption after 5. Doses are in the Patient is taking one pill of ibuprofen by mouth three times a day ( every 8 hours).if she would start to take the pill four times a day ( every 6 hours) it would change the following pharmacokinetic parameters of ibuprofen , except of : 1. The peak plasma drug concentration 2. The average blood drug concentrations 3. The free drug concentration in the blood 4. The amount of drug excreted in the urine 5. The volume of distribution of the drug The value of the oral bioavailability for a specific drug reflects the : 1. Fraction of the drug that is absorbed by the intestinal epithelial cells 2. Fraction of the drug that reaches the systemic circulation 3. Fraction of the drug that reaches the site of action 4. Rate of the drug absorbed from the gastrointestinal tract 5. The rate of drug eliminated by the liver and kidneys A patient received an oral dose of 650 mg aspirin. the plasma drug concentration and its Inhibiting effect on thromboxane B2 product were measured ( see the graphs below)

40.)

41.

From the data, it can be determined that aspirin : 1. Is slowly absorbed from in the gastrointestinal tract 2. Has a long half-life ( approximately 24 hours) 3. Has a short duration of action 4. Has indirect concentration-effect relationship 5. Undergoes very rapid renal elimination What represented by the area under the drug concentration vs. time : 1. Rate of drug renal and hepatic elimination 2. Rate of drug intestinal absorption 3. Efficacy of drug permeation of peripheral tissues 4. Amount of drug that reaches the blood circulation 5. Solubilization and ionization state of the drug molecules

42. 43. 44. 45. 46.

47.

48.

What is the appropriate dosing regimen of allopurinol in this patient? 1. 100 mg once a day 2. 300 mg once a day 3. 900 mg once a day 4. 1200 mg once a day 5. Cannot be calculate insufficient data The half-life of cyclosporine is 20 hours. Blood sample that has been obtained from a Patient contained 0.8 mg/mL cyclosporine. How soon the cyclosporine concentration in the Patients blood is expected to reach the concentration of 0.2 mg /ml? 1. In 4 hours 2. In 20 hours 3. In 40 hours 4. In 44 hours 5. None of the above answers is correct Phase II clinical trials : 1. Are conducted in healthy volunteers

49.

50.

51.

52.

53.

54.

55.

2. Investigate the relationship between the drug dose and the clinical 3. Investigate the clinical response of the drug on more than 100 patients 4. Are not double-blinded 5. Usually examine several types if drugs formulation (e.g. immediate Release ) What parameters are needed to calculate body surface : 1. Height and waist circumference 2. Height , gender and the age of the patient 3. Height and weight 4. Height, weight and the age of the patient 5. Weight and the waist circumference The renal clearance of ampicillin is 25 L/hr. it is known that ampicillin protein binding ( f= 80%). What processes are responsible for the = 1. Only filtration 2. Filtration and 3. . 4. . 5. . Potassium supplements are administered in all of the following routes except: 1. IV infusion 2. Iv bolus 3. Oral elixirs 4. Effervescent tablets 5. Slow-release tablets A pharmacist has reviewed several clinical papers concerning irritable bowel syndrome and is preparing a publication with a summary of his findings. What issued to describe this type of review? 1. Dimensional analysis 2. Double blind study 3. Review article 4. Peer review 5. Crossover design What are the common building blocks for generation of liposomes? 1. Anionic surfactant and mineral oil 2. Nonionic surfactant and mineral oil 3. Phospholipids 4. Polyethylene glycols (PEGs) 5. Linear hydrocarbons combined with phosphoric acid Which of the following parameters must be identical between a solution and the blood, for a solution to be considered isotonic with blood? 1. Total salt count 2. PH 3. Fluid pressure 4. Osmotic pressure 5. Concentration of sodium chloride When mixing a hypertonic solution with red blood cells (RBCs) the RBCs might undergo:

56.

57.

58.

1. Bursting 2. Chelation 3. Shriveling 4. Hemolysis 5. Hydrolysis What is the capacity of the human eye for instillation of ophthalmic drops? 1. 0.01-0.05 ml 2. 0.1 ml 3. 0.5 ml 4. 1.0 ml 5. 2.0 ml Ibuprofen has pKa of 5.5. If the ph. of a patient is 7.5, what would be the ratio of Ionized to un-ionized drug? 1. 1:2 2. 1:100 3. 1:20 4. 2:1 5. 100:1 Pharmaceutical policy and regulations A customer came to the pharmacy with a prescription for a drug that is not registered in the Israeli state drug list. The pharmacist should explain (to not written on the paper )the customer that : 1. It is absolutely prohibited to use a drug which is not listed in the Israeli state drug list 2. The drug can be imported from abroad according to regulation number 29(a)3 of the drug regulations ( medical preparations 1986 ) if a physician will sign an appropriate form 3. Since the import of drug from abroad will be handled by the pharmacy, it is possible to import it following an oral request by the physician 4. Only a medical institution is allowed to import a drug that is not registered in the Israeli state drug list from abroad 5. Only if a drug is registered and approved for marketing in Israel , it is allowed to register if for a different indication than that stated in the Israeli state drug list An application for inclusion of a drug in Israeli state drug list in applied by the : 1. Pharmacist 2. Registration owner 3. Registration applicant 4. Physician 5. Pharmaceutical factory The use of narcotic drug in a higher daily dose than stated in column B of the second amendment to the schedule drug regulations is allowed when: 1. A specialist physician prescribed a daily dose which is higher than the allowed by the law 2. A patient suffers from cancer and physician specified in the

59.

60.

61.

62.

63.

64.

65.

prescription 3. if the prescription that was brought to the pharmacy was issued by a hospital physician 4. There is no limitation for a drug doe that can be prescribed in a narcotic prescription 5. A prescribing physician is an oncologist from a certified hospital Which of the following statements regarding psychotropic drugs from the fourth amendment to the Israeli pharmacists regulations is correct? 1. The drugs should be in a safe 2. The drugs should be stored inside a closed drawer 3. There is no requirement to store the drugs inside a closed drawer/closet 4. The law requires submitting a daily report regarding such drugs 5. The drugs should be stored inside a refrigerator Which of the following statements is correct? 1. The general manager of the ministry of health is allowed to require an additional examination to be taken by a candidate for pharmacists license before issuing him the license 2. The governmental examination in pharmacy is intended only for those who accomplished degree in a non-recognized university 3. Those possessing a doctor of clinical pharmacy (pharm D) degree from abroad automatically receive an Israeli pharmacist license 4. Those possessing masters degree in pharmacy from abroad, automatically receive and Israeli pharmacist license 5. None of the above If a medical board was appointed to examine an applicants fitness to practice pharmacy then: 1. The general manager of the ministry of health cant issue the applicant a license pharmacy as long as he didnt appear before the board 2. The board can issue the license to practice pharmacy 3. This means that the applicant didnt receive a certificate of good conduct from 4. Such board is appointed only after the applicant received a temporary license to practice pharmacy 5. Such board is appointed for each pharmacist before he gets the permanent license to practice pharmacy A pharmacist or an assistant pharmacist who turned out to have a disease which may clearly endanger the public : 1. The general manager of the ministry of health may suspend ( temporarily deny) his license to practice pharmacy 2. The medical board can revoke his license to practice pharmacy 3. Only the minister of health may order the suspension of his license 4. He must not practice pharmacy in drug rooms of health medical organizations ( 5. He is allowed to continue practicing pharmacy if he filed the board proof that he is properly treated The minimal area of a drug room belonging to a medical institution is

66.

67.

68.

69.

1. 30 square meters 2. 45 square meters 3. 60 square meters 4. 120 square meters 5. There is no maximal area of a drug room defined by the law The validity of a medical prescription is : 1. Two months 2. Six months 3. One year 4. For life 5. One month from the date issued When the district pharmacist is allowed to cancel the license 1. When the pharmacist has obtained the license after presenting false documents 2. When the pharmacist committed gross negligence of duty 3. When the pharmacist continued to violate the provisions of the pharmacists regulations 4. The district pharmacist has no authority to cancel a license of a licensed pharmacist 5. When the pharmacist acted in a manner unbecoming his profession The area of the laboratory of an institutional pharmacy which area is below 120 square meters 1. Should not exceed half of the area of the pharmacy 2. Should not be below half of the area of the pharmacy 3. Should not be below 12 square meters 4. Should not exceed 12 square meters 5. Should be at least 18 square meters The pharmacys lab : 1.can be locate at a different level if no pharmaceutical preparations 2.must be large enough to be used as storage when no 3.must be adjacent to the storage and at the same level 4.must be adjacent to the reception room and at the same 5. The toilets in the pharmacy must be inside the lab. Providing a schedule drug to a hospitalized person the daily dose specified in column B of the second amendment regulates: 1is subjected to approval of a district pharmacist of the hospit2.is subjected to a signed approval of the hospital director 3.is subjected to a signed approval of the department head nurse 4.there is no dosage limit for a hospitalized patient and no ho5. Exceeding the daily dosage specified in column B of the second drugs regulations is prohibited. Pharmacies on duty are scheduled by: 1. The municipal authority (municipality or the local -) or the ministry of health 2. The ministry of health 3. The pharmacy department of the ministry of health 4. The pharmacists association 5. The minister of health

70.

71.

72.

73.

74.

75.

Supply of a generic substitute is possible: 1. Only if the prescribed product is out of the market 2. If the physician didnt explicitly specified to supply the exact substituting it 3. You can always issue a generic substance if it contain the- dose as the prescribed drug, even if the physician explicitly 4. Generic substitute cannot be issued without a telephone ap5. Issuing of a generic substitute is completely prohibited substance Which of the following statement is correct? 1. Any drug product containing codeine requires a prescription 2. Any psychotropic drug product requires a prescription 3. All the separanda drug products contain psychotropic active ingredients 4. All the pharmaceutical preparations prepared at the pharmacy dont require a prescription 5. A drug product containing a schedule drug listed in the fourth amendment of the pharmacists regulations is necessary defined as toxica According to the law, the appointment of a responsible pharmacist requires 1. Written examination 2. Oral examination 3. The pharmacy owner is the one who determines whether the pharmacist fits for the pharmacy management 4. The district pharmacists approval 5. At least one year of experience of working at the ministry of health An approval of residency in pharmacy to the graduates of forging universities is issued by 1. The director of the medical professions division 2. The pharmacy where the residency was conducted 3. The district pharmacist of the pharmacy district 4. The administrative physician of an health medical organization ( in the pharmacy district 5. One who studied pharmacy in Israel has full exemption from the

76. 77. 78. 79. 80. 81.

The next two question ( 81 82) refer to the following case : A 73-year-old patient suffering from HTN (hypertension), CHF (chronic heart failure) and s/p MI (status post myocardial infraction). The patient is being treated with the following drugs: Digoxin 0.25 mg X 2/d new treatment Hydrochlorothiazide 50 mg X 1/d Enalapril 2.5 mg x 1/d Atenolol 100 mg 1/d

Mark the incorrect statement: 1. The initial dose of digoxin for this elderly patient is too high 2. The recommended daily dose of hydrochlorothiazide is 25 mg since at higher doses there are more adverse effects but no increase in efficiency 3. Combination of enalapril with digoxin may cause hypokalemia that may lead to dangerous arrhythmias 4. Combination of hydrochlorothiazide with digoxin may cause hypokalemia that might lead to dangerous arrhythmias 5. Combination of digoxin and atenolol slows the conduction through the AV node The patient complains of erectile dysfunction (impotence). What would be the right treatment: 1. Lower the dose of digoxin as erectile dysfunction is common at doses above 0.25 mg 2. Immediately discontinue atenolol as erectile dysfunction is its common side effect 3. Immediately discontinue enalapril as erectile dysfunction is its common side effect 4. Replace enalapril with losartan 5. None of the above Patient underwent heart valve replacement with bio-prosthetic heart valve. On his first night of hospitalization began to receive treatment with warfarin 5 mg/d. on the second day of warfarin treatment the patient developed blood clots at his hands and feet. Select the correct statement: 1. The doctors should have started at higher warfarin dose the dose was too low 2. The dose of warfarin should be increased until hypercoagulation phenomenon passes 3. To prevent this phenomenon heparin should be given the first few days of warfarin treatment 4. To prevent this phenomenon heparin should be administered during the entire period of warfarin treatment 5. This is a rare allergic reaction to warfarin Simultaneous administration of ferrous sulfate 325 mg with sinemet containing a combination of levodopa 100 mg with carbidopa 25 mg , will: 1. Increase the bioavailability of levodopa and carbidopa as result of decreased first pass metabolism 2. Decrease the bioavailability of levodopa and carbidopa as a result of decreased first pass metabolism 3. Decrease plasma concentration of levodopa and carbidopa as a result of interaction in intestinal lumen 4. Increase concentration of levodopa and carbidopa as a result of interaction in the intestinal wall 5. Mot affect the plasma concentration profile of sinemet A patient received phenazopyridine to relive the pain associated infection. During the treatment the patient reported that his urine red

82.

83.

84.

85.

86.

brown. Select the correct statement: 1. The patient has glucose-6-phosphate dehydrogenase ( G6PD) deficiency 2. This is due to the acute kidney failure 3. This is due to hemolysis of red blood cells in the urinary tract 4. The treatment with this drug must be immediately discontinued 5. None of the above Co-administration of codeine and fluoxetine: 1. is expected to cause reduction in the analgesic activity of codeine 2. Leads to enhanced respiratory depression side-effect 3. Is expected to cause an increase in the analgesic activity of codeine 4. There is no clinically significant interaction between these two drugs 5. At least two-hour interval is required between codeine and fluoxetine Woman suffering from epilepsy became pregnant, what treatment teratogenic risk? 1. Phenytoin 600 mg per day 2. Valporic acid 1400 mg per day 3. Valporic acid 800 mg per day 4. Lamotrigine 150 mg per day 5. Tegretol 100 mg and phenobarbital 5 mg per day A 70 year old patient is being treated with the following medication: T. verapamil 240 mg x 1/d T. digoxin 0.25 mg x 1/d T. furosemide 80 mg x 1/d The patient has been diagnosed with: edema and arrhythmia. The patient was admitted in hospital due to digoxin poisoning. Mark the incorrect answer: 1. Its possible that the toxicity was caused due to a pharmacokinetic interaction following P-gp inhibition by verapamil causing a decrease in the renal clearance of digoxin 2. The toxicity could be a result of hyponatremia caused by furosemide 3. The toxicity could be avoided by consuming potassium-rich foods 4. The use of digoxin antibodies is effective in the treatment of digoxin toxicity 5. It is possible that the toxicity was caused due to a pharmacokinetic interaction following P-gp inhibition by verapamil causing an increase in the digoxin absorption The following statements refer to treatment with furosemide and hydrochlorothiazide, mark the correct statement. 1. Furosemide has a very strong diuretic effect and therefore it is an appropriate treatment of edema 2. In treatment of patients suffering from kidney failure furosemide should be replaced with hydrochlorothiazide which is more efficient in this disease

87.

88.

89.

90.

91.

92.

93.

94.

95.

3. Hydrochlorothiazide containing sulfur atom, therefore patients who are sensitive to sulfonamides might develop sensitivity to this drug 4. Common side effects of furosemide is Hypercalcemia, as opposed to hydrochlorothiazide which causes hypoglycemia 5. None if the above The following statements refer to metoclopramide and Domperidone. All of the following statements are correct except: 1. Metoclopramide does not cross the blood-brain barrier (BBB) and therefore has no extra-pyramidal side effect 2. Domperidone does not cross the blood-brain barrier (BBB) and therefore has no extra-pyramidal side effect 3. Domperidone increases the motility of the gastrointestinal tract 4. Metoclopramide is safe drug (risk factor B) to treat nausea vomiting during pregnancy 5. Domperidone is not intended for chronic administration due to the risk of QT interval prolongation Tremor and tachycardia are typical side effects of : 1. Salbutamol 2. Propranolol 3. Metformin 4. Cefuroxime 5. Budesonide Which of the following pharmaceutical combinations does not require dose adjustment treatment discontinuation in patients with severe kidney failure ( CLcr <10): 1. Alendronate, pravastatin 2. Digoxin, metoclopramide 3. Enalapril, spironolactone 4. Ciprofloxacin, metformin 5. Lactulose, paracetamol Prolonged treatment with which two drugs (at least for over a month) does not have to be discontinued gradually? 1. Prednisone, verapamil 2. Metoprolol, propranolol 3. Amiodarone, fluoxetine 4. Brotizolam, amitryptyline 5. Venlafaxine, paroxetine Which of the following substances is a pro-drug? 1. Prednisone 2. Cilazapril 3. Enalapril 4. Vitamin D 5. All of the above A 45 year old patient suffers from heart failure and newly diagnosed type 2 after receiving a drug to control her blood sugar level, her edema and syn heart failure got worse. Which of the following medication did she receive? 1. Rosiglitazone 2. Metformin 3. Glibenclamide

96.

97.

98.

99.

4. Acrabose 5. Insulin Which of the following drugs may elevate the liver damage tests (the liver enzymes) therefore requires monitoring liver metabolic function before and during the drug treatment 1. Risperdone 2. Fluconazole 3. Metformin 4. Glibenclamide 5. 2+4 Mark the correct statement referring to methylphenidate: 1. Common side effects of the drug are: increased appetite and agitation 2. The drug is an adrenergic agonist 3. When having difficulty to swallow the capsule with the drug (concerta), it can be opened and the content can be dispersed on soft food 4. Ritalin LA is an extended-release formulation of methylphenidate, however is has fast onset of drug action 5. All of the above A pharmacy student reads a patients chart and notes that the patient has blepharitis. The patient suffers from inflammation of what organ 1. Colon 2. Eyelid 3. Throat 4. Tongue 5. Ear What is true regarding who block the beta-adrenergic receptors? 1. At low doses they are selective to B1 receptor, however at high doses the lose their selectivity 2. Their use during pregnancy is common and is not associated with health risks the 3. There is no correlation between their half-life and their duration of action 4. They have pharmacokinetic interaction with amiodarone, digoxin and verapamil 5. None of the above Co-administration with fluconazole may increase the blood concentration of which of the following drugs: 1. HMG CoA reductase inhibitors, atenolol 2. HMG CoA reductase inhibitors, cyclosporine 3. Cyclosporine, codeine 4. Brotizolam, cefuroxime 5. Amitriptyline, methylphenidate Which fetal organ/s are still considerably susceptible to teratogenic effects at the fifth month of pregnancy? 1. Heart 2. Brain

100.

101.

102.

103.

104.

105.

106.

107.

108.

3. Upper limbs 4. Lower limbs 5. 1+2 Which of the following patients will enjoy the maximal analgesic effect of codeine? 1. Poor CYP2D6 metabolizer 2. Poor CYP2C9 metabolizer 3. Extensive CYP2C9 metabolizer 4. Extensive CYP2D6 metabolizer 5. The analgesic effect of codeine is dependent only on the glucuronidation efficiency A patient was hospitalized with severe arrhythmia as a result of hyperkalemia. Doctors that checked his drug chart identified three medications that could, each by itself, cause hyperkalemia. Which drugs could have caused this effect? 1. Digoxin; enalapril; spironolactone 2. Prednisone; potassium chloride; cilazapril 3. Losartan; spironolactone; potassium chloride 4. Enalapril; hydrochlorothiazide; furosemide Which medication is not indicated for migraine prophylaxis? 1. Propranolol 2. Amitriptyline 3. Citalopram 4. Topiramate 5. Valporic acid Which of the following beta-blockers has the highest incidence of the central nervous system side effects 1. Propranolol 2. Atenolol 3. Metoprolol 4. Timolol 5. The incidence of central nervous system side effects is the same for all beta-blockers Combination of lithium with which of the following drugs may cause lithium toxicity? 1. Simvastatin 2. Hydrochlorothiazide 3. Atenolol 4. Famotidine 5. 1+2 Which one if the following drugs increase the level of dopamine in the brain? 1. Methylphenidate 2. Paroxetine 3. Risperdone 4. Amitriptyline 5. Fluoxetine A woman is referred to a teratology consulting center at the ninth week of pregnancy because up to that day she was receiving warfarin treatment.

109.

110.

111.

112.

What would be your diagnosis/advice? 1. Warfarin does not cross the placenta so there is no additional risk to the fetus 2. There is a risk of fetal abnormalities: stippled epiphyses and hypoplasia of nasal bridge 3. To monitor the pregnancy by ultrasound. It can be concluded that the fetus was not affected if the abnormalities will be detected 4. Warfarin can cause risk of fetal abnormalities only if taken in the 12th week of pregnancy 5. Replacing warfarin with heparin at this time point will prevent fetal abnormalities The following two questions (109-110) refer to the following case: A patient comes to the pharmacy with the following prescription: T. Amitriptyline 25 mg X 2/d Ovules clindamycin 100 mg X 1/d , for 3 days T. Levodopa 250 mg + carbidopa 25 mg X 4/d T. simvastatin 20 mg X 1/d What illnesses does he suffer from? 1. Depression, Parkinsons, hypercholesterolemia and vaginal candidiasis 2. Herpes zoster, Parkinsons, hypercholesterolemia and vaginal bacterial infection 3. Migraine, Parkinsons, hypercholesterolemia and vaginal candidiasis 4. Depression, Parkinsons, hypercholesterolemia and vaginal bacterial infection 5. Neuroleptic pain, Parkinsons, hypercholesterolemia and vaginal candidiasis Which of the following drugs can be co-administered without the risk of drug interactions : 1. Lithium 2. Risperdone 3. Fluconazole 4. Entacapone 5. Metformin The better treatment for nausea and vomiting in patients having Parkinsons disease is: 1. Domperidone 2. Metoclopramide 3. Either Metoclopramide or Domperidone 4. Both metoclopramide and Domperidone are contraindicated for treatment of Parkinsons disease patients 5. None of the above Which if the following is not typical side effect of amiodarone? 1. QT interval prolongation at ECG 2. Blue skin discoloration 3. Liver damage 4. Pulmonary fibrosis 5. Kidney damage

113.

114.

115.

116.

117.

Which of the following is defined as primary data source? 1. Cohort studies 2. Review articles 3. Brief description of the information displayed in an article-abstract 4. Textbooks 5. 1+2+3 Which statement regarding spironolactone is incorrect? 1. Co-administration of spironolactone and ACE inhibitor is dangerous due to the risk of hypokalemia 2. During the treatment, potassium blood levels should be monitored due to the risk of hyperkalemia 3. Gynecomastia ( breast enlargement ) in men is considered to be one of the drugs side effects 4. The regular dose for treatment of heart failure treatment is lower than of edema treatment 5. This drug is used for the treatment of hepatic cirrhosis with edema and ascites All the statements regarding digoxin toxicity are correct except: 1. Hypokalemia may exacerbate digoxin-induced toxicity 2. Dioxin toxicity cannot occur at the steady-state plasma digoxin concentration of 0.8 mcg\L ( the accepted therapeutic window is 12 mcg\L) 3. Gastrointestinal disorder such as loss of appetite are early symptoms of digoxin toxicity 4. Strict monitoring of drug blood levels can reduce the risk of digoxin toxicity 5. Drugs that inhibit P-gp may increase the risk of digoxin toxicity Choose the correct statement: 1. As compared to verapamil, nifedipine has greater effect on the AV node conduction 2. Grapefruit juice increases metabolism of nifedipine 3. Verapamil reduces blood pressure mainly by dilating of peripheral vessels 4. Verapamil inhibits P-gp pumps and CYP3A4 enzyme is the intestinal epithelial cells (enterocytes) 5. None of the above A patient was discharged from the hospital 2 days ago with a prescription for the following drugs: Tab. Aspirin 100 mg * 1/day Tab. Clopidogrel 75 mg *1/day Choose the incorrect statement: 1. patient with active bleeding can be treated with Clopidogrel but not aspirin 2. the combination of aspirin and Clopidogrel in patients after acute myocardial infraction is not recommended 3. a loading dose of Clopidogrel should be given to a patient after and acute myocardial infraction 4. in patients with cardiovascular disease the combination of the drugs is more effective that when administered alone

118.

119.

120.

121.

5. the combination of aspirin and Clopidogrel in patients after stroke is not recommended Choose the incorrect statement: 1. The most side effect associated with nitrates is headache 2. Nitrates mainly dilates systemic veins and reduce preload 3. When nitrates are co-administered with PDE5 inhibitors (e.g. sildenafil) the dose of both drugs should be reduced to prevent a sharp decline of blood pressure 4. When daily nitrate-free of 8 12 hours is not provided, tolerance to nitrate treatment can develop 5. Sildenafil is used to treat pulmonary hypertension The interaction between aspirin and naproxen is : 1. Pharmacokinetic ibuprofen competes with aspirin for its binding site at cox2 and reduce the effect of aspirin on platelet aggregation 2. Pharmacodynamics ibuprofen increases the risk of gastrointestinal bleeding associated with aspirin use 3. Pharmacokinetic aspirin inhibits the activity of CYP3A4 enzyme responsible for the metabolism of ibuprofen, therefore ibuprofen levels are increased 4. Pharmacodynamics ibuprofen competes with aspirin for its site at cox1 and reduce the effect of aspirin on platelet aggregation 5. There is no interaction between the two drugs A patient has been treated with enalapril for a month. Two days ago started to complain about suspicious cough and swelling of the face. The doctor decided to change his treatment to cilazapril. What was the reason for his decision? 1. Cilazapril belongs to the family of angiotensin receptor blockers, which dont have cough as side effect 2. Swelling of the face may be a manifestation of angioedema, which is not typical side of cilazapril, thus the treatment was exchanged 3. Apparently a mistake was made, both drugs belong to the family of angiotensin converting enzyme inhibitors and their side effect profile is similar 4. There is no need to change the treatment; cough and swelling are common side effects of enalapril that pass on their own 5. None of the above Combinations of the following drugs pair increase the risk of reduced blood pressure in which drug combination will not cause this side effect? 1. Naproxen sildenafil 2. Doxazosin nifedipine 3. Furosemide isosorbide mononitrate 4. Doxazosin furosemide 5. Enalapril cilazapril Select the correct statement regarding pharmacokinetic parameters 1. All the pharmacokinetic parameters of drugs, except for the volume of distribution, are affected by childs growth and development 2. In younger children the oxidation processes in the liver by the

122.

123.

124.

125.

cytochrome p450 are slow and therefore the daily dose of phenobarbital ( per weight ) should be lower 3. Maturation of renal function is a dynamic process that begins during fetal organogenesis and ends only in adolescence (12years) 4. Extent of protein binding of drugs, that are weak acids, is lower in neonates than in children 5. None of the above Patient with diabetes checked his blood sugar levels and discovered that he suffers from hypoglycemia. The last time he took any medication was 10 hours ago. Which of the following drugs did he take? 1. Glibenclamide 2. Metformin 3. Rosiglitazone 4. Prednisone 5. lactulose The following statement refers to acyclovir. Select the incorrect statement: 1. It is an anti-viral drug which inhibits viral DNA synthesis and viral replication 2. It should be taken immediately with the onset of symptoms 3. The drug does not cure herpes, but shortens the duration of the infection outbreak 4. When acyclovir is administered by IV infusion, hydration fluid should be given to prevent precipitation of the drug in the kidneys 5. The drug is safe in patients with renal insufficiency as it is mainly eliminated by the liver The following graph shows the steady-state concentrations of phenytoin in patients chronically treated with the drug. X-axis describes the daily dose administered per kg of body weight and the yaxis represents the steady-state concentration in the individual patients. What can be deduced from the data shown in the graph? 1. The high degree of variability presented in the graph demonstrates inter-patient pharmacodynamics variability 2. Normalizing patient dose according to patient body weight reduces the variability in drug plasma concentration 3. It is important to maintain a dose of 5 mg/Kg in order to achieve steady-state concentration within the therapeutic window (10-20 mg\L) 4. Plasma blood levels should be monitored in each patient personally 5. The finding are misleading as drugs plasma concentration depend on the time the drug was administered Why treatment with B blockers should be discontinued gradually 1. Chronic treatment stimulates the up-regulation of B receptors

126.

127.

therefore sudden treatment discontinuation may lead to a sharp decline in blood pressure and loss of consciousness 2. Only selective B1 receptor blocker should be discontinued gradually 3. Gradual cessation is important only if the patient took the drug for at least six months 4. Similarly to other drugs used to lower blood pressure, treatment with B blockers should be discontinued gradually 5. Abrupt B blocker withdrawal may cause rhythm disturbance and hypertension A 35 year old patient entered a pharmacy with a prescription for rizatriptan prescribed by her neurologist. Additionally, she is being regularly treated for high blood pressure by her family doctor. Which of the following is incorrect? 1. If the effect of the first dose wears off she can take another does every two hours as long as maximum daily dose in not exceeded 2. If the first dose of rizatriptan was not effective at all, she can take another dose of rizatriptan after two hours 3. The pharmacist must ensure that her blood pressure is balanced, since the use of trip contraindicated in patient with uncontrolled blood pressure 4. She should be informed that there are effervescent tablets available allowing the ea of swallowing in case she experience nausea and vomit 5. If she is being treated with propranolol for her high blood pressure her doctor as propranolol may increase rizatriptans plasma concentration by 70% Which of the following statements regarding atorvastatin is correct 1. The most dangerous side effect is myopathy 2. Must be taken at bed time 3. Not intended to be used in the elderly patients due to the risk of adverse drug 4. Co-administration with metformin increases the risk of hypoglycemia Mark the incorrect statement regarding haloperidol : 1. Is used to treat hiccups and nausea 2. May cause prolongation of the QT interval on ECG 3. Should not be used in patients with Parkinsons disease 4. Decanoate formulation is administered once a week 5. Co-administration with tramadol lowers the seizure threshold Mark the incorrect statement regarding venlafaxine: 1. Blocks reuptake of both serotonin and norepinephrine 2. Is not effective from the first dose taken 3. May increase blood pressure and cause tachycardia 4. May cause sexual dysfunction 5. Has long half-life thus can be discontinued at once A diabetic patient comes into the pharmacy with a prescription for atenolol during the interview the pharmacist realizes that atenolol was prescribed to the patient for the first time.

128.

129.

130.

131.

132.

133.

134.

Mark the most correct statement: 1. Atenolol can mask signs of hypoglycemia, therefore the patients should be instructed to monitor blood glucose levels especially at the beginning of the treatment 2. Atenolol can mask signs of hypoglycemia, therefore is contraindicated in patients with diabetes 3. Atenolol, at low doses, selectively blocks B2 receptors, therefore does not mask the signs of hypoglycemia 4. Atenolol is contraindicated in patients treated with insulin 5. Due to the risk of renal damage diabetic patients should not be treated with atenolol Enoxaparin is less likely to cause dangerous bleeding than standard heparin, because enoxaparin: 1. Does not bind to anti-thrombin III 2. Does not inhibit coagulation factor II 3. Affects only the platelet function 4. Is not efficiently absorbed after SC administration 5. Not correct, both drugs have similar risk of bleeding The following statements refer to drugs of the fibrates and statins group. Mark the correct answer. 1. Statins therapy has been shown to reduce morbidity and mortality 2. Fibrates are more effective in lowering LDL levels 3. Statins are more effective in lowering triglycerides levels 4. Statins are more effective in lowering HDL levels 5. Statins have no advantage over fibrates Selegiline and rasagiline are approved for use in Parkinsons disease. Their mechanism of action is: 1. Dopamine agonists 2. Monoamine oxidase B enzyme inhibitors 3. Anticholinergic agents 4. Dopa decarboxylase inhibitors 5. COMT enzyme inhibitors Which statement regarding tardive dyskinesia is incorrect 1. It is caused by antipsychotic medications 2. It is more common in older women 3. it is a disorder that involves involuntary movement , especially of the mouth ,jaw and tongue 4. this phenomenon can be relieved by lowering the dose of antipsychotic drug 5. it appears at the beginning of the treatment and passes by itself during chronic treatment Clinical symptoms of hypoparathyroidisim include 1. Hypocalcemia and hyperphospatemia 2. Hypocalcemia and Hypophospatemia 3. Hypercalcemia and hypochlorhydia 4. Hypercalcemia and hypophosphatemia 5. Hypercalcemia and hyperphosphatemia What is the typical for aminoglycoside antibiotics 1. Can be orally administered for treatment of acute systemic

135.

136.

137.

138.

139.

140.

141.

142.

143.

infection with pseudo 2. Dosage adjustment is necessary in patients with hepatica dysfunction 3. Active against a wide range of gram- positive and gram-negative bacteria 4. Suitable for long-term treatment of several urinary tract infections 5. Drug of choice for prevention of infections in neonates and premature infants What is the advantage of dopamine use in cardiogenic shock? 1. Dopamine dies not cross the blood brain barrier and therefore, does cause system side effects 2. Dopamine does not increase blood pressure 3. Dopamine can be orally administered 4. Dopamine causes a dose-dependent increase in cardiac output and renal perfusion 5. Dopamine does not affect alpha and beta adrenergic receptors Which of the following substances provide the greatest value of calories/gram? 1. Ethanol 2. Protein 3. Carbohydrate 4. Long chain triglycerides 5. dextrose Which of the following drugs can cause an increase in concentration? 1. Nifedipine 2. Losartan 3. Enalapril 4. Clonidine 5. Metoprolol What is the choice for 7-years old boy with otitis media? 1. Amoxicillin 2. Gentamycin 3. Tetracycline HCL 4. Ciprofloxacin 5. Metronidazole Which antidote is useful for systemic atropine toxicity? 1. Acetylcysteine 2. lactulose 3. Polyethylene glycol 4. Flumazenil 5. Physostigmine Which of the following symptoms is not typical in type 1 diabetes? 1. Weight loss 2. Thirst 3. Appearance of glucose in urine 4. Urinary retention 5. weakness

144.

Which of the following curves represent best the time course of plasma levels of insulin detemir ( levemir ) 1. A 2. B 3. C 4. D 5. E 145. Which of the following curves represent best the time course of plasma levels of insulin aspart ( novorapid) 1. A 2. B 3. C 4. D 5. E Which of the following curves represent best the time course of plasma levels of insulin NPH (humulin NPH) 1. A 2. B 3. C 4. D 5. E Which of the curves represents best the time course of plasma levels of human insulin (humulin R)? 1. A 2. B 3. C 4. D 5. E In addition to treating epilepsy, carbamazepine is approved by the FDA for:

146.

147.

148.

149.

150.

A. Management of diabetic neuropathy B. Migraine prophylaxis C. Management of neuropathic pain and trigeminal neuralgia D. Treatment of bipolar disorder 1. A only 2. C only 3. A and C 4. C and D 5. A, B, C, and D Which of the following medication when given to infant cause gray baby syndrome? 1. Gentamycin 2. Ciprofloxacin 3. Doxycycline 4. Amphotericin B 5. chloramphenicol Patients receiving clozapine should be monitored since they can develop: 1. Agranulocytosis 2. Hepatocellular necrosis 3. Lupus-like side effects 4. Thrombocytopenia 5. Stevens Johnson syndrome

151.